Orbital wall thickness and the spread of infection from the paranasal sinuses

Ninety-three human skulls (80 adults and 13 children) have been examined and the extent of thin bone in the party walls between the orbit and the frontal, ethmoidal and maxillary sinuses has been assessed. Translucent bone is most often present in the lateral wall of the ethmoidal labyrinth and least often in the floor of the frontal sinus. In children such bone is present significantly less often in the roof of the maxillary sinus (P less than 0.001) than in adults. Computerized tomography scans and clinical data from 6 patients with orbital cellulitis were reviewed. In one of these an inferolateral subperiosteal abscess of the orbit was associated with a defect in the roof of the maxillary sinus. Two patients had a medial subperiosteal abscess associated with ethmoiditis and in one there was direct continuity between the abscess and the adjacent ethmoidal cells. In another case a superolateral abscess was demonstrated in continuity with a surgical defect in the floor of the frontal sinus. We conclude that the ethmoidal, frontal or maxillary sinuses may be sources of orbital infection and that spread occurs either by direct extension through the sinus wall or by local thrombophlebitis.     

Characteristics of paranasal sinus osteoma and treatment outcomes

Conclusion: The incidence of paranasal sinus (PNS) osteoma was 6.4%. The most common site of PNS osteoma was the ethmoid sinus. All surgically treated patients underwent endoscopic surgery, and there was no recurrence in any patient. Technical improvements, including an image guidance system, extended the indications for endoscopic surgery for PNS osteomas, especially in the frontal sinus region. Objective: The purpose of this study was to investigate the incidence and location of PNS osteomas detected by computed tomography (CT) scan at our hospital, and to describe our experience in the surgical treatment of PNS osteomas. Methods: This study was performed on 1724 patients undergoing CT scans because of suspected sinus disease between 2004 and 2013. Endoscopic surgery was performed in 34 symptomatic patients. Medical records of the patients were reviewed, and clinical findings and treatment outcomes were investigated. Results: PNS osteomas were detected in 110 patients (6.4%). Triple osteomas were detected in two patients. Double osteomas were detected in seven patients. In total, 121 lesions were identified as PNS osteomas. The ethmoid sinus was the most commonly affected site (57.0%), followed by the frontal sinus (25.6%), frontal recess (9.1%), maxillary sinus (5.0%), olfactory fissure (1.7%), and sphenoid sinus (1.7%) in descending order of frequency. Thirty-three patients were surgically treated for PNS osteomas through a purely endoscopic approach, and one patient with a frontal sinus osteoma underwent combined endoscopic surgery and frontal trephination. Image-guided surgery was performed in nine patients with involvement of the orbit and skull base, including the frontal sinus/recess. There were no major surgical complications and there was no tumor recurrence.     

Inverted papilloma of the nasal cavity and paranasal sinuses: clinical data, surgical strategy and recurrence rates

BACKGROUND: In the last decade inverted papillomas of the nasal cavity and paranasal sinuses have been observed in increasing numbers, and treatment modalities have ranged from extensive open radical procedures to microinvasive endonasal surgical excision. OBJECTIVE: To establish criteria for selecting patients for open osteoplastic or endonasal surgery according to clearly defined pathological and clinical data. MATERIAL AND METHOD: In a retrospective study, clinical data of 55 patients treated surgically in the University ENT Clinic Giessen from 1991 to 1998 were analysed. In 33 patients (60%) endonasal excision of the papillomas was carried out and in 22 (40%) osteoplastic lateral rhinotomy or maxillotomy were performed. All histological specimens were revised. Patients were followed up and endoscopically examined until 31 March 1999. RESULTS: In 22 patients, tumours involving the frontal sinus, maxillary sinus, parts of the frontal skull base and anterior ethmoid, and the orbit were operated on using open osteoplastic procedures, with 4 (18%) recurrences observed. Tumours excised endonasally showed the same recurrence rate: 6 out of 33 (18%). These tumours were smaller in size and localized in the nasal cavity, the middle and posterior parts of the ethmoid involving the sphenoid, and the medio-posterior wall of the maxillary sinus. The functional outcome was excellent for all patients; two patients developed a mucocele. Cancerization was observed in three cases. CONCLUSIONS: In select cases the endonasal microsurgical approach to inverted papillomas has the same good results concerning function and tumour control as osteoplastic open rhinotomy. This method should still be preferred in tumours localized in the frontal sinus, anterior ethmoid. anterior. caudal and lateral parts of the maxillary sinus and beyond the sinuses.     

