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Stan C, Blebea C, Tănase MI, Ujvary PL, Tănase M, Pop SS, Maniu AA, Cosgarea M, Rădeanu DG. Exploring the Ovine Anatomy: A Comprehensive Study of the Sheep's Head for Basic Training in Functional Endoscopic Sinus Surgery. Cureus 2024; 16:e53529. [PMID: 38445146 PMCID: PMC10912782 DOI: 10.7759/cureus.53529] [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: 02/03/2024] [Indexed: 03/07/2024] Open
Abstract
INTRODUCTION Training young doctors in functional endoscopic sinus surgery requires dedicated centers for cadaveric dissections. However, ethical constraints have limited cadaver availability. Alternative anatomical models, like the ovine model, are being explored for effective training, offering easier procurement and resembling human head anatomy. This study aims to demonstrate that the ovine model is useful for endoscopic sinus surgery training, highlighting the anatomical, imaging, histological, and endoscopic aspects. METHODS Three adult Native Romanian Turcana sheep's heads were obtained fresh and frozen from a local slaughterhouse. Using a helical scanner, CT scans were performed, and anatomical structures in the images were carefully labeled. Two heads frozen at -20°C were serially sectioned, with one cut sagittally, dividing the skull, and the other head sectioned transversely with 2.5 cm thickness. Sectional photographs were taken. The third sheep's head underwent endoscopy, and samples from the septal mucosa and inferior turbinate were collected for histopathology examination. The specimens were processed, stained, and examined by a pathologist. RESULTS The study successfully highlighted the gross anatomy, CT imaging aspects, histological characteristics of sheep nasal mucosa, and endoscopic features, demonstrating the similarity of the sheep's head to human anatomy, making it a suitable anatomical training model for endoscopic sinus surgery. CONCLUSION The use of sheep's heads as substitutes for human cadaver heads in nasal surgery simulations presents a promising avenue for research. The anatomical similarities and cost-effectiveness make sheep's heads a practical choice for certain aspects of nasal surgery investigation. However, researchers must approach this methodology with a thorough understanding of its limitations, including anatomical and biomechanical differences. Validation studies comparing outcomes with human models are crucial to establishing reliability. The sheep's head anatomical model provides a highly valuable experience for young trainees in endoscopic sinus surgery. Despite encountering several challenges, including some anatomical differences, considering its advantageous attributes renders it an ideal material for mimicking surgical procedures in functional endoscopic sinus surgery.
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Affiliation(s)
- Constantin Stan
- Department of ENT, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, ROU
- Department of Surgical Clinical, "Lower Danube" University, Faculty of Medicine and Pharmacy, Galati, ROU
| | - Cristina Blebea
- Department of ENT, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, ROU
| | - Mihai I Tănase
- Department of ENT, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, ROU
| | - Peter L Ujvary
- Department of ENT, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, ROU
| | - Mara Tănase
- Department of ENT, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, ROU
| | - Septimiu Sever Pop
- Department of ENT, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, ROU
| | - Alma A Maniu
- Department of ENT, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, ROU
| | - Marcel Cosgarea
- Department of ENT, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, ROU
| | - Doinel G Rădeanu
- Department of ENT, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, ROU
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Dogan ME, Kotanlı S, Yavuz Y, Wahjuningrum DA, Pawar AM. Computed tomography-based assessment of sphenoid sinus and sella turcica pneumatization analysis: a retrospective study. PeerJ 2023; 11:e16623. [PMID: 38130934 PMCID: PMC10734430 DOI: 10.7717/peerj.16623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 11/16/2023] [Indexed: 12/23/2023] Open
Abstract
Background A preoperative three-dimensional examination of the sphenoid sinus anatomy, its pneumatization pattern, and its relevance to neighboring neurovascular constructions is crucial to preventing possible complications. In this study, the aim was to evaluate the relationship between sphenoid sinus pneumatization types and the sella turcica using computed tomography (CT). Methods CT data from 420 patients referred to the Department of Dentomaxillofacial Radiology were evaluated retrospectively. Sella pneumatization types were classified as conchal, presellar, incomplete sellar, and complete sellar, and they were evaluated. Obtained data were evaluated using the IBM SPSS 25.0 (Armonk, New York, USA) package program. Results CT images of 420 individuals, including 174 women and 246 men with a mean age of 43.87 ± 17.58 years, were included in the study. When the sella turcica morphologies were evaluated, the most widespread morphological type was irregularity in the posterior part of the dorsum sella, in 51.2% of cases. In addition, a statistically significant correlation was found between the pneumatization of the sphenoid sinus and the morphological types of sella (p < 0.05). Conclusion In this research endeavor, the predominant observation comprised the complete sellar sphenoid sinus pneumatization type, exhibiting irregularity in the posterior aspect of the dorsum sella, representing one of the sellar types. Notwithstanding, it is imperative to conduct additional investigations to establish the generalizability of the present study's findings.
