Nghien cmi Y hoc Y Hpc TP. Hb Chi Minh * T | p 21 * So 5 * 2017
KHAO SAT CAC DANG DLfOlNG DAN LUtJ XOANG TRAN Tl/ONG QUAN V 6 l CAC TE BAO NGACH TRAN
BANG PHAN MEM SCOPIS BUILDING BLOCKS
Traw Viet tudn*
TOMTAT
Mtu: tieu: Xdc dmh ti li tebao Agger Nasi, tebao tien Agger Nasi vd tebao tien Agger Nasi xoang tidn (iheo phan loin m&i) tie di? liiu MSCT miii xoang bang pMn nOm Scopis Building B/ocfcs o cdc tru&ng hgp khong CO hinh ly xoang tidn, tie do xdc dinh cdc dang tuong quan ciia duong ddn luu xoang tidn v&i 3 ti'bdo ndy vd ti li ciia no.
Phucmg phdp nghien ciiu: Nghiin deu mo td cat ngang 208 ngddi trdn (cua 114 hinh nhdn) d^ kham va chup MSCT mm xoang tai binh din Td MUi Hgng TP.HCM tie thdng 06/2016 Mh thdng 06/2017.
K^ qua: Phan tich 208 die lieu MSCT mUi xoang ciia cdc binh nhdn khong co benh ly xoang tidn hdng phan niem Scopis Building Blocks. Ti li cdc truong hgp co tebao Agger Nasi Id 95,7%, tebao tiin Agger Nasi Id 16,35%, tebd) tiin Agger Nasi xoang tidn Id 12,98%>.Trong so 199 truong hap CO su Men dien ciia tebao Agger Nasi tiong mau nghiin ciru, ti li du&ng dan luu di sau ti'bdo ndy Id 65,83%, di tiong ti'bdo ndy la 32,67%, di ngodi ti'bdo ndy Id l,51%.Trong so 34 truong hgp co su hiin diin cua ti'bdo tiin Agger Nasi tiong mau nghien cuu, tl li duang d§n luu di sau tehdo ndy la 26,47%, di tiong ti'bdo ndy Id 70,59%, di ngodi ti'bdo Agger Nasi tiong 2,94%.Trong so 27 tru&ng hap co su Men dien cua ti'bdo trin Agger Nasi xoang tidn tiong mdu nghiin diu, ti le du&ng dan luu di sau ti'bdo ndy Id 11,11%, di tiong ti'bdo ndy Id 81,48%, di ngoM ti'bdo Agger Nasi tiong 7,41%.
Ket luam Plmn niem Scopis Building Blocfes giiip khdo sdt rdi hiiu qud cdc ki^ duang dan luu xoang tian tuong quan v&i cdc ti'bdo ngdch tidn.Chung toi dua ra dugc cdc kieu du&ng dan luu xoang tidn v&i cdc ti le thuong gap nhdi la: tucmg quan v&i tebao Agger nasi, du&ng dan luu xoang trdn di phia sau tehdo ndy cMan da s&: 65,83%; dm v&i tebao tiin Agger Nasi, du&ng d&n luu xoang tidn di phut tiong tehdo nay chiem da sd'v&i ti li 70,59%; doi v&i ti'bdo tiin Agger Nasi xoang tidn, die&ng din luu di tiong ti'bdo ndy v&i da so tru&ng hgp, chiHn tile 81,48%.
Tit khoa: IFAC 2016, ti'bdo Agger Nasi, tebao ngdch tidn, tehdo tiin Agger Nad, ti'bdo tiin Agger Nasi xoang trdn, duang dan luu xoang tidn, plmn niem Scopis Building Blocks.
ABSTRACT
USING THE SCOPIS BUILDING BLOCKS PLANNING SOFTWARE TO DETERMINE FRONTAL SINUS DRAINAGE PATHWAY TYPES IN RELATION TO FRONTAL CELLS
Tran Viet Luan * Y Hoc TP. Ho Chi Minh"" Vol. 21 - No 5 - 2017:124 -134 Objectives: The goals of this study is to determine the prevalence (rf Agger Nasi cell, supra Agger cell, supra Agger frontd cell (classified by IFAC 2016), and the frontal sinus drainage pathway types (based on its anatomic relationships with these cells), using Scopis Building Blocks phmning software.
Methods: This is a descriptive cross-sectional study of radiological datas from 208 frontal recesses of 114 patients at Ear Nose Throat hospital cfHo Chi Minh dtyfrom June 2016 to June 2017.