Inverted Papilloma of the Nasal Cavity and Paranasal Sinuses: Clinical Data,Surgical Strategy and Recurrence Rates

Background: In the last decade inverted papillomas of the nasal cavity and paranasal sinuses have been observed in increasing numbers, and treatment modalities have ranged from extensive open radical procedures to microinvasive endonasal surgical excision. Objective: To establish criteria for selecting patients for open osteoplastic or endonasal surgery according to clearly defined pathological and clinical data. Material and method: In a retrospective study, clinical data of 55 patients treated surgically in the University ENT Clinic Giessen from 1991 to 1998 were analysed. In 33 patients (60%) endonasal excision of the papillomas was carried out and in 22 (40%) osteoplastic lateral rhinotomy or maxillotomy were performed. All histological specimens were revised. Patients were followed up and endoscopically examined until 31 March 1999. Results: In 22 patients, tumours involving the frontal sinus, maxillary sinus, parts of the frontal skull base and anterior ethmoid, and the orbit were operated on using open osteoplastic procedures, with 4 (18%) recurrences observed. Tumours excised endonasally showed the same recurrence rate: 6 out of 33 (18%). These tumours were smaller in size and localized in the nasal cavity, the middle and posterior parts of the ethmoid involving the sphenoid, and the medio-posterior wall of the maxillary sinus. The functional outcome was excellent for all patients; two patients developed a mucocele. Cancerization was observed in three cases. Conclusions: In select cases the endonasal microsurgical approach to inverted papillomas has the same good results concerning function and tumour control as osteoplastic open rhinotomy. This method should still be preferred in tumours localized in the frontal sinus, anterior ethmoid, anterior, caudal and lateral parts of the maxillary sinus and beyond the sinuses.     

Paranasal sinus mucoceles: surgical management and long term results

BACKGROUND: The aim of this study was to determine the best surgical approach in the treatment of paranasal sinus mucoceles according to their localization. MATERIAL AND METHODS: A retrospective analysis was carried out in 255 patients with 290 sinus mucoceles who were treated surgically at the ENT-Department of the Hospital Fulda gAG between 1983 and 2001. This series include 125 frontal sinus, 23 frontoethmoid, 41 ethmoid, 72 maxillary sinus and 26 sphenoid mucoceles. The patients' history, presenting symptoms, radiological findings, and surgical management were reviewed. Of them, 185 patients were followed by endoscopic and CT or MRI control during a period of up to 19 years, median follow-up was 12 years. RESULTS: In 168 out of 255 patients (66 %) the mucoceles were arisen due to previous sinus surgery, in 37 cases (14 %) after traumatic lesions, in 5 patients (2 %) due to chronic sinusitis and in 2 cases (<1 %) according to tumors. In 43 cases (17 %) no causes were found. In 78.8 % the previous operation was performed via an external approach, either according to Jansen/Ritter or Caldwell-Luc, contrary to 1.5 % after endonasal surgery. The median period until mucocele appearance was 15 years for maxillary sinus, 13 years for frontoethmoid, 10 years for ethmoid, and 8 years for frontal and sphenoid sinus celes, respectively. 201 mucoceles (69.3 %) have been operated endonasal micro-endoscopically, 18.6 % via the osteoplastic approach, 10 % endoscopically combined with an osteoplastic procedure and only 2 % according to Jansen/Ritter. Thereafter, recurrence of mucoceles was found in 4 patients only ( = 2.2 %; related to the endonasal approach = 1.6 %). CONCLUSION: Frontoethmoidal, ethmoidal, sphenoidal and maxillary sinus mucoceles are excellent indication for exclusively endonasal micro-endoscopic surgery. The osteoplastic approach combined with endonasal surgery is suitable in far lateral located frontal or maxillary sinus mucoceles.     

