原发性鼻窦骨瘤临床分析

目的 总结并分析原发性鼻窦骨瘤的临床特征、诊断方法、手术入路及预后.方法 回顾性分析南京医科大学第一附属医院2007年1月至2013年12月收治的48例原发性鼻窦骨瘤患者的临床资料.所有患者均行术前CT检查,8例另行MRI检查,并依据影像检查结果制定手术方案.手术入路方式为鼻侧切开术14例,鼻内镜下鼻窦骨瘤切除术12例,冠状切口颅骨切开术13例,颅面联合径路(颅底前入路-额颞入路术)4例,传统Caldwell-Luc进路手术5例.结果 本组患者术后病理诊断密质型骨瘤20例,松质型骨瘤15例,混合型骨瘤13例.该组48例鼻窦骨瘤患者术后6例失访,余42例平均随访6个月至5年,有5例骨瘤复发.本组患者术后并发鼻窦黏液囊肿4例,脑脊液鼻漏3例.结论 鼻窦骨瘤较常见,CT和/或MRI有助于评估肿瘤的大小、位置、可能的来源和手术方案的制定.手术切除是主要治疗方式,鼻侧切开术和鼻内镜下鼻窦骨瘤切除术可切除绝大多数肿瘤.鼻窦骨瘤预后好,较少复发.     

鼻窦骨化纤维瘤手术探讨

目的　探讨鼻窦骨化纤维瘤的手术进路 ,分析各种手术的方法和特点。方法　回顾性分析我院 1994年 8月～ 2 0 0 1年 7月治疗的鼻窦骨化纤维瘤 35例的临床资料。结果　 35例中男 2 3例 ,女 12例 ,年龄 2～ 4 5岁 ,平均 17 1岁。手术方式包括鼻侧切开手术、鼻内镜下手术、冠状切口颅骨切开手术 (包括冠状切口颅骨切开联合鼻内镜下手术及冠状切口颅骨切开联合鼻侧切开手术 )、Caldwell Luc进路手术。鼻内镜下手术 2 2例 ,彻底切除 8例 ,部分切除 14例。 2例在影像导航辅助下手术。鼻侧切开手术 6例 ,彻底切除 4例 ,部分切除 2例。冠状切口颅骨切开手术 5例 ,彻底切除 2例 ,部分切除 3例 ,有 2例联合鼻内镜下手术 ,1例联合鼻侧切开手术。Caldwell Luc进路手术 2例 ,均为部分切除。 35例患者随访 33例 ,失访 2例 ,平均随访时间 3 5年。结果 14例无复发 ,14例带瘤生存 ,5例复发后再次手术。结论　鼻窦骨化纤维瘤手术进路的选择主要依据病变范围 ,同时要考虑器官结构的功能、美容、手术的难易程度以及术者的经验和习惯等。     

鼻窦骨化纤维瘤手术探讨

目的 探讨鼻窦骨化纤维瘤的手术进路，分析各种手术的方法和特点。方法 回顾性分析我院1994年8月～2001年7月治疗的鼻窦骨化纤维瘤35例的临床资料。结果 35w例中男23例，女12例，年龄2～45岁，平均17．1岁。手术方式包括鼻侧切开手术、鼻内镜下手术、冠状切口颅骨切开手术(包括冠状切口颅骨切开联合鼻内镜下手术及冠状切口颅骨切开联合鼻侧切开手术)、Cadwell-Luc进路手术。鼻内镜下手术22例，彻底切除8例，部分切除14例。2例在影像导航辅助下手术。鼻侧切开手术6例，彻底切除4例，部分切除2例。冠状切口颅骨切开手术5例，彻底切除2例，部分切除3例，有2例联合鼻内镜下手术，1例联合鼻侧切开手术。Cadwell-Luc进路手术2例，均为部分切除。35例患者随访33例，失访2例，平均随访时间3．5年。结果 14例无复发，14例带瘤生存，5例复发后再次手术。结论 鼻窦骨化纤维瘤手术进路的选择主要依据病变范围，同时要考虑器官结构的功能、美容、手术的难易程度以及术者的经验和习惯等。     

