鼻内窥镜下经上颌窦开口切除上颌窦囊肿

目的：探讨鼻内窥镜下切除上颌窦囊肿的方法。方法：鼻内窥镜下经上颌窦开口单纯上颌窦囊肿摘除术36例，其中单侧囊肿30例，双侧囊肿6例。顶壁囊肿4侧，前壁囊肿6侧，后壁囊肿6侧，底壁囊肿9侧，内侧壁囊肿11侧，自然开口处囊肿2侧。同一侧同时有底壁和后壁囊肿的2侧，同时有内侧壁和底壁囊肿的有2侧。单纯使用粘膜钳切除18侧，对24侧底壁囊肿和内侧壁囊肿同时结合使用电动切割器切除囊肿。结果：所有囊肿均在鼻内窥镜下经上颌窦开口完全切除。术后无明显并发症。随访0．5～2a，无复发。结论：应用鼻内窥镜经上颌窦开口切除上颌窦囊肿创伤小，操作简便，治疗效果确切，是治疗上颌窦囊肿的有效方法。     

上颌窦癌63例临床诊治分析

目的探讨上颌窦癌的临床诊治经验。方法回顾性分析1995～2001年间经病理证实的上颌窦癌63例,鳞癌36例,腺癌17例,其他类型10例。分别采用术前放疗 手术、手术 术后放疗以及单纯放疗的治疗方法。结果早期误诊23例。术前放疗 手术组、手术 术后放疗组、单纯放疗组的5年生存率分别为50%、55.6%、37.5%。结论为避免上颌窦癌的早期误诊,应熟悉上颌窦癌早期症状,提高队该病的认识。手术和放疗相结合的综合治疗5年存率高于单纯的放射治疗,应根据病情尽量采用综合治疗手段。     

上颌窦内镜手术的解剖与临床

上颌窦病变的处理自Caldwell（1893年）和Luc（1897年）报道后形成了经典的Caldwell—Luc手术,在临床上已应用了近百年,成为治疗上颌窦病变的规范化手术方式。内镜手术兴起后,内镜下筛窦开放术加上颌窦开窗术逐渐替代Caldwell-Luc手术成为鼻科临床最常见的手术方式。     

上颌窦应用解剖的某些观测

本文在50侧(男37、女13)成人标本上,对上颌窦的容积及其与上颌窦前壁的关系、窦壁的厚度进行了了观测。并对与上颌窦手术的径路有关问题,上颌窦穿刺术的进针点和角度的选择进行了讨论。     

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.     

上颌窦穿刺中晕厥的预防及护理

上颌窦穿刺是耳鼻喉科既简便又有不同程度危险的有效治疗方法。据文献报道，上颌窦穿刺时引起晕厥是常见的并发症。我科自2001年1月至2006年1月上颌窦穿刺2049例，其中105例发生晕厥前先驱症状或典型的晕厥，在严密观察和精心护理下，均未发生意外。现将上颌窦穿刺中晕厥的预防及护理报告如下。     

藏酋猴上颌窦的应用解剖

目的 通过对藏酋猴上颌窦的应用解剖,为上颌窦的临床应用提供形态学依据。方法 对6只藏酋猴的12侧上颌窦进行大体解剖,从整体和局部对上颌窦的位置、形态,窦腔与眶、鼻腔和口腔的结构进行观察和测量。结果 藏酋猴的上颌窦位于上颌骨体内,由前、后窦构成。后窦位于前窦的后方,窦腔较小。前窦和人的上颌窦类似,位于第1前臼齿至第2臼齿及相应骨腭的上方,毗邻眶、鼻腔、口腔,窦腔较大且形态无异常;窦腔与眶间骨质较薄,有鼻泪管连通,其管径为(4.31±0.10)mm、长度为(15.89±0.31)mm;窦腔底与鼻腔间有大且恒定的上颌窦裂孔,自然状态下裂孔长度(12.59±0.46)mm、高度(1.01±0.12)mm;向上牵拉海绵状血管球可使裂孔高度增大到(11.14±1.44)mm;窦腔与口腔间骨质最厚处位于第1前臼齿根尖的上方,厚度为(6.20±0.20)mm,最薄处位于第2臼齿根尖的上方,厚度为(1.57±0.23)mm,窦底最低处位于第1、2臼齿间。同一个体双侧对比,差异无统计学意义。结论 藏酋猴上颌窦的形态结构特点,适合于作为动物模型,应用于人类上颌窦病变、上颌窦提升及种植牙的相关研究;其上颌窦裂孔是上颌窦底非开窗手术入路的最佳部位。     

