Retrieval-of-displaced-root-fragment-associated-with-fungal-ball-in-the-maxillary-sinus-using-functional-endoscopic-sinus-surgery-a-case-report

Introduction: Fungal ball is a non-invasive sinus disease and the incidence of this disease has increased in recent years and also several case reports and case series have suggested a relationship with the accidental displacement of root into maxillary sinus. We report a case where fungal ball was removed along with the dental root fragment which was accidentally displaced into the maxillary sinus following traumatic dental extraction. A 32-years-oldCase Report: female patient presented to Maxillofacial Surgery Department with complaint of pain in the left orofacial region for one month. The patient had a history of traumatic extraction of posterior maxillary teeth 4 years back. On examination, no dental cause of pain was detected. On further evaluation, a foreign body within the left maxillary sinus was seen in the panoramic radiograph. Computed tomography images revealed displaced root in the left maxillary sinus with surrounding heterogenous soft tissue opacity. Following the detection of foreign body, patient underwent Functional Endoscopic Sinus Surgery (FESS) and the root was retrieved and the adjacent soft tissue specimen was sent for histopathological examination. The presence of fungus consistent with the Aspergillus species was confirmed. Conclusion: This article emphasizes the importance of atraumatic dental extraction, the association of fungal ball with displaced root and the utility of FESS in clearing the same.

Anatomical findings in patients with chronic rhinosinusitis without nasal polyps requiring revision surgery

Abstract Objectives For the treatment of chronic rhinosinusitis functional endoscopic sinus surgery is a well-established therapy with high initial success rates. However, a significant proportion of patients have persistent disease requiring revision surgery. To date, studies including data of large patient collectives are missing. In this study, we aimed to identify anatomic factors increasing the need for revision surgery in a large patient collective with chronic rhinosinusitis without nasal polyps. Methods Data were collected retrospectively on patients with recurrent or persistent chronic rhinosinusitis without nasal polyps requiring revision surgery. The patients' symptomatology, endoscopic and radiographic findings were analyzed. Preoperatively, patients were evaluated with endoscopic examination of the nose and paranasal sinuses. In all individuals computed tomography of the sinuses was performed. Images were evaluated according to the Lund-Mackay system. Information was also collected intraoperatively. Results 253 patients were included. The most common anatomic factor was incomplete anterior ethmoidectomy (51%), followed by residual uncinated process (37%), middle turbinate lateralization (25%), incomplete posterior ethmoidectomy (20%), frontal recess scarring (19%), and middle meatal stenosis (9%). Other factors such as persistent sphenoid pathology was less frequent. Conclusion Iatrogenic causes with inadequate resection of obstructing structures seem to be a principal risk factor for recurrent chronic rhinosinusitis and the need for revision sinus surgery. Meticulous attention in the area of the ostiomeatal complex during surgery with ventilation of obstructed anatomy as well as avoidance of scarring and turbinate destabilization may reduce the failure rate after primary endoscopic sinus surgery. Level of evidence: 2b.

Role of High-Resolution Computed Tomography in the Evaluation of Anatomical Variations of Sphenoid Sinus and Its Clinical Importance in FESS.

Sphenoid sinus of all sinuses is generally the most inaccessible sinus to the surgeons. The trans-sphenoid route is considered to be the standard approach for surgery of pituitary adenomas. Knowing the details of the anatomy of sphenoid sinus and the extent of pneumatization can guide the surgeon through difficult corners of the approach. We wanted to evaluate the incidence of the different anatomical variations of sphenoid sinus as detected by HRCT scan and their impact on related neurovascular structures for the safe removal of inter sphenoid and pituitary lesions.METHODSThis prospective study was conducted in Sree Gokulam Medical College & Research Foundation, Trivandrum. Study population included 150 cases who were referred for HRCT of the paranasal sinuses to the Department of Radiodiagnosis, over a period of 12 months (from November 2018 to October 2019). After obtaining a written informed consent and history, all the patients underwent HRCT axial section of PNS. Once the axial sections were obtained through the paranasal sinuses, these images were reconstructed into coronal sections by multiplanar reconstruction (MPR) technique without exposing the patient.RESULTSOnodi cells were found predominantly in female patients with male:female ratio 2:7. Optic nerve protrusion and dehiscence had male predominance. Rest of the variations had no significant gender difference and few variations were seen equally distributed among both males and females. The most common variation observed in our study was pterygoid process pneumatization. Of the total 150 patients, pterygoid process pneumatization was identified in 76 patients including bilateral in 54 patients. Next common variation observed was vidian nerve protrusion, identified in 62 patients along with dehiscence of wall in 38 patients. Maxillary nerve protrusion was present in 42 patients and its dehiscence of wall in 10 patients. Optic nerve protrusion was identified in 41 patients and dehiscence of wall was noted in only 6 patients.CONCLUSIONSSphenoid sinuses are the most inaccessible paranasal sinuses and are surrounded by significant anatomical structures such as the orbit and its contents, cavernous sinus, internal carotid artery (ICA) and the anterior cranial fossa. HRCT of sphenoid sinus for the demonstration of the anatomical variations and its relation to the vital adjacent crucial anatomical structures helps in reducing the complications during trans-sphenoidal surgeries and functional endoscopic sinus surgery. Our study of HRCT findings delineates most of the anatomical variations in sphenoid sinus and thus helps the surgeons in appropriate surgical planning and helps them to reduce the intraoperative complications.

