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Kondo M, Seresirikachorn K, Gomes JPMC, Wong E, Png LH, Kalish L, Sacks R, Harvey RJ. Preservation or removal of the lateral nasal wall in endoscopic management of maxillary sinus neoplasia: A comparison of approach related morbidity. Am J Otolaryngol 2024; 45:104314. [PMID: 38663327 DOI: 10.1016/j.amjoto.2024.104314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Accepted: 04/15/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND The endoscopic modified medial maxillectomy (MMM) and prelacrimal approach (PLA) are two routinely performed endoscopic approaches to the maxillary sinus when access via a middle meatal antrostomy is insufficient. However, there is no data in the literature that has compared outcomes and complication profile between the two procedures to determine which approach is superior. OBJECTIVE To compare the approach related morbidity of PLA and MMM. METHODS A retrospective cohort study of all consecutive adult patients undergoing either MMM or PLA from 2009 to 2023 were identified. The primary outcome was development of epistaxis, paraesthesia, lacrimal injury, iatrogenic sinus dysfunction within a minimum of 3 months post-operative follow up. RESULTS 39 patients (44 sides) underwent PLA and 96 (96 sides) underwent MMM. There were no statistically significant differences between the rates of paraesthesia (9.1 % vs 14.6 %, p = 0.367) or prolonged paraesthesia (2.3 % vs 5.2 %, p = 0.426), iatrogenic maxillary sinus dysfunction (2.3 % vs 5.2 %, p = 0.426) or adhesions requiring removal (4.5 % vs 4.2 %, p = 0.918). No cases of epiphora or nasal cavity stenosis occurred in either arm in our study. CONCLUSIONS According to our data, the endoscopic modified medial maxillectomy and prelacrimal approach are both equally safe approaches with their own benefits to access.
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Affiliation(s)
- Mickey Kondo
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia.
| | - Kachorn Seresirikachorn
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia; Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Joao P M C Gomes
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
| | - Eugene Wong
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
| | - Lu Hui Png
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia; Department of Otorhinolaryngology - Head and Neck Surgery, Singapore General Hospital, Singapore, Singapore
| | - Larry Kalish
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia; Department of Otolaryngology, Head and Neck Surgery, Concord General Hospital, University of Sydney, Sydney, Australia; Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Raymond Sacks
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia; Department of Otolaryngology, Head and Neck Surgery, Concord General Hospital, University of Sydney, Sydney, Australia; Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Richard J Harvey
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia; Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia; School of Clinical Medicine, St Vincent's Healthcare Clinical Campus, Faculty of Medicine and Health, UNSW, Sydney, Australia
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2
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Godse NR, Sreenath S, Lobo BC, Sindwani R. Management of the Nasolacrimal Duct in Expanded Endoscopic Approaches to the Maxillary Sinus: A Systematic Review with Evidence-based Recommendations. Am J Rhinol Allergy 2024:19458924241249802. [PMID: 38803159 DOI: 10.1177/19458924241249802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
BACKGROUND Utilizing expanded endoscopic approaches to the maxillary sinus for the endonasal management of a variety of tumors is increasing in popularity. The nasolacrimal duct (NLD) may be injured inadvertantly or need to be removed during tumor resection or to augment visualization. Management of the NLD can take the form of transection alone, transection with stenting, or performing a formal dacryocystorhinostomy to avoid postoperative sequelae of injury. The purpose of this study was to review the literature and determine the optimal management of the NLD during expanded maxillary sinus approaches. METHODS A systematic review of Ovid, Embase, Medline, and Cochrane databases was performed to identify studies involving expanded approaches to the maxillary sinus and that explicitly reported the status of the NLD and postoperative outcomes. RESULTS Nineteen studies were included in the analysis and divided into two groups: NLD-preserving (n = 9 studies; n = 191 patients in aggregate) and NLD-involving (n = 10 studies; n = 296 patients in aggregate). In the NLD-preserving subgroup, one patient out of a subgroup aggregate of 191 patients (0.5%) developed epiphora. In the NLD-involving subgroup, sharp transection alone was the most common method of NLD removal and was associated with a low rate of epiphora (study rates: 0 to 18.2%; aggregated subgroup rate: 7.0%, 21 / 296). Spontaneous resolution of symptoms was common (60%-100% cases). CONCLUSIONS The NLD should be preserved when feasible from an exposure and tumor-control perspective. When pathology or approach requires the removal of the NLD, rates of persistent epiphora are very low, regardless of surgical technique. When expanded maxillary approaches are employed, particularly for benign tumors, and require removal of the NLD, sharp transection is the simplest method of removal, provides a low rate of postoperative epiphora, and is supported by the available literature.
