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1.
Rev. otorrinolaringol. cir. cabeza cuello ; 80(1): 91-96, mar. 2020. graf
Article in Spanish | LILACS | ID: biblio-1099208

ABSTRACT

Los leiomiosarcomas de la cavidad nasal y senos paranasales son neoplasias malignas de baja frecuencia, localmente agresivas. Presentan una alta tendencia a la recurrencia de aproximadamente 55% en nariz y senos paranasales. Están conformados por células musculares lisas. Según diversos autores, aproximadamente el 50% de los pacientes mueren antes del primer año y la supervivencia a los 5 años es del 20%. Anteriormente se pensaba que no poseían potencial metastásico, sin embargo, en series actuales se ha visto que presentan un alto poder metastásico de hasta el 50%. Las metástasis se presentan de forma tardía. El tratamiento recomendado consiste en la resección radical del tumor primario con un amplio margen de tejido normal y la radioterapia es de uso controversial en el manejo.


Leiomyosarcoma of the nasal cavity and paranasal sinuses are malignant, low frequency, locally aggressive neoplasm. They present a high tendency to recurrence of approximately 55% in the nose and paranasal sinuses. They are made up of smooth muscle cells. According to different authors, approximately 50% of patients die before the first year and survival at 5 years is 20%. Previously it was thought that they did not possess metastatic potential, however in current series it has been seen that they have a high metastatic power of up to 50%. Metastases present late. The recommended treatment consists of radical resection of the primary tumor with a wide margin of normal tissue.


Subject(s)
Humans , Female , Middle Aged , Nose Neoplasms/surgery , Nose Neoplasms/diagnostic imaging , Leiomyosarcoma/surgery , Leiomyosarcoma/diagnostic imaging , Paranasal Sinuses , Magnetic Resonance Imaging , Nose Neoplasms/pathology , Endoscopy , Leiomyosarcoma/pathology , Nasal Cavity/surgery , Nasal Cavity/diagnostic imaging
2.
Braz. j. otorhinolaryngol. (Impr.) ; 85(4): 427-434, July-Aug. 2019. graf
Article in English | LILACS | ID: biblio-1019590

ABSTRACT

Abstract Introduction: One of the main concerns in endoscopic endonasal approaches to the skull base has been the high incidence and morbidity associated with cerebrospinal fluid leaks. The introduction and routine use of vascularized flaps allowed a marked decrease in this complication followed by a great expansion in the indications and techniques used in endoscopic endonasal approaches, extending to defects from huge tumours and previously inaccessible areas of the skull base. Objective: Describe the technique of performing endoscopic double flap multi-layered reconstruction of the anterior skull base without craniotomy. Methods: Step by step description of the endoscopic double flap technique (nasoseptal and pericranial vascularized flaps and fascia lata free graft) as used and illustrated in two patients with an olfactory groove meningioma who underwent an endoscopic approach. Results: Both patients achieved a gross total resection: subsequent reconstruction of the anterior skull base was performed with the nasoseptal and pericranial flaps onlay and a fascia lata free graft inlay. Both patients showed an excellent recovery, no signs of cerebrospinal fluid leak, meningitis, flap necrosis, chronic meningeal or sinonasal inflammation or cerebral herniation having developed. Conclusion: This endoscopic double flap technique we have described is a viable, versatile and safe option for anterior skull base reconstructions, decreasing the incidence of complications in endoscopic endonasal approaches.


Resumo Introdução: Uma das principais preocupações em abordagens endoscópicas endonasais da base do crânio tem sido a alta incidência e morbidade associada a fístulas liquóricas. A introdução e o uso rotineiro de retalhos vascularizados permitiram uma acentuada redução dessa complicação, seguida por uma grande expansão nas indicações e técnicas utilizadas nas abordagens endoscópicas endonasais, incluindo grandes tumores e áreas anteriormente inacessíveis da base do crânio. Objetivo: Descrever a técnica cirúrgica realizando uma reconstrução endoscópica multicamadas da base anterior do crânio com duplo retalho, sem craniotomia. Método: Descrição passo a passo da técnica endoscópica com duplo retalho (retalhos vascularizados nasoseptal e pericraniano e enxerto livre de fascia lata), utilizados e ilustrados em dois pacientes com meningioma do sulco olfatório submetidos à cirurgia por via endoscópica endonasal. Resultados: Em ambos os pacientes procedeu-se ressecção total macroscópica seguido de reconstrução da base anterior do crânio com os retalhos nasoseptal e pericraniano onlay e enxerto livre de fáscia lata inlay. Os pacientes apresentaram uma excelente recuperação, sem sinais de fístula liquórica, meningite, necrose do retalho, inflamação meníngea crônica ou sinonasal ou hérnia cerebral. Conclusão: A técnica endoscópica de duplo retalho, como descrita, trata-se de uma opção viável, versátil e segura para as reconstruções da base anterior do crânio, diminuindo a incidência de complicações em abordagens cirúrgicas endoscópicas endonasais.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Skull Base Neoplasms/surgery , Reconstructive Surgical Procedures/methods , Endoscopy/methods , Nasal Cavity/surgery , Postoperative Complications , Surgical Flaps , Cadaver , Magnetic Resonance Imaging , Tomography, X-Ray Computed , Cerebrospinal Fluid Rhinorrhea/surgery , Minimally Invasive Surgical Procedures/methods , Meningeal Neoplasms/surgery , Meningeal Neoplasms/diagnostic imaging , Meningioma/surgery , Meningioma/diagnostic imaging
3.
Braz. j. otorhinolaryngol. (Impr.) ; 84(6): 677-686, Nov.-Dec. 2018. tab, graf
Article in English | LILACS | ID: biblio-974387

ABSTRACT

Abstract Introduction: Functional endonasal endoscopic surgery is a frequent surgical procedure among otorhinolaryngologists. In 2014, the European Society of Rhinology published the "European Position Paper on the Anatomical Terminology of the Internal Nose and Paranasal Sinuses", aiming to unify the terms in the English language. We do not yet have a unified terminology in the Portuguese language. Objective: Transcultural adaptation of the anatomical terms of the nose and paranasal cavities of the "European Anatomical Terminology of the Internal Nose and Paranasal Sinuses" to Portuguese. Methods: A group of rhinologists from diverse parts of Brazil, all experienced in endoscopic endonasal surgery, was invited to participate in the creation of this position paper on the anatomical terms of the nose and paranasal sinuses in the Portuguese language according to the methodology adapted from that previously described by Rudmik and Smith. Results: The results of this document were generated based on the agreement of the majority of the participants according to the most popular suggestions among the rhinologists. A cross-cultural adaptation of the sinonasal anatomical terminology was consolidated. We suggest the terms "inferior turbinate", "nasal septum", "(bone/cartilaginous) part of the nasal septum", "(middle/inferior) nasal meatus", "frontal sinus drainage pathway", "frontal recess" and "uncinate process" be standardized. Conclusion: We have consolidated a Portuguese version of the European Anatomical Terminology of the Internal Nose and Paranasal Sinuses, which will help in the publication of technical announcements, scientific publications and the teaching of the internal anatomical terms of the nose and paranasal sinuses in Brazil.


