Efficacy of glucocorticoid stent implantation in ethmoid sinus after endoscopic sinus surgery for chronic rhinosinusitis with nasal polyps / 临床耳鼻咽喉头颈外科杂志

Objective:To evaluate the efficacy of glucocorticoid sinus stents implanted 2 weeks after functional endoscopic sinus surgery（FESS） for the treatment of chronic rhinosinusitis with nasal polyps（CRSwNP）. Methods:CRSwNP patients with similar bilateral lesions were randomly divided into two groups, with a stent group of 25 patients and a control group of 24 patients. Patients in the stent group had glucocorticoid sinus stents implanted into the bilateral ethmoid sinuses 2 weeks after FESS, while the control group underwent postoperative debridement only. Follow-up assessments occurred at postoperative weeks 2, 4, 8, and 12. Patients were asked to assess their sensation of nasal symptoms using a 10-point visual analog scale. Efficacy was assessed by endoscopic evaluations. Sinus obstruction, crusting/coagulation, polyp formation, middle turbinate position, adhesions, mucosa epithelialization, and postoperative intervention were assessed as efficacy outcomes. GraphPad Prism 9 was applied for statistical analysis. Results:At 4 and 8 weeks postoperatively, the stent group showed significant improvement in VAS scores of nasal congestion and runny nose compared with the control group（P<0.05）. No significant difference was observed in the VAS scores of head and facial stuffiness, loss of smell, or nasal dryness/crusting between the two groups（P>0.05）. Compared with the control group, the stent group had a lower rate of polypoid formation at 4, 8, and 12 weeks postoperatively. At postoperative week 12, the rate of mucosal epithelialization in the ethmoid cavity was significantly higher in the stent group. During the follow-up, the frequency of postoperative intervention was significantly lower in the stent group than in the control group（P<0.05）. Besides, a lower incidence of middle turbinate lateralization was found in the stent group at 8 and 12 weeks postoperatively. At 8 weeks postoperatively, the stent group had a percentage of adhesion lower than that of the control group（all P<0.05）. Conclusion:Implantation of glucocorticoid sinus stents after FESS can maintain sinus cavity patency, improve the inflammatory status of the operative cavity, reduce postoperative interventions, and promote benign regression of the operative cavity.

Complicación orbitaria recurrente por rinosinusitis. Reporte de un caso / Recurrent orbital complication by rhinosinusitis. A case report

El compromiso orbitario es la complicación más frecuente de la rinosinusitis aguda en pediatría, y el etmoides es el seno más afectado. La recurrencia es infrecuente. Existen solo tres casos publicados en la literatura. Una anomalía anatómica del proceso unciforme o un mucocele podrían ser factores predisponentes, que pueden obstruir el drenaje normal de los senos junto con la presencia de etmoiditis.La tomografía computada y la resonancia magnética orientan el diagnóstico. El tratamiento quirúrgico está indicado ante la falta de respuesta al tratamiento instaurado luego de 48 horas o disminución de la agudeza visual o recurrencias sin patología tumoral de base.Se presenta a un paciente de 4 años de edad que consultó por un cuadro compatible con etmoiditis complicada recurrente. Presentó celulitis preseptal en seis oportunidades y un episodio de absceso subperióstico, desde los 3 meses de edad. Evolucionó favorablemente luego de la operación quirúrgica.

Orbital infection is the most frequent complication of ethmoiditis. Recurrent periorbital cellulitis is a very rare complication of rhinosinusitis with only three reports in the literature describing this pathological process.This complication can be favored by an anatomical abnormality of the uncinate process or mucocele obstructing the normal drainage pathway, in addition to ethmoidal sinusitis.Computed tomography and magnetic resonance guide the diagnosis. The treatment is based on antibiotics, corticosteroids and local decongestants. Surgical treatment is indicated in the absence of response to treatment established after 48 hours or decrease in visual acuity or recurrent orbital complications without underlying tumor pathology. In this report, we present a case of orbital complication of rhinosinusitis in a 4 year-old-child with six episodes of unilateral periorbital cellulitis and one episode of subperiosteal orbital abscess since the age of 3 months. There was a complete resolution with no recurrence after the surgical intervention

