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Sinonasal inverted papilloma（SNIP） is a kind of benign tumor originating from the nasal cavity and paranasal sinuses, accounting for 70% of papillomas. The incidence of the disease is more common in males, with an average age of 50-60 years. It is most likely to occur in unilateral maxillary sinus and ethmoid sinus, followed by sphenoid sinus and frontal sinus.It has the characteristics of local invasion, high recurrence rate and malignant tendency, and most malignant transformation into squamous cell carcinoma. Endoscopic nasal resection and appropriate adjuvant therapy can help to reduce the recurrence rate and inhibit further deterioration. We report the results of a 10-year follow-up of a SNIP patient, including the clinical manifestations, recurrence course and treatment plan during the 10 years. The patient underwent multiple nasal endoscopic surgeries, and had a recurrence of multiple focal attachment pattern, and finally had direct invasion and distant metastasis. Tumor recurrence and further deterioration persisted despite the use of a comprehensive treatment.
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Male , Humans , Middle Aged , Papilloma, Inverted , Follow-Up Studies , Neoplasm Recurrence, Local , Head and Neck Neoplasms , Frontal SinusABSTRACT
Abstract Introduction: Endoscopic access to the sellar region by videoendoscopy shows a low rate of surgical complications, with findings that indicate risk factors for reducing morbidities during and after the postoperative period. Objective: To evaluate, over a nine-year period, the acquisition of skills by the anterior skull base surgical team, according to the time of elimination of nasal crusts and/or the presence of morbidities in the postoperative follow-up of individuals treated in a tertiary public hospital. Methods: After confirming the diagnosis of skull base pathologies, the individuals in this study underwent endoscopic surgery according to the rostrocaudal or coronal axis. For the skull base reconstruction, the nasoseptal flap (associated or not with fascia lata with thigh fat) or free graft was used; clinical follow-up of individuals occurred for a minimum period of 12 months. To assess the impact of the surgical approach on patient clinical evolution, qualitative data related to smoking, post-nasal discharge, nasal flow, smell, taste, clinical symptoms of headache, cranial paresthesia, comorbidities and postoperative morbidities were obtained. Results: The most frequent diagnosis was pituitary macroadenoma (84.14%). The mean absence of crusts in this cohort was 124.45 days (confidence interval 95% = 119.50-129.39). There was a low cerebrospinal fluid fistula rate (3%). Reconstruction with the nasoseptal flap with a fat graft was an independent variable that recorded the highest mean time for the elimination of nasal crusts (=145 days, confidence interval 95% = 127.32-162.68). Allergic rhinitis and smoking were shown to be the most important and independent variables that increased the mean time to eliminate nasal crusts. Conclusion: The mean time to eliminate nasal crusts did not change over the years during which the procedures were performed, demonstrating the adequate training of the surgical team. Debridement and nasal irrigation with saline solutions should be performed more frequently and effectively in patients with allergic rhinitis, smokers and those who received the nasoseptal flap and fascia lata graft with autologous fat.
Resumo Introdução: O acesso endoscópico à região selar por videoendoscopia demonstra baixo índice de complicações cirúrgicas, com achados que apontam fatores risco para reduzir as morbidades durante e após o período pósoperatório. Objetivo: Avaliar fatores morbidades no seguimento pós-operatório de indivíduos atendidos em um hospital público terciário. Método: Depois de confirmado o diagnóstico de doenças da base do crânio, os indivíduos deste estudo foram submetidos a cirurgia endoscópica conforme o eixo rostrocaudal ou coronal. Para a reconstrução da base do crânio usava-se o retalho nasoseptal (associado ou não à fáscia lata com gordura de coxa) ou enxerto livre; o seguimento clínico dos indivíduos ocorreu por um período mínimo de 12 meses. Para avaliar o impacto da abordagem cirúrgica na evolução clínica dos pacientes foram obtidos os dados qualitativos relativos ao tabagismo, descarga pós-nasal, fluxo nasal, olfato, paladar, sintomas clínicos de dor de cabeça, parestesia craniana, comorbidades e morbidades pós-operatórias. Resultados: O diagnóstico mais frequente foi o macroadenoma hipofisário (84,14%). A média da ausência de crostas nesta coorte foi de 124,45 dias (intervalo de confiança [95% CI] 119,50-129,39). Baixo índice de fístula liquórica (3%). A reconstrução com o retalho nasoseptal com enxerto de gordura apresentou-se com variável independente que necessitou de maior tempo médio para a eliminação de crostas nasais (=145 dias, 95% CI 127,32-162,68). A rinite alérgica e o tabagismo se demonstraram como as variáveis mais importantes e independentes para aumentar o tempo médio de eliminação de crostas nasais. Conclusão: O tempo médio de eliminação de crostas nasais não se alterou ao longo dos anos em que os procedimentos foram feitos. Deve-se fazer com maior frequência e eficácia o debridamento e as irrigações nasais com soluções salinas nos pacientes com rinite alérgica, tabagistas e os que usaram o retalho nasoseptal e enxerto de fáscia lata com gordura autóloga.