Resumo: Introdução: A cirurgia endoscópica funcional endonasal é um procedimento cirúrgico frequente entre os otorrinolaringologistas. Em 2014, a Sociedade Europeia de Rinologia publicou o "Documento Europeu para Posicionamento sobre a Terminologia Anatômica Interna do Nariz e das Cavidades Paranasais" com o objetivo de unificar os termos na língua inglesa. Ainda não dispomos de uma terminologia unificada na língua portuguesa. Objetivo: Adaptação transcultural dos termos anatômicos do nariz e das cavidades paranasais para o português da "European Anatomical Terminology of the Internal Nose and Paranasal Sinuses". Método: Um grupo de rinologistas de todo o Brasil, com experiência em cirurgia endoscópica endonasal, foi convidado a participar da elaboração desse posicionamento sobre os termos anatômicos do nariz e das cavidades paranasais para o português conforme metodologia adaptada da previamente descrita por Rudmik e Smith. Resultados: Os resultados desse documento foram gerados a partir da concordância da maioria dos participantes conforme as sugestões mais populares entre os rinologistas. Uma adaptação transcultural da terminologia anatômica nasossinusal foi consolidada. Sugerimos que se busque uniformizar termos como "concha inferior", "septo nasal", "porção (óssea/cartilaginosa) do septo nasal", "meato (médio/ inferior) nasal", "via da drenagem do seio frontal", "recesso frontal" e "processo uncinado". Conclusão: Consolidamos uma versão adaptada em português da "European Anatomical Terminology of the Internal Nose and Paranasal Sinuses" que auxiliará a publicação de comunicados técnicos, publicações científicas e o ensino dos termos anatômicos internos do nariz e das cavidades paranasais no Brasil.


Subject(s)
Humans , Paranasal Sinuses/anatomy & histology , Nose/anatomy & histology , Cross-Cultural Comparison , Terminology as Topic , Paranasal Sinuses/surgery , Brazil , Nose/surgery , Prospective Studies , Consensus , Language , Nasal Cavity/anatomy & histology , Nasal Cavity/surgery
4.
Rev. otorrinolaringol. cir. cabeza cuello ; 78(3): 281-286, set. 2018. ilus
Article in Spanish | LILACS | ID: biblio-978813

ABSTRACT

RESUMEN El cavum de Meckel (CM) es un divertículo localizado en la fosa media adyacente al seno cavernoso. Las neoplasias de esta región son extremadamente raras y representan un desafío para el cirujano debido a las estructuras neurovasculares que se encuentran en la región. Para los tumores ubicados en esta área se han descrito diversos abordajes quirúrgicos, los cuales no logran una adecuada exposición a la porción anteromedial del CM. En la última década, se ha postulado el abordaje endoscópico endonasal extendido (AEE) como una alternativa quirúrgica para el manejo de lesiones ubicadas en esta región. Se presenta el caso de un paciente portador de un schwannoma del nervio trigémino situado en el CM derecho tratado mediante AEE.


ABSTRACT The Meckel's cave (CM) is a diverticulum located in the middle fossa adjacent to the cavernous sinus. The neoplasms of this region are extremely rare and represent a challenge for the surgeon due to the neurovascular structures that occupy and surround the parasellar region. For tumors located in this area, several surgical approaches have been described, all of which do not achieve an adequate exposure to the anteromedial portion of CM. In the last decade, the extended endonasal endoscopic approach (EEA) has been postulated as an alternative for the surgical management of tumors located in this region. We present the case of a patient with a trigeminal schwannoma located in the right CM treated by EEA.


Subject(s)
Humans , Male , Adult , Infratentorial Neoplasms/surgery , Neurosurgical Procedures/methods , Endoscopy/methods , Nasal Cavity/surgery , Infratentorial Neoplasms/diagnostic imaging , Tomography, X-Ray Computed , Skull Base/surgery , Neurilemmoma/surgery
5.
Braz. j. otorhinolaryngol. (Impr.) ; 84(2): 196-205, Mar.-Apr. 2018. tab, graf
Article in English | LILACS | ID: biblio-889363

ABSTRACT

Abstract Introduction Rapid maxillary expansion can change the form and function of the nose. The skeletal and soft tissue changes can influence the esthetics and the stability of the results obtained by the procedure. Objective The aim of this retrospective study was to evaluate the short-term effects of rapid maxillary expansion on the skeletal and soft tissue structures of the nose, in mouth-breathing patients, using a reliable and reproducible, but simple methodology, with the aid of computed tomography. Methods A total of 55 mouth-breathing patients with maxillary hypoplasia were assessed and were divided into an experimental group treated with rapid maxillary expansion(39 patients, 23 of which were male and 16 female, with an average age of 9.7 years and a standard deviation of 2.28, ranging from 6.5 to 14.7 years) and a control group (16 patients, 9 of which were male and 7 female, with an average age of 8.8 years, standard deviation of 2.17, ranging from 5.11 to 13.7 years). The patients of the experimental group were submitted to multislice computed tomography examinations at two different points in time: (T1) pre-rapid maxillary expansion and (T2) three months after the procedure. The control group underwent to the same exams at the same intervals of time. Four skeletal and soft tissue variables were assessed, comparing the results of T1 and T2. Results There was in the experimental group a significant increases in all the skeletal and soft tissue variables (p < 0.05) but no significant alteration was found in the control group. When comparing the experimental group and the control group, the most important change occurred in the width of the pyriform aperture (p < 0.001). Conclusion Rapid maxillary expansion is capable of altering the shape and function of the nose, promoting alterations in skeletal and soft tissue structures. This kind of study may, in the future, permit the proper planning of esthetic procedures at the tip and base of the nose and also the performance of objective measurements in early or late surgical outcomes.


