Application experience of prelacrimal recess combined with septotomy in resection of recurrent inverted papilloma
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摘要: 目的 探讨鼻内镜下泪前隐窝入路联合鼻中隔临时开窗在复发性鼻内翻性乳头状瘤切除术中的临床效果。方法 对广东医科大学附属医院耳鼻咽喉科近2年收治复发的鼻内翻性乳头状瘤再次行手术切除的患者，考虑肿瘤基底部位于上颌窦前内侧壁，使用70°鼻内镜虽然能观察到上颌窦前内侧壁的病变，但在泪前隐窝这个狭小的孔径内，同时使用内镜、吸引器及手术器械处理上颌窦前内侧壁的病变难以完全到达并根治的部分原因是受中隔的限制。结果 故此次采用在泪前隐窝入路的基础上加做鼻中隔临时开窗，利用开窗口从对侧鼻孔进入鼻内镜或器械，以提供更好视野广角和器械活动的角度范围。结论 复发的鼻内翻性乳头状瘤经过再次鼻内镜下泪前隐窝入路联合鼻中隔临时开窗手术切除随访2年半未见复发，对于基底部位于上颌窦前内侧壁等难以处理的内翻性乳头状瘤能更彻底的切除，值得临床推广。
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关键词:
- 复发性鼻内翻性乳头状瘤 /
- 泪前隐窝 /
- 鼻中隔开窗
Abstract: Objective To investigate the effectiveness of nasal endoscopic anterior lacrimal recess approach combined with temporary fenestration of the nasal septum in resecting recurrent nasal inverted papilloma.Methods Patients with recurrent nasal inverted papilloma who underwent reoperation in our hospital during the past 2 years were included. The nasal septum may hinder full access to and effective treatment of the lesions at the anterior and medial wall of the maxillary sinus by endoscope, aspirator and surgical instrument in the narrow aperture of the prelacrimal recess, although these lesions could be observed by 70° nasal endoscope.Results The nasal septum is temporarily opened on the basis of the prelacrimal recess approach, and the nasal endoscope and instrument was introduced through trans-septal window, so as to provide a better view of the operative field and the angular range of the instrument's movement.Conclusion The recurrent nasal inverted papilloma could be successfully managed by re-endoscopic anterior lacrimal recess approach combined with temporary fenestration of the nasal septum, and no recurrence was observed during the 2-year follow-up. This surgical approach is recommended for the inverted papilla which originates from the anterior medial wall of the maxillary sinus, as the tumor can be removed completely using this surgical approach.-
Key words:
- recurrent nasal inverted papilloma /
- prelacrimal recess /
- septotomy
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