B型超声对上颌窦疾病的诊断价值

我科１９９６～１９９８年对１００例上颌窦疾病患者作Ｂ超诊断，并与ＣＴ诊断进行比较，借以探讨Ｂ超检查对上颌窦疾患的诊断价值。１临床资料１００例中，男５８例，女４２例；年龄９～７６（平均４０）岁。采用ＨＰ８５００ＧＰ彩色多普勒超声诊断仪和ＳＩＥＭＥＮＳＳＩ４００型超声诊断仪，探头频率３．５ＭＨｚ。其中３１例行瓦氏位Ｘ线摄片，６９例行ＣＴ扫描；４９例行上颌窦穿刺，８例行上颌窦手术探查、鼻内窥镜检查及病理活检，以作对照。２结果上颌窦炎７４例中，急性者５例声像图表现为窦内低回声区、窦壁粘膜增厚、毛糙，部分…     

侵袭性上颌窦真菌病16例报告

目的：提高临床对上颌窦真菌病的诊疗水平。方法：侵袭性上颌窦真菌病患者１６例均行ＣＴ扫描诊断,１３例行Ｃａｌｄｗｅｌｌ－Ｌｕｃｓ‘ｓ术,３例行Ｌａｍａ’ｓ术,均未用抗真菌药物治疗。结果：其骨化缺损呈溶骨性破坏,与良性肿瘤引起的膨胀性骨质缺损没,而与恶性肿瘤相似,随访６个月￣２年无一例复发。结论：ＣＴ诊断该病有重要意义,尽早手术探查有利于明确诊断 。     

上颌窦病变的CT诊断

为探讨ＣＴ在上颌窦病变中的诊断价值，对资料完整的１００例上颌窦病变（６４例炎性病变，１４例良性肿瘤，１７例恶性肿瘤，５例外伤骨折）患者的临床所见，ＣＴ扫描的病理检查进行对比分析。结果：ＣＴ与临床诊断符合率９５．０％（９５／１００）；ＣＴ与病理诊断符合率９２．６％（８８／９５）。认为ＣＴ能较好的显示上颌窦的炎性病变，肿瘤和外伤的范围，肿瘤病变的骨质破坏程度及对周围组织的侵犯情况，有助于准确进行肿瘤的     

干酪性上颌窦炎与上颌窦癌的CT鉴别诊断（摘要）

干酪性上颌窦炎与上颌窦癌的ＣＴ鉴别诊断（摘要）翟立杰，赵力干酪性上颌窦炎可出现与上颌窦癌相似的临床症状，ＣＴ扫描可有骨质破坏并向周围组织浸润。因此，二者的鉴别诊断十分重要。我院自１９９３年３月于１９９４年３月间共收治６例ＣＴ诊断为上颌窦癌，而经手术探...     

上颌窦病变的CT诊断

为探讨ＣＴ在上颌窦病变中的诊断价值，对资料完整的１００例上颌窦病变（６４例炎性病变，１４例良性肿瘤，１７例恶性肿瘤，５例外伤骨折）患者的临床所见、ＣＴ扫描和病理检查进行对比分析。结果：ＣＴ与临床诊断符合率９５．０％（９５／１００）；ＣＴ与病理诊断符合率９２．６％（８８／９５）。认为ＣＴ能较好的显示上颌窦的炎性病变、肿瘤和外伤的范围，肿瘤病变的骨质破坏程度及对周围组织的侵犯情况，有助于准确进行肿瘤的ＴＮＭ分期及划定放疗野，为制定手术方案提供可靠参考。ＣＴ扫描较Ｘ线平片及多轨迹断层摄影具有明显的优越性，但鉴别诊断和定性诊断还应密切结合临床和病理。     

以鼻出血为特征的上颌窦病变27例分析

目的:探讨以鼻出血为特征的上颌窦病变的诊断和治疗.方法:回顾分析1995年1月至1999年6月住院治疗27例患者的临床资料.结果:22例患者经手术切除窦内病变,病理证实为上颌窦息肉、出血坏死性息肉,血管瘤,乳头状瘤,曲霉菌性上颌窦炎等疾病.其中14例行上颌窦根治术,6例行上颌窦根治伴窦内筛窦开放或鼻内筛窦开放术,2例行功能性上颌窦手术.术后恢复良好,随访0.5～4年,除1例失访,无复发.结论:要提高对以鼻出血为特征的上颌窦病变的认识,鼻窦CT扫描有助于诊断,手术切除病灶效果良好.     