Resumo Introdução A expansão rápida da maxila pode alterar a forma e a função do nariz. As alterações do esqueleto e dos tecidos moles podem influenciar a estética e a estabilidade dos resultados obtidos através deste procedimento. Objetivo Avaliar, em curto prazo, os efeitos da expansão rápida da maxila sobre as estruturas esqueléticas e tegumentares do nariz em pacientes respiradores orais por meio de uma metodologia confiável e reprodutível, porém simples, com a ajuda da tomografia computadorizada. Método Foram avaliados 55 pacientes respiradores orais com hipoplasia maxilar que foram divididos em grupo experimental tratado com expansão rápida da maxila (39, 23 do sexo masculino e 16 do feminino, com média de 9,7 anos e desvio padrão de 2,28, variação de 6,5 a 14,7 anos) e um grupo controle (16 pacientes, nove do sexo masculino e sete do feminino, com média de 8,8 anos, desvio padrão de 2,17, variação de 5,11-13,7 anos). Os pacientes do grupo experimental foram submetidos a exames de tomografia computadorizada multislice em dois tempos distintos: (T1) pré-expansão rápida da maxila e (T2) três meses após o procedimento. O grupo controle foi submetido aos mesmos exames nos mesmos intervalos de tempo. Foram avaliadas quatro variáveis esqueléticas e quatro tegumentares comparando-se os resultados de T1 e T2. Resultados O grupo experimental apresentou aumentos significativos em todas as variáveis esqueléticas e tegumentares (p < 0,05), mas não houve alterações significativas no grupo controle. Ao compararem-se o grupo experimental e o grupo controle, foi observado que a alteração mais importante ocorreu na largura da abertura piriforme (p < 0,001). Conclusão A expansão rápida da maxila é capaz de alterar a forma e a função do nariz, promove alterações nas estruturas esqueléticas e dos tecidos moles. Esse tipo de estudo pode, no futuro, permitir o planejamento adequado de procedimentos estéticos na ponta e base do nariz e também a feitura de medidas objetivas em resultados cirúrgicos iniciais ou tardios.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Palatal Expansion Technique , Maxilla/surgery , Mouth Breathing/surgery , Nasal Cavity/surgery , Tomography, X-Ray Computed , Cephalometry/methods , Reproducibility of Results , Retrospective Studies , Mouth Breathing/physiopathology , Mouth Breathing/diagnostic imaging , Nasal Cavity/abnormalities , Nasal Cavity/diagnostic imaging
6.
Rev. otorrinolaringol. cir. cabeza cuello ; 78(1): 15-24, mar. 2018. tab, ilus
Article in Spanish | LILACS | ID: biblio-902809

ABSTRACT

RESUMEN Introducción: El carcinoma adenoide quístico es una neoplasia originada en glándulas exocrinas de todo el cuerpo, principalmente en glándulas salivales mayores. En cavidad nasal y senos paranasales es poco frecuente y se caracteriza por presentar una alta frecuencia de recurrencia y de metástasis a distancia posterior a su remisión y a pesar de su tratamiento. Objetivo: Describir características de una serie de casos de pacientes con carcinoma adenoide quístico de cavidad nasal y senos paranasales operados. Material y método: Estudio descriptivo-retrospectivo. Período enero de 2012 y enero de 2017. La información se obtuvo a partir de las fichas electrónicas de la Clínica Las Condes. Se describen procedencia, edad y sexo, características clínicas, hallazgos anatomopatológicos, métodos diagnósticos, tratamiento, evolución. Resultados: Total de 5 pacientes operados, 3 mujeres y 2 hombres. La edad promedio fue de 63 años, con rango de 33 años a 90 años de edad. 100% de los casos sin factores asociados. La presentación clínica más frecuente fue la obstrucción nasal unilateral, seguida por el dolor facial. Dos pacientes se presentaron con diagnóstico inicial, dos por recurrencia y uno por persistencia. En tres casos el tumor se origina de seno maxilar y en dos en seno etmoidal. Todos presentaron enfermedad avanzada, etapa IV y III. Tres pacientes histológicamente fueron de bajo grado y dos de alto grado. En los cinco casos el tratamiento primario fue quirúrgico, en el 60% endoscópico, 20% abierto y 20% combinado. En cuatro casos se usó radioterapia posoperatoria y en tres de éstos, quimioterapia concomitante. Todos se encuentran sin signos de recidiva tumoral en último control. Conclusiones: El carcinoma adenoide quístico de cavidad nasal y senos paranasales es bastante infrecuente, su incidencia es menor a 1/100.000 casos por año. Es más frecuente en mujeres entre 40 y 50 años. Se identifica más con su origen en el seno maxilar (50%) y de patrón cribiforme. Clínicamente se presenta en estadíos avanzados ya que en etapa precoz es asintomático o presenta clínica inespecífica inflamatoria. El diagnóstico se realiza con biopsia complementada con imagenología. El tratamiento más utilizado es la cirugía endoscópica o abierta asociado a radioterapia posoperatoria, a pesar de la cual, se presentan con alta recurrencia a largo plazo.