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Affiliation(s)
- Mehmet Emin Dogan
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Harran University, Haliliye, Şanlıurfa, Turkey
| | - Sedef Kotanlı
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Harran University, Haliliye, Şanlıurfa, Turkey
| | - Yasemin Yavuz
- Department of Restorative Dentistry, Harran University, Faculty of Dentistry, Haliliye, Şanlıurfa, Turkey
| | - Dian Agustin Wahjuningrum
- Department of Conservative Dentistry, Faculty of Dental Medicine, Universitas Airlangga, Surabaya City, East Java, Indonesia.
| | - Ajinkya M. Pawar
- Department of Conservative Dentistry, Faculty of Dental Medicine, Universitas Airlangga, Surabaya City, East Java, Indonesia.
- Conservative Dentistry and Endodontics, Nair Hospital Dental College, Mumbai, Maharashtra, India
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Kanotra S, Bashir S, Sharma P, Purbi S, Manzoor M, Gupta K. Anatomical Variations of the Optic Nerve in the Sphenoid Sinus: Do Ethnic Variations Matter? Indian J Otolaryngol Head Neck Surg 2023; 75:1943-1949. [PMID: 37636678 PMCID: PMC10447864 DOI: 10.1007/s12070-023-03798-y] [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: 02/21/2023] [Accepted: 04/09/2023] [Indexed: 08/29/2023] Open
Abstract
There are several variations in the anatomical relations of the optic nerve with the sphenoid sinus. Proper understanding of these variations is clinically important to minimize injuries associated with surgical procedures that involve the sphenoid sinus. CT scans of paranasal sinuses obtained prior to any endoscopic surgery in the sphenoid sinus area is useful for designing operative strategies. Ethnic variations in sinonasal anatomy have been documented. The objective was to study the pattern of relationship between optic nerve and the sphenoid sinus using computerized tomographic imaging in a north Indian population, to compare our findings with previous studies in different ethnic groups and find out if ethnic variations in such a relationship matter. A prospective study was conducted on 300 patients who underwent computed tomography of the paranasal sinuses from Sept 2020 to June 2021. Relationship of optic nerves to the sphenoid sinuses was categorized according to DeLano classification. Pneumatization of the anterior clinoid process and bony dehiscence of optic nerve was also observed. Type 1 position of optic nerve was seen in 69.3%, Type 2 in 20.9%, Type 3 in 3% and Type 4 in 6.8% of sinuses. The pneumatization of anterior clinoid process (ACP) was observed in 10.5% and the bony dehiscence of optic nerve was noted in 6.5% sinuses. Bony dehiscence of optic canal had associated ACP pneumatization in 64.1% sinuses.The variability of the relation of optic nerve to the sphenoid sinus even in the persons of same ethnicity precludes a definite role of ethnicity in these variations. Other factors possibly contributing to such a relationship have been discussed.
