鼻中隔偏曲与单侧上颌窦炎性病变的临床观察与CT图像处理

目的通过临床和CT图像观察了解鼻中隔偏曲与单侧上颌窦炎性病变的关系，探讨鼻中隔偏曲在慢性鼻窦炎发病中的作用。方法前瞻性、连续收集经鼻窦冠状位CT扫描证实的鼻中隔偏曲伴单侧上颌窦炎性病变（包括慢性上颌窦炎、上颌窦浆液性囊肿、上颌窦后鼻孔息肉和霉菌性上颌窦炎）患者56例，观察单侧上颌窦炎性病变与鼻中隔偏曲的关系。随机抽取10例患者的鼻窦冠状位CT图像，按Uygur法计算钩突所在平面两侧下鼻甲、钩突和中鼻甲的横断面积（以坐标纸格数表示）在各自鼻腔所占的百分数，并与10例正常对照（鼻中隔正直、无鼻窦病变）进行比较。结果56例患者中，单侧慢性上颌窦炎25例，上颌窦后鼻孔息肉9例，上颌窦浆液性囊肿5例，霉菌性上颌窦炎17例；病变位于鼻中隔偏曲鼻腔宽大侧35例（62．5％），狭窄侧21例（37．5％）。10例鼻中隔偏曲伴单侧上颌窦炎性病变患者下鼻甲、钩突和中鼻甲的横断面积在各自鼻腔所占的百分数在鼻腔宽侧为48．8％，窄侧为44．1％，两侧无显著性差异（P〉0．05）。10例正常对照下鼻甲、钩突和中鼻甲的横断面积在各自鼻腔所占的百分数为右侧40．1％，左侧39．8％，两侧无显著性差异（P〉0．05）。结论鼻中隔偏曲使鼻腔宽大侧发生单侧上颌窦炎性病变的机会大于鼻腔狭窄侧；临床处理上颌窦炎性病变的同时应矫正偏曲的鼻中隔，恢复鼻腔鼻窦正常的结构和功能，阻断鼻中隔偏曲造成的代偿失调。

The clinical observation and CT image processing of nasal septum deviation and unilateral inflammatory maxillary sinus disease

Objective To observe the relation of nasal septum deviation and unilateral inflammatory maxillary sinus disease and to evaluate the role of nasal septum deviation on etiological factor of unilateral inflammatory maxillary sinus disease. Methods 56 cases of unilateral inflammatory maxillary sinus diseases (including chronic maxillary sinusitis, maxillary cyst, antro-choanal polyp, mycotic maxillary sinusitis) with nasal septum deviation were collected prospectively and successively. The relation of nasal septum deviation and unilateral inflammatory maxillary sinus diseases was observed by coronal CT scan. The CT images from 10 patients were used for image processing. The percentage of cross sectional area of inferior turbinate, uncinate process and middle turbinate in respective nasal cavity was calculated and compared with Kemal Uygur's scale-paper method. The results were compared with normal control (10 cases, no nasal septum deviation and no rhinosinusopathia) and statistically analyzed. Results Among 56 cases, 25 cases were found to have unilateral chronic maxillary sinusitis, 17 cases mycotic maxillary sinusitis, 9 cases antro-choanal polyp, 5 cases maxillary cyst. In patients with unilateral inflammatory maxillary sinus diseases, 35 cases were in wide side of nasal cavity,21 cases were in narrow side. On the base of CT image of paranasal sinus of 10 patients, percentage of cross sectional area of inferior turbinate, uncinate process and mesoturbinate were 48.8% in wide side of nasal cavity, 44.1% in narrow side. There was no differences between two sides (P>0.05). In 10 cases of normal control, the percentage was 40.1% in right side, 39.8% in left side. The result showed no significant differences between two sides of nasal cavity (P>0.05). Conclusion The difference of cross sectional area in nasal cavity resulted from nasal septum deviation. Compensatory hypertrophy of inferior turbinate, uncinate process and middle turbinate in wide side resulted in the similar proportion of nasal airway of two sides of nasal cavity. However, compensatory hypertrophy lead to obstruction and stricture, accordingly, the probability of unilateral inflammatory maxillary sinus diseases in wide side of nasal cavity was higher than that in narrow side. In clinical practice, the deviated nasal septum should be corrected at the time of dealing with inflammatory maxillary sinus diseases. The normal structure and function of nasal cavity were recovered. The decompensation due to septum deviation was blocked.