眼部症状为首要表现的鼻窦良性病变鼻内镜下手术

目的探讨以眼部症状为首要表现的鼻窦良性病变的临床特点与治疗。方法以眼部症状为首要表现的鼻窦良性病变患者32例，结合临床特点及CT扫描结果，采用鼻内镜下手术进行治疗。术后行鼻内镜常规处理。同时一并治疗相关病变。结果本组患者中，术后眼球复位32例，术前溢泪8例症状消失，其中2例有眶尖综合征者于术后5d症状改善、头痛消失，感觉恢复正常；术前存在视力下降的4例患者在术后1周改善，2例复视患者在术后2周内恢复。所有患者术后视力均无下降。随访6～12个月，术后均无复发。结论CT扫描是诊断眼部症状为首要表现的鼻窦良性病变的重要指标，采用鼻内镜下手术治疗该病安全、有效。     

鼻腔鼻窦鳞癌侵犯眼眶时眼球的处理

目的探讨鼻腔鼻窦鳞状细胞癌侵犯眼眶时保留或剜除眼球对生存率和复发率的影响.方法回顾性分析1989年1月～1998年2月我院收治的43例侵犯眶骨壁和眶骨膜的鼻腔、鼻窦鳞状细胞癌患者的临床和随访资料,其中25例剜除眼球,18例保留眼球.比较患者的3年生存率和复发率.结果随访38～126个月,43例患者中,眼球剜除组3年生存率为56%(14/25),局部复发率为36%(9/25),保留眼球组3年生存率为55.5%(10/18),局部复发率为38.8%(7/18),其中1例为眶内复发.结论经术前或术后放疗,对侵犯眶骨壁和眶骨膜的鼻腔、鼻窦鳞癌,保留眼球组与剜除眼球组相比:有相似的局部复发率和生存率,但保留眼球提高了术后生活质量.     

鼻窦黏液囊肿87例的临床特征及治疗分析

目的探讨鼻窦黏液囊肿的临床特征、诊断及治疗方法。方法分析本院2005年12月-2013年12月收治的87例鼻窦黏液囊肿患者的临床表现、影像学特点、鼻内镜检查特点及手术治疗效果。结果 87例鼻窦黏液囊肿患者的主要表现为头痛、眼球突出、视力下降、面部隆起等非鼻部症状。影像学检查见鼻窦占位;病理检查示囊肿发生于蝶窦9例、筛窦14例、蝶-筛窦26例、额窦15例、额-筛窦9例、上颌窦14例。结论鼻窦黏液囊肿的鼻部症状不明显。CT、磁共振成像和鼻内镜检查有助于鼻窦黏液囊肿的诊断。根据病变特点选择合适的手术方法,早期诊断、早期治疗对预防严重并发症有着重要的意义。     

鼻窦源性肿瘤侵犯眼眶52例临床分析

目的 探讨侵犯眼眶的继发于鼻窦肿瘤的临床、影像学特点及治疗方法.方法回顾性分析52例侵犯眼眶的鼻窦肿瘤患者的临床表现、CT和MRI特点及治疗.结果 患者首发症状为单眼眼球突出.其中副鼻窦黏液囊肿29例,腺样囊性癌11例,鳞状上皮癌6例,其他恶性肿瘤6例.CT检查平扫25例,增强扫描5例,表现为鼻窦内形状不规则软组织肿块,眶内侧壁及眶下壁可见骨质中断,可见肿物向眶内突出,增强后肿瘤眼明显强化.MRI检查12例,均为平扫＋增强扫描,可见上颌窦或筛窦肿块与眼眶内肿块信号相等且连续.增强后肿瘤明显强化.58例全部行手术治疗.结论 鼻窦肿瘤易侵及眼眶,临床多以眼球突出为首发症状.CT、MRI检查有助诊断.多学科联合诊治,对提高鼻窦肿瘤的诊断和综合治疗水平有十分重要的临床意义.     

