鼻内镜下额筛窦骨瘤切除术

目的：评价额筛窦骨瘤鼻内镜径路切除术的效果。方法：18例额筛窦骨瘤患者中,位于额窦者8例,筛窦者6例,起源于筛窦突入额窦者4例,骨瘤大小为1cm×1cm×1cm～1．5cm×3．0cm×4．0cm,单纯采用鼻内镜径路切除17例,鼻内镜联合鼻外径路切除1例。结果：全部患者均完整切除肿瘤,无脑脊液鼻漏和眶筋膜损伤等并发症。术后随访6个月～3年,术前症状消失,未见复发。结论：对于额筛窦骨瘤,通过鼻内镜必要时结合眉弓切口外径路手术能够完整切除,并能够保护颅底、额窦后壁以及眶纸板等重要结构免受损伤。     

鼻内镜下经筛窦眶纸板入路眶内占位病变切除术

目的 探讨鼻内镜下经筛窦眶纸板入路切除眶内占位病变的可行性.方法 回顾性分析2003年6月～2006年8月以突眼为主要症状的9例眶内占位(2例脂肪瘤、2例海绵状血管瘤、2例炎性假瘤和3例血肿)和1例眶内异物患者.除1例海绵状血管瘤外,均在鼻内镜下经筛窦眶纸板进入眼眶,清除眶内病变.结果 眶内异物一次性取出;1例海绵状血管瘤经眶外切开入路切除;突眼和复视症状均完全消除;术前手动视力提高到0.3,光感视力提高到0.1,伤后14天就诊者视力未恢复.随访3个月至2年,炎性假瘤1例治愈,1例复发,再次手术后切除,现随访中;其余8例均一次性治愈,临床症状消失,无复发.结论 鼻内镜下筛窦眶纸板入路眶内占位性病变切除术,具有术野清楚、损伤小、恢复快及面部无瘢痕等优点,可以完整切除占位病变,方法切实可行.     

经鼻内镜筛窦径路治疗眶骨爆折的疗效观察

目的 :探讨筛窦径路经鼻内镜手术治疗眶骨爆折的临床疗效。方法 :总结 1998年 10月～ 2 0 0 1年 10月收治眶壁骨折患者 19例 ,均在鼻内镜下 ,行眶骨骨折整复术。结果 :经 6～ 12个月随访眶骨骨折 19例 ,术后复视消失 ,眼球凹陷改善。结论 :经鼻内镜筛窦径路手术治疗眶骨爆折 ,入路简捷 ,操作方便 ,眶内侵袭少 ,无面部疤痕 ,疗效可靠。     

侵犯眶内鼻窦囊肿的手术治疗

目的探讨改良眉弓径路联合鼻内镜技术在侵犯眶内的哑铃形筛窦囊肿手术中的应用及疗效分析。方法2002年8月N2012年4月我科收治的7例侵犯眼眶的哑铃形巨大筛窦囊肿患者,全麻下采用改良眉弓切口,鼻内镜辅助下沿眶壁分离并切除眶内囊肿,然后采用鼻内镜囊肿造袋术,切除囊肿。结果7例患者术中眶内及鼻窦囊肿均能充分暴露,并在直视下全部去除。术后无脑脊液鼻漏、眶筋膜损伤和眶内、颅内感染等并发症。术后随访6-18个月,均未见复发。结论采用改良眉弓径路联合鼻内镜行侵犯眶内的哑铃形筛窦囊肿手术,增加了手术的精确性和安全性,切口短,瘢痕小,切除彻底,降低复发率,减少对面部美观的影响,是治疗侵犯眶内的巨大哑铃形筛窦囊肿的有效术式之一。     

经额经鼻内镜联合径路修补额窦脑脊液鼻漏

目的 建立一种治疗额窦脑脊液鼻漏的新技术。方法 7例额窦脑脊液鼻漏，5例行经额一鼻内镜联合径路额窦脑脊液鼻漏修补术，其余2例行单纯经鼻内镜脑脊液鼻漏修补术。结果 4例一次手术修补成功：2例接受了二次手术，另1例三次手术才修补成功。平均随访3年。尽管7例脑脊液鼻漏最终都修补成功，但接受经额经鼻内镜联合径路手术的病人比单纯行经鼻内镜脑脊液鼻漏修补术的病人术后恢复快得多。结论 经额一鼻内镜联合径路是额窦脑脊液鼻漏治疗的首选手术径路。     

眶、额、鼻陈旧性骨折的整复

目的探讨眼眶、额、鼻陈旧性骨折的整复方法.方法陈旧性眶、额、鼻骨折27例中4例用局部切口外固定,13例经下睑下切口,7例经下睑下切口和柯陆氏手术联合径路,3例用头皮冠状切口(包括1例半冠状切口).3例伤期在1月内行局部切口复位固定,24例行眶、额、鼻部植骨,伴眼球移位的患者行眼球复位术.结果23例临床效果满意,4例效果不理想,2次手术整复2例治愈.结论眶、额、鼻区骨折多伴有严重的颅脑损伤,早期常以急救治疗为主,以至此区的损伤不能得到及时治疗,致使眶、额、鼻区和眼球凹陷及复视、运动障碍等,根据病情行手术整复可取得满意效果.     

