The Morphological Interaction Between the Nasal Cavity and Maxillary Sinuses in Living Humans

To understand how variation in nasal architecture accommodates the need for effective conditioning of respired air, it is necessary to assess the morphological interaction between the nasal cavity and other aspects of the nasofacial skeleton. Previous studies indicate that the maxillary sinuses may play a key role in accommodating climatically induced nasal variation such that a decrease in nasal cavity volume is associated with a concomitant increase in maxillary sinus volume. However, due to conflicting results in previous studies, the precise interaction of the nasal cavity and maxillary sinuses, in humans, is unclear. This is likely due to the prior emphasis on nasal cavity size, whereas arguably, nasal cavity shape is more important with regard to the interaction with the maxillary sinuses. Using computed tomography scans of living human subjects (N=40), the goal of this study is to assess the interaction between nasal cavity form and maxillary sinus volume in European‐ and African‐derived individuals with differences in nasal cavity morphology. First, we assessed whether there is an inverse relationship between nasal cavity and maxillary sinus volumes. Next, we examined the relationship between maxillary sinus volume and nasal cavity shape using multivariate regression. Our results show that there is a positive relationship between nasal cavity and maxillary sinus volume, indicating that the maxillary sinuses do not accommodate variation in nasal cavity size. However, maxillary sinus volume is significantly correlated with variation in relative internal nasal breadth. Thus, the maxillary sinuses appear to be important for accommodating nasal cavity shape rather than size. Anat Rec, 296:414–426, 2013. © 2013 Wiley Periodicals, Inc.     

The quantitative effect of an accessory ostium on ventilation of the maxillary sinus

The airflow and gas exchange behaviors of the human maxillary sinus were quantified to better understand the effect of an accessory ostium (AO). An anatomically correct numerical domain was constructed using CT data from a male patient with mild nasal obstruction. For the purpose of comparison, a numerical model without an AO was also generated by artificially removing the AO from the original model using CAD software. A steady-flow field through the nasal cavity was simulated using ANSYS-FLUENT v13.0 with a target flow rate of 250 ml/s. The Volume of Fluid (VOF) method was used to investigate the concentration field of nitric oxide (NO) initially filled in the maxillary sinus. The simulation results showed that a transit flow through the maxillary sinus developed in the presence of an AO. As the flow entered the sinus through either a natural or accessory ostium from the middle meatus, the velocity was significantly reduced to a local maximum of approximately 0.034 m/s inside the sinus. This by-pass flow rate through the sinus of 2.186×10(-1) to 3.591×10(-1) ml/s was a small fraction of the total flow rate inhaled from the nostril, but it effectively changed the local flow topology and led to a larger reduction in NO concentration in the maxillary sinus. This more rapid reduction in NO concentration was due to enhanced ventilation activity afforded by convective transport of the transit stream through the flow path connecting the natural ostium and the AO. The inspiration and expiration phases were qualitatively similar in flow pattern except for the flow direction in the maxillary sinus, suggesting that the AO plays a similar physiological role during both inspiration and expiration in terms of ventilation.     

应用于功能性内窥镜鼻窦手术后引流器的工作原理分析

目的设计一种应用于功能性内窥镜鼻窦手术后的引流器,可以在上颌窦术后防止窦口的粘连,通过鼻腔呼吸气流将上颌窦内的积液引出,及将药物输送到窦口鼻道复合体处,方便术后的管理。方法根据重建的三维鼻腔模型进行数值模拟的结果和鼻阻力仪测量的结果得到窦口鼻道复合体处的气流流动情况,以此作为依据,设置合理的边界条件。通过两相流理论和建立的引流器计算模型,对于"引流和给药过程"进行数值模拟和定量分析。在数值模拟过程中,改变引流器的管径以及引流物质的黏性系数,分别计算并比较结果来优化引流器形状。结果计算了几种管径的引流器和同一管径引流器对不同黏性系数液体引流效果并进行了比较,得到一种比较合理的能够完成引流、给药和通气功能的引流器。结论设计的引流器可以完成通气、引流,给药和保持上颌窦口不粘连的功能。     