Resultados clínicos e imagenológicos en pacientes con rinosinusitis crónica odontogénica / Evaluation of clinical and imaging results in patients with chronic odontogenic rhinosinusitis

INTRODUCCIÓN: La rinosinusitis crónica odontogénica (RSCO) es un proceso inflamatorio/infeccioso de la mucosa nasal y senos paranasales (SPN) de origen dental. Corresponde a una patología subdiagnosticada en la actualidad. El gold standard diagnóstico es la tomografia computarizada. Los tratamientos difieren, desde tratamiento médico aislado hasta médico-quirúrgico de SPN o combinados. OBJETIVO: Caracterizar los resultados clinicos e imagenológicos de pacientes con RSCO en función del tratamiento recibido, para establecer recomendaciones terapéuticas. Describir la frecuencia de subdiagnóstico de esta patología. MATERIAL Y MÉTODO: Estudio descriptivo, retrospectivo. Se incluyeron pacientes con diagnóstico clínico e imagenológico de RSCO entre los años 2013-2017 en un centro de atención médico privado, a los que se realizó una tomografía computarizada cone beam de control. Fueron excluidos aquellos con rinosinusitis crónica, cirugía endoscópica funcional (CEF) previa, cáncer, embarazadas, rechazo a tomografía computarizada cone beam, ausencia de imágenes preoperatorias y menores de 18 años. RESULTADOS: De un total de 27 pacientes, en los operados de CEF (n =24; 89%) la resolución total de los síntomas se logró en 20/24 (83%), resolución parcial 3/24 (12,5%) y persistencia de los síntomas 1/24 (4%). Discusión: De los pacientes con RSCO 22/27 (81%) no tenían reportado el foco dental en el informe radiológico a pesar de ser visible. Aquellos pacientes con sintomatologia postratamiento, hubo factores identificados como la bilateralidad, mala dentadura general, falta de combinación de tratamiento dental y CEF. CONCLUSIONES: La CEF combinada con tratamiento dental concomitante, tiene un alto grado de éxito radiológico y clínico en esta patología. No fue posible demostrar si siempre es requerida la exodoncia con cierre de fístula oro-antral o si se pueden seleccionar pacientes para un tratamiento más conservador.

INTRODUCTION: Chronic odontogenic rhinosinusitis (CORS) is an inflammatory/infectious process of the nasal mucosa and sinuses of dental origin. Actually, it corresponds to an underdiagnosed pathology. The gold standard diagnosis is computed tomography. The treatments differ, from isolated medical treatment to medical-surgical sinuses or combined. AIM: To characterize the clinical and imaging results of patients with CORS according to the treatment received, to establish therapeutic recommendations. In addition to describing the frequency of subdiagnosis of this pathology. MATERIAL AND METHOD: Descriptive, retrospective study. Patients with clinical and imaging diagnosis of CORS between 2013-2017 were included in a private medical care center, to whom a cone beam computed tomography control was performed. Those with chronic rhinosinusitis, previous functional endoscopic sinus surgery (FESS), cancer, pregnant women, rejection of cone beam computed tomography, absence of preoperative images and those under 18 years were excluded. RESULTS: Of all patients operated on FESS (n =24; 89%) the total resolution of the symptoms was 20/24 (83%), partial resolution 3/24 (12.5%) and persistence of the symptoms a 1/24 (4%). Discussion: 22/27 (81%) of patients with CORS had not reported the dental focus in the radiological report despite being visible. Those patients with post-treatment symptoms had identified factors such as bilaterality, general bad teeth, lack of combination of dental treatment and FESS. CONCLUSION: The FESS combined with concomitant dental treatment, has a high degree of radiological and clinical success in this pathology. It was not possible to demonstrate whether exodontia with closure of oroantral fistula is always required or if patients can be selected for a more conservative treatment.