经鼻内镜筛窦纸板进路眶内手术

目的探讨经鼻内镜筛窦纸板进路手术治疗眶内各种疾病的可行性并确立临床处理的基本原则.方法经鼻内镜进路眶内手术10例眶内异物取出术4例、球后海绵状血管瘤切除术1例、眶内侵犯或转移的恶性肿瘤切除术5例.结果眶内异物取出术3例成功,1例失败;球后海绵状血管瘤1例完整切除;鼻咽癌眶内转移1例手术切除+放射治疗后随访4年无复发,视力恢复至0.6;其他眶内恶性肿瘤4例,手术后随访1～4年均健在.10例手术后1例视力损伤,9例均保留原有视力,其中3例失明病例中2例视力有一定程度的恢复.结论位于视神经内侧的某些占位性病变可以经鼻内镜筛窦纸板进路完成.当代先进的放射治疗技术为眶内恶性肿瘤的保守性手术创造了条件.     

经上颌窦前壁双管穿刺径路治疗上颌窦囊肿

目的 研究上颌窦囊肿的手术治疗方法,为临床治疗提供理论依据。方法 对40例上颌窦囊肿患者行经上颌窦前壁双管穿刺径路鼻内镜手术治疗。结果 术后均无牙列酸痛、面部麻木等不适,单纯上颌窦囊肿患者均术后3 d出院。随诊3个月至半年经鼻内镜及鼻窦CT检查,无脓性分泌物,未见囊肿复发。结论 经上颌窦前壁双管穿刺径路治疗上颌窦囊肿具有手术方法简单、治愈率高、创伤小的优点,可减轻患者痛苦,值得临床推广应用。     

经鼻内镜筛窦径路治疗眶骨爆折的疗效观察

目的：探讨筛窦径路经鼻内镜手术治疗眶骨爆折的临床疗效。方法：总结1998年10月-2001年10月收治眶壁骨折患者19全然 ，均在鼻内镜下，行眶骨骨折整复术，结果：经6-12个月随访眶骨骨折19你，术后复视消失，眼球凹陷改善。结论：经鼻内镜筛窦径路手术治疗眶骨爆折，入路简捷，操作方便，眶内侵袭少，无面部疤痕，疗效可靠。     

经鼻内镜颅底进路手术的探索

目的　探讨经鼻内镜颅底进路手术的可行性和适应证范围。方法　分别采用经鼻内镜前颅底进路和蝶窦后上壁进路完成前颅窝异物取出术、前颅窝嗅神经母细胞瘤和脑膜瘤切除术、侵入前颅窝的鼻腔内翻性乳头状瘤切除术、侵入中颅窝的巨大蝶窦囊肿切除术、原发性中颅窝鞍旁岩尖部胆脂瘤切除术、侵入鞍区的占位性病变切除术共 9例。结果　 9例手术均获成功 ,未发生术中和术后并发症。除 1例低分化鳞癌鞍区占位性病变术后 2年死于其他非相关性疾病外 ,另外良性 ( 5例 )和恶性 ( 3例 )占位性病变随访 1～ 7年未见复发。结论　紧靠颅底的颅内占位性病变有经鼻内镜手术的可能性 ,但是适应证选择应非常严格 ,术者必须具备熟练的解剖学知识、手术技巧和经验 ,并配备先进的手术设备。对范围局限的恶性病变 ,应强调手术后的综合性治疗     

功能性鼻内窥镜手术不同中鼻甲处理方法 与疗效关系

目的探讨功能性鼻内窥镜手术不同中鼻甲处理方法与慢性鼻窦炎手术疗效及鼻功能恢复之间 的关系。方法为l62例、302侧慢性鼻窦炎和(或)鼻息肉患者行功能性鼻内窥镜手术。中鼻甲病变包括肥 厚及息肉样变。依中鼻甲切除与否分为中鼻甲切除组与保留组，按分层抽样、摒弃Ⅰ型和Ⅱ型l期病例的原 则分组。结果(1)中鼻甲保留组治愈、好转及无效分别为72％(36/50)、28％(14/50)和O；中鼻甲切除组治 愈、好转及无效分别为76％(38／50)、24％(12／50)和0。经x     

The effects of functional endoscopic sinus surgery on chronic obstructive pulmonary disease (COPD) and asthma: A comparative study

