下鼻甲神经分布研究

目的：通过尸头解剖明确下鼻甲神经分布情况,为选择性切断支配下鼻甲神经治疗变应性鼻炎提供解剖基础。方法：4％多聚甲醛固定成人尸头标本20例（40侧）,从正中矢状位锯开,在10倍手术显微镜下解剖下鼻甲。结果：①鼻后下神经在黏膜和骨膜之间下行由下鼻甲附着处末端前方6～13mm处进入下鼻甲黏膜下,另有分支通过下鼻甲附着处末端进入下鼻甲黏膜下。②筛前神经在下鼻甲附着处上缘距前端2．0～4．6mm进入下鼻甲黏膜下。结论：鼻内镜下选择性地切断支配下鼻甲的神经支配是可行的。     

Infected inferior turbinate pneumatization

With the widespread utilization of endoscopic nasal surgery, the interest in nasal structures has increased. Inferior turbinate pneumatization is among the most rare causes of nasal obstruction. In the current literature, there are only ten reported cases of inferior turbinate pneumatization. A 52-year-old male patient presented with nasal obstruction, purulent nasal discharge, facial pain and headache. Anterior rhinoscopic examination showed bilateral middle and inferior turbinate hypertrophy and edema of the nasal mucosa. Computed tomography (CT) revealed bilateral frontal, anterior and posterior ethmoidal and maxillary sinusitis with bilateral concha media bullosa and right infected inferior turbinate pneumatization. In this report, infection of this rare anatomical abnormality is presented for the first time and documented with acoustic rhinometry, CT and peroperative photography.     

Extranasopharyngeal angiofibroma of the inferior turbinate

The first reported case of angiofibroma of an inferior turbinate is presented. The tumour occurred in a 9-year-old boy and was extirpated by subperiosteal dissection of the lateral nasal wall.     

The inferior turbinate: An autonomic organ

The inferior turbinate has well-recognized respiratory and immune functions to provide the airway with appropriate warmth, humidification, and filtration of the inspired air while sampling the environment for pathogens. Normal functioning of the inferior turbinate relies on an intact autonomic system to maintain homeostasis within the nasal cavity. The autonomic nervous system innervates the submucosal glands and the vasculature within the inferior turbinate, resulting in control of major turbinate functions: nasal secretions, nasal patency, warmth, and humidification. This review will summarize the autonomic innervations of the turbinates, both the normal and abnormal autonomic processes that contribute to the turbinate functions, and the clinical considerations regarding optimal functioning of the turbinate autonomic system.     

Pleomorphic adenoma originated from the inferior nasal turbinate

Although pleomorphic adenoma is the most common benign neoplasm of the salivary glands, it has also been reported to be present in the neck, ear, mediastinum, external nose and nasal cavity. Intranasal localization of this lesion is very rare and mainly originates from the nasal septum. From wherever the lesion originates, the main treatment modality should be surgical. We presented a very rare case of intranasal pleomorphic adenoma originated from the inferior nasal turbinate. Due to the expansile nature of the lesion, a midfacial degloving approach was preferred.     

人下鼻甲微血管内皮细胞的体外培养及鉴定

目的:研究人下鼻甲微血管内皮细胞的体外培养方法,为鼻腔、鼻窦相关疾病的研究提供实验基础。方法:采用手术中获得的人下鼻甲边缘黏膜及黏膜下组织,机械分离和酶解消化微血管内皮细胞,在体外条件下进行培养。分别行细胞形态学观察、细胞生长曲线的测定和培养细胞免疫荧光鉴定。结果:体外培养条件下得到人下鼻甲微血管内皮细胞,经细胞形态学观察、细胞生长曲线测定及免疫荧光鉴定证实为血管内皮细胞。结论:本研究获得的体外培养人下鼻甲微血管内皮细胞,可为鼻腔过敏性疾病和炎症性疾病的微血管病理改变及药物对鼻腔下鼻甲微血管功能影响等研究提供实验基础。     

Improving the design of the pedicled nasoseptal flap for skull base reconstruction: a radioanatomic study

BACKGROUND: Reconstruction of the skull base after an expanded endonasal approach (EEA) is critical to achieve a good outcome. A novel technique based on the use of a pedicled nasoseptal flap has proven to be a reliable and versatile reconstructive option for extensive defects of the skull base. Data regarding the potential dimensions of a nasoseptal flap are lacking in the literature. This pilot study was developed to help optimize the design of the nasoseptal flap and to ensure that when harvesting the flap, its width and length are adequate to reconstruct the defects that are created by various EEAs. METHODS: We analyzed the computed tomographic (CT) scans of four patients who underwent EEAs for skull base lesions. Sagittal and coronal CT reconstructions were generated from axial images. The measurements were divided into skull base measurements, flap dimensions required to cover skull base defects resulting from various EEAs, and potential maximal dimensions of the nasoseptal flap. Measurements were studied for three different EEAs: sellar/transplanar, transclival, and transcribiform/anterior skull base. We measured the potential defects for each of these EEAs and the nasoseptal flap dimensions that would be required to reconstruct them. We estimated all dimensions based on the most extensive defect that could result with each EEA. We then compared these with various modifications of the nasoseptal flap. RESULTS: Two male and two female patients were studied. Twenty-seven measurements were taken to compare the different skull base defects and nasoseptal flaps. CONCLUSIONS: The length of the nasal septum comprises sufficient mucoperichondrium and mucoperiosteum to allow the harvesting of a nasoseptal flap that could cover any defect resulting from an anterior skull base, a transsellar/transplanar, or a transclival EEA. Similarly, the height of the nasal septum has the potential to yield a nasoseptal flap with a width that is adequate to cover the laterolateral aspect of any defect of the anterior skull base and clivus. Skull base defects resulting from combined EEAs, such as those that would create a defect that comprises the skull base from sella turcica to frontal sinus, are beyond the potential dimensions of a single nasoseptal flap. This and other defects resulting from a combination of EEAs require other strategies, such as the use of bilateral nasoseptal flaps, or the use of other reconstructive options.     