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Affiliation(s)
- Neal Rajan Godse
- Section of Rhinology & Skull Base Surgery, Head and Neck Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Satyan Sreenath
- Division of Rhinology & Endoscopic Skull Base Surgery, Department of Otolaryngology - Head and Neck Surgery, Indiana University, Indianapolis, IN, USA
| | - Brian C Lobo
- Division of Rhinology & Skull Base Surgery, Department of Otolaryngology - Head and Neck Surgery, University of Florida, Gainesville, FL, USA
| | - Raj Sindwani
- Section of Rhinology & Skull Base Surgery, Head and Neck Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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Lou Z. The choice of endoscopic surgical approach and four steps of operation of inverted papilloma of the maxillary sinus. BMC Surg 2023; 23:7. [PMID: 36631783 PMCID: PMC9835294 DOI: 10.1186/s12893-023-01908-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 01/09/2023] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE The aim of this study was to determine the long-term efficacy of four steps of operation on the treatment of maxillary sinus (MS) inverted papilloma (IP). METHODS 83 patients who were diagnosed with IP that originated from the MS, underwent four step procedure of attachment sites, including mucosal stripping, periosteum ablation, bone drilling and bone ablation and had postoperative follow-up of 3 years were enrolled. RESULTS Of the 83 patients, 59 (71.1%) patients were primary surgery and revision surgery in 24 (28.9%), single attachment was in 31(37.3%) patients and multifocal attachments in 52 (62.7%).When the numbers were not mutually exclusive, the most common origin sites of IPs were the medial wall in 54 (37.2%), lateral wall in 29 (20.0%), anterior wall in 18 (12.4%), inferior wall in 22 (15.2%), posterior in 15 (10.3%), and superior wall in 7 (4.8%). Large MMA alone was performed in 5 (6.0%), MMA combined with medial maxillectomy 76 (91.6%), and MMA combined with Caldwell-Luc approach in 2 (2.4%). No major intra- or postoperative complications were observed. The average follow-up was 41 months (range, 37-61 months). CT and endoscope showed that tumor and symptom recurrence occurred in 2 patients (2.41%). In addition, although the opening of antrostomy was closed and CT revealed the uniform soft tissue shadow and hyperostosis of MS in 11(13.3%) patients, they didn't report any symptoms and showed well epithelization of middle meatus mucosa. CONCLUSION The four steps of operations of attachment sites of MS IP, including mucosal stripping, periosteum ablation, bone drilling and bone ablation, may effectively prevent the recurrence of MS IP.
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Affiliation(s)
- Zhengcai Lou
- grid.513202.7Department of Otorhinolaryngology, Yiwu Central Hospital, Affiliated Yiwu Hospital of Wenzhou Medical University, 699 Jiangdong Road, Yiwu, 322000 Zhejiang China
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4
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Upadhya IB, Rao K. Sinonasal Inverted Papilloma: A Narrative Review. Indian J Otolaryngol Head Neck Surg 2022; 74:1017-1022. [PMID: 36452822 PMCID: PMC9701979 DOI: 10.1007/s12070-020-02089-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 08/20/2020] [Indexed: 10/23/2022] Open
Abstract
Inverted papilloma (IP) is a relatively rare sinonasal benign lesion, peculiar in its etiology, clinical presentation and treatment. Its resemblance to other sinonasal pathologies and varied approaches, makes it an interesting disease. Recently there have been several advances in the management of IP. This article aims to summarize the contemporary developments thus enabling the readers to understand the years of research behind IP. To integrate the available literature on IP and study the current scenario in its management. A comprehensive literature review was done on Google Scholar and PubMed database using the following key words: "inverted papilloma", "Schneiderian", "sinonasal", "medial maxillectomy". Articles published in English were used. Articles published till May 2020 were reviewed. Years of research have aimed to gain more information regarding the epidemiology, histopathology, staging systems and surgical management of IP. To briefly summarize the research so far, it is safe to say that there exists an association between Human Papilloma Virus and IP. The Krouse staging system is the most commonly used. The treatment itself has changed from a conservative approach to a more aggressive excision with or without external approach and with or without chemoradiotherapy. In IP, whether or not associated with SCC, complete surgical removal of the tumour is advocated as the treatment of choice. With the advancements in endoscopic technique, surgeons have been using it to their advantage for the surgical evaluation and cure of IP, depending upon the stage. Endoscopic treatment is preferred, whereas for lesions less accessible endoscopically, or in those with peripheral extension, open surgery is indicated. Every patient requires counselling before discharge and thorough examination during the follow-up to detect any evidence of recurrence.