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Affiliation(s)
- Sonika Kanotra
- Department of E.N.T., Head and Neck Surgery, Govt. Medical College and S.M.G.S. Hospital, Jammu, India
| | - Seerat Bashir
- Department of E.N.T., Head and Neck Surgery, Govt. Medical College and S.M.G.S. Hospital, Jammu, India
| | - Preeti Sharma
- Department of E.N.T., Head and Neck Surgery, Govt. Medical College and S.M.G.S. Hospital, Jammu, India
| | - Shweta Purbi
- Department of E.N.T., Head and Neck Surgery, Govt. Medical College and S.M.G.S. Hospital, Jammu, India
| | - Misba Manzoor
- Department of Radio-Diagnosis, Govt. Medical College, Jammu, India
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Kahinga AA, Batule IJ, Abraham ZS, Mushi EM. An Audit of Endoscopic Sinus Surgery at a Tertiary Hospital in Tanzania. Niger Med J 2023; 64:563-568. [PMID: 38952879 PMCID: PMC11214714 DOI: 10.60787/nmj-64-4-325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2023] [Indexed: 07/03/2024] Open
Abstract
Background Being a frequently used approach by otorhinolaryngologists, Endoscopic sinus surgery (ESS) has been useful in the surgical management of different sinonasal conditions in this era. Although ESS is most commonly performed for inflammatory and infectious sinus diseases since its introduction in the 1960s by Prof. Messserklinger and Wigand, the current advancement in instrumentation has led to an increase in its indications. This study therefore aimed at auditing the ESS done at a tertiary hospital in our settings. Methodology This was a retrospective descriptive cross-sectional study which was conducted at Muhimbili National Hospital. It involved all patients who underwent ESS in the department of otorhinolaryngology. Information was extracted from patients' files, ledger, and admission books. The obtained data were analyzed using a statistical package for social sciences (SPSS) version 22. Descriptive statistics were performed to present the frequency distribution of the demographic characteristics, indications for ESS, and mean for the length of hospital stay. Results Out of 1261 surgeries done during the study period, 6.7% (84/1261) were endoscopic sinus surgeries. Of patients who underwent ESS, an almost equal proportion of males and females was found and ages ranged from 8 to 71 years with a mean age of 32 .2 ±16 .9 years. The commonest indication for ESS was sinonasal polyposis at 50.0% (42/84) followed by chronic rhinosinusitis at 20.4% (17/84). The majority of patients 52.4% (44/84) had a hospital stay of 1-3 days. The mean length of postoperative hospital stay following ESS in this study was found to be 2.8 days. Conclusion Endoscopic sinus surgeries accounted for 6.7% of all surgeries with sinonasal polyposis being the commonest indication and the estimated mean length of postoperative hospital stay being 3 days.
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Affiliation(s)
- Aveline Aloyce Kahinga
- Department of Otorhinolaryngology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Isaac John Batule
- Department of Otorhinolaryngology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Elimath Martin Mushi
- Department of Otorhinolaryngology, Muhimbili National Hospital, Dar es Salaam, Tanzania
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Nagarajah D, Kueh YC, Lazim NM, Abdullah B. The hemostatic effect of hot saline irrigation in endoscopic sinus surgery: a systematic review and meta-analysis. Syst Rev 2022; 11:246. [PMID: 36401259 PMCID: PMC9675124 DOI: 10.1186/s13643-022-02113-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 11/02/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND A good control of intraoperative bleeding is key for adequate anatomical visualization during endoscopic sinus surgery (ESS). The objective of this review was to assess the practice of hot intranasal saline irrigation (HSI) in achieving intraoperative hemostasis and good surgical field quality during ESS. METHODS An electronic search was performed via PubMed, SCOPUS, Google Scholar, and Cochrane from inception to June 2022. The included trials were evaluated according to the recommendations of the Cochrane Handbook for Systematic Reviews. The primary outcome assessed was the intraoperative bleeding score of the surgical field. The mean arterial pressure, duration of the surgery, amount of blood loss and surgeon's satisfaction score were assessed as the secondary outcomes. The risk of bias for each study was evaluated using the Cochrane risk of bias tool. RESULTS A total of 254 records were identified after removal of duplicates. Based on the title and abstract 246 records were excluded, leaving seven full texts for further consideration. Five records were excluded following full text assessment. Three trials with a total of 212 patients were selected. Hot saline irrigation was superior to control in the intraoperative bleeding score (MD - 0.51, 95% CI - 0.84 to - 0.18; P < 0.001; I2 = 72%; very low quality of evidence) and surgeon's satisfaction score (RR 0.18, 95% CI 0.09 to 0.33; P < 0.001; I2 = 0%; low quality of evidence). The duration of surgery was lengthier in control when compared to HSI (MD - 9.02, 95% CI - 11.76 to - 6.28; P < 0.001; I2 = 0; very low quality of evidence). The volume of blood loss was greater in control than HSI (MD - 56.4, 95% CI - 57.30 to - 55.51; P < 0.001; I2 = 0%; low quality of evidence). No significant difference between the two groups for the mean arterial pressure was noted (MD - 0.60, 95% CI - 2.17 to 0.97; P = 0.45; I2 = 0%; low quality of evidence). CONCLUSIONS The practice of intranasal HSI during ESS is favorable in controlling intraoperative bleeding and improving the surgical field quality. It increases the surgeon's satisfaction, reduces blood loss, shortens operative time and has no effect on intraoperative hemodynamic instability. TRIAL REGISTRATION PROSPERO registration number: CRD42019117083.
