面中部翻欣术联合鼻内镜术切除鼻腔鼻窦内翻性乳头状瘤

目的 探讨面中部翻掀术联合鼻内镜术切除鼻腔鼻窦内翻性乳头状瘤的疗效。方法 采用面中部翻欣术联合鼻内镜术切除鼻腔鼻窦内翻性乳头状瘤１１例,上网检索了近５年鼻腔鼻窦内翻性乳头状瘤手术治疗的相关文献,对不同手术方式的复发率进行了统计分析。结果 随访１２－６６个月,无１例复发。结论 采用这种联合手术方式为鼻腔鼻窦内翻性乳头状瘤的彻底切除提供了一种较好的方法。具有避免面部切口、肿瘤切除彻底、复发率低的优点。术后定期鼻内镜随访可确保复发肿瘤的早期发现及妥善处理。     

Glomangioma in the nasal cavity and paranasal sinuses

The glomangioma is a hyperplastic lesion of the glomus body. This uncommon tumor is seldom located in the nasal cavity or paranasal sinuses. We present what is to our knowledge the eleventh documented case of an intranasal glomangioma. The differential diagnosis of this lesion, its symptoms, pathogenesis and therapy are discussed. Complete excision is normally curative for this tumor.     

Glomangioma of the nasal cavity and paranasal sinuses

The glomangioma, a benign vascular tumour, derived from the cutaneous glomus bodies, should not be confused with paragangliomas, which are occasionally also referred to as glomus tumours. Up to now, only eleven cases of a glomangioma of the nasal cavity and the paranasal sinuses have been published. We report the case of a patient with a glomangioma of the ethmoidal aircell system. The tumour was completely removed under endoscopic-microscopic vision via endonasal access. A tumour recurrence was not observed over a period of eighteen months. The clinical signs, diagnosis, therapy and histological features will be discussed with reference to the literature.     

Microsurgery of the nasal cavity and paranasal sinuses

Out of a total of 295 cases in which endonasal microsurgery of the nasal cavity and the paranasal sinuses was performed, 221 were submitted to a detailed analysis. Compared with transfacial sinus surgery, the rate of complications was significantly lower. Further advantages of the transnasal microsurgical technique are better functional results, considerably fewer complaints during the postoperative period, and a reduced duration of hospitalization.     

Extranasopharyngeal angiofibroma of the nasal cavity and paranasal sinuses

BACKGROUND: Angiofibromas commonly arise in the nasopharynx in young male patients. Diagnosis is widely based on radiographic imaging to avoid ill-advised biopsy which may result in brisk bleeding. This study was undertaken to evaluate the incidence, clinical features and complications that may occur during the process of diagnosis and surgical therapy of angiofibromas outside the nasopharynx. METHODS AND PATIENTS: Case report of a 13-year-old female patient and review of the literature. RESULTS: Our patient received multi-agent chemotherapy elsewhere due to a misdiagnosed angiofibroma. Computed Tomography (CT) revealed a maxillary tumor which was repeatedly biopsied. Hypervascularity was excluded by arteriography and the lesion removed after lateral rhinotomy. The data of 42 patients were analyzed including our own case. 32 patients were male, 10 female. The majority became symptomatic aged 19 years or younger (71.4 %). The maxilla was most commonly affected (38 %), less frequently the ethmoid, nasal cavity or septum, beside others. In 38 patients, symptoms developed within 12 months or less (average: 8.5 months). Epistaxis, nasal obstruction and facial swelling were reported for most patients. Brisk bleeding occurred in 10 patients during tumor removal and resulted from biopsies in 11 of 20 patients. Angiography detected hypervascularity in 3 of 4 patients. There was no case with lethal outcome. CONCLUSION: Extranasopharyngeal angiofibromas of the nasal cavity or paranasal sinuses should be included in the differential diagnosis of nasal tumors. Compared to nasopharyngeal angiofibromas, more female patients are involved, symptoms develop more quickly but hypervascularity is less common. Signs of questionable hypervascularity in Computed Tomography and Magnetic Resonance Imaging (MRI) should indicate arteriography prior to surgical procedures. Preoperative embolization of hypervascular lesions during arteriography will reduce the risk of brisk bleeding during biopsy or surgical tumor removal.     

Mucosal melanoma of the nasal cavity and paranasal sinuses

Mucosal melanoma of the nasal cavity and paranasal sinuses is a rare disease, but its incidence appears to be increasing. The mean age at diagnosis is between 65 and 70 years. Unilateral nasal obstruction and epistaxis are the most common presenting complaints. Melanoma arises in the septum or lateral wall of the nasal cavity in the great majority of cases. The histological diagnosis is based on specific immunohistochemical labelling and is usually established at an advanced stage of disease: stage T3 or T4 tumours according to the 7th edition of the American Joint Committee on Cancer (AJCC) classification of tumours. First-line treatment consists of surgery. The place of intranasal endoscopic surgery remains controversial due to the difficulty of controlling surgical margins and should be reserved for experienced teams. Adjuvant radiotherapy is usually performed due to its efficacy on local and regional disease control. Five-year overall survival of mucosal melanoma of the nasal cavity and paranasal sinuses in the most recent series does not exceed 40%. Local recurrence is observed in about 50% of cases and metastatic disease is common. The quality of initial tumour resection with negative surgical margins is the most important prognostic factor for tumours confined to the nasal cavity. Hopes for improvement of survival are based on early diagnosis, progress in radiotherapy techniques and cell and gene therapy that are currently under evaluation.     

改良面中部揭翻加激光辅助治疗鼻腔鼻窦广泛性内翻性乳头状瘤

目的探讨面中部揭翻加激光治疗鼻腔鼻窦广泛性内翻性乳头状瘤的疗效.方法采用改良面中部揭翻加激光切除鼻腔鼻窦广泛性内翻性乳头状瘤32例.结果32例的切口均I期愈合,无并发症.随访6个月至4年,32例中复发3例,2次手术后未再复发.结论改良面中部揭翻加激光是治疗鼻腔鼻窦广泛性内翻性乳头状瘤可靠且有效的方法.     

Malignant neoplasms of the nasal cavity and paranasal sinuses. Analysis of 216 cases of malignant neoplasms of nasal cavity and paranasal sinuses

This study is a retrospective analysis of 216 cases of malignant tumours of the nasal cavity and paranasal sinuses, treated from 1965 to 1980. The mean age at diagnosis was 59 years, 70 per cent were men and 30 per cent women. There were 121 (56%) epidermoid carcinomas, and 31 (14%) adenocarcinomas. Three-year and five-year actuarial survival rate was 40 and 33 per cent respectively for epidermoid carcinomas, 72 and 50 per cent respectively for adenocarcinomas. Recurrences occurred in 46 per cent of epidermoid carcinomas and 42 per cent of adenocarcinomas. Early diagnosis is important to improve the survival rate, and radical primary treatment should be carried out to reduce the rate of recurrence.     

Primary intestinal-type adenocarcinoma of the nasal cavity and paranasal sinuses

Forty-nine cases of adenocarcinoma of the nasal cavity and paranasal sinuses were reviewed, in which 5 cases showed a marked similarity to colonic adenocarcinoma. Diagnosis of intestinal-type adenocarcinoma chiefly depends on pathological examination and mucous staining. Although well differentiated, the intestinal-type adenocarcinoma has a marked propensity for recurrence and a lethal potential.