1
|
Lenze NR, Bharadwaj SR, Baldassari CM, Kirkham EM. Surgical Management of Pediatric Obstructive Sleep Apnea Beyond Adenotonsillectomy: The Nose, Nasopharynx, and Palate. Otolaryngol Clin North Am 2024; 57:421-430. [PMID: 38508883 PMCID: PMC11060425 DOI: 10.1016/j.otc.2024.02.008] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
While adenotonsillectomy is the primary treatment of pediatric obstructive sleep apnea (OSA), persistent OSA after surgery is common and may be due to residual obstruction at the nose, nasopharynx, and/or palate. Comprehensive evaluation for persistent pediatric OSA ideally includes clinical examination (with or without awake nasal endosocpy) as well as drug-induced sleep endoscopy in order to accurately identify sources of residual obstruction. Depending on the site of obstruction, some of the surgical management options include submucous inferior turbinate resection, septoplasty, adenoidectomy, and expansion sphincter pharyngoplasty.
Collapse
Affiliation(s)
- Nicholas R Lenze
- Department of Otolaryngology-Head & Neck Surgery, The University of Michigan, University of Michigan Medical Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Suhas R Bharadwaj
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, 600 Gresham Drive, Suite 1100, Norfolk, VA 23507, USA
| | - Christina M Baldassari
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, 600 Gresham Drive, Suite 1100, Norfolk, VA 23507, USA
| | - Erin M Kirkham
- Department of Otolaryngology-Head & Neck Surgery, The University of Michigan, University of Michigan Medical Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
| |
Collapse
|
2
|
Rüttgers M, Waldmann M, Vogt K, Ilgner J, Schröder W, Lintermann A. Automated surgery planning for an obstructed nose by combining computational fluid dynamics with reinforcement learning. Comput Biol Med 2024; 173:108383. [PMID: 38555704 DOI: 10.1016/j.compbiomed.2024.108383] [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] [Received: 11/10/2023] [Revised: 02/26/2024] [Accepted: 03/24/2024] [Indexed: 04/02/2024]
Abstract
Septoplasty and turbinectomy are among the most common interventions in the field of rhinology. Their constantly debated success rates and the lack of quantitative flow data of the entire nasal airway for planning the surgery necessitate methodological improvement. Thus, physics-based surgery planning is highly desirable. In this work, a novel and accurate method is developed to enhance surgery planning by physical aspects of respiration, i.e., to plan anti-obstructive surgery, for the first time a reinforcement learning algorithm is combined with large-scale computational fluid dynamics simulations. The method is integrated into an automated pipeline based on computed tomography imaging. The proposed surgical intervention is compared to a surgeon's initial plan, or the maximum possible intervention, which allows the quantitative evaluation of the intended surgery. Two criteria are considered: (i) the capability to supply the nasal airway with air expressed by the pressure loss and (ii) the capability to heat incoming air represented by the temperature increase. For a test patient suffering from a deviated septum near the nostrils and a bony spur further downstream, the method recommends surgical interventions exactly at these locations. For equal weights on the two criteria (i) and (ii), the algorithm proposes a slightly weaker correction of the deviated septum at the first location, compared to the surgeon's plan. At the second location, the algorithm proposes to keep the bony spur. For a larger weight on criterion (i), the algorithm tends to widen the nasal passage by removing the bony spur. For a larger weight on criterion (ii), the algorithm's suggestion approaches the pre-surgical state with narrowed channels that favor heat transfer. A second patient is investigated that suffers from enlarged turbinates in the left nasal passage. For equal weights on the two criteria (i) and (ii), the algorithm proposes a nearly complete removal of the inferior turbinate, and a moderate reduction of the middle turbinate. An increased weight on criterion (i) leads to an additional reduction of the middle turbinate, and a larger weight on criterion (ii) yields a solution with only slight reductions of both turbinates, i.e., focusing on a sufficient heat exchange between incoming air and the air-nose interface. The proposed method has the potential to improve the success rates of the aforementioned surgeries and can be extended to further biomedical flows.
Collapse
Affiliation(s)
- Mario Rüttgers
- Jülich Supercomputing Centre, Forschungszentrum Jülich GmbH, Wilhelm-Johnen-Straße, 52425 Jülich, Germany; Institute of Aerodynamics and Chair of Fluid Mechanics, RWTH Aachen University, Wüllnerstraße 5a, 52062 Aachen, Germany; Jülich Aachen Research Alliance, Center for Simulation and Data Science, 52074 Aachen, Germany.
| | - Moritz Waldmann
- Institute of Aerodynamics and Chair of Fluid Mechanics, RWTH Aachen University, Wüllnerstraße 5a, 52062 Aachen, Germany; Jülich Aachen Research Alliance, Center for Simulation and Data Science, 52074 Aachen, Germany
| | - Klaus Vogt
- Faculty of Medicine, Center of Experimental Surgery, University of Latvia, 1586 Riga, Latvia
| | - Justus Ilgner
- Department of Otorhinolaryngology, Head and Neck Surgery, Uniklinik RWTH Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Wolfgang Schröder
- Institute of Aerodynamics and Chair of Fluid Mechanics, RWTH Aachen University, Wüllnerstraße 5a, 52062 Aachen, Germany; Jülich Aachen Research Alliance, Center for Simulation and Data Science, 52074 Aachen, Germany
| | - Andreas Lintermann
- Jülich Supercomputing Centre, Forschungszentrum Jülich GmbH, Wilhelm-Johnen-Straße, 52425 Jülich, Germany; Jülich Aachen Research Alliance, Center for Simulation and Data Science, 52074 Aachen, Germany
| |
Collapse
|
3
|
Sliman J, Carsuzaa F, Tanaka L, Gallet P, Moser PO, Captier G, Favier V. Anatomical variations of interest for posterior nasal nerve cryotherapy in the treatment of chronic rhinitis: A radioanatomic study. Int Forum Allergy Rhinol 2024; 14:995-998. [PMID: 38018899 DOI: 10.1002/alr.23305] [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] [Received: 09/16/2023] [Revised: 10/23/2023] [Accepted: 11/17/2023] [Indexed: 11/30/2023]
Abstract
KEY POINTS An unfavorable insertion of the middle turbinate for cryotherapy was present in 74.2% of cases. Placing cryoprobe 15-30 mm above the nasal floor targets the nerves in 95.8% of cases. Centering the cryoprobe 38 mm behind the inferior turbinate axilla targets the nerves in 94.6% of cases.
Collapse
Affiliation(s)
- Juliette Sliman
- Department of Otolaryngology Head and Neck Surgery, Gui de Chauliac Hospital, University Hospital of Montpellier, Montpellier, France
| | - Florent Carsuzaa
- Service ORL, Chirurgie Cervico-Maxillo-Faciale et Audiophonologie, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
- Laboratoire Inflammation Tissus Epithéliaux et Cytokines, UR15560, Université de Poitiers, Poitiers, France
| | - Lei Tanaka
- Service d'Orl et Chirurgie Cervico-Faciale, Assistance Publique-Hôpitaux de Paris, Université Paris-Saclay, Hôpital Bicêtre, le Kremlin-Bicêtre, France
| | - Patrice Gallet
- Department of ENT, Regional University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France
- Virtual Hospital of Lorraine, University of Lorraine, Vandoeuvre-lès-Nancy, France
- NGERE, INSERM U1256 Lab, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Pierre-Olivier Moser
- Department of Neurosurgery, Gui de Chauliac Hospital, University Hospital of Montpellier, Montpellier, France
| | - Guillaume Captier
- Laboratory of Anatomy, Faculty of Medicine of Montpellier-Nîmes, Montpellier University, Montpellier, France
- Research-Team ICAR, Laboratory of Computer Science, Robotics and Microelectronics of Montpellier, Montpellier University, French National Centre for Scientific Research, Montpellier, France
| | - Valentin Favier
- Department of Otolaryngology Head and Neck Surgery, Gui de Chauliac Hospital, University Hospital of Montpellier, Montpellier, France
- Research-Team ICAR, Laboratory of Computer Science, Robotics and Microelectronics of Montpellier, Montpellier University, French National Centre for Scientific Research, Montpellier, France
| |
Collapse
|
4
|
Kommentar zu „Behandlung der hypertrophen unteren Nasenmuschel – eine Analyse der Kosten“. Laryngorhinootologie 2024; 103:332. [PMID: 38697080 DOI: 10.1055/a-2219-0598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
|
5
|
Al-Salihi MM, Rahman M, Al-Jebur MS, Al-Salihi Y, Shihadeh O, Hammadi F, Ayyad A. Effect of preservation versus resection of turbinate on olfactory function in endoscopic trans-nasal trans-sphenoidal pituitary surgery: a systematic review and meta-analysis. Neurol Res 2024; 46:444-452. [PMID: 38467610 DOI: 10.1080/01616412.2024.2328493] [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] [Received: 11/02/2023] [Accepted: 03/03/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Utilizing endoscopes in surgery offers advantages and concerns, including potential nasal function impacts. Hyposmia following Transseptal Transsphenoidal hypophysectomy ranges from 0% to 2.2%. Debates persist about managing the M.T. in endoscopic sinus surgery due to its impact on nasal function. While preservation is recommended for sinonasal health, debates continue, as certain cases require resection. Our meta-analysis aims to compare turbinate resection and preservation effects on olfactory function. METHODS We searched five electronic databases to collect all relevant studies. Records were screened for eligibility. Data were extracted from the included studies independently. Our continuous outcomes were pooled as standardized mean difference with 95% CI. Statistical analyses was done by RevMan. RESULTS Our meta-analysis included four studies involving 235 patients (81 males). Evaluating changes in olfaction scores, two one-month studies (82 patients) revealed no significant difference between preservation and resection groups (Std.MD = 0.05[-0.39, 0.50], p = 0.81). For three-month assessments (146 patients), SNOT tests indicated no significant difference (Std.MD = 0.21, 95% CI[-0.11, 0.54], p = 0.20). Two studies used other tests on 70 patients at three months, yielding no significant difference (Std.MD = 0.13, 95% CI [-0.35, 0.62], p = 0.59). Two six-month studies (72 patients) similarly found no significant difference (Std.MD = 0.09, 95% CI [-0.39, 0.56], p = 0.72). CONCLUSION Our meta-analysis involving 235 patients examined olfaction score changes over various time frames in trans-nasal trans-sphenoidal pituitary surgeries. No significant differences were observed between turbinate preservation and resection groups at one month, three months, or six months post-surgery.
Collapse
Affiliation(s)
- Mohammed Maan Al-Salihi
- Department of Neurological Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Mohammed Rahman
- Department of Neurosurgery, St. Marys Hospital, Decatur, IL, USA
| | | | | | - Omar Shihadeh
- Department of Neurosurgery, Hamad General Hopsital, Doha, Qatar
| | - Firas Hammadi
- Department of Neurosurgery, Hamad General Hopsital, Doha, Qatar
| | - Ali Ayyad
- Department of Neurosurgery, Hamad General Hopsital, Doha, Qatar
- Department of Neurosurgery, Saarland University Hospital, Homburg, Germany
| |
Collapse
|
6
|
Behandlung der hypertrophen unteren Nasenmuschel – eine Analyse der Kosten. Laryngorhinootologie 2024; 103:330-1. [PMID: 38697079 DOI: 10.1055/a-2219-0574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
|
7
|
Kim DH, Kim SW, Basurrah MA, Hwang SH. Evaluation of Post-Intervention Outcomes in Patients with Empty Nose Syndrome. Laryngoscope 2024; 134:2005-2011. [PMID: 37750541 DOI: 10.1002/lary.31077] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/06/2023] [Accepted: 09/15/2023] [Indexed: 09/27/2023]
Abstract
OBJECTIVES To conduct a systematic review and meta-analysis of published articles to assess the impact of inferior turbinate/meatus augmentation in patients diagnosed with empty nose syndrome (ENS). DATA SOURCES PubMed, Cochrane database, Embase, Web of Science, SCOPUS, and Google Scholar. REVIEW METHODS Six databases were searched to December 2022. We retrieved studies evaluating improvements in refractory ENS-related symptoms based on various patient-reported outcome measures after inferior turbinate/meatus augmentation. RESULTS As a result of meta-analysis, Sinonasal Outcome Test, Empty Nose Syndrome 6-Item Questionnaire (ENS6Q), and depression scores were measured at 1 week; 1, 3, and 6 months; and later than 12 months after intervention for patients with ENS. All scores revealed significant symptom improvement. By reference to the minimal clinically important difference of the ENS6Q (6.25), inferior turbinate/meatus augmentation relieved the nasal symptoms of ENS in the long term. Although the improvements in anxiety scores at 1 week (0.4133 [-0.3366; 1.1633], 0.00, I2 = NA) and 1 month (0.4525 [-0.0529; 0.9579], I2 = 0.0%) were not statistically significant, the scores differed significantly at 3 months (0.7351 [0.4143; 1.0559], I2 = 28.4%), 6 months (0.8297 [0.6256; 1.0337], I2 = 37.2%), and longer than 12 months (0.7969 [0.4768; 1.1170], I2 = 0.0%). CONCLUSION These data and analysis suggest that performing inferior turbinate/meatus augmentation on ENS patients may improve not only nasal symptom scores but also accompanying psychological problems such as anxiety and depression. Laryngoscope, 134:2005-2011, 2024.
Collapse
Affiliation(s)
- Do Hyun Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Won Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | | | - Se Hwan Hwang
- Department of Otolaryngology-Head and Neck Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| |
Collapse
|
8
|
Sagar M, Dharmavaram Rajasekhar P, Singh CA, Khandkar H. Juvenile trabecular ossifying fibroma of the inferior turbinate. BMJ Case Rep 2024; 17:e259397. [PMID: 38627043 PMCID: PMC11029416 DOI: 10.1136/bcr-2023-259397] [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: 04/19/2024] Open
Abstract
Nasal obstruction is a commonly reported issue in the Otorhinolaryngology Outpatient Department. In this case, an early adolescent boy with a long-standing problem of right-sided nasal obstruction since childhood sought consultation. Diagnostic nasal endoscopy revealed a deviation of the nasal septum to the left, coupled with right inferior turbinate hypertrophy, all overlying healthy mucosa. A CT scan of the nose and paranasal sinuses further identified a bony hyperdense lesion with ground glass attenuation, confined to the right inferior turbinate. Subsequent biopsy confirmed juvenile trabecular ossifying fibroma (JTOF). The patient underwent endoscopic right medial maxillectomy, and the final histology affirmed the diagnosis of JTOF.
