先天性鼻中线皮样囊肿及瘘管的诊疗进展

先天性鼻中线肿块临床少见,每20 000至40 000名新生儿中发生1例[1-2].包括鼻中线皮样囊肿及瘘管(nasal dermoid sinus cysts,NDSC)、脑膜脑膨出及鼻神经胶质瘤,其中NDSC最常见,占先天性鼻中线肿块的61％以上[3],占全身皮样病变的1％?3％及头颈部皮样囊肿的4％?12％[1-...     

儿童先天性鼻中线囊肿及瘘管切除术

目的探讨内镜辅助下儿童先天性鼻中线囊肿及瘘管切除术的手术效果及诊治经验。方法回顾性分析2007年1月至2018年12月,北京儿童医院收治的53例先天性鼻中线囊肿及瘘管患儿的临床资料,其中男童30例,女童23例,月龄9~145个月,平均月龄35.6个月。全部患儿术前均行鼻窦薄层低辐射CT及MRI检查。所有患儿均接受全身麻醉下鼻中线囊肿及瘘管切除术,根据病变部位及影像学检查提示的病变范围采取不同的手术入路,对全部鼻骨深层、颅内硬膜外型以及疑似囊壁残留的鼻骨浅层病例均采用了内镜辅助下手术。对患儿的病史、临床表现、影像学检查结果、手术方法、并发症、复发及外观情况进行分析。采用描述性统计学方法分析结果。结果53例患儿中,主要临床表现包括鼻根类圆形包块21例(39.6%)、鼻梁针尖样瘘口13例(24.5%)、鼻梁类圆形包块9例(17.0%)等。病变部位包括鼻根22例(41.5%)、鼻梁中上段27例(50.9%)、鼻梁下段及鼻尖4例(7.5%)。病变深度包括鼻骨浅层24例(45.3%)、鼻骨深层19例(35.8%)、颅内硬膜外层10例(18.9%)。手术入路包括鼻根横形小切口22例(41.5%)、鼻正中小切口27例(50.9%)、开放式鼻整形入路4例(7.5%)。全部患儿手术顺利,术中无并发症出现,均未行一期鼻背重建术。术后随访9~151个月(平均67.3个月),术后复发5例(9.4%),再次手术后治愈。全部患儿外鼻无畸形,外观满意。结论内镜辅助下鼻中线囊肿及瘘管切除术具有视野清晰、手术创伤小、复发率低等优点。     

先天性鼻正中瘘管及皮样囊肿10例

鼻正中瘘管及皮样囊肿属先天性疾病,是在胚胎发育过程中,上皮组织遗留于皮下而形成的囊肿,如有窦道穿出皮肤表面则形成瘘管。两者可沿鼻梁中线生长,瘘管小者仅有一小凹点,或有毛发长出,较大瘘管可分泌皮脂,常伴有继发感染。1992~2003年我科收治先天性鼻正中瘘管及皮样囊肿患儿10例,现报告如下。1资料与方法1.1临床资料10例中,男女各5例;年龄1~5岁,平均3岁。鼻正中瘘管7例,主要表现为出生后鼻梁正中有一小孔或凹陷,其中5例出现反复瘘口周围红肿、流脓,检查见鼻正中线上有一小孔,压之可自小孔溢出皮脂样物,4例继发感染灶位于内眦部,1例位于瘘…     

鼻背中线瘘管及先天性皮样囊肿的治疗

目的分析并回顾鼻背中线瘘管及先天性皮样囊肿的临床诊治方法。方法回顾我院2008～2012年共收治的13例鼻背中线瘘管及先天性皮样囊肿患者的临床资料,并结合之前的相关文献进行分析。结果 13例患者均行手术治疗。随访观察6～54个月无一例复发,9例术后外形恢复满意,4例尚需进一步随访。结论鼻背中线瘘管及先天性皮样囊肿应在排除颅内侵犯后,尽早手术治疗,定期随访。较为复杂的病变建议用内镜辅助手术。术后局部出现缺损或发育畸形可在成年后再行修复。     

内镜下经鼻中隔进路鼻皮样窦囊肿手术

目的介绍在内镜下经鼻中隔进路施行鼻皮样窦囊肿鼻内造袋术的新方法。方法报告1例先天性鼻皮样窦囊肿患者的临床资料，CT检查结果，手术方法、手术效果以及18个月的随访结果。复习相关文献，讨论先天性鼻皮样窦囊肿的诊断和治疗的进展。结果在内镜下经鼻中隔进路施行鼻皮样窦囊肿造袋术避免了颜面部切口，随访18个月患者情况良好，外鼻无畸形，鼻皮样窦囊肿无复发。结论内镜下经鼻中隔进路鼻皮样窦囊肿造袋术为先天性鼻皮样窦囊肿的治疗提供了一种新的可供选择的手术方法。     

