Frontal recess locates at the anterosuperior part of the ethmoidal labyrinth,the anatomical structure of which is most complicated. The acknowledgement of this area is fundamental for the endoscopic frontal sinus surgery. With the development of technology,images of the computed tomography can display more delicate micro structure of the anatomy. So we can study the frontal recess anatomy in detail with the technique. This study reviewed the current research on the image anatomy of the frontal recess.

Objective To evaluate the value of multi-slice spiral CT in nasal endoscopic surgery.Methods The multi-slice spiral CT data of 232 patients who were scanned prior to nasal endosopic surgery were analyzed.Results The nasal and sinus disease could be diagnosed correctly with multi-slice spiral CT.The ostiomeatal complex and the channels of the frontal sinus' drainage could be showed clearly.All the manifestation of the multi-slice spiral CT was in correspondence with the endoscopy showed in the surgery.Conclusion The multi-slice CT has the advantages of short scan time,less radiation dosage and multiplanar reconstruction.So it can display the nasal and sinus structures in detail,and has a great value in guiding the nasal endoscopic surgery.

Objective To explore the features of ostiomeatal complex under endoscopic observation,so as to provide reliable landmarks for a safe and perfect endoscopic sinus surgery.Methods Twelve heads from adult cadavers(8 males and 4 females) were split axially on midline with the nasal septum removed,and nasal endoscopic operation was performed for the observation of tristar of groove with professional surgical instruments on anterior ethmoid,frontal sinus and maxillory sinus.Results The tristar of groove was consisted of beak of the ethmoidal bulla and its prolonging process,apex of the uncinate process and anterior peak of the middle turbinate,at the region of frontal recess.The structures called meatal groove,uncinate groove and bullar groove were observed around the ethmoidal bulla and the tristar of groove located at their origination.Under endoscopic view these structures looked like a triangular clefts,so it was named.The cells of the meatal groove located anteromedially to the tristar,the cells of the uncinate groove were anterolateral and just inferoposterior to the meatal groove,those of the bullar groove superoposteriorly located to the cells of the uncinate groove.The ostia of these cells were constant and did not connect each other,their locations at the tristar of grooves were fixed relatively.Conclusion Tristar of grooves is a key area for endoscopic frontal sinusotomy.Due to the great structural variations,the constant landmarks,which can be seen under sinus endoscope,and the regular pattern of the nasal sinuses distribution are important and can guide the endoscopic sinus surgery.

0.05). Ac-cording to the classification criteria of ARIA in 2001, 26 children suffered from intermittent A(R22 mild cases,4 moderate-severe cases),while 22 suf-fered from persistent AR(10 mild cases,12 mod-erate-severe cases). Forty percent patients with AR also had bronchial asthma. Domestic decora-tion was an important factor in the induction of AR and 27.1% of the children with AR had inher-ent predisposition. CONCLUSION The prevalence rate of AR in children aged from 9 to 10 in Nanjing is 5.1 %. Strategy of prevention and treatment of AR should beworked out according to the epidemic feature of AR.

Objective To compare the impacts of sustained and intermittent gradient pressure on perfusion disorders and myofiber injuries and to explore the mechanism by which intermittent gradient pressure helps treat deep tissue injury (DTI). MethodsTwenty Sprague-Dawley rats 10-12 weeks old were randomly divided into an experimental group and a control group.The tibialis anterior muscles of the experimental group received intermittent fluctuating pressure at 8.0-21.3 kPa while the control group received sustained pressure at 13.3 kPa.The contralateral notpressed muscles served as healthy controls.The experiment was terminated after 3 cycles of compression where each cycle involved 2 h of compression and 30 min of conpression release.The general condition of the rats'skin and muscles in the compressed region were observed and laser doppler perfusion imaging was used to detect blood perfusion of the skin of the compressed leg after 3 cycles of compression.Any pathomorphological changes in the tibialis anterior muscles of the compressed region were observed by phosphotungstic acid hematoxylin (PTAH) staining. Results Blood perfusion of the skin and muscle in the control group was significantly less than in the experimental group after compression,and blood flow velocity increased with time in both groups.However,perfusion was significantly more extensive in the experimental group.PTAH staining showed that muscle injury in the experimental group was significantly less severe than in the control group. ConclusionCompared to the sustained pressure,intermittent pressure cause significantly less severe DTI by reducing compression-induced ischemia and hypoxia.