“吸除法”上颌窦囊肿取出术

目的探讨鼻内窥镜下去除单纯上颌窦囊肿简单有效的方法。方法21例单纯上颌窦囊肿患者均经鼻内窥镜上颌窦自然开口扩大"吸引法"上颌窦囊肿吸除。结果21例手术均获成功,术后恢复良好,随访无复发。结论"吸引法"上颌窦囊肿取出术治疗单纯上颌窦囊肿,操作简便、创伤小、效果满意。     

上颌窦的CT三维重建及其临床意义

目的 为上颌牙种植术等临床口腔外科提供解剖学基础。方法 选取全牙志愿者20名,在螺旋CT机以眦耳线（CML）为基线连续扫描,采用ADW 4.2重建软件的曲面重组技术（CPR）重建上颌窦,观察上颌窦的位置、形态和测量上颌窦下壁至上颌后牙牙根的距离。在Amira 3D重建软件下重建上颌骨及上颌窦的可视化模型,观察半透明上颌骨内上颌窦的位置及其与上颌牙根的关系。结果 上颌窦系一呈三边形或四边形的锥形腔隙,其下壁常有凸起的骨隔。半透明上颌骨可视化模型内的上颌窦可清晰显示其位置、形态及其与上颌牙根的关系。上颌窦下壁至上颌后牙牙根的距离以第一磨牙最近,由近及远依次为第一磨牙、第二磨牙、第三磨牙、第二前磨牙和第一前磨牙。上颌窦下壁至左右侧第一前磨牙、第二前磨牙、第一磨牙、第二磨牙、第三磨牙牙根尖的最短距离分别为（9.58±1.13） mm和（9.64±1.15） mm、（4.54±0.92） mm和（4.60±0.90） mm、（2.13±0.50） mm和（2.21±0.53） mm、（2.19±0.65） mm和（2.27±0.65） mm、（3.94±1.14） mm。结论 上颌窦的3D重建,对指导临床选择适宜长度的牙种植体、避免牙种植体误入上颌窦等并发症具有重要的临床意义。     

上颌窦相关解剖结构的锥形束CT影像学特征

背景：为了避免相关并发症的发生以及方便手术方式的选择,上颌窦提升术前准确了解上颌窦区域的解剖结构特点显得尤为重要。 目的：通过牙科锥形束CT影像研究上颌窦区的解剖结构特点,为上颌窦提升种植手术提供参考。 方法：选取符合标准的249例成年人的锥形束CT影像资料,在选择的层面上测量左侧上颌窦内壁的近远心距离和上颌窦的宽度,并对上颌窦内分嵴的情况和上颌窦壁血管的走行特点进行初步观察和分析。 结果与结论：上颌窦内壁的近远心距离的总平均值为(32.0±3.81) mm,上颌窦的宽度总平均值为(21.70±5.16) mm。不同性别、年龄段上颌窦内壁的近远心距离和上颌窦的宽度差别无显著性意义(P > 0.05),上颌窦内分嵴的发生率为33%(78/249);锥形束CT能清晰准确的显示出上颌窦壁血管的分布和走行特点。说明牙科锥形束CT能够全面并准确反映上颌窦的解剖结构,对决定上颌窦提升术的适应证和手术方式以及避免或降低手术并发症的发生率具有重要意义。     

Maxillary sinusitis caused by Actinomucor elegans

We report the first case of maxillary sinusitis caused by Actinomucor elegans in an 11-year-old patient. Histopathological and mycological examinations of surgical maxillary sinuses samples showed coenocytic hyphae characteristic of mucoraceous fungi. The fungi recovered had stolons and rhizoids, nonapophyseal and globose sporangia, and whorled branched sporangiophores and was identified as A. elegans. After surgical cleaning and chemotherapy with amphotericin B administered intravenously and by irrigation, the patient became asymptomatic and the mycological study results were negative.     