曲安奈德联合鼠神经生长因子治疗眶下壁骨折后眶下神经损伤

目的：评价局部应用曲安奈德联合鼠神经生长因子治疗眶下壁骨折后眶下神经损伤的临床疗效。

方法：前瞻性分析南昌大学附属眼科医院2020-04/2021-02接受眶下壁骨折整复术的眶下壁骨折患者43例43眼。患者随机分为两组,其中试验组20例20眼术中将浸润曲安奈德和鼠神经生长因子的明胶海绵放置于神经损伤处; 对照组23例23眼术中无特殊处理。术后随访6mo,通过定量感觉测试(两点定位觉、痛觉、触觉)比较患侧和健侧下睑区的测试结果,结果以不对称指数(AI)表示。

结果：基线结果显示,两组性别、年龄、受伤时间、术前两组间感觉测试无差异(均P>0.05)。两组患者术后1wk的两点定位觉、触觉、痛觉AI值均较术前升高(均P<0.05),感觉障碍症状加重; 术后1mo不同程度改善,术后3mo痛觉有差异(P<0.05); 术后6mo两点定位觉、触觉、痛觉均较治疗前明显改善(均P<0.01)。术后1mo,两组间两点定位觉、痛觉有差异(t=-2.082、-2.143,P=0.044、0.038); 术后3mo,两组间痛觉有差异(t=-2.118,P=0.04); 术后6mo,两组间定量感官测试无差异(P>0.05)。

结论：局部应用曲安奈德联合鼠神经生长因子治疗眶下壁骨折后的眶下神经损伤早期内恢复效果良好,优于术中无特殊处理组。     

未成年人眶壁爆裂性骨折的临床特点及治疗分析

目的 分析未成年人不同年龄眶壁爆裂性骨折的临床特点与骨折类型的相关性.探讨少年儿童眶壁骨折的治疗方案.方法 选取18岁以下眶壁爆裂性骨折患者69例,5～14岁组23例和15～18岁组46例.观察术前眼位和复视情况.眼球内陷程度和眼球运动,CT影像特点表现和术中所见,术后眼位、眼球内陷和眼球运动恢复情况.结果 5～14岁组伤后出现恶心、呕吐,眼球垂直运动受限的构成比高于15～18岁组(P均<0.05).5～14岁组眼球无内陷的构成比高于15～18岁组(P<0.05).5～14岁组眶下壁活板门样(trapdoor)骨折的构成比高于15～18岁组(P<0.05).CT显示为眶下壁线性骨折的20例患者术中发现16例骨折区呈trapdoor表现,下直肌嵌夹于骨折区呈紫红色肿胀.结论 5～14岁儿童生眶下壁trapdoor骨折的风险较高,确诊后早期手术对促进眼外肌功能恢复和减少复视残留具有重要意义.     

眶壁爆裂性骨折手术治疗的临床疗效观察

目的 评价眶壁修补术治疗眶壁爆裂性骨折的疗效。方法 采用眶壁修补术治疗30例眶壁爆裂性骨折。术后随访3～6月，平均4．5月。观察术后视力、眼球突出度、眼球活动度及其并发症。结果 视力：3例因伴有眼部有它病变，严重影响视力，治疗的视力有提高；余27例手术前后视力基本不变。跟球突出度：术后增加1mm者4例；增加2mm者9例；增加3mm者9例；增加4mm者8例。眼球活动度：术前上转或外转完全受限或部分受限者，术后均得到了不同程度的改善。结论 眶壁修补术是治疗眶壁爆裂性骨折的有效方法。     

眶骨膜瓣矫治固定性内斜视

目的 探讨固定性内斜视的手术治疗方式.方法 采用眼眶骨膜瓣锚定术加强外直肌矫治固定性内斜视18例(24眼).通过内直肌断腱术外直肌缩短联合眶骨膜瓣锚定术加强外直肌的综合手术治疗方式,矫治固定性内斜视眼位.结果 18例(24眼)均取得良好效果.除2眼内斜欠矫5°～10°外,其他术后眼位居中,眼位均较术前明显改善.其中12眼术后矫正视力0.2 ～0.4,基本恢复了视功能,其余则达到了美容效果,术眼可轻度外转,眼球运动灵活且自然.无1例过矫或发生垂直性斜视,随访1～5年,无1例复发,无感染等并发症.结论 由于眶骨膜作为有良好血运活体的组织瓣,而且眶骨膜是自身组织,不具有抗原性,又临近术区,具备良好的取材优势.质地坚韧,不会发生吸收变形,眶骨膜瓣矫治固定性内斜视是一种安全有效的治疗方式,美容效果显著而且自然,近远期效果稳定良好.     