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Humans , Plastic Surgery Procedures , Postoperative Period , Retrospective Studies , Follow-Up Studies , Morbidity , Treatment Outcome , Skull Base/surgery , Endoscopy , Nasal Septum/surgeryABSTRACT
Objective@#To analyse the outcomes and the prognostic factors of patients with sinonasal malignancies following endoscopic endonasal approach, and to compare the pre- and post-operative quality of life.@*Methods@#A retrospective single-center review of 79 patients who underwent endoscopic endonasal approach for sinonasal malignancies in Beijing Tongren Hospital from October 2004 to March 2017 was performed, including 51 males and 28 females, with a median age of 48 years. Data of demography, imaging (including nasal CT and MRI before operation), histopathology and treatment strategy were collected. Recurrence and distant metastasis were diagnosed according to endoscopic examination, MRI and general check-up after surgery. Pre- and post-operative quality of life scores were obtained by sinonasal outcome test-22, visual analog scale and anterior skull base surgery questionnaire. SPSS 22 software was used for statistical analysis.@*Results@#The study consisted of 13 pathological types with sinonasal T1-T4 stage tumors, including cervical lymph nodes and/or distant metastasis. All patients underwent endoscopic endonasal approach surgery. After 43 months of median follow-up time, the overall, disease-free, and recurrence-free survival rates at 1, 3, 5 and 10 years was 97.4%, 92.5%, 92.5% and 83.7%; 83.2%, 68.3%, 56.8% and 33.6%; 84.5%, 66.6%, 58.0% and 34.4%, respectively. Postoperative recurrence was an independent risk factor affecting the overall survival rate (HR=8.852, P=0.044), and preoperative recurrence (secondary surgery) was an independent risk factor affecting the disease-free and recurrence-free survival rate (HR value was 2.237 and 2.095 respectively, P value was 0.029 and 0.047 respectively). After surgery, the olfaction and nasal scab got worse, while the nasal obstruction and breathing were improved.@*Conclusions@#Endoscopic endonasal approach for sinonasal malignancies can achieve satisfactory outcomes, and has obvious advantages in improving the quality of life. Postoperative recurrence and preoperative recurrence are the prognostic factors.
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OBJECTIVE：To systematically evaluate the effectiveness and safety of dexmedetomidine versus other controlled hypotension drugs for functional nasal endoscopic surgery ，and to provide evidence-based reference for clinic. METHODS ： Retrieved from PubMed ，EBSCO，Springer，Ovid，Cochrane library ，CJFD，VIP，Wanfang database ，relevant journals and references of the included literature were also searched manually. RCTs about the effectiveness and safety of dexmedetomidine （trial group）versus other controlled hypotension drugs （control group ）for functional nasal endoscopic surgery were collected. After data extraction of included literatures ，quality evaluation with modified Jada quality scoring method ，Meta-analysis was performed by using Rev Man 5.3 software. RERULTS ：A total of 8 RCTs involving 497 patients were included. Meta-analysis results showed that compared with control group ，the ratio patients of hypotensive drug supplement [OR ＝－0.37，95％CI（0.21，0.65），P＝0.000 6] and the bleeding volume [MD ＝－77.74，95％CI（－99.52，－55.96），P＜0.001] of trial groups were lower ；hemodynamics such as MAP during extubation [MD ＝－13.40，95％CI（－16.24，－10.56），P＜0.001] and heart rate during extubation [MD ＝－33.13， 95％CI（－33.40，－26.87），P＜0.001] was more stable during extubation ；quality score of Fromme surgical field was higher [MD ＝ －0.80，95％CI（－0.96，－0.65），P＜0.001]；while the incidence of chill [OR ＝0.37，95％CI（0.18，0.75），P＝0.006]，nausea and vomit [OR ＝0.28，95％CI（0.14，0.59），P＝0.008] were lower. CONCLUSIONS ：Dexmedetomidine has a certain advantage than routine drugs for controlled hypotension during nasal endoscopic surgery ，and with better safety.