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Affiliation(s)
- Ila B. Upadhya
- Department of E.N.T, Government Medical College and New Civil Hospital, Surat, India
| | - Kartika Rao
- Department of E.N.T, Government Medical College and New Civil Hospital, Surat, India
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5
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Rao KR, Upadhya IB. A Review on Esthesioneuroblastoma. Indian J Otolaryngol Head Neck Surg 2022; 74:1584-1590. [PMID: 36452592 PMCID: PMC9702120 DOI: 10.1007/s12070-021-02726-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 06/27/2021] [Indexed: 10/20/2022] Open
Abstract
Background Esthesioneuroblastoma (ENB) is a rare, aggressive and malignant sinonasal tumour. This tumour makes for a very interesting study because ever since its mention in medical literature, although quite a lot of research has been put into it, a lot is yet to be known about it. Aim To summarize the available literature & document an article on the contemporary practises in the management of ENB. Methods A comprehensive literature review was done using Google Scholar and PubMed database with the key words: "esthesioneuroblastoma", "olfactory neuroblastoma", "Kadish" and "Hyams". Articles published in English were used. Articles published till April 2021 were reviewed. Conclusion ENB has a diverse histological appearance. This tumour has a bimodal age distribution without any gender predilection. Prompt identification and treatment is required for a favourable outcome and requires close collaboration of radiology, pathology, and rhinology. Staging, management and prognosis are determined by regional involvement in non-metastatic cases due to its proximity to neurological structures and locally destructive nature. Immunohistochemistry is a must for accurate diagnosis. Uni-modality of treatment has high chances of local recurrence. Multi-modality provides good results even in advanced stage. A combination of surgery and radiotherapy seems to be the optimum approach to treatment. The exact role of chemotherapy in treatment protocols is still unclear. Cervical lymph node metastases are commonly studied, however its management in patients who present without apparent nodal involvement is not yet clear. An extended follow-up period is recommended in all patients of ENB patients.
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Affiliation(s)
- Kartika Ramesh Rao
- Department of E.N.T., Government Medical College and New Civil Hospital, Surat, India
| | - Ila B. Upadhya
- Department of E.N.T., Government Medical College and New Civil Hospital, Surat, India
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6
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Prelacrimal Window Approach in the Management of Odontogenic Maxillary Sinusitis from Dental Foreign Body. Case Rep Dent 2022; 2022:1730656. [PMID: 36133402 PMCID: PMC9484961 DOI: 10.1155/2022/1730656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/20/2022] [Accepted: 08/26/2022] [Indexed: 11/17/2022] Open
Abstract
The floor of the maxillary sinus is partly formed by the alveolar process of the maxilla, and this anatomical relationship forms an interface for collaboration between rhinologists, maxillofacial and dental surgeons, and dentists. Odontogenic maxillary sinusitis (ODMS) occurs secondary to infectious processes of the maxillary molar and premolar teeth or following complications from dental procedures. Extruded dental foreign bodies within the sinus can cause chronic mucosal irritation leading to mucociliary dysfunction and sinogenic symptoms. Anteriorly placed foreign bodies are difficult to access via the conventional endoscopic maxillary antrostomy. Endoscopic approaches to access the anterior maxillary sinus involve extended resection of the medial maxillary wall, potentially with the removal of the inferior turbinate and nasolacrimal duct mobilisation. The prelacrimal window approach (PLWA) is a favourable modification that provides excellent visualisation of the maxillary sinus with minimal tissue resection and displacement. We describe the case of an extruded distobuccal 27 tooth root into the anterior maxillary sinus, presenting with acute sinusitis. The patient was successfully managed via a PLWA. This case represents the importance of recognition of ODMS with early referral to otorhinolaryngologists.
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7
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Varghese G, Thomas RM. Modified Transseptal Approach: An Adjunct to Prelacrimal Recess Approach for Extensive Inverted Papilloma of Maxillary Sinus, How We Do It. JOURNAL OF RHINOLOGY 2022. [DOI: 10.18787/jr.2021.00368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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8
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Machado A, Briner HR, Schuknecht B, Simmen D. Assessment of the anterior superior alveolar nerve and its impact on surgery of the lateral nasal wall. Rhinology 2021; 59:475-480. [PMID: 34428266 DOI: 10.4193/rhin21.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The anterior superior alveolar nerve (ASAN) plays a major role in innervation of the lateral nasal wall. Its damage during nasal surgery can cause dental paraesthesia and numbness around the upper lip. METHODOLOGY Retrospective evaluation of the computed tomographic (CT) scans of 50 consecutive patients analysing 100 sides. We measured the mean distance from the shoulder of the inferior turbinate to the descending portion of the anterior superior alveolar nerve, to the anterior superior alveolar canal and the anterior-posterior distance between the 'shoulder' of the inferior turbinate and the pyriform aperture. RESULTS The mean distance from the shoulder of the inferior turbinate to the descending portion of the anterior superior alveolar nerve was 6.4 ± 2.33 mm, with no difference between sides The mean relative height of the shoulder in relation to the anterior superior alveolar nerve canal was 4.78 ± 2.31mm with no significant difference between the two sides. The anterior-posterior distance between the 'shoulder' of inferior turbinate and the pyriform aperture was 6.96± 2.28mm, with no significant difference between the two sides. CONCLUSIONS We found the anterior superior alveolar nerve to be a constant landmark in the lateral nasal wall. Therefore, the course of the ASAN should be assessed on a CT scan when a surgical approach through the pyriform aperture or anterior medial wall of the maxillary sinus is planned.
