上颌窦曲菌病内窥镜手术治疗(附15例报告)

目的探讨鼻窦内窥镜下改良柯-陆手术治疗上颌窦曲菌病的临床应用价值.方法回顾分析15例上颌窦曲菌病患者经鼻窦内窥镜施行改良柯-陆手术的临床资料.结果 15例患者经上颌窦前壁钻孔行鼻腔内窥镜手术,术后症状消失,内窥镜下创面愈合,窦口开放良好,窦腔黏膜上皮化;随访2年,症状无复发.结论该术式观察方便、出血少、反应轻、操作方便、并发症少及术后复发率低.     

电子鼻咽喉镜在鼻内镜鼻窦手术中的应用

目的 探讨鼻内镜结合电子鼻咽喉镜在鼻窦手术中的应用.方法 对32例上颌窦侧壁与底壁交界处囊肿,16例蝶窦囊肿,12例真菌球性上颌窦炎,采用鼻内镜和电子鼻咽喉镜相结合进行手术治疗.结果 所有患者均一次手术成功,术中出血较少,平均约(20±3)mL.术后随访6个月,复查见鼻窦自然开口均无闭锁或粘连,所有患者均未见复发.结论 鼻内镜结合电子鼻咽喉镜在鼻窦手术中,尤其是对上颌窦前壁、前壁与底壁交界处,蝶窦底壁、侧壁病灶的清除,能在尽可能减少窦口开窗范围的情况下,充分发挥各内镜的优点,以达到微创目的.     

两种术式治疗非侵袭性真菌性上颌窦炎的效果

目的 比较鼻内镜下上颌窦开放术和上颌窦根治术治疗非侵袭性真菌性上颌窦炎的疗效.方法 本科收治的真菌性上颌窦炎患者89例(102侧),将其分为两组,A组39例(49侧,经鼻内镜开放上颌窦自然口并保留鼻窦黏膜);B组50例(53侧,上颌窦根治术+下鼻道造口术).术后6个月开始随访,24个月时终止.结果 (1)术后疗效:A组显效36例(92.3%),B组35例(68.6%),两组显效率比较差异有统计学意义(P＜0.05).(2)鼻窦局部形态:A组窦口引流通畅,窦内黏膜恢复好39侧(79.6%),迁延性炎性反应9侧(18.4%),寞口闭塞1侧(2.0%);B组下鼻道造口引流通畅、窦内光滑13侧(24.5%),下鼻道造口狭窄、窦内纤维结缔组织增生或瘢痕样组织增厚26侧(49.1%),窦口闭塞14侧(26.4%),两组间差异具有统计学意义(P＜0.05).结论 鼻内镜上颌窦开放术并保留实腔黏膜治疗真菌性上颌窦炎效果优于传统上颌窦根治术.(中国眼耳鼻喉科杂志,2008,8:357-359)     

鼻内窥镜手术(二)

(二)根治性筛窦手术(全蝶筛开放术) 　　如果病变已累及多组鼻窦或在多发性鼻息肉的情况下,尤其既往已有鼻窦手术史的患者,则需要作根治性筛窦手术.此时切除的范围应包括全部前后组筛窦气房,开放上颌窦口,并根据具体情况扩大额窦开口和打开蝶窦前壁.按功能性鼻内窥镜手术的方法处理前组筛窦以后,以眼眶纸样板为外界向后打开后组筛窦并清除周围的全部气房.视病情和蝶窦开口情况决定是否打开蝶窦前壁. 　　……     

球囊管扩张术治疗儿童先天性泪道阻塞的临床观察

目的 观察球囊管扩张术治疗儿童先天性泪道阻塞的手术方法、疗效与并发症.方法 前瞻性研究.2008年5月至2009年10月,对就诊于首都医科大学附属北京儿童医院眼科的31例(50只眼)泪道探通、插管和激光术后失败的先天性鼻泪管阻塞患儿进行全身麻醉下鼻泪管球囊管扩张术,探针经泪小管探通直至鼻泪管,顺行插入尾端带有球囊的导管探针,进行鼻泪道球囊管扩张.手术前后进行症状评估、荧光染料消失试验以及泪道冲洗检查,同时对术中出血、水肿、假道形成等并发症进行观察与分析.随访时间为术后4～17个月.结果 50只眼中44只眼治愈,总成功率为88.0%(95%CI 85.5%～96.9%),荧光染料消失试验40只眼(80.0%)显示为1级或0级.主要术中并发症有10只眼(20.0%)鼻腔少量出血,有2只眼(4.0%)出现泪小点裂伤.结论 球囊管扩张术是一种便捷、安全、有效,不破坏局部解剖结构的新型儿童泪道手术方法,可用于泪道探通、插管或泪道激光手术失败后的儿童先天性泪道阻塞治疗.

