头颈部浆细胞肉芽肿临床分析

目的:探讨头颈部浆细胞肉芽肿(PCG)的临床诊断及治疗方法。方法:回顾性分析3例头颈部PCG患者的临床资料。1例行鼻内镜手术完全切除,术后使用鼻用和口服类固醇激素;2例行上颌窦根治术部分切除肿物,术后结合口服类固醇激素药物和局部放疗,其中1例并行化疗。结果:治疗后1例患者随访5年,鼻腔未见肿物复发,上颌窦开口处及窦腔内黏膜光滑无分泌物;1例患者术后2年行鼻窦CT检查,残留肿物未见增生;1例患者3年后行鼻窦CT检查,肿物较术前减小,患者无明显张口受限,疗效满意。结论:头颈部PCG较为少见,虽然是一种炎性反应性病变,但临床体征及影像学表现类似于恶性肿瘤。该病变具有侵袭性,治疗首选手术切除,不能完全切除者应结合激素和放、化疗,预后较好。     

颌骨外巨细胞肉芽肿3例报告并文献复习

目的:探讨颌骨外巨细胞肉芽肿的临床病理特征、诊断与治疗.方法:对3例鼻咽部、颞骨、上颌窦巨细胞肉芽肿患者的临床病理资料进行回顾性分析,并复习相关文献.结果:颌骨外巨细胞肉芽肿临床表现为局限性无痛性肿块,有时具有侵袭性.组织病理学特征为骨组织被纤维组织代替,多核巨细胞呈散在或灶性分布于纤维基质中.结论:颌骨外巨细胞肉芽肿是一种非真性肿瘤,临床极为罕见,诊断有一定困难,结合临床和病理分析对诊断更加有意义,彻底切除病变是有效的治疗方法.     

经上颌窦前壁双管穿刺径路治疗上颌窦囊肿

目的 研究上颌窦囊肿的手术治疗方法,为临床治疗提供理论依据。方法 对40例上颌窦囊肿患者行经上颌窦前壁双管穿刺径路鼻内镜手术治疗。结果 术后均无牙列酸痛、面部麻木等不适,单纯上颌窦囊肿患者均术后3 d出院。随诊3个月至半年经鼻内镜及鼻窦CT检查,无脓性分泌物,未见囊肿复发。结论 经上颌窦前壁双管穿刺径路治疗上颌窦囊肿具有手术方法简单、治愈率高、创伤小的优点,可减轻患者痛苦,值得临床推广应用。     

引起骨壁广泛破坏的上颌窦胆固醇肉芽肿

目的探讨上颌窦胆固醇肉芽肿的发病机制、诊断及治疗.方法报告引起上颌窦骨壁广泛破坏的胆固醇肉芽肿1例,并复习有关文献.结果胆固醇肉芽肿是肉芽组织反应的一种特殊类型,好发于乳突及颞骨的气房,但发生于上颌窦者少见.结论此病的病因可能是上颌窦口阻塞,窦腔内出血或渗出致胆固醇在窦腔内或囊肿内沉积.确诊需依靠病理,建立永久的窦口鼻道通气可根治.     

以鼻出血为特征的上颌窦病变27例分析

目的:探讨以鼻出血为特征的上颌窦病变的诊断和治疗.方法:回顾分析1995年1月至1999年6月住院治疗27例患者的临床资料.结果:22例患者经手术切除窦内病变,病理证实为上颌窦息肉、出血坏死性息肉,血管瘤,乳头状瘤,曲霉菌性上颌窦炎等疾病.其中14例行上颌窦根治术,6例行上颌窦根治伴窦内筛窦开放或鼻内筛窦开放术,2例行功能性上颌窦手术.术后恢复良好,随访0.5～4年,除1例失访,无复发.结论:要提高对以鼻出血为特征的上颌窦病变的认识,鼻窦CT扫描有助于诊断,手术切除病灶效果良好.     