Soaking oro-pharyngeal pack with triamcinolone acetonide lowers discomfort in functional endoscopic sinus surgeries / Pack orofaringeo con triamcinolone disminuye molestias luego de cirugía endoscópica sinusal

BACKGROUND: Postoperative sore throat (POST) is defined as pain or discomfort in the throat following general anesthesia. Throat packs are used by many surgical subspecialties for different benifits, however they may increase the incidence of POST. Many interventions can be used to decrease incidence of POST. Triamcinolone acetonide (TA) is a moderately potent topical corticosteroid preparation. In this study, we hypothesized that soaking the throat pack with TA may decrease POST. METHODS AND MATERIAL: This prospective interventional comparative study was performed on 54 patients planned for Functional Endoscopic Sinus Surgeries (FEES) surgery. After endotracheal intubation, a standard length of oro-pharyngeal pack was placed, then patients were randomly allocated into: Group I: Oro-pharyngeal packs were soaked with 15 mg Triamcinolone acetonide 0.1% and Group II: packs were soaked with the same volume of lubricating gel (K-Y gel®). The patients were postoperatively asked about: sore throat, dysphagia, hoarseness of voice and nausea and vomiting. RESULTS: Thirty minutes and 24 hours after extubation, Group I patients showed lower but statistically insignificant sore throat scores. Two to six hours after extubation, Group I showed a statistically significant reduction in sore throat scores. Six patients suffered dysphagia in group I compared with 8 patients in group II. Hoarseness of voice occurred in 1 patient in group I and 3 patients in group II. No patient complained of nausea or vomiting. cONCLUSIÓN: Soaking oropharyngeal pack with triamcinolone acetonide in orabase gel was able to decrease POST in FESS patients.

Measurements Of Maxillary Sinus In Correlation To Age And Gender By Computed Tomography

Introduction: The sinonasal region is often imaged because of infectious and allergic diseases of the nasal cavityand paranasal sinuses. Improved knowledge of normal pneumatization and development of paranasal sinusesis important to allow sinus diseases to be evaluated and an adequate treatment to be proposed.Materials and methods: 100 patients (72 males and 28 females) undergoing coronal and axial sections of computedtomography scan of maxillary sinus of head and neck aged between 1year to 90 years at the Radiology Department,Vydehi Institute of Medical Science & Research Centre Bangalore for reasons other than due to craniofacialabnormalities or sinus problem were taken for the study. Volume and dimensions of the maxillary sinuses withits anatomical variations were obtained. Mean, SD, significant difference between age & gender was calculated.Results: Maxillary sinuses in Males on both sides have higher values in mean height, depth and volume thanfemales except right side width which was lesser in value than females. All the mean parameters were more onleft sinus both in male and females, except mean height of right sinus in males, on side comparison all the meanparameters were more on right side in females. There is a significant difference in mean height of right and leftmaxillary sinus in between male and female. There is a significant difference on right and left side widthbetween male and female in the age group 51-60 yrs and 61-70 yrs. The maximum age growth in males was during11-20 yrs and 41-50 yrs in height, width and volume, in 21-30 yrs and 31-40 yrs in depth, later dimensions weredecreasing in growth by 61-70 yrs in height and 81-90 yrs both in depth, width and volume. In females maximumgrowth was in 21-30 yrs and 51-70 yrs for height, depth, volume, 11-20 yrs and 51-60 yrs for width dimensions, laterdecreases by 61-70 yrs onwards in height, width and 11-20 yrs in depth and volume.Conclusion: These results will be helpful in understanding normal and pathological conditions of the maxillarysinuses and useful in clinical planning of medical or surgical interventions of the maxillary sinuses

