Histomorphometric analysis of human sphenoid and maxillary mucosa: measurement of relative density of goblet cells and basal cells.

The majority of malignant tumors of the paranasal sinus are squamous cell carcinomas and arise most commonly in the maxillary sinus, and less commonly in the nasal cavity and other sinuses. Glandular tumors (nonsquamous tumors) develop much less commonly and have a different distribution within the paranasal sinuses. The majority of adenomatous tumors arise from the surface mucosa and submucosal seromucinous glands. Attempts to explain tumorigenesis propose that the distribution of these tumors is based on the variance of different cell types among the sinuses. The authors used morphometric analysis to measure the relative density of goblet cells and basal cells from maxillary, and sphenoid sinus specimens. Surgical specimens of normal maxillary and sphenoid mucosa were retrieved from 5 and 10 patients, respectively. All specimens were stained with periodic acid-Schiff stain. The area of goblet and basal cells in five representative areas of each specimen were measured and compared to the total cross-sectional area of the mucosa, giving a relative density of each cell type. The average goblet cell density was 31.19% (SD +/- 10.27%) in maxillary tissue and 33.25% (SD +/- 20.80%) in sphenoid tissue. Student's t-test showed no statistically significant difference in goblet cell density between the two sinuses. The average basal cell density was 9.53% (SD +/- 0.87%) for maxillary tissue and 10.91% (SD +/- 1.91%) for sphenoid tissue. Again, no statistically significant difference between the two sinuses existed. In conclusion, there is no clearly detectable difference in the histologic composition of these two paranasal sinuses to explain the different incidence of glandular tumors, and other etiologic factors must be considered in explaining tumorigenesis at these sites.     

Squamous cell carcinoma of the paranasal sinuses: the Cleveland Clinic experience 1977-1986

Fifty-four of 103 malignancies of the paranasal sinuses treated at the Cleveland Clinic Foundation between 1977 and 1986 were squamous cell carcinomas. Six arose from the ethmoid sinus and 48 from the maxillary sinus. Of the maxillary sinus patients, 11 presented with T1 or T2 lesions, 20 with T3, 16 with T4, and 7 of these had nodal disease. Treatment was surgery and/or radiation therapy. There was local recurrence in 25 of 48 maxillary sinus patients and in 1 of 6 ethmoid patients. Overall 5-year survival was 38.2% in the maxillary sinus group: T1, 100.0%; T2, 85.7%; T3, 31.8%; and T4, 6.7%. Three of six patients with ethmoid tumors were cured. There was a statistical trend for better prognosis in those patients presenting with ethmoid primaries, with early lesions, treated with both radiation and surgery, and with history of inverting papilloma. There were complications of treatment in 10 patients, four of which resulted in death. Local control was the major problem for these patients; therefore, early detection and aggressive local treatment are desirable.     

Metachronous adenocarcinoma of the maxillary sinuses: a rare entity

Malignant tumours of the nasal cavities and paranasal sinuses are uncommon. They constitute less than one per cent of all tumours and less than three per cent of head and neck tumours. Although multiple primary carcinomas of the aerodigestive tract are commonly reported, metachronous maxillary sinus carcinomas are rare. To date, all of these cases reported are of squamous cell origin. The incidence of metachronous maxillary carcinoma involving both sinuses is in the range of 1.4 per cent amongst patients with maxillary carcinoma. We present the first reported case, to our knowledge, of a patient with metachronous adenocarcinoma of the maxillary sinus.     

The paranasal sinuses as metastatic site of renal cell carcinoma]