鼻内翻性乳头状瘤手术进路选择

目的探讨不同手术进路切除鼻内翻性乳头状瘤的适应证。方法对35例(39侧)鼻内翻性乳头状瘤患者术前行鼻窦CT扫描和鼻内镜检查,根据肿瘤部位和范围分别采取鼻侧切开术9例(9侧),鼻内镜下经鼻进路20例(22侧),面正中掀翻进路2例(4侧)和经鼻内外联合进路术式4例(4侧)。术后随访23个月～11年,平均37个月。结果9侧行鼻侧切开术中1侧复发(11%),22侧鼻内镜下经鼻进路中2侧复发(9%),其它进路无复发病例。结论应根据肿瘤原发部位和范围选择相应的术式。局限于筛窦、蝶窦、上颌窦窦口周围以及额隐窝周围的肿瘤可采取鼻内镜下经鼻进路手术。     

鼻内镜下鼻窦骨瘤切除术后疗效分析

目的探讨经鼻内镜手术治疗鼻窦骨瘤的手术方法及治疗效果，总结鼻窦骨瘤手术经验。方法回顾性分析2012年5月—2016年6月于贵州省人民医院耳鼻咽喉头颈外科经鼻内镜手术治疗的11例鼻窦骨瘤的临床资料，其中鼻塞5例、溢泪2例、眼球凸出1例、头痛1例、视力下降2例。所有患者术前均行鼻窦三维CT检查，确定骨瘤的位置和侵犯范围，完善视力、视野、眼压、视神经诱发电位（VEP）及光学相干断层扫描（OCT）等眼科检查，麻醉方式均为全身麻醉及控制性降压，手术均在鼻内镜下完成，术中根据鼻窦CT范围选择具体的手术方式，选择恒定的解剖结构作为标志，尽量达到骨瘤的完全切除，同时采用鼻中隔带蒂黏膜瓣覆盖术腔，促进术腔上皮化，术后1周复查鼻窦CT，术后定期门诊复诊。结果术后1周复查鼻窦CT显示肿瘤彻底切除 9例，部分切除2例，随访26~76个月，患者较术前症状明显好转，其中头痛、鼻塞及溢泪症状均消失，2例视力下降患者中1例视力有部分提高，但1例眼球凸出患者在术后1年复发，转外院治疗，现已失访，其余患者均未见肿瘤复发。结论鼻内镜手术治疗鼻窦骨瘤安全、有效、微创，术前鼻窦CT可为鼻内镜手术提供可靠的保障，术中选用恒定的解剖结构定位肿瘤边界，以求骨瘤完全切除。     

鼻窦骨瘤的诊断与治疗

目的：探讨鼻窦骨瘤的临床特征与手术治疗。方法：51例鼻窦骨瘤患者经鼻窦X线摄片或CT扫描确诊，均经手术切除骨瘤。其中经眶上眉弓内眦切口42例，鼻侧切开4例，上颌窦根治术切口3例，颅面联合径路2例。结果：全部患者手术切口均Ⅰ期愈合，术后无脑脊液鼻漏等并发症发生。随访6个月～5年，均无骨瘤复发或鼻窦黏液囊肿发生。结论：鼻窦骨瘤生长缓慢，X线摄片或CT扫描有助于明确诊断及合理选择手术径路。     

鼻-前颅底骨化纤维瘤的手术治疗

目的 探讨侵犯前颅底的鼻窦骨化纤维瘤的手术治疗。方法 回顾性分析6例侵犯前颅底的鼻窦骨化纤维瘤的手术方式，其中3例采用冠状切口加鼻侧切开，3例采用冠状切口加鼻内镜手术。结果 术后无并发症，随访1年6个月～7年无复发。结论 冠状切口加鼻侧切开术式能最大限度暴露病变，彻底切除肿瘤，减少并发症。冠状切口加鼻内镜手术术式不仅兼具上述特点，还可避免颜面部遗留手术瘢痕，符合微创和美容要求。     

