鼻窦骨结构变异及其临床意义

目的：进一步探讨鼻窦骨结构变异与鼻窦炎发生的关系。方法：对１０９疑为鼻窦炎患者进行鼻窦冠状位ＣＴ扫描。结果：鼻窦粘膜异常改变者９３例（８５．３％），１６例粘膜呈正常影像（１４．７％）。在９３例鼻窦粘膜异常改变者中，鼻窦骨结构变异为７０例９７５．３％）其中Ｈａｌｌｅｒ气房出现率为３１．２％，中鼻甲气化为３１．２％，中鼻甲反相弯曲为１０．８％，钩突气化为２．２％，结论：鼻窦骨结构变异可能是鼻窦炎致病因     

鼻窦炎患者鼻窦骨结构变异和鼻窦粘膜异常的CT扫描分析

对１０９例临床疑为鼻窦炎患者的ＣＴ冠状扫描结果进行了分析，鼻窦粘膜异常改变者９３例（８５．３％），１６例粘膜呈正常影像（１４．７％），９３例鼻窦粘膜异常改变者鼻窦骨结构变异６０例（６４．５％）。通过对鼻窦骨结构变异和鼻窦炎情况的观察分析，认为处窦骨结构变异可能是鼻窦炎致病因素之一。鼻窦慕 前组筛窦和上颌窦发生率最高，同时伴有窦口 道复合体粘膜异常，支持了鼻窦口吲流障碍可以继发鼻窦炎的观点。作者认为     

鼻窦炎患者鼻窦骨结构变异和鼻窦粘膜异常的CT扫描分析

对109例临床疑为鼻窦炎患者的CT冠状扫描结果进行了分析,鼻窦粘膜异常改变者93例(85.3％),16例粘膜呈正常影像(14.7％),93例鼻窦粘膜异常改变者中,发现鼻窦骨结构变异60例(64.5％)。通过对鼻窦骨结构变异和鼻窦炎情况的观察分析,认为鼻窦骨结构变异可能是鼻窦炎致病因素之一。鼻窦粘膜异常以前组筛窦和上颌窦发生率最高,同时伴有窦口鼻道复合体粘膜异常,支持了鼻窦口引流障碍可以继发鼻窦炎的观点。作者认为采用鼻窦CT冠状扫描对判断鼻窦炎的病因和临床诊断具有重要意义。     

内窥镜鼻窦手术160例及中药辅佐

采用内窥镜进行具窦手术加中药辅佐治疗160例患者（A组），与单纯行内窥镜鼻窦手术66例患者（B组）进行术后0．5～1年随访及内窥镜检查显示：A组与B组中复发性耳窦炎患者治愈率分别为84．1％与60．0％，鼻窦炎伴鼻息肉患者复发率分别为10．2％与21％，鼻窦囊肿患者复发率分别为0％与16.7％．以上均经x2检验及统计学处理（P＜0．01），差异显著．表明中药对内窥镜鼻窦手术的辅佐，明显减轻患者症状，降低了复发率。并且提示，鼻内窥镜手术时，对气化的中鼻甲有积脓及呈息肉样改变者，则不宜再予保留。     

内窥镜鼻窦手术与传统鼻窦手术对中鼻甲及嗅觉的影响

目的：观察内窥镜鼻腔，鼻手术与传统鼻腔，鼻窦手术在慢性鼻窦炎，鼻息肉（I型2期，Ⅱ型2期）中的手术疗效对中鼻甲形态及嗅觉的影响，方法：对1997年9月－1999年9月间参加该项研究并随半年以上的二组病例85例（163侧），经冠状位鼻窦CT扫描，术前，术后鼻内窥镜检查及嗅觉测试，二级分别施行内窥镜鼻腔，鼻窦手术及传统鼻腔，鼻窦手术，对中鼻甲病变采取完整保留和部分切除二类方式。结果：经内窥镜鼻腔，鼻窦手术，随访半年以上的52例（101侧）患者鼻窦炎治愈，好转，无效率分别是64．4％，29．7％，5．9％，相应中鼻甲恢复正常率分别为63．1％，30．0％，0．0％，嗅觉恢复正常率分别为66．2％，36．7％，0．0％，33（例）62侧经传统鼻腔，鼻窦手术患者鼻窦炎治愈，好转，无效率分别为30．6％，48．4％，21．0％，相应中鼻甲恢复正常率分别是47．4％，3．3％，0．0％，嗅觉恢复正常率分别是63．2％，23．3％，0．0％。结论：内窥镜鼻窦手术较传统鼻窦手术更有效地解决窦口鼻道复合体病变，从而提高I型，II型鼻窦炎治毹愈率，本研究表明中鼻甲形态的转归，嗅觉恢复与鼻窦炎治愈率有明显的相关性。     