Manejo endoscópico de osteoma etmoidal con extensión orbitaria: a propósito de un caso / Endoscopic manegement of frontoethmoidal osteoma: on case subject

El osteoma es el tumor más frecuente de los senos paranasales, habitualmente asintomático debido a su lento crecimiento, sin embargo, pueden desarrollarse síntomas dependiendo del tamaño, localización y extensión, con potencial compromiso de órbita y cerebro. La cirugía está indicada en casos sintomáticos pudiendo realizarse abordaje externo, endoscópico o combinado. Presentamos un caso de osteoma etmoidal con compromiso orbitario resuelto, manejado por medio de la cirugía endoscópica nasal, con apoyo de navegación.

The osteoma is the most common tumor of the paranasal sinuses, is usually asymptomatic because of their slow growth, however, may develop symptoms depending on the size, location and extent, with potential compromise of orbit and brain. Surgery is indicated in symptomatic cases, with external, endoscopic or combined approach. We present a case of ethmoidal osteoma with orbital involvement managed by endoscopic image guided surgery.

Osteoma frontoetmoidal, otras aplicaciones del Draf III, a raíz de un caso clínico / Frontoethmoidal osteoma, other applications of Draf III on the grounds of a clinical case

Presentamos el caso de una mujer de 57 años, que consulta tras notar un aumento de volumen pétreo y de lento crecimiento en el reborde orbitario medial derecho, asociado a obstrucción nasal, anosmia y descarga posterior. La evaluación clínico radiológica evidenció un gran osteoma frontoetmoidal derecho con compromiso orbitario y de la lamela lateral de la lámina cribosa, y además, una rinosinusitis crónica con pólipos. Se realizó una resección endoscópica del tumor por medio de un Draf III y una cirugía endoscópica funcional del resto de las cavidades perinasales para el tratamiento de la rinosinusitis crónica. Describimos el caso y discutimos sus aspectos relevantes.

We report the case of a 57 year-old woman consulting because of a slow growing solid tumor in the right medial orbital rim associated with nasal obstruction, anosmia and posterior nasal drip. Clinical and radiological evaluation evidenced a large right frontoethmoidal osteoma involving the orbit and thelateral lamella of the cribriform plate, and chronic rhinosinusitis with polyps. A Draf III was performed to remove the osteoma and a bilateral functional endoscopic sinus surgery of the remaining sinuses was performed to treat thechronic rhinosinusitis. We described the case and discuss its relevant aspects.

[Effect of motiomycin-c [1 mg] in prevention of adhesion affer endoscopic sinus surgery in ethmoid spheniod sinuses]

This study was performed to determine the efficacy of Mitomycin C on synechia after FESS in ethmoid sinuses in patients admitted in Imam-Khomeini Hospital in 2011 and 2012. In this interventional study, 30 patients with pan rhinosinusitis attending to Imam-Khomeini Hospital in 2011 and 2012 were enrolled and in one side after FESS, the mitomycin C and in the other side the normal saline was used and then the synechia frequency and severity and side effects were compared in one and six months between two sides. One month after operation, six [85.7%] patients in Mitomycin C and six [66.7%] patients of normal saline group had mild synechia and one [14.3%] patient in Mitomycin C and three [33.3%] patients in normal saline group had complete synechia. Six months after operation, eight [88.9%] patients in Mitomycin C and six [66.7%] patients of normal saline group had mild synechia and one [11.1%] patient in Mitomycin C and four [40%] patients in normal saline group had complete synechia. The frequency and severity of synechia after FESS and the adverse effects were not significantly differed between two sides in one and six months after surgery. Totally, based on the results of this study and comparison with other studies it may be concluded that Mitomycin C would have no statistically significant effect on prevention from postoperative synechia and reduction of its severity after FESS surgeries

Ligadura endoscópica da artéria etmoidal anterior: estudo de dissecção em cadáveres / Endoscopic ligation of the anterior ethmoidal artery: a cadaver dissection study

