上颌窦气化与牙源性上颌窦炎的相关性分析

目的 探讨上颌窦气化与牙源性上颌窦炎发病的关系.方法 回顾性分析牙源性上颌窦炎患者鼻窦CT中双侧牙槽突骨质厚度、牙槽突气化深度,冠状位上颌窦高度及矢状位对角线长度,观察牙源性上颌窦炎患者双侧上颌窦气化程度的差异.结果 牙源性上颌窦炎患者患侧上颌骨牙槽突厚度:(5.67±1.79)mm,健侧上颌骨牙槽突厚度:(7.88±...     

单侧上颌窦真菌球患者上颌窦解剖参数的CT研究

目的 探讨单侧上颌窦真菌球（UMFB）与上颌窦解剖参数的关系。方法 回顾性分析55例UMFB患者的鼻窦CT资料,应用Mimics 21.0软件对双侧上颌窦进行三维重建,同时测量计算患侧与健侧上颌窦的容积、表面积、气化系数、骨壁厚度及密度等解剖参数,并对得到的数据进行统计学分析。结果 ①UMFB患者的双侧上颌窦中,患侧上颌窦容积、内表面积、气化系数、上下径均较健侧小,差异具有统计学意义（P<0.05）,而左右径、前后径的差异无统计学意义（P>0.05）;患侧上颌窦骨壁厚度及密度均较健侧大,差异具有统计学意义（P<0.05）;②UMFB患侧上颌窦解剖参数与Lund-Mackay评分均无相关性（P>0.05）。结论 UMFB更好发于上颌窦容积、表面积、气化系数以及上下径较小的一侧。上颌窦骨壁厚度及密度增大对于诊断UMFB具有一定价值。     

鼻中隔偏曲与上颌窦气化分型的相关性分析

目的 探讨鼻中隔偏曲与上颌窦气化分型的关系。方法 实验组纳入CT结果显示鼻中隔偏曲且无鼻窦合并症的患者100例,对照组为CT结果显示鼻中隔无偏曲患者60例。使用美国GE Light Speed 64层螺旋CT进行图像观测,观察上颌窦气化程度及鼻中隔偏曲的程度,比较鼻中隔偏曲与上颌窦气化之间的关系。采用SPSS 22.0软件对数据进行统计处理。结果 鼻中隔偏曲患者中,54.0%(n=54)鼻中隔偏向右侧,46.0%(n=46)鼻中隔偏向左侧;鼻中隔偏曲角度5.4°～31.1°,平均(12.8±4.1)°,鼻中隔偏曲患者与对照组相比,其性别分布差异具有统计学意义(χ²=12.62,P<0.05),性别分布与鼻中隔正常的上颌窦气化之间差异具有统计学意义(χ²=4.32,P<0.05)。Ⅰ型和Ⅲ型上颌窦与鼻中隔偏曲角度之间存在相关性(r=0.27,P<0.05)。鼻中隔是否偏曲与上颌窦的气化分型之间存在显著的关系(χ²=18.52,P<0.05)。结论 男性更容易出现鼻中隔偏曲及上颌窦过度气化。鼻中隔是否...     

正常成人上颌窦锥形束CT的影像学研究

目的：本研究将锥形束CT应用于上颌窦影像学参数的测量,并比较不同性别、左右侧上颌窦间不同参数的差异性。方法选择200例正常成人的头颅锥形束CT影像,导入InVivo Dental软件进行三维重建,测量上颌窦前后径、左右径、上下径、容积和眶下壁骨质厚度,并使用SPSS 11.5统计软件进行分析。结果双侧上颌窦组间比较,上颌窦左右径、前后径、上下径、容积和眶下壁骨质厚度的差异均无统计学意义（P均＞0.05）;在不同性别组间比较,双侧上颌窦上下径、右侧上颌窦左右径和双侧上颌窦容积的差异均有统计学意义（P均＜0.05）。而左侧上颌窦的左右径、双侧上颌窦的前后径和双侧眶下壁骨质厚度的差异均无统计学意义（P均＞0.05）。结论锥形束CT可用来测量上颌窦的影像学参数,为临床提供影像学解剖数据。     

