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Jeong CY, Cho JH, Park YJ, Kim SW, Park JS, Abdullah Basurrah M, Kim DH, Kim SW. Differences in the predicted nasoseptal flap length among races: A propensity score matching analysis. PLoS One 2023; 18:e0283140. [PMID: 36928861 PMCID: PMC10019619 DOI: 10.1371/journal.pone.0283140] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 03/02/2023] [Indexed: 03/18/2023] Open
Abstract
OBJECTIVES We compared the lengths of a nasoseptal flap (NSF) and skull base according to race, age, and sex. METHODS We performed paranasal sinus computed tomography in 19,961 adult patients between 2003 and 2022. The race of the patients was East Asian (n = 71), Caucasian (n = 71), or Middle Eastern (n = 71). The expected lengths of the NSF and anterior skull base defect were measured and analyzed according to race, age, and sex. RESULTS Compared with Caucasians and Middle Easterners, East Asians had a shorter NSF length (p < 0.001) and lower ratio of the expected NSF length to the expected defect length (p < 0.001). There was no difference in the values among age groups. The expected NSF length was longer, and the ratio of the expected NSF length to the expected defect length was higher, in males than females (p < 0.001 for both). CONCLUSIONS East Asians and females had a shorter NSF length and lower ratio of expected NSF to surgical defect lengths after anterior skull base reconstruction compared with the other races and with males, respectively. Anatomical differences should be considered when long NSF lengths are required, such as for anterior skull base reconstruction.
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Affiliation(s)
- Chang Yeong Jeong
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin Hee Cho
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong Jin Park
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Won Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae-Sung Park
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | | | - Do Hyun Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Soo Whan Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Klimenko KE, Kryukov AI, Rusetsky YY, Tovmasyan AS, Kudryashov SE. [History of frontal sinus surgery and current view of the problem. Part 1]. Vestn Otorinolaringol 2023; 88:81-86. [PMID: 37767595 DOI: 10.17116/otorino20228804181] [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: 09/29/2023]
Abstract
Surgical treatment of inflammatory diseases of the frontal sinus is one of the biggest challenges of modern otorhinolaryngology. Close proximity of the frontal sinus and frontal sinus drainage pathways to the skull base, the orbit and the anterior ethmoid artery, great limitations with its visualization and instrumentation, and high risk of the frontal recess scarring cause difficulties in either endoscopic or external approaches to the frontal sinus. At the same time endoscopic approach to the frontal sinus is considered as preferred method of frontal sinusitis surgical treatment by majority of peers nowadays. The introduction of extended approaches to the frontal sinus pathology treatment with frontal sinus floor and interfrontal sinus septum drill-out as well as superior septectomy with common drainage pathway formation gave an opportunity to greatly decrease a rate of indications for external frontal sinus procedures. In this paper historical backgrounds of endonasal approaches to frontal sinuses are presented, current controversies in proper selection of extent and methods of the frontal sinus surgery are analyzed and endoscopic as well as external approaches to frontal sinuses are summarized.
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Affiliation(s)
- K E Klimenko
- Central Clinical Hospital with Polyclinic of Administrative Directorate of the President of the Russian Federation, Moscow, Russia
- Central State Medical Academy of Administrative Directorate of the President of the Russian Federation, Moscow, Russia
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - A I Kryukov
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - Yu Yu Rusetsky
- Central Clinical Hospital with Polyclinic of Administrative Directorate of the President of the Russian Federation, Moscow, Russia
- Central State Medical Academy of Administrative Directorate of the President of the Russian Federation, Moscow, Russia
| | - A S Tovmasyan
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - S E Kudryashov
- Central Clinical Hospital with Polyclinic of Administrative Directorate of the President of the Russian Federation, Moscow, Russia
- Central State Medical Academy of Administrative Directorate of the President of the Russian Federation, Moscow, Russia
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Park SJ, Kim HJ, Kim DY, Rhee CS, Lee CH, Paek SH, Won TB. Radioanatomic study of the skull base and septum in Asians: implications for using the nasoseptal flap for anterior skull-base reconstruction. Int Forum Allergy Rhinol 2017; 7:999-1005. [PMID: 28834303 DOI: 10.1002/alr.21993] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 05/29/2017] [Accepted: 06/28/2017] [Indexed: 11/05/2022]
Abstract
BACKGROUND The objective of this work was to assess the feasibility of using the nasoseptal flap (NSF) for covering the anterior skull-base defect in Asians, and to compare the results in whites. METHODS A retrospective radioanatomic analysis was conducted in 100 Korean adult patients. Septal and skull-base dimensions were measured and the feasibility of the NSF in reconstructing a full anterior skull-base defect was evaluated. Scans of 49 white patients were analyzed for a comparative study. RESULTS Among various septal dimensions, the length of the septum was significantly different in Koreans when compared to whites. Skull-base dimensions such as anterior skull-base length and width at the level of the anterior ethmoidal artery were different between the 2 ethnic groups. Individual differences between the anterior width of the hypothetical NSF and the anterior margin of the skull-base defect (2.8 ± 3.1 vs 6.4 ± 4.8) and the difference between the hypothetical NSF length and the length of the flap needed for full coverage of the defect were significantly smaller in Korean patients (7.2 ± 3.8 vs 13.1 ± 5.6), leading to a statistically higher chance of flap insufficiency. The insufficiency was more often found in female patients. CONCLUSION The risk of NSF insufficiency for covering the anterior skull-base defect in Koreans is higher relative to whites, and is accentuated in female patients. Efforts to increase the size of the NSF as well as efforts to avoid intraoperative shrinkage of the NSF should be considered to compensate for the relatively small NSF in Asians.