Apoptosis as a Mechanism of Maxillary Sinus Mucosa Injury in Rats after Experimental Transection of the Maxillary Nerve

Transection of the maxillary nerve initiates apoptosis of the maxillary sinus mucosa cells in rats. Significant activation of apoptosis and proapoptotic factor p53 was found in the epithelium during week 1 after nerve transection. In delayed period after injury, apoptotic cells predominated in the submucosa against the background of Bcl-2 hypoexpression.     

Maxillary Adenoid Cystic Carcinoma with Annulate Lamellae

Of 29 reviewed ultrastructural studies of adenoid cystic carcinoma, only 1 mentions the presence of annulate lamellae. The present report describes a 65-year-old woman who presented with an adenoid cystic carcinoma in her left maxillary sinus. At the light microscopic level, most of the connective tissue was loose and myxomatous and contained fine strands, cords, and islands of epithelium that in places had a cribriform pattern. The ultrastructural appearance was similar to that described by others. Two epithelial cell types predominated. The cytoplasm of one type contained mainly ribosomes, and that of the other type also had peripheral microfilaments. Also present were pseudocysts, lumina with microvilli, and replicated basal lamina. In addition, a number of both types of cells contained parallel arrays of cisternae that had regular small pores. These were annulate lamellae.     

上颌骨缺损修复的研究进展

上颌骨是面中份外形和功能的重要骨骼结构,参与组成眼眶、颧上颌复合体、鼻腔、口腔等各种面中份重要结构.由肿瘤切除、外伤、炎症及先天畸形所致的上颌骨缺损,往往伴随周围重要结构的破坏或缺失,不仅严重影响外形,而且直接影响语言、咀嚼、吞咽、呼吸等多项生理功能,如不修复,会遗留严重的面部畸形和功能障碍,严重影响患者的身心健康和生存质量[1].……     

Maxillary Adenoid Cystic Carcinoma with Annulate Lamellae

Of 29 reviewed ultrastructural studies of adenoid cystic carcinoma, only 1 mentions the presence of annulate lamellae. The present report describes a 65-year-old woman who presented with an adenoid cystic carcinoma in her left maxillary sinus. At the light microscopic level, most of the connective tissue was loose and myxomatous and contained fine strands, cords, and islands of epithelium that in places had a cribriform pattern. The ultrastructural appearance was similar to that described by others. Two epithelial cell types predominated. The cytoplasm of one type contained mainly ribosomes, and that of the other type also had peripheral microfilaments. Also present were pseudocysts, lumina with microvilli, and replicated basal lamina. In addition, a number of both types of cells contained parallel arrays of cisternae that had regular small pores. These were annulate lamellae.     

Maxillary sinusitis caused by Pleurophomopsis lignicola.

An immunocompetent 59-year-old man developed sinusitis over a 6- to 8-month period after cutting down a rotted maple tree (Acer sp.). A polypoid obstruction with a bloody drainage was evident in his right nasal cavity. A computed tomographic scan showed an opacification of the maxillary sinus. Surgery was performed to remove a fungus ball that had extended into the patient's medial sinus cavity. Sections of the sinonasal mucosa revealed marked acute and chronic sinusitis with inflammation, congestion, and hemorrhage. Sections from the pasty brown to black debrided material revealed a fungus ball consisting of an extensive network of brown-pigmented, septate, profusely branched hyphae. When grown on oat agar, the phaeoid fungus produced pycnidia and was identified as Pleurophomopsis lignicola. The genus Pleurophomopsis includes seven species, which are all known from plant material. This report documents for the first time a coelomycetous fungus, P. lignicola, causing sinusitis in an immunocompetent patient.