牙源性上颌窦炎中窦腔黏膜增厚与牙根尖关联螺旋CT研究

目的：探讨牙根尖是否突入上颌窦与牙源性上颌窦炎患者窦腔黏膜厚度之间的CT影像学关联性。方法回顾性分析牙源性上颌窦炎患者52例（104侧）的螺旋CT影像学资料,评估上颌窦黏膜厚度与牙根尖是否突入上颌窦窦腔的关系。结果本组患者检出58侧（55.7%）有牙根尖突入窦腔,其中46侧（79.3%）存在上颌窦局部黏膜增厚大于2mm。牙根突入窦腔的上颌窦黏膜厚度（7.76＆#177;8.39mm）和无牙根突入窦腔的黏膜厚度（3.17＆#177;4.14mm）组间差异统计学意义显著（P=0.001）。结论螺旋CT影像提示,牙源性上颌窦炎患者上颌窦黏膜增厚的发生及其严重程度与牙根尖是否突入窦腔呈现明显的正相关。     

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     

上颌窦发育过程的CT研究

本研究对 4 8例儿童鼻窦用层距为 5mm的连续冠状 CT扫描进行上颌窦容积的测量并与既往成人鼻窦CT资料相比较。 4 8例儿童 94侧 CT分两组 ,正常组4 0侧 ,双侧鼻窦炎组 58侧 ,后者又分为手术治疗亚组16侧和药物治疗亚组 38侧。应用数学积分原理按鼻窦由前至后的冠状 CT资料计算上颌窦容积。其结果如下 :按 4～ 9岁以至 70～ 79各年龄段平均上颌窦容积的分布作成曲线呈单峰状 ,正常人组或手术治疗亚组的峰值均位于 2 0岁左右处。在 4～ 9岁年龄段 ,正常组女孩较男孩上颌窦容积大 ,这可能因为在日本该年龄段女孩发育较男孩早的缘故。从上颌…     

CT影象上颌窦壁肥厚的研究

CT在鼻窦疾患诊断上的价值已经肯定。作者研究CT影象上颌窦壁肥厚的意义,辨明炎症引起的骨壁肥厚或人为假象。对X线平片和CT影象上颌窦壁的厚度进行比较;对比手术采取的上颌窦前壁和CT影象上颌窦前壁的厚度。观察慢性上颌窦灸11例(17侧)、正常上颌窦2例(2侧)。以眶下孔下方10mm处为中心取上颌窦前壁骨片,直径约10mm,测量骨片厚度为0.1mm。CT层面通过眶下孔下方10mm处,测定影象中上颌窦前壁的厚度,并探讨上颌窦内容物CT值对测量结果有何影响。结果:一侧慢性上颌窦炎,患侧骨壁较健侧为厚     

计算机辅助婴儿鼻窦CT影像解剖学研究

目的:了解婴儿鼻窦解剖特点和发育规律,为婴儿鼻窦发育提供具体数据,为婴儿鼻窦炎的诊断治疗提供理论依据。方法:通过CT影像工作站研究36例婴儿鼻窦冠状位CT,观察各鼻窦是否发育正常,并对发育鼻窦测量左右径和上下径。结果:36例婴儿72侧(100%)额窦均未发育。72侧上颌窦均发育,左侧上颌窦左右径为(8.69±3.75)mm,上下径为(9.37±2.36)mm;右侧上颌窦左右径为(8.95±2.79)mm,上下径为(9.06±2.66)mm。72侧前组筛窦均发育,左侧前组筛窦左右径为(3.63±1.17)mm,上下径为(8.21±2.72)mm;右侧前组筛窦左右径为(3.48±1.32)mm,上下径为(8.28±2.62)mm。72侧后组筛窦均发育。左侧后组筛窦左右径为(4.09±1.13)mm,上下径为(6.61±1.36)mm;右侧后组筛窦左右径为(4.01±1.28)mm,上下径为(6.63±1.97)mm。72侧蝶窦中22侧(30.6%)可见气化腔,50侧(69.4%)未见气化腔。结论:婴儿期鼻窦开始发育,以上颌窦和前后筛窦为主,部分婴儿蝶窦开始发育,额窦未发育。     