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Affiliation(s)
- A Machado
- Department of Otolaryngology, Centro Hospitalar Universitario do Porto, Porto, Portugal; Faculdade de Ciencias da Saude, Universidade da Beira Interior, Covilha, Portugal
| | - H R Briner
- ORL-Zentrum - Otorhinolaryngology and Facial Plastic Surgery, Hirslanden Klinik, Zurich, Switzerland
| | - B Schuknecht
- Medizinisch Radiologisches Institut, Zurich, Switzerland
| | - D Simmen
- ORL-Zentrum - Otorhinolaryngology and Facial Plastic Surgery, Hirslanden Klinik, Zurich, Switzerland
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Endoscopic maxillectomy: anatomo-radiological description of the "double" maxillary sinus window. Eur Arch Otorhinolaryngol 2021; 278:3813-3820. [PMID: 33481079 DOI: 10.1007/s00405-021-06604-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/05/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVES/HYPOTHESIS To present a modified endoscopic medial maxillectomy (MEMM) approach to control maxillary sinus pathologies. METHODS MEMM was completed in 13 fresh-frozen specimens. An MEMM includes cutting the nasolacrimal duct, inferior meatus flap, and repositioning the inferior turbinate (IT). The following measurements were obtained: length of IT, height from the nasal floor to valve of Hasner, height of the IT at the level of valve of Hasner, height of the IT at the insertion of the middle turbinate, and distance from the piriform aperture to the posterior wall of maxillary sinus and to the posterior border of palatine bone. Similar measurements were also performed on craniofacial computed tomography (CT) scans (n = 50). The surgical technique was performed in a case series (n = 8). RESULTS The mean of the specimens was 82 (range 70-95) years old. The average area of the harvested inferior meatus flap area was 9.6 ± 1.0 cm2. In the radiologic study, the mean maximum antrostomy area was 8.8 ± 1.7 cm2 and the IT area overlapping the antral window was 5.8 ± 1.1 cm2, the area allowing a double window control was 3.1 ± 1.9 cm2, the posterior IT insertion length was 0.7 ± 0.4 cm, and the inferior meatus flap covering the inferior meatotomy had an area measuring 6.7 ± 1.7 cm2. Eight patients underwent MEMM for various benign conditions showing no recurrence after 26 month follow-up. CONCLUSION The proposed modifications of MEMM provide a "double" window maxillary sinus control with access to all maxillary walls and preservation of the IT.
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10
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Abstract
PURPOSE OF REVIEW The endoscopic medial maxillectomy (EMM) has remained a relevant procedure for certain sinus diseases and at the same time reemerged as a salvage technique or even as a primary procedure for other diseases. Several mucosal-sparing techniques have also been described and the outcome of the surgeries is available for review. RECENT FINDINGS Modifications of the EMM technique in the last two decades, aimed at mucosal preservation of the inferior turbinate, nasolacrimal duct, and medial maxillary wall have been successful in addressing a multitude of diseases. There are also evidences to support adjunct procedures/methods to improve access, healing, and to address associated dysfunction such as impaired mucociliary clearance. Tailored approaches have shown favourable outcomes with a low rate of adverse effects. SUMMARY The EMM is appropriate for selected indications, in particular lesions causing medial wall destruction or extensive tumour involving the anterior wall or the prelacrimal recess. As for other maxillary sinus diseases including those identified to a limited site, a modified EMM is a reasonable consideration. The choice is appropriate provided instrument access, visualization, the ability for complete resection, postoperative care, and the requirement for surveillance is not compromised. A tailored approach with or without adjunct procedures is recommended.
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Nakayama T, Tsunemi Y, Kuboki A, Asaka D, Okushi T, Tsukidate T, Otori N, Kojima H, Haruna SI. Prelacrimal approach vs conventional surgery for inverted papilloma in the maxillary sinus. Head Neck 2020; 42:3218-3225. [PMID: 32639072 DOI: 10.1002/hed.26376] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 02/08/2020] [Accepted: 06/23/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The prelacrimal approach, termed endoscopic modified medial maxillectomy (EMMM), has recently been applied for treatment of inverted papilloma (IP) in the maxillary sinus. EMMM provides wider access to the maxillary sinus while preserving the inferior turbinate and nasolacrimal duct. METHODS We reviewed patients with IP in the maxillary sinus to compare the surgical results obtained by conventional surgery (ie, endoscopic maxillary sinus antrostomy or in combination with the Caldwell-Luc approach) with those obtained by EMMM. RESULTS All patients had a T3 on the Krouse staging system, and the average follow-up time was 46.0 months. Of the 18 patients in the conventional group, recurrence was seen in 3 patients (16.6%). No recurrence was seen in the 27 patients who showed preservation of the inferior turbinate and nasolacrimal duct, and no complications occurred in the EMMM group. CONCLUSIONS EMMM is an effective surgical approach that reduces recurrence with fewer complications.