Results: Analysis by Scopis Building B/ocfcs software of 208 CT scans was perftmned. The proportion of
* Tmong Dai Hpc Y Khoa Ph^m Ngoc Th^ch
Tdc gid Uin lac: TS. Tran Vigt Luan DT: 0908137755 Email: [email protected] 124
Y Hpc TP, H b C h i M i n h * T^p 21 * So 5 * 2017 N g h i e n c m i Y h p c Agger Nasi cells was 95.7%>, supra Agger cells was 16.35%, and supra Agger frontal cells was 12.98%. In 199 cases that Agger Nasi cells are presented, the percentage of frontd sinus drainage pathway posterior to this cell is 65.83%, medial to this cell is 32.67%i, lateral to this cell is 1.51%. In 34 cases that supra Agger cells are presented, the percentage of frontal sinus drdnage pathway posterior to this cell is 26.47%, medial to this cell is 70.59%, lateral to this cell is 2.94%. In 34 cases that supra Agger frontal cells are presented, the percentage of frontal sinus drdnage pathway posterior to this cell is 11.11%, medial to this cell is 81.48%}, laterd to this cell is 7.41%>.
Conclusicm: The Scopis Building Blocks software is very usful to ddermine the frontal sinus drainage pathway types in relation to frontal cells. In our study, the most common frontal sinus drainage pathway types are- posterior to Agger nasi cell in 65.83%) of cases, medid to supra Agger cells in 70.59%, and medial to supra Agger frontal cells in 81.48%.
Keywords: IFAC 2016, frontal cells. Agger Nasi cell, supra Agger cell, supra Agger frontal cell, frontal sinus drdnage pathway types, Scopis Building Blocks planning software.
D A T V A N D E
Xoang tran co duong dan luu phiic tap va da dgng nhat trong tat ea cae xoang earth miii. Cae te bao ngach tran dupe xem la nguyen nhan lam h?p duong dan luu xoang tranf^-^. Viee xae dinh ducmg dan luu xoang tran, nhat la doan 6 ngach tran, nam 6 vi tri nao so voi cac te bao ngach tran rat hiiu idi trong phau tiiuat npi soi xoang tran.
Tuy nhien tren th^ gioi eung chua co nlueu cong trinh nghien ciiu vS van de nay, nhat la nghien eiiu ve eae loai ducmg dan luu tucmg quan voi te bao ngach tran theo phan loai moi eiia IFAC 2016, thi chung toi chua thay de cap trong y van.
Phan mem Scopis Building Blocks ngoai viec xae dinh cae te bao ngach tran, n6 c6n giiip ve duong dan luu di gjiia cac te bao nay mpt each chinh xae.
Chiing toi sii dyng phan mem nay de khao sat cae kieu duong dan luu xoang tran tuong quan voi cac te bao ngach tran thupc nhom phia truoe duong dan luu, bao gom 3 lo^i te bao:
Agger nasi, te bao tren Agger nasi va te bao tren Agger nasi xoang tran, th\rc hi?n tr&i phim C I scan xoang tran 6 ngucri truong thanh, drai kham tai b?nh vi?n Tai Miii Hpng TP.Ho Chi Minh tu thang 06/2016 d&i thang 06/2017.
T6NG QUAN
Xoang tran co duong dan luu phiic tgp va da d ^ g nhSTt trong tSft ck cdc xoang c?nh miii. Cdc
te bao ngach tran dupe xem la nguyen nhan lam hep duong dan luu xoang tran*^^.
Duong dan luu xoang tran doan trong ngdch tran dupe bao quanh boi cac te bao ngach tran:
phia sau boi bong sang, te bao bong sang xoang tran (theo phan loai mod), phia trong boi te bao vach lien xoang tran, phia truoe boi te bao Agger nasi, te bao tren Agger nasi va tebao tren Agger nasi xoang Iran. Ducmg dan luu xoang tran lien quan voi nhom te bao phia truoe kha phtie tap va Ihay doi.
Scopis Building Blocks la san pham dupe phat trien boi giao su Peter John Wormald, mpt trong nhiing chuyen gia hang (^u ve phau thuat miii xoang hien nay tren the gio, hpp tac cung cong iy Scopis., dupe gioi thieu Ian dau tien vao nam 2014. Phan mem su dung dii lieu MSCT mui xoang, giiip phlu lhu|t vien dung hinh cac te bao ngach tran duoi dang khoi hop, tcr do hieu va dinh hucmg phlu thuat sao cho chinh xac va phu hpp nhat.
