Mucoceles of the paranasal sinuses: surgical treatment and long term results

To present our long term results managing paranasal sinus mucoceles highlighting the pros and cons of the endoscopic approach. Retrospective analysis of the clinical characteristics and treatment outcome of 40 patients with paranasal sinus mucoceles managed by the author over a 9-year period. All patients were subjected to thorough history taking, general otolaryngologic examination, nasal endoscopy and preoperative computed tomography scan of the paranasal sinuses. Magnetic resonance imaging was done whenever indicated to evaluate intracranial and br intraorbital extension. An ophthalmological examination was carried out in patients with ocular or visual disturbances. The patients were 24 males and 16fengles, their age ranged from 6 to 53 years. The clinical presentation consisted mainly of ophthalmological signs and ymptoms that reflects the preferential localization of mucoceles in the frontoethmoid complex [52.5%]. Thirty six case were managed solely and successfully via endoscopic means. The remaining 4 cases were managed by external approach alone [2 cases] or through combined external and endoscopic approaches [2 cases]. Follow-up ranged between 10-70 months. At the last follow up visit, the presenting symptoms resolved completely in 33 patients, improved in 5 patients. Two patients reported persistence of headache which was later diagnosed as migraine. Our study pointed out the usefulness of the endoscopic approach for both the treatment and follow up of mucoceles. This mini-invasive technique permits accurate drainage and marsipulization of the mucocele with low morbidity, excellent visualization, lack of external incision, and a short hospital stay. Throughout our experience, the endonasal endoscopic approach has proved to be a reliable intervention modality with a favorable long term outcome

Allergic fungal sinusitis: clinical aspects and treatment outcome

To highlight the clinical approach to patients with allergic fungal sinusitis and describe our surgical technique to enhance access and minimize recurrence among these patients. Retrospective analysis of the clinical characteristics and treatment outcome of 20 patients with AFS managed by the author over a 6- year period. Full history taking, complete endoscopic evaluation, CT scan of the paranasal sinuses and histopathological evaluation of the retrieved allergic mucin were done in all cases. The patients were 8 males and 12 females, 10 to 60 years. All patients were subjected to endoscopic sinus surgery followed by meticulous follow up and steroid therapy. Follow-up ranged between 2 - 65 months. At the last follow up visit, 12 patients had endoscopically well healed cavities with no evidence of disease. Seven patients had revision surgery during the follow up period. Allergic mucin is the most consistent feature of AFS. The cornerstone of management is ample and lasting drainage of the affected areas followed by topical and systemic steroids. Long term endoscopic surveillance is mandatory to detect and manage early recurrence

FESS: realistic expectations

To evaluate the outcome of functional endoscopic sinus surgery [FESS] in managing chronicrhino sinusitis [CRS] patients and to identify some of the risk factors that might have an impact on the outcome of surgery. Retrospective analysis of the outcome of FESS in 200 patients with CRS operated upon by the author over 6- year period. Mean follow up duration was 3.2 years. Both subjective and objective parameters were considered in the evaluation pre and postoperatively. The study population consisted of 120 males and 80 females. Mean age at time of surgery was 40 years. Preoperative symptoms improved in 93% of the operated patients. Nasal obstruction was the symptom most responsive to surgery. Endoscopic surveillance revealed only 59.7% of the study population to have well- healed normal cavities. Disease extent, smoking and history of prior surgery significantly affected the outcome of surgery. FESS remains the best alternative to treat patients with CRS resistant to medical treatment. Discrepancy between subjective and objective parameters was evident. The beneficial effects of endoscopic surgery can only be maintained by intensive postoperative medical treatment and thorough endoscopic aftercare

utility of nasal endoscopy in the diagnosis of sinonasal and pulmonary sarcoidosis

Sarcoidosis is a granulomatous disease of unknown etiology that may affect any organ. Although involvement of the epithelium of the upper respirafory tract is comparatively infrequent, nasal symptoms may be the first manifestation of the disease. In this study, we are trying to highlight the importance of the noninvasive nasal endoscopy in the early detection and diagnosis of patients with sarcoidosis. Our study population consisted of 80 patients; group A [50 patients with biopsy proved pulmonary sarcoidosis] and group B [30 patients with quiery pulmonary sarcoidosis]. Positive nasal biopsies were found among 14% and 16.6% of both groups respectively. The easily accessible nasal cavity can yield important information that help diagnose patients with sarcoidosis without resorting to any invasive procedures

Endoscopic coagulation of sphenopalatine neurovascular bundle for intractable allergic rhinitis: a histopathological study

Manifestations of allergic rhinitis are due to a primary immunologic response which leads to a battery of neurovascular reactions. The sphenopalatine foramen [SPF] transmits both the blood and nerve supply to and from the nasal mucosa. We aimed at controlling the allergic reaction by endoscopically coagulating the neurovascular bundle at the SPF. The results were evaluated in patients with intractable allergic rhinitis by comparing the histopathological changes in biopsy specimens from the middle turbinate on the operated sides with control biopsies from the unoperated sides both at 1 month and at 2 years postoperatively. Qualitative and morphometric quantitative histopathological evaluation of the middle turbinate mucosa showed dramatic diminution of the mucosal reactivity and inflammatory cellular infiltrate compared with the control levels at one month postoperatively: At 2 years postoperatively, there is a gradual weaning of these effects Endoscopic coagulation of the sphenopalatine neurovascular bundle is a minimally invasive technique that seems promising in controlling intractable allergic rhinitis that fails to respond to medical treatment