48例上颌窦恶性肿瘤的CT影像分析

目的分析总结上颌窦肿瘤性病变的临床症状和CT表现,探讨CT扫描在诊断上颌窦肿瘤中的价值及其与临床表现的关系,以提高对其临床特征的认识和CT的诊断价值。方法回顾性分析48例上颌窦肿瘤患者,全部患者均经CT扫描、鼻内镜检查及手术病理证实。结果临床特征表现为鼻塞98％,鼻分泌物增多72％,鼻出血65％,面部疼痛25％。CT示恶性肿瘤窦壁骨质呈溶骨性或筛孔样骨破坏,窦腔内均见软组织肿块,窦腔轮廓消失,软组织肿块突出腔外;良性肿瘤CT示肿块边界清楚,周围组织受压,呈膨胀性生长,未见明显的骨质破坏。结论上颌窦肿瘤缺乏临床特异性,而CT可以较好的显示病变程度、范围及与邻近结构的关系,可帮助定性,对制定手术方案有一定的价值。     

颌内动脉栓塞治疗小儿鼻腔上颌窦血管瘤2例

单纯用栓塞的方法治疗小儿鼻腔上颌窦血管瘤 (ｈｅｍａｎｇｉｏｍａ)国内鲜见报道 ,现报告 2例 ,以探讨栓塞治疗的可行性及临床价值。1　资料与方法1 .1 　 病例介绍例 1　男 ,6岁。右侧鼻腔反复出血 2年 ,右面颊部隆起半年。ＣＴ检查见右上颌窦内呈软组织密度影 ,窦腔消失 ,窦壁骨质变薄 ,前壁骨质不连续 ,右侧鼻腔及鼻后孔内亦见软组织密度影 ,密度均匀。临床及病理诊断为海绵状血管瘤。例 2　男 ,9岁。左鼻腔反复出血 3年余。左上颌窦内见 4.0ｃｍ× 2 .0ｃｍ大小类圆形软组织肿块 ,边缘光滑 ,密度均匀 ,窦壁骨质完整。病理诊断为海绵状…     

上颌窦出血性坏死性息肉（附20例报告）

上颌窦出血性坏死性息肉（附２０例报告）潘黎明，余延令上颌窦出血件坏死性息肉属良性疾病，而在临床症状、体证及Ｘ线、ＣＴ相中有恶性肿瘤样表现，诊断上容易混淆，影响手术方式的选择。现将我科收冶经手术、病理证实的２０例报告分析如下。１临床资料２０例小，男８例...     

鼻内镜下三种不同入路治疗上颌窦黏膜囊肿的比较

目的探讨因上颌窦黏膜囊肿位置不同,应用不同入路行鼻内镜下上颌窦黏膜囊肿治疗方法的临床比较。方法统计2010年1月-2012年1月收入我院的上颌窦囊肿62例行鼻内镜手术,25例经上颌窦自然窦口行囊肿摘除,20例经下鼻道黏膜下开窗囊肿摘除,17例行鼻内镜辅助下尖牙窝穿刺摘除上颌窦囊肿。结果62例均行鼻内镜手术,术后经病理检查,证实为黏膜囊肿,随访6个月～2年。结论经鼻内镜辅助下不同手术方式治疗上颌窦黏膜囊肿效果明显,损伤较小,治愈率高。     