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Affiliation(s)
- Sung Joon Park
- Department of Otorhinolaryngology and Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
| | - Hyun-Jik Kim
- Department of Otorhinolaryngology and Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
| | - Dong-Young Kim
- Department of Otorhinolaryngology and Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
| | - Chae-Seo Rhee
- Department of Otorhinolaryngology and Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
| | - Chul Hee Lee
- Department of Otorhinolaryngology and Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
| | - Sun Ha Paek
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.,Center for Minimally Invasive Skull Base Surgery, Seoul National University Hospital, Seoul, Korea.,Pituitary Center, Seoul National University Hospital, Seoul, Korea
| | - Tae-Bin Won
- Department of Otorhinolaryngology and Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea.,Center for Minimally Invasive Skull Base Surgery, Seoul National University Hospital, Seoul, Korea.,Pituitary Center, Seoul National University Hospital, Seoul, Korea
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Thirty years of endoscopic sinus surgery: What have we learned? World J Otorhinolaryngol Head Neck Surg 2017; 3:115-121. [PMID: 29204590 PMCID: PMC5683659 DOI: 10.1016/j.wjorl.2016.12.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 11/29/2016] [Accepted: 12/02/2016] [Indexed: 12/16/2022] Open
Abstract
Prior to adaptation of endoscopic approaches for sinonasal pathology, patients regularly endured significant morbidity from open approaches to the sinonasal cavity that were often fraught with failure. With improvements in transnasal endoscopy, functional endoscopic sinus surgery subsequently emerged from the work of Messerklinger and other pioneers in the field. The popularity of endoscopic sinus surgery quickly escalated and expanded to pathology other than inflammation. Here, we discuss the evolution of endoscopic sinus surgery as it relates to improvements in understanding disease pathogenesis, improvements in instrumentation and expansion of indications.
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Brown SM, Sadoughi B, Cuellar H, von Jako R, Fried MP. Feasibility of near real-time image-guided sinus surgery using intraoperative fluoroscopic computed axial tomography. Otolaryngol Head Neck Surg 2016; 136:268-73. [PMID: 17275552 DOI: 10.1016/j.otohns.2006.09.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2006] [Accepted: 09/25/2006] [Indexed: 11/15/2022]
Abstract
Objective One of the main limitations of image-guided surgery is that navigation relies on the use of a CT scan obtained before surgery and is unable to be updated during the procedure. A software addition has been developed to allow reconstruction of CT-like images from a series of fluoroscopic scans and integrate these into an image-guided system (GE Healthcare Surgical Navigation, Lawrence, MA). We report our initial experience with a series of patients undergoing intraoperative fluoroscopic navigation in sinus surgery. Study Design and Settings After institutional review board clearance, we prospectively studied 14 consecutive patients undergoing image-guided sinus surgery with the use of intraoperative fluoroscopy. Results All patients had preoperative and postoperative fluoroscopic images reconstructed into CT-like images. By the conclusion of the study, images were adequate in quality and accurate navigation was achieved. Conclusion Real-time image-guided sinus surgery using fluoroscopy is feasible. Future studies will need to focus on defining the procedures that could benefit, such as tumor resection, to enhance patient safety during these operations.
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Affiliation(s)
- Seth M Brown
- Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, NY 10467, USA.
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Weber RK, Hosemann W. Comprehensive review on endonasal endoscopic sinus surgery. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2015; 14:Doc08. [PMID: 26770282 PMCID: PMC4702057 DOI: 10.3205/cto000123] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Endonasal endoscopic sinus surgery is the standard procedure for surgery of most paranasal sinus diseases. Appropriate frame conditions provided, the respective procedures are safe and successful. These prerequisites encompass appropriate technical equipment, anatomical oriented surgical technique, proper patient selection, and individually adapted extent of surgery. The range of endonasal sinus operations has dramatically increased during the last 20 years and reaches from partial uncinectomy to pansinus surgery with extended surgery of the frontal (Draf type III), maxillary (grade 3-4, medial maxillectomy, prelacrimal approach) and sphenoid sinus. In addition there are operations outside and beyond the paranasal sinuses. The development of surgical technique is still constantly evolving. This article gives a comprehensive review on the most recent state of the art in endoscopic sinus surgery according to the literature with the following aspects: principles and fundamentals, surgical techniques, indications, outcome, postoperative care, nasal packing and stents, technical equipment.
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Affiliation(s)
- Rainer K. Weber
- Division of Paranasal Sinus and Skull Base Surgery, Traumatology, Department of Otorhinolaryngology, Municipal Hospital of Karlsruhe, Germany
- I-Sinus International Sinus Institute, Karlsruhe, Germany
| | - Werner Hosemann
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Greifswald, Germany
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Mukherjee B, Priyadarshini O, Ramasubramanian S, Agarkar S. Iatrogenic Injury to Medial Rectus After Endoscopic Sinus Surgery. Indian J Otolaryngol Head Neck Surg 2015; 67:394-402. [PMID: 26693458 DOI: 10.1007/s12070-015-0887-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Accepted: 07/31/2015] [Indexed: 11/25/2022] Open
Abstract
Endoscopic sinus surgery (ESS) is the mainstay of the treatment in sinus disorders, to re-establish the drainage of the affected sinus. The close proximity of the orbital structures to paranasal sinuses makes them vulnerable to inadvertent injury during the sinus surgery. Medial rectus (MR) muscle is the most commonly injured extraocular muscle during ESS due to its anatomic proximity to the thin medial wall of the orbit. This is a non-comparative, retrospective, interventional case series of six patients presenting with MR injury after ESS. We discuss the management, outcome and review the published literature. A total of six patients met the inclusion criteria. The presenting complaints were diplopia, squinting and limitation of ocular movements. Two patients underwent surgical exploration of the MR muscle and reattachment of the muscle along with injection botulinum to the antagonist lateral rectus muscle. Two patients who had small angle strabismus and who were able to fuse were advised orthoptic exercises and prisms as management. Remaining two patients were advised surgical intervention to correct strabismus but they declined further surgical intervention. Management of MR injury following ESS is complex, often resulting in suboptimal outcomes. Since early intervention is associated with better outcomes, early referral by otolaryngologists to ophthalmologists would result in better outcome.