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Affiliation(s)
- Darshini Nagarajah
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia
| | - Yee Cheng Kueh
- Unit Biostatistic and Research Methodology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Norhafiza Mat Lazim
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia
| | - Baharudin Abdullah
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia.
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Serindere G, Serindere M. Cone beam computed tomographic evaluation of infraorbital canal protrusion into the maxillary sinus and its importance for endoscopic surgery. Braz J Otorhinolaryngol 2022; 88 Suppl 5:S140-S147. [PMID: 36064817 PMCID: PMC9801060 DOI: 10.1016/j.bjorl.2022.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/26/2022] [Accepted: 07/23/2022] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE The aim of this retrospective study is to investigate the prevalence of Infraorbital Canal Protrusion (ICP) degree into the maxillary sinus and its relationship with variations in adjacent structures on Cone Beam Computed Tomography (CBCT) images. METHODS 350 CBCT images (700 Infraorbital Canal [IC]) were evaluated retrospectively. ICP was divided into 3 subtypes according to the protrusion degree. The correlation between IC types and variations in adjacent anatomical structures (Haller cell, middle nasal concha pneumatization, maxillary sinus mucosal thickening and septa) was evaluated. The distance between Infraorbital Canal and Cnine Root (IC-CR) was also measured. For type 3, measurements were performed on IC as the length of the bony septum from the IC to the Mxillary Sinus Wall (IC-MSW), the distance from the inferior orbital rim, where the IC begins to protrude into the maxillary sinus (IOR-ICP), the vertical distance from the IC to the Maxillary Sinus Roof (IC-MSR) and Floor (IC-MSF). RESULTS The prevalence of type 1, 2 and 3 was 62.9%, 29.1%, and 8% respectively. IC-CR was 10.2, 10.7 and 11.4 mm in type 1, 2 and 3, respectively. IC-MSW, IOR-ICP, IC-MSR and floor IC-MSF was 3.8, 10.9, 7.4 and 27.7 mm, respectively. On the right and left side, statistically significant correlation was found between IC types and the presence of the Haller cell and sinus septa. But there was no significant correlation between IC types and middle concha pneumatization. CONCLUSION Accurate diagnosis of ICP is very important in preventing infraorbital nerve damage in surgical procedures to be performed in the maxillary region. The results of this study could be a guide for surgical planning in this region. LEVEL OF EVIDENCE Retrospective study.
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Affiliation(s)
- Gozde Serindere
- Hatay Mustafa Kemal University, Faculty of Dentistry, Department of Dentomaxillofacial Radiology, Hatay, Turkey,Corresponding author.
| | - Mehmet Serindere
- Hatay Education and Research Hospital, Department of Radiology, Hatay, Turkey
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Extraction of sphenochoanal polyp with functional endoscopic sinus surgery approach: A rare case and review article. Int J Surg Case Rep 2022; 97:107429. [PMID: 35905676 PMCID: PMC9403174 DOI: 10.1016/j.ijscr.2022.107429] [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: 05/24/2022] [Revised: 07/12/2022] [Accepted: 07/17/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Sphenochoanal polyp, a rare case of nasal polyp, is a benign mass that originates in the sphenoid sinus and develops into a choanal polyp. CASE PRESENTATION A 36-year-old Indonesian male complained of irregular right nasal obstruction and runny nose for one year. Physical examination showed soft tissue mass in the right nasal cavity, cyst retention in the right maxillary sinus, right sphenoid sinus, and cervical spondylosis. Diagnosis of sphenochoanal polyp was supported by nasoendoscopy and CT-Scan of paranasal sinuses. The patient got medical care and underwent functional endoscopic sinus surgery (FESS) and rinsed the nose with normal saline and topical steroids. Evaluation at six months after the surgery, the patient came without complaint and showed no sign of polyp mass or cysts recurrence, so the patient was declared to have a full recovery. DISCUSSION FESS is proven effective for managing sphenochoanal polyp and minimizes complications post-surgery and repetition of the polyp. CONCLUSION FESS is recommended for management of sphenochoanal polyp in term of minimizing recurrency.
