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Elhassan HA, Karligkiotis A, Searyoh K, Zocchi J, Bozkurt G, Bandi F, Birss M, Adegboyega G, Turri-Zanoni M, Battaglia P, Bignami M, Castelnuovo P. Cross-over septal flap technique for choanal atresia surgery in two centres: how I do it. J Laryngol Otol 2023; 137:930-933. [PMID: 36515068 DOI: 10.1017/s0022215122001529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Choanal atresia is a congenital obstruction of the posterior nasal aperture. Endoscopic endonasal surgery has led to successful choanal atresia repair. This paper describes our surgical technique using septal mucosal flaps without the need for stenting. METHODS This study comprised a multicentre retrospective review of patient notes. A cross-over septal technique is described, whereby bilateral vertical mucosal incisions are made at the posterior third of the septum, and the atretic plate and posterior vomer are removed. One flap is pedicled superiorly and rotated over the bare skull base and sphenoid bone; the contralateral flap is pedicled inferiorly to cover the exposed vomer remnant and hard palate. RESULTS There were 12 patients from 2013 to 2020, aged 0.07-50 years, with a male to female ratio of 1:5. Ten patients had unilateral and two had bilateral choanal atresia. Nine patients had bony choanal atresia, with the remainder mixed. CONCLUSION The cross-over technique for choanal atresia has low morbidity and 100 per cent success in our series. The use of mucoperiosteal flaps to cover exposed bone and minimal instrumentation to the lateral nasal wall reduce post-operative stenosis.
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Affiliation(s)
- H A Elhassan
- ENT Department, Homerton University Hospital, London, UK
| | - A Karligkiotis
- Department of Otorhinolaryngology, Circolo Hospital and Macchi Foundation, University of Insubria, Varese, Italy
| | - K Searyoh
- ENT Department, Korle Bu Teaching Hospital, Accra, Ghana
| | - J Zocchi
- Department of Otorhinolaryngology, Circolo Hospital and Macchi Foundation, University of Insubria, Varese, Italy
| | - G Bozkurt
- Department of Otorhinolaryngology, Circolo Hospital and Macchi Foundation, University of Insubria, Varese, Italy
| | - F Bandi
- Department of Otorhinolaryngology, Circolo Hospital and Macchi Foundation, University of Insubria, Varese, Italy
| | - M Birss
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - G Adegboyega
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - M Turri-Zanoni
- Department of Otorhinolaryngology, Circolo Hospital and Macchi Foundation, University of Insubria, Varese, Italy
| | - P Battaglia
- Department of Otorhinolaryngology, Circolo Hospital and Macchi Foundation, University of Insubria, Varese, Italy
| | - M Bignami
- Department of Otorhinolaryngology, Circolo Hospital and Macchi Foundation, University of Insubria, Varese, Italy
| | - P Castelnuovo
- Department of Otorhinolaryngology, Circolo Hospital and Macchi Foundation, University of Insubria, Varese, Italy
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Vinciguerra A, Mattavelli D, Turri-Zanoni M, Ferrari M, Schreiber A, Rampinelli V, Dohin I, Valentini M, Pontillo V, Gaudioso P, Karligkiotis A, Atallah S, Chatelet F, Saccardo T, Piazza C, Verillaud B, Nicolai P, Castelnuovo P, Herman P. Validation of modular endoscopic medial maxillectomies for inverted papilloma of the maxillary sinus. Rhinology 2023:3103. [PMID: 37515817 DOI: 10.4193/rhin23.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2023]
Abstract
BACKGROUND Treatment of inverted papilloma of the maxillary sinus (IPMS) has a lower success rate compared to other IPs. As such, its correct management generally needs trans-nasal endoscopic medial maxillectomy (EMMs) for adequate resection. The aim of this manuscript is to describe outcomes and major prognostic factors of a cohort of patients with IPMS who were treated with EMM. METHODOLOGY In this multicentric study, patients affected with IPMS and treated with EMMs were included. The site of origin of the IPMS were studied as well as the type of EMM performed. The histological features (IP vs dysplasia), type of mucosal resection (total vs. pedicle oriented), and post-operative complications were analyzed. RESULTS 310 patients were included (212 primary and 98 recurrent cases). After a mean follow-up of 45.4 months, 15 patients experienced recurrence (4.8%) due to the application of EMMs tailored to the surgical insertion point. Dysplasia was significantly associated with a higher risk of recurrence. The rates of early and late complications were 11.6% and 11.9%, respectively. CONCLUSIONS IPMS resection via tailored EMM is associated with excellent disease control, thus excluding the systematic use of extended EMMs, which can however be justified in case of dysplastic IPMS given its significant impact on recurrence.