PurposeChronic Rhinosinusitis (CRS) can be accompanied by asthma and, rarely by chronic obstructive pulmonary disease (COPD). Functional endoscopic sinus surgery (FESS) is the most common surgical approach for CRS which also improves asthma symptoms, but little is known about its effects on COPD. This study investigates the effects of FESS on COPD and asthma symptoms in CRS patients referred to a university hospital in northern Iran.Materials and methodsIn a prospective study, patients with COPD or asthma and CRS who were candidates for FESS underwent endoscopic examination, spirometry, and evaluation of symptoms of CRS, COPD, and asthma before, and 2 and 6 months after FESS. Statistical analyzes were performed using SPSS software version 21 and the level of significance was considered as P < 0.05.ResultsEighty-two CRS patients (45 with asthma/ mean age: 49.24 ± 12.75 years and 37 patients with COPD/ mean age: 61.43 ± 6.93 years) enrolled. In asthmatic patients, the mean FEV1 and FVC, and ACT (Asthma Control Test) score increased significantly after FESS (P < 0.001). In COPD cases, spirometry indices decreased, but CAT (COPD Assessment Test) score improved significantly (from 15.70 to 32.11) after FESS (P < 0.001). The mean SNOT score in both groups was significantly reduced.ConclusionsIn CRS patients with COPD, FESS improves the condition of SNOT-22 and CAT, although does not increase spirometry parameters. In asthmatic patients, FESS improves pulmonary function and asthma symptoms. So both patient groups (i.e. CRS with COPD and with asthma) will benefit from FESS.     

Vestibular evoked myogenic potentials of undiagnosed dizziness

OBJECTIVE: Recording of vestibular evoked myogenic potentials (VEMP) can facilitate the evaluation of otolith function. The dizziness caused by otolith lesions is not completely understood. To clarify which symptoms of dizziness originate from the otolith organs, we examined the relationship between symptoms and VEMP results in patients with undiagnosed dizziness. METHODS: The subjects were 18 patients with undiagnosed dizziness aged less than 40 years who underwent VEMP examination. The VEMP results were evaluated using the interaural ratio of p13-n23 amplitude. RESULTS: Abnormal VEMP results were obtained in five of seven patients who experienced a sensation of falling (p=0.013), in none of the three patients who experienced a swaying sensation (p>0.05), and in one of eight patients who experienced a floating sensation (p>0.05). Five of six patients with abnormal VEMP results complained of disequilibrium lasting a few seconds. CONCLUSIONS: Dizziness with a sensation of falling lasting for a few seconds was related to abnormal VEMP results, suggesting that it resulted from saccular dysfunction. VEMP examination may be considered a useful modality in the diagnosis of dizziness of unknown origin.     

2 353例鼻腔鼻窦肿瘤临床病理分析

目的:了解我科20年来鼻腔鼻窦肿瘤的发生特点及其临床病理特征。方法:用常规病理方法分析了活检或手术切除的2 353例鼻腔鼻窦良性肿瘤,恶性肿瘤的构成及其临床病理特点。结果:良性肿瘤20种,584例,占24.82%;恶性肿瘤25种,1 769例,占75.18%。最常见的良性肿瘤分别是内翻性乳头状瘤,血管瘤和骨瘤,分别占该组病变的43.32%,15.75%,12.33%;最常见的恶性肿瘤分别为鳞状细胞癌,恶性淋巴瘤和腺癌,分别占该组病变的66.67%、14.13%、5.94%。结论:发生于鼻腔鼻窦区的新生物,在临床病理学上具有多样性和复杂性的特点。     

Paranasal sinus fungus ball and surgery: a review of 175 cases

OBJECTIVE: To analyze the surgical results after Functional Endoscopic Sinus Surgery (FESS) in patients with paranasal sinus fungus ball. MATERIAL AND METHODS: Retrospective analysis of the results of FESS performed in 175 patients suffering from paranasal sinus fungus balls. RESULTS: All maxillary (n = 150), sphenoidal (n = 20), and ethmoidal (n = 4) locations have been treated exclusively by FESS to obtain a wide opening of the affected sinuses, allowing a careful extraction of all fungal material without removal of the inflamed mucous membrane. No major complication occurred. Postoperative care was reduced to nasal lavage with topical steroids for 3 to 6 weeks. Only 1 case of local failure have been observed (maxillary sinus, n = 1), and 6 cases of persisting of fungus ball (maxillary sinus, n = 4; frontal sinus, n = 2) with a mean follow-up of 5 years. No medical treatment (antibiotic, antifungal) was required. CONCLUSION: Surgical treatment of a fungus ball consists in opening the infected sinus cavity at the level of its ostium and removing fungal concretions while sparing the normal mucosa. No antifungal therapy is required. Finally, through this 175 patients study, FESS appears a reliable and safe surgical treatment with a low morbidity.     