藏酋猴上颌窦的应用解剖

目的 通过对藏酋猴上颌窦的应用解剖,为上颌窦的临床应用提供形态学依据。方法 对6只藏酋猴的12侧上颌窦进行大体解剖,从整体和局部对上颌窦的位置、形态,窦腔与眶、鼻腔和口腔的结构进行观察和测量。结果 藏酋猴的上颌窦位于上颌骨体内,由前、后窦构成。后窦位于前窦的后方,窦腔较小。前窦和人的上颌窦类似,位于第1前臼齿至第2臼齿及相应骨腭的上方,毗邻眶、鼻腔、口腔,窦腔较大且形态无异常;窦腔与眶间骨质较薄,有鼻泪管连通,其管径为(4.31±0.10)mm、长度为(15.89±0.31)mm;窦腔底与鼻腔间有大且恒定的上颌窦裂孔,自然状态下裂孔长度(12.59±0.46)mm、高度(1.01±0.12)mm;向上牵拉海绵状血管球可使裂孔高度增大到(11.14±1.44)mm;窦腔与口腔间骨质最厚处位于第1前臼齿根尖的上方,厚度为(6.20±0.20)mm,最薄处位于第2臼齿根尖的上方,厚度为(1.57±0.23)mm,窦底最低处位于第1、2臼齿间。同一个体双侧对比,差异无统计学意义。结论 藏酋猴上颌窦的形态结构特点,适合于作为动物模型,应用于人类上颌窦病变、上颌窦提升及种植牙的相关研究;其上颌窦裂孔是上颌窦底非开窗手术入路的最佳部位。     

Necrotizing sialometaplasia involving the mucous glands of the nasal cavity

Necrotizing sialometaplasia was found in maxillary sinus mucous glands of an 83 year old woman who had undergone a radical maxillectomy for basal cell carcinoma 10 days earlier. Previously recognized as an ulcerating lesion involving salivary glands in the oral cavity, this benign reactive process may also occur in the mucous glands of the nasal cavity and sinuses and can simulate squamous cell or mucoepidermoid carcinoma. Ischemia appears to be pathogenetic.     

CT矢状位重建对鼻内窥镜手术相关解剖结构的测量

目的:探讨CT矢状位重建图像上测量与鼻内窥镜手术相关解剖结构对鼻内窥镜手术的参考价值。方法:对66例132侧健康志愿者鼻腔行CT轴位薄层扫描后矢状位重建,以鼻小柱下端外缘为参考点,鼻底为基线,测量与鼻内窥镜手术相关的重要结构与起点的距离及与基线的夹角。结果:所测鼻腔侧壁结构在矢状位重建图像上显示清晰,能准确区分额隐窝、钩突、蝶窦口、前筛顶及其相互关系。鼻小柱至额隐窝的角度和距离分别是(66.1±6.31)°和(52.2±4.55)mm;额隐窝前后径所测值为(5.1±2.72)mm;鼻小柱至前筛顶的角度和距离分别为(62.9±5.75)°和(60.3±5.48)mm;钩突长度为(12.7±3.92)mm;蝶窦口至鼻小柱的距离是(67.0±5.00)mm;准确获得了鼻小柱至鼻腔侧壁与鼻内窥镜手术相关各解剖结构的角度及长度数据。结论:CT鼻腔矢状位重建图像上能准确测量与鼻内窥镜手术相关解剖结构,对了解患者个体差异,减少术中并发症有较大帮助,具有较大的临床价值。     

比格犬上颌窦的应用解剖

目的探讨比格犬上颌窦正常解剖,为与上颌窦有关的动物实验提供解剖学依据。方法收集16个比格犬上颌窦,利用锥形束投照计算机重组断层影像(CBCT)扫描,并完成局部解剖,详细观察上颌窦形态、位置、容积、自然窦口位置及与周围组织的毗邻关系。另购买2只健康成年比格犬,利用CBCT确定上颌窦窦底,经腭侧开窗,显露软组织,夹取该位点黏膜行组织学检查,光学显微镜下验证所夹取黏膜是否为上颌窦黏膜。结果比格犬上颌窦形状略似锥形,前部较窄,后部宽大,位于上颌第3前磨牙与第1磨牙之间的腭侧,四周均有骨壁包绕。于第4前磨牙远中牙尖腭侧,距腭中缝约17~18mm处可见上颌窦最低点。同一个体双侧对比,差异无统计学意义。结论比格犬双侧上颌窦无明显差异,有利于上颌窦相关研究进行随机分组;窦腔内无明显骨嵴或分隔,降低窦黏膜穿孔的危险;行上颌窦外提升时,结合CBCT于上颌窦最低点经腭侧骨板开窗是最佳的术式。     

