云南地区正常儿童与鼻窦炎患儿鼻窦发育情况比较

目的:研究我国儿童的鼻窦发育规律,探讨儿童鼻窦炎性疾病与鼻窦发育的相关性,为儿童鼻窦及其相关疾病的治疗提供依据.方法:随机选取无鼻窦相关病史儿童1705例及有鼻窦相关病史患儿1424例,均行螺旋CT检查,测量各鼻窦矢状径、冠状径及上下径,并进行统计分析.结果:有鼻窦病史者各鼻窦发育径线值均大于无病史者(P<0.01);经Pearson相关性分析,性别与鼻窦相关病史间差异无统计学意义(P>0.05),儿童年龄与鼻窦相关病史有低度相关(P<0.01),CT影像学诊断与临床鼻窦炎诊断有中高度一致性.结论:鼻窦炎患儿与正常儿童之间鼻窦发育存在差异,鼻窦炎患儿鼻窦总体发育好于正常儿童.     

儿童鼻窦骨纤维异常增殖症1例

患者,女,11岁,因发现鼻窦内肿物半个月,于2004年8月18日入院,6年前发现突眼,视物侧头,视力减弱,并进行性加重,无进食饮水增多及体重降低。休检：双侧眼球突出,右侧较明显,运动可：双侧瞳孔等大等圆,直接及间接对光反射可引出。右侧面额肿胀,表面皮肤无充血,无庄痛。咽部无充血,双侧扁桃体Ⅱ度,右侧扁桃体上极可见毛细血管充盈,     

儿童鼻窦-前颅底骨化纤维瘤1例

患者,女,14岁。因鼻塞、突眼伴视物模糊6个月于2003年8月12日入院。鼻窦CT扫描示：右侧筛窦及额窦实变,可见不规则分叶状囊性占位,肿块呈膨胀性生长,密度不均匀,病变累及并侵犯前颅底和右侧眼眶内侧壁,局部骨质破坏明显,并见软组织肿块影,CT值26～490HU,其内有程度不同的高密度钙化,周围组织受压变形,边界尚清晰。增强扫描：肿块密度轻度增高。临床拟诊：     

儿童鼻窦手术的软组织电动切削器

本文主要介绍了儿童鼻窦手术中软组织电动切削器的作用原理,功能,优点,适用范围。     

儿童鼻腔鼻窦占位病变的临床分析

目的　探讨儿童鼻腔鼻窦占位病变的诊断及治疗方法。方法　回顾性分析我科2008年1月～2013年6月收治的68例鼻腔鼻窦占位病变患儿,全部患儿行前鼻镜、鼻 咽镜及CT检查。结果　52例接受鼻内镜肿物切除术。病理：炎性息肉46例,毛细血管瘤4例,良性幼年型血管内皮瘤1例,鼻中隔化脓性肉芽肿1例。12例行鼻内镜肿物活检术,其中Burkit淋巴瘤2例,结外NK/T细胞淋巴瘤2例,原始神经外胚层肿瘤2例,急性淋巴细胞白血病1例,神经母细胞瘤1例,上颌窦非角化上皮鳞状细胞癌1例,上颌窦黏液性软骨肉瘤1例,朗格汉斯细胞增生症1例,骨纤维异常增殖症1例。结论　儿童鼻腔鼻窦占位病变不能完全复制成人的诊疗思路,应以儿童生理、病理特点出发,提出特有的诊疗流程。     

PROPELLER Duo DW-MRI鉴别鼻腔鼻窦内翻性乳头状瘤与鼻腔鼻窦鳞状细胞癌的价值

目的　通过周期性旋转重叠平行线采集和增强处理重组（PROPELLER）Duo DW-MRI对鼻腔鼻窦内翻性乳头状瘤（sinonasal inverted papilloma,SNIP）与鼻腔鼻窦鳞状细胞癌MR定量分析,评估表面弥散系数（apparent diffusion coefficient,ADC）值对鉴别二者的价值。方法　回顾性分析经手术病理证实的SNIP 61例、鼻腔鼻窦鳞状细胞癌41例患者的脂肪抑制PROPELLER Duo DW-MRI资料（b值0、1000 s/mm2）,采用病变最大层面感兴趣区（ROI）和局部ROI（ADC值最小区域,圆形,面积30 mm2）两种方法分别测量ADC值（简称最大层面ADC值、最小ADC值）。采用独立样本t 检验比较两种肿瘤ADC值有无差异,通过ROC曲线分析ADC值对鉴别二者的能力。结果　两种测量方法获取的鼻腔鼻窦鳞状细胞癌的最大层面ADC值、最小ADC值均低于SNIP（P 均=0.000）,最大层面ADC值大于最小ADC值（P =0.000）。以1.46×10-3mm2/s为临界值,最大层面ADC值鉴别鼻腔鼻窦鳞状细胞癌与SNIP的ROC曲线下面积为0.979;以1.40×10-3mm2/s为临界值,最小ADC值鉴别鼻腔鼻窦鳞状细胞癌与SNIP的ROC曲线下面积为0.948,最大层面ADC值鉴别鼻腔鼻窦鳞状细胞癌与SNIP的能力高于最小ADC值（P =0.018）。结论　PROPELLER Duo DW-MRI在SNIP与鼻腔鼻窦鳞状细胞癌的鉴别诊断中具有重要价值。     

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.     