Unilateral pathological lesions of paranasal sinuses removed by endoscopic surgery

Introduction

The aim of this study was to analyze the incidence and nature of unilateral pathological lesions of paranasal sinuses in patients who had endoscopic sinus surgery performed in ENT. Materials and methods: In the years 2006–2011 endoscopic sinus surgery for unilateral pathological lesions of paranasal sinuses was performed in 1847 patients (838 women and 1009 men). The enrollment of patients was based on the findings of otolaryngological clinical and subjective examinations, assessment of the paranasal sinuses on three-dimensional CT scans, and laboratory examinations. Based on the analysis of medical history data, including gender, age, the type of surgical procedure performed, and histopathological findings the cases were finally analyzed.

Results

Pathological lesions of the paranasal sinuses were localized on the left side in 132 (57%) patients, and on the right side in 100 (43%) patients. Of the 232 patients with unilateral pathological changes, 41.8% subjects underwent endoscopic sinus surgery for polypotic changes in the ethmoid and maxillary sinuses; 28.4% for the maxillary sinus; 10.8% for the ethmoid, maxillary and frontal sinuses; and 8.6% patients for all paranasal sinuses on one side. The number of operations of only one sinus was considerably lower: sphenoid sinus, 4.7%; ethmoid sinus, 2.2%; and frontal sinus, 1.7% patients. The histopathological analysis of unilateral pathological lesions removed by endoscopic surgery showed chronic paranasal sinusitis with polyps in 56.5% patients; chronic paranasal sinusitis in 22.8% patients; and maxillary sinus cyst was confirmed in 11.6% patients. In 5.1% patients inverted papilloma was diagnosed and in 2.2% patients the presence of osteoma was found.

Conclusions

Unilateral paranasal pathological lesions, leaving aside rather typical maxillary sinus cysts, require a particularly thorough pre-operative diagnosis and a precise histopathological assessment.     

Top 10 Reasons for Endoscopic Maxillary Sinus Surgery Failure

Objective/Hypothesis Endoscopic sinus surgery has enjoyed impressive success curing chronic disease in sinuses and has virtually replaced the Caldwell‐Luc procedure for correction of problems with the maxillary sinus. Unfortunately, a significant number of patients have persistent maxillary symptoms after one or more endoscopic sinus operations. Existing reviews of this issue have identified only a few general causes for surgical failure. Methods The records of 85 patients presenting to the author over a 5‐year period with persistent maxillary sinus symptoms were reviewed. Results In reviewing the causes of persistent disease requiring revision surgery, the author identified 10 categories of reasons for failure to improve. Many patients have multiple causes that could be individually or sequentially identified. Some problems associated with surgical failure were likely present at the time of initial presentation, whereas others were undoubtedly caused by the first surgical procedure. Ten reasons for maxillary sinus surgical failure identified were clustered into the following categories: 1) obstructed natural ostia, 2) disease in the anterior ethmoid or frontal sinus, 3) resistant organisms, 4) intrasinus foreign body, 5) incurable mucosal disease, 6) noncompliant patient, 7) wrong primary diagnosis, 8) maxillary osteitis, 9) mucus maltransport, and 10) fundamental immunodeficiency. Conclusions A careful assessment of each patient with persistent maxillary sinus disease is central to understanding each specific patient and should include a careful history, a detailed endoscopic examination, repeat computed tomography imaging, culture of secretions, and possible revision surgery.     

Endoscopic trans-septal frontal sinusotomy: the rationale and results of an alternative technique.

