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Endoscopic nasal surgery for 86 patients with contact point headaches


Science, Qufu 273100) nasal contact headache is the nasal septum and nasal mucosal contact points between the resulting headache. With the extensive application of nasal endoscopy,[link widoczny dla zalogowanych], nasal contact headache gradually been recognized. Treatment course are summarized headache nasal contacts of 86 cases of clinical data, reported as follows: Materials and Methods 1. General Information The group of 86 patients, 52 males and 34 females; aged 18 to 64 years, mean 34.6 years; course of 2 months of a 16-year average of 6 months. Headache location: nasion Department 31 cases, 22 cases of periorbital,[link widoczny dla zalogowanych], temporal or zygomatic arch in 18 cases, frontal in 15 cases, the majority of cases no obvious common nasal congestion runny nose and other nasal symptoms, only isolated cases have intermittent nasal obstruction. Endoscopic examination: 22 cases of simple nasal septum deviation, nasal septum deviation with inferior turbinate hypertrophy l8 cases, middle turbinate hypertrophy, gasification or anti-sheets in 29 cases,[link widoczny dla zalogowanych], 2 cases on the gasification turbinate, uncinate process hypertrophy, hypertrophy or bubble screen 15 cases of polypoid changes, all cases were confirmed by endoscopic examination or cT mucosal contact points exist, and the exclusion of sinusitis and nasal sinus lesions. All patients in the tetracaine placebo-controlled experiment: headache 1% tetracaine when the cotton pad placed mucosal contact point headaches disappeared within 5 minutes. 2. All patients were treatment endoscopic surgery,[link widoczny dla zalogowanych], the different lines for different causes of treatment; the key is to correct nasal anatomic abnormalities, eliminating mucosal contact points. Simple line deviated septum nasal surgery; nasal septum deviation with inferior turbinate hypertrophy, and line deviation of nasal septum, and then the mucosa of inferior turbinate hypertrophy, or bone fracture of the inferior turbinate were performed, or the relocation of part of the inferior turbinate submucosal resection ; in the middle turbinate turbinate lesions underwent angioplasty; on line turbinate gasification by partial turbinectomy; uncinate lesions or removal of ethmoid bulla and uncinate open ethmoid, maxillary sinus. 3. Determine the efficacy of the standard recovery: does not disappear after treatment, recurrence of headache; improved: the intensity and frequency of headache decreased; invalid: headache intensity and frequency did not change significantly. Results All cases were successfully operated, were followed up for 9-30 months,[link widoczny dla zalogowanych], mean 24 months, with no complications. Which recovered: 30 patients (34.9%); improved: 47 cases (54.7%); invalid: 9 cases (10.4%). The total effective rate: 89.6%. Point of contact to discuss headache nasal mucosa is due to the oppressed, the distribution of nasal mucosa in three and neural reflex caused by stimulation of the headache. Because of the existence of nasal mucosa substance P, so that nasal contact headache is more evident. Not only because of substance P-induced pain in itself is a strong material, and the nasal mucosa can induce the release of bradykinin, bradykinin and substance P to pain nerves suffered a double blow. 2004 International Headache Society (IHS) for the first time developed a nasal contact headache diagnostic criteria, standards, mucosal contact point is clearly a necessary condition for diagnosis. However, clinical work, because of the simple mucosal contact point headaches due to the lack of other common symptoms of nasal and often missed or misdiagnosed. The group of 16 patients to treatment because of chronic headaches in neurology, misdiagnosed as migraine or cluster headache, the line more than six months of drug treatment ineffective, and occasionally line cT examination revealed abnormal nasal anatomy and referred to our department. As for the treatment of patients at the Department of Otolaryngology, pure nose endoscopy, often because they can not find the top or the rear of the nasal cavity caused by anatomical abnormalities missed. The endoscopic examination of these parts can in-depth, intuitive and detailed understanding of the abnormal anatomy of the nasal cavity, nasal contact headache for a clear diagnosis. Therefore, long-term headache for the treatment of clinical cases of poor results, it is necessary line cT examination or endoscopy to rule out mucosal contact point headaches. For the diagnosis of clear nasal contact headache, the treatment principle is the cause for the removal of mucosal contact points. The group 2 patients with intractable headache patients, headache is severe, serious impact on work and life, nasal examination revealed: nasal septum deviation and the formation of bone spurs spine-like sting of the inferior turbinate, inferior turbinate mucosa caused by pale edema. Surgical correction of the nasal septum, nasal extraction postoperative headache disappeared after stuffing, followed up for 2 years without recurrence. The remaining cases are for the abnormal anatomy of the limitations of endoscopic surgery to remove the lesion, eliminating the cause of the nasal cavity while preserving the normal anatomical structures and physiological functions, and achieved good results.
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