鼻内窥镜下经上颌窦开口切除上颌窦囊肿

目的：探讨鼻内窥镜下切除上颌窦囊肿的方法。方法：鼻内窥镜下经上颌窦开口单纯上颌窦囊肿摘除术36例，其中单侧囊肿30例，双侧囊肿6例。顶壁囊肿4侧，前壁囊肿6侧，后壁囊肿6侧，底壁囊肿9侧，内侧壁囊肿11侧，自然开口处囊肿2侧。同一侧同时有底壁和后壁囊肿的2侧，同时有内侧壁和底壁囊肿的有2侧。单纯使用粘膜钳切除18侧，对24侧底壁囊肿和内侧壁囊肿同时结合使用电动切割器切除囊肿。结果：所有囊肿均在鼻内窥镜下经上颌窦开口完全切除。术后无明显并发症。随访0．5～2a，无复发。结论：应用鼻内窥镜经上颌窦开口切除上颌窦囊肿创伤小，操作简便，治疗效果确切，是治疗上颌窦囊肿的有效方法。     

Micro and nanoparticle deposition in human nasal passage pre and post virtual maxillary sinus endoscopic surgery

Realistic 3-D models of the human nasal passages were developed pre and post virtual uncinectomy and Middle Meatal Antrostomy. A 3-D computational domain was constructed by a series of coronal CT scan images from a healthy subject. Then a virtual uncinectomy intervention and maxillary antrostomy were performed on the left nasal passage by removing the uncinate process and exposing the maxillary sinus antrum. For several breathing rates corresponding to low or moderate activities, the airflows in the nasal passages were simulated numerically pre and post virtual routine maxillary sinus endoscopic surgery. The airflow distribution in the nasal airway, maxillary and frontal sinuses were analyzed and compared between pre and post surgery cases. A Lagrangian trajectory analysis approach was used for evaluating the path and deposition of microparticles in the nasal passages and maxillary sinuses. A diffusion model was used for nanoparticle transport and deposition analysis. The deposition rate of the inhaled micro and nanoparticles in the sinuses were evaluated and compared for pre and post operation conditions. The results showed that after maxillary sinus endoscopic surgery, the inhaled nano and microparticles can easily enter this sinus due to penetration of the airflow into the sinus cavity. This was in contrast to the preoperative condition in which almost no particles entered the sinuses. These results could be of importance for a better understanding of the effect of sinus endoscopic surgery on patient exposure to particulate pollution and inhalation drug delivery. The significantly higher airflow rate and particle deposition in the sinus could be a reason for the discomfort reported by some patient after maxillary sinus endoscopic surgery.     

Ectopic primary olfactory neuroblastoma of the maxillary sinus

Olfactory neuroblastoma (ONB) is a rare malignant tumor. Although the vast majority of cases arise in the nasal cavity, ONB is rarely reported in ectopic locations. We report a case of ONB in the maxillary sinus. A 63-year-old woman presented with left-sided nasal obstruction and epistaxis. Magnetic resonance imaging showed a nonenhancing left maxillary sinus tumor. Histologic sections showed ONB, Hyams grade IV, invading bone, skeletal muscle, and adjacent fibroadipose tissue. It is essential to be accurate when diagnosing sinonasal tumors because the differential diagnosis is broad, and one must consider the possibility of ectopic ONB, although it is rare. The behavior of ONB and other neuroendocrine tumors of the sinonasal region is quite different, and there are varied approaches to treatment. Therefore, an accurate diagnosis as well as correct grade and stage must be assigned.     

模拟内镜下经双鼻孔至Meckel腔的解剖

目的 通过模拟内镜下经双鼻孔至Meckel腔手术入路,对Meckel腔及入路的相关结构进行解剖学研究,为临床内镜下Meckel腔手术提供解剖学及形态学资料。
方法 对10具(20侧)动静脉灌注乳胶的成人尸头标本,完全模拟经双鼻孔至Meckel腔的手术入路逐层显微解剖,对入路相关解剖标志进行观察、分析、拍摄和测量。 结果 该入路可分4步,即寻找上颌窦口,进入上颌窦,进入翼腭窝和进入Meckel腔。鼻小柱距上颌窦口的距离为（45.07±2.01）mm,与蝶腭孔的距离为(64.84±3.00)mm,距翼管前孔距离为(71.34±2.99)mm。以鼻小柱至鼻后棘的连线为底边,其与鼻小柱与上颌窦口连线的夹角为(38.81±1.72)。其与鼻小柱与蝶腭孔连线的夹角为(25.92±2.05) °。蝶腭动脉及翼管动脉平均外径分别为(2.21±0.24)mm和(1.07±0.27)mm。翼腭窝区结构复杂,其内上颌动脉及其终支蝶腭动脉和腭降动脉变异较大,沿蝶腭动脉逆行解剖有助于寻找上颌动脉及其分支结构。解剖分离翼腭窝内神经、血管等结构,追踪翼管神经血管束,依据翼管后端正对颈内动脉破裂孔段的特点,解剖分离四方形空间可较直接进入Meckel腔。结论 侵犯Meckel腔肿瘤的入路选择应该个体化,应依据肿瘤主体在Meckel腔的位置及范围等决定选1种或联合入路;内镜下经双鼻孔至Meckel腔入路可较直接地暴露Meckel腔的前下内面及翼腭窝区域的解剖结构;手术中重要的解剖标志为蝶腭孔、翼管神经、翼管和上颌神经;翼腭窝中浅部血管结构的解剖有助于深部神经结构的保护,深部神经结构（如翼管神经和上颌神经）和其穿行的骨孔有助于在颅底辨别和控制颈内动脉。     