BACKGROUND: Malignant tumors very seldom establish metastasis in the paranasal sinuses. Renal cell carcinomas (RCC) are one of the possible primary tumors displaying metastases in this location. The incidence of metastasis from the renal cell carcinoma in the paranasal sinuses is higher as would be expected by the incidence of this tumor. PATIENTS: We report here about 3 patients from the ENT clinic with metastasis in the paranasal sinus derived from primary RCC. Two of them showed metastases in the maxillary sinus and the third patient had a metastasis in the sphenoid sinus. RESULTS AND CONCLUSIONS: Further progression of the patients disease exhibited the paranasal sinuses being only a localisation of the generalised tumor disease. 2 of 3 patients developed the metastasis many years after nephrectomy and the third patient displayed a renal cell carcinoma by the diagnosis of a paralysis of the abducens nerve. All patients were treated with radiation of the tumor, but in one case with a metastasis in the maxillary sinus the tumor was also treated surgically. 2 of the 3 patients (one with a metastasis in the maxillary sinus and the other in the sphenoidal sinus) were inoperable due to the expanded tumor size. Nowadays surgical resection of the tumor seems to be the only therapy. In the follow-up all patients developed multiple distant metastasis. With respect to the quality of life of the patients the indication of a radical operation should be discussed very critically. Palliative methods, like interferon-therapy or selective embolisation of tumor, may also reduce the symptoms of the tumor and increase the quality of life for the patients.     

Epidemiologic analysis of 72 carcinomas of the nasal cavity and paranasal sinuses

ObjectiveThe aim of this study is to define the epidemiological aspects of carcinoma of the nasal cavity and paranasal sinusesMaterial and methodsWe performed a retrospective study of 72 carcinomas of the nasal cavity and paranasal sinuses. Various sites, age and sex distribution, drug consumption, TNM stage grouping and treatment were reported.ResultsThe average age was 63. Seventy- five percent of patients (54/72) were male and 25% (18/72) female. The site of origin was paranasal sinuses in 46 patients (64%), 30 in ethmoid sinus, 15 in maxillary sinus and 1 in sphenoid sinus. Twenty-six patients (36%) were located in nasal cavity.Squamous cell carcinoma was the most frequent histological type in both localizations. The 5-yea adjusted survival rate for all patients was 60% (IC: 54-66), 36% (IC: 28-44) for paranasal sinus carcinoma and 86% (IC: 79-93) for nasal cavity carcinoma. The 5-year adjusted survival rate according to the T distribution in 46 carcinomas paranasal sinus was 80% T2, 71% T3, 19% T4a and 6% T4b.(p=0.0002).ConclusionsCarcinoma of nasal cavity and paranasal sinuses represent a group of tumors that differ from the rest of carcinomas of the head and neck.     

Revision of carcinomas in paranasal sinuses

The annual incidence rate for paranasal sinus cancer is quite low in Europe at approximately 1 case a year per 100 000 inhabitants. The most frequent site is the maxillary sinus; in some countries such as Spain, however, carcinomas of the ethmoidal sinus complex are more prevalent. Squamous cell carcinoma is the most frequent histological type and adenocarcinoma is the one with the best prognosis. In general terms, the association of surgery and radiotherapy continues to be the optimal therapeutic option. The inclusion of an endoscopic endonasal approach for the treatment of these lesions must be considered in very selective cases. Most authors currently accept invasion of the fat and muscles of the orbital apex and infiltration of the conjunctiva and/or sclera as an absolute indication for orbital exenteration. Lymph node involvement at diagnosis or in the course of the disease is infrequent, so prophylactic lymph node treatment would therefore not be indicated.     

Survival and staging characteristics for non-squamous cell malignancies of the maxillary sinus

OBJECTIVE: To characterize the clinical behavior of non-squamous cell cancer of the maxillary sinus. METHODS: Cases of non-squamous cell maxillary sinus malignancy during 1988 through 1998 were extracted from the Surveillance, Epidemiology, and End Results database. Data for histologic type of tumor, tumor stage, and survival were analyzed using the Kaplan-Meier method to determine mean, median, and 5-year survival statistics for the overall cohort and for individual histologic types of tumor. The effect of tumor stage on overall survival was assessed. To determine relative survival, the non-squamous cell group was compared with a second group of patients with squamous cell carcinoma, matched according to age at diagnosis, year of diagnosis, and T stage. RESULTS: One hundred eighty-eight cases of non-squamous cell malignancy were identified. The mean patient age was 57.8 years, and 143 patients (76%) presented with T3 or T4 tumors. There were 31 adenocarcinomas, 64 adenoid cystic carcinomas, 15 mucoepidermoid carcinomas, 22 melanomas, 45 sarcomas, and 11 undifferentiated carcinomas. The overall mean survival was 63.4 months, and 5-year survival was 45.6%. Adenoid cystic carcinoma exhibited the best mean survival (79 months), whereas melanoma and undifferentiated carcinoma exhibited poor mean survivals (30.3 and 12.8 months, respectively). T stage did not statistically affect overall survival (P =.86). Survival for patients with non-squamous cell cancer was substantially better than survival for the matched group with squamous cell carcinomas (mean survival, 41.5 months; 5-year survival, 27.4%). CONCLUSIONS: Patients with non-squamous cell carcinoma of the maxillary sinus typically present with advanced T stage but have significantly better survival than patients with similar-stage squamous cell carcinoma of the maxillary sinus. T stage has less effect than histologic type of tumor on prognosis in non-squamous cell carcinoma of the maxillary sinus.     

