三维图像上颌窦口面积的测量

目的　探讨正常和窦口引流通畅的上颌窦炎症患者上颌窦口、筛漏斗外口面积 ,并比较二者的差异。方法　经过螺旋CT冠状位扫描或轴位扫描的原始数据被传输到SunUltra 10Aw 3 1工作站上 ,然后利用Navigator软件行仿真内镜成像 ,调节CT仿真内镜阈值 ,观察窦口 鼻道复合体(ostium meatuscomplex ,OMC)等解剖结构 ,测量像素面积。在相同物距、视角等条件下 ,测量某一线段在三维图像和二维图像上的像素比 ,计算出面积。对正常组数值与炎症组数值进行比较。结果　鼻甲、鼻道和窦口 鼻道复合体等结构在仿真内镜下能更好地被显示 ,正常组上颌窦口的面积为 (16 45± 1 2 1)mm2 ,炎症组上颌窦口面积为 (18 2 8± 2 12 )mm2 。正常组筛漏斗外口面积为 (15 0 7± 0 78)mm2 ,炎症组筛漏斗外口为 (17 19± 1 5 9)mm2 。结论　正常组与炎症组上颌窦自然口面积无显著性差异 ,而筛漏斗外口面积差异有显著性 ,提示筛漏斗外口的增大可能是窦口非阻塞性上颌窦炎的诱发因素     

Mucus circulation between accessory ostium and natural ostium of maxillary sinus

We report a case of one asymptomatic 28-year-old male with mucus circulation between the natural ostium and the accessory ostium of the maxillary sinus. Computerized tomography (CT) revealed a recirculating mucus ring between the two ostia of the maxillary sinus.     

鼻内镜手术中扩大上颌窦自然口的意义

目的：探讨鼻内镜手术中扩大上颌窦自然口对上颌窦炎转归的影响。方法：将慢性上颌窦炎218例随机均分为两组,A组的手术范围是切除钩突、筛泡,开放前、中、后组筛窦,扩大上颌窦自然开口,切除部分肥厚明显的中鼻甲;B组手术范围是切除钩突、筛泡,开放前、中组筛窦,不处理上颌窦自然开口,尽量保留中鼻甲,特别肥厚者也行部分切除。结果：218例均随访1年以上。按海口1997年疗效评定标准,A组治愈100例,治愈率92%,B组治愈99例,治愈率91%;A组好转9例,好转率8%,B组好转10例,好转率9%。结论：鼻内镜手术范围的关键是切除窦口鼻道复合体的解剖变异,是否扩大上颌窦口并不十分重要。     

Patency of the maxillary sinus ostium in healthy individuals

In a group of 20 healthy subjects the patency of the maxillary ostium has been evaluated in 35 maxillary sinuses with three different techniques: simultaneous pressure recording in the sinus and the ipsi- and contralateral nasal cavity; simultaneous recording of differential pressure between the sinus and the ipsilateral nasal cavity and air-flow through the ostium during nasal breathing; recording of the pressure rise in the sinus with an artificial air-flow of 1 litre per minute applied to the sinus. The tests were carried out in sitting and recumbent positions. In 5 persons (10 sinuses) a retest was performed after 2 months. These subjects were also tested with an inflatable neck cuff in order to obtain an increased venous pressure. Rhinomanometry at rest and after physical effort was also performed. The pressure relationship between the maxillary sinus and the ipsilateral nasal cavity was 1:1 in both the sitting and the recumbent position, but less than 1 when the contralateral nasal cavity was measured. Pressure recording alone gives no quantitative information about the patency of the ostium. Determination of the ostial resistance during nasal breathing could be performed in 13 sinuses, but in the remaining 22 the ostia were too wide to give a measurable resistance. The equivalent ostial diameter during inspiration could be estimated in 12 of the sinuses from a diagram constructed from known ostial diameters in model experiments. With an artificial air-flow applied into the sinus, the equivalent ostial diameters could be estimated from the diagram in all cases. No statistical difference was found in comparable cases between the mean equivalent ostial diameters estimated with the two methods. The equivalent ostial diameters showed a statistically significant reduction in the recumbent position and after application of the neck cuff. A statistically significant relationship was also found between the airway resistance of the nasal cavity and the equivalent diameter of the ostium in sitting and recumbent positions. Such a relationship could not be found between the equivalent ostial diameters measured at rest and the nasal resistance recorded after physical effort.     

鼻内镜下上颌窦口处理方法的探讨

目的：探讨内窥镜鼻窦手术中上颌窦自然开口处理方法与预后的关系。方法：对慢性鼻窦炎、鼻息肉患者682例采用不同途径寻找上颌窦开口并根据窦口的形态和上颌窦本身的病变情况,决定开口方式与处理方法。结果：随访6个月,发现窦口开发率为84.22%(574/682例),闭锁率为16.88%（106/682）。结论：上颌窦口的处理方法是鼻内窥镜手术重要步骤,也是影响疗效与预后的关键因素之一。     

鼻内镜手术中上颌窦口的识别与处理

鼻内镜鼻窦手术的关键是处理窦口鼻道复合体，建立与恢复以窦口鼻道复合体为中心的各组鼻窦通气引流通道。要提高手术成功率，上颌窦口需要保持长期通畅。由于上颌窦口位置变异较多，特别是严重炎症、息肉增生等，有时寻找上颌窦口并非易事。现将我们识别与处理上颌窦口的经验报告如下。     

The location of maxillary sinus ostium and its clinical application

The endoscopic sinus surgeons must have a detailed knowledge of inconsistent location of maxillary sinus openings in any interventional maxillary sinus surgeries as it relates to the orbital floor, ethmoid infundibulum and the nasolacrimal duct. Forty cadaver head and neck specimens had been cut sagittally through the nose, such that the lateral nasal wall had been preserved. The findings were documented with an emphasis on location of the maxillary sinus openings. In the present study maxillary sinus ostium opened more commonly into posterior third of the hiatus semilunaris. Accessory maxillary ostium was another variation seen in nearly three-fourths of the cases which opened into membranous meatus inferior to the uncinate process.     

