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Kolak M, Kızılgöz V, Kantarci M. Examination of ethmoidal roof regarding Keros and Yenigun classifications in a Turkish population: a computerized tomography study. Surg Radiol Anat 2024; 46:19-25. [PMID: 38062267 DOI: 10.1007/s00276-023-03270-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/14/2023] [Indexed: 01/13/2024]
Abstract
PURPOSE Understanding ethmoid roof morphology is crucial to prevent complications in endoscopic sinus surgery. This study aimed to evaluate the morphological properties of the ethmoidal roof regarding gender and age differences using Keros and Yenigun classifications on high-resolution computed tomography images. METHODS We retrospectively analyzed 891 high-resolution computed tomography paranasal sinus study images and measured the depth of the cribriform plate in coronal sections and the anterior-posterior length in axial planes. The study retrospectively examined CT images of paranasal sinuses of patients living in the eastern Anatolian region of Turkey. RESULTS In both Keros and Yenigun Classifications, the most common class was type 2, and the least common class was type 3. According to Keros et al.'s method, no significant difference was observed between men and women (p = 0.698). However, according to Yenigun et al., the average values of women in terms of the anterior-posterior distance of the ethmoid roof were significantly higher than men (p = 0.001). When examined according to age, a very low, negative correlation was revealed regarding Keros and Yenigun classifications (p = 0.047 and p < 0.001 retrospectively). According to Keros and Yenigun's classification, there was no significant difference between the left and right sides (p = 0.488 and p = 0.919, respectively). CONCLUSION The morphological properties of the ethmoidal roof have importance to be considered for preoperative planning. Studying larger patient groups and meta-analyses that gather various research results about this subject might help better understand the ethmoidal roof morphology among populations.
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Affiliation(s)
- Merve Kolak
- Oral and Dental Health Training and Research Hospital, Erzincan Binali Yıldırım University, 24100, Erzincan, Turkey.
| | - Volkan Kızılgöz
- Department of Radiology, Faculty of Medicine, Erzincan Binali Yıldırım University, 24100, Erzincan, Turkey
| | - Mecit Kantarci
- Department of Radiology, Faculty of Medicine, Erzincan Binali Yıldırım University, 24100, Erzincan, Turkey
- Department of Radiology, Faculty of Medicine, Atatürk University, 25240, Erzurum, Turkey
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Makihara S, Uraguchi K, Naito T, Shimizu A, Murai A, Higaki T, Noda Y, Kariya S, Okano M, Ando M. Risk Factors for Anterior Skull Base Injury in Endoscopic Sinus Surgery. Cureus 2023; 15:e49273. [PMID: 38143696 PMCID: PMC10746922 DOI: 10.7759/cureus.49273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2023] [Indexed: 12/26/2023] Open
Abstract
Objectives This retrospective study aimed to investigate the relationships between the Keros classification, the Gera classification, the vertical height of the posterior ethmoid roof (ER), and anterior ethmoidal artery (AEA) types in Japanese patients. Methods We investigated the computed tomography (CT) slices of paranasal sinuses (120 sides) of 60 patients; measured the cribriform plate (CP) depth, lateral lamella CP angle (LLCPA), and vertical height of the lateral ER from the hard palate (LERHP) at the coronal plane of the posterior ethmoidal artery (PEA); and reviewed the AEA types, whether floating or non-floating. Results CP depth was positively correlated with LLCPA (r=0.63; p<0.01) and the height of LERHP (r=0.19; p<0.05). The height of the LERHP in females was significantly lower than that in males. With increased CP depth, floating AEAs became prevalent (p<0.001). Conclusion In females, low height of the posterior ethmoid sinus roof, where cerebrospinal fluid (CSF) leaks occurred while penetrating the basal lamella, often existed; the heights positively correlated with the Keros classification in Japanese patients. The Keros and Gera classifications, AEA type, and posterior ER height do not individually constitute a complete risk assessment but may correlate, preventing major complications, such as CSF leak and orbital hemorrhage.
