目的:鼻内镜手术已广泛应用于大多数上颌骨疾病的治疗,尽管无法进入上颌窦前壁和下壁的病变是一个主要缺点。在少数情况下,可以使用泪前隐窝(PLR)方法,确保上颌窦内的整体视野。上颌前壁与泪道之间的距离与PLR入路的难易程度有关。首先,我们使用解剖图像分析测量上颌前壁与泪道之间的距离,以对类型进行分类,然后评估解剖因素是否与结果有关。
方法:在272名参与者(544侧)中评估了鼻窦的两侧。在通过上颌窦前壁后表面的切线(线1[L1])和与泪道前表面的平行线(线2[L2])标记后,测量L1和L2之间的垂直距离。垂直距离<3mm,3-7毫米,>7毫米被归类为PLR进近类型I,II,III,分别。在轴平面图像中,绘制线3(L3)(从上颌窦前内壁开始的水平线),并测量与L1的角度(L1-L3A)。
结果:类型I的比例,II,III为23.2%(126),55.0%(299),和21.8%(119),分别。I型的平均L1-L3As,II,和III为12.87±4.92°,11.20±5.08°,和10.40±4.47°,分别,显示平均值的显着差异(p<0.001)。L1-L3A与L1和L2的垂直距离呈显著负相关(r=-0.201,p<0.001)。
结论:我们观察到从上颌前壁到泪道的距离与L1-L3A之间存在相关性。L1-L3A表示上颌前壁的弯曲程度;因此,L1-L3A越小,访问PLR可能越容易。
OBJECTIVE: Endoscopic sinus surgery has been widely used in the treatment of most maxillary diseases, although the inability to access lesions in the anterior and inferior maxillary sinus walls is a major disadvantage. In few cases, the prelacrimal recess (PLR) approach can be used, which secures an overall view within the maxillary sinus. The distance between the anterior maxillary wall and lacrimal duct is related to the ease of the PLR approach. First we measured the distance between the anterior maxillary wall and lacrimal duct using anatomical image analysis to classify the types and then evaluated whether anatomical factors were related to the results.
METHODS: Both sides of the sinuses were evaluated in 272 participants (544 sides). After marking a tangent line (line 1 [L1]) through the posterior surface of the anterior maxillary sinus wall and a parallel line (line 2 [L2]) to the anterior surface of the lacrimal duct, the vertical distance between L1 and L2 was measured. Vertical distances of < 3 mm, 3-7 mm, and > 7 mm were classified as PLR approach types I, II, and III, respectively. In the axial plane image, line 3 (L3) (a horizontal line starting from the inner anterior maxillary sinus wall) was drawn and the angle with L1 (L1-L3A) was measured.
RESULTS: The proportions of types I, II, and III were 23.2% (126), 55.0% (299), and 21.8% (119), respectively. The mean L1-L3As for types I, II, and III were 12.87 ± 4.92°, 11.20 ± 5.08°, and 10.40 ± 4.47°, respectively, showing a significant difference in mean values (p < 0.001). The L1-L3A and vertical distance between L1 and L2 showed a significant negative correlation (r = - 0.201, p < 0.001).
CONCLUSIONS: We observed a correlation between the distance from the anterior maxillary wall to the lacrimal duct and L1-L3A. The L1-L3A indicates the degree of curvature of the anterior maxillary wall; therefore, the smaller the L1-L3A, the easier it may be to access the PLR.