鼻内镜下筛泡前径路额窦开放手术

目的探讨经鼻内镜筛泡前径路额窦开放术的技术路线,讨论该术式在额窦开放中的疗效和安全性。方法选取23例(36侧)确诊为慢性额窦炎的成人病例,采用经鼻内镜筛泡前径路术式开放额窦。术后随访观察评估其安全性及疗效。结果20例经该径路开放成功,3例经额钉补充定位后开放成功。全部病例均无严重并发症出现,术后随访12～39个月,术前症状均消失,无复发。经鼻内镜检查额窦口开放良好。结论经鼻内镜筛泡前径路额窦开放手术是一种解剖标志易辨认、技术路线安全、疗效肯定的术式。     

筛泡前径路额窦开放术的鼻内镜解剖

目的研究鼻内镜下额窦开口及周围解剖结构,为筛泡前径路额窦开放术式提供应用解剖依据。方法鼻内镜下按照筛泡前径路额窦开放的手术步骤,解剖12例24侧外观无异常,经10%福尔马林固定的成人尸头(男8例,女4例)标本,观察额窦开口的解剖特征以及与周围结构的关系。结果①星状裂及其周围结构是识别额窦开口的重要解剖标记。②星状裂由筛泡、钩突和中鼻甲的顶端共同汇合形成。③额窦开口始终位于星状裂的中心,钩突基板的后方,后鼻道气房或筛泡基板的前方,周围有后鼻道气房和前鼻道气房围绕。④筛泡及伸出的前、后角是星状裂的后界限。⑤筛泡前入路开放额窦可以避开筛前动脉和筛顶。结论通过鼻内镜对额窦开口及周围解剖结构的观察,认为星状裂作为恒定的解剖标志是识别额窦开口的关键区域。筛泡前径路是鼻内镜下额窦开放的安全入路,能避免其他径路存在的某些风险。     

以钩突、筛泡为标志的额窦手术

鼻内镜下额窦手术因操作空间小,观察受限,毗邻复杂、解剖变异等因素,使鼻内镜下判断额窦开口和开放成为困难,我们试图通过鼻内镜下相邻解剖的观察,探讨鼻内镜额窦手术中较恒定的解剖标志。1资料与方法1.1资料收集2002年1月~2003年1月,需额窦手术的鼻窦炎、鼻息肉住院病人40例50     

绕开钩突由筛泡径路的内镜精准术式的临床观察

目的 探讨应用绕开钩突由筛泡径路的内镜精准术式在临床应用可行性及疗效.方法 回顾性分析2018年6月～2020年6月间30例行绕开钩突由筛泡径路的内镜精准术式患者的临床资料,详细分析和记录术中情况及总体疗效.结果 由筛泡径路术式适合目前精准手术要求,特别适合有筛上颌窦气房、眶下气房及Haller气房等存在变异患者.术后...     

额窦前壁骨折并发筛窦同种异体牙异物1例

患者,男,34岁。于2002年10月6日骑自行 车时不慎与迎面骑车者相撞,对方唇齿部撞击患者 右侧额部,使其额部挫裂出血。患者伤后在外院获 清创缝合及抗生素、破伤风抗毒素治疗,术后伤口 感染不愈,经加强抗感染用药,感染症状减轻,但停 药后症状加重,并相继出现低热、头痛、鼻塞、脓     

经额窦径路微创手术切除额下颅底巨大肿瘤

作者报道了1组14例经额径路手术治疗前颅底肿瘤的病例,10男4女,平均年龄58．2岁。病理类型包括脑膜瘤6例,嗅神经母细胞瘤3例,鳞状细胞癌3例,腺癌1例及腺样囊性癌1例。5例硬膜内切除,9例硬膜外切除。全组病例均无大的并发症发生,全部病例都不需传统的经面径路或开颅手术。     

内镜鼻窦手术中眶上筛房的定位作用和筛前动脉分型的意义

目的:探讨内镜鼻窦手术中眶上筛房(SOEC)定位额窦口(FO)和筛前动脉(AEA)的作用,以及AEA内镜分型的临床意义.方法:收集116例慢性鼻窦炎患者的临床资料,筛选出伴有SOEC并完成DrafⅡ A型手术者36例(47侧),记录SOEC与FO、AEA的影像-解剖关系.根据内镜下AEA隆起范围与筛顶的关系,将其分为1...     