Metastases to the paranasal sinuses: case report and review of the literature

The case of an 87-year old man with widespread prostatic cancer is reported. During the autopsy macroscopically visible metastases were found within the frontal sinuses. These tumor masses destroyed the posterior osseous wall of the frontal sinus and formed polypoid bulging masses. In contrast to the macroscopically unaffected mucous membrane of the sphenoid sinus the maceration specimen of the skull base demonstrated a spongious-mossy, osteoplastic metastasis, lining the sphenoid sinus like a tapestry. This affection started from an exhaustive osteoplastic metastasis within the clivus. No metastases could be found in both antrums or the ethmoids. Retrospectively no symptoms from the paranasal sinuses could be eruated, only occasional pain of the frontal bone. The review of the world literature with 123 reports revealed 169 cases. Renal cell carcinomas most frequently metastasize into the paranasal sinuses (67 cases), followed by bronchogenic carcinomas (15 cases). Thyroid cancers and cancers of the mammary gland are responsible for 13 respectively 14 cases. The prostate also adds 12 cases. The paranasal sinuses are affected in diminishing frequency: maxillary sinus (55 cases), sphenoid sinus (37 cases), ethmoidal cells (23 cases) and frontal sinus (15 cases). In 38 cases exhaustive metastases affecting two or more paranasal sinuses are reported. The statement of literature, that metastases affecting the paranasal sinuses are much more frequent than reported, cannot be supported by our study, because the intensive autoptic investigation of 50 skulls of patients suffering from widespread cancers revealed no further cases of metastatic processes of the paranasal sinuses.     

Malignomas of the nasal cavity and the paranasal sinuses: clinical characteristics, therapy and prognosis of different tumor types

BACKGROUND: Malignomas of the nasal cavity and the paranasal sinuses count for less than 3 % of the ENT-malignancies. PATIENTS AND METHODS: This retrospective chart review reports about 46 patients that were first diagnosed and treated with a nasal cavity or paranasal sinus malignancy between 1998 and 2002 in the ENT department of the Ruhr-Universit?t Bochum. RESULTS: 18 of 46 malignomas were squamous cell carcinomas. At initial diagnose, already 52 % of malignomas were staged T4. Accordingly the origin in 17 % of malignomas could not be determined anymore. Additional 43 % of malignomas originated from the nasal cavity, another 20 % from the maxillary sinus. 11 of 46 patients (24 %) showed histological proven nodal involvement at initial diagnose. 92 % of patients underwent surgical therapy. 25 patients were radiated postoperatively. Over-all 1-year-survival-rate was 75 %, over-all 2-year-survival-rate was 47 %. Beside patients age, tumor free margins at initial surgery and absence of nodal involvement correlated to improved survival. 16 (76 %) of the 21 patients who died had local recurrence. Maxillary sinus malignomas recurred more often than malignomas of the ethmoid and the nasal cavity. CONCLUSIONS: Malignancies of the nasal cavity and paranasal sinuses are very often diagnosed in advanced T-stages because of unspecific symptoms. The limited prognosis mainly depends on free surgical margins at the first resection and nodal involvement at the first diagnose. For improvement in outcome of nasal and paranasal sinuses malignancies, prospective multi-center trials are necessary.     

