鼻窦骨折急诊期的诊断和处理

目的探讨提高急诊期鼻窦骨折的诊断及治疗水平。方法对70例鼻窦骨折患者按骨折情况分型,并对部分病例采用上颌窦骨折复位固定及经鼻窦内窥镜手术复位的方法处理。结果复位24例,满意22例,基本满意2例。结论为明确诊断①除局部征象外应注意眼的症状和体征;②鼻窦CT应列为常规检查;③注意眶底骨折及鼻筛骨折以及并发的其它严重损伤。治疗建议按骨折情况分型及处理。     

鼻窦骨折急诊期的诊断和处理(附70例报告)

目的 :探讨提高急诊期鼻窦骨折的诊断及治疗水平。方法 :对 70例鼻窦骨折患者按骨折情况分型 ,并对部分病例采用上颌窦骨折复位固定及经鼻窦内窥镜手术复位的方法处理。结果 :复位 2 4例 ,满意 2 2例 ,基本满意 2例。结论 :为明确诊断 1除局部征象外应注意眼的症状和体征 ;2鼻窦 CT应列为常规检查 ;3注意眶底骨折及鼻筛骨折以及并发的其它严重损伤。治疗建议按骨折情况分型及处理     

计算机辅助外科技术在颌面部复杂骨折内固定手术治疗中的临床应用

目的研究计算机辅助外科手术(Computer Aided Surgery,CAS)在颌面部复杂骨折坚强内固定手术治疗中的应用及其效果评价。方法选取颌面部复杂骨折患者7例,术前行三维CT重建,将所获得CT图像数据利用计算机辅助制成三维实体模型。对模型进行手术设计,模拟手术及个体化钛板的预制,行颌面部复杂骨折的切开复位内固定术。术后CT复查,并与术前设计比较,检验骨折复位情况。结果计算机辅助外科可以使颌面部复杂骨折的治疗做到术前准确设计、术中参照定位,简化了手术步骤,提高了手术效果。术后CT检查示骨折复位与术前设计基本一致。结论计算机辅助外科有助于提高颅颌面复杂骨折的复位精度,是一种较为理想有效的治疗颌面部复杂骨折的辅助方法 。     

影响内窥镜鼻窦手术疗效的相关因素分析

目的 :探讨影响内窥镜鼻窦手术疗效的相关因素。方法 :16 8例 (2 72侧 )慢性鼻窦炎鼻息肉患者均行内窥镜鼻窦手术 ,先评估其总体疗效 ,再用模糊综合评判法对年龄、病程、疾病分期、术后鼻窦内窥镜检查定期与否四个因素进行评判 ,分析各因素对疗效的影响。结果 :116 8例 (2 72侧 )慢性鼻窦炎鼻息肉患者行内窥镜鼻窦手术 ,术后随访 2～ 3年 ,其总体疗效为治愈 111例 (6 6 .1% ) ,好转 42例 (2 3.2 % ) ,无效 15例 (10 .7% ) ,总有效率 89.3%。 2用模糊综合评判法得出对疗效影响最大的因素为术后定期内窥镜检查与否 ,比重占 85 % ,其次为疾病分期占 10 .6 2 % ,年龄占 3.84% ,病程占 0 .5 3%。结论 :术后定期内窥镜检查是影响内窥镜鼻窦手术疗效的最为重要的因素。     

鼻内镜下夫雷氏尿管治疗上颌骨粉碎性骨折7例疗效观察

目的探讨在鼻内镜下利用夫雷氏尿管治疗上颌骨粉碎性骨折的方法,并分析其临床优势。方法 7例上颌骨粉碎性骨折患者在鼻内镜下对进入鼻腔的泪骨、上颌骨额突进行复位,并经下鼻道打开骨创引入夫雷氏尿管,利用其水囊扩张复位上颌窦的骨折。结果 7例患者术后7 d取出鼻腔填塞碘仿纱条,15 d取出窦腔夫雷氏尿管后鼻外形恢复良好。结论鼻内镜和夫雷氏尿管治疗粉碎性上颌骨骨折是一种简便有效的治疗手段。     