Abstract：

Objective To introduce the procedure of balloon dacryocystoplasty and to evaluate its effectiveness and complications as the treatment of congenital nasolacrimal duct obstruction after a previous unsuccessful surgery. Methods Prospective case series. Balloon dacryocystoplasty was performed under general anesthesia in 50 eyes of 31 children with congenital nasolacrimal duct obstruction following previous unsuccessful surgery in Beijing Children's Hospital between May 2008 and October 2009. A probe was introduced through the punctum into the inferior meatus of the nasal cavity. A deflated balloon catheter was introduced anterogradely and the balloon was inflated several times to perform the dilation of the nasolacrimal duct. Treatment success was defined as absence of epiphora and mucous discharge,negative results of fluorescein dye disappearance test(FDDT) and the unobstructed irrigation of the lacrimal system during the follow-up period of 4 - 17 months after tube removal. Results Successful operation was reported in 44 of 50 eyes ( 88.0%;95% confidence interval 85.5% - 96. 9% ). Forty of 50 eyes were FDDT 0 - 1(80. 0% ). Major complications included epistaxis (10 eyes,20. 0% ) and lacrimal duct laceration (2 eyes,4. 0% ). Conclusion Balloon dacryocystoplasty is a safe,simple and effective procedure for congenital nasolacrimal duct obstruction following previous unsuccessful surgery without disturbing the anatomy of normal lacrimal drainage system.     

鼻内镜术后闭角型青光眼急性发作1例

患者,男性,63岁.因双侧鼻塞10年,睡眠时打鼾6年,以"阻塞性睡眠呼吸暂停综合征(中度)、慢性鼻窦炎、慢性鼻炎"诊断入院.患者既往患有高血压病,无青光眼病史.鼻内镜检查见双侧下鼻甲肥大,双侧钩突异常肥大,鼻窦CT检查见双侧筛窦、上颌窦炎症改变,入院后在局部麻醉下行鼻内镜鼻窦功能性手术,下鼻甲部分切除术.术中将双侧钩突完全切除,上颌窦口扩大,前筛完全开放,术中多次嘱咐患者注意眼部情况,均未见异常.     

鼻内镜手术治疗鼻窦炎鼻息肉280例

目的 探讨鼻内镜手术治疗鼻窦炎及鼻息肉的疗效及影响疗效的相关因素.方法 回顾分析我科行鼻内镜手术280例患者的临床资料.结果 随访6～12个月,治愈211例(75.3%),好转55例(19.7%),无效14例(5%).术中无严重并发症发生.术后并发症包括大出血5例,眼部并发症10例,鼻腔粘连18例,窦口闭锁6例.复发23例(8%).结论 熟练的麻醉技术、术者丰富的操作经验、恰当的术后处理、定期合理的鼻内镜随访是保证鼻内镜鼻窦手术远期疗效、降低手术并发症的关键.(中国眼耳鼻喉科杂志,2009,9:165-166)     

微创折叠球囊巩膜外加压治疗孔源性视网膜脱离的临床研究

目的:探讨微创折叠球囊巩膜外加压治疗孔源性视网膜脱离(RRD)的临床效果。方法:回顾性研究。收集2023-05/07于我院采用折叠球囊行微创巩膜外加压术连续治疗的RRD患者11例11眼,术中均采用结膜下麻醉、不做肌肉牵拉线、不做术中视网膜裂孔定位,不做视网膜冷冻和视网膜下放液、不做球囊巩膜固定缝线,观察手术最佳矫正视力(BCVA)、眼压和术后并发症。结果:纳入11眼中视网膜成功复位10眼(91%),1眼(9%)术后视网膜再脱离,因多发视网膜裂孔行玻璃体切除联合硅油填充术。成功行球囊顶压手术的10眼中球囊顶压一次成功4眼(40%),球囊顶压后行玻璃体注气1眼(10%),球囊顶压后再次调位3眼(30%),球囊顶压后再次调位及玻璃体腔注气2眼(20%);5眼(50%)术后4-12 wk行球囊取出,视网膜脱离无复发;术前平均最佳矫正视力(LogMAR)为1.30±1.10,术后4 wk为0.37±0.39(P<0.01);术前平均眼压11.51±3.37 mmHg,术后4 wk为13.72±2.57 mmHg(P>0.05)。所有患者术后均未发生严重并发症。结论:微创折叠球囊巩膜外...     