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Usmani T, Fatima E, Raj V, Aggarwal K. Prospective Study to Evaluate the Role of Multidetector Computed Tomography in Evaluation of Paranasal Sinus Pathologies. Cureus 2022; 14:e24011. [PMID: 35547426 PMCID: PMC9090213 DOI: 10.7759/cureus.24011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2022] [Indexed: 11/05/2022] Open
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Goel R, Kishore D, Kumar S, Nagpal S. Comparison of external versus diode laser conjunctivodacryocystorhinostomy with lacrimal bypass tube placement in proximal canalicular blocks. Oman J Ophthalmol 2021; 14:100-107. [PMID: 34345144 PMCID: PMC8300289 DOI: 10.4103/ojo.ojo_49_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 08/31/2020] [Accepted: 02/09/2021] [Indexed: 11/04/2022] Open
Abstract
AIMS Hyperlacrimation due to ocular surface or lid abnormality was ruled out and apposition of lower punctum to globe was checked. SUBJECTS AND METHODS This was a pilot study at a tertiary eye care center where 40 patients of proximal canalicular block <8 mm on probing were divided into two equal groups. The external CDCR group underwent routine dacryocystorhinostomy with partial carunculectomy. A tract was created from canthus to nasal cavity with von Graefe knife. In the laser CDCR group, the osteotomy was created using 980 mm diode laser with a power of 8 W. Glass tubes of appropriate length were placed and fixed using 5-0 polypropylene with our "mirror tuck technique." Results were analyzed using the Chi-square test for parametric and ANOVA test for nonparametric variables using SPSS software. RESULTS Success defined as patency on syringing was achieved in 18 patients in the laser group and 16 in the external CDCR group which was comparable (P > 0.05). Complications include tube extrusion, dislocation, conjunctival overgrowth, and sump syndrome. CONCLUSION Laser and external CDCRs are both effective and safe procedures for the treatment of proximal canalicular blocks with comparable success rates and complications.
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Affiliation(s)
- Ruchi Goel
- Department of Opthalmology, Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, India
| | - Divya Kishore
- Department of Opthalmology, Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, India
| | - Sushil Kumar
- Department of Opthalmology, Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, India
| | - Smriti Nagpal
- Department of Opthalmology, Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, India
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Isolated Inferior Rectus Muscle Entrapment following Endoscopic Sinus Surgery. Case Rep Otolaryngol 2018; 2018:4620510. [PMID: 30057842 PMCID: PMC6051265 DOI: 10.1155/2018/4620510] [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: 04/06/2018] [Accepted: 06/13/2018] [Indexed: 11/17/2022] Open
Abstract
Orbital complications are known risks of endoscopic sinus surgery (ESS). The lamina papyracea and medial rectus muscle are the most commonly injured structures during ESS. Inferior rectus injury is more rare, with only one reported case of isolated inferior rectus injury in the literature. Guidelines for managing ESS-induced inferior rectus injury do not exist, and delayed intervention and management of adjacent sinuses may affect long-term outcomes such as persistent diplopia and disfigurement. In this report, we present a case of a 67-year-old man with diplopia due to isolated left inferior rectus muscle entrapment and injury from violation of the orbital floor during previous ESS. We postulate that an incomplete maxillary antrostomy contributed to scar band formation and entrapment of the inferior rectus muscle after the orbital floor was violated, and advocate early intervention with a wide, complete maxillary antrostomy if the orbital floor is injured during ESS.