A-mode ultrasound in the diagnosis of chronic polypous sinusitis

A-mode ultrasound (A-US) is a simple, non-invasive and non-ionizing method for detecting fluid or even mucosal swelling in inflamed maxillary and frontal sinuses. A-US has been shown to be a quite reliable tool in the diagnosis of acute maxillary sinusitis. However, controversy still exists over the reliability of A-US in detecting fluid retention or mucosal swelling in patients suffering from chronic polypous rhinosinusitis or in transantrally operated maxillary sinuses. We have compared the results of maxillary sinus A-US with computed tomography (CT) images in a selected series of chronic polypous rhinosinusitis comprising 40 patients. Fluid retention was seen in 20 of 79 maxillary sinuses on CT scanning. Only 6 of these 20 retentions were detected with A-US. There were 11 false positive findings. In six of these cases a back-wall echo was received through polypoid masses in the sinus. Mucosal swelling was also difficult to diagnose. The results of A-US were not easily reproduced; only in 50% of cases were identical results obtained by two investigators. We do not recommend the use of A-US to diagnose fluid retention or mucosal swelling in a patient with chronic mucosal changes in the maxillary sinus or if surgery has been performed on the anterior wall of the maxillary sinus.     

上颌窦恶性肿瘤侵及骨壁的CT影像与组织病理对比观察分析

目的　通过术前CT影像与术后组织病理检查对比分析,探索和评价CT诊断上颌窦恶性肿瘤的窦内外侵犯的应用价值和受累骨壁的准确性。方法　无淋巴结及远处转移的上颌窦鳞状细胞癌患者11例,术前给予组织病理学检查、增强CT扫描,根据CT影像特征和范围实施上颌骨部分切除或全切除,标记切下的骨组织标本的部位和方位,给予常规固定、脱钙、包埋、切片和HE染色,光镜下观察各壁上颌骨的骨组织病理学改变。结果　11例患者鼻腔鼻窦增强CT扫描显示上颌窦内侧壁均有破坏吸收（4例内壁缺失）,其中侵犯前壁6例,上壁7例,底壁3例,后外壁9例;组织病理学检查见除外内壁缺失患者外,上颌窦内壁均有肿瘤细胞侵犯,且前壁和底壁均有肿瘤细胞侵及,其中上壁4例,后外壁4例;术前CT表现为骨质内壁虫蚀样改变但骨壁连续无中断且伴有增厚硬化的骨壁,术后病理验证无肿瘤侵及。结论　术前CT骨壁的破坏并不意味着骨质被肿瘤侵犯,而且上颌骨各壁侵犯的机率是不同的;综合分析发现术前CT表现为骨质内壁呈虫蚀样改变但骨壁连续无中断且伴有增厚硬化的“改建性骨破坏”者,术后病理验证无肿瘤侵及骨壁;术后常规选取上颌骨骨组织病理分析,可以补充术前CT诊断上颌窦恶性肿瘤侵犯范围的不足,从而精确判断肿瘤的T分级,可能为选择微创的手术方式及术者术后评估手术效果、更科学的制定术后综合治疗提供更有力的依据。     

鼻内镜手术治疗上颌窦良性占位性病变

目的探讨上颌窦良性占位性病变的CT诊断及鼻内镜手术疗效。方法回顾性分析51例上颌窦良性占位性病变的临床资料,临床表现主要有涕中带血、头痛、面部麻木、视力改变等。所有病例术前均行CT检查,术后并经病理检查证实。结果51例中囊肿27例,真菌感染13例,息肉6例,内翻性乳头状瘤3例,出血坏死性息肉1例,血管瘤1例。随访6～24个月,2例复发,治愈率96.1%,无术后并发症。结论上颌窦良性占位性病变以囊肿、真菌性上颌窦炎多见;CT检查有利于本病的诊断及手术方案的制定;鼻内镜手术是治疗上颌窦良性占位性病变的优选术式。     

