Congenital vomeral bone defect: report of two cases and a review of the literature

Nasal septum perforations or defects can have a variety of causes. Defects of the septum tend to occur in the antero-inferior region. We report two cases of congenital vomeral defect of the septum detected during nasal endoscopy. Neither of the patients in this report had any nasal surgery, trauma, infectious disease, or drug abuse. Our findings suggest that a developmental abnormality of the vomer during the prenatal period resulted in congenital defects of the vomer. Congenital defects of the nasal septum should be added to the etiology of septal perforation and defect.     

Histopathology of the inferior turbinate with compensatory hypertrophy in patients with deviated nasal septum

OBJECTIVE: To measure the dimensions, composition, and possible structural and/or histopathological changes of the compensatory hypertrophic inferior turbinate in patients with deviated nasal septum. STUDY DESIGN: A prospective, nonrandomized, and morphometric study. METHODS: Nineteen patients with deviated nasal septum and compensatory hypertrophy of the inferior turbinate in the contralateral nasal cavity underwent surgery for correction of nasal obstruction. Patients' specimens were compared with those of a control group consisting of 10 inferior turbinates removed at autopsy. Quantitative measurements of the inferior turbinate histological sections were carried out and included the width of the layers and morphometric calculations of the relative proportions of the soft tissue constituents. Also, qualitative study was performed to detect pathological changes. RESULTS: Of all layers, the inferior turbinate bone underwent a twofold increase in thickness and manifested the most significant expansion (P < or =.001), whereas the contribution of the mucosal layers to the inferior turbinate hypertrophy was modest. The morphometric analysis revealed a larger proportion of venous sinusoids in hypertrophic turbinates, but the difference was small and statistically insignificant. Qualitative assessment disclosed normal mucosal architecture in all inferior turbinates with compensatory hypertrophy. Eleven remained intact, while eight disclosed mild to moderate pathological changes. CONCLUSIONS: The data gathered in the present study are of importance to the decision-making process regarding turbinate surgery. The significant bone expansion and the relative minor role played by the mucosal hypertrophy would support the decision to excise the inferior turbinate bone at the time of septoplasty.     

Congenital vomeral bone defect: report of two cases and a review of the literature

Nasal septum perforations or defects can have a variety of causes. Defects of the septum tend to occur in the antero-inferior region. We report two cases of congenital vomeral defect of the septum detected during nasal endoscopy. Neither of the patients in this report had any nasal surgery, trauma, infectious disease, or drug abuse. Our findings suggest that a developmental abnormality of the vomer during the prenatal period resulted in congenital defects of the vomer. Congenital defects of the nasal septum should be added to the etiology of septal perforation and defect.     

鼻中隔偏曲患者双侧下鼻甲的影像学和病理学观察

目的：观察鼻中隔偏曲患者双侧下鼻甲的形态结构及其黏膜的病理改变。方法：为住院行手术治疗鼻中隔偏曲患者30例行术前鼻窦冠状位CT扫描,在CT片上直接测量下鼻甲的宽度和高度,将测量数值根据CT片上的标尺换算成实际值。手术全麻后、鼻腔表麻前,在鼻内镜下,于鼻中隔明显偏曲处对称切取下鼻甲组织,在光镜、透射电镜下观察下鼻甲的黏膜上皮层及固有层组织结构的改变。结果：从30例鼻中隔偏曲患者的鼻窦CT中观察到,偏曲对侧下鼻甲的高度和宽度均大于同侧,差别有统计学意义。光镜结果：偏曲对侧下鼻甲较同侧黏膜上皮、基底膜增厚,血管增生,纤维组织增生,腺体密度同侧较对侧减小。电镜结果：偏曲对侧较同侧的下鼻甲黏膜固有层的结缔组织胶原纤维增生明显;黏膜固有层毛细血管及腺体周围毛细血管的内膜具有窗格样空隙,小静脉内皮基底膜变透明,间隙增大,肿胀样,结构疏松。结论：在鼻中隔偏曲患者中,偏曲两侧的下鼻甲在宽度和高度上差异有统计学意义。偏曲对侧下鼻甲的肥大,既有骨质增生的成分,也有黏膜及黏膜下层组织增生的因素。     

Vomer aplasia in a patient carrying a de novo mutation of the TP63 gene (3q27)

The congenital vomer defect (CVD) is a rare and still partially unknown condition. Only few cases have been reported in the international literature and the large majority of them appeared to be isolated. We report a case of CVD detected in a 7-year-old girl affected by ectodermal dysplasia clefting syndrome caused by a mutation of the TP63 gene.     

