Special radiologic imaging of paranasal sinuses. A prerequisite for functional endoscopic sinus surgery

Endoscopic diagnosis and surgery of inflammatory diseases of the lateral nasal wall and the paranasal sinuses require a very detailed preoperative knowledge of the individual anatomical conditions and pathological changes. Pluridirectional tomography and computed tomography are used best to visualize this region. The complicated radiologic anatomy of the lateral nasal wall together with the most important anatomical variations are demonstrated and the underlying pathophysiologic principles of chronic recurrent sinusitis are discussed.     

空勤人员鼻科疾病谱研究

目的 通过分析空勤人员鼻科疾病谱提出飞行人员鼻科疾病的防治建议.方法 对1966-2007年间住院的320名空勤人员的373例次鼻科疾病谱进行对比分析.结果 排在鼻科疾病谱前位的为慢性鼻窦炎鼻息肉、鼻窦气压伤、鼻中隔偏曲、变应性鼻炎、慢性鼻炎、鼻窦囊肿、急性鼻窦炎、鼻腔鼻窦肿瘤和鼻外伤等.飞行合格283人,暂时飞行不合格12人,飞行不合格25人.结论 飞行人员鼻科疾病较常见,且与气压伤的关系密切,应积极治疗Ⅰ类鼻腔鼻窦疾病(地面生活有症状),阻止其向地面生活无症状、飞行中出现鼻窦气压伤和(或)耳气压伤症状的Ⅱ类疾病转化.有效治疗Ⅱ类疾病是降低停飞率的重要措施. Abstract： Objective To suggest the protection of aircrews on the base of analyzing disease spectrum of nasal cavity and sinus. Methods The disease spectrum of nasal cavity and sinus was made by analyzing 373 cases of 320 aircrews who were hospitalized from 1966 to 2007. The medical evaluation was reviewed. Results The top diseases in spectrum were chronic sinusitis and nasal polyp, sinus barosinusitis, deviation of nasal septum, allergic rhinitis, chronic rhinitis, cyst in nasal sinus, acute sinusitis, tumor in nasal cavity and sinus, and nasal injuries. In medical evaluation, 283 aircrews were qualified for flying compared to 12 were temporarily grounded and 25 were permanently grounded. Conclusions The nasal cavity and sinus diseases are common in aircrews and usually character barosinusitis and (or) aural barotrauma. The type Ⅰ nasal cavity and sinus diseases (with symptoms on ground) should be treated in time to prevent their transition to type Ⅱ (no obvious symptoms on ground but with symptoms of sinus barosinusitis and (or) aural barotrauma in flight).Duly treating type Ⅱ nasal cavity and sinus diseases would be the effective measure for reducing aircrew's grounding rate.     

飞行人(学)员鼻科疾病诊治和医学鉴定规范

目的 规范飞行人(学)员鼻科疾病诊断、治疗和医学鉴定行为,提高航卫保障质量.方法 分析我院40年飞行人(学)员鼻科疾病住院资料,借鉴国内外该领域的研究成果,总结笔者的临床航空医学经验,提出统一的操作规范.结果 ①飞行人员人(学)员鼻科疾病的诊断分为急性和慢性[包括慢性鼻-鼻窦炎(不伴鼻息肉)和慢性鼻-鼻窦炎(伴鼻息肉)],Ⅰ类(地面生活有症状或体征,包括Ia地面生活有症状和体征,Ib仅有体征)和Ⅱ类(地面生活无症状,飞行中出现气压伤表现,包括Ⅱa鼻窦气压伤、Ⅱb耳气压伤和Ⅱc鼻窦气压伤合并耳气压伤);鼻窦气压伤分为原发性(窦口本身病变所致)和继发性(窦口周围病变所致,包括I型-鼻腔结构异常型、Ⅱ型-炎症型、Ⅲ型-变态反应型、Ⅳ型-肿瘤型,窦外型和窦内型),及轻度和重度.②飞行人(学)员鼻科疾病应根据急慢性、分类分型和分度特点及有无并发症采用无创或微创治疗.③飞行人(学)员鼻科疾病应根据疗效、功能检查(包括鼻窦气压功能)进行医学鉴定.结论 按规范进行飞行人(学)员鼻科疾病诊断、治疗和医学鉴定,可以降低停飞率,提高复飞率.     