Hipoplasia del seno maxilar

Maxillary sinus hypoplasia is rare, with an estimated prevalence of 1-5%. Out of the CT scans performed in sinusal patients between March 1998 and June 1999, we report on 4 isolated maxillary sinus hypoplasia, 4 maxillary sinus hypoplasia associated to concha bullosa, and 10 isolated conchae bullosas. All cases were evaluated by nasosinusal endoscopy and CT scan. Size, location and uni/bilateral presentation of concha bullosa is correlated to maxillary sinus hypoplasia presence, specially with regards to uncinate process presence, medial or lateral retraction. The pathogenesis of maxillary sinus hypoplasia is reviewed, and its relation to concha bullosa, evaluating how this could explain some cases of the so called chronic maxillary sinus atelectasia, as an acquired and progressive variant of maxillary sinus hypoplasia in adults.     

Hematoma-like mass of the maxillary sinus

CONCLUSIONS: We have reported a non-neoplastic, heterogeneous, hemorrhagic lesion of the maxillary sinus characterized by a mixture of dilated vessels, hemorrhage and fibrin exudation. This lesion should be distinguished from hemangioma and hematoma. We propose the name "hematoma-like mass of the maxillary sinus" for this disease, based on its histological characteristics. OBJECTIVE: To describe the clinicopathological characteristics of a non-neoplastic, heterogeneous, hemorrhagic lesion of the maxillary sinus associated with mucosal swelling and bone destruction. MATERIAL AND METHODS: This was a retrospective review of six patients who were treated surgically for masses and met the following criteria: (i) CT demonstrated an expanding unilateral maxillary lesion, with thinning or destruction of the surrounding bony tissue; (ii) MRI demonstrated a heterogeneous mass; (iii) macroscopically, a mass with a hemorrhagic and heterogeneous appearance was observed; and (iv) histologically, a non-neoplastic tissue with mucosal hemorrhage was observed. RESULTS: The clinical features of this disease, such as a mass expanding from the maxillary sinus with bone destruction, resembled those of maxillary carcinoma. However, CT and MRI provided sufficient information to differentiate this condition from malignancy. Resection was straightforward due to a firm capsule. Characteristic histological findings were a mixture of dilated vessels, hemorrhage and fibrin exudation.     

单侧上颌窦占位性病变的CT诊断

目的探讨CT扫描对常见的单侧上颌窦占位性病变的诊断意义。方法回顾性总结2006年1月～2008年1月我科治疗的108例单侧上颌窦占位性病变患者的临床及影像学资料,并以组织病理学结果作为对照,对比分析CT扫描在单侧上颌窦占位性病变中的诊断意义。结果108例单侧上颌窦占位性病变中慢性上颌窦炎36例（33．3％）,上颌窦肿瘤32例（29．6％）,真菌性上颌窦炎19例（17．6％）,上颌窦囊肿14例（13．0％）,上颌窦后鼻孔息肉5例（4．6％）,上颌窦出血坏死性息肉及上颌窦嗜酸性肉芽肿各1例（0．9％）。大多数上颌窦占位性病变都具有其特有的临床及影像学表现,鼻窦CT扫描在单侧上颌窦占位性病变的术前诊断总体准确率为79．1％;其中上颌窦囊肿的术前诊断准确率为92．9％,慢性上颌窦炎为90．0％,上颌窦癌为80．0％,真菌性上颌窦炎为86．4％,鼻内翻性乳头瘤为50．0％。结论CT扫描对单侧上颌窦占位性病变的术前诊断有着十分重要的作用,大多数病变通过鼻窦CT检查可以作出初步的定位或定性诊断,并制定出合理的手术方案,最终确诊仍有赖于组织病理学检查。     