Doi t u p n g va phuong phap nghien cuu Nghien ciiu mo ta eat ngang, tii du lieu eua 208 ngach tran khong bi viem (114 berth nhan) d m kham va chup MSCT miii xoang tai benh vien Tai Miii Hpng TP.HCM tCc thang 06/2016 den thang 06/2017, chiing toi Ipc chpn dupe 199 truong hpp eo te bao Agger nasi, va trong 199 trudng hpp nay co 170 ngach tran eo te bao ngach tran khong phai Agger nasi.
N g h i e n ciiti Y hoc Y Hpc TP. Hb Chi M i n h * T i p 21 * So 5 * 2017 Chung toi sii dyng phan lo?i quoc te mcri ve
gjai phau xoang tran 2016 (Intemational Frontal Sinus Anatomy Classification: IFAC 2016). Trong nghien ctiu nay, cac te bao sau dupe dinh nghia theo phan loai moi bao gbm'*':
Te bao Agger Nasi,
Te bao tren Agger Nasi (Supra agger cell) (tucmg duong voi te bao Tl va T2 theo phan loai cua Bent va Kuhn).
Te bao tren Agger Nasi xoang tran (Supra agger frontal cell) (tuong ducmg voi te bao T3 va T4 theo phan loai aia Bent va Kuhn).
K E T Q U A
Ti le te bao Agger Nasi, va cac te bao ngach t r i n theo p h a n loai ni6i trong 208 trucmg hop khao sat
Te bao Agger Nasi hien dien trong 199 truong hop chian ti le 95,67%
Ngoai te bao Agger Nasi, trong nghien eiiu ciia ehiing toi, eae ^ b a o ngach tran cac loai hien dien trong 170 truong hpp, ehi&n ti le 81,73%.
Trong do chiing toi khao sat 2 loai te bao tren Agger nasi va te bao tren Agger nasi xoang tran nam phia truoe duong dan luu xoang tran voi ti le nhu sau:
Te bao tren Agger Nasi hien dien d 34 truong hpp chiem 16,35%.
Te bao tren Agger Nasi xoang tran hien dien 6 27 truong hop chiem 12,98%.
Hinh 1: Ti'bdo tien Agger Nasi (mdu xanh luc), tehdo Agger Nasi (mdu do)
126
Y Hpc TP. Hb Chi Minh * Tap 21 * So 5 * 2017
Hinh 2: T^Jdo tien Agger Nasi xoang tidn (mdu vdng) vd ti'bdo Agger Nasi (mdu do)
Ti 1? cac d?ng duorng dan luu xet tren mbi Duong dan hm di ngodi tebao Agger Nasi tuong quan vdi le bao Agger Nasi Ducmg dan luu di ngoai te bao Agger Nasi
Khao sat tren 199 ngach h:an eo te bao Agger trong 3/199 ngach tran (1,51%).
nasi
Hinh 3: Du&ng dan luu di ngoai Nasi, ti'bdo Agger Nasi (do), bong sdng (xanh bim)
Nghien cmi Y hpc Y Hpc TP. Hb Chi Minh * Tap 21 * So 5 * 2017 Duong dan hat di sau tebao Agger Nasi:
Ducmg dan luu di sau tebao Agger Nasi trong 131/199 ngach tran (65,83%).
I. SCOPIS
Hiiih 4: Duong dan luu di sau tebao Agger Nasi Tebao Agger Nasi (do), bong sang (xanh biai), tebao tren hong sang (fwng).
Ehtcng dan heu di trong tebdo Agger Nasi
EXrong dan luu di trong te bao Agger Nasi trong 65/199 ngach tran (32,67%), L SCOPIS
Hinh 5: Du&ng dan lim di tiong tehdo Agger Nasi. T^ao Agger Nasi (do), bong sdng (xanh bien), tebdo trin hon;
sdng (mail fwng), ti'bdo bong trdn (mdu cam).
Y Hpc TP. Hb Chi Minh * Tap 21 * So 5 * 2017 Nghien ciru Y hgc So sanh moi tuong quan giira duong dan luu Ti le cac dang duong dan lini xet tren moi voi te bao Agger Nasi:
Trong Agger Nasi 32.fi7<
Ngoai Agger Nasi...