鼻内镜下鼻内外联合入路手术治疗鼻腔鼻窦内翻性乳头状瘤

目的探讨鼻内镜下鼻内外联合径路手术治疗鼻腔鼻窦内翻性乳头状瘤(sinonasal inverted Papilloma,NIP)Krouse分级II级以上病变的手术方法、疗效、应用价值等。方法对经过鼻窦冠位CT扫描及鼻内镜检查,评估为NIPKrouse分级II级以上病变,采用鼻内镜下经犬齿窝和中鼻道双进路联合的方法切除鼻腔鼻窦病变,并随访观察临床效果。结果 35例患者均得以彻底切除肿瘤。术后鼻阻塞、一侧头痛、颌面部肿胀等均消失,且无严重并发症发生。8例有唇龈沟切口及面部麻木感,在4~8周内经局部按摩等治疗逐步恢复。部分患者术后出现鼻腔干燥、结痂等,经鼻腔盐水冲洗等治疗2~4周内逐步消失。术后鼻内镜正规随访0.5~7年,随访期间仅见2例术后3年复发,后行扩大根治性手术治愈。结论对术前Krouse分级评估为NIPII级以上病变,鼻外径路能够对单纯鼻内镜经鼻径路手术起到很好的补充作用,双进路联合切除鼻腔鼻窦病变,视野清晰、手术快捷、肿瘤切除彻底、并发症少,疗效好,有较好的临床应用价值。     

鼻腔鼻窦异位脑膜瘤临床病理分析

目的:探讨鼻腔鼻窦异位脑膜瘤的诊断与治疗方法。方法:对我科1990-01-2011-10有完整随访资料的8例鼻腔鼻窦异位脑膜瘤患者的临床资料进行分析。其中5例采用鼻侧切开术,2例采用鼻内镜下肿瘤切除术,1例为鼻内镜下联合柯陆进路手术,并对所有患者术后情况进行随访。结果:全部患者术后无并发症,随访6个月～22年,其中2例复发,分别在术后18个月和1年,经再次手术,未再复发。结论:鼻腔鼻窦异位脑膜瘤罕见,临床症状和体征无特异性,诊断困难。最终诊断需依赖组织学检查,免疫组织化学有助于进一步明确诊断。手术完整切除后预后良好。     

鼻腔鼻窦少见良性肿瘤8例报告

目的：提高鼻腔鼻窦少见良性肿瘤的诊治水平。方法：回顾性分析8例鼻腔鼻窦少见良性肿瘤患者的临床资料。根据病变范围．4例行鼻侧切开术,4例行上颌窦根治术。结果：8例术后随访2～10年均无复发。结论：鼻腔鼻窦良性肿瘤呈膨胀性生长,发展缓慢,以青少年发病为主,临床表现无特异性,诊断以术前CT加术后病理检查为主,手术彻底切除肿瘤是治疗并防止其复发的惟一方法。     

Surgery of ossifying fibroma of the sinuses]

OBJECTIVE: To explore the different surgical choices for treating the ossifying fibroma of the sinuses. To summarize the management and characteristics of each surgical operation. METHODS: A retrospective evaluation of thirty-five patients with ossifying fibroma of the sinuses from August 1994 to July 2001 was presented. RESULTS: Among 22 patients operated by nasal endoscopic management, complete ossifying fibroma removed was achieved in 8 cases, and the majority part of tumor removed in 14 cases. Six patients were operated through a lateral rhinotomy with radical operation in 4 cases. Five ossifying fibromas were removed with a coronal incision. Two cases underwent Caldwell-Luc' surgery. The clinical symptoms, location of ossifying fibroma, and surgical procedures were analyzed. All patients outcomes were successful, no serious complication from the surgical technique occurred. Thirty-three cases were followed-up for 1 to 8 years with an average of three and half years. Fourteen patients had no recurrence, fourteen cases lived with the remains of ossifying fibroma, and five cases recurred. CONCLUSIONS: The choice of surgical operations on ossifying fibroma of the sinuses was mainly decided by the location of ossifying fibroma, in the meanwhile, the organ function, the cosmetology, the surgical degree of difficulty, and the doctor's experience were taken into account.     

