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Heiland LD, Farmer HG, Nguyen SA, Soler ZM, Schlosser RJ. Headache and Facial Pain/Pressure in the Chronic Rhinosinusitis Population: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2024. [PMID: 38895867 DOI: 10.1002/ohn.855] [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: 01/24/2024] [Revised: 04/16/2024] [Accepted: 05/26/2024] [Indexed: 06/21/2024]
Abstract
OBJECTIVE To evaluate the severity and prevalence of headache and facial pain/pressurere in the chronic rhinosinusitis (CRS) population. DATA SOURCES CINAHL, PubMed, Scopus. REVIEW METHODS The literature was searched from inception through June 2023 for English language articles documenting "headache" or "facial pain/pressure" and "chronic rhinosinusitis." Data collected included Lund-MacKay computed tomography score, Lund-Kennedy endoscopy score, sinonasal outcome test, and visual analog scale. Meta-analyses were performed on continuous measures (mean), proportions (%), and regression. RESULTS A total of 69 studies were included with 8643 CRS patients and 703 control patients. The CRS group had a mean age of 44.1 (range: 16-82; 95% confidence interval [CI]: 40.3-48) and 86.1% [95% CI: 76.4-93.5] with nasal polyposis. The control group had a mean age of 39.2 (range: 17-88; 95% CI: 28.7-49.8). All CRS subgroups had significantly more severe headache and facial pain/pressure when compared to the control (P < .0001). Patients without polyps had significantly more severe facial pain/pressure and headache when compared to patients with polyps (P < .0001). Facial pain/pressure is a moderate problem or worse in 29.8% of polypoid patients versus 56.4% of nonpolypoid patients; Δ26.6% [95% CI: 0.7-50; P = .045]. CONCLUSIONS Across all outcome metrics, CRS patients experience significantly more severe headache and facial pain/pressure when compared to a control population. Nonpolypoid patients experience significantly more severe facial pain/pressure and headache when compared to polypoid patients. The majority of nonpolypoid patients experience facial pain/pressure that is moderate in severity or worse.
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Affiliation(s)
- Luke D Heiland
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
- Saint Louis University School of Medicine, St Louis, Missouri, USA
| | - Hannah G Farmer
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Zachary M Soler
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Rodney J Schlosser
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Surgery, Ralph H. Johnson VA Medical Center, Charleston, South Carolina, USA
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Heiland LD, Marrero-Gonzalez AR, Nguyen SA, Farmer HG, Rathi VK, Soler ZM, Schlosser RJ. Surgical management of headache and facial pain/pressure in chronic rhinosinusitis: A systematic review and meta-analysis. Int Forum Allergy Rhinol 2024. [PMID: 38739100 DOI: 10.1002/alr.23359] [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: 02/06/2024] [Revised: 04/10/2024] [Accepted: 04/22/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND Headache and facial pain are common symptoms of chronic rhinosinusitis (CRS). However, given the numerous etiologies that can cause these symptoms, the impact of sinus surgery is not well characterized. METHODS A systematic review was performed by searching the literature from inception through June 6, 2023. English-language articles reporting outcomes for facial pain/pressure or headache following endoscopic sinus surgery were selected for inclusion. Meta-analyses were performed using random and fixed effect models on continuous measures (mean), mean difference (Δ), and proportions (%). RESULTS A total of 26 articles reporting on 2839 patients were selected for inclusion. The mean patient age was 44.0 ± 3.9 (range 16.0-84.0), with an average symptom duration of 5.3 ± 2.8 years. Among these patients, 56.5% (95% confidence interval [CI]: 52.3-60.6) were male and 77.0% (95% CI: 56.6-92.3) had nasal polyposis (NP). Patients with and without NP reported substantial reductions in both 22-item sino-nasal outcome test facial pain/pressure (with NP: -1.4 [95% CI: -1.6 to -1.2; relative reduction 59.1%]; without NP: -1.5 [95% CI: -1.9 to -1.1; relative reduction 60.9%]) and visual analogue scale (VAS) headache (with NP: -2.5 [95% CI: -2.8 to -2.1; relative reduction 67.2%]; without NP: -2.8 [95% CI: -4.7 to -1.0; relative reduction 42.7%]). Symptom reductions were greater in the without NP versus with NP group; VAS facial pain/pressure: Δ0.4 (95% CI: 0.2-0.6; p = 0.0006) and VAS headache: Δ0.4 (95% CI: 0.1-0.7; p = 0.02). CONCLUSIONS Our findings suggest that CRS patients, regardless of polyp status, benefit from significant reductions in facial pain/pressure and headache following surgical therapy.