Collapse
Affiliation(s)
- Milind Sagar
- ENT, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | | | - Chirom Amit Singh
- Department of Otorhinolaryngology and Head-Neck Surgery, AIIMS, New Delhi, Delhi, India
| | - Hena Khandkar
- Department of Pathology, AIIMS, New Delhi, Delhi, India
| |
Collapse
|
9
|
Conti DM, Hellings PW, Smith PK, Scadding GK. A EUFOREA Comment In Reference to Cost-Effectiveness Analysis of Inferior Turbinate Reduction and Immunotherapy in Allergic Rhinitis. Laryngoscope 2024; 134:E12-E13. [PMID: 38153194 DOI: 10.1002/lary.31246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 10/24/2023] [Indexed: 12/29/2023]
Affiliation(s)
- Diego M Conti
- The European Forum for Research and Education in Allergy and Airway Diseases Scientific Expert Team Members, Brussels, Belgium
| | - Peter W Hellings
- Department of Otorhinolaryngology, And Laboratory of Allergy and Clinical Immunology, University of Leuven, Leuven, Belgium
- Upper Airways Disease Laboratory, University of Ghent, Ghent, Belgium
| | - Peter K Smith
- School of Medicine, Griffith University, Southport, Queensland, Australia
| | - Glenis K Scadding
- Department of Allergy & Rhinology, Royal National ENT Hospital, London, UK
- Division of Immunity and Infection, University College, London, UK
| |
Collapse
|
10
|
Aljeraisi T. Efficacy and safety of turbinate reduction surgery in children: a systematic review. Eur Arch Otorhinolaryngol 2024; 281:1629-1641. [PMID: 37943317 DOI: 10.1007/s00405-023-08327-9] [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] [Received: 08/07/2023] [Accepted: 10/28/2023] [Indexed: 11/10/2023]
Abstract
PURPOSE Inferior turbinate hypertrophy is not a rare problem in children, it causes chronic nasal obstruction which can severely impact the quality of life. This study aimed to investigate the efficacy and safety of turbinate reduction surgery in children with impaired nasal breathing due to hypertrophied inferior turbinate that's refractory to medical treatment. METHODS We included 23 articles with various study designs: randomized controlled trials, single-arm clinical trials, and prospective and retrospective cohort studies. We searched PubMed, Scopus, Cochrane Library, and Web of Science with the relevant keywords till April 9th, 2023. The inclusion criteria were studied with the three prespecified study design that addressed children under 18 years who underwent turbinate reduction with any technique and evaluating the improvement whether by objective or subjective methods. RESULTS Studies used objective measures favor turbinate surgery except two that showed no significant difference between pre and postoperative results. All studies used subjective measures showed an improvement postoperatively except one study. Complication rates are rare, with crust formation is being the commonest (6.03%), however, the procedure is generally safe in children. In addition, follow-up periods varied widely between 2 weeks and more than 5 years. CONCLUSION Turbinate reduction in children is an effective as a treatment method for nasal blockage due to inferior turbinate hypertrophy which is resistant to medical treatment. It is a safe procedure with low rates of complications, however, due to the heterogenicity of the study designs, with a possible risk of bias we could not conduct a meta-analysis besides our systematic review.
Collapse
Affiliation(s)
- Talal Aljeraisi
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Taibah University, Al-Madinah Al-Munawwarah, Saudi Arabia.
| |
Collapse
|
11
|
Yong M, Aravinthan K, Kirubalingam K, Thamboo A, Hwang PH, Nadeau K, Walgama E. Cost-effectiveness Analysis of Inferior Turbinate Reduction and Immunotherapy in Allergic Rhinitis. Laryngoscope 2024; 134:1572-1580. [PMID: 37642388 DOI: 10.1002/lary.31003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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] [Received: 05/31/2023] [Revised: 07/14/2023] [Accepted: 08/09/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Allergic rhinitis (AR) is a common condition that is frequently associated with atopic inferior turbinate hypertrophy (ITH) resulting in nasal obstruction. Current guidelines support the use of subcutaneous allergen immunotherapy (SCIT) when patients fail pharmacologic management. However, there is a lack of consensus regarding the role of inferior turbinate reduction (ITR), a treatment that we hypothesize is cost-effective compared with other available treatments. METHODS We conducted a cost-effectiveness analysis comparing the following treatment combinations over a 5-year time horizon for AR patients presenting with atopic nasal obstruction who fail initial pharmacotherapy: (1) continued pharmacotherapy alone, (2) allergy testing and SCIT, (3) allergy testing and SCIT and then ITR for SCIT nonresponders, and (4) ITR and then allergy testing and SCIT for ITR nonresponders. Results were reported as incremental cost-effectiveness ratios (ICERs). RESULTS For patients who fail initial pharmacotherapy, prioritizing ITR, either by microdebrider-assisting submucous resection or radiofrequency ablation, before SCIT was the most cost-effective strategy. Probabilistic sensitivity analysis demonstrated that prioritizing ITR before SCIT was the most cost-effective option in 95.4% of scenarios. ITR remained cost-effective even with the addition of concurrent septoplasty. CONCLUSION For many AR patients who present with nasal obstruction secondary to atopic inferior turbinate hypertrophy that is persistent despite pharmacotherapy, ITR is a cost-effective treatment that should be considered prior to immunotherapy. LEVEL OF EVIDENCE NA - Laryngoscope, 2023 Laryngoscope, 134:1572-1580, 2024.
Collapse
Affiliation(s)
- Michael Yong
- Department of Otolaryngology - Head & Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Kaishan Aravinthan
- Division of Otolaryngology - Head and Neck Surgery, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | | | - Andrew Thamboo
- Division of Otolaryngology - Head and Neck Surgery, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Peter H Hwang
- Department of Otolaryngology - Head & Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Kari Nadeau
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, U.S.A
| | - Evan Walgama
- Pacific Neuroscience Institute, Santa Monica, California, U.S.A
| |
Collapse
|
12
|
Çelik M, Altunal SK, Kocer U, Kucukguven A. Comprehensive Assessment of the Functional Outcomes of Partial Turbinectomy: A Prospective Clinical Trial. Aesthetic Plast Surg 2024; 48:1547-1556. [PMID: 37474819 DOI: 10.1007/s00266-023-03503-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 06/30/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVES The inferior and middle turbinates have crucial roles in nasal function, but their enlargement can cause obstructive effects, which can lead to breathing difficulties, sleep and smell disorders, and headaches. Partial turbinectomy is a common surgical technique used to address this issue during septorhinoplasty, but it carries risks such as empty nose syndrome. A clinical trial was designed to evaluate the functional outcomes of middle and inferior partial turbinectomy with a holistic approach. METHODS Patients with NOSE questionnaire scores of 30 or higher, and grade 4 inferior turbinates and/or advanced middle concha bullosa were included. Patients completed questionnaires related to breathing, empty nose syndrome, headache, and olfaction preoperatively and at one-month, three-month, six-month, and first-year periods postoperatively. The partial excisions of the inferior and middle turbinates were carried out with serrated scissors while trying to preserve adequate turbinate size to maintain function. RESULTS This study found that NOSE scores, headache frequency, and severity improved postoperatively. The olfactory-related quality of life of the patients with impairments in this area significantly improved found to be improved at all postoperative evaluations. None of the patients experienced prolonged bleeding requiring surgical intervention. No cases of anosmia and empty nose syndrome were reported. CONCLUSION Partial turbinectomy of middle and inferior turbinates during septorhinoplasty can alleviate symptoms of turbinate hypertrophy, such as breathing issues, olfactory disorders, and headaches. It is an easy, reliable, and efficient surgical maneuver. Proper technique can minimize the risk of empty nose syndrome and other complications of turbinectomy surgery. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Collapse
Affiliation(s)
- Murat Çelik
- Department of Plastic, Reconstructive and Aesthetic Surgery, Ankara Training and Research Hospital, 06230, Ankara, Turkey.
| | - Sinan Kadir Altunal
- Department of Plastic, Reconstructive and Aesthetic Surgery, Ankara Training and Research Hospital, 06230, Ankara, Turkey
| | - Ugur Kocer
- Department of Plastic, Reconstructive and Aesthetic Surgery, Ankara Training and Research Hospital, 06230, Ankara, Turkey
| | - Arda Kucukguven
- Department of Plastic, Reconstructive and Aesthetic Surgery, Ankara Training and Research Hospital, 06230, Ankara, Turkey
| |
Collapse
|
13
|
Huang CC, Wu PW, Huang CC, Chang PH, Fu CH, Lee TJ. A 3-year follow-up study after nasal reconstruction surgery in patients with empty nose syndrome. Int Forum Allergy Rhinol 2024; 14:841-844. [PMID: 37615646 DOI: 10.1002/alr.23257] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/09/2023] [Accepted: 08/11/2023] [Indexed: 08/25/2023]
Abstract
KEY POINTS Empty nose syndrome (ENS) is characterized by a patent nasal airway and a sense of nasal obstruction. ENS and psychological symptoms improved after surgery and remained stable for up to three years. Identifying residual disease is necessary for enhancing therapeutic outcomes in ENS patients.
Collapse
Affiliation(s)
- Chien-Chia Huang
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Pei-Wen Wu
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Chi-Che Huang
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Po-Hung Chang
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Chia-Hsiang Fu
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ta-Jen Lee
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Otolaryngology, Xiamen Chang Gung Hospital, Xiamen, China
| |
Collapse
|
14
|
Yeguas-Ramírez L, Santamaría-Gadea A, Vaca-González M, de Los Santos-Granados G, Mariño-Sánchez F. Minimally Anterior Medial Maxillary Approach (MAMMA): a novel technique for a wide access to the maxillary sinus. Eur Arch Otorhinolaryngol 2024; 281:1799-1806. [PMID: 37987827 DOI: 10.1007/s00405-023-08335-9] [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] [Received: 08/06/2023] [Accepted: 11/03/2023] [Indexed: 11/22/2023]
Abstract
PURPOSE To describe a novel endoscopic technique to approach the maxillary sinus (MS), the Modified Anterior Medial Maxillary Approach (MAMMA), preserving the inferior turbinate (IT) and the nasolacrimal duct (NLD). To perform radiological measurements and describe a case series to study the feasibility and limits of MAMMA. METHODS Computed tomography (CT) scans (n = 150 nasal cavities) were used to calculate areas of the MAMMA to define surgical limits and extensions. Measurement of distances to critical anatomy landmarks and total area for the MAMMA were calculated. An instructional case illustrating the surgical technique and outcome was also included. RESULTS Radiological analysis showed a mean distance from the Piriform Aperture (PA) to the anterior limit of the NLD of 1.03 ± 0.18 cm (range 0.59-1.48) and a mean distance from de PA to the posterior limit of the NLD of 1.57 ± 0.22 cm (range 1.02-2.11). The mean distance from the nasal floor to the Hasner's valve was 1.61 ± 0.27 cm (range 1.06-2.52) and the distance from the nasal floor to the insertion of the IT was 2.20 ± 0.36 cm (range 1.70-3.69). Finally, the mean total area for the MAMMA was 4.04 ± 0.52 cm2 (range 3.17-5.53). No complications or recurrence of the pathology were observed in operated patients. CONCLUSION The MAMMA provides a wide surgical field of the MS walls comparable to more aggressive techniques, with preservation of the sinonasal and lacrimal function. MAMMA is an effective alternative to treat different MS pathologies including benign recurrent maxillary sinus tumors.
Collapse
Affiliation(s)
- L Yeguas-Ramírez
- Rhinology and Skull Base Surgery Unit, Otorhinolaryngology Department, Ramón y Cajal University Hospital, Ctra. de Colmenar Viejo Km. 9,100, 28034, Madrid, Spain
| | - A Santamaría-Gadea
- Rhinology and Skull Base Surgery Unit, Otorhinolaryngology Department, Ramón y Cajal University Hospital, Ctra. de Colmenar Viejo Km. 9,100, 28034, Madrid, Spain
| | - M Vaca-González
- Rhinology and Skull Base Surgery Unit, Otorhinolaryngology Department, Ramón y Cajal University Hospital, Ctra. de Colmenar Viejo Km. 9,100, 28034, Madrid, Spain
| | - G de Los Santos-Granados
- Rhinology and Skull Base Surgery Unit, Otorhinolaryngology Department, Ramón y Cajal University Hospital, Ctra. de Colmenar Viejo Km. 9,100, 28034, Madrid, Spain
- Universidad Alcalá de Henares, Madrid, Spain
| | - F Mariño-Sánchez
- Rhinology and Skull Base Surgery Unit, Otorhinolaryngology Department, Ramón y Cajal University Hospital, Ctra. de Colmenar Viejo Km. 9,100, 28034, Madrid, Spain.