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Affiliation(s)
- Tsuguhisa Nakayama
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan.,Department of Otorhinolaryngology-Head and Neck Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Yasuhiro Tsunemi
- Department of Otorhinolaryngology-Head and Neck Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Akihito Kuboki
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan.,Department of Otorhinolaryngology-Head and Neck Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Daiya Asaka
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan
| | - Tetsushi Okushi
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan
| | - Toshiharu Tsukidate
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan.,Department of Otorhinolaryngology-Head and Neck Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Nobuyoshi Otori
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan
| | - Hiromi Kojima
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan
| | - Shin-Ichi Haruna
- Department of Otorhinolaryngology-Head and Neck Surgery, Dokkyo Medical University, Tochigi, Japan
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Frasson G, Cesaro S, Cazzador D, Traverso G, Emanuelli E, Borsetto D, Munari G, Salmaso R, Martini A, Boscolo-Rizzo P, Rugge M. High prevalence of human papillomavirus infection in sinonasal inverted papilloma: a single-institution cohort of patients. Int Forum Allergy Rhinol 2020; 10:629-635. [PMID: 32104983 DOI: 10.1002/alr.22539] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 12/27/2019] [Accepted: 01/30/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Both the prevalence of sinonasal inverted papilloma (IP) and the causal association with alpha-human papillomaviruses (alpha-HPVs) are controversial. In this study we aimed to determine HPV status in histologically selected, microdissected, formalin-fixed, and paraffin-embedded tissue samples of IP. METHODS HPV status was assessed retrospectively by polymerase chain reaction (PCR)-bead-based multiplex genotyping on tissue samples of patients diagnosed with IP and consecutively treated with endoscopic resection. Forty-one HPV genotypes were considered, distinguishing between high risk and low risk. HPV status was correlated with demographics and clinical variables. Sixty sinonasal IP tissue samples were initially considered. After exclusion of 5 cases due to insufficient quality/quantity of the samples, 55 patients were included for analysis. RESULTS HPV-DNA sequences were identified in 34 of 55 (61.8%) IPs, with a higher prevalence of high-risk than low-risk HPV genotypes (19 [55.9%] and 15 cases [44.1%], respectively). HPV16 strongly prevailed among the high-risk HPV cases (84.2%), and HPV54 prevailed among the low-risk HPV cases (53.3%). IPs with origin within the maxillary sinus were significantly associated with high-risk HPV (p = 0.019). No significant associations emerged between HPV status and demographics or clinical variables. CONCLUSION In a series of 55 IP tissue samples, HPV-DNA sequences were identified in 61.8% of cases, which differs from the data of previous investigations. Further case-control studies are advocated to confirm this prevalence in the Italian population addressed, and also to clarify any pathogenic involvement of HPV in the natural history of IPs.
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Affiliation(s)
- Giuliana Frasson
- Department of Neuroscience, Otolaryngology Section, University of Padova, Padova, Italy
| | - Sonia Cesaro
- Department of Medicine, Surgical Pathology and Cytopathology Section, University of Padova, Padova, Italy
| | - Diego Cazzador
- Department of Neuroscience, Otolaryngology Section, University of Padova, Padova, Italy.,Department of Neuroscience, Section of Human Anatomy, University of Padova, Padova, Italy
| | - Giulia Traverso
- Department of Medicine, Surgical Pathology and Cytopathology Section, University of Padova, Padova, Italy
| | - Enzo Emanuelli
- Department of Neuroscience, Otolaryngology Section, University of Padova, Padova, Italy
| | - Daniele Borsetto
- Department of Neuroscience, Otolaryngology Section, University of Padova, Padova, Italy
| | - Giada Munari
- Department of Medicine, Surgical Pathology and Cytopathology Section, University of Padova, Padova, Italy
| | - Roberta Salmaso
- Department of Medicine, Surgical Pathology and Cytopathology Section, University of Padova, Padova, Italy
| | - Alessandro Martini
- Department of Neuroscience, Otolaryngology Section, University of Padova, Padova, Italy
| | - Paolo Boscolo-Rizzo
- Department of Neuroscience, Otolaryngology Section, University of Padova, Padova, Italy
| | - Massimo Rugge
- Department of Medicine, Surgical Pathology and Cytopathology Section, University of Padova, Padova, Italy.,Veneto Cancer Registry-Veneto Regional Authority, Venezia, Italy
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13
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Saibene AM, Felisati G, Pipolo C, Bulfamante AM, Quadrio M, Covello V. Partial Preservation of the Inferior Turbinate in Endoscopic Medial Maxillectomy: A Computational Fluid Dynamics Study. Am J Rhinol Allergy 2020; 34:409-416. [PMID: 31992048 DOI: 10.1177/1945892420902005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background Endoscopic medial maxillectomy (EMM) is a workhorse for multiple sinonasal conditions. To reduce its burden on the sinonasal physiology, several modified EMM (M-EMM) have been proposed. Objective: In order to provide a theoretical basis for EMM and its modifications, this study introduces a computational fluid dynamics (CFD) model, based on a time-resolved direct numerical simulation, describing EMM and assessing the role of the M-EMM in preserving the overall fluid dynamics of the sinonasal cavities. Methods A normal sinonasal CT scan was converted into a geometrical model and used as a reference; 2 anatomies were then created by virtual surgery, mimicking EMM and M-EMM, with the latter sparing the anterior portion of inferior turbinate and medial maxillary sinus wall. The airflow was simulated in the models via the OpenFOAM CFD software and compared in terms of flow rate, mean and fluctuating velocity, vorticity, and turbulent structures. Results The analysis shows that EMM induces a massive flow rate increase in the operated side, which becomes less obvious in the M-EMM model. In contrast to M-EMM, EMM induces higher velocity fields that reach the maxillary sinus. Velocity and vorticity fluctuations are negligible in the baseline model, but become increasingly evident and widespread in the M-EMM and EMM models. Conclusions A significant disruption of the nasal fluid dynamics is observed in EMM, while M-EMM minimizes variations and reduces interference with nasal air conditioning. Our analysis provides insights into the pathophysiology of radical sinus surgery and provides a theoretical basis for the ability of M-EMM to reduce the temporary surgery-related changes on both healthy and operated sides.
