Department of Otolaryngology Head and Neck Surgery, San Antonio Military Medical Center, Lackland AFB, TX, USA.
Int Forum Allergy Rhinol. 2011 May-Jun;1(3):183-6. doi: 10.1002/alr.20022. Epub 2011 Apr 26.
Anatomic limitations complicate complete eradication of debris from the maxillary sinus using an exclusively transnasal (TN) endoscopic technique. Creation of a canine fossa trephination (CFT) permits a more direct approach than removal via the maxillary ostium.
Microdebrider eradication of debris completely filling the maxillary sinus was performed on 5 thawed fresh-frozen cadaver heads (10 sides) using a TN or CFT approach. Postdebridement computed tomography (CT) scanning assessed remaining debris. Additional outcome measures included time of debris removal, number of different angled blades utilized, and clogging.
A significantly greater amount of debris was left after the TN approach compared with CFT (3.88 cm(3) vs 2.88 cm(3), p = 0.015). Median blade utilization was significantly higher with the TN approach vs CFT (4 vs 1, p < 0.002). Time for debris eradication with CFT was similar regardless of expertise (323.4 vs 272.4 seconds, p = 0.21), but the TN approach showed a statistical difference in time-to-completion (698.8 vs 438.51 seconds, p = 1.7 × 10(-5)).
Controversy surrounds the appropriate application of CFT due to disease process and approach-related morbidity. Rhinologists should have numerous well-studied options at their disposal. This model suggests that maxillary debris removal is accomplished more thoroughly with fewer microdebrider blades when a CFT approach is employed.
解剖学局限性使通过单纯经鼻（TN）内镜技术彻底清除上颌窦内的碎片变得复杂。创建犬齿窝磨钻术（CFT）可提供比经上颌窦口去除更直接的方法。
使用 TN 或 CFT 方法对上颌窦完全充满碎片的 5 个解冻新鲜冷冻尸体头颅（10 侧）进行微钻清创术。清创后行计算机断层扫描（CT）评估残留碎片。其他结果指标包括碎片清除时间、使用的不同角度刀片数量和堵塞。
与 CFT 相比，TN 方法后留下的碎片量明显更多（3.88 cm3 比 2.88 cm3，p = 0.015）。与 CFT 相比，TN 方法的刀片使用中位数明显更高（4 比 1，p < 0.002）。无论经验如何，CFT 清除碎片的时间都相似（323.4 秒比 272.4 秒，p = 0.21），但 TN 方法在完成时间上存在统计学差异（698.8 秒比 438.51 秒，p = 1.7×10（-5））。
由于疾病过程和与方法相关的发病率，CFT 的适当应用存在争议。鼻科医生应该有许多经过充分研究的选择。该模型表明，当使用 CFT 方法时，使用更少的微钻可更彻底地清除上颌窦碎片。