Indications for the surgical treatment of osteomas of the frontal and ethmoid sinuses

Sixty-one patients with an osteoma of the frontal or ethmoid sinuses have been studied. The following indications for surgical removal of these osteomas are suggested: osteomas extending beyond the boundaries of the frontal sinus, if enlarging, if localized in the region adjacent to the nasofrontal duct, if signs of chronic sinusitis are present, osteomas of the ethmoid sinuses, irrespective of their size and if patients with osteomas complain of headache and other causes of headache have been excluded. The operation of choice is the osteoplastic flap operation.     

Osteomas of the internal auditory canal: a report of two cases

OBJECTIVES: To determine the optimal medical or surgical treatment of osteomas of the internal auditory canal (IAC) as well as their growth characteristics. STUDY DESIGN: Information was obtained from case histories, images from computed tomography and magnetic resonance imaging, surgical and pathologic findings, and long-term clinical results. METHODS: Two patients, along with 10 additional patients reported in the literature, with osteomas of the IAC with varying symptoms were studied. Clinical history, audiometric and vestibular test results, and radiographic studies were reviewed on all patients. Histopathologic examination of the surgical specimens confirmed the presence of osteomas. The clinical outcomes were studied to determine if the preoperative symptoms had resolved. RESULTS: Eight of 12 patients underwent surgical removal of their IAC osteomas. Three of eight patients had total resolution of all symptoms. Three patients had improvement of their sensorineural hearing loss. Five patients had resolution of their dizziness. Four patients noted resolution of their tinnitus. In the absence of auditory symptoms, vestibular symptoms may be controlled with medical therapy. Long term follow-up of the two patients discussed showed little or no growth over a 4- to 5-year period. CONCLUSIONS: Surgical intervention may be warranted to remove an osteoma of the IAC if symptoms are present. Patients should be made aware that symptoms may or may not improve. Continuation of symptoms may be a result of chronic compression of the auditory and vestibular nerves.     

影像导航辅助鼻内镜下筛窦骨瘤切除术

目的 探讨影像导航辅助鼻内镜下切除筛窦骨瘤的微创治疗技术.方法 回顾性分析烟台毓璜顶医院耳鼻咽喉头颈外科2005年4月至2009年10月筛窦骨瘤患者19例,其中男15例,女4例;年龄14～67岁,中位数37岁.术前行16排CT扫描并行三维重建,全部病例采用影像导航鼻内镜下手术切除治疗.结果 19例患者均在影像导航鼻内镜下成功切除了骨瘤,其中1例联合眉弓切口,1例联合唇龈切口切除肿瘤,余17例全部通过鼻腔切除.肿瘤直径≤2 cm且局限于筛窦的5例患者在影像导航鼻内镜下直接切除骨瘤;肿瘤直径＞2 cm且基底部较窄的2例患者在影像导航引导下切断蒂部,将肿瘤推人口腔取出;肿瘤基底部宽,与前中颅底、纸样板、眶尖、视神经管、眼眶骨质等部分或广泛相连、融合的12例患者在影像导航引导下采用虫蚀样电钻逐渐磨除肿瘤.所有病例术后随访8～64个月,全部病例术后头痛、鼻塞、流脓涕、面部不适等症状逐渐消失;1例复视患者术后1个月复视逐渐消失;2例面部隆起者,1例术后消失,1例好转.2例同时做了鸡冠切除,术后嗅觉丧失,分别随访9个月和26个月嗅觉未恢复;1例切除鸡冠者术后出现脑脊液鼻漏,行2次鼻内镜下修复手术后痊愈.结论 影像导航鼻内镜下手术适用于中线生长和局限于筛窦内的骨瘤,该术式切除准确、安全、微创,CT扫描是术前评估及制定正确治疗方案的保障.

