额隐窝区域结构立体影像研究

目的：对测试对象鼻窦区域行螺旋CT扫描后,将额隐窝区域内重要的含气结构行三维重建,对其中重要的解剖结构进行观察并测量相关参数。方法：选择30例因病接受鼻窦CT检查的患者为研究对象,对其头部行多排螺旋CT扫描（螺距1mm,扫描层厚2mm,层距-1mm）,通过工作站对数据进行三维图像重建形成3D模型。对该模型上各种气房的结构、形态、相对空间排列以及其相应的引流途径进行观察及分析,对额窦和鼻丘气房的几何尺寸以及两者之间的空间距离进行相对精确地测量,并进行归纳、分析。结果：在重建后的额隐窝立体模型上可清晰地辨识出鼻丘气房、额气房等重要气房结构以其相互间的空间排列关系,并对其自然形态以及额窦引流模式有了直观的印象。鼻丘气房的高度为（9.45±3.60）mm,前后径为（8.08±3.37）mm,额窦的上下径和左右径分别为（26.98±6.82）mm、（26.86±9.45）mm,额窦底与鼻丘气房顶部之间的距离为（7.80±3.36）mm。结论：借助三维CT重建技术获得了额隐窝区域气房3D结构模型;该模型对认识和界定额隐窝区域各种气房结构有重要的指导意义,同时获得的相关参数可为额窦手术提供可靠的依据。     

鼻内镜下中鼻道联合泪前隐窝入路治疗真菌性上颌窦炎

目的 探讨鼻内镜下经中鼻道上颌窦自然口扩大联合泪前隐窝入路治疗真菌性上颌窦炎的适应证及疗效。 方法 回顾分析2008年6月至2014年6月行鼻内镜下经中鼻道上颌窦自然口扩大联合泪前隐窝入路治疗真菌性上颌窦炎32例患者的临床资料,分析联合入路的适应证、疗效及并发症。 结果 患者均完整彻底清除病变,无并发症发生。随访1年半以上,均无复发。 结论 鼻内镜下经中鼻道上颌窦自然口扩大联合泪前隐窝入路视野清晰,对上颌窦暴露充分,上颌窦霉菌清除彻底,创伤小,疗效确切,可作为鼻内镜下经中鼻道行上颌窦扩大或辅助下鼻道开窗仍无法彻底清除窦内霉菌的首选方法。     

100例尸头额隐窝气房正常变异及额窦引流通道分析方法

目的 探讨中国人额隐窝气房变异种类及额窦引流通道类型,指导鼻科医生安全开放额窦。 方法 100例尸头标本行解剖前薄层轴位CT扫描,按照额隐窝气房分类及“搭积木”式额窦引流通道分析方法,分析额窦引流通道,并通过解剖得以证实。 结果 中国人额隐窝气房发育变异较大,包括前方外侧的鼻丘气房、鼻丘上气房、鼻丘上额气房;内侧的额窦间隔气房;后方的筛泡、筛泡上气房、筛泡上额气房;100例标本中,鼻丘气房发生率95%;鼻丘上气房发生率为32%;鼻丘上额气房发生率为19%;筛泡上气房发生率为53.5%;筛泡上额气房(额泡气房)发生率为22%;额窦间隔发生率为23.5%;额窦引流通道形式有多种,按出现情况,从多到少为:前内侧型(右侧34例,左侧35例);前方型(右侧18例,左侧17例);内侧型(右侧14例,左侧13例);前外侧型(右侧10例,左侧10例);后方型(右侧6例,左侧7例);外侧型(右侧6例,左侧5例);直接型(右侧3例,左侧5例);后内侧型(右侧3例,左侧4例);夹缝型(右侧2例,左侧0例);后外侧型(双侧均有1例)。 结论 采用额隐窝气房分类法,按照“搭积木”方式分析额窦引流通道,是一个“以不变应万变”的方法,可以帮助鼻科医生术前了解额窦引流通道形式,术中安全、彻底开放额窦。     

A computer-assisted anatomical study of the nasofrontal region.

