功能性上颌窦手术与上颌窦根治术的疗效比较

对显微镜下行功能性上颌窦手术，即上颌窦自然口扩大术，及传统上颌窦根治术共８９例外 颌窦疾病患者，进行术后随访。其中，行自然口扩大术３９例，传统上颌窦根治术５０匀作鼻及鼻窦内窥镜检查。结果显示，Ａ组的治愈率及造口通虫经，均较Ｂ组为高，但窦腔或窦口息肉以Ａ组发生率为高。表明前者疗效较后者更具优势，但亦有其不足。     

Caldwell—Luc进路联合鼻内镜治疗上颌窦病变

目的 探讨治疗上颌窦良性病变较好的手术方法。方法 采用传统的Caldwell—Luc手术进路与鼻内镜手术联合治疗39例上颌窦病变。上颌窦息肉12例，其中伴鼻腔筛窦息肉7例，出血坏死性息肉3例，上颌窦后鼻孔息肉2例；上颌窦、筛窦息肉术后复发9例；慢性上颌窦炎3倒；真菌性上颌窦炎7例；上颌窦囊肿5例；上颌蜜内翻性乳头状瘤2例；上颌窦炎性假瘤1例。结果 39例经6个月～3年的随访，治愈32例（82．1％），好转6例（15．4％）．1例炎性假瘤术后1个月复发并发眶内感染，总有效率为97．4％。结论 Caldwell—Luc手术联合鼻内镜治疗上颌窦病变。视野清楚，操作方便．既能彻底清除病变，叉保证了窦内黏膜纤毛系统功能的恢复，减少了复发率。     

Important clinical symptoms in patients undergoing functional endoscopic sinus surgery for chronic rhinosinusitis

OBJECTIVE: To evaluate the prevalence and severity of individual Rhinosinusitis Task Force (RSTF) symptoms in patients with chronic rhinosinusitis (CRS) undergoing functional endoscopic sinus surgery (FESS). METHODS: Retrospective analysis of prospectively collected data in 201 patients treated with FESS. The prevalence and severity of individual RSTF major and minor symptom scores graded on a visual analogue scale (VAS) were compared. Correlation between absolute improvement in individual symptom scores at 1-year postoperative was performed. RESULTS: One-hundred fifty-eight of 201 patients met inclusion criteria giving a response rate of 78%. The average age was 49.4 (range 18-80) with a male-to-female ratio of 1.1:1. The preoperative leading mean symptom scores were postnasal drip (5.8 +/- 0.3), nasal obstruction (5.7 +/- 0.3), and facial congestion (5.1 +/- 0.3). These symptoms were also the most prevalent with 82%, 84%, and 79% of patients reporting these symptoms, respectively. Postoperative symptom improvements were significant (P < .0001) across all RSTF domains except fever. The highest percentage improvement was seen with facial congestion (93%), nasal obstruction (92%), and postnasal drip (85%). Multivariate analysis revealed significant (P < .0001) high correlation between improvements of facial pain/pressure with facial congestion (R = 0.72), facial congestion with nasal obstruction (R = 0.65), and facial pain/pressure with headache (R = 0.72). CONCLUSION: The top three RSTF symptoms were postnasal drip, nasal obstruction, and facial congestion in terms of prevalence and severity. Symptom scores improved after FESS. Of these symptoms, the degree of improvement of facial pain/pressure, facial congestion, nasal obstruction, and headache are highly correlated.     

The contemporary practice of functional endoscopic sinus surgery: a nationwide survey

Recent years have seen a rapid growth in the practice of functional endoscopic sinus surgery (FESS). Its introduction into clinical practice has, however, been conspicuous by an absence of good scientific evidence that it is superior to previous techniques. This postal questionnaire survey aimed to identify the diversity in the practice of FESS at a national level and, as a result, highlights areas of patient management requiring standardization. All full members of the British Association of Otolaryngologists—Head and Neck Surgeons (BAO-HNS) were contacted, 64% responded: 14% of surgeons do not always perform preoperative computerized tomography (CT) scanning; only 25% use grading systems for symptoms and/or CT assessment; a wide variety of topical agents are used both before and after operation; nearly half (47%) no longer operate principally under endoscopic vision but via TV monitors; and the majority of surgeons review patients more than 1 week after surgery with a minority advocating earlier postoperative assessment.     