- Immunoallèrgia Respiratòria Clínica i Experimental (IRCE), Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
| |
Collapse
|
15
|
Obermeyer IP, Nguyen CH, Yoo F, Garg R, Kuan EC. Anatomic Relationship Between the Head of the Middle Turbinate and First Olfactory Filum: A Radiographic Assessment. Ann Otol Rhinol Laryngol 2024; 133:418-423. [PMID: 38240258 DOI: 10.1177/00034894241227034] [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: 02/27/2024]
Abstract
BACKGROUND The endoscopic modified Lothrop procedure (EMLP) has become a frequently utilized procedure in rhinologic surgery. One of the most serious complications of the procedure is cerebrospinal fluid leak, which may occur due to lack of recognition of the anterior skull base in the region of the first olfactory filum (FOF), or direct injury to the FOF itself. OBJECTIVES To evaluate the position of the head of the middle turbinate (MT) relative to the FOF, which is an important landmark in the EMLP. METHODS A series of previously obtained patient computed tomography scans of the sinus were reviewed. A reproducible process was implemented to obtain the measurements. First, the FOF was identified on an axial series. Using a localization feature of the radiographic software, this anteroposterior (AP) position could be visualized in a coronal plane. Subsequently, the MT was viewed in a sagittal plane, where a measurement between the head of the MT and the AP position of the FOF could be performed. RESULTS The AP distance between the head of the MT and the FOF was measured in 92 patients. The head of the MT was either at or anterior to the FOF in all measured subjects. The mean anterior distance of the head of the MT to FOF was 3.6 mm (±2.4 mm) on the right, and 3.8 mm (±2.2 mm) on the left. The range in AP distance was 0 to 12 mm. There was no significant difference in AP distance between the head of the MT and FOF based on gender (P = .413) or diagnosis (P = .254). CONCLUSIONS In our study, the head of the MT was reliably at or anterior to the FOF in all subjects, suggesting its utility as a fixed landmark in endoscopic sinus surgery, particularly in the EMLP. LEVEL OF EVIDENCE N/A.
Collapse
Affiliation(s)
- Isaac P Obermeyer
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Irvine, CA, USA
| | - Cecilia H Nguyen
- School of Medicine, University of California Irvine, Irvine, CA, USA
| | - Frederick Yoo
- Department of Otolaryngology-Head and Neck Surgery, Kaiser Permanente, Anaheim, CA, USA
| | - Rohit Garg
- Department of Otolaryngology-Head and Neck Surgery, Kaiser Permanente, Anaheim, CA, USA
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Irvine, CA, USA
| |
Collapse
|
16
|
Yong M, Aravinthan K, Kirubalingam K, Thamboo A, Hwang PH, Nadeau K, Walgama E. In Response to Cost-effectiveness Analysis of Inferior Turbinate Reduction and Immunotherapy in Allergic Rhinitis. Laryngoscope 2024; 134:E14-E15. [PMID: 38153190 DOI: 10.1002/lary.31247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 12/06/2023] [Indexed: 12/29/2023]
Affiliation(s)
- Michael Yong
- Pacific Neuroscience Institute, Santa Monica, California, U.S.A
| | - Kaishan Aravinthan
- Division of Otolaryngology-Head and Neck Surgery, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | | | - Andrew Thamboo
- Division of Otolaryngology-Head and Neck Surgery, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Peter H Hwang
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Kari Nadeau
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, U.S.A
| | - Evan Walgama
- Department of Otolaryngology-Head and Neck Surgery, Cedars-Sinai, Los Angeles, California, U.S.A
| |
Collapse
|
17
|
Musleh A. Septoplasty with or without Inferior Turbinectomy: A Declaration of Clinical Consensus. Int Tinnitus J 2024; 27:203-210. [PMID: 38507636 DOI: 10.5935/0946-5448.20230031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Affiliation(s)
- Abdullah Musleh
- Associate Professor, Consultant Otolaryngology, Head & Neck Surgery, College of Medicine, King Khalid University, Saudi Arabia
| |
Collapse
|
18
|
Maniaci A, Calvo-Henriquez C, Cammaroto G, Garcia-Magan C, Garcia-Paz V, Iannella G, Jiménez-Huerta I, La Mantia I, Lechien JR, Leong SC, Lobo-Duro D, Maza-Solano J, Mitchell R, Otero-Alonso A, Peng Y, Radulesco T, Simon F, Teissier N, Cocuzza S, Saibene AM. Pediatric Inferior Turbinate Hypertrophy: Diagnosis and Management. A YO-IFOS Consensus Statement. Laryngoscope 2024; 134:1437-1444. [PMID: 37497872 DOI: 10.1002/lary.30907] [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] [Received: 03/23/2023] [Revised: 07/06/2023] [Accepted: 07/08/2023] [Indexed: 07/28/2023]
Abstract
OBJECTIVE Pediatric inferior turbinate hypertrophy (PedTH) is a frequent and often overlooked cause or associated cause of nasal breathing difficulties. This clinical consensus statement (CCS) aims to provide a diagnosis and management framework covering the lack of specific guidelines for this condition and addressing the existing controversies. METHODS A clinical consensus statement (CCS) was developed by a panel of 20 contributors from 7 different European and North American countries using the modified Delphi method. The aim of the CCS was to offer a multidisciplinary reference framework for the management of PedTH on the basis of shared clinical experience and analysis of the strongest evidence currently available. RESULTS A systematic literature review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria was performed. From the initial 96 items identified, 7 articles were selected based on higher-evidence items such as randomized-controlled trials, guidelines, and systematic reviews. A 34-statement survey was developed, and after three rounds of voting, 2 items reached strong consensus, 17 reached consensus or near consensus, and 15 had no consensus. CONCLUSIONS Until further prospective data are available, our CCS should provide a useful reference for PedTH management. PedTH should be considered a nasal obstructive disease not necessarily related to an adult condition but frequently associated with other nasal or craniofacial disorders. Diagnosis requires clinical examination and endoscopy, whereas rhinomanometry, nasal cytology, and questionnaires have little clinical role. Treatment choice should consider the specific indications and features of the available options, with a preference for less invasive procedures. LEVEL OF EVIDENCE 5 Laryngoscope, 134:1437-1444, 2024.
Collapse
Affiliation(s)
- Antonino Maniaci
- Young Otolaryngologists-International Federation of Otorhinolaryngological Societies, Paris, France
- Department of Medical, Surgical Sciences and Advanced Technologies G.F. Ingrassia, University of Catania, Catania, Italy
| | - Christian Calvo-Henriquez
- Young Otolaryngologists-International Federation of Otorhinolaryngological Societies, Paris, France
- Service of Otolaryngology, Rhinology Unit, Hospital Complex at the University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Giovanni Cammaroto
- Young Otolaryngologists-International Federation of Otorhinolaryngological Societies, Paris, France
- Otolaryngology Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Carlos Garcia-Magan
- Department of Pediatrics, Hospital Complex at the University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Vanesa Garcia-Paz
- Allergy Department, Hospital Complex at the University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Giannicola Iannella
- Young Otolaryngologists-International Federation of Otorhinolaryngological Societies, Paris, France
- Otorhinolaryngology Department, Sapienza University of Rome, Rome, Italy
| | - Ignacio Jiménez-Huerta
- Young Otolaryngologists-International Federation of Otorhinolaryngological Societies, Paris, France
- Service of Otolaryngology, Pediatric Otolaryngology Unit, Gregorio Marañon University Hospital, Madrid, Spain
| | - Ignazio La Mantia
- Department of Medical, Surgical Sciences and Advanced Technologies G.F. Ingrassia, University of Catania, Catania, Italy
| | - Jérome R Lechien
- Young Otolaryngologists-International Federation of Otorhinolaryngological Societies, Paris, France
- Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium
| | - Samuel C Leong
- Young Otolaryngologists-International Federation of Otorhinolaryngological Societies, Paris, France
- The Liverpool Head and Neck Centre, Aintree University Hospital NHS Foundation Trust, Liverpool, UK
| | - David Lobo-Duro
- Young Otolaryngologists-International Federation of Otorhinolaryngological Societies, Paris, France
- Otolaryngology Service, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Juan Maza-Solano
- Young Otolaryngologists-International Federation of Otorhinolaryngological Societies, Paris, France
- Otolaryngology Service, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Ron Mitchell
- Department of Pediatric Otolaryngology-Head and Neck Surgery, Children's Health, Children's Medical Center Dallas, Dallas, Texas, U.S.A
| | - Andrea Otero-Alonso
- Allergy Department, Hospital Complex at the University of Santiago de Compostela, Santiago de Compostela, Spain
| | - You Peng
- Young Otolaryngologists-International Federation of Otorhinolaryngological Societies, Paris, France
- Department of Otolaryngology-Head & Neck Surgery, Western University, London, Ontario, Canada
| | - Thomas Radulesco
- Young Otolaryngologists-International Federation of Otorhinolaryngological Societies, Paris, France
- Department of Otorhinolaryngology and Head and Neck Surgery, APHM, IUSTI, CNRS, La Conception University Hospital, Aix Marseille University, Marseille, France
| | - François Simon
- Young Otolaryngologists-International Federation of Otorhinolaryngological Societies, Paris, France
- Otolaryngology Service, Université Paris Cité, Hôpital Necker-Enfants Malades, APHP, Paris, France
| | - Natasha Teissier
- Young Otolaryngologists-International Federation of Otorhinolaryngological Societies, Paris, France
- Pediatric Otolaryngology Department, Robert-Debré Hospital, Paris 7 Denis Diderot University, Paris, France
| | - Salvatore Cocuzza
- Department of Medical, Surgical Sciences and Advanced Technologies G.F. Ingrassia, University of Catania, Catania, Italy
| | - Alberto M Saibene
- Young Otolaryngologists-International Federation of Otorhinolaryngological Societies, Paris, France
- Otolaryngology Unit, ASST Santi Paolo E Carlo, Department of Health Sciences, Università Degli Studi Di Milano, Milan, Italy
| |
Collapse
|
19
|
Abdelhamid HI, Awad AMM, Albadea AMA, Khaled IA, El-Anwar MW, El-Ahl MAS. A novel technique with butterfly splint for middle turbinate stabilization in sinus surgery. Eur Arch Otorhinolaryngol 2024; 281:1325-1330. [PMID: 37966539 DOI: 10.1007/s00405-023-08322-0] [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] [Received: 09/11/2023] [Accepted: 10/27/2023] [Indexed: 11/16/2023]
Abstract
OBJECTIVE To assess the efficacy of newly designed butterfly splint with special technique for middle turbinate stabilization in preventing adhesion following bilateral endoscopic sinus surgery (ESS) for chronic rhinosinusitis with nasal polyps (CRSwNP). STUDY DESIGN Prospective, double-blind, randomized controlled. SETTING University hospitals. METHODS Following ESS, in cases of traumatized and/or unstable middle turbinates, newly designed butterfly plastic splint was randomly inserted in the middle meatus of one nasal side, while no splint was inserted in the other (control). Patients were followed up on after 1 week, 1 month, and 6 months. Endoscopic examination and a visual analog scale were used to evaluate each side of the nasal cavity for adhesion, crusting, pus, pain, nasal obstruction, and nasal discharge. RESULTS Thirty patients (60 nasal sides) were included. For all investigated parameters, there was no significant difference between the splinted and non-splinted sides at the first week visit. Adhesion was found significantly less in the splinted sides (3%) than the non-splinted sides (27%) after 1 month (P = 0.038). The adhesion rate in the splinted sides remained 3% at the 3 month follow-up visit, however, in the non-splinted sides, the rate increased up to 30% (P = 0.007). Throughout the follow-up visits, all other investigated parameters remained statistically insignificant between both sides. CONCLUSIONS The newly designed butterfly plastic splints to avoid middle turbinate adhesion is safe and effective in both reducing middle meatal adhesion with low complication rate in CRSwNP patients undergoing ESS and middle turbinate stabilization in its intermediate position.
Collapse
Affiliation(s)
- Hoda Ismael Abdelhamid
- Otorhinolaryngology-Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ali Mohammad Mohammad Awad
- Otorhinolaryngology-Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Amany Mohamed Abd Albadea
- Otorhinolaryngology-Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ibrahim Ahmed Khaled
- Otorhinolaryngology-Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohammad Waheed El-Anwar
- Otorhinolaryngology-Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
| | - Magdy Abdalla Syed El-Ahl
- Otorhinolaryngology-Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| |
Collapse
|
20
|
Dholakia SS, Grimm D, Daum R, Bravo DT, Salvi N, Zarabanda D, Overdevest JB, Thamboo A, Nakayama T, Nayak JV. The Serpentine Sign: A Reliable Endoscopic and Radiographic Finding in Empty Nose Syndrome. Laryngoscope 2024; 134:1089-1095. [PMID: 37702458 DOI: 10.1002/lary.30938] [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] [Received: 05/16/2023] [Revised: 07/06/2023] [Accepted: 07/19/2023] [Indexed: 09/14/2023]
Abstract
OBJECTIVE Empty nose syndrome (ENS) is a relatively uncommon disease that greatly impacts the quality of life and presents diagnostic challenges. We sought to identify objective clinical findings unique to patients with ENS, and in doing so identified compensatory mucosal hypertrophy in an alternating, undulating swelling on endoscopy and coronal computerized tomography (CT) that we have termed the "Serpentine Sign." Here, we investigated whether this radiographic finding is a reliable manifestation in ENS patients. METHODS Retrospective review was undertaken to identify ENS patients with past turbinoplasty, an ENS6Q score of at least 11/30, and symptomatic improvement with the cotton placement test. Control patients without complaints of ENS symptoms (ENS6Q < 11) were identified for comparison. ENS and control patients had coronal CT imaging available to evaluate for the Serpentine Sign, as well as ENS6Q scores, and histologic analysis of nasal tissue. RESULTS 34 ENS and 74 control patients were evaluated for the presence of the Serpentine Sign. Of the 34 patients with ENS, 18 exhibited this radiographic finding on CT imaging (52.9%) compared to 0 of the 74 control patients (p < 0.0001). Further analysis demonstrated that ENS patients with the Serpentine Sign had lower median scores on ENS6Q than ENS patients without (17.5 vs. 22, p = 0.033). Histology revealed disorganized subepithelium rich in seromucinous glands similar to the nasal septum swell body. CONCLUSION The "Serpentine Sign" is a unique presentation of hypertrophic change to the nasal septum soft tissue that is specific to ENS patients and may serve as a reliable radiographic and endoscopic finding in diagnosis. LEVEL OF EVIDENCE 4 Laryngoscope, 134:1089-1095, 2024.