X-ray computed tomographic study of the ethmoid and middle meatus. II. Radio-anatomy (axial incidence) and morphological variations

Chronic rhinosinusitis endoscopic surgery needs an accurate evaluation of diseases and paranasal sinus anatomic variations. High resolution CT by thin section (2 mm) allow this pre-operative assessment. An anatomical study of the ethmoid air cell system is always possible in axial plane. The bidimensional CT exploration (axial and coronal plane) displays the anatomic variations of ostiomeatal unit, that have been reported to predispose sinusitis. They are nasal septal deviation, pneumatization and paradoxical curvature of the middle turbinate, pneumatization of unciform process, Haller's cells, prominent agger nasi cell and ethmoid bulla. The endoscopic endonasal surgery landmarks, the individual morphologic variations, the topographic relations to the orbit and to the brain are also well shown by CT.     

鼻中隔偏曲与单侧上颌窦炎性病变的临床观察与CT图像处理

目的通过临床和CT图像观察了解鼻中隔偏曲与单侧上颌窦炎性病变的关系，探讨鼻中隔偏曲在慢性鼻窦炎发病中的作用。方法前瞻性、连续收集经鼻窦冠状位CT扫描证实的鼻中隔偏曲伴单侧上颌窦炎性病变（包括慢性上颌窦炎、上颌窦浆液性囊肿、上颌窦后鼻孔息肉和霉菌性上颌窦炎）患者56例，观察单侧上颌窦炎性病变与鼻中隔偏曲的关系。随机抽取10例患者的鼻窦冠状位CT图像，按Uygur法计算钩突所在平面两侧下鼻甲、钩突和中鼻甲的横断面积（以坐标纸格数表示）在各自鼻腔所占的百分数，并与10例正常对照（鼻中隔正直、无鼻窦病变）进行比较。结果56例患者中，单侧慢性上颌窦炎25例，上颌窦后鼻孔息肉9例，上颌窦浆液性囊肿5例，霉菌性上颌窦炎17例；病变位于鼻中隔偏曲鼻腔宽大侧35例（62．5％），狭窄侧21例（37．5％）。10例鼻中隔偏曲伴单侧上颌窦炎性病变患者下鼻甲、钩突和中鼻甲的横断面积在各自鼻腔所占的百分数在鼻腔宽侧为48．8％，窄侧为44．1％，两侧无显著性差异（P〉0．05）。10例正常对照下鼻甲、钩突和中鼻甲的横断面积在各自鼻腔所占的百分数为右侧40．1％，左侧39．8％，两侧无显著性差异（P〉0．05）。结论鼻中隔偏曲使鼻腔宽大侧发生单侧上颌窦炎性病变的机会大于鼻腔狭窄侧；临床处理上颌窦炎性病变的同时应矫正偏曲的鼻中隔，恢复鼻腔鼻窦正常的结构和功能，阻断鼻中隔偏曲造成的代偿失调。     

多层CT对窦口鼻道复合体解剖变异与慢性副鼻窦炎的关系的分析

目的:探讨窦口鼻道复合体(OMC)解剖变异与慢性副鼻窦炎的相关性。方法:收集经多层螺旋CT扫描的慢性副鼻窦炎100例。通过多平面重组重点观察钩突、中鼻甲、筛泡、鼻中隔的解剖变异,并和正常组进行对比,行统计处理并分析解剖变异与慢性鼻窦炎的关系。结果:慢性副鼻窦炎组窦口鼻道复合体解剖变异为89%,其中钩突改变25%,筛漏斗狭窄14%,中鼻甲改变22%,鼻中隔改变20%,多种解剖变异8%;正常组中窦口鼻道复合体解剖变异为19%,其中钩突改变1%,中鼻甲改变6%,鼻中隔改变12%。窦口鼻道复合体解剖变异与慢性副鼻窦炎呈正相关(P<0.05)。结论:慢性副鼻窦炎与窦口鼻道复合体的解剖变异有明显的相关性,CT检查发现泛发性副鼻窦炎时,应重点观察窦口鼻道复合体,为临床治疗提供详细的依据。     

