鼻内镜下额隐窝解剖特征与额窦开放手术

目的　通过术中鼻内镜下解剖额隐窝 ,总结与内镜额窦手术相关的镜下额窦引流通道解剖特征 ,探讨额窦鼻内镜手术相关问题。方法　病例资料为慢性鼻窦炎、鼻息肉患者 30 1例 ( 5 6 2侧 ) ,有前期手术史者除外。术前鼻窦CT扫描证实合并额窦炎者 2 80例 ( 4 79侧 ) ,术前根据CT扫描判定额窦引流方式 ;术中以钩突为参考标志 ,2 5 0例 ( 4 2 1侧 )行鼻内镜下额窦开放手术 ,并对鼻内镜下额隐窝解剖结构特征进行分型。结果　冠状CT扫描提示额窦开口于钩突与中鼻甲之间为 2 0 3侧( 4 8 2 % ) ;额窦开口于钩突和眶纸板之间 2 18侧 ( 5 1 8% )。对应上述规律的鼻内镜下额隐窝解剖特征分型 :前者属Ⅰ型 2 0 3侧 ( 4 8 2 % ) ,后者属Ⅱ型 2 18侧 ( 5 1 8% )。结论　以额窦口为中心的额隐窝鼻内镜下解剖特征及分型 ,对额窦开放手术有重要意义 ;钩突上部为CT扫描和术中定位额窦口解剖参考标志

Endoscopic anatomic characteristics of frontal recess and frontal sinus surgery

Objective To study the endoscopic anatomic characteristics of frontal recess (FR) in relation to endoscopic frontal sinus surgery (EFSS) according to the anatomic findings during surgery Methods We conducted a review of the surgical outcome and computed tomographic imaging in 301(562 sides) patients with chronic sinusitis 280 cases (479 sides) had chronic frontal sinusitis confirmed by coronal and axial CT scan, except for patients with prior sinus surgery The drainage patterns of frontal sinus (FS) were judged according to CT scans 250 cases (421 sides) underwent EFSS We tried to classified the endoscopic anatomic characteristics of FR into two types Results CT showed 203 (48 2%) sides of FS opened and drained between the uncinate and middle turbinate in FR when uncinate process was attached to the lamina papyracea; 218 (51 8%) sides of FS opened and drained directly into the infundibulum in the FR when uncinate process was attached to the roof of anterior skull base or the anterior superior part of attachment of middle turbinate We divided the anatomic characteristics of FR into two types Among them, type I was 203 sides(48 2%),type II was 218 sides(51 8%) Conclusions The endoscopic anatomic characteristics of FR and its classification would well benefit for EFSS The upper part of the uncinate process is a dependable anatomic landmark for the orientation of frontal sinus ostium in the CT scan and EFSS