ABSTRACT Introduction: Adenoid Cystic Carcinoma is a neoplasm originating in exocrine glands throughout the body, mainly in the major salivary glands. In the nasal cavity and paranasal sinuses is rare and characterized by a high frequency of recurrence and distant metastasis after remission and despite its treatment. Aim: To describe characteristics of a series of patients with operated adenoid cystic carcinoma of the nasal cavity and paranasal sinuses. Material and method: Descriptive-retrospective study. Period January 2012 and January 2017. The information was obtained from the electronic tabs of the Las Condes Clinic. It describes origin, age and sex, clinical characteristics, anatomopathological findings, diagnostic methods, treatment, evolution. Results: Total 5 patients operated, 3 women and 2 men. The average age was 63 years, ranging from 33 years to 90 years of age. 100% of the cases without associated factors. The most frequent clinical presentation was unilateral nasal obstruction, followed by facial pain. 2 patients presented with initial diagnosis, 2 due to recurrence and 1 due to persistence. In 3 cases the tumor originates from the maxillary sinus and in 2 in the ethmoidal sinus. All had advanced disease, stage IV and III. 3 patients were histologically low grade and 2 high grade. In all 5 cases, the primary treatment was surgical, 60% endoscopic, 20% open and 20% combined. In 4 cases, postoperative radiotherapy was used and in 3 of this concomitant chemotherapy. All are without signs of tumor recurrence in the last control. Conclusion: Adenoid Cystic Carcinoma of the nasal cavity and paranasal sinuses is quite infrequent; its incidence is less than 1/100,000 cases per year. It is more common in women between 40 and 50 years. It is identified more with its origin in the maxillary sinus (50%) and cribriform pattern. Clinically it presents in advanced stages since at an early stage, it is asymptomatic or it presents nonspecific inflammatory clinic. Diagnosis is performed with biopsy supplemented with imaging. The most commonly used treatment is endoscopic or open surgery associated with postoperative radiotherapy, despite which, they present with high recurrence in the long term.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Paranasal Sinus Neoplasms/surgery , Carcinoma, Adenoid Cystic/surgery , Nasal Cavity/surgery , Paranasal Sinus Neoplasms/diagnostic imaging , Retrospective Studies , Follow-Up Studies , Carcinoma, Adenoid Cystic/diagnostic imaging , Nasal Cavity/diagnostic imaging
7.
Rev. otorrinolaringol. cir. cabeza cuello ; 78(1): 52-58, mar. 2018. ilus
Article in Spanish | LILACS | ID: biblio-902814

ABSTRACT

RESUMEN La fístula de líquido cefalorraquídeo (LCR) corresponde a una comunicación anormal entre el espacio subaracnoideo y la porción neumatizada de la base de cráneo anterior en relación con las cavidades paranasales. Fístulas persistentes requieren reparación quirúrgica por el riesgo de meningitis, abscesos cerebrales y neumoencéfalo asociado. El gold standard es el abordaje extracraneal endoscópico. Uno de los principales inconvenientes es dañar estructuras intracraneanas nobles. La ayuda de tecnologías como la cirugía guiada por imágenes, contribuye a disminuir este problema. A continuación se presentan dos casos clínicos de fístula de líquido cefalorraquídeo en base de cráneo anterior, asociado a meningoencefalocele, intervenidos por cirugía endonasal guiada por imágenes.


ABSTRACT Endoscopic management of anterior skull base meningoencephalocele. The cerebrospinal fluid leak (CSF) is an abnormal communication between the subaracnoid space and the pneumatic portion of the anterior cranial base which is related to the paranasal cavities. The persistent leak requires surgery due to the potential complications such as meningitis, cerebral abscess or pneumoencephalus. Extracranial endoscopic approach is the gold standard procedure. One of the most important risk of the surgery is to damage noble intracranial structures. This situation can be ameliorated by using image guided surgery. We present two cases of CSF in anterior cranial base associated with meningoencephalocele that were treated in our center using nasal image guided endoscopic surgery.


Subject(s)
Humans , Female , Middle Aged , Aged , Endoscopy/methods , Cerebrospinal Fluid Leak/surgery , Meningocele/surgery , Nasal Cavity/surgery , Cerebrospinal Fluid Rhinorrhea/surgery , Skull Base , Fistula , Meningocele/diagnostic imaging
8.
Rev. otorrinolaringol. cir. cabeza cuello ; 77(4): 441-448, dic. 2017. graf
Article in Spanish | LILACS | ID: biblio-902801

ABSTRACT

RESUMEN La obstrucción dependiente de la vía aérea nasal representa un gran impacto en la calidad de vida de los pacientes. Las causas de ésta son múltiples, donde aquellas de tipo estructural son las que requieren frecuentemente cirugía. La obstrucción nasal debido a la disfunción de la válvula nasal puede ser olvidada como única causa de una obstrucción nasal. La decisión sobre qué técnica quirúrgica utilizar para solucionar una insuficiencia valvular es compleja y muchas veces la bibliografía utiliza conceptos anatómicos muy variados que no ayudan a seleccionar una técnica en particular. Se realizó una revisión bibliográfica del tema destacando anatomía, diagnóstico y tratamiento; las técnicas quirúrgicas más frecuentemente utilizadas son descritas.


ABSTRACT Nasal airway obstruction represents a major impact on patients' quality of life. The causes are multiple, where those of a structural type, frequently require surgery. Nasal obstruction due to nasal valve dysfunction may be overlooked as a cause of nasal obstruction. The decision about which surgical technique to use in order to solve a valvular insufficiency is complex and often the literature uses diverse anatomical concepts that do not help to select a particular technique. A literature review of the subject was carried out, highlighting anatomy, diagnosis and treatment; The most frequently used surgical techniques are described.


Subject(s)
Humans , Rhinoplasty/methods , Nasal Obstruction/surgery , Nasal Cavity/surgery , Nasal Obstruction/diagnosis , Airway Obstruction , Nasal Cavity/anatomy & histology
9.
Rev. chil. neurocir ; 43(1): 53-58, July 2017. ilus
Article in Spanish | LILACS | ID: biblio-869779

ABSTRACT

A pesar del desarrollo de las técnicas quirúrgicas de base de cráneo, los meningiomas petroclivales constituyen un reto para el neurocirujano debido a su localización y relación con estructuras neurológicas y vasculares críticas. Se reportan 2 pacientes con diagnóstico de meningioma petroclival que recibieron tratamiento por etapas incluyendo derivación ventrículo peritoneal asistida por endoscopia para la hidrocefalia, abordaje endonasal endoscópico (AEE) extendido al ápex petroso, keyhole subtemporal y retromastoideo con remoción de la lesión. La evolución fue satisfactoria. Se concluyó que los abordajes endoscópicos y por etapas constituyen una excelente opción en el tratamiento de los meningiomas petroclivales.


In spite of the development of the skull base surgery techniques, petroclival meningiomas are a challenge for neurosurgeon due to their localization and relationship with neurovascular structures. Those are two patient with diagnostic of petroclival meningioma whom received treatment step by step included ventricle peritoneal shunt with endoscopic guide for hydrocephalus, extended endonasal approach to petrous apex, subtemporal and retrosigmoid keyhole. The endoscopic approach is an excellent option in the treatment of petroclival meningioma.


