Hosemann Werner, Scotti Oliver, Bentzien Sabine
Department of Otorhinolaryngology-Head and Neck Surgery, University of Greifswald, Germany.
Am J Rhinol. 2003 Sep-Oct;17(5):311-6.
Contemporary endonasal surgical treatment of chronic hyperplastic paranasal sinusitis strives for microsurgical excision of all spots of irreversibly diseased hyperplastic mucosa. However, anatomy of the maxillary sinus reveals distinct hidden areas and niches that pose problems to optical and instrumental control.
The specific range of view of common telescopes (30, 45, and 70 degrees) inside the maxillary sinus after generous middle meatal antrostomy is analyzed in three different-sized anatomic specimens. The examinations are paralleled by investigations on the range of action of 14 surgical instruments. The results are visualized by means of a three-dimensional computed tomograph of all specimens.
The different telescopes and surgical tools that are introduced via the middle meatal antrostomy reveal a specific overlap in the range of view and in the range of action, respectively. Anatomic areas that are difficult to reach e.g., are the medial and anterior parts of the sinus and the alveolar recess. An additional inferior antrostomy offers minor benefits with respect to control of the prelacrimal recess.
Routine surgery on the maxillary sinus in case of chronic hyperplastic pansinusitis via middle meatal antrostomy does not cover all hidden niches of the sinus. The most important area that is out of sight and control is the prelacrimal recess.
当代慢性增生性鼻窦炎的鼻内手术治疗致力于对所有不可逆病变的增生黏膜部位进行显微手术切除。然而，上颌窦的解剖结构显示出明显的隐蔽区域和凹陷，给视觉和器械控制带来了问题。
在三个不同大小的解剖标本中，分析了在充分的中鼻道上颌窦造口术后，普通望远镜（30度、45度和70度）在上颌窦内的特定视野范围。同时对14种手术器械的操作范围进行了研究。通过对所有标本的三维计算机断层扫描将结果可视化。
经中鼻道上颌窦造口术引入的不同望远镜和手术工具，分别在视野范围和操作范围内显示出特定的重叠。难以到达的解剖区域，例如窦的内侧和前部以及牙槽隐窝。额外的下鼻道上颌窦造口术在控制泪前隐窝方面益处不大。
对于慢性增生性全鼻窦炎，经中鼻道上颌窦造口术对上颌窦进行常规手术并不能覆盖窦的所有隐蔽凹陷。最难以看到和控制的重要区域是泪前隐窝。