OBJECTIVES/HYPOTHESIS: Objectives were as follows: 1) to define the variations of the uncinate process' superior attachment, 2) to study the diameter of the frontal sinus ostium, 3) to study the prevalence of the agger nasi cells, and 4) to evaluate the side-to-side variability of these structures. STUDY DESIGN: A retrospective clinical study at a tertiary care center. METHODS: One hundred forty-four consecutive computed tomography scans were studied with image-guided surgery software (InstaTrak, Visualization Technology, Inc., Wilmington, MA) that provides continuous coronal, sagittal, and axial sections. We reported the superior attachment sites of the uncinate process, the diameter of the frontal sinus ostium, and prevalence of the agger nasi cells. RESULTS: The uncinate process' main superior attachment into the surrounding structures was found to have the following distribution: 52% to the lamina papyracea, 18.5% to the posteromedial wall of the agger nasi cell, 17.5% to the lamina papyracea and the junction of the middle turbinate with the cribriform plate, 7% to the junction of the middle turbinate with the cribriform plate, 3.6% to the ethmoid roof, and 1.4% to the middle turbinate. The frontal ostium anterior-posterior diameter (mean +/- SD) was 7.22 +/- 2.78 mm and its transverse diameter (mean +/- SD) was 8.92 +/- 2.95 mm. Agger nasi cells were found in 78% of the scans. CONCLUSIONS: The frontal sinus opens into the middle meatus medial to the uncinate process in 88% of the patients and lateral to the uncinate process in 12% of the patients. The naturally wide dimensions of the frontal ostium help to explain why postoperative patency can be achieved merely by exposing the ostium without the need to enlarge it. The frontal ostium dimensions in one side may differ considerably from the contralateral side. An agger nasi cell or a terminal recess, or both, are found in most cases. Image-guided surgery software is a helpful new tool for anatomical studies and for preoperative evaluation.     

Imaging of the patulous eustachian tube: high-resolution CT evaluation with multiplanar reconstruction technique

Objective—To evaluate the 3D anatomy of the ET and its surrounding tissues in cases with or without patulous Eustachian tube (ET) using CT with the multiplanar reconstruction (MPR) technique.

Material and Methods—Twenty patients with a patulous ET and 25 without middle ear problems were investigated. After performing a temporal bone CT examination, MPR images of the ET were reconstructed and measurements were made.

Results—The ET lumen and its surrounding tissues were clearly identified. In the patulous ET group, the ET lumen was open throughout the cartilaginous portion and the volume of the low-density area was smaller in size than in the controls. In unilateral patulous ET patients, the anatomical features were found to be similar on both sides, in spite of the fact that the non-involved side did not show symptoms associated with a patulous ET.

Conclusion—For the first time, we were able to obtain clear reconstructed images of the patulous ET and its surrounding structure and to study its anatomical features. This method is useful for obtaining a better understanding of the ET and ET-related diseases such as patulous ET.     

蝶窦、视神经管多层螺旋CT三维重建后的影象解剖学测量

目的：为经鼻内镜蝶窦手术、视神经管减压术提供影象解剖学基础。方法：利用螺旋CT三维重建技术对40例(80侧)鼻、鼻窦正常的受试者行蝶窦、视神经管有关解剖数据的影象学测量。结果：两侧视神经管各壁长度均值为：内侧壁12.08±0.62?mm,外侧壁10.16±1.73?mm,上壁9.16±1.17?mm,下壁10.24±1.35?mm。两侧视神经管及蝶窦有关径线均值为：视神经管颅口处：左右径5.57±0.95?mm,上下径4.53±0.78?mm;中部：左右径4.40±0.67?mm,上下径4.36±0.67?mm;眶口处：左右径5.09±0.85?mm,上下径5.90±0.98?mm;鼻小柱前缘中点到蝶窦前壁中点的距离：7.08±0.54?cm;蝶窦最大左右径：17.83±4.38?mm,最大上下径：18.40±3.76?mm,最大前后径：23.19±6.73?mm。结论：螺旋CT三维重建技术可以准确有效地测量蝶窦、视神经管的解剖结构,对经鼻内镜手术具有重要指导价值。     