Ligadura da artéria etmoidal anterior (AEA) pode ser necessária em casos de epistaxe grave refratária ao tratamento tradicional. O uso da ligadura endoscópica endonasal da AEA ainda é bastante limitado. Existem poucos estudos na literatura sobre a técnica de abordagem endoscópica desta artéria. OBJETIVOS: Demonstrar a aplicabilidade técnica da ligadura periorbitária da AEA por via endoscópica transetmoidal. MATERIAL E MÉTODOS: Estudo prospectivo. 50 fossas nasais de cadáveres foram dissecadas. Após a realização de uma etmoidectomia anterior e remoção parcial da lâmina papirácea, a periórbita foi cuidadosamente dissecada até a identificação da AEA. Após sua identificação, a artéria foi exposta e ligada dentro da órbita. RESULTADOS: Todas as dificuldades inerentes ao procedimento, as complicações associadas, a curva de aprendizado e variações anatômicas foram coletados. CONCLUSÕES: A abordagem endoscópica da AEA na órbita de cadáveres mostrou-se factível. A identificação da artéria é fácil e a técnica evita incisões externas. Este acesso parece ser uma excelente alternativa para a abordagem da AEA. Estudos clínicos futuros são necessários para comprovar os benefícios desta técnica.

Anterior ethmoidal artery (AEA) ligation may be necessary in cases of severe epistaxis not controllable with traditional therapy. Endoscopic endonasal ligation of the AEA is not used frequently; there are few studies in the literature for standardization of the endoscopic technique for this vessel. AIM: To demonstrate the feasibility of periorbital AEA ligation in a transethmoidal endoscopic approach. METHODS: A prospective study where 50 nasal cavities were dissected. After anterior ethmoidectomy and partial removal of lamina papyracea, the periorbital area was carefully dissected along a subperiosteal plane to identify the AEA. The vessel was exposed within the orbit and dissected. RESULTS: Data on technical difficulties, complications, the learning curve and anatomical variations were gathered. CONCLUSION: An endonasal endoscopic approach to the AEA within the orbit was shown to be feasible. Identifying the artery is not difficult, and this technique avoids external incisions. This approach appears to be an excellent alternative for approaching the AEA. Further clinical studies are needed to demonstarte the benefits of this technique.

Variantes anatómicas relevantes en tomografía computarizada de cavidades perinasales / Remarkable anatomic variations on paranasal CT scans

Introducción: La anatomía ósea de las cavidades perinasales (CPN) es altamente variable, pudiendo ser causa o factor predisponente de patología rinosinusal, o servir de reparo anatómico para la cirugía endoscópica nasal (CEN). Objetivos: Conocer la frecuencia de variaciones anatómicas en pacientes que consultan en nuestra Red de Salud. Material y método: Revisión retrospectiva de todas las tomog rafias computarizadas (TC) de CPN, realizadas en el Servicio de Radiología de la Red de Salud UC entre abril y junio de 2009. Resultados: Se encontraron las distintas variantes anatómicas en frecuencias similares a las descritas en la literatura internacional. Se estudió también la trayectoria de la arteria etmoidal anterior (AEA), y la configuración del techo etmoidal, utilizando la clasificación de Keros. Conclusiones: La frecuencia de variaciones anatómicas encontrada en nuestra revisión es similar a la descrita en la literatura internacional. La mayoría de nuestros pacientes presenta configuración de techo etmoidal tipo Keros I, hallazgo diferente al reportado en otras series. El estudio metódico de las variantes anatómicas en TC de CPN nos permitiría evitar complicaciones quirúrgicas.

Introduction: Paranasal sinus anatomy is quite variable. Some variations are involved in rinosinusal pathology, others are landmarks ofFESS (functional endoscopic sinus surgery). Aim: To determine the frecuency of paranasal anatomic variations in our consulting population. Material and method: Retrospective revision of all paranasal CT scans achieved in our Radiology Service during a two month period during 2009. Results: We found most of ethmoid anatomic variations, with similar frecuencies as described in literature. We also studied anterior ethmoidal artery anatomy, and ethmoid roof configuration, using Keros classification Conclusions: We found, in general, similar frecuencies as described in foreign series. More than half of our patients had Keros I ethmoid roof configuration type, a differing result from most of other series. Every ENT surgeon should be trained in routine search of these variations, helping to avoid possible surgical complications.