^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ F .Agger 65.830.^
Bieu do 1: Tuong quan giiea du&ng dan luu v&i ti' bao Agger Nasi •
SCOPIS
tuong quan voi te bao tren Agger Nasi:
Te bao tren Agger Nasi hien dien d 34 ngach tran
Duong dan luu di trcmg ti'bdo trin Agger Nasi Ducmg dan luu di trong te bao tren Agger Nasi trong 24/34 ngach tran (70,59%)
Hinh 6: Ehe&ng ddn lieu di trong ti'bdo tiin Agger Nasi
Tebao Agger Nasi (do), bong sang (xanh bi^), tehdo tiin hong sdng (hong), t^do tien Agger Nasi (xtmh luc).
Buong ddn luu di sau tebdo tren Agger Nasi
Duong dan luu di sau te bao tren Agger Nasi trong 9/34 ngach tran (26,47%).
129
N g h i e n cuu Y hpc
SCOPIS
Y Hpc TP. Hb Chi M i n h * Tap 21 * So 5 * 2017
Hinh 7: Ehe&ng tian luu di sau tebdo tiin Agger Nasi
Tebdo Agger Nasi (da), bong sdng (xanh bim), tehdo tien Agger Nasi (xanh luc).
tcong dan luu di ngodi tebdo tren A^er Nasi
Duong dan luu di ngoai te bao tren Agger Nasi trong 1/34 ngach tran (2.94%)
Hinh 8: Du&ng dan luu di ngodi ti'bdo tiin Agger Nasi Ttbdo Agger Nasi (do), hdng sang (xanh him), tebdo trin bong sdng (hdng), tebdo trin Agger Nasi (xanh luc).
130
Y Hpc TP. Hb Chi Minh * Tap 21 * So 5 * 2017 Nghien cuu Y hpc So sanh tuong quan giua duong d i n luu vdi t^bao tren Agger Nasi
Bioi do 2: Tuang quan giiea du&ng dan luu v&i ti'bdo tiin Agger Nasi
Nhan xet Duong d i n luu di trong te bao tren Agger Nasi co ti le eao nhat (70,59%)
Ti le cac dang du6ng d i n lim xet tren mbi tuong quan vdi te bao tren Agger Nasi xoang tran: te bao tren Agger Nasi xoang tran hien dien 6 27 ngach tran
Di^g dan hai di trong ti'bdo trin Agger Nasi xoang trdn
Duong dan luu di trong te bao tren Agger Nasi xoang tran trong 22/27 ngach Iran (81,48%).
Hinh 9: Du&ng ddn luu di tiong tebdo tiin Agger Nasi xoang trdn.
Ttbao Agger Nasi (mdu do), bong sang (mdu xanh bim), tehdo trin Agger Nasi xoang tian (mdu vdng).
Duong dan hot di sau ti'bdo tren Agger Nasi xoang trdn
Ehrong dan luu di sau te bao tren Agger Nasi xoang tran trong 3/27 ngach tran (11,11%).
N g h i e n cmi Y hoc
ISCOPIS
Y Hoc TP. H o Chi Minh * Tap 21 * S « 5 * 2017
m
THAHHmHsnH f i i / O T / i i w ) WMM711M^ • " • ^ " " " • « • "
Hinh 10: Du&ng dan luu di sau tebdo trin Agger Nasi xoang tidn. Ttbdo Agger Nasi (do), bong smg (xanh bim), te bdo tiin Agger Nasi xoang trdn (vdng), ttbdo trin bdng sang xoang trdn (cam).
Dudng dan luu di ngoai tebdo tren Agger Nasi xoang trdn
E>ucmg dan luu di ngoai te bao tren Agger Nasi xoang tran trong 2/27 ngach tran (7,41%).
NGUVEN lOH HOA (*(»/0//19W) hhlM/OMM
HitOi 11: Du&ng dan luu di ngod tebdo tien Agger Nasi xoang trdn. Tebao Aggei Nasi (do), bang sang (xanh biBi), tebdo trin Agger Nasi xoang trdn (vdng)
132
Y Hpc TP. Hb Chi Minh * T?p 21 * So 5 * 2017 Nghien ciiu Y hpc So sank tuang quan giiia dudng dan luu vd TB
trin Agger Nasi xoang trdn
Bieu do 3: Tuong quan giiia du&ng dSn luu v&i te hdo trin Agger Nasi xoang tidn
Nhan xet E)uong dan Itm di trong te bao tren Agger Nasi xoang tran co ti le eao nhat (81,48%).
