急性上颌窦炎粘膜上皮表面凝集素受体的表达及意义

目的：探讨凝集素受体在急性上颌窦炎粘膜上皮表面的表达及意义。方法：利用已建立的实验动物模型将急性炎症标本及正常鼻窦粘膜标本行凝集素亲合组织化学ABC法染色。结果：正常鼻窦粘膜上皮表面欧州白脉根凝集素(LTL)和花生凝集素(PNA)染色基本阴性，而炎症粘膜呈弱阳性；双花扁豆凝集素(DBA)在炎症粘膜染色阳性减弱；N—PNA(预先经神经氨酸酶处理后再进行PNA染色)染色其阳性均显著加深。结论：上颌窦急性炎症期，粘膜上皮表面糖复合物糖链发生改变，这种改变可能一方面是致病菌侵袭的结果，另一方面也是机体局部抵抗炎症的重要防御因素之一。     

兔急性上颌窦炎早期一氧化氮合酶的表达及意义

目的 :探讨一氧化氮合酶 (NOS)在兔急性上颌窦炎 (AMS)窦粘膜中的表达及其意义。方法 :健康新西兰白兔 36只 ,分为空白、阴性对照组和AMS组。通过阻塞窦口并注入 1.0ml的肺炎链球菌悬液 (10 9CFU)建立AMS模型 ,观察时间点为自手术第 5、10天。应用黄递酶———NADPH组织化学技术 ,以NADPH脱氢酶特异性测定NOS在空白、阴性对照组和AMS组兔上颌窦粘膜中的分布及不同时间点AMS组NOS活性表达。结果 :正常和急性上颌窦炎兔窦粘膜酶化学染色均有反应 ,主要分布于粘膜上皮、血管内皮和腺体细胞 (染色程度与正常组相比 ,P<0 .0 5或P <0 .0 1)。结论 :正常兔上颌窦粘膜存在NOS ,一氧化氮 (NO)与上颌窦急性炎症有关 ,炎症时NOS活性明显增高 ,过多的NO会对组织或细胞产生损伤 ,提示NO在AMS发病机制中有重要意义     

干槽症合并急性上颌窦炎一例

干槽症为拔牙2～3日后拔牙创剧烈疼痛,并可向耳颞部、下颌区、或头颈部放散,一般镇痛药物不能止痛;拔牙窝空虚,或有腐败变性的血凝块,腐臭味强烈。罹患慢性根尖周炎的上颌牙齿,因长期炎症致根尖骨质的吸收,牙根与上颌窦之间仅剩薄层粘膜相隔,拔除后往往可出现口腔上颌窦交通导致急性上颌窦炎。笔者遇见1例左上第二磨牙干槽症并发左急性上颌窦炎的患者,现报告如下：     

上颌窦炎及咽炎患者肺炎链球菌带菌及耐药性调查

目的 调查急慢性上颌窦炎及咽炎患者肺炎链球菌带菌及耐药情况。方法 用E—test法及纸片扩散法测定耐药情况．结果 86株肺炎链球菌中，对青霉素敏感64株(74.4％)，低度耐药18株(20．9％)，高度耐药4株(4．7％)，青霉素耐药菌株对红霉索、氯霉素、复方新诺明及四环素的耐药率比青霉素敏感株高，所有菌株对万古霉素敏感．结论 了解细菌耐药性的变化是合理应用抗生素的重要依据。     

鼻内镜手术治疗真菌性上颌窦炎36例

目的：研究鼻内镜手术治疗真菌性上颌窦炎的临床疗效。方法：回顾分析我院2009年1月～2012年6月收治的36例真菌性上颌窦炎患者,在30°鼻内镜上颌寞开放术后,换70°鼻内镜下清除上颌窦内真菌团块,对窦腔高度水肿及息肉样变粘膜,一并切除。结果：术后所有病例均经过6个月的随访,未发现有复发及真菌团块残留的患者。36例患者均达到治愈,未见手术并发症。结论：70°鼻内镜具有大角度,能显示上颌窦腔内全视野的特点,便于术中彻底清除上颌窦腔内干酪样团块,杜绝了术中真菌团块的残留,减少了术后复发。     