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Affiliation(s)
- Luke D Heiland
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, St. Louis, Missouri, USA
- Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Alejandro R Marrero-Gonzalez
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Hannah G Farmer
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Vinay K Rathi
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Zachary M Soler
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Rodney J Schlosser
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, St. Louis, Missouri, USA
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Afzalzadeh M, Khademi S, Kazemi A, Divanbeigi R. A review of the revisions and complications management procedure in sinus surgery. J Family Med Prim Care 2022; 11:887-895. [PMID: 35495831 PMCID: PMC9051709 DOI: 10.4103/jfmpc.jfmpc_897_21] [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: 04/16/2021] [Revised: 07/21/2021] [Accepted: 10/25/2021] [Indexed: 11/10/2022] Open
Abstract
One of the most standard and least invasive surgical procedures that could be applied mostly for the treatment of inflammation of the paranasal sinuses is endonasal endoscopic sinus surgery. The main objective of this study is to assess the available strategies for avoiding, diagnosis and also dealing with various kinds of potential complications of sinus disorders as well as the symptoms which specify the need for revision endoscopic sinus surgery mainly for the treatment of chronic rhinosinusitis. Based on the objectives of this study, the studies were categorized within four main groups; sinus disorders, diagnosis, management, and treatment. In this regard, wide research has been done in various scientific databases of PubMed, EMBASE, Europe PMC, HubMed, MEDLINE, Scientific Information Database (SID) and Google Scholar. From a total of 315 founded records, the final number of 91 records were reviewed. The rate of complication associated with endoscopic sinus surgery is not much and the improvement of surgical technology and experience could decrease its side effects. Performing immediate extensive surgery among patients who have inflammatory sinonasal disease could modify long-term consequences. Applying endoscopic sinus surgery could yield the most appropriate positive outcomes. For achieving the most suitable surgical consequences, the surgeon should be adequately qualified in diagnosis and facing with any possible complications during the operation in addition to cases with complex and revision problems.
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Yang X, Shen S, Deng Y, Wang C, Zhang L. Air Pollution Exposure Affects Severity and Cellular Endotype of Chronic Rhinosinusitis With Nasal Polyps. Laryngoscope 2021; 132:2103-2110. [PMID: 34870326 DOI: 10.1002/lary.29974] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 11/16/2021] [Accepted: 11/24/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS Air pollution has emerged as an important environmental risk factor for chronic rhinosinusitis (CRS) progression. This study assessed exposure to five types of air pollution (PM2.5/10 , SO2 , NO2 , CO, O3 ) and explored their effects on CRS with nasal polyps (CRSwNP) severity and endotype. STUDY DESIGN Retrospective cohort study. METHODS Air pollution data from monitoring sites in Beijing were obtained to assess individual air pollution exposure. Outcomes of CRSwNP (n = 282) including Lund-Mackay (L-M) score, Lund-Kennedy (L-K) score, visual analogue scale (VAS) score and nasal patency/airflow resistance and so on were measured to analyze correlations with air pollution and compare groups with different exposure types. Multivariable-adjusted binary logistic regression was used to determine potential air pollution risk factors of the endotype of eosinophilic CRSwNP (ECRSwNP). RESULTS Short-term exposures to PM2.5/10 , SO2 , CO, NO2 , and O3 were weak but significantly associated with increased L-M scores. Short-term exposures to PM10 , CO, and NO2 were correlated with increased VAS headache/facial pain scores. The L-M scores of the group of the highest PM2.5 (≥150 μg/m3 ) exposure were significantly higher than those of control group. For each increased unit of the average concentration of PM2.5 , there was a 1.047-fold (95% confidence interval, 1.005-1.091) increased risk of the endotype of ECRSwNP. CONCLUSIONS Air pollution exposure exacerbated CRSwNP severity and PM2.5 could be a risk factor for endotype of ECRSwNP, suggesting the role of air pollution in CRSwNP pathogenesis. LEVEL OF EVIDENCE 4 Laryngoscope, 2021.