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Affiliation(s)
- Seiichiro Makihara
- Otolaryngology-Head and Neck Surgery, Okayama University Hospital, Okayama, JPN
| | - Kensuke Uraguchi
- Otolaryngology-Head and Neck Surgery, Okayama University Hospital, Okayama, JPN
| | - Tomoyuki Naito
- Otolaryngology-Head and Neck Surgery, Kagawa Rosai Hospital, Marugame, JPN
| | - Aiko Shimizu
- Otolaryngology-Head and Neck Surgery, Okayama University Hospital, Okayama, JPN
| | - Aya Murai
- Otolaryngology-Head and Neck Surgery, Okayama University Hospital, Okayama, JPN
| | - Takaya Higaki
- Otolaryngology-Head and Neck Surgery, Okayama University Hospital, Okayama, JPN
| | - Yohei Noda
- Otolaryngology-Head and Neck Surgery, Fukuyama City Hospital, Fukuyama, JPN
| | - Shin Kariya
- Otolaryngology, Kawasaki Medical School, Kurashiki, JPN
| | - Mitsuhiro Okano
- Otolaryngology, School of Medicine, International University of Health and Welfare, Narita, JPN
| | - Mizuo Ando
- Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama, JPN
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A computed tomography study on the olfactory fossa in dried skulls. Surg Radiol Anat 2022; 44:925-932. [PMID: 35543750 DOI: 10.1007/s00276-022-02949-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 04/13/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The computed tomography (CT) study investigates the olfactory fossa (OF) morphometry and morphology. METHODS Fifty Greek adult dried skulls were macroscopically investigated for the detection of the OF morphological patterns and after a multiplanar CT reconstruction, the OF morphometry was accurately calculated using a digital ruler. RESULTS Types I and II surface contour patterns were the most frequently identified (36 and 32%), followed by types III, IV, and V (16, 12, and 4%). Crista galli mean length, height, and width were 19.46 ± 2.34 mm, 12.69 ± 2.7 mm, and 5.18 ± 1.11 mm. The OF mean maximum length was 22.29 ± 2.16 mm on the right and 22.10 ± 2.44 mm on the left side, and symmetry was detected. The OF median values of the maximum depth for its anterior, middle, and posterior third were 4.91 mm, 4.72 mm, and 2.78 mm on the right and 4.55 mm, 4.75 mm, and 2.55 mm on the left side. Symmetry was observed in any third of the OF. The OF median values of the surface maximum width for the anterior, middle, and posterior thirds were 9.29 mm, 11.48 mm, and 13.07 mm. A significant gradual increase of the OF surface maximum width was detected in the anteroposterior direction in the total sample (p < 0.001), with the highest value (23.12 mm) in the posterior third. A significant (p < 0.001) very strong (rs = -0.798) and a moderate (rs = -0.524) negative linear correlation in the OF anterior and middle third were, respectively, identified between its maximum depth and width. No gender impact was identified. CONCLUSIONS The study helps to familiarize with the calculation of the OF dimensions and simplifies the understanding of its complex anatomy, to reach successful surgical planning and minimize perioperative complications.
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Almushayti ZA, Almutairi AN, Almushayti MA, Alzeadi HS, Alfadhel EA, AlSamani AN. Evaluation of the Keros Classification of Olfactory Fossa by CT Scan in Qassim Region. Cureus 2022; 14:e22378. [PMID: 35321069 PMCID: PMC8935634 DOI: 10.7759/cureus.22378] [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] [Accepted: 02/18/2022] [Indexed: 11/25/2022] Open
Abstract
Objective Endoscopic sinus surgery (ESS) is now the most often utilized surgical procedure for treating chronic sinonasal disorders. Therefore, anatomical knowledge of its variations is required to avoid serious postoperative complications. Thus, careful preoperative examination for patients with a paranasal sinus CT scan is necessary. Our study aims to evaluate Keros types and their incidence by evaluating the olfactory fossa (OF) depth according to the Keros classification on paranasal sinus CT scans in the Qassim region. Methods A cross-sectional study was conducted between January 2018 and January 2021 on 148 patients with an average age of 32.59 ± 6.1 who had a non-enhanced paranasal sinus CT scan evaluated by a consultant radiologist using the PACS (picture archiving and communication system) software. Statistical analysis was performed using the statistical software package SPSS version 25 (IBM Corp., Armonk, NY). The chi-square test was used to analyze the relationship between findings and patient characteristics. Also, a p-value of < 0.05 was kept in mind to indicate statistical significance. Results The average depth of the right olfactory fossa (OF) was 5.1 mm with a standard deviation of 1.756 while it was 5.28 on the left side with a standard deviation of 1.66. According to the Keros classification, out of a total of 296 OF, type 1 was found in 84 (28.4%), type 2 in 188 (63.5%), and type 3 in 24 (8.1%). Consequently, the majority of cases were of type 2. Also, we found that type 2 was the most common on both sides in males, whereas, in females, type 2 was the most common on the left side and type 1 on the right side. Conclusion The study of the Keros classification is significantly important to evaluate the anatomy of the anterior skull base and give the surgeon knowledge about the depth of the olfactory fossa. Thus, a preoperative CT scan of the paranasal sinus is critical to ensure that the surgical approach is properly planned and possible surgical complications related to the anatomy of this area can be prevented. Our study showed that Keros type II is the most common, followed by type I and then type III.
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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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Tseng CC, Gao J, Barinsky GL, Grube JG, Fang CH, Eloy JA, Hsueh WD. Inpatient Sinus Surgery Patient Morbidity and Outcomes: A National Analysis. Laryngoscope 2021; 132:1523-1529. [PMID: 34581441 DOI: 10.1002/lary.29881] [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: 07/28/2021] [Revised: 08/25/2021] [Accepted: 09/13/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS To investigate the morbidity and mortality of patients undergoing endoscopic sinus surgery (ESS) in the inpatient setting. STUDY DESIGN Retrospective database review. METHODS The Nationwide Inpatient Sample was queried for all ESS between 2008 and 2014. Using All Patients Refined Diagnosis Related Groups (APR-DRG) codes, cases with APR-DRG codes under Major Diagnostic Category 3 (Diseases and Disorders of the Ear, Nose, Mouth, and Throat) were designated as patients with primary otolaryngology diagnoses undergoing ESS (ORL), and all other codes were designated as patients with non-otolaryngology pathologies as their primary reason for admission but undergoing ESS (non-ORL). A univariate analysis and a logistic regression were used to compare patient demographics, comorbidities, disease severity, and mortality. RESULTS There were 8,305 ORL patients and 6,342 non-ORL patients. ORL patients were more likely to be elective admissions (61.3% vs. 48.5%, P < .001), have a deviated nasal septum (17.9% vs. 12.3%, P < .001), nasal polyps (15.8% vs. 5.0%, P < .001), obstructive sleep apnea (10.7% vs. 5.2%, P < .001), and pulmonary disease (15.9% vs. 10.5%, P < .001). Non-ORL patients had a higher likelihood of in-hospital mortality (odds ratio [OR] 6.22, 95% confidence interval [CI] 3.29-11.78, P < .001), length of stay in the highest quartile (OR 2.43, 95% CI 2.16-2.74, P < .001), and a higher proportion had APR-DRG subclasses indicating extreme severity of illness (19.3% vs. 4.3%, P < .001) or extreme risk of mortality (12.5% vs. 2.0%, P < .001). CONCLUSION Patients undergoing ESS in the inpatient setting have a higher than expected mortality rate which can be associated with a non-otolaryngology pathology as the primary reason for their admission. LEVEL OF EVIDENCE 4 Laryngoscope, 2021.
