上颌窦前部气化的CT观察及临床意义

刘锦峰; 戴金升; 周沫; 郝鹏鹏; 刘启桐; 王宁宇

doi:10.13201/j.issn.1001-1781.2016.18.006

上颌窦前部气化的CT观察及临床意义

- 1. 首都医科大学附属北京朝阳医院耳鼻咽喉头颈外科(北京, 100020);
- 2. 首都医科大学附属北京朝阳医院放射科
基金项目:
北京市自然科学基金(No:7162066)

国家自然科学基金(No:81271090/H1304)

北京市教委科技计划重点项目(No:KZ201410025027))联合资助

详细信息

通讯作者: 王宁宇,E-mail:wny@sohu.com

中图分类号: R322.31

收稿日期: 2016-06-16

The CT observation and clinical significance of pneumatization of the anterior maxillary sinus

- 1. Department of Otorhinolaryngology-Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China;
- 2. Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University

More Information

Corresponding author: WANG Ningyu, E-mail: wny@sohu.com

Received Date: 16 June 2016

摘要

摘要: 目的:通过鼻窦CT观察上颌窦气化的特征,探讨上颌窦气化分型及其临床意义。方法:对100例患者的鼻窦CT结果进行观察分析。依据上颌窦内侧壁与鼻泪管、上颌窦外侧壁与眶外侧壁、上颌窦底与硬腭的解剖关系以此将上颌窦气化分型。结果:①上颌窦泪前隐窝气化分为3型:Ⅰ型:上颌窦额突气化未达鼻泪管前,左侧占42%,右侧占42%;Ⅱ型:上颌窦额突气化延伸到鼻泪管前方,但未超过鼻泪管周长1/2,左侧占39%,右侧占37%。Ⅲ型:鼻泪管前部气化超过鼻泪管周长的1/2,左侧占19%,右侧占21%。②上颌窦底腭突气化也分为3型:Ⅰ型:上颌窦腭突未气化,左侧占49%,右侧占53%;Ⅱ型:腭突气化进入鼻底,但未超过鼻腔底宽度的1/2,左侧占45%,右侧占43%;Ⅲ型:腭突气化进入鼻底超过了鼻腔底部的1/2,左侧占6%,右侧占4%。③上颌窦向牙槽突的气化分为3型:上颌窦底部不低于硬腭的口腔面为Ⅰ型,左侧占49%,右侧占51%;上颌窦底部低于硬腭的口腔面,颌窦底完整,牙根未突入上颌窦为Ⅱ型,左侧占44%,右侧占39%;牙根突入到上颌窦为Ⅲ型,左侧占7%,右侧占11%。④颧突气化分为3型。Ⅰ型:气化未超过眶外侧壁,左侧占80%,右侧占82%;Ⅱ型:超过了眶外侧壁,左侧占20%,右侧占18%;Ⅲ型:向颧骨气化,超过眶下壁,该文未观察到Ⅲ型气化。⑤上颌窦前壁气化分为3型。Ⅰ型:眶下神经管完全在骨壁内,左侧占51%,右侧占57%;Ⅱ型:眶下神经管半突入到上颌窦腔内,左侧占39%,右侧占31%;Ⅲ型:眶下神经管完全突入到上颌窦腔内,左侧占10%,右侧占12%。结论:鼻内镜上颌窦手术之前要确认上颌窦不同结构区域的气化程度,不同程度的上颌窦气化是上颌窦手术入路选择的基础,也决定着上颌窦内病变清除的难度。
- 上颌窦 /
- 气化 /
- 内镜鼻窦手术 /
- 额突 /
- 腭突 /
- 颧突 /
- 牙槽突 /
- 眶下神经
Abstract: Objective:To discuss the clinical significance of the pneumatization of the maxillary sinus by sinus CT.Method:One hundred patients encountered in our hospital during March 2012 and December 2012 were included in this study. The pneumatization of the anterior part of the maxillary sinus were observed.Result:①The pneumatization of prelacrimal recess was divided into 3 types.Type Ⅰ:The pneumatization of maxillary sinus frontal process did not reach into the front of the nasolacrimal duct(42% of the left, 42% of the right); Type Ⅱ:The pneumatization of maxillary sinus frontal process extended into the front of the nasolacrimal duct, but not exceeding 1/2 of the nasolacrimal duct circumference(39% of the left, 37% of the right); Type Ⅲ:The pneumatization of maxillary sinus frontal process extended into the front of the nasolacrimal duct more than 1/2 of the circumference(19% of the left, 21% of the right).