The infundibulochiasmatic angle and the favorability of an endoscopic endonasal approach in type IV craniopharyngioma: illustrative case

BACKGROUND

Lesions located in the floor of the third ventricle are among the most difficult to access in neurosurgery. The neurovascular structures can limit transcranial exposure, whereas tumor extension into the third ventricle can limit visualization and access. The midline transsphenoidal route is an alternative approach to tumor invading the third ventricle if the tumor is localized at its anterior half and a working space between the optic apparatus and the pituitary infundibulum exists. The authors introduce the "infundibulochiasmatic angle," a valuable measurement supporting the feasibility of the translamina terminalis endoscopic endonasal approach (EEA) for resection of type IV craniopharyngiomas.

OBSERVATIONS

Due to a favorable infundibulochiasmatic angle measurement on preoperative magnetic resonance imaging (MRI), an endoscopic endonasal transsellar transtubercular approach was performed to resect a type IV craniopharyngioma. At 2-month follow-up, the patient's neurological exam was unremarkable, with improvement in bitemporal hemianopsia. Postoperative MRI confirmed gross-total tumor resection.

LESSONS

The infundibulochiasmatic angle is a radiological tool for evaluating the feasibility of EEA when resecting tumors in the anterior half of the third ventricle. Advantages include reduced brain retraction and excellent rates of resection, with minimal postoperative risks of cerebrospinal fluid leakage and permanent pituitary dysfunction.

[The outcome of transnasal endoscopic total maxillectomy in the treatment of sinonasal adenoid cystic carcinoma]

Objective:To assess the prognosis of sinonasal adenoid cystic carcinoma with hard palatine invasion treated by transnasal endoscopic total maxillectomy. Methods:Clinical data of twenty-six patients with sinonasal adenoid cystic carcinoma invading hard palatine treated by transnasal endoscopic total maxillectomy between May 2014 and December 2020 was analyzed retrospectively. Survival rate, local recurrence and distant metastasis were analyzed using Kaplan-Meier method. Cox regression was used to investigate the prognosis factors. Masticatory function after maxillectomy has also been assessed using the questionnaire of patients' satisfaction about masticatory function. Results:Margins in 8 patients（30%） were positive. The median time of follow-up was 38 months（6 to 85 months）. Twenty-five patients recurred. Four patients died of distant metastasis. The 5-year overall survival rate and relapse-free survival rate was 79.5% and 89.1%, respectively. Independent predictors of outcome on multivariate analysis were positive margin（P=0.018）, recurrence（P=0.006） and distant metastasis（P=0.04）. Conclusion:Transnasal endoscopic total maxillectomy could be performed for the treatment of the sinonasal adenoid cystic carcinoma with hard palatine invasion. Positive margin, local recurrence and distant metastasis were important predictors for patients' prognosis.

Transcanal endoscopic management of isolated congenital middle ear malformations

BACKGROUND

A few studies have reported transcanal endoscopic management of isolated congenital middle ear malformations (CMEMs).

OBJECTIVE

The purpose of this study is to describe our surgical experience in endoscopic ear surgery for isolated CMEMs and evaluate the surgical effect of hearing reconstruction.

METHODS

From January 2017 to January 2022, a retrospective study was performed on 36 patients (37 ears) with isolated CMEMs who all underwent endoscopic surgery. Demographic data, high-resolution computed tomography (HRCT) findings, intraoperative findings, surgical management and audiometric data were recorded.

RESULTS

Anomalies were categorized according to the Teunissen and Cremers classification system: 8 ears were categorized as class I, 8 ears as class II, 19 ears as class III and 2 ears as class IV. The air conduction pure tone average (AC-PTA) of 37 cases was 61.5 ± 8.6 dB preoperatively and 29.6 ± 6.9 dB postoperatively (p < 0.001). The mean preoperative air-bone gap (ABG) significantly decreased from 43.1 ± 8.7 dB to 12.8 ± 5.5 dB postoperatively. 36 of 37 cases (97%) met the criteria for successful operation.

CONCLUSION

Isolated CMEMs are mainly manifested as aplasia of the stapes' superstructure and dysplasia of the long process of the incus. Transcanal endoscopic surgery seems a safe technique for the management of isolated CMEMs.

[Effect of endonasal endoscopic dacryocystorhinostomy combined with lacrimal duct drainage tube implantation in treating lacrimal duct obstruction]

Objective:To investigate the clinical effect of endonasal endoscopic dacryocystorhinostomy（EES-DCR） combined with lacrimal duct drainage tube implantation in treating the patients with lacrimal duct obstruction. Methods: 32 patients （37 eyes） with lacrimal duct obstruction were included into this study, including 1 patient （2 eyes） of functional nasal lacrimal duct obstruction,2 patients （2 eyes） of recurrence after EES-DCR,17 patients （19 eyes） of nasal lacrimal duct obstruction,6 patients （8 eyes） of small lacrimal sac, and 6 patients （6 eyes） of lacrimal duct obstruction. Intraoperative EES-DCR was performed, and lacrimal drainage tubes were implanted from the upper and lower lacrimal points. Septoplasty was performed in 3 patients with nasal septum deviation, and endoscopic sinus surgery was performed in 1 patient with chronic sinusitis.After operation, nasal hormone spraying was performed. During follow-up, the operation effect was evaluated according to the degree of symptom improvement, the patency of lacrimal passage irrigation and the opening state of dacryocystorhinostomy under nasal endoscope. Results:After 3-30 months of follow-up, 29 cases（34 eyes） were cured, 2 cases（2 eyes） were improved, and 1 case（1 eye） was ineffective. The total effective rate was 97.3%（36/37）. No intraorbital, intracranial or nasal complications occurred in all patients. Conclusion:EES-DCR combined with lacrimal duct drainage tube implantation is safe and effective in treating lacrimal duct obstruction. Implantation of lacrimal duct drainage tube can effectively avoid stoma blockage, prevent the adhesion of lacrimal duct, and significantly improve the success rate of surgery.

Effect of endoscopic urethral procedures applied after robotic radical prostatectomy on urinary incontinence: A prospective cohort pilot study

OBJECTIVES

The most common complications after radical prostatectomy (RP) are erectile dysfunction (ED) and urinary incontinence (UI). After RP, patients may require endoscopic urethral procedures (EUP) for other urological diseases such as hematuria, urinary system stone disease, and suspicion of bladder tumor. In clinical practice we observed that EUP performed after robot assisted RP (RARP) can cause an increase in the UI level. In this study, we investigated whether there is a change in the UI level in patients that underwent EUP after RARP and whether this change was affected by the duration of the procedure and type of endoscopic device used.

MATERIAL AND METHODS

Twenty-six patients were included who underwent EUP after RARP in this study. The patients were divided into three groups based on the endoscopic device used: group 1 rigid cystoscopy (n = 9), group 2 flexible cystoscopy (n = 7), and group 3 semi-rigid ureterorenoscopy (URS) (n = 10). The Turkish version of the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-SF) and the number of pads used daily was questioned before the EUP and 1 month after the procedure.

RESULTS

While a significant increase in ICIQ-SF score was observed in group 1 (p = 0.027), no significant increase was observed in group 2 and group 3 (p > 0.05). No significant difference was observed between the number of pads used preoperatively and the postoperative first month in all groups (p > 0.05). There was no significant correlation between increased operation time and both the pad usage and ICIQ-SF score (p > 0.05).

