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Vermassen T, De Keukeleire S, Saerens M, Heerwegh S, Debacker JM, Huvenne W, Deron P, Creytens D, Ferdinande L, Rottey S, Bachert C, Duprez F, Van Zele T. Choice of surgery in intestinal-type adenocarcinoma of the sinonasal tract: a long-term comparative study. Eur Arch Otorhinolaryngol 2024; 281:2993-3004. [PMID: 38228884 DOI: 10.1007/s00405-024-08447-w] [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: 08/30/2023] [Accepted: 12/29/2023] [Indexed: 01/18/2024]
Abstract
PURPOSE Intestinal-type adenocarcinoma (ITAC) is a rare sinonasal malignancy. Curative treatment requires multidisciplinary approach, with surgical options consist of the endonasal endoscopic approach (EEA) and external surgery (EXTS). Here, we provide the post-operative and survival results from a single-center long-term follow-up. METHODS We report long-term follow-up of 92 ITAC cases treated between 1998 and 2018, treated with EEA (n = 40) or EXTS (n = 52). Survival estimates, post-operative complications and duration of hospitalization were compared between surgical modalities. RESULTS Baseline characteristics were similar. A higher number of T4b tumors (16%), and subsequently more tumoral invasion (39%), was present in patients undergoing EXTS compared to EEA (3% and 18%, respectively). No difference in Barnes histology subtypes was noticed. Patients undergoing EEA had a shorter post-operative hospitalization stay versus EXTS (4 versus 7 days). Use of EEA was associated to improved disease-specific survival (DSS; 11.4 versus 4.4 years; HREEA = 0.53), especially for patients with T3-4a tumors (11.4 versus 3.0 years; HREEA = 0.41). Patients with T3-4 stage, tumoral invasion, positive surgical margins, mucinous or mixed histology, and prolonged post-operative hospital stay showed poor local relapse-free, disease-free, overall, and DSS. CONCLUSIONS Long-term follow-up in locally advanced ITAC demonstrates that resection by EEA is correlated with improved DSS compared to EXTS, especially for T3-4 tumors. No significant differences between both treatment modalities was observed regarding per- and post-operative complications, although hospitalization in patients undergoing EEA was shorter than for patients treated with EXTS. These results confirm that EEA should remain the preferred surgical procedure in operable cases of sinonasal ITAC.
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Affiliation(s)
- Tijl Vermassen
- Department Medical Oncology, University Hospital Ghent, Corneel Heymanslaan 10, Ghent, Belgium.
- Biomarkers in Cancer, Ghent University, Ghent, Belgium.
- Cancer Research Institute Ghent, Ghent, Belgium.
| | - Stijn De Keukeleire
- Department Internal Medicine, University Hospital Brussels, Brussels, Belgium
| | - Michael Saerens
- Department Medical Oncology, University Hospital Ghent, Corneel Heymanslaan 10, Ghent, Belgium
- Biomarkers in Cancer, Ghent University, Ghent, Belgium
- Cancer Research Institute Ghent, Ghent, Belgium
| | - Sylvester Heerwegh
- Department Medical Oncology, University Hospital Ghent, Corneel Heymanslaan 10, Ghent, Belgium
| | - Jens M Debacker
- Cancer Research Institute Ghent, Ghent, Belgium
- Laboratory for Molecular Imaging and Therapy, Vrije Universiteit Brussel, Brussels, Belgium
- Department Head and Neck Surgery, University Hospital Ghent, Ghent, Belgium
| | - Wouter Huvenne
- Cancer Research Institute Ghent, Ghent, Belgium
- Department Head and Neck Surgery, University Hospital Ghent, Ghent, Belgium
- Upper Airway Research Laboratory, Ghent University, Ghent, Belgium
| | - Philippe Deron
- Department Head and Neck Surgery, University Hospital Ghent, Ghent, Belgium
| | - David Creytens
- Cancer Research Institute Ghent, Ghent, Belgium
- Department Pathology, University Hospital Ghent, Ghent, Belgium
- Department Diagnostic Sciences, Ghent University, Ghent, Belgium
| | - Liesbeth Ferdinande
- Department Pathology, University Hospital Ghent, Ghent, Belgium
- Department Diagnostic Sciences, Ghent University, Ghent, Belgium
| | - Sylvie Rottey
- Department Medical Oncology, University Hospital Ghent, Corneel Heymanslaan 10, Ghent, Belgium
- Biomarkers in Cancer, Ghent University, Ghent, Belgium
- Cancer Research Institute Ghent, Ghent, Belgium
| | - Claus Bachert
- Upper Airway Research Laboratory, Ghent University, Ghent, Belgium
- Department Otorhinolaryngology, University Hospital Ghent, Ghent, Belgium
| | - Fréderic Duprez
- Cancer Research Institute Ghent, Ghent, Belgium
- Department Radiation Oncology, University Hospital Ghent, Ghent, Belgium
- Department Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Thibaut Van Zele
- Upper Airway Research Laboratory, Ghent University, Ghent, Belgium
- Department Otorhinolaryngology, University Hospital Ghent, Ghent, Belgium
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Hildenbrand T, Weber RK. [Inverted papilloma of the nose and paranasal sinuses : Diagnosis, treatment, and malignant transformation]. HNO 2024; 72:257-264. [PMID: 38214715 DOI: 10.1007/s00106-023-01406-7] [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] [Accepted: 11/28/2023] [Indexed: 01/13/2024]
Abstract
Inverted papilloma (IP) are benign tumors that show a locally aggressive behavior, a high rate of recurrence, and a potential for malignant transformation. Specific radiological signs such as hyperostosis at the origin of the IP and convoluted cerebriform patterns, as well as the typical endoscopic aspect, can lead to diagnosis and enable preoperative planning of surgical access and the extent of surgery. Endonasal endoscopic techniques are considered the gold standard and the introduction of extended surgical techniques such as the prelacrimal approach, frontal drillout, or orbital transposition facilitate complete subperiosteal resection with preservation of important physiological structures. There is a risk of synchronous and metachronous squamous cell carcinomas (IP-SCC). Research focuses on radiological criteria to differentiate benign IP from IP-SCC, genetic and epigenetic factors in the process of malignant transformation, and estimation of the risk of IP progressing to IP-SCC.
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Affiliation(s)
- Tanja Hildenbrand
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland.
| | - Rainer K Weber
- Sektion Nasennebenhöhlen- und Schädelbasischirurgie, Traumatologie, Klinik für Hals‑, Nasen- und Ohrenheilkunde, Städtisches Klinikum Karlsruhe, Karlsruhe, Deutschland
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Maspero JF, Anselmo-Lima W, Bedoya D, Jimenez Chobillón MA, Ospina J, Roithmann R, Sadek Gonzalez A, Silva Rueda R. Management of CRSwNP in Latin America: A multidisciplinary consensus from an expert working group. World Allergy Organ J 2024; 17:100886. [PMID: 38463018 PMCID: PMC10924205 DOI: 10.1016/j.waojou.2024.100886] [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: 08/11/2023] [Revised: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 03/12/2024] Open
Abstract
Chronic rhinosinusitis with nasal polyps (CRSwNP) is an inflammatory condition of the nasal and paranasal tissues, characterized by the presence of bilateral nasal polyps. While etiology and pathogenetic mechanisms are heterogeneous and complex, in most patients, disease is mediated predominantly through type 2 inflammatory processes. Clinical management is challenging, and a multidisciplinary approach is preferred. Principal treatment approaches are the use of local/systemic corticosteroids and sinonasal surgery, although outcomes can be unsatisfactory. Recent availability of biological therapies targeting underlying inflammatory processes can offer effective treatment options in uncontrolled disease. Specialist guidelines greatly assist clinical decision-making, although as these are chiefly written from a global/international perspective, they may not wholly accommodate disease patterns and clinical practice at a regional level. An expert panel of specialists from Latin America was convened to develop regional guidance on the management of CRSwNP through a consensus approach. The present article presents the chief observations and recommendations which can provide guidance for clinicians in the Latin American region.