真菌性鼻窦炎CT的非特征性表现

目的：回顾分析真菌性鼻窦炎患者术前CT,提出非特征性的临床表现,以提高术前诊断的准确性。方法：术后病理诊断为真菌性鼻窦炎患者CT176例,术前均行鼻窦CT检查及鼻内镜检查。所有患者均经鼻内镜下鼻窦开放术,术中清理窦内病变并经病理检查证实为真菌感染。其中单纯蝶窦35例,单纯上颌窦84例,筛窦上颌窦49例,全组鼻窦3例,筛窦蝶窦5例。观察以上各组术前CT除病变钙化特征以外的非特征性表现。结果：本组患者共176例179侧,其中单侧173例,双侧3例（全组鼻窦感染）。CT的非特征性改变包括：窦内病变密度均匀增高,窦内病变密度不均匀增高,受累鼻窦内侧壁可有骨质吸收。病理证实179侧中,单纯蝶窦组CT病变钙化27侧,CT病变非特征性改变8侧,其中窦内均匀密度增高5侧,不均匀密度增高3侧;单纯上颌窦组病变钙化72侧,病变非特征性改变12侧,其中窦内均匀密度增高8侧,不均匀密度增高4侧,伴有骨质吸收5侧;筛窦上颌窦组病变钙化36侧,病变非特征性改变13侧,其中窦内均匀密度增高9侧,不均匀密度增高4侧,伴有骨质吸收6侧;全组鼻窦组病变钙化6侧;筛窦蝶窦组病变钙化5例。窦内病变钙化达81.56％。结论：窦内病变的钙化被视为真菌性鼻窦炎CT的特征性表现,但在临床工作中可观察到部分真菌性鼻窦炎术前CT的非特征性改变。当缺乏CT的特征性表现时,仅通过CT尚不能作出真菌性鼻窦炎的术前诊断,需其他检查手段来做鉴别诊断,甚至需经手术探查后的病理诊断来确诊。     

Organized hematoma of the maxillary sinus

OBJECTIVE: Organized hematoma of the maxillary sinus can develop by means of organization of hematoma in the unaerated maxillary sinus. To our knowledge, this is only the second article describing organized hematoma in the maxillary sinus. MATERIAL AND METHODS: We have observed eight cases of organized hematoma of the maxillary sinus recently and here we describe the clinical features (using CT scans and medical records), radiologic characteristics and pathologic findings. RESULTS: The patients comprised five males and three females (mean age 58 years), all of whom had a history of frequent epistaxis. They also complained of nasal obstruction, hyposmia, headache and swollen cheeks. Rhinoscopy revealed obliterated nasal cavities due to bulging lateral walls. CT scans showed soft-tissue densities expanding the maxillary sinus into the nasal cavity. The treatment modalities used (applied either alone or in combination) were Denker's operation, Caldwell-Luc's operation and endonasal endoscopic surgery, and the outcomes were successful. CONCLUSION: Organized hematoma should be included in the differential diagnosis when patients have frequent epistaxis and an expansile mass in the maxillary sinus.     

Anxiolytics reduce residual dizziness after successful canalith repositioning maneuvers in benign paroxysmal positional vertigo

Conclusions. We have reported a non-neoplastic, heterogeneous, hemorrhagic lesion of the maxillary sinus characterized by a mixture of dilated vessels, hemorrhage and fibrin exudation. This lesion should be distinguished from hemangioma and hematoma. We propose the name “hematoma-like mass of the maxillary sinus” for this disease, based on its histological characteristics. Objective. To describe the clinicopathological characteristics of a non-neoplastic, heterogeneous, hemorrhagic lesion of the maxillary sinus associated with mucosal swelling and bone destruction. Material and methods. This was a retrospective review of six patients who were treated surgically for masses and met the following criteria: (i) CT demonstrated an expanding unilateral maxillary lesion, with thinning or destruction of the surrounding bony tissue; (ii) MRI demonstrated a heterogeneous mass; (iii) macroscopically, a mass with a hemorrhagic and heterogeneous appearance was observed; and (iv) histologically, a non-neoplastic tissue with mucosal hemorrhage was observed. Results. The clinical features of this disease, such as a mass expanding from the maxillary sinus with bone destruction, resembled those of maxillary carcinoma. However, CT and MRI provided sufficient information to differentiate this condition from malignancy. Resection was straightforward due to a firm capsule. Characteristic histological findings were a mixture of dilated vessels, hemorrhage and fibrin exudation.