孤立性蝶窦炎性疾病的诊治

目的 :提高对孤立性蝶窦炎性疾病症状、体征的认识和首诊准确率。方法 :分析 4 9例孤立性蝶窦炎性疾病的临床表现 ,比较非内窥镜手术 10例和内窥镜手术 39例的手术效果。结果 :未经鼻窦内窥镜手术者 ,1例行蝶窦灌洗后头痛立即缓解 ,4例症状在 1周内缓解 ,5例 2～ 4个月后症状复发 ,窦口瘢痕狭窄阻塞 ,需手术切开引流。经鼻窦内窥镜蝶窦开放术者 ,治愈 31例 ,其中 10例手术后症状立即消失 ,2 1例术后 3～ 5d症状缓解 ;好转 8例 ,其中 5例仅感轻微头痛和嗅觉失灵 ,鼻内窥镜见窦口粘膜肿胀 ,CT、MRI复查未见窦腔病变 ;3例术后2个月视力恢复。术后 1个月复诊窦口开放率为 87.2 %。随访 6～ 4 8个月无病变及症状复发 ,未再次手术。结论 :孤立性蝶窦炎经CT或MRI等高清晰度的影像学检查加之以鼻窦内窥镜检查均可明确诊断 ,且经鼻窦内窥镜手术对其治愈有显著的优越性     

孤立性蝶窦病变的诊治体会

随着诊断技术水平的不断提高，近年来孤立性蝶窦病变的发病率有明显的提高。我科2004年1月-2005年12月共收治孤立性蝶窦病变23例，经鼻内镜手术取得良好疗效。报道如下。     

以神经系统表现为首发症状的孤立性蝶窦炎诊治分析

目的探讨以神经系统表现为首发症状的孤立性蝶窦炎的临床特征和治疗方法。方法回顾性分析1998年4月-2004年4月在本院接受治疗的以神经系统表现为首发症状的孤立性蝶窦炎21例的临床表现、影像学资料及诊治经过。结果21例中主诉单纯头痛9例，视力下降和／或复视6例，头痛并有眼部表现者5例，眼球突出者1例。10例有明确的脑神经损害定位症状，包括第Ⅱ对脑神经损害4例，第Ⅲ对脑神经损害1例，第Ⅳ对脑神经损害1例，第Ⅱ、Ⅲ、Ⅳ对脑神经联合损害者2例，第Ⅵ对脑神经损害2例。全部病例均行鼻内镜下蝶窦开放病变清除术，除1例死于颅内感染外，其余病例症状全部缓解。结论以神经系统表现为首发症状的孤立性蝶窦炎尚未被临床各科室充分认识，常在眼科和神经内科误诊误治，因此，在头痛和／或有眼部神经损害病人中应注意孤立性蝶窦炎的鉴别诊断，CT和MRI是其最佳确诊手段，经鼻内镜手术是治疗孤立性蝶窦炎的有效方法。     

孤立性真菌球性蝶窦炎的诊断和治疗

目的 总结孤立性真菌球性蝶窦炎的临床特征及其诊断与治疗经验.方法 回顾性分析12例孤立性真菌球性蝶窦炎的临床资料及鼻内镜手术后的随访结果,总结本病诊断与治疗的临床经验与体会.结果 所有病例中,表现头痛或眼部疼痛者9例(75％),涕中带血3例(25％).CT扫描均表现为窦腔高密度影,窦内有斑点状或条块状钙化影者10例(83％).12例均在鼻内镜下手术治疗.术后随访6～24个月,术腔黏膜康复良好,无病变复发.结论 孤立性真菌球性蝶窦炎临床症状无诊断特异性,CT扫描是诊断本病的主要影像学方法,鼻内镜下经蝶窦前壁自然口的术式应为首选手术方法.     

蝶窦孤立炎症性疾病的诊治体会

正蝶窦位于鼻腔最后上方,解剖位置深在,部位隐蔽,而且蝶窦各壁毗邻许多重要结构,由于蝶窦良性病变早期症状无特异性,易于造成误诊或漏诊。为了提高对该类疾病的认识,本文回顾分析我科收治的28例蝶窦孤立炎症性疾病的临床资料,报告如下。1资料与方法1.1一般资料2008年至2016年南京市第一医院耳鼻咽喉科收治28例蝶窦孤立炎症性疾病,其中男13例,女15例,23~71岁,中位数年龄51岁。本     

鼻内镜下蝶窦开放术治疗真菌性蝶窦炎32例临床体会

目的 探讨鼻内镜下蝶窦开放术治疗真菌性蝶窦炎的技术要点和疗效分析。方法 回顾分析2006年6月～2009年6月在我院确诊为真菌性蝶窦炎患者32例的临床资料,总结其影像学特征及临床表现,并分析手术技术要点及治疗效果。结果 鼻窦CT显示蝶窦腔内可见明显的高密度斑点或条块状钙化影,是本病特征性的表现。真菌性蝶窦炎临床表现以头痛、涕中带血为主。术后随访12~18个月,患者症状明显好转,无鼻腔黏连、复发等发生。结论 鼻窦CT检查可提高真菌性蝶窦炎的诊断率,鼻内镜手术具有视野清晰、创伤小、出血少、安全性高等优点,符合功能性手术的理念,是治疗真菌性蝶窦炎的首选术式。     