Abstract：

Objective To investigate the minimally-invasive ablation of osteomas of the ethmoid sinuses endonasally.Methods A retrospective analysis was done in 19 patients (15 male,4 female,aged between 14 - 67,medium 37) diagnosed as osteomas of ethmoid sinuses hospitalized from April 2005 to Ocotober 2009.All patients underwent sixteen-detector row computed tomography scan and 3D reconstruction preoperatively.All underwent operation with the help of navigation system and nasal endoscope.Results The ethmoid osteoma in all 19 patients was removed successfully with endoscope and navigation system.Two open procedures(1 through superciliary arch incision and 1 through labiogingival incision) were performed to assist the removal of the tumor,17 tumors were removed under endoscopic and navigation guidance. In 5 patients whose osteoma was localized or with the diameter no more than 2 cm,these osteomas were removed endonasally with the help of navigation system.The osteomas in 2 patients was found to have narrow basilar part and relatively dissociative were removed from oral cavity after abscising the basilar part.The osteomas in 12 patients were found to have basilar part connected with ante-meso skull base,lamina papyracea,orbital apex,cranalis opticus,fossa orbitalis bone,these osteomas were removed using electric drill with the guidance of navigation system.All patients were followed up from 8 to 64 months,and were asymptomatic (1 patient who suffered from ambiopia had the sysmptom disappered,2 patients suffered from prosopo-eminencce,1 patient was asymptomatic and 1 patient was feeling better).Two patients underwent removal of crista galli,1 of them suffered from postoperative cerebro-spinal rhinorrhea,and recovered after endoscopic repairing procedure and iodoform gauze packing and recovered 15 days later.Two patients who underwent removal of crista galli suffered from anodmia and never recovered after 9 and 26 months follow-up.One patient with enormous osteoma suffered from repeated crusting and abnomal odor,and recovered after nasal flushing.Conclusions Endoscopic ablation of osteomas of the ethmoid sinuses with the guidance of navigation system is an accurate,secure,minimally-invasive procedure. Osteomas on median line and localized in ethmoid sinus is an indication of this operation.Preoperative CT scan is a safeguard for an accurate operation.     

Clinical experience and treatment approaches in sinonasal osteomas from a Tertiary Care Hospital in Turkey

ObjectiveOsteomas are slow-growing benign osseous tumors that particularly located in the paranasal sinuses (PS). Here, we aimed to define the clinical symptoms and features, diagnostic conditions caused by osteomas located in four different PSs, to evaluate the surgical indications and methods, to compare the factors that can affect the surgical decision, radiological findings, and prognosis. Methods: The data of patients with paranasal sinus lesions and diagnosed as osteoma according to the radiological imaging, who applied to our clinic between 2010 and 2020, were retrospectively collected and re-evaluated in the light of clinical, radiological, and pathological data. Patients who underwent surgical treatments and were definitively diagnosed as osteoma by pathology were enrolled in this study. Results: We presented the data of 117 patients retrospectively. Most of these cases (n = 77, 65.8%) had an osteoma located in the frontal sinus, while 32 cases (27.4%) had osteoma in the ethmoid, two cases (1.7%) had in sphenoid and six cases (5.1%) had in maxillary sinus. We found that the presence of symptoms, diameter of osteoma, surgical indications including state of sinus drainage, and chronic/recurrent sinusitis influence the choices of physicians in management of frontal sinus osteomas. Moreover, we found a significant correlation between the grading systems defined to classify the frontal sinus osteoma to be operated (r = 0.878, 95% CI: 0.724–0.949, P<0.0001). Conclusion: There are several grading systems useful for the choice of surgical approaches, however, the clinical symptoms and surgical indications should not be neglected in the follow-up of patients with frontal sinus osteoma. If there are concerns about the grade of osteoma and the endoscopic approach is considered not to be sufficient for resection, the surgical procedure may be initiated endoscopically, and, if necessary, it can be combined with an external approach.     