筛泡前气房CT三维重组的影像特征及手术技巧

目的筛泡前气房可严重阻碍额窦引流,但却常被忽视,本文通过CT三维重组技术分析筛泡前气房的影像特点及其同额窦引流通道的关系,探讨手术去除筛泡前气房、开放额窦的技巧。方法对鼻及鼻窦炎患者术前轴位薄层螺旋CT扫描,冠状位、矢状位重组,明确筛泡前气房的存在,在鼻内镜下确认,分析它同额隐窝引流通道的关系。结果筛泡前气房在矢状位和轴位CT均表现为额窦区域后上方的气房,从额隐窝沿着颅底进人额窦：手术中沿着筛泡前气房的前壁可顺利找到额窦口。结论 CT三维重组对明确筛泡前气房和额窦引流通道的关系有重要意义,筛泡前气房是筛泡过度气化形成从颅底越过额窦口延伸至额窦内影响额窦引流,手术中去除筛泡前气房,可明显扩大额窦口,改善额窦引流。     

筛泡基板前上端在鼻内镜额窦手术中的定位作用

目的寻找适合鼻内镜手术下开放额窦的解剖学标志,以降低手术并发症的发生率。方法对30例(60侧)慢性鼻窦炎病人行鼻窦CT扫描,根据CT扫描中筛泡基板前上端向上附着的部位与纸样板/筛顶的关系,术中以筛泡基板前上端为标志,寻找额窦开口,进行鼻内镜额窦手术。并与同期40例(75侧)依据前筛顶额突为标志进行鼻内镜额窦开放术的手术并发症的发生率进行比较。结果30例(60侧)病人在以筛泡基板前上端为解剖标志进行鼻内镜额窦开放术中,手术并发症的发生率为3.3%(1/30),与同期40例(75侧)病人依照颅底额突作解剖标志进行鼻内镜额窦开放术的手术并发症的发生率20%(8/40)进行比较有统计学意义(P<0.05)。结论在鼻内镜额窦手术中以筛泡基板前上端为解剖标志,能有效地帮助寻找额窦开口,降低手术并发症的发生率。     

前组筛窦相关解剖变异的CT影像学观察及临床意义

目的：探讨国人前组筛窦的相关解剖变异,为临床手术提供参照数据和资料。方法:回顾性分析263例患者前组筛窦的影像学资料,对前组筛窦相关解剖变异进行统计和评估,并进行年龄相关性比较。结果:筛泡肥大和中鼻甲气化的出现率在成年组和未成年组差异有统计学意义。结论:CT检查不仅可以评估病变,而且可以检出与鼻腔-鼻窦疾病手术危险性相关的解剖变异,有助于预防鼻内镜手术并发症的发生。     

CT扫描对前筛窦及其毗邻结构的研究

将40具完整成人尸头进行冠状位及横断位CT扫描，其中部分尸头还运用横断位CT扫描重建矢状位CT扫描，对前筛窦及其毗邻结构进行观察。结果示：根据CT扫描，可将前筛窦气房分为4组：即漏斗前筛房（出现率87．5％）、漏斗外气房（出现率82．7％）、漏斗后气房（出现率86．3％）、筛泡筛房（出现率100．0％）；同时又可将前筛窦分为筛内型（出现率71．2％）和筛外型（出现率28．8％）。表明CT扫描能充分显示前筛窦气房的气化变异及其邻近结构的影像学特征。这对于提高鼻内窥镜手术的疗效，减少严重并发症的发生，具有重要的指导意义。     

Combined anterior-to-posterior and posterior-to-anterior approach to paranasal sinus surgery: an update

OBJECTIVES: To develop an anatomically and functionally based approach to endoscopic intranasal ethmoidectomy; to develop such an approach using the salient features of the anterior-to-posterior (AP) and posterior-to-anterior (PA) intranasal sinus operations; to assess the safety of this form of ethmoidectomy in a patient population. STUDY DESIGN: Retrospective chart review of patients undergoing ethmoidectomy by the authors or by residents under their direct supervision. SETTING: University teaching hospital. RESULTS: Two thousand three hundred and forty-four patients underwent either unilateral or bilateral ethmoidectomies between April 1992 and August 2005. A complication rate of 0.34% was observed. CONCLUSIONS: Combining an AP approach to conserve sinus anatomy with a PA approach to avoid surgery directed toward the skull base provides a functional and safe procedure, as demonstrated by the reported results.     

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.     

Direct approach to the anterior and lateral part of the maxillary sinus with an endoscope

ObjectiveThe Caldwell-Luc (CL) approach with a sublabial incision is used to manipulate the anterior wall of the maxillary sinus. Paresthesia is one of the major complications associated with the CL approach. We developed a new method, “direct approach to the anterior and lateral part of the maxillary sinus with an endoscope” (DALMA), that negates the need for a sublabial incision and minimizes dental paresthesia by reducing the risk of anterior superior alveolar nerve injury. This study aimed to describe how to perform the DALMA technique, and to review its effectiveness and associated complications.MethodsWe retrospectively reviewed 10 patients who had received DALMA.ResultsTen patients underwent DALMA. The anterior superior alveolar nerve was identified in all patients. Access to the lateral side beyond the infraorbital canal and anterior wall of the maxillary sinus was achieved.ConclusionsDALMA is a simple, effective, and minimally invasive technique that can be used as an alternative to CL with sublabial incision.