②The pneumatization of maxillary sinus palatal process was divided into 3 types.Type Ⅰ:maxillary sinus palatal process non gasified (49% of the left, 53% of the right); Type Ⅱ:palatal process gasification into the nasal floor, but not more than 1/2 of the width of nasal floor(45% of the left and 43% of the right);Type Ⅲ:palatal process gasification into the nasal floor more than 1/2 of the width of nasal floor(6% of the left, 4% of the right).③The pneumatization of maxillary sinus extended into alveolar process was divided into 3 types.Type Ⅰ:the bottom of the maxillary sinus is higher than the oral surface of hard palate(49% of the left and 51% of the right); Type Ⅱ:the bottom of the maxillary sinus is lower than the oral surface of hard palate and non tooth root protruding into the maxillary sinus(44% of the left and 39% of the right); Type Ⅲ:the tooth root process was protruded into maxillary sinus(7% of the left and 11% of the right).④The pneumatization of maxillary sinus extended into the zygomatic process was divided into 3 types. Type Ⅰ:the gasification of the zygomatic process is not more than the orbital lateral wall(80% of the left, 82% of the right); Type Ⅱ:the gasification of the zygomatic process is more than the orbital lateral wall, (20% of the left, right 18% of the right); type Ⅲ:the gasification of the zygomatic process is also more than the inferior orbital wall, this paper is not observed Ⅲ type pneumatization.⑤The pneumatization of of the anterior wall of the maxillary sinus was divided into 3 types. Type Ⅰ:infraorbital nerve tube completely in the bone wall of the maxillary sinus(51% of the left, 57% of the right); Type Ⅱ:the half of the infraorbital neural tube was inburst into the maxillary sinus(39% of the left and 31% of the right); Type Ⅲ:infraorbital neural tube was totally protruding into to the cavity of the maxillary sinus(10% of the left and 12% of the right).Conclusion:The pneumatization of the anterior part of the maxillary sinus varies considerably and requires attention during ESS. The pneumatization degree of maxillary sinus should be confirmed accurately in preparation. It is foundamental for selecting the suitable surgical approach for Nasal endoscopic maxillary sinus surgery. It is also important for completely removed the maxillary lesions in operation.
- maxillary sinus /
- pneumatization /
- endoscopic sinus surgery /
- frontal process /
- alveolar process /
- zygomatic process /
- infraorbital nerve /

HTML全文

参考文献(24)