Endoscopic management of benign sinonasal tumors: a decade of experience

BACKGROUND: A variety of benign tumors present in the nasal and paranasal sinuses. METHODS: We review our experience over the last 10 years with endoscopic management of these tumors and discuss (presentation, diagnostic considerations, and therapeutic options. RESULTS: Eighteen patients with benign sinonasal tumors were managed with endoscopic techniques. Representative cases are presented, including pleomorphic adenoma, ameloblastoma, meningioma, cholersterol granuloma, ossifying fibroma, fibrous dysplasia, and osteomas. Three patients (16.7%) required one revision endoscopic sinus procedure. Average follow-up was 4 years. CONCLUSIONS: With the treatment of more complex cases being undertaken endoscopically, the need for individual therapeutic consideration and close follow-up is stressed. The combination of removal of benign tumors endoscopically and endoscopic surveillance in the outpatient setting has allowed a less radical surgical approach while resulting in decreased morbidity and better tumor control.     

鼻咽纤维血管瘤22例手术分析

目的：探讨鼻咽纤维血管瘤的手术方法。方法：22例鼻咽纤维血管瘤患者均行手术治疗，其中经腭径路12例，经鼻腔径路5例（鼻侧切开2例，梨状孔径路2例，经前鼻孔径路1例），经口腔口咽径路2例，硬腭-唇龈径路2例，鼻-硬腭径路1例。结果：术中出血量最多1600ml，最少400ml。1例复发，其余21例随访1～2年无复发。结论：做好术前准备、选择适当的手术径路及采取颈外动脉结扎或数字减影血管栓塞术对防止复发、减少术中出血和完整切除肿瘤最为关键。     

Our experience with the surgical management of paranasal sinus osteomas

The aim of this work is to describe our experience with the management of osteomas of the fronto-ethmoidal region, and to evaluate the limits and possibilities of different approaches: endonasal endoscopic versus external surgical resection of symptomatic osteomas. A review of 26 patients with detected osteomas in tertiary health care center was accomplished. We analysed the 26 adult patients, which detected paranasal sinus (PNS) osteomas—patients who underwent paranasal sinus CT examinations almost exclusively for other reasons. We analysed the patient’s symptoms, localization and size of osteomas, clinical and imaging signs, in relation to adjacent structures. Of the 26 cases, 16 located in the etmoid sinus, eight in the frontal sinus, of which two with orbital one with an ethmoid extension, and one isolated maxillary and sphenoid sinus were involved. We treated 11 patients with endoscopic (eight cases) and external surgical approaches (three cases). Besides this surgical excision; 15 cases were kept in follow up, because of asymptomatic nature of the PNS osteomas or patients lack of consent. While the extranasal approach is still a part of the treatment concept for removing osteomas; over the last years, in suitable cases, the endoscopically controlled endonasal approach has greatly gained importance due to the improved surgical equipment and experience.     

耵聍腺肿瘤临床分析 (附18例分析)

目的提高临床对耵聍腺肿瘤的认识。方法回顾分析18例耵聍腺肿瘤的临床资料,其中耵聍腺 腺瘤14例,多形性腺瘤1例,耵聍腺癌2例,腺样囊性癌1例。结果治疗首选手术切除。3例复发,其中2 例术后约10个月复发,再次手术随访3年未见复发,耵聍腺癌1例术后3年死于复发。结论耵聍腺肿瘤的 治疗应以手术为主,手术应有足够的安全界限。     

鼻腔鼻窦腺样囊性癌18例临床分析

目的：探讨鼻腔鼻窦腺样囊性癌的临床特点。方法：18例鼻腔鼻窦腺样囊性癌患者,16例行手术＋术后放疗,2例行单纯放疗。结果：随访5年,早期（Ⅰ、Ⅱ期）患者8例均无死亡;晚期（Ⅲ、Ⅳ期）患者10例,死亡5例,失访1例。高分化组11例中,1例死亡;中低分化组7例中,死亡4例,失访1例。结论：鼻腔鼻窦腺样囊性癌临床症状不典型,应提高对该病的认识,防止误诊;预后有赖于病理分型和临床分期;高分期及高侵袭性腺样囊性癌预后差。