腭裂患儿鼻腔和鼻窦的形态学观察

应用组织病量学，ＣＴ扫描、计算机图像处理和三维ＣＴ重建方法观察了８例先天性腭裂患儿鼻腔和鼻窦的形态学改变，发现（１）８例腭裂患儿中，３例有双侧上颌窦炎，１例双上颌窦和前组筛窦有分泌物潴留，提示咽帆关闭不全可能是腭裂患儿鼻窦炎高发的主要原因；（２）连续ＣＴ扫描的计算机图像处理，结合三维ＣＴ重建可以准确计算鼻空运原体积，显示鼻窦的形态，为今后深入研究儿单鼻塞的发育和解剖节一条新路。计算机三维ＣＴ重建可     

鼻窦真菌病10例临床分析

总结我院１９９２￣１９９８年收治鼻窦真菌病１０例，认为鼻窦真菌病的主要临床特征是：（１）单个侧鼻窦受累，尤其是上颌窦；（２）单侧头痛，鼻塞，脓血涕或鼻腔干酪样物；（３）ＣＴ扫描常见鼻腔鼻窦有软组织块影或钙化斑；（４）鼻腔鼻窦有阻塞因素存在，柯－陆氏手术是本病的主要治疗手段，而鼻内窦镜手术在清理筛窦或蝶窦病变组织及术后窦腔护理有明显的优点。     

三维图像辅助下切除蔓延至颅底的鼻腔鼻窦良性肿瘤

使用徒手、实时术中的三维ＣＴ定位法，切除累及颅底、眼眶的鼻腔鼻窦病变是现代头颈外科的新进展。三维ＣＴ是一种术前用ＣＴ扫描作为定位的计算机辅助技术。以前的技术尽管很少有术中错误，却需使用笨重的坚固关节的手臂和附着的探针，从而限制了活动范围，并需要坚实地固定头部。一种新的徒手倒转技术，摆脱上述限制，被广泛应用。前瞻性挑选７个良性病变累及鼻腔鼻窦、颅底或眼眶的病人，所有病人利用徒手三维ＣＴ定位法，使用内窥镜开放或联合操作进行肿瘤切除。该装置能协助手术医生精确地判断其中３例视神经的异位，可精确地判断其位…     

鼻窦真菌病10例临床分析

总结我院１９９２～１９９８年收治鼻窦真菌病１０例,认为鼻窦真菌病的主要临床特征是：①单个侧鼻窦受累,尤其是上颌窦;②单侧头痛、鼻塞、脓血涕或鼻腔干酪样物;③ＣＴ扫描常见鼻腔鼻窦有软组织块影或钙化斑;④鼻腔鼻窦有阻塞因素存在。柯－陆氏手术是本病的主要治疗手段。而鼻内窥镜手术在清理筛窦或蝶窦病变组织及术后窦腔护理有明显的优点。     

蝶窦后鼻孔息肉二例

蝶窦后鼻孔息肉少见，１９９５～１９９７年我科遇到２例，报道如下。例１男，６１岁。主诉左侧鼻塞２年。检查时发现左侧后鼻孔息肉。鼻窦冠状位ＣＴ扫描显示左侧上颌窦和筛窦正常，蝶窦模糊、密度增高。左侧鼻腔后部及鼻咽部有软组织密度影（图１，２）。在４ｍｍ０°内...     

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。     

鼻腔－鼻窦肿瘤侵犯颅底的CT与MRI诊断

鼻腔－鼻窦肿瘤侵犯颅底无论在诊断方面，还是在治疗方面都是棘手的问题。为了准确判定肿瘤的原发部位、大小及侵犯范围，影像学检查至关重要。１９９３年１月至１９９５年１月，收集了１２例鼻部肿瘤侵犯颅底病人的临床与影像学（ＣＴ与ＭＲＩ）资料，结果发现：①鼻腔－鼻窦肿瘤侵犯颅底的病人平均年龄偏低，本组１２例的平均年龄为３４岁；②对有鼻塞，鼻出血等鼻部症状的病人伴眼部症状时，应引起临床医师的高度重视；③从观察鼻腔。鼻窦肿瘤是否有颅底受累的角度看，以冠状位ＣＴ扫描最为适宜；④ＣＴ可以较好地显示筛骨水平板、筛骨纸样板、颅底等骨性结构，ＭＲＩ能很好地显示脑膜、脑、视神经、颈内动脉等软组织改变，并可以清楚地显示肿瘤的边界。在临床工作中，ＣＴ的费用比ＭＲＩ低廉，而且更为普遍，对怀疑有颅底侵犯的病人，应首先做ＣＴ检查，为了更好地观察颅底软组织的受累情况，以决定手术的可行性及手术方法，最好加做ＭＲＩ检查。     

