Isaacs Seth J, Goyal Parul
Department of Otolaryngology, State University of New York Upstate Medical University, Syracuse, New York 13210, USA.
Am J Rhinol Allergy. 2009 Sep-Oct;23(5):502-5. doi: 10.2500/ajra.2009.23.3350.
Despite advances in endoscopic surgical techniques, management of frontal sinus disease remains challenging. Much of this is related to the complex nature of frontal recess anatomy. A thorough understanding of frontal recess anatomy is paramount for the safety and success of frontal sinus surgery. Three-dimensional (3D) computed tomography (CT) may allow surgeons to obtain a more complete preoperative assessment of frontal recess anatomy. The purpose of this study was to determine if reconstructed 3D CT images as an adjunct to conventional triplanar imaging provide additional information regarding the frontal recess anatomy.
A prospective study was performed. Two otolaryngologists reviewed the CT scans of 25 patients referred for routine paranasal sinus disease. The findings from review of the triplanar CT images were compared with the findings from review of the 3D reconstructions. Each study was assessed for (1) frontoethmoidal cells, (2) agger nasi cell, (3) subrabullar and frontal bullar cells, (4) intersinus septal cell, (5) superior uncinate process attachment site, and (6) and frontal sinus outflow tract. The examiners rated the usefulness of each study to identify each of the aforementioned anatomic subsites using a modified 5-point Likert scale.
Intersinus septal cells, supraorbital ethmoid cells, and the anterior-posterior dimension of the frontal sinus outflow tract were better defined on the reconstructed 3D CT images.
Three-dimensional CT is a useful adjunct to the conventional triplanar studies for the evaluation of frontal sinus and recess anatomy. This technique can define certain anatomic variants more effectively than 2D multiplanar reconstructed images.
尽管内镜手术技术有所进步，但额窦疾病的治疗仍然具有挑战性。这很大程度上与额隐窝解剖结构的复杂性有关。全面了解额隐窝解剖结构对于额窦手术的安全性和成功率至关重要。三维（3D）计算机断层扫描（CT）可能使外科医生能够对额隐窝解剖结构进行更全面的术前评估。本研究的目的是确定重建的3D CT图像作为传统三平面成像的辅助手段是否能提供有关额隐窝解剖结构的更多信息。
进行了一项前瞻性研究。两位耳鼻喉科医生回顾了25例因常规鼻窦疾病转诊患者的CT扫描图像。将三平面CT图像回顾的结果与3D重建图像回顾的结果进行比较。每项研究评估以下方面：（1）额筛气房，（2）鼻丘气房，（3）泡下和额泡气房，（4）鼻窦间隔气房，（5）钩突上附着位点，以及（6）额窦流出道。检查者使用改良的5点李克特量表对每项研究识别上述每个解剖亚部位的有用性进行评分。
鼻窦间隔气房、眶上筛骨气房以及额窦流出道的前后径在重建的3D CT图像上显示得更清晰。
三维CT是传统三平面研究评估额窦和隐窝解剖结构的有用辅助手段。该技术比二维多平面重建图像能更有效地确定某些解剖变异。