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Affiliation(s)
| | - Wilma Anselmo-Lima
- Ribeirao Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - David Bedoya
- Department of Otorhinolaryngology, Universidad de Antioquia, Medellin, Colombia
| | | | - Javier Ospina
- Division of Otolaryngology - Sinus and Skull Base Surgery, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Renato Roithmann
- Universidade Luterana do Brasil, Faculdade de Medicina, Porto Alegre, RS, Brazil
| | - Andrés Sadek Gonzalez
- Hospital Angeles del Pedregal, Camino a Santa Teresa 1055, Delegacion Alvaro Obregon, CP10700 Mexico City, Mexico
| | - Ricardo Silva Rueda
- Department of Otorhinolaryngology, Hospital Militar Central, Bogotá, Colombia
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Marglani O, Al Abri R, Al Ahmad M, Alsaleh S, Abuzakouk M, Kamel R. Management of Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) in the Pan-Arab Region: Consensus Recommendations from a Multidisciplinary Expert Working Group. J Asthma Allergy 2023; 16:1055-1063. [PMID: 37795191 PMCID: PMC10547061 DOI: 10.2147/jaa.s413610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 09/14/2023] [Indexed: 10/06/2023] Open
Abstract
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic and often debilitating inflammatory condition of the nasal and paranasal tissues. An expert panel of specialists from the Gulf region (the Kingdom of Saudi Arabia, Kuwait, Oman and the United Arab Emirates) and from Egypt gathered to evaluate existing guidance and develop regional guidance on the management of CRSwNP through a consensus approach. The present article presents the main observations and recommendations from this panel. CRSwNP diagnosis requires the presence of bilateral, endoscopically visualized polyps in the middle meatus (via nasal endoscopy or CT). In most patients, CRSwNP is mediated through predominantly type 2 inflammatory processes and is often observed in patients with asthma and other allergic disease. While many patients respond to medical treatment (principally topical irrigation and intranasal corticosteroids, and adjunctive short-term use of systemic corticosteroids), clinical management of CRSwNP is challenging, and a multidisciplinary approach for complete evaluation and treatment is recommended. Patients with more severe/uncontrolled disease (despite adequate medical therapies) require a complete endoscopic sinus surgery (ESS), although outcomes can be unsatisfactory, and further revision surgery is common. Biological therapies targeting underlying inflammatory processes offer additional, effective treatment options for those patients with persistent symptoms despite complete ESS, and also in those patients where surgery may be contraindicated.
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Affiliation(s)
- Osama Marglani
- Department of Ophthalmology, and Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
- Department of Surgery, King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia
| | | | | | - Saad Alsaleh
- Rhinology and Endoscopic Skull Base Surgery Division, Otolaryngology – Head and Neck Surgery Department, King Saud University, Riyadh, Saudi Arabia
| | - Mohamed Abuzakouk
- Department of Allergy and Immunology, Respiratory Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Reda Kamel
- Department of Otorhinolaryngology, Cairo University, Cairo, Egypt
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Numano Y, Nomura K, Hemmi T, Ikeda R, Kakuta R, Sugawara M. The Factors Related to the Time for Sinus Debridement after Functional Endoscopic Sinus Surgery - A Retrospective Study. Ann Maxillofac Surg 2023; 13:49-52. [PMID: 37711532 PMCID: PMC10499281 DOI: 10.4103/ams.ams_6_23] [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: 01/08/2023] [Revised: 05/16/2023] [Accepted: 07/03/2023] [Indexed: 09/16/2023] Open
Abstract
Introduction Post-operative care after functional endoscopic sinus surgery (FESS) is essential for managing the long-term success of chronic rhinosinusitis. Post-operative sinus debridement promotes proper wound healing, but the procedure can be accompanied by discomfort and pain. Hence, we analysed the clinical factors related to sinus debridement time after FESS. Materials and Methods We evaluated retrospectively the clinical factors affecting the time taken for post-operative sinus debridement on the first visit after the discharge. We reviewed 101 patients who underwent FESS at our hospital by the same surgeon and extracted patient information. The time for post-operative sinus debridement at the first outpatient clinic was measured. Results The days of putting the cotton ball in the operated nostril were negatively associated with sinus debridement time (coefficient - -16.4 ± 5.7 seconds/day, P = 0.005). In contrast, current or history of asthma, amount of bleeding during the surgery, number of opened sinuses by the operation or the number of eosinophils in resected tissues under a microscope at ×400 was not associated. Discussion We recommend the use of a cotton ball in the nostril after FESS because it shortens the sinus debridement time. Placing cotton balls in the nostril helps to maintain a humid wound environment and reduce crusting, leading to easier sinus debridement and better wound healing.
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Affiliation(s)
- Yuki Numano
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Kazuhiro Nomura
- Department of Otolaryngology, Tohoku Kosai Hospital, Sendai, Miyagi, Japan
| | - Tomotaka Hemmi
- Department of Otolaryngology, Tohoku Kosai Hospital, Sendai, Miyagi, Japan
| | - Ryoukichi Ikeda
- Department of Otolaryngology, Head and Neck Surgery, Iwate Medical University Hospital, Iwate, Japan
| | - Risako Kakuta
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Mitsuru Sugawara
- Department of Otolaryngology, Tohoku Kosai Hospital, Sendai, Miyagi, Japan
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Klimenko KE, Kryukov AI, Rusetsky YY, Tovmasyan AS, Kudryashov SE. [History of frontal sinus surgery and current view of the problem. Part 2]. Vestn Otorinolaringol 2023; 88:76-81. [PMID: 37970774 DOI: 10.17116/otorino20238805176] [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] [Indexed: 11/17/2023]
Abstract
Surgical treatment of inflammatory diseases of the frontal sinus is one of the biggest challenges of modern otorhinolaryngology. Close proximity of the frontal sinus and frontal sinus drainage pathways to the skull base, the orbit and the anterior ethmoid artery, great limitations with its visualization and instrumentation, and high risk of the frontal recess scarring cause difficulties in either endoscopic or external approaches to the frontal sinus. At the same time endoscopic approach to the frontal sinus is considered as preferred method of frontal sinusitis surgical treatment by majority of peers nowadays. The introduction of extended approaches to the frontal sinus pathology treatment with frontal sinus floor and interfrontal sinus septum drill-out as well as superior septectomy with common drainage pathway formation gave an opportunity to greatly decrease a rate of indications for external frontal sinus procedures. In this paper historical backgrounds of endonasal approaches to frontal sinuses are presented, current controversies in proper selection of extent and methods of the frontal sinus surgery are analyzed and endoscopic as well as external approaches to frontal sinuses are summarized.
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Affiliation(s)
- K E Klimenko
- Central Clinical Hospital with Polyclinic of Administrative Directorate of the President of the Russian Federation, Moscow, Russia
- Central State Medical Academy of Administrative Directorate of the President of the Russian Federation, Moscow, Russia
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - A I Kryukov
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - Yu Yu Rusetsky
- Central Clinical Hospital with Polyclinic of Administrative Directorate of the President of the Russian Federation, Moscow, Russia
- Central State Medical Academy of Administrative Directorate of the President of the Russian Federation, Moscow, Russia
| | - A S Tovmasyan
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - S E Kudryashov
- Central Clinical Hospital with Polyclinic of Administrative Directorate of the President of the Russian Federation, Moscow, Russia
- Central State Medical Academy of Administrative Directorate of the President of the Russian Federation, Moscow, Russia
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7
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Klimenko KE, Kryukov AI, Rusetsky YY, Tovmasyan AS, Kudryashov SE. [History of frontal sinus surgery and current view of the problem. Part 1]. Vestn Otorinolaringol 2023; 88:81-86. [PMID: 37767595 DOI: 10.17116/otorino20228804181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
Surgical treatment of inflammatory diseases of the frontal sinus is one of the biggest challenges of modern otorhinolaryngology. Close proximity of the frontal sinus and frontal sinus drainage pathways to the skull base, the orbit and the anterior ethmoid artery, great limitations with its visualization and instrumentation, and high risk of the frontal recess scarring cause difficulties in either endoscopic or external approaches to the frontal sinus. At the same time endoscopic approach to the frontal sinus is considered as preferred method of frontal sinusitis surgical treatment by majority of peers nowadays. The introduction of extended approaches to the frontal sinus pathology treatment with frontal sinus floor and interfrontal sinus septum drill-out as well as superior septectomy with common drainage pathway formation gave an opportunity to greatly decrease a rate of indications for external frontal sinus procedures. In this paper historical backgrounds of endonasal approaches to frontal sinuses are presented, current controversies in proper selection of extent and methods of the frontal sinus surgery are analyzed and endoscopic as well as external approaches to frontal sinuses are summarized.