Endoscopic transseptal frontal sinusotomy (TSFS) represents an alternate approach to surgical treatment of chronic frontal sinus disease that is refractory to traditional modes of medical and surgical therapy. We retrospectively reviewed our experience with endoscopic TSFS from 1995-1997. Twenty-one procedures were performed through a transseptal approach. One patient was excluded for failure to follow-up, for a total of 20 procedures. Patients were followed with serial endoscopic examinations and a telephone questionnaire with a mean follow-up of 12 months (Range 1-24 months) and 16 months (range 5-31), respectively. The primary indication for surgery was frontal recess stenosis after previous endoscopic frontal sinusotomy in 17/20 (85%). Three patients were considered poor candidates for a primary endoscopic frontal sinusotomy. Patency was maintained in all patients during the follow-up period. A diameter of greater than 3 mm was confirmed by passage of a curved suction in 19/20 (95%). Of the 19 patients that were evaluated via a telephone questionnaire, 17 patients (89.5%) reported some degree of improvement in their nasal/sinus symptoms, and 12/18 patients (67%) felt the frequency of medication requirements was less than that before undergoing endoscopic TSFS. We conclude that endoscopic TSFS represents an alternate approach to the frontal sinus that may be used by the experienced endoscopist, to augment treatment of refractory frontal sinus disease. This procedure seems especially suited for revision surgery in those patients with acquired frontal sinus stenosis. In revision operations with distorted anatomical landmarks, localization of the frontal sinus may be improved with the aid of 3-dimensional computer assisted localization systems. Unlike traditional frontal sinus obliteration, endoscopic TSFS does not preclude radiographic assessment postoperatively, and allows for endoscopic evaluation of the frontal sinus in the office setting.     

Extensive maxillary sinus pneumatization

AIM: To determine the incidence of variations of maxillary sinus pneumatization especially when it is extensive and the associated anomalies. STUDY DESIGN: Two hundred consecutive direct coronal paranasal sinus computed tomography (CT) scans were reviewed retrospectively. Extensive maxillary sinus pneumatization (EMSP) was defined as one in which the largest horizontal and/or vertical dimension of the maxillary sinus equalled or exceeded 90% of the corresponding diameter of the orbit. Further subtype I, II & III were defined depending on whether the pneumatization was extensive in one dimension (horizontal or vertical), two dimensions (horizontal & vertical) and by the presence of sphenomaxillary plate, intermaxillary plate or extension into frontal recess. RESULTS: EMSP was found in 8%, of these 7% were bilateral and 1% was unilateral. (Subtype I, II and III constituting 1%, 3% & 4% respectively). CONCLUSION: EMSP has been defined as a group and a classification proposed. EMSP will result in an atypical clinical picture, has a role in the pathogenesis of frontal sinusitis in some cases and may predispose injury to the orbit during endoscopic sinus surgery (ESS).     

鼻内镜下额窦开放术并置双管引流治疗慢性额窦炎

目的：探讨鼻内镜下额窦开放并置管引流术疗效,以期找到一种提高慢性额窦炎治愈率的有效方法。方法：68例（130侧）慢性额窦炎行功能性鼻内镜额窦手术患者,随机分为3组,A组：鼻内镜下额窦开放术并置双管引流术;B组：鼻内镜下额窦开放术并置管引流、倍氯米松滴注;C组：鼻内镜下单纯额窦开放术。结果：3组患者平均随访18个月,鼻内镜下评价3组患者治愈率,A组为93％,B组为93％,C组为71％。B组与C组疗效比较,差异有统计学意义。未见严重手术并发症。结论：慢性额窦炎手术成功与否与术后额窦开口是否再次狭窄或者闭锁密切相关,鼻内镜下额窦开放术后持续6个月以上置双管引流可降低额窦口再次狭窄或者闭锁概率,而且置管保留6～12个月比较合适。我们建议这种方法应用于病情复杂的成人患者或者任何儿童患者。     

