上颌窦良性占位性病变的早期诊断与治疗

目的探讨单纯上颌窦良性占位性病变的早期诊治方法.方法回顾分析1997年11月至2002年6月48例单纯上颌窦良性占位性病变的临床资料.结果患者均行鼻窦CT检查明确诊断为上颌窦良性占位性病变,经鼻内窥镜手术,术后随访6月至3年,全部治愈.结论对反复出血或有头昏、头痛等症状而鼻腔及其它无异常者应行鼻窦CT,如果发现上颌窦内密度增高,应及时经鼻内窥镜手术治疗,可取得根治和微创的效果.     

Transcannular maxillary antral biopsy with Tru-Cut needle

A Transcannular Tru-Cut needle maxillary antral biopsy technique, which has been devised as an out-patient procedure to speed up histological diagnosis in antral disease, is here described. A trial carried out with this technique shows that the histological diagnosis reached from such biopsy specimens compares favourably with that reached from specimens taken through an intranasal antrostomy.     

Use of a Braunula for maxillary sinus irrigation

Puncture and lavage of the maxillary sinuses is a common procedure in ENT practice. Repeated irrigations are required in chronic sinusitis refractory to treatment. In our department we use a No. 14 gauge Braunula for such cases. Over 100 patients have been treated over the past two years with no significant complications. This device is inexpensive, sterile, safe and easy to use and we recommend its use for patients with chronic maxillary sinusitis requiring repeated irrigations.     

鼻内镜手术治疗上颌窦良性占位性病变

目的探讨上颌窦良性占位性病变的CT诊断及鼻内镜手术疗效。方法回顾性分析51例上颌窦良性占位性病变的临床资料,临床表现主要有涕中带血、头痛、面部麻木、视力改变等。所有病例术前均行CT检查,术后并经病理检查证实。结果51例中囊肿27例,真菌感染13例,息肉6例,内翻性乳头状瘤3例,出血坏死性息肉1例,血管瘤1例。随访6～24个月,2例复发,治愈率96.1%,无术后并发症。结论上颌窦良性占位性病变以囊肿、真菌性上颌窦炎多见;CT检查有利于本病的诊断及手术方案的制定;鼻内镜手术是治疗上颌窦良性占位性病变的优选术式。     

Cytologic diagnosis of the maxillary sinus reevaluated

Preoperative cytologic diagnosis of the maxillary sinus was performed on 57 patients by examining of solutions obtained by local washing following sinus puncture. There were 6 cases of cancer (5 squamous cell carcinomas and 1 adenoid cystic carcinoma), 1 malignant melanoma, 1 odontoma, 8 aspergillosis, 1 inflammatory pseudotumor, 9 odontogenic maxillary sinusitis and conventional chronic sinusitis in residual cases. There were 2 false-negative cytologies in the 7 cases of malignant tumor (i.e., 1 adenoid cystic carcinoma and 1 squamous cell carcinoma). The significance and usefulness of the cytologic approach to preoperative diagnosis of malignancies, including malignant melanoma and fungal infection were discussed.     

B-modes ultrasonic diagnosis of the maxillary sinus

As a routine preoperative evaluation for chronic sinusitis and postoperative maxillary cyst (mucocele and pyocele), CT scans and B-mode ultrasonic diagnosis including three methods, linear, sector, and convex scans, were performed. By chronic sinusitis, 112 sides by linear scans, 43 sides by sector scans, and 29 sides by convex scans were included in the study. By the postoperative cyst, 43 sides by linear scans, 24 sides by sector scans, and 12 sides by convex scans were included. The positive diagnostic finding by ultrasonography is defined as the depicted echo of the posterior wall. In chronic sinusitis, positive diagnostic rates were as follows: linear scans, 73.2%, sector scans, 88.2%, and convex scans, 77.8%. As for the scan planes, horizontal plane yielded more positive than sagittal one. In postoperative cyst similarly, linear, 86.0%, sector, 95.8%, and convex, 83.3%. Horizontal more positive than sagittal also. The negative findings were caused, in chronic sinusitis, by attenuation by the air in the sinus, thick anterior wall, and artifacts. In postoperative cysts, the negative findings were caused by specific location of the cysts (lateral or posterior). Our results recommend the use of sector scan because of its easy manipulation and higher positive diagnostic rates due to the radial beam conforming to the curvature of the posterior wall. Especially, the sector scan was higher diagnostic rate than linear scan, because the sector scan transmitted radial beam, and received its reflective wave easily from a curved posterior wall of the maxillary sinus. The sector scan, its manipulation is easy, and its diagnostic rate is higher than any other scans.     