Anatomic and magnetic resonance imaging bases for the naso-maxillo-cheek flap technique

A transfacial approach to the deep cranio-maxillo-facial areas by the naso-maxillo-cheek flap technique (NMCF) is indicated for the treatment of some bulky tumors of the naso-pharynx. The procedure requires precise preoperative imaging. This study presents the morphologic bases of this surgical access and the reasonable limits of the excision preoperatively determined by magnetic resonance imaging (MRI). 18 facial and skull specimens were submitted to surgical facial dismantling by the NMCF technique according to Curioni’s method. The clinical application in a 66-year-old patient suffering from a neuroblastoma of the olfactory nerve extended into the naso-pharynx is presented. Pre- and postoperative MRI correlations were made in transverse, sagittal and frontal acquisitions. Several structures were preserved in the procedure: facial reliefs, inferior orbital rim and orbital floor, posterior wall of the maxillary sinus covering the pterygopalatine fossa, lateral and medial pterygoid plates and pterygopalatine ganglion with its branches, lateral facial neurovascular pedicle, teeth and soft palate. Other structures were sacrificed: arteries and nerves located at the sites of skin and mucosal incision, and at the sites of osteotomies, ie the infraorbital nerve, the distal part of the greater palatine nerve, the nerves supplying the naso-pharynx, the nasal septum and the nasal conchae, nasolacrimal groove and lacrimal canal. The NMCF technique gives wide access to the deep nasal and nasopharyngeal areas. It is essential to preserve the lateral facial neurovascular pedicle to prevent necrosis of the midface structures. Preservation of the bony architecture surrounding the osteotomy sites is of great importance to allow precise final bone reassembly. Preoperative MRI appears of paramount importance to determine the borders of the lesion and the possibility of block resection.     

The pterygopalatine recess of the superior nasal meatus

The pneumatizations surrounding the pterygopalatine fossa (PPF) and closely related to the sphenopalatine foramen are anatomically variable. During the assessment of a cone beam computed tomography of a 64-year-old male patient, we found bilaterally a previously unreported anatomic variant. This was represented by a lateral or pterygopalatine recess (PPR) of the superior nasal meatus which extended in the anterior wall of the PPF and protruded within the maxillary sinus to determine a maxillary bulla. The PPR was antero-superior to the sphenopalatine foramen. Additionally were found a right nasal septal deviation, seemingly compensated by a left middle concha bullosa and a left prominent ethmoidal bulla. The superior turbinates were also pneumatized. Such anatomic variants related to the pterygopalatine angle of the maxillary sinus should be explored prior to surgical or endoscopic procedures which target the maxillary sinus, the pterygopalatine fossa, or the skull base.     

Fluid mechanics based classification of the respiratory efficiency of several nasal cavities

The flow in the human nasal cavity is of great importance to understand rhinologic pathologies like impaired respiration or heating capabilities, a diminished sense of taste and smell, and the presence of dry mucous membranes. To numerically analyze this flow problem a highly efficient and scalable Thermal Lattice-BGK (TLBGK) solver is used, which is very well suited for flows in intricate geometries. The generation of the computational mesh is completely automatic and highly parallelized such that it can be executed efficiently on High Performance Computers (HPCs). An evaluation of the functionality of nasal cavities is based on an analysis of pressure drop, secondary flow structures, wall-shear stress distributions, and temperature variations from the nostrils to the pharynx. The results of the flow fields of three completely different nasal cavities allow their classification into ability groups and support the a priori decision process on surgical interventions.     

