Hosemann W, Kühnel T, Held P, Wagner W, Felderhoff A
Department of Otorhinolaryngology, University Hospital of Regensburg, Germany.
Am J Rhinol. 1997 Jan-Feb;11(1):1-9. doi: 10.2500/105065897781446793.
Frontal sinusotomy was performed on 110 patients undergoing routine endoscopic endonasal ethmoidectomy and the minimum diameter of the frontal sinus neo-ostium was determined intraoperatively. A total of 82 patients could be subjected to follow-up and redetermination of the neo-ostium diameter 13 months later. A postoperative CT was scheduled in 62 cases. The average minimum diameter of the frontal sinus neo-ostium, measured intraoperatively, was 5.6 mm (0-11 mm). After completion of wound healing, 81% of the frontal sinuses could be explored by probing or even inspected by rigid endoscopy. The average minimum diameter of the neo-ostia determined postoperatively was 3.5 mm (0-11 mm). Patients exhibiting aspirin sensitivity or diffuse nasal polyposis showed a more pronounced scarred constriction of the frontal sinus access compared to other cases. Neo-ostia exceeding 5 mm intraoperatively were preserved with a considerably higher percentage than those with diameters of less than 5 mm. Radiologically, the fenestrated frontal sinuses frequently showed continued or even increasing mucosal congestion. No conclusive relationship was found to exist between such post-operative clouding and frontal sinus accessibility (endoscopy and/or probing) or patient complaints. The investigations confirm the safety and reliability of frontal sinusotomy in surgical management of chronic paranasal sinusitis. The mucosa of the frontal sinus often reacts to surgery in the form of persistent or even newly developing mucosal swelling to which a specific pathophysiological significance cannot always be attributed.
对110例行常规鼻内镜下鼻内筛窦切除术的患者进行了额窦切开术，并在术中确定了额窦新开口的最小直径。共有82例患者能够接受随访，并在13个月后重新测定新开口直径。62例安排了术后CT检查。术中测量的额窦新开口平均最小直径为5.6毫米（0 - 11毫米）。伤口愈合后，81%的额窦可通过探针探查甚至硬质内镜检查。术后测定的新开口平均最小直径为3.5毫米（0 - 11毫米）。与其他病例相比，表现出阿司匹林敏感性或弥漫性鼻息肉病的患者额窦开口处瘢痕性狭窄更为明显。术中新开口直径超过5毫米的保留比例明显高于直径小于5毫米的。放射学上，有开窗的额窦经常显示黏膜持续充血甚至加重。未发现这种术后混浊与额窦可及性（内镜检查和/或探针探查）或患者主诉之间存在明确关系。这些研究证实了额窦切开术在慢性鼻窦炎手术治疗中的安全性和可靠性。额窦黏膜常以持续性甚至新出现的黏膜肿胀形式对手术作出反应，而这种反应不一定具有特定的病理生理意义。