牙源性鼻旁瘘管(附6例报告)

目的 探讨上颌尖牙根尖炎并发鼻旁瘘管的诊断和治疗方法.方法 对6例上颌尖牙根尖炎并发鼻旁瘘管进行回顾分析。6例患者行鼻部CT或X线拍片检查未见明显异常,4例误诊为上颌骨骨髓炎、皮脂腺囊肿感染和基底细胞癌等;2例行牙X线摄片检查确诊为牙源性鼻旁瘘管;手术治疗采用局部切除缝合、拔除病源牙、搔刮根尖创面,清除病灶。结果 6例患者面部切口全部I期愈合,经过2～10年追踪观察,瘘管未再复发。结论 鼻旁瘘管应首先考虑牙源性疾病所致,进行口腔科检查有助于减少误诊。     

天性鼻正中瘘管及皮样囊肿10例

鼻正中瘘管及皮样囊肿属先天性疾病，是在胚胎发育过程中，上皮组织遗留于皮下而形成的囊肿，如有窦道穿出皮肤表面则形成瘘管。两者可沿鼻梁中线生长，瘘管小者仅有一小凹点，或有毛发长出，较大瘘管可分泌皮脂，常伴有继发感染。1992-2003年我科收治先天性鼻正中瘘管及皮样囊肿患儿10例，现报告如下。     

鞍鼻成形术21例报告

鞍鼻畸形是鼻骨、鼻软骨支架塌陷。植入填充物如固体硅胶或多晶体羟基磷灰石人工骨粉后 ,畸形可获得满意矫正。我院近两年来收治 2 1例 ,现报告如下。1　资料与方法　　本组 2 1例 ,男 6例 ,女 1 5例 ;年龄 1 8～ 4 5岁。采用固体硅胶整形者 1 3例 ,羟基磷灰石人工骨粉整形者 8例。患者平卧 ,用龙胆紫药水在鼻梁正中画出鼻中线 ,干后用乙醇固定。用 1 %的普鲁卡因作双侧滑车上神经、眶下神经阻滞及鼻尖切口区浸润麻醉。作一侧鼻前庭与鼻孔外缘平行切口或鼻尖部的蝶形切口。在鼻背筋膜深层 ,以鼻正中线为中轴 ,向两侧分离至鼻根部 ,形成一隧…     

先天性鳃裂囊肿及瘘管的外科治疗(附67例分析)

目的探讨先天性鳃裂囊肿及瘘管的诊断和治疗方法.方法回顾分析1984至2002年8月收治的67例患者的临床资料.其中男35例,女32例,5～73岁;其中11～30岁41例,占61.2%;左侧38例,右侧27例,双侧2例;单纯囊肿48例,囊肿合并瘘管3例,单纯瘘管16例;合并其它鳃器畸形3例先天性耳前瘘管3例次,先天性小耳、外耳道闭锁及先天性面瘫1例;囊肿恶变2例,其中1例为异时性双原发癌(鳃裂癌术后3年出现下咽癌).结果所有病例均经手术治疗,第二鳃裂畸形58例,占86.57%, 第一、第三鳃裂畸形分别为5例和4例.经随访,一期治愈59例,复发再次手术治愈8例.结论影像学检查及术前针吸活检是术前确诊的重要依据;食管稀钡造影或囊肿碘油造影有助于囊肿及内瘘口定位,术前少量多次吞服稀释美蓝溶液,有助于术中寻找瘘管及内瘘口.完整切除囊肿及瘘管是避免复发的重要措施,寻找内瘘口并予以荷包缝扎,使瘘管口上皮层朝向咽腔是手术成功的关键.     

鼻内镜下改良黏膜瓣技术治疗新生儿及婴幼儿先天性后鼻孔闭锁

目的:探讨鼻内镜下改良黏膜瓣技术治疗新生儿及婴幼儿先天性后鼻孔闭锁的手术效果及预后情况。方法:回顾性分析2016年1月至2018年5月于北京儿童医院接受鼻内镜手术的先天性后鼻孔闭锁的新生儿及婴幼儿38例,其中男性13例,女性25例,手术时年龄5 d至3岁不等（其中15例为新生儿）。收集患儿的临床资料、影像学资料、治疗效...     

