鼻竇內視鏡下經淚前隱窩路徑治療上頷竇疾病

Transnasal Endoscopic Prelacrimal Recess Approach for Maxillary Sinus Diseases

許原禎(Yuan-Jhen Hsu) ； 黃同村(Tung-Tsun Huang) ； 邱贊仁(Tsan-Jen Chiu) ； 陳培榕(Pei-Rong Chen)

《台灣耳鼻喉頭頸外科雜誌》 48卷4期 (2013/12) Pp. 272-279

https://doi.org/10.6286/2013.48.4.272

摘要

背景：鼻竇內視鏡下經淚前隱窩路徑手術來治療上頷竇病變的方式，在台灣尚無完整病例分析，本文旨在採討此手術之手術方式、適應症與可能的併發症。方法：採病歷回溯性分析，收集於2011年5月至2012年7月期間，接受鼻竇內視鏡下經淚前隱窩手術治療上頷竇病變的病例共9例，其中倒生性乳突瘤3例，上頷竇齒源性囊腫3例，上頷竇黏液囊腫2例，顳下窩腫瘤1例。病患皆於術前接受鼻竇電腦斷層掃描。手術先在下鼻甲前緣做一切口，分離出膜性鼻淚管並將膜性鼻淚管－下鼻甲皮瓣內移，移除部分上頷竇內側壁後，經淚前隱窩進入上頷竇腔，處理上頷竇腔病變或是在移除上頷竇後壁後，進入顳下窩進行病理切片，處理病灶後將鼻淚管－下鼻甲皮瓣復位，縫合手術切口並依病況行下鼻道開窗術。結果：所有病患皆順利完成手術，其中8例病患術中均可清除上頷竇內病變，另1例病患可成功取得顳下窩腫瘤組織，術後平均追蹤8.8個月，內視鏡下可見下鼻甲切口癒合，上頷竇上皮化良好。有兩例溢淚情形發生，經藥物或內視鏡淚囊鼻腔造口手術治療後皆順利復原，所有病例皆無面部麻木等併發症，於追蹤期間亦無復發情形。結論：鼻竇內視鏡下經淚前隱窩路徑進入上頷竇是一種微創，安全且有效的手術，對於處理上頷竇難治之病灶以及進入眼眶底部、翼顎窩與顳下窩等提供一種新的處理方式。

關鍵字

鼻淚管(nasolacrimal duct) ； 淚前隱窩(prelacrimal recess) ； 上頷竇(maxillary sinus) ； 鼻竇內視鏡內側上頷竇切除術(endoscopic medial maxillectomy)

並列摘要

BACKGROUND: Transnasal endoscopic prelacrimal recess approach for maxillary sinus diseases has not been reported in literature in Taiwan. We would like to share our experience in utilizing this procedure in our hospital. The surgical procedure, indication, and possible complication would be discussed.METHODS: A retrospective chart review was performed in patients who had undergone transnasal endoscopic prelacrimal recess approach from May 2011 to July 2012. Computed tomography of sinus was routinely performed. The procedure was carried out under general anesthesia. Incision was made along the anterior margin of the inferior turbinate. Dissection was made posteriorly along the subperiosteal plane and ostium of the nasolacrimal duct was identified. Nasolacrimal duct-inferior turbinate mucosal flap was developed and medialized. After removing part of the medial wall of maxillary sinus, access via prelacrimal recess into the maxillary sinus was gained. Further removal of mucocele, odontogenic cyst, inverted papilloma and biopsy for infratemporal fossa tumor were performed. The procedure ended by suturing anterior edge of inferior turbinate mucosa. The patients were followed up regularly in our outpatient clinic.RESULTS: Nine patients were enrolled in this study. The diagnosis of these patients included 3 odontogenic cyst, 2 mucocele, 3 inverted papilloma and 1 infratemporal fossa tumor. The follow-up period ranged from 1 to 17 months, with a mean of 8.8 months. Two patients had epiphora after surgery. One was treated by dacryocystorhinostomy successfully and the other recovered after medical treatment. Neither facial numbness nor parasthesia was recorded. Overall, no local recurrence was seen in all patients.CONCLUSIONS: Transnasal endoscopic prelacrimal recess approach can be applied in the diffuse or severe diseases of maxillary sinus.