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Affiliation(s)
- Xiaozhe Yang
- Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China.,Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Shen Shen
- Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China.,Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yuzhoujia Deng
- Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, China.,Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Chengshuo Wang
- Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China.,Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Luo Zhang
- Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China.,Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Felisati E, Saibene AM, Borloni R, Prades JM, Felisati G. Mini-Invasive Endoscopic Approaches to the Maxillary Sinus Floor: A Comparative Anatomical Study. Am J Rhinol Allergy 2020; 35:467-473. [PMID: 33023295 DOI: 10.1177/1945892420964096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND While middle antrostomy (MA) is the most common approach to the maxillary sinus (MS), it is known for not allowing to fully inspect the whole MS, especially in its inferior and anterior portions. To overcome this limitation, alternative approaches have been proposed, such as inferior antrotomy (IA) and canine fossa accesses (CFA). OBJECTIVE Given the lack of studies on the MS floor visualization with different accesses, our study aims, in a cadaver lab setting, to systematically compare three different approaches (MA, IA and CFA) in these regards. METHODS Eight cadaver heads, previously submitted to CTscan, were prepared inserting fixtures corresponding to teeth 2, 4, 6, 11, 13 and 15 and into the canine fossae. Three approaches were prepared: a wide MA, an IM and a CFA. We endoscopically evaluated, for each specimen, side, access type and scope angle (0°, 30°, 45°, and 70°), which fixtures were visible on the maxillary sinus floor and whether the canine fossa fixture was visible (MA and IA only). RESULTS IA allowed to visualize all fixtures in nearly all cases (14/16 with 70° endoscope), while MA showed poor visualization results (3/16 with 70° endoscope); CFA failed to gain full visualization in most specimens (7/16 with 70°endoscope). Such difference was statistically significant. MA proved unable to visualize the canine fossa fixture in most cases while IA showed excellent possibilities. All differences were statistically significant (p < .001, Mcnemar's test). CONCLUSIONS Our data show that the IA grants a statistically significant superior surgical field vision when compared to MA and CFA, though in vivo validation of these results is still required.
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Affiliation(s)
- Elena Felisati
- Otolaryngology Unit, University of Jean Monnet, Saint Etienne, France
| | - Alberto Maria Saibene
- Otolaryngology Unit, ASST Santi Paolo and Carlo, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Roberto Borloni
- Otolaryngology Unit, ASST Santi Paolo and Carlo, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Jean Michel Prades
- Otolaryngology Unit, University of Jean Monnet, Saint Etienne, France.,Departement of Anatomy, University of Jean Monnet, Saint Etienne, France
| | - Giovanni Felisati
- Otolaryngology Unit, ASST Santi Paolo and Carlo, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
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Schalek P. Extent of surgery in chronic rhinosinusitis: primarily focused on nasal polyposis. ACTA ACUST UNITED AC 2017. [DOI: 10.17352/2455-1759.000060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Lou Z. Multifactorial assessment is essential to maximize the likelihood of good outcomes after endoscopic dacryocystorhinostomy. Eur Arch Otorhinolaryngol 2017; 274:4261-4262. [DOI: 10.1007/s00405-017-4685-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 07/19/2017] [Indexed: 10/19/2022]
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Sireci F, Nicolotti M, Battaglia P, Sorrentino R, Castelnuovo P, Canevari FR. Canine fossa puncture in endoscopic sinus surgery: report of two cases. Braz J Otorhinolaryngol 2017; 83:594-599. [PMID: 28400177 PMCID: PMC9444727 DOI: 10.1016/j.bjorl.2017.03.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 01/29/2017] [Accepted: 03/01/2017] [Indexed: 11/17/2022] Open
Abstract
Introduction Chronic rhinosinusitis with nasal polyposis is a common chronic disease that often affects maxillary sinus. Endoscopic sinus surgery is the most common procedure for treating the majority of maxillary sinus lesions. Objective To demonstrate the role of canine fossa puncture during endoscopic sinus surgery procedure in patients with severe maxillary sinus disease. Methods We present 2 cases where canine fossa puncture has been performed as method to obtain a complete access to the maxillary antrum. Results According our experience, 2 cases on 296 endoscopic sinus surgery (0.6%) where antrostomy and used of angled microdebrider were not sufficient, canine fossa puncture has been performed as an alternative method to obtain a complete access to the maxillary antrum. Conclusion Although the advent of endoscopic sinus surgery, our cases support the fact that actually canine fossa puncture is a minimally invasive technique useful in selected cases.