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Affiliation(s)
- K E Klimenko
- Central Clinical Hospital with Polyclinic of Administrative Directorate of the President of the Russian Federation, Moscow, Russia
- Central State Medical Academy of Administrative Directorate of the President of the Russian Federation, Moscow, Russia
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - A I Kryukov
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - Yu Yu Rusetsky
- Central Clinical Hospital with Polyclinic of Administrative Directorate of the President of the Russian Federation, Moscow, Russia
- Central State Medical Academy of Administrative Directorate of the President of the Russian Federation, Moscow, Russia
| | - A S Tovmasyan
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - S E Kudryashov
- Central Clinical Hospital with Polyclinic of Administrative Directorate of the President of the Russian Federation, Moscow, Russia
- Central State Medical Academy of Administrative Directorate of the President of the Russian Federation, Moscow, Russia
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Molinari G, Emiliani N, Cercenelli L, Bortolani B, Gironi C, Fernandez IJ, Presutti L, Marcelli E. Assessment of a novel patient-specific 3D printed multi-material simulator for endoscopic sinus surgery. Front Bioeng Biotechnol 2022; 10:974021. [PMID: 36466346 PMCID: PMC9712453 DOI: 10.3389/fbioe.2022.974021] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 11/01/2022] [Indexed: 12/01/2023] Open
Abstract
Background: Three-dimensional (3D) printing is an emerging tool in the creation of anatomical models for surgical training. Its use in endoscopic sinus surgery (ESS) has been limited because of the difficulty in replicating the anatomical details. Aim: To describe the development of a patient-specific 3D printed multi-material simulator for use in ESS, and to validate it as a training tool among a group of residents and experts in ear-nose-throat (ENT) surgery. Methods: Advanced material jetting 3D printing technology was used to produce both soft tissues and bony structures of the simulator to increase anatomical realism and tactile feedback of the model. A total of 3 ENT residents and 9 ENT specialists were recruited to perform both non-destructive tasks and ESS steps on the model. The anatomical fidelity and the usefulness of the simulator in ESS training were evaluated through specific questionnaires. Results: The tasks were accomplished by 100% of participants and the survey showed overall high scores both for anatomy fidelity and usefulness in training. Dacryocystorhinostomy, medial antrostomy, and turbinectomy were rated as accurately replicable on the simulator by 75% of participants. Positive scores were obtained also for ethmoidectomy and DRAF procedures, while the replication of sphenoidotomy received neutral ratings by half of the participants. Conclusion: This study demonstrates that a 3D printed multi-material model of the sino-nasal anatomy can be generated with a high level of anatomical accuracy and haptic response. This technology has the potential to be useful in surgical training as an alternative or complementary tool to cadaveric dissection.
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Affiliation(s)
- Giulia Molinari
- Department of Otolaryngology-Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria of Bologna, Bologna, Italy
- Department of Experimental Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Nicolas Emiliani
- eDIMES Lab-Laboratory of Bioengineering, Department of Experimental Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Laura Cercenelli
- eDIMES Lab-Laboratory of Bioengineering, Department of Experimental Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Barbara Bortolani
- eDIMES Lab-Laboratory of Bioengineering, Department of Experimental Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Camilla Gironi
- eDIMES Lab-Laboratory of Bioengineering, Department of Experimental Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Ignacio Javier Fernandez
- Department of Otolaryngology-Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria of Bologna, Bologna, Italy
- Department of Experimental Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Livio Presutti
- Department of Otolaryngology-Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria of Bologna, Bologna, Italy
- Department of Experimental Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Emanuela Marcelli
- eDIMES Lab-Laboratory of Bioengineering, Department of Experimental Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
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Machado A, Simmen D, Schuknecht B, Briner HR. Greater Palatine Canal: Computed Tomography-Based Anatomic Analysis And Clinical Significance for the Sinus and Skull Base Surgeon. EAR, NOSE & THROAT JOURNAL 2022:1455613221111063. [PMID: 36073506 DOI: 10.1177/01455613221111063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Our aim is to describe the location and course of the greater palatine canal (GPC) by analyzing its relationship with anatomical landmarks that can be used during endoscopic sinus surgery. This information might help prevent injury to the neurovascular bundle. METHODS A retrospective evaluation of paranasal sinus CT scans of 100 consecutive random patients, 200 sides, was performed. Five measurements related to the course of the GPC were conducted, from cranial to caudal. The anatomical landmarks were the inferior bony border of the sphenopalatine foramen to the cranial entrance of the GPC, the distance from the most dorsal, and inferior bony insertion of the middle turbinate and the inferior turbinate bones to the anterior margin of the GPC. The angle between the horizontal palatine bone and the GPC, its length, and the prevalence of osteophytes in GPC was also assessed. RESULTS The mean distance of the inferior border of the sphenopalatine foramen to the cranial entrance of the GPC was 9.39 ± 1.72 mm. The mean distance of the dorsal insertion of the middle turbinate to the anterior margin of the GPC was 3.89 ± 0.93 mm. The distance of the dorsal insertion of the inferior turbinate to the anterior margin of the GPC was 3.16 ± 0.81 mm. The mean angle between the horizontal palatine bone and the GPC was 114.33 ± 10.92º and the mean length of the GPC was 30.23 ± 3.74 mm. None of the measurements showed a significant difference between the two sides. CONCLUSIONS The landmarks used are easy to locate and assess on CT scans. These findings may help to make dissection safer in pathologies related to the pterygopalatine fossa, lateral sphenoid sinus or adjacent skull base.
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Affiliation(s)
- André Machado
- Otolaryngology, Head & Neck surgery Department of Centro Hospitalar Universitário do Porto, Porto, Portugal
- Faculdade de Ciências da Saúde - Universidade da Beira Interior, Covilhã, Portugal
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10
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Tsai T, Shih LC, Lee IT, Ng TY, Wang JY, Hsu CL, Bau DAT, Tai CJ. Older Age Is Associated With Better Compliance With Follow-up in Taiwan After Functional Endoscopic Sinus Surgery. In Vivo 2021; 34:2571-2576. [PMID: 32871786 DOI: 10.21873/invivo.12074] [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] [Received: 05/28/2020] [Revised: 06/25/2020] [Accepted: 06/27/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND/AIM Functional endoscopic sinus surgery (FESS) is frequently conducted for restoring sinus ventilation and function. Postoperative care is critical for success. However, loss to follow-up is disturbing. The specific aim of this study was to identify critical factors contributing to loss of patients to follow-up and how to improve it. PATIENTS AND METHODS A total of 221 patients with chronic rhinosinusitis undergoing FESS were enrolled. Patients were divided into three groups according to their follow-up after surgery: Less than 1 month (short-term), 1-3 months (medium-term) and more than 3 months (long-term). The gender, age, smoking status, comorbidities, laterality, Lund-Mackay score, 22-question Sinonasal Outcome Test, nasal obstruction Visual Analogue Scale and mucociliary clearance were evaluated for their contribution to better compliance in follow-up. RESULTS The results revealed that older patients had better compliance in follow-up compared with younger ones (p=0.0093). Other factors were not contributory (p>0.05). CONCLUSION In contrast to the US, older patients in Taiwan have better compliance in postoperative follow-up, while younger ones require more education on the importance of follow-up.