单侧上颌窦占位性病变的CT诊断

目的探讨CT扫描对常见的单侧上颌窦占位性病变的诊断意义。方法回顾性总结2006年1月～2008年1月我科治疗的108例单侧上颌窦占位性病变患者的临床及影像学资料,并以组织病理学结果作为对照,对比分析CT扫描在单侧上颌窦占位性病变中的诊断意义。结果108例单侧上颌窦占位性病变中慢性上颌窦炎36例（33．3％）,上颌窦肿瘤32例（29．6％）,真菌性上颌窦炎19例（17．6％）,上颌窦囊肿14例（13．0％）,上颌窦后鼻孔息肉5例（4．6％）,上颌窦出血坏死性息肉及上颌窦嗜酸性肉芽肿各1例（0．9％）。大多数上颌窦占位性病变都具有其特有的临床及影像学表现,鼻窦CT扫描在单侧上颌窦占位性病变的术前诊断总体准确率为79．1％;其中上颌窦囊肿的术前诊断准确率为92．9％,慢性上颌窦炎为90．0％,上颌窦癌为80．0％,真菌性上颌窦炎为86．4％,鼻内翻性乳头瘤为50．0％。结论CT扫描对单侧上颌窦占位性病变的术前诊断有着十分重要的作用,大多数病变通过鼻窦CT检查可以作出初步的定位或定性诊断,并制定出合理的手术方案,最终确诊仍有赖于组织病理学检查。     

鼻不愈性肉芽肿的鼻窦X线表现

本文复习了20例Wegener肉芽肿病及7例致死性中线肉芽肿的临床及鼻窦X线所见。20例Wegener肉芽肿病患者都常规摄鼻窦平片,3例常规断层片,3例CT。全部病人的病史中都有鼻症状。7例致死性肉芽肿,除全摄了X线平片外,2例常规断层,1例CT。结果:Wegener肉芽肿病的X线平片中,4例正常;11例呈非特异性改变如粘膜增厚、云雾状混浊、液平面和窦壁骨性硬化。所有病例上颌窦均有上述改变,其他各窦受累的频度则依次为筛、额和蝶窦;5例有骨质破坏(鼻中隔2例,鼻甲2例,上颌窦内壁1例)。断层片有6例示骨质破坏,在相应的平片中仅2例能见到骨质破坏。破坏的部位为:鼻中隔5例,鼻甲3例,上颌窦内壁2例,筛房底2例。致死性中线肉芽肿7例中1例正常,鼻、鼻窦及鼻咽部软组织阴影3例,余3例示鼻骨及窦壁大块破坏。断层片证实平片所见。     

3D打印辅助上颌骨切除术后缺损重建

目的：探讨3D打印技术在上颌窦恶性肿瘤外科治疗中的可行性和应用效果。方法对5例因上颌窦恶性肿瘤行手术治疗的患者,根据术前CT扫描数据,应用3 D打印技术打印出患侧上颌窦的树脂模型,在此模型上对钛网进行塑形,制备出个性化钛网,将个性化钛网植入缺损区。通过临床和CT检查,评价其颌面部外形与功能。结果所有病例手术顺利,颌面部外形恢复良好,两侧对称,未见复视及眼球内陷,植入的钛网与缺损周边骨床贴合紧密。术后随访8～30个月,经临床和CT检查未见肿瘤复发。结论3 D打印技术在上颌窦恶性肿瘤的外科治疗中具有较好的可行性和可靠性,可提高上颌窦恶性肿瘤手术治疗的精确性及临床治疗效果。     

