Papilomas rinosinusales en un centro de referencia otorrinolaringológico privado: revisión de 22 años de experiencia / Sinonasal papillomas in a private referral otorhinolaryngology centre: Review of 22 years experience

Objetivos: Evaluar la presentación clínica, los resultados al tratamiento y el seguimiento de los pacientes con papilomas rinosinusales (PRS), en un centro de atención terciaria otorrinolaringológica en Caracas (Venezuela). Material y métodos: Se realizó una revisión de 94 pacientes con PRS que fueron diagnosticados en nuestro centro otorrinolaringológico desde el 1de julio de 1993 hasta el 31 de junio de 2015. Se evaluaron los datos demográficos, las características clínicas, los hallazgos radiológicos, el origen anatómico, la extensión de la enfermedad hacia estructuras adyacentes, los procedimientos quirúrgicos realizados, la histopatología, el riesgo de recurrencia y la tasa de transformación maligna, y las terapias coadyuvantes. Resultados: Sesenta y cinco pacientes (69,1%) eran varones y 29 (30,9%) mujeres, con una edad promedio de 44,5 años (rango 9-80 años). Todos los pacientes fueron sometidos a cirugía endoscópica de senos paranasales. Los subtipos histológicos más comunes de PRS fueron el papiloma invertido (58 pacientes; 61,7%), el papiloma fungiforme o exofítico (35 pacientes; 37,2%) y el papiloma oncocítico (un paciente; 1,1%). El papiloma invertido se asoció en 2 pacientes con carcinoma indiferenciado de células escamosas. Doce pacientes (12,8%) presentaron enfermedad de extensión extrasinusal. Todos estos pacientes recibieron tratamiento adyuvante con técnicas avanzadas de radioterapia. El promedio de duración del seguimiento fue de 9 años y 2 meses. Dieciocho pacientes (19,1%) presentaron enfermedad recurrente durante todo ese periodo de seguimiento. Conclusiones: La resección endoscópica completa de los PRS es el tratamiento de elección. En lesiones menos accesibles endoscópicamente, con extensión periférica o tumores resecados de forma incompleta, las técnicas de radioterapia avanzadas como la radioterapia de intensidad modulada y la radioterapia en arcos de volumen modulado pueden estar indicadas con éxito. El control endoscópico postoperatorio oportuno con biopsias de lesiones sospechosas son importantes para la detección precoz de recidivas y malignización asociada (AU)

Objectives: To evaluate the clinical presentation, treatment outcome and follow-up of all patients managed with sinonasal papillomas (SP), at a tertiary private otorhinolaryngology centre in Caracas (Venezuela). Material and methods: We reviewed 94 patients with SP that were treated at our otolaryngology center, from July 1st 1993 to June 31st 2015. The demographic data, clinical features, radiological findings, anatomical origin, disease extension into the adjacent structures, surgical approaches performed, histopathology outcomes, recurrent risk, malignant transformation rate and coadjuvant therapies were assessed. Results: Sixty-five patients (69.1%) were male and 29 (30.9%) female with an average age of 44.5 years (range 9-80 years). All patients underwent endoscopic sinus surgery. The most commont histologic subtypes of SP were inverted papilloma (58 patients; 61.7%), fungiform papilloma (35 patients; 37.2%) and oncocytic papilloma (one patient; 1.1%). SP was associated in 2 patients with undifferentiated squamous cell carcinoma. Twelve patients (12.8%) had disease with extension beyond the sinus without associated malignancy. All these patients received adjuvant treatment with advanced techniques of radiotherapy. The mean duration of the follow-up period was 9 years and 2 months. Eighteen patients (19.1%) had recurrent disease during the entire course of follow-up.Conclusions: Complete endoscopic surgical removal of SP is the treatment of choice. In less endoscopically accessible tumours, with peripheral extension or incompletely resected, Intensity Modulated Radiotherapy and Volumetric Modulated Arc Therapy may be indicated. Timely post-operative endoscopic follow-up with biopsy of suspected lesions is important for early detection of recurrences and associated malignancy (AU)

Sinonasal papillomas in a private referral otorhinolaryngology centre: Review of 22 years experience. / Papilomas rinosinusales en un centro de referencia otorrinolaringológico privado: revisión de 22 años de experiencia.

OBJECTIVES: To evaluate the clinical presentation, treatment outcome and follow-up of all patients managed with sinonasal papillomas (SP), at a tertiary private otorhinolaryngology centre in Caracas (Venezuela). MATERIAL AND METHODS: We reviewed 94 patients with SP that were treated at our otolaryngology center, from July 1st 1993 to June 31st 2015. The demographic data, clinical features, radiological findings, anatomical origin, disease extension into the adjacent structures, surgical approaches performed, histopathology outcomes, recurrent risk, malignant transformation rate and coadjuvant therapies were assessed. RESULTS: Sixty-five patients (69.1%) were male and 29 (30.9%) female with an average age of 44.5 years (range 9-80 years). All patients underwent endoscopic sinus surgery. The most commont histologic subtypes of SP were inverted papilloma (58 patients; 61.7%), fungiform papilloma (35 patients; 37.2%) and oncocytic papilloma (one patient; 1.1%). SP was associated in 2 patients with undifferentiated squamous cell carcinoma. Twelve patients (12.8%) had disease with extension beyond the sinus without associated malignancy. All these patients received adjuvant treatment with advanced techniques of radiotherapy. The mean duration of the follow-up period was 9 years and 2 months. Eighteen patients (19.1%) had recurrent disease during the entire course of follow-up. CONCLUSIONS: Complete endoscopic surgical removal of SP is the treatment of choice. In less endoscopically accessible tumours, with peripheral extension or incompletely resected, Intensity Modulated Radiotherapy and Volumetric Modulated Arc Therapy may be indicated. Timely post-operative endoscopic follow-up with biopsy of suspected lesions is important for early detection of recurrences and associated malignancy.