CONCLUSION

The use of small diameter endoscopic instruments and flexible instruments is important for patient comfort and to avoid damage to urethrovesical anastomosis in patients who need to undergo EUP after RP.

Contemporary Management of Male Anterior Urethral Strictures by Reconstructive Urology Experts-Results from an International Survey among ESGURS Members

Assessment of anterior urethral stricture (US) management of European urology experts is relevant to evaluate the quality of care given to the patients and plan future educational interventions. We assessed the practice patterns of the management of adult male anterior US among reconstructive urology experts from European countries. A 23-question online survey was conducted among European Association of Urology Section of Genito-Urinary Reconstructive Surgeons (ESGURS) members. A total of 88 invitations were sent by email at two different times (May and October 2019). Data were prospectively collected from May 2019 to December 2019. The response rate was 55.6%. Most of the responders were between 50 and 59 y.o. and mainly from University Public Teaching/Academic Hospitals. A total of 73.5% treated ≥20 patients/year with US. Retrograde urethrogram (RUG) was the commonest diagnostic tool, followed by uroflowmetry (UF) +/− post-void residual (PVR). Urethroplasty using grafts was the most frequent treatment (91.8%). Of responders, 55.3% performed >20 urethroplasties/year. Anastomotic urethroplasties were performed by 83.7%, skin flap repairs by 61.2%, perineal urethrostomy by 77.6% and non-transecting techniques by 63.3%. UF was the most common follow-up tool. Most of the responders considered urethroplasty as the primary option when indicated. Male anterior US among ESGURS members are treated mainly using urethroplasty graft procedures. RUG is preferred for diagnosis, and UF for follow-up.

Full Endoscopic Thoracic Discectomy: Is the Interlaminar Approach an Alternative to the Transforaminal Approach? A Technical Note

BACKGROUND

Various approaches are used for decompressive surgeries in the thoracic spine depending on the location and consistency of the pathology, always avoiding manipulation of the thoracic spinal cord. Recently, there has been an effort to achieve adequate results and reduce morbidity with minimally invasive surgeries. Good outcomes and the advantages of full endoscopic spine surgery (FESS) have been proven for surgerical correction of herniated discs and stenoses in the lumbar and cervical spine. Similar evidence has recently been described for the thoracic spine, but it has not previously been reported in Brazil. Although the transforaminal approach is already established for the thoracic spine, the newly described interlaminar approach is equally efficient, and both techniques must be considered when treating thoracic spine diseases. The objective of the present article was to present the full endoscopic interlaminar and transforaminal techniques in patients with symptomatic disc herniation of the thoracic spine, discuss the rationality for implementing FESS in thoracic spine, and discuss the rationality in choosing between both approaches.

METHODS

Two patients were submitted to thoracic FESS. A transforaminal approach was chosen for a T10-T11 foraminal disc herniation; an interlaminar approach was selected for a paramedian T7-T8 disc extrusion. Data regarding operating time, intraoperative images, hospital stay, visual analog scales before and after FESS, course of recovery, and surgery satisfaction were evaluated.

RESULTS

The patients had eventless surgeries, improved from preoperative pain without morbidity. Both were satisfied and recovered well. Hospital stay was less than 6 hours after surgery.

CONCLUSIONS

Transforaminal and interlaminar FESS for thoracic disc herniation are safe, efficient, and minimally invasive alternatives.

CLINICAL RELEVANCE

Despite being an innovative technique with evident advantages, it should be carefully considered along with conventional technique for the treatment of thoracic spine diseases, since its clinical relevance is yet to be determined.

LEVEL OF EVIDENCE: 4

[Clinical research of unilateral posterior glottic cleft dilatation in the treatment of bilateral vocal cord paralysis dyspnea]

Objective:The aim of this study is to evaluate the efficacy of unilateral posterior glottic cleft dilatation with low-temperature plasma under the endoscope in the treatment of bilateral vocal cord paralysis dyspnea. Methods:Forty-one patients with bilateral vocal cord paralysis were recruited, and they were all admitted to the Department of Otorhinolaryngology Head and Neck Surgery, the First Affiliated Hospital of Zhengzhou University from March 2014 to June 2019. Those 41 patients were all treated with low-temperature plasma to completely resect unilateral arytenoid cartilage and the posterior 1/3 of the ipsilateral vocal cord. Fiber laryngoscopy was performed before and after operation. The clinical efficacy of the operation was evaluated by the size of glottis cleta, the improvement rate of dyspnea, voice satisfaction, swallowing function, the tracheal cannula removal rate and postoperative complication rate. Results:Forty-one patients were followed up for 24-88 months. The rate of one-pass extubation was 88.57%（31/35）. The satisfaction rate of voice was 92.11%（35/38）. The recovery rate of swallowing function was 97.56%（40/41）. Conclusion:This study demonstrated that the application of low-temperature plasma in unilateral posterior glottic cleft dilatation could significantly improved the ventilation function of patients with bilateral vocal cord paralysis, with a reliable curative effect and a high extubation rate. It is a safe, reliable, simple and minimally invasive treatment option for the treatment of bilateral vocal cord paralysis.

[Application of endoscopic nasopharyngeal enlargement excision in the surgical treatment of oncology in the nasopharyngeal]

Objective:To evaluate the clinical indication, technique, effect and cautions of intranasal endoscopic surgery for nasopharyngeal tumor. Methods:Between December 2016 and April 2021, 31 patients who received endoscopic nasopharyngectomy for nasopharyngeal tumors were analyzed retrospectively, 8 benign and 23 malignant cases were included. 8 benign cases included 7 cases with nasopharyngeal fiber hemangioma and 1 case with polymorphic adenoma. Twenty-three malignant cases included 12 cases with recurrent nasopharyngeal carcinoma after chemoradiotherapy and 11 cases with various types of malignancies. All patients underwent endoscopic resection of nasopharyngeal tumors through bilateral transnasal approach. Results:Total resection of the tumor was achieved for all cases without severe surgical complications. 8 cases with benign tumors, with following-up of 5-49 months, showed no recurrence. 23 cases with malignant tumors, with following-up of 6-58 months, 22 cases show no recurrence, 1 recurent nasopharyngeal osteosarcoma, curved after another operation and assisted with chemotherapy, 1 case with nasopharyngeal carcinoma survived with disease after two endoscopic operations. Conclusion:Nasopharyngeal tumor could be completely resected with endonasal endoscopic surgery according to the anatomic structure. Surgery should provide a panoramic view on nasopharyngeal cavity and tumors, protect important structures.

SALVAGE SURGERY IN GASTRIC CANCER

AIM

Salvage surgery (SS) is defined as surgical resection after the failure of the first treatment with curative intent. The aim of this study was to report the experience of a reference center with SS for stomach adenocarcinoma.

METHODS

This is a retrospective study of patients with gastric cancer (GC) operated on between 2009 and 2020.