Collapse
Affiliation(s)
- Sachi S Dholakia
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - David Grimm
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - Rachel Daum
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - Dawn T Bravo
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - Nicole Salvi
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - David Zarabanda
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - Jonathan B Overdevest
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - Andrew Thamboo
- Department of Otolaryngology - Head and Neck Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tsuguhisa Nakayama
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, USA
- Department of Otolaryngology - Head and Neck Surgery, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Jayakar V Nayak
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, USA
- Department of Otolaryngology - Head and Neck Surgery, VA Palo Alto Health Care System, Palo Alto, California, USA
| |
Collapse
|
21
|
Chang CF. Using platelet-rich fibrin scaffolds with diced cartilage graft in the treatment of empty nose syndrome. Ear Nose Throat J 2024; 103:NP168-NP172. [PMID: 34569297 DOI: 10.1177/01455613211045567] [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: 11/15/2022] Open
Abstract
Empty nose syndrome (ENS) is a rare entity in patients who undergo sinonasal surgery due to over-resection of the turbinate. This syndrome leads to debilitating symptoms that include dry nose, painful nasal breathing, paradoxical nasal obstruction, crusting, and sleep disorder. The goal of surgical treatment is to reestablish the volume of the turbinates to rehabilitate the nasal resistance. Endonasal microplasty with cartilage implants on the lateral wall of the nasal cavity is useful for creating the neoturbinate. Here, we present 2 cases that describe the management of empty nose syndrome by endonasal microplasty using platelet-rich fibrin (PRF) scaffolds embedded with a diced cartilage graft. The integration of the PRF scaffolds with diced cartilage efficiently facilitated the reestablishment of the neoturbinate. This autologous biomaterial is suitable for the treatment of ENS.
Collapse
Affiliation(s)
- Chin-Fang Chang
- Department of Otorhinolaryngology, Head and Neck Surgery, Jen-Ai Hospital, Taichung, Taiwan
- Rong Hsing Research Center For Translational Medicine, National Chung Hsing University, Taichung, Taiwan
- Basic Medical Education Center, Central Taiwan University of Science and Technology, Taichung, Taiwan
- Department of Medical Education and Research, Jen-Ai Hospital, Taichung, Taiwan
| |
Collapse
|
22
|
Patel S, Mahr G, Deeb R, Craig JR. Numerous unsuccessful surgeries for empty nose syndrome in a patient with somatic symptom disorder. Am J Otolaryngol 2024; 45:104149. [PMID: 38070377 DOI: 10.1016/j.amjoto.2023.104149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 12/02/2023] [Indexed: 03/16/2024]
Affiliation(s)
- Shivali Patel
- Department of Psychiatry, University of Michigan, 1500 E Medical Center Dr., Ann Arbor, MI 48109, United States of America
| | - Gregory Mahr
- Department of Behavioral Health, Henry Ford Health, 1 Ford Place Suite 1C, Detroit, MI 48202, United States of America
| | - Robert Deeb
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health, 2799 W Grand Blvd, Detroit, MI 48202, United States of America
| | - John R Craig
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health, 2799 W Grand Blvd, Detroit, MI 48202, United States of America.
| |
Collapse
|
23
|
Vishak MS, Raja K. In reference to medial flap middle turbinoplasty for solid middle turbinate hypertrophy: improving airway, speeding healing and preserving olfaction. Eur Arch Otorhinolaryngol. 2023 Oct 16. doi: 10.1007/s00405-023-08264-7. Eur Arch Otorhinolaryngol 2024; 281:1067-1068. [PMID: 38102313 DOI: 10.1007/s00405-023-08357-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 11/14/2023] [Indexed: 12/17/2023]
Affiliation(s)
- M S Vishak
- Department of Otorhinolaryngology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India.
| | - Kalaiarasi Raja
- Department of Otorhinolaryngology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| |
Collapse
|
24
|
Ozdem A, Ozturan O, Sutcu AO, Dogan R, Senturk E. Medial flap middle turbinoplasty for solid middle turbinate hypertrophy: improving airway, speeding healing and preserving olfaction. Eur Arch Otorhinolaryngol 2024; 281:805-816. [PMID: 37843616 DOI: 10.1007/s00405-023-08264-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Received: 05/24/2023] [Accepted: 09/25/2023] [Indexed: 10/17/2023]
Abstract
PURPOSE The techniques to be performed for bullous middle turbinates are well-defined and widely accepted in the literature. However, in the case of solid middle turbinate hypertrophy, information on surgical techniques that take into account function and sense of smell is very limited in the literature. The aim of this study was to compare the airway patency and olfaction results of patients diagnosed with solid middle turbinate hypertrophy, who underwent subtotal (transverse) resection or medial flap turbinoplasty of the middle turbinates. METHODS Thirty-five adult patients who were diagnosed with solid middle turbinate hypertrophy were divided into two groups, namely medial flap middle turbinoplasty (study group = 17) and transverse resection to the middle turbinate (control group = 18). Acoustic rhinometry, anterior rhinomanometry, peak nasal inspiratory flowmeter test, odor identification test, and n-butanol threshold measurements were performed before and 3 months after the surgery. In addition, preoperative and postoperative nasal obstruction and olfactory senses of the patients were evaluated with visual analog scale and nasal obstruction symptom evaluation scale. RESULTS Visual analog scores for olfaction were significantly higher in the study group compared to the control group. In odor identification test, a significant improvement was observed in the study group, while a decrease was observed in the control group. While there was a decrease in the n-butanol thresholds values in the study group, there was an increase in the control group. CONCLUSIONS Medial mucosal flap technique is an effective and functional turbinoplasty technique that can be used in solid hypertrophy of the middle turbinate, which offers advantages in terms of enhanced airway healing and olfactory results.
Collapse
Affiliation(s)
- Abdullah Ozdem
- Department of Otorhinolaryngology, Pendik Training and Research Hospital, Marmara University Medical Faculty, Pendik, Istanbul, Turkey.
| | - Orhan Ozturan
- Department of Otorhinolaryngology, Faculty of Medicine, Bezmialem Vakif University, Fatih, Istanbul, Turkey
| | - Ahmet Onur Sutcu
- Department of Otorhinolaryngology, Faculty of Medicine, Bezmialem Vakif University, Fatih, Istanbul, Turkey
| | - Remzi Dogan
- Department of Otorhinolaryngology, Faculty of Medicine, Bezmialem Vakif University, Fatih, Istanbul, Turkey
| | - Erol Senturk
- Department of Otorhinolaryngology, Faculty of Medicine, Bezmialem Vakif University, Fatih, Istanbul, Turkey
| |
Collapse
|
25
|
Ma R, Hu Z, Tian L, Zheng G, Wang Y, Chen X, Lou M, Gong M, Wang B, Yang F, Dong J, Zhang Y. Numerical and experimental analysis of pollen inhalation exposure in nasal airways following various middle turbinectomy. Sci Total Environ 2024; 907:168156. [PMID: 37898207 DOI: 10.1016/j.scitotenv.2023.168156] [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] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND Middle turbinectomy (MT) has always been controversial. MT significantly alters the anatomy and redistributes the inhaled air. The current study is designed to quantify the effect of MT with varying resection volumes on airflow and associated pollen inhalation exposure characteristics in the nasal airways. METHODS Six realistic models following bilateral comprehensive Functional Endoscopic Sinus Surgery (FESS) deriving from CT images were constructed and their corresponding post-MT models with four types of MT procedures were virtually conducted. Inhalation exposure to pollen particles was simulated by the Computational Fluid-Particle Dynamics (CFPD) approach and validated through in vitro experiments. RESULTS Following the excision of the middle turbinate, a significant escalation in airflow was observed within the upper-middle region of the nasal cavities. Pollen deposition was observed to be more prominent in the nasal septum, laryngopharynx, and maxillary sinus, varying with the types of MT procedures. Notably, particles with diameters smaller than 50 μm exhibited two distinct "high peaks" and three "small peaks" within the nasal airways. CONCLUSION MT resulted in increased airflow volume within the upper-middle region of the nasal cavities. Following MT, notable shifts in pollen particle deposition hot spots were observed, transitioning from the nasal vestibule, nasal septum, and middle meatus to the nasal septum and laryngopharynx. These findings are anticipated to contribute valuable perspectives on pollen inhalation exposure risk assessments following diverse MT surgical interventions.
Collapse
Affiliation(s)
- Ruiping Ma
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710000, China
| | - Zhenzhen Hu
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710000, China
| | - Lin Tian
- School of Engineering - Mechanical and Automotive, RMIT University, Bundoora, VIC, Australia
| | - Guoxi Zheng
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710000, China
| | - Yusheng Wang
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710000, China
| | - Xiaole Chen
- School of Energy and Mechanical Engineering, Nanjing Normal University, Nanjing, Jiangsu 210046, China
| | - Miao Lou
- Department of Otolaryngology Head and Neck Surgery, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi 710021, China
| | - Minjie Gong
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710000, China
| | - Botao Wang
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710000, China
| | - Feilun Yang
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710000, China
| | - Jingliang Dong
- Institute for Sustainable Industries & Liveable Cities, Victoria University, PO Box 14428, Melbourne, VIC 8001, Australia; First Year College, Victoria University, Footscray Park Campus, Footscray, VIC 3011, Australia.
| | - Ya Zhang
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710000, China.
| |
Collapse
|
26
|
Thomas AS, Trupthi MC, Ponmar M, Issac R. Misdiagnosed long-standing unilateral nasal obstruction: ossifying fibroma of the inferior turbinate. BMJ Case Rep 2024; 17:e255881. [PMID: 38199659 PMCID: PMC10806964 DOI: 10.1136/bcr-2023-255881] [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: 01/12/2024] Open
Abstract
A man in his 20s presented with complaints of unilateral nasal obstruction for the past 6 years that progressively worsened leading to irrational use of over-the-counter nasal decongestants. With the worsening of symptoms, a non-contrast CT was done. It showed a dense expansile sclerotic lesion of the right inferior turbinate, which was excised endoscopically. Cemento-ossifying fibromas of the inferior turbinate are rare and require assessment and surgical excision to relieve the symptom of nasal obstruction. It derives its name from the variable proportions of fibrous and mineralised tissue present in it and exclusively develops in the craniofacial region. It can be surgically managed by an endoscopic, an endonasal non-endoscopic (with a speculum) or an open approach (lateral rhinotomy, sublabial approach or mid-facial degloving). Here, we present how such a case was detected and managed surgically by the endoscopic approach, which is a minimally invasive option with shorter hospital stay and early recovery.
Collapse
Affiliation(s)
- Akhila Sarah Thomas
- Department of ENT, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Menuskodige C Trupthi
- Department of ENT, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Madhurima Ponmar
- Department of General Pathology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Rijo Issac
- Department of General Pathology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| |
Collapse
|
27
|
Park MJ, Jang YJ. Facial Pain Triggered by Inferior Turbinate Partial Resection in a Patient with a Previous History of Inferior Meatal Antrostomy: A Case Report. Ann Otol Rhinol Laryngol 2024; 133:115-118. [PMID: 37377141 DOI: 10.1177/00034894231180948] [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: 06/29/2023]
Abstract
OBJECTIVES Inferior meatal antrostomy (IMA) is regarded as a safe method, with minimal complications, for managing various lesions in the maxillary sinus. However, in patients with persisting IMA window, resection of the inferior turbinate may result in direct airflow into the antrum, irritating the antral mucosa. METHODS Case report and review of literature. RESULTS/CASE The present report describes a 29-year-old man who previously underwent unilateral IMA for the excision of a dentigerous cyst. The patient did not report any facial pain following the excision of the cyst. One year later, this patient underwent partial resection of the inferior turbinate for the resolution of nasal stuffiness by another surgeon. Soon after surgery, the patient developed severe facial and ocular pain on the side of the IMA, with the pain being especially aggravated upon inhalation. Endoscopy and computed tomography (CT) revealed a persisting IMA window. The patient's severe discomfort was thought to result from direct airflow into the maxillary sinus, as the resected turbinate may have altered normal nasal airflow. A unilateral inferior meatal augmentation procedure (IMAP) with an autologous ear cartilage implant was performed, resulting in complete relief of pain and discomfort. CONCLUSIONS Although IMA alone is a relatively safe surgical procedure, care should be taken when performing inferior turbinoplasty in patients with persistent IMA opening.
Collapse
Affiliation(s)
- Marn Joon Park
- Department of Otorhinolaryngology-Head & Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
- Graduate School of Medicine, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yong Ju Jang
- Department of Otorhinolaryngology-Head & Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| |
Collapse
|
28
|
Calvo-Henriquez C, Maldonado-Alvarado B, Rodriguez-Rivas P, Rodriguez-Iglesias M, Martínez-Capoccioni G, Lobo D, Martin-Martin C, Alobid I. Effect of turbinate surgery on mucociliary clearance. A systematic review and metanalysis. Acta Otorrinolaringol Esp (Engl Ed) 2024; 75:47-60. [PMID: 37722657 DOI: 10.1016/j.otoeng.2023.09.002] [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] [Received: 07/06/2022] [Accepted: 04/02/2023] [Indexed: 09/20/2023]
Abstract
Despite the fact that turbinate surgery provides satisfactory results regarding nasal obstruction, most of these procedures are destructive, to some extent, for the respiratory epithelium. There are valid hypotheses suggesting either that turbinate surgery may improve mucociliary clearance (MCC) by improving rhinitis, as well hypotheses suggesting that these surgeries may impair it by damaging the nasal ciliated epithelia. This systematic review is designed with the objective of exploring the effect of turbinate surgery on MCC. Pubmed (Medline), the Cochrane Library, EMBASE, SciELO were analyzed. Four authors members of the YO-IFOS rhinology study group independently analyzed the articles. Extracted variables encompassed: sample size, age, indication for surgery, surgical technique, method used to measure mucociliary clearance, mucociliary transport time before and after surgery, and main outcome. 15 studies with a total population of 1936 participants (1618 patients excluding healthy controls) met the inclusion criteria. 9 studies could be combined in a metanalysis, wich revealed a non-statistically significant decrease of 3.86 min in MCTT after turbinate surgery (p = 0.06). The subgroup analysis of the 5 cohorts who underwent microdebrider turbinoplasty reached statistical significance under a random effect model, revealing a 7.02 min decrease in MCTT (p < 0.001). The laser turbinoplasty subgroup, composed of 4 cohorts, also reached significance, although the difference was lower than that for microdebrider turbinoplasty, 1.01 min (p < 0.001). This systematic review and meta-analysis suggests that turbinate surgery does not compromise mucociliary clearance. The available evidence also suggests that turbinate surgery with mucosa sparing techniques improves MCC, while with aggressive techniques it increases or remains the same. This beneficial effect is evident since the first to third month after surgery. However, for solid conclusions, a standard way to measure MCTT should be stablished, as well as a method to appropriately describe the extension of the surgery.