鼻内镜在招飞体检中的应用价值及效果分析

目的 探讨鼻内镜在招飞体检中的应用价值.方法 对某航空大学2002年至2006年经过招飞体检合格录取入校的飞行学员进行分组,其中2002-2003年入校学员为前鼻镜检查组;2004-2006年人校学员为鼻内镜检查组,以入校地面基础学习两年为期限,对两年中因鼻科疾病而导致停学的飞行学员进行比较分析.结果 鼻内镜检查组的飞行学员总的停学率明显小于前鼻镜检查组(χ~2=27.43,P<0.01);其中因变应性鼻炎、慢性鼻窦炎、鼻息肉及息肉样变而导致的停学率鼻内镜组明显小于前鼻镜检查组(χ~2=11.19、16.45、6.83,P<0.01).结论 我军在招飞中应用鼻内镜检查手段后,明显降低了入校学员因鼻科疾病导致的停学率,特别是在慢性鼻窦炎、鼻息肉及息肉样变等疾病上做到了早发现、早淘汰,有效提高了招飞质量.     

鼻及鼻窦常见病变和解剖变异的CT冠状位靶扫描(附507例分析)

目的：探讨鼻及鼻窦常见病变和解剖变异的CT特征。方法：回顾性分析507例病人的冠状位CT表现。结果：慢性鼻及鼻窦炎占61．73％(313／507)；鼻息肉占22．87％(116／507)；囊肿占4．93％(25／507)，真菌性鼻窦炎占1．38％(7／507)；恶性占位性病变占0．79％(4／507)，未见异常占7．88％(40／507)。鼻中隔弯曲占65．66％(333／507)。Onodi气房占29．19％(148／507)；Haller气房占12．42％(63／507)。蝶窦发育不良占3．94％(20／507)；上颌窦发育不良占1．97％(10／507)。结论：冠状位CT靶扫描可对各种鼻及鼻窦病变做出诊断，并可显示其解剖变异的特征。     

The ostiomeatal unit and endoscopic surgery: anatomy, variations, and imaging findings in inflammatory diseases.

Recent and ongoing advances made in endoscopic surgical techniques require the radiologist to understand the anatomy and pathophysiology of the paranasal sinuses and nasal passage. Endoscopy and CT are complementary procedures, and, as such, the normal anatomic relationships and their CT appearances need to be well understood in order for radiologists to offer continued support as consultants to their clinical colleagues. In this article, we review the pertinent anatomy of the lateral nasal wall and paranasal sinuses, discuss the most frequently encountered normal variations that may predispose a patient to inflammatory sinus disease, outline imaging protocols for evaluation of this region, and introduce the reader to current endoscopic surgical techniques. Last, the imaging findings in various inflammatory processes involving the sinuses, as well as the local and regional complications associated with paranasal sinus inflammatory diseases, are presented.     

Polyp inside the concha bullosa: unusual manifestation of chronic rhinosinusitis

Chronic rhinosinusitis has complex pathophysiological features. The role of anatomic variations in the development of sinusitis remains unclear. We describe a rare manifestation of this disease, a polyp inside the pneumatized concha polyposa. A 23-year-old male patient had been suffering from headache, nasal obstruction, loss of the sense of smell, and postnasal discharge. Computed tomographic scans of the sinuses showed bilateral conchae bullosae, with a polyp inside the left one. Therapy included endoscopic nasal surgery and postoperative topical corticosteroid and macrolide treatment. We discuss the influence of sinusitis on the phenomenon of "sinus headache." We also comment on the use of topical corticosteroids and macrolides in preoperative and postoperative treatment of chronic rhinosinusitis with nasal polyposis.     

微波凝固术在鼻及咽喉疾病的临床应用

目的：报道278例鼻及咽喉疾病的微波治疗效果,探讨微波在此领域的应用。方法：将278例随机分成微波治疗组：慢性肥厚性鼻炎34例,慢性颗粒性咽炎57例,鼻衄鼻粘膜糜烂52例;手术或药物治疗组（对照组）：慢性肥厚性鼻炎31例,慢性颗粒性咽炎59例,鼻衄鼻粘膜糜烂45例。结果：所选病例微波治疗组痊愈131例占91.61%,有效9例占6.29%,无效3例占2.10%。手术或药物治疗组痊愈117例占86.67%,有效12例占8.89%,无效6例占4.44%。两组疗效相比差异有统计学意义,P〈0.05。结论：微波治疗方法简便,且治疗鼻衄病变不需要填塞鼻腔,其治疗时间短,价格便宜,尤其适用于基层医院,值得推广。     