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Affiliation(s)
- Federico Sireci
- University of Palermo, Department of Experimental Biomedicine and Clinical Neurosciences (BioNeC), Otorhinolaryngology Section, Palermo, Italy.
| | - Matteo Nicolotti
- SS Antonio Biagio e Cesare Arrigo Hospital, Otorinolaryngology Section, Alessandria, Italy
| | - Paolo Battaglia
- University of Insubria, Department of Otorhinolaryngology, Varese, Italy
| | - Raffaele Sorrentino
- SS Antonio Biagio e Cesare Arrigo Hospital, Otorinolaryngology Section, Alessandria, Italy
| | - Paolo Castelnuovo
- University of Insubria, Department of Otorhinolaryngology, Varese, Italy
| | - Frank Rikki Canevari
- SS Antonio Biagio e Cesare Arrigo Hospital, Otorinolaryngology Section, Alessandria, Italy
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Bikhazi N, Light J, Truitt T, Schwartz M, Cutler J. Standalone Balloon Dilation versus Sinus Surgery for Chronic Rhinosinusitis: A Prospective, Multicenter, Randomized, Controlled Trial with 1-year Follow-up. Am J Rhinol Allergy 2014; 28:323-9. [DOI: 10.2500/ajra.2014.28.4064] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background The objective of this prospective, multicenter, randomized trial was to evaluate and compare 1-year outcomes from the REMODEL study between office balloon dilation and functional endoscopic sinus surgery (FESS). Methods Adults with maxillary chronic rhinosinusitis (CRS), including those with anterior ethmoid disease, who failed medical management and were surgical candidates for FESS, underwent either standalone balloon dilation or FESS in a 1:1 randomization scheme and were followed through a minimum of 1 year. Sinonasal symptom improvement was assessed using the validated 20-item Sino-Nasal Outcome Test (SNOT-20) survey. Standardized effect sizes were computed to further assess clinical significance. Ostial patency rate, rhinosinusitis episode frequency, impact of sinus disease on activity and work productivity using the validated Work Productivity and Activity Impairment survey, complications, and revision rate were also compared between the two groups. Results Ninety-two patients (50 balloon dilation; 42 FESS) were treated and 89 (96 %) completed 1-year follow-up. Both groups showed clinically meaningful and statistically significant (p < 0.0001) improvement in mean overall SNOT-20 scores and in all four SNOT-20 subscales. The 1-year mean change in SNOT-20 after balloon dilation (-1.64) was noninferior to FESS (-1.65; p < 0.001). The standardized effect size was large, showing clinically significant improvement for both interventions. Ostial patency was 96.7 and 98.7% after balloon dilation and FESS, respectively, and each group reported significant reductions (p < 0.0001) in rhinosinusitis episodes (mean decrease, 4.2 for balloon dilation and 3.5 for FESS). Overall work productivity and daily activity impairment due to chronic sinusitis were significantly improved (p < 0.001) in both groups. There were no complications and revision surgery rate was 2% in each arm through 1 year. Conclusion With 1-year follow-up, standalone balloon dilation is as effect as FESS in the treatment of CRS in patients with maxillary sinus disease with or without anterior ethmoid disease who failed medical therapy and met the criteria for medically necessary FESS.