Septoplastia endoscópica en casos primarios mediante el uso de instrumentación electromecánica: técnica quirúrgica, efectividad y resultados / Endoscopic septoplasty in primary cases using electromechanical instruments: surgical technique, efficacy and results

Introducción y objetivos: El microdebridador es una herramienta quirúrgica que ha sido exitosamente utilizada en diversos procedimientos de cirugía endoscópica en otorrinolaringología. En el presente estudio se analiza nuestra experiencia en el uso de la instrumentación electromecánica en la reparación de las desviaciones obstructivas del septum nasal. Materiales y métodos: Este es un estudio descriptivo, prospectivo y longitudinal realizado entre enero y junio del 2007, sobre 141 pacientes que consultaron por obstrucción nasal crónica producida por desviación o deformidad del tabique, y que se sometieron a septoplastia endoscópica con instrumentación electromecánica (SEIE). Resultados: La edad media fue de 39,9 años (15-63 años) de los cuales, 60,28% fueron varones (n = 85). El cambio en la gravedad de los síntomas nasales después de la cirugía descendió de 6,12 (preoperatorio) a 2,01 (postoperatorio). Los pacientes sometidos a SEIE tuvieron una reducción significativa de los síntomas nasales en el pre y postoperatorio y fue estadísticamente significativa (p < 0,05). No hubo diferencias estadísticamente significativas en los resultados obtenidos entre la segunda y sexta semana, y al quinto año después de la intervención. El 100% de los pacientes están satisfechos con los resultados de la cirugía, y ningún paciente respondió «No» a la pregunta añadida para conocer la satisfacción del paciente después de la operación. Complicaciones menores en el postoperatorio estuvieron presentes en un 4,96%. Conclusiones: La SEIE permite una reparación correcta y conservadora de las desviaciones obstructivas del tabique nasal, con menos complicaciones y mejores resultados funcionales. En nuestra experiencia, esta técnica ofrece importantes ventajas intraoperatorias con una alta satisfacción postoperatoria del paciente en términos de reducción de la severidad de los síntomas nasales (AU)

Introduction and objectives: The microdebrider is a surgical tool which has been used successfully in many endoscopic surgical procedures in otolaryngology. In this study, we analysed our experience using this powered instrument in the resection of obstructive nasal septum deviations. Subjects and methods: This was a longitudinal, prospective, descriptive study conducted between January and June 2007 on 141 patients who consulted for chronic nasal obstruction caused by a septal deviation or deformity and underwent powered endoscopic septoplasty (PES). Results: The mean age was 39.9 years (15–63 years); 60.28% were male (n = 85). The change in nasal symptom severity decreased after surgery from 6.12 (preoperative) to 2.01 (postoperative). Patients undergoing PES had a significant reduction of nasal symptoms in the pre- and postoperative period, which was statistically significant (P< 0.05). There were no statistically significant differences between the results at the 2nd week, 6th week and 5th year after surgery. All the participated patients were satisfied with the results of surgery and no patient answered «No» to the question added to compare patient satisfaction after surgery. Minor complications in the postoperative period were present in 4.96% of the cases. Conclusions: Powered endoscopic septoplasty allows accurate, conservative repair of obstructive nasal septum deviations, with fewer complications and better functional results. In our experience, this technique offered significant perioperative advantages with high postoperative patient satisfaction in terms of reducing the severity of nasal symptoms (AU)

Endoscopic septoplasty in primary cases using electromechanical instruments: surgical technique, efficacy and results.

INTRODUCTION AND OBJECTIVES: The microdebrider is a surgical tool which has been used successfully in many endoscopic surgical procedures in otolaryngology. In this study, we analysed our experience using this powered instrument in the resection of obstructive nasal septum deviations. SUBJECTS AND METHODS: This was a longitudinal, prospective, descriptive study conducted between January and June 2007 on 141 patients who consulted for chronic nasal obstruction caused by a septal deviation or deformity and underwent powered endoscopic septoplasty (PES). RESULTS: The mean age was 39.9 years (15-63 years); 60.28% were male (n=85) The change in nasal symptom severity decreased after surgery from 6.12 (preoperative) to 2.01 (postoperative). Patients undergoing PES had a significant reduction of nasal symptoms in the pre- and postoperative period, which was statistically significant (P<.05). There were no statistically significant differences between the results at the 2 nd week, 6th week and 5th year after surgery. The 100% of patients were satisfied with the results of surgery and no patient answered "No" to the question added to compare patient satisfaction after surgery. Minor complications in the postoperative period were present in 4.96% of the cases. CONCLUSIONS: Powered endoscopic septoplasty allows accurate, conservative repair of obstructive nasal septum deviations, with fewer complications and better functional results. In our experience, this technique offered significant perioperative advantages with high postoperative patient satisfaction in terms of reducing the severity of nasal symptoms.