鼻腔鼻窦骨化纤维瘤的螺旋CT诊断

目的探讨螺旋CT在鼻腔鼻窦骨化纤维瘤的诊断价值。方法回顾性研究本院行手术治疗并经病理确诊的鼻腔鼻窦骨化纤维瘤患者24例,分析其临床资料及螺旋CT影像学特征,探讨螺旋CT诊断程序。结果侵犯单个鼻窦的肿瘤12例,包括筛窦8例,上颌窦4例;其中6例伴有鼻腔侵犯。病变同时侵犯多个鼻窦和鼻腔者12例,包括上颌窦和筛实8例,筛窦和额窦4例。肿瘤的CT表现为鼻腔／鼻窦内单发类圆形或不规则形高密度肿块,部分区域可见低密度影,其周边显示完整的骨性包壳,呈膨胀性生长,周围组织受压变形但界限清晰。结论螺旋CT扫描是诊断鼻腔鼻炎骨化纤维瘤最常用和最有价值的影像学检查手段。     

单侧鼻腔鼻窦病变CT诊断与临床分析

目的研究单侧鼻腔鼻窦病变的CT表现，探讨CT检查在单侧鼻腔鼻窦病变的诊断价值。方法回顾性分析2003年1月～2011年10月经手术、组织病理学证实的381例单侧鼻腔鼻窦病变的临床资料，并结合病理检查结果，评价CT扫描的诊断意义。结果病灶位于左侧鼻腔鼻窦198例，右侧183例。其中单纯上颌窦病变102例，孤立性蝶窦病变29例，上颌窦为主、累及筛窦及鼻腔191例，多鼻窦病变累及鼻腔59例。临床症状主要以单侧鼻塞、流涕为主326例（其中涕中带血者47例），单侧嗅觉减退或丧失31例，元明显临床症状24例。术前CT诊断准确率：慢性鼻窦炎鼻息肉136例，准确率为93．4％；鼻窦囊肿54例，准确率为96．3％；真菌性鼻窦炎98例，准确率为87．8％；鼻腔鼻窦内翻性乳头状瘤65例，准确率为81．5％；其他良性肿瘤3例，准确率为66．7％；鼻腔鼻窦恶性肿瘤25例，准确率为88．0％。结论单侧鼻腔鼻窦病变以慢性鼻窦炎、真菌性鼻窦炎等病变为主。CT能清晰显示炎性病变、肿瘤范围及与邻近组织的关系，是诊断单侧鼻腔鼻窦病变的重要影像学手段。     

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。     

Virtual Endoscopy of the Paranasal Sinuses Using Perspective Volume Rendered Helical Sinus Computed Tomography

Our goal was to use three-dimensional information obtained from helical computed tomographic (CT) data to explore and evaluate the nasal cavity, nasopharynx, and paranasal sinuses by simulated virtual endoscopy (VE). This was done by utilizing a new image reconstruction method known as perspective volume rendering (PVR). Thin-section helical CT of the nasal cavity, nasopharynx, and paranasal sinuses was performed on a conventional CT scanner. The data were transferred to a workstation to create views similar to those seen with endoscopy. Additional views not normally accessible by conventional endoscopy were generated. Key perspectives were selected, and a video “flight” model was choreographed and synthesized through the nasal cavity and sinuses based on the CT data. VE allows evaluation of the nasal cavity, nasopharynx, and paranasal sinuses with appreciation of the relationships of these spatially complex structures. In addition, this technique allows structural visualization with unconventional angles, perspectives, and locations not conventionally accessible. Although biopsies, cultures, and lavages routinely done with endoscopy cannot be performed with VE, this technique holds promise for improving the diagnostic evaluation of the nasal cavity, the nasopharynx, and the paranasal sinuses. The unconventional visual perspectives and very low morbidity may complement many applications of simple diagnostic endoscopy.     