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Affiliation(s)
- Christopher C Tseng
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Jeff Gao
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Gregory L Barinsky
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Jordon G Grube
- Department of Otolaryngology, Albany Medical Center, Albany, New York, U.S.A
| | - Christina H Fang
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, The University Hospital of Albert Einstein College of Medicine, Bronx, New York, U.S.A
| | - Jean A Eloy
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Department of Otolaryngology and Facial Plastic Surgery, Saint Barnabas Medical Center, RWJBarnabas Health, Livingston, New Jersey, U.S.A
| | - Wayne D Hsueh
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
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AKTUNA BELGİN C, BAYRAK S, ORHAN K. Evaluation of The Ethmoid Bone Using by Cone Beam Computed Tomography In Turkish Subpopulation. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2021. [DOI: 10.33808/clinexphealthsci.732867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Pagella F, Emanuelli E, Benazzo M, Pusateri A, Ugolini S, Melegatti M, Ciorba A, Pelucchi S. Are sinonasal dissection courses a valid instrument for endoscopic sinus surgeons? A report on 7-years of experience. ACTA ACUST UNITED AC 2021; 40:415-420. [PMID: 33558769 PMCID: PMC7889255 DOI: 10.14639/0392-100x-n0705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 05/30/2020] [Indexed: 11/23/2022]
Abstract
Sinonasal dissection courses have been reported to be effective in teaching sinonasal anatomy to trainees, and in improving surgical skills for trained surgeons. Between 2013 and 2019, a standardised structured questionnaire was handed out to 130 participants of 8 sinonasal dissection courses. Each questionnaire included questions about the medical equipment the surgeons were fitted, and the problems encountered during the dissection.The majority of the participants, regardless of their experience and age, considered uncinectomy and anterior ethmoidectomy as the simplest parts of the dissection, whereas the most complicated step was the approach to the frontal sinus. All participants considered the dissection course as a useful way to improve their medical skills while performing an endoscopic surgery procedure, such as their anatomical knowledge, and confidence with instrumentation and the dissection. Sinonasal dissection courses can be considered to be useful for both trainees and trained surgeons. Improving anatomical knowledge can reduce the occurrence of complications, especially in endoscopic surgery.
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Affiliation(s)
- Fabio Pagella
- ENT Department, I.R.C.C.S. Policlinico San Matteo-University of Pavia, Italy.,ENT Department, University of Pavia, Italy
| | - Enzo Emanuelli
- Department of Neuroscience, Institute of Otorhinolaryngology, University Hospital of Padova, Italy
| | - Marco Benazzo
- ENT Department, I.R.C.C.S. Policlinico San Matteo-University of Pavia, Italy.,ENT Department, University of Pavia, Italy
| | - Alessandro Pusateri
- ENT and Skull-Base Surgery Department, Department of Neurosciences, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Sara Ugolini
- ENT Department, I.R.C.C.S. Policlinico San Matteo-University of Pavia, Italy.,ENT Department, University of Pavia, Italy
| | - Michela Melegatti
- ENT & Audiology Unit, Department of Neuroscience and Rehabilitation, University Hospital of Ferrara, Italy
| | - Andrea Ciorba
- ENT & Audiology Unit, Department of Neuroscience and Rehabilitation, University Hospital of Ferrara, Italy
| | - Stefano Pelucchi
- ENT & Audiology Unit, Department of Neuroscience and Rehabilitation, University Hospital of Ferrara, Italy
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Evaluation of the Relationship Between Olfactory Fossa Measurements and Nasal Septum Deviation for Endoscopic Sinus Surgery. J Craniofac Surg 2020; 31:801-803. [PMID: 31934966 DOI: 10.1097/scs.0000000000006168] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Endoscopic sinus surgeries (ESS) are frequently used in the treatment of optic nerve decompression, other intracranial lesions and sinonasal pathologies. The olfactory fossa can be localized on different levels in relation to the anterior cranial fossa. The aim of the present study was to evaluate the depth and width of the olfactory fossa (OF) in relation to nasal septum deviation (NSD). METHODS A total of 225 patient (141 female and 84 male, age range between 15 to 56 years) of cone beam computed tomography (CBCT) data was used in this study. NSD, OF width, OF depth were measured. OF depth which was grouped according to the Keros classification as Type I, II, and III was calculated. All measurements were performed bilaterally except for NSD. RESULTS In the right and left OF depth were found Keros Type I 32 (14.2%) and 30 (13.3%), Keros Type II 171 (76%) and 167 (74.2%), and Keros Type III 22 (9.8%) and 28 (12.4%) respectively. There was no statistically significant found between OF depth and NSD (P > 0.05). The mean angle of the NSD in men and women were 4.36 ± 4.69 in women 4.11 ± 4.36, respectively. The mean width of the right OF was 2.50 ± 0.64 mm and 2.58 ± 0.72 mm for the left side and there was no statistically significant association between OF width - NSD and OF width - OF depth (P > 0.05). CONCLUSION The anatomy of the OF should be well established before surgical intervention increase of the length of the lateral lamella is also increases the risk of developing complications such as cerebral damage, hemorrhage, and cerebrospinal fluid fistula during endoscopic sinus surgery. Although there is no significant difference between OF measurement and NSD, with three-dimensional imaging detailed research is required before endoscopic sinus surgical operations.