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Affiliation(s)
- Tammy Tsai
- Department of Otorhinolaryngology, China Medical University Hospital, Taichung, Taiwan, R.O.C
| | - Liang-Chun Shih
- Department of Otorhinolaryngology, China Medical University Hospital, Taichung, Taiwan, R.O.C.,Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan, R.O.C
| | - Ivan T Lee
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, U.S.A
| | - Teik-Ying Ng
- Department of Otorhinolaryngology, China Medical University Hospital, Taichung, Taiwan, R.O.C.,School of Medicine, China Medical University, Taichung, Taiwan, R.O.C
| | - Jong-Yi Wang
- Department of Health Services Administration, China Medical University, Taichung, Taiwan, R.O.C
| | - Che-Lun Hsu
- Department of Otorhinolaryngology, China Medical University Hospital, Taichung, Taiwan, R.O.C
| | - DA-Tian Bau
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan, R.O.C. .,Terry Fox Cancer Research Laboratory, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan, R.O.C.,Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan, R.O.C
| | - Chih-Jaan Tai
- Department of Otorhinolaryngology, China Medical University Hospital, Taichung, Taiwan, R.O.C. .,School of Medicine, China Medical University, Taichung, Taiwan, R.O.C.,Department of Health Services Administration, China Medical University, Taichung, Taiwan, R.O.C
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11
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Kühnel TS, Hosemann WG, Weber R. [Postoperative treatment following paranasal sinus surgery]. HNO 2021; 69:517-528. [PMID: 33942126 DOI: 10.1007/s00106-021-01057-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 10/21/2022]
Abstract
Postoperative care is a crucial aspect for the success of paranasal sinus interventions. Basic procedures include saline nasal wash, which should be started on the first postoperative day, topical steroids, and antibiotics in cases of infection. Medical treatment involves aspiration of secretion in the inferior meatus during the first week. Removal of scabs in the surgical field should be carried out under endoscopic control beginning at the second week. Intervals are scheduled individually. Occlusion of the nose for the time of epithelium regeneration provides a moist space in the ethmoid, which improves wound healing.
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Affiliation(s)
- Thomas S Kühnel
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland.
| | - Werner G Hosemann
- Fachbereich HNO, Helios Hanseklinikum Stralsund, Große Parower Straße 47, 18435, Stralsund, Deutschland
| | - Rainer Weber
- HNO-Klinik, Städtisches Klinikum Karlsruhe, Moltkestraße 90, 76133, Karlsruhe, Deutschland
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12
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Oviedo P, Zamora S, Vinocur D, Levy ML, Nation J. Influence of Pediatric Endoscopic Endonasal Skull Base Resections on Midface and Skull Base Development. Pediatr Neurosurg 2021; 56:345-356. [PMID: 34010830 DOI: 10.1159/000516236] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 03/27/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The purpose of this study is to use imaging data to determine if endoscopic endonasal surgery (EES) for skull base tumor resection interrupts skull base growth and development, resulting in an atrophic midface skeletal structure, compared to matched normal controls. METHODS Data were collected by a retrospective chart review done on children aged 16 years and below who underwent endoscopic tumor resection and had pre- and postoperative magnetic resonance imaging with relevant midface anatomy. 121 normal controls were matched to 20 EES patients by age and gender. Three measurements related to midface anatomy were taken from 1 sagittal T1 slice and 1 axial T2 slice of each scan. Statistical analysis was used to compare growth measures between cases and controls. RESULTS Twenty patients who underwent EES between November 2015 and April 2018 met our inclusion criteria. The mean age of the patients, 11 males and 9 females, was 10 years, and 8 patients (38%) were aged 7 years or younger. Six patients who had a high-flow CSF leak obtained a nasoseptal flap. A student T test and multivariate regression analysis found that EES did not affect midface and skull base growth. Among the variables assessed, age appears to be the only driver of growth. CONCLUSION There were no identified differences in craniofacial growth in pediatric patients undergoing EES for skull base tumor resection as compared to the control group. EES does not appear to significantly interfere with midface/skull base development and is a good surgical option for pediatric patients.
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Affiliation(s)
- Parisa Oviedo
- University of California San Diego School of Medicine, La Jolla, California, USA
| | - Steven Zamora
- Division of Pediatric Otolaryngology, Rady Children's Hospital San Diego, San Diego, California, USA
| | - Daniel Vinocur
- University of California San Diego School of Medicine, La Jolla, California, USA.,Division of Pediatric Radiology, Rady Children's Hospital San Diego, San Diego, California, USA
| | - Michael L Levy
- University of California San Diego School of Medicine, La Jolla, California, USA.,Division of Pediatric Neurosurgery, Rady Children's Hospital San Diego, San Diego, California, USA
| | - Javan Nation
- University of California San Diego School of Medicine, La Jolla, California, USA.,Division of Pediatric Otolaryngology, Rady Children's Hospital San Diego, San Diego, California, USA.,Division of Otolarngology/Head and Neck Surgery, University of California San Diego, San Diego, California, USA
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13
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Flanagan D. Postextraction sinus lining prolapse. Clin Case Rep 2021; 9:236-240. [PMID: 33489166 PMCID: PMC7812993 DOI: 10.1002/ccr3.3505] [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: 06/05/2020] [Revised: 09/22/2020] [Accepted: 10/04/2020] [Indexed: 12/29/2022] Open
Abstract
A prolapse of the sinus lining through an extraction socket occurred after 4 weeks. The lining was pushed into the socket and maintained with a buccal fat pad pedicle graft. Healing was complete after several weeks. A sinus decongestant can be prescribed to promote sinus drainage and reduce pressure.
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14
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Abstract
BACKGROUND Silent sinus syndrome (SSS), organized hematoma (OH), and pneumosinus dilatans (PD) are rare, usually unilateral diseases of the maxillary sinus. Due to misinterpretation, excessive diagnostics and unnecessarily aggressive surgery or a delay in diagnostics and treatment are common. OBJECTIVE The objective of this study was to develop reasonable and comprehensible diagnostic criteria to improve diagnosis and treatment of these rare diseases. METHODS In this retrospective study, all patients treated for SSS, OH, and PD from 2012 to 2019 were identified. Patient history, diagnostic tests and results, and postoperative course were analyzed and compared with the available literature. RESULTS During the study period, 7 patients with SSS, 3 patients with PD, and 2 patients with OH were treated and available for follow-up. Comparison of these patients with the literature allowed us to develop diagnostic criteria. CONCLUSION Medical history combined with endoscopic and radiologic criteria should improve preoperative diagnosis of these three rare diseases of the maxillary sinus and help to distinguish them from other differential diagnoses. This approach should minimize morbidity for the patients.