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Affiliation(s)
- A Vinciguerra
- Otorhinolaryngology and Skull Base Center, AP-HP, Hospital Lariboisière, Paris, France
| | - D Mattavelli
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - M Turri-Zanoni
- Unit of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - M Ferrari
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy
| | - A Schreiber
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - V Rampinelli
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - I Dohin
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - M Valentini
- Unit of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - V Pontillo
- Otorhinolaryngology and Skull Base Center, AP-HP, Hospital Lariboisière, Paris, France
| | - P Gaudioso
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy
| | - A Karligkiotis
- Unit of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - S Atallah
- Otorhinolaryngology and Skull Base Center, AP-HP, Hospital Lariboisière, Paris, France
| | - F Chatelet
- Otorhinolaryngology and Skull Base Center, AP-HP, Hospital Lariboisière, Paris, France
| | - T Saccardo
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy
| | - C Piazza
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - B Verillaud
- Otorhinolaryngology and Skull Base Center, AP-HP, Hospital Lariboisière, Paris, France
| | - P Nicolai
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy
| | - P Castelnuovo
- Unit of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - P Herman
- Otorhinolaryngology and Skull Base Center, AP-HP, Hospital Lariboisière, Paris, France
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Adegboyega G, Elhassan HA, Zocchi J, Lambertoni A, Bozkurt G, Karligkiotis A, Turri-Zanoni M, Battaglia P, Bignami M, Castenuovo P. 351 Anterior Ethmoid Artery Septal Flap for Endoscopic Reconstruction of Frontal Sinus CSF Leak. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
Anterior skull base cerebrospinal fluid (CSF) leaks are managed successfully with endonasal surgery. Endoscopic closure of CSF leaks from posterior table of the frontal sinus remains challenging. Vascularized Hadad-Bassagasteguy flap (HBF) reconstruction of the skull base has increased CSF closure rates but does not extend to frontal sinus. We describe our technique using septal flap pedicled by anterior ethmoid artery (AEA) for repairing frontal defects.
Method
Retrospective review of cases of frontal CSF leak repair using the AEA flap reconstruction. Flap design: an anterior vertical septal mucosa incision at posterior border of the frontal sinusotomy is made and extended to nasal floor. Posterior vertical incision is made 1 cm posterior to the projection of the axilla of the middle turbinate on the septum and extended to nasal floor. A horizontal incision along the nasal floor joins the two incisions. The flap is raised and rotated into the frontal sinus over the posterior table reconstructed defect.
Results
Three patients identified. Two males, one female, aged 11, 33 and 56. Patient histories included recurrent bacterial meningitis following head trauma, recurrent sinusitis and fronto-ethmoidal osteoma, with intraoperative CSF leak and CSF rhinorrhea due to meningoencephalocele. The three posterior wall defects were successfully repaired endoscopically with multilayer reconstruction and the AEA septal flap.
Conclusions
The anterior ethmoid artery septal flap can be successfully utilised for frontal CSF leak repair. Flap is conveniently located for frontal sinus defects. When the septum is intact it provides an excellent final layer as part of multilayer reconstruction.
