Nose Clinic Tokyo, Yaesuguchi Daiei Bldg., 1-3-1 Kyobashi, Chuo-ku, Tokyo, 104-0031, Japan.
Department of Otorhinolaryngology, Keio University, Tokyo, Japan.
Eur Arch Otorhinolaryngol. 2023 Jan;280(1):199-206. doi: 10.1007/s00405-022-07517-1. Epub 2022 Jul 8.
To perform endoscopic sinus surgery safely and effectively, surgeons need to visualize the complex anatomy of the anterior ethmoid and frontal sinus region. Because this anatomy is so variable and individualized, the foundation of understanding lies in identifying, following, and visualizing the drainage pathway patterns and anticipating possible variations.
We studied 100 sides (50 cases: 22 male, 28 female, aged 12-86, average age 46.5 years, ± 19.5) using computed tomography (CT) and multiplanar reconstruction (MPR) to identify and classify the drainage pathways leading to the frontal sinus and anterior ethmoidal cells.
Analysis revealed five patterns of drainage pathways defined by their bony walls: between the uncinate process and the lamina papyracea [UP-LP]; between the uncinate process and the middle turbinate [UP-MT]; between the uncinate process and the accessory uncinate process [UP-UPa]; between the uncinate process and the basal lamella of the ethmoidal bulla [UP-BLEB]; and between the basal lamella of the ethmoidal bulla and the basal lamella of the middle turbinate [BLEB-BLMT]. In most cases, BLEB formed the posterior wall of the drainage pathway of the frontal sinus, indicating BLEB could be one of the most important landmarks for approaching the frontal sinus.
As endoscopic sinus surgery depends on an understanding of this anatomy, this study may help surgeons to identify and follow the drainage pathways more accurately and safely through the anterior ethmoid to the frontal sinus.
为了安全有效地进行鼻窦内窥镜手术，外科医生需要可视化额窦和前筛窦区域的复杂解剖结构。由于这种解剖结构非常多变和个体化，理解的基础在于识别、遵循和可视化引流途径模式，并预测可能的变异。
我们使用计算机断层扫描（CT）和多平面重建（MPR）研究了 100 侧（50 例：22 名男性，28 名女性，年龄 12-86 岁，平均年龄 46.5±19.5 岁），以识别和分类通向额窦和前筛窦细胞的引流途径。
分析显示，有五种引流途径模式由其骨壁定义：钩突与纸样板之间[UP-LP]；钩突与中鼻甲之间[UP-MT]；钩突与副钩突之间[UP-UPa]；钩突与筛泡基底之间[UP-BLEB]；筛泡基底与中鼻甲基底之间[BLEB-BLMT]。在大多数情况下，BLEB 形成额窦引流途径的后壁，表明 BLEB 可能是接近额窦的最重要标志之一。
由于鼻窦内窥镜手术依赖于对这种解剖结构的理解，本研究可能有助于外科医生更准确、更安全地通过前筛窦识别和跟踪引流途径。
