Ye Jing, Yu Hongmeng, Draf Wolfgang, Zheng Chunquan, Wang Dehui
Department of Otolaryngology, First Affiliated Hospital of Nanchang University, Nanchang, China.
ORL J Otorhinolaryngol Relat Spec. 2009;71(5):257-62. doi: 10.1159/000240648. Epub 2009 Sep 25.
To perform the anterior-to-posterior-to-anterior technique in revision endoscopic sinus surgery, and to assess the effects and safety of this technique in treating recurrent chronic sinusitis and nasal polyps.
One hundred and thirteen patients with recurrent chronic sinusitis and nasal polyps received anterior-to-posterior-to-anterior revision endoscopic sinus surgery. This surgical technique has 5 important steps, including exposing the choana, enlarging the maxillary sinus ostium, opening the sphenoid sinus and posterior ethmoid sinus anteriorly to posteriorly, resecting the ethmoid sinus posteriorly to anteriorly, and opening the frontal sinus posteriorly to anteriorly. The choana, maxillary sinus ostium, middle turbinate remnant, and the roof and lateral wall of the sphenoid sinus are 4 stable anatomic reference points.
Twelve months postoperatively, the mean SNOT-22 score had improved by 18.48 and 100 (88.50%) patients had an improvement in nasal obstruction; thick nasal discharge, loss of smell or taste, and facial pain/pressure improvements were noted in 102 (90.27%), 64 (56.64%) and 76 (67.26%) patients, respectively. Postoperative endoscopic evaluation after 12 months indicated that 29 (25.66%), 12 (10.62%), 5 (4.42%), 6 (5.31%), and 2 (1.77%) patients had mucosal edema, nasal discharge, synechiae, polyps, and crusting, respectively. No severe complications were observed.
The anterior-to-posterior-to-anterior technique is an effective and safe approach to revision endoscopic sinus surgery. The 4 stable anatomic reference points are helpful for preventing severe complications in total ethmoidectomy.
在行修正性鼻内镜鼻窦手术时采用前后前技术，并评估该技术治疗复发性慢性鼻窦炎和鼻息肉的效果及安全性。
113例复发性慢性鼻窦炎和鼻息肉患者接受了前后前修正性鼻内镜鼻窦手术。该手术技术有5个重要步骤，包括暴露后鼻孔、扩大上颌窦开口、从前向后开放蝶窦和后组筛窦、从后向前切除筛窦以及从后向前开放额窦。后鼻孔、上颌窦开口、中鼻甲残余以及蝶窦的顶壁和外侧壁是4个稳定的解剖参考点。
术后12个月，平均鼻窦症状测试-22（SNOT-22）评分改善了18.48，100例（88.50%）患者鼻塞情况得到改善；102例（90.27%）、64例（56.64%）和76例（67.26%）患者的浓稠鼻涕、嗅觉或味觉丧失以及面部疼痛/压迫感分别得到改善。术后12个月的内镜评估显示，分别有29例（25.66%）、12例（10.62%）、5例（4.42%）、6例（5.31%）和2例（1.77%）患者出现黏膜水肿、鼻涕、粘连、息肉和结痂。未观察到严重并发症。
前后前技术是修正性鼻内镜鼻窦手术一种有效且安全的方法。4个稳定的解剖参考点有助于在全筛窦切除术中预防严重并发症。