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Burton BN, Gilani S, Swisher MW, Urman RD, Schmidt UH, Gabriel RA. Factors Predictive of Postoperative Acute Respiratory Failure Following Inpatient Sinus Surgery. Ann Otol Rhinol Laryngol 2018; 127:429-438. [PMID: 29766740 DOI: 10.1177/0003489418775129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The impact of perioperative risk factors on outcomes following outpatient sinus surgery is well defined; however, risk factors and outcomes following inpatient surgery remain poorly understood. We aimed to define risk factors of postoperative acute respiratory failure following inpatient sinus surgery. METHODS Utilizing data from the Nationwide Inpatient Sample Database from the years 2010 to 2014, we identified patients (≥18 years of age) with an Internal Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) procedure code of sinus surgery. We used multivariable logistic regression to identify risk factors of postoperative acute respiratory failure. RESULTS We identified 4919 patients with a median age of 53 years. The rate of inpatient postoperative acute respiratory failure was 3.35%. Chronic sinusitis (57.7%) was the most common discharge diagnosis. The final multivariable logistic regression analysis suggested that pneumonia, bleeding disorder, alcohol dependence, nutritional deficiency, heart failure, paranasal fungal infections, and chronic kidney disease were associated with increased odds of acute respiratory failure (all P < .05). CONCLUSION To our knowledge, this represents the first study to evaluate potential risk factors of acute respiratory failure following inpatient sinus surgery. Knowledge of these risk factors may be used for risk stratification.
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Affiliation(s)
- Brittany N Burton
- 1 School of Medicine, University of California, San Diego, San Diego, California, USA
| | - Sapideh Gilani
- 2 Division of Otolaryngology-Head and Neck Surgery, University of California, San Diego, San Diego, California, USA
| | - Matthew W Swisher
- 3 Department of Anesthesiology, University of California, San Diego, San Diego, California, USA
| | - Richard D Urman
- 4 Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School/Brigham & Women's Hospital, Boston, Massachusetts, USA
| | - Ulrich H Schmidt
- 3 Department of Anesthesiology, University of California, San Diego, San Diego, California, USA
| | - Rodney A Gabriel
- 3 Department of Anesthesiology, University of California, San Diego, San Diego, California, USA.,5 Division of Biomedical Informatics, University of California, San Diego, San Diego, California, USA
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Single-sided sinonasal mass: A retrospective study. North Clin Istanb 2018; 5:139-143. [PMID: 30374480 PMCID: PMC6191561 DOI: 10.14744/nci.2017.57984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 09/21/2017] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE: A unilateral sinonasal mass is a common pathology in ear, nose, and throat clinical practice. However, it may be confused with early stage inflammatory pathologies. The aim of this study was to examine the diagnostic histopathological, clinical, and radiological criteria for a unilateral nasal mass. METHODS: The present study examined the clinical and pathological profiles of unilateral sinonasal masses observed in patients at an ear, nose, and throat clinic in Istanbul between January 2008 and January 2016. During the period of this retrospective study, 195 patients presented with a single-sided sinonasal mass (males: 130, females: 65; age range: 9-93 years). The data analyzed were obtained from patient records. RESULTS: The single-sided sinonasal mass was benign in 187 (95.9%) cases and malignant in 8 (4.1%) cases. Inflammatory polyps (81.03%) were the most frequent benign finding. Squamous cell carcinoma (1.54%) was the most commonly diagnosed malignant lesion. CONCLUSION: A single-sided sinonasal mass is commonly detected by otorhinolaryngologists. Although most often the diagnosis is inflammatory nasal polyposis, the risk of malignancy should not be overlooked. For this reason, careful endoscopic examination should be performed, all lesions should undergo a pathological examination, and it should be kept in mind that neoplastic disease can occur at any age and may be associated with many symptoms.
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Sandhaus H, Chen PG. Intraoperative Functional Endoscopic Sinus Surgery Training: Efficient Teaching Techniques-A New Method. CLINICAL MEDICINE INSIGHTS. EAR, NOSE AND THROAT 2018. [PMID: 29531479 PMCID: PMC5843097 DOI: 10.1177/1179550618758647] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: Functional endoscopic sinus surgery is a complex procedure used by otorhinolaryngologists to treat a host of nasal sinus pathologies. Due to the involved nasal anatomy and the nature of the procedure, teaching residents to use an endoscope is challenging. Simulation labs have been helpful but intraoperative instruction can still present difficulty in communication between resident and attending physicians during the teaching process. The purpose of this is to hypothesize a method of teaching intraoperatively that can be used supplemental to or independently of virtual reality teaching. Method: Literature review to determine current intraoperative verbal teaching methods used by surgeons was performed. Review was also performed on the effects of simulation techniques in preparing residents for the operating room. Although this was not a systematic review including statistical analysis, a gap was found in the literature on how residents can be efficiently taught intraoperatively to navigate an endoscope while maintaining patient safety. A novel and inexpensive method has been devised as a possible teaching method. Conclusions: Extensive literature is not available in intraoperative teaching techniques. It is therefore uncertain whether such a method has been used before. Further study, possibly in the form of surveys and intraoperative trials, must be done to determine the effectiveness of this mechanism.
