Prelacrimal recess'in sinus maxillaris ön duvarına göre yerleşiminin endoskopik endonasal cerrahi girişimler açısından incelenmesine ilişkin bilgisayarlı tomografi çalışması
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2022-11-14
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info:eu-repo/semantics/openAccess
Özet
Sinus maxillaris’in (SM) anterior duvarındaki ve tabanındaki lezyonlara cerrahi olarak erişmek
oldukça zordur. Bu alanlara erişim için geleneksel açık cerrahi yaklaşımlardan olan Caldwell-Luc,
lateral rinotomi veya midfasiyal degloving gibi teknikler kullanılmaktadır. Fakat bu tekniklerin
komplikasyon ve postoperatif morbidite oranları oldukça yüksektir. Günümüzde cerrahlar bu
yaklaşımlar yerine mümkün olan en non-invaziv müdahaleyle PLR’nin medial duvarının çıkarılmasını
sağlayan endoskopik prelacrimal recess (PLR) yaklaşımını sıklıkla tercih etmektedirler. Bu yaklaşım
ile hem concha nasalis inferior (CNI) hem de canalis nasolacrimalis (CNL) korunarak SM’nin anterior
duvarı, fossa pterygopalatina (FPP), fossa infratemporalis ve fossa cranii media gibi yapılara erişim
sağlanır. Bu yaklaşım açık cerrahi yaklaşımlara göre limitasyonlarının olmaması veya az olması
sebebiyle oldukça güvenilir bir tekniktir.
Çalışmada, Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi Radyoloji AD arşivinde
kayıtlı bulunan 19-72 yaş arası 150 (75 kadın, 75 erkek) hastanın paranazal sinus MDBT görüntüleri
retrospektif olarak incelendi. PLR’ye ait parametreler SM’nin normal, hipoplazik ve hiperplazik
pnömatizasyon tiplerinde sağ ve sol taraf için ayrı ayrı ölçüldü ve varyasyonları tespit edildi. Elde edilen
verilerin cinsiyete, lateralizasyona, yaş gruplarına göre analizi yapıldı ve parametreler arasındaki
korelasyon ilişkileri tespit edildi.
Endoskopik PLR yaklaşımının uygulandığı yer olan SM anterior duvarı ile CNL anterior
duvarı arası güvenli mesafe hipoplazik SM’lerde 3,33 mm, normal SM’lerde 5,42 mm, hiperplazik
SM’lerde ise 7,79 mm olarak bulundu. PLR yaklaşımının yapıldığı PLR’nin medial duvar kalınlığı
hipoplazik SM’lerde 6,62 mm, normal SM’lerde 4,39 mm, hiperplazik SM’lerde 2,75 mm olarak
bulundu. Yaş ile birlikte güvenli mesafenin anlamlı derecede azaldığı, duvar kalınlığının ise arttığı tespit
edildi. PLR yaklaşımı sonrasında potansiyel nöral morbiditeyi tahmin etmek için preoperatif
planlamada kullanılan PA açısı hipoplazik SM’lerde 31,49°, normal SM’lerde 48,50°, hiperplazik
SM’lerde ise 47,28° olarak bulundu. Cerrahi girişim yapılan yerin belirlenmesinde oldukça önemli olan
PLR’nin tipi ve konumu tüm SM pnömatizasyon tiplerinde en fazla sırasıyla ayrı ve anterior tipte
bulundu. PLR’nin olmaması durumu en fazla hipoplazik SM’lerde gözlendi.
Çalışmamız sonucunda elde ettiğimiz verilerin, PLR boyutları ve varyasyonları hakkında bir
veri tabanı oluşturarak bölgeye yapılacak endoskopik endonasal cerrahi girişimlerde komplikasyonların
azaltılması ve bölgedeki patolojilerin tespitinin kolaylaştırılması açısından faydalı olacağı
kanaatindeyiz.