RESULTS

Notably, 40 patients were recommended for salvage gastrectomy with curative-intent treatment. For analysis purpose, patients were divided into two groups: 23 patients after endoscopic resection and 17 patients after gastrectomy. In the first group, all patients underwent R0 resection, their average hospital length of stay (LOS) was 15.7 days, and 2 (8.6%) patients had major complications. During the average follow-up of 37.2 months, there was only one recurrence. The median overall survival (OS) was 46 months. In the postgastrectomy group, 9 (52.9%) patients were rescued with curative intent, the average hospital LOS was 12.2 days, and 3 (17.6%) had major complications. In a mean follow-up of 22 months, five patients relapsed. Median OS and disease-free survival were 24 and 16.5 months, respectively.

CONCLUSION

SS in GC offers the possibility of long-term disease control and increased survival rate with an acceptable complication rate.

[Research advances on endoscopic surgical approach for infratemporal fossa tumors]

The tumors occurring in infratemporal fossa （ITF） and parapharyngeal space account for 0.5%-1.0% of head and neck tumors, 80% of which are benign and 20% are malignant. At present, a variety of ITF surgical approaches have been described in domestic and foreign literatures. However, the selection of surgical approaches in clinical practice is still based on the habits and experience of the operators, there is still a lack of standardized clinical guidance. This article mainly introduces the advantages and disadvantages of the latest anatomical division of ITF and the corresponding endoscopic surgical approach as well as the research progress, so as to provide reference for the selection of the optimal surgical approach for ITF tumors.

[Advances in the surgical treatment of cholesteatoma of the middle ear]

Middle ear cholesteatoma, as a common ear disease, has been further understood in terms of its molecular mechanism, classification and staging, and it is generally believed that surgical treatment is the first choice, but there is no final conclusion on its surgical choice. Microscopic surgery includes complete or open radical mastoidectomy with or without reconstruction of the middle ear cavity, and their pros and cons have been debated for decades. In the past decade, a variety of surgical methods have been developed, including various improvements and combined operations that combine the advantages of traditional open radical mastoidectomy and complete mastoidectomy. On the other hand, the emergence of ear endoscopic surgery has opened up new surgical methods, as well as the use of laser and other new technologies to improve the surgical effect and prognosis, but also can not avoid their limitations and shortcomings. The purpose of this paper is to summarize the advantages and disadvantages of various surgical treatments for middle ear cholesteatoma in order to provide guidance and help for otologists in the treatment of middle ear cholesteatoma.

[The application of pedicled middle turbinate mucosal flap in transnasal endoscopic repair of cerebrospinal fluid rhinorrhea]

Objective:To investigate the application and efficacy of pedicled middle turbinate mucosal flap in transnasal endoscopic repair of cerebrospinal fluid rhinorrhea. Methods:15 patients with cerebrospinal fluid rhinorrhea were retrospectively analyzed，including 13 patients with simple cerebrospinal fluid rhinorrhea （86.7%） and 2 patients with cerebrospinal fluid rhinorrhea with meningoencephalocele （13.3%）. According to the location of the fistula, the pedicled middle turbinate mucosal flap under nasal endoscopy was used to repair cerebrospinal fluid rhinorrhea, in which 5 cases （33.3%） had leakage at the top of the sieve and 8 cases （53.3%） had leakage at the sieve plate. Two cases had leakage at the lateral racess of sphenoid sinus. Results:All cases of cerebrospinal fluid rhinorrhea were repaired successful and the mucosa epithelialized well in the operative area. There was no recurrence of cerebrospinal fluid rhinorrhea or other complications during the follow-up period of 4-24 months （average 13 months）. Conclusion:The pedicled middle turbinate mucosal flap has a high success rate for repairing cerebrospinal fluid rhinorrhea, and the nasal cavity damage is small, which is worthy of clinical promotion.

[Clinical characteristics of neuroendocrine carcinoma of nose and skull base and analysis of curative effect of endoscopic surgery]

Objective:To investigate the clinical features of neuroendocrine carcinoma of nose and skull base and the efficacy and prognosis of endoscopic resection. Methods:The clinical data of 7 patients with neuroendocrine carcinoma of nose and skull base treated by endoscopic surgery were retrospectively analyzed. According to the international TNM staging, there were 1 case of stage Ⅰ, 1 case of stage Ⅱ, 1 case of stage Ⅲ, 1 case of stage ⅣA and 3 cases of stage ⅣB. All patients were treated by endoscopic surgery, including 1 case of postoperative radiotherapy, 1 case of chemotherapy and 3 cases of radiotherapy and chemotherapy. Results:During the follow-up of 9-58 months, 2 cases died after recurrence, 1 case had ipsilateral cervical lymph node metastasis（tumor-free survival after neck dissection）, and 4 cases had tumor-free survival at the last follow-up. Conclusion:At present, there is no standard treatment for neuroendocrine carcinoma of the nose and skull base. The comprehensive treatment based on complete resection of the tumor by endoscopic surgery is an effective and feasible treatment.

[The effect of endoscopic dacryocystorhinostomy on different lacrimal duct obstruction]

Objective:To observe the effect of endoscopic dacryocystorhinostomy on different lacrimal duct obstruction. Methods:Eighty eyes with the lacrimal passage obstruction were collected, and treated with endoscopic dacryocystorhinostomy. Meanwhile, the abnormal structures of the nasal cavity were corrected and the pathological changes of the nasal cavity and sinuses were treated. The patients were followed up and the curative effect was observed. Follow-up period ranged from 10 months to 8 years. Results:The first operation cure rate was 78.8%, the effective rate was 17.5%, the ineffective rate was 3.8%, and the success rate was 96.2%. Two of the 3 eyes failed in first operation were cured by reoperation. The total success rate was 98.8%. Conclusion:Endoscopic dacryocystorhinostomy can be used as a routine operation in the treatment of different lacrimal duct obstruction. The structural abnormalities and pathological changes of the nasal cavity and paranasal sinuses can be treated simultaneously. Combined with postoperative treatment and follow-up, long-term curative effect can be obtained.

[Analysis of clinical effect of nasal endoscope-assisted nasal columella approach for simultaneous correction of nasal septum deviation and crooked nose deformity]

Objective:To analyze the clinical effect of nasal endoscope-assisted nasal columella approach in the correction of nasal septum deviation and crooked nose deformity. Methods:The clinical data of 33 patients with deviation of nasal septum with crooked nose deformity in First Affiliate Hospital of Air Force Military Medical University from January 2016 to June 2019 were collected. All patients underwent surgery under general anesthesia. Nasal columella inverted "V" incision was used to expose and release. The deviated nasal septum cartilage and bone were removed with the assistance of nasal endoscope. Twelve（36.4%） patients underwent osteotomy of nasal bone and frontal process of maxilla at the same time, 13（39.4%） patients used autologous nasal septum to reshape the tip, back and external nose. Results:During a follow-up of 18 months to 60 months, 30（90.9%） patients were satisfied with the improvement of postoperative nasal function, 3（9.1%） patients were basically satisfied; 23（69.7%） patients were satisfied with the appearance of the nose after operation, 8（24.2%） patients were basically satisfied, and 2（6.1%） patients were dissatisfied. No postoperative complications such as nasal adhesion, nasal septum perforation, nasal septum hematoma and nasal dorsal collapse occurred in all patients. Conclusion:The nasal endoscope-assisted nasal columella approach and the correction of nasal septum deviation and crooked nose deformity can solve the nasal deformity and nasal ventilation function at the same time, realize the unity of cosmetology and function, and reduce the frequency and cost of surgical treatment at the same time. The effect is good, and the patients benefit greatly.

