Critical review of diagnosis in rhinology and its therapeutical implications.

Diagnosis in rhinology is currently based on the concept of inflammation (chronic rhinosinusitis [CRS]) or the clinical concept of chronic nasal dysfunction (CND). The complementarity between these two approaches can be discussed by a critical review of the literature structured by the analysis of the fundamental and diagnostic bases and the therapeutic implications linked to each. The concept of CRS is based on the anatomical continuity of the nasal and sinus respiratory mucosa and molecular biology data, seeking to analyze the mechanisms of chronic inflammation and to identify proteins and biomarkers involved in the different supposed endotypes of chronic inflammation of this mucosa. The concept of CND seeks to analyze medical, instrumental or surgical diagnostic and therapeutic strategies, taking account of both inflammatory and non-inflammatory causes impacting the anatomy or physiology of each of the three noses (olfactory, respiratory and sinus) that make up the mid-face sinonasal organ of evolution-development (Evo-Devo) theory. Thus, the concept of CRS offers an endotypic approach, based on biological characterization of mucosal inflammation, while the concept of CND offers a compartmentalized phenotypic and pathophysiological approach to sinonasal diseases. The joint contribution of these two concepts in characterizing nasal functional pathology could in future improve the medical service provided to patients.

Management of a Posterior Mesotympanic Cholesteatoma using the Transcanal Endoscopic Approach.

With the constant evolution in the role of endoscopy in middle ear surgery, this article presents a technical note on the transcanal endoscopic approach to resection of a cholesteatoma limited to the posterior mesotympanum. We believe that this technique provides a suitable, minimal-invasive alternative to the classic microscopic transmastoid approach.

Evaluation of Eye Movement Desensitization and Reprocessing in the management of tinnitus. An observational study.

OBJECTIVES: Tinnitus can induce disabling psychological suffering, requiring an integrative multimodal approach, combining neuromodulation and psychotherapeutic methods. We sought to evaluate the therapeutic efficacy and acceptability of Eye Movement Desensitization and Reprocessing (EMDR) in tinnitus. MATERIALS AND METHODS: This was a single-center prospective non-comparative study. Inclusion criteria comprised: adult patient, with chronic tinnitus, Tinnitus Handicap Inventory (THI) score>17, causing psychological distress motivating active treatment after ineffective "classic" treatment (combining advice, sound therapy and first-line drug treatment), and agreement to EMDR therapy. Therapeutic efficacy was defined by a decrease in THI or Visual Analog Scale (VAS) scores. Treatment acceptability was defined by the rate of included patients who completed therapy. RESULTS: Thirty-eight patients were included. There was a significant reduction of 53.5% in THI score in 78.9% of patients (P<0.0001; 64.8±20.8 before versus 31.8±24.7 after treatment), and of 51% in VAS score in 76.3% of patients (P<0.0001; 7.24±2.12 before versus 3.58±2.03 after treatment). The treatment acceptability was 86.8%. CONCLUSION: EMDR appeared to be an effective alternative that was acceptable to the majority of patients, after failure of "classic" first-line treatment, improving quality of life in tinnitus patients and thus relieving disability.

In-house tooth-supported guide for the injection of botulinum toxin into the lateral pterygoid muscle using Blue Sky Plan software: A technical note.

Hyperactivity of the lateral pterygoid muscle (LPM) is one of the theories postulated to explain anterior disc displacement, which can result in difficulty in jaw opening, jaw protrusion, or jaw-deviation dystonias and interferes with mastication, speech, and swallowing. Injection of botulinum toxin of the LPM is considered a conservative therapeutic modality for this condition. The LPM is a deep facial structure and several techniques have been described that use magnetic resonance imaging, arthroscopic, or electromyographic guidance to perform intramuscular botulinum toxin injection safely this to prevent incorrect injection or complications, such arterial bleeding. This study provided a described step-by-step description of the computer-aided design and manufacturing procedure for the fabrication of an in-house guide to simplify the method of botulinum toxin injection in the LPM and ensure accuracy and safety in medical office.

Combined mentalis weakening and periosteal flaps in mandibular anterior alveolar corticotomy-assisted orthodontics with bone grafting.

Inter-alveolar augmented corticotomies with bone grafting may be used before orthodontic treatment in cases of root out or in major proclination movements in the lower anterior region. Bone graft particle spreading with reduced confinement and strong labial muscle contractions may cause graft resorption. Herein we describe a combined orthodontic corticotomy technique involving periosteal flap grafting confinement and a surgical muscle-weakening flap to avoid resorption.

Tubomanometry: An effective and promising assessment of Eustachian tube dysfunction in chronic rhinosinusitis patients.