鼻腔鼻窦病变CT扫描与鼻内窥镜检查的对照观察

目的　比较CT和鼻内窥镜 (nasalendoscope ,NE)对鼻腔和鼻窦病变的诊断价值 ,为临床诊断提供理论依据。方法　收集80例同一时期内具有鼻腔鼻窦区CT和鼻内窥镜检查结果 ,并得到病理证实的病例 ,对两者进行对照分析。结果　CT、NE的检查结果与病理结果对照 ,鼻窦炎、鼻窦肿瘤诊断正确率相似 ,鼻腔、鼻窦息肉、鼻腔肿瘤、鼻甲肥大NE诊断正确率高于CT ,副鼻窦体的解剖变异、鼻窦囊肿CT高于NE。结论　NE可以了解病变的形状、质地、颜色 ,并可在镜下活检 ,有助于病变的定性。CT可以了解病变的大小、形状和病变与邻近解剖结构的关系 ,两者互补可更全面诊断病变     

鼻骨细微解剖结构和鼻骨骨折的高分辨率CT研究

目的 探讨易与骨折混淆的鼻骨正常细微解剖结构及其高分辨率CT(HRCT)表现，提高鼻骨骨折诊断的准确性。方法 对60例正常志愿者及30例鼻骨骨折病人全部行鼻区HRCT横轴面及冠状面扫描。观察正常鼻区细微结构，并与外伤组骨折患者进行对比分析，总结2者在影像上的区别。结果 由3位高年资放射科医生对60例正常组进行盲法观察：54例诊断为正常，3例可疑骨折(鼻骨孔1例，鼻骨外侧缘末端明显内凹2例)，3例误诊骨折(鼻骨变异2例，缝间骨1例)。(1)易与骨折混淆的鼻区正常结构有鼻骨缝、鼻骨孔、缝间骨及鼻骨正常变异。(2)横轴面观察正常鼻颌缝表现为膨大57例，咬合39例，缝间骨31例，及薄鼻骨16例，骨折线无此特征形态。(3)鼻骨外侧缘末端过度凹陷或平直(与鼻骨的发育有关)，冠状面扫描鼻骨末端呈内勾状，左、右共25例，外翘状左、右共8例，易被误诊为骨折。30例鼻骨骨折患者中，累及鼻骨中下段28例。冠状面可见鼻骨中下段明确骨折线24例，横轴面鼻骨下段鼻骨压迹处骨质明显成角19例，无明显骨折征象5例。横轴面示鼻颌缝错位、成角22例，冠状面示患侧鼻骨内移14例，外移3例，5例未见明确移位改变。结论 鼻骨骨折在面部外伤中常见，在日常工作中以下几点应引起重视：认识鼻骨正常结构及正常变异；采用HRCT的扫描方法；结合横轴面和冠状面扫描可以相互补充、验证。     

Radiologic imaging of chronic sinusitis in the adult

The diagnosis of chronic sinusitis is based on clinical presentation, nasal endoscopy and CT scan. As a matter of fact, the CT scan of the paranasal sinuses is absolutely necessary to characterise the lesions, to visualise anatomic variations which are risk factors for the endoscopic surgery and to follow up treated and/or operated patients with recurrent symptoms. Nowadays, plain films of paranasal sinuses do not have any indication. MR Imaging may be indicated in selected cases of complicated sinusitis and of pseudotumors associated to sinusitis.     

沈阳军区108例飞行人员鼻部检查临床研究

目的探讨飞行人员鼻部体检的相关方法,以早期发现并干预鼻部疾病或与疾病相关的解剖变异,提高体检质量和效能。方法选择2013年1月至2015年12月在解放军第四六三医院进行住院或体检的108例飞行人员,应用前鼻镜、电子内镜及鼻窦CT三种方法进行鼻部检查,并对三种检查方法的结果进行比较分析。结果 108例飞行人员中,解剖总变异率为100.0%(108/108),其中窦口鼻道复合体(OMC)处解剖变异的发生率为89.0%(96/108),鼻部疾病发生率为19.4%(21/108)。前鼻镜只能发现部分鼻中隔偏曲(不包括后端偏曲)和肥厚性鼻炎(不含骨质增生),电子内镜可以发现更多的微小或深在的解剖变异或病变。鼻窦CT检查可以确定所有的骨性解剖畸形,但不足之处在于对炎症或软组织病变无法做到确诊。结论飞行人员中存在常规检查无法发现的鼻部解剖变异或病变,对飞行会有潜在影响。鼻部的三种检查手段各有优势和不足,应根据情况合理选择,以提高飞人行员鼻部体检的准确性和效能。     