80例单侧上颌窦病变的临床特征分析

目的 通过回顾性分析影像学特点为单侧上颌窦病变患者的临床特征,进一步探讨单侧上颌窦病变的临床发病规律及临床诊治。方法 收集2019年1月-2019年12月在我科住院的80例影像学表现为单侧上颌窦病变患者完整的临床资料,包括病史、辅助检查资料,然后进行统计学分析,对不同的病变类型及临床特征进行相关讨论。结果 纳入的80例患者中,男性患者36例,女性患者44例;其中左侧40例,右侧40例;共7中临床病变类型,各种病变类型中:慢性鼻窦炎共36例(其中伴息肉样变13例),真菌性上颌窦炎共31例,内翻性乳头状瘤9例,上颌窦后鼻孔息肉2例,上颌窦囊肿2例,上颌窦骨瘤1例,鼻硬结病1例。结论 单侧上颌窦病变是耳鼻喉科临床的常见病、多发病,而且临床类型多样,其中以慢性上颌窦炎、真菌性上颌窦炎常见,临床诊疗中需结合患者临床症状、内镜检查、影像学检查及活检病理综合评估诊断,避免漏诊误诊,并根据患者病变范围采取不同手术方式。     

上颌窦黏液囊肿24例

目的 探讨引起窦壁破坏的上颌窦囊肿的诊断及治疗。方法 回顾分析1994年9月～2004年1月24例引起窦壁破坏的上颌窦黏液囊肿患者的临床资料。所有患者经CT检查及上颌窦穿刺明确诊断。柯-陆氏手术10例，鼻内镜下囊肿开放术（造袋术）14例。结果 随访2年以上2例，3年以上6例，5年以上16例。柯-陆氏术后3年复发1例，再次鼻内镜下囊肿造袋术，余均未见复发。结论 引起窦壁破坏的上颌窦囊肿有独特的CT影像学特征，结合上颌窦穿刺获得囊性液可明确诊断。鼻内镜下手术具有简洁、微创、出血少、术后恢复快等优点，可成为治疗该病的最佳选择。     

Cholesterol granuloma of the maxillary and frontal sinuses

5 cases of cholesterol granuloma are described, 3 within the maxillary sinuses and 2 within the frontal sinuses. The lesions arise from the mucosa and can be recognized on plain films and tomograms of the sinus as opacity, sometimes resembling a mucocele. Radical operation seems to give absolute cure without any recurrence. The pathogenesis is hemorrhage and/or filtration. The closed cavities of the paranasal sinuses provide favorable conditions for cholesterol to become dissociated from the lipoprotein complex and to precipitate and to give rise to a granulomatous reaction.     

Cholesterol granuloma of the maxillary antrum

The cholesterol granuloma is a particular form of granulation tissue developing as part of a variety of tissue reactions, Cholesterol granuloma is not related to cholesteatoma which may be regarded as an epidermoid cyst of the middle ear or temporal bone. Cholesterol granulomas are rarely associated with such cases (Friedmann, 1976; Gherini et al., 1985). Microscopically, the cholesterol granuloma consists of dense masses of cholesterol crystals which appear as clefts. They are surrounded by foreign body giant cells, foam cells, plasma cells and lymphocytes. There is frequently some fresh blood and some blood pigment (Wilhelm, 1977; Beales, 1979; Gibb, 1979). It seems probable that inflammation and prolonged obstruction of a bony cavity that is normally aerated, are the main ways in which cholesterol is concentrated in the paranasal sinuses. It could be expected to be relatively frequent in the maxillary and frontal sinus, but only a few cases have been reported in the literature and only nine cases affecting the maxillary sinus have been published over the last 22 years (Milton and Bickerton, 1986). We have recently found a cholesterol granuloma arising in the maxillary antrum.     

Squamous cell carcinoma of the maxillary sinus: A retrospective analysis of 36 cases.