与鼻内镜上颌窦手术视野相关的上颌窦形态特征

目的：观察与鼻内镜上颌窦手术视野相关的上颌窦形态特征。方法：通过对1000例（2000侧）正常成人的鼻窦CT（轴位＋冠状位）扫描,观察其上颌窦形态并进行分型。结果：CT显示上颌窦与手术相关的形态变化主要在其内侧壁,水平位鼻窦CT显示上颌窦内侧壁的形态在中部较恒定,一般都呈现以内侧壁为底边的三角形或半圆形,前者有857例（85．7％）,后者有143例（14．3％）;冠状位显示上颌窦内侧壁形态前、后层面较为恒定,中间层面的差异较大,有外凸形和平直形,其中外凸形341例（34．1％）,平直形659例（65．9％）。根据中间层面内侧壁的形态及上颌窦气化程度将上颌窦形态分为三型：I型662例（66．2％）,Ⅱ型265例（26．5％）,Ⅲ型73例（7．3％）。结论：上颌窦内侧壁形态影响鼻内镜中鼻道人路的上颌窦手术视野,在鼻内镜上颌窦手术前应充分考虑其形态对于手术视野及病变的清除的影响。     

Changes of maxillary sinus volume and bony thickness of the paranasal sinuses in longstanding pediatric chronic rhinosinusitis

OBJECTIVES: To evaluate the chronic bony changes in the paranasal sinuses of longstanding chronic rhinosinusitis (CRS) in pediatric patients and to compare them with normal controls. STUDY DESIGN: A single-institution retrospective analysis. METHOD: Thirty 15- and 16-year-old children with longstanding CRS, for more than 2 years, despite maximal medical treatment and had a Lund CT score over 20 were enrolled as the CRS group. They were compared with 45 age and gender matched randomly selected normal controls without CRS. No enrolled patient had a history of nasal or adenoid surgery. The volume of the maxillary sinus was measured using a three-dimensional CT reconstruction program (V-works 4.0). The bony thickness of the maxillary (MS) and ethmoid sinuses (ES) and the middle turbinate (MT) was measured and compared. In addition, we evaluated the effect of disease duration on the sinus volume and bony thickness. RESULTS: The mean volume of the MS was 22.5+/-4.4 cm(3) in the normal group and 20.0+/-4.1 cm(3) in the CRS group; this difference was statistically significant (p=0.02). However, there was no correlation found between the disease duration and maxillary sinus volume (r=-0.07, p=0.69). The mean thicknesses of the bony walls were 1.0+/-0.4 mm (MS), 0.8+/-0.4 mm (ES) and 1.8+/-0.5 mm (MT) in the normal group and 1.2+/-0.3 mm (MS), 1.2+/-0.4 mm (ES) and 2.4+/-0.5 mm (MT) in the CRS group; these differences were significant (p<0.01). In addition, the bony thickness of the ES was significantly correlated with the duration of symptoms (r=0.44, p=0.03). CONCLUSION: The volume of the maxillary sinuses decreased and the bony thickness of the paranasal sinuses increased with longstanding pediatric CRS.     

Long-term results following reconstruction of maxillary sinus wall defects with titanium micro-mesh: a CT-based study]

BACKGROUND: Extensive bony defects of maxillary sinus walls have to be reconstructed to prevent long-term complications. Different autogenous, allogeneic, and alloplastic materials, e.g., titanium mesh, are used for reconstruction. MATERIAL AND METHODS: In 26 patients large defects of the facial and laterodorsal walls of the maxillary sinus were reconstructed using titanium micro-mesh. The mean follow-up period was 49 months (5 months-10 years). All patients were examined with computed tomography applying multiplanar reconstruction techniques and three-dimensional volume rendering. RESULTS: In the CT scans stable scars of 3-6 mm thickness could be found on the antral surfaces of all titanium meshes bridging the defects. In 70% of the patients the volume of the reconstructed maxillary sinus reached 80-100% of the contralateral side. Volume losses were not due to poor adaptation of the titanium mesh but were caused by thickening of maxillary sinus walls or traumatic malpositions. In 77% of the patients ventilation of the maxillary sinus was undisturbed. After mesh removal neither facial contour disturbances nor changes of sinus volume were noted. Soft tissue invasion into the sinus was prevented by a stable scar which had formed underneath the mesh. Three-dimensional reconstruction confirmed symmetrical facial contours in all patients. CONCLUSIONS: The titanium micro-mesh offers a simple and effective alternative to autogenous tissue with stable long-term results for reconstruction of large maxillary sinus wall defects.     