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Affiliation(s)
- Bipasha Mukherjee
- Orbit, Oculoplasty, Reconstructive & Aesthetic Services, Sankara Nethralaya, Medical Research Foundation, 18, College Road, Chennai, 600 006 India
| | - Omega Priyadarshini
- Orbit, Oculoplasty, Reconstructive & Aesthetic Services, Sankara Nethralaya, Medical Research Foundation, 18, College Road, Chennai, 600 006 India
| | - Srikanth Ramasubramanian
- Department of Pediatric Ophthalmology & Strabismus, Sankara Nethralaya, Medical Research Foundation, Chennai, India
| | - Sumita Agarkar
- Department of Pediatric Ophthalmology & Strabismus, Sankara Nethralaya, Medical Research Foundation, Chennai, India
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Bachert C, Pawankar R, Zhang L, Bunnag C, Fokkens WJ, Hamilos DL, Jirapongsananuruk O, Kern R, Meltzer EO, Mullol J, Naclerio R, Pilan R, Rhee CS, Suzaki H, Voegels R, Blaiss M. ICON: chronic rhinosinusitis. World Allergy Organ J 2014; 7:25. [PMID: 25379119 PMCID: PMC4213581 DOI: 10.1186/1939-4551-7-25] [Citation(s) in RCA: 130] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 08/27/2014] [Indexed: 02/06/2023] Open
Abstract
Chronic rhinosinusitis (CRS) is a public health problem that has a significant socio-economic impact. Moreover, the complexity of this disease due to its heterogeneous nature based on the underlying pathophysiology - leading to different disease variants - further complicates our understanding and directions for the most appropriate targeted treatment strategies. Several International/national guidelines/position papers and/or consensus documents are available that present the current knowledge and treatment strategies for CRS. Yet there are many challenges to the management of CRS especially in the case of the more severe and refractory forms of disease. Therefore, the International Collaboration in Asthma, Allergy and Immunology (iCAALL), a collaboration between EAACI, AAAAI, ACAAI, and WAO, has decided to propose an International Consensus (ICON) on Chronic Rhinosinusitis. The purpose of this ICON on CRS is to highlight the key common messages from the existing guidelines, the differences in recommendations as well as the gaps in our current knowledge of CRS, thus providing a concise reference. In this document we discuss the definition of the disease, its relevance, pharmacoeconomics, pathophysiology, phenotypes and endotypes, genetics and risk factors, natural history and co-morbidities as well as clinical manifestations and treatment options in both adults and children comprising pharmacotherapy, surgical interventions and more recent biological approaches. Finally, we have also highlighted the unmet needs that wait to be addressed through future research.
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Affiliation(s)
- Claus Bachert
- Upper Airways Research Laboratory (URL), University Hospital Ghent, Kragujevac, Belgium
| | - Ruby Pawankar
- Div. of Allergy, Dept. of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - Luo Zhang
- Beijing Key Laboratory of Nasal diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - Chaweewan Bunnag
- Faculty of Medicine, Siriraj Hospital Mahidol University, Bangkok, Thailand
| | - Wytske J Fokkens
- Department of Otorhinolaryngology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Daniel L Hamilos
- Division of Rheumatology, Allergy & Immunology, Massachusetts General Hospital, Boston, MA USA
| | | | - Robert Kern
- Department of Otolaryngology Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois USA
| | - Eli O Meltzer
- Allergy & Asthma Medical Group & Research Center, San Diego, California USA
| | - Joaquim Mullol
- Rhinology Unit & Smell Clinic, Hospital Clínic - IDIBAPS, Barcelona, Catalonia Spain
| | - Robert Naclerio
- Section of Otolaryngology Head and Neck Surgery, Department of Surgery, University of Chicago, Chicago, Illinois USA
| | - Renata Pilan
- Department of Otorhinolaryngology, Clinics Hospital/University of Sao Paulo Medical School, Kragujevac, Brazil
| | - Chae-Seo Rhee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Seoul National University College of Medicine, Seoul, Korea
| | - Harumi Suzaki
- Dept. of Otorhinolaryngology, Showa University, Tokyo, Japan
| | - Richard Voegels
- Department of Rhinology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Michael Blaiss
- University of Tennessee Health Science Center, Memphis, Tennessee
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Manes RP, Batra PS. Etiology, diagnosis and management of chronic rhinosinusitis. Expert Rev Anti Infect Ther 2013; 11:25-35. [PMID: 23428100 DOI: 10.1586/eri.12.151] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Chronic rhinosinusitis (CRS) is a common health care problem, yet many aspects of this diagnosis remain poorly understood. Its etiology is often debated and remains a significant area of research. The diagnosis of CRS is based on subjective symptoms, duration of symptoms and objective evidence of inflammation. Each of these criteria must be met to make a diagnosis of CRS. Management of CRS often involves a combination of systemic and topical therapies with surgery reserved for patients who fail medical therapy. This review provides a comprehensive view of the etiology, diagnosis and management of CRS.
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Affiliation(s)
- R Peter Manes
- Section of Otolaryngology, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
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Guo L, Liu J, Sun X, Wang D. Sinonasal tract chondrosarcoma: 18-year experience at a single institution. Auris Nasus Larynx 2013; 41:290-3. [PMID: 24183859 DOI: 10.1016/j.anl.2013.10.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 09/25/2013] [Accepted: 10/04/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Sinonasal tract chondrosarcomas are considered rare malignancies. Few large series evaluated the clinicopathological characteristics of these tumors. The aim of this study was to describe clinical findings, management and outcome of 24 cases of sinonasal tract chondrosarcoma from a single institution and to focus on the validity and advantage of endoscopic technique compared with conventional surgery. METHODS A retrospective analysis of clinical information was performed on 24 patients diagnosed as the sinonasal tract chondrosarcomas between 1994 and 2011. RESULTS There were 10 males and 14 females (age range, from 7 months to 67 years; mean age, 34.9 years) in this study. The main complaints were nasal obstruction and swelling/mass. The most common affected sites were maxillary sinus and sphenoid sinus. Except one case of myxoid chondrosarcoma and two cases of mesenchymal chondrosarcoma, 17 patients (70.8%) and 4 patients (16.7%) were, respectively, grade I and II. Three patients were misclassified as other tumors at other hospitals. Two cases had a history of radiation. Five cases superimposed upon a preexisting benign bony conditions. Twenty-three of 24 patients were treated with wide surgical excision, including 15 patients with conventional surgeries by external approach and 8 patients with endoscopic surgeries. Local recurrence was observed in 12 patients. The mean interval of recurrence with endoscopic surgery (37.8 months) was longer than conventional approach (21.9 months), but it did not achieve statistical significance due to small sample size. The 5-year disease-specific survival rate was 83.3%. CONCLUSION Chondrosarcomas of the sinonasal tract are rare. The patients with earlier diagnosis and adequate surgical treatment have a more favorable prognosis. Uncontrollable local disease resulting in compression of adjacent critical structures is the most common cause of death.