It is very difficult to surgically access the lesions on the anterior wall and floor of the maxillary sinus (SM). Techniques such as Caldwell-Luc, lateral rhinotomy or midfacial degloving, which are traditional open surgical approaches, are used to access these areas. However, the complication and postoperative morbidity rates of these techniques are quite high. Today, instead of these approaches, surgeons often prefer the endoscopic prelacrimal recess (PLR) approach, which allows the medial wall of the PLR to be removed with the most non-invasive intervention possible. With this approach, both the inferior turbinate (CNI) and the nasolacrimal canal (CNL) are preserved, providing access to structures such as the anterior wall of the SM, pterygopalatine fossa (FPP), infratemporal fossa and middle cranial fossa. This approach is a very reliable technique as it has few or no limitations compared to open surgical approaches. In the study, paranasal sinus MDCT images of 150 patients (75 females, 75 males) aged between 19-72 years, registered in the archive of Necmettin Erbakan University Meram Medical Faculty Department of Radiology, were retrospectively analyzed. Parameters of PLR were measured separately for the right and left sides in normal, hypoplasic and hyperplasic pneumatization types of SM, and their variations were determined. The obtained data were analyzed according to gender, lateralization and age groups, and correlation relations between parameters were determined. The safe distance between the anterior wall of the SM, where the endoscopic PLR approach was applied, and the anterior wall of the CNL was found to be 3.33 mm in hypoplasic SMs, 5.42 mm in normal SMs, and 7.79 mm in hyperplastic SMs. The medial wall thickness of the PLR, in which the PLR approach was performed, was found to be 6.62 mm in hypoplasic SMs, 4.39 mm in normal SMs, and 2.75 mm in hyperplastic SMs. It was determined that the safe distance decreased significantly with age, while the wall thickness increased. The PA angle used in preoperative planning to predict potential neural morbidity after the PLR approach was found to be 31.49° in hypoplasic SMs, 48.50° in normal SMs, and 47.28° in hyperplastic SMs. The type and location of the PLR, which is very important in determining the surgical intervention site, were found mostly in the separate and anterior type, respectively, in all SM pneumatization types. The absence of PLR was mostly observed in hypoplasic SMs. We believe that the data we obtained as a result of our study will be beneficial in terms of reducing complications in endoscopic endonasal surgical interventions to be performed in the region and facilitating the detection of pathologies in the region by creating a database on PLR sizes and variations.
It is very difficult to surgically access the lesions on the anterior wall and floor of the maxillary sinus (SM). Techniques such as Caldwell-Luc, lateral rhinotomy or midfacial degloving, which are traditional open surgical approaches, are used to access these areas. However, the complication and postoperative morbidity rates of these techniques are quite high. Today, instead of these approaches, surgeons often prefer the endoscopic prelacrimal recess (PLR) approach, which allows the medial wall of the PLR to be removed with the most non-invasive intervention possible. With this approach, both the inferior turbinate (CNI) and the nasolacrimal canal (CNL) are preserved, providing access to structures such as the anterior wall of the SM, pterygopalatine fossa (FPP), infratemporal fossa and middle cranial fossa. This approach is a very reliable technique as it has few or no limitations compared to open surgical approaches. In the study, paranasal sinus MDCT images of 150 patients (75 females, 75 males) aged between 19-72 years, registered in the archive of Necmettin Erbakan University Meram Medical Faculty Department of Radiology, were retrospectively analyzed. Parameters of PLR were measured separately for the right and left sides in normal, hypoplasic and hyperplasic pneumatization types of SM, and their variations were determined. The obtained data were analyzed according to gender, lateralization and age groups, and correlation relations between parameters were determined. The safe distance between the anterior wall of the SM, where the endoscopic PLR approach was applied, and the anterior wall of the CNL was found to be 3.33 mm in hypoplasic SMs, 5.42 mm in normal SMs, and 7.79 mm in hyperplastic SMs. The medial wall thickness of the PLR, in which the PLR approach was performed, was found to be 6.62 mm in hypoplasic SMs, 4.39 mm in normal SMs, and 2.75 mm in hyperplastic SMs. It was determined that the safe distance decreased significantly with age, while the wall thickness increased. The PA angle used in preoperative planning to predict potential neural morbidity after the PLR approach was found to be 31.49° in hypoplasic SMs, 48.50° in normal SMs, and 47.28° in hyperplastic SMs. The type and location of the PLR, which is very important in determining the surgical intervention site, were found mostly in the separate and anterior type, respectively, in all SM pneumatization types. The absence of PLR was mostly observed in hypoplasic SMs. We believe that the data we obtained as a result of our study will be beneficial in terms of reducing complications in endoscopic endonasal surgical interventions to be performed in the region and facilitating the detection of pathologies in the region by creating a database on PLR sizes and variations.
Açıklama
Yüksek Lisans Tezi
Anahtar Kelimeler
Canalis nasolacrimalis, Endoskopik endonasal cerrahi, MDBT, Prelacrimal recess, Sinus maxillaris, Nasolacrimal canal, Endoscopic endonasal surgery, MDCT, Maxillary sinus
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Soyal, R. (2022). Prelacrimal recess'in sinus maxillaris ön duvarına göre yerleşiminin endoskopik endonasal cerrahi girişimler açısından incelenmesine ilişkin bilgisayarlı tomografi çalışması. (Yayımlanmamış yüksek lisans tezi). Necmettin Erbakan Üniversitesi, Sağlık Bilimleri Enstitüsü, Anatomi Anabilim Dalı, Konya.