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Affiliation(s)
| | - Joshua Light
- Ear, Nose, and Throat Associates of South Florida, Boynton Beach, Florida
| | | | - Michael Schwartz
- Ear, Nose, and Throat Associates of South Florida, West Palm Beach, Florida
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Byun JY, Lee JY. Canine fossa puncture for severe maxillary disease in unilateral chronic sinusitis with nasal polyp. Laryngoscope 2013; 123:E79-84. [PMID: 23794185 DOI: 10.1002/lary.24274] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/30/2013] [Accepted: 05/30/2013] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate the efficacy of canine fossa puncture (CFP) by comparing patients with unilateral chronic rhinosinusitis (CRS) accompanying nasal polyposis (NP) who underwent CFP with those who underwent maxillary sinus clearance through a middle meatal antrostomy (MMA). STUDY DESIGN Prospective randomized study. METHODS Twenty-nine patients were randomly assigned to the CFP and MMA groups. Preoperative computed tomography (CT) established that all patients had severely diseased maxillary sinuses. Subjective outcomes were evaluated preoperatively and at 3, 6, and 12 months postoperatively using the Sino-Nasal Outcome Test 20 (SNOT-20) and a visual analogue scale (VAS). Additionally, mucosal thickening was measured as a percentage of total maxillary sinus volume on CT images taken 12 months postoperatively. RESULTS Twenty-five patients who completed the follow-up, questionnaires, and postoperative CT evaluation were included in the analysis. SNOT-20 and VAS scores improved significantly at 3, 6, and 12 months postprocedure in both groups. However, significant improvement of SNOT-20 at 12 months and VAS scores for purulent discharge, foul odor, and postnasal drip at 6 and 12 months were observed in the CFP group compared with the MMA group. In addition, the volume of mucosal thickening was significantly greater in the MMA group than in the CFP group on postoperative CT images. CONCLUSIONS CFP is a useful method for the removal of severe maxillary mucosal disease that cannot be reached through MMA, and is superior to conventional MMA for improving subjective and objective outcomes in patients with unilateral CRS accompanying NP.
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Affiliation(s)
- Jang Yul Byun
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, South Korea
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Five 'nontraditional' techniques for use in patients with recalcitrant sinusitis. Curr Opin Otolaryngol Head Neck Surg 2013; 21:39-44. [PMID: 23262744 DOI: 10.1097/moo.0b013e32835bf65b] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Although endoscopic sinus surgery remains the mainstay of surgical approaches to treating paranasal sinus disease, some disease may require alternative approaches. We review here five techniques: endoscopic middle turbinectomy, maxillary sinoscopy, the Caldwell-Luc procedure, intranasal inflammatory polyp steroid injection, and frontal sinus trephine. RECENT FINDINGS Recent findings suggest that endoscopic sinus surgery is limited in certain cases to access particular anatomic sites that may contain disease. The anterior, inferior maxillary wall and the frontal sinus may be accessed externally with minimal morbidity, and this access may be critical to treating the disease. The middle turbinate can contribute to preoperative and postoperative obstruction of sinus drainage, and resection of it can benefit the patient in many ways. Finally, the management of intranasal inflammatory polyps remains a challenge. In both preoperative and postoperative patients, the polyps may not respond to standard and even aggressive topical therapies. Intrapolyp steroid injection can provide a substantial anti-inflammatory effect and may avoid surgery for some patients. SUMMARY This article will review five ancillary procedures that add to the rhinologist's skill set to treat difficult or recalcitrant paranasal sinus disease.
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13
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[Rhinosinusitis guidelines--unabridged version: S2 guidelines from the German Society of Otorhinolaryngology, Head and Neck Surgery]. HNO 2012; 60:141-62. [PMID: 22139025 DOI: 10.1007/s00106-011-2396-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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14
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CT anatomy of the anterior superior alveolar nerve canal: a macroscopic and microscopic study. Oral Radiol 2011. [DOI: 10.1007/s11282-011-0067-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Feldt BA, McMains KC, Weitzel EK. Cadaveric comparison of canine fossa vs transnasal maxillary sinus access. Int Forum Allergy Rhinol 2011; 1:183-6. [PMID: 22287370 DOI: 10.1002/alr.20022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Revised: 09/07/2010] [Accepted: 10/11/2010] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Anatomic limitations complicate complete eradication of debris from the maxillary sinus using an exclusively transnasal (TN) endoscopic technique. Creation of a canine fossa trephination (CFT) permits a more direct approach than removal via the maxillary ostium. METHODS Microdebrider eradication of debris completely filling the maxillary sinus was performed on 5 thawed fresh-frozen cadaver heads (10 sides) using a TN or CFT approach. Postdebridement computed tomography (CT) scanning assessed remaining debris. Additional outcome measures included time of debris removal, number of different angled blades utilized, and clogging. RESULTS A significantly greater amount of debris was left after the TN approach compared with CFT (3.88 cm(3) vs 2.88 cm(3), p = 0.015). Median blade utilization was significantly higher with the TN approach vs CFT (4 vs 1, p < 0.002). Time for debris eradication with CFT was similar regardless of expertise (323.4 vs 272.4 seconds, p = 0.21), but the TN approach showed a statistical difference in time-to-completion (698.8 vs 438.51 seconds, p = 1.7 × 10(-5)). CONCLUSION Controversy surrounds the appropriate application of CFT due to disease process and approach-related morbidity. Rhinologists should have numerous well-studied options at their disposal. This model suggests that maxillary debris removal is accomplished more thoroughly with fewer microdebrider blades when a CFT approach is employed.
