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Management of Sphenoidal Sinus Lesions by Septal-assisted Approach: Surgical Skills and Advantages

Journal of Huazhong University of Science and Technology(Medical Sciences) 2015年第4期35卷 558-562页

作者：洪海裕李艳妮樊韵平冯韶燕高洁冰 Department of Otolaryngology-Head and Neck Surgery the 5th Affiliated Hospital of Sun Yat-sen University Department of Otolaryngology Pu’ai HospitalTongji Medical CollegeHuazhong University of Science and Technology Department of Radiology the 5th Affiliated Hospital of Sun Yat-sen University

Summary： The aim of this study was to develop a less invasive trans-septal approach for the endo- scopic management of sphenoid sinus lesions. We performed a septal-assisted surgical procedure for endoscopic sphenoidectomy in 38 patients with isolated or combined sphenoidal sinus lesions, including fungal balls, mucoceles, purulent cystic sphenoidal sinusitis, etc. The posterior portion of the nasal sep- turn became flexible after removal of the vomer and the sphenoidal rostrum. The superior portion of the common meatus was expanded to accommodate the endoscope after the septum was repositioned con- tra-laterally. The lesions were individually managed through the enlarged ostiums while damage to the mucosa of the front sphenoidal wall was avoided. All the procedures were completed successfully without intraoperative complications, and the bony ostiums were identified easily and enlarged accu- rately. During the follow-up period of 16 weeks to 2 years, no re-atresia or restenosis was observed. The recurrence rate was 0. No postoperative complications were recorded. All the responses from the pa- tients were satisfactory. It was concluded that endoscopic sphenoidectomy assisted by trans-septal ap- proach is a feasible, safe, effective and minimally invasive approach for selected cases with unilateral or bilateral lesions in the sphenoid sinuses.

关键词： sphenoid sinus operation nasal septum nasal endoscope

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Intranasal endoscopic prelacrimal recess approach to maxillary sinus

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Chinese Medical Journal 2013年第7期126卷 1276-1280页

作者： ZHOU Bing HAN De-min CUI Shun-jiu HUANG Qian WANG Cheng-shuo Department of Otolaryngology-Head and Neck Surgery Beijing Tongren Hospital Capital Medical University Key Laboratory of Otolaryngology Head and Neck Surgery (Capital Medical University) Ministry of Education Beijing 100730 China

Background The inferior turbinate （IT） and nasolacrimal duct （NLD） are often sacrificed while managing the diffuse lesion of maxillary sinus （MS）. We report a new approach to MS without ablation of NLD and IT. Methods This retrospective study enrolled 19 hospitalized patients （aged from 42 to 68 years） who underwent endoscopic sinus surgery between 2003 and 2008. Twelve patients had inverted papilloma （IP）, two had nasal polyps, two had Kubo＇s postoperative cyst of MS, one had recurrent bone cyst of maxilla, one had dentigerous cyst and one had bleeding of internal maxillary artery secondary to CaldwelI-Luc operation respectively. Two IP patients were excluded from this group since the follow-up time was less than 12 months. The NLD was dissected after removing the anterior bony portion of nasal lateral wall. The prelacrimal recess approach （PLRA） to MS was established when IT-NLD flap was raised medially. The flap was repositioned when MS lesion was removed. Results All the 17 patients had unilateral lesions. Ten MS IP patients were at the T3 Krouse stage. The follow-up ranged from 7 to 60 months. No recurrence was seen in 16 patients. Only one IP patient had a local recurrence in MS. All of them had no any complications. Conclusion The diffuse or severe diseases of MS may be the potential indications for PLRA.

关键词： nasal endoscope maxillary sinus prelacrimal recess inferior turbinate nasolacrimal duct

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