Subject(s)
Humans , Male , Adult , Middle Aged , Nasal Cavity/surgery , Natural Orifice Endoscopic Surgery/methods , Endoscopy/methods , Petrous Bone/pathology , Meningioma/surgery , Meningioma/diagnostic imaging , Ventriculoperitoneal Shunt , Brain Neoplasms , Skull Base/surgery , Hydrocephalus, Normal Pressure , Hypertension , Magnetic Resonance Imaging/methods , Osteotomy/methods , Paresis , Radiosurgery/methods , Tomography, Spiral Computed/methods
10.
Rev. otorrinolaringol. cir. cabeza cuello ; 77(2): 169-174, jun. 2017. ilus
Article in Spanish | LILACS | ID: biblio-902758

ABSTRACT

Presentamos el caso de una mujer de 13 años con un gran tumor de características óseas en la fosa infratemporal derecha, el cual fue biopsiado mediante un abordaje endoscópico transeptal transpterigoídeo. La biospia mostró un osteocondroma. Describimos el caso y discutimos sus aspectos relevantes.


We report the case of a 13-year-old woman with a large tumor with osseous appearance in her right infratemporal fossa, which was biopsied through an endoscopic transpterygoid approach. The biopsy showed an osteocondroma. We described the case and discuss its relevant aspects.


Subject(s)
Humans , Female , Adolescent , Biopsy/methods , Osteochondroma/pathology , Skull Base Neoplasms/pathology , Endoscopy/methods , Osteochondroma/surgery , Osteochondroma/diagnostic imaging , Skull Base Neoplasms/surgery , Skull Base Neoplasms/diagnostic imaging , Neuronavigation , Nasal Cavity/surgery
11.
An. Fac. Cienc. Méd. (Asunción) ; 49(2): 78-86, jul-dic. 2016.
Article in Spanish | LILACS | ID: biblio-884956

ABSTRACT

Los trastornos metabólicos ocasionados por la insuficiencia renal y la diálisis para su tratamiento pueden conducir a la precipitación de sales de fosfato cálcico con la consecuente formación de tumores en diversas localizaciones. Estos pueden ser únicos o múltiples, pudiendo ocasionar obstrucción y compresión de distintas estructuras anatómicas con la consecuente alteración funcional. Si bien el manejo clínico de las alteraciones antes citadas es fundamental, la cirugía adquiere relevancia en estas situaciones. Se presenta un caso de Calcinosis Tumoral única ubicada en el tercio anterior del septum nasal, ocasionando obstrucción de la fosa nasal. La tomografía computada orientó el diagnóstico y la resección tumoral completa por vía nasal fue el tratamiento elegido. El informe de anatomía patológica confirma el diagnóstico de Calcinosis Tumoral. A los nueve meses de seguimiento en el postoperatorio no se evidencia recidiva.


Metabolic disorders caused by chronic renal failure and dialysis for its treatment can lead to the precipitation of calcium phosphate salts with the consequent formation of tumors in various locations. These can be single or multiple, and may cause obstruction and compression of different anatomical structures with consequent functional alteration. Although the clinical management of the above mentioned alterations is fundamental, the surgery acquires relevance in these situations. We present a case of unique tumoral calcinosis located in the anterior third of the nasal septum, causing obstruction of the nasal fossa. Computed tomography guided diagnosis and complete tumor resection by nasal route was the treatment chosen. The pathological anatomy report confirms the diagnosis of tumor calcinosis. At nine months post-operative follow-up there was no evidence of tumor recurrence.


Subject(s)
Humans , Adult , Calcinosis/etiology , Nose Diseases/etiology , Renal Dialysis/adverse effects , Renal Insufficiency, Chronic/complications , Nasal Septum/pathology , Calcinosis/surgery , Calcinosis/diagnostic imaging , Tomography, X-Ray Computed , Nasal Obstruction/surgery , Nasal Obstruction/etiology , Nose Diseases/surgery , Nose Diseases/diagnostic imaging , Follow-Up Studies , Nasal Cavity/surgery , Nasal Cavity/pathology , Nasal Septum/surgery
12.
Braz. j. otorhinolaryngol. (Impr.) ; 82(6): 630-635, Oct.-Dec. 2016. tab, graf
Article in English | LILACS | ID: biblio-828250

ABSTRACT

Abstract Introduction: Diseases of paranasal sinuses, nasal cavity, and skull base can be treated by endonasal operations using a nasal rigid endoscope. When conducting this kind of surgery, anatomical references are critical for safety. Objective: To measure the distance from the posterior wall of the maxillary sinus to the skull base, according to socio-demographic characteristics, and to detail an anatomical reference point for paranasal sinus operations and for an access to the anterior skull base, comparing anatomical variations between right and left sides, gender, height, weight, age, and ethnicity in cadavers. Methods: Measures were taken from the 90° angle (the starting point where deflection of the skull base begins to form the anterior wall of the sphenoid, also known as Δ90°) to the upper, middle, and lower points of the posterior wall of the maxillary sinus. This study used 60 cadavers aged over 17 years, and evaluated these bodies with respect to age, height, BMI, weight, gender, and ethnicity, comparing measurements of right and left sides. Results: The measurements were >1.5 cm in all cadavers and did not vary with age, height, weight, gender, and ethnicity on their right and left sides. The lack of association between the measurement from Δ90° to the upper, middle, and lower posterior walls of the maxillary sinus (categorical or quantitative) is noteworthy, considering the characteristics studied. Conclusion: The methodology defined the nasal point of reference, considering an absence of variation in the cadavers’ characteristics.