[The efficacy of endoscopic plasty for children with bilateral congenital choanal atresia]

Objective:To evaluate the clinical effect of endoscopic repair for the treatment of children with bilateral congenital choanal atresia. Methods:A retrospective analysis was conducted in our department that six children who were diagnosed as bilateral congenital choanal atresia by nasopharyngeal endoscopy and nasal CT scanning. All cases underwent endoscopic repair and placed the silicone stent to support the enlarged nostrils for six months, and these patients were followed up to observe re-atresia rate after taking out of the supporting tube. Results:Six cases' nasal ventilation were effectively improved after operation without serious complications, 5 cases showed a satisfactory curative effect after taking out of the supporting tube, only 1 case with bony atresia found choanal re-atresia during follow-up. Conclusion:The clinical effect of using endoscopic repair for children with bilateral congenital choanal atresia showed remarkable efficacy with a low re-atresia.

[Diagonistic and prognostic analysis of olfactory neuroblastoma]

Objective:To explore the therapeutic effect and prognostic risk factors of olfactory neuroblastoma. Methods:Retrospective analysis of clinical data of 31 patients with olfactory neuroblastoma. The Kaplan-Meier method was used for survival analysis to calculate the overall survival rate and progress-free survival rate. Results:All 31 patients underwent surgical treatment and 7 patients died, of which 4 patients died of simple intracranial invasion and 3 patients died of concurrent distant metastasis （lung and spinal cord）. The average death time was 40.7 （20-57） months. Statistical analysis showed that craniocerebral invasion （P=0.035）, age ≥60 years （P=0.042）, and Ki-67≥20%（P=0.018） were closely related to the poor prognosis. It is speculated that the increase of T staging and modified Kadish staging are also predictors of poor prognosis. The 1-year and 5-year overall survival rates were 100.0% and 72.5%, and the 1-year and 5-year progress-free survival rates were 87.8% and 33.6% after first surgery. Conclusion:Surgery combined with radiotherapy and chemotherapy are the main treatments for olfactory neuroblastoma, but postoperative recurrence and metastasis are common. About 22.6% of the patients died during the follow-up. Advanced age, intracranial invasion and Ki-67≥20% are closely related to poor prognosis. The tumor was completely removed by the initial surgery and restricted in nasal cavity and sinuses are the key factors for a good prognosis.

[Diagnosis and treatment of 11 cases of subperiosteal orbital abscess caused by acute sinusitis]

Objective:The aim of this study is to explore the diagnosis, clinical manifestations and surgical treatment experience of acute sinusitis complicated with orbital subperiosteal abscess. Methods:The clinical data of 11 patients with acute sinusitis complicated by orbital subperiosteal abscess from 1 year and 8 months to 50 years were retrospectively analyzed, including clinical manifestations, imaging manifestations, bacteriological examinations, surgical methods and therapeutic effects. All patients were given antibacterial drugs, glucocorticoids, and surgery. Results:All 11 patients had unilateral lesions. The imaging examinations all supported the appearance of orbital subperiosteal abscess. Nine patients underwent nasal endoscopic sinus opening+SPOA incision and drainage, 2 patients underwent nasal endoscopic sinus opening+ultrasound guided abscess puncture. Eyelid swelling and exophthalmia of all patients were alleviated when discharged. Ten of the 11 patients had no visual acuity change, and one patient had light perception only when she came to the hospital and recovered to 0.05 when discharged, there was no change in visual acuity after 3 months follow-up. The bacterial cultures of nasal secretion or pus were positive in 7 cases, the main pathogenic bacteria were Staphylococcus aureus（3 cases, includes one case of MRSA）, Streptococcus anginosus（2 cases）, and Streptococcus intermedius（2 cases）. Conclusion:Rhinogenous orbital subperiosteal abscess has a rapid onset and progresses quickly. Once an abscess is formed, patients with poor conservative treatment should choose surgical treatment as soon as possible. The most common surgical method is nasal endoscopic sinus opening+SPOA incision and drainage. If the abscess is located above or above the eyeball, puncture or incision and drainage should be combined with ultrasound guidance.

[The influence of contoured sinus endoscopy on the recurrence of nasal polyps]

Objective:The aim of this stusy is to study the effect of endoscopic surgery quality on the recurrence of nasal polyps. Methods:A total of 32 patients（64 sides） with recurrent nasal polyps were collected from December 2016 to June 2018, all of which were bilateral type Ⅱ diffuse nasal polyps in stage 3. According to the post-operative pathological results, patients were divided into eosinophilic nasal polyps group（EOS） and non-eosinophilic nasal polyps group（NEOS）. All patients underwent sinus CT scan and three-dimensional reconstruction, combined with the sinus CT image performance and intraoperative findings, the quality of the patients' previous endoscopic sinus surgery was analyzed, and the CT L-M scores of sinuses before and after reoperation were compared between the two groups. Endoscopic L-K score, nasal symptoms VAS score, quality of life Snot-20 score. Results:Among 32 patients with recurrent nasal polyps, 17 cases （53.1%） of EOS nasal polyps were confirmed pathologically after surgery, and 15 cases （46.9%） of NEOS nasal polyps were confirmed. After the previous operation, the patient still has 60 sides（93.8%） of ethmoidal cells or ethmoidal septum, 56 sides（87.5%） of bone hyperplasia, 50 sides（78.1%） of bones in frontal recess air-cell or bone air-cell, and nasal cavity adhesion there were 10 sides（15.6%）, residual uncinate process 8（12.5%）, improper treatment of maxillary sinus ostia or atresia were 6（9.4%）, sphenoid sinus not open or atresia were 8（12.5%）, nasal septal deviation untreated were 4 cases（12.5%）, 1 case（3.1%） had recurrence without ethmoidal cells and residual bone interval. Patients both in the EOS group or the NEOS group were followed up with L-M score, L-K score, VAS score, and Snot-20 score after surgery, the result were significantly improved compared with the preoperative results. After follow-up of 1.5-3 years, 25 cases of polyps were completely controlled and 7 cases were partially controlled. Among them, 2 cases of EOS nasal polyps and asthma patients still had some polypoid changes in local mucosa one year after operation and was currently under medication control. Conclusion:Although the recurrence of nasal polyps is closely related to its intrinsic type, the technique of endoscopic surgery is also an important factor affecting the recurrence of nasal polyps. For patients with bilateral symmetric diffuse nasal polyps, high-quality sinus surgery of first time combined with standardized follow-up can reduce the recurrence rate of nasal polyps and prolong the relapse time.