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Affiliation(s)
- G Adegboyega
- Barts and The London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - H A Elhassan
- ENT Department, Homerton University Hospital, London, United Kingdom
| | - J Zocchi
- Department of Otorhinolaryngology, University of Insubria, Varese, Italy
| | - A Lambertoni
- Department of Otorhinolaryngology, University of Insubria, Varese, Italy
| | - G Bozkurt
- Department of Otorhinolaryngology, University of Insubria, Varese, Italy
| | - A Karligkiotis
- Department of Otorhinolaryngology, University of Insubria, Varese, Italy
| | - M Turri-Zanoni
- Department of Otorhinolaryngology, University of Insubria, Varese, Italy
| | - P Battaglia
- Department of Otorhinolaryngology, University of Insubria, Varese, Italy
| | - M Bignami
- Department of Otorhinolaryngology, University of Insubria, Varese, Italy
| | - P Castenuovo
- Department of Otorhinolaryngology, University of Insubria, Varese, Italy
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Adegboyega G, Elhassan HA, Karligkiotis A, Searyoh K, Zocchi J, Bozkurt G, Bandi F, Turri-Zanoni M, Battaglia P, Bignami M, Castelnuovo P. 350 Cross Over Septal Flap Technique for Choanal Atresia Surgery: Two Centre Series with Outcomes. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
Choanal atresia (CA) is a congenital obstruction of the posterior nasal aperture due to nasal cavity canalisation failure. Endoscopic endonasal surgery has led to successful CA repair and fewer complications compared to open surgery. We describe our surgical technique that uses septal mucosal flaps without need for stenting or subsequent intubation.
Method
A multicentre retrospective review of patients who underwent surgery using the cross over septal technique. Patient demographics and outcomes were recorded. Flap design: bilateral vertical septal mucosa incisions are performed on either side of the posterior third of the septum to form two mucoperiosteal flaps. The posterior vomer and atretic plates are removed. One flap is pedicled superiorly and rotated over the bare sphenoid rostral bone. The contralateral flap is pedicled inferiorly and rotated to cover exposed bone of nasal cavity floor. Lateral nasal wall mucosal integrity is maintained. This technique is used both for unilateral and bilateral atresia.
Results
Twelve patients from 2013 to 2020 were included. Age range was 0.07-50 years, male to female ratio of 1:5. Ten patients had unilateral CA, two had bilateral. Nine had bony CA, the remainder mixed. 5 patients (mean age 2.8 years) underwent second-look endoscopy under sedation an average 36 days following primary surgery.
Conclusions
The cross over technique for CA has low morbidity and 100% success in our multicentre series. Use of mucoperiosteal flaps to cover the exposed bone, removal of vomer and minimal instrumentation to the lateral nasal wall are the best ways to avoid postoperative stenosis.
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Affiliation(s)
- G Adegboyega
- Barts and The London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - H A Elhassan
- ENT Department, Homerton University Hospital, London, United Kingdom
| | - A Karligkiotis
- Department of Otorhinolaryngology, University of Insubria, Varese, Italy
| | - K Searyoh
- ENT Department, Korle Bu Teaching Hospital, Accra, Ghana
| | - J Zocchi
- Department of Otorhinolaryngology, University of Insubria, Varese, Italy
| | - G Bozkurt
- Department of Otorhinolaryngology, University of Insubria, Varese, Italy
| | - F Bandi
- Department of Otorhinolaryngology, University of Insubria, Varese, Italy
| | - M Turri-Zanoni
- Department of Otorhinolaryngology, University of Insubria, Varese, Italy
| | - P Battaglia
- Department of Otorhinolaryngology, University of Insubria, Varese, Italy
| | - M Bignami
- Department of Otorhinolaryngology, University of Insubria, Varese, Italy
| | - P Castelnuovo
- Department of Otorhinolaryngology, University of Insubria, Varese, Italy
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Pietrobon G, Karligkiotis A, Turri-Zanoni M, Fazio E, Battaglia P, Bignami M, Castelnuovo P. Surgical management of inverted papilloma involving the frontal sinus: a practical algorithm for treatment planning. ACTA ACUST UNITED AC 2019; 39:28-39. [PMID: 30936576 PMCID: PMC6444166 DOI: 10.14639/0392-100x-2313] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 10/15/2018] [Indexed: 11/23/2022]
Abstract
Inverted papilloma of the frontal sinus is a challenging disease. Given its rarity, only small case series are present in the literature. The objectives of the present study are to review our experience in the surgical management of inverted papillomas involving the frontal sinus and to propose a practical algorithm for selecting the most appropriate approach. Data on patients affected by inverted papilloma involving the frontal sinus and surgically treated between 2002 and 2016 were collected. The type of involvement of frontal sinus and extent of surgery performed (endoscopic endonasal, external or combined approaches) were analysed. A brief review of consistent literature was also carried out. Forty-seven consecutive patients were treated using an exclusive endoscopic endonasal approach (EEA) in 18 cases, while a combined endonasal with external osteoplastic approach was required in 29 cases. Most patients (29/47, 62%) had been treated previously, mainly by an endoscopic approach. A single intraoperative complication occurred (1/47, 2%), i.e. cerebrospinal fluid (CSF) leak, that was successfully repaired intraoperatively without any consequences. Recurrences were observed in only 2/47 cases (4%) after a mean follow-up of 43 months (range, 12-137). The management of inverted papilloma involving the frontal sinus requires great expertise and the surgical technique should be tailored to the site of attachment of the tumour, its extension and the anatomical conformation of each frontal sinus. The encouraging results obtained in this case series support the use of this practical treatment algorithm.
