鼻窦CT冠位扫描对鼻窦内窥镜手术的指导意义

为探讨鼻窦ＣＴ冠位扫描对鼻窦内窥镜手术的指导意义，将２６０例（４６６侧）鼻窦疾病患者的ＣＴ冠位扫描所见与内窥镜鼻窦手术结果进行对比分析。结果显示鼻窦ＣＴ冠位扫描与临床诊断符合率为９９．２％。认为，通过影像学检查指导鼻内窥镜手术，有助于术中识别鼻腔鼻窦的各种解剖变异，这对于手术的难易估计及并发症的预防均起着积极作用，并同时指出ＣＴ冠位扫描尚存在一定局限性。     

内窥镜鼻窦手术中CT冠状位影像的应用

本文通过对７１例慢性鼻窦炎ＣＴ冠状位扫描的诊断和手术中所见，认为冠状位ＣＴ扫描病变发现率高，鼻窦的精细结构、病变范围和程度能清楚地显示出来，有指导鼻内窥镜手术的作用，应做为鼻内窥镜手术前必要的检查方法。     

鼻窦CT和功能性鼻内窥镜手术

观察３０具成人尸头和８０例患者鼻窦ＣＴ，重点注意中鼻道解剖变异及窦口复合体阻塞同鼻窦炎的关系。结果发现：鼻丘气房、中鼻甲气化和曲线反常、钩常偏曲是最常见的中鼻道解剖变异，且鼻窦密度同筛漏斗阻塞有密切关系。认为鼻窦ＣＴ能清晰显示鼻窦和中鼻道解剖及变异，因此，鼻窦ＣＴ应作为鼻内窥镜手术前的常规检查。     

鼻窦内窥镜手术治疗小儿鼻腔,鼻窦疾病

以往的观点认为,小儿慢性鼻窦炎的治疗应尽量避免手术.因为传统的外科手术难免会影响小儿颌面与牙胚的发育,破坏其鼻腔、鼻窦的生理功能,疗效亦不满意.鼻窦内窥镜手术(endoscopic sinussurgery,ESS)成功地用于治疗成人鼻腔、鼻窦疾病的经验,使人们重新探讨对药物治疗无效的小儿慢性鼻腔、鼻窦疾病外科手术治疗的可行性.对小儿不同发育时期鼻腔、鼻窦解剖学的详细研究,及对鼻窦炎发病机理和病理生理学的重新认识,为ESS治疗小儿鼻腔、鼻窦疾病提供了可靠的理论依据,并使ESS治疗逐步成为可能.本文试就ESS治疗小儿鼻腔、鼻窦疾病的现状作一综述,以供同道们参考.1 ESS适应证据Wolf等对1～12岁小儿的干颅骨94具、尸头8具的鼻腔、鼻窦进行观察,证明其前后组筛窦、中鼻道、钩突、半月裂和筛漏斗已经发育.因此,在内窥镜下对上述部位行ESS是可行的.手术适应证的选择:①窦口鼻道复合体阻塞:如筛泡肥大,中道粘膜肥厚、息肉样变.中鼻甲息肉样变等,选择钩     

鼻丘及其邻近结构CT观察及其在内窥镜鼻窦手术中的 …

目的 为了深入开展鼻内窥镜下额窦手术和鼻腔泪囊造口术等,观察鼻丘形态及其邻近结构的关系。方法 采用鼻窦连续冠状和矢状和矢状位扫描,观察１００例患者（包括鼻中隔偏曲３０例,慢性鼻炎４０例,慢性鼻窦炎３０例）,其中成人８０例,儿童２０例。结果①绝大多数病例（９９％）有鼻丘气房,儿童（９￣１６岁）鼻丘发育与成人相比无差异性;②鼻丘形态变化很大,但与中鼻甲前端、筛泡和鼻泪管的关系是恒定的;③鼻丘向上气化程     

