Wen Yi-Hui, Hou Wei-Jian, Lei Wen-Bin, Chen Feng-Hong, Zhu Xiao-Lin, Wang Zhang-Feng, Ma Ren-Qiang, Wen Wei-Ping
Department of Otolaryngology, The First Affiliated Hospital, Otolaryngology Institute, Sun Yat-sen University, Guangzhou, Guangdong 510080, China.
Department of Otolaryngology Head and Neck Surgery, Kiang Wu Hospital, Macau 999078, China.
Chin Med J (Engl). 2017 Aug 5;130(15):1816-1823. doi: 10.4103/0366-6999.211545.
Foreign bodies within the sinuses, orbit, and skull base (FBSOS) are rare; hence, diagnosis and management guidelines are lacking. Endoscopic sinus surgery (ESS) removal is preferred because of the less invasiveness and minimal morbidity. This study was designed to summarize clinical experience with ESS management of FBSOS.
We retrospectively reviewed clinical manifestations, imaging findings, treatment, and outcomes in consecutive patients with ESS removal of FBSOS between 2004 and 2015 at a tertiary academic medical center. The Chi-square test was performed to compare the infection rate between wooden and nonwooden FBSOS.
There were 23 male and five female patients, with median age of 11 years. FBSOS were located within the sinuses (86%), orbit (75%), and skull base/intracranial region (46%). Wooden FBSOS had a significantly higher risk of infection (78%) compared with nonwooden FBSOS (5%, P < 0.05). Contrast-enhanced computed tomography (CT) plus three-dimensional reconstruction was sensitive in all cases. Twenty-seven (96%) FBSOS were removed by ESS alone, while 1 (4%) FBSOS was removed using the combined ESS and lateral cervical approach. Four of the nine intracranial penetrating FBSOS patients had intraoperative cerebrospinal fluid (CSF) leak and received endoscopic CSF leak repair. Twelve (43%) patients suffered complications (meningitis, diplopia, and vision loss).
ESS is a minimally invasive, safe, and promising surgical approach for FBSOS removal. Contrast-enhanced CT is effective in preoperative diagnosis and intraoperative guidance. Wooden FBSOS had higher risk of infection, thus antibiotics are recommended.
鼻窦、眼眶和颅底异物（FBSOS）较为罕见，因此缺乏诊断和治疗指南。由于内镜鼻窦手术（ESS）具有微创性且发病率极低，故首选该方法进行切除。本研究旨在总结ESS治疗FBSOS的临床经验。
我们回顾性分析了2004年至2015年期间在一家三级学术医疗中心连续接受ESS切除FBSOS患者的临床表现、影像学检查结果、治疗方法及预后。采用卡方检验比较木质和非木质FBSOS的感染率。
共有23例男性和5例女性患者，中位年龄为11岁。FBSOS位于鼻窦（86%）、眼眶（75%）和颅底/颅内区域（46%）。与非木质FBSOS（5%）相比，木质FBSOS的感染风险显著更高（78%，P<0.05）。增强计算机断层扫描（CT）加三维重建在所有病例中均具有敏感性。27例（96%）FBSOS仅通过ESS切除，而1例（4%）FBSOS采用ESS联合外侧颈侧入路切除。9例颅内穿透性FBSOS患者中有4例术中发生脑脊液（CSF）漏，并接受了内镜下CSF漏修补术。12例（43%）患者出现并发症（脑膜炎、复视和视力丧失）。
ESS是一种微创、安全且有前景的FBSOS切除手术方法。增强CT在术前诊断和术中指导方面有效。木质FBSOS感染风险较高，因此建议使用抗生素。