BANLUAN
- Hian mem Scopis Building Blocks giiip ehuy&i doi dii lieu MSCT miii xoang thanh dang 3 diieu, ghip dung hinh khoi cac ^ bao ngach tran, tii do hieu ro giai phlu vimg xoang tran.
Muc dich su dung ehinh eiia p l ^ mem nay la xac dinh va danh dau cac te bao ngach tran tren Cet 3 binh di?n coronal, axial, sagittal, tii do dung hinh ducd dang 3D eae te bao ngach tran va ve duong dan luu xoang tran di xuyen qua eae t^
bao nay, phuc vu eho len ke hoach phlu Ihuat ngach tran va xoang tran.
- Chiing toi six dung phan loai quoc t^ ve gidi phau xoang 2016 (IFAC 2016) Ihay eho phan logi cii ciia Bent & Kuhn. Phan loai cu cho biet vj tri aia t^ bao trong ngach tran, nhung khong ndu day dii chi tiet mSi lien he cnia cdc te bao 6 vimg nay nham gjiip ieh eho phlu thuat ngach Iran va xoang tran. Do la ly do phan loai moi ra doi sau khi CO su d&ig thuan ciia cac chuyen gia miii xoang h a i ^ dau tren the gjoi**'.
- Te bao Agger Nasi tii lau da dupe xem ddng vai tro quan trpng trong benh sinh viem xoang tran m ^ tinh, la ehia khoa ciia phlu thugt npi soi xoang trant^-?). Trong cac nghi&i ciiu trong va ngoai nude, ti le hien dien te bao Agger Nasi dao dpng tii 86% den 98%("^'4). Ti \% nay trong
nghien ciiu eua chiing toi la 95,67%. Cac ^ b a o ngach tran noi ehung con laii (ngogi trii Agger nasi) hien dien trong 170 truong hop, ehi&n ti Ie 81,73%, kha tuong dong voi ti le nay ciia tdc gid EweissAZla78,6%ii'.
- Trong nghien a i u ciia chiing toi co sii dung phan loai moi IFAC 2016, theo do, te bao Tl va te bao T2 theo phan loai ciia Bent va Kuhn dupe dinh nghia la te b^o tren Agger Nasi, va te bao T3 va T4 theo phan toai Bent va Kuhn dupe dinh nghia la te bao tren Agger Nasi xoang tran'^.
Phan loai nay eon kha moi (thang 11/2016) nfen ehua CO dii lieu hay nghien ciiu sii dung theo phan loai nay. Ti le te bao tren Agger Nasi va te bao tren Agger Nasi xoang tran trong mau nghien ctiu Ian lupt la 16,35% va 12,98%.
- Ehrong dan luu xoang tran dogn trong ngach trdn dupe bao quanh boi cac te bao ngdch tran: phia sau bdi bong s ^ g , te bao bdng sang xoang trdn (theo phan loai moi), phia trong boi te bao vach lien xoang tran, phia trudc bdi te bao Agger nasi, te bao tren Aggemasi va te bao t r ^ Agger nasi xoang tran. E)udng dan luu xoang Iran lien cjuan vdi nhdm te bao phia trudc khd phiic tap va Ihay doi, do la ly do ehung toi chpn khdo sdt sy tuong quan giiia dudng dan luu ngdch tran va nhom tebao nam phia trudc.
- Wormald (2005) cd dua ra 8 kieu dudng dan luu, trong do 4 loai tuong quan vdi cac te bao Tl, T2 (tuong ducmg te bao tren Agger nasi theo phan loai mdi) la loai A, B, C, va D;
va 4 loai tucmg quan vdi cdc te bao T3,T4 (tuong duong te bao tren Agger nasi xoang tran theo phan loai mdi) la logi E,F,G, va H.
Tuy nhien khi nay ong ehi dung hinh Building Block bang cdch ve thii cdng, va eung khong de cgp den ti le cdc logi nayi^.