鼻骨骨折急诊期的诊断和整复

目的 :提高急诊期鼻骨骨折的诊治效果。方法 :对 30 4例本病患者行鼻骨骨折整复术 16 1例 ,鼻骨骨折整复加鼻中隔矫正术 118例 ,鼻骨骨折整复加鼻窦骨折整复术 13例。结果 :除自动出院 7例外 ,治愈 2 79例 ,好转 18例。结论 :详细检查并酌行 CT扫描 ,注意发现鼻中隔骨折、颅脑损伤及鼻窦骨折的存在 ;严重复合伤按常规救治原则处理 ,伴鼻中隔骨折者可同时行鼻中隔矫正术。     

两种术式处理慢性肥厚性鼻炎疗效分析

目的 分析不同手术方式治疗慢性肥厚性鼻炎的疗效。方法 将124例患者随机分为2组。A组64例,取下鼻甲前端切口黏骨膜下骨部分切除术;B组60例,以微型切吸刀头行黏膜下组织切吸术。比较术后1、6、12个月的疗效。结果 术后1年疗效差异有统计学意义, A组远期疗效优于B组(P<0.01)。结论 下鼻甲前端切口黏骨膜下骨部分切除术后的远期疗效明显好于以微型切吸刀头行黏膜下组织切吸术,该术式对下鼻甲功能影响不大,对下鼻甲黏膜下组织增生或下鼻甲骨质增生所引起的鼻阻塞均有良好的效果,并且保留了全部正常黏膜以及维持下鼻甲的正常舒缩功能的血窦组织,值得适当放宽手术适应证。     

下鼻甲肥大对功能性溢泪影响的分析

目的探讨下鼻甲肥大与功能性溢泪的关系及临床治疗价值。方法 11例下鼻甲肥大伴溢泪患者中,7例同时伴鼻中隔偏曲,术前完善检查,并利用CT泪囊造影术和三维重建,排除溢泪的眼部疾病,行下鼻甲减容术伴或不伴鼻中隔偏曲矫正术,观察疗效。术后随访12个月。结果 11例患者中8例(72.7%)溢泪症状消失,3例(27.3%)溢泪症状好转。7例患者术后鼻中隔均居中,下鼻甲明显缩小。其中鼻塞痊愈10例(90.9%),好转1例(9.1%)。结论下鼻甲肥大为功能性溢泪的一个重要的原因,对其进行治疗可治愈或改善功能性溢泪。     

鼻内镜下鼻中隔成形联合鼻骨复位术一期治疗鼻骨骨折伴鼻中隔偏曲

目的 探讨鼻内镜下行鼻中隔成形联合鼻骨复位术一期治疗鼻骨骨折伴鼻中隔偏曲的可行性、必要性及手术要点.方法 回顾性分析经鼻内镜下行鼻中隔成形联合鼻骨复位术治疗56例鼻骨骨折伴鼻中隔偏曲的诊疗情况,对手术方式、效果、并发症等进行分析.结果 56例患者鼻部外观满意,鼻腔通气畅,嗅觉良好,1例鼻中隔前端穿孔,经放置软骨支撑愈合.术后无鼻中隔脓肿、血肿,随访半年也无外鼻塌陷等并发症.结论 鼻骨骨折伴鼻中隔偏曲可在鼻内镜下同期行鼻中隔成形联合鼻骨复位术,同期手术具有直视下操作,复位精确,切口灵活,微创、并发症少等优点,同时具有卫生经济学意义,但要知情告知并征得患者同意。     