儿童上气道咳嗽综合征74例临床分析

目的探讨儿童上气道咳嗽综合征的临床特点和治疗方案。方法对74例UACS患儿的症状、体征、影像学检查及综合治疗方法进行分析。结果 74例中慢性鼻窦炎26例(35%),变应性鼻部疾病20例(27%),小儿特有的腺样体和/或腭扁桃体肥大15例(20%),慢性鼻炎13例(18%),均以慢性咳嗽为主诉。经过积极的抗炎与抗变态反应治疗以及必要的手术治疗,咳嗽消失63例,咳嗽明显减轻9例。结论 儿童UACS以咳嗽为主要临床特点,表现或不表现出鼻部、咽部疾病特点,是儿童慢性咳嗽较常见的原因,详细询问病史,合理检查,可减少误诊。     

内镜治疗慢性鼻窦炎鼻息肉临床疗效分析

目的探讨鼻内镜下治疗慢性鼻窦炎鼻息肉的临床效果。方法回顾分析经鼻内镜手术治疗的60例慢性鼻息肉的临床资料。结果患者均经鼻内镜手术治疗,随访6个月-2年,未见复发及明显并发症发生。结论鼻内镜手术治疗慢性鼻窦炎鼻息肉具有损伤小、并发症少、疗效好等优点,值得推广。     

鼻内窥镜手术治疗慢性鼻窦炎、鼻息肉的临床效果分析

目的分析和研究鼻内窥镜手术治疗慢性鼻窦炎以及鼻息肉的治疗效果，同时探讨鼻内窥镜下自动切割器进行鼻炎及鼻息肉的治疗方法。方法2006年7月～2011年7月在本院治疗慢性鼻窦炎、鼻息肉的患者1230例中选取100例进行鼻内窥镜手术的患者，其中Ⅱ型68例，Ⅲ型32例。对患者进行全身麻醉或者黏膜表面加局部麻醉；手术后随访一年。结果治愈率Ⅱ型为80．90％，治愈率Ⅲ型84．40％。结论鼻内窥镜手术对于治疗慢性鼻窦炎以及鼻息肉有着良好治疗效果，与临床分期有些密切的关系，也关系到并发症的情况和治疗的效果，但是就治愈率而言非常适合临床推广。     

鼻窦炎鼻内镜治疗效果临床观察分析

目的：探讨鼻内镜治疗慢性鼻窦炎的临床效果。方法分析2012年5月～2013年5月耳鼻喉科采用鼻内镜治疗的鼻窦炎患者的临床资料。对比未在鼻内镜下治疗的慢性鼻窦炎的临床效果。结果鼻内镜患者138例,治疗有效率69.6％,对照组患者105例,治疗有效率51.4％,对比差异有统计学意义,P＜0.05。结论鼻内镜下手术治疗慢性鼻窦炎效果好,微创,值得推广。     

High-resolution CT: pre-operative assessment of chronic and recurrent rhinosinusitis

The better understanding of chronic and recurrent rhinosinusitis and the advance in endoscopic endonasal surgery have modified the radiological pre-operative investigation of this condition. The ethmoid labyrinth, not accessible to the endoscope, may be explored by axial and coronal high-resolution thin section (2 mm) CT. We have reviewed 100 CT scans with endoscopic correlation in order to assess the accuracy of this pre-operative method.This anatomical study reveals the presence and extent of parasinus diseases which are usually concentrated in the area of the ostiomeatal unit. The anatomic variations of the lateral nasal wall that have been reporded as predisposing to sinusitis and the morphologic variations altering the relationships of the ethmoid with the orbits and the brain were also studied. This pre-operative radiological assessment is currently necessary for functional and safe surgery.Correspondence to: J. C. FerriePaper presented at ECR 1991