鼻腔鼻窦非霍奇金淋巴瘤的CT表现

目的：探讨鼻腔鼻窦非霍奇金淋巴瘤（ＣＨＬ）的ＣＴ影像学特征,方法：对９例经病检确诊为鼻腔鼻窦ＮＨＬ患者的ＣＴ片进行回顾性分析。结果;原发于鼻腔鼻窦的ＮＨＬ在临床上有着典型的恶性特征,但在ＣＴ影像上所表现的骨质破坏,类似于良性病变的骨改建、骨膨胀性改变,而非其他恶性肿瘤那样表现为侵入性骨质破坏;其在鼻腔内形成均匀软组织密度影,常累及下鼻道、下鼻甲;并伴有鼻中隔前份粘膜对称性增厚;结论：原发于鼻腔鼻窦     

Hyperaeration of the frontal sinus

The nasal cavity and paranasal sinuses constitute an anatomical and functional unit. Paranasal sinuses communicate with the nasal cavities, which are covered by the same mucosa, via small openings and narrow ducts that allow both aeration and sinus drainage. Anatomical variations of the paranasal sinuses and nasal cavity are important in sinus diseases. Computerized tomography (CT) plays a critical role in evaluation of the patients with paranasal sinus pathology and variations. A 38-year-old man admitted to our clinic with headache and postnasal dripping for 1 year. His paranasal CT scanning revealed that there is hyperaeration of the frontal sinus which is in continuity with the sphenoid sinus. Hyperaeration of the sinuses may be kept in mind in a patient complaining of headache.     

鼻腔及鼻窦内翻性乳头状瘤临床分期中CT的作用

目的探讨鼻腔及鼻窦内翻性乳头状瘤临床分期中CT的应用价值。方法回顾性分析33例鼻腔及鼻窦内翻性乳头状瘤的CT影像资料及手术资料。结果按照Krouse分期标准,将本组病例分为四期(四组)。在每组中将CT分期与手术所见分期比较,结果如下(相符/不相符):T1期1/0,T2期22/2,T3期3/3,T4期2/0,总共28/5。结论鼻腔及鼻窦内翻性乳头状瘤虽无特异CT表现,但CT影像与手术所见对比显示,它能较准确判断肿瘤的侵及范围,是鼻腔及鼻窦内翻性乳头状瘤分期中不可缺少的资料之一。     

Nasal chondromesynchymal hamartoma presenting in an adolescent

Nasal chondromesenchymal hamartoma (NCMH) is extremely uncommon primary benign cartilaginous growth of the nasal and paranasal sinuses. To date, it has been reported almost exclusively in infancy. We report a NCMH in a 16-year-old patient who presented with an asymptomatic, fixed swelling on the left side of the nose approximately 2x2 cm in size. Computed tomography (CT) and magnetic resonance imaging (MRI) of the nose, paranasal sinuses and neck confirmed a heterogeneous, calcified polypoidal mass protruding caudally into the left nasal cavity. After an initial inconclusive incisional biopsy, the patient underwent a complete radical resection, with staged reconstruction of the full nasal defect using septal mucosal flap, conchal cartilage graft and forehead skin flap. Histological examination of the resected specimen confirmed NCMH, which, we believe, had probably been present and undetected for many years. This report greatly extends the age at which NCMH may be entertained as part of the differential diagnosis of cartilaginous lesions of the nose and paranasal sinuses.     

Acoustic rhinometry in healthy humans: accuracy of area estimates and ability to quantify certain anatomic structures in the nasal cavity