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Affiliation(s)
- G Pietrobon
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - A Karligkiotis
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.,Head and Neck Surgery & Forensic Dissection Research center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - M Turri-Zanoni
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.,Head and Neck Surgery & Forensic Dissection Research center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - E Fazio
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - P Battaglia
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.,Head and Neck Surgery & Forensic Dissection Research center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - M Bignami
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.,Head and Neck Surgery & Forensic Dissection Research center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - P Castelnuovo
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.,Head and Neck Surgery & Forensic Dissection Research center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
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6
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Pietrobon G, Bignami M, Preti A, Pistochini A, Bandi F, Gallo S, Bahranifard H, Locatelli D, Karligkiotis A, Castelnuovo P. Frontal sinus ablation (Riedel-Mosher’s procedure): indications and role in the endonasal endoscopic era. Rhinology 2019; 57:293-302. [PMID: 30984921 DOI: 10.4193/rhin18.197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this article is to describe the Riedel-Mosher’s surgical technique and identify its current role in the endoscopic endonasal era based on the experience of a tertiary care medical centre. It also provides a brief excursus on materials available for frontal reconstruction. METHODS A retrospective review of patients submitted to Riedel-Mosher’s procedure from 2005 to 2018 at a single tertiary care centre was carried out. Details of the surgical technique along with data on frontal reconstruction timing and materials used were collected. RESULTS A total of 21 patients (16 males and 5 females) underwent the Riedel-Mosher’s procedure. The age of the patients ranged from 15 to 84 years. The underlying pathology was represented mainly by chronic osteitis of the frontal bone (17 cases), followed by benign tumours (3 cases) and malignancy (1 case). Perioperative complications occurred in 3 patients. Cranioplasty was carried out only on 16 cases and delayed by an average time of 10 months. Materials for reconstruction included titanium, ceramic, plastic and free flap . CONCLUSIONS Nowadays, Riedel-Mosher’s procedure is still indicated in selected cases of benign and malignant pathologies of the frontal sinus and/or frontal bone. Surgical expertise is key to approach the frontal sinus safely. Its reconstruction requires proper planning and a wide variety of materials to perform it is now available.
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Affiliation(s)
- G Pietrobon
- Division of Otorhinolaryngology and Head and Neck Surgery, European Institute of Oncology, Milan, Italy
| | - M Bignami
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy; Head and Neck Surgery and Forensic Dissection Research centre (HNS and FDRc)
| | - A Preti
- Department of Otorhinolaryngology, University of Milan and IRCCS Multimedica, Ospedale San Giuseppe, Milan, Italy
| | - A Pistochini
- Division of Otorhinolaryngology, Department of Specialized Surgeries, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - F Bandi
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - S Gallo
- Division of Otorhinolaryngology, Department of Specialized Surgeries, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - H Bahranifard
- Department of Otorhinolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - D Locatelli
- Division of Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - A Karligkiotis
- Division of Otorhinolaryngology, Department of Specialized Surgeries, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - P Castelnuovo
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy; Head and Neck Surgery and Forensic Dissection Research centre (HNS and FDRc)
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7
