Development of Paranasal Sinus Mucocele Following Endoscopic Sinus Surgery

Backround and Objectives: Mucocele of the paranasal sinuses could be developed as secondary to trauma, tumor or surgical manipulation. This study was conducted to investigate clinical eatures of paranasal sinus mucocele following endoscopic sinus surgery and to determine the effect of endoscopic wide marsupialization for the treatment of mucocele. MATERIALS AND METHODS: Thirty-five patients with paranasal sinus mucocele who were diagnosed and surgically treated at Seoul National University Hospital from Nov. 1996 through Dec. 2002 were retrospectively analyzed by their medical records and radiological imaging. RESULTS: The most common chief complaint of patients with mucocele were ocular symptoms including periorbital swelling, proptosis and headache. Previous sinus operation, especially endoscopic sinus surgery was the most common cause of mucocele, which developed at mean period of 50 months after surgery. Most commonly involved sinuses were ethmoid and frontal sinuses. Thirty-three out of 35 patients underwent endoscopic wide marsupialization of the mucocele cavity, and the other two patients were treated via external approaches. No recurrence was observed until mean followup of 33 months. CONCLUSION: One should suspect the possibility of mucocele recurrence if a patient complains of ocular symptoms several years after endoscopic sinus surgery. Meticulous operation and postperative treatment, and regular followup are needed for patients who underwent endoscopic sinus surgery because of a possible development of mucocele as a late complication. Although transnasal endoscopic wide marsupialization for the treatment of mucocele showed safe and good results, long term follow-up data is needed to establish it as the gold standard for treatment of paranasal sinus mucocele.

Long-Term Outcomes of Transnasal Endoscopic Marsupialization through Middle, Inferior Meatal Antrostomy or Extended Middle Meatal Antrostomy in Maxillary Sinus Mucoceles

Backgroud and Objectives: There are few reports about long-term outcomes of transnasal endoscopic marsupialization of isolated maxillary sinus mucocele. The approach routes of endoscopic marsupialization in those papers were mainly through middle meatal antrostomy. However, it is difficult or impossible to treat maxillary sinus mucocele by transnasal endoscopic middle meatal antrostomy in some cases. The aim of this study was to investigate long-term outcomes of transnasal endoscopic marsupialization according to three different approach routes. Materials and Methods: We reviewed 20 consecutive patients underwent transnasal endoscopic marsupialization and followed up for at least 66 months, retrospectively. Ten patients were treated by transnasal endoscopic middle meatal antrostomy with marsupialization, four by inferior meatal antrostomy and six by extended middle meatal antrostomy. RESULTS: No evidence of recurrence and major complications were observed during follow-up periods ranging from 66 to 102 months (mean, 80 months) according to three different approach routes. CONCLUSION: Transnasal endoscopic marsupialization with the appropriate antrostomy route according to the location and bulging direction of maxillary sinus mucoceles is considered to be an effective therapeutic method with favorable long-term outcomes

Surgical Treatment of Medial Orbital Wall Fracture According to Proper Indication

Compared with orbital floor fracture, the frequency and significance of medial orbital wall fracture has been relatively ignored because of the lack of proper diagnosis and the difficulty of surgical approach. The surgical delay results to the troublesome complications like enophthalomos, extraocular muscle movement dysfunction. For the reason, it is necessary to measure the exact fracture part and bone defect size with CT scan, the ophthalmologic evaluation and the proper treatment for the indication. We operated on 17 medial orbital wall fracture patients with transnasal endoscopic approach, open reduction through minimal medial canthus incision(6-7 mm), or both methods according to the fracture type. We classified them into three types according to the degree of periosteal injury, the size of the bone defect and the degree of comminution with CT scanning and ophthalmologic evalution. In the case of Type 1, there is no herniation of orbital contents and periosteum is intact despite fracture. The patients of Type 1 can be treated by packing with Foley catheter, Merocel(R) sponge, etc. after bone reduction with transnasal endoscope. In the case of Type 2, which has the herniation of orbital contents and bone defect of approximately 1 cm or less in diameter with periosteum injury, after the bone defect site can be confirmed with an endoscope, the medial wall can be reconstructed by Titanium Mesh, silastic sheet or autogenous bone graft through minimal medial canthus incision. In the case of Type 3, the bone defect is over 1 cm in diameter accompanying comminuted fracture. The fractured medial wall of type 3 can be reconstructed with bone graft through coronal incision or open sky incision. Minor complications occurred in 7 patients but all patients were successfully treated without patient's complaints during the follow-up period of 6-18 months. In addition, the scar by minimal medial canthus incision is imperceptible. The indicaions make the fracture reduction easy and accurate. Especially, it is proper to pediatric patients and young female patients because it corresponds to minimal invasive Technique.

Long-Term Outcomes of Transnasal Endoscopic and Extranasal Management in Inverted Papilloma of Nasal Cavity and Paranasal Sinuses / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES:Extranasal approach has been emphasized treatment of choice in inverted papilloma of nasal cavity and paranasal sinuses until several years ago. However, nowadays conservative transnasal endoscopic surgery is done in properly selected cases of inverted papilloma. The aim of this study was to compare the long-term outcomes of transnasal endoscopic and extranasal surgical management of inverted papilloma. MATERIALS AND METHODS: Among 33 patients who were pathologically diagnosed as inverted papilloma from January 1990 to August 1997, we reviewed the medical records and CT scans of 25 patients who underwent surgical treatment and were available for the follow up at least more than 2 years, retrospectively. RESULTS: Thirteen patients were treated via transnasal endoscopic approach and twelve patients by extranasal approach. According to Skolnik(1966)'s stage classification, 20 patients showed stage T3. Eleven patients of them were treated via transnasal endoscopically and 9 patients extranasally. Four minor postoperative complications, such as epiphora, septal perforation, vestibular pain and facial parasthesia, were noted in extranasal approach group. One case(7.7%) recurred in conservative transnasal endoscopic surgery group during mean 38 months follow up period. However, no recurrence was found in extranasal approach group during mean 60 months follow up period. CONCLUSION: If endoscopic surgery is performed by experienced surgeons in adequately selected patients, conservative transnasal endoscopic surgery can be considered as an alternative surgical modality in inverted papilloma of nasal cavity and paranasal sinuses.