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Affiliation(s)
- Limin Guo
- Department of Otolaryngology, Eye Ear Nose and Throat Hospital, Shanghai Medical College of Fudan University, 83 Fen Yang Road, Shanghai 200031, PR China
| | - Juan Liu
- Department of Otolaryngology, Eye Ear Nose and Throat Hospital, Shanghai Medical College of Fudan University, 83 Fen Yang Road, Shanghai 200031, PR China
| | - Xicai Sun
- Department of Otolaryngology, Eye Ear Nose and Throat Hospital, Shanghai Medical College of Fudan University, 83 Fen Yang Road, Shanghai 200031, PR China
| | - Dehui Wang
- Department of Otolaryngology, Eye Ear Nose and Throat Hospital, Shanghai Medical College of Fudan University, 83 Fen Yang Road, Shanghai 200031, PR China.
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Angélico FV, Rapoport PB. Analysis of the Agger nasi cell and frontal sinus ostium sizes using computed tomography of the paranasal sinuses. Braz J Otorhinolaryngol 2013; 79:285-92. [PMID: 23743742 PMCID: PMC9443836 DOI: 10.5935/1808-8694.20130052] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 03/14/2013] [Indexed: 11/20/2022] Open
Abstract
The Agger nasi cell (ANC) and the frontal sinus ostium (FO) are important structures that can influence the anatomy and physiology of the frontal recess. The aim of this study was to evaluate the presence and size of ANC and the FO and correlate them according to gender, race and among themselves. Method A prospective study with 40 patients who underwent CT of the paranasal sinuses with sagittal reconstruction. Measurements: ANC (APAN) anteroposterior diameter, ANC (CCAN) craniocaudal diameter, ANC (LLAN) side-to-side diameter, anteroposterior diameter of the FO (APFO) and side-to-side diameter of the FO (LLFO). Results Twenty-two patients were male and 18 females, mean age 33.7 years. Most patients were white (45%), followed by browns (32.5%), blacks (20%) and asians (2.5%). The ANC was present in 98.7% of patients. There was statistical difference for APAN on females and LLAN on females and on the total sample. There were no differences for all measurements regarding gender, as well as the race. ANC and FO measurements showed positive correlation, but poor or very poor. Conclusion The prevalence of ANC in our sample was high and did not show a statistically significant difference for most measurements. The correlation between measurements of ANC and the FO was poor or very poor.
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Pinheiro-Neto CD, Fernandez-Miranda JC, Prevedello DM, Carrau RL, Gardner PA, Snyderman CH. Transposition of the Pterygopalatine Fossa during Endoscopic Endonasal Transpterygoid Approaches. J Neurol Surg B Skull Base 2013; 74:266-70. [PMID: 24436922 DOI: 10.1055/s-0033-1347367] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Accepted: 02/29/2012] [Indexed: 10/26/2022] Open
Abstract
Introduction Complete or partial removal of the pterygoid process provides lateral extension of the endonasal corridor necessary to approach the Meckel cave, infrapetrous skull base, and medial infratemporal fossa. This paper provides the anatomical foundations for the endoscopic endonasal transpterygoid approach with preservation of all neurovascular structures inside the pterygopalatine fossa. Methods Eight endoscopic transpterygoid approaches were performed in fresh cadaveric specimens. In all dissections the vidian nerve and the periosteal sac enclosing the pterygopalatine fossa were preserved. Results We reliably transposed the pterygopalatine fossa to approach the Meckel cave, infrapetrous skull base, and medial infratemporal region, preserving the neurovascular structures inside the pterygopalatine fossa in all specimens. Conclusions The transposition of the pterygopalatine fossa neurovascular structures for endoscopic endonasal approaches to the skull base is an alternative technique that is both feasible and desirable. The transposition requires no additional technical skills but requires comprehensive knowledge of its anatomy. The anatomical preservation of the neurovascular structures is potentially beneficial to the quality of life of patients. Clinical studies are necessary to prove the real benefits of this technique.
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Affiliation(s)
- Carlos D Pinheiro-Neto
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Juan C Fernandez-Miranda
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | | | - Ricardo L Carrau
- Department of Otolaryngology-Head & Neck Surgery, The Ohio State University Columbus, Ohio, United States
| | - Paul A Gardner
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Carl H Snyderman
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA ; Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Maharshak I, Hoang JK, Bhatti MT. Complications of vision loss and ophthalmoplegia during endoscopic sinus surgery. Clin Ophthalmol 2013; 7:573-80. [PMID: 23658475 PMCID: PMC3607413 DOI: 10.2147/opth.s40061] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To describe two rare cases of concurrent vision loss and external ophthalmoplegia following powered endoscopic sinus surgery (ESS). DESIGN Observational case report. RESULTS The records of two patients who underwent powered ESS and developed multiple concurrent ophthalmic complications were retrospectively reviewed for clinical history, neuro-ophthalmologic examination, and imaging findings. Patient 1 developed a retinal vascular occlusion and complete loss of adduction. Patient 2 developed an orbital hemorrhage, optic neuropathy, and a restrictive global ophthalmoplegia. Similar published case reports were also reviewed. CONCLUSION Despite advances in powered ESS technique and instrumentation, serious ophthalmic complications can still occur. Inadvertent entry into the medial orbital wall can result in a combination of blindness and ocular motility dysfunction. The variety of mechanisms responsible for these complications underscores the importance of thorough pre- and postoperative clinical examination and review of imaging studies.
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Affiliation(s)
- Idit Maharshak
- Department of Ophthalmology, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel ; Department of Ophthalmology, Duke Eye Center and Duke University Medical Center, Durham, NC, USA
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Pinheiro-Neto CD, Ramos HF, Peris-Celda M, Fernandez-Miranda JC, Gardner PA, Snyderman CH, Sennes LU. Study of the nasoseptal flap for endoscopic anterior cranial base reconstruction. Laryngoscope 2012; 121:2514-20. [PMID: 22109750 DOI: 10.1002/lary.22353] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS Measure the dimensions of the nasoseptal (NS) flap and the anterior skull base (ASB) defect. Verify whether the flap is sufficient to cover the defect. Study the anatomy of the septal artery (SA). STUDY DESIGN Anatomical and radiological study. METHODS After endoscopic craniofacial resection, sufficiency of the flap to cover the ASB defect was assessed. The SA was dissected. The number of branches in the pedicle and the distance between the artery and the sphenoid ostium were noted. Radiologic study analyzing CT scans of 30 patients for comparison among measurements of the NS flap and the ASB defect was performed. RESULTS In all cases the flap was sufficient to cover the ASB. Two branches of the SA were found in the pedicle in 71.4%. The distance between the SA and the sphenoid ostium was 9.3 mm. The reconstruction area of the flap (17.12 cm(2) ) was larger than the defect area (8.64 cm(2) ) (P < .001). The difference between the superior length of the flap and the anterior-posterior distance of the defect was ≤ 5 mm in 26.7%. Comparison between the anterior flap width and the anterior defect width revealed that in 33% the difference was ≤ 5 mm. CONCLUSIONS The dimensions of NS flap are sufficient to cover completely the ASB defect. The anterior edge of the defect presents increased risk for failure in coverage. Additional width adding the nasal floor mucosa to the flap is important to decrease the risk of gap in the anterior orbit-orbit defect. It is more common to find two branches of the SA in the pedicle.