上颌窦的胚胎发育

对46例(92侧)12～40周胎儿标本的上颌窦,行冠状切,HE染色,光镜观察:(1)原始上颌窦在胚胎第20～22周由原始筛漏斗底部扩展而成,上颌窦位于钩突和中鼻道外侧壁的外侧,窦腔与眼眶之间的骨板最薄,且骨化较晚.(2)窦口位于上颌窦的顶部(壁),随胎龄增长,”钩突角”变小.向外下的筛漏斗渐近水平位.(3)出生时,上颌窦大小约3.0×5.0×6.5mm.窦内粘膜上皮细胞呈立方形或矮柱状,其纤毛稀疏,,固有膜增厚、疏松,内含极少量血管和腺体.结果表明:出生时,上颌窦虽已出现,但粘膜厚,窦腔小,且与眼眶的毗邻关系密切,上颌窦粘膜的组织结构与鼻腔粘膜的结构有所不同.     

鼻内镜术后联合置管冲洗治疗真菌性上颌窦炎的疗效观察

目的 探究鼻内镜术后联合置管冲洗治疗真菌性上颌窦炎安全性和临床效果。方法 选择2013年3月~2017年3月我院用鼻内镜术后行鼻腔冲洗的真菌性上颌窦炎患者840例,随机分为实验组440例和对照组400例。实验组术后配合常规治疗的同时给予生理盐水500 ml置管冲洗术腔,1次/d,持续14 d;对照组则在术后配合常规治疗的同时给予生理盐水500 ml常规冲洗术腔,1次/d,持续14 d。比较两组患者鼻内镜术后1月、2月、3月及6月鼻腔恢复情况。结果 实验组术后第1、2、3及6月痊愈率与对照组比较,差异有统计学意义（P＜0.05）,第6月实验组痊愈率为45.45%,显著高于对照组的27.50%,差异有统计意义（P＜0.05）。结论 真菌性上颌窦炎患者在鼻内镜手术术后,采用常规综合治疗配合置管冲洗术腔,能够很好地把术腔分泌物及痂皮冲出,减轻鼻腔、鼻窦的炎性反应,缩短鼻窦上皮化的时间,恢复保护和防御功能。     

经上颌窦筛窦手术的应用解剖

在60个尸头(男34,女26)上观察与测量了经上颌窦筛窦手术时有关的形态结构。眶下孔至眶下缘的距离平均6.8±3.4mm;眶下孔至梨状孔缘距离13.1±4.1mm;筛上颌板长9.1±3.0mm;宽5.4±1.5mm;筛上颌板上缘至后筛板顶的高度为 22. 3±3. 7 mm。筛顶板内缘与筛板间的高度差为 0～4 mm者有 59侧(占 49.2％);4～7mm者有 52侧(占43. 3％);7 mm以上者有9侧(占7.5％)。     

对影响上颌窦观测指标的多因素分析

本文用100侧带有窭粘膜的成人头颅标本,对上颌窭容量等与颅而骨性指标,经微机逐步回归多元分析,筛选出与窦腔有相关的颅面指标,并建立了多元回归方程,用于推算上颌窦穿刺冲洗注水量及根治术凿进点位置。另对22侧上颌窦容量回代估算,结果与实际容量无显著性差异(P>0.05),     

Allergy in patients with acute maxillary sinusitis

The occurrence of allergy was studied in 224 patients with verified acute maxillary sinusitis by means of an allergy questionnaire, skin testing, and nasal smears. Allergy was found in 56 patients (25%). In addition, allergy was considered probable in 14 patients (6.5%). The corresponding percentages in the control group were 16.5 and 3, respectively. The difference is statistically significant P less than 0.05). However, the frequency of allergy is lower in the present series than in those previously reported on chronic sinusitis. There were no differences between allergic and non-allergic patients in the number of prior acute sinusitis episodes or of previously performed sinus irrigations. Bacteriological and radiological findings did not differ significantly between the groups.     

