中鼻甲、鼻中隔解剖变异的螺旋CT评价

MDCT Evaluation of Anatomic Variants of Middle Turbinate and Nasal Septum

目的：采用高分辨多排螺旋CT研究鼻中隔和中鼻甲解剖变异，并评价它们对前组鼻副窦引流通道的影响。方法：回顾分析60例行鼻腔和副鼻窦高分辨多排螺旋CT检查患者的图像资料。其中男35例，女25例，平均年龄42岁。所有受试者均采用16排螺旋CT机行高分辨容积扫描，层面从硬腭至额窦上缘，准直0．75～1mm，横断、冠状和矢状重建，层厚及层距均为1mm。分别观察和统计鼻中隔和中鼻甲解剖变异的类型和发生率，并评价其与前组鼻副窦引流通道的关系。结果：60例中，共发现鼻中隔变异45例（75％），其中鼻隔偏曲45例（单向偏曲31例，双向偏曲14例）；犁骨一软骨结合部畸形5例（肥大2例，脱位3例）；鼻隔刺16例。中鼻甲变异共43例（71．7％），其中反曲15例；气化9例；双侧不对称20例（46．5％）。不对称中鼻甲中，增大一侧多见于鼻隔偏移方向的对侧，多数伴有不同程度的钩突移位和筛漏斗或鼻道狭窄。结论：鼻腔和中鼻甲不对称与鼻中隔偏曲关系密切，后者是导致前组鼻副窦引流通道中的关键部位一中鼻道和筛漏斗狭窄的重要原因。

Objective：To study anatomic variants of nasal septum and middle turbinate and evaluate their effects to drainage pathways of anterior paranasal sinuses by high resolution MDCT. Methods： Sixty subjects （male, 35 cases;female, 25 cases;with average age of 42 years） ,whose nasal meatus and paranasal sinuses were examed by 16-row MDCT in our institute, were analyzed retrospectively. The technique of high resolution, with the collimation of 0.75-1 mm and the scan level form palatine to superior margin of frontal sinus, was used in this series. Axial,coronal and sagittal multiplanar reconstruction with 1 mm slice width were acquired. The categories and incidences of variants of nasal septa and middle turbinates were observed and analyzed, and their relation with drainage pathways of anterior paranasal sinuses were evaluated. Results： In this series, 45 septal deformities （75% ） and 43 variations of middle turbinates （ 71.7 %） were demonstrated. There were 45 septal deviations （single deviation, 31;double deviation, 14）, 5 deformities of vomer-cartilage junction （enlargement, 2 ; dislocation, 3） and 16 septal spurs in the cases with septal deformities, and 15 paradoxical curves,9 pneumatizations and 20 enlargements in the cases with variations of middle turbinates. In most commonly,enlarged middle turbinates occurred in the sides opposite to septal deviation （46.6 %）, which could stenose middle meatus and ethmoid infundibulum. Conclusion ： Asymmetry of nasal meatus and middle turbinates is closely associated with septai deviations, which are important reason leading to stenosis of middle meatus and ethmoid infundibulum that are key posi tion of drainage pathways of anterior paranasal sinuses including frontal,anterior ethmoidal and maxillary sinuses.