鼻内镜下一期行鼻骨复位术和鼻中隔矫正术

目的 探讨鼻内镜下鼻骨骨折并鼻中隔偏曲同期处理的可行性、必要性及手术注意事项。方法 对32 例鼻骨骨折并鼻中隔偏曲的患者在外伤后10d内行一期鼻骨骨折复位术和鼻中隔矫正术。结果 30例患者外观无明显畸形,2例术后1周再次于黏膜麻醉下行鼻骨骨折矫正术,效果满意;鼻道通畅, 鼻功能恢复良好,无并发症。结论 在鼻内镜下可同时行鼻骨骨折复位术及鼻中隔矫正术     

两种鼻骨复位器在鼻骨复位术中的应用研究

目的 探究3D打印鼻骨复位器在鼻骨复位术中的安全性和有效性.方法 收集2017年11月—2020年6月在上海交通大学医学院附属第九人民医院耳鼻咽喉头颈外科接受手术治疗的鼻骨骨折患者85例.随机分为两组,对照组(41例)术中使用传统鼻骨复位器,实验组(44例)术中使用3D打印鼻骨复位器;最终对照组和实验组纳入分析各39例...     

软骨膜和脱钙骨基质联合移植修复鼻翼软骨缺损

目的探讨软骨膜与同种异体脱钙骨基质（demineralized bone matrix,DBM）联合移植对鼻软骨缺损的修复效果。方法新西兰兔18只随机分为3组,每组6只。制作鼻翼软骨和软骨膜缺损模型,于缺损处移植修复组织。A组为自体耳软骨膜包裹同种异体DBM;B组为自体耳软骨;C组为自体耳软骨膜。10周后取缺损处软骨行大体和病理组织学观察,S100（Soluble protein-100）、转化生长因子β1（transforming growth factor-β1,TGF-β1）免疫组化染色,评价修复效果。结果 A、B两组所得软骨细胞和基质与正常软骨相类似,两组比较差异不明显。C组所得软骨细胞少,基质浅淡,S100、TGF-β1染色阳性细胞少,与A、B组比较均有统计学意义（P〈0.01）。结论软骨膜与同种异体DBM联合移植对鼻软骨缺损的修复效果与自体软骨基本一致,明显优于自体软骨膜移植。     

低温等离子消融术与下鼻甲成形术治疗慢性鼻炎的对比研究

目的 通过研究低温等离子消融术与下鼻甲成形术术后患者鼻塞改善情况和对鼻腔黏膜纤毛功能的影响,探讨治疗慢性鼻炎更有效的方法。方法 选取慢性鼻炎患者40例,随机分为两组,分别行等离子消融术(A组)与下鼻甲成形术(B组)。术前,术后1周、1个月、3个月分别用VAS评分评价患者鼻腔症状。糖精试验评价术前及术后3个月患者鼻腔黏膜纤毛传送功能。结果 等离子组术中出血、手术时间较下鼻甲成形组明显减少,且术后并发症较少;术后3个月两组患者鼻塞均有明显改善;两种手术方式对鼻腔黏膜纤毛功能无影响。结论 对单纯黏膜肥厚的慢性鼻炎,等离子消融疗效显著;对鼻甲骨质肥厚或形态异常的慢性鼻炎,下鼻甲成形术效果好。     

异种脱细胞真皮基质在鼻中隔缺损修复中的应用

目的 探讨应用异种（牛）脱细胞真皮基质修复膜修复鼻中隔术后黏膜缺损的价值。方法 对27例鼻中隔术后的黏膜缺损或穿孔应用异种（牛）脱细胞真皮基质修复膜行一期修复。结果 随访4周～2年,24例鼻中隔偏曲矫正及肿瘤切除术后患者均无穿孔,3例鼻中隔穿孔患者一次性修复成功,外形满意。结论 异种（牛）脱细胞真皮基质修复膜修复鼻中隔术后的黏膜缺损或穿孔手术操作简便,效果良好,有很好的临床应用价值。