CT扫描对鼻腔鼻窦病变的诊断价值

对５４例鼻腔鼻窦疾病患者ＣＴ扫描，结果显示，ＣＴ能准确显示鼻腔鼻窦病变的形态范围，骨质破坏情况，病变向周围器官如眼眶，翼腭窝等侵犯情况，对良，恶性病变的鉴别有一定意义，可区别急，慢性炎症与新生物或骨瘤，但同时表明，ＣＴ值对软组织密度病变的组织学鉴别诊断价值不大。     

鼻窦CT扫描

鼻窦ＣＴ扫描已成为功能性鼻内窦镜治疗鼻窦炎的术前必不可少的检查方法。本着重论述了鼻窦ＣＴ的检查方法，正常及正常变异的ＣＴ表现，鼻窦炎症的基本ＣＴ征象。     

鼻内窥镜手术治疗非侵袭性鼻窦真菌病

目的 :探讨鼻内窥镜手术代替传统柯 陆手术治疗非侵袭性鼻窦真菌病的疗效。方法 :采用Storz30°鼻内窥镜行病侧钩突切除 ,扩大上颌窦开口 ,行下鼻道开窗 ,双进路清除病灶。术后用 1%H2 O2 及生理盐水冲洗 ,不用抗真菌药。结果 :2 9例随访 6个月～ 3年 ,原有症状消失 ,未见复发。结论 :采用鼻内窥镜手术治疗非侵袭性鼻窦真菌病 ,较之柯 陆手术创伤小、照明好、清除病灶准确 ;不损害鼻腔正常生理功能 ;保证鼻窦通气引流 ,减少复发 ,治愈率高     

Functional endoscopic sinus surgery

Summary The Messerklinger technique is a primarily diagnostic endoscopic concept demonstrating that the frontal and the maxillary sinuses are subordinate cavities. Disease usually starts in the nose and spreads through the ethmoidal prechambers to the frontal and maxillary sinuses, with infections of these latter sinuses thus usually being of secondary nature. Standard rhinoscopy and sinus X-rays are frequently not sufficient to demonstrate the underlying causes for chronic or recurring acute sinusitis in the clefts of the anterior ethmoidal sinuses. The combination of diagnostic endoscopy of the lateral nasal wall with conventional or computed tomography in the coronal plane has proven to be the ideal method for the examination of inflammatory diseases of the paranasal sinuses. In so doing, diseases and lesions that other-wise might have gone undiagnosed can be identified and consequently treated. Based on this diagnostic approach, an endoscopic surgical concept was developed, aiming for the underlying causes of sinus diseases instead of the secondarily involved larger sinuses. With usually very limited surgical procedures, diseased ethmoid compartments are operated on, stenotic clefts widened and prechambers to the frontal and maxillary sinuses freed from disease. In our experience, there is rarely a need for major manipulations inside the larger sinuses per se. Based on exact diagnosis, the surgical technique used allows a very individualized staging according to the prevailing pathology. In the extreme, a total sphenoethmoidectomy can be performed with this technique, although the true advantage of the technique is that even in cases of massive disease such radical procedures can be avoided. By reestablishing sinus ventilation and drainage via the natural ostia, there is also no need for fenestration of the inferior meatus. The Messerklinger technique can be applied to a wide spectrum of indications, apart from nasal polyposis. The technique has its clear limits as well as its specific problems. Adequate training and experience are required for the surgical approach, as the technique bears all the risks and hazards of all kinds of endonasal ethmoid surgery but has a minimal complication rate in the hands of an experienced surgeon. Results and complications of a series of more than 4500 patients over a period of over 10 years are presented and discussed in detail.Dedicated to Professor W. Messerklinger on the occasion of his 70th birthdayoffprint requests to: H. Stammberger     

鼻窦内窥镜手术处理病变中鼻甲的意义

目的：探讨功能性鼻窦内窥镜于术（ＦＥＳＳ）中处理病变中鼻甲的临床意义。方法：按照成人中鼻甲解剖学标准,在３２例鼻窦炎、鼻息肉患者ＦＥＳＳ中,对病变中鼻甲进行适当处理,并于术后对中鼻甲形态恢复、筛窦术腔及上凳窦窦中开放率进行随访观察。结果：术后６个月中鼻甲形态恢复正常２４例（７５％）,发生粘连８例（２５％）,其中术腔闭塞２例（６．３５％）;上颌窦窦口开放良好２５例（７８．１％）,狭窄６例（１８．８％     