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Olfactory Fossa and New Angle Measurements: Lateral Lamella-Cribriform Plate Angle. J Craniofac Surg 2020; 30:1911-1914. [PMID: 31343591 DOI: 10.1097/scs.0000000000005848] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES The authors investigated the olfactory fossa (OF) in patients with unilateral nasal septal deviation (NSD) and presented the lateral lamella-cribriform plate angle (LLCPA). METHODS Paranasal sinus computed tomography images of 300 adult subjects with unilateral NSD (111 males, 189 females) were evaluated retrospectively. Septal deviation angle (SDA), Keros Classification, OF depth and width, LLCPA; and orbital plate and cribriform plate (OPCP) distance were measured. RESULTS The OF depth values (ipsilateral, contralateral) were found as Keros III >Keros II >Keros I (Padjusted <0.0175). The OF width values (ipsilateral) were detected as Keros I >Keros II and Keros I >Keros III (Padjusted <0.0175). In patients with higher SDA values, ipsilateral OF depth values decreased (P <0.05). The LLCPA and OPCP values were higher in Keros I and lower in Keros III (P <0.05). CONCLUSION In patients with lower LLCPA and OPCP, endoscopic sinus surgery will be more dangerous for trauma to lateral lamella and intracranial penetration.
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Sakandar G, Haron J, Mohamad A, Mohamad I, Ramli RR. Adult and Pediatric Lateral Lamella Cribriform Plate Height: In Need for a Comparative Study. ALLERGY & RHINOLOGY 2019; 10:2152656719874775. [PMID: 31534825 PMCID: PMC6737862 DOI: 10.1177/2152656719874775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Surgery for sinuses has evolved with the advancement of instruments and modification in techniques. Endoscopes have expanded the surgical roles for lesions in the nose and para-nasal sinuses with reduced rate of complications and cosmetic side effects. Nevertheless sinus surgery in pediatrics patients has its own challenges. Pre-operative imaging is of paramount important especially when embarking on skull base procedures. The differences between adult and pediatric anatomy need to be further studied.
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Affiliation(s)
- Gilbert Sakandar
- Department of Radiology, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia
| | - Juhara Haron
- Department of Radiology, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia
| | - Adam Mohamad
- Department of Otorhinolaryngology-Head & Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia
| | - Irfan Mohamad
- Department of Otorhinolaryngology-Head & Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia
| | - Ramiza R Ramli
- Department of Otorhinolaryngology-Head & Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia
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V. AM, Santosh B. A Study of Clinical Significance of the Depth of Olfactory Fossa in Patients Undergoing Endoscopic Sinus Surgery. Indian J Otolaryngol Head Neck Surg 2017; 69:514-522. [PMID: 29238684 PMCID: PMC5714917 DOI: 10.1007/s12070-017-1229-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Accepted: 10/06/2017] [Indexed: 11/25/2022] Open
Abstract
The endoscope has revolutionized the diagnosis and treatment of diseases of the nose and paranasal sinuses. Endoscopic sinus surgery (ESS), like all minimally invasive surgery, is designed to combine an excellent outcome with minimal patient discomfort. Successful outcome with minimal complications can only be achieved with good knowledge of the endoscopic anatomy, appropriate training in the procedure and the understanding of the anatomical variations. The intraoperative complications of ESS are bleeding and injury to surrounding structures commonly the orbital structures and fovea ethmoidalis. This is a hospital based prospective observational study with an objective to define the distribution of Keros classification of the depth of olfactory fossa and its asymmetrical distribution rates based on Keros type. Prospective study in a tertiary rural based hospital. 100 patients above the age of 10 years from October 2013 to March 2015 for a period of one year six months undergoing endoscopic sinus surgery in the Department of ENT, P.E.S. Institute of Medical Sciences and Research, Kuppam were chosen randomly. The data was collected from these patients who will met the inclusion criteria of the study and before undergoing endoscopic sinus surgery by subjecting them to CT scan of paranasal sinuses. It is observed that a total of 100 patients had been studied in which the mean age of the population is 36.65 + 13.36 years. Youngest patient was 12 years old and eldest patient was 70 years old. Among the patients 50(50%) were males and remaining 50(50%) were females with a female to male ratio is 1:1. In the present study, the depth of olfactory fossa ranged from 2.1 to 8.3 mm inclusive of both sides in 200 CT images with a mean height of 5.21 mm. Of the 