Bertrán Mendizábal J M, Pérez Martínez C, Martínez Vidal A
Hospital Ramón y Cajal, Madrid.
Acta Otorrinolaringol Esp. 1998 Jun-Jul;49(5):380-4.
Osteoplastic flap of the frontal sinus, described by Macbeth over 40 years ago, still is the best surgical approach for the diagnosis and definitive treatment of chronic disease. Forty-seven patients were treated with this technique between 1978 and 1995. The conditions treated were, by order of frequency: 16 fronto-ethmoidal mucocele, 12 osteoma, 12 hypertrophic sinusitis, and less frequent disorders, such as osteomyelitis (2), fibrous histiocytoma (2), tuberculosis (1), frontal fracture (1) and dilated pneumosinus (1). The surgical approach was coronal in 28 patients, brow in 18 and hemicoronal in 3. In some cases, other approaches were associated: 13 lateral rhinotomy, 6 sublabial and 1 intranasal. Nasofrontal duct obstruction was found in 89% of cases and erosion of one or more sinus walls in 70%. Intraoperative complications included 4 small dural tears, 1 with leakage of cerebrospinal fluid. Postoperative complications included 4 frontal deformity, 2 persistent frontal anesthesia, 1 supraorbital nerve neuralgia, 1 post-anticoagulant epistaxis and 1 death from pulmonary embolism.
40多年前麦克白所描述的额窦骨成形瓣，至今仍是诊断和最终治疗慢性疾病的最佳手术方法。1978年至1995年间，有47例患者接受了该技术治疗。按出现频率排序，所治疗的病症有：16例额筛窦黏液囊肿、12例骨瘤、12例肥厚性鼻窦炎，以及一些不太常见的病症，如骨髓炎（2例）、纤维组织细胞瘤（2例）、结核病（1例）、额骨骨折（1例）和鼻窦扩张（1例）。手术入路采用冠状切口的有28例患者，眉弓切口的有18例，半冠状切口的有3例。在某些情况下，还联合采用了其他入路：13例鼻侧切开术、6例唇下切口和1例鼻内入路。89%的病例发现鼻额管阻塞，70%的病例发现一个或多个鼻窦壁侵蚀。术中并发症包括4例硬脑膜小撕裂，其中1例伴有脑脊液漏。术后并发症包括4例额部畸形、2例持续性额部麻醉、1例眶上神经痛、1例抗凝后鼻出血和1例因肺栓塞死亡。