Definition and management of odontogenic maxillary sinusitis / 대한악안면성형재건외과학회지

BACKGROUND: Maxillary sinusitis of odontogenic origin, also known as maxillary sinusitis of dental origin or odontogenic maxillary sinusitis (OMS), is a common disease in dental, otorhinolaryngologic, allergic, general, and maxillofacial contexts. Despite being a well-known disease entity, many cases are referred to otorhinolaryngologists by both doctors and dentists. Thus, early detection and initial diagnosis often fail to detect its odontogenic origin. MAIN BODY: We searched recent databases including MEDLINE (PubMed), Embase, and the Cochrane Library using keyword combinations of “odontogenic,” “odontogenic infection,” “dental origin,” “tooth origin,” “sinusitis,” “maxillary sinus,” “maxillary sinusitis,” “odontogenic maxillary sinusitis,” “Caldwell Luc Procedure (CLP),” “rhinosinusitis,” “functional endoscopic sinus surgery (FESS),” “modified endoscopy-assisted maxillary sinus surgery (MESS),” and “paranasal sinus.” Aside from the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) trial, there have been very few randomized controlled trials examining OMS. We summarized the resulting data based on our diverse clinical experiences. CONCLUSION: To promote the most efficient and accurate management of OMS, this article summarizes the clinical features of rhinosinusitis compared with OMS and the pathogenesis, microbiology, diagnosis, and results of prompt consolidated management of OMS that prevent anticipated complications. The true origin of odontogenic infections is also reviewed.

Quality of Life after Functional Endoscopic Sinus Surgery in Patients with Chronic Rhinosinusitis at Tertiary Care Hospital

Background: Chronic rhinosinusitis (CRS) is a pathogenic disease of infection commonly affected the ear, nose and throat. Chronic Rhinosinusitis (CRS) has a serious negatively impact over quality of life of patients. Quality of life, nature of job and environmental conditions are the primary reasons of spread of rhinosinusitis. Most of the symptoms of CRS are not life threatening but generally these leads to poor quality of life by affecting the efficiency of individuals. Methods: This prospective study was conducted in the department of ENT in tertiary care hospital among the 50 patients with clinical presentation, endoscopy examination and CT-scan changes of chronic rhinosinusitis (CRS) without a polyp. The history of the patients were taken and then the different ENT examinations were done like endoscopic examination of the nose and CT-scan imaging. All the surgeries like uncinectomy, middle meatal antrostomy, anterior and posterior ethmoidectomy, or opening of the sphenoid sinus were performed under general anesthesia with orotracheal intubation and hypotensive technique. All the patients were regularly given the postoperative antibiotic and nasal steroid treatments and reviewed regularly. Sinonasal Assessment Questionnaire - 11 (SNAQ-11) were used for the collection of data because this questionnaire contains 11 questions covering most of the symptoms of sinonasal diseases. Results: ‘Total 50 patients were included in this study among them 32 (64%) were male and 18 (36%) were females. All the patients was between 18-60 years among them 16 (32%) were the age group 25-35 years, followed by age group 35-45 years 14 (28%). The most common preoperative complaint of the patients was nasal obstruction (100%) patients, followed by nasal congestion (96%), facial pain (94%), running nose (90%), anterior nasal discharge (76%), and least complaint was sneezing (28%) and earache (28%). Conclusion: The study concludes, this study shows the significant outcome of improvement in the quality of life of patients in all the three subgroups of chronic rhinosinusitis which can be assessed by using SNOT-11 questionnaire. The Functional endoscopic sinus surgery performed in patients with chronic rhinosinusitis has statistically significant with the association of improvement in the QoL after twenty 24 month follow up. There is paucity of data so more studies are required to the scientific evidence gathered on the effectiveness of surgery offered to our population, as seen in studies performed in other countries.

Clinical outcome and patient satisfaction using biodegradable (NasoPore) and non-biodegradable packing, a double-blind, prospective, randomized study / Desfecho clínico e satisfação do paciente com o uso de tampão biodegradável (NasoPore) e não biodegradável: estudo prospectivo, duplo-cego e randomizado