Statistical observation of vertigo and dizziness patients]

Subjects visiting the Department of Otolaryngology at Suita Municipal Hospital reporting vertigo or dizziness numbered 664 women and 343 men from April 1999 to December 2000. As a city hospital, we play an important role in the diagnosis and treatment of acute vertigo or dizziness. The frequency of diagnosis of these cases was divided almost equally into 5 groups: (1) benign paroxysmal positional vertigo (BPPV) 23%; (2) suspected BPPV, 18%; (3) peripheral vestibular disorders other than BPPV, 22%; (4) disorders other than peripheral origin, 18%; and (5) undiagnosed, 19%. Based on our results, BPPV, other peripheral vestibular disorders, and disorders of other origins should be differentiated from the first screening. BPPV was most frequent and diagnosed by typical positioning nystagmus. Many other peripheral vestibular disorders were accompanied by nystagmus. It is also important to differentiate serious illnesses such as cerebrovascular disease (7%), space-occupying lesions in the posterior fossa (1.2%), and cardio-circulatory disease (3.6%).     

Long-term Results of Functional Endoscopic Sinus Surgery

Although much has been reported on the short-term outcomes of functional endoscopic sinus surgery (FESS), little has been reported with regard to its long-term impact on chronic sinusitis. The senior author (D.W.K.) previously reported detailed subjective and endoscopic follow-up on 120 patients at a mean of 18 months following surgery. This current study represents a long-term follow-up (average, 7.8 years) of 72 patients (60%) from the same cohort. Of patients responding to a question about overall symptoms, 98.4% (n = 66) reported improvement compared with before surgery. There was a trend toward continued subjective improvement in symptom scores with longer follow-up, but the changes did not reach statistical significance. Thirteen patients (18%) required subsequent surgical procedures. Preoperative stage, prior surgery, and other factors that might affect outcome were evaluated. The study demonstrates that excellent subjective results following FESS can be maintained in the long term with appropriate postoperative management. The study also validates the concept that patients in whom the cavity can be normalized following surgery are unlikely to require further surgery     

Ischemic brain lesions in aged patients with dizziness

OBJECTIVE: To compare neuro-otological test results in aged patients complaining of dizziness with their magnetic resonance imaging findings. DESIGN: The presence of lacunar infarcts of the hind-brain was used as a gold standard. SETTING: A department of otolaryngology in a regional general hospital. PATIENTS: All patients over 60 years old with dizziness during a period of 1 year 2 months, excluding those with central lesions of other than vascular origin (n=48). RESULT: Lacunar infarcts were found in 22 patients: the cerebellum for two patients, the brain stem for 17, and both regions for three. Patients with lesions of the cerebellum or the lower brain stem showed central vestibular abnormalities, whereas eight patients with only the upper brain-stem lacunae did not. A canal paresis was found in 12 of 20 patients with the brain-stem lacunae. Patients without lesions in the posterior fossa did not show significant abnormalities, indicating central disorders. CONCLUSION: This study documents a high prevalence of lacunar infarcts of the hindbrain in patients over 60 years old with dizziness, and it also demonstrates the difficulty in detecting small lesions of only the upper brain stem by neuro-otological tests. This calls attention to a differential diagnosis in aged patients with dizziness.     

Influence of extensive functional endoscopic sinus surgery (FESS) on facial growth in children with cystic fibrosis. Comparison of 10 cephalometric parameters of the midface for three study groups

OBJECTIVES: To determine the impact of FESS after the first and before the second growth spurt on facial growth and in particular of the maxilla. DESIGN: Prospective study of 23 patients with cystic fibrosis, 13 patients requiring extensive endoscopic spheno-ethmoidectomy (FESS) because of massive nasal polyposis, with a follow-up of at least 10 years. SETTING: A cystic fibrosis referral centre in an academic tertiary pediatric hospital. PATIENTS: At the time the standard cephalometric measurements were performed all patients were adults with cystic fibrosis. One group of patients underwent FESS during facial growth (N=9), a second group of patients had no previous surgery (N=9), and in a third group FESS has been performed after the second growth spurt (N=5). RESULTS: No statistically significant differences (Kruskall-Wallis test) were found in the cephalometric measurements of these three patient groups. CONCLUSIONS: Extensive FESS after the first and before the second growth spurt has no impact on the outcome of facial growth.     

Functional endoscopic sinus surgery in china

The functional endoscopic sinus surgery (FESS) technique was introduced in China at the beginning of the 1980s and popularized gradually. Now its application has extended to the management of skull base lesions, orbital lesions and sinonasal tumors. This paper will review the application and relevant research of nasal endoscopic surgery and discuss its further perspectives in China.