下鼻道泪后开窗上颌窦手术47例临床分析

目的：探讨经鼻内镜下鼻道泪后开窗处理上颌窦病变的疗效。方法：对47例上颌窦病变的患者,采取在鼻内镜鼻窦手术基础上进行下鼻道泪后开窗,经下鼻道窗和扩大的自然窦口对上颌窦息肉、内翻性乳头状瘤、侵袭性鼻窦真菌病等病变进行清理。结果：47例患者上颌窦腔清洁,上颌窦窦口引流好,黏膜转归良好,中鼻道引流好,无囊泡水肿等黏膜病变。仅2例（4．25％）下鼻道窗口约2个月闭锁,1年后上颌窦腔清洁,无病灶复发。结论：经鼻内镜下鼻道泪后开窗联合扩大的自然窦口完全满足处理上颌窦良性病变的需要,同时保留下鼻道窗可在术后起到机械性重力引流作用,在鼻腔鼻窦黏膜纤毛运输系统功能修复前尤为重要。     

Rofecoxib versus hydrocodone/acetaminophen for postoperative analgesia in functional endoscopic sinus surgery

OBJECTIVES/HYPOTHESIS: Functional endoscopic sinus surgery (FESS) is less invasive and more tissue sparing than extirpative techniques, with an assumed benefit of diminished postoperative pain. Oral opioids are commonly prescribed after sinus surgery but are associated with adverse effects, including gastrointestinal and neurologic symptoms. Nonopioid analgesics have been suggested to offer similar pain control efficacy with fewer adverse effects. STUDY DESIGN: To investigate postoperative analgesia in FESS, a prospective randomized, double-blinded comparison of hydrocodone/acetaminophen 7.5/750 mg (an opioidderivative) with rofecoxib 50 mg (a cyclooxygenase-2 inhibitor) was performed. METHODS: Forty subjects were enrolled, of which 28 successfully completed the study. Subjects recorded peak pain levels and requirement for rescue analgesia on the day of surgery and for 4 days thereafter. On postoperative day 5, subjects completed an exit survey in which adverse effects and overall satisfaction with pain control were recorded. RESULTS: In this study, there were no statistical differences in peak pain levels between the groups at any point in the postoperative period, regardless of extent of surgery. Adverse effect profiles were also similar for the two groups. CONCLUSIONS: The use of nonopioid analgesics after FESS may provide similar pain control to oral opioids.     

Evaluation of the lacrimal recess of the maxillary sinus: an anatomical study

The anatomical relation between the maxillary sinus and the nasolacrimal duct has gained greater importance with the advent of microsurgeries and endoscopic-assisted sinonasal procedures, and the growing use of endonasal surgery to perform middle meatus procedures and transnasal dacryocystorhinostomy. We did not find reports on maxillary sinus classification concerning its lacrimal recess, nor how often it is found.ObjectiveTo assess how frequent the lacrimal recess can be found in the maxillary sinuses of dissected anatomical specimens.MethodWe assessed 31 half-heads from cadavers. We dissected the area corresponding to the middle third of the face, by lateral access so as to be able to observe the most lateral portion of the nasolacrimal duct vis-à-vis the maxillary sinus. The maxillary sinuses were assessed by two examiners simultaneously, getting to a consensus in relation to the type of nasolacrimal duct.ResultsWe assessed 18 maxillary sinuses of the lateral type (58.1%) and 13 anterior sinuses (41.9%). The difference in frequency of the anterior type of maxillary type of the right side (35.7%) and left (47.1%) did not have statistical significance (p = 0.524).ConclusionWe found a frequency of 41.9% of lacrimal recesses in the maxillary sinuses.     

Three-hundred and sixty degrees of surgical approaches to the maxillary sinus

Objectives::To demonstrate three-hundred and sixty degrees of maxillary sinus (MS) surgical approaches using cadaveric dissections, highlighting the step-by-ste...     

Fibrosarcoma of the maxillary sinus

Fibrosarcoma arising in the sinonasal cavities are very rare. By the time of clinical diagnosis, they are usually advanced. Lack of adequate surgical margins predisposes these patients to tumor recurrences. Most common sites are the extremities, with only one percent of fibrosarcoma arising in the head and neck area. The imaging features of these tumors reflect their aggressive behavior. We report the case of a maxillary sinus fibrosarcoma in a 16 year-old male patient. Neoadjuvant chemotherapy, medial maxillectomy, adjuvant chemotherapy and subsequent external irradiation was perfomed.     