Symptoms and signs in culture‐proven acute maxillary sinusitis in a general practice population

The objective of this study was to assess symptoms and signs in patients with maxillary sinusitis and a bacteriological diagnosis obtained by sinus aspiration or lavage. Designed as a prospective cohort study in general practice, the study included 174 patients, aged 18–65 years, suspected of having acute maxillary sinusitis by their general practitioner. The main outcome measures were the independent association of symptoms, signs, erythrocyte sedimentation rate (ESR), and C‐reactive protein (CRP) concentration and confirmed infection with the predominant bacterial pathogens Streptococcus pneumoniae and Haemophilus influenzae. The predominant organisms found in patients with acute maxillary sinusitis were S. pneumoniae and H. influenzae. Body temperature >38 °C and maxillary toothache were significantly associated with the presence of S. pneumoniae and H. influenzae. Positive bacteriological culture results were significantly associated with increasing ESR and CRP values. None of the symptoms and signs, with the exception of body temperature >38 °C and maxillary toothache, were particularly sensitive indicators of the specific aetiology in patients with acute maxillary sinusitis. Elevated ESR and CRP values were significantly associated with positive bacteriological culture results. On the other hand, absence of these symptoms and signs did not exclude the presence of acute maxillary sinusitis.     

The association between paranasal computerized tomography scans and symptoms and signs in a general practice population with acute maxillary sinusitis

The objective of this study was to evaluate the association between changes revealed by computerized tomography scan (CT) and symptoms, signs, and bacteriological diagnoses in a general practice population who had been diagnosed with acute maxillary sinusitis (AMS). This study was designed as a prospective cohort study in Danish general practice in cooperation with the otorhinolaryngology and neuroradiology departments at Aalborg County Hospital. One hundred and seventy-four patients, aged 18-65 years, suspected of having AMS were included. The strongest associations were with purulent nasal discharge, preceding upper respiratory tract infection, maxillary toothache and oedema over the maxillary sinuses. Self-reported previous sinusitis was negatively associated with sinus infection. There was a strong association between increasing values of C-reactive protein (CRP) and erythrocyte sedimentation rate and changes on the CT scan. CT scans contributed only little to the final diagnosis, whereas increased CRP values and elevated erythrocyte sedimentation rates were more reliable indicators of inflammation in the sinuses.     

Fine‐needle aspiration biopsy as an initial diagnostic modality in a clinically unsuspected case of invasive maxillary fungal sinusitis: A case report

Cases of invasive fungal lesions involving the paranasal sinuses are generally diagnosed either on histologic examination or on fungal culture. Here, we report a case of invasive fungal sinusitis diagnosed primarily by a fine‐needle aspiration biopsy (FNAB). Our patient was a 36‐year‐old male who presented with a history of slowly progressive, painless swelling over the left cheek. The only positive clinical finding was a bony hard swelling in the left maxillary region, which was clinically interpreted as “fibrous dysplasia.” A computed tomographic (CT) examination of the paranasal sinuses showed a soft tissue attenuation lesion involving the bilateral maxillae, with the destruction of multiple bones and involvement of multiple sinuses and the bilateral orbits. FNAB of the maxillary swelling showed several giant cells, many of them exhibiting ingested organisms with a morphologic resemblance to the Aspergillus species of fungi. Strikingly, no significant inflammatory cells were seen on cytologic smears. Unfortunately, owing to a lack of initial clinical suspicion, as well as the patient's loss to further follow‐up, a culture/histopathologic examination could not be carried out. This case is presented chiefly to highlight the clinical utility of a simple FNAB procedure, as an initial diagnostic modality in cases of fungal sinusitis, which can masquerade clinically as a neoplastic lesion. In addition, if radiologic findings are also available at the time of cytologic examination, a pretherapeutic comment on the invasive nature of the lesion can also be made. Diagn. Cytopathol. 2010. © 2009 Wiley‐Liss, Inc.     

Anatomic and histological study of maxillary sinus in albino rat

Histotopography of the maxillary sinus in the nasal compartment of the rat head was studied. Anatomical parameters of the sinus were determined, histological structure of the mucosa described, and similarity with organization of human maxillary sinus was revealed.Translated from Byulleten Eksperimentalnoi Biologii i Meditsiny, Vol. 138, No. 12, pp. 680–683, December, 2004This revised version was published online in April 2005 with a corrected cover date.     