Resumo Introdução: Doenças dos seios paranasais, cavidades nasais e doenças da base do crânio podem ser tratadas com operação endonasal utilizando-se endoscópio rígido nasal. Referências anatômicas são importantes para a segurança durante a realização dessas operações. Objetivo: Medir a distância da parede posterior do seio maxilar à base anterior do crânio de acordo com características sócio-demográficas. Detalhar um ponto de referência anatômico para operações dos seios paranasais e acesso à base anterior do crânio comparando variações anatômicas entre os lados direito e esquerdo, gênero, altura, peso, idade e etnia em cadáveres. Método: Medidas do ângulo de 90º (ponto onde inicia a deflexão da base do crânio para formar a parede anterior do esfenoide, chamado de ângulo de 90º – Δ_90º) aos pontos superior, médio e inferior da parede posterior do seio maxilar. Foram utilizados 60 cadáveres com idade acima de 17 anos, e avaliados com idade, altura, peso IMC, gênero e etnia, comparando-se as medidas dos lados direito e esquerdo. Resultados: As medidas foram maiores que 1,5 cm em todos os cadáveres e não variaram com a idade, altura, peso, gênero e etnia nos lados direito e esquerdo dos cadáveres. Destaca-se falta de associação entre a medida do Δ90º à parede posterior superior; média e inferior do maxilar (categórico ou quantitativo) com as características estudadas. Conclusão: A metodologia empregada definiu o ponto de referência nasal por não variar com as características dos cadáveres.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Paranasal Sinuses/anatomy & histology , Nasal Cavity/anatomy & histology , Paranasal Sinuses/surgery , Cadaver , Endoscopy/methods , Nasal Cavity/surgery
13.
Braz. j. med. biol. res ; 49(9): e5182, 2016. tab, graf
Article in English | LILACS | ID: lil-788942

ABSTRACT

We used a computational fluid dynamics (CFD) model to study the inspiratory airflow profiles of patients with anterior nasal cavity stenosis who underwent curative surgery, by comparing pre- and postoperative airflow characteristics. Twenty patients with severe anterior nasal cavity stenosis, including one case of bilateral stenosis, underwent computed tomography (CT) scans for CFD modelling. The pre- and postoperative airflow characteristics of the nasal cavity were simulated and analyzed. The narrowest area of the nasal cavity in all 20 patients was located within the nasal valve area, and the mean cross-sectional area increased from 0.39 cm2 preoperative to 0.78 cm2 postoperative (P<0.01). Meanwhile, the mean airflow velocity in the nasal valve area decreased from 6.19 m/s to 2.88 m/s (P<0.01). Surgical restoration of the nasal symmetry in the bilateral nasal cavity reduced nasal resistance in the narrow sides from 0.24 Pa.s/mL to 0.11 Pa.s/mL (P<0.01). Numerical simulation of the nasal cavity in patients with anterior nasal cavity stenosis revealed structural changes and the resultant patterns of nasal airflow. Surgery achieved balanced bilateral nasal ventilation and decreased nasal resistance in the narrow region of the nasal cavity. The correction of nasal valve stenosis is not only indispensable for reducing nasal resistance, but also the key to obtain satisfactory curative effect.


Subject(s)
Humans , Male , Female , Nasal Cavity/surgery , Nasal Obstruction/surgery , Respiratory Mechanics/physiology , Computer Simulation , Constriction, Pathologic/diagnostic imaging , Constriction, Pathologic/physiopathology , Constriction, Pathologic/surgery , Hydrodynamics , Imaging, Three-Dimensional , Nasal Cavity/diagnostic imaging , Nasal Cavity/physiopathology , Nasal Obstruction/diagnostic imaging , Nasal Obstruction/physiopathology
14.
Arq. neuropsiquiatr ; 73(7): 611-615, 07/2015. graf
Article in English | LILACS | ID: lil-752376

ABSTRACT

Objective The purpose of this study was to describe the endoscopic combined “transseptal/transnasal” approach with a pedicled nasoseptal flap for pituitary adenoma and skull base reconstruction, especially with respect to cerebrospinal fluid (CSF) fistula.Method Ninety-one consecutive patients with pituitary adenomas were retrospectively reviewed. All patients underwent the endoscopic combined “transseptal/transnasal” approach by the single team including the otorhinolaryngologists and neurosurgeons. Postoperative complications related to the flap were analyzed.Results Intra- and postoperative CSF fistulae were observed in 36 (40%) and 4 (4.4%) patients, respectively. Among the 4 patients, lumbar drainage and bed rest healed the CSF fistula in 3 patients and reoperation for revision was necessary in one patient. Other flap-related complications included nasal bleeding in 3 patients (3.3%).Conclusion The endoscopic combined “transseptal/transnasal” approach is most suitable for a two-surgeon technique and a pedicled nasoseptal flap is a reliable technique for preventing postoperative CSF fistula in pituitary surgery.


Objetivo O objetivo deste estudo foi descrever o acesso endoscópico transeptal/transnasal combinado com a criação do flap naso-septal pediculado para reconstrução da base do crânio em cirurgias de resseção de adenoma de hipófise, especialmente nos casos que ocorrem fístula líquido cefalorraquidiano (FLC).Método Noventa e um pacientes consecutivos portadores de adenoma de hipófise foram retrospectivamente revisados. Complicações pós-operatórias relacionadas ao flap foram analisadas.Resultados Fístulas líquido cefalorraquidiano intra e pós-operatórias foram observadas em 36 (40%) e 4 (4,4%) dos pacientes, respectivamente. Entre os 4 pacientes, drenagem lombar e repouso absoluto foram suficientes para o fechamento da fístula e intervenção cirúrgica foi necessária em apenas um paciente. Outra complicação relacionada ao flap foi o sangramento em 3 (3,3%) dos pacientes.Conclusão O acesso endoscópico transeptal/transnasal combinado é melhor aplicado quando realizado por dois cirurgiões e o flap naso-septal é uma técnica eficaz para prevenção de fístula pós-operatória em cirurgias de hipófise.


Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Adenoma/surgery , Cerebrospinal Fluid Leak/prevention & control , Fistula/prevention & control , Natural Orifice Endoscopic Surgery/methods , Pituitary Neoplasms/surgery , Skull Base/surgery , Surgical Flaps/surgery , Cerebrospinal Fluid Leak/etiology , Fistula/etiology , Nasal Cavity/surgery , Nasal Septum/surgery , Natural Orifice Endoscopic Surgery/adverse effects , Postoperative Complications/prevention & control , Reproducibility of Results , Retrospective Studies , Risk Factors , Reconstructive Surgical Procedures/methods , Time Factors , Treatment Outcome
15.
Säo Paulo med. j ; 132(6): 377-381, Nov-Dec/2014. tab, graf
Article in English | LILACS | ID: lil-726378

ABSTRACT

CONTEXT: Pituitary macroadenomas are rare intracranial tumors. In a few cases, they may present aggressive behavior and invade the sphenoid sinus and nasal cavity, causing unusual symptoms. In this paper, we report an atypical case of pituitary adenoma presenting as a nasal mass. CASE REPORT: The patient was a 44-year-old woman who had had amenorrhea and galactorrhea for ten months, with associated nasal obstruction, macroglossia and acromegaly. Both growth hormone and prolactin levels were increased. Magnetic resonance imaging showed a large mass originating from the lower surface of the pituitary gland, associated with sella turcica erosion and tumor extension through the sphenoid sinus and nasal cavity. Histopathological analysis demonstrated a chromophobe pituitary adenoma with densely packed rounded epithelial cells, with some atypias and rare mitotic figures. There was no evidence of metastases. CONCLUSION: Macroadenoma invading the nasal cavity is a rare condition and few similar cases have been reported in the literature. This study contributes towards showing that tumor extension to the sphenoid sinus and nasopharynx needs to be considered and investigated in order to make an early diagnosis when atypical symptoms like nasal obstruction are present. .