Collapse
Affiliation(s)
- Christian Calvo-Henriquez
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Service of Otolaryngology, Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain.
| | - Byron Maldonado-Alvarado
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Service of Otolaryngology, Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
| | - Paula Rodriguez-Rivas
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Service of Otolaryngology, Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
| | - Miguel Rodriguez-Iglesias
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Service of Otolaryngology, Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
| | - Gabriel Martínez-Capoccioni
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Service of Otolaryngology, Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
| | - David Lobo
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Service of Otolaryngology, Rhinology and Skull Base Department, Marques de Valdecilla Hospital, Santander, Spain
| | - Carlos Martin-Martin
- Service of Otolaryngology, Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
| | - Isam Alobid
- Service of Otolaryngology, Rhinology and Skull Base Department, Clinic Hospital, Barcelona, Spain
| |
Collapse
|
29
|
Shomorony A, Weitzman R, Chen YH, Liao D, Sclafani AP. Augmented Virtual Examination for Cosmetic and Functional Rhinoplasty. Facial Plast Surg Aesthet Med 2024; 26:65-70. [PMID: 37358622 DOI: 10.1089/fpsam.2023.0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023] Open
Abstract
Background: Few studies have critically evaluated the quality of data obtained during telemedical evaluations of patients with nasal complaints. Objective: To compare the quality of data provided by remote endoscopic and external nasal examination with those by in-person evaluations for rhinoplasty and functional nasal surgery, measured by detectability of anatomic features, and to assess associated patient experience measured by reported ease, discomfort, and likelihood of peer recommendation. Materials and Methods: Twenty healthy subjects performed a nasal self-examination using an endoscope and webcam under remote videoconferencing service (VCS) guidance. They subsequently underwent in-person examination and were surveyed about their experience. Inter-rater reliability was calculated using kappa coefficients. Detectability of anatomic features by in-person versus virtual examination was compared using Wilcoxon and chi-square tests. Results: Median subject age was 27.5 years (range 23-77). Kappa coefficients were 0.78 for in-person and 0.66 for virtual evaluations. Only the internal nasal valve and inferior turbinate were better visualized in person. There were no differences between detectability of external features on in-person versus virtual examinations. Subjects' average likelihood of recommending this technology (1-10) was 8.65 (SD 1.4). Conclusions: Intranasal examination by physician-guided remote endoscopy and webcam-based facial analysis demonstrate nasal anatomy comparable with in-person evaluation and anterior rhinoscopy.
Collapse
Affiliation(s)
- Andre Shomorony
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Rachel Weitzman
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Yu Han Chen
- Weill Cornell Medical College, New York, New York, USA
| | - David Liao
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Anthony P Sclafani
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, New York, USA
| |
Collapse
|
30
|
Tovmasyan AS, Zelikovich EI, Kurilenkova AG, Klimenko KE, Kolbanova IG, Shatalov VG, Filina EV, Kishinevskii AE, Ramazanov SR. [Intraosseous cavernous hemangioma of the middle turbinate. Clinical cases]. Vestn Otorinolaringol 2024; 89:45-51. [PMID: 38506026 DOI: 10.17116/otorino20248901145] [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: 03/21/2024]
Abstract
Intraosseous vascular pathology of the turbinates is extremely rare in the practice of an otorhinolaryngologist and can be presented in various histopathological variants. The article presents two clinical cases in which an intraosseous cavernous hemangioma was hidden under the mask of a hypertrophied middle turbinate. The final diagnosis was established by the results of histological examination. The analysis of these clinical cases indicates that, despite the low prevalence, atypical clinical and CT picture, intraosseous formations of the nasal cavity can be of a vascular nature and certainly require a comprehensive examination, including CT, CT with contrast and/or MRI of the nose and paranasal sinuses. These clinical observations indicate that preliminary embolization of feeding vessels before surgical treatment is not required.
Collapse
Affiliation(s)
- A S Tovmasyan
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - E I Zelikovich
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - A G Kurilenkova
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - K E Klimenko
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
- Central State Medical Academy of Administrative Directorate of the President of the Russian Federation, Moscow, Russia
- Central Clinical Hospital with Polyclinic of Administrative Directorate of the President of the Russian Federation, Moscow, Russia
| | - I G Kolbanova
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - V G Shatalov
- City Clinical Oncology Hospital No. 1, Moscow, Russia
| | - E V Filina
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - A E Kishinevskii
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - S R Ramazanov
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| |
Collapse
|
31
|
Weiland T, Gellner V, Pondorfer P, Hortobagyi D, Maitz E, Kiss P, Borenich A, Reininghaus EZ, Thurnher D, Tomazic PV. Endoscopic trans-sphenoidal pituitary surgery does not impact postoperative nasal quality of life. Eur Arch Otorhinolaryngol 2024; 281:245-256. [PMID: 37650929 PMCID: PMC10764578 DOI: 10.1007/s00405-023-08203-6] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/21/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE The aim of this prospective longitudinal study was to assess both subjective quality of life using questionnaires and objective examination of nasal function with regard to olfaction, nasal air flow and mucociliary clearance in patients after minimally invasive, turbinate-preserving endoscopic transnasal trans-sphenoidal pituitary surgery. METHODS Patients undergoing endoscopic transnasal pituitary surgery were recruited prospectively and examined during three study visits, preoperatively and 3 and 6 months postoperatively. We examined nasal function using sniffin' sticks test, rhinomanometry, saccharin transit time test, and endoscopic and radiological scores. In addition, the influence on subjective quality of life and mental health was recorded using the Sinonasal-Outcome-Test-20 (SNOT-20) and the Hospital-Anxiety-and-Depression-Scale (HADS). RESULTS 20 patients undergoing endoscopic pituitary tumor resections were included. No significant changes in olfaction or mucociliary clearance were noted. Nasal air flow showed a tendency to increase in the postoperative course lacking significance. Both the endoscopy and the radiological scores showed a significant deterioration, especially after 3 months, with a trend towards improvement over time. However, neither the SNOT-20 nor the HADS showed significant changes compared to baseline. CONCLUSIONS Our concept of minimally invasive endoscopic tumor resections on the pituitary gland with preservation of nasal turbinates shows low morbidity for the patient. Despite objectifiable surgery-associated changes in the nose, nasal physiology in terms of smell, airflow and mucociliary clearance can be preserved and the subjective quality of life of our patients remains stable.
Collapse
Affiliation(s)
- Thomas Weiland
- Department of Otorhinolaryngology-Head and Neck Surgery, Medical University of Graz, Auenbruggerplatz 26, 8036, Graz, Austria.
| | - Verena Gellner
- Department of Neurosurgery, Medical University of Graz, Graz, Austria
| | - Prisca Pondorfer
- Department of Otorhinolaryngology-Head and Neck Surgery, Medical University of Graz, Auenbruggerplatz 26, 8036, Graz, Austria
| | - David Hortobagyi
- Department of Otorhinolaryngology-Head and Neck Surgery, Medical University of Graz, Auenbruggerplatz 26, 8036, Graz, Austria
| | - Emanuel Maitz
- Department of Otorhinolaryngology-Head and Neck Surgery, Medical University of Graz, Auenbruggerplatz 26, 8036, Graz, Austria
| | - Peter Kiss
- Department of Otorhinolaryngology-Head and Neck Surgery, Medical University of Graz, Auenbruggerplatz 26, 8036, Graz, Austria
| | - Andrea Borenich
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Eva Z Reininghaus
- Department for Psychiatry and Psychotherapy, Medical University of Graz, Graz, Austria
| | - Dietmar Thurnher
- Department of Otorhinolaryngology-Head and Neck Surgery, Medical University of Graz, Auenbruggerplatz 26, 8036, Graz, Austria
| | - Peter Valentin Tomazic
- Department of Otorhinolaryngology-Head and Neck Surgery, Medical University of Graz, Auenbruggerplatz 26, 8036, Graz, Austria
| |
Collapse
|
32
|
Khedr Y, Rostron E, Vize C. Retrospective radiological analysis to establish anatomical variation in angulation between medial canthus and the middle turbinate, for optimal positioning of Lester Jones Lacrimal bypass tubes in treatment of Epiphora. PLoS One 2023; 18:e0288856. [PMID: 38157347 PMCID: PMC10756506 DOI: 10.1371/journal.pone.0288856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 12/12/2023] [Indexed: 01/03/2024] Open
Abstract
PURPOSE To determine the optimum angle for placement of Lester Jones lacrimal bypass tube using fixed radiological markers on CT scan head with axial and coronal cuts, as well as analysing the anatomical variation and range of angulation between individuals within our local population. METHODS A retrospective radiological study conducted on a randomly selected sample of 384 adult patients in a UK Teaching Hospital. The angle between the medial canthus and the middle turbinate was measured on CT scans of the head using fixed radiological anatomical landmarks and analysed using the IMPAX software. Patients with orbital or nasal fractures, as well as those with history of surgical procedures involving the facial bones, were excluded. The accuracy of our measurements was validated using three dimensional (3D) CT head reconstruction technology. RESULTS Analysis of the results showed a range of angulation between 28-45 degrees, with a mean angle of 36.99 ± 4.78 SD. There was no significant correlation found when comparing the different age groups using the One Way ANOVA test. Furthermore, a non-significant correlation was found between males and females when their mean angles were compared using the independent t-test. CONCLUSION Our study showed that the ideal angle for insertion of Lester Jones tube would be between 30-45 degrees, with a mean of 37 degrees. No significant correlation was found between the age of the patient and the ideal angle of insertion of Lester Jones tube. Moreover, no significant difference was found in the angle measurements between males and females.
Collapse
Affiliation(s)
- Yahya Khedr
- Hull University Teaching Hospitals and University of Edinburgh, Hull, United Kingdom
| | - Egle Rostron
- Hull University Teaching Hospitals, Hull, United Kingdom
| | - Colin Vize
- Hull University Teaching Hospitals, Hull, United Kingdom
| |
Collapse
|
33
|
Chen R, Gao J, Liu Z, Gao J. Juvenile psammomatoid ossifying fibroma arising from the middle turbinate: A case report with literature review. Asian J Surg 2023; 46:6061-6062. [PMID: 37867081 DOI: 10.1016/j.asjsur.2023.09.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 09/12/2023] [Indexed: 10/24/2023] Open
Affiliation(s)
- Ruofan Chen
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital, Medical College, Xiamen University, Xiamen, 361003, China; Teaching Hospital of Fujian Medical University, Xiamen, 361003, China; Xiamen Key Laboratory of Otolaryngology Head and Neck Surgery, Xiamen, 361003, China; The School of Clinical Medicine, Fujian Medical University, Fuzhou, China; The Graduate School of Fujian Medical University, Fuzhou, China
| | - Jing Gao
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital, Medical College, Xiamen University, Xiamen, 361003, China; Teaching Hospital of Fujian Medical University, Xiamen, 361003, China; Xiamen Key Laboratory of Otolaryngology Head and Neck Surgery, Xiamen, 361003, China
| | - Zhihui Liu
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital, Medical College, Xiamen University, Xiamen, 361003, China; Teaching Hospital of Fujian Medical University, Xiamen, 361003, China; Xiamen Key Laboratory of Otolaryngology Head and Neck Surgery, Xiamen, 361003, China; The School of Clinical Medicine, Fujian Medical University, Fuzhou, China; The Graduate School of Fujian Medical University, Fuzhou, China
| | - Jing Gao
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital, Medical College, Xiamen University, Xiamen, 361003, China; Teaching Hospital of Fujian Medical University, Xiamen, 361003, China; Xiamen Key Laboratory of Otolaryngology Head and Neck Surgery, Xiamen, 361003, China; The School of Clinical Medicine, Fujian Medical University, Fuzhou, China.
| |
Collapse
|
34
|
Comer JC, Hess AO, Rarey KE, Justice JM, Collins WO, Lobo BC. The Transverse Turbinate Line: A Reliable Landmark for the Maxillary Sinus Natural Ostium. Laryngoscope 2023; 133:3285-3291. [PMID: 37132596 DOI: 10.1002/lary.30678] [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] [Received: 09/29/2022] [Revised: 03/03/2023] [Accepted: 03/12/2023] [Indexed: 05/04/2023]
Abstract
OBJECTIVES Approximating the maxillary sinus natural ostium's (MSNO) natural position during anterograde surgery is challenging, as only a single visual "landmark," the maxillary line, is routinely offered to guide the identification of the MSNO in three-dimensional space. Despite almost 40 years of endoscopic sinus surgery (ESS) experience in North America, maxillary recirculation and discontinuity between the natural and surgical ostia are commonly encountered during revision ESS. Consequently, we feel an additional visual landmark would assist in localizing the MSNO with or without image guidance. In this study, we aim to provide a second reliable landmark in the sinonasal cavity. METHODS We present a cadaveric anatomical landmark series that provides a second visual landmark for the MSNO, which we have labeled the transverse turbinate line (TTL): a 2-millimeter zone of confidence for the craniocaudal positioning of the MSNO that can be combined with the anteroposterior (AP) landmark of the maxillary line. RESULTS In our study, 40 cadaveric sinuses were dissected, and the TTL was found to correspond consistently with the zone between the superior and inferior aspects of the MSNO. CONCLUSION We anticipate that this second relational landmark may decrease the time required for anterograde access to the MSNO in trainees, increase the accuracy of identification, and translate to lower long-term recirculation and maxillary surgery failure rates. LEVEL OF EVIDENCE NA Laryngoscope, 133:3285-3291, 2023.