- Te bao Agger Nasi ehinh la ehia khoa de md thong ngdch tran. Lay bd te bao Agger Nasi doi vdi cae trudng hpp khdng phiic tap ciing du de d i n luu xoang tran bj viem, nhat la nhiing trudng hpp ed te bao Agger nasi to(8).Viec xdc djnh moi tuong quan giiia te bao
N ^ i e n cuu Y hpc Y Hpc TP. Hb Chi Minh * Tap 21 * So 5 * 2017 Agger Nasi va dudng dan luu xoang trdn cho
phep phau thuat vien du dodn trudc mo vi tri dua dung cu tham do vao ngach tran. Theo nghien ciiu ciia ehiing toi, vdi cac trudng hop cd te bao Agger Nasi, 94% trudng hpp phau thuat vien cd the tim tiiay dudng dan luu khi dua dung cu ve phia sau hoac phia trong te bao nay. Trudng hpp dudng dan luu di phia ngoai te bao chiem ti le khd nhd, chi 2%.
- Xdc dinh moi tuong quan giua te bao tren Agger Nasi va tebao tren Agger Nasi xoang tran la vo cung tjuan trpng de giiip phlu thuat vien biet each dua dung eu phlu tieh md ngach trdn.
Nghien cim ciia chiing toi eho thay dudng dan luu phan Idn nam phia trong te bao tren Agger Nasi va te bao tren Agger Nasi xoang tran Mpt so trudng hop khac, dudng d i n luu xoang tran nam phia sau 2 te bao nay.
- Chi 2,94% duong dan luu nam ben ngoai te bao tren Agger Nasi va te bao tren Agger Nasi xoang tran. Cac te bao nay nam hep gjap vdi phan gan ciia cuon mui giiia vao hen so lam dudng dan luu xoang tran bj day ra ngoai. Dang dudng dan luu nay thudng it gap nhung viec nhan biet no la rat quan trpng. Vi?e nhgn ra vi tri dudng dan luu cho phep p h l u thuat vien hm ki&n d phia ngoai va hoc lo dupe 16 Ihong xoang tran hoan toan.
KETLUAN
Phan mem Scopis Building Blocks, giiip khao sdt rat hieu qua eae kieu dudng dan luu xoang tran tuong quan vdi cac te bao ngach trdn.
Chiing toi dua ra dupe cac kieu dudng dan luu xoang tran tirong quan vdi nhom te bao nam
phia trudc ngach tran vdi cae ti le thudng gap nhat la: tuong quan vdi te bao Agger nasi, dudng dan luu xoang tran di phia sau te bao nayehiem da so: 65,83%; ddi vdi te bao tren Agger Nasi, dudng d i n luu xoang tran di phia trong te bao nay chiem da so vdi ti. 1? 70,59%; doi vdi te bao tren Agger Nasi, dudng din luu di trong te bao nay vdi da so trudng hpp, chiem ti le 81,48%
TAI LIEU THAM KHAO
1 Eweiss A Z , H i s h a m SK (2013), "The Prevalence of Frontal Cells and Their Relation to Frontal Sinusitis: A Radiological Study of the Frontal Recess Area", ISRN Otolaiyngology. 2013, p p . 4.
2. Kountalds SE, et al (2005), The Frontal Sinus, Spnnger.
3. Kubola K, Sachio Ta , Katsuhiro H (2015), T i o n t a l recess anatomy in Japanese subjects and its effect on the development of frontal sinusitis: computed tomography analysis", Joumal of Otolaryngology - Head & Neck Surgery 44 (1), p p . 21
4 l « e WT, K u h n FA, Citardi MJ (2004), "3D computed tomographic analysis of frontal recess anatomy in patients without frontal sinusitis", Otolaryngol Head Neck Sarg. 131 (3), p p . 164-173.
5 Sagar GRS, Bhal CJ, M e g h a n a d h KR (2013), "A Study of A n a t o m y of Frontal Recess in Patients Suffering from 'Chronic Ftontal Sinus Disease'", Indian journal of Otolaryngology and Head & Neck Surgery. 65 (Suppl 2), pp.
435-439.
6 Wormald FJ, H o s e m a n W, Callings C, et al (2016), •"The Intemational Frontal Sinus Anatomy Classification (IFAC) a n d Classification of the Extent of Endoscopic Frontal Sinus Surgery (EFSS)", Int Forum Allergy Rhmol 6 (7), pp.
677.696
7 W o n n a l d PI (2005), Endoscopic Sinus Surgery: Anatomy, Three-dimensional Reconstruction, and Surgical Technique, Thieme Medical Publishers.
Ngdy nhan bdi bdo: 13/07/2017 Ngay phan biin nhan xel bai bdo: 20/07/2017 Ngdy bai bdo dugc dang: 05/09/2017