200 sides measured, the distribution of Keros classification is as the following-Keros type I 39(19.5%), Keros type II 143(71.5%) and Keros type III 18(9%) sides. Based on these observations, type II is the most common Keros type prevalent followed by type 1 Keros type and the least prevalent is the type III Keros type in the studied population. In the present study, on considering sides separately, the right side olfactory fossa depth ranged from 2.1 to 8.3 mm with a mean height of 5.43 mm and the left side olfactory fossa depth ranged from 2.1 to 8.1 mm with a mean height of 4.98 mm. On the right side, of 100 sides measured, the distribution of Keros classification is as the following-Keros type I 19(19%), Keros type II 68(68%) and Keros type III 13(13%) sides. On the left side, of 100 sides measured, the distribution of Keros classification is as the following-Keros type I 25(25%), Keros type II 70(70%) and Keros type III 5(5%) sides. Based on these observations, type II is the most common Keros type prevalent followed by type 1 Keros type and the least prevalent is the type III Keros type in the studied population on both sides. In the present study, out of 100 patients 23 patients were having asymmetric olfactory fossa between right and left sides based on Keros type, where as remaining 77% had symmetric Keros type on right and left sides. Out of 23 patients, 16 patients were having lower or deep olfactory fossa on right side, where as remaining 7 patients were having lower or deep olfactory fossa on left side. Based on these observations, a lower or deep ethmoid roof occurred more frequently on the right side than on the left side. Wilcoxon matched pair signed rank test is applied to see the significant difference between depth of right and left olfactory fossae. Since P value is < 0.001 the depth of olfactory fossa is significantly different from each other. The present study presents a precise, quantitative analysis of the olfactory fossa and ethmoid roof position as well as individual asymmetry. This information may be useful during pre-operative evaluation of CT images, as well as intraoperatively. The surgeon's understanding of the anatomy of a patient's ethmoid roof and its possible variations is crucial for countering possible complication risks during endoscopic sinus surgery.
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Affiliation(s)
- Ashok Murthy V.
- Department of ENT, PES Institute of Medical Science and Research, Kuppam, 517 425 India
| | - Bollineni Santosh
- Department of ENT, PES Institute of Medical Science and Research, Kuppam, 517 425 India
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Karabayirli S, Ugur KS, Demircioglu RI, Muslu B, Usta B, Sert H, Ark N. Surgical conditions during FESS; comparison of dexmedetomidine and remifentanil. Eur Arch Otorhinolaryngol 2016; 274:239-245. [PMID: 27470115 DOI: 10.1007/s00405-016-4220-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 07/18/2016] [Indexed: 11/29/2022]
Abstract
To compare dexmedetomidine with remifentanil in functional endoscopic sinus surgery (FESS) in regards to intra-operative bleeding, anesthetic consumption and post-operative recovery. Randomized, double blind study. Tertiary care medical center. Fifty patients with nasal polyposis who had been scheduled for FESS were randomly divided into two groups. In group D (n = 25), dexmedetomidine 1 µg/kg infused intravenous (IV) over 10 min before anesthesia induction, followed by a continuous of 0.7 µg/kg/h infusion during operation. In group R (n = 25), 1 µg/kg remifentanil IV bolus, was administered with induction of anesthesia and continued 0.25-0.50 µg/kg/min during operation. Heart rates, mean arterial pressure, end tidal CO2, end tidal sevoflurane were recorded. The amount of bleeding, surgical field condition for bleeding and the time to reach Aldrete recovery score 9-10 were recorded. Postoperative nausea, vomiting, pain, shivering, sedation were followed up over 24 h. There was no significant difference between groups according to the amount of bleeding during surgery, assessment of surgical field condition, consumption of sevoflurane, scores of postoperative VAS, rates of nausea and vomiting, shivering, demands of additional analgesic medication (P > 0.05). The time to reach Aldrete recovery score 9-10, sedation scores at the postoperative first hour were significantly higher in group D (P = 0.001). We concluded that in comparison to remifentanil, dexmedetomidine during FESS for controlled hypotension is of limited value as it has no additional benefits in terms of control of hypotension and amount of bleeding in the surgical field and it is associated with higher recovery time and first-hour postoperative sedation scores.
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Affiliation(s)
- Safinaz Karabayirli
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Turgut Ozal University, Alparslan Turkes Caddesi, No: 57, 06510, Emek, Ankara, Turkey.