CONTEXTO: Macroadenomas hipofisários são tumores intracraniais raros. Em alguns casos, podem apresentar comportamento agressivo e invadir o seio esfenoidal e a cavidade nasal, causando sintomas não usuais. Neste relato de caso, descrevemos um caso atípico de adenoma hipofisário manifestando-se como uma massa nasal. RELATO DE CASO: A paciente de 44 anos, do sexo feminino, apresentava amenorreia e galactorreia por 10 meses associando-se a obstrução nasal, macroglossia e acromegalia. Os níveis do hormônio de crescimento e de prolactina apresentaram-se aumentados. Ressonância magnética mostrou uma grande massa originada da superfície inferior da glândula hipofisária associada com erosão da sela túrcica e extensão do tumor através do seio esfenoidal e cavidade nasal. Análise histopatológica demonstrou adenoma hipofisário cromófobo com células epiteliais arrendondadas densamente agrupadas com algumas atipias e escassas figuras de mitose. Não houve evidências de metástase. CONCLUSÃO: O macroadenoma invasivo para a cavidade nasal é uma condição rara e há poucos relatos similares descritos na literatura. Este trabalho contribui para mostrar que, na presença de sintomas atípicos como a obstrução nasal, a extensão para o seio esfenoidal e para a nasofaringe deve ser considerada e investigada para um diagnóstico precoce. .


Subject(s)
Adult , Female , Humans , Adenoma/pathology , Nasal Cavity/pathology , Nose Neoplasms/pathology , Paranasal Sinus Neoplasms/pathology , Pituitary Neoplasms/pathology , Sphenoid Sinus/pathology , Adenoma/surgery , Diagnosis, Differential , Human Growth Hormone/blood , Insulin-Like Growth Factor I/analysis , Magnetic Resonance Imaging , Nasal Cavity/surgery , Nasal Obstruction/etiology , Neoplasm Invasiveness/pathology , Nose Neoplasms/surgery , Paranasal Sinus Neoplasms/surgery , Pituitary Neoplasms/surgery , Sphenoid Sinus/surgery
16.
Rev. bras. cir. plást ; 29(3): 438-441, jul.-sep. 2014. tab, ilus
Article in English, Portuguese | LILACS | ID: biblio-741

ABSTRACT

INTRODUÇÃO: Tradicionalmente, a fissura palatina é corrigida em duas camadas - uma camada mucosa nasal e camada muco-periosteal oral. Este estudo avaliou os resultados do fechamento em camada única de fissura palatina comparado ao fechamento tradicional em camada dupla. MÉTODOS: Trata se de revisão de prontuários de 101 casos de correção de fissura palatina realizados entre 1981 e 2012 em uma clínica assistencial/hospital terciário localizado no centro de Wisconsin. Os casos utilizaram fechamento em camada única e foram acompanhados em Clínica de Lábio Leporino por 12 meses. Foram incluídas fissura labial e palatina também como fissura palatina isolada. RESULTADOS: Todos os casos apresentaram cicatrização satisfatória exceto dois casos que necessitaram de correção posterior de pequena fistula. CONCLUSÃO: O fechamento em camada única de fissura palatina é tão efetivo quanto o fechamento tradicional em camada dupla, além disso apresenta mínimas complicações.


INTRODUCTION: Traditionally, cleft of the hard palate is repaired in two layers, with a nasal mucosal layer and an oral mucoperiosteal layer. The aim of this study was to evaluate the results of one layer closure of hard palate cleft compared to the traditional two layers closure. METHODS: The charts of 101 consecutive cases of repair of hard palate cleft performed by the authors from 1981 to 2012 at a tertiary care clinic/hospital in central Wisconsin were reviewed. The cases utilized the single layer closure and were followed in the Cleft Palate Clinic on a yearly basis. Cases included unilateral and bilateral cleft lip and palate as well as isolated cleft palate. RESULTS: All cases healed satisfactorily except for two cases that later required small fistulae repair. CONCLUSION: Single layer closure of the hard palate cleft is as effective as traditional two-layer closure, with minimal complications.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , History, 21st Century , Surgery, Plastic , Comparative Study , Cleft Lip , Cleft Palate , Review , Oral Surgical Procedures , Evaluation Study , Palate, Hard , Mouth , Nasal Cavity , Surgery, Plastic/methods , Cleft Lip/surgery , Cleft Lip/pathology , Cleft Palate/surgery , Oral Surgical Procedures/methods , Palate, Hard/surgery , Mouth/surgery , Mouth/pathology , Nasal Cavity/surgery , Nasal Cavity/pathology
17.
Rev. chil. neurocir ; 40(1): 12-17, jul. 2014. tab
Article in Spanish | LILACS | ID: biblio-831376

ABSTRACT

Introducción: Los craneofaringiomas, son tumores frecuentes y aunque son histológicamente benignos, plantean importantes problemas terapéuticos por su naturaleza y morbilidad asociada a la cirugía, siendo una lesión desafiante para los neurocirujanos. Material y Método: Se realizó un estudio descriptivo de los resultados alcanzados con el abordaje endonasal endoscópico extendido trans-tubérculo trans-plano en una serie de pacientes con diagnóstico de craneofaringioma en el período de 2009 al 2012 en el Hospital Clínico Quirúrgico “Hermanos Ameijeiras”. Resultados: Se intervinieron 37 pacientes, (23 F/14 M). Se logró la resección total macroscópica en 34 pacientes. La complicación más frecuente fue la diabetes insípida presentada en 16 enfermos. Tuvimos 4 fallecidos: 3 de ellos por complicaciones médicas en el postoperatorio tardío. Conclusiones: El abordaje endonasal endoscópico extendido trans-tubérculo trans-plano permite acometer el tratamiento quirúrgico favoreciendo una resección amplia para este tipo de lesión. Con tecnología aun en desarrollo este abordaje representa una alternativa esperanzadora para los pacientes con craneofaringiomas.