Excision of a Nasal Dermoid Sinus Cyst via Open Rhinoplasty Approach and Primary Reconstruction Using Tutoplast-Processed Fascia Lata

Nasal dermoid sinus cysts are the most common congenital midline nasal lesion, accounting for 1% to 3% of all dermoid cysts, and 4% to 12% of all head and neck dermoids. Selection of the appropriate reconstruction technique, after dermoid resection, is important for treatment. Here we describe the successful management of a case with a nasal dermoid sinus cyst using an open rhinoplasty approach, and primary reconstruction using Tutoplast-processed fascia lata and crushed septal cartilage.     

Open septorhinoplasty approach for the excision of a dermoid cyst and sinus with primary dorsal reconstruction

Adult nasal dermoid cysts and sinuses are rare. Here we describe the surgical management of a 37-year-old patient with a longstanding nasal dermoid cyst and discharging sinus. A combination of an open rhinoplasty approach with a small dorsal incision was used to excise the lesion followed by primary reconstruction with septal cartilage.     

The external rhinoplasty approach for congenital nasal lesions in children

Objective

Congenital lesions of the nose can be challenging to excise. While some lesions carry infection risks, in most cases surgery is primarily performed for cosmesis. Some lesions may extend up to the skull base and this can occasionally be missed on MRI scans. Surgical access has to allow complete excision in all circumstances, but access must be balanced against cosmetic results. We present our experience of the external rhinoplasty approach which allows wide access with little visible scarring.

Methods

Retrospective chart review of all cases performed between November 2003 and October 2009.

Results

15 children underwent excisional surgery using the external rhinoplasty approach. They were aged 1-5 years at the time of surgery, and 12 were male. Pathology comprised congenital midline nasal dermoid cysts in 13 (of which 4 extended intracranially), extranasal glioma in 1 and non-resolving haemangioma in 1. The surgical approach provided adequate visualisation in all cases. The children with intracranial dermoids had resection and repair of the dura as part of their procedure. No post-operative CSF leaks occurred. One child with nasal dermoid had a small cyst recurrence in the skin of the nasal tip requiring further surgery but no deep recurrences occurred. Follow up ranges from 3 months to 6 years. Children with widened nasal bones before surgery have all shown rapid bony remodelling after surgery.

Conclusions

The external rhinoplasty approach offers excellent access in young children, even for intracranial lesions.     

Treatment outcomes of pediatric rhinoplasty: The Asan Medical Center experience

Objective

Performing rhinoplasty in children has been an issue of some debate due to concerns about potential harmful effects on nasoseptal growth. However, there is a paucity of evidence describing the outcomes of pediatric rhinoplasty. This study presents our experience of performing this procedure in children of 17 years of age and younger.

Methods

The study population consisted of 64 Korean children between 4 and 17 years of age who underwent rhinoplasty between May 2003 and August 2011. Forty-six of the patients were boys and 18 were girls with a mean follow-up period of 59 months. The diagnosis of the patients, the extent of the surgical maneuver performed, and the surgical outcomes were reviewed. Subjective satisfaction of the patients was investigated by telephone interview. Surgical outcomes, which were judged by two independent ENT surgeons, were evaluated by comparing preoperative and postoperative photographs. Satisfaction scores were graded using a visual analog scale (from 1 = satisfied, to 4 = dissatisfied). Anthropometric measurements of nasal parameters were performed preoperatively and postoperatively.

Results

Rhinoplasty was performed in our patient cohort due to a deviated nose (32.8%), nasal bone fracture (18.8%), flat nose (6.3%), nasal mass (4.7%), hump nose (3.1%), nasal dermoid sinus cyst (1.6%), and additional cosmetic rhinoplasty for planned septoplasty (32.8%). The median patient satisfaction score was 2.09 compared with a median doctor satisfaction score of 1.81. Anthropometric measurements showed statistically significant improvements in nasal tip projection, nasal length, dorsal height, and radix height after rhinoplasty. Seventeen patients (26.6%) experienced esthetic dissatisfaction such as deviation, tip depression, bulbous tip, short nose, and nostril asymmetry. Eight patients (12.5%) experienced postoperative difficulty in nasal breathing, and two patients (3.1%) complained of transient nasal pain after rhinoplasty. Six patients (9.4%) underwent revision surgery, and four patients (6.3%) were seriously considering a revision operation.

Conclusions

The outcome analysis in our series reveals that rhinoplasty in children is complicated by a high rate of revision and esthetic dissatisfaction. The results of this study may indicate that surgeons should have a conservative attitude and apply strict indication in selecting pediatric rhinoplasty candidates.     