Investigation of C-arm cone-beam CT-guided surgery of the frontal recess

OBJECTIVE/HYPOTHESIS: A cone-beam CT (CBCT) imaging system based on a mobile C-arm (Siemens PowerMobil) incorporating a high-performance flat-panel detector (Varian PaxScan) has been developed in our laboratory. We hypothesize that intraoperative C-arm CBCT provides image quality and guidance performance sufficient to assist surgical approach to the frontal recess. STUDY DESIGN: A preclinical prospective study was conducted using six cadaver heads to assess the performance characteristics and the potential clinical utility of this imaging system. METHODS: The mobile C-arm was employed for intraoperative CBCT guidance of the endoscopic approach to twelve frontal recesses. RESULTS: The imaging system is capable of sub-mm 3D spatial resolution with bone and soft-tissue visibility and a field of view sufficient for guidance of head and neck surgery. The system can generate intraoperative, volumetric CT images rapidly with an acceptably low radiation exposure to the patient and with image quality sufficient for most surgical tasks. Moreover, the system is portable and compatible with the surgical setup, providing excellent access to the patient. Finally, the accuracy of the system is not bound to a registration process. CONCLUSIONS: The ability to create updated images as surgery progresses introduces the concept of 'near-real-time' CT guidance for head and neck surgery. We found that the use of CBCT increased surgical confidence in accessing the frontal recess, resolved ambiguities with anatomical variations, and provided valuable teaching information to surgeons in training in both preoperative planning and correlation between tri-planar CT scans and intraoperative endoscopic findings.     

Detection of small fenestral otosclerotic lesions by high-resolution computed tomography using multiplanar reconstruction

Objective

The aim of this study was to assess the value of multislice computed tomography (MSCT) using multiplanar reconstruction (MPR) to detect the small fenestral lesions in patients with otosclerosis.

Methods

MSCT with MPR imaging was used to evaluate 27 ears of 17 patients with otosclerosis (3 male and 14 females) ranging in age from 33 to 69 years with a mean of 49.8 year. MSCT imaging was performed using Aquilion^®. Axial spiral scans with a 0.5-mm slice thickness were obtained. The acquired high-resolution data were transferred to a workstation (ALATO VIEW). MPR images were created in the planes parallel to the stapedial crus and then analyzed on the monitor screen by two radiologists (Y.T. and N.K.).

Results

MPR images showed abnormal findings in 26 of 27 ears with otosclerosis (96%), whereas axial images showed abnormal findings in only 15 of 27 ears (56%). The similar classification between both images was shown only in 9 of 27 ears (33%). In 16 ears (67%) axial images under-evaluated the lesions compared with MPR images. MPR images detected smaller foci than axial images. Air-bone gap at 0.5–4 kHz tended to increase dependently on the extension of fenestral lesions evaluated by MPR images.

Conclusion

MPR images detected fenestral lesions in otosclerosis more frequently and more precisely than axial images. The extent of fenestral lesions observed on MPR images tends to be related to the degree of conductive hearing loss.     

Impact of residual ethmoid cells on postoperative course after endoscopic sinus surgery for chronic rhinosinusitis

Objective

Endoscopic sinus surgery (ESS) is a worldwide standard surgical procedure for chronic rhinosinusitis (CRS). Residual ethmoid cells (RECs), which result from failure to completely remove them, have been thought to be a cause of recurrence of CRS. Our objective was to investigate the relationship between the REC score and post ESS recurrence of CRS.

Methods

From January 2002 through December 2003, a total of 138 consecutive CRS patients (86 men and 52 women; mean age: 44 years) underwent ESS at the Department of Otorhinolaryngology, Ota General Hospital. CT was performed at 6 or more months post ESS for all patients. The left and right ethmoid sinuses were each divided into superior-anterior, inferior-anterior and posterior parts. The extent of RECs in each part was assessed using a 3-grade scoring system. The outcome of CRS was classified into a satisfactory outcome group and a poor outcome group based on the improvement rate determined from the pre ESS and post ESS CT image findings. The two groups were then compared for the age, gender, presence/absence of nasal polyps, presence/absence of allergic rhinitis, presence/absence of asthma, the peripheral eosinophil count (%) and the total REC score. In addition, the individual correlations between the above variables and the poor outcome group were analyzed by logistic regression analysis.