内镜鼻窦手术治疗孤立性蝶窦炎疗效分析

功能性鼻窦内镜手术对于孤立性蝶窦炎的治疗,得到临床普遍认可。现将我院2005年5月-2011年12月经治的42例孤立性蝶窦炎鼻内镜手术的疗效报告如下。     

18例孤立性蝶窦囊肿的诊断和治疗

蝶窦囊肿少见报道 ,随着CT、MRI等影像学技术的发展以及鼻内镜的广泛应用 ,该病的诊断和治疗水平有了很大提高。我科 1994～ 2 0 0 2年共收治18例孤立性蝶窦病变患者 ,现将其临床资料分析如下。1　资料与方法1.1　临床资料18例患者中 ,男 10例 ,女 8例 ;年龄 18～ 6 5岁 ,平均 4 5岁。病程 2 0d～ 1年。头痛 13例 (72 .2 %) ,头痛部位在双侧颞部、前额、球后、枕部和眶部 ,有的甚至表现为全头痛或部位不明确 ,头痛部位同蝶窦病变性质无相关性 ;视力下降或视物不清 8例 (4 4 .4 %) ,复视 5例(2 7.8%) ,眼球运动障碍 2例 (11.1%) ,其中 2例…     

急性孤立性蝶窦炎

本对蝶窦与其周围神经血管的结构、蝶窦炎的临床表现、并发症及影像学检查资料进行综述。认为孤立性蝶窦炎的发病率远高于以往的报告，并可因其并发症而涉及多科室，应充分利用鼻内窦镜、ＣＴ和ＭＲＩ尽早做出诊断和治疗，以免造成一些不可逆的或致死性的并发症。     

孤立性蝶窦病变18例报告

孤立性蝶窦病变临床较少见 ,随着ＣＴ、ＭＲＩ等影像学技术的发展及鼻内镜在临床的广泛应用 ,该病的诊治水平有了很大的提高。我科 1 999～ 2 0 0 2年共收治 1 8例孤立性蝶窦病变患者 ,现将其临床资料报告如下。1　资料与方法1 .1 　 临床资料1 8例患者中 ,男 1 0例 ,女 8例 ;年龄 1 8～ 65岁 ,平均 45岁。病程 2 0ｄ～ 3年。其中孤立性蝶窦炎 9例 ,霉菌性蝶窦炎 5例 ,蝶窦粘液囊肿 4例。全部病例均经ＣＴ或ＭＲＩ确诊 ,术后经病理检查证实。主诉头痛 1 3例 ,头痛部位在双侧颞部、前额、球后、枕部和眶部 ,有的甚至表现为全头痛或部位不明确…     

Current management of isolated sphenoiditis

Isolated sphenoiditis (IS) is a relatively rare clinical entity which might present with serious complications. The clinical records of ten patients with IS were reviewed. The presenting symptoms, the findings, and the treatments given were noted. Eight patients were female and two were male, and their age varied between 9 and 65 years (mean 31 years). The main presenting symptom was headache in five patients, diplopia in four patients, and postnasal drainage in one patient. The duration of the symptoms ranged between 48 h and 1 year. The diagnosis was accomplished by history, nasal endoscopy and radiological examination (computed tomography and/or magnetic resonance imaging). Two patients had fungus ball. One patient was a scuba diver as a possible predisposing factor. All of the patients underwent medical treatment consisting of intravenous antibiotics or oral antibiotics, and endoscopic sinusotomy was performed in nine patients additionally. Complete resolution was obtained for all patients except one who had diplopia for one year. IS may present with headache and orbital symptoms. Timely diagnosis and treatment are substantial in order to avoid serious complications, and to obtain a complete recovery. Medical treatment does not avoid surgery in majority of cases. Surgery is indicated from the very beginning specifically for the cases starting with diplopia which might be suggestive of a progression of the infection. Currently the most frequently used approach is endoscopic transnasal sphenoidotomy. This technique seems to be effective and less traumatic compared to other approaches.     

The sphenoiditis spectrum

The sphenoiditis spectrum This retrospective, comparative study involves 13 patients with sphenoiditis from 2 specialist centres: the Royal National Throat, Nose and Ear Hospital, Gray's Inn Road (7 patients) and the National Hospital for Nervous Diseases, Queen's Square (6 patients). It was found that the ENT patients had a very much longer history, had more nasal symptoms, and suffered none of the neurological complications attributable to the disease. All the neurological patients presented with a complication after a comparatively short history and had few nasal symptoms. One ENT patient was found to have a mucopyocoele, whereas 5 were found in the neurological patients, all of whom had bony deficiencies demonstrated by radiology and at surgery. Once diagnosed and treated the ENT patients all made full recoveries while 3 of the neurological patients remain with sequelae of the disease. Our study suggests that dehiscences of the surrounding bone increase the risk of potentially serious intracranial problems from sphenoiditis, whereas the chronicity of symptoms is of secondary importance.     