鼻内镜辅助下外鼻整形同期鼻中隔偏曲矫正术

目的 总结33例外鼻畸形伴鼻中隔偏曲患者施行内镜辅助下鼻整形术同期鼻中隔偏曲矫正术的临床资料,分析手术方法和术后疗效。 方法 患者均在全麻下经鼻小柱鼻前庭做切口,骨膜下暴露鼻骨及上颌骨额突,在内镜辅助下进行截骨整复并矫正鼻中隔,酌情将取出的自体鼻中隔骨质及软骨条修整后填于塌陷处或支撑鼻小柱、修整鼻尖等。术中可同期行下鼻甲成形术。随访3个月以上。 结果 全部患者术后均取得满意的整形效果,鼻腔通气良好。 结论 鼻内镜辅助下鼻整形术同期行鼻中隔偏曲矫正术效果好,无排异反应,不仅能改善鼻部外观,而且能改善鼻腔通气效果。     

Endoscopic removal of a dermoid cyst via scalp incision

Nasal dermoid sinus cysts are the most common congenital midline nasal lesions. We describe a novel technique for the excision of a nasal dermoid cyst in a 2‐year‐old boy using a four hand endoscopic approach via a small scalp incision behind the hairline. The technique, although somewhat challenging, avoids a facial scar. Laryngoscope, 123:1862–1864, 2013     

Adult nasal dermoid sinus cyst

Nasal dermoid sinus cysts (NDSCs) are uncommon occurrences that require intervention usually because of complications with cyst expansion such as chemical meningitis, infection, and sequelae of mass effect such as new-onset seizures. Although many cysts are removed in childhood, some are not detected until adulthood. They become symptomatic and further evaluations illuminate an NDSC that has progressed. Most present as extracranial lesions in childhood and are effectively removed via open rhinoplasty with no recurrence; however, occasionally, they extend intracranially. This case report presents a unique (unusual) extension of the NDSC into the frontal sinus requiring an osteoplastic flap to access the frontal sinus floor combined with a local midline nasal incision at the sinus tract origin. A discussion of various clinical presentations and surgical approaches and a case report of a 35-year-old man are presented. This case adds to the growing amount of literature on NDSCs and demonstrates an unusual presentation, which has thus far not been documented.     

Endonasal endoscopic approach for intracranial nasal dermoid sinus cysts in children

Nasal dermoid sinus cysts are the most common congenital midline nasal lesions. The frequency of intracranial extensions varies from 5% to 45%. Complete surgical excision of nasal dermoid cyst and any associated sinus tract is essential for cure and any residual ectodermal elements result in a high rate of recurrence and complicated infections. Many different approaches have been described for the removal of nasal dermoids in the past two decades, ranging from a simple extracranial excision to complex procedures in which a combined extracranial-intracranial approach is required. We hereby report two cases of nasal dermoid sinus cysts in children with intracranial extension which were managed with an endonasal endoscopic procedure. We describe the technique we implemented for this procedure and for the reconstruction of the skull base defect.     

鼻腔鼻窦青少年型骨化纤维瘤六例临床分析

目的 分析鼻腔鼻窦青少年骨化纤维瘤的临床特点,并探讨治疗方法。 方法 选取2015年5月至2017年12月治疗的6例鼻腔鼻窦青少年骨化纤维瘤,男4例、女2例,年龄2个月~12岁6个月,中位年龄6岁2个月。肿瘤发生于上颌窦1例,筛窦3例,蝶窦1例,额窦1例。患儿入院后均行手术治疗,1例患儿肿物累及视神经,为保留患儿视力行鼻内镜下肿物部分切除术,术后半年发现肿物累及视神经并广泛累及颅底,行第2次鼻内镜下肿物部分切除术,术后半年因肿物复发且累及范围广泛,在第3次手术时行右侧鼻侧切开联合鼻内镜下鼻-鼻窦骨化纤维瘤部分切除术。其余患儿均行鼻内镜下肿物切除术。除1例年龄为2个月的患儿未行导航CT检查外,患儿术中均采用美敦力FUSION ENT Image Guidance System电磁导航技术对肿物边缘予以定位。另有1例患儿因肿物位于蝶窦且有明确的滋养血管,鼻内镜术前1 d予以介入血管造影及栓塞术。患儿术后均定期随访,包括鼻内镜检查及鼻窦CT检查,了解患儿术区情况、症状是否缓解及有无并发症出现。 结果 6例患儿病理分型为砂砾样5例,小梁状1例。患儿均未失访,平均随访时间2.2年。其中1例复发,予以肿物部分切除,术后带瘤生存。其余患儿随访期内均未发现肿物复发且无并发症出现,患儿的原发症状均得到有效缓解。 结论 鼻腔鼻窦青少年骨化纤维瘤具有侵袭性生长和术后易复发的临床特点,手术是惟一有效的治疗方法。影像导航下鼻内镜手术是适合儿童的术式。