[Clinical application of transcanal endoscopic ear surgery in the diagnosis and treatment of conductive hearing loss with intact tympanic membrane]

Objective:To explore the clinical efficacy of transcanal endoscopic ear surgery in the diagnosis and treatment of conductive hearing loss with intact tympanic membrane. Method:The clinical data of 16 patients with conductive hearing loss with intact tympanic membrane were retrospectively analyzed. They were diagnosed and treated by transcanal endoscopic ear surgery. Result:All patients were diagnosed by exploratory tympanotomy, including 6 cases of congenital middle ear anomalies, 5 cases of congenital cholesteatoma, 2 cases of congenital middle ear anomalies with congenital cholesteatoma, 2 cases of otosclerosis, and 1 case of traumatic ossicular chain disruption. During the tympanic exploration by transcanal endoscopic ear surgery, different methods of hearing reconstruction were applied according to the intraoperative lesions. Among 14 cases（14 ears）, 7 patients underwent reconstruction with partial ossicular replacement prosthesis （PORP）, 5 patients had total ossicular replacement prosthesis （TORP）, and 2 patients had piston. The remaining 2 patients did not undergot ossicular reconstruction. After the operation, the mean air-conductive threshold of 14 patients decreased from （61.7±6.5） dB HL to （29.8±10.7） dB HL （P<0.01） and the mean ABG decreased from（36.8±3.2） dB HL to （10.7±6.9） dB HL （P<0.01）. 1 case of congenital middle ear anomalies with congenital cholesteatoma underwent the lesion resection without ossicular reconstruction. Due to lack of suitable Piston, 1 case of congenital middle ear anomalies with fixed stapes did not perform hearing reconstruction. No serious complications occured after operations. Conclusion:Transcanal endoscopic ear surgery was suitable for the diagnosis and treatment of conductive hearing loss with intact tympanic membrane. It was minimally invasive with low complications, and the patients had a good hearing recovery after ossicular reconstruction.

[Use of balloon catheter dilation and bioabsorbable steroid-releasing sinus implants in pediatric chronic rhinosinusitis]

Objective:To evaluate the effect of use of balloon catheter dilation （BCD） with bioabsorbable steroid-releasing sinus implants in pediatric chronic rhinosinusitis（PCRS）. Method:A retrospective study was performed of 49 children with failed medical therapy, who underwent surgery, and children all accepted adenoidectomy.77 sides of sinus were performed with balloon catheter dilation sinuplasty. They were divided into two groups：the balloon group and the balloon with implant group. The balloon group included 26 cases, 16 cases of which accepted balloon catheter dilation sinuplasty of both maxillary sinuses, and 10 cases of which accepted one side. The balloon with implant group included 23 cases,12 cases of which accepted balloon catheter dilation sinuplasty of both maxillary sinuses plus positioning of bioabsorbable steroid-releasing sinus implants, and 11 cases of which accepted one side. VAS and SN-5 scales were completed by children and their parents to evaluate subjective symptoms. Children all accepted CT of sinus and CT score （Lund-Mackey） was completed by a doctor. We use the SPSS 23.0 with the way of Repeated measures ANOVA to analyze the data between two groups, aiming to identify the effect of the operation manners. Result:The procedures were successful in all patients in the balloon with implant group. No complications happened. No sinus implants moving and no detachment. In the balloon with implant group, VAS score declined from 6.9 before operation to 2.0 of six months after operation and SN-5 score declined from 2.397 to 1.376 and CT score of one side of operation declined from 9.628 to 1.314. VAS score, SN-5 score and CT score of the balloon with implant group all declined significantly after operation. The remission rate of the VAS and SN-5 score in the balloon with implant group were 100% and 95% respectively. The SN-5 score data of patients in two groups with SN-5 score <2.5 before operation was analyzed. There was no statistical significance between the data of two groups before operation（P=0.199）, and there was no statistical significance between the data decline of SN-5 score of two groups after operation （F=2.336，P=0.14）. The data of patients in two groups with SN-5 score ≥2.5 before operation was analyzed. There was no statistical significance between the data of two groups before operation（P=0.628）, and, after operation, there was statistical significance between the data decline of SN-5 score of two groups （F=13.861，P=0.001）.It meant the balloon with implant group declined more. The CT score data of patients in two groups with CT score （3-8） before operation was analyzed. There was no statistical significance between the data of two groups before operation（P=0.411）,and there was no statistical significance between the data decline of CT score of two groups after operation（F=1.108，P=0.300）.The data of patients in two groups with CT score （9-12） before operation was analyzed. There was no statistical significance between the data of two groups before operation（P=0.792）, and, after operation, there was statistical significance between the data decline of CT score of two groups （F=13.059，P＝0.001）. It meant the balloon with implant group declined more. Conclusion:In our study, the use of balloon catheter dilation （BCD） with bioabsorbable steroid-releasing sinus implants made a clinical curative effect in the treatment of PCRS with failed medical therapy, and it was safety. In severe PCRS patients, balloon catheter dilation （BCD） with bioabsorbable steroid-releasing sinus implants was more effective than the use of balloon catheter sinuplasty （BCS） alone.

[Neurofibromatosis type Ⅰwith parapharyngeal space invasion: report of one case]

We described a 56-year-old male who was admitted to the hospital due to no sweat on the right side of face for 4 years, and paraesthesia pharynges for 1 month. The physical examination was carried out. And the horizontal local uplift on right lateral wall of pharynx was found with café-au-lait spot scattered all over the right arm. MRI showed a rounded mass on the right parapharyngeal space with clear boundary. Later the tumor was removed by a transoral route with the assist of endoscope. The patient was eventually diagnosed with neurofibromatosis 1 and did not relapse after follow-up.

General Complications after Endoscopic Sinus Surgery in Smokers: A 2005-2016 NSQIP Analysis

BACKGROUND

Exposure to cigarette smoke has been associated with a higher incidence of postoperative complications across a variety of surgical specialties. However, it is unclear if smoking increases this risk after endoscopic sinus surgery (ESS). Because complication rates after ESS are relatively low, a large national database allows for a statistically meaningful study of this topic.

METHODS

The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) dataset from 2005 to 2016 was analyzed. Patients who underwent ESS were identified. Thirty-day postoperative complication rates between smokers and nonsmokers were compared. Complications included infection, thromboembolic events, reintubation, readmission, acute renal failure, and cardiovascular events.

RESULTS

921 patients who underwent ESS were identified. 182 (20%) were smokers and 739 (80%) were nonsmokers. 609 patients underwent outpatient ESS, while 312 patients underwent inpatient ESS. A total of 12 patients experienced postoperative surgical site infections involving the deeper tissues beyond the wound (organ/space SSI). On univariate analysis, smoking was associated with a higher incidence of organ/space SSI (P = .0067) and pulmonary embolism (P = .0321) after ESS. On multivariate logistic regression, smoking was associated with increased odds (4.495, 1.11- 8.17, P = .0347) of organ/space SSI after ESS.

CONCLUSIONS

This study demonstrates an association between exposure to cigarette smoke and potentially serious surgical site infections in the 30-day postoperative period after ESS. Our findings may help when counseling smokers who are considering ESS. Further study is required to understand the nature of these infections and ways to prevent them.Level of Evidence: 2c ("health outcomes").