诱生型一氧化氮合酶在慢性上颌窦炎黏膜的表达

目的 观察诱生型一氧化氮合酶(inducible nitric oxide synthase，iNOS)在慢性鼻窦炎病人鼻窦粘膜中的表达。方法 将实验分为两组：对照组为正常成人，无鼻窦病变。实验组为确诊为慢性上颌窦炎的病人。在局麻鼻内镜下行鼻窦黏膜活检，石蜡包埋、切片，用免疫组织化学的方法观察iNOS在两组上颌窦黏膜中的表达。结果 iNOS在正常上颌窦炎黏膜呈阴性表达，在慢性上颌窦炎黏膜呈阳性表达，阳性区域主要在黏膜上皮细胞。结论 iNOS在慢性上颌窦炎黏膜呈阳性表达，提示一氧化氮在慢性上颌窦炎的发病机制中起重要作用。     

Microbial flora of nose and paranasal sinuses in chronic maxillary sinusitis

Nasal secretions, maxillary sinus aspirates and specimens of the maxillary sinus mucosa were collected in 44 patients aged between 25 and 60 affected by mono- or bilateral chronic maxillary sinusitis, in order to establish the best sampling technique for microbiological purposes, the most frequently involved bacteria and the physiopathological mechanism underlying chronic maxillary disease. The sinusal mucosa resulted to be the most reliable sample as it reduces contamination and microbial variability. Anaerobic bacteria were isolated in nasal swab (15.6%), in maxillary sinus aspirates (30.4%) and in maxillary sinus mucosa (36.4%) of maxillary sinusitis patients. In controls anaerobic bacteria were isolated only in one nasal swab (2.3%), while they could not be isolated in maxillary sinus aspirates and in maxillary sinus mucosa. The presence of anaerobic bacteria in chronic maxillary sinusitis patients and their absence in controls seem to confirm that anaerobic microorganisms represent the main pathogenetic agents of chronic maxillary sinusitis. The possible physiopathological mechanisms underlying chronic maxillary sinus disease are finally discussed.     

Surgical revision of the post-Caldwell-Luc maxillary sinus

BACKGROUND: Endoscopic sinus surgeons are commonly faced with the management of patients with persistent maxillary sinusitis despite previous Caldwell-Luc surgery. Given the potential for altered mucociliary clearance in the post-Caldwell-Luc maxillary sinus, the optimal approach for surgical revision has not been well characterized. The objective of this study was to review our experience in endoscopic versus repeat Caldwell-Luc approaches in patients who have failed Caldwell-Luc surgery for chronic maxillary sinusitis. METHODS: Retrospective chart review was performed on patients who had a history of a Caldwell-Luc procedure and who then underwent a surgical revision for persistent maxillary sinusitis at the Oregon Health and Science University and Medical College of Wisconsin between 1983 and 2002. RESULTS: Sixty-eight patients were identified, with a total of 156 revision procedures performed on 103 maxillary sinuses. Fifty-three percent of the sinuses underwent endoscopic maxillary antrostomy as the first surgical revision, while 47% underwent a revision Caldwell-Luc procedure. Sixty-seven percent of the sinuses in the revision endoscopic group had clinical resolution with a single surgical revision, and 60% of the sinuses in the revision Caldwell-Luc group had clinical improvement with one surgical revision (p = 0.46). The endoscopic group averaged 1.3+/-0.5 revision procedures per sinus to achieve clinical resolution, and the revision Caldwell-Luc group averaged 1.7+/-1.0 revision procedures per sinus (p = 0.3). Mean follow-up was 25 months. CONCLUSION: Endoscopic revision of the maxillary sinus yields comparable outcomes to repeat Caldwell-Luc procedure in patients with a history of previous failed Caldwell-Luc surgery. Endoscopic revision surgery is a viable alternative for surgical rehabilitation of the post-Caldwell-Luc maxillary sinus.     