功能性鼻内镜鼻窦手术后换药应用布地奈德混悬液的效果分析

目的 探讨在慢性鼻-鼻窦炎患者术后应用布地奈德混悬液（普米克令舒）的效果。方法 分析280例慢性鼻-鼻窦炎行鼻内镜手术的患者,随机分为2组,A组常规换药,术后常规使用布地奈德鼻喷剂喷鼻;B组对有囊泡及水肿明显者在术后换药过程中清理后予以明胶海绵浸润布地奈德混悬液置于囊泡及水肿部位,每周1~2次,观察术后1个月、3个月及6个月的疗效,包括VAS视觉量表主观评估及鼻内镜Lund-Kennedy客观评估。结果 A、B组术后1、3、6个月VAS评分分别为4.48±1.33,2.16±0.81,2.04±0.96;3.85±1.09,1.90±0.88,1.93±0.74。A、B组术后1、3、6个月Lund-Kennedy评分分别为11.44±1.73,4.51±1.05,3.94±0.86;6.82±2.08,4.26±1.17,2.17±0.79。两组患者的VAS评分在术后三个时间点差异均有统计学意义（P<0.05）;术后3个月、6个月与术后1个月比较,差异有统计学意义（P<0.05）;而术后3个月与术后6个月相比,差异无统计学意义。两组间Lund-Kennedy 客观评估比较,在术后1个月和6个月两个时间点差异有统计学意义（P<0.05）,而在术后3个月,两组比较差异无统计学意义;术后3个月、6个月与术后1个月比较,差异有统计学意义（P<0.05）;而术后3个月与术后6个月相比,A组在两个时间点差异有统计学意义,B组在两个时间点差异无统计学意义。结论 慢性鼻-鼻窦炎鼻内镜术后应用布地奈德混悬液能更好地减少术后囊泡形成、减轻水肿,促进黏膜上皮化。     

The effect of functional endoscopic sinus surgery on nasal resonance

Background and objectiveFunctional endoscopic sinus surgery (FESS) increases the nasal volume, and thereby it can alter the nasal resonance. The objectives were to measure the percentage of nasal resonance following FESS and compare it with healthy individuals with normal nasal findings.MethodsThe nasometric analysis of voice was done using n/p/m consonant sounds in 72 individuals with healthy post FESS cavities (group 1) and 72 healthy individuals with normal nasal findings without any nasal pathology (group 2). The scores of nasal resonances were expressed in percentages and were compared between the two groups. Both in group 1 and group 2, 32 (44.4%) were females, and 40(55.6%) were males. In group 1, 51 participants had bilateral FESS cavities, and 21 had unilateral FESS cavities. Kannada was the mother tongue in 30 (41.7%) participants in group 1 and 36 (50.0%) in group 2. Malayalam was the mother tongue in 42(58.3%) participants in group 1 and 36 (50.0%) in group 2.ResultsIn both cases and control groups, more than 80% of the participants were showing less than 20% of nasal resonance. In group 1, the mean values of/n/p/m sounds were 11.23%, 10.23% and 11.42% respectively, and in group 2 the mean values were 8.27%, 8.58% and 8.58% respectively. But the P value was not statistically significant. Individuals with unilateral FESS cavities had more nasal resonance values compared to bilateral FESS cavities. Similarly, Kannada speaking people had more values compared to Malayam speaking individua.ConclusionChanges in nasal resonance after FESS is minimal, and it is unnoticed. But it may affect the speech quality in professional voice users, depending on their language. Though the nasometer is considered as the most validated instrument to record nasal resonance, we feel that further standardization is needed to evaluate the nasalance.     

Diplopia secondary to endoscopic sinus surgery

Objective—Diplopia after endoscopic sinus surgery (ESS) is rare but very serious. In this study, we investigated the characteristics, prognosis and treatment of diplopia occurring after ESS.

Material and Methods—A retrospective analysis was carried out to investigate three patients with diplopia after ESS referred to us from other hospitals.