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Bertazzoni G, Accorona R, Schreiber A, Pietrobon G, Karligkiotis A, Fazio E, Castelnuovo P, Nicolai P. Postoperative long-term morbidity of extended endoscopic maxillectomy for inverted papilloma. Rhinology 2018; 55:319-325. [PMID: 28687815 DOI: 10.4193/rhin17.035] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Extended endoscopic maxillectomy (Sturmann-Canfield procedure) allows full visualization of the maxillary sinus by sectioning the lacrimal duct and removing the medial part of the anterior maxillary wall. The aim of this study is to evaluate the morbidity of Sturmann-Canfield procedure in patients treated for inverted papilloma. METHODOLOGY The clinical records of all patients treated with a Sturmann-Canfield procedure for inverted papilloma from October 2000 to September 2015 at two teaching hospitals were reviewed. All patients were evaluated by nasal endoscopy and lacrimal system patency was assessed. Pre-maxillary cutaneous sensitivity was tested with a Semmes-Weinstein aesthesiometer and thermic stimulation. The SNOT-22 questionnaire was administered. Patients were also asked to report any other post-surgical complaints. RESULTS Fifty-nine patients were identified. Mean follow-up after surgery was 66.3 months. Mean SNOT-22 score was 5.94 (range 0-20); the majority of patients (86%) had a SNOT-22 symptom score of 3 or lower. Mucocoele occurred in 3 (5%) cases. Lacrimal pathway obstruction was observed in 7 (12%) patients. Fourteen (24%) patients complained of paraesthesia in the malar area; hypoesthesia was present in only 5 (8%) cases. Hypoesthesia in the region innervated by the anterior superior alveolar nerve was detected in 17 (29%) patients. One patient reported a slight depression of paralateronasal soft tissues. CONCLUSIONS Although nasal function outcomes and the results from SNOT-22 questionnaires were favourable, a high rate of neurologic and lacrimal complications was observed. Potential morbidity of the intervention, including the possibility of negative aesthetic sequelae, should be discussed during preoperative counselling.
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Affiliation(s)
- G Bertazzoni
- Department of Otorhinolaryngology, University of Brescia, Brescia, Italy
| | - R Accorona
- Department of Otorhinolaryngology, University of Brescia, Brescia, Italy
| | - A Schreiber
- Department of Otorhinolaryngology, University of Brescia, Brescia, Italy
| | - G Pietrobon
- Department of Otorhinolaryngology, University of Insubria, Varese, Italy
| | - A Karligkiotis
- Department of Otorhinolaryngology, University of Insubria, Varese, Italy
| | - E Fazio
- Department of Otorhinolaryngology, University of Insubria, Varese, Italy
| | - P Castelnuovo
- Department of Otorhinolaryngology, University of Insubria, Varese, Italy
| | - P Nicolai
- Department of Otorhinolaryngology, University of Brescia, Brescia, Italy
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8
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Gera R, Mozzanica F, Karligkiotis A, Preti A, Bandi F, Gallo S, Schindler A, Bulgheroni C, Ottaviani F, Castelnuovo P. Lateral lamella of the cribriform plate, a keystone landmark: proposal for a novel classification system. Rhinology 2018; 56:65-72. [DOI: 10.4193/rhin17.067] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Locatelli D, Pozzi F, Agresta G, Padovan S, Karligkiotis A, Castelnuovo P. Extended Endoscopic Endonasal Approach for Suprasellar Craniopharyngioma. J Neurol Surg B Skull Base 2018; 79:S196-S198. [PMID: 29404249 PMCID: PMC5796833 DOI: 10.1055/s-0038-1623529] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 12/07/2017] [Indexed: 10/31/2022] Open
Abstract
Objectives We illustrate a suprasellar craniopharyngiomas treated with an extended endoscopic endonasal approach (EEEA). Design Case report of a 43-year-old male affected by cerebral lesion located in suprasellar region involving the third ventricle and compressing the neurovascular structures, causing an anterosuperior dislocation of the chiasma. There is a complete disruption of the pituitary stalk that can explain the clinical finding of partial anterior hypopituitarism and hyperprolactinemia. The lesion is characterized by a solid and cystic component. Considering the absence of lateral extension and the suprasellar location of the lesion, an EEEA is preferred. Setting University Hospital "Ospedale di Circolo," Department of Neurosurgery, Varese, Italy. Participants Neurosurgical and ENT Skull Base Team. Main Outcome Measures A bilateral parasagittal approach is performed using a four-hand technique. The first step of the surgery is the preparation of the Hadad's flap. The approach is extended to the planum sphenoidalis to expose the suprasellar region. The lesion is completely removed employing also an ultrasound aspirator. Skull base reconstruction is performed with three-layer technique: graft of fat tissue, fascia lata, and nasoseptal flap. Results No postoperative complications occurred. In the post-op, the patient presents a panhypopituitarism and an improvement in neurological status. The visual deficit remains stable. Post-op magnetic resonance imaging at 1 year documents the complete absence of pathological contrast enhancement. Conclusions EEEA is a feasible approach in treating craniopharyngioma with suprasellar extension. The advantages include optimal visualization, good resection rate, and absence of brain retraction. The link to the video can be found at: https://youtu.be/IYm-8P1jbBo .
