Sikand Ashley
USA.
Ann Otol Rhinol Laryngol. 2011 Oct;120(10):656-62. doi: 10.1177/000348941112001005.
A clinically relevant reconstruction of the ethmoid infundibulum and maxillary sinus ostium was developed to use 3-dimensional computed tomographic (CT) imaging technology and measurement software in an effort to better understand the anatomy of the maxillary sinus ostium and to optimize the maxillary sinus balloon dilation technique.
A retrospective review was performed of reconstructed high-resolution CT scans of patients from a private otolaryngology practice who underwent imaging for evaluation of sinus disease using multiplanar reconstruction software. The CT scans were retrospectively obtained from patients who presented for evaluation of chronic sinus disease and were analyzed with quantitative multiplanar reconstruction software that allowed measurements to be computed in clinically meaningful planes.
Data were obtained from 31 sinuses on 18 CT scans. The mean anteroposterior distance from the guidewire exit to the maxillary ostium was 3.5 mm, and the mean optimal guide trajectory ("clocking") angle was 17.50 from the pure axialplane (95% confidence interval, 12.58 degrees to 22.48 degrees). The curvilinear guidewire travel distance was 6.9 mm from the guidewire exit to the ostial entry.
This study reveals specific anatomic information that is applicable to the technique of transnasal maxillary sinus balloon catheter dilation. The data collected allow surgeons to anticipate the direction in which a guidewire must be manipulated in order to correctly enter the maxillary ostium. According to the data, a gentle anterior retraction of the uncinate process and a starting guide orientation 180 from pure lateral will best facilitate maxillary sinus ostial access. Application of the readily available software used for this study affords the opportunity to predict the location of the natural ostium within the infundibulum before operation and customize the technique to each specific patient.
利用三维计算机断层扫描（CT）成像技术和测量软件，开发一种临床上相关的筛漏斗和上颌窦口重建方法，以更好地了解上颌窦口的解剖结构，并优化上颌窦球囊扩张技术。
对一家私立耳鼻喉科诊所中使用多平面重建软件进行鼻窦疾病评估成像的患者的高分辨率CT扫描重建图像进行回顾性分析。CT扫描图像是从前来评估慢性鼻窦疾病的患者中回顾性获取的，并使用定量多平面重建软件进行分析，该软件允许在具有临床意义的平面上进行测量。
从18例CT扫描图像中获取了31个鼻窦的数据。导丝出口到上颌窦口的平均前后距离为3.5毫米，平均最佳导丝轨迹（“时钟定位”）角度相对于纯轴平面为17.50°（95%置信区间，12.58°至22.48°）。从导丝出口到窦口入口的曲线形导丝行进距离为6.9毫米。
本研究揭示了适用于经鼻上颌窦球囊导管扩张技术的特定解剖学信息。所收集的数据使外科医生能够预测为正确进入上颌窦口而必须操纵导丝的方向。根据数据，钩突的轻柔向前牵拉以及相对于纯外侧方向180°的起始导丝方向将最有利于进入上颌窦口。应用本研究中使用的现成软件有机会在手术前预测漏斗内自然窦口的位置，并针对每个特定患者定制技术。
