Yang Hyung Chae, Kim Young Yoon, Jin Seoung Min, You Hyesu, Han Jung Hyun, Nam Kwang Il
Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Republic of Korea.
Research Institute of Medical Sciences, Chonnam National University Medical School, Gwangju, Republic of Korea.
Eur Arch Otorhinolaryngol. 2017 Sep;274(9):3383-3390. doi: 10.1007/s00405-017-4637-1. Epub 2017 Jun 12.
Surgical morbidity from open reduction and internal fixation (ORIF) of maxillary sinus wall fracture often surpasses the benefits of ORIF. Hence, the authors devised transnasal endoscopic-assisted reduction of maxillary sinus wall fracture (TERM) without internal fixation as a minimally invasive surgery for maxillary sinus wall fracture. The purpose of this study was to investigate the feasibility of TERM in cadavers and patients. Six cadavers were dissected to evaluate the feasibility of TERM. In addition, 20 patients with maxillary sinus wall fractures who underwent TERM in a tertiary hospital from August of 2013 to December of 2015 were enrolled in this study. Demographic factors, type of anesthesia, computed tomography (CT) scans, clinical characteristics of patients, and patient satisfaction with surgery were analyzed. Cadaveric study showed that endoscopic inferior meatus antrostomy is a feasible method of approaching the maxillary sinus wall in cadavers. In addition, counterforce could be applied to the maxillary sinus wall by pushing packed Vaseline-soaked gauze or using a zygomatic process approach via a Gillies incision. Clinical experience revealed that patients experienced good facial contour restoration postoperatively. The extent of fractured bony segments was reduced on postoperative CT without complications. Patient satisfaction with TERM was greater than that with ORIF (p = 0.031). TERM showed its feasibility in both cadaveric study and clinical study. TERM can be a good alternative to ORIF, especially in patients who are reluctant to undergo a facial incision.
上颌窦壁骨折切开复位内固定术（ORIF）的手术并发症常常超过该手术带来的益处。因此，作者设计了经鼻内镜辅助上颌窦壁骨折复位术（TERM），不进行内固定，作为上颌窦壁骨折的微创手术。本研究的目的是探讨TERM在尸体和患者中的可行性。解剖了6具尸体以评估TERM的可行性。此外，纳入了20例在2013年8月至2015年12月期间于一家三级医院接受TERM治疗的上颌窦壁骨折患者。分析了人口统计学因素、麻醉类型、计算机断层扫描（CT）、患者的临床特征以及患者对手术的满意度。尸体研究表明，内镜下鼻道开窗术是在尸体中接近上颌窦壁的一种可行方法。此外，通过推送填充凡士林的纱布或经吉利斯切口采用颧突入路可对上颌窦壁施加反作用力。临床经验显示，患者术后面部轮廓恢复良好。术后CT显示骨折骨段范围缩小，无并发症。患者对TERM的满意度高于ORIF（p = 0.031）。TERM在尸体研究和临床研究中均显示出其可行性。TERM可以成为ORIF的良好替代方法，尤其是对于不愿接受面部切口的患者。