鼻腔鼻窦占位性病变累及颅底的手术处理

报告２９例鼻腔、鼻窦占位性病变累及颅底的病例。其中良性病变１２例。恶性病变１７例。经鼻侧进路手术１７例，颅鼻联合进路６例，上颌骨截除并眶内容剜出３例，经额和经面中部揭翻入路各１例，还有１例行颈廓清后干颈外动脉插管作区域性化疗。其中有１８例行颅底骨缺损修复。修复材料为自体筛骨垂直板、犁骨、鼻中隔软骨、中鼻甲和额骨或额窦内板。１４例脑膜修补，修补材料为自体肌肉、筋膜和帽状健膜等，除１例因手术进路选择不当术后发生脑脊液漏外，其余病例未发生术后并发症。重点讨论了这类病例的手术进路选择、颅底和脑膜缺损修复方法等。     

鼻窦内窥镜手术处理儿童泡性中甲

大约５％～１０％的儿童在上呼吸道感染的后期并发鼻窦炎［１］。随着小儿鼻窦炎的日益被重视，越来越多的研究认为骨质解剖结构的变异是儿童鼻窦炎的主要病因，泡性中甲即为其中之一，发生率在５％～３０％之间［２，３，４］，且多为双侧性［５，６］。目前认为其有两种致病机理：一是直接或通过向外挤压钧突阻塞前筛、额窦或上颌窦的引流［５］；二是中甲的泡性增大使中甲的外侧与鼻腔外侧壁的粘膜相贴，可能导致粘膜纤毛清理功能的机制失常［７］，同时释放出神经肽物质导致局部炎症［８］。但泡性中甲与鼻窦炎之间的确切关系尚不是很清…     

Aneurysmal bone cyst of paranasal sinuses

Aneurysmal hone cyst is rare in paranasal sinuses. It may be uni or multilocutar It occurs alone or with other benign bone lesions. The exact pathogenesis of it is still unknown. The aggressiveness of the disease needs early diagnosis and proper management to prevent recurrence. This report describes a case of aneurysmal bone cyst involving the ethmoid and maxillary sinuses which was successfully managed.     

CT findings of aspergillosis in the paranasal sinuses

Summary The diagnosis of aspergillosis in the paranasal sinuses is preoperatively difficult to make in spite of the increasing number of reports showing its prevalence. However, because symptoms are usually non-diagnostic and infection is usually confined to a single sinus, X-ray findings are often suspect for possible neoplasm. We have studied six patients with aspergillosis, all of whom were suspected of having sinus tumors, but were otherwise healthy persons. Affected sinuses were examined by CT and the diagnosis of non-invasive aspergillosis was confirmed by operation. In this report, we have compared the CT and X-ray findings in our cases of aspergillosis. These findings indicate that CT is useful in the preoperative diagnosis of sinus aspergillosis.     

鼻内镜术治疗非侵袭性鼻窦真菌病

目的分析鼻内镜术治疗非侵袭性鼻窦真菌病的疗效.方法回顾性分析我科1998～2003年间经鼻内镜术治疗的20例非侵袭性鼻窦真菌病的临床资料.结果全部病例均治愈,随访6个月～5年,未见复发.结论鼻内镜术是治疗非侵袭性鼻窦真菌病较为理想的方法.     

Volumetric evaluation of the paranasal sinuses in normal subjects using computer tomography images: a stereological study

OBJECTIVE: The size and shape of paranasal sinuses are especially relevant when considering endoscopic sinus surgery. For this reason, the size of the paranasal sinuses has been the subject of many studies, none of which has used stereological methods to estimate the volume. In the present stereological study, we estimated the volume of paranasal sinuses of normal males and females. MATERIAL AND METHODS: We used a combination of the Cavalieri principle and computer tomography scans taken from 39 male and 38 female patients to estimate the volumes of frontal, maxillary, ethmoidal and sphenoidal sinuses. RESULTS: The mean volumes of frontal, maxillary, ethmoidal and sphenoidal sinuses were estimated bilaterally, producing mean volumes of 11.6+/-0.8, 35.9+/-1.3, 11.8+/-0.4 and 13.6+/-0.7 cm(3), respectively. When the correlations between estimated volumes were analyzed statistically a positive relation was found for the paranasal sinuses. The size of the sinuses tends to decrease with age. CONCLUSION: The findings of the present study using the stereological methods could provide data for the evaluation of normal and pathological volumes of the paranasal sinuses.     