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Affiliation(s)
- Henya Sandhaus
- Touro College of Osteopathic Medicine, Middletown, NY, USA
| | - Philip G Chen
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
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Evaluation of Infraorbital Canal in Cone Beam Computed Tomography of Maxillary Sinus. JOURNAL OF DENTISTRY (SHIRAZ, IRAN) 2018; 19:41-47. [PMID: 29492415 PMCID: PMC5817342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
STATEMENT OF THE PROBLEM Ignoring anatomic variations may lead to iatrogenic injuries by surgeons. PURPOSE The aim of this study was to examine the relationship between the course of infraorbital canal and maxillary sinus using cone beam computed tomography scans (CBCT). MATERIALS AND METHOD One hundred and ninety two CBCT scans were reviewed for 384 infraorbital canals. The anatomic variants of infraorbital canals were classified into three types based on the protrusion degree of the infraorbital nerve from the maxillary roof into the sinus. Measurements were made on infraorbital canal as vertical distance from the infraorbital rim to the infraorbital foramen, the maximum horizontal distance from the infraorbital canal to the canine root, the maximum diagonal length of the nerve protruded in sinus, the maximum vertical distance from the center of the nerve to the sinus roof. RESULTS 26.5% of infraorbital canals were entirely contained within the sinus roof. 50.3% of infraorbital canals were located below the roof but remaining juxtaposed to it. In 23.2%, the nerve canal descended into the sinus. The prevalence of type3 of infraorbital canal significantly increased from 14.8% in cases without an ipsilateral Haller cell to 29.1% when a Haller cell was present. The average distance between the infraorbital foramen and the infraorbital rim were increased proportionally to the degree of protrusion of the nerve course into the maxillary sinus (ANOVA p< 0.001). CONCLUSION The infraorbital canal protrusion into the sinus is a common variation that must be considered during surgical procedures to avoid iatrogenic injury.
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Shirazi N, Bist SS, Selvi TN, Harsh M. Spectrum of Sinonasal Tumors: A 10-year Experience at a Tertiary Care Hospital in North India. Oman Med J 2015; 30:435-40. [PMID: 26674709 DOI: 10.5001/omj.2015.86] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Sinonasal tumors are a highly heterogeneous group of tumors that account for less than 1% of all cancers. Precise diagnosis is essential because the natural history, treatment, and prognosis vary for different neoplasms. We reviewed 610 cases of sinonasal lesions to understand this entity better. METHODS A total of 610 sinonasal biopsies/specimens were received over a period of 10 years (2004-14). All the samples were processed and stained with hematoxylin and eosin. Special staining for microorganisms and immunohistochemistry were performed where indicated. RESULTS Benign lesions were 72% with nasal polyp being the most common. Malignant lesions made up 21.2% of lesions with nasopharyngeal carcinoma being the most common while 7.7% cases were inflammatory/non-neoplastic. The most common cause for this was fungal sinusitis. The maxillary sinus was the most frequently involved site in all the lesions (62%). The average age of presentation was 40 years old, and the male to female ratio was 3:1 in those with benign tumors. The average age of presentation in the malignant and inflammatory group were 45 and 43 years, respectively, with an almost equal sex ratio in both categories. Computed tomography and magnetic resonance imaging scans were done in virtually all cases to assess the extent of the tumor as well as bony destruction. Local recurrence was the most frequent cause of treatment failure. CONCLUSION Tumors of the nasal cavity are often grouped with those in the paranasal sinuses. Benign tumors constituted approximately 75% of tumors in our hospital. Squamous cell carcinoma was the most common malignancy of this region. These tumors need to be studied closely and accurately because their proximity to vital structures pose significant challenges for their treatment and may be the source of significant patient morbidity.