鼻鼻窦解剖变异与慢性鼻窦炎的关系

目的量化研究鼻鼻窦解剖变异与慢性鼻窦炎的发病的关系。方法用自行开发的计算机图像分析系统定量分析９１例慢性鼻窦炎患者的冠状位鼻窦ＣＴ，观测指标包括：骨性解剖结构变异（包括中鼻甲气化、反常曲线中鼻甲、Ｈａｌｅｒ气房、鼻中隔偏曲、上颌窦发育不良、鼻丘气房、钩突气化）、筛漏斗、钩突角度、筛泡等，测量相应结构的冠状位截面积、角度、长度。应用统计软件ＳＰＳＳ进行统计。结果全中甲或中甲下部气化的发生率随前筛、上颌窦内软组织影增厚而升高；有额窦炎组病人的鼻丘气房最大纵向垂径明显大于无额窦炎组（分别为１１．７±５．５ｍｍ和８．５±３．７ｍｍ，Ｐ＜０．０１）；Ｈａｌｅｒ气房在上颌窦炎组和非上颌窦炎组的发生率无显著差异，但前组发生炎症的Ｈａｌｅｒ气房明显多于后组（分别为７７．８％和３３．３％，Ｐ＜０．０５），且前组Ｈａｌｅｒ气房的冠状位截面积明显大于后组（分别为９１．６±１７．８ｍｍ２和４１．６±１２．６ｍｍ２，Ｐ＜０．０５）；钩突角度随上颌窦内软组织增厚而减小；筛泡冠状位截面积随前筛窦内软组织增厚而增大（Ｐ＜０．０１）。结论某些鼻、鼻窦解剖变异与慢性鼻窦炎的发病相关。     

鼻内镜鼻窦手术中鼻腔鼻窦解剖变异与慢性鼻窦炎的关系

目的 探讨鼻内镜鼻窦手术中鼻腔鼻窦解剖变异与慢性鼻窦炎的关系。 方法 选取慢性鼻窦炎患者206例,根据是否患有慢性鼻窦炎分为观察组85例与对照组121例。记录两组患者是否存在鼻中隔偏曲、泡状中鼻甲、下鼻甲及鼻丘气房肥大、中鼻甲反向偏曲及钩突气化等鼻腔鼻窦解剖变异现象。 结果 观察组鼻中隔偏曲、下鼻甲及鼻丘气房肥大、泡状中鼻甲发生率均显著高于对照组(P<0.05),而中鼻甲反向偏曲及钩突气化发生率比较无显著差异(P>0.05)。两组鼻中隔偏曲均以高位偏曲为主,但观察组鼻中隔高位偏曲发生率显著高于对照组(P<0.05)。 结论 鼻中隔偏曲、泡状中鼻甲、鼻丘气房及下鼻甲肥大均为慢性鼻窦炎发展中的重要结构变异,与慢性鼻窦炎的发生密切相关。     

电动微切吸器在功能性鼻窦内窥镜手术中对中鼻甲的处理方式

目的：探讨电动微切吸器在功能性鼻窦内窥镜手术中对中鼻甲的处理方式。方法：介绍电动微切吸器技术在70例功能性鼻窦内窥镜手术中对病变中鼻甲的处理方式及其优点。结果：术后随访70例病例6个月以上，70例（118侧）中，治愈115侧（97．5％）；好转2侧（1．7％）；无效1侧（0．8％）。结论：对不同分期的慢性鼻窦炎、鼻息肉患者进行鼻窦内镜手术时，尽可能保留中鼻甲或合理地处理中鼻甲是保证手术疗效的重要因素之一。     

CT扫描分析窦口鼻道复合体解剖变异在鼻窦炎发病中的意义

目的 探讨窦口鼻道复合体解剖变异与慢性鼻窦炎的关系。分析其在内窥镜鼻窦手术中的重要性。方法 以２９７例（５９４例）冠状位鼻窦ＣＴ片材料研究中鼻甲、钩突、筛泡和处 的解剖变异及Ｈａｌｌｅｒ气房的影像特点,结合病史分析解剖变异与慢性鼻窦炎的关系,用ＳＰＳＳ５．０作统计分析。结果 ＯＭＣ解剖变异包括中鼻甲反向（１３．９７％）、气化（３４．８５％）,钩突肥大（１９．３６％）、移（４５．２７％）筛泡过度气化     