Collapse
Affiliation(s)
- Julia C Comer
- Department of Otolaryngology Head and Neck Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Andrew O Hess
- Department of Otolaryngology Head and Neck Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Kyle E Rarey
- Department of Anatomy & Cell Biology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Jeb M Justice
- Department of Otolaryngology Head and Neck Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - William O Collins
- Department of Otolaryngology Head and Neck Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Brian C Lobo
- Department of Otolaryngology Head and Neck Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
| |
Collapse
|
35
|
Khatri H, Salati H, Wong E, Bradshaw K, Inthavong K, Sacks R, Singh N. Modelling the effects of post-FESS middle turbinate synechiae on sinonasal physiology: A computational fluid dynamics study. Auris Nasus Larynx 2023; 50:911-920. [PMID: 37137797 DOI: 10.1016/j.anl.2023.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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] [Received: 11/20/2022] [Revised: 03/23/2023] [Accepted: 04/11/2023] [Indexed: 05/05/2023]
Abstract
OBJECTIVE(S) Chronic rhinosinusitis (CRS) is common and often requires surgical intervention. Surgical failure may lead to persistent symptoms and recalcitrant disease, often secondary to synechiae between the middle turbinate (MT) and lateral nasal wall. Synechiae prevention techniques have been extensively investigated, however evidence for the effect of synechiae on sinonasal physiology is lacking. We aimed to model the effects of MT synechiae on a post-functional endoscopic sinus surgery (FESS) sinonasal cavity using computational fluid dynamics (CFD). METHODS DICOM data from a CT-sinus of a healthy 25-year-old female was segmented to create a three-dimensional model. Virtual surgery was performed to simulate a "full-house" FESS procedure. Multiple models were created, each with a single unilateral virtual MT synechia of varying extent. CFD analysis was performed on each model and compared with a post-FESS control model without synechiae. Airflow velocity, humidity and mucosal surface and air temperature values were calculated. RESULTS All synechiae models demonstrated aberrant downstream sinonasal airflow. There was reduced ventilation of the ipsilateral frontal, ethmoid and sphenoid sinuses, with a concentrated central "jet" in the middle meatus region. Effects were proportionate to the size of synechiae. The impact on bulk inspired airflow was negligible. CONCLUSION Post-FESS synechiae between the MT and lateral nasal wall significantly disrupt local downstream sinus ventilation and nasal airflow. These findings may explain the persistent symptoms seen in post-FESS CRS patients with MT synechiae, reinforcing the importance of prevention and adhesiolysis. Larger cohort studies with multiple models of actual post-FESS patients with synechiae are required to validate these findings.
Collapse
Affiliation(s)
- Hershil Khatri
- Department of Otolaryngology, University of Sydney, Sydney, NSW, Australia
| | - Hana Salati
- School of Engineering, Royal Melbourne Institute of Technology, Melbourne, Vic, Australia
| | - Eugene Wong
- Department of Otolaryngology, University of Sydney, Sydney, NSW, Australia
| | - Kimberley Bradshaw
- Department of Otolaryngology, University of Sydney, Sydney, NSW, Australia
| | - Kiao Inthavong
- School of Engineering, Royal Melbourne Institute of Technology, Melbourne, Vic, Australia.
| | - Raymond Sacks
- Department of Otolaryngology, University of Sydney, Sydney, NSW, Australia
| | - Narinder Singh
- Department of Otolaryngology, University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
36
|
Ormiskangas J, Valtonen O, Harju T, Rautiainen M, Kivekäs I. Computational fluid dynamics calculations in inferior turbinate surgery: a cohort study. Eur Arch Otorhinolaryngol 2023; 280:4923-4931. [PMID: 37341759 PMCID: PMC10562334 DOI: 10.1007/s00405-023-08058-x] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/08/2023] [Indexed: 06/22/2023]
Abstract
PURPOSE To investigate how the results of nasal computational fluid dynamics (CFD) simulations change due to inferior turbinate surgery and how the results correlate with patient specific subjective assessment and volumetric results in the nasal cavities. METHODS The steady inspiratory airflow of 25 patients was studied pre- and postoperatively with heat transfer from the mucous membrane by performing CFD calculations to patient-specific nasal cone beam computed tomography images. These results were then compared to the severity of the patients' nasal obstruction Visual Analogue Scale (VAS) and Glasgow Health Status Inventory assessments, and acoustic rhinometry measurements. RESULTS Total wall shear forces decreased statistically significantly (p < 0.01) in the operated parts of the inferior turbinates. Patients' subjective nasal obstruction VAS assessment changes between the pre- and postoperative conditions correlated statistically significantly (p = 0.04) with the wall shear force results. CONCLUSION Inferior turbinate surgery lead to decreased total wall shear force values postoperatively. Changes in subjective nasal obstruction VAS results against total wall shear force changes between the pre- and postoperative conditions were statistically significant. CFD data have a potential to be used for the evaluation of nasal airflow.
Collapse
Affiliation(s)
- Jaakko Ormiskangas
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
- Faculty of Engineering and Natural Sciences, Automation Technology and Mechanical Engineering Unit, Tampere University, Tampere, Finland.
| | - Olli Valtonen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Otorhinolaryngology - Head and Neck Surgery, Tampere University Hospital, Tampere, Finland
| | - Teemu Harju
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Otorhinolaryngology - Head and Neck Surgery, Tampere University Hospital, Tampere, Finland
| | - Markus Rautiainen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Otorhinolaryngology - Head and Neck Surgery, Tampere University Hospital, Tampere, Finland
| | - Ilkka Kivekäs
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Otorhinolaryngology - Head and Neck Surgery, Tampere University Hospital, Tampere, Finland
| |
Collapse
|
37
|
Hangjin L, Junting Y, Yiqin W, Hui Q, Shen Y, Jizhe W. Culture expansion of primary human nasal epithelial cells (NEC) isolated with a nasal scraping spoon. J Int Med Res 2023; 51:3000605231207759. [PMID: 37917806 PMCID: PMC10623993 DOI: 10.1177/03000605231207759] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 09/21/2023] [Indexed: 11/04/2023] Open
Abstract
OBJECTIVE To obtain high-purity nasal epithelial cells (NEC) while avoiding the irritation experienced by patients during nasal biopsies. METHODS This prospective, observational study enrolled patients undergoing surgical treatment for nasal septum deviation. After general anaesthesia, a novel nasal scraping spoon was used to collect epithelial cells from the mid-part of the inferior turbinate. The cells were evenly plated on six-well plates coated with rat tail collagen. The morphology and growth of the cells were observed at different time-points using an inverted phase-contrast microscope. Immunofluorescent staining of cytokeratin 18 was used to identify NEC. Ki67 staining was used to check cell viability. RESULTS This study collected samples from 19 patients during a short procedure. No postoperative complications were observed. Cell samples ranging from 8.31 × 105 to 2.04 × 106 cells/sample were obtained. The culture model was suitable for primary NEC culture as demonstrated by the faster proliferation (5-7 days). There was no fungal or bacterial contamination. Immunofluorescent staining confirmed the presence and proliferative activity of NEC in the cultures. CONCLUSION A novel nasal scraping spoon provided an easy sampling method, avoided nasal injuries and psychological barriers to sampling and sufficient viable NEC to establish primary cultures.
Collapse
Affiliation(s)
- Li Hangjin
- Department of Otolaryngology, Head and Neck Surgery, Second Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Yin Junting
- Department of Otolaryngology, Head and Neck Surgery, Second Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Wang Yiqin
- Department of Otolaryngology, Head and Neck Surgery, Second Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Qu Hui
- Department of Otolaryngology, Head and Neck Surgery, Second Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Yu Shen
- Dalian University of Technology, Dalian, Liaoning Province, China
| | - Wang Jizhe
- Department of Otolaryngology, Head and Neck Surgery, Second Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| |
Collapse
|
38
|
El-Sisi HE, Etman M, Ebada HA. Medial Flap Coblation Turbinoplasty Versus Submucous Resection: Outcomes. Am J Rhinol Allergy 2023; 37:670-678. [PMID: 37408328 DOI: 10.1177/19458924231185727] [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: 07/07/2023]
Abstract
BACKGROUND Variable surgical options are available for turbinate reduction. These options include total turbinectomy, partial turbinectomy, submucosal resection, laser surgery, cryosurgery, electrocautery, radiofrequency ablation, and turbinate out-fracture. However, there remains a lack of consensus for the preferred technique. OBJECTIVES The aim of this study was to describe the use of coblation for medial flap turbinoplasty procedure. Furthermore, the outcomes of this technique were compared to submucous resection in terms of improvement of patients' symptoms, postoperative bleeding, crusting, and pain scores. METHODS This prospective, randomized, comparative surgical trial was conducted on 90 patients. Patients were randomly allocated into 2 groups: medial flap coblation turbinoplasty group (n = 45), and submucous resection group (n = 45). The outcomes of both techniques were analyzed and compared. RESULTS Both techniques were equally in alleviating patients' symptoms of nasal obstruction. However, postoperative healing was significantly better in medial flap coblation turbinoplasty group. Additionally medial flap turbinoplasty showed a statistically significant better outcome in terms of postoperative bleeding, crusting and pain scores. CONCLUSION Both submucous resection and medial flap coblation turbinoplasty are effective in relieving nasal obstruction and enabling optimal volume reduction with preservation of function of the inferior turbinate. Coblation turbinoplasty has superior outcomes in terms of better healing and less postoperative pain and crusting.
Collapse
Affiliation(s)
| | - Mohammed Etman
- Otorhinolaryngology, Mansoura University, Mansoura, Egypt
| | | |
Collapse
|
39
|
Tomomatsu N, Nakamura T, Takahara N, Kurasawa Y, Kachi H, Yoda T. Study of Anatomical Changes of the Inferior Nasal Passage After Le Fort I Osteotomy With Superior Repositioning. J Craniofac Surg 2023; 34:e678-e682. [PMID: 37801719 DOI: 10.1097/scs.0000000000009585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 06/04/2023] [Indexed: 10/08/2023] Open
Abstract
The relationship between postoperative morphological changes in the inferior nasal cavity and inferior turbinate after Le Fort I osteotomy remains unclear. This study aimed to investigate how the bone volume of the inferior turbinate affects contact with the inferior nasal cavity of patients who underwent superior repositioning. We evaluated the 3-dimensional relationship between the anatomical changes in the inferior nasal passage before and after surgery in 51 patients who underwent Le Fort I osteotomy with an elevation of >4.0 mm in the first molar. The soft tissue and bone volumes of the inferior turbinate and airway volume of the inferior nasal passage were calculated using Proplan CMF 3.0 and compared according to the size of the bone volume of the inferior turbinate. In addition, we reclassified the maxillary movements in the pitch direction and compared the results. The contact rates of the postoperative inferior nasal airway and the inferior turbinate in the large-bone group was 72.3% and that in the small-bone group was 40.0% in the χ2 test. The reduction in the inferior nasal passage volume was significantly greater in the large-bone group (pitch+) than in the small-bone group (pitch+). For patients with well-developed bony tissue of the inferior turbinate, caution is advised if the maxillary elevation is ≥4.0 mm, because the possibility of postoperative obstruction of the inferior nasal passages exist, which may lead to deterioration of nasal ventilation.
Collapse
Affiliation(s)
- Nobuyoshi Tomomatsu
- Department of Maxillofacial Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | | | | | | | | | | |
Collapse
|
40
|
Bliss A, Sheehan C, Erwin E, Jatana K, Elmaraghy CA. Local Allergen-Specific IgE Production in Turbinate Tissue of Pediatric Patients. Ann Otol Rhinol Laryngol 2023; 132:1216-1221. [PMID: 36541625 DOI: 10.1177/00034894221141769] [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: 08/23/2023]
Abstract
OBJECTIVES The objective of this study is to compare serum allergen-specific IgE to IgE levels in nasal tissue taken from the inferior turbinates of pediatric patients undergoing turbinate reduction. METHODS Twenty-six pediatric patients were recruited at the time of turbinate reduction surgery. At the time of recruitment, parents of patients completed the validated 22 item Sinonasal Outcome Test (SNOT-22) to describe symptoms prior to surgery. A sample of turbinate tissue was taken during turbinate reduction and blood was collected. Tissue and serum IgE were measured and differences in the group characteristics were evaluated using Chi-square tests for binary variables and Wilcoxon-Mann-Whitney tests for continuous variables. Student's t test was used to assess differences in means of total SNOT-22 scoring between the groups, and Wilcoxon-Mann-Whitney tests were used again for the rest of the SNOT-22 analysis. RESULTS Levels of IgE in the serum were compared to levels in the turbinate tissue from all patients for each individual allergen. Every allergen except Alternaria displayed significant correlation between the serum and turbinate IgE levels. Additionally, each allergen except Alternaria and oak tree resulted in a strong correlation (r > .7) based on the correlation coefficients. Levels of Alternaria were found to be poorly correlative between serum and turbinate tissue, and significance was not achieved (r = -.346, P = .11). CONCLUSION Certain allergen-specific IgE antibodies in the nasal mucosa seem to be highly associated with those in the serum, based upon the significant correlations we found between the two.