Results

The total REC score was 0 in only 35 (25.4%) of the total patients. The most common total REC scores were 1–6 in 85 (61.6%) patients. The superior-anterior part had the largest number of patients with an REC score of 1 or more. The satisfactory outcome group comprised 97 patients (70.3%), while the poor outcome group comprised 41 patients (29.7%). Comparison of these two groups found that the peripheral eosinophil count, the prevalence rate of asthma and the total REC score were each significantly higher in the poor outcome group than in the satisfactory outcome group. Logistic regression analysis identified a peripheral eosinophil count of ≥9.5%, the presence of asthma and a total REC score of ≥4 as factors that correlated significantly with a poor outcome.

Conclusion

The findings of this study indicate that RECs are involved in the recurrence of CRS following ESS. It can be thought that how to achieve full opening of the superior-anterior part of the ethmoid sinus, which includes the frontal recess, will be an issue in the future.     

鼻内镜治疗额、筛窦囊肿的临床分析

目的比较鼻内镜手术和鼻内镜与鼻外联合进路手术治疗额、筛窦黏液囊肿的疗效。方法37例鼻内镜手术和鼻内镜与鼻外联合进路治疗额、筛窦黏液囊肿患者及随访14个月～3年，比较两种术式的治疗效果。结果26例采用鼻内镜手术，11例采用鼻内镜与鼻外联合进路，均能够较好暴露术野，术后囊腔得到充分引流；34例获得满意疗效，无严重并发症发生。结论鼻内镜手术是治疗额、筛窦黏液囊肿安全的有效方法。     

正常人鼓窦入口和鼓窦CT三维重建及解剖学研究

目的:对正常人鼓窦入口及鼓窦不同方向的直径进行CT测量及三维重建,检测其正常值范围。并对年龄、性别及侧别这3个因素分类后分别进行比较。方法:随机选取90例无耳部病变受试者,行矢状面、横断面及冠状面高分辨率CT扫描,后期对扫描图像进行鼓窦入口、鼓窦三维重建,左右径、上下径及前后径测量和分组对照分析。结果:不同年龄段鼓窦入口CT三维重建构像较为恒定,而鼓窦则较为多样;鼓窦入口左右径平均值为(5.19±1.39)mm,上下径为(5.74±1.16)mm。鼓窦左右径平均值为(8.27±1.41)mm(<6岁),(5.41±1.32)mm(≥6岁);上下径平均值为(11.78±1.65)mm(<6岁),(9.91±2.04)mm(≥6岁);前后径平均值为(12.25±1.23)mm(<6岁),(10.05±1.69)mm(≥6岁)。鼓窦入口左右径无年龄、性别和侧别差异(P>0.05),鼓窦入口上下径存在性别差异,即男性鼓窦入口上下径大于女性(P<0.05);鼓窦左右径、上下径及前后径均存在年龄间的差异(P<0.05),但无性别、侧别间的差异(P>0.05)。结论:正常人鼓窦入口影像学表现较为恒定,而鼓窦较为多样;不同性别鼓窦入口上下径存在显著性差异;不同年龄组间鼓窦左右径、上下径及前后径均存在显著性差异。     

鼻腔,鼻窦冠状位CT扫描解剖学观测及其指导意义

对１００例无明显鼻部疾病的成人行鼻腔，鼻窦冠状位ＣＴ扫描，从不同层面观测鼻腔，鼻窦重要解剖结构的值限范围和形态。结果昌：高台型筛板与筛顶间的平均高度差为５．１７ｍｍ，筛泡宽度为１１．１５ｍｍ，中鼻甲的宽度为５．４０ｍｍ；Ｈａｌｌｅｒ气房的出现率为１４．０％，中鼻甲气化为１４．０％，Ｏｎｏｄｉ气房的出现率为８．５％。     

The diagnostic value of measurement of cochlear length and height in temporal bone CT multiplanar reconstruction of inner ear malformation

Conclusion: The cochlear length (CL) and cochlear height (CH) measured through MPR will provide for more accurate quantitative diagnosis of inner ear malformation, and are subsequently convenient for calculating cochlear duct length (CDL) before cochear implant.