[1]	马有祥.上颌窦不同手术入路选择的利与弊[J].中华耳鼻咽喉头颈外科杂志,2014,49(9):708-710.
[2]	周兵.鼻内镜外科技术的创新与发展[J].中华耳鼻咽喉头颈外科杂志,2014,49(9):705-707.
[3]	廖建春.上颌窦内镜手术的解剖与临床[J].中华解剖与临床杂志,2014,19(6):524-527.
[4]	尚红坤,阮标,李斯斯,等.上颌窦三维立体形态与上颌窦炎关系的研究[J].临床耳鼻咽喉头颈外科杂志,2012,26(20):921-925.
[5]	HERZALLAH I R,SAATI F A,MARGLANI O A,et al.Retromaxillary pneumatization of posterior ethmoid air cells:novel description and surgical implications[J].Otolaryngol Head Neck Surg,2016.
[6]	刘婷婷,董振辉,张念凯,等.与鼻内镜上颌窦手术视野相关的上颌窦形态特征[J].临床耳鼻咽喉头颈外科杂志,2013,27(23):1293-1295.
[7]	赵光明,陈克敏,柴维敏,等.眶下神经管多层螺旋CT图像重组和测量[J].中国医学影像技术,2008,24(4):517-519.
[8]	KALAVAGUNTA S,REDDY K T.Extensive maxillary sinus pneumatization[J].Rhinology,2003,41:113-117.
[9]	THOMAS A,RAMAN R.A comparative study of the pneumatization of the mastoid air cells and the frontal and maxillary sinuses[J].AJNR Am J Neuroradiol,1989,10:S88-88.
[10]	韩嘉为,张罗,韩德民.上颌窦形态与阻塞性睡眠呼吸暂停低通气综合征严重程度的关系[J].首都医科大学学报,2011,32(1):32-36.
[11]	周兵,韩德民,崔顺九,等.鼻内镜下鼻腔外侧壁切开上颌窦手术[J].中华耳鼻咽喉头颈外科杂志,2007,42(10):743-748.
[12]	HOSEMANN W,SCOTTI O,BENTZIEN S.Evaluation of telescopes and forceps for endoscopic transnasal surgery on the maxillary sinus[J].Am J Rhinol,2003,17:311-316.
[13]	于德林,马有祥.鼻内镜双径治疗上颌窦病变[J].临床耳鼻咽喉科杂志,1998,12(2):90-91.
[14]	ROBINSON S,WORMALD P J.Patterns of innervation of the anterior maxilla:a cadaver study with relevance to canine fossa puncture of the maxillary sinus[J].Laryngoscope,2005,115:1785-1788.
[15]	WEBER R K,HOSEMANN W.Comprehensive review on endonasal endoscopic sinus surgery[J].GMS Curr Top Otorhinolaryngol Head Neck Surg,2015,14:8-8.
[16]	ZHOU B,HAN D M,CUI S J,et al.Intranasal endoscopic prelacrimal recess approach to maxillary sinus[J].Chin Med J(Engl),2013,126:1276-1280.
[17]	周兵,黄谦,崔顺九,等.内镜下经鼻泪前隐窝入路切除翼腭窝及颞下窝神经鞘瘤[J].中华耳鼻咽喉头颈外科杂志,2013,48(10):802-806.
[18]	马有祥,丁秀勇,田昊,等.下鼻甲反转扩大下鼻道入路上颌窦手术[J].中华耳鼻咽喉头颈外科杂志,2014,49(9):717-720.
[19]	WANG C,HAN D,ZHANG L.Modified endoscopic maxillary medial sinusotomy for sinonasal inverted papilloma with attachment to the anterior medial wall of maxillary sinus[J].ORL J Otorhinolaryngol Relat Spec.2012,74:97-101.
[20]	舒畅,陈建超,岳承,等.鼻内镜中鼻道和下鼻道融合开窗术治疗上颌窦病变[J].中华耳鼻咽喉科杂志,2000,35(4):303-303.
[21]	WILHELM C P,DESHAZO R D,TAMANNA S,et al.The nose,upper airway,and obstructive sleep apnea[J].Ann Allergy Asthma Immunol,2015,115:96-102.
[22]	韩德民,叶京英,王军,等.上气道压力测定对一阻塞性呼吸睡眠暂停综合症阻塞部位定位诊断研究[J].中华耳鼻咽喉头颈外科杂志,2001,36(3):301-304.
[23]	曹洁,陈宝元,朱宝玉,等.阻塞性睡眠呼吸暂停综合症患者鼻阻力的变化[J].中华结核呼吸杂志,2000,23(12):725-726.
[24]	王震震.MSCT对阻塞性睡眠呼吸暂停低通气综合征上气道的评估[D].昆明:昆明医科大学,2012.