| | - Kadriye Serife Ugur
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, Turgut Ozal University, Ankara, Turkey
| | - Ruveyda Irem Demircioglu
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Turgut Ozal University, Alparslan Turkes Caddesi, No: 57, 06510, Emek, Ankara, Turkey
| | - Bunyamin Muslu
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Turgut Ozal University, Alparslan Turkes Caddesi, No: 57, 06510, Emek, Ankara, Turkey
| | - Burhanettin Usta
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Turgut Ozal University, Alparslan Turkes Caddesi, No: 57, 06510, Emek, Ankara, Turkey
| | - Huseyin Sert
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Turgut Ozal University, Alparslan Turkes Caddesi, No: 57, 06510, Emek, Ankara, Turkey
| | - Nebil Ark
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, Turgut Ozal University, Ankara, Turkey
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Shama SA, Montaser M. Variations of the height of the ethmoid roof among Egyptian adult population: MDCT study. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2015. [DOI: 10.1016/j.ejrnm.2015.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Guney A, Kaya FN, Yavascaoglu B, Gurbet A, Selmi NH, Kaya S, Kutlay O. Comparison of esmolol to nitroglycerine in controlling hypotension during nasal surgery. Eurasian J Med 2015; 44:99-105. [PMID: 25610218 DOI: 10.5152/eajm.2012.23] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Accepted: 04/09/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The aim of this study was to compare esmolol to nitroglycerine in terms of effectiveness in controlling hypotension during nasal surgery. MATERIALS AND METHODS After approval by our institutional Ethics Committee, 40 patients were recruited and randomized into two drug groups: esmolol (Group E) and nitroglycerine (Group N). In group E, a bolus dose of 500 μg/kg esmolol was administered over 30 sec followed by continuous administration at a dose of 25-300 μg/ kg/min to maintain systolic arterial pressure at 80 mmHg. In group N, nitroglycerine was administered at a dose of 0.5-2 μg/kg/min. RESULTS During the hypotensive period, systolic arterial pressure, diastolic arterial pressure, mean arterial pressure, and heart rate were decreased 24%, 33%, 27% and 35%, respectively, in group E (p<0.001, p<0.001, p<0.001, p<0.001) and were decreased 30%, 33%, 34% and 23%, respectively, in group N (p<0.001, p<0.001, p<0.001, p<0.001). The decrease in heart rate was higher in group E during the hypotensive period (p=0.048). During the recovery period, diastolic arterial pressure and heart rate were decreased 9% and 18%, respectively, in group E (p=0.044, p<0.001). Systolic arterial pressure, diastolic arterial pressure, and mean arterial pressure were decreased 7%, 3% and 7%, respectively, in group N (p=0.049, p=0.451, p=0.045). CONCLUSION Esmolol provides hemodynamic stability and good surgical field visibility and should be considered as an alternative to nitroglycerine.
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Affiliation(s)
- Ayla Guney
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Fatma Nur Kaya
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Belgin Yavascaoglu
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Alp Gurbet
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Nazan Has Selmi
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Sener Kaya
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Oya Kutlay
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Uludag University, Bursa, Turkey
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Kaplanoglu H, Kaplanoglu V, Dilli A, Toprak U, Hekimoğlu B. An analysis of the anatomic variations of the paranasal sinuses and ethmoid roof using computed tomography. Eurasian J Med 2015; 45:115-25. [PMID: 25610263 DOI: 10.5152/eajm.2013.23] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 03/02/2013] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To determine the Keros classification and asymmetrical distribution rates of the ethmoid roof and the frequency of anatomic variations of the paranasal sinuses. MATERIALS AND METHODS Paranasal sinus scans of 500 patients obtained using computed tomography were evaluated retrospectively. Measurements were performed using a coronal plan with right-left comparison and with distance measurement techniques. The depth of the lateral lamella was calculated by subtracting the depth of the cribriform plate from the depth of the medial ethmoid roof. The results were classified according to their Keros classification. Any asymmetries in the ethmoid roof depth and fovea ethmoidalis configuration were examined. The anatomic variations frequently encountered in paranasal sinuses (pneumatized middle concha, paradoxical middle concha, agger nasi cells, Haller cells, Onodi cells, etc.) were defined. RESULTS The mean height of the lateral lamella cribriform plate (LLCP) was 4.92±1.70 mm. The cases were classified as 13.4% Keros Type I, 76.1% Keros Type II, and 10.5% Keros Type III. There was asymmetry in the LLCP depths of 80% of the cases, and a configuration asymmetry in the fovea in 35% of the cases. In 32% of the cases with fovea configuration asymmetry, there was also asymmetry in the height of the right and left LLCP. The most frequent variations were nasal septum deviation (81.8%), agger nasi cells (63.8%), intralamellar air cells (45%), and concha bullosa (30%). CONCLUSION Using the Keros classification for LLCP height, higher rates of Keros Type I were found in other studies than in our study. The most frequent classification was Keros Type II. The paranasal sinus variations in each patient should be carefully evaluated. The data obtained from these evaluations can prevent probable complications by informing rhinologists performing endoscopic sinus surgery about preoperative and intraoperative processes.
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Affiliation(s)
- Hatice Kaplanoglu
- Department of Radiology, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Veysel Kaplanoglu
- Department of Radiology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Alper Dilli
- Department of Radiology, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Ugur Toprak
- Department of Radiology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Baki Hekimoğlu
- Department of Radiology, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
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Armengot-Carceller M, Hernandez-Sandemetrio R. Endocranial Complications of Endoscopic Sinus Surgery: Learning from Experience. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/ijohns.2014.35053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Re M, Magliulo G, Romeo R, Gioacchini FM, Pasquini E. Risks and medico-legal aspects of endoscopic sinus surgery: a review. Eur Arch Otorhinolaryngol 2013; 271:2103-17. [PMID: 23942813 DOI: 10.1007/s00405-013-2652-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 07/24/2013] [Indexed: 10/26/2022]
Abstract
The aim of this study was to perform a systematic literature review of risks and medico-legal aspects of endoscopic sinus surgery. The development of sophisticated technologies and instruments for endoscopic sinus surgery (ESS) has caused a dramatic increase in the number of otolaryngologists performing sinus surgery and the number of cases performed. This expansion was accompanied by an increase in malpractice lawsuits. Over the past 20 years, rhinology claims represented 70 % of the total indemnity compensation for otolaryngology claims and ESS was the surgical procedure most often involved. Only then will a careful analysis and assessment of the possible and potential risk factors of ESS, which may mislead the surgeon, allow a correct clinical risk management, with activities and procedures aimed at reducing the possibility of complications that may expose the physician to a malpractice suit.
