Topuz Muhammet Fatih, Sarı Murat, Binnetoglu Adem, Dogrul Ramazan, Bugdaycı Onur, Şeker Aşkın
Department of Otorhinolaryngology, Dumlupinar University School of Medicine, İstiklal Parish Okmeydani st. No: 10 Merkez, Kütahya, Turkey.
Department of Otorhinolaryngology, Marmara University School of Medicine, Fevzi Çakmak Parish Muhsin Yazıcıoğlust No: 10 Kaynarca, Pendik, Istanbul, Turkey.
Eur Arch Otorhinolaryngol. 2017 Aug;274(8):3065-3069. doi: 10.1007/s00405-017-4598-4. Epub 2017 May 3.
The aim of the study was to analyze whether the measurement of changes in the anatomical position and volume of middle concha, the volume changes in the area between the middle concha and lamina papyracea, the evaluation of opacification in major paranasal sinuses, and osteomeatal complex occlusion in cases with middle concha by out-fracture technique during endoscopic endonasal transsphenoidal approach is a minimally invasive surgery, and also to find out whether these changes lead to the development of tendency to rhinosinusitis. It was a retrospective clinical study. Forty-five cases, between 2013 and 2015, planned for endoscopic endonasal transsphenoidal surgery due to hypophyseal pathology at the Neurosurgery Departments of Marmara University Hospital were evaluated retrospectively. The patients were evaluated for the changes in the anatomy of the middle concha and the effects of these changes to paranasal sinuses by paranasal computed tomographies were studied at the preoperative second week and postoperative 12 month. The Lund-Mackay scoring system was used for the evaluation of opacification in the five major paranasal sinuses and occlusion of the osteomeatal complex in the pre- and postoperative period. The Lund-Mackay scoring system was used to analyze the paranasal computed tomography of the patients at the preoperative 2 weeks and postoperative first year. According to the Lund-Mackay scoring system, no significant difference was detected between the preoperative and postoperative opacification of paranasal sinuses (p > 0.05). Besides, there was also no significant difference between the preoperative and postoperative osteomeatal complex occlusion (p > 0.05). Considering the distance between middle concha and lamina papyracea following the out-fracture of the middle concha, a significant lateralization of 0.5 mm between the preoperative and postoperative period was observed (p < 0.05). In addition, a significant change was also detected in the volume of middle concha (p < 0.05). The volume of the area between the middle concha and lamina papyracea was decreased with a statistical significance (p < 0.05). The endoscopic endonasal transsphenoidal surgery causes some variations in the structures of the middle concha, paranasal sinuses, and OMC, but these changes do not lead to significant rhinologic pathologies.
本研究的目的是分析在内镜下经鼻蝶窦入路过程中，通过外折技术对中鼻甲解剖位置和体积变化、中鼻甲与纸样板之间区域的体积变化、主要鼻窦的浑浊情况评估以及中鼻甲病例的窦口鼻道复合体阻塞情况进行测量，是否属于微创手术，同时还要弄清楚这些变化是否会导致鼻窦炎倾向的发展。这是一项回顾性临床研究。对2013年至2015年间在马尔马拉大学医院神经外科因垂体病变计划接受内镜下经鼻蝶窦手术的45例患者进行回顾性评估。在术前第二周和术后12个月，通过鼻窦计算机断层扫描对患者中鼻甲的解剖结构变化以及这些变化对鼻窦的影响进行研究。采用Lund-Mackay评分系统评估术前和术后五个主要鼻窦的浑浊情况以及窦口鼻道复合体的阻塞情况。使用Lund-Mackay评分系统分析患者术前2周和术后第一年的鼻窦计算机断层扫描。根据Lund-Mackay评分系统，术前和术后鼻窦浑浊情况无显著差异（p>0.05）。此外，术前和术后窦口鼻道复合体阻塞情况也无显著差异（p>0.05）。考虑到中鼻甲外折后中鼻甲与纸样板之间的距离，术前和术后观察到有0.5毫米的显著侧向移位（p<0.05）。此外，中鼻甲体积也有显著变化（p<0.05）。中鼻甲与纸样板之间区域的体积有统计学意义的减小（p<0.05）。内镜下经鼻蝶窦手术会导致中鼻甲、鼻窦和窦口鼻道复合体结构出现一些变化，但这些变化不会导致明显的鼻科病理情况。
