鼻腔接触性头痛的临床分析

目的研究鼻中隔与鼻腔外侧壁接触导致头痛患者的鼻腔解剖异常情况及鼻内镜手术治疗效果。方法回顾性分析58例鼻腔接触性头痛患者,经鼻窦CT及鼻内镜检查评估鼻腔解剖异常情况,并通过鼻内镜手术纠正鼻腔解剖异常。术后3个月进行疗效评估。结果鼻腔解剖异常以鼻中隔高位偏曲、中鼻甲变异及其邻近结构的病变最明显。鼻内镜术后随访3～18个月,平均6个月。治愈32例,好转23例,无效3例。结论鼻中隔高位偏曲及其邻近结构病变产生的黏膜挤压是鼻腔接触性头痛的主要原因,鼻窦CT扫描和鼻内镜检查能较准确地发现引起鼻源性头痛病灶的确切部位,及时行鼻内镜手术治疗可获得良好的效果。

Clinical analyses of intranasal contact point headaches

OBJECTIVE This objective of this study was to investigate intranasal anatomic abnormalities in cases of contact point headaches caused by contact between the nasal septum and the lateral nasal wall,as well as the clinical outcomes in these cases treated by endoscopic sinonasal surgery. METHODS A retrospective review was performed on 58 cases that met the criteria of having contact points between the septum and the lateral nasal wall, as demonstrated by CT scans of the sinuses and endoscopic examinations. These patients underwent surgical intervention in order to correct the contact points. They were re-evaluated for clinical parameters three months after the surgical correction of their anatomic abnormalities. RESULTS Abnormal nasal septa, enlarged turbinates and other anatomic abnormalities were the most common findings in contact point headaches. Fifty-eight patients underwent surgical correction of intranasal anatomic abnormalities. After follow-up periods of 3-18 mouths, 32 patients were cured, 23 were relieved to an extent, and 3 did not benefit. A significant decrease in the severity and frequency of headaches was noted after surgery. CONCLUSION Pressure from mucosal contact between the septum and lateral nasal wall mucosa is the key cause of contact point headaches, as seen in CT scans of the sinuses and endoscopic examinations. Clinically significant pain may improve after surgical correction of intranasal anatomic abnormalities.