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Affiliation(s)
- Carlos D Pinheiro-Neto
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA.
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Preoperative magnetic resonance imaging protocol for endoscopic cranial base image-guided surgery. Am J Otolaryngol 2011; 32:451-4. [PMID: 21035917 DOI: 10.1016/j.amjoto.2010.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Accepted: 08/11/2010] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Despite the increasing utilization of image-guided surgery, no radiology protocols for obtaining magnetic resonance (MR) imaging of adequate quality are available in the current literature. At our institution, more than 300 endonasal cranial base procedures including pituitary, extended pituitary, and other anterior skullbase procedures have been performed in the past 3 years. To facilitate and optimize preoperative evaluation and assessment, there was a need to develop a magnetic resonance protocol. METHODS Retrospective Technical Assessment was performed. DISCUSSION Through a collaborative effort between the otolaryngology, neurosurgery, and neuroradiology departments at our institution, a skull base MR image-guided (IGS) protocol was developed with several ends in mind. First, it was necessary to generate diagnostic images useful for the more frequently seen pathologies to improve work flow and limit the expense and inefficiency of case specific MR studies. Second, it was necessary to generate sequences useful for IGS, preferably using sequences that best highlight that lesion. Currently, at our institution, all MR images used for IGS are obtained using this protocol as part of preoperative planning. The protocol that has been developed allows for thin cut precontrast and postcontrast axial cuts that can be used to plan intraoperative image guidance. It also obtains a thin cut T2 axial series that can be compiled separately for intraoperative imaging, or may be fused with computed tomographic images for combined modality. The outlined protocol obtains image sequences effective for diagnostic and operative purposes for image-guided surgery using both T1 and T2 sequences.
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Ochi N, Doi K, Uranagase M, Nishikawa T, Katsunuma S, Nibu KI. Bone marrow stem cell transplantation to olfactory epithelium. Ann Otol Rhinol Laryngol 2010; 119:535-40. [PMID: 20860279 DOI: 10.1177/000348941011900806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES We sought to develop a new therapeutic strategy for degeneration of olfactory receptor neurons (ORNs). METHODS We transplanted into Balb/C mice, locally by transnasal injection and systemically via the tail vain, BrdU-labeled bone marrow stem cells, also known as NRGs, which have the ability to differentiate into neural cells. Bone marrow stem cells engrafted into the olfactory epithelium were examined immunohistochemically. RESULTS Compared with previous studies, in which bone marrow was transplanted rather than bone marrow stem cells, migration of transplanted bone marrow stem cells into the olfactory epithelium was observed earlier, and engraftment rates were significantly higher. However, migrated bone marrow stem cells were positive for GAP43 but not for olfactory marker protein. CONCLUSIONS These results suggest that engrafted cells had differentiated into premature, but not mature, ORNs. Further experiments using autologous bone marrow stem cells in combination with various growth factors and/or neurotrophic factors should aid the development of new therapeutic methods for degenerated ORNs.
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Affiliation(s)
- Naoki Ochi
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Endoscopic sinus surgery: evolution and technical innovations. The Journal of Laryngology & Otology 2009; 124:242-50. [PMID: 19930748 DOI: 10.1017/s0022215109991368] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Prior to the introduction of functional endoscopic sinus surgery, several surgeons had begun to use telescopes to perform surgical procedures in the nose and sinuses. However, the central concepts of functional endoscopic sinus surgery evolved primarily from Messerklinger's endoscopic study of mucociliary clearance and endoscopic detailing of intranasal pathology. The popularity of a combination of endoscopic ethmoidectomy plus opening of secondarily involved sinuses grew rapidly during the latter part of the twentieth century, and endoscopic intranasal techniques began to expand to deal with pathology other than inflammation. We present a review of the evolution of knowledge regarding the pathogenesis of inflammatory sinus disease since that point in time, and of the impact that this has had on the management of inflammatory sinus disease. We also detail the technological advances that have allowed endoscopic intranasal techniques to expand and successfully treat other pathology, including skull base and orbital disease. In addition, we describe evolving technologies which may further influence development within this field.
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Szyfter W, Mielcarek-Kuchta D, Leszczyńska M, Wielgosz R, Pastusiak T. [9-years results of the functional endoscopic sinus surgery in ENT department in Poznań--from microscope to four hands technique]. Otolaryngol Pol 2008; 62:165-9. [PMID: 18637440 DOI: 10.1016/s0030-6657(08)70234-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Surgical procedure is used in chronic rhinosinusitis and aims at restoring proper drainage and ventilation. For this reason the surgery of this region is referred to as functional and in English literature is termed as FESS. It supplanted classical method of Caldwell-Luc or Denker. In the study nine years experience in the Department of Otolaryngology, Head and Surgery University of Poznań in the treatment of chronic sinusitis has been presented. 1463 patients treated with FEES were analyzed. Moreover, the method of selecting patients for the surgery, the diagram showing surgeries performed step by step as well as a list of various surgeries and intraoperative complications were presented. This work is the first part of the study. In the other part the results of the treatment based on the questionnaires sent to patients will be presented.
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Affiliation(s)
- Witold Szyfter
- Katedra i Klinika Otolaryngologii i Onkologii Laryngologicznej Uniwersytetu Medycznego w Poznaniu.
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Abstract
PURPOSE OF REVIEW To provide an update on the state of biofilm research in otolaryngology. RECENT FINDINGS Chronic rhinosinusitis is a polymicrobial infection, which includes planktonic and biofilm infections with bacterial and fungal elements. The importance of genetic shift in microbes, when converting into a biofilm state, as well as the multiple phenotypes in each bacterial colony cannot be overemphasized. This creates a very sophisticated community of pathogens, some of which will likely survive a simple chemical treatment. Sinus cultures cannot be expected to provide a complete knowledge of the cause of chronic sinusitis. A new diagnostic method and innovative treatment plans will be necessary to provide a lasting treatment of chronic rhinosinusitis. Surgery combined with postoperative treatment is the most effective mean of controlling the majority of chronic rhinosinusitis infections. The challenges associated with the treatment of chronic rhinosinusitis patients may be met by focusing more on the community of microorganism present in the sinuses. SUMMARY The understanding of the implication of chronic biofilm infections is growing rapidly but will require an enormous effort to completely control chronic rhinosinusitis.
