Hinohira Yasuyuki, Hyodo Masamitsu, Gyo Kiyofumi
Department of Otolaryngology, Takanoko Hospital, 525-1 Takanoko-cho, Matsuyama, Ehime 790-0925, Japan.
Auris Nasus Larynx. 2009 Aug;36(4):411-5. doi: 10.1016/j.anl.2008.09.008. Epub 2008 Nov 20.
Surgery for localized sphenoid sinus disease can be performed in different ways. Direct (transnasal) and indirect (transethmoidal) approaches are now prevalent in endoscopic endonasal sinus surgery (ESS) because they are safe and effective. However, the identification or treatment of a sinus is occasionally difficult due to the anatomical variation, postoperative changes, or other reasons. In such difficult cases, we currently used an endoscopic endonasal transseptal approach (EETA) to the sphenoid sinus. The indications, procedures, and outcomes of this surgical method are presented here.
Six of 11 patients with localized sphenoid sinus disease (mycetoma, n=1; mucocele, n=5) were treated using EETA. Surgery was performed under local anesthesia in all subjects. Following endoscopic conventional septoplasty, the sphenoid sinus was opened by perforating the anterior wall through the septoplasty wound. The sphenoid disease was treated through this opening, and then drained to the nasal cavity.
The patients operated on using EETA had no surgical complications or disease recurrence, and the use of navigation or fluoroscopy systems was not required. The mean follow-up period of the patients was 27.7 months (range 18-48 months). Follow-up management included endoscopic examination and computed tomography.
A transseptal approach to the sphenoid sinus with a sublabial incision was once frequently performed in pituitary surgery. We modified the transseptal approach as EETA with the use of an endoscope and endonasal incision. This approach is practical and reliable for ESS, and may serve as an alternative for difficult-to-manage sphenoid sinus disease. EETA can be performed in the office as it can be achieved under local anesthesia without a navigation system.
局部蝶窦疾病的手术方式多样。直接（经鼻）和间接（经筛窦）入路目前在内镜鼻窦手术（ESS）中很常见，因为它们安全有效。然而，由于解剖变异、术后改变或其他原因，偶尔难以识别或处理蝶窦。在这类困难病例中，我们目前采用内镜经鼻鼻中隔入路（EETA）治疗蝶窦疾病。本文介绍了该手术方法的适应证、操作步骤及结果。
11例局部蝶窦疾病患者（霉菌性鼻窦炎1例，黏液囊肿5例）中的6例采用EETA治疗。所有患者均在局部麻醉下进行手术。在内镜下进行常规鼻中隔成形术后，通过鼻中隔成形术切口穿透前壁打开蝶窦。通过该开口处理蝶窦病变，然后引流至鼻腔。
采用EETA手术的患者无手术并发症或疾病复发，且无需使用导航或透视系统。患者的平均随访期为27.7个月（范围18 - 48个月）。随访管理包括内镜检查和计算机断层扫描。
经唇下切口的鼻中隔入路曾常用于垂体手术。我们通过使用内镜和鼻内切口将鼻中隔入路改良为EETA。该入路在ESS中实用且可靠，可作为处理难治性蝶窦疾病的一种替代方法。EETA可在门诊进行，因为它可在局部麻醉下完成，无需导航系统。