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Affiliation(s)
- T Hildenbrand
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland.
| | - S B Klein
- Hals‑, Nasen- und Ohrenklinik, Universitätsklinikum Marburg, UKGM, Marburg, Deutschland
| | - N Schramek
- Hals-Nasen-Ohrenklinik, Städtisches Klinikum Karlsruhe, Karlsruhe, Deutschland
| | - R K Weber
- Hals-Nasen-Ohrenklinik, Städtisches Klinikum Karlsruhe, Karlsruhe, Deutschland
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15
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Shcherbakov DA, Krotova AS, Aleksanyan TA. [Modification of the method for closing the defect of the medial wall of the maxillary sinus]. Vestn Otorinolaringol 2020; 85:37-40. [PMID: 32476387 DOI: 10.17116/otorino20208502137] [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: 11/17/2022]
Abstract
Pathological ventilation of the maxillary sinus (MS) is one of the risk factors for the formation of chronic maxillary sinusitis. PURPOSE OF STUDY Is to evaluate the effectiveness of the method of restoring the medial wall of the MS with an autograft - a quadrangular cartilage of the nasal septum using the butterfly technique (Patent Application No. 2018140468, priority of 11/19/2018). MATERIAL AND METHODS The study included patients who underwent septoplasty, endoscopic surgery on the MS with plasty of the medial wall of the MS (1st, main group, n=136), as well as patients who underwent surgery according to Caldwell-Luc with the formation of persistent nasoantral anastomosis in the lower nasal passage (2nd, control group, n=56). The criteria for the inclusion of patients in the study were as follows: the presence of MS fungal body; inverted papilloma with lesions of the MS; cysts and/or a foreign body of the MS with localization in the alveolar bay without involving the natural anastomosis in the pathological process; concomitant 3rd or 4th, or 5th or 6th types of curvature of the nasal septum according to R. Mladina (1987). An objective assessment of the condition of the patients was carried out using the SNOT-22 clinical questionnaire, and for analysis the state of aerodynamics of the nasal cavity and MS in patients of various groups after surgical treatment used the method of computational aerodynamics. RESULTS In patients with nasoantral ostium in the lower nasal meatus, the pathological maxillary sinus aeration one was observed. It is recommended to close the nasoantral ostium to prevent violations of the aerodynamics of the nasal cavity and the maxillary sinus during surgery through the lower nasal meatus. CONCLUSION Our proposed method for closing a defect in the lower nasal passage is effective. The autograft is well established, contributes to the speedy restoration of normal sinus aerodynamics.
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Affiliation(s)
- D A Shcherbakov
- All-Russian Center for Eye and Plastic Surgery of the Ministry of Health of Russia, Ufa, Russia
| | | | - T A Aleksanyan
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology of the Moscow Healthcare Department, Moscow, Russia
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16
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Linxweiler M, Pillong L, Kopanja D, Kühn JP, Wagenpfeil S, Radosa JC, Wang J, Morris LGT, Al Kadah B, Bochen F, Körner S, Schick B. Augmented reality-enhanced navigation in endoscopic sinus surgery: A prospective, randomized, controlled clinical trial. Laryngoscope Investig Otolaryngol 2020; 5:621-629. [PMID: 32864433 PMCID: PMC7444769 DOI: 10.1002/lio2.436] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/11/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Endoscopic sinus surgery represents the gold standard for surgical treatment of chronic sinus diseases. Thereby, navigation systems can be of distinct use. In our study, we tested the recently developed KARL STORZ NAV1 SinusTracker navigation software that incorporates elements of augmented reality (AR) to provide a better preoperative planning and guidance during the surgical procedure. METHODS One hundred patients with chronic sinus disease were operated on using either a conventional navigation software (n = 52, non-AR, control group) or a navigation software incorporating AR elements (n = 48, AR, intervention group). Incidence of postoperative complications, duration of surgery, surgeon-reported benefit from the navigation system and patient-reported postoperative rehabilitation were assessed. RESULTS The surgeons reported a higher benefit during surgery, used the navigation system for more surgical steps and spent longer time with preoperative image analysis when using the AR system as compared with the non-AR system. No significant differences were seen in terms of postoperative complications, target registration error, operation time and postoperative rehabilitation. CONCLUSION The AR enhanced navigation software shows a high acceptance by sinus surgeons in different stages of surgical training and offers potential benefits during surgery without affecting the duration of the operation or the incidence of postoperative complications. LEVEL OF EVIDENCE 1b.
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Affiliation(s)
- Maximilian Linxweiler
- Department of Otorhinolaryngology, Head and Neck SurgerySaarland University Medical CentreHomburgGermany
| | - Lukas Pillong
- Department of Otorhinolaryngology, Head and Neck SurgerySaarland University Medical CentreHomburgGermany
| | - Dragan Kopanja
- Department of Otorhinolaryngology, Head and Neck SurgerySaarland University Medical CentreHomburgGermany
| | - Jan P. Kühn
- Department of Otorhinolaryngology, Head and Neck SurgerySaarland University Medical CentreHomburgGermany
| | - Stefan Wagenpfeil
- Institute of Medical Biometry, Epidemiology and Medical InformaticsSaarland University Medical CentreHomburgGermany
| | - Julia C. Radosa
- Department of Gynecology, Obstetrics and Reproductive MedicineSaarland University Medical CentreHomburgGermany
| | - Jingming Wang
- Human Oncology and Pathogenesis ProgramMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Luc G. T. Morris
- Immunogenomics and Precision Oncology PlatformMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
- Department of SurgeryMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Basel Al Kadah
- Department of OtorhinolaryngologyBethanien HospitalPlauenGermany
| | - Florian Bochen
- Department of Otorhinolaryngology, Head and Neck SurgerySaarland University Medical CentreHomburgGermany
| | - Sandrina Körner
- Department of Otorhinolaryngology, Head and Neck SurgerySaarland University Medical CentreHomburgGermany
| | - Bernhard Schick
- Department of Otorhinolaryngology, Head and Neck SurgerySaarland University Medical CentreHomburgGermany
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17
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Dassi CS, Demarco FR, Mangussi-Gomes J, Weber R, Balsalobre L, Stamm AC. The Frontal Sinus and Frontal Recess: Anatomical, Radiological and Surgical Concepts. Int Arch Otorhinolaryngol 2020; 24:e364-e375. [PMID: 32754249 PMCID: PMC7394634 DOI: 10.1055/s-0040-1713923] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 05/10/2020] [Indexed: 10/25/2022] Open
Abstract
Introduction The frontal sinus (FS) is the most complex of the paranasal sinuses due to its location, anatomical variations and multiple clinical presentations. The surgical management of the FS and of the frontal recess (FR) is technically challenging, and a complete understanding of its anatomy, radiology, main diseases and surgical techniques is crucial to achieve therapeutic success. Objectives To review the FS and FR anatomy, radiology, and surgical techniques. Data Synthesis The FS features a variety of anatomical, volumetric and dimensional characteristics. From the endoscopic point of view, the FR is the point of greatest narrowing and, to have access to this region, one must know the anatomical limits and the ethmoid cells that are located around the FR and very often block the sinus drainage. Benign diseases such as chronic rhinosinusitis (CRS), mucocele and osteomas are the main pathologies found in the FS; however, there is a wide variety of malignant tumors that can also affect this region and represent a major technical challenge to the surgeon. With the advances in the endoscopic technique, the vast majority of diseases that affect the FS can be treated according to Wolfgang Draf, who systemized the approaches into four types (I, IIa, IIb, III). Conclusion Both benign and malignant diseases that affect the FS and FR can be successfully managed if one has a thorough understanding of the FS and FR anatomy, an individualized approach of the best surgical technique in each case, and the appropriate tools to operate in this region.
