| Purposes:By observing and measuring the main anatomical structures of paranasal sinuses in cadaveric heads,the important structures and their adjacent relationships were analyzed,and the CT imaging characteristics of paranasal sinuses in patients with sinusitis were summarized.These morphological data will provide reference for personalized treatment of clinical endoscopic sinus surgery.Methods:From June 2016 to June 2017,30 adult dry skulls and 6 adult cadaveric heads(aged 20-40 years)fixed with 10% formalin solution were selected to observe and measure the anatomical structure of the lateral wall of nasal cavity and adjacent paranasal sinuses.Meanwhile,the CT images of 224 patients with sinusitis were summarized and analyzed.On this basis,the traditional fenestration of the middle nasal meatus and maxillary sinus was improved.From July 2017 to June 2018,100 patients who underwent endoscopic sinus surgery were treated modified fenestration of the middle nasal meatus and maxillary sinus,as the treatment group.And a total of 100 patients who underwent traditional fenestration of the middle nasal meatus and maxillary sinus before July 2017 were selected as the control group.The quality effect was compared and analyzed.Results:1.Results of specimen data(1)The anatomical position of middle turbinate and uncinate process is relatively constant,which can be used as an anatomical marker for endoscopic sinus surgery.(2)The maxillary sinus osseous fissure locates the anterior-upper quadrant.The other three quadrants are closed by the membranous structure of bilateral mucosa and dense connective tissue,i.e.the nasal fontanel.The natural orifice of the maxillary sinus is membranous tubular,and the diameter and length of the tube vary greatly.The proportion of the orifice affects the patency of the maxillary sinus.The safety limit of maxillary sinus posterior natural orifice is wider than that of anterior orifice,and the distance from middle turbinate is longer and wider,which is more suitable for maxillary sinus fenestration.(3)The ostiomeatal complex is centered around the ethmoidal funnel and its adjacent structures.This area is closely related to the anterior nasal sinuses.Even if there is a slight lesion,it will affect the ventilation and drainage of the sinuses.2.CT imaging characteristics of sinusesPatients with sinusitis are often accompanied by deviation of nasal septum,mutation of hook,hypertrophy of inferior turbinate,alveolar middle turbinate,Haller's,Onodi's and nasal hill's air chambers.Sinus-orifice-nasal complex is usually difficult to see on nasal endoscopy and conventional X-ray,but can be clearly displayed on coronal CT.Its drainage and ventilation disorders are the main causes of chronic inflammation of various sinuses,such as the anterior sinuses.Sagittal measurements are more in line with endoscopic sinus surgery,which is a supplement to and improvement of autopsy data.3.Curative effect of modified fenestration of middle nasal meatus and maxillary sinusThe improved fenestration of the middle nasal meatus and maxillary sinus is superior to the traditional operation in bleeding volume,cure rate and continuous opening of the maxillary sinus window,which improves the opening rate of the sinus orifice and reduces the complications after operation.Conclusions:1.There are many structures around the nasal cavity and paranasal sinus,and their position is relatively stable,and the main vessels and nerves are adjacent to each other.Familiar with the skeletal structures of the nasal cavity and the location of paranasal sinuses is of great significance for endoscopic sinus surgery.2.Most patients with sinusitis have deviation of nasal septum,hook mutation,hypertrophy of inferior turbinate,and bullous middle turbinate,which have positive clinical value in diagnosis,prevention and surgical treatment of sinusitis.3.Modified endoscopic fenestration of the middle nasal meatus and maxillary sinus improves the opening rate of the sinus orifice and further reduces the postoperative complications. |
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