Efficacy of endoscopic sinus surgery for paranasal sinus mucocele including modified endoscopic Lothrop procedure for frontal sinus mucocele

This study evaluated the efficacy of the modified endoscopic Lothrop procedure (MELP) for complicated frontal mucoceles and endoscopic marsupialization for other paranasal sinus mucoceles. It was a retrospective, consecutive case review of sinus mucoceles treated endoscopically by a single surgeon over a four-year period (1998-2002). There were 41 mucoceles in 28 patients, including 24 frontal, eight frontoethmoidal, three ethmoidal, five maxillary and one frontal mucocele. Twenty-one patients underwent the modified Lothrop procedure for frontal mucoceles, and seven underwent simple drainage and marsupialization for frontoethmoidal, ethmoidal and maxillary mucoceles. At median follow-up of 16 months, all patients had a patent mucocele opening. Patients treated by drainage and marsupialization did not have any complications or mucocele recurrence. All patients treated by the modified endoscopic Lothrop procedure had improvement in symptoms and signs. Four patients had minor complications including epistaxis and adhesions and five required further surgery. The average hospital in-patient stay was 2 +/- 1.4 days. Endoscopic techniques, including MELP are effective in the short term for the management of complex and simple paranasal sinus mucoceles. MELP has a useful place in the management of mucoceles with a significant bony partition from an adjacent sinus or nasal cavity. It is also indicated when the mucocele is associated with loss of lateral support in the sinus with risk of medial-wall collapse of the orbital contents obstructing drainage.     

Nasal cavity and paranasal sinus malignancies in the ENT clinic of Charité since 1959

A retrospective analysis of 235 cases suffering from nasal and/or paranasal sinus malignant tumours who were admitted to the Charité ENT-Clinic between 1959 and 1989, is presented. 94 of the patients were women and 141 men, the mean age being 63.8 years (women) and 61.8 years (men), respectively. The most common histomorphological diagnosis was carcinoma (66%), followed by lymphoma/sarcoma (17%). 35% of all tumours originated in the nasal cavity, 38% in the maxillary sinus, 22% in the ethmoidal sinuses. At the time of admission many tumours had already invaded surrounding structures. Tumour invasion of the pterygopalatine fossa was noted in 52 patients, invasion of the orbit in 89 and of the skull base in 65 cases. Our therapy mainly depended on the histology of the tumours. 19% of all carcinomas were treated by surgery only, in 48% surgery and postoperative radiation was the therapy of choice. 59% of lymphomas/sarcomas were treated by radiation only. 100 out of these 227 patients treated because of sinus malignancy developed recurrencies. The 5-year survival rate was 30% in general, 29% for the years 1959-1970, 31% for the years 1971-1984 and for the T1 to T4 type cancers 54%, 38%, 19% and 19%, respectively.     

Inverted papilloma and squamous cell carcinoma.

Since 1960, 15 patients with histologically proven inverted papilloma of the nose and paranasal sinuses have been treated at the University Hospital, City Hospital, and V. A. Hospital in Boston. Eight of these patients have been found to have squamous cell carcinoma in the pathological specimens; four of these patients have died of carcinoma. Wide surgical excision, usually through a lateral rhinotomy with exenteration of the invaded sinus as indicated, was the therapy of choice. In spite of the published incidence of carcinoma in inverted papilloma of approximately 7-24 per cent, we have found a much higher rate. We therefore, suggest that meticulous microscopic examination of multiple sections of inverted papilloma specimens be carried out in a search for evidence of squamous cell carcinoma. Inverted papilloma should be treated as a premalignant lesion by appropriate radical surgery.     