Objectives: Qualitative and quantitative diagnosis of inner ear malformation in deaf patients through multiplanar reconstruction (MPR) was performed to provide a reference for cochlear implants.

Methods: One hundred and two cases without sensorineural deafness and 560 patients with sensorineural deafness had MPR of temporal bone computed tomography performed to obtain the standardized cochlear-view and oblique coronal-view images. The inner ear radial lines were measured to formulate normal values for inner ear malformation diagnosing, and the CDL was estimated based on CL.

Results: The normal range values of inner ear radial lines were measured and formulated, of which CL was 8.1–9.59?mm and CH was 3.28–3.90?mm. According to inner ear morphology and the normal values measured above, 61 cases of incomplete partition-type II (IP-II) and a high percentage (27/110, 24.5%) of hypoplasia of cochlea (HC) were diagnosed. The HC group was further divided into 1-turn, 1.5-turn, and 2-turn sub-groups, which had CDL of 15.98?±?1.48?mm, 21.36?±?0.96?mm, and 26.56?±?0.60?mm, respectively.     

蝶窦口的影像解剖测量及其临床意义

目的测量蝶窦口与周围解剖结构的影像解剖数据,为临床提供相关数据。方法选取30例蝶窦无异常的健康成年志愿者行鼻窦薄层扫描,并行矢状位及冠状位的重建,利用工作站对蝶窦口与周围结构进行测量。结果蝶窦口的最大上下径为(2.28±0.52)mm,左右径为(2.06±0.32)mm,蝶窦口与前鼻孔的距离为(72.34±3.67)mm,蝶窦口与蝶窦顶壁、后壁、下壁及外侧壁的最大距离分别为(10.64±3.99)、(17.68±2.78)、(13.25±3.50)、(8.76±3.79)mm。结论蝶窦口为经蝶手术的重要解剖标志,扩大蝶窦口应自蝶窦口向内下方扩大,向上不易超过(10.64±3.99)mm,向外侧不易超过(8.76±3.79)mm。     

螺旋CT在额窦引流系统解剖研究中的应用

目的 探讨额窦引流系统的CT影像学解剖特征及其临床应用价值.方法 35例志愿者,应用螺旋CT作额窦引流系统的横断面容积扫描,然后经工作站进行冠状面和矢状面、曲面三维重建.结果 螺旋CT三维成像技术能清楚地显示钩突附着部位和类型.在70侧钩突中,附着于纸样板31侧（44.3%）,鼻丘后壁10侧（14.3%）,中鼻甲15侧（21.4%）,前颅底14侧（20.0%）.在69侧额隐窝气房中,鼻丘气房13侧（18.8%）,前筛气房14侧（20.3%）.69侧额窦内气房中,眶上气房24侧（34.8%）,额窦中隔气房（M气房）8侧（11.6%）.结论 额窦引流系统CT影像学解剖特征的显示,可为鼻内镜外科术前决策提供有价值的信息,具有重要的临床参考意义.     

鼻内镜下泪前隐窝入路处理医源性上颌窦异物

目的 探讨经鼻内镜下泪前隐窝入路处理医源性上颌窦异物的方法及疗效。方法 2012年1月至2014年6月为11例医源性上颌窦异物行鼻内镜下泪前隐窝开窗上颌窦异物取出术。结果 11例上颌窦异物均一次取出, 术后上颌窦自然口引流好, 黏膜愈合佳。术后随访3至6个月, 鼻腔、鼻窦恢复良好, 无并发症发生。结论 鼻内镜下泪前隐窝入路处理医源性上颌窦异物具有视野好、操作方便、损伤小、功能保护佳的优点, 处理巨大异物优势更明显。