CT扫描分析窦口鼻道复合体解剖变异在鼻窦炎发病中的意义

目的探讨窦口鼻道复合体（ｏｓｔｉｏｍｅａｔａｌｃｏｍｐｌｅｘ,ＯＭＣ）解剖变异与慢性鼻窦炎的关系,分析其在内窥镜鼻窦手术中的重要性。方法以２９７例（５９４侧）冠状位鼻窦ＣＴ片为材料研究中鼻甲、钩突、筛泡和鼻丘的解剖变异及Ｈａｌｅｒ气房的影像特点,结合病史分析解剖变异与慢性鼻窦炎的关系,用ＳＰＳＳ５．０作统计分析。结果ＯＭＣ解剖变异包括中鼻甲反向弯曲（１３．９７％）、气化（３４．８５％）,钩突肥大（１９．３６％）、偏移（４５．２７％）,筛泡过度气化（３０．３０％）,鼻丘过度气化（０．７０％）,Ｈａｌｅｒ气房（１．００％）。ＯＭＣ解剖变异总出现率为８１．１４％;钩突、中鼻甲和筛泡的变异与慢性鼻窦炎的发病呈正相关（Ｐ＜０．０１）。结论ＯＭＣ解剖变异常见,且与慢性鼻窦炎密切相关,处理ＯＭＣ解剖变异是内窥镜鼻窦手术的一项重要内容。     

Paranasal sinus bony anatomic variations and mucosal abnormalities: CT analysis for endoscopic sinus surgery

Coronal plane computerized tomographic (CT) scanning has dramatically improved the imaging of paranasal sinus anatomy as compared to sinus radiographs. Increasingly, subtle bony anatomic variations and mucosal abnormalities of this region are being detected. Data regarding the “background” prevalence of these findings are needed to determine their clinical relevance. A detailed analysis of coronal plane CT scans of the paranasal sinuses obtained in 202 consecutively imaged patients was conducted. Special attention was directed toward identifying bony anatomic variations and mucosal abnormalities. Anatomic variations studied included pneumatization of the middle turbinate, paradoxical curvature of the middle turbi-nate, Haller's cells, and pneumatization of the unci-nate process. Such bony anatomic variations were detected in 131 (64.9%) of 202 patients and were found with a similar frequency in patients scanned for sinus complaints and in those scanned for nonsinus reasons. Mucosal abnormalities were detected in 168 (83.2%) of 202 patients. For those patients scanned during the evaluation of sinus-like complaints, mucosal abnormalities were noted in 153 (92.2%) of 166 cases, and were predominantly detected in the anterior ethmoid region. For patients scanned during nonsinus evaluations, mucosal abnormalities were detected in 15 (41.7%) of 36 cases, without predilection for the anterior ethmoid region. Discussion regarding the prevalence and clinical significance of paranasal sinus bony anatomic variations and mucosal abnormalities is included as a guide to assist the otolaryngologist and/or radiologist in the evaluation of coronal sinus CT scans.     

Anatomic variations of the paranasal sinuses: CT examination for endoscopic sinus surgery

Chronic rhinosinusitis endoscopic surgery requires an accurate evaluation of diseases and paranasal sinus anatomic variations. This study aims to show the main anatomical variations in the ostiomeatal complex and paranasal sinuses which are usually depicted by computed tomography (CT). CT scans obtained 2 mm thickness in axial and coronal plane from a series of 200 patients with chronic sinusitis were examined to determine the prevalence of anatomic variants. Anatomical variations determined were supraorbital recess in 6%, concha bullosa in 30%, sphenomaxillary plate in 17%, infra-orbital ethmoid cells (Haller's cells) in 6%, spheno-ethmoid cells (Onodi's cells) in 12%, pneumatization of the anterior clinoid process in 6%, carotid artery bulging into the sphenoid sinus in 8%, pneumatization of the uncinate process in 2%, paradoxical curvature of the middle turbinate in 3% and septal deviation in 36%. Level difference between the ethmoid roof and nasal vault was an average of 8 mm in right side and 9.5 mm in left side. Awareness of these different variations will help the rhinologic surgeon in his orientation during endoscopic surgical procedures.     

Anatomic variations of the bone in sinonasal C.T.