Endoscopic resection of benign and malignant tumors in the nasal cavity and paranasal sinus

Endoscopic resection of nasal and paranasal sinus tumors is more aesthetic and less invasive than conventional resection, such as Luc's operation and lateral rhinotomy. We clarified the effect of radical endoscopic tumor excision and the control of local bleeding hazardous in endoscopic surgery. Subjects were patients with benign lesions in the nasal cavity, medial wall of the maxillary sinus, ethmoid sinus, and/or sphenoid sinus without concurrent malignant lesions. Although patients selection for malignant tumor excision was based on (1) possible en bloc resection, (2) low-grade malignant tumors, and (3) tumors in the nasal cavity and adjoining paranasal sinus, the final decision was made individual. Subjects were 23 patients with benign tumor (10 inverted papilloma, 9 hemangioma, 2 juvenile angiofibroma, and 2 other tumors) and 4 with malignant tumor (olfactory neuroblastoma, acinic cell carcinoma, squamous cell carcinoma, and chondroid chordoma) in the nasal and paranasal sinus. The tumor was resected en bloc except for patients with inverted papilloma (2 cases) and chondroid chordoma. Recurrence in benign tumors was zero during a mean observation of 21 months. One with chondroid chordoma, however, suffered a recurrent lesion 7 months after the initial operation. The lesion was successfully salvaged by a similar endoscopic procedure and subsequently treated with electron beam irradiation. Preoperative arterial embolization, laser coagulation, and ligation of the sphenopalatine artery were very useful in reducing blood loss during surgery and maintaining a clear endoscopic view. In intraoperative bleeding volume, less than 100 ml of bleeding occurred during surgery in 23 of 27 patients. The endoscopic excision of benign lesions in the nasal and paranasal sinus is thus as effective as conventional radical surgery. Endoscopic removal of malignant lesions remains controversial because of the small number of patients and short postoperative observation.     

A comparison between sinus radiographic findings and the macroscopic appearances of the para-nasal sinus mucosa

The results of a retrospective study comparing the preoperative state of the sinus mucosa with the pre-operative sinus radiographic findings are reported. In contrast to a low false-positive rate, the incidence of false-negative reporting in the ethmoidal and sphenoidal air cell systems was 43-55% and was 20% in the maxillary sinuses.     

Therapeutic tactics in isolated and combined exudative ethmoid sinusitis in children]

This paper presents the results of treatment of 81 children, aged 5 to 14 years, suffering from exudation ethmoid sinusitis; isolated ethmoid sinusitis was diagnosed in 17.8% and ethmoid sinusitis combined with maxillary sinusitis was detected in 61.7% cases. Most sinusitis cases (82.7%) were diagnosed in 5 to 10 year-old children. The ethmoidal labyrinth and maxillary sinus were treated by the puncture method, infection of other paranasal sinuses being excluded by the application of antibacterial, enzymic, corticosteroid drugs, immune agents, and adenotomy. Antibiotic therapy of 2 weeks in duration applied to the ethmoid labyrinth and maxillary sinus was more efficient when compared to the sinus treatment alone. The stable clinical effect was seen in 86.4% cases. This therapeutic approach can find application in practical otolaryngology.     

Nitric oxide production in the sphenoidal sinus by the inducible and constitutive isozymes of nitric oxide synthase

OBJECTIVE: To study the production of nitric oxide (NO), and the presence of different isoforms of the NO-synthesising enzyme, NO-synthase (NOS), in the paranasal sinus. MATERIALS AND METHODS: Ten patients, undergoing surgery for pituitary adenoma, were examined for the presence of NO gas in the sphenoidal and maxillary sinus. The distribution of different NOS isozymes in mucosal biopsies from sphenoid and maxillary sinus and ethmoidal cells was studied. RESULTS: The mean concentration of NO was 2575 ppb in the sphenoidal sinus and 6792 ppb in the maxillary sinus. Morphological analyses revealed intense NADPH-diaphorase staining throughout the epithelium. Immunoreactivity against NOS2 (inducible NOS) was observed in the apical cell layer but not of the basal layer. NOS1 (neuronal NOS)-immunoreactivity was mainly seen in the subapical part of the epithelium and NOS3 (endothelial NOS)-immunoreactivity was observed only in the most apical part of the epithelium. CONCLUSION: NO concentration in the sphenoidal sinus is about the same as in the nasal cavity and approximately half of the concentration found in the maxillary sinus. All of the three main different isozymes of NOS can be demonstrated in the mucosa of the sphenoidal and maxillary sinus and ethmoidal cells, NOS2 being the most abundant isoform.     