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Objective To explore the comfort of the patients with nasal packing after nasal endoscopic surgery from the angle of the patients, and to provide references for improving the comfort of the patients and developing the nasal comfort scale. Methods The phenomenology research method was adopted in this study. Sixteen patients with nasal packing after nasal endoscopic surgery participated in the in-depth interview which interview outline was designed basis on Kolcaba K's comfort theory. Data were analyzed by using Colaizzi's phenomenological method. Results Four level-1 themes and sixteen level-2 themes were extracted. The physical discomfort included discomfort in nose, head, eye, month, face, ear, sleep, diet and movement. The psychological discomfort included sense of unevenness and anxiety. The sociocultural discomfort included discomfort in the role of patients and bad relationship. The environmental discomfort included dry, noise and bad air in the ward. Conclusions Patients with nasal packing after nasal endoscopic surgery had many uncomfortable experiences, especially the physical discomfort. So the nurses should pay attention and develop a good reliability and validity nasal comfort scale to evaluate the comfort of these patients. Then the nurses should take active measures to relieve these discomforts, improve the patients' quality of life, make nurse-patient relationship harmonious and improve patients'satisfaction.
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The extensive application of transnasal endoscopy for the treatment of rhino-orbital related diseases re-quires ophthalmologists to master the skill in lacrimal surgery. Unlike other ocular surgeries,endoscopic endonasal procedures needs a well understanding of the anatomical structures inside the nose as well as the skilled use of en-doscopes,which makes the training more specialized and difficult. The step-by-step mode combined with other learning methods is designed to enhance surgical skills and shorten the learning time during residency and fellowship training. It is anticipated to back up the minimally invasive and precise targeting therapy for lacrimal dis-eases.
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To review retrospectively six cases of rhino-orbital related endoscopic surgeries aided by Fusion electromagnetic system,to explore the indications and clinical value of image guided technique in endonasal endoscopic surgery.Retrospective research methods were used.In this study,six cases of nasal endoscopic sinus surgery using Fusion electromagnetic system were analyzed,including 1 nasal penetrating foreign body,2 optic nerve decompressions,1 orbital apex hemangioma,1 sieve frontal sinus cyst,1 intraorbital mass biopsy.The preparation time of navigation system,the accuracy of intraoperative positioning and surgical coherence,intraoperative and postoperative complications of surgery were recorded.The average preparation time was(8.13 ± 1.858)min.In the navigation,the sinus ostium,orbital cardboard,skull base,optic nerve,internal carotid artery and other important structures can be accurately located in all patients,while registrations had been accurate within 1 mm.Six patients were successfully operated by image guided technique.There was no intracranial or intraorbital complications due to intraoperation error.Image guided technique allows for a truely microinvasive and accurate rhino-orbital related endoscopic surgeries.It requires less preoperative preparation time,has high surgical navigation accuracy,improves the surgical coherence and safety,and reduces the surgical complicationgs.However,as an auxiliary tool,it can not replace the surgeon's anatomical knowledge,surgical training and clinical experience.
Subject(s)
Humans , Endoscopy , Methods , Nasal Cavity , General Surgery , Orbit , General Surgery , Retrospective Studies , Skull Base , General Surgery , Surgery, Computer-AssistedABSTRACT
Introducción: La epistaxis corresponde a una de las causas más frecuentes de consulta otorrinolaringológica en los servicios de urgencia. La epistaxis posterior es menos frecuente pero su presentación más severa. Existen varias alternativas terapéuticas, en las últimas décadas el manejo quirúrgico endoscópico de la arteria esfenopalatina (AEP) ha ido en aumento dado las ventajas en comodidad para el paciente y reducción de costos asociados. Objetivo: Revisar el manejo realizado en los cuadros de epistaxis posterior en el Hospital Clínico de la Universidad de Chile (HCUCh). Material y método: Estudio descriptivo en el Servicio de Otorrinolaringología del HCUCh de pacientes que presentaron epistaxis posterior entre el año 2013 y 2016. Resultados: Se revisó un total de 33 casos. La edad promedio de los pacientes fue 61,6 años siendo las comorbilidades más frecuentes la hipertensión arterial (36,3%) y fibrilación auricular (18,1%). Se realizó tratamiento quirúrgico en 57,6% de los pacientes siendo el clipaje de AEP la intervención quirúrgica más frecuente. Discusión y conclusiones: Tanto el manejo tradicional como las técnicas quirúrgicas presentaron eficacia similar en la serie revisada.