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Han D, Zhang L, Ge W, Tao J, Xian J, Zhou B. Multiplanar computed tomographic analysis of the frontal recess region in Chinese subjects without frontal sinus disease symptoms. ORL J Otorhinolaryngol Relat Spec 2008; 70:104-12. [PMID: 18408408 DOI: 10.1159/000114533] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The purposes of this study were to determine the prevalence of frontal-ethmoidal cells and to evaluate variation in the superior attachment of the uncinate process in Chinese subjects. 202 normal Chinese subjects (404 sides) underwent spiral computed tomography and multiplanar reconstruction images were evaluated. Agger nasi cells showed a prevalence of 94.1%. Of all the frontal cells identified in 159 sides (39.6%) of frontal recesses, the prevalence of type I, type II and type III cells was 24.4, 7.0 and 8.2%, respectively. Suprabullar, frontal bullar and interfrontal septal cells were identified in 148 sides (36.6%), 36 sides (9.0%) and 25 subjects (12.4%), respectively. 244 uncinate processes (60.4%) had 1 superior attachment and the remainder (39.6%) had 2 superior attachments. The prevalence of terminal recesses was 89.1%. Our results characterized normal frontal recess pneumatization patterns in Chinese subjects. That, together with variation in the superior attachment of the uncinate process, emphasized the role of agger nasi cells and the uncinate process in endoscopic frontal sinus surgery.
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Affiliation(s)
- Demin Han
- Beijing Institute of Otolaryngology, Department of Otolaryngology Head and Neck Surgery, Capital University of Medical Sciences, Beijing, PR China
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Han D, Zhang L. Functional endoscopic sinus surgery in china. ORL J Otorhinolaryngol Relat Spec 2008; 70:80-3. [PMID: 18408404 DOI: 10.1159/000114529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The functional endoscopic sinus surgery (FESS) technique was introduced in China at the beginning of the 1980s and popularized gradually. Now its application has extended to the management of skull base lesions, orbital lesions and sinonasal tumors. This paper will review the application and relevant research of nasal endoscopic surgery and discuss its further perspectives in China.
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Affiliation(s)
- Demin Han
- Department of Otolaryngology Head and Neck Surgery, Beijing Institute of Otolaryngology, Beijing Tongren Hospital, Capital University of Medical Sciences, Beijing, PR China
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Abstract
PURPOSE OF REVIEW This review aims to provide an overview of powered endoscopic sinus surgery and raise awareness of the possible neuro-ophthalmic complications associated with the procedure. RECENT FINDINGS The neuro-ophthalmic complications of endoscopic sinus surgery can be categorized into five anatomic sites: eye, orbit, optic nerve, extraocular muscle, and lacrimal drainage system. Double vision may be caused by various ocular motility abnormalities. Visual loss may be the result of orbital hemorrhage or direct optic nerve trauma. SUMMARY A wide range of neuro-ophthalmic complications may occur during endoscopic sinus surgery. The use of powered cutting instruments has been a recent advance in endoscopic sinus surgery, but it has also been implicated in rapid, irreversible, and devasting complications. Multiple preoperative and intraoperative factors appear to be involved in the adverse events associated with endoscopic sinus surgery. Ophthalmologists may be asked to evaluate and manage ocular damage in patients who have undergone endoscopic sinus surgery, and in some cases emergent intervention may be required in an attempt to avoid permanent visual loss.
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Affiliation(s)
- M Tariq Bhatti
- Duke University Eye Center, Duke University Medical Center, Durham, North Carolina 27710-3802, USA.
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Eisenberg G, Pérez C, Hernando M, Taha M, González R, Montojo J, Echarri R, García V, Onrubia T, Plaza G. Nasosinusal Endoscopic Surgery as Major Out-Patient Surgery. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2008. [DOI: 10.1016/s2173-5735(08)70191-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Pinheiro-Neto CD, Prevedello DM, Carrau RL, Snyderman CH, Mintz A, Gardner P, Kassam A. Improving the design of the pedicled nasoseptal flap for skull base reconstruction: a radioanatomic study. Laryngoscope 2007; 117:1560-9. [PMID: 17597630 DOI: 10.1097/mlg.0b013e31806db514] [Citation(s) in RCA: 116] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Reconstruction of the skull base after an expanded endonasal approach (EEA) is critical to achieve a good outcome. A novel technique based on the use of a pedicled nasoseptal flap has proven to be a reliable and versatile reconstructive option for extensive defects of the skull base. Data regarding the potential dimensions of a nasoseptal flap are lacking in the literature. This pilot study was developed to help optimize the design of the nasoseptal flap and to ensure that when harvesting the flap, its width and length are adequate to reconstruct the defects that are created by various EEAs. METHODS We analyzed the computed tomographic (CT) scans of four patients who underwent EEAs for skull base lesions. Sagittal and coronal CT reconstructions were generated from axial images. The measurements were divided into skull base measurements, flap dimensions required to cover skull base defects resulting from various EEAs, and potential maximal dimensions of the nasoseptal flap. Measurements were studied for three different EEAs: sellar/transplanar, transclival, and transcribiform/anterior skull base. We measured the potential defects for each of these EEAs and the nasoseptal flap dimensions that would be required to reconstruct them. We estimated all dimensions based on the most extensive defect that could result with each EEA. We then compared these with various modifications of the nasoseptal flap. RESULTS Two male and two female patients were studied. Twenty-seven measurements were taken to compare the different skull base defects and nasoseptal flaps. CONCLUSIONS The length of the nasal septum comprises sufficient mucoperichondrium and mucoperiosteum to allow the harvesting of a nasoseptal flap that could cover any defect resulting from an anterior skull base, a transsellar/transplanar, or a transclival EEA. Similarly, the height of the nasal septum has the potential to yield a nasoseptal flap with a width that is adequate to cover the laterolateral aspect of any defect of the anterior skull base and clivus. Skull base defects resulting from combined EEAs, such as those that would create a defect that comprises the skull base from sella turcica to frontal sinus, are beyond the potential dimensions of a single nasoseptal flap. This and other defects resulting from a combination of EEAs require other strategies, such as the use of bilateral nasoseptal flaps, or the use of other reconstructive options.