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Affiliation(s)
- Camila S Dassi
- São Paulo Skull Base Center, São Paulo, SP, Brazil.,São Paulo Ear, Nose, and Throat Center, Hospital Edmundo Vasconcelos, São Paulo, SP, Brazil
| | - Flávia R Demarco
- São Paulo Skull Base Center, São Paulo, SP, Brazil.,São Paulo Ear, Nose, and Throat Center, Hospital Edmundo Vasconcelos, São Paulo, SP, Brazil
| | - João Mangussi-Gomes
- São Paulo Skull Base Center, São Paulo, SP, Brazil.,São Paulo Ear, Nose, and Throat Center, Hospital Edmundo Vasconcelos, São Paulo, SP, Brazil
| | - Raimar Weber
- São Paulo Ear, Nose, and Throat Center, Hospital Edmundo Vasconcelos, São Paulo, SP, Brazil
| | - Leonardo Balsalobre
- São Paulo Skull Base Center, São Paulo, SP, Brazil.,São Paulo Ear, Nose, and Throat Center, Hospital Edmundo Vasconcelos, São Paulo, SP, Brazil
| | - Aldo C Stamm
- São Paulo Skull Base Center, São Paulo, SP, Brazil.,São Paulo Ear, Nose, and Throat Center, Hospital Edmundo Vasconcelos, São Paulo, SP, Brazil
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18
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Bani-Ata M, Aleshawi A, Ahmad M, Saleh O, Ashour R, Khalil H, Alomari S, Alhowary AAA. Endoscopic dacryocystorhinostomy: A comparison of double-flap and single-flap techniques. Ann Med Surg (Lond) 2020; 54:1-5. [PMID: 32300477 PMCID: PMC7153027 DOI: 10.1016/j.amsu.2020.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 03/28/2020] [Indexed: 11/26/2022] Open
Abstract
Background Dacryocystorhinostomy (DCR) is a procedure to restore the flow of tears into the nose from the lacrimal sac when the nasolacrimal duct obstructed. This study aimed to compare the success rates of two different techniques in endonasal endoscopic DCR; namely single and double mucosal flap techniques. Material and methods A nonequivalent quasi-experiment design was used in this study. Retrospectively, patients underwent endoscopic DCR for primary nasolacrimal duct (NLD) obstruction were included. Patients were divided into the single-flap technique and the double-flap technique groups. Success was defined as the achievement of patency of the NLD throughout the period of follow-up with significant improvement in epiphora. Results Overall, 77 cases were included in the final analysis. Mean age was 41 years and 60% were female. Forty-six cases underwent the single-flap technique and 31 cases underwent the double-flap technique. Recurrence of NLD obstruction occurred in 11 (23.9%) cases in the single-flap group and in only one case (3.2%) in the double-flap group. Conclusion The modified double-flap technique for primary NLD obstruction resulted in less recurrence compared to the single-flap technique. Creating double flaps to cover any exposed lacrimal bone may reduce the rate of postoperative adhesions over the nasolacrimal duct ostium. DCR is used to restore the tears into the nose from the obstructed lacrimal sac. Single and double mucosal flap techniques can be used. Double-flap technique for primary NLD obstruction resulted in less recurrence.
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Affiliation(s)
- Majid Bani-Ata
- Otolaryngology Branch, Department of Special Surgery, Jordan University of Science and Technology, P.O Box 3030, Irbid, 22110, Jordan
| | | | - Muayyad Ahmad
- Clinical Nursing Department, School of Nursing, University of Jordan, Amman, 11942, Jordan
| | - Omar Saleh
- Ophthalmology Branch, Department of Special Surgery, Faculty of Medicine, Jordan University of Science and Technology, P.O Box 3030, Irbid, 22110, Jordan
| | - Raneem Ashour
- Otolaryngology Branch, Department of Special Surgery, Jordan University of Science and Technology, P.O Box 3030, Irbid, 22110, Jordan
| | - Hanen Khalil
- Otolaryngology Branch, Department of Special Surgery, Jordan University of Science and Technology, P.O Box 3030, Irbid, 22110, Jordan
| | | | - Ala A A Alhowary
- Department of Anesthesia, Jordan University of Science and Technology, P.O Box 3030, Irbid, 22110, Jordan
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19
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Whyte A, Boeddinghaus R. The maxillary sinus: physiology, development and imaging anatomy. Dentomaxillofac Radiol 2019; 48:20190205. [PMID: 31386556 PMCID: PMC6951102 DOI: 10.1259/dmfr.20190205] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/27/2019] [Accepted: 07/31/2019] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES The maxillary sinus is of paramount importance for otolaryngologists, rhinologists, oral and maxillofacial surgeons, head and neck and dental and maxillofacial radiologists. A comprehensive review article concerning the physiology, development and imaging anatomy was undertaken. METHODS Relevant literature pertaining to the physiology of the sinonasal cavity, development of the paranasal sinuses and imaging anatomy of the maxilla and maxillary sinus from 2000 to 2019 was reviewed. Emphasis was placed on literature from the last 5 years. RESULTS Extensive recent research using imaging has provided new insights into the development of the maxillary sinus, the other paranasal sinuses and the midface. The fundamental physiological concept of mucociliary clearance and its role in sinus health is emphasized. The paranasal sinuses are an integral part of a common mucosal organ formed by the upper and lower airway.An in-depth understanding of the soft-tissue and neurovascular relationships of the maxillary sinus to the deep fascial spaces and branches of the trigeminal nerve and external carotid artery respectively is required to evaluate and report imaging involving the maxillary sinus.Sinusitis of rhinogenic, rather than odontogenic origin, originates from nasal inflammation followed by anterior ethmoid disease and secondary obstruction of the ostiomeatal unit. The role of anatomical variants that predispose to this pattern of disease is discussed in detail with illustrative examples.The maxillary sinus is intimately related to the roots of the posterior maxillary teeth; the high frequency of mucosal disease and sinusitis of odontogenic aetiology is now well recognized. In addition, an understanding of the anatomy of the alveolar process, morphology of the alveolar recess of the maxillary sinus and neurovascular supply are essential both for deliberate surgical intervention of the sinus and complications related to oral surgical procedures. CONCLUSIONS An understanding of the fundamental principles of the development, physiology, anatomy and relationships of the maxillary sinus as depicted by multi-modality imaging is essential for radiologists reporting imaging involving the paranasal sinuses and midface.
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20
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Surgery of Inverted Papilloma of the Maxillary Sinus via Translacrimal Approach-Long-Term Outcome and Literature Review. J Clin Med 2019; 8:jcm8111873. [PMID: 31694225 PMCID: PMC6912689 DOI: 10.3390/jcm8111873] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 10/21/2019] [Accepted: 11/01/2019] [Indexed: 12/19/2022] Open
Abstract
There are several differential diagnoses of unilateral sinus disease. One of these is inverted papilloma (IP) of the maxillary sinus, which is a common benign tumor with a substantial rate of malignant transformation. In general, endoscopic endonasal techniques for addressing the tumor are favored nowadays instead of classical external approaches. The aim of this retrospective study was to investigate the long-term outcome of inverted papilloma treated endoscopically via the prelacrimal approach. We reviewed 17 patients with primary or recurrent IP of the maxillary sinus that were treated via the prelacrimal endoscopic endonasal technique. After a median follow-up period of 45.9 months (3.8 years), none of the 17 included patients showed signs of recurrent disease and no serious complications were reported. Hypoesthesia of the incisors was reported by four patients and was resolved with time in one. All of the maxillary sinuses could be fully visualized with the flexible endoscope. IP is an important differential diagnosis in the clinical finding of unilateral nasal polypoid lesions. The prelacrimal approach is an effective and safe method in the treatment of IP with limited patient morbidity.
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21
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Combined endoscopic and intra-oral approach for chronic maxillary sinusitis of dental origin-a prospective clinical study. Oral Maxillofac Surg 2019; 23:429-437. [PMID: 31332583 DOI: 10.1007/s10006-019-00792-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 07/10/2019] [Indexed: 12/16/2022]
Abstract
AIMS AND OBJECTIVES The traditional Caldwell-Luc approach for maxillary diseases has been criticized for its shortcomings such as removal of a large amount of bone, numbness of the teeth, flap dehiscence, and recurrent sinusitis. On account of its minimal invasiveness and physiological approach, functional endoscopic sinus surgery (FESS) has come to replace the Caldwell-Luc approach for the treatment of chronic rhinosinusitis. Chronic maxillary sinusitis of dental origin (CMSDO) is a less common variant on the chronic rhinosinusitis spectrum whose treatment involves simultaneous management of both the diseased maxillary sinus and the dental source of infection. Thus, this study was undertaken to assess the efficacy of FESS when combined with an intra-oral approach for the treatment of CMSDO. MATERIAL AND METHODS Eighteen patients with CMSDO in the age group of 18-50 years were treated with a combined endoscopic and intra-oral approach (buccal advancement flap with/without buccal fat pad) in this study. The patients were followed up for a total duration of 18 months. The primary outcome measurements were the SNOT-22 Quality of Life questionnaire and the Lund and Mackay CT Scan Scoring Criteria. The Friedman test was used to assess improvement in the above variables and the level of significance was set at 0.05. OBSERVATIONS AND RESULTS There was a statistically significant reduction (p < 0.05) in both the above parameters at all post-operative intervals. Two patients presented with epistaxis (immediate post-operative phase) and synechiae (second week follow-up interval). Both complications were successfully resolved. Two patients showed recurrence at the 6th-month interval for which they underwent revision surgery successfully. Overall, results were maintained even at the 18th month follow-up interval. CONCLUSION The endoscopic approach appears to be a reliable, minimally invasive technique associated with less morbidity and stable long-term results. Thus, a multi-disciplinary approach between maxillofacial surgeons and otolaryngologists is essential in the treatment of CMSDO.