Objective To investigate the causes,diagnosis,treatment of the difficult postoperative decannulation resulting from tracheotomy between children and adults and the method of improving the rate of successful decannulation.Methods Clinical data of 56 cases with difficult decannulation after tracheotomy were analysed retrospectively,all the patients were admitted in our hospital between Jan 1990 and Oct 2006.All the patients were separated into two groups,children group including 24 cases of 14 months ～ 14 years old,adult group including 32 cases of age ranging 15 ～ 48 years old.The postoperative time after tracheotomy were 6 month ～ 1.5 year and 6 month ～ 2 year respectively.Results There were differences of the etiology,diagnostic choice and the clinical manifestation in the treatment of the diffficult decannulation after tracheotomy between children and adults.Children with difficult decannulation after tracheotomy occurred mainly in laryngitis and airway foreign body airway caused by obstruction retrieved after tracheotomy (14/24,58.33 ％),followed by the emergency tracheotomy,such as head and neck trauma (7/24,29.17％).Adults with difficult decannulation after tracheotomy mainly occurred in the throat caused by traumatic lesions of the larynx (including malformations,subglottic stenosis of larynx or vocal cord paralysis) (23/32,71.88％).The average block time in children with anti-inflammatory treatment was significantly lower than that in without anti-inflammatory therapy (6.2 d vs 10.1 d,t =4.26,P ＜ 0.01).However,there was no significant difference in the average block time in adults with anti-inflammatory and without anti-inflammatory treatment (t =1.63,P ＞ 0.05).In the course of treatment,rates of children consciously breathing difficulties (21/21,100％) was also significantly higher than the adult group (13/28,46.43％).Conclusion Children less than 3 years old should avoid tracheotomy.There is no definite relation between the successful treatment in the difficult decannulation and the age of the patients over 3 years old.The first failure treatment in children may be related with the local inflammation.When in treatment,doctors should observe the characteristics of respiratory difficulties,take attention to the influence of children psychological factors to the treatment.Children should be treated in the non-traumatic examination methods.

0.05). Conclusion: Although the mechanism of the correlation between upper and lower airway inflammatory diseases is not yet clear,chronic sinusitis and nasal polyposis may share some characteristics in involving the lower airway.

Objective To describe the effects of allergic and nonallergic rhinitis on patients with bronchial inflammation by comparing the bronchial inflammation characteristics . Methods All patients enrolled in the study were categorized into two groups according to rhinitis diagnostic criteria , 377 cases in the allergic rhinitis ( AR) group, 262 cases in non-allergic rhinitis ( NAR) group and another 264 patients without rhinitis as control group .Induced sputum differential cytology tests , exhaled nitric oxide concentration measurements and methacholine bronchial provocation tests were performed .The characteristics and differences in lower airway inflam-mation among the three groups were compared . Results The exhaled nitric oxide level and the positive rate of the exhaled nitric ox-ide were different significantly in AR group and NAR group than the control group (P<0.05);Bronchial provocation positive rate was 12.20%in AR group, and 6.10%in the NAR group, the difference was significant (P<0.05), and the levels in the two groups were significantly higher than the control group (P<0.05).AR group and NAR group has a significant different (P<0.05) propor-tions of eosinophil in induced sputum , while the positive rate of eosinophil in induced sputum was not different significantly ( P >0.05). Conclusion Bronchial inflammation may be aggravated by AR and NAR , so all patients with AR and NAR need treatment , and the degree of inflammation was higher in AR patients than the NAR patients .

0.05); The concentrations of NO in nasal polyp tissues was higher than that of the nasal mucosa in control group(P

OBJECTIVE To explore the therapeutic effect of modified uvulopalatopharyngoplasty(UPPP) combined with temperature-controlled radiofrequency ablation(TCRFA) in the treatment of moderate and severe obstructive sleep apnea hypopnea syndrome(OSAHS) . METHODS A total of 83 patients with moderate or severe OSAHS were underwent modified UPPPcombined with TCRFA. All patients were followed-up more than 2 years. Polysomnography was examined at 6 months,1 year and 2 years after operation. RESULTS The curative rate,obvious effective rate and effective rate were 28.9 %,33.7 % and 20.5 % respectively with a total effective rate of 83.1 % at 2 years after operation. The PSG showed that,the AHI values decreased signifi cantly(P