下鼻甲骨折外移术在功能性鼻内窥镜鼻窦手术中的临床效果研究

目的 观察功能性鼻内窥镜鼻窦手术中应用下鼻甲骨折外移术的临床价值。方法 研究以东部战区总医院镇江医疗区行功能性鼻内窥镜鼻窦手术患者为研究对象,患者均于2018年1月-2019年12月时间段入院,按照患者入院时间均分两组,对照组单一行功能性鼻内窥镜鼻窦手术,观察组在对照组基础上行下鼻甲骨折外移术,观察两组患者住院时间、鼻道纤毛清除速度以及粘连情况。结果 观察组患者住院时间(Ⅰ型、Ⅱ型)相比对照组无差异(P>0.05)。治疗前患者鼻道纤毛清除速度无统计学差异(P>0.05)。治疗后观察组(Ⅰ型、Ⅱ型)鼻道纤毛清除速度明显优于对照组,差异显著(P<0.05)。观察组患者粘连率0.00%明显优于对照组25.00%,存在统计学差异,(P<0.05)。结论 功能性鼻内窥镜鼻窦手术中应用下鼻甲骨折外移术可以有效提升治疗效果,改善患者临床症状,降低粘连几率,促使患者早日康复,临床推广价值较高。     

鼻内窥镜手术与经鼻外径路手术治疗眼眶内壁骨折疗效比较

目的 :探讨眼眶内壁骨折的治疗方法及其效果。方法 :对 34例眼眶内壁骨折患者 ,10例行鼻内窥镜手术治疗 ,另 2 4例行经鼻外径路手术治疗并进行疗效比较。结果 :经鼻内窥镜手术、鼻外径路手术治疗的总有效率分别为 90 .0 %、91.6 % ,两者差异无显著性意义 (P >0 .0 5 ) ,但前者的优点明显多于后者。结论 :鼻内窥镜手术治疗眶内壁骨折具有无面部切口、低创伤、视野清晰、能同时清除鼻窦病变、便于手术后复查等优点 ,是治疗本病最为适用的方法。     

鼻窦内窥镜下探明鼻出血部位及其临床应用价值(附226例报告)

目的 :探讨鼻窦内窥镜下诊治鼻出血的应用价值及其适应证。方法 :回顾分析 2 2 6例非外伤鼻出血患者经鼻窦内窥镜检查的临床资料。结果 :出血部位 :中鼻道 5 2例 ,中鼻甲 6例 ,鼻中隔后段 4 4例 ,下鼻甲后端 5 7例 ,鼻底部 6例 ,鼻中隔前上端 2 8例 ,部位不明确 3 3例。鼻窦内窥镜下鼻腔填塞 12 6例 ,微波、激光、烧灼 78例 ,手术 4 2例。患者均获得满意的止血效果。结论 :鼻窦内窥镜检查鼻出血 ,诊断准确 ,治疗方便 ,效果好。     

鼻窦内窥镜在耳鼻咽喉疾病诊治中的应用(附213例报告)

目的探讨鼻窦内窥镜在诊治耳鼻喉疾病中的应用.方法将鼻窦内窥镜用于鼻腔鼻窦手术131例,检查耳鼻咽喉隐匿区72例,在鼻窦内窥镜指引下取组织活检10例.结果通过213例的临床实践,证明鼻内窥镜除用于鼻腔鼻窦手术外,还可用于耳鼻喉隐匿区的检查或相关区域的活检等.结论鼻窦内窥镜具有多项功能,可以一镜多用.     