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Affiliation(s)
- Carlos Diogenes Pinheiro-Neto
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA
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Cirugía endoscópica nasosinusal: estudio de 110 pacientes con rinosinusitis crónica con pólipos. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2007. [DOI: 10.1016/s0001-6519(07)74922-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Puranik V, El-Sheikha A. Uncinectomy: Stammberger or swing-door technique? Eur Arch Otorhinolaryngol 2007; 264:1151-5. [PMID: 17516078 DOI: 10.1007/s00405-007-0326-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2006] [Accepted: 04/19/2007] [Indexed: 10/23/2022]
Abstract
Uncinectomy is the first step performed in functional endoscopic sinus surgery (FESS). The technique of performing uncinectomy by various methods depends on training and personal preferences. A postal survey of 585 practising British otorhinolaryngologists has revealed no significant difference in the various techniques of uncinectomies described by Stammberger and the swing-door technique (Wormald). Most surgeons are comfortable with the various techniques of uncinectomy, although the Stammberger technique (45.20%) appears to be easier compared to swing-door (37.34%). The postoperative complications including any comments have been recorded. The aim of this study was to determine which technique of uncinectomy (Stammberger, swing-door) was well advocated by the UK otorhinolaryngologists in FESS.
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Affiliation(s)
- Vishwanath Puranik
- Department of ENT and Head and Neck, Northwest Wales NHS Trust, Ysbyty Gwynedd Hospital, Bangor, Northwest Wales, UK.
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Podboj J, Smid L. Endoscopic surgery with curative intent for malignant tumors of the nose and paranasal sinuses. Eur J Surg Oncol 2007; 33:1081-6. [PMID: 17329065 DOI: 10.1016/j.ejso.2007.01.016] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2006] [Accepted: 01/11/2007] [Indexed: 11/21/2022] Open
Abstract
AIM To assess the efficacy of endoscopic surgical treatment in patients with nasal and paranasal sinus malignancies. PATIENTS AND METHODS During the period 1991-2006, 16 patients with nasal and paranasal sinus malignancies underwent endoscopic surgery with curative intent. The lesions included 11 carcinomas, two malignant melanomas, one olfactory neuroblastoma, one hondrosarcoma and one leiomyosarcoma. Tumors originated from the ethmoids in eight, and from the nasal cavity in another eight patients. Oncologic radicality of resection was verified by intraoperative frozen-section examination of biopsy specimens from the margins of the defect site. RESULTS Radical resection was accomplished in 15 out of 16 operated patients. There were no major intra- or postoperative complications. Ten patients were postoperatively irradiated. Follow up of the treated patients ranged from 15 to 178 months (median 67 months). One patient with malignant melanoma died of generalized disease nine months after treatment, another with malignant melanoma recurred locally 30 months and again 49 months after first operation and is at the time of evaluation disease free and one died 21 months after operation without evidence of disease. CONCLUSIONS It seems that in selected cases, endoscopic surgery with curative intent for removal of malignant tumors of the nasal and paranasal cavities in the hands of highly experienced surgeon is justified.
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Affiliation(s)
- J Podboj
- Clinical Center, University Department of Otorhinolaryngology and Cervicofacial Surgery, Zaloska 2, 1525 Ljubljana, Slovenia.
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Guerrero J, Molina B, Echeverría L, Arribas I, Rivera T. Endoscopic Sinonasal Surgery: Study of 110 Patients With Nasal Polyposis and Chronic Rhinosinusitis. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2007. [DOI: 10.1016/s2173-5735(07)70344-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Abstract
BACKGROUND Functional endoscopic sinus surgery (FESS) is the most popular method for treating medicine-refractory sinonasal disease. However, there are some pitfalls with this technique that can result in serious complications. Under the assistance of a navigation system, surgeons can overcome such problems. This study aimed to evaluate the efficacy of FESS aided by a navigation system. METHODS There were 79 patients who underwent FESS under the assistance of a navigation system in our department between September 2004 and September 2005. Data on preoperative setup time, accuracy of the navigation system, operative time, and amount of blood loss during the operation were collected and analyzed. RESULTS Mean preoperative setup time and mean operative time were 10.6 minutes and 112.3 minutes, respectively. The mean number of paranasal sinuses operated on was 5.8. The mean accuracy of the navigator system was 1.08 mm. Mean blood loss was 102.5 mL. Compared with data collected 2 years ago, preoperative setup time and operative time had both shortened. In addition, the number of operated paranasal sinuses had increased. This indicates that operative skill had improved. Moreover, operative time, amount of blood loss during the operation, and number of operated paranasal sinuses presented positive associations and significant differences (p < 0.05). No major complications such as blindness or cerebral spinal fluid leakage were noted. CONCLUSION The characteristics of FESS aided by a navigation system include: (1) being able to pilot the relative positions of the operative instruments correctly in 3 dimensions; (2) being able to remove lesions more thoroughly; and (3) its inability to disclose the positions of vessels. As the number of patients we operated on increased, operative time was reduced. On the other hand, blood loss increased when the operations became more aggressive. However, performing FESS with the assistance of a navigation system is a safe way to treat patients with chronic paranasal sinusitis.
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Affiliation(s)
- Sau-Tung Chu
- Department of Otolaryngology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
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Abstract
Since the introduction of endoscopic sinus surgery, a number of significant technological advances, as well as an improved understanding of disease pathogenesis and management, have enabled major evolutions in surgical techniques. Modifications to surgical instruments, imaging, the development of the microdebrider, and other newer instrumentation have all contributed to the current level of patient success associated with endoscopic intranasal techniques. At the same time, it has become evident that anatomic variations are less important in the pathogenesis of chronic rhinosinusitis than was previously thought, and that ventilation alone is insufficient to resolve well-established disease. This paper reviews the changes that have occurred in endoscopic sinus surgery over the past 20 years since the techniques were first introduced into the United States, and the technologies that have enabled these changes and the development of extended endoscopic techniques. Continuing developments of interactive computer-guided surgery, endoscopic 3-dimensional imagery, robotics, and improved adjunctive therapies will further extend the role of endoscopic transnasal approaches to an expanded number of skull base and intracranial lesions.