Introduction: Epistaxis corresponds to one of the most frequent causes of otorhinolaryngological consultation in the emergency services. Posterior epistaxis is less frequent but more severe. There are several therapeutic alternatives, in recent decades the surgical endoscopic management of the sphenopalatine artery (AEP) has been increasing given the advantages in comfort for the patient and reduction of associated costs. Aim: To review the management of posterior epistaxis in the Clinical Hospital of the University of Chile (HCUCh). Material and method: Descriptive study in the Otorhinolaryngology Service of the HCUCh of patients who presented posterior epistaxis between the years 2013 and 2016. Results: A total of 33 cases were reviewed. The mean age of the patients was 61.6 years, with the most frequent comorbidities being hypertension (36.3%) and atrial fibrillation (18.1%). Surgical treatment was performed in 57.6% of the patients, with AEP clipping being the most frequent surgical intervention. Conclusion: Both traditional management and surgical techniques presented similar efficacy in the revised series.
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Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Epistaxis/surgery , Epistaxis/epidemiology , Endoscopy/methods , Arteries/surgery , Sphenoid Sinus/blood supply , Comorbidity , Chile , Epistaxis/therapy , Cross-Sectional Studies , Retrospective Studies , Risk Factors , Treatment Outcome , Length of Stay , LigationABSTRACT
Objectives To explore the clinical characteristics of hematologic disease complicated by rhino-orbital-cerebral mucormycosis (HD-ROCM) and improve the understanding, diagnosis and treatment of M-ROC.Methods For mastering the clinical characteristics, treatment and prognosis of HD-ROCM, the medical records of 6 HD-ROCM patients admitted from 2009 to 2015 were analyzed retrospectively, and related literatures were also retrieved and reviewed.Results All the patients had bone marrow transplantation, 2 out of 6 patients had neutropenia, 5 had endoscopic debridement in a few days to several months after the onset of symptoms, and 1 had open debridement. 3 out of 6 achieved local debridement, and the other 3 had radical debridement. Out of them, one died 8 days postoperation, 1 died at 1 month, 2 at 2 months and 2 at 6 months.ConclusionEarly diagnosis and timely surgical treatment are the key points for improving the survival rate of HD-ROCM patients.
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Objective To study the fixed nasal endoscopic surgery combined with turbinate resection system of refractory nasal polyps sinusitis patients curative effect.Methods From December 2014 to June 2016,92 patients in our hospital for treatment of refractory nasal polyps sinusitis which were randomly divided into observation group and control group,with 46 cases in each.The patients in the observation group were treated with modified nasal endoscopic surgery combined with turbinate resection treatment system,and control group patients underwent conventional surgical treatment.The effects of two groups were compared.Results Total efficiency of the observation group was significantly higher than that of the control group.Symptoms after treatment in the two groups,SNOT-20 scores were significantly lower thon these in the treatment before,and symptoms after the treatment group,SNOT-20 scores were significantly lower than these of control group.The complication rate and recurrence rate in the observation group were significantly lower than the control group.The differences were statistically significant (P ＜ 0.05).Conclusion The correction of nasal endoscopic surgery combined with turbinate resection system in the treatment of refractory nasal polyps sinusitis effect significantly,can significantly reduce the pain of patients,and promote an early recovery of patients.
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Objective To investigate the effect of Biyankang Tablets on quality of life and recurrence rate in patients with chronic rhinosinusitis after functional endoscopic sinus surgery (FESS). Methods A total of 78 patients with chronic rhinosinusitis treated in our hospital during October 2014 to November 2016 were selected, and they were randomly divided into the control group and the traditional Chinese medicine (TCM) group according to the order of admission, with 39 cases in each group. Both groups were treated with FESS, and the TCM group was additionally treated with Biyankang Tablets. The clinical efficacy, inflammatory factors [interleukin-4 (IL-4), interleukin-8 (IL-8)], the prognosis [visual analogue scale (VAS) score of rhinosinusitis and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30)], drug safety and recurrence rates in the two groups were observed. Results After treatment, the total effective rate of treatment in TCM group was significantly higher than that in the control group (89.74% vs 71.79%) (χ2=4.044, P<0.05). After treatment, IL-4, IL-8 and VAS scores in the two groups were significantly decreased, and the scores of EORTC and QLQ-C30 were significantly increased, and the changes of scores in TCM group after treatment were more significant than those in the control group (P<0.05). After treatment, there was no significant difference in the incidence of adverse reactions between the two groups, and the recurrence rate in TCM group was significantly lower than that in the control group in 1 year after treatment (P<0.05). Conclusion TCM Biyankang Tablets is significantly effective in the treatment of patients with chronic rhinosinusitis after FESS. It can significantly inhibit the expression of inflammatory factors, effectively improve the prognosis and quality of life, and significantly reduce the recurrence rate.