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22
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Abdullah B, Lim EH, Husain S, Snidvongs K, Wang DY. Anatomical variations of anterior ethmoidal artery and their significance in endoscopic sinus surgery: a systematic review. Surg Radiol Anat 2018; 41:491-499. [PMID: 30542930 DOI: 10.1007/s00276-018-2165-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 12/08/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE Anterior ethmoidal artery (AEA) is at risk of injury in endoscopic sinus surgery due to its location. The aim of this review was to assess the anatomical variations of AEA and their significance. METHODS A literature search was performed on PUBMED, SCOPUS AND EMBASE. The following keywords were used: ethmoidal artery; anterior ethmoidal artery; anterior ethmoidal canal; ethmoid sinus; ethmoid roof; skull base. The search was conducted over a period of 6 months between October 2016 and April 2017. RESULTS 105 articles were retrieved. 76 articles which were either case reports or unrelated topics were excluded. Out of the 29 full text articles retrieved, 16 articles were selected; 3 were cadaveric dissection, 5 combined cadaveric dissection and computed tomography (CT) and the rest were of CT studies. All studies were of level III evidence and a total of 1985 arteries were studied. Its position at the skull base was influenced by the presence of supraorbital ethmoid cell (SOEC) and length of the lateral lamella of cribriform plate (LLCP). Inter population morphological variations contribute to the anatomical variations. CONCLUSIONS The average diameter of AEA was 0.80 mm and the intranasal length was 5.82 mm. 79.2% was found between the second and third lamellae, 12.0% in the third lamella, 6% posterior to third lamella and 1.2% in the second lamella. Extra precaution should be taken in the presence of a well-pneumatized SOEC and a long LLCP as AEA tends to run freely below skull base.
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Affiliation(s)
- Baharudin Abdullah
- Department of Otolaryngology-Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia.
| | - Eng Haw Lim
- Department of Otolaryngology-Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia
| | - Salina Husain
- Department of Otorhinolaryngology-Head and Neck Surgery, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur, Malaysia
| | - Kornkiat Snidvongs
- Department of Otolaryngology Head and Neck Surgery, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - De Yun Wang
- Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228, Singapore
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23
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Friedrich DT, Sommer F, Scheithauer MO, Greve J, Hoffmann TK, Schuler PJ. An Innovate Robotic Endoscope Guidance System for Transnasal Sinus and Skull Base Surgery: Proof of Concept. J Neurol Surg B Skull Base 2017; 78:466-472. [PMID: 29134165 PMCID: PMC5680027 DOI: 10.1055/s-0037-1603974] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 05/16/2017] [Indexed: 12/18/2022] Open
Abstract
Objective Advanced transnasal sinus and skull base surgery remains a challenging discipline for head and neck surgeons. Restricted access and space for instrumentation can impede advanced interventions. Thus, we present the combination of an innovative robotic endoscope guidance system and a specific endoscope with adjustable viewing angle to facilitate transnasal surgery in a human cadaver model. Materials and Methods The applicability of the robotic endoscope guidance system with custom foot pedal controller was tested for advanced transnasal surgery on a fresh frozen human cadaver head. Visualization was enabled using a commercially available endoscope with adjustable viewing angle (15-90 degrees). Results Visualization and instrumentation of all paranasal sinuses, including the anterior and middle skull base, were feasible with the presented setup. Controlling the robotic endoscope guidance system was effectively precise, and the adjustable endoscope lens extended the view in the surgical field without the common change of fixed viewing angle endoscopes. Conclusion The combination of a robotic endoscope guidance system and an advanced endoscope with adjustable viewing angle enables bimanual surgery in transnasal interventions of the paranasal sinuses and the anterior skull base in a human cadaver model. The adjustable lens allows for the abandonment of fixed-angle endoscopes, saving time and resources, without reducing the quality of imaging.
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Affiliation(s)
- D T Friedrich
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
| | - F Sommer
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
| | - M O Scheithauer
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
| | - J Greve
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
| | - T K Hoffmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
| | - P J Schuler
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
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24
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Risk Factors of Recurrence and Malignant Transformation of Sinonasal Inverted Papilloma. BIOMED RESEARCH INTERNATIONAL 2017; 2017:9195163. [PMID: 29250552 PMCID: PMC5700512 DOI: 10.1155/2017/9195163] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 10/22/2017] [Indexed: 12/28/2022]
Abstract
Sinonasal inverted papilloma is a relatively rare disease; however, it is prevalent enough for every ENT practitioner to encounter it several times throughout medical routines. Despite the developments in experimental and clinical medicine as well as surgical techniques, our knowledge of this disease is still inadequate. With improved imaging and better diagnostic techniques, proper diagnosis and qualification for surgical approaches leave no doubt. Although the endoscopic approach seems to be the gold standard for such condition, some cases may additionally require an external approach. Regardless of the type of surgery, postoperative management is crucial for both healing and long-term follow-up. Unfortunately, the procedures are still lacking in explicit and standardized postoperative management guidelines. Moreover, an important issue is still the need for a biomarker indicative of inverted papilloma and its malignant transformation. Several particles, within the spotlight of the researchers, have been SCCA, Ki-67, Bcl-2, Wnt proteins, and many more. Nevertheless, the topic requires further investigations.
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Kanai K, Okano M, Haruna T, Higaki T, Omichi R, Makihara SI, Tsumura M, Kariya S, Hirata Y, Nishizaki K. Evaluation of a new and simple classification for endoscopic sinus surgery. ALLERGY & RHINOLOGY (PROVIDENCE, R.I.) 2017; 8:118-125. [PMID: 29070268 PMCID: PMC5662536 DOI: 10.2500/ar.2017.8.0208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE In 2013, the Japanese Rhinologic Society proposed a simple classification for endoscopic sinus surgery (ESS). This classification consists of five procedures (type I, fenestration of the ostiomeatal complex, with uncinectomy and widening of the natural ostium; type II, single-sinus procedure, with manipulating the inside of the sinus; type III, polysinus procedure; type IV, pansinus procedure; type V, extended procedure beyond the sinus wall). The clinical relevance of this classification in chronic rhinosinusitis (CRS) and paranasal sinus cyst was evaluated. STUDY DESIGN A retrospective validation study. METHODS A total of 122 patients (195 sinuses) who underwent ESS in Okayama University Hospital in 2012 were enrolled. The relationships between the ESS classification and the clinical course, including the operation time, bleeding amounts during surgery and postoperative changes of olfaction, the computed tomography (CT) score, and nasal airway resistance were analyzed. RESULTS A total of 195 ESS procedures were classified into type I (n = 3), type II (n = 17), type III (n = 91), type IV (n = 82), and type V (n = 2). The major phenotypes of type II, III, and IV ESS were paranasal sinus cyst (68%), CRS without nasal polyps (77%), and CRS with nasal polyps (55%), respectively, and the difference was significant. The degree of ESS based on this classification was positively and significantly correlated with the operation time and bleeding amounts. As a whole, olfaction, CT score, and nasal airway resistance were significantly improved after surgery. The degree of improvement was similar between type III and type IV ESS. CONCLUSION This simple classification for ESS reflected the perioperative burden of the disease.