[Osteoradionecrosis of skull base: clinical analysis and experience]

Objective:To discuss the diagnosis and treatment process of skull base osteoradionecrosis and improve the recognization of this disease. Method:We reviewd skull base and nasopharyngeal osteoradionecrosis in 7 patients retrospectively, including 5 nasopharyngeal carcinoma, 1 squamous cell carcinoma of sphenoid sinus, 1 adenoid cystic carcinoma; 6 patientd received skull base debridement surgery and the other one attempted but failed because of her unstable condition. Result:Follow-up period ranged from 3 to 31 months （mean 11.5 month）. During the review time, 2 patients died, 1 patient still had osteoradionecrosis with partly alleviated clinical symptom. At the latest follow-up visit, she was diagnosed as tumor recurrence and was advised to take targeted therapy by multi-discipline team; the symptom was significant improved in the rest of the patients. Conclusion:Osteoradionecrosis of skull base is often associated with other post-radiotherapy related complications. Once diagnosed definitely, extensive skull base debridement surgery should be performed in early time, which can significantly relieve symptoms, improve living quality and reduce the incidence of lethal complications.

[The role of palatovaginal canal and sphenopalatine artery in the localization of vidian canal during vidian neurotomy]

Objective:To explore the role of palatovaginal canal and sphenopalatine artery in the localization of pterygoid canal during pterygoid neurotomy. Method:55 patients with or without nasal polyps were divided into two groups: group A（twenty-nine cases, anterior wall approach of sphenoid sinus） and group B（twenty-six cases, middle nasal meatus approach）. All patients underwent unilateral vidian neurectomy under nasal endoscope. The vidian canal was located by palatal canal and sphenopalatine artery in group A and B, respectively. Result:The vidian canal was located successfully in all patients, with small wound, fast postoperative recovering. There was no irreversible complication. Conclusion:The relationship between the palatovaginal canal, sphenopalatine artery and the external orifice of vidian canal is constant, which can be used as an anatomical marker of vidian neurotomy.

[Clinical treatment experience of perioperative nasal endoscopic surgery in patients with cardiovascular disease]

Objective:To investigate the perioperative management of endoscopic nasal surgery in patients with cardiovascular disease. Method:Sixty-two patients with cardiovascular disease underwent endoscopic sinus surgery. Individualized medical treatment was used according to the patient's perioperative condition, followed by functional endoscopic surgery. Result:Two patients had cardiovascular complications after endoscopic surgery and were transferred to internal medicine. One patient developed massive hemorrhage after operation, and hemostasis was performed again under nasal endoscopic surgery. The remaining 59 patients had no adverse cardiovascular events after operation. There are no complications such as massive hemorrhage, visual impairment, and cerebrospinal fluid rhinorrhea. All patients were followed up for more than half a year, 39 cases（62.90%） of nasal sinus disease were completely controlled, 18 cases（29.03%） of nasal sinus disease were partially controlled, and the effective rate was 91.94%. Conclusion:Reasonable perioperative management measures can reduce the risk of nasal sinus surgery in patients with cardiovascular disease, ensure the successfully implementation of surgery and achieve a successful prognosis.

[Clinical analysis of transnasal endoscopic repair of cerebrospinal fluid rhinorrhea]

Objective:To summarize the common clinical types of cerebrospinal fluid（CSF） rhinorrhea and key points of transnasal endoscopic repair of CSF rhinorrhea. To evaluate clinical effects. Method:In 29 patients with cerebrospinal fluid rhinorrhea, 9 patients with traumatic CSF rhinorrhea, 10 patients with spontaneous CSF rhinorrhea, 7 patients with CSF rhinorrhea after tumour excision, and 3 patients with iatrogenic CSF rhinorrhea. All the 29 patients were treated with transnasal endoscopic repair of CSF rhinorrhea. Result:There were 25 patients were successfully repaired at one time. Three patients developed intracranial infection and 2 patient developed pneumocephalus after surgery, all of them were cured with conservative treatment. All the patients who were followed-up for more than half a year had no recurrence. Conclusion:Transnasal endoscopic repair of CSF rhinorrhea is safe and effective, the success rate of operation is high, it is not easy to recur, and the complications are few. It can be used as the first choice for repairing of CSF rhinorrhea and effective prevention measures. Accurate location of leak, appropriate repair, effective reconstruction of the skull base, continuous drainage of the lumbar cistern when necessary and active prevention of intracranial infection are critical to the success of operation.

[Clinical effect of nasal endoscope combined with supporting laryngoscope surgery in the treatment of polyps of vocal cord and its influence on voice function of patients]

Objective:To explore the clinical value of nasal endoscope combined with supporting laryngoscope surgery in the treatment of polyps of vocal cord. Method:Ninety-four patients with vocal cord polyps were randomly divided into the control group (47 cases) and the observation group (47 cases). The patients in the control group were treated with simply supporting laryngoscope surgery while the patients in the observation group were treated with nasal endoscope combined with supporting laryngoscope. The therapeutic effects, voice function changes before and after operation, complications and recurrence of the two groups were observed. Result:The total effective rate was 93.62% in the observation group, compared to 78.72% in the control group, the difference was statistically significant (P<0.05). The incidence of postoperative complications in the observation group was 8.51%, compared with 25.53% in the control group, the difference was statistically significant (P<0.05). Six months after operation, there was no recurrence in the observation group, but the recurrence rate in the control group was 4.26%. There was no significant difference between the two groups (P>0.05). 12 months after operation, the recurrence rate of the observation group was 2.13%, compared with 14.89% of the control group, the difference was statistically significant (P<0.05). Conclusion:Nasal endoscope combined with supporting laryngoscope for vocal cord polyps has a definite effect and can significantly improve the voice function of patients with high safety and low recurrence rate, which is worthy of promotion..

[Comparison and analysis of spontaneous cerebrospinal fluid rhinorrhea with and without empty sella patients]

Objective:To investigate the clinical characteristics and the diagnosis and treatment of spontaneous cerebrospinal fluid rhinorrhea with and without empty sella.Method: Retrospective analysis clinical data of 51 patients with spontaneous cerebrospinal fluid rhinorrhea，comparison of non-empty sella syndrome of spontaneous cerebrospinal fluid rhinorrhea with empty sella syndrome of spontaneous cerebrospinal fluid rhinorrhea patients with general characteristics，localization and treatment effect.Result:The incidence of spontaneous cerebrospinal fluid rhinorrhea patients was higher in females than in males，BMI index was higher than the normal value.Of these 51 patients，5 of them were discharged after conservative treatment.Endoscopic sinus surgery was performed in 46 cases，of which 4 cases recurred and all had empty sella syndrome，the success rate of surgical repair was 91.3%.The age of empty sella group，the proportion of high blood pressure and the number of patients with surgical recurrence were significantly higher than those in the non-empty sella group（P<0.05）.The defect locations of two groups were most common in the ethmoid roof，there were no statistically significant differences in each defect location （P＞0.05）. Conclusion:The spontaneous cerebrospinal fluid leak was common in obese middle-aged women，most common defect location in ethmoid roof，nasal endoscopic repair success rate was high，with empty sella surgery were more likely to recur.