Management of frontal sinus fractures: a review of 96 cases

OBJECTIVES: The optimal treatment algorithm for frontal sinus fracture management remains ill-defined. The purpose of the study was to classify fracture types, review management methods, document associated injuries, and identify complications associated with various treatment options. STUDY DESIGN: The authors conducted a retrospective chart review evaluating a 13-year experience with frontal sinus fracture management. METHODS: Complete medical records of 96 frontal sinus fracture patients treated by the University of Kentucky Otolaryngology Service from 1990 to 2003 were reviewed. RESULTS: The average patient age was 39 years. Fifty percent of the fractures involved the anterior table of the frontal sinus alone, and 50% involved both anterior and posterior tables. Forty-seven percent of the injuries were managed with observation, whereas 50% of patients underwent surgical repair. In the surgical group, 60% underwent open reduction and internal fixation (ORIF), 23% had a cranialization procedure, and 17% underwent sinus obliteration. The average length of follow up was 9 months. Complications occurred in 17% of the patients (5% in the nonsurgical group and 12% in the surgical group). CONCLUSION: Our results support conservative management of nondisplaced or minimally displaced fractures based on the low complication rate seen in this series. Significant bone displacement can frequently be managed with simple ORIF. Complex fractures affecting the orbit or intracranial contents require cranialization or possibly obliteration. A subset of patients with suspected frontal sinus outflow obstruction can be considered for observation or simple ORIF with close follow up and endoscopic repair if outflow complications manifest.     

带蒂骨-骨膜肌瓣转移植入治疗原发性萎缩性鼻炎的临床观察

目的评价上颌窦前外侧壁骨-骨膜肌瓣鼻腔黏骨膜下植入术对中、重度原发性萎缩性鼻炎治疗的疗效。方法对2007年2月～2010年2月收治的40例中、重度原发性萎缩性鼻炎患者行上颌窦前外侧壁骨-骨膜肌瓣鼻腔黏骨膜下植入术,术后随访2～5年,观察患者疗效。结果全部手术成功,手术时间平均为60 min,无严重并发症。所有患者术后随访2年,按萎缩性鼻炎记分及分度标准进行疗效评估,其中中度原发性萎缩性鼻炎术后显效率为95.45%（21/22）,重度原发性萎缩性鼻炎术后显效率为66.67%（12/18）。8例患者术后随访5年以上,总有效率100%（40/40）。结论上颌窦前外侧壁骨-骨膜肌瓣鼻腔黏骨膜下植入术操作简便,对中、重度原发性萎缩性鼻炎疗效显著,值得临床推广使用。     

Surgical treatment of subperiosteal abscess of the orbit: Sendai's ten-year experience

OBJECTIVE: One of the common complications of acute infection of the paranasal sinus is cellulitis of the orbit. This is secondary to the spread of infection through the very thin bony wall between the ethmoid sinuses and the orbit, the roof of the orbit in frontal sinusitis, and the floor of the orbit in maxillary sinusitis. When the infection does not penetrate the periorbita, it dissects under the periosteum and forms subperiosteal abscess. METHODS: We experienced 10 patients with subperiosteal abscess for 10 years from 1992 to 2002 that required surgical drainage. The age of the patients ranged from 4 to 76 years including five males and five females. RESULTS: Successful and safe drainage of the abscess with endoscopic sinus surgery was obtained in four patients while six patients required external surgery. The selection of the surgical approach depended upon the localization of abscess in the orbit. Five of the seven patients with visual disturbance resulted in a complete recovery of vision after surgery. However, there was no improvement of visual acuity in the other two patients who had already shown severe damage of vision prior to treatment. CONCLUSION: Ocular symptoms such as exophthalmos, double vision, and ptosis subsided completely in all patients. It is suggested that prompt diagnosis and surgical drainage before severe loss of visual acuity rescue or recover the vision.     

Surgical Causes of Failure in Endoscopic Sinus Surgery

Objectives: Evaluate causes of surgical failure at time of revision endoscopic sinus surgery. Study Design: Prospective review of 682 cases that had endoscopic sinus surgery performed between 1991 and 1995. Methods: In all cases, variables of age, sex, asthma, allergy, computed tomography stage, associated procedures, complications, and operative findings were collected. Those cases that had a failure after a previous endoscopic sinus procedure and not an intranasal procedure or an external procedure were evaluated. Results: Fifty-two patients (7.6%) were identified. The age range was 24 to 70 years. The most common cause of failure was residual air cells and adhesions in the ethmoid area (30.7%), followed by maxillary sinus ostium stenosis in 27%, frontal sinus ostium stenosis in 25%, and a separate maxillary sinus ostium stenosis in 15% of the cases. Conclusion: Review of surgical causes of failure in endoscopic sinus surgery patients revealed that residual air cells and stenotic maxillary or frontal sinus ostium were the most common causes of failures.     