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Affiliation(s)
- M Re
- Department of Otorhinolaryngology, Polytechnic University of Marche: Ospedali Riuniti of Ancona, Via Conca 71, 60020, Torrette, AN, Italy,
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Asymmetry of lateral lamella of the cribriform plate: a software-based analysis of coronal computed tomography and its clinical relevance in endoscopic sinus surgery. Surg Radiol Anat 2013; 35:843-7. [PMID: 23525641 DOI: 10.1007/s00276-013-1106-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2012] [Accepted: 03/12/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND Endoscopic sinus surgery is a known approach for sinonasal pathologies. Due to close proximity of sinuses to orbits and brain, surgeon should be aware of sinonasal anatomy and associated variations. The roof of ethmoid (fovea ethmoidalis) separates the ethmoidal cells from the anterior cranial fossa. Medially the fovea attaches to the lateral lamella of the cribriform plate, which is the thinnest bone of the skull base. Hence, it is at a high risk of getting damaged during surgery. OBJECTIVE To ascertain the quantitative analysis of height of lateral lamella according to Keros classification in the computed tomographic (CT) images of patients presenting to our clinic. METHODS It was retrospective review of 77 CT scans using computerized software known as picture archiving and communication system. The height of lateral lamella was examined for both sides and then classified according to Keros classification. Asymmetry between two sides was also reported. RESULTS Keros type I was seen in 46 sides (29.8%), type II in 75 sides (48.7%) and type III was seen in 33 (21.4%) sides. Keros type I was seen in 38 sides in males and 8 sides in females. Type II was seen in 46 and 29 sides in males and females, respectively. Type III was seen in 18 sides in males and in 15 sides in females. CONCLUSION Understanding of the anatomy of ethmoid roof with its possible variation is crucial to give the surgeon optimal information about the possible risk that one can face during the surgery. Hence dreadful complications can be avoided.
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[Management of motility disorders secondary to iatrogenic orbital fracture during endoscopic sinus surgery]. J Fr Ophtalmol 2012; 35:684-9. [PMID: 22819340 DOI: 10.1016/j.jfo.2011.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Revised: 10/25/2011] [Accepted: 11/04/2011] [Indexed: 11/20/2022]
Abstract
PURPOSE Orbital wall fracture may occur during endoscopic sinus surgery, resulting in oculomotor disorders. We report the management of four cases presenting with this surgical complication. METHODS A non-comparative observational retrospective study was carried out on four patients presenting with diplopia after endoscopic ethmoidal sinus surgery. All patients underwent full ophthalmologic and orthoptic examination as well as orbital imaging. RESULTS All four patients presented with diplopia secondary to a medial rectus lesion confirmed by orbital imaging. A large horizontal deviation as well as limitation of adduction was present in all cases. Surgical management consisted of conventional recession-resection procedures in three cases and muscle transposition in one patient. A useful field of binocular single vision was restored in two of the four patients. CONCLUSION Orbital injury may occur during endoscopic sinus surgery and cause diplopia, usually secondary to medial rectus involvement due to the proximity of this muscle to the lamina papyracea of the ethmoid bone. Surgical management is based on orbital imaging, duration of the lesion, evaluation of anterior segment vasculature, results of forced duction testing and intraoperative findings. In most cases, treatment is aimed at the symptoms rather than the cause, and the functional prognosis remains guarded.
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Campbell RG. Sphenopalatine artery pseudoaneurysm after endoscopic sinus surgery: a case report and literature review. EAR, NOSE & THROAT JOURNAL 2012; 91:E4-11. [PMID: 22359145 DOI: 10.1177/014556131209100215] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Previously reported cases of iatrogenic sphenopalatine artery (SPA) pseudoaneurysm have occurred only after trans-sphenoidal surgery for pituitary tumors or maxillofacial surgery. In this article, the author presents what to the best of her knowledge is the first reported case of an SPA pseudoaneurysm that developed following endoscopic sinus surgery (ESS). The patient was a 76-year-old woman with myelodysplastic syndrome who presented with a 6-month history of unilateral sinus symptoms. She underwent septoplasty and unilateral ESS, which included frontal recess clearance and sphenoidotomy. However, during surgery, severe generalized bleeding was encountered. The bleeding was arrested only after anterior and posterior nasal packing. After two attempts to remove the packing failed, angiography was obtained. It revealed an SPA pseudoaneurysm, which was immediately and successfully embolized. SPA pseudoaneurysm is a rare but significant complication of ESS, and it should be considered in patients with posterior epistaxis after ESS or prolonged posterior nasal packing. The pathogenesis may include intraoperative trauma, infection, pressure necrosis from packing, or a combination of these factors. Optimal management includes either ligation or embolization, depending on anatomic, patient, staff, and resource factors. The author reviews the pertinent anatomy and the pathophysiology, diagnosis, management, and prevention of this rare complication.