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Objective To explore the manufacture methods of a new nasal ice compress cover,and to observe its clinical application effect.Methods The nasal ice compress cover body is a silica gel cover,which contains the upper cover body and the lower cover body.The shape of the upper cover body is consistent to the shape of frontal temporal while the shape of the lower cover body is consistent to the shape of the nose root,and the upper cover body and the lower cover body are integrally formed.The inner surface of the cover body is equipped with a ice pack,and the ice pack is of the same shape with the inner surface.And the cover body is provided with two elastic bands.Patients of the experimental group use the nasal ice compress cover and patients of the control group use the traditional ice hockey ice so as to detect the clinical effect of the new nasal ice compress cover and satisfaction rate and adverse reaction of patients.Results The new nasal ice compress cover has good clinical application effect,and patients consider that it has the advantages of convenient,effective and highly satisfactory. Conclusion The new nasal ice compress cover improves patients’comfort degree and satisfaction rate,and it is worthy of wide promotion.
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La rinosinusitis crónica es una patología que se presenta en pacientes con fibrosis quística y se asocia a la expresión de numerosos genes que determinan una alteración en la secreción de cloro del canal CFTR e hiperplasia de las glándulas submucosas del epitelio sinusal. En este artículo se efectúa una revisión acerca de las indicaciones y distintas alternativas de cirugía endoscópica nasal para la rinosinusitis crónica en pacientes con fibrosis quística. Se realizó una búsqueda de artículos en PubMed, la biblioteca de Cochrane y en SciELO con fecha de publicación hasta el año 2014, en los que se trata específicamente la rinosinusitis crónica asociada a fibrosis quística.
Chronic sinusitis is a condition that occurs in patients with cystic fibrosis and is associated with the expression of numerous genes that determine an alteration in the secretion of chloride channel CFTR and hyperplasia of submucosal glands sinus epithelium. This article reviews about the indications and alternatives of endoscopic nasal surgery for chronic rhinosinusitis in patients with cystic fibrosis. Searches were performed in PubMed, Cochrane Library, and SciELO with a publication date until 2014, specifically chronic rhinosinusitis associated with cystic fibrosis.
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Humans , Sinusitis/surgery , Rhinitis/surgery , Endoscopy , Sinusitis/etiology , Rhinitis/etiology , Chronic Disease , Cystic Fibrosis/complicationsABSTRACT
Objective To explore the effect of double silicone balloon catheter used as nasal packing materials after functional endoscopic sinus sur?gery(FESS). Methods Totally 80 patients(47 males and 33 females,median age of 43 years)with bilateral chronic sinusitis who underwent en?doscopic surgery under general anesthesia were randomly divided into two groups,each group with 40 patients. The hemostatic sponge group used he?mostatic sponge for postoperative nasal packing and the hemostatic catheter group used double silicone balloon catheter plus medical sponge. Patients were observed for postoperative pain,ventilation and bleeding after packing removal to evaluate efficacy. Results Double silicone balloon catheter was superior to hemostatic sponge in ventilation maintenance(mean scores:78.8 vs 2.32)and pain relief(mean scores:0 vs 5.26),the difference was statistically significant(P<0.05). Moreover,double silicone balloon catheter was also superior to hemostatic sponge regarding to nasal bleeding after packing removal. Conclusion Double silicone balloon catheter is a preferable material for nasal packing after endoscopic surgery,which has reliable hemostatic effect and can better maintain the nasal ventilation,reduce pain in patients,and improve the patient's quality of life during treat?ment.
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The application and expanding of nasal endoscopic surgery,an epoch-making transform of rhinology,have a very close associations with medical imaging,which includes anatomy photograph,conceptual diagram,radiological imaging,nasal endoscopic image display system,operation photographic recording and computer assisted instruction courseware,etc.It is important to collect the medical imaging through various means and set up medical imaging resources library for nasal endoscopic surgery teaching.
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Objective To evaluate the value of multi-slice spiral CT in nasal endoscopic surgery.Methods The multi-slice spiral CT data of 232 patients who were scanned prior to nasal endosopic surgery were analyzed.Results The nasal and sinus disease could be diagnosed correctly with multi-slice spiral CT.The ostiomeatal complex and the channels of the frontal sinus' drainage could be showed clearly.All the manifestation of the multi-slice spiral CT was in correspondence with the endoscopy showed in the surgery.Conclusion The multi-slice CT has the advantages of short scan time,less radiation dosage and multiplanar reconstruction.So it can display the nasal and sinus structures in detail,and has a great value in guiding the nasal endoscopic surgery.