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Affiliation(s)
- D Locatelli
- Department of Neurosurgery, University of Insubria - Ospedale di Circolo Fondazione Macchi, Varese, Italy
| | - F Pozzi
- Department of Neurosurgery, ASST Sette Laghi, Ospedale di Circolo Fondazione Macchi, Varese, Italy
| | - G Agresta
- Department of Neurosurgery, University of Pavia, Italy
| | - S Padovan
- Department of Neurosurgery, University of Pavia, Italy
| | - A Karligkiotis
- Department of Otorhinolaryngology, ASST Sette Laghi, Ospedale di Circolo Fondazione Macchi, Varese, Italy
| | - P Castelnuovo
- Department of Otorhinolaryngology, University of Insubria - Ospedale di Circolo Fondazione Macchi, Varese, Italy
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10
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Ciniglio Appiani M, Verillaud B, Bresson D, Sauvaget E, Blancal JP, Guichard JP, Saint Maurice JP, Wassef M, Karligkiotis A, Kania R, Herman P. Ossifying fibromas of the paranasal sinuses: diagnosis and management. Acta Otorhinolaryngol Ital 2017; 35:355-61. [PMID: 26824919 PMCID: PMC4720932 DOI: 10.14639/0392-100x-533] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Fibro-osseous benign lesions rarely affect the sinonasal tract and are divided into 3 different entities, namely osteoma, fibrous dysplasia and ossifying fibroma. They share several clinical, radiological and histological similarities, but have different behaviours. Ossifying fibroma, and in particular the "juvenile" histological subtype, may have a locally aggressive evolution and a high risk for recurrence if removal is incomplete. The purpose of the present study is to compare the clinical behaviour of ossifying fibroma with the other benign fibro-osseous lesions; highlight different behaviour between the histological subtypes; compare the advantages, limitations and outcomes of an endoscopic endonasal approach with reports in the literature. We retrospectively reviewed 11 patients treated for sinonasal ossifying fibroma at a tertiary care centre. All patients underwent CT scan, and MRI was performed in cases of cranial base involvement or recurrence. Pre-operative biopsy was performed in cases where it was possible to use an endoscopic approach. One patient underwent pre-operative embolisation with ipsilateral visual loss after the procedure. Depending on its location, removal of the tumour was performed using an endoscopic (n = 7), or an external (n = 3) or combined (n = 1) approach. Histopathologically, 5 patients presented the conventional type, 5 the juvenile psammomatoid variant, which was associated in 1 case with an aneurismal bone cyst, and 1 case presented the trabecular juvenile variant. Three patients affected by the juvenile psammomatoid histological variant presented invasion of the skull base and underwent a subtotal removal that subsequently required, due to the regrowth of the remnant, a transbasal approach. Clinical, radiological and histological findings should all be considered to establish differential diagnosis among fibrous osseous lesions. More studies are necessary to conclude if the localisation and extension of the disease at the time of diagnosis is more important than the histological variant. An endoscopic approach is the first choice in most of cases even if an external open approach may be necessary in selected patients.