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Affiliation(s)
- Brent Alan Feldt
- Department of Otolaryngology Head and Neck Surgery, San Antonio Military Medical Center, Lackland AFB, TX, USA
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Robey A, O'Brien EK, Leopold DA. Assessing current technical limitations in the small-hole endoscopic approach to the maxillary sinus. Am J Rhinol Allergy 2011; 24:396-401. [PMID: 21244743 DOI: 10.2500/ajra.2010.24.3486] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Endoscopic sinus surgery has evolved to become the standard surgical approach to address paranasal sinus disease. To access inflammatory mucosal disease and other benign processes, it is desirable to reach all parts of the maxillary sinus. This project explores the combination of three medial wall small-hole antrostomies with multiple angled microdebrider blades to determine if an ideal combination exists. A prospective cadaveric study was performed. METHODS Each 3.5-mm blade was passed through the natural ostium and two separate inferior meatal antrostomies. The space reached by the tip of four different microdebrider blades (12, 60, 90 and 120°) within each maxillary sinus was mapped using an image guidance system. Percent volume of the sinus reached and access to subsites were determined. RESULTS Regardless of instrument or antrostomy combination, mean percent volume of maxillary sinus reached was 28% (range, 24-34%). The anterior wall was rarely reached by any combination, with the best blade/antrostomy combination (90° blade/anterior inferior antrostomy) only reaching 28% of the anterior wall. Likewise, the floor of the maxillary sinus was also poorly reached in general. The lateral and posterior maxillary sinus walls were most reliably reached with the roof and medial walls being intermediate. CONCLUSION Using the endoscopic small-hole approach to the maxillary sinus results in <⅓ of the sinus being routinely reached regardless of antrostomy or angled microdebrider instrument selected. Further study and development of new technologies to more thoroughly reach benign processes within the maxillary sinus via a small-hole approach is warranted.
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Affiliation(s)
- Ashley Robey
- Department of Otolaryngology–Head & Neck Surgery, University of Nebraska Medical Center, Omaha, 68198-1225, USA.
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Albu S, Gocea A, Necula S. Simultaneous inferior and middle meatus antrostomies in the treatment of the severely diseased maxillary sinus. Am J Rhinol Allergy 2011; 25:e80-5. [PMID: 21199596 DOI: 10.2500/ajra.2011.25.3592] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Although the majority of the maxillary pathology can be eradicated through the enlarged middle meatus antrostomy (MMA), some patients have extensive disease that is difficult to cope with. The aim of this study was to estimate the usefulness of simultaneous middle and inferior meatal antrostomies (MIMAs) in cases with severely diseased maxillary sinus by comparing the subjective and objective outcomes between patients that underwent MIMA and those who experienced maxillary clearance through conventional MMA. METHODS A prospective study was performed on patients with nasal polyps and severely diseased maxillary sinus (Lund-Mackay CT score = 2). All diseased sinuses were addressed with the same endoscopic sinus surgery technique; the only difference consisted of the management of the maxillary sinus: 34 patients underwent MIMAs and in 38 cases maxillary sinus was approached solely through the MMA. After 12 months of follow-up, outcomes consisted of the visual analog scale (VAS) for the main symptoms, the Lund-Mackay and maxillary sinus endoscopic scores, and the percent of airspace occluded by inflammatory mucosal thickening on CT. RESULTS Subjective improvement in VAS scores for nasal obstruction, facial pain, and nasal discharge/retronasal drip was significantly better in the MIMA group. The mucosal thickening as expressed by the CT scan and maxillary endoscopic score was significantly reduced in the MIMA group. CONCLUSION The MIMA technique is useful for removing severe disease that can not be reached through the MMA and yields both better subjective and better objective outcomes. The additional inferior antrostomy most likely improves drainage and ventilation in the postoperative period.