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Affiliation(s)
- Alberto M Saibene
- Unit of Otolaryngology, ASST Santi Paolo e Carlo, Milan, Italy.,Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Giovanni Felisati
- Unit of Otolaryngology, ASST Santi Paolo e Carlo, Milan, Italy.,Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Carlotta Pipolo
- Unit of Otolaryngology, ASST Santi Paolo e Carlo, Milan, Italy.,Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Antonio Mario Bulfamante
- Unit of Otolaryngology, ASST Santi Paolo e Carlo, Milan, Italy.,Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Maurizio Quadrio
- Department of Aerospace Sciences and Technologies, Politecnico di Milano, Milan, Italy
| | - Vanessa Covello
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.,Department of Aerospace Sciences and Technologies, Politecnico di Milano, Milan, Italy
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Surgery of Inverted Papilloma of the Maxillary Sinus via Translacrimal Approach-Long-Term Outcome and Literature Review. J Clin Med 2019; 8:jcm8111873. [PMID: 31694225 PMCID: PMC6912689 DOI: 10.3390/jcm8111873] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 10/21/2019] [Accepted: 11/01/2019] [Indexed: 12/19/2022] Open
Abstract
There are several differential diagnoses of unilateral sinus disease. One of these is inverted papilloma (IP) of the maxillary sinus, which is a common benign tumor with a substantial rate of malignant transformation. In general, endoscopic endonasal techniques for addressing the tumor are favored nowadays instead of classical external approaches. The aim of this retrospective study was to investigate the long-term outcome of inverted papilloma treated endoscopically via the prelacrimal approach. We reviewed 17 patients with primary or recurrent IP of the maxillary sinus that were treated via the prelacrimal endoscopic endonasal technique. After a median follow-up period of 45.9 months (3.8 years), none of the 17 included patients showed signs of recurrent disease and no serious complications were reported. Hypoesthesia of the incisors was reported by four patients and was resolved with time in one. All of the maxillary sinuses could be fully visualized with the flexible endoscope. IP is an important differential diagnosis in the clinical finding of unilateral nasal polypoid lesions. The prelacrimal approach is an effective and safe method in the treatment of IP with limited patient morbidity.
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15
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Cazzador D, Borsetto D, Alexandre E, Chiumenti FA, Pusateri A, Pagella F, Emanuelli E. Comments on "Nasolacrimal Duct Management During Endoscopic Sinus and Skull Base Surgery". Ann Otol Rhinol Laryngol 2019; 129:93-94. [PMID: 31801378 DOI: 10.1177/0003489419873353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Diego Cazzador
- Department of Neuroscience, Unit of Otorhinolaryngology, University of Padova, Padova, Italy
| | - Daniele Borsetto
- Department of Neuro-otology and Skull Base Surgery, Cambridge University Hospital, Cambridge, UK
| | - Enrico Alexandre
- Department of Neuroscience, Unit of Otorhinolaryngology, University of Padova, Padova, Italy
| | | | - Alessandro Pusateri
- ENT and Skull-Base Surgery Department, Department of Neurosciences, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Fabio Pagella
- ENT Department, I.R.C.C.S. Policlinico San Matteo-University of Pavia, Pavia, Italy
| | - Enzo Emanuelli
- Department of Neuroscience, Unit of Otorhinolaryngology, University of Padova, Padova, Italy
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16
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Rotsides JM, Franco A, Albader A, Casiano RR, Lieberman SM. Nasolacrimal Duct Management During Endoscopic Sinus and Skull Base Surgery. Ann Otol Rhinol Laryngol 2019; 128:932-937. [PMID: 31088142 DOI: 10.1177/0003489419848454] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To evaluate rates of epiphora after transection and marsupialization of the nasolacrimal duct (NLD) during endoscopic sinus and skull base surgery. INTRODUCTION The nasolacrimal canal forms part of the medial wall of the maxillary sinus. Transecting the NLD is sometimes necessary for tumor resection or surgical access to maxillary sinus and infratemporal fossa pathology. There is no consensus for the endoscopic management of the NLD when only the duct is transected without