Owens M, Klotch D W
Division of Otolaryngology, University of South Florida College of Medicine, Tampa.
Laryngoscope. 1993 Aug;103(8):883-9. doi: 10.1288/00005537-199308000-00009.
The management of the frontal sinus remains controversial for traumatic and inflammatory disease. The osteoplastic flap with fat obliteration has become the treatment standard, although late failures with infection and mucocele formation may arise. Theories for mucocele formation include regrowth of residual mucosa from the sinus and ingrowth of mucosa from a nonobliterated nasofrontal duct. A study to evaluate the means of nasofrontal duct obliteration was developed. Three cat groups were evaluated at 1, 2, and 3 months. Group 1 had the duct and sinus obliterated with fat. Group 2 had the duct obliterated with bone and the sinus with fat. Group 3 had only the duct obliterated with bone. There was no mucosal ingrowth in any of the sinuses for the intervals studied. In group 1, fat volume was seen to decrease over time with replacement by fibrous tissue within the duct. Groups 2 and 3 developed progressive obliteration of the duct with new bone formation. One may infer that fat obliteration alone does not provide a predictable stable situation as fat atrophies within the duct and may allow mucosal ingrowth. Bone obliteration was shown to be progressive within the duct from osteogenesis. This is the first experimental model to correlate clinical observations of the use of bone for sinus obliteration. This study concluded that bone obliterates the nasofrontal duct better than the accepted standard of fat, independent of the material used to obliterate the sinus.
对于创伤性和炎性疾病，额窦的治疗仍存在争议。带脂肪填塞的骨成形瓣已成为治疗标准，尽管可能会出现感染和黏液囊肿形成等晚期失败情况。黏液囊肿形成的理论包括窦内残留黏膜的再生以及来自未闭塞鼻额管的黏膜向内生长。开展了一项评估鼻额管闭塞方法的研究。在1个月、2个月和3个月时对三组猫进行了评估。第1组用脂肪闭塞鼻额管和窦。第2组用骨闭塞鼻额管，用脂肪闭塞窦。第3组仅用骨闭塞鼻额管。在所研究的时间段内，任何鼻窦均未出现黏膜向内生长。在第1组中，随着时间的推移，可见脂肪体积减少，鼻额管内被纤维组织替代。第2组和第3组随着新骨形成，鼻额管逐渐闭塞。可以推断，仅用脂肪填塞并不能提供可预测的稳定情况，因为脂肪会在鼻额管内萎缩，可能会导致黏膜向内生长。骨闭塞显示出在鼻额管内通过骨生成而逐渐进展。这是第一个将使用骨进行鼻窦闭塞的临床观察结果关联起来的实验模型。该研究得出结论，与公认的脂肪标准相比，骨能更好地闭塞鼻额管，与用于闭塞窦的材料无关。