An unusual mucinous osteoma with features of an ossifying fibroma in the nasal cavity of a horse

A 4-month-old Warm-blooded colt presented with facial distorsion and an abnormal respiratory noise of 2 weeks' duration. A proliferative mass was found endoscopically and by computer tomography. Clinical differential diagnosis included cyst formation of the concha, malformation and neoplasia. Euthanasia was followed by post-mortem examination, which revealed a well-circumscribed, semi-solid, jelly like structure, measuring 14.5 x 9.0 x 12.0 cm, in the left posterior nasal cavity extending into the left frontal and maxillary sinus. Histologically, the mass consisted of trabeculae of woven bone, focal lamellar bone and fibroblast proliferation within a moderate fibro-vascular stroma. Abundant mucin production was noted within areas of fibroblastic differentiation. Some areas contained irregularly shaped spicules of osteoid rimmed by osteoblasts, randomly distributed within a moderately vascularized, fibro-osseous stroma. On the basis of the histopathological features, a nasal mucinous osteoma with focal ossifying fibroma-like structures was diagnosed.     

Nasal polyps in children

During the 1980-1995 period, 957 patients were admitted for nasal polyposis, 59 (6.2%) of them children. Results were analyzed with respect to localization of the polyps, allergy, histologic picture, bacteriologic tests, radiologic findings of paranasal sinuses, cytology of nasal mucosa, therapeutic approach, and tendency to relapse. Forty children (22 boys and 18 girls) were analyzed. Their mean age was 11.1 years. Unilateral polyposis was found in 29, and bilateral in 11 children. Antrochoanal polyps (ACP) were found in 30, bilateral nasal polyps in 5, polyps in maxillary sinus in 5, and allergy in 8 children. Inflammation of the maxillary sinus was present in 93% of children with ACP. Their correlation between ACP and inflammation in maxillary sinus suggested that edema of the sinus mucosa have led to protrusion through the ostium and formation of the nasal polyp.     

兔适合构建鼻窦炎动物模型

背景：以实验动物模拟人类相关疾病是研究疾病发生发生及治疗的基础,鼻腔、鼻窦疾病也需要恰当实验动物作为其模型。 目的：观察兔鼻腔、鼻窦的CT和局部解剖表现,探讨兔应用于鼻窦炎动物模型的可行性。 方法：利用CT使用常规鼻窦冠状位与水平位扫描新西兰兔,随后进行常规鼻腔、鼻窦解剖学观察。 结果与结论：兔鼻中隔将鼻腔分为左右两个腔,鼻腔外侧壁由上颌鼻甲、中间鼻甲、内侧鼻甲、下鼻甲组成,上颌窦窦腔最大,筛窦、蝶窦、额窦相对较小,以上结构均对称分布。兔鼻腔、鼻窦在CT扫描下显示清晰。兔鼻腔、鼻窦的解剖与人类鼻腔、鼻窦解剖结构既有相似也有不同,其上颌窦解剖部位与人相似且窦腔较大便于操作,具有动物实验模型建立的可行性,适用于鼻窦炎动物模型建立,可应用于模拟人类鼻窦炎的研究。 中国组织工程研究杂志出版内容重点：肾移植;肝移植;移植;心脏移植;组织移植;皮肤移植;皮瓣移植;血管移植;器官移植;组织工程全文链接：     

急性上颌窦炎实验动物模型的建立

目的:拟建立急性上颌窦炎的实验动物模型,并探讨窦口的阻塞和致病菌的毒力在急性上颌窦炎的发病机制中的地位。方法:第一天,阻塞单侧窦口,对侧做假手术。次日,注入0.5ml108CFU/ml肺炎链球菌悬浮液。第五天处死动物、观察、分离培养细胞、取材和制作切片。结果:阻塞上颌窦口和注入肺炎链球菌的联合组,鼻部症状明显;进食量减少;鼻窦粘膜水肿、微红,具有较多脓性分泌物,微血管扩张,白细胞浸润;肺炎链球菌的重新分离培养率为100％（与其余组比较具有显著意义P<0.01）。而仅阻塞上颌窦口或仅注入肺炎链球菌或假手术均无明显临床症状及组织病理学改变,细胞培养率也低。结论:窦口的阻塞和致病菌的毒力是上颌窦炎发生发展的重要的条件,其中,窦口的阻塞起着关键性作用;联合阻塞窦口并注入有荚膜的肺炎链球菌能较理想地建立急性上颌窦炎实验动物模型。