Anesthetic manipulations to minimize bleeding and improve outcome of functional endoscopic sinus surgery

The present study was designed as a trial to improve field visibility daring functional endoscopic sinus surgery [FESS] by means of positional changes and the use of controlled hypotension achieved through maintenance of anesthesia using remifentanil and either of propofol infusion [Total Intravenous; TI] or isoflurane inhalation [Combined Intravenous/Inhalational; CII]. The study included 32 patients; 23 males and 9 females, with mean age of 39.2 +/- 8.4 years and assigned to undergo FESS. Patients were divided randomly into two equal groups according maintenance anesthetic regimen: Group TI and Group CII. Each group was subdivided according to patients' position during surgery into supine and anti-Trendelenburg by 30°. Anesthesia was maintained in both groups by infusion of 0.5 micro g/kg/min of remifentanil in addition to 10 micro g/ kg/min propofol infusion in Group TI or isoflurane 2% in Group CII Patients were monitored non-invasively; before induction of anesthesia [T0] and 20 [T20], 40 [T40] and 60 min [T60] after induction of anesthesia, for mean arterial pressure [MAP] and heart rate [HR]. The approach for FESS was conducted totally endonasal. The visibility of the operative field during FESS was evaluated using 6-points Fromme scale and total amount of bleeding as judged by the amount evacuated was also recorded. Both anesthetic modalities reduced blood pressure significantly and decreased heart rate throughout times of observation compared to preoperative levels with significantly lower MAP measures in anti-Trendelenburg compared to supine position. All surgeries were conducted completely without intraoperative complications and no extensive bleeding was recorded. There was a significant increase in the frequency of good field visibility with TI compared to CII anesthesia with significantly improved field visibility in patients maintained in anti-Trendelenbwg position compared to supine position. Estimated mean blood loss was significantly less and the recorded field visibility scores were significantly higher in TI group compared to CII group. There was a negative significant correlation between the field visibility score and mean MAP and mean amount of bleeding. Using regression analysis, the use of hypotensive anesthesia was found to be a significant independent factor for improving filed visibility, and the, use of TI anesthesia was found to be significant determinant independent factor for induction of hypotensive anesthesia. The receiver operating characteristic [ROC] curve analysis judged by the area under the curve [AUC] defined the superiority of use of TI over CII anesthesia as independent determinant for field visibility. It could be concluded that maintaining patients in anti-Trendelenburg position and anesthetic manipulation using total intravenous anesthesia could minimize bleeding and improve field visibility during FESS and thus this combination of manipulations could be appropriate strategy for such type of surgery

Abordagem via Le Fort I para nasoangiofibroma juvenil: estudo de 32 casos

Introdução: O Nasoangiofibroma Juvenil (NJ) é um raro tumor benigno vascular, não encapsulado, com comportamento maligno, por causa do crescimento invasivo e extensão para regiões adjacentes, que acomete exclusivamente adolescentes do sexo masculino. Origina-se na fossa pterigopalatina, na margem superior do forame esfenopalatino e apresenta prevalência de 0,05% dos tumores de cabeça e pescoço. Sua etiologia é desconhecida e o principal tratamento é a ressecção cirúrgica completa. Entretanto, a via de acesso a este tumor tem sido motivo de debates. É descrito o acesso transantral, transpalatal, endoscópio, Le Fort I e outros. As taxas de recorrência após tratamento cirúrgico variam de 0 a 55%, a depender do estadiamento inicial, do tratamento escolhido, bem como da via de acesso. Objetivo: Avaliar pacientes portadores de NJ submetidos a ressecção cirúrgica via Le Fort I, de março de 1983 a março de 2008, atendidos no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto - USP. Resultados: A idade do diagnóstico variou de 8 a 28 anos, com média de 16 anos. O sítio mais comum de acometimento foi a nasofaringe e fossa pterigopalatina em 100% dos casos, seguido da cavidade nasal (90%), seio esfenoidal (81%), seio etmoidal (68%), seio maxiliar (46%), órbita (25%), fossa infratemporal e região intracranial (21%). Angiografia e embolização forma realizadas no pré-operatório em 75% dos pacientes. Quanto às complicações, um paciente apresentou desoclusão após cirurgia, um paciente apresentou infecção no sítio operatório, dois pacientes apresentaram sangramento moderado e um grave no intra-operatório. Conclusão: Concluímos que a abordagem Le Fort I é uma técnica cirúrgica que permite a ressecção total do NJ, com pequena taxa de complicações e recidivas.