Collapse
Affiliation(s)
- Alessandra Bliss
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Wexner Medical Center, Columbus, OH, USA
| | - Cameron Sheehan
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Wexner Medical Center, Columbus, OH, USA
| | - Elizabeth Erwin
- Department of Pediatrics, Division of Allergy and Immunology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Kris Jatana
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Wexner Medical Center, Columbus, OH, USA
- Department of Pediatric Otolaryngology-Head and Neck Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Charles A Elmaraghy
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Wexner Medical Center, Columbus, OH, USA
- Department of Pediatric Otolaryngology-Head and Neck Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| |
Collapse
|
41
|
Ricciardiello F, Pisani D, Viola P, Pellini R, Russo G, Longo G, Chiarella G, Oliva F, Romano D, Petruzzi G, Mazzone S. The Role of Quantic Molecular Resonance (QMR) in the Treatment of Inferior Turbinate Hypertrophy (ITH): Our Experience With Long-Term Follow-Up in Allergic and Nonallergic Rhinitis Refractory to Medical Therapy. Preliminary Results. Ear Nose Throat J 2023; 102:NP457-NP465. [PMID: 34082610 DOI: 10.1177/01455613211001599] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 11/16/2022] Open
Abstract
OBJECTIVE The aim of this study was to assess the long-term effectiveness of quantic molecular resonance (QMR) in the treatment of inferior turbinate hypertrophy (ITH) in allergic and nonallergic rhinitis refractory to medical therapy. METHODS This study enrolled 281 patients, 160 males (56.9%) and 121 females (43.1%), mean age 37.8 ± 4.1 years, range 18 to 71. Fifty-four patients have been lost to follow up and have been therefore excluded from the final analysis. Based on skin prick test results, 69 patients were considered allergic (group A) and 158 nonallergic (group B). All subjects underwent before surgery (T0) and 3 (T1), 12 (T2), 24 (T3), and 36 months (T4) after QMR treatment to: 4-phase rhinomanometric examination, nasal endoscopy evaluation, and visual analogue scale to quantify the subjective feelings about nasal obstruction. RESULTS Subjective and objective parameters showed statistically significant improvement in both groups. Group B parameters not changed during follow-up, while group A showed significant worsening between T1 and subsequent assessments. T4 outcome indicates a better result in nonallergic patients. CONCLUSIONS In accordance with the literature, our preliminary data validate QMR treatment as a successful therapeutic option for nasal obstruction due to ITH. Nonallergic patients had a very good T4 outcome. Allergic patients showed a worsening trend after 1 year probably due to other causes.
Collapse
Affiliation(s)
- Filippo Ricciardiello
- Ear Nose and Throat Unit, Azienda Ospedaliera di Rilievo Nazionale Antonio Cardarelli, vi Antonio Caradelli, Napoli, Italy
| | - Davide Pisani
- Department of Experimental and Clinical Medicine, Unit of Audiology, Regional Centre of Cochlear Implants and ENT Diseases, Magna Graecia University, Catanzaro, Italy
| | - Pasquale Viola
- Department of Experimental and Clinical Medicine, Unit of Audiology, Regional Centre of Cochlear Implants and ENT Diseases, Magna Graecia University, Catanzaro, Italy
| | - Raul Pellini
- Department of Otolaryngology and Head and Neck Surgery, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Giuseppe Russo
- Ear Nose and Throat Unit, Azienda Ospedaliera di Rilievo Nazionale Antonio Cardarelli, vi Antonio Caradelli, Napoli, Italy
| | - Giuseppe Longo
- Ear Nose and Throat Unit, Azienda Ospedaliera di Rilievo Nazionale Antonio Cardarelli, vi Antonio Caradelli, Napoli, Italy
| | - Giuseppe Chiarella
- Department of Experimental and Clinical Medicine, Unit of Audiology, Regional Centre of Cochlear Implants and ENT Diseases, Magna Graecia University, Catanzaro, Italy
| | - Flavia Oliva
- Ear Nose and Throat Unit, Azienda Ospedaliera di Rilievo Nazionale Antonio Cardarelli, vi Antonio Caradelli, Napoli, Italy
| | - Domenico Romano
- Ear Nose and Throat Unit, Azienda Ospedaliera di Rilievo Nazionale Antonio Cardarelli, vi Antonio Caradelli, Napoli, Italy
| | - Gerardo Petruzzi
- Department of Otolaryngology and Head and Neck Surgery, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Salvatore Mazzone
- Ear Nose and Throat Unit, Azienda Ospedaliera di Rilievo Nazionale Antonio Cardarelli, vi Antonio Caradelli, Napoli, Italy
| |
Collapse
|
42
|
Dharanipathy S, Kumar A, Agrawal D. Posterior pedicle inferior turbinate flap for recurrent cerebrospinal fluid leak following endoscopic transsphenoidal surgery. Eur Arch Otorhinolaryngol 2023; 280:4279-4283. [PMID: 37405451 DOI: 10.1007/s00405-023-08096-5] [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] [Received: 03/28/2023] [Accepted: 06/27/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND Adequate reconstruction of skull base following endoscopic transsphenoidal surgery is the most crucial step in reducing postoperative morbidity and mortality. Although, the success rate of traditional nasoseptal flap is very high, specific surgical scenarios preclude its use. A variety of vascularised endonasal and tunnelled scalp flaps have been described in the literature to address such situations. Posterior pedicle inferior turbinate flap (PPITF) is one such locally available vascularised flap. METHODS Two patients with recurrent CSF leak following endoscopic transsphenoidal resection of pituitary adenoma were included. The nasoseptal flap was not available in both patients due to previous surgery. Hence, a PPITF based on the posterolateral nasal artery, a branch of sphenopalatine artery, was harvested and used for skull base reconstruction. RESULTS In both patients, CSF leak subsided in the immediate postoperative period. In one patient, sensorium improved and was subsequently discharged in stable condition. Other patient succumbed to meningitis in the postoperative period. CONCLUSIONS The PPITF is a valuable alternative to the conventional nasoseptal flap when the latter is not available and it is very important for an endoscopic skull base surgeon to be familiar with the technique of harvesting and using the PPITF.
Collapse
Affiliation(s)
| | - Amandeep Kumar
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
| | - Deepak Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
43
|
Alves de Sousa F, Santos M, Casanova M, Nóbrega Pinto A, Gonçalves Ferreira M, Meireles L, Coutinho MB. Pediatric inferior turbinate surgery: A review and meta-analysis of midterm nasal patency. Int J Pediatr Otorhinolaryngol 2023; 172:111661. [PMID: 37480809 DOI: 10.1016/j.ijporl.2023.111661] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/29/2023] [Accepted: 07/15/2023] [Indexed: 07/24/2023]
Abstract
OBJECTIVES The surgical treatment of children with enlarged inferior turbinates is still controversial. Foundational evidence for indicating turbinoplasty is still scarce, and there is a myriad of proposed techniques. This work aimed to address the midterm nasal obstruction outcomes of pediatric inferior turbinate surgery. MATERIAL AND METHODS A Literature search across PUBMED and Cochrane collaboration databases was undertaken, using the MeSH terms: turbinates, nasal obstruction, surgery, and children. Articles focusing on turbinate surgery with an exclusively pediatric cohort were included. The minimum follow-up time for inclusion was set at four months, and only the latest available follow-up in each study was considered. All the integrated studies used objective instruments to quantify nasal obstruction before and after surgery. A comprehensive review and meta-analysis were performed to assess nasal outcomes after the intervention. The 95% confidence interval of the effect magnitude for each study was calculated to elucidate effect sizes. RESULTS Seven studies met the inclusion criteria for review, and five were included in the meta-analysis, accounting for a total of 510 patients. The follow-up period ranged from 4 months to 1 year. Pooled results showed that nasal patency was significantly improved after surgery (p < 0.001) in the midterm follow-up. No significant differences were found between bone-sparing and bone-removal procedures (p = 0.38). CONCLUSION This is the first meta-analysis to address midterm results of pediatric turbinate surgery. Our results suggest a positive impact of inferior turbinate surgery on nasal patency, irrespective of technique.
Collapse
Affiliation(s)
- Francisco Alves de Sousa
- Serviço de Otorrinolaringologia e Cirurgia cérvico-facial (Otorhinolaryngology and Head & Neck surgery), Centro Hospitalar Universitário de Santo António, Largo do Prof. Abel Salazar, 4099-001, Porto, Portugal.
| | - Mariline Santos
- Serviço de Otorrinolaringologia e Cirurgia cérvico-facial (Otorhinolaryngology and Head & Neck surgery), Centro Hospitalar Universitário de Santo António, Largo do Prof. Abel Salazar, 4099-001, Porto, Portugal.
| | - Maria Casanova
- Serviço de Otorrinolaringologia e Cirurgia cérvico-facial (Otorhinolaryngology and Head & Neck surgery), Centro Hospitalar Universitário de Santo António, Largo do Prof. Abel Salazar, 4099-001, Porto, Portugal.
| | - Ana Nóbrega Pinto
- Serviço de Otorrinolaringologia e Cirurgia cérvico-facial (Otorhinolaryngology and Head & Neck surgery), Centro Hospitalar Universitário de Santo António, Largo do Prof. Abel Salazar, 4099-001, Porto, Portugal.
| | - Miguel Gonçalves Ferreira
- Serviço de Otorrinolaringologia e Cirurgia cérvico-facial (Otorhinolaryngology and Head & Neck surgery), Centro Hospitalar Universitário de Santo António, Largo do Prof. Abel Salazar, 4099-001, Porto, Portugal.
| | - Luís Meireles
- Serviço de Otorrinolaringologia e Cirurgia cérvico-facial (Otorhinolaryngology and Head & Neck surgery), Centro Hospitalar Universitário de Santo António, Largo do Prof. Abel Salazar, 4099-001, Porto, Portugal.
| | - Miguel Bebiano Coutinho
- Serviço de Otorrinolaringologia e Cirurgia cérvico-facial (Otorhinolaryngology and Head & Neck surgery), Centro Hospitalar Universitário de Santo António, Largo do Prof. Abel Salazar, 4099-001, Porto, Portugal.
| |
Collapse
|
44
|
Rezende NC, Leonel LCPC, Kosugi EM, Pinheiro-Neto CD, Peris-Celda M. The Arterial Pattern of the Upper Nasal Septum (S-Point) and Potential Role in Severe Epistaxis. Laryngoscope 2023; 133:2075-2080. [PMID: 36382868 DOI: 10.1002/lary.30487] [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] [Received: 07/12/2022] [Revised: 10/18/2022] [Accepted: 10/26/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The previously described S-point, corresponds to the medial projection of the middle turbinate axilla in the superior nasal septum and has been identified as a common source of severe epistaxis. The objective is to define the anatomical patterns of vascularization of the S-point area that could explain its clinical relevance. METHODS Thirty-three nasal septums of latex-injected formalin-embalmed and fresh human cadaveric heads were dissected to analyze the arterial arrangement of the S-point area. Measurements and patterns of vascularization were described. RESULTS The S-point area, was consistently surrounded by a single or multiple arterial anastomotic arches consistently formed superiorly by the anterior ethmoidal and posterior ethmoidal artery branches, and inferiorly by the posterior septal artery. The caliber of the arterial arches was typically larger than the caliber of the arterial branches supplying them. A single arch was present in 36.3% of septums, and multiple arches in 63.6%. The mean distance from the S-point to the anterior limit of the arch was 9 mm, to the posterior arch when the present was 3 mm, to the superior limit 6 mm, to the inferior limit 6 mm, and to the nasal roof was 10 mm. CONCLUSION This study demonstrates the dense arterial configuration of the S point area, which is characterized by a single or multiple vascular arches of greater caliber than the branches of origin. This finding could explain why the S-point area is a frequent source of epistaxis, and guide its surgical cauterization when an obvious vascular ectasia is not visualized. LEVEL OF EVIDENCE N/A Laryngoscope, 133:2075-2080, 2023.
Collapse
Affiliation(s)
- Natália Cerqueira Rezende
- Division of Rhinology and Skull Base Surgery, Department of Otolaryngology - Head & Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Otorhinolaryngology and Head and Neck Surgery, Federal University of Sao Paulo (UNIFESP-EPM), Sao Paulo, Brazil
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, USA
| | - Luciano C P C Leonel
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, USA
| | - Eduardo Macoto Kosugi
- Department of Otorhinolaryngology and Head and Neck Surgery, Federal University of Sao Paulo (UNIFESP-EPM), Sao Paulo, Brazil
| | - Carlos Diógenes Pinheiro-Neto
- Division of Rhinology and Skull Base Surgery, Department of Otolaryngology - Head & Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, USA
| | - Maria Peris-Celda
- Division of Rhinology and Skull Base Surgery, Department of Otolaryngology - Head & Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
45
|
Folic MM, Barac AM, Ugrinovic AB, Jotic AD, Trivic AS, Milovanovic JP, Borozan NN, Peric AR, Stevanovic G, Krejovic-Trivic SB, Cvorovic L, Stojkovic GM. Effectiveness of the Treatment of Rhinogenic Headache Caused by Intranasal Contact. Ear Nose Throat J 2023; 102:605-610. [PMID: 34077274 DOI: 10.1177/01455613211019706] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 01/03/2023] Open
Abstract
OBJECTIVES The aim of the study is to evaluate the effectiveness of the surgical and nonsurgical treatment of headache caused by contact points (CPs) between the nasal septum and inferior or middle turbinate. METHODS The research was designed as a prospective clinical case-series study. The patients with CP headaches were offered to choose between 2 treatment options, surgery and medical treatment. Two groups of surgically treated patients (surgery groups 1 and 2, depending on whether there is a contact between nasal septum and inferior turbinate or middle turbinate) were evaluated and compared for headache intensity and frequency. Headache intensity was measured using a visual analog scale value from 0 to 10; the frequency of headache was expressed as the number of days during 1 month with a headache (before surgery, 1 month, and 6 months after surgery). A comparison was also made between surgically and nonsurgically treated patients. RESULTS We found more intensive and frequent headache in patients who had CP between the nasal septum and the middle turbinate (P = .038 and P = .003, respectively). A significant reduction in headache intensity and frequency was found in both groups of surgically treated patients 6 months after surgery; however, this reduction was more significant in patients with mucosal contact between nasal septum and middle turbinate. The nonsurgical treatment made a significant reduction of headache intensity and frequency at 1-month follow-up (P = .012 and P = .031, respectively), but not at 6-month follow-up (P = .114 and P = .088, respectively). CONCLUSION Surgery gave a statistically significant reduction in the intensity and frequency of headache, which was assessed 6 months after surgery. Surgery was found as superior to nonsurgical treatment in the therapy of CP headache.
