ABSTRACT
BACKGROUND: Predicting which chronic rhinosinusitis patients have nasal obstruction due to reversible mucosal inflammation could prevent unnecessary surgery. AIM: To investigate whether the change in nasal peak inspiratory flow following maximal decongestion (i.e. mucosal reversibility) at first visit predicts the response to topical steroids in chronic rhinosinusitis patients, as measured by the 22-item Sinonasal Outcome Test. METHODS: Prospective study of 128 consecutive new adult patients presenting with nasal obstruction due to chronic rhinosinusitis (January 2008 to July 2010). The 22-item Sinonasal Outcome Test questionnaire was administered and the nasal peak inspiratory flow assessed. Following maximal nasal decongestion, the nasal peak inspiratory flow was again tested and the difference calculated. Topical steroids were administered for at least six weeks. The 22-item Sinonasal Outcome Test was then repeated and the difference calculated. RESULTS: Data were analysed using means and correlation studies (Spearman's rank correlation). There was no correlation between the pre- versus post-decongestion nasal peak inspiratory flow difference and the pre- versus post-steroid 22-item Sinonasal Outcome Test difference, in chronic rhinosinusitis patients with or without nasal polyps. CONCLUSION: The difference between pre- and post-decongestion nasal peak inspiratory flow does not predict chronic rhinosinusitis patients' response to topical steroids.
Subject(s)
Nasal Decongestants/administration & dosage , Nasal Obstruction/drug therapy , Phenylephrine/administration & dosage , Rhinitis/drug therapy , Sinusitis/drug therapy , Steroids/administration & dosage , Administration, Intranasal , Adult , Aged , Chronic Disease , Humans , Lidocaine/administration & dosage , Middle Aged , Nasal Obstruction/physiopathology , Peak Expiratory Flow Rate/drug effects , Prospective Studies , Rhinitis/complications , Rhinitis/physiopathology , Sinusitis/complications , Sinusitis/physiopathology , Surveys and Questionnaires , Treatment Outcome , Young AdultABSTRACT
OBJECTIVE: We present two cases of dental implant migration into the maxillary sinus, with subsequent removal via image-guided, transnasal endoscopy. METHOD: Presentation of clinical cases, together with a literature review of alternative surgical techniques, the theories behind implant migration, and the benefits of an image-guided, endoscopic approach. RESULTS: One patient was asymptomatic, and the other had begun to experience sinogenic symptoms after implant displacement. Both patients presented to the ENT clinic, and both underwent the BrainLab protocol to generate computed tomography images for navigational reconstruction. Transnasal endoscopy was carried out with this guidance, and the implants were removed successfully in both cases. Previously used surgical techniques such as the Caldwell-Luc procedure or extraction through the tooth socket have higher rates of conversion to open procedures, more damage to the nasal sinuses and higher post-operative complication rates compared with the transnasal endoscopic approach. CONCLUSION: Both patients underwent successful removal of their migrated dental implants with no complications, and neither required any follow-up intervention.
Subject(s)
Dental Implants , Endoscopy/methods , Foreign-Body Migration/surgery , Maxillary Sinus/diagnostic imaging , Device Removal/methods , Diagnostic Imaging , Female , Humans , Maxillary Sinus/surgery , Middle Aged , Surgery, Computer-Assisted , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Retrieval of foreign bodies lodged in the orbit present a challenging surgical problem. The trans-nasal approach when combined with image-guided navigation allows clear identification of structures and increased safety. We report a case of a successful removal of a foreign body under image-guidance using a trans-nasal approach.
