筛泡前气房CT三维重组的影像特征及手术技巧

目的筛泡前气房可严重阻碍额窦引流,但却常被忽视,本文通过CT三维重组技术分析筛泡前气房的影像特点及其同额窦引流通道的关系,探讨手术去除筛泡前气房、开放额窦的技巧。方法对鼻及鼻窦炎患者术前轴位薄层螺旋CT扫描,冠状位、矢状位重组,明确筛泡前气房的存在,在鼻内镜下确认,分析它同额隐窝引流通道的关系。结果筛泡前气房在矢状位和轴位CT均表现为额窦区域后上方的气房,从额隐窝沿着颅底进人额窦：手术中沿着筛泡前气房的前壁可顺利找到额窦口。结论 CT三维重组对明确筛泡前气房和额窦引流通道的关系有重要意义,筛泡前气房是筛泡过度气化形成从颅底越过额窦口延伸至额窦内影响额窦引流,手术中去除筛泡前气房,可明显扩大额窦口,改善额窦引流。

3D CT analysis of frontal bullar cell and the surgical technique in patients with rhinosinusitis

OBJECTIVE The frontal bullar cell can obstruct the frontal sinus outflow tract,but it is poorly described in literature.The purpose of the study was to study the frontal bullar cell and its relationship with the frontal sinus drainage pathway with three dimension computed tomography and to discuss the surgical technique about how to remove the frontal bullar cell and open the frontal sinus ostium.METHODS Multislice helical CT scans of the sinuses were performed with overlapping 0.5-mm thick axial cuts.Sagittal and coronal planes were reconstructed.The presence of the frontal bullar cells was identified,and how to remove it and open the frontal sinus ostium by endoscopic sinus surgery was studied.RESULTS The frontal bullar cell was obvious when reviewing the sagittal and coronal CT scans.It was pneumatized along skull base into frontal sinus from posterior frontal recess.The frontal sinus drainage pathway was anterior to the frontal bullar cell and the upper portion of the bulla lamella should be removed to open the frontal ostium.CONCLUSION Three dimensional CT reconstruction is very useful for identifying the relationship between frontal bullar cell and the frontal sinus drainage pathway.The frontal bullar cell caused serious obstruction of the drainage pathway and remove it can obtain a patent frontal ostium.