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Affiliation(s)
- M Ciniglio Appiani
- ENT Section, Department of Sensory Organs, Sapienza University of Rome, Italy
| | - B Verillaud
- ENT Department, Lariboisière Hospital, Assistance Publique, Hopitaux de Paris, Paris 7 University, Paris, France
| | - D Bresson
- Neurosurgery Department, Lariboisière Hospital, Assistance Publique, Hopitaux de Paris, Paris 7 University, Paris, France
| | - E Sauvaget
- ENT Department, Lariboisière Hospital, Assistance Publique, Hopitaux de Paris, Paris 7 University, Paris, France
| | - J-P Blancal
- ENT Department, Lariboisière Hospital, Assistance Publique, Hopitaux de Paris, Paris 7 University, Paris, France
| | - J-P Guichard
- Neuroradiology Department, Lariboisière Hospital, Assistance Publique, Hopitaux de Paris, Paris 7 University, Paris, France
| | - J-P Saint Maurice
- Neuroradiology Department, Lariboisière Hospital, Assistance Publique, Hopitaux de Paris, Paris 7 University, Paris, France
| | - M Wassef
- Pathology Department, Lariboisière Hospital, Assistance Publique, Hopitaux de Paris, Paris 7 University, Paris, France
| | - A Karligkiotis
- Division of Otorhinolaryngology, Department of Surgical, Microsurgical and Medical Sciences, University of Sassari, Italy
| | - R Kania
- ENT Department, Lariboisière Hospital, Assistance Publique, Hopitaux de Paris, Paris 7 University, Paris, France
| | - P Herman
- ENT Department, Lariboisière Hospital, Assistance Publique, Hopitaux de Paris, Paris 7 University, Paris, France
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11
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Battaglia P, Turri-Zanoni M, De Bernardi F, Dehgani Mobaraki P, Karligkiotis A, Leone F, Castelnuovo P. Septal flip flap for anterior skull base reconstruction after endoscopic resection of sinonasal cancers: preliminary outcomes. Acta Otorhinolaryngol Ital 2017; 36:194-8. [PMID: 27214830 PMCID: PMC4977006 DOI: 10.14639/0392-100x-748] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 11/08/2015] [Indexed: 11/23/2022]
Abstract
Over the past decade surgery for sinonasal malignancies encroaching into the anterior skull base (ASB) has evolved from open craniofacial resection to the use of minimally invasive transnasal endoscopic approaches. Using these techniques, ASB reconstruction is most often performed in a multilayer fashion with autologous free grafts (fascia lata or iliotibial tract) which leads to the production of abundant nasal crusting in the postoperative months and discomfort for patients. In carefully selected cases, we propose harvesting a flap from the contralateral nasal septum based on the septal branches of the anterior and posterior ethmoidal arteries (Septal Flip Flap, SFF), which can be rotated to resurface the ASB defect. The exclusion criteria for using the SFF were as follows: cases where the tumour extended to both ethmoid complexes; cases where there was nasal septum or planum spheno-ethmoidalis involvement by the disease; cases of sinonasal malignant tumour with multifocal histology. In our tertiary care referral centre, skull base reconstruction using the SFF was performed in four patients; one was affected by ethmoidal teratocarcinosarcoma, one by persistence of sinonasal undifferentiated carcinoma after radio-chemotherapy, another by olfactory cleft esthesioneuroblastoma and the fourth by ethmoidal squamous cell carcinoma. Successful skull base reconstruction was obtained in all four cases without any intra- or post-operative complications. Post-operatively, nasal crusting was significantly reduced with faster healing of the surgical cavity. No recurrences of disease have been observed after a mean follow-up of 15 months. The SFF can be considered as a safe and effective technique for ASB reconstruction with high success rates similar to those obtained with other pedicled flaps. This flap also ensured a faster healing process with reduction of nasal crusting and improvement in the quality of life of patients in the postoperative period. This technique appears to be a safe and effective option for ASB reconstruction after endonasal resection of sinonasal malignancies in selected cases. Larger case series with a longer follow-up are needed to validate the preliminary results obtained with such an innovative and promising surgical technique.
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Affiliation(s)
- P Battaglia
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Varese, Italy;,Head and Neck Surgery & Forensic Dissection Research center (HNS&FDRc), DBSV, University of Insubria, Varese, Italy
| | - M Turri-Zanoni
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Varese, Italy;,Head and Neck Surgery & Forensic Dissection Research center (HNS&FDRc), DBSV, University of Insubria, Varese, Italy
| | - F De Bernardi
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Varese, Italy
| | - P Dehgani Mobaraki
- Section of Otorhinolaryngology, Head and Neck Surgery, Department of Surgery and Biomedical Science, S.M. della Misericordia Hospital, University of Perugia, Italy, Association "Naso Sano" Onlus, Umbria Regional Registry of Volunteers, Corciano, Italy
| | - A Karligkiotis
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Varese, Italy
| | - F Leone
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Varese, Italy
| | - P Castelnuovo
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Varese, Italy;,Head and Neck Surgery & Forensic Dissection Research center (HNS&FDRc), DBSV, University of Insubria, Varese, Italy
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