微创结膜囊鼻腔吻合术治疗完全性上下泪小管阻塞

目的：探讨微创结膜囊鼻腔吻合术治疗完全性上下泪小管阻塞的有效性,并评价这种手术的优势、术后并发症及患者满意度。
　　方法：选取完全性上下泪小管阻塞患者22例22眼作为研究对象,施行微创结膜囊鼻腔吻合术。术后随访3~27mo,记录患者的人口学数据、手术时长、义管长度、随访时间、义管的通畅情况、术后并发症、对手术是否满意,分析数据结果,评价微创结膜囊鼻腔吻合术的临床意义。
　　结果：手术总体成功率为95%(21/22),患者总体满意度为68%(15/22)。术后并发症包括鼻腔肉芽组织包裹义管下口2例(9%),中鼻甲黏膜堵塞义管下口3例(14%),鼻黏膜覆盖义管下口1例(5%),义管管腔被分泌物堵塞5例(23%),异物不适感10例(45%),干眼2例(9%),鼻腔分泌物逆流入结膜囊8例(36%)。
　　结论：微创结膜囊鼻腔吻合术可有效治疗完全性上下泪小管阻塞。手术方法操作简单,成功率高,手术时间短,组织损伤小,并发症少,且不遗留面部皮肤瘢痕。     

基层医院开展鼻内镜鼻窦手术的体会（附238例报告）

鼻内镜鼻窦手术的目的是在彻底清除病变组织的基础上，尽可能地保留鼻腔、鼻窦的正常黏膜和结构，形成良好的通气和引流，以达到其自身功能的恢复。笔者所在的基层医院，开展鼻内镜鼻窦手术的时间尚短，现就该手术在基层医院开展过程中术前诊断、术中处理以及术后随访等相关问题作些肤浅的探讨。     

Frontoethmoidal mucocele presenting with ocular manifestations

Mucocele of the paranasal sinuses is a slowly expanding benign lesion developing when there is impeded physiological drainage of the mucous produced by the epithelial lining of the paranasal sinuses, at the sinus ostium, which is an opening that connects the sinus to the nasal cavity. Aetiologies of ostial occlusion include infection, allergy, trauma, previous surgery, benign neoplasm (osteoma or fibrous dysplasia), and malignant or metastatic tumours. Mucoceles commonly develop in the frontal sinus (70–80 per cent), followed by the ethmoid (25 per cent), frontoethmoidal (10–14 per cent), and maxillary (three per cent or less) sinuses. The most common manifestations in these cases are ocular oedema, proptosis (22–83 per cent), and diplopia (28 per cent). Due to these ocular signs and symptoms, the optometrist may be first in line managing paranasal sinus disease patients, reducing the risk of permanent damage. A case report and review of frontoethmoidal mucocele will be discussed in this report, to include the role of the optometrist in its management and treatment.     

Ophthalmic complications of endoscopic sinus surgery

The intimate anatomical relationship between the orbit and the paranasal sinuses places the orbit and its contents at risk of harm from primary pathologic processes of the sinuses. In the absence of ophthalmic signs or symptoms, ophthalmologists are not routinely involved in the management of patients with sinus disease. Occasionally, some patients may develop ophthalmic complaints after surgical intervention. The orbit, optic nerve, extraocular muscles, and lacrimal drainage system are susceptible to injury during endoscopic sinus surgery. The risk of injury is related to the skill of the sinus surgeon, history of previous surgery, extent and severity of disease, and anatomic variation. Furthermore, recent advances in endoscopic sinus surgery, in particular the use of powered cutting instruments, has resulted in a novel mechanism of injury to the ocular structures.     

Major orbital complications of endoscopic sinus surgery

BACKGROUND: The paranasal sinuses are intimately related to the orbit and consequently sinus disease or surgery may cause severe orbital complications. Complications are rare but can result in serious morbidity, the most devastating of which is severe visual loss. METHODS: A retrospective review was undertaken of four cases of severe orbital trauma during endoscopic sinus surgery. RESULTS: All the cases suffered medial rectus damage, one had additional injury to the inferior rectus and oblique, and two patients were blinded as a result of direct damage to the optic nerve or its blood supply. CONCLUSION: Some ophthalmic complications of endoscopic sinus surgery are highlighted, the mechanisms responsible are discussed, and recommendations for prevention, early recognition, and management are proposed.     

Inverted papilloma presenting as unilateral proptosis: A case report with review of literature

Inverted papilloma is an interesting benign tumour arising from lining epithelium of paranasal sinuses which most commonly involves nasal cavity and paranasal sinuses. However, involvement of orbit and intracranial extension without malignant transformation is very rare. We report a case of extensive inverted papilloma of frontal sinus which primarily presented with proptosis, an uncommon presentation. Ophthalmologic symptoms are rare manifestations of paranasal sinus inverted papilloma without malignant transformation and signify extensive disease with possible intracranial extension.     