involving the nasolacrimal sac. METHODS Medical records of 29 patients from 2 academic institutions who underwent endoscopic sinus and skull base surgery with transection of the NLD were retrospectively reviewed. Whether the duct was marsupialized or simply transected was recorded, and the postoperative rate of epiphora was calculated. RESULTS Mean age was 59 years (range, 14-86 years). Mean follow-up was 10.5 months (range, 1-33 months). The NLD was marsupialized in 16 (55%) and simply transected in 13 (45%) patients. Six patients underwent postoperative radiation. No patients in the marsupialization group had epiphora postoperatively, all with Munk score of 0. One patient in the transection group developed postoperative epiphora with Munk score of 1. Pathology included inverted papilloma (8), acute on chronic inflammation (6), B-cell lymphoma (3), juvenile nasopharyngeal angiofibroma (2), squamous cell carcinoma (2), Schneiderian papilloma (2), metastatic melanoma (1), HPV-related carcinoma (1), adenocarcinoma (1), benign epithelial cyst (1), adenoid cystic carcinoma (1), and erosive chronic sinusitis without nasal polyposis (1). CONCLUSION Management after transection of the NLD varies widely. The duct may be simply transected or marsupialized, or a formal dacryocystorhinostomy can be performed. The surgeon must also choose whether to place a stent. Based on our small series and review of the literature, marsupialization or simple transection of the NLD results in a low rate of postoperative epiphora in the setting of endoscopic sinus and skull base surgery.
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Affiliation(s)
- Janine M Rotsides
- 1 Department of Otolaryngology-Head and Neck Surgery, New York University Langone Health, NY, USA
| | - Alexa Franco
- 2 Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Abdullah Albader
- 3 Department of Otolaryngology-Head and Neck Surgery, Zain Hospital-AlSabah Medical Area, Kuwait City, Kuwait
| | - Roy R Casiano
- 2 Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Seth M Lieberman
- 1 Department of Otolaryngology-Head and Neck Surgery, New York University Langone Health, NY, USA
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17
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Emanuelli E, Comiati V, Cazzador D, Schiavo G, Alexandre E, Fedeli U, Frasson G, Zanon A, Martini A, Scapellato ML, Mastrangelo G. Malignant Versus Benign Tumors of the Sinonasal Cavity: A Case-Control Study on Occupational Etiology. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E2887. [PMID: 30562946 PMCID: PMC6313789 DOI: 10.3390/ijerph15122887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 12/13/2018] [Accepted: 12/15/2018] [Indexed: 11/16/2022]
Abstract
Case-control studies on malignant sinonasal tumors and occupational risk factors are generally weakened by non-occupational confounders and the selection of suitable controls. This study aimed to confirm the association between sinonasal malignant tumors and patients' occupations with consideration for sinonasal inverted papillomas (SNIPs) as a control group. Thirty-two patients affected by adenocarcinoma (ADC) and 21 non-adenocarcinoma epithelial tumors (NAETs) were compared to 65 patients diagnosed with SNIPs. All patients were recruited in the same clinical setting between 2004 and 2016. A questionnaire was used to collect information on non-occupational factors (age, sex, smoking, allergies, and chronic sinusitis) and occupations (wood- and leather-related occupations, textile industry, metal working). Odds ratios (OR) with 95% confidence intervals (CI) associated with selected occupations were obtained by a multinomial and exact logistic regression. Between the three groups of patients, SNIP patients were significantly younger than ADC patients (p = 0.026). The risk of NAET increased in woodworkers (OR = 9.42; CI = 1.94⁻45.6) and metal workers (OR = 5.65; CI = 1.12⁻28.6). The risk of ADC increased in wood (OR = 86.3; CI = 15.2⁻488) and leather workers (OR = 119.4; CI = 11.3⁻1258). On the exact logistic regression, the OR associated to the textile industry was 9.32 (95%CI = 1.10⁻Inf) for ADC, and 7.21 (95%CI = 0.55⁻Inf) for NAET. Comparing sinonasal malignant tumors with controls recruited from the same clinical setting allowed demonstrating an increased risk associated with multiple occupations. Well-matched samples of cases and controls reduced the confounding bias and increased the strength of the association.
