Weber R, Draf W, Sengstock R, Keerl R, Kahle G, Kind M
Klinik für HNO-Krankheiten, Kopf-, Hals- und Plastische Gesichtschirurgie, Kommunikationsstörungen, Klinikum Fulda.
Laryngorhinootologie. 1999 Aug;78(8):435-40. doi: 10.1055/s-2007-996904.
The osteoplastic flap procedure with fat obliteration has been hailed as the gold standard of definitive frontal sinus procedures for chronic inflammatory disease. The value of magnetic resonance imaging (MRI) in postoperative follow-up has not yet been sufficiently examined.
All postoperative MRI scans performed in patients undergoing surgery between January 1, 1986, and December 31, 1996 were evaluated. The outcome parameters were time-dependent changes in the distribution of fatty or connective tissue and development of necroses or oil cysts, as well as recurrences, inflammatory complications, or mucoceles.
Sixty-eight operations were performed in the specified period and a total of 73 postoperative MRI scans from 45 operations were available for evaluation. In 16 cases, between two and five MRI scans were available. The individual time between surgery and the last MRI scan ranged from two weeks to 130 months with an average of 30.1 months. We found four mucoceles 34, 49, 106, and 130 months, respectively. Three of the mucoceles were diagnosed on the first postoperative MRI scan. In the fourth case the mucocele had not been seen on the previous scan. The amount of adipose tissue depictable on the last scan was less than 20% in the majority of cases (58%) and more than 60% in only 18% of cases, although in the latter group the time between surgery and MRI was less than 7 months in half the cases.
MRI is the most valuable diagnostic tool after frontal sinus obliteration using adipose tissue. Despite the good soft tissue differentiation, the method has some limitations with regard to detection of small recurrent mucoceles and differentiation between vital adipose tissue and fat necrosis in the form of oil cysts. In these difficult cases, long-term MRI follow-up is necessary for definitive evaluation. We therefore recommend MRI 1, 2, and 5 years after osteoplastic frontal sinus surgery with obliteration.
带脂肪填塞的骨成形瓣手术被誉为慢性炎症性疾病确定性额窦手术的金标准。磁共振成像（MRI）在术后随访中的价值尚未得到充分研究。
对1986年1月1日至1996年12月31日期间接受手术患者的所有术后MRI扫描进行评估。观察指标为脂肪或结缔组织分布的时间依赖性变化、坏死或油囊肿的形成，以及复发、炎症并发症或黏液囊肿。
在规定时期内共进行了68例手术，45例手术的73次术后MRI扫描可供评估。16例患者有2至5次MRI扫描。手术至最后一次MRI扫描的时间间隔从2周至130个月不等，平均为30.1个月。我们分别在术后34、49、106和130个月发现4例黏液囊肿。其中3例黏液囊肿在首次术后MRI扫描时被诊断出。第4例黏液囊肿在之前的扫描中未被发现。在大多数病例（58%）中，最后一次扫描显示的脂肪组织量少于20%，只有18%的病例脂肪组织量超过60%，尽管在后一组中，手术至MRI的时间间隔有一半病例少于7个月。
MRI是使用脂肪组织进行额窦闭塞术后最有价值的诊断工具。尽管软组织分辨能力良好，但该方法在检测小的复发性黏液囊肿以及区分活性脂肪组织和油囊肿形式的脂肪坏死方面存在一些局限性。在这些困难病例中，需要进行长期MRI随访以进行明确评估。因此，我们建议在带脂肪填塞的骨成形性额窦手术后1年、2年和5年进行MRI检查。
