Treatment of intractable diseased tissue in the maxillary sinus after endoscopic sinus surgery with high-pressure water jet and preservation of the periosteum.

OBJECTIVE: To describe a new high-pressure water jet (HPWJ) treatment to remove intractable diseased mucosa persisting in the maxillary sinus several months after endoscopic sinus surgery (ESS) while preserving the periosteum. DESIGN: A retrospective review of HPWJ treatment in 45 consecutive patients with at least 12 months follow-up. SETTING: A private surgicenter in Japan. PATIENTS: Patients (25 male and 20 female) ranged in age from 8 to 59 years. All patients had diffuse intractable lesions in the opened maxillary sinus after the initial ESS, with or without disease of the ethmoid and other major sinuses. MAIN OUTCOME MEASURES: Resolution of diffuse intractable disease in the maxillary sinus and postoperative change in the size of the cavity were evaluated using nasal endoscopy and computed tomographic scan. RESULTS: Twenty-six (81%) of 32 sides in 25 patients with isolated persistent maxillary sinus disease were restored after HPWJ procedures; 25 (93%) of 27 sides in 20 patients who also had ethmoiditis also were restored. In the latter group, ethmoiditis recurred in 5 sides, which also included 2 sides of unrestored maxillary sinuses. Of the 51 restored sides, 33 (65%) were restored within 3 months after HPWJ treatment under endoscopic observation. No complications were seen during the surgery. Except for 1 side in 1 patient from which all diseased mucosa was removed almost completely, along with the periosteum, no reduction of the cavity by scar tissue formation was observed. This method did not affect the development of the maxillary bone in children. CONCLUSION: Removing diffuse intractable diseased mucosa in the maxillary sinus while preserving the periosteum with HPWJ treatment is an effective surgical therapy that fulfills the ultimate purpose of ESS.

Extended endoscopic frontal sinus surgery to interrupted nasofrontal communication caused by scarring of the anterior ethmoid: long-term results.

OBJECTIVE: To examine the long-term results of extended endoscopic frontal sinus surgery, including removal of the floor of the frontal sinus (Draf type II procedure) and the median drainage operation (Draf type III procedure or modified Lothrop procedure), for obstructive frontal sinusitis caused by postoperative scar formation, with the emphasis on the long-term success of the median drainage procedure. DESIGN: Retrospective review of 22 consecutive cases of extended endonasal frontal sinus surgery in patients with obstructive frontal sinusitis caused by postoperative scarring. SETTING: The procedures were performed at a private surgicenter in Japan. PATIENTS: Twenty-two patients (15 males and 7 females) ranging in age from 14 to 61 years. All patients had scar formation in the anterior ethmoid, either with or without middle turbinate lateralization or ethmoiditis. Three patients underwent Draf type II procedure followed by Draf type III procedure because of surgical failure of the type II procedure. MAIN OUTCOME MEASURES: Restoration of communication to the frontal sinus was evaluated by computed tomography. All patients were examined at least 12 months after surgery or stent removal. RESULTS: Of the 16 patients who underwent the type III procedure, in 14 (88%) the patency of the opening to the frontal sinus and an aerated sinus were confirmed. Of 12 sides in 9 patients who underwent Draf type III procedure, 5 sides (42%) were also confirmed as "cured." CONCLUSIONS: The median drainage operation (Draf type III procedure) on the frontal sinus showed excellent long-term results compared with the type II procedure. Extended endoscopic frontal sinus surgery, particularly the median drainage procedure, is useful in the functional treatment of obstructive frontal sinusitis caused by postoperative scarring.

[A case of lymphoma which developed bone, liver, and skin lesions two years after the diagnosis of lymphoid interstitial pneumonia].

We reported a case of lymphoid interstitial pneumonia (LIP) in 1985. The patient, a 37-year-old housewife, had suffered from cough and dyspnea. Her chest roentgenograms revealed bilateral diffuse micronodular shadows. After open lung biopsy in 1983, the lesion was interpreted as LIP in the premalignant state. After pulse therapy her condition remarkably improved. She was readmitted because of fever and shoulder pain in 1985. X-ray films revealed punched out lesions on the extremities. As liver dysfunction and skin eruptions had been recognized to wax and wane since the first admission, transcutaneous liver biopsy and skin biopsy was done. The diagnosis was middle- to large-sized T cell lymphoma. CHOP therapy seemed effective. However there appeared dyspnea and cotton-like patchy shadows in both lung fields. Despite chemotherapy, she died of pulmonary fungal and cytomegaloviral infection in 1986. As a result of the reevaluation of the open lung biopsy specimen, we concluded that this case should have been considered as lymphoma at onset.