鼻内镜下切除筛窦骨瘤13例

目的:报告鼻内镜下切除筛窦骨瘤13例(14侧),并探讨相关的技术方法.方法:采用回顾性研究方法,并复习文献进行讨论.13例筛窦骨瘤患者,7例(8侧)术前CT示骨瘤未附着在纸样板、前颅底,在鼻内镜下解剖骨瘤与周围的联系后切除;4例术前CT示骨瘤附着在纸样板、2例术前CT示骨瘤附着在前颅底,在鼻内镜下解剖、暴露骨瘤后用电钻磨除.结果:13例(14侧)筛窦骨瘤在鼻内镜下完整切除,无眶内和颅内并发症,所有患者术腔在6～8周内上皮化.结论:术前冠位加轴位CT扫描能较完整评价骨瘤与筛窦各壁的关系,为手术方法和器械的选择提供有益的帮助;鼻内镜下配合适宜的手术器械,如电钻等切除筛窦骨瘤,无面部瘢痕、创伤小,是经鼻内途径切除筛窦骨瘤的理想选择.

Endoscopic removal of ethmoid osteoma:report of 13 cases

Objective:To report 13 cases of ethmoid osteoma removed through an endoscopic approach and discuss the operative technique and clinical value.Method:Thirteen cases with ethmoid osteoma were retrospectively reviewed in the study. All procedures were performed with CT image guidance-according to the site of attachment. The anterior ethmoid cell was resected, and the whitish osteoma found. A double blunt elevator was used to separate the osteoma from ethmoid cell, and to push the osteoma medially toward the nasal septum, and (or) inferiorly toward the middle meatus. This method was performed in 7 patients (8 sides), whose CT scan showed the osteoma bases were not attached to lamina papyrace, and (or) anterior skull base. The others were drilled out with a intranasal powered drill for its attached to lamina papyrace in 4 patients and to anterior skull base in 2 patients.Result:Thirteen cases of ethmoid osteoma were removed completely through an endoscopic approach and there were no intraorbital or intracranial complication. Endoscopy showed normal epithelization at around 6 to 8 weeks after surgery.Conclusion:Preoperative CT scans, including coronal and axial images, is very helpful to determine the sites of the osteoma attachment and plan the operation. Endoscopic removal of ethmoid osteoma is not only an ideal, less invasive surgical approach, but also no cosmetic alteration.