Endoscopic sinus surgery for paranasal sinus mucocoele with orbital involvement

PURPOSE: To evaluate the results of endoscopic sinus surgery (ESS) for paranasal sinus mucocoele with orbital involvement and assess the frequency with which a direct orbital approach is required in these cases. METHODS: Retrospective, consecutive series of sinus mucocoeles with orbital involvement treated by ESS by a single surgeon over a 4-year period (1998-2002). RESULTS: A total of 24 mucocoeles of 15 patients, including 10 frontal, eight frontoethomoidal, two ethmoidal, and four maxillary. All cases demonstrated radiological orbital extension. Globe displacement was seen in 73%. At a median follow-up of 15.5 months, the mean cumulative clinical score improved from 4.2 +/- 1.5 (range 1-7) to 0.4+/-0.7 (range 0-2). Ophthalmic symptoms and signs resolved in all patients but one who had complex sinus anatomy following neurosurgery. Minor, self-limiting complications including epistaxis and intranasal adhesions occurred in three cases. Additional endoscopic sinus surgery was required in four patients for revision of narrowed frontal sinus ostium (two), mucocoele recurrence (two), and sinus toileting (one). No cases required external sinus surgery and the average hospital in-patient stay was 2.5 +/- 1.6 days. At final follow-up, sinus ostia were patent in all excluding one case that required a stent due to disrupted anatomy. CONCLUSION: ESS is effective in improving ophthalmic symptoms and signs due to paranasal sinus mucocoele. ESS may be a viable treatment for paranasal sinus mucocoele with orbital extension, and a direct orbital approach is rarely necessary.     

Fronto-ethmoid sinus mucocele: a case report.

BACKGROUND: Mucoceles are epithelium-lined cavities in the paranasal sinuses filled with mucus. They develop because of scarring and obstruction of the sinus ostium, whether from chronic sinusitis, trauma, or surgery. They commonly erode the bony sinus wall and can have serious complications of brain and orbital invasion, with potential for abscess and rupture. CASE REPORT: A 39-year-old woman had diplopia in left gaze and a hard nodule above the right eye for 1 year. She recently noted a bulging right eye, nasal congestion, and occasional headaches. She was 9 years post-sinus surgery. All aspects of the afferent optic nerve function were intact. Right-sided proptosis was evident as was a right adduction and supraduction deficit, prompting immediate imaging, both with a computed tomography scan and magnetic resonance imaging of the orbits. These results showed a large right ethmoid sinus mucocele, with bony erosion and orbital invasion, prompting an immediate surgical referral. CONCLUSION: Mucoceles may arise from any of the paranasal sinuses and, because of the close proximity of these spaces to the orbit, may initially manifest with visual and ocular signs and symptoms. Therefore, eye care providers need to be aware of this entity and the need for immediate referral or workup if a mucocele is suspected.     

Inverted squamous papilloma with neuro-ophthalmic features.

The schneiderian or inverted papilloma is an infrequent and usually benign tumor of the paranasal sinuses. It most commonly manifests as unilateral nasal obstruction. This is a case of an inverted papilloma in a 92-year-old woman who presented with severe proptosis, loss of vision in the left eye, and rhinorrhea. The mass was visible in her left nostril; neuroimaging studies showed that the lesion extended from the left paranasal sinus into the frontal sinuses. In addition, there was secondary spread into the cranial cavity and brain substance.     

Orbital floor implant migration across the ethmoidal sinuses and nasal septum

PURPOSE: To report an unusual case of orbital floor implant migration across the ethmoidal sinuses and nasal septum.METHOD: Case report. A 61-year-old woman with a history of right orbital floor fracture repair 25 years earlier is described.RESULTS: The patient presented with sinus congestion and difficulty breathing through the right nostril. Computed tomographic scan disclosed medial migration of the right orbital floor implant across the ethmoidal sinuses and nasal septum. The patient underwent transorbital and transnasal endoscopic surgery with removal of the implant.CONCLUSIONS: When an alloplastic orbital floor implant is required, size and fixation of the implant are important. Late paranasal sinus or nasal airway problems may be sequelae, and the possibility of implant migration should be considered.     

Orbital complications of paranasal sinus surgery

Despite the low complication rate from surgery of the paranasal sinuses, orbital injury may be seen in up to 3% of all procedures. These complications include orbital edema, orbital hemorrhage, enophthalmos, extraocular muscle injury, and nasolacrimal duct obstruction. The most devastating complication is blindness, usually resulting from optic nerve compression with central retinal artery occlusion, or direct injury to the nerve itself. Early recognition of orbital injury during sinus surgery and appropriate intervention may prevent later, more serious ophthalmic complications.     

Adenoid cystic carcinoma with orbital and cranial metastases: case report.

Adenoid cystic carcinoma of the paranasal sinuses was demonstrated in a patient who subsequently developed a metastatic lesion to both orbits resulting in total blindness. While there are reports of extension of adenoid cystic carcinoma of the lacrimal gland to the adjacent orbit, this patient is an example of orbital extension of an adenoid cystic carcinoma of minor salivary gland originating in a paranasal sinus. The frequency and classification of this tumor also is reviewed.