Surgical management of chronic sinusitis in children

OBJECTIVES/HYPOTHESIS: The objective was to compare three common surgical modalities in children for the treatment of chronic sinusitis that is refractory to medical management. STUDY DESIGN: Prospective nonrandomized study in a pediatric otolaryngology tertiary service. METHODS: Two hundred two children who satisfied criteria for surgery and were referred over a 10-year period were studied. Children were divided into three surgical groups. Group 1 had both endoscopic sinus surgery and adenoidectomy, group 2 had endoscopic sinus surgery alone, and group 3 had adenoidectomy. After a follow-up period of 12 months, improvement of symptoms was assessed. RESULTS: One hundred eighty-three children had adequate follow-up. Eighty seven percent of children in group 1 had improved symptoms, compared with 75% in group 2 and 52% in group 3 (P < .0001). Multivariate analysis showed that surgical procedure was a predictor of success. Asthma, smoke exposure, and age were independent predictors of success. CONCLUSION: Children who fail medical therapy benefit from surgery. Following certain criteria, one can chose between adenoidectomy alone or endoscopic sinus surgery with adenoidectomy to optimize surgical treatment of these children.     

Comparative analysis of the outcome of external and endoscopic frontal sinus surgery in children

Abstract

Background: Both open and functional endoscopic sinus surgery (FESS) are performed in the case of pediatric frontal rhinosinusitis. However, data from comparative analysis of these surgery types are insufficient.

Objective: Prospective randomized trial for comparison of open and endoscopic surgery outcome in pediatric chronic rhinosinusitis.

Material and methods: The cohort included 30 pediatric patients (7–17?years) with open frontal sinus surgery and 34 patients who underwent FESS using DrafIIa. Lund‐Kennedy and Lund-Mackay scores, as well as Sino-Nasal Outcome Test-20 (SNOT-20)questionnaire was used for pre- and postoperative assessment.

Results: Open surgery and FESS resulted in a significant improvement in total Lund‐Kennedy, Lund-Mackay, and SNOT-20 scores, being more profound in FESS group. Using FESS significantly reduced surgery duration by 15% as compared to open surgery. In addition, open surgery was associated with a higher rate of scar formation, reduced local sensitivity, as well as local soreness, lacrimation, and psychological discomfort. In regression models FESS was negatively associated with postoperative total Lund‐Kennedy, Lund-Mackay, and SNOT-20 scores.

Conclusion and significance: Generally, FESS resulted in better surgery outcome as compared to open surgery, although both approaches resulted in a significant improvement in chronic rhinosinusitis.     

经鼻内窥镜治疗真菌性蝶窦炎

目的探讨经鼻内窥镜治疗真菌性蝶窦炎的手术方法。方法9例真菌性蝶窦炎患者,均采用鼻窦内窥镜手术治疗。结果经6～36个月随访,9例均治愈。结论经鼻内窥镜手术治疗真菌性蝶窦炎具有手术进路安全,患者痛苦小,疗效肯定,术后不易复发等优点。     

Endoscopic management of 108 sinus mucoceles

OBJECTIVES/BACKGROUND: Traditional teaching has emphasized the need for complete removal of sinus mucoceles to achieve a cure. However, with the introduction of endoscopic sinus surgical instruments and techniques, there has been a trend toward transnasal endoscopic management of sinus mucoceles. The aim of this study is to establish the efficacy of endoscopic management of sinus mucoceles. STUDY DESIGN: Retrospective review. PATIENTS AND METHODS: Between 1988 and 2000, 103 patients with 108 paranasal sinus mucoceles were treated endoscopically. This series includes 66 frontal and frontoethmoid, 17 ethmoid, 7 sphenoethmoid, 12 sphenoid, and 6 maxillary mucoceles. Ninety patients (83.3%) had intraorbital extension and 85 of them presented with some degree of proptosis or eye displacement. Sixty patients (55.5%) had erosion of the skull base with varying degrees of intracranial extension of the mucocele. Follow- up ranged from 1 to 131/2 years with a median of 4.6 years. INTERVENTION: All patients underwent endoscopic-wide marsupialization of the mucocele cavity. Stents were used in frontal mucoceles only. RESULTS: Recurrence of a frontal mucocele was seen in 1 patient (0.9%). In 5 patients, out of 23 patients who presented with massive pansinus polyposis in addition to the mucocele, recurrent polyposis required revision surgery. However, the mucoceles did not recur in those patients. CONCLUSIONS: There is increasing evidence in the literature that endoscopic management of sinus mucoceles results in long-term control with recurrence rates at or close to 0%. Rhinologic surgeons should consider the endoscopic technique as the surgical treatment of choice.