与鼻内镜上颌窦手术视野相关的上颌窦形态特征

目的：观察与鼻内镜上颌窦手术视野相关的上颌窦形态特征。方法：通过对1000例（2000侧）正常成人的鼻窦CT（轴位＋冠状位）扫描,观察其上颌窦形态并进行分型。结果：CT显示上颌窦与手术相关的形态变化主要在其内侧壁,水平位鼻窦CT显示上颌窦内侧壁的形态在中部较恒定,一般都呈现以内侧壁为底边的三角形或半圆形,前者有857例（85．7％）,后者有143例（14．3％）;冠状位显示上颌窦内侧壁形态前、后层面较为恒定,中间层面的差异较大,有外凸形和平直形,其中外凸形341例（34．1％）,平直形659例（65．9％）。根据中间层面内侧壁的形态及上颌窦气化程度将上颌窦形态分为三型：I型662例（66．2％）,Ⅱ型265例（26．5％）,Ⅲ型73例（7．3％）。结论：上颌窦内侧壁形态影响鼻内镜中鼻道人路的上颌窦手术视野,在鼻内镜上颌窦手术前应充分考虑其形态对于手术视野及病变的清除的影响。     

低温等离子射频辅助下功能性内镜鼻窦手术初步临床观察

目的:通过对低温等离子辅助下的功能性内镜鼻窦手术(CAFESS)患者的术前、术后的临床观察,探讨CAFESS的临床疗效。方法:选取行CAFESS的慢性鼻-鼻窦炎伴或不伴鼻息肉患者30例作为研究对象。术后对患者的主观症状及局部变化过程进行6～9个月的随访观察。结果:术后患者鼻塞、头面部胀痛、流脓涕、鼻涕倒流、头痛等症状明显缓解,并有其他症状的缓解。SNOT-20评分由术前的(22.53±6.26)分减少为术后6个月的(7.80±3.63)分,差异有统计学意义(t=16.741,P<0.05)。Lund-Kennedy评分由术前的(4.30±1.15)分降低为术后6个月的(1.17±0.83)分,差异有统计学意义(t=19.947,P<0.05)。鼻内镜检查:术后第6周,部分患者鼻腔黏膜开始上皮化,直至第12周所有患者鼻腔黏膜完成上皮化。结论:CAFESS是继功能性内镜鼻窦手术后治疗慢性鼻窦炎、鼻息肉的一项新技术,术后临床疗效满意。     

Recurrence rates after endoscopic sinus surgery for massive sinus polyposis

BACKGROUND AND OBJECTIVES: Most studies on outcome after endoscopic sinus surgery (ESS) include patients with varying degrees of disease severity. Recurrence rates cited by those studies may not apply to the subset of patients with severe polyposis. Our aim is to provide reference information for recurrence rates and need for revision surgery in patients with severe disease. STUDY DESIGN, PATIENTS, AND METHODS: Review of patients with severe polyposis with a minimum Lund-McKay score of 16 and with a Kennedy computed tomography stage 3 or 4. Data collection included demographics, presence of asthma or documented allergy, history of previous surgery, extent of surgery, preoperative and postoperative management, recurrence rates, revision surgery rates, and follow-up. RESULTS: One hundred and eighteen records were reviewed. Fifty-nine (50%) patients had asthma, and 93 (79%) had documented allergy. All patients required extensive bilateral nasal polypectomy, complete anterior and posterior ethmoidectomy, and maxillary sinusotomy. One hundred (85%) also had frontal or sphenoid sinusotomy. Follow-up ranged from 12 to 168 (median 40) months. Seventy-one (60%) developed recurrent polyposis. Fifty-five (47%) were advised to undergo revision surgery, and 32 (27%) underwent surgery. History of previous sinus surgery or asthma predicted higher recurrence (P <.005, P <.001) and revision surgery rates (P =.02, P <.001). History of allergy also predicted recurrence and need for revision (P <.001, P <.001). CONCLUSIONS: Recurrence rates after ESS for severe polyposis are significant. In our study, patients with asthma are at higher risk of recurrence.     