经眶取出副鼻窦内巨大异物一例

患者 ,男 ,2 0岁 ,因车祸摔伤头面部急诊入院。入院检查 :一般情况可 ,神志清 ,关节活动自如。眼科检查 :左眼视力 :0 8,眼球上移 ,轻度突出 ,向下活动受限 ,下眼睑内侧近睑缘 1ｃｍ处可见皮肤裂口长约 1 2ｃｍ ,余 (-)。行手术探查 ,局部皮下浸润麻醉 ,稍扩大伤口 ,向下钝性分离至眶下缘 ,与眶下缘水平分次取出树皮状植物异物数片 ,继续探查发现有异物嵌顿于眶下缘骨壁 ,用弯血管钳触及并取出一长 5 5ｃｍ ,直径 1 0ｃｍ圆形树杈 ,此树杈由眶下缘斜向后下方 ,血管钳可由眶壁创口进入筛窦、上颌窦 ,逐层缝合。术后应用菌必治预防感染 ,术…     

眶尖部及视神经肿瘤的早期诊断

目的探讨眶尖部及视神经肿瘤在眼球突出前的临床表现、影像学检查特征及临床诊断要点。方法回顾性分析22例无明显眼球突出单侧眼眶肿瘤患者的病历资料,包括主要症状、首发表现、临床诊治过程及影像学检查结果。结果22例肿瘤患者中,海绵状血管瘤6例,神经鞘瘤、视神经鞘脑膜瘤、鼻窦及鼻咽腔恶性肿瘤眶内蔓延各4例,后组筛窦黏液囊肿2例,神经纤维瘤和视神经胶质瘤各1例。以视力下降为首发症状者17例,视力下降合并复视者3例。全部患者均在CT或MRI检查后确诊。肿瘤位于眶尖部或起源于视神经。结论眶尖部及视神经肿瘤的早期症状是视功能障碍,无眼球突出表现。视力呈缓慢进行性下降,按视神经炎治疗效果差。CT或MRI检查对早期诊断起重要作用。     

继发于前额粘液囊肿的眼眶脓肿1例

目的:报告1例继发于前额粘液囊肿的左眼眶脓肿患者。方法:病例报告。结果:1例30岁马来西亚妇女,表现为左眼疼痛、肿胀3d,伴视力下降和上眼睑下垂。CT报告左额窦粘液囊肿蔓延至左眶内。手术引流治疗,视力和上眼睑下垂很快改善。结论:眼眶脓肿可继发于前额粘液囊肿,而且患者可无鼻旁窦既往病史。     

Fronto-ethmoid sinus mucocele: a case report.

BACKGROUND: Mucoceles are epithelium-lined cavities in the paranasal sinuses filled with mucus. They develop because of scarring and obstruction of the sinus ostium, whether from chronic sinusitis, trauma, or surgery. They commonly erode the bony sinus wall and can have serious complications of brain and orbital invasion, with potential for abscess and rupture. CASE REPORT: A 39-year-old woman had diplopia in left gaze and a hard nodule above the right eye for 1 year. She recently noted a bulging right eye, nasal congestion, and occasional headaches. She was 9 years post-sinus surgery. All aspects of the afferent optic nerve function were intact. Right-sided proptosis was evident as was a right adduction and supraduction deficit, prompting immediate imaging, both with a computed tomography scan and magnetic resonance imaging of the orbits. These results showed a large right ethmoid sinus mucocele, with bony erosion and orbital invasion, prompting an immediate surgical referral. CONCLUSION: Mucoceles may arise from any of the paranasal sinuses and, because of the close proximity of these spaces to the orbit, may initially manifest with visual and ocular signs and symptoms. Therefore, eye care providers need to be aware of this entity and the need for immediate referral or workup if a mucocele is suspected.     

Paranasal sinus carcinoma causing orbital mucocele.

Three patients presented with typical orbital mucoceles. However, subsequent histopathologic study revealed paranasal sinus concomitant squamous cell carcinoma in all three cases. Careful histologic investigation is necessary before considering orbital mucocele a benign process.     

Malignant neoplasia of the paranasal sinuses associated with mucocele.

Paranasal sinus mucoceles are histologically benign and typically cause ophthalmic morbidity only after significant orbital extension. The authors describe seven patients who had both a mucocele and a malignant tumor in the same paranasal sinus and in whom the neoplasm was discovered incidentally during operation for mucocele. Although malignancy coexistent with paranasal sinus mucocele is uncommon, the association should be considered and appropriate biopsy specimens obtained if operation for mucocele is required.     

Ethmoid sinus osteoma presenting as epiphora and orbital cellulitis: case report and literature review.