Abstract Introduction Nasal packing after endoscopic sinus surgery is used as a standard procedure. The optimum solution to minimize or eliminate all disadvantages of this procedure may be accomplished using biodegradable packs. Objective The aim of this study was to compare patient satisfaction and clinical outcome associated with absorbable and non-absorbable packing after FESS. Methods In total, 50 patients were included in a prospective, double-blind, randomized trial. One side was packed with polyurethane foam, while the opposite side was packed with gauze packing. On the 2nd, 10th, and 30th postoperative day, the patients were questioned with the aid of a visual analog scale. The standardized questionnaires for bleeding, nasal breathing, feeling of pressure, and headache were used. The presence of synechiae, infection, or granulation was noted and recorded with the video-endoscopy. Results A significant difference according to lower pressure was found in the NasoPore group compared to the controls on day ten after surgery. The NasoPore packing had lower scores with respect to postoperative nose blockage on the 2nd and 10th days. Mucosal healing was better for the NasoPore group, both at day ten and 30 compared with the control group. Conclusion The overall patient comfort is higher when using NasoPore compared to non-resorbable traditional impregnated gauze packing. Intensive saline douches applied three to four times per day are mandatory after the operation to prevent synechiae formation and fluid resorption by the packing.

Resumo Introdução O tamponamento nasal após cirurgia sinusal endoscópica é procedimento de rotina. A solução ideal para minimizar ou eliminar as desvantagens desse procedimento pode ser alcançada com o uso de tampões biodegradáveis. Objetivo Comparar a satisfação do paciente e o desfecho clínico associados ao uso de tampões absorvíveis e não absorvíveis após a cirurgia funcional dos seios paranasais (FESS- Functional Endoscopic Sinus Surgery). Método Foram incluídos 50 pacientes neste estudo prospectivo, duplo-cego e randomizado. Um dos lados foi tamponado com espuma de poliuretano, enquanto no outro lado foi feito um tamponamento com gaze. Nos 2º, 10º e 30º dias após a operação, os pacientes foram perguntados com a ajuda de uma escala analógica visual. Foram empregados questionários padronizados para sangramento, respiração nasal, sensação de pressão e cefaleia. A presença de sinequias, infecção ou granulação foi registrada por videoendoscopia. Resultados Foi observada diferença significante, da sensação de pressão, menor no lado tratado com NasoPore vs. controles no 10º dia após a cirurgia. O tamponamento com NasoPore obteve escores mais baixos com respeito ao bloqueio nasal pós-operatório no 2º e 10º dias. A cicatrização da mucosa foi melhor no lado do NasoPore, mas no 10º e 30º dias os resultados foram comparáveis com os do lado de controle. Conclusão O conforto geral do paciente é maior com o uso de NasoPore vs. tamponamento tradicional com gaze besuntada não reabsorvível. O uso vigoroso de jatos de solução salina aplicados 3-4 vezes ao dia é um procedimento obrigatório após a cirurgia, para evitar a formação de sinequias e para uma absorção natural do tampão.

Setting of an endoscopic nasal reference point for surgical access to the anterior base through an anatomical study on cadavers / Definição do ponto de referência endoscópica nasal ao acesso cirúrgico à base anterior por estudo anatômico em cadáveres

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.

Quality of life after FESS among patients with nasal polyps using the NOSE questionnaire translated in Filipino (NOSE-Ph)

@#<p><strong>OBJECTIVE:</strong> To evaluate the quality of life before, and after Functional Endoscopic Sinus Surgery (FESS) among patients with nasal obstruction due to nasal polyposis using the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire translated in Filipino (NOSE-Ph) in a tertiary government hospital in Metro Manila.</p> <p><strong>METHODS:</strong></p> <p><strong>Design:</strong>Cross-Sectional QOL Study</p> <p><strong>Setting:</strong>Tertiary Government Hospital</p> <p><strong>Participants:</strong>  40 patients with nasal polyposis who underwent FESS from April 2014 to June 2015 were included in the study. Patients who underwent FESS due to other nasal tumors other than nasal polyp were excluded. The subjects answered the previously-validated NOSE-Ph questionnaire pre- and post-operatively and the scores were gathered and analyzed.</p> <p><strong>RESULTS:</strong>Based on the pre and post-operative scores, there was a statistically significant improvement in all 5 parameters (1. nasal congestion, 2. nasal obstruction, 3. trouble breathing, 4.  trouble sleeping, and 5. inability to get enough air through the nose during exercise).</p> <p><strong>CONCLUSION:</strong>There was a statistically significant improvement in the quality of life of patients who underwent FESS based on the pre and post-operative scores using the NOSE-Ph questionnaire translated in Filipino.  </p>

Clinical Study of Headache in Relation to Sinusitis and its Management.