核磁共振与内镜检查在带血管蒂鼻中隔黏骨膜瓣颅底重建术后管理中的意义

目的:探讨核磁共振(MR)与内镜检查在带血管蒂鼻中隔黏骨膜瓣颅底修复术后管理中的意义。方法:回顾性分析8例应用带血管蒂的鼻中隔黏骨膜瓣内镜下修复颅底硬膜缺损的资料。其中7例术后(术后5～7d)和近期随访(术后3～7个月)MR和内镜检查资料完整,1例因金属植入物而行CT和内镜检查。2种检查方法配合应用,掌握与颅底重建成败相关的信息,包括术后颅内及颅底修复局部、组织瓣供区和鼻腔鼻窦黏膜术后转归状况,以掌握愈合规律,提高重建成功率。结果:MR结合内镜检查可以准确获取带血管蒂鼻中隔瓣重建颅底术后颅内和修复局部的关键信息。MR可以排除术后常见的颅内并发症如颅内血肿、脑水肿或气颅,显示颅底缺损的位置及大致范围,提示组织瓣的位置及其与硬膜缺损边缘之间的重叠覆盖状态,定位术后脑脊液漏口。在术后和近期随访加强MR中,中隔瓣在颅底大致呈"C"形,7例中隔瓣均匀强化明显,提示血供佳。术后内镜检查证明7例中隔瓣无缺血坏死。6例组织瓣同颅底骨质愈合佳,1例内镜检查发现MR提示的脑脊液漏口并处理。中隔瓣在术后有一定程度的水肿和充血,近期随访时消失,组织瓣有缩小、变薄的征象,1例行CT和内镜检查者,中隔瓣发生坏死,因内衬人工硬膜完好,颅底一期愈合。内镜随访鼻腔鼻窦黏膜水肿在术后近期随访时明显减轻或消失,中隔瓣供区处裸露的中隔软骨在2个月左右被黏膜覆盖。结论:MR结合内镜检查可获取血管化中隔瓣重建颅底术后颅内外关键信息。排除术后并发症,掌握与修复成败密切相关的信息如组织瓣位置,血供及缺损处愈合情况,定位术后脑脊液漏的位置等,为及时处理并发症提供准确信息。所得结果可以提高外科和放射科医师对中隔瓣修复颅底缺损术后康复过程的认识,提高对修复失败情况的辨识和处理能力。     

A review of outcomes following inferior turbinate reduction surgery in children for chronic nasal obstruction

Background

The surgical management of enlarged inferior turbinates in children is controversial. The evidence base for turbinate surgery is weak and surgeons empirically offer surgery where the predominant symptom was nasal obstruction.

Objective

To evaluate the evidence for inferior turbinate surgery in children suffering with chronic nasal congestion.

Methods

A structured review of the PubMed, EMBASE and the Cochrane Collaboration databases (Cochrane Central Register of Controlled Trials, Cochrane Database of Systemic Reviews) was undertaken, using the MeSH terms: nasal obstruction, turbinates, surgery and children. Only articles focusing on turbinate surgery with an exclusively paediatric cohort were included.

Results

Eleven studies fulfilled the inclusion criteria. The ages of the children ranged from 1 to 17 years at the time of surgery and were followed-up for a period of 3 months to 14 years. Surgical indication for all studies was chronic nasal congestion, resistant to a trial of medical treatment for 2-3 months preceding surgery. Of the 730 cases reviewed, 79.1% had turbinate surgery as the standalone procedure. The remaining 21.9% had other concurrent procedures performed, the most common being adeno-tonsillectomy. Although all studies generally supported the effectiveness of turbinate reduction surgery for inferior turbinate hypertrophy, the outcome measures used were varied and did not allow comparison across studies.

Conclusions

There is currently little evidence to support turbinate reduction surgery in children. The role of surgery, if any, has not been properly examined. Furthermore, the long-term effects on nasal airflow dynamics, nasal physiology and long-term complications remain to be studied.     

慢性肥厚性鼻炎4种术式特点及下鼻甲黏膜的超微结构观察

目的：探讨治疗慢性肥厚性鼻炎4种不同术式的手术特点及下鼻甲黏膜超微结构的变化。方法：88例慢性肥厚性鼻炎患者行鼻内镜下鼻甲黏膜下成形术（A组），30例行下鼻甲部分切除术（B组），36例行射频消融下鼻甲减容术（C组），10例行下鼻甲硬化剂注射术（D组）。分别比较A、B、C3组术式治疗慢性肥厚性鼻炎的有效率、手术特点及术前、术后下鼻甲黏膜超微结构特征。结果：术后随访4～6个月，A、B、C3组的有效率分别为97．4％、100．0％和93．4％，差异无统计学意义（均P〉0．05）。A组和C组术式优点突出，下鼻甲黏膜纤毛结构保存较好。结论：鼻内镜下鼻甲黏膜下成形术和射频消融下鼻甲减容术是治疗慢性肥厚性鼻炎较好的手术方法。