Computed tomography findings after endoscopic sinus surgery with preserving or enlarging maxillary sinus ostium surgery

Endoscopic sinus surgery (ESS) is the main surgical approach in the treatment of chronic rhinosinusitis (CRS) after failure of medical treatment. ESS is based on the theory that obstruction of the maxillary sinus ostium is mainly behind the pathogenesis of CRS. Controversy remains concerning the enlargement of the natural maxillary sinus ostium. The aim of this study was to compare computed tomography (CT) findings after preservation or enlargement of the maxillary sinus ostium. Thirty patients with non-polypous CRS underwent randomized endoscopic sinus surgery with uncinectomy on one side and additional middle meatal antrostomy on the other side. Lund-Mackay (LM) scores and the ostium diameters were analysed from CT scans taken preoperatively and nine months postoperatively, and were used for comparison of the two operative techniques. In addition, the correlation between CT findings and subjective outcomes was studied. Comparison of the preoperative and postoperative CT scans revealed that significant reduction of LM score was achieved on both sides, regardless of the type of procedure performed. The postoperative area of the ostium remained significantly larger on the antrostomy side compared to the uncinectomy side. A large maxillary sinus ostium size seems to associate with lower postoperative LM score, but does not seem to provide superior symptom relief.     

The influence of the size of the maxillary sinus ostium on the nasal and sinus nitric oxide levels

BACKGROUND: Nitric oxide (NO) is produced in significant quantities in the nasal sinuses and is thought to have a beneficial effect on the mucociliary transport of the sinuses and nose and to have significant antibacterial properties that contribute to the health of the sinuses. Recently, the concept of "mini-functional endoscopic sinus surgery" has been introduced where the uncinate is removed without enlargement of the maxillary ostium. Although no scientific evidence has been published, enlargement of the ostium is thought to possibly disrupt the mucociliary pathway and decrease the concentration of NO in the nose and sinuses. The aim of this study was to establish the effect of enlargement of the maxillary ostium on sinus and nasal NO. METHODS: Twenty-nine patients who were post-endoscopic sinus surgery were included with 52 who were maxillary sinus ostia cannulated. There were 22 large maxillary sinus ostia and 30 small ostia. Smoking, allergy status, and topical steroid use were recorded. NO levels were measured in the nose and maxillary sinus after decongestion with patients mouth breathing and breath holding. RESULTS: This study shows that enlargement of the maxillary sinus ostium above its normal size (20 mm2) produces a significant decrease in both the maxillary sinus and the nasal cavity NO levels. In addition, the size of the ostium showed a significant correlation to the sinus NO level. Use of topical nasal steroid sprays and topical decongestants were shown to effect NO levels in the sinuses and nasal cavity. The lowered levels of NO were found irrespective of the technique of measurement of the NO. CONCLUSIONS: The effect of this lowered NO level on the susceptibility of the maxillary sinuses to recurrent infection is yet to be determined.     

上颌窦三维立体形态与上颌窦炎关系的研究

目的:通过螺旋CT影像学研究,重建上颌窦的三维立体形态,探讨上颌窦炎症与上颌窦三维立体形态、容积和气化系数之间的关系。方法:对双侧上颌窦正常者、单侧上颌窦炎症及双侧上颌窦炎症者各50例(均为成年人)行鼻-鼻窦螺旋CT扫描,重建上颌窦的三维立体形态;测量并计算上颌窦的容积和气化系数,分析上颌窦三维立体形态、容积和气化系数与上颌窦炎的关系。结果:上颌窦炎组上颌窦形态不规则(凹陷、变形),容积为(14 971.86±360.93)mm3,气化系数为0.252±0.057;正常组上颌窦形态规则,容积为(15 018.64±473.36)mm3,气化系数为0.345±0.071;两组之间容积比较差异无统计学意义,气化系数比较差异有统计学意义。结论:上颌窦三维重建更加直观地描述了上颌窦的三维结构和立体形态;上颌窦炎症与上颌窦容积无相关性,而主要与上颌窦的三维立体形态及气化系数有关;上颌窦三维立体形态规则,气化系数>0.300,上颌窦发生炎症的概率较低;反之机会增大。成人炎症上颌窦可能来源于儿童及青少年期一个较大的上颌窦。     

Osteoma of the maxillary sinus]

BACKGROUND: Osteoma of the paranasal sinuses is a rare and benign entity that develops slowly. If they occur, locations within the frontal sinus and ethmoid cells are more frequent, whereas osteomas in the sphenoid or maxillary sinus are very rare. CASE: We report on a 25-year old female patient presenting with a bony mass in the right maxillary sinus. A standard external approach using a modified Caldwell-Luc procedure was successfully employed as endoscopic endonasal surgery was limited by the size of the bony lesion. CONCLUSIONS: Trauma or infection are often suggested as an etiologic factor in the pathogenesis of osteoma. In our case the development of maxillary osteoma was related to dental extraction and postoperative fistula. External standard procedures remain mandatory if endonasal endoscopic surgery fails in the removal of osteoma 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％。