Paranasal sinus fungus ball and surgery: a review of 175 cases

OBJECTIVE: To analyze the surgical results after Functional Endoscopic Sinus Surgery (FESS) in patients with paranasal sinus fungus ball. MATERIAL AND METHODS: Retrospective analysis of the results of FESS performed in 175 patients suffering from paranasal sinus fungus balls. RESULTS: All maxillary (n = 150), sphenoidal (n = 20), and ethmoidal (n = 4) locations have been treated exclusively by FESS to obtain a wide opening of the affected sinuses, allowing a careful extraction of all fungal material without removal of the inflamed mucous membrane. No major complication occurred. Postoperative care was reduced to nasal lavage with topical steroids for 3 to 6 weeks. Only 1 case of local failure have been observed (maxillary sinus, n = 1), and 6 cases of persisting of fungus ball (maxillary sinus, n = 4; frontal sinus, n = 2) with a mean follow-up of 5 years. No medical treatment (antibiotic, antifungal) was required. CONCLUSION: Surgical treatment of a fungus ball consists in opening the infected sinus cavity at the level of its ostium and removing fungal concretions while sparing the normal mucosa. No antifungal therapy is required. Finally, through this 175 patients study, FESS appears a reliable and safe surgical treatment with a low morbidity.     

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.     

Paranasal sinus malignancies: an 18-year single institution experience

OBJECTIVES: To characterize a single institution experience with management of paranasal sinus malignancies during an 18-year time period, report long-term survival rates, and identify prognostic factors. STUDY DESIGN: Retrospective chart review. METHODS: Studied were 141 patients treated for a paranasal sinus malignancy at a single institution from 1980 to 1997 with a minimum 3-year follow-up. Gender, age, TNM stage, anatomic site, pathology, treatment, and recurrence rates were reviewed. Multivariate analysis was performed to determine factors affecting survival. RESULTS: The male to female ratio was 1.6:1, and the median patient age was 60 years. Most patients presented with T3/T4 or locally advanced disease (88%), N0 status (96%), and M0 status (96%). The maxillary sinus was the most commonly affected site (70%), followed by the ethmoid sinus (26%). The most common malignancy was squamous cell carcinoma (51%), followed by adenoid cystic carcinoma (12%) and adenocarcinoma (11%). Sixty-two percent of this study group underwent surgery as part of a multimodality curative treatment plan or alone as curative treatment. Eighteen patients (13%) had unresectable local disease and received non-surgical palliative treatment. Kaplan-Meier analysis revealed the 5-year and 10-year disease-specific survival was 52% and 35%, respectively. Multivariate analysis revealed T4 stage (P =.005), N-positive stage (P =.009), and M-positive stage (P =.018) negatively impacted survival. Seventy-two patients (51%) developed recurrent disease at a median time of 336 days after initial treatment. CONCLUSIONS: Most patients with paranasal sinus malignancies presented with locally advanced disease. Advanced T stage, regional, and distant metastasis are highly predictive of poor survival. Recurrence rate is high and typically occurs within the first year after treatment.     

鼻源性突眼的临床分析

目的：探讨鼻源性突眼的诊断和治疗,以降低其误诊、漏诊的发生率。方法：对本院1998年1月～2005年10月62例鼻源性突眼患者进行回顾性分析。结果：62例鼻源性突眼患者中,47例首诊眼科,15例以鼻塞、头痛、鼻出血等症状首诊于耳鼻咽喉科。其中额筛囊肿18例,全组鼻窦炎12例,真菌性额窦炎6例,上颌窦癌10例,嗅神经母细胞瘤4例,外伤性颈动脉海绵窦瘘6例,筛窦骨瘤6例。全部病例均经CT、MRI或病理检查确诊。额筛囊肿、筛窦骨瘤及鼻窦炎引起的突眼患者全部治愈。上颌窦癌引起的突眼患者术后随访5年,2例健在,2例失访;嗅神经母细胞瘤引起的突眼患者术后2年均死亡;外伤性颈动脉海绵窦瘘引起的突眼患者2例死亡,4例治愈。结论：以突眼为主要表现的鼻科疾病临床上少见,临床医师对该病认识不足易致误诊、漏诊,根据造成突眼的病因,选择正确的治疗方案,可获满意治疗效果。