上颌窦病变的CT诊断

为探讨ＣＴ在上颌窦病变中的诊断价值，对资料完整的１００例上颌窦病变（６４例炎性病变，１４例良性肿瘤，１７例恶性肿瘤，５例外伤骨折）患者的临床所见、ＣＴ扫描和病理检查进行对比分析。结果：ＣＴ与临床诊断符合率９５．０％（９５／１００）；ＣＴ与病理诊断符合率９２．６％（８８／９５）。认为ＣＴ能较好的显示上颌窦的炎性病变、肿瘤和外伤的范围，肿瘤病变的骨质破坏程度及对周围组织的侵犯情况，有助于准确进行肿瘤的ＴＮＭ分期及划定放疗野，为制定手术方案提供可靠参考。ＣＴ扫描较Ｘ线平片及多轨迹断层摄影具有明显的优越性，但鉴别诊断和定性诊断还应密切结合临床和病理。     

上颌窦病变的CT诊断

为探讨ＣＴ在上颌窦病变中的诊断价值，对资料完整的１００例上颌窦病变（６４例炎性病变，１４例良性肿瘤，１７例恶性肿瘤，５例外伤骨折）患者的临床所见，ＣＴ扫描的病理检查进行对比分析。结果：ＣＴ与临床诊断符合率９５．０％（９５／１００）；ＣＴ与病理诊断符合率９２．６％（８８／９５）。认为ＣＴ能较好的显示上颌窦的炎性病变，肿瘤和外伤的范围，肿瘤病变的骨质破坏程度及对周围组织的侵犯情况，有助于准确进行肿瘤的     

低剂量CT扫描在鼻窦疾病诊断中的应用

目的 探求最合适的鼻窦低剂量CT扫描技术及其在鼻窦疾病诊断中的应用价值。方法 常规CT扫描确诊为鼻窦病变的39例患者随机分成A、B两组，在其他扫描参数不变的情况下，A组以50mAs条件、B组以30mAs条件再次扫描，以窦口鼻道复合体的显示情况为主要指标，比较两种低剂量扫描所得图像质量与常规剂量图像的质量差异。结果 两组低剂量扫描的曝光量分别降低了79．89％和87．99％。50mAs剂量扫描所得图像与常规剂量图像质量比较无明显下降，而30mAs扫描图像与常规剂量图像质量比较差异有统计学意义。结论 利用50mAs低剂量对鼻窦进行CT扫描，可以有效地应用于鼻窦疾病的临床诊断。     

Computed tomography--guided needle biopsy of head and neck lesions

OBJECTIVE: To evaluate the diagnostic efficacy of computed tomography (CT)-guided needle biopsies of head and neck lesions. DESIGN: All CT-guided needle biopsies of head and neck lesions performed between September 1994 and February 1999 were included. Cytopathologic and histologic records, along with patient clinical records, were reviewed. SETTING: A tertiary care medical center. PATIENTS: Patients referred for evaluation of lesions inaccessible to routine methods of needle biopsy. RESULTS: Thirty-seven patients underwent 42 CT-guided biopsies. There were included 12 lesions in or adjacent to the skull base and 9 lesions around the pharyngoesophageal or laryngotracheal complex; the other lesions were located in the deep lobe of the parotid gland (n = 7), deep neck area (n = 12), and thyroid gland (n = 2). Diagnostic cytologic biopsy specimens were obtained in 38 (91%) of 42 needle biopsy procedures. The results were supported histologically and/or clinically in 36 cases (95%). Eighteen patients underwent open surgical procedures. Histologic confirmation was found in 86% of cases. Nineteen patients (51%) avoided an open surgical procedure: 11 with benign disease and 8 with recurrent malignancy. There were no false-positive or false-negative results, and no complications were identified. CONCLUSIONS: Computed tomography-guided needle biopsy is a safe and reliable minimally invasive technique for the diagnosis of poorly accessible or deep-seated lesions of the head and neck. Diagnostic needle biopsies allow improved preoperative planning and patient counseling in surgical patients and avoidance of open surgical procedures in patients with benign disease or recurrent malignant neoplasms.     

The radiologic diagnosis of pneumocele of the maxillary sinus.

Pneumocele of the maxillary sinus is a recently described disease, first noted in 1974. Three subsequent cases have been encountered. Pneumocele refers to an expansile cystic air-containing mass, occupying the entire maxillary sinus, and lined by the original attenuated mucous membrane. It is analogous to mucocele, but containing air rather than fluid content. Radiologic signs are diagnostic, and it is the purpose of this presentation to enumerate these radiologic findings.     

Image-guided needle biopsy of inaccessible head and neck lesions

Fine-needle biopsy and large-needle core biopsy of inaccessible and deep-space lesions of the head and neck are difficult and sometimes hazardous to perform. Patients subsequently may have to undergo a major surgical procedure with exploration of the neck and open biopsy. We describe our experience with computed tomography and ultrasound-guided fine-needle and core-needle biopsy for 11 patients with inaccessible lesions in the head and neck. Carcinoma was diagnosed in three patients and nonmalignant pathologic findings in eight patients. Three of the needle biopsy findings were confirmed by surgical excision. The initial diagnoses made from the cytopathologic findings have remained unchanged in all patients. Compared with the alternative of open biopsy, we have found this method to be technically easy, diagnostically expeditious, and safe. Head and neck surgical oncologists should be familiar with image-guided biopsy techniques, since many of their patients may benefit from these diagnostic procedures.     

Automatic boundary detection and pathological diagnosis of the maxillary sinus

A method for automatic boundary detection of the maxillary sinus from a cranial X-ray radiograph has been developed. An algorithm using the local segmental properties of the X-ray image to transform a continuous tone image into a bi-level image is introduced. In addition, the global shape information such as the area, the perimeter, and the complexity, are considered for the boundary detection. The boundary of the maxillary sinus detected by this method coincided precisely with the area plotted-by experienced otolaryngologists. Furthermore, the cumulative distribution function (CDF) calculated from the density histogram of the maxillary sinus has been employed to perform the tonal evaluation of the intra-maxillary pathological changes. The distance between the CDFs successfully demonstrated the difference in pathological stages of the chronic sinusitis.