半冠状切口结合小钛板固定治疗颧骨复合体骨折

目的 观察半冠状切口结合小钛板固定治疗颧骨复合体骨折的疗效。方法 25例颧骨复合体骨折患者，其治疗方案均采用半冠状切口下完成骨折复位，继以小钛板内固定，术后随访3～12月，观察治疗效果。结果所有病例术后创口均Ⅰ期愈合，无术后并发症发生，面部外形及功能恢复满意。结论 半冠状切口结合小钛板固定治疗颧骨复合体骨折具有切口隐蔽、安全、固定可靠及可以早期进行功能锻炼等优点，疗效满意，值得临床推广。     

Ethmomaxillary sinus and hypoplasia of maxillary sinus.

In a series of 410 coronal CT scans performed to assess paranasal sinus disease, we have identified eight cases in which an ethmomaxillary sinus was present. The ethmomaxillary sinus was unilateral in five cases and bilaterally present in three. The sex incidence was equal. Four patients had generalized mucosal disease of their paranasal sinuses which included the ethmomaxillary sinus whereas four patients had osteomeatal complex disease and sparing of their ethmomaxillary sinus. The characteristic radiological features of an ethmomaxillary sinus were drainage into an enlarged superior meatus, reduction in the size of the maxillary sinus and a normal bony orbital cavity. The differential diagnosis of an apparently hypoplastic maxillary sinus is briefly discussed.     

外伤及手术后鼻窦黏液囊肿形成(附22例报告)

目的:分析手术及外伤后鼻窦黏液囊肿形成的原因,探讨手术治疗方法及避免囊肿复发的措施.方法:回顾性分析22例鼻窦手术及外伤后形成黏液囊肿的病例.结果:所有患者均于鼻内镜下行囊肿切除术.1例额窦黏液囊肿术后1年后复发,2例术后复查见中鼻甲与鼻腔外侧壁粘连.结论:鼻窦手术及外伤后可致黏液囊肿形成.鼻窦外伤骨折部位应尽量固定,黏膜复位;鼻窦手术中宜保持中鼻甲稳定性、保留窦内正常黏膜,术后密切随访,以减少囊肿复发.     

鼻内镜下上颌窦囊肿的手术治疗

目的探讨鼻内窥镜下切除上颌窦囊肿的方法.方法于鼻窦内窥镜下行中鼻道开窗、下鼻道开窗及中鼻道、下鼻道联合开窗术治疗上颌窦囊肿32例.结果所有囊肿均在内窥镜下完整切除,随访0.5～1年无复发.结论应用鼻内窥镜切除上颌窦囊肿创伤小,操作简便,治疗效果确切,是治疗上颌窦囊肿的有效方法.     

鼻内窥镜术上颌窦自然开口的处理

目的探讨内窥镜鼻窦手术治疗慢性鼻窦炎、鼻息肉的上颌窦中鼻道开口的重要性及处理方法。方法配对研究５６例双侧鼻窦炎、鼻息肉患者，比较同一患者术中扩大或不扩大上颌窦自然开口的术后情况。结果窦口的开放率在不扩大和扩大上颌窦自然开口的术侧中分别为９２．９％和８０．４％（随访６个月时）。回顾性观察５１例施ＣａｌｄｗｅｌＬｕｃ术的患者，下鼻道造口的术后开放率仅为４０．６％。分析３８张单侧鼻窦炎或鼻息肉的鼻窦ＣＴ片，测量对照侧与病变侧的上颌窦口膜样部的上下径和前后径，差异无显著性。病变侧上颌窦口周围的中鼻甲气化、增生及钩突偏曲、筛泡骨性增生等解剖结构异常的发生率明显高于对照侧（Ｐ＜０．０５）。结论鼻内窥镜下处理上颌窦自然开口的关键是窦口周围的解剖异常因素。     

Ethmomaxillary sinus

Ethmomaxillary sinus is a variation of the posterior ethmoid cells. It is formed by the extension of the posterior ethmoid cells into the maxillary sinus and drains into superior nasal meatus. It is incidentally seen on paranasal sinus computerized tomography (CT) scans. Its prevalence has been reported as 0.7 and 2% in two studies. In this study, paranasal CT scans of 466 patients were investigated for the presence of ethmomaxillary sinus. The patients had paranasal CT with the preliminary diagnoses of septal deviation, chronic inflammatory paranasal sinus disease and nasal turbinate disorders. The ethmomaxillary sinus was present in nine of those patients (1.93%). It was septated in one of them. The CTs were further investigated for other anatomical variations and co-existent mucosal disease of the paranasal sinuses.     