扩大鼻内镜上颌窦手术视野的解剖学研究

目的:通过对鼻腔和上颌窦相关解剖结构的观测,寻找扩大鼻内镜上颌窦手术视野的解剖学方法,为获得满意的手术视野提供指导。方法:以30例(60侧)经4%甲醛固定的成人尸头(男21例,女9例)为研究对象,去除鼻腔外侧壁的黏膜,保留各个重要骨性结构的完整性,以骨性鼻泪管和下鼻甲骨附着缘为标志,观察测量相关结构的解剖特点以及与周围毗邻结构的位置关系。通过解剖学观测,寻找影响鼻内镜下扩大上颌窦手术视野的解剖学因素。结果:骨性鼻泪管前界上、中、下端到上颌窦前壁与内侧壁交界的水平距离分别为0、(1.90±1.03)、(3.29±1.04)mm;骨性鼻泪管前下端到下鼻甲前缘的水平距离为(5.13±0.62)mm,到鼻底的垂直距离为(16.89±0.97)mm,左右侧测量数据差异无统计学意义。去除的骨质范围:下鼻甲附着缘以上部分上下径为(9.43±1.72)mm,前后径由上往下为(9.76±0.83)、(11.39±0.50)、(12.85±0.66)mm,下鼻甲附着缘以下部分上下径为(13.52±0.83)mm,前后径由上往下为(19.89±1.37)、(16.59±0.77)、(12.48±0.91)mm。结论:鼻内镜下中鼻道入路的上颌窦手术视野,受上颌窦口前方的骨性鼻泪管、上颌骨额突及下方的下鼻道外侧壁骨质的影响而无法充分显露,同过去除窦口周边无用的骨质而保留重要结构,可以扩大内镜下中鼻道入路上颌窦手术的视野,利于彻底清除上颌窦内底壁、前壁的病变。     

Saccharin test of maxillary sinus mucociliary function after endoscopic sinus surgery

OBJECTIVES: To determine the usefulness of the saccharin time (ST) test for evaluating the mucociliary function of the maxillary sinus after endoscopic sinus surgery (ESS) for chronic sinusitis. STUDY DESIGN: METHODS: This study was conducted on 88 maxillary sinuses of 74 patients after ESS. The maxillary sinus fontanel was broadly opened via the middle meatus using an endoscope, and a saccharin granule was adhered to the bottom of the maxillary sinus mucosa The time until the patient recognized the sweet taste was recorded. Before the ST test, the bilateral maxillary sinuses were classified into the following four groups on the basis of the post-ESS severity of mucosal edema and swelling as revealed by endoscopic observation: normal (45 sinuses), mild mucosal edema and swelling (24), moderate mucosal finding (14), and severe mucosal finding or filling of the sinus with a polyp(s) (5). RESULTS: The mean ST values in the normal group and the groups with mild, moderate, and severe mucosal edema and swelling were 35.7, 38.1, 63.6, and 88.0 minutes, respectively. Thus the ST increased with the post-ESS severity of the mucosal lesion. However, for the group with mild mucosal edema and swelling, scanning electron microscopic observation of three maxillary sinuses in which the ST exceeded 120 minutes and four sinuses in which the ST was 40 minutes revealed extensive cilia loss in the former sinuses, but not in the latter. A second post-ESS endoscopic observation was performed in 17 patients, revealing improvement in 11 sinuses, no change in 5 sinuses, and aggravation in 1 sinus (compared with the initial test). The ST test was also repeated, revealing that the ST became shorter in most of the endoscopically improved sinus group. However, a few sinuses showed a discrepancy between the change in the endoscopic findings and the ciliary function (ST). CONCLUSION: Measurement of the maxillary sinus ST is a simple, accurate, and useful technique for assessing the post-ESS mucociliary function in conjunction with endoscopy, and the information gained can help in deciding subsequent therapy.     

Clinical feature of odontogenic maxillary sinusitis--symptomatology and the grade in development of the maxillary sinus in cases of dental maxillary sinusitis

Odontogenic maxillary sinusitis may occur by draining of an apical dental root abscess into the maxillary sinus. It has been reported that the disease is usually frequent in cases aged of the second and third decades. In most of them, either the first or second molar tooth is assumed to be the origin of the disease. As clinical characteristic symptoms, it is mentioned that an acute unilateral sinusitis appears since the onset and the patient complains a fetid purulent nasal discharge from an early stage. The symptom and its clinical time course in 43 cases with dental maxillary sinusitis, who had been treated by surgical procedures in ENT Clinic in Kitasato University Hospital during past 14 years from 1972 to 1985, were studied retrospectively. The size of the affected maxillary sinus in each case of the disease was measured from the X-ray films. An influence of development of the maxillary sinus to the occurrence of dental sinusitis was discussed by comparing the sizes of the maxillary sinuses in both the group of the disease and the group of simple unilateral maxillary sinusitis.