[Clinical research on surgical treatment of benign lesions in maxillary sinus by modified prelacrimal duct recess approach]

Objective:To explore the clinical effects, surgical procedure and indications of surgical treatment for benign lesions in maxillary sinus through modified prelacrimal duct recess approach. Method:All 21 patients in this study who diagnosed with benign lesions in maxillary sinus, received routine preoperational exam and underwent endoscopic maxillary sinus surgery through modified prelacrimal duct recess approach. Postoperatively patients received routine medical treatment, and regular follow-up for average 11.3 months(from 3 months to 16 months). Result:Among 21 patients, there were 9 cases diagnosed with maxillary sinus cyst, 6 cases diagnosed with maxillary sinus choanal polyps, and 5 cases diagnosed with maxillary sinus hemorrhagic and necrotic polyps, 1 case of maxillary sinus root cyst. During the operation, the roots of maxillary sinus cyst or polyps were found in anterior or inferior wall of maxillary sinus. All patients recovered very well without recurrence. Conclusion:Modified prelacrimal duct recess approach appears to be a safe and effective method to resect benign lesions in the maxillary sinus, especially when lesions involved in anterior and inferior wall of the maxillary sinus.

[Application of image navigation assisted nasal endoscopic surgery in optic nerve decompression]

Objective:To explore the application and to evaluate the advantage of image navigation assisted nasal endoscopic surgery in optic nerve decompression. Method:Sixty patients accepted the image navigation assisted nasal endoscopic surgery therapy in optic nerve decompression were included in this retrospective study and followed up for about six months to four years. Result:The visual acuity was improved in 16 cases with visual acuity above light. One case is 10 cm index, two cases are 40 cm index, one case is 70 cm index, the visual acuity of rest 12 cases was between 0.04 and 0.30, two of them were missing from the field of view, the effective rate was 100%. The 44 cases without light sensation before operation, postoperative visual acuity was improved in 11 cases, four of which were light sensation and visible figure. Visual acuity of seven cases was between 0.03 and 0.08, one of them was missing from the field of view, the effective rate was 25%. No complications occurred. Conclusion:With the help of the image navigation, it is convenient and accurate to locate the anatomical marker sites such as orbital apex, optic canal and fracture site, internal carotid artery and so on, as a result, the accuracy and the success rate of the surgery were greatly improved.

[One case of Pott's puffy tumor: inverted papilloma of nasal sinus postoperative complications]

A 45 years old male patient presented with recurrent abscess of the nasal root and right periorbital tissue. The incision and drainage were performed repeatedly, and anti-infection had poor effect of treatment. Previous history of sinusitis surgery. Nasal cavity and frontal sinus infections and abscesses were treated in other hospitals. CT showed enhanced patchy foci and abscesses on the right temporal side, frontal, periorbital and nasal roots. Repeated discharge of purulent secretions during hospitalization in our hospital prompted Klebsiella pneumoniae infection. After the patient was discharged from the hospital, he was diagnosed with Pott's tumor by repeated consultation with the literature.

[Causes and management of frontal sinusitis after transfrontal craniotomy]

Objective:The aim of this study is to investigate the causes and the strategy of frontal sinusitis after transfrontal craniotomy by endoscopic frontal sinus surgery and traditional surgery with facial incision. Method:A total of thirty-four patients with frontal sinusitis after transfrontal craniotomy were admitted, with the symptom of purulence stuff, headache and upper eyelid discharging. The onset time was 2.6 years on average. The frontal sinus CT and MRI images showed frontal sinusitis. Twenty-seven patients were treated with endoscopic frontal sinus surgery, and seven patient was treated with combined endoscopic and traditional frontal sinus surgery. In the revision surgery, the bone wax and inflammatory granulation tissue were cleaned out in both operational methods. The cure standard was that the postoperative frontal sinus inflammation disappeared and the drainage of the volume recess was unobstructed. Result:Thirty-four patients had a history of transfrontal craniotomy, and there was a record of bone wax packing in every operation. Among twenty-seven patients with endoscopic frontal sinus surgery, Twenty-five cases cured and two cases were operated twice. Seven patients were cured with combined endoscopic and traditional frontal sinus surgery. Conclusion:The frontal sinusitis after transfrontal craniotomy may be related to the inadequate sinus management, especially bone wax to be addressed to the frontal sinus ramming leading to frontal sinus mucosa secretion obstruction and poor drainage. Endoscopic frontal sinus surgery is a way of minimally invasive surgery. The satisfying curative effect can be obtained by endoscopic removal of bone wax, inflammatory granulation tissue, and the enlargement of frontal sinus aperture after exposure to the frontal sinus, and some cases was treated with both operation method.

[Endoscopic transnasal approach for surgical treatment of skull base clival area chordomas (Report of 2 cases)]

The case 1 performanced submandibular trauma because of the faint Suddenly. There were no obvious abnormality in physical examination. CT result showed that the tumour located in the lower clivus, and the atlas was infringed. MRI imaging showed the tumour located in the both sides of the internal carotid artery, infringed clivus and atlas front, forwarded into the nasal cavity and oral cavity. The case 2 performanced the left nose stuffy and increased gradually, nasopharyngeal mirror showed the left nasal cavity filled with new life. CT showed the lesions located in the cranial fossa under the sella turcica and sphenoid bone, down into the sphenoid sinus and the nasopharyngeal cavity. MRI imaging showed the lesions located in the front of clivus. According to the CT and MRI imaging features before surgery, the two cases adopted endoscopic transsphenoidal approach, and the postoperative pathology were chordoma in the central line of the skull base.

[The application of image guided system in nasal endoscopic surgery]

Development of endoscopic sinonasal surgery (ESS) has made it possible to reach diseases located in difficult areas of nose, sinuses and skull base. Development of Image guided surgery (IGS) system have greatly revolutionized the field of ESS. IGS system has improved the precision and accuracy of surgery and thus reduced complication rates. IGS is extremely useful for anatomic location in risk sinus surgery: extensive inflammatory disease, sinus cavity revision, and frontal sinus, posterior ethmoid, sphenoid or nasosinal tumor surgery. This paper will emphasize on the mechanism of working, the indications and the advantages of using IGS system, as well as the development and future directions.

[The treatment of nose-eye correlated diseases with external nasal incision combined with nasal cavity approach surgery through endoscope]

Objective:To explore the indications and characteristics for the treatment of nose-eye correlated diseases with endoscopic surgery through external nasal incision combined with nasal cavity approach.Method:The clinical data of 13 patients whom hospitalized in our department and treated by endoscopic surgery through external nasal incision combined with nasal cavity approach since October 2011, were retrospectively analyzed and the characteristics of different pathological changes, clinical manifestations, surgical approach and follow-up results were summarized.Four cases of patients underwent endoscopic surgery through nasal cavity and lacrimal caruncle conjunctival incision, 4 cases received bone fracture reduction and DCR with endoscope through double path of nasal cavity and the original trauma wound, 2 cases with endoscopic bone tumor resection through nasal cavity and external nasal incision, the rest of the 3 cases with endonasal endoscopic and peri-orbit incision surgery.Result:Two cases of tumor patients showed no recurrence followed up for 1.5 to 2 years; the diplopia disappeared in 2 cases of orbital medial wall fracture; surgeries of 4 cases of orbital wall fracture with lacrimal duct obstruction patients, 3 cases succeeded, 1 case failed and change into dacryocystorhinotomy with external nasal incision, and epiphora of all patients vanished; all of the patients of sinus osteoma, foreign bodies and abscess were cured and symptoms disappeared; the symptoms of ectopic meningioma patient gradually died down with eyebrow scars left.Conclusion:The surgery with external nasal incision combined with nasal cavity approach through endoscope to treat noseeye correlated diseases can effectively deal with relevant pathological changes, with the advantages of clear operation field and less damage, but its exact indications and surgical methods still need to be further explored.