Aim: To study relation of headache with sinusitis and its management. Material and methods: Patients clinically presenting with headache were selected. Only patients with headache due to rhinogenic causes were subjected to X-ray paranasal sinuses (PNS) and diagnostic nasal endoscopy (DNE) and were followed up to evaluate management. Results: Majority of the patients were of age group 21-30 years and it is more predominant in males. Majority of the patients with headache had deviated nasal septum (DNS) (28.9%), acute sinusitis (28.9%), osteomeatal complex disease (24.63%); few patients had nasal polyp (8.69%), allergic rhinitis (5.79%) and rarely patients had atrophic rhinitis (2.89%). Headache was localized in forehead (43.4%), more than one site (34.7%) in majority of cases and few number of patients had headache at glabella (13.04%) and top of head (8.69%). Majority of the patients who underwent antral washout were not relieved, so they underwent functional endoscopic sinus surgery (FESS), which gave dramatic results in improving symptoms including headache. Conclusions: Headache is nearly a universal human experience. The lifetime incidence of headache is estimated to be at least 90%. To know whether the headache is sinogenic or not, the patient is first assessed clinically and then radiological investigations (X-ray PNS) are done. Role of FESS is huge and ultimately it is FESS that is the cure for headache due to rhinogenic causes.

The Effect of Fentanyl for Patient-controlled Analgesia after Functional Endoscopic Sinus Surgery / 医学研究杂志

Objective To observe the analgesic effects and the side effects of fentanyl after the FESS with general anesthesia.Methods 101 adult male patients,ASA Ⅰ～Ⅱ,undergoing elective FESS were divided into two groups randomly,received fentanyl through PCA or no analgesia.The PCA device was set at background infusion 0.1?g/(kg?h),bolus dose 0.4?g/kg?time,lockout time 15 minutes.The maximum dose is 600?g per day.Virtual signs,VAS,Ramsay sedation,dizzy,nausea,vomit and appetite were observed after the operation for two days.Results The VAS of the two groups is significant different in the time of the second morning and 24 hours later after the operation(P

A Case of Medial Rectus Muscle Injury and Optic Nerve Transection Developed During Functional Endoscopic Sinus Surgery

PURPOSE: We encountered a patient with right medial rectus muscle injury and optic nerve transection that had developed during functional endoscopic sinus surgery(FESS) and thus, report the present case with a literature review. METHODS: A 59-year-old woman was transferred to the present hospital due to the inability to adduct the right eye to the midline, exotropia, and loss of vision after she had underwent functional endoscopic sinus surgery due to bilateral chronic paranasal sinusitis and polyps in a local ENT clinic. RESULTS: The right eye could not perceive the light. The patient showed 40 exodeviation by the Hirschberg's test and marked limitation on adduction. Flame-shaped retinal hemorrhages and a cherry-red spot were present in the posterior pole on the fundus examination using slit-lamp biomicroscopy. Orbital computerized tomography showed the evidence of medial rectus muscle injury and complete transection of the optic nerve. Postoperative endoscopic paranasal sinus examination showed the evidence of complete transection of the ophthalmic artery and vein. CONCLUSIONS: Clinicians should have thorough understanding of the anatomy of the paranasal sinus, especially, the ethmoid sinus and orbit in order to prevent serious complications as in our case. Endoscopic examination of the nasal cavity and orbital computerized tomography must be performed before surgery for accurate diagnosis. Furthermore, experienced surgeons who would perform this type of surgery with great precision could prevent permanent loss of vision through extraocular muscle injury or optic nerve transection.

Expression of Transforming Growth Factor-beta(TGF-beta) Family in Nasal Polyps and Postoperative Polypoid Mucosa after Functional Endoscopic Sinus Surgery

Transforming growth factor (TGF)-beta1, beta2, and beta3 are multifunctional proteins which play an important role in chronic inflammatory process, angiogenesis, and epithelial differentiation. In nasal polyps and postoperative polypoid mucosa after functional endoscopic sinus surgery (FESS), changes of expression of TGF-beta family were assessed to identify its role in formation of nasal polyps and mucosal healing after FESS. Nasal polyps and polypoid mucosa were obtained during FESS and in outpatient clinic after the surgery, respectively. Immunohistochemical staining was performed. TGF-beta family was highly expressed in the epithelium, subepithelial glands, neutrophils and eosinophils of nasal polyps. On the other hand, expression of TGF-beta family decreased in the epithelium and subepithelial gland of polypoid mucosa according to a postoperative period after FESS. These results suggest that TGF-beta family may play an important role in formation of nasal polyps and it decreases in process of mucosal healing after FESS.