Results—In one case, an improvement in ocular motility was seen after surgical treatment. In the other cases, no improvement was observed, despite surgical treatment.

Conclusion—In order to prevent diplopia after ESS, the surgeon must possess a complete anatomical knowledge obtained by means of cadaveric dissection, the ability to carefully read preoperative CT scans and the necessary surgical experience.     

Informed consent in functional endoscopic sinus surgery

OBJECTIVES: Functional endoscopic sinus surgery (FESS) is one of the more common procedures performed by otolaryngologists. Before performing FESS, surgeons are obligated to discuss the procedure and its risks through the process of informed patient consent. The study identifies current practices in informed consent for FESS and formulates guidelines for informed consent for FESS. STUDY DESIGN: Survey. METHODS: Surveys were sent to 1000 American Academy of Otolaryngology-Head and Neck Surgery members in the United States. Surveys inquired about current informed consent practices related to FESS. RESULTS: Three hundred forty-six surveys were returned. Nearly 60% of respondents thought that 1% incidence of a complication warrants a discussion with patients. The percentage of respondents who discuss specific risks were as follows: bleeding, 96.7%; infection, 84.8%; cerebrospinal fluid leak, 99.1%; orbital injury, 96.7%; smell changes, 40.2%; cerebrovascular accident, 17.9%; myocardial infarction, 81%; and death, 28.0%. CONCLUSIONS: The study suggests that there is variability in specific informed consent practices for FESS among otolaryngologists. It also suggests that the incidence or severity of a complication does not necessarily correlate with whether or not it is mentioned during the informed consent process. The authors think that practicing otolaryngologists may be able to use this information to improve their consent practices.     

Sorbalgon藻酸钙敷料在功能性鼻内镜手术中的应用

目的：选择有效的鼻腔堵塞止血材料。方法：比较功能性鼻内镜手术凡士林纱条和Sorbalgon藻酸钙敷料鼻腔堵塞止血效果及堵塞后鼻腔反应情况。结果：应用Sorbalgon藻酸钙敷料止血效果好，头痛及鼻腔疼痛较轻，抽除堵塞物时鼻腔很少出血，术后鼻粘膜反应轻。结论：Sorbalgon藻酸钙敷料是一种良好的鼻腔，鼻窦手术后堵塞止血材料。     

The cytology and microbiology of persistent paranasal sinus secretions after endoscopic sinus surgery: a controlled study

OBJECTIVE: To determine the cellular composition and influence of microbiology on persistent paranasal sinus secretions after endoscopic sinus surgery (ESS). METHODS: Persistent sinus secretions from a consecutive series of patients after ESS were studied with cytopathology and cultures for aerobic, anaerobic, and fungal organisms. A control group consisting of patients without persistent secretions after ESS was also studied. Epithelial, neutrophil, and eosinophil cell presence was semiquantitatively assessed on a 4-point scale and compared between control and diseased groups. Cellular composition was then stratified and analyzed according to the presence of microorganisms. RESULTS: A total of 50 diseased and 24 control patients were studied. Both diseased and control patients demonstrated sloughed epithelial cells in secretions (53.1% and 66.7%, respectively, P = .131). The diseased group exhibited significantly higher eosinophilic or eosinophilic/neutrophilic cellularity than the controls (P = .048). The average neutrophil infiltration score was 0.82 versus 0.54 for the controls (P = .104). For the diseased group, the mean eosinophil score was 1.56 versus 0.96 in the control group (P = .035). Pathogenic bacteria were identified in 64% of the diseased group patients versus 54.2% in controls (P = .454). Only two fungal cultures were positive (diseased group). Microbiological analysis indicated that in the absence of bacteria, diseased group patients mainly manifested an eosinophilic presence, whereas in the presence of bacteria, the neutrophil response was enhanced in diseased patients and eosinophil response was enhanced in controls. CONCLUSIONS: Persistent sinus secretions after ESS are primarily driven by an eosinophilic presence. Patients without inflammatory exudate after ESS respond to bacteria with increased eosinophilia, whereas hypersecretory patients demonstrate both increased neutrophil and eosinophil presence.