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Affiliation(s)
- Nadia Shirazi
- Departments of Pathology, Swami Rama Himalayan University, Dehradun, India
| | - Sampan S Bist
- Ear, Nose, and Throat Department, Swami Rama Himalayan University, Dehradun, India
| | - Thamarai N Selvi
- Departments of Pathology, Swami Rama Himalayan University, Dehradun, India
| | - Meena Harsh
- Departments of Pathology, Swami Rama Himalayan University, Dehradun, India
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Jain R, Singhal SK, Singla N, Punia RS, Chander J. Mycological Profile and Antifungal Susceptibility of Fungal Isolates from Clinically Suspected Cases of Fungal Rhinosinusitis in a Tertiary Care Hospital in North India. Mycopathologia 2015; 180:51-9. [DOI: 10.1007/s11046-015-9873-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 02/06/2015] [Indexed: 02/05/2023]
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A SH, P MN, Joseph B. A PROSPECTIVE STUDY ON OUTCOME OF ENDOSCOPIC OPTIC NERVE DECOMPRESSION FOR VISUAL LOSS AFTER CRANIO - ORBITAL TRAUMA. ACTA ACUST UNITED AC 2014. [DOI: 10.18410/jebmh/2014/106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Kolethekkat AA, Paul RR, Kurien M, Kumar S, Al Abri R, Thomas K. Diagnosis of adult chronic rhinosinusitis: can nasal endoscopy predict intrasinus disease? Oman Med J 2013; 28:427-31. [PMID: 24223247 DOI: 10.5001/omj.2013.120] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 10/10/2013] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To define the role of endoscopic evaluation of middle meatus in adult patients clinically diagnosed to have chronic rhino-sinusitis and its ability to predict intra-sinus mucosal involvement as compared to CT scan. METHODS This prospective analytical study was conducted on consecutive patients with diagnosis of chronic rhino-sinusitis who were symptomatic and fulfilled the American Academy of Otolaryngology - Head and Neck Surgery Task Force criteria. The patients were enrolled prospectively and were subjected to rigid diagnostic nasal endoscopy and classified as defined by the revised Sinus Allergy Health Partnership Task Force criteria. The patients then underwent non contrast CT sinuses on the same day. Results were analyzed as a diagnostic test evaluation using CT as a gold standard. RESULTS Among the 75 study patients with symptom based chronic rhino-sinusitis, nasal endoscopy was abnormal in 65 patients (87%). Of these patients, 60/65 (92%) showed positive findings on CT scan. Ten patients had normal endoscopy, of these 6/10 (60%) had abnormal CT scan. Sensitivity and specificity of diagnostic nasal endoscopy against CT scan were 91% (95% CI: 81-97) and 44% (95% CI: 14-79), respectively. The likelihood ratio for positive nasal endoscopy to diagnose chronic rhino-sinusitis was 1.6 and the likelihood ratio to rule out chronic rhino-sinusitis when endoscopy was negative was 0.2. CONCLUSION Nasal endoscopy is a valid and objective diagnostic tool in the work up of patients with symptomatic chronic rhino-sinusitis. When clinical suspicion is low (<50%) and endoscopy is negative, the probability of rhino-sinusitis is very low (<17%) and there is no need to perform a CT scan to reconfirm this finding routinely. Endoscopy alone is able to diagnose chronic rhino-sinusitis in >90% of patients when clinical suspicion is high (88%) as defined in this study by AAO-HNS Task Force criteria. Negative endoscopy, however, does not totally exclude the sinus disease in patients fulfilling task force criteria. CT scan may be needed on follow-up if there is clinical suspicion in 10% of these patients who are negative on endoscopy if symptoms persists. It is thus possible to reduce the number of CT scans if patients are carefully selected based on clinical criteria and endoscopy is done initially as part of their evaluation.
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Affiliation(s)
- Arif Ali Kolethekkat
- ENT Division, Department of Surgery, Sultan Qaboos University Hospital, PO Box 38, P C 123, Al Khoudh, Sultanate of Oman
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Al-Zaabi K, Al Riyami M, Al-Abri R. A unilateral maxillary sinus tumor. Oman Med J 2013; 28:220-1. [PMID: 23772293 DOI: 10.5001/omj.2013.60] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 04/13/2013] [Indexed: 11/03/2022] Open
Affiliation(s)
- Khalid Al-Zaabi
- ENT Division, Surgery Department, Sultan Qaboos University Hospital, Sultanate of Oman
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