Coronal plane Computed Tomographic (C.T) Scanning of paranasal sinuses is importannt as a preoperative evaluation tool and providing a road map for Functional Endoscopic Sinus Surgrey. The present study wea crried out on 61 patients of chronic sinusitis who underwent C.T. Scan of paranalal sinus, (coronal section) prior to Functional Endoscopic Sinus Surgery.The incidence of anatomical variations of the bone such as Agger nasi cells, Middle turbinate pneumatisation, Heller’s Cells,Paradoxically curved middle turbinate, Deviated septum and Uncinate process variations, etc. were investigated in each C.T.Scan. Mucosal abnormalities in each paranasal sinus were also reported. The purpose of this investigation was to determine the background prevalence of bony anatomical variations and mucosal abnormalities of paranasal sinuses and assess the possile pathogenecity of these findings in patients undergoing evalation for Functional Endoscopic Sinus Surgery.     

The relationship between anatomic variations of paranasal sinuses and chronic sinusitis in children

CONCLUSIONS: Anatomical variations in the nose and paranasal sinuses are common in children. Due to the absence of a definitive relationship between anatomical variations and sinus disease, local, systemic or environmental factors appear to be more significant in pediatric sinusitis than the anatomic variations. OBJECTIVE: Chronic sinusitis is increasing in the pediatric population. Following the initial reports of functional endoscopic sinus surgery (FESS) for children, the majority of patients undergoing this procedure have experienced improved quality of life. Thus, we need to know the precise anatomy and anatomical variations of the nose, as well as the relationship between such anatomy and chronic sinusitis. PATIENTS AND METHODS: To determine the extent and distribution of disease, as well as associated anatomic abnormalities, computed tomography (CT) scans were performed on 113 children with persistent symptoms of sinusitis after failure of medical therapies. RESULTS: The maxillary sinus was the most commonly involved sinus, followed by the ethmoid, sphenoid, and frontal sinuses. There was no relationship between age and severity of sinusitis. Agger nasi cell was the most common anatomical variation, followed by septal deviation, Haller cell, concha bullosa, paradoxical middle turbinate, and Onodi cell. The prevalence of septal deviation increased with age. There was no significant relationship between the sinusitis and anatomic variations.     

窦口鼻道复合体区解剖变异影像分析及与鼻-鼻窦炎的关系

目的 用高分辨率CT对鼻腔鼻窦炎进行影像学分析,探讨窦口鼻道复合体(OMC)区的解剖变异与儿童鼻窦炎、成人慢性鼻-鼻窦炎的关系。 方法 回顾性分析有明显临床表现且经CT扫描确诊为慢性鼻-鼻窦炎167例的临床资料,年龄4~74岁,并将其影像学资料分为儿童组和成人组,并对其分析结果进行比较。 结果 (1)儿童组和成人组的窦腔炎症最常累及上颌窦、前组筛窦和额窦;(2)儿童组的窦口鼻道复合体区解剖变异与慢性鼻-鼻窦炎的发生没有明显关系,而成人组的窦口鼻道复合体区解剖变异与慢性鼻-鼻窦炎的发生关系显著(P<0.05)。 结论 窦口鼻道复合体区的解剖变异对儿童慢性鼻-鼻窦炎的发生不如对成人的影响大,儿童慢性鼻-鼻窦炎的诊断和手术指征不能单凭异常的鼻窦CT扫描图作为惟一依据,应该切实联系临床症状。     

Anatomic variations of the sphenoid sinus on computed tomography

Anatomic variations of the vital structures adjacent to the sphenoid sinus can be jeopardized during functional endoscopic sinus surgery (FESS). The knowledge of the size and extent of pneumatization of the sphenoid sinus (SS) is an important condition for adequate surgical treatment of its disease. The bony anatomic variations of SS as well as its relationship with adjacent vital structures were reviewed in this paper. The study was performed on 267 patients with a complaint of chronic or recurrent sinusitis. Computed tomographic (CT) scans were obtained upon completion of therapy. The evaluations of the sphenoid sinuses were regarded separately, so as 534 sides were examined. Especially bony anatomic variations as well as mucosal abnormalities of the sphenoid sinuses were examined. Pneumatization of the pterygoid process and anterior clinoid process were found in 39.7% and 17.2% of the patients respectively. Vidian canal protrusion was found in a total of 158 sides of which 60 were bilateral. These entities were encountered usually when pneumatization of the pterygoid process occurred. Carotid canal and optic canal protrusions were found in 5.2% and 4.1% of the patients respectively. Mucosal thickening, and polyps or cysts of sphenoid sinuses were detected in 20.6% and 4.5% of the patients respectively. There was a statistically significant correlation between pterygoid pneumatization and vidian canal protrusion (p < 0.001), and vs. foramen rotundum protusion (p = 0.004). While the optic canal protrusion was found significantly associated with the anterior clinoid pneumatization (p < 0.001), there was no statistically significant correlation between a carotid canal protrusion and anterior clinoid pneumatization (p = 0.250). Sphenoid sinus surgery is very risky, because of changing variations of the cavity. We are in the opinion that detailed data from CT scans of SS will enable the surgeon to interpret any anatomic variations and pathological conditions before initiation of the surgical therapy.     