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Affiliation(s)
- David W Kennedy
- Division of Rhinology, Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Medical Center, 5 Silverstein/Ravdin, 3400 Spruce St, Philadelphia, PA 19104, USA
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Danielsen A, Olofsson J. Endoscopic endonasal sinus surgery: a review of 18 years of practice and long-term follow-up. Eur Arch Otorhinolaryngol 2006; 263:1087-98. [PMID: 16937113 DOI: 10.1007/s00405-006-0129-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2006] [Accepted: 07/07/2006] [Indexed: 11/30/2022]
Abstract
A study of 1,915 patients operated on with a total of 4,285 endoscopic endonasal ethmoidal procedures during a period of 18 years is presented. The study comprises five groups of patients with (1) acute recurrent and chronic sinusitis--long-standing symptoms >3 months--(n = 733), (2) nasal/paranasal polyposis (n = 710), (3) sinogenic headache (n = 325), (4) mucoceles (n = 59) and (5) other nasal/paranasal disorders (n = 88). This group includes acute sinus infection with complications (n = 38), acute trauma/injury (n = 22), Grave's disease with exophthalmus (n = 12) and olfactory dysfunction (n = 16). The need for a thorough examination leading to a final diagnosis is emphasized. Endoscopy and CT/MRI are standard tools in the diagnostic and postoperative process. Close cooperation and educational teaching of the patient are necessary to obtain highest compliance. Long-standing medical treatment of inflammatory diseases is important to the long-term outcome and is of utmost importance to surgical success. Surgery is recommended to be performed under general anesthesia (total intravenous anesthesia or laryngeal mask anesthesia) with additional local, topical anesthetics, and can be easily performed on a day-case out-patient basis. The surgery is based upon the Messerklinger technique (MT). Peroperative complications are reduced by a skilled and meticulous surgical conduct and an adequate medication preoperatively. During this period of time, necessary controls within the first postoperative month were reduced from 3-4 to only one. Long-term follow-up secures a long-standing optimal result. Endoscopic surgery for more rare conditions, such as orbital decompression, CSF leaks and meningoceles, is recommended to be performed in specialized centers with adequate trained staff and necessary equipment. The possibilities of the picture archiving communication system, giving a number of different projections and angles and video-guided imaging peroperatively, facilitates safe surgical performances in areas usually associated with great risks and hazards. The long-term results are very good during the above circumstances. Reoperations are few and the patient satisfaction is very high.
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Affiliation(s)
- Arild Danielsen
- Department of Otorhinolaryngology, Aleris Medical Hospital, Fredrik Stangs gt. 11-13, 0264 Oslo, Norway.
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Cantù G, Riccio S, Bimbi G, Squadrelli M, Colombo S, Compan A, Rossi M, Pompilio M, Solero CL. Craniofacial resection for malignant tumours involving the anterior skull base. Eur Arch Otorhinolaryngol 2006; 263:647-52. [PMID: 16538505 DOI: 10.1007/s00405-006-0032-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2005] [Accepted: 11/15/2005] [Indexed: 12/01/2022]
Abstract
Ethmoid malignant tumours are rare, but nearly all at least approach or involve the lamina cribrosa. An anterior craniofacial resection is almost always mandatory for a radical resection. While almost everything has been written about technical details, few studies reported meaningful analysis about prognostic factors and long-term results, for a series of reasons: the infrequency of these tumours, the variety of histologies, small patients cohorts presented by each author, a medley of untreated and pre-treated patients, the lack of a universally accepted classification. We perform a review of the literature in the light of our experience of 330 anterior craniofacial resections for ethmoid malignant tumours. We present our classification of ethmoid malignant tumours (called INT, Istituto Nazionale Tumori). It turned out to be more prognostic than AJCC-UICC classification.
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Affiliation(s)
- Giulio Cantù
- Cranio-Maxillo-Facial Surgery, Istituto Nazionale Tumori, Via Venezian 1, 20133, Milan, Italy.
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Danielsen A, Reitan E, Olofsson J. The role of computed tomography in endoscopic sinus surgery: a review of 10 years’ practice. Eur Arch Otorhinolaryngol 2006; 263:381-9. [PMID: 16456692 DOI: 10.1007/s00405-005-1032-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2005] [Accepted: 08/15/2005] [Indexed: 10/25/2022]
Abstract
CT scans from 100 patients undergoing endoscopic sinus surgery (ESS) were primarily re-examined in order to assess the quality of the radiological examinations and the information it could provide years later. The material comprised the cases of patients who had undergone ESS by one surgeon (AD) in the 1990s. The indications for surgery were acute recurrent or chronic sinus infections, polyposis of the nasal and paranasal cavities, mucoceles and sinogenic headache. All examinations were described using a scheme modified according to Stoney et al., evaluating the opacity/mucosal thickening, drainage/pathways, the lateral nasal walls, septum and other bony walls. This study has been re-evaluated and an additional group of 20 patients consecutively operated on in 2002/2003 has been added. The initial radiological examinations often proved incomplete, with insufficient descriptions of either the drainage/pathways, the lateral nasal wall or the septum and bony walls, which all are structures of great value to evaluate preoperatively for the endoscopic surgeon. The operative findings correlated well with the CT if taken between 4-6 weeks before the operation. The structural pathology correlated with preoperative endoscopic findings independently of the time lapse between the scans taken and the date of surgery. The development and the gradual implementation of the picture archiving and communication system (PACS) certainly represent huge advantages in radiological assessment. The need for CT scans to be available in the operating room calls for specific computer installations to make PACS readily available peroperatively and in an easily workable way for the surgeon.
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Affiliation(s)
- Arild Danielsen
- Department of Otorhinolaryngology, Axess Medical Hospital, Hjalmar Brantingsv. 8, 0581, Oslo, Norway.
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Kitamura A. Removal of a migrated dental implant from a maxillary sinus by transnasal endoscopy. Br J Oral Maxillofac Surg 2006; 45:410-1. [PMID: 16457911 DOI: 10.1016/j.bjoms.2005.12.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2005] [Revised: 12/16/2005] [Accepted: 12/19/2005] [Indexed: 12/23/2022]
Abstract
A 54-year-old woman presented with maxillary sinusitis as a result of the migration of an implant into the sinus. We removed it endoscopically through the nose.
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Affiliation(s)
- Akira Kitamura
- Department of Developmental and Reconstructive Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Sakamoto, Nagasaki 852-8501, Japan.
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