以筛前动脉为蒂的鼻腔外侧壁黏膜瓣在额窦后壁缺损重建中的应用

Application of pedicle mucosal flap of nasal lateral wall with anterior ethmoidal artery to reconstruct the posterior wall defect of frontal sinus

摘要:

 目的介绍一种以筛前动脉为血管蒂的鼻腔外侧壁黏膜瓣应用于额窦后壁缺损修复重建的新方法，并总结其疗效和初步应用体会。方法回顾性分析应用带蒂鼻腔外侧壁黏膜瓣修复15例额窦后壁脑脊液鼻漏病例，其中男12例，女3例，年龄12~51岁，平均年龄32岁，均为外伤引起的颅底骨折、术前均经过至少1个月保守治疗无效的脑脊液鼻漏患者。采用内镜下DrafIIB型额窦开放+上方带蒂的鼻腔外侧壁黏膜瓣进行颅底修复。结果所有病例均一次性重建成功，术后1个月拔除填充物后无脑脊液鼻漏发生，随访1~3年，无脑脊液鼻漏和颅内感染发生，额窦及上颌窦均引流通畅，上皮化好。主要副反应为鼻腔干燥结痂。结论以筛前动脉为血管蒂的鼻腔外侧壁黏膜瓣取材方便，应用于额窦后壁颅底缺损修复疗效满意，该术式有创新性。

Abstract:

 ObjectiveTo introduce a novel method to reconstruct the posterior wall defect of frontal sinus by pedicle mucosal flap of nasal lateral wall with anterior ethmoidal artery, and to summarize the therapeutic effect as well as our preliminary application experiences.MethodsA retrospective study was conducted on 15 patients who underwent endoscopic treatment of cerebrospinal fluid (CSF) rhinorrhea from the posterior wall of frontal sinus. A total of 12 males and 3 females were included, aging from 12 to 51 years old, with a mean age of 32 years. The skull base defects of all patients were caused by trauma, and the expectant treatment for at least 1 month turned out to be ineffective. All patients underwent endoscopic skull base reconstruction through Draf IIB frontal sinusotomy combined with pedicle mucosal flap of nasal lateral wall with anterior ethmoidal artery.ResultsSuccessful onetime skull base reconstruction was achieved in all patients. Nasal stuffing was removed 1 month after surgery, and no CSF rhinorrhea occurred. All patients were followed up for 1 to 3 years, and neither recurrence of CSF rhinorrhea nor intracranial infection was observed. Both frontal sinus and maxillary sinus possessed unobstructed drainage as well as satisfactory epithelization with mycteroxerosis as the main side effect.ConclusionWith advantages of convenience in acquisition and satisfactory therapeutic effect, Draf IIB frontal sinusotomy combined with pedicle mucosal flap of nasal lateral wall with anterior ethmoidal artery is an innovative surgical technique to reconstruct the posterior wall defect of frontal sinus.