Relationship between pediatric sinusitis and middle turbinate pneumatization--ethmoidal sinus pyocele thought to be caused by middle turbinate pneumatization

OBJECTIVE: To investigate whether the presence of pediatric middle turbinate pneumatization causes narrowing of the ostiomeatal complex (OMC) and is associated with the development of paranasal sinusitis. METHODS: CT scans of 190 nasal sides of 95 children (1-15 years old) were analyzed for the presence of middle turbinate pneumatization and mucosal thickness in the paranasal sinus. RESULTS: Middle turbinate pneumatization was detected in nine (4.6%) of the nasal cavities. Only one of these sides was in a patient younger than 10 years of age, while the other eight sides were in patients at least 13 years old. In six of those nine sides with pneumatization, paranasal sinusitis was also found. However, the images showed that in five sides the middle turbinate pneumatization itself did not obstruct the OMC. In addition, the mean +/- standard deviation (S.D.) of the total score for the paranasal sinus opacification on the side which had the middle turbinate pneumatization was 5.67 +/- 2.95. The corresponding value for the 76 sides without pneumatization was 5.29 +/- 2.53, and the difference between these mean total scores was not statistically significant. However, in one side, the OMC was obstructed or narrowed due to the middle turbinate pneumatization, and an ethmoidal sinus pyocele formed on this side. CONCLUSION: A causal relationship was not found between middle turbinate pneumatization and the mechanism of development of paranasal sinusitis in children. However, in the event that the OMU becomes obstructed at some time, frequent cycles of improvement and aggravation of pediatric paranasal sinusitis may occur and lead to the development of a serious condition.     

儿童鼻窦正常气化规律初探

目的 利用磁共振成像探讨儿童鼻窦正常气化规律.方法 选取280例无鼻窦炎的年龄17 d(＜1岁患儿本研究中称为0岁)至14岁患儿的鼻窦MRI图像,观察各组鼻窦的气化规律,测量左侧上颌窦轴位与矢状位最大面积值.结果 0～1岁患儿上颌窦气化率为85%;至3岁时,气化率达95%,且男女患儿上颌窦气化率差异无统计学意义(x2=0.741,P=0.389);4岁以后全部气化.0～14岁患儿筛窦气化率达100%.＜1岁患儿蝶窦未见气化;至5岁时平均气化率为49%,且男女患儿气化率差异无统计学意义(x2=2.452,P=0.117);7岁以后气化率达100%.＜5岁患儿额窦未见气化;5～9岁额窦平均气化率为62%;10岁以后额窦气化率达到95%,男女患儿额窦气化率差异无统计学意义(x2=0.124,P=0.724).女性患儿上颌窦气化轴位、矢状位最大面积分别为(689.28±221.79)、(659.76±263.31)mm2,男性分别为(668.13±206.38)、(638.60±207.67)mmz,差异均有统计学意义(t=-19.78,P＜0.001;t=-19.89,P＜0.001).结论 了解儿童鼻窦正常气化规律有助于对不同年龄儿童鼻窦病变,特别是炎性病变的诊断提供参考.     

The relationship between anatomic variations of paranasal sinuses and chronic sinusitis in children

Conclusions. Anatomical variations in the nose and paranasal sinuses are common in children. Due to the absence of a definitive relationship between anatomical variations and sinus disease, local, systemic or environmental factors appear to be more significant in pediatric sinusitis than the anatomic variations. Objective. Chronic sinusitis is increasing in the pediatric population. Following the initial reports of functional endoscopic sinus surgery (FESS) for children, the majority of patients undergoing this procedure have experienced improved quality of life. Thus, we need to know the precise anatomy and anatomical variations of the nose, as well as the relationship between such anatomy and chronic sinusitis. Patients and methods. To determine the extent and distribution of disease, as well as associated anatomic abnormalities, computed tomography (CT) scans were performed on 113 children with persistent symptoms of sinusitis after failure of medical therapies. Results. The maxillary sinus was the most commonly involved sinus, followed by the ethmoid, sphenoid, and frontal sinuses. There was no relationship between age and severity of sinusitis. Agger nasi cell was the most common anatomical variation, followed by septal deviation, Haller cell, concha bullosa, paradoxical middle turbinate, and Onodi cell. The prevalence of septal deviation increased with age. There was no significant relationship between the sinusitis and anatomic variations.