Plasma catecholamine levels during functional endoscopic sinus surgery

Plasma adrenaline and noradrenaline concentrations were measured in 10 consecutive patients during functional endoscopic sinus surgery (FESS). Surgery was preceeded by nasal packing with 5 ml 2% cocaine solution, followed by infiltration with 1:80 000 adrenaline and 2% lignocaine. All patients showed a marked rise in plasma adrenaline concentration within 4 min of commencing infiltration, which was not related to the patient's sex, age, weight, the total amount injected, nor the amount injected into the nose. Surgeons should be aware of this marked, but unpredictable, systemic absorption of locally infiltrated vasoconstrictors. Pulse and ECG monitoring should be considered mandatory for such procedures, even when surgery is performed under local anaesthesia.     

Diagnosis and pathology of unilateral maxillary sinus opacification with or without evidence of contralateral disease

OBJECTIVE: Determine the diagnostic criteria and etiology of complete unilateral maxillary sinus opacification. METHODS: A prospective analysis was performed on patients presenting to a tertiary care rhinology practice with complaints of chronic rhinosinusitis or acute exacerbation. Sixty-four consecutive patients were identified with unilateral maxillary sinus opacification on computed tomography (CT) scan after at least a 3-week medical therapy for rhinosinusitis. The study population comprised 30 men and 34 women with a mean age of 47.0 years. All patients completed a symptom score questionnaire, received nasal endoscopy, and CT imaging. Patient symptoms and endoscopic and radiographic findings were analyzed to determine patterns related to final diagnosis. RESULTS: All 64 patients underwent functional endoscopic sinus surgery. Each surgical specimen was sent for pathologic confirmation of the diagnosis. Sixteen mucoceles, 12 cases of nasal polyposis, 27 cases of acute or chronic sinusitis, 7 cases of inverting papilloma, and 2 cases of mycetoma were identified. Endoscopic and radiographic appearances were correlated with each disease process. CONCLUSION: Unilateral maxillary sinus opacification is a relatively common finding. Early identification of inverting papillomas and mucoceles may avoid delay in surgical intervention, whereas acute/chronic rhinosinusitis and nasal polyposis can initially be managed medically. Careful history, endoscopic examination, and radiographic studies can often determine the responsible disease process.     

复发性上颌窦内翻性乳头状瘤二次手术探讨

目的：探讨复发性上颌窦内翻性乳头状瘤二次手术治疗策略。方法回顾性分析32例复发性上颌窦内翻性乳头状瘤的临床资料,包括复发并恶变7例。鼻内镜下手术28例,泪前隐窝入路9例,上颌窦内侧壁切除入路13例,扩大上颌窦内侧壁切除入路6例,上颌骨切除术4例。总结疗效,分析其手术治疗策略。结果术后随访13～39个月,治愈29例;复发3例,其中2例经再次手术治愈;死亡1例。结论对于本病,应根据病变侵犯范围合理选择二次手术的手术入路及手术范围,以彻底切除病灶。内镜下多种手术入路可达切除肿瘤目的,可以避免鼻外辅助切口。     

Long-term results after endoscopic sinus surgery involving frontal recess dissection

OBJECTIVE: To assess long-term follow-up on a cohort of patients who underwent endoscopic frontal sinus surgery with identification and preservation of the natural frontal outflow tract. STUDY DESIGN AND SETTINGS: Retrospective chart review, telephone interview, and endoscopic evaluation on a previously studied cohort of patients at a university affiliated medical center. RESULTS: Two hundred patients who underwent endoscopic frontal sinus surgery were previously studied and reported after short-term (mean = 12.2 mo) follow-up. One hundred fifty-two (76%) patients were available for long-term (mean 72.3 mo) follow-up and assessment of subjective symptoms. Fifty-seven of 152 (37.5%) patients also had nasal endoscopy for evaluation of objective findings. The percentage of patients responding to telephone interview reporting overall improvement after surgery was 92.4%. Endoscopic assessment revealed patency of the frontal sinus in 67.6% of the patients after initial surgery. Thirteen additional patients had patent sinuses after revision procedures, bringing overall patency rate to 71.1%. We found statistically significant correlation of asthma and smoking and poor subjective and objective outcome. CONCLUSION: Long-term assessment of subjective and objective findings in our previously reported cohort of patients who underwent frontal sinus surgery indicates that the frontal sinus, similar to any other sinus, can be successfully treated surgically by preserving the natural frontal sinus outflow tract.