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Affiliation(s)
- Kengo Kanai
- From the Department of Otolaryngology—Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
- Department of Otolaryngology—Head and Neck Surgery, Kagawa Prefectural Central Hospital, Takamatsu, Japan
| | - Mitsuhiro Okano
- From the Department of Otolaryngology—Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
- Department of Otorhinolaryngology, International University of Health and Welfare School of Medicine, Narita, Japan, and
| | - Takenori Haruna
- From the Department of Otolaryngology—Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Takaya Higaki
- From the Department of Otolaryngology—Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Ryotaro Omichi
- From the Department of Otolaryngology—Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Sei-ichiro Makihara
- Department of Otolaryngology—Head and Neck Surgery, Kagawa Rosai Hospital, Marugame, Japan
| | - Munechika Tsumura
- From the Department of Otolaryngology—Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Shin Kariya
- From the Department of Otolaryngology—Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yuji Hirata
- Department of Otolaryngology—Head and Neck Surgery, Kagawa Prefectural Central Hospital, Takamatsu, Japan
| | - Kazunori Nishizaki
- From the Department of Otolaryngology—Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Chakrabarti A, Kaur H. Allergic Aspergillus Rhinosinusitis. J Fungi (Basel) 2016; 2:E32. [PMID: 29376948 PMCID: PMC5715928 DOI: 10.3390/jof2040032] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 11/29/2016] [Accepted: 12/01/2016] [Indexed: 12/19/2022] Open
Abstract
Allergic fungal rhinosinusitis (AFRS) is a unique variety of chronic polypoid rhinosinusitis usually in atopic individuals, characterized by presence of eosinophilic mucin and fungal hyphae in paranasal sinuses without invasion into surrounding mucosa. It has emerged as an important disease involving a large population across the world with geographic variation in incidence and epidemiology. The disease is surrounded by controversies regarding its definition and etiopathogenesis. A working group on "Fungal Sinusitis" under the International Society for Human and Animal Mycology (ISHAM) addressed some of those issues, but many questions remain unanswered. The descriptions of "eosinophilic fungal rhinosinusitis" (EFRS), "eosinophilic mucin rhinosinusitis" (EMRS) and mucosal invasion by hyphae in few patients have increased the problem to delineate the disease. Various hypotheses exist for etiopathogenesis of AFRS with considerable overlap, though recent extensive studies have made certain in depth understanding. The diagnosis of AFRS is a multi-disciplinary approach including the imaging, histopathology, mycology and immunological investigations. Though there is no uniform management protocol for AFRS, surgical clearing of the sinuses with steroid therapy are commonly practiced. The role of antifungal agents, leukotriene antagonists and immunomodulators is still questionable. The present review covers the controversies, recent advances in pathogenesis, diagnosis, and management of AFRS.
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Affiliation(s)
- Arunaloke Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India.
| | - Harsimran Kaur
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India.
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Abstract
This brief history of topographical anatomy begins with Egyptian medical papyri and the works known collectively as the Greco-Arabian canon, the time line then moves on to the excitement of discovery that characterised the Renaissance, the increasing regulatory and legislative frameworks introduced in the 18th and 19th centuries, and ends with a consideration of the impact of technology that epitomises the period from the late 19th century to the present day. This paper is based on a lecture I gave at the Winter Meeting of the Anatomical Society in Cambridge in December 2015, when I was awarded the Anatomical Society Medal.
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Kumar H, Jain R, Douglas RG, Tawhai MH. Airflow in the Human Nasal Passage and Sinuses of Chronic Rhinosinusitis Subjects. PLoS One 2016; 11:e0156379. [PMID: 27249219 PMCID: PMC4889048 DOI: 10.1371/journal.pone.0156379] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 05/13/2016] [Indexed: 11/18/2022] Open
Abstract
Endoscopic surgery is performed on patients with chronic inflammatory disease of the paranasal sinuses to improve sinus ventilation. Little is known about how sinus surgery affects sinonasal airflow. In this study nasal passage geometry was reconstructed from computed tomographic imaging from healthy normal, pre-operative, and post-operative subjects. Transient air flow through the nasal passage during calm breathing was simulated. Subject-specific differences in ventilation of the nasal passage were observed. Velocity magnitude at ostium was different between left and right airway. In FESS, airflow in post-surgical subjects, airflow at the maxillary sinus ostium was upto ten times higher during inspiration. In a Lothrop procedure, airflow at the frontal sinus ostium can be upto four times higher during inspiration. In both post-operative subjects, airflow at ostium was not quasi-steady. The subject-specific effect (of surgery) on sinonasal interaction evaluated through airflow simulations may have important consequences for pre- and post-surgical assessment and surgical planning, and design for improvement of the delivery efficiency of nasal therapeutics.
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Affiliation(s)
- Haribalan Kumar
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
- * E-mail:
| | - Ravi Jain
- Department of surgery, The University of Auckland, Auckland, New Zealand
| | - Richard G. Douglas
- Department of surgery, The University of Auckland, Auckland, New Zealand
| | - Merryn H. Tawhai
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
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Wormald PJ, Hoseman W, Callejas C, Weber RK, Kennedy DW, Citardi MJ, Senior BA, Smith TL, Hwang PH, Orlandi RR, Kaschke O, Siow JK, Szczygielski K, Goessler U, Khan M, Bernal-Sprekelsen M, Kuehnel T, Psaltis A. The International Frontal Sinus Anatomy Classification (IFAC) and Classification of the Extent of Endoscopic Frontal Sinus Surgery (EFSS). Int Forum Allergy Rhinol 2016; 6:677-96. [DOI: 10.1002/alr.21738] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 12/03/2015] [Accepted: 12/31/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Peter-John Wormald
- Department of Surgery-Otolaryngology; University of Adelaide; Adelaide Australia
| | - Werner Hoseman
- Department of Otorhinolaryngology-Head and Neck Surgery; University of Greifswald; Greifswald Germany
| | - Claudio Callejas
- Otorhinolaryngology Department; Pontificia Universidad Católica de Chile; Santiago Chile
| | - Rainer K. Weber
- Division of Sinus and Skull Base Surgery; Department of Otorhinolaryngology Hospital; Karlsruhe Germany
| | - David W. Kennedy
- Department of Otorhinolaryngology-Head and Neck Surgery; University of Pennsylvania; Philadelphia PA
| | - Martin J. Citardi
- Department of Otorhinolaryngology-Head and Neck Surgery; University of Texas Medical School at Houston; Houston TX
| | - Brent A. Senior
- Division of Rhinology, Allergy, and Endoscopic Skull Base Surgery; University of North Carolina at Chapel Hill; Chapel Hill NC
| | - Timothy L. Smith
- Division of Rhinology and Sinus/Skull Base Surgery; Oregon Health and Science University; Portland OR
| | - Peter H. Hwang
- Department of Otolaryngology-Head and Neck Surgery; Stanford University School of Medicine; Stanford CA
| | - Richard R. Orlandi
- Division of Otolaryngology-Head and Neck Surgery; University of Utah; Salt Lake City UT
| | - Oliver Kaschke
- Department of ENT; Sankt Gertrauden Krankenhaus; Berlin Germany
| | - Jin Keat Siow
- Department of Otolaryngology; Tan Tock Seng Hospital National University of Singapore; Singapore
| | | | - Ulrich Goessler
- Department of Otolaryngology-Head and Neck Surgery; University of Mannheim; Frankfurt Germany
| | - Martin Khan
- HNO-Klinik; Klinikum Dahme-Spreewald GmbH, Königs-Wusterhausen; Germany
| | | | - Thomas Kuehnel
- ORL-Dept, Head and Neck Surgery; University of Regensburg; Germany
| | - Alkis Psaltis
- Department of Surgery-Otolaryngology; University of Adelaide; Adelaide Australia
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