Clinical Characteristics and Endoscopic Endonasal Removal of Foreign Bodies within Sinuses, Orbit, and Skull Base  

作　　者：Yi-Hui Wen Wei-Jian Hou Wen-Bin Lei Feng-Hong Chen Xiao-Lin Zhu Zhang-Feng Wang Ren-Qiang Ma Wei-Ping Wen 

机构地区：[1]Department of Otolaryngology, The First Affiliated Hospital, Otolaryngology Institute, Sun Yat-sen University, Guangzhou, Guangdong 510080, China [2]Department of Otolaryngology Head and Neck Surgery, Kiang Wu Hospital, Macao 999078, China

出　　处：《Chinese Medical Journal》2017年第15期1816-1823,共8页中华医学杂志（英文版）

基　　金：This work was supported by grants from the Natural Science Foundation of Guangdong Province, China （No. 2015A030310236）, and Medical Scientific Research Foundation of Guangdong Province, China （No. A2013192）.

摘　　要：Background：Foreign bodies within the sinuses,orbit,and skull base （FBSOS） are rare;hence,diagnosis and management guidelines are lacking.Endoscopic sinus surgery （ESS） removal is preferred because of the less invasiveness and minimal morbidity.This study was designed to summarize clinical experience with ESS management of FBSOS.Methods：We retrospectively reviewed clinical manifestations,imaging findings,treatment,and outcomes in consecutive patients with ESS removal of FBSOS between 2004 and 2015 at a tertiary academic medical center.The Chi-square test was performed to compare the infection rate between wooden and nonwooden FBSOS.Results：There were 23 male and five female patients,with median age of 11 years.FBSOS were located within the sinuses （86%）,orbit （75%）,and skull base/intracranial region （46%）.Wooden FBSOS had a significantly higher risk of infection （78%） compared with nonwooden FBSOS （5%,P 〈 0.05）.Contrast-enhanced computed tomography （CT） plus three-dimensional reconstruction was sensitive in all cases.Twenty-seven （96%） FBSOS were removed by ESS alone,while 1 （4%） FBSOS was removed using the combined ESS and lateral cervical approach.Four of the nine intracranial penetrating FBSOS patients had intraoperative cerebrospinal fluid （CSF） leak and received endoscopic CSF leak repair.Twelve （43%） patients suffered complications （meningitis,diplopia,and vision loss）.Conclusions：ESS is a minimally invasive,safe,and promising surgical approach for FBSOS removal.Contrast-enhanced CT is effective in preoperative diagnosis and intraoperative guidance.Wooden FBSOS had higher risk of infection,thus antibiotics are recommended.Background：Foreign bodies within the sinuses,orbit,and skull base （FBSOS） are rare;hence,diagnosis and management guidelines are lacking.Endoscopic sinus surgery （ESS） removal is preferred because of the less invasiveness and minimal morbidity.This study was designed to summarize clinical experience with ESS management of FBSOS.Methods：We retrospectively reviewed clinical manifestations,imaging findings,treatment,and outcomes in consecutive patients with ESS removal of FBSOS between 2004 and 2015 at a tertiary academic medical center.The Chi-square test was performed to compare the infection rate between wooden and nonwooden FBSOS.Results：There were 23 male and five female patients,with median age of 11 years.FBSOS were located within the sinuses （86%）,orbit （75%）,and skull base/intracranial region （46%）.Wooden FBSOS had a significantly higher risk of infection （78%） compared with nonwooden FBSOS （5%,P 〈 0.05）.Contrast-enhanced computed tomography （CT） plus three-dimensional reconstruction was sensitive in all cases.Twenty-seven （96%） FBSOS were removed by ESS alone,while 1 （4%） FBSOS was removed using the combined ESS and lateral cervical approach.Four of the nine intracranial penetrating FBSOS patients had intraoperative cerebrospinal fluid （CSF） leak and received endoscopic CSF leak repair.Twelve （43%） patients suffered complications （meningitis,diplopia,and vision loss）.Conclusions：ESS is a minimally invasive,safe,and promising surgical approach for FBSOS removal.Contrast-enhanced CT is effective in preoperative diagnosis and intraoperative guidance.Wooden FBSOS had higher risk of infection,thus antibiotics are recommended.

关 键 词：Foreign Body ORBIT Paranasal Sinuses Skull Base 

分 类 号：S858.31[农业科学—临床兽医学] TH773.02[农业科学—兽医学]