Primary sinonasal tuberculosis confined to the unilateral maxillary sinus

Extrapulmonary tuberculosis is not rare and occurs mainly in the head and neck region. Cervical tuberculous lymphadenopathy is the most common form of extrapulmonary tuberculosis. Sinonasal tuberculosis is known to occur very rarely due to the protective functions of sinonasal mucosa. Although some signs of sinonasal tuberculosis may be present, such as associated facial abscesses, the symptoms and signs are usually nonspecific. Clinical suspicion is important for timely diagnosis and proper management of sinonasal tuberculosis due to its rarity and nonspecific clinical presentation. We report a case of tuberculosis confined to the unilateral maxillary sinus that was first misdiagnosed as recurrent rhinosinusitis after endoscopic sinus surgery.     

上颌窦窦口的形态观察及其临床意义

目的：为了指导鼻内窥镜下功能性上颌窦手术。方法：对６０个头部标本（男３４，女２６）１２０侧进行了上颌窦口及其毗邻结构的观察测量。结果：上颌窦鼻通道的鼻开口口径为平均３．８ｍｍ，上颌窦通道长度为５．６ｍｍ，鼻内开口到前鼻棘连线与鼻底平面夹角为４５．２°，前鼻棘至鼻内开口的距离为３７．０ｍｍ，下鼻甲前端至鼻内开口距离为１９．５ｍｍ，中鼻甲前端至鼻内开口距离为１４．６ｍｍ。结论：上颌窦窦口为管状通道，该处的病变可以导致窦腔炎症，可以进行内窥镜下窦口扩大术，术中应避免损伤眼眶及鼻泪管。     

Arterial blood supply of the maxillary sinus.

Knowledge of the arterial supply of the maxillary sinus region is essential for surgical treatment in this area (e.g., implantation of grafting materials, repair of injuries, sinus floor elevation). The goal of this study was to describe the arterial architecture of the maxillary sinus region in respect to sinus lift procedures. In 18 unfixed human cadavers, the arterial vessels of the head were injected with a mixture of latex and barium sulfate. Afterward, the arteries entering the maxilla were prepared. The number and calibers as well as anastomoses were carefully documented. In addition, we measured the distance between the alveolar ridge and the lower main branches. The arterial supply of the maxilla originated from the posterior superior alveolar artery as well as from the infraorbital artery. In all specimens we found an intraosseous anastomosis between these two vessels. The oral mucosa in the area of interest is supplied by the posterior superior alveolar artery and the infraorbital artery, and an extraosseous anastomosis was found in 44% of our cases. The two anastomoses build up a double arterial arcade, supplying the lateral wall of the antrum and parts of the alveolar process.     

Clinical features and treatments of odontogenic sinusitis

Purpose

The aim of this study was to investigate how clinical features such as sex, age, etiologic factors, and presenting symptoms of odontogenic sinusitis are differentiated from other types of sinusitis. Also, this study was designed to find methods for reducing the incidence of odontogenic sinusitis.

Materials and Methods

A retrospective chart analysis was completed on twenty-seven patients with odontogenic sinusitis. They were all treated at Kangbuk Samsung Hospital between February 2006 and August 2008. The study protocol and informed consent forms were approved by the institutional review boards for human beings at Kangbuk Samsung Hospital.

Results

Ten patients (37.0%) had dental implant related complications and 8 (29.6%) had dental extraction related complications. Unilateral purulent nasal discharge was the most common symptom (66.7%). The therapeutic modality included transnasal endoscopic sinus surgery in 19 (70.4%) patients, and a Caldwell-Luc operation in two (7.4%) patients.

Conclusion

In our study, there was no significant difference in the incidence between genders. The average age of the patients was 42.9 years. The incidence was highest in the fourth decade. There were no significant differences between the symptoms of odontogenic sinusitis and that of other types of sinusitis. However, almost all of the patients with odontogenic sinusitis had unilateral symptoms. Iatrogenic causes, which include dental implants and dental extractions, were the most common etiologic factors related to the development of odontogenic sinusitis. Therefore, a preoperative consultation between a rhinologist and a dentist prior to the dental procedure should be able to reduce the incidence of odontogenic sinusitis.