Paranasal sinus osteoma is a slow-growing, benign, encapsulated bony tumor that may be commonly asymptomatic, being detected incidentally in 1% of plain sinus radiographs or in 3% of sinus computerized tomographic scans. In a patient presenting with orbital cellulitis and epiphora, computed tomography disclosed a large osteoma of the ethmoid sinus. Excision of the osteoma allowed recovery of vision, return of extraocular muscle function, and resolution of choroidal folds. Proptosis, diplopia, and visual loss are other frequent presenting signs of paranasal osteomas. Epidemiology, diagnosis, treatment, and pathologic findings in paranasal sinus osteoma are reviewed.     

Optic neuropathy produced by a compressed mucocele in an Onodi cell

PURPOSE: To describe a patient with compressive optic neuropathy caused by a mucocele in an Onodi cell. DESIGN: Interventional case report. METHODS: A 73-year-old man complained of sudden visual loss in the left eye 10 days after cataract surgery. Coronal computed tomography showed a homogeneous mass in an Onodi cell. Magnetic resonance imaging revealed an oval-shaped lesion that compressed the left optic nerve. RESULTS: After endoscopic microsurgery of the paranasal sinus, visual acuity in the left eye improved. Histopathological examination of the excised specimen showed a mucocele. CONCLUSIONS: Ophthalmologists should be aware that the mucocele in the Onodi cell, an anatomical variation of the paranasal sinus, may compress the optic nerve.     

Spheniodal mucocele causing bilateral optic neuropathy and ophthalmoplegia

Sphenoid sinus mucocele comprises only 2% of all paranasal sinus mucoceles. In literature, there is a case report on sphenoidal mucocele causing bilateral optic neuropathy, with unilateral partial recovery and cranial nerve palsy, but we did not come across any literature with bilateral optic neuropathy and ophthalmoplegia together caused by spheno-ethmoidal mucocele. We present such a rare case of spheno-ethmoidal mucocele causing bilateral optic neuropathy and unilateral sixth nerve palsy who had postsurgery, unilateral good vision recovery, and complete resolution of sixth nerve palsy.     

Ethmoidal osteoma with intraorbital extension: excision through a transcutaneous paranasal incision

PURPOSE: To describe a case of conjunctival hyperaemia and proptosis of the right eye. METHODS: Three-dimensional computed tomography (CT) was performed to reveal the size and position of a lesion of osseous density extending into the right orbit. The lesion was then excised using a right paranasal transcutaneous approach. RESULTS: The pathology report suggested ethmoidal osteoma. The postoperative course was uncomplicated and the lesion did not recur during a 5-year follow-up period. Repeated postoperative ophthalmic examinations revealed preservation of visual acuity and visual fields postoperatively. DISCUSSION: Diagnosis is based on imaging studies, especially CT and three-dimensional CT scans. A three-dimensional CT scan is critical in understanding the actual dimensions of the tumour and its relations with other structures. Surgical removal is indicated in cases with orbital matrix compression and displacement. A transcutaneous paranasal approach allows for increased exposure of affected structures.     

Frontal sinus mucopyocele in cystic fibrosis

This report summarizes the treatment of two patients with cystic fibrosis and frontal sinus mucopyocele. The first patient, an 18-year-old boy, had a 1-year history of a proptosis of the left eye. The second patient, a 28-year-old woman, had a 3-month history of intermittent diplopia. In both cases, the frontal sinus mucocele was diagnosed by computed tomographic scans; both were successfully treated with an osteoplastic flap and fat obliteration of the frontal sinus. When a patient with cystic fibrosis presents with a history of unilateral proptosis, diplopia, or frontal headaches, a paranasal sinus mucocele should be suspected.     

与副鼻窦沟通的眼眶病变的临床影像学分析

目的探讨与副鼻窦沟通的眼眶病变的临床影像学表现。方法回顾性分析我院诊断的副鼻窦病变40例（40眼）术前均行CT检查,6例行X线检查、7例行MRI检查,均经手术及病理证实。结果上颌窦源性10例,筛窦21例,额窦7例,蝶窦2例。40例中良性病变31例,恶性病变9例。眼眶CT扫描结果显示良性病变边界清楚光滑,密度均匀,呈膨胀性骨质吸收破坏。恶性病变CT表现为边界不清,形状不规则,可见侵蚀性骨质破坏。结论副鼻窦病变易侵及眼眶,影像学检查有助于早期定性定位诊断。X线对副鼻窦病变的诊断具有筛查作用,CT和MRI结合对副鼻窦恶性肿瘤的诊断与鉴别诊断具有重要意义。