OBJECTIVES: We evaluated the accuracy of acoustic rhinometry (AR) measurements in healthy humans and assessed the ability of AR in quantifying the dimensions of the paranasal sinuses and certain anatomic structures in the nasal cavity. METHODS: Twenty nasal passages of 10 healthy adults were examined by AR and computed tomography (CT) before and after decongestion. Actual cross-sectional areas of the nasal cavity and actual locations of the nasal valve, the head of the inferior turbinate, the head of the middle turbinate, the ostia of the frontal and maxillary sinuses, and the choana were determined from CT sections perpendicular to the curved acoustic axis of the nasal passage. RESULTS: The AR-measured cross-sectional areas in the anterior nasal cavity were in reasonable agreement with the corresponding areas determined from CT, whereas AR consistently overestimated the passage areas at locations posterior to the paranasal sinus ostia. The nasal valve was identified as a pronounced minimum on the AR area-distance curve. However, AR did not discretely identify the head of the inferior turbinate, the head of the middle turbinate, or the choana. CONCLUSIONS: The local minima on the AR area-distance curve beyond the nasal valve are caused by acoustic resonances in the nasal cavity, and do not correspond to any anatomic structure. The AR area overestimation beyond the paranasal sinus ostia is due to the interaction between the nasal cavity and the paranasal sinuses, rather than to sound loss into the sinuses. Acoustic rhinometry provides no quantitative information on ostium size or sinus volume in either non-decongested or decongested nasal cavities.     

Rhinologic computed tomographic evaluation in patients with cleft lip and palate.

OBJECTIVE: To investigate the anatomical characteristics of the nasal cavity and paranasal sinuses in relation to the presence of sinusitis in patients with cleft lip and palate. DESIGN: Retrospective survey. SETTING: Tertiary care hospital. PATIENTS: Forty-seven consecutive patients with cleft lip and alveolus with or without cleft palate. MAIN OUTCOME MEASURES: The patients underwent computed tomographic scans of the maxilla, and the following parameters were evaluated: nasal septal shift from the midline, soft tissue density shadow of the maxillary sinus, cross-sectional area of the maxillary sinus, and height of the floor of the maxillary sinus. RESULTS: The nasal septum was convex to the cleft side in most of the patients with unilateral clefts, and there was a significant correlation between the cleft side and the direction of nasal septal deviation (P<.001). Sinusitis was more severe in the noncleft side than in the cleft side (P =.04), and in the concave side than in the convex side (P= .02). The cross-sectional area of the maxillary sinus was not statistically different between the cleft side and noncleft side, nor between the septal concave side and convex side. The floor of the maxillary sinus was situated higher in the cleft side than in the noncleft side (P = .02). CONCLUSIONS: The occurrence of maxillary sinusitis associated with cleft lip and palate is dependent on both the cleft side and the deviated nasal septum, but not on the size of the sinus. The cleft side is responsible for the direction of the septal deviation and the height of the floor of the maxillary sinus. A low-situated sinus floor may be in contact with the root of the teeth, and thus may be one of the etiologic factors of sinusitis in patients with clefts.     

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。     

鼻腔鼻窦胚胎型横纹肌肉瘤磁共振表现及临床价值

目的 探讨鼻腔鼻窦胚胎型横纹肌肉瘤(embryonal rhabdomyosarcoma,ERMS)的磁共振(MRI)表现和临床价值.方法 回顾性分析5例经组织病理学证实的鼻腔鼻窦ERMS的临床、病理和MRI资料,重点分析肿瘤发生的年龄、临床症状、发生部位和MRI特点,以及MRI在诊断和治疗过程中的价值.结果 ERMS患者主要临床症状包括:鼻塞4例次,眼球突出4例次,视力下降2例次,涕中带血1例次,嗅觉下降1例次,眼球活动受限1例次.本组5例中,有4例病变主体位于筛窦,1例位于鼻中隔,均累及眼眶、前颅窝底脑膜及多个鼻窦.依据国际横纹肌肉瘤研究组(Intergroup Rhabdomyosarcoma Studies,IRS)分期标准,Ⅱ期1例,Ⅲ期4例.病变与脑灰质比较,T1W1为均匀等信号2例;以等信号为主,散在小片状高信号3例.T2W1以稍高信号为主,混杂片状低信号2例;以稍高信号为主,见散在小点状、片状更高信号3例.5例ERMS增强扫描均为明显不均匀强化,内见散在片状无强化区,其中2例见线环样、葡萄样强化.4例肿瘤内有出血.全部5例均有不同程度的骨质推压改变和骨质破坏,骨质破坏区均见残存骨质.结论 鼻窦ERMS的MRI表现具有一定的特征性,MRI能准确显示肿瘤的侵犯范围,对肿瘤的定性诊断、临床分期和治疗效果的评价均有一定的指导意义.