摘要
目的:研究鼻腔鼻窦骨化纤维瘤的病理及影像特点,临床表现,治疗方法。
方法和资料:本文回顾广西医科大学一附院耳鼻喉科1985—2007年所收治的16例鼻腔鼻窦骨化纤维瘤病例,结合近年来相关文献,对鼻腔鼻窦骨化纤维瘤这一临床少见疾病作分析及综述。从所收集的16个临床病例中选出有代表性的4个病例,加以详细报告,从影像学及病理学特点等方面,将鼻腔鼻窦骨化纤维瘤同骨纤维异常增殖作重点鉴别。
讨论:鼻腔鼻窦骨化纤维瘤的发病原因不明,一般认为是骨组织起源的良性新生物,也可能与外伤及发育异常有关。
鼻腔鼻窦骨化纤维瘤中,以筛窦,蝶窦易发。
鼻腔鼻窦骨化性纤维瘤临床上常见的典型表现是无痛性、进行性面部肿胀,眼球突出和移位。其他症状为鼻塞、流涕、鼻出血、头痛,无明确特异性。
鼻腔鼻窦骨化性纤维瘤临床诊断主要依靠CT和病理活检,临床主要与骨纤维异常增殖相鉴别。
鼻腔鼻窦骨化纤维瘤影像学表现为以髓腔为中心向四周膨胀性生长,多单骨受累,边界清楚、影像学上,骨化纤维瘤和骨纤维异常增殖在密度上没有太大差别,两者的主要区别在于不同的生长方式和病灶边界
病理学特征:骨质小体是骨化性纤维瘤的主要病理特征,肿瘤中心部分的骨小梁为纤维性骨,其外周则向板状骨过渡;细胞成份无细胞异型及核分裂像
鼻腔鼻窦骨化纤维瘤临床治疗的主要措施是手术切除肿瘤。主要术式包括:影像导航辅助下鼻内镜手术,头皮冠状切口颅面联合进路,鼻侧切开术,鼻内镜手术+鼻侧切开术,Caldwell-Luc进路。
骨化纤维瘤预后较好,一般彻底切除后无复发。
小结:鼻腔鼻窦骨化纤维瘤是临床上一种少见疾病,多见于青少年,主要表现为无痛性、进行性面部肿胀,眼球突出和移位。临床诊断主要依靠CT及病理活检。手术切除肿瘤是治疗鼻腔鼻窦骨化纤维瘤的主要措施。该病预后较好,一般彻底切除后无复发。
Objective:To study the pathogeny,pathogenesis,epidemiology,symptom, sign,laboratory diagnosis,CT,pathology,clinic treatment,operation, subsequentness and prognosis of Ossifying fibroma in nasal cavity and paranasal sinuses
Methods:reviewing the 8 cases of Ossifying fibroma in nasal cavity and paranasal sinuses which were dianosised and treated in First Affiliated Hospital of Guangxi Medical University from 1985 to 2007,referencing the articles about Ossifying fibroma in recent years,we have a analysis and summarization to Ossifying fibroma.4 typical cases are particularly reported.we also differentiate Ossifying fibroma to Fibrous dysplasia by CT and pathology.
Discussion,the pathogeny of Ossifying fibroma in nasal cavity and paranasal sinuses is not clear yet.some hypotheses are popular—benign tumour from bone structure,trauma and heteroplasia,among the nasal sinuses, ethmoid sinus and sphenoid sinus are the easiest ones to be invaded by Ossifying fibroma.The typical signs of Ossifying fibroma in nasal cavity and paranasal sinuses are the indolence,progressing face tumefaction, exophthalmos and eyeball shift,other signs include the sniffles,nasal mucus, rhinorrhagia and headache.The clinical diagnosiss mainly depends on comparative imaging analysis and pathology.The main clinical differential diagnosis is Fibrous dysplasia.Ossifying fibroma showed an expansive well-defined lesions with calcium-like high density.The main imaging differential diagnosis between Ossifying fibroma and Fibrous dysplasia is their growth pattern,margin and size.Cementicle is the character of Ossifying fibroma in pathology.The main treatment of Ossifying fibroma in nasal cavity and paranasal sinuses is surgical operation.The operation methods include: nasal endoscopic management lateral rhinotomy,coronal incision, Caldwell-Luc'surgery,lateral rhinotomy with nasal endoscope,and image navigation in resection of the ossifying fibroma with nasal endoscope.The prognosis of ossifying fibroma is satisfying.Commonly,It will not recrudesce by a completely resection.
Conclusion.Ossifying fibroma in nasal cavity and paranasal sinuses of the sinuses is a no-common disease in clinic.Most patients are teenagers.The typical signs are the indolence,progressing face tumefaction,exophthalmos and eyeball shift.The clinical diagnosiss mainly depends on comparative imaging analysis and pathology.The main treatment of Ossifying fibroma is surgical operation.The choice of surgical operations on was mainly decided by the location of ossifying fibroma,in the meanwhile,the organ function,the cosmetology,the surgical degree of difficulty,and the doctor's experience were taken into account.The prognosis of Ossifying fibroma in nasal cavity and paranasal sinuses is satisfying.Commonly,It will not recrudesce by a completely resection.
引文
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