Balín como cuerpo extraño en cavidades paranasales / Pellet as foreign body in paranasal cavities

Las heridas por balines en cavidades paranasales son raras. La presencia de balines como cuerpos extraños en cavidades paranasales es extremadamente infrecuente. Se presenta el caso de un paciente con un balín alojado en etmoides quien presentó como complicación, 16 años más tarde, un piomucocele que comprometió el nervio óptico. El balín fue removido por cirugía endoscópica con buenos resultados quirúrgicos.

Multiple mucoceles in cystic fibrosis and Role of endoscopic sinus surgery in its treatment

Cystic Fibrosis [CF] is a hereditary disorder of mucous glands which due to impairment of sodium and chloride secretion affects mucosal surfaces. Although sinonasal complaints are common in CF patients, it presents usually as sinusitis or nasal polyposis and mucocele formation is a rare presentation of CF. Here we present a six year-old boy presenting with telecanthus and progressive nasal deformity as a result of multiple mucoceles in ethmoid, maxillary and sphenoid sinuses. This article discuss about this patient and reviews the role of endoscopic sinus surgery in CF patients

Maxilectomía medial más etmoidectomía total endoscópica para el tratamiento del papiloma invertido nasosinusal / Medial maxillectomy plus total endoscopic ethmoidectomy for the treatment of nasosinusal inverted papilloma

Paciente masculino de 54 años con un papiloma invertido (PI) que ocupa la fosa nasal derecha, pared medial del seno maxilar, etmoides, extendiéndose hasta la nasofaringe, respetando el seno frontal, esfenoidal y las paredes lateral y ántero-inferior del seno maxilar. Se práctico tratamiento quirúrgico efectuándosele una maxilectomía medial modificada más etmoidectomía total, ambas por vía endoscópica. Se revisa la técnica quirúrgica endoscópica y la literatura en cuanto a las indicaciones, contraindicaciones y limitaciones de este tipo de abordaje y, además, su comparación respecto a las vías clásicas externas.

Naso-ethmoid schwannoma with intracranial extension: case report

Intranasal schwannomas are rare lesions, specially when they present with an intracranial extension. The fifth case in the medical literature of a naso-ethmoid schwannoma with extension into the anterior cranial fossa is presented. The magnetic resonance findings and the details of the combined intracranial / transfacial operative approach used are described. The possible origin and the clinical characteristics of this rare lesion are reviewed.

Infrasellar craniopharyngioma: case report

We report a case of infrasellar craniopharyngioma in a 34 year-old woman who presented with progressive headache and diplopia. Computed tomographic and magnetic resonance images showed a heterogeneous tumor originating from the sphenoid bone with ethmoid sinus and sella turcica extension. A sublabial rhinoseptal transsphenoidal surgery was performed. Craniopharyngiomas with infrasellar development are very rare. Infrasellar craniopharyngioma is uncommon, thirty-five cases has been reported in literature. The embryology, clinical features and radiographic investigation of these tumors are discussed

Cirurgia endoscópica funcional dos seios paranasais e sinusite crônica / Functional endoscopic sinus surgery and chronic sinusitis

A sinusite crônica é uma patologia frequente, observando-se preocupação crescente com o seu diagnóstico e tratamento. A cirurgia ocupa um papel de destaque entre os recursos terapêuticos utilizados. O objetivo deste trabalho é relatar os princípios da cirurgia endoscópica funcional dos seios paranasais aplicados ao tratamento da sinusite crônica. Para tanto, iremos discutir os conceitos anatômicos e fisiológicos relevantes, a fisiopatologia, o diagnóstico e as indicações de tratamento cirúrgico da sinusite crônica. Descreveremos as principais técnicas de cirurgia endoscópica funcional aplicáveis no tratamento desta patologia, bem como suas possíveis complicações.

Wooden foreign body in the orbital cavity: a case report.

Orbital foreign bodies in Thailand are uncommon. The diagnosis depends on history taking, physical examination and complete investigations. A case of orbital foreign body was reported with satisfactory result of treatment by transethmoidal approach: ethmoidectomy with antrostomy.