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Affiliation(s)
- Silviu Albu
- Second Department of Otolaryngology, University of Medicine and Pharmacy Cluj-Napoca, Romania.
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Seiberling K, Ooi E, MiinYip J, Wormald PJ. Canine fossa trephine for the severely diseased maxillary sinus. Am J Rhinol Allergy 2010; 23:615-8. [PMID: 19958612 DOI: 10.2500/ajra.2009.23.3373] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The appropriate surgical approach to the severely diseased maxillary sinus is still debatable. Some advocate creating a wide maxillary antrostomy to allow for increased ventilation and improved delivery of postoperative medication. Others, however, recommend more aggressive surgery with complete clearance of all diseased tissue. The aim of this study was to evaluate the outcome of canine fossa puncture and canine fossa trephine (CFT) for the severely diseased maxillary sinus. METHODS A retrospective chart review was performed on 97 patients who underwent a CFT as a part of endoscopic sinus surgery or modified Lothrop procedure. Outcomes were measured in terms of the maxillary sinus endoscopy grade at last follow-up and need for revision surgery. Two groups were formed: those who experienced recurrence of disease and those who were disease free at last follow-up. A comparison was made between the two groups and differences were noted. RESULTS A CFT was performed in 97 patients with nasal polyposis (NP) who had an average number of 2.38 previous sinus surgeries. At an average follow-up of 27.8 months, 80 of the patients were disease free. In 17 patients disease recurred, and 11 of those required revision surgery with a CFT. Those patients who had recurrence of disease tended to be more allergic, have higher Lund-Mackay score, and had an increased number of prior sinus surgeries. In addition, allergic fungal sinusitis was associated with a poorer prognosis after CFT. CONCLUSION CFT allows for complete clearance of all gross disease in the maxillary sinus. CFT decreases the chance of disease recurrence in patients with severe NP.
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Affiliation(s)
- Kristin Seiberling
- Department of Surgery-Otolaryngology, University of Adelaide, South Australia, Australia
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Lee JY, Baek BJ, Kim DW, Byun JY, Lee SW, Hong HS. Changes in the maxillary sinus volume and the surgical outcome after the canine fossa puncture approach in pediatric patients with an antrochoanal polyp: results of a minimum 3-year follow-up. Am J Rhinol Allergy 2009; 23:531-4. [PMID: 19807989 DOI: 10.2500/ajra.2009.23.3353] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND An antrochoanal polyp (ACP) originates from the maxillary antrum and simple excision results in high recurrence rates. Canine fossa puncture (CFP) has been proposed as an alternative method of accessing the entire maxillary antrum. To investigate the long-term effects of the CFP approach on changes in the maxillary sinus volume in pediatric patients with an ACP, we compared the sinus volume on the operated and normal sides, using preoperative computed tomography (CT), and postoperative CT performed at least 3 years after the procedure. The surgical outcomes were also assessed using endoscopic and CT findings. METHODS Seven patients met the inclusion criteria and the ACP was removed via the CFP approach. After a mean follow-up period of 43.9 months, we compared the changes in the maxillary sinus volume between the operated and normal sides, using the pre- and postoperative CT data. RESULTS No contractures or decrease in the maxillary sinus volume on the diseased side were observed in any of the patients on postoperative CT, and the average volume of both maxillary sinuses was greater on postoperative CT compared with the preoperative scans. None of the patients showed evidence of recurrence on the endoscopic and CT examinations. CONCLUSION CFP did not affect the maxillary sinus volume in pediatric patients with an ACP and led to a successful surgical outcome in all of the patients. Based on these results, we recommend CFP as a safe, effective method for the treatment of ACP.
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Affiliation(s)
- Jae Yong Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, South Korea.
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Tan NCW, Floreani SR, Robinson S, Nair S, Sunkaraneni VS, Faris C, Wormald PJ. Transillumination-assisted maxillary trephination: cadaver validation of a new technique. Laryngoscope 2009; 119:984-7. [PMID: 19266581 DOI: 10.1002/lary.20154] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Neil C-W Tan
- Department of Surgery-Otolaryngology Head and Neck Surgery, University of Adelaide, Adelaide, Australia
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Regan EN. Diagnosing rhinitis: viral and allergic characteristics. Nurse Pract 2008; 33:20-27. [PMID: 18941386 DOI: 10.1097/01.npr.0000335565.56896.d9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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