Clinical Significance of Nasal Pathologies in Transnasal Transsphenoidal Pituitary Surgery

BACKGROUND

We evaluated the frequency of nasal pathologies and the significance of surgical access to the sellar region in patients who underwent an operation for sellar mass using the endonasal and microscopic transsphenoidal approaches.

METHODS

We retrospectively evaluated all patients who underwent surgery for pituitary macroadenoma using microscopic (n = 78) and endonasal (n = 20) transsphenoidal approaches. Patients' epicrisis, preoperative, and postoperative imaging as well as their operative notes were reviewed. Nasal pathologies and surgeries performed before or during the pituitary surgery were also documented. All endonasal surgeries were binostril and performed jointly by an ear, nose, and throat specialist and neurosurgeon. To determine the feasibility of endonasal and microscopic approaches, we developed an algorithm using the septum deviation classifications to determine the need for septoplasty.

RESULTS

The most common nasal pathology was septum deviation (n = 17; 17.3%). Of the other nasal pathologies, 6 cases (6%) were chronic sinusitis and 2 were (2.1%) middle turbinate bullosa.

CONCLUSIONS

The preoperative evaluation of patients undergoing endonasal transsphenoidal surgery by an ear, nose, and throat surgeon allows for the detection and treatment of nasal pathologies that may lead to serious perioperative and postoperative complications. Evaluating patients with septum deviation using our classification will help determine the necessity of preoperative or perioperative septum surgery, depending on the preferred pituitary surgical method.

Digital imaging techniques applied to a case of concha bullosa from an early medieval funerary area in central Italy

OBJECTIVE

Concha bullosa is a rather common condition of the nasal turbinates, rarely reported in archaeological skeletal collections. This paper examines a case of concha bullosa as seen in a female cranium from a burial in central Italy, dated to the Longobard domination in the Peninsula (mid-7th- early 8th century CE).

MATERIALS

The individual under investigation (T86/17) comes from the funerary area of Selvicciola, located near the town of Viterbo in northern Latium, Italy.

METHODS

The skeleton was macroscopically examined. We analyzed the CT-scans of the defect by applying innovative R-based virtual tools.

RESULTS

It was possible to calculate the inner volume of the concha bullosa and to provide a 3D visual assessment of its shape.

CONCLUSIONS

Its size and shape suggest that the individual had this condition for a considerable period of time, during which its presence may have had affected her daily activities and health status.

SIGNIFICANCE

An under-represented paleopathological defect is examined for the first time through a virtual approach aimed at visualizing its shape and the assessment of its volume. New methods of 3D based virtual assessment can increase the informative value of defects.

SUGGESTIONS FOR FURTHER RESEARCH

Techniques used in this assessment should be considered as an evaluative tool for other conditions when macroscopic and radiographic imaging are limited.

A comparison of symptoms and quality of life before and after nasal septoplasty and radiofrequency therapy of the inferior turbinate

Background

The primary goal of this study is to compare pre- and postoperative symptoms and health related quality of life (HQOL) in 57 patients who underwent septoplasty (group-1), 56 patients who underwent septoplasty combined with radiofrequency therapy of inferior turbinates (RFIT) (group-2) and 58 patients who underwent RFIT alone (group-3). The secondary goal is to investigate if the change in symptoms and HQOL differed between these three patient groups after surgery.

Methods

All patients reported symptoms on a visual analogue scale (VAS) and HQOL on Sino-Nasal-Outcome-Test-20 (SNOT-20) and Short-Form-Health-Survey-36 (SF-36) before and 6 months after surgery. The pre- and postoperative scores and improvement were compared within and between the three patient groups.

Results

Preoperatively the three patient groups had a fairly similar symptom burden and HQOL, except for group-1 which reported more symptoms of oral breathing than group-3 (p < 0.01) and group-3 which reported more problems in the ear/facial--subset of SNOT-20 and in the general-mental-health-domain of SF-36 than group-1 (p < 0.01).

Postoperatively all patient groups reported improved symptom scores of nasal obstruction, nasal discharge, snoring, oral breathing and reduced general health (p < 0.01), and better HQOL (p < 0.05). Patients in group-2 had less symptoms of nasal obstruction than group-3 (p < 0.05). Postoperative symptom score for nasal obstruction was 29.1 (SD67.6) in group-1, 27.5 (SD22.5) in group-2 and 37.2 (SD24.8) in group-3. Revision cases reported more nasal obstruction postoperatively; 41.3 (SD27) than non revision cases; 28.6 (SD24) (p < 0.01).

The HQOL after surgery was about the same in all three patient groups, but we found that patients with comorbidities as sleep apnea and asthma reported worse HQOL than other patients (p < 0.01).

Conclusion

Surgical treatment of nasal obstruction led to less symptoms and better HQOL for all three patient groups. Comparing the postoperative scores between the patient groups we find that all groups reached the same level of HQOL. Regarding symptoms, the patients who underwent septoplasty combined with RFIT reported postoperatively less nasal obstruction than patients who underwent RFIT alone which may indicate that a combined procedure of septoplasty and RFIT is better than RFIT alone to treat nasal obstruction. Furthermore, revision cases, patients with sleep apnea and asthma patients seem to have poorer outcome after surgery than other patients. Both disease specific and general QOL instruments add valuable information for identifying factors influencing outcome.

Electronic supplementary material

The online version of this article (10.1186/s12901-017-0050-z) contains supplementary material, which is available to authorized users.

TEMPS-A Temperament Scale Before and After Septoplasty in Patients with Nasal Septum Deviation

The present study aimed to evaluate whether patients undergoing an operation for septum deviation exhibited a change in affective status. The temperament evaluation of the Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A) was administered to all patients at the pre-operative and post-operative periods. The mean age of the patients was 32.46 ± 11.22 years. Of the patients, 34 (65.4%) were males and 18 (34.6%) were females. A significant difference was found between pre- and post-operative scores of the patients on all TEMPS-A subscales (p < 0.05). Patients with symptoms of upper airway obstruction may have mood disorders due to the decrease in blood oxygen levels. This condition can be corrected with septoplasty procedure. In the present study, it was demonstrated that patients had a better affective status post-operatively as compared to the pre-operative period.

Assessment of the relationship between palatum durum and maxillary bone in patients with nasal polyp, chronic sinusitis or septum deviation

Nasal obstruction most commonly occurs due to mucosal abnormalities and those in cartilage-bone structure such as nasal polyp, septum deviation, concha hypertrophy and chronic sinusitis in adults. Adenoid vegetation is the most prominent cause in childhood. In the present study, we aimed to investigate whether maxillary and palatal bone developments continue in patients with abnormalities causing nasal obstruction. As computerized tomography is the optimal imaging modality in nasal cavity abnormalities, CT scan findings of patients with Control nasal polyp, chronic sinusitis and septum deviation were retrospectively evaluated; and palatal curve changes were compared. In our study, it was found that maxillary bone curve was widened in adult patients with nasal polyp; this angle was further narrowed in those with chronic sinusitis; and maxillary bone curve narrowing and increase in the distance to palatal bone was smaller in patients with septum deviation than those in chronic sinusitis. In the light of these findings, we concluded that, in adults, maxillary and palatal bone developments continue in certain circumstances including nasal polyp, chronic sinusitis or septum deviation.