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Affiliation(s)
- Raewyn G Campbell
- Department of Ear, Nose and Throat Surgery, The Alfred Hospital, Melbourne, Australia.
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Abstract
OBJECTIVES My aim in this article is to report 26 years of experience in order to evaluate the applicability and efficiency of centripetal dissection in intranasal ethmoid sinus surgery. METHODS I performed a retrospective review of 2,500 patients treated in the Felippu Institute, São Paulo, over the 26-year period from 1984 to July 2010. All of the patients underwent intranasal ethmoid sinus surgery with the centripetal technique. Before surgery, an otolaryngological examination, nasal endoscopy, and computed tomographic scans with axial, coronal, and sagittal projections were performed. All surgeries were carried out under general anesthesia and with the help of a surgical microscope or (after 1997) a rigid 30 degrees endoscope. The surgical technique required a standard endoscopic sinus surgery set. The complications of intranasal ethmoid sinus surgery were recorded and classified as intraoperative, short-term, or long-term. RESULTS I observed an intraoperative complication (cerebrospinal fluid leak) in 4 patients. There were no cases of periorbital damage. I recorded no short-term or long-term complications. All of the intraoperative complications were resolved during surgery. CONCLUSIONS With the use of this technique, the surgeon can precisely identify the position of the surgical instrument without losing his or her orientation, and thereby significantly reduce the risk of complications.
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Stankiewicz JA, Lal D, Connor M, Welch K. Complications in endoscopic sinus surgery for chronic rhinosinusitis. Laryngoscope 2011; 121:2684-701. [DOI: 10.1002/lary.21446] [Citation(s) in RCA: 146] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Revised: 11/08/2010] [Accepted: 11/16/2010] [Indexed: 11/10/2022]
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Radiological analysis of the ethmoid roof in the Malaysian population. Auris Nasus Larynx 2011; 39:393-6. [PMID: 22055509 DOI: 10.1016/j.anl.2011.10.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Revised: 09/29/2011] [Accepted: 10/03/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To ascertain the prevalence of the lateral lamella of the cribriform plate height according to Keros classification in the Malaysian population, and to find if there is any difference between the major ethnic groups in Malaysia (Malay, Chinese, Indian). METHODS Retrospective analysis of 150 CT scan studies of the paranasal sinuses. RESULTS The mean height of the lateral lamella of the cribriform plate (LLCP) in 300 sides was 2.64mm. Keros type I was seen in 240 sides (80%), while, Keros type II was seen in 60 sides (20%). There was no significant difference in the distribution of Keros classification among the major ethnic groups of Malaysia (Malay, Chinese, Indian). Keros type I was seen in 103 sides in males and 137 sides in females. Significant difference was observed in type II between the male and female (47 sides in males and 13 sides in female; p-value <0.001). When comparing the difference in the height of the LLCP in the same individual, asymmetry was observed in 139 patients. The LLCP height was higher on the left side in 71 patients and higher on the right in 68. CONCLUSION The understanding of the anatomy of the ethmoid roof with its possible variation is crucial to give the surgeon the optimal information about the possible risk that one can face during the surgery.
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Saleh H, Al Bahkaly S. Image-guided endoscopic repair of cerebrospinal fluid rhinorrhea by the bath plug grafting technique. Laryngoscope 2011; 121:909-13. [PMID: 21448985 DOI: 10.1002/lary.21355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Revised: 08/29/2010] [Accepted: 08/31/2010] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS Several techniques of endoscopic repair of cerebrospinal fluid (CSF) rhinorrhea were prescribed. Defect localization was mandatory for all. STUDY DESIGN Prospective study. METHODS A prospective study was conducted on nonaccidental CSF rhinorrhea. The sensitivity and specificity of image-guided navigation in localizing the defect were studied. The feasibility and reliability of the bath plug technique in repairing the defect were assessed. Six cases were included. RESULTS CFS rhinorrhea was spontaneous in four and iatrogenic in two. Two defects were in the fovea ethmoidalis, two in the cribriform plate, and two in the sphenoid. The repairing graft was successfully positioned in five cases. In one case a sphenoid obliteration was done. Image-guided navigation proved useful in localizing the defect with a sensitivity and specificity of 100%. All patients were available for follow-up (mean = 19 months). The overall success rate was 83%, and the mean number of surgeries per patient was one. CONCLUSIONS The bath plug was feasible for repairing the anterior skull base defects but not for all the sphenoid defects. It proved reliable as a single management in cases with normal intracranial pressure. The image-guided navigation overrides, in sensitivity and specificity, other methods of localization of the anterior skull base defects.
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Affiliation(s)
- Hazem Saleh
- Ear, Nose, and Throat Services Department, King Abdul Aziz Medical City, Riyadh, Saudi Arabia.
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Bibliography. Current world literature. Nose and paranasal sinuses. Curr Opin Otolaryngol Head Neck Surg 2010; 18:60-3. [PMID: 20068410 DOI: 10.1097/moo.0b013e328335385c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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