Introduction: The craneopharyngiomas, are frequent tumors and although they are histological benign lesion, they outline therapeutic important problems for their nature and morbidity associated to the surgery, being a defiant lesion for neurosurgeons. Material and Methods: In this article, we present the results using Extended Endonasal Endoscopic Approach trans-tuberculum trans-planum in patient with craniopharyngioma in “Hermanos Ameijeiras” Hospital between 2009 and 2012. Results: 37 patients were operated, (23 F/ 14 M). We achieve gross total resection in 34 patients. The most frequent complication was insipid diabetes presented in 16 patients. We had 4 deaths, 3 of them were for postoperative medical complication. Conclusions: The extended endonasal endoscopic approach trans-tuberculum trans-planum allows performing the surgical treatment with a wide resection in this type lesion. With technology even in development this approaches represents an alternative for patients with craniopharyngioma.


Subject(s)
Humans , Male , Craniofacial Abnormalities/surgery , Nasal Cavity/surgery , Craniopharyngioma/surgery , Craniopharyngioma/complications , Craniopharyngioma/mortality , Craniopharyngioma , Endoscopy/methods , Diabetes Insipidus, Neurogenic , Epidemiology, Descriptive , Magnetic Resonance Spectroscopy , Tomography, X-Ray Computed
18.
Acta cir. bras ; 29(5): 313-319, 05/2014. tab, graf
Article in English | LILACS | ID: lil-709233

ABSTRACT

PURPOSE: Evaluate and compare two different experimental techniques of maxillary sinus ostium occlusion using N-butyl cyanoacrylate in developing chronic histological findings without the inoculation of pathogenic bacteria among rabbits. METHODS: In a randomized study, sixteen New Zealand rabbits were assigned for occlusion of the right maxillary sinus through a transmaxillary approach or through the roof of the nasal cavity. The contralateral sinus served as a control. After 12 weeks, the animals were sacrificed for blinded histopathological analysis of the maxillary sinus mucosa. RESULTS: Histopathological changes consistent with CRS were found in eight (100%) of the maxillary sinuses approached transmaxillary and three of those through the roof of the nasal cavity (37.5%), p 0.008 and 0.250, respectively, comparing with the control side. Chronic mucosal changes were significantly better induced using the transmaxillary approach (p 0.026). CONCLUSION: It is possible to induce a model of chronic sinusitis among rabbits with transmaxillary sinus occlusion without bacterial inoculation. This model can be replicated for future cellular studies. .


Subject(s)
Animals , Male , Rabbits , Disease Models, Animal , Maxillary Sinus/pathology , Nasal Cavity/pathology , Rhinitis/pathology , Sinusitis/pathology , Biopsy , Chronic Disease , Enbucrilate , Maxillary Sinus/surgery , Nasal Cavity/surgery , Nasal Mucosa/pathology , Reference Values , Reproducibility of Results , Rhinitis/etiology , Sinusitis/etiology , Time Factors
19.
Rev. otorrinolaringol. cir. cabeza cuello ; 73(2): 133-139, ago. 2013. graf, tab
Article in Spanish | LILACS | ID: lil-690557

ABSTRACT

Introducción: Para acceder a la región selar, podemos utilizar las técnicas transcraneal, transeptal, o transnasal endoscópica, pudiendo provocar diferentes grados de hiposmia. Se ha descrito menor morbilidad al utilizar la técnica endoscópica, pero faltan estudios dirigidos a los resultados olfatorios. Objetivo: Determinar la presencia de deterioro olfatorio en los pacientes sometidos a un abordaje transnasal endoscópico. Material y método: Se reclutaron 12 pacientes con tumores en la región selar durante 8 meses. Se les realizó un test de olfato preoperatorio, fueron intervenidos mediante abordaje transnasal endoscópico y controlados al mes posoperatorio. Resultados: Se logró seguimiento a 10 pacientes. Seis (60%) presentaron un test de olfato preoperatorio normal. Al mes posoperatorio, se constató mejoría olfatoria en 1 (10%) paciente, 8 (80%) se mantuvieron en la misma categoría y 1 (10%) presentó deterioro olfatorio. En suma, 9 de 10 pacientes (90%) mantienen o mejoran su olfato al mes posoperatorio. Conclusión: Nuestros resultados sugieren que el abordaje transnasal endoscópico utilizado en este estudio no produce deterioro olfatorio. Dado que además es una técnica de abordaje efectiva y relativamente segura, consideramos que constituye una alternativa factible para utilizar en pacientes con patología tumoral en la región selar.


Introduction: To access the sellar region we can use the transcranial, transeptal, or transnasal endoscopic approaches, which may cause different degrees of hyposmia. It has described less morbidity to use the endocopic technique, however, there are few studies directed at olfactory outcomes. Aim: To determine the presence of olfactory impairment secondary to endoscopic transnasal approach. Material and method: 12 patients with tumors in the sellar region were enrolled during 8 months. They were underwent a smell test preoperatively, operated by endoscopic transnasal approach, and controlled with postoperative retesting, after one month. Results: Follow-up was achieved to 10 patients. 6 (60%) presented a normal preoperative smell test. Within one postoperative month, olfactory improvement was found in 1 (10%) patient, 8 (80%) remained in the same category and 1 (10%) had olfactory impairment. In all, 9 out of 10 patients (90%) maintain or improve their sense of smell after surgery. Conclusions: Our results suggest that the transnasal endoscopic approach used in this study, doesn't produce olfactory impairment. Given that is also an effective and relatively safe approach, we believe that is a feasible alternative for use in patients with tumor pathology in the sellar region.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Smell/physiology , Skull Base Neoplasms/surgery , Endoscopy/adverse effects , Olfaction Disorders/diagnosis , Sphenoid Bone/surgery , Olfactory Mucosa/surgery , Cohort Studies , Follow-Up Studies , Endoscopy/methods , Olfaction Disorders/etiology , Olfaction Disorders/physiopathology , Nasal Cavity/surgery
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