The modified endoscopic Lothrop procedure in the treatment of complicated chronic frontal sinusitis

The purpose of this study was to evaluate the modified endoscopic Lothrop procedure in the management of complicated frontal sinus disease which has breached the confines of the sinus walls and extended into the cranial cavity or orbit. Fourteen patients with radiological evidence of 17 complications of frontal sinus disease presented over a 23-month period. CT scan and MRI scans revealed the presence of posterior table erosion and extension of the frontal sinus disease into the anterior cranial fossa in 10 patients. In addition, seven patients had intraorbital complications, with three patients having both intracranial and orbital complications. All patients underwent a modified endoscopic Lothrop procedure as part of the management of the complication. In addition, one patient required an orbital abscess drainage and repair of an encephalocele, with a second patient requiring drainage of an orbital subperiosteal abscess. At follow-up, all patients were asymptomatic and had patent frontal sinus ostia. Follow-up ranged from 8 months to 38 months with a median of 25 months. Three patients required a revision of their frontal ostium. Two patients had allergic fungal sinusitis with aggressive polyp recurrence and ostial re-stenosis while one patient developed recurrent orbital infections from a retained frontal sinus cell. Currently, all have patent ostia, with an average size of 14.6 x 11 mm. The modified endoscopic Lothrop procedure is an effective form of treatment in the management of complicated frontal sinus disease. The results are comparable to those achieved with other surgical approaches such as the osteoplastic flap with obliteration.     

Surgical policy in patients with basally advanced form of juvenile nasopharyngeal angiofibroma

The authors has modified surgical policy in a basicranially extending form of juvenile nasopharyngeal angiofibroma (JNA) which is classified into tumors of stage I, II and III. Basally advanced tumors were diagnosed in 28 of 40 JNA patients: basicranially extended tumor (n=12, 30%), stage I tumor invading nasopharynx, nasal cavity, sphenoid sinus (n=4, 14.3%), stage II tumor invading nasopharynx, nasal cavity, sphenoid sinus, pterygopalatine fossa, ethmoid sinuses (n=9, 32.1%), stage III tumor invading nasopharynx, nasal cavity, sphenoid sinus, pterygopalatine fossa, ethmoid sinuses, infratemporal fossa, orbit, maxillary sinus and parapharyngeal space (n=15, 53.6%). Differential surgical treatment according to Owens (stage I tumors), Denker (stage II tumors), Moure (stage III tumors) provides radical removal of the tumor in the majority of the patients (87.7%) and therefore is an effective therapy of surgical treatment of the above patients.     

Orbital complications of infected mucocele in the paranasal sinuses

ObjectiveInfected mucocele of the paranasal sinuses can induce orbital infection, including orbital subperiosteal abscess, which may lead to life-threatening intracranial complications. Effective diagnosis is important, and treatment should be aggressive. This paper presents our experiences in endoscopic surgical management of orbital complications secondary to infected paranasal sinus mucoceles.MethodsFrom our retrospective review of the medical charts for 82 patients with 92 sides diagnosed with paranasal sinus mucoceles, we present 7 sides in 7 adult patients with orbital complications secondary to infected mucoceles. The collected data include the suggested etiology, side of sinus involvement, localization of abscess in the orbit, orbital wall bone defects caused by mucocele compression, ophthalmic symptoms, duration between symptom onset and initial visit, operation date, type of surgery performed, and follow-up.ResultsThe mucocele was located in the ethmoid-frontal region in 9.8% of the sides (9/92), in the frontal sinus in 7.6% (7/92), in the ethmoidal sinus in 9.8% (9/92), in the maxillary sinus in 67.4% (62/92), in the maxillary-ethmoidal sinus in 3.3% (3/92), and in the sphenoid sinus in 2.2% (2/92). The patients with ethmoid-frontal mucoceles had a significantly higher incidence of orbital complications (6/9) as compared with the other sub-types of mucoceles (frontal, 0/7; ethmoidal, 0/9; maxillary, 1/62; maxillary-ethmoidal, 0/3; sphenoid, 0/2). Chandler's classification showed Type I in one, Type II in three, and Type III in three. Sinus involvement was observed at the ethmoid-frontal sinuses in six cases and the maxillary sinus in one case. All seven cases had a partial defect of the orbital wall bone (lamina papyracea, or inferior orbital wall bone) by mucocele compression, and the patients underwent endoscopic marsupialization. For the cases with subperiosteal abscess, the lamina papyracea was also removed partially for draining the abscess. In all cases, symptoms were resolved without any recurrence of the mucocele.ConclusionsInfected ethmoid-frontal mucoceles with a defect of the lamina papyracea tend to induce orbital infection, so prompt surgery for the infected mucoceles should be considered early even with Types I and II, before visual acuity is impaired, because surgery is the only curative treatment for the mucoceles.     