Collapse
Affiliation(s)
- Miljan M Folic
- Clinic for Otorhinolaryngology and Maxillofacial Surgery, Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Serbia
| | - Aleksandra M Barac
- Faculty of Medicine, University of Belgrade, Serbia
- Clinic for Infectious and Tropical Diseases, Clinical Centre of Serbia, Belgrade, Serbia
| | - Aleksandar B Ugrinovic
- Clinic for Otorhinolaryngology and Maxillofacial Surgery, Clinical Centre of Serbia, Belgrade, Serbia
| | - Ana D Jotic
- Clinic for Otorhinolaryngology and Maxillofacial Surgery, Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Serbia
| | - Aleksandar S Trivic
- Clinic for Otorhinolaryngology and Maxillofacial Surgery, Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Serbia
| | - Jovica P Milovanovic
- Clinic for Otorhinolaryngology and Maxillofacial Surgery, Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Serbia
| | | | - Aleksandar R Peric
- Department of Otorhinolaryngology, Faculty of Medicine, Military Medical Academy, Belgrade, Serbia
| | - Goran Stevanovic
- Faculty of Medicine, University of Belgrade, Serbia
- Clinic for Infectious and Tropical Diseases, Clinical Centre of Serbia, Belgrade, Serbia
| | - Sanja B Krejovic-Trivic
- Clinic for Otorhinolaryngology and Maxillofacial Surgery, Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Serbia
| | - Ljiljana Cvorovic
- Clinic for Otorhinolaryngology and Maxillofacial Surgery, Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Serbia
| | - Goran M Stojkovic
- Clinic for Otorhinolaryngology and Maxillofacial Surgery, Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Serbia
| |
Collapse
|
46
|
Wakeford W, Ioannidis D. Nasal obstruction in a 14 year old girl caused by a huge middle turbinate mucocele appearing radiologically as an inverted papilloma. J Radiol Case Rep 2023; 17:29-33. [PMID: 38098962 PMCID: PMC10718309 DOI: 10.3941/jrcr.v17i8.4774] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023] Open
Abstract
Introduction We present a case of a fourteen year old girl who presented with a large intra-nasal mass to the ENT team at a district general hospital in the UK. Presentation of case The girl presented predominantly with nasal obstruction and some symptoms of allergic rhinitis. Imaging revealed a large lesion abutting the skull base and causing bony remodelling with marked septal deviation. Based both on CT and MRI imaging, the reporting (non-head and neck) radiologist suggested inverted papilloma as a differential diagnosis. Intra-operative exploration in fact revealed a very large left middle turbinate mucocele extending to the left frontal sinus. The mass was excised endoscopically without complications. Discussion Although concha bullosa of the middle turbinate of the nose are common, development of a mucocele within them is far less common and for such a mucocele to develop to this size in a child is extremely rare. The egg shell lining of the lesion can be a tell-tale sign of their aetiology when taken alongside other radiological factors. This case highlights challenges in radiological diagnosis of intra-nasal masses in children, which can lead to delays and increased anxiety. Conclusion When assessing nasal masses in children it is important to keep a wide differential due to the challenges of diagnosis. A close conversation should be had with local head and neck radiologists and, of course, where there is a unilateral nasal mass tissue sampling is essential and may be taken as part of a full excision where clinically indicated.
Collapse
Affiliation(s)
- William Wakeford
- ENT Specialty Registrar, ENT Department, Colchester Hospital, East and North Essex NHS Foundation Trust, Colchester, UK
| | - Dimitrios Ioannidis
- Consultant ENT Surgeon, ENT Department, Colchester Hospital, East and North Essex NHS Foundation Trust, Colchester, UK
| |
Collapse
|
47
|
Gillman GS, Bakeman AE, Soose RJ, Wang EW, Schaitkin BM, Lee SE, Chang YF, Mims MM. Will nasal airway surgery improve my sense of smell? A prospective observational study. Int Forum Allergy Rhinol 2023; 13:1511-1517. [PMID: 36413461 DOI: 10.1002/alr.23115] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Received: 07/18/2022] [Revised: 11/10/2022] [Accepted: 11/21/2022] [Indexed: 07/25/2023]
Abstract
BACKGROUND The effect of nasal airway surgery on olfaction has not been well established. The goal of this study is to assess changes in olfaction after septoplasty with inferior turbinate reduction through both objective and patient-reported measures. METHODS Prospective, observational study was conducted of patients with nasal airway obstruction presenting between July 2017 and October 2019 who underwent septoplasty with inferior turbinate reduction. Nasal airflow was characterized with the Nasal Obstruction Symptom Evaluation (NOSE) scale and an 11-point ease-of-breathing (EOB) Likert scale, and olfaction with an 11-point olfactory Likert scale and the 40-item University of Pennsylvania Smell Identification Test (UPSIT), pre- and postoperatively. Pearson correlations were used to assess the relationship between measures of nasal obstruction and olfaction. RESULTS Among 80 patients, mean NOSE scores improved from 67.4 preoperatively to 19.6 postoperatively (p < 0.001). EOB Likert scores improved from a mean of 3.9/10 to 8.1/10 after surgery (p < 0.001). Olfactory Likert scores improved from a baseline of 6.1/10 preoperatively to 7.9/10 after surgery (p < 0.001). No statistically significant difference was noted in UPSIT testing pre- versus postoperatively. A moderate correlation was noted between the degree of change in NOSE scores and improved olfactory Likert scores (r = 0.51, p < 0.001), and similarly between the degree of change in EOB Likert scores and improved olfactory Likert scores (r = 0.55, p < 0.0001). CONCLUSIONS Based on our data, subjective tests of olfaction may improve with nasal airway surgery in some patients. Changes in olfaction best correlate with the extent to which surgery can improve subjective nasal obstructive symptoms.
Collapse
Affiliation(s)
- Grant S Gillman
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Anna E Bakeman
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ryan J Soose
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Eric W Wang
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Barry M Schaitkin
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Stella E Lee
- Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Yue-Fang Chang
- Department of Neurologic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Mark M Mims
- Department of Otolaryngology - Head and Neck Surgery, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, USA
| |
Collapse
|
48
|
Lee JH. Lobular Capillary Hemangioma Originating From the Posterior End of the Inferior Turbinate: A Very Rare Occurrence. Ear Nose Throat J 2023; 102:NP298-NP300. [PMID: 33848204 DOI: 10.1177/01455613211009133] [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: 11/15/2022] Open
Abstract
Lobular capillary hemangioma mostly occurs in the anterior portion of the nasal cavity, rarely occurring in the posterior end of the inferior turbinate, as in this case. We report a case of lobular capillary hemangioma originating from the posterior end of the right inferior turbinate, which was successfully removed via an endoscopic endonasal approach.
Collapse
Affiliation(s)
- Jae Hoon Lee
- Department of Otolaryngology, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Chonbuk, Republic of Korea
| |
Collapse
|
49
|
唐 志, 曾 宪, 张 秋, 李 定, 王 再. [Clinical analysis of the treatment of maxillary odontogenic cyst by nasal endoscope fenestration through nasal base]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2023; 37:333-337. [PMID: 37138393 PMCID: PMC10495778 DOI: 10.13201/j.issn.2096-7993.2023.05.003] [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] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Indexed: 05/05/2023]
Abstract
Objective:To investigate the feasibility and clinical effect of the surgical approach and method of transnasal fenestration under nasal endoscope for the treatment of maxillary odontogenic cyst. Methods:The clinical data of 23 cases with maxillary odontogenic cysts treated by nasal endoscopy through nasal fenestration were retrospectively analyzed. All cases underwent nasal endoscopy and CT examination before the operation. The mucosal membrane of the parietal wall of the cyst was excised through fenestration of the nasal base. The cyst fluid was removed by decompression, and the bony opening of the nasal base was trimmed and enlarged to the edge of the cyst. The intraoperative and postoperative effects were observed. Results:All cases were well exposed under the direct vision of nasal endoscope. The top wall of the cyst was removed to maximize the communication between the cyst cavity and the nasal floor. There were no complications such as nasolacrimal duct injury, turbinate atrophy, necrosis, and facial numbness. All patients were followed up for 6-12 months, and the clinical symptoms gradually disappeared after surgery. The inferior turbinate was in good shape, the cyst cavity was smooth, the cyst wall was determined, and no cyst recurrence was observed. Conclusion:The treatment of odontogenic cyst of maxilla under nasal endoscope through nasal fenestration is convenient. It has less trauma, fewer complications and a satisfactory curative effect, which is worthy of clinical promotion.
Collapse
Affiliation(s)
- 志元 唐
- 深圳市龙岗区耳鼻咽喉医院耳鼻咽喉科 深圳市耳鼻咽喉研究所(广东深圳,518172)Department of Otolaryngology, Longgang E.N.T. Hospital & Shenzhen Key Laboratory of E.N.T., Institute of E.N.T., Shenzhen, 518172, China
| | - 宪海 曾
- 深圳市龙岗区耳鼻咽喉医院耳鼻咽喉科 深圳市耳鼻咽喉研究所(广东深圳,518172)Department of Otolaryngology, Longgang E.N.T. Hospital & Shenzhen Key Laboratory of E.N.T., Institute of E.N.T., Shenzhen, 518172, China
| | - 秋航 张
- 深圳市龙岗区耳鼻咽喉医院耳鼻咽喉科 深圳市耳鼻咽喉研究所(广东深圳,518172)Department of Otolaryngology, Longgang E.N.T. Hospital & Shenzhen Key Laboratory of E.N.T., Institute of E.N.T., Shenzhen, 518172, China
| | - 定波 李
- 深圳市龙岗区耳鼻咽喉医院耳鼻咽喉科 深圳市耳鼻咽喉研究所(广东深圳,518172)Department of Otolaryngology, Longgang E.N.T. Hospital & Shenzhen Key Laboratory of E.N.T., Institute of E.N.T., Shenzhen, 518172, China
| | - 再兴 王
- 深圳市龙岗区耳鼻咽喉医院耳鼻咽喉科 深圳市耳鼻咽喉研究所(广东深圳,518172)Department of Otolaryngology, Longgang E.N.T. Hospital & Shenzhen Key Laboratory of E.N.T., Institute of E.N.T., Shenzhen, 518172, China
| |
Collapse
|
50
|
Gu Y, Yu B, Wan X, Gu Y, Zhu G, Xiao Z. Effects of modified posterior nasal nerve neurectomy combined with accessory posterior nasal nerve neurectomy on controlling intractable allergic rhinitis. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2023; 48:404-413. [PMID: 37164924 PMCID: PMC10930075 DOI: 10.11817/j.issn.1672-7347.2023.220593] [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] [Grants] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Indexed: 05/12/2023]
Abstract
OBJECTIVES A subset of intractable allergic rhinitis (iAR) patients experience severe symptoms which cannot be effectively controlled by standard drug therapy and/or antigen specific immunotherapy. In recent decades, endoscopy vidian neurectomy and posterior nasal nerve neurectomy (PNNN) were introduced as treatments of iAR that have shown to be highly successful at symptom management in a number of patients. But some patients experience relapse or suboptimal symptom control postoperation. To improve the effectiveness of PNNN to control iAR, a modified PNNN surgical approach (mPNNN) combined with accessory posterior nasal nerve neurectomy (aPNNN), which called as mPNNN-aPNNN was used. This study aims to compare the effects between mPNNN-aPNNN and PNNN on controlling the symptoms of iAR and evaluate the surgical effectiveness and safety of mPNNN-aPNNN. METHODS The patients with iAR experienced mPNNN-aPNNN or PNNN surgery at the department of Otolaryngology Head and Neck Surgery of the Second Xiangya Hospital, Central South University from January 2018 to December 2019 were analyzed retrospectively. The approach of PNNN, a selective resection of the posterior nasal nerve branches, was modified to the neurectomy of total branches of posterior nasal nerve at the sphenopalatine foramen, and combined the operation of aPNNN in which the accessory posterior nasal nerve at the palatine bone perpendicular plate was resect in our study. Daily Nasal Symptom Scores (DNSS), Total Rhinitis Medication Score (TRMS), and the Rhinoconjunctivitis Qualities of Life Questionnaires Scores (RQLQS) were used to evaluate the complications during the operation and after the operation at the 3rd, 6th, 12th, and 24th month postoperatively. Total Nasal Symptom Scores (TNSS) was used to assess the total effective rate and markedly effective rate of the operations. RESULTS A total of 140 iAR patients experienced mPNNN-aPNNN or PNNN. Those with concomitant septoplasty and/or inferior turbinate reduction, and were absent during the postoperative follow-up were excluded. The final 62 patients with mPNNN-aPNNN and 34 with PNNN were enrolled. DNSS, TNSS, TRMS, and RQLQS at the postoperation were significantly improved compared with the preoperation in all patients (all P<0.001). Compared with PNNN, the postoperative DNSS, TNSS, and TRMS of mPNNN-aPNNN were obviously improved (all P<0.001). There was a persisted relief of symptoms at the postoperation in all patients with mPNNN-aPNNN. The total effective rate and markedly effective rate at the postoperative 24th month were 100% and 83.3%, respectively. Furthermore, the postoperative RQLQS decreased significantly (P<0.001). Only 5 sides of all patients (5/192, 2.6%) reported upper palate numbness during the first week after operation, with all recovered spontaneously in 1 month without treatment. No other postoperative complications occurred in mPNNN-aPNNN and PNNN. CONCLUSIONS The surgery of mPNNN-aPNNN improve TNSS more significantly than PNNN. The operation of mPNNN-aPNNN is safe and effective to control iAR symptoms.
Collapse
Affiliation(s)
- Yunfangzi Gu
- Department of Otolaryngology and Head Neck Surgery, Second Xiangya Hospital, Central South University, Changsha 410011, China.
| | - Benquan Yu
- Department of Otolaryngology and Head Neck Surgery, Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Xin Wan
- Department of Otolaryngology and Head Neck Surgery, Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Yu Gu
- Department of Otolaryngology and Head Neck Surgery, Second Xiangya Hospital, Central South University, Changsha 410011, China.
| | - Ganghua Zhu
- Department of Otolaryngology and Head Neck Surgery, Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Zi'an Xiao
- Department of Otolaryngology and Head Neck Surgery, Second Xiangya Hospital, Central South University, Changsha 410011, China.
| |
Collapse
|