Masses of nasal cavity, paranasal sinuses and nasopharynx: A clinicopathological study

An analysis of clinicopathological features of 240 cases presenting as mass in nasal cavity, paranasal sinuses and nasopharynx observed, both retrospectively and prospectively, over a period of 5 years in Jawaharlal Nehru Medical College. Aligarh. The incidence of masses in nasal cavity, paranasal sinuses and nasopharynx was 34.3 cases per year. Amongst the 240 cases studied, there were 144 cases (60%) of non-neoplastic lesions, 56 cases (23.33%) of benign lesions and 40 cases (16.67%) of malignant lesions. All age groups were involved and the mean age of presentation with the increasing age were: — non-neoplastic (22.5 years), benign tumors (26.8 years) and malignant tumors (35.3 years). The male to female ratio was 1.7:1 for non-neoplastic lesions; 3:1 for benign tumors: and 2.3:1 for malignant lesions. In this study maximum number of cases were present in nasal cavity (65%) followed by paranasal sinuses (20%) and least number of cases involved the nasopharynx (15%). The relative number of non-neoplastic and neoplastic lesions varies from region to region. A provisional diagnosis was made after clinical assessment and radiological investigation but final diagnosis was made after histopathological examination.     

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     

Unilateral pathological lesions of paranasal sinuses removed by endoscopic surgery

Introduction

The aim of this study was to analyze the incidence and nature of unilateral pathological lesions of paranasal sinuses in patients who had endoscopic sinus surgery performed in ENT. Materials and methods: In the years 2006–2011 endoscopic sinus surgery for unilateral pathological lesions of paranasal sinuses was performed in 1847 patients (838 women and 1009 men). The enrollment of patients was based on the findings of otolaryngological clinical and subjective examinations, assessment of the paranasal sinuses on three-dimensional CT scans, and laboratory examinations. Based on the analysis of medical history data, including gender, age, the type of surgical procedure performed, and histopathological findings the cases were finally analyzed.

Results

Pathological lesions of the paranasal sinuses were localized on the left side in 132 (57%) patients, and on the right side in 100 (43%) patients. Of the 232 patients with unilateral pathological changes, 41.8% subjects underwent endoscopic sinus surgery for polypotic changes in the ethmoid and maxillary sinuses; 28.4% for the maxillary sinus; 10.8% for the ethmoid, maxillary and frontal sinuses; and 8.6% patients for all paranasal sinuses on one side. The number of operations of only one sinus was considerably lower: sphenoid sinus, 4.7%; ethmoid sinus, 2.2%; and frontal sinus, 1.7% patients. The histopathological analysis of unilateral pathological lesions removed by endoscopic surgery showed chronic paranasal sinusitis with polyps in 56.5% patients; chronic paranasal sinusitis in 22.8% patients; and maxillary sinus cyst was confirmed in 11.6% patients. In 5.1% patients inverted papilloma was diagnosed and in 2.2% patients the presence of osteoma was found.

Conclusions

Unilateral paranasal pathological lesions, leaving aside rather typical maxillary sinus cysts, require a particularly thorough pre-operative diagnosis and a precise histopathological assessment.     

Volumetric study in the development of paranasal sinuses by CT imaging in Asian: A Pilot study

Background and objectives

The volume of the air cavities in the paranasal sinuses is not only the simplest, but also the most important index for paranasal sinus evaluation. However, few volumetric studies have been performed in all age groups. The purpose of the current study was to outline the normal development of paranasal sinuses in all age groups, and to determine normal adult volumetric values by means of computed tomographic (CT) scan of paranasal sinus using volumetric procedures.

Materials and methods

A prospective volumetric CT study was conducted with 260 patients (520 sides) < 25 years of age by means of three-dimensional reconstruction.

Results

The frontal sinuses began to pneumatize at 2 years of age, exhibited a faster growth pattern between 6 and 19 years of age, and the mean volume after full growth was 3.46 ± 0.78 cm³. The maxillary sinuses were pneumatized at birth in all cases, exhibited a monomodal growth pattern increasing until 15 years of age, and the mean volume after full growth was 14.83 ± 1.36 cm³. The floor of the sinus was the same level as the floor of the nasal cavity was between 7 and 15 years of age. The ethmoid sinuses exhibited a faster initial tendency to increase until 7 years of age, were completed by 15-16 years of age, and the mean volume after full growth was 4.51 ± 0.92 cm³. The sphenoid sinuses exhibited a growth spurt between 6 and 10 years of age, were completed by 15 years of age, and the mean volume after full growth was 3.47 ± 0.93 cm³.

Conclusion

The results of this study are presented to provide the basis for an objective normal volume of sinus development and for studies involving diseases of the sinuses.     

Solitary fibrous tumor of the paranasal sinuses

Although solitary fibrous tumors are well-recognized in the pleura, their occurrence in the paranasal sinuses is decidedly uncommon. We have encountered two cases of solitary fibrous tumors in the paranasal sinuses and report the clinicopathological findings including CD34 immunoreactivity. One tumor arose in a 55-year-old Japanese businessman and the other in a 53-year-old man who had been in the hospital for schizophrenia for 20 years. The tumors showed characteristic findings. Immunoperoxidase stains on paraffin sections showed staining of the cells for anti-vimentin, but there was no staining for anti-keratin, anti-S-100 protein, anti-desmin, anti-glial fibrillary acidic protein (GFAP), or anti-actin. Anti-CD34 monoclonal antibodies also reacted with these tumors, as those of the pleura generally do, and were found to be useful in diagnosing these tumors. Received: 25 November 1998 / Accepted: 4 December 1998