[A preliminary study of a modified transnasal endoscopic three step vidian neurectomy]

Objective:The aim of this study is to explore an improved trans-nasal endoscopic surgical approach for vidian neurectomy. Method:Ninety-one patients with nasal hyperreactive disease were collected, including 49 cases of allergic rhinitis and 42 cases of non allergic rhinitis. All sufferers enrolled in the study have treated with medicine, but the symptoms were not effectively controlled. Preoperative CT localization of the vidian canal was performed in each candidate. During the surgery a"Three-step" surgical approach were followed under endoscopic guidance in accordance with the operation procedures. Briefly, such a three-step procedure consists of the following, that is, a transnasal endoscopic sphenoidectomy through sphenoethmoidal recess as step one, with enlargement of the sinus ostium along the junction of the anterior wall and the floor of the sinus until the exposure of the vidian nerve canal toward the lateral wall of the sinus as step two. The last step was further exposure of the vidian nerve going through the canal and electric cautery preventing bleeding from the neurovascular bundle in the canal. Result:All patients were completed successfully with 100% preoperative CT location of the vidian canal in the CT scan and 100% intraoperative accurate exposure of the canal and therefore the cut of the vidian nerve. Conclusion:"Three-step" endoscopic resection of the vidian neurectomy is easy to master and repetitive with less injury.

[Analysis of the recurrence related factors of sinonasal inverted papilloma]

Objective:To evaluate the influence risk factors of recurrence and the methods for reducing recurrence of sinonasal inverted papilloma (SNIP). Method:Clinical data of 34 patients with SNIP were analyzed retrospectively. All of them were unilateral onset. The diagnosis was confirmed pathologically and the range of lesions was determined by endoscopic and imaging examination; clinical classification according to Krouse classification method; All operations were performed under nasal endoscope, of which 20 cases were operated by simple nasal endoscope, and 14 cases were operated by endoscopic anterior lacrimal recess approach. The patients were followed up for 12-36 months. The curative effects were observed and the prognostic factors of the patients were analyzed. Result:Thirty-four cases of SNIP patients with postoperative recurrence rate was 17.65% (6/34); simple nasal endoscopic surgery in 20 cases, the recurrence rate was 25.00%(5/20); endoscopic anterior lacrimal recess approach in 14 cases, the recurrence rate was 7.14%(1/14), the difference was statistically insignificant (χ²=1.807, P>0.05). Four cases in stage Ⅰ had no recurrence；20 cases in stage Ⅱ, the recurrence rate was 15.0%(3/20); 9 cases in stage Ⅲ, the recurrence rate was 33.3%(3/9); 1 case in stage Ⅳ had no recurrence, the recurrence rate of the patients with different stages were statistically insignificant (χ²=2.692, P>0.05). Conclusion:Simple endoscopic resection of the tumor and endoscopic anterior lacrimal recess surgery are effective methods for the treatment of SNIP. The nasal surgery history and tumor origin are the risk factors for recurrence. The operation completely tumorresection,detailed preoperative examination and postoperative regular endoscopic examination are the keys to preventing recurrence.

[Removal of a giant ethmoidal sinus osteoma with orbital extension]

Osteomas are slow growing bony tumors of the nasal sinuses. Ethmoid osteomas with orbital extension are unusual. Any surgical approach has to take into account protection of the vital structures, particularly the optic nerve and internal rectus muscle, skull base. A 65-year-old man, without past medical history, was referred to our hospital with a 1-month history of double vision and persisting pain around the left eye. Three-dimensional computed tomography (CT) revealed a large calcified dense mass measuring 32 mm × 25 mm × 25 mm in the left ethmoidal sinus with orbital extension. An endoscopic endonasal approach combined with inner canthus way was planned. Most of the tumor was removed from nasal cavity, the rest part of the tumor was taken out of the inner canthus incision. The medial wall of the orbital cavity was repaired with titanium mesh. No cerebrospinal fluid (CSF) leakage was observed during the procedure. The patient recovered rapidly and had no visual impairment and occular motility disorders after operation. The double vision was alleviated and disappeared after one months. Treatment of large ethmoid osteomas requires a combined approach to prevent injury to the orbital content. The cooperation of both otolaryngologists and ophthalmologists is necessary to achieve risk-free surgery.

[Double-way endoscopic surgery in a patient with cystic degeneration of maxillary sinus ossifying fibroma: a case report]

Ossifying fibroma is a rare benign osteogenic neoplasm arising from undifferentiated cells of the periodontal ligament and with a potential to form fibrous tissue, cementum and bone, which is usually in molar area of the mandible, predominantly seen in young girls. And ossifying fibroma poses diagnostic and therapeutic difficulties due to their clinical, radiological and histological variabilities. We report a rare case of an 18 year old girl with cystic degeneration of ossifying fibroma in maxilla which is an uncommon site of occurrence.

[One case of 28+ weeks pregnancy with esthesioneuroblastoma]

A 21 years old female patient was admitted to hospital for "menolipsis of 28 weeks, discovery of nasal neoplasm for 2 months, headache for 10 days" .check: The left nasal cavity was filled with a red neoplasm extending to the edge of the nasal vestibule , with incrustation on its surface and easy haemorrhage when touched.Sinus CT: the left side of the nasal vestibule, nasal meatus and the whole sets of sinuses were full of soft tissue density with nasal bone absorption, malignant diseases not excluded.MRI: The left side of the nasal vestibule, nasal passages, cribriform roof and frontal sinus were filled with equal T1 and long T2 signal, with obvious tortuous signal of voids of vessel , partially extending into the left orbit, and accompanied with obstructive sinusitis.Postoperative pathologic and immunohistochemical results diagnosed as esthesioneuroblastoma.

[A study of the curative effect of endoscopic-assisted posterior nasal neurotomy on patients with moderate severe persistent allergic rhinitis]

Objective:To investigate the feasibility and effect of endoscopic-assisted posterior nasal neurotomy on patients with moderate-severe persistent allergic rhinitis (AR).Method:Endoscopic-assisted posterior nasal neurotomy were operated on 32 moderate-severe persistent AR patients who were insensitive to drugs and desensitization treatment,and curative effect were evaluated by scoring according to the diagnosis and curative effect evaluation standard of AR.Result:Follow-up evaluations were perfected after one year. Among them 17 cases were markedly effective,15 cases were effective,and the rate of total effective was 100%,without complications such as nose bleeds,dry eye,etc.Conclusion:The advantages of endoscopic-assisted posterior nasal neurotomy on moderate-severe persistent allergic rhinitis patients include the localization of posterior nasal nerve is clear,easy to operate,the short-term effect is remarkable,and less complications,therefore it's worth using on the AR patients who are failing in drugs and specific immune treatment.

[Giant rhinolith: a case report]

My department reports a case of giant rhinolith.Rhinolith is a rare and slow-progressing disease. Clinically, rhinolith is easily to be misdiagnosed as sinusitis or sinus tumor. High-resolution computed tomography (HRCT) can be used to diagnose of rhinolith and differentiate it from sinusitis or sinus tumors. HRCT can also provide reliable evidence for evaluating surgery difficulty level and determining operation method.