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Affiliation(s)
- Enzo Emanuelli
- Department of Neurosciences, Operative Unit of Otorhinolaryngology, University of Padova, Via Giustiniani 2, 35125 Padova, Italy.
| | - Vera Comiati
- Department of Cardiac Thoracic Vascular Sciences and Public Health, Preventive Medicine and Risk Assessment Unit, University of Padova, Via Giustiniani 2, 35128 Padova, Italy.
| | - Diego Cazzador
- Department of Neurosciences, Operative Unit of Otorhinolaryngology, University of Padova, Via Giustiniani 2, 35125 Padova, Italy.
| | - Gloria Schiavo
- Department of Neurosciences, Operative Unit of Otorhinolaryngology, University of Padova, Via Giustiniani 2, 35125 Padova, Italy.
| | - Enrico Alexandre
- Department of Neurosciences, Operative Unit of Otorhinolaryngology, University of Padova, Via Giustiniani 2, 35125 Padova, Italy.
| | - Ugo Fedeli
- Epidemiological Department, Veneto Region. Passaggio Gaudenzio 1, 35131 Padova, Italy.
| | - Giuliana Frasson
- Department of Neurosciences, Operative Unit of Otorhinolaryngology, University of Padova, Via Giustiniani 2, 35125 Padova, Italy.
| | - Alessia Zanon
- Department of Neurosciences, Operative Unit of Otorhinolaryngology, University of Padova, Via Giustiniani 2, 35125 Padova, Italy.
| | - Alessandro Martini
- Department of Neurosciences, Operative Unit of Otorhinolaryngology, University of Padova, Via Giustiniani 2, 35125 Padova, Italy.
| | - Maria Luisa Scapellato
- Department of Cardiac Thoracic Vascular Sciences and Public Health, Preventive Medicine and Risk Assessment Unit, University of Padova, Via Giustiniani 2, 35128 Padova, Italy.
| | - Giuseppe Mastrangelo
- Department of Cardiac Thoracic Vascular Sciences and Public Health, Preventive Medicine and Risk Assessment Unit, University of Padova, Via Giustiniani 2, 35128 Padova, Italy.
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18
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Intranasal endoscopic prelacrimal recess approach for maxillary sinus inverted papilloma. Eur Arch Otorhinolaryngol 2018; 275:2297-2302. [PMID: 30078130 PMCID: PMC6096575 DOI: 10.1007/s00405-018-5078-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 07/25/2018] [Indexed: 12/12/2022]
Abstract
Purpose This study aims to determine the indications and effectiveness of transnasal endoscopic prelacrimal recess approach (PLRA) in patients with maxillary sinus inverted papilloma (IP). Methods We retrospectively analyzed 71 patients treated in our institution for maxillary sinus IP between August 2008 and April 2015. 20 patients underwent endoscopic surgery via PLRA. All the patients who had postoperative follow-up for 3 years were enrolled. Demographic data, surgical technique, location of IP attachment, intra- and postoperative complications, follow-up duration and recurrence were recorded. Results The outpatient follow-up period was 3–10 years after surgery. Recurrence of IP was seen in 6 (8.5%) of 71 patients, including 1 patient in the PLRA group. The recurrence rate was 5% in the PLRA group. Six of 71 patients experienced postoperative complications, but none was observed in the PLRA group. Conclusion Transnasal endoscopic PLRA is a minimally invasive, safe and effective method for maxillary sinus IP. The indication for PLRA is tumor pedicle located on the antero-inferior or infero-lateral wall or at multiple attachment sites of the maxillary sinus.
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Wang F, Yang Y, Wang S, Chen H, Wang D, Wang Q. Management of maxillary sinus inverted papilloma via endoscopic partial medial maxillectomy with an inferior turbinate reversing approach. Eur Arch Otorhinolaryngol 2017; 274:4155-4159. [PMID: 28936551 DOI: 10.1007/s00405-017-4749-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 09/19/2017] [Indexed: 02/06/2023]
Abstract
The aim of this study is to evaluate the efficacy of endoscopic treatment for maxillary inverted papilloma (IP) through partial medial maxillectomy with an inferior turbinate reversing approach. A retrospective analysis of patients treated in our institution for maxillary sinus IP between July 2011 and August 2015 was performed. Demographics, operative technique, characteristics of tumors, complications, postoperative follow-up, and recurrence were evaluated. Twenty-two patients were enrolled in the study. All tumor attachments were identified intraoperatively. Adequate visualization was obtained following our approach. All inferior turbinate and nasolacrimal ducts were preserved. The median follow-up time was 41 months. One recurrence occurred at the follow-up time of 27 months. Postoperative hemorrhage and numbness at the ipsilateral frontal teeth were reported in two and one patients, respectively. Endoscopic surgery through partial medial maxillectomy using an inferior turbinate reversing approach provides full access to the maxillary sinus and preserves the inferior turbinate and nasolacrimal duct.
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Affiliation(s)
- Feng Wang
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003, China
| | - Yang Yang
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003, China
| | - Shenqing Wang
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003, China
| | - Haihong Chen
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003, China
| | - Dehui Wang
- Department of Otolaryngology, Affiliated Eye, Ear, Nose and Throat Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Qinying Wang
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003, China. .,, 79 Qingchun Road, Hangzhou, 310001, China.
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