AIMS: Obstructive eustachian tube (ET) dysfunction involves otologic complications, including cholesteatoma, and requires specific treatment. A causal relationship between obstructive ET dysfunction and chronic rhinosinusitis has only been suspected so far. Tubomanometry (TMM) is a new tool in ET dysfunction diagnosis and description. It has mainly been studied in chronic otitis patients but never in chronic rhinosinusitis (CRS). The aim of this work was to obtain TMM results from a CRS patient population presenting clinical ET dysfunction. MATERIALS AND METHODS: A prospective monocentric non-blinded study was performed between November 1 2015 and February 29 2016, involving all adult patients (>18 years; n=294) suffering from bilateral chronic rhinosinusitis who consulted at the rhinology unit at our referral ENT university center; 129 patients were included. An obstructive ET dysfunction clinical screening questionnaire (ETDQ-7) was obtained from all patients. When the mean ETDQ-7 score was≥2.1, a more extensive clinical assessment was performed including clinical maneuvers, otoscopy, transnasal endoscopy, audiometry, tympanometry and TMM for the diagnosis of ET dysfunction. RESULTS: Forty-seven per cent (n=61) had a positive ETDQ-7, 64% (n=39) of which had pathologic tubomanometric results: thirty-two (52.5%) had obstructive ET dysfunction TMM results and the remaining 7 (11.5%) patients had patulous ET TMM results. CONCLUSIONS: Tubomanometry is a promising new tool for the evaluation of ET dysfunction and could be added to clinical assessment of chronic rhinosinusitis patients.

Orofacial management for epidermolysis bullosa during wisdom tooth removal surgery: A technical note.

INTRODUCTION: Epidermolysis bullosa (EB) is a heterogeneous group of genetic diseases characterized by cutaneous and/or mucosal fragility. Blisters can occur spontaneously or because of minor friction on facial skin or the oral cavity. The repercussions of these dermatoses complicate the management of patients during surgery; for example, wisdom teeth removal might be complicated because of the limited mouth opening and mucosal lesions may be aggravated when the area of the wisdom teeth is being explored. Here, we describe the orofacial surgical management procedure for the extraction of the wisdom teeth of a patient with microstomia complicated by dystrophic epidermolysis bullosa (DEB) with high risk of mucosal lesion aggravation. TECHNIQUE: A 25-year-old woman with recessive DEB sought extraction of four wisdom teeth because of inclusion, recurrent pain, and dental caries. Anaesthesia was supported with conventional sequence induction and fibre-optic device-assisted nasotracheal intubation. A paediatric cuffed endotracheal tube and a fiberscope were lubricated before use in order to reduce friction against the naso-oropharyngeal mucosa. Hydrocellular foam dressing was applied on the face with soft adhesive silicone to avoid cutaneous wounds. No pressure was exerted on the patient's body during surgery. Surgical retractors were covered with hydrocellular foam dressing with silicone, and the labial commissures were protected with petroleum jelly. The dental extractions were performed with caution. DISCUSSION: Intraoral blistering in EB and scarring may result in microstomia and obliteration sulci, which can lead to difficulties in navigating the oral cavity. Consensus on a reasonable treatment protocol is lacking because no large cohort study exists. Lack of preparation of the facial skin and surgical instruments can lead to aggravation of lesions, especially when reaching for the third molars. A standardized procedure with general anaesthesia might pose fewer difficulties during the operation and limit facial and oral lesion aggravation. Prophylactic extraction of the third molar in younger patients with EB should be considered to avoid complications. CONCLUSION: Atraumatic anaesthesia procedures and specific surgical care for these patients can be provided by using a protocol that protects the skin and mucous membranes from traumas.

Dental occlusal-surface-supported titanium guide to assist cutting and drilling in mandibular bilateral sagittal split osteotomy.

INTRODUCTION: Cutting and drilling guides manufactured using computer-aided design/computer-aided manufacturing (CAD/CAM) technologies have attracted increasing interest in orthognathic surgery, particularly in complex cases. The development of these guides requires virtual surgery planning and three-dimensional modelling before they can be printed in titanium, polyamide or resin. We report the use of a personalized titanium device to assist bilateral sagittal split osteotomy (BSSO) with or without genioplasty combined with individual implants for repositioning and fixation. This one-piece guide for both sides of the BSSO allows the initiation of cutting and drilling with less invasive drill placement and greater accuracy. PROCEDURE: The titanium guide was manufactured using CAD/CAM technologies after conventional digital planning of BSSO. Intraoperatively, the guide was fitted on each side of the mandibular occlusal surface and screwed to predesigned drill holes. