下鼻甲翻转在真菌性上颌窦炎鼻内镜手术中的应用

Inferior nasal concha flipping for mycotic maxillary sinusitis under a rhino-endoscope

目的探讨真菌性上颌窦炎手术入路和手术方法。方法2003年6月至2006年6月应用下鼻甲翻转治疗真菌性上颌窦炎32例,所有病例特点为病变占据整个上颌窦腔,单纯经中鼻道或下鼻道无法彻底处理病变,其中伴有不同程度骨质破坏或吸收19例。全部病例采用鼻内镜下经鼻手术,自下鼻甲前端距离前缘附着处约0.5 cm切断下鼻甲,将下鼻甲制作成蒂在后方的条状组织瓣,依据需要将下鼻甲翻向后方或上方,充分暴露上颌窦腔手术视野。应用0°3、0°、70°鼻内镜可处理上颌窦各个方向病变,对于上颌窦内下角病变可采用内镜下刮匙刮除。病变清除彻底以后将下鼻甲复位,下鼻甲前端切断处缝合1~2针或应用耳脑胶粘附。结果所有病变在鼻内镜下经鼻处理彻底,随访1~4年,未见复发,5例患者术后感觉干燥,应用鼻腔冲洗等处理,症状半个月、1个月逐步消失,所有病例3个月后没有鼻腔干燥、头痛等不适。无鼻腔粘连、狭窄及下鼻甲坏死等。结论应用下鼻甲翻转经鼻手术一方面可以减小创伤,避免了唇龈沟切口;另一方面提供了开阔的手术视野,特别是上颌窦内下角病变的处理,克服了内镜下单纯经中鼻道无法暴露和处理上颌窦内下角病变的不足;克服了因纤毛破坏导致术后不能经中鼻道排泄分泌物的缺点,术后可以从下鼻道引流;同时为术后鼻内镜的复查和复发后的处理提供了充足的视野;另外,保留了下鼻甲结构和容积,避免了因为鼻腔外侧壁去除过多而导致的术后干燥、结痂、头痛等后遗症。

Objective To explore the treatment method for mycotic maxillary sinusitis. Methods 32 patients hospitalized from June 2003 to June 2006 were treated by an inferior nasal concha flipping pathway. All patients are characterized with a fully occupied maxillary antnun cavity, and the pathological tissues could not be completely removed through middle or sub. 19 patients featured bone destruction or absorption to different degrees. All patients underwent rhino-endoscope surgeries. The inferior nasal concha was partly cut off0.5 cm from the anterior adhering point, and the hamular process and the tissues around the opening of maxillary sinus as well as the tissues of the inferior nasal meatus were removed. The inferior nasal concha was made into a banded tissue flap with the pedicle at the rear, and then based on the situation, it was flipped backwards or upwards exposing the fields of view in the operations. Using 0°, 30° and 70° endoscopes, the disordered tissues in the endo-inferior part of maxillary cavity were erased using a curette, and the lacrimal canal in the front end and the sphenopalatine artery were well preserved. After complete removal of the disordered tissues, the inferior nasal concha was repositioned, and the anterior incisions were sutured or glued. Results All disordered tissues were completely removed and no recurrence was found after a follow-up of 1 to 4 years. 5 patients complained about dry nasal cavities and after a nasal douche their symptoms disappeared in 15 to 30 days. 3 months after the operations no complaints about dry nasal cavities or headache were found. No nasal synechia, angusty or necrosis were found. Conclusions Inferior nasal concha flipping can reduce trauma, avoid labiogingval incisions and provides an expansive field of view. Especially when it comes to the management of the endo-inferior part of the maxillary antrum, the pathway can be discharged through the middle meatus. The pathway also provides an expansive field of view for post-operative recheck and management for relapse. By preserving the structure and volume of the inferior nasal concha, the sequel of dry nasal cavity, incrustation and headache are decreased.