鼻内窥镜术上颌窦自然开口的处理

探讨内窥镜鼻窦手术治疗慢性鼻窦炎，鼻息肉的上颌窦中鼻道开口的重要性及处理方法。方法 配对研究５６例双侧鼻窦炎，鼻息肉患者，比较同一患者术中扩大或不扩大上颌窦自然开口的术后情况。结果 窦口的开放率在不扩大和扩大上颌窦自然开口的术侧中分分别为９２．９％和８０．４％。     

Microbiology of the ethmoid sinus following endoscopic sinus surgery

We prospectively studied the native microbiology of the ethmoid sinus following endoscopic sinus surgery in 113 patients (mean age: 41.3 yr). After each patient had regained complete mucosalization (minimum follow-up: 6 wk), we obtained a bacterial swab of the ethmoid sinus and submitted it for culture and sensitivity analysis. We then compiled data on sensitivity patterns and the number and type of bacteria isolated. Of the 113 patients, 67 (59.3%) had positive cultures, 26 (23.0%) had sterile cultures, and 20 (17.7%) had normal flora. Multiple bacteria were isolated in 31 of the 113 patients (27.4%). The most common isolates were gram-positive cocci, and the most common bacteria were staphylococcal species. A significant degree (42.9%) of beta-lactamase resistance was exhibited. We conclude that the ethmoid sinus is not microbiologically sterile following endoscopic sinus surgery.     

The variant type of preauricular sinus: postauricular sinus

OBJECTIVE: Preauricular sinuses (PAS) are common congenital malformations that usually occur at the anterior margin of the ascending limb of the helix, but the positions of PAS and directions on the fistular tracts are rarely posterior to the external auditory canal (EAC), which presents as a postauricular swelling. We named these cases as the variant type of PAS ('postauricular sinuses'), and compared their clinical manifestations with those of the classical type. STUDY DESIGN: A retrospective study. METHODS: We retrospectively reviewed the charts of patients who had undergone preauricular fistulectomy from 2002 to 2006. These patients were then categorized into two groups according to the position of the preauricular sinus sac. The classical group was defined as the group of patients with sacs located on the (superior) anterior to the EAC, and the variant group as those whose sacs are located on the posterior site of the EAC. We analyzed the incidence, previous histories, clinical manifestations, recurrence rates, and surgical techniques of the variant type of preauricular sinuses and compared them with those of the classical type. RESULTS: Eleven (10.9%) of 101 patients were diagnosed with preauricular sinuses of the variant type. The male to female ratios of the classical and the variant groups were 44:46 and 7:4, respectively. The average age of the patients was approximately 11 to 13 years in both groups. All variant types of preauricular sinuses showed preauricular pits located posterior to the imaginary line that connects the tragus with the posterior margin of the ascending limb of the helix, unlike the classical type. Most (72.8%) of the fistular tracts of the variant type were directed in the posterior-middle direction from the pits. The variant types were operated with a dual approach using preauricular and retroauricular incisions, unlike the classical type, and the recurrence rate was 0% (compared with 2.2% in the classical type). CONCLUSION: Frequent postauricular infected swellings may indicate the presence of the variant type of preauricular sinuses. The variant type of preauricular sinuses presenting in the postauricular area were found to have an unusual location of the fistula pit that was positioned posterior to the imaginary tragal extended line. A comprehensive physical examination of the preauricular pits should be performed to avoid incomplete excision of the variant types.