| Objective:The nasal inverted papilloma is a benign tumor commonly seen in nasal cavity and accessory nasal sinuses, but its causes are not clear.Males at the ages from 50 to 70 have this disease more than females. Nip is common in one side, mostly in nose and sometimes in the lateral wall of nose.And then it is also common in antrum highmori and ethmoidal cells,but rare in rfontal antrum sinus sphenoidalis. Its symptoms include nasal obstruction, nasaldischarge and blood bleeding. In addition, olfactory impairment and facial pain may appear. In clinical examination the surface of tumor looks like corpora mammillaria, which is rough, pink, hard and easy to bleed when it is touched. The best way is to cut it off completely,including its base and infiltrate, or it will reappear. The radio therapy is effectively poor.The common operative way is nasal lateral approach operation, endoscopic surgery as well as nasal endoscopic combined approach operation. This research is based on the individual CT image to design surgery and evaluate. By surgery, tumor is cut off completely. The design covers the range of cutting, matters to pay attention to and post-operative evaluation. In the condition of ensuring the minimum impact of the face, tumor is cut off completely and will never reappear.Methods:1 Acquiring the Image: a male patient, aged 65, 70 kg in weight and 170 cm in height, is selected in this investigation. He has no trauma of head history, operation history or familial history. Head is CT scanned according to canthomeatal line from the bottom of skull to frontal eminence.Lightspeed VCT is used. The scanning thickness is 0.7mm and the scanning scope is head. 166 CT images are got and use to reconstruction.2 Constructing 3d Diorama: CT images of this patient are stored in compact disc in the form of Dicom. In the Mimics 15.0 of reverseengineering, importing images are used to read, convert and direct dimensionally the original CT images. After it, skull, skin, air and tumor of head are segmented according to threshold, mask is produced. The 3D models are acquired by calculating 3D.3 Designing operation. This software is used to move, whirl, display and cut for the model. So computer simulation and design operation are completed.4 Measuring before operation and evaluation after operation: 3D models from this simulation are measured in the software of 3-Matic 7.0, including shape and size of theaccessory nasal sinuses and the inverting pappilloma. In operation, Pathologic diagnosis is inverted papilloma and he volume of crash tumor has 45 ml after operation.results:1 This 3D models of skull, accessory nasal sinuses including frontal sinus, ethmoidal cellules, saphenoidal sinus and maxillary are clear and similar in shape, have the same data as CT images.2 The skin model of head has good connections, which can reflect the outer appearances of the patient.3 The 3D models of air of nose and tumor are reconstructed. The model of air is approach of simulating opertation and designing operation. The nasal inverted papilloma will be cutted by doctor.4 The designing operation can be completed successfully. Doctor can cut the tumor of frontal sinus completely by opening the sinus for the left sinu and the right are conneted each other. The tumor fills the ethmoidal cellules which lateral wall are distroyed by the tumor, so the operation become difficult to cut the tumor because of distroying the eye.5 Appraisal of the tumor after operation. The shape and size of tumor is similar to the model of 3D reconstruction. The volume is approach to measure of the tumor model. So we believe the tumor cutted completely.Conclusion: 1 Individuation of design operation can guide doctor to cut tumor completely. The data from 3D reconstruction of the skull, the accessory nasal sinuses, the gap of breath and the tumor can not use to theother people. But to patient, the 3D models can use to design and plan the operation. So this method may use to contrive individual operation.2 The operation of assessment of the accessory nasal sinuses.According to the design and plan before operation, the operation can complete successfully, avoiding complication, inducing time of operation in operation. The volume of tumor computed before the operation corresponds to the cut tumor.3 The result of 3D reconstruction clear depends on the CT photos which show air and bones clearly.4 The doctor can cut the stage I and II nasal inverted papilloma by nasal endoscopy. But to the stage III and IV nasal inverted papillma, the doctor may cut it by nasal endoscopy except the design and plan before the operation. |
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