Division of Sinus and Skull Base Surgery, Traumatology, Department of Ear, Nose, and Throat, Hospital Karlsruhe, Moltkestrasse 90, 33 Karlsruhe, Germany.
Am J Rhinol Allergy. 2010 Nov-Dec;24(6):132-5. doi: 10.2500/ajra.2010.24.3531.
Endonasal endoscopic medial maxillectomy usually includes removal of the inferior turbinate (IT) even if it is not involved in the disease. A surgical approach is presented in which the IT is temporarily excised and then reinserted, followed by postoperative occlusion of the nose for at least 2 weeks.
A retrospective case series of 12 patients with inverted papilloma (IP) of the maxillary sinus (Krouse II-III) and 2 patients with 3 mucoceles of the maxillary sinus after a Caldwell-Luc operation were reviewed. After a follow-up period of 12-80 months (28 months on average) all patients underwent endoscopy, and in four cases, additionally, an MRI was performed.
There was no recurrence of tumor or mucocele after 12-80 months. The IT and its important function for warming and humidifying the inhaled air could be preserved up to now in all 15 operated sides. The patients did not have any specific pain postoperatively and there was no postoperative bleeding. They all tolerated occlusion for 2-4 weeks. Two patients developed mucoceles due to the formation of scar tissue after endonasal tumor surgery. In three cases of endonasal endoscopic Denker operation patients reported some degree of numbness or irritation of the ipsilateral frontal teeth.
The IT can be preserved in endonasal endoscopic medial maxillectomy for treatment of IP without a higher incidence of tumor recurrence. Aftercare should specifically focus on preventing the development of mucoceles caused by scarring.
经鼻内镜内侧上颌窦切除术通常包括切除下鼻甲（IT），即使它没有参与疾病。本文提出了一种手术方法，其中 IT 被暂时切除，然后再重新插入，并在术后至少 2 周内进行鼻腔闭塞。
回顾性分析了 12 例上颌窦内翻性乳头状瘤（IP）（Krouse II-III）和 2 例 Caldwell-Luc 手术后上颌窦 3 例黏液囊肿的患者。在 12-80 个月（平均 28 个月）的随访期后，所有患者均接受了内镜检查，其中 4 例还进行了 MRI 检查。
在 12-80 个月后，肿瘤或黏液囊肿无复发。到目前为止，在所有 15 例手术侧，IT 及其对吸入空气的加热和加湿的重要功能均得以保留。患者术后无特殊疼痛，无术后出血。他们都能耐受 2-4 周的闭塞。2 例患者因经鼻肿瘤手术后形成的瘢痕组织而发生黏液囊肿。在 3 例经鼻内镜 Denker 手术患者中，报告同侧额牙有一定程度的麻木或刺激。
在治疗 IP 时，经鼻内镜内侧上颌窦切除术可以保留 IT，而不会增加肿瘤复发的风险。后续护理应特别关注预防由瘢痕形成引起的黏液囊肿的发展。