36 patients with advanced squamous cell carcinomas of the maxillary sinuses formed the basis of this review. There were 16 T3 and 20 T4. Treatment consisted of radiotherapy alone in 21 cases and radiotherapy followed by systemic chemotherapy in 15 cases. The median survival for all analysed patients was 19 months and the 3-year and 5-year estimated survivals were 30% and 17%. The respective 3-and 5-year survival probabilities were 19% and 9% for patients treated with radiotherapy alone and 40% and 27% for patients treated with radiotherapy and chemotherapy (p= 0.01). Our findings seem to suggest that the addititon of systemic chemotherapy to radiotherapy may imporve overall survival in advanced squamous cell carcinomas of the maxillary sinuses.     

Meningiomas of the nose and paranasal sinuses

In material of ENT Department, Medical University of Gdańsk we have three cases of extracranial meningioma localized in the nose and sinuses. Two of them are presented in this paper. One case was 29 year woman with meningioma of the nose and ethmoid and maxillary sinuses; it was residual tumor after removal of intracranial meningioma 3 years earlier. Second case was 14 year boy with meningioma of the nose, ethmoid and maxillary sinuses and of the orbit. In both patients tumor was removed by rhinosurgical access (lateral rhinotomy). Late results of the operation were very good. Basing on clinical and radiological pictures of both cases, pathological characteristics of naso-sinusal meningioma was made.     

鼻-鼻窦侵袭型真菌病的临床和病理学观察

目的探讨真菌侵袭黏膜组织所引起的临床和病理学特点及组织损伤的致病机理。方法对1984年4月至2002年8月16例经病理学证实为侵袭型真菌性鼻-鼻窦炎患者的临床资料进行回顾性分析，并对其病理形态进行观察。用HE染色观察真菌侵袭组织的方式及组织损伤的特点，Warthin-Starry(W-S)、过碘酸-Schiff(periodic acid-Schiff，PAS)染色显示侵入组织内真菌的形态特征，对其中1例作透射电镜观察。结果发现有基础疾病患者13例(糖尿病4例、鼻腔T细胞淋巴瘤1例、急性巨细胞性白血病伴甲型肝炎1例、慢性粒细胞性白血病1例、鼻窦及眶内恶性肿瘤2例、乙型肝炎合并肝硬变1例、眶内肿瘤切除术后1例、慢性上颌窦炎行上颌窦根治术后2例)，无基础疾病者仅3例。真菌培养检出曲霉菌10例，毛霉菌4例，镰刀霉菌1例，1例未作培养。随访6个月～5年，死亡8例(50．0％)。病理学观察：形成化脓性肉芽肿14例，真菌对小血管浸润16例，小动脉闭塞5例，小动脉菌栓1例，组织凝固性坏死16例。同侧眶内真菌侵袭8例，侵袭视神经3例。结论糖尿病、恶性肿瘤等基础疾病引起免疫功能低下，是侵袭型真菌性上颌窦炎的重要的发病基础。真菌性血管炎是造成组织损伤的直接原因。侵袭组织内的真菌主要为曲霉菌和毛霉菌等。     

CT检查在真菌性鼻窦炎术前诊断的意义

目的 探讨CT检查在真菌性鼻窦炎术前诊断中的意义。方法 对67例真菌性鼻窦炎患者CT改变、临床表现和术中所见进行回顾性对比分析。结果 CT表现为：鼻窦充填密度不均软组织影29例,术前明确诊断为真菌性鼻窦炎12例;窦内充填软组织影伴散在不规则钙化灶34例,术前均明确诊断为真菌性鼻窦炎;上颌窦内壁吸收破坏21例,术前明确诊断为真菌性鼻窦炎14例：筛顶骨壁吸收破坏2例,术前均明确诊断为真菌性鼻窦炎：上颌窦骨壁出现增生硬化19例,术前明确诊断为真菌性鼻窦炎14例。67例中CT诊断鼻窦炎症60例,其中46例术前临床初诊为真菌性鼻窦炎,7例为上颔窦／筛窦肿物或占位性变。结论 窦腔内散在斑块状钙化的软组织充填是真菌性鼻窦炎CT诊断的主要征象,其它的CT表现常会导致术前误诊。虽然真菌性鼻窦炎的确诊有赖于病理学检查,但CT在其诊断中仍具有重要参考价值,并且是显示鼻窦解剖结构和病变范围的较好方法。     