以星状裂解剖标志定位经筛泡前径路行额窦开放术

目的实施以星状裂解剖标志定位经筛泡前径路行额窦开放术,评价该术式的有效性及安全性。方法对225例（407侧）慢性额窦炎患者行星状裂解剖标志定位的筛泡前径路额窦开放术。术前常规鼻窦CT扫描,确定额窦自然开口与钩突及筛泡的关系。术中保留筛泡,依据星状裂解剖标志定位额窦开口行额窦开放手术。结果220例患者按该手术步骤开放了额窦自然开口;5例（8侧）术中暴露额窦开口困难,通过经皮额窦穿刺,注水时在内镜下观察,确定额窦自然开口位置后继续手术获得成功。无一例出现筛前动脉破裂出血和前颅底骨折等术中并发症,2例患者纸样板损伤出现眶周血肿。术后随访6～12个月,293侧（72％）可见额窦窦口开放良好,完全上皮化。201例患者（89％）主观感觉症状缓解。结论以星状裂为解剖标志定位经筛泡前径路行额窦开放术术中能较准确地寻找额窦开口,提高了额窦手术成功率,可减少手术并发症的发生。     

导航鼻内镜下治疗鼻窦囊肿

目的 探讨应用影像导航系统在鼻内镜下治疗鼻窦囊肿的方法及优势。方法 在导航鼻内镜下对121例鼻窦囊肿施行手术,其中上颌窦黏液囊肿12例,上颌窦黏膜囊肿5例,筛窦黏液囊肿43例,额窦黏液囊肿29例,蝶窦黏液囊肿32例。均采用气管插管全麻,根据手术中的需要标定探针或吸引器作为术中的定位设备,在鼻内镜下使用导航定位设备以判断囊肿的准确位置,根据术中探针的指引通过最短的距离到达囊肿,完整或部分切除囊壁,通畅引流。结果 121例手术均准确定位了囊肿的位置,完成手术, 无术中、术后并发症发生。结论 影像导航系统结合鼻内镜治疗鼻窦囊肿具有定位准确、手术创伤小的优点,可以有效地提高手术疗效和避免并发症的发生。     

鼻内镜下下鼻甲翻转入路治疗上颌窦内翻性乳头状瘤

目的 探讨上颌窦内翻性乳头状瘤的手术入路及方法。方法 2006年1月至2011年6月应用下鼻甲翻转治疗上颌窦内翻性乳头状瘤29例,根据Krouse临床分级标准所有病例均为Ⅲ级。其中原发于上颌窦者4例,原发于其他部位累及上颌窦者25例,均采用鼻内镜下下鼻甲翻转方式清除病变组织。结果 所有患者随访12～36个月,仅3例术后复发,有2例病变广泛,为全组鼻窦病变,1例为原发于额隐窝,余26例预后良好,未见复发。结论 应用下鼻甲翻转入路可以减少创伤,提供开阔的手术视野,是治疗上颌窦内翻性乳头状瘤的有效手段。