Chronic maxillary sinusitis. Definition, diagnosis and relation to dental infections and nasal polyposis

Various definitions have been proposed for the term 'chronic sinusitis' but too often reports on chronic sinusitis lack a definition. In order to improve the diagnosis and treatment of this disease, and also to facilitate comparisons between clinical investigations, definitions of 'chronic maxillary sinusitis' of either rhinogenous or dental origin are proposed. It is suggested that the differential diagnosis should be based upon the duration of symptoms, ENT and dental examinations, sinus radiographs and/or sinoscopy, and results of conservative treatment. In a study conducted over a 5-year period, 198 patients with 244 affected sinuses fulfilled the proposed criteria. The incidence of chronic maxillary sinusitis in the population was 0.02%. A dental cause was found in 40.6% of the sinuses. The dental cause could be confirmed by routine dental examination in only 43 of 99 cases, while an extended maxillo-dental examination was conclusive in the other cases (56/99). Marginal periodontitis was found as frequently as periapical granuloma and together they constituted 83% of all dental causes. Sinusitis of dental origin was rare before the age of 30. Every sixth patient was found to have nasal polyposis. When related to the number of affected sinuses, the incidence of nasal polyposis was 13.1% in sinusitis of dental origin and 23.4% in that of rhinogenous origin. The importance of close cooperation between the ENT specialist and the oral surgeon is stressed.     

Diagnosis of postoperative changes in the frontal and maxillary sinuses]

The paper specifies x-ray picture of surgically treated frontal and maxillary sinuses in uneventful healing without inflammation relapses (30 cases), in relapse of purulent (21 sinuses), purulent-polypous (15 sinuses), polypous (4 sinuses) sinusitis, in pain syndrome in the region of the operated on maxillary sinus projection (7 patients). X-ray symptoms of postoperative changes in the sinuses, varying in clinical course, are characterized.     

Cholesterol granuloma of the maxillary sinus

Cholesterol granuloma (CG) of the maxillary sinus is very rare. In this study, the searching of the literature was performed with the keywords of cholesterol granuloma and maxillary sinus. All retrieved literature were reviewed throughout to identify and analyze all individual characteristics. Two additional cases in our hospital were also included. The result showed that, in the overall 37 cases, the ratio of male to female was about 3:1. Caucasian (14/37) and Turkish (10/37) were reported more frequently. CG of maxillary sinus had an opposite sex predilection compared with the fungus balls of the maxillary sinus. In addition, the comorbidity of these two diseases was found only in one patient in the literature. These results suggested that the different mechanisms other than poor aeration of the maxillary sinus played a role in the formation of CG of maxillary sinus. The diagnosis for CG of the maxillary sinus before operation is difficult, but the clear golden yellow rhinorrhea and hemorrhagic signs may provide a good diagnostic evidence. The symptoms were vague and about half of the patients presented with non-specific symptoms. Therefore, it seemed reasonable that CG of the maxillary sinus was under diagnosed in the clinical practice. Treatment consists of complete excision via Caldwell–Luc or endoscopic approach and provides a good prognosis. Bilateral involvements are rare but possible in this disease entity.     

鼻内镜下治疗鼻腔及鼻窦内翻性乳头状瘤

目的 探讨鼻内镜下治疗鼻腔鼻窦内翻性乳头状瘤的疗效.方法 总结28例鼻腔及鼻窦内翻性乳头状瘤经鼻内镜手术切除的治疗效果.结果 28例随访7个月～5年,仅6例术后复发（21%）,其中2例累及筛窦与蝶窦,4例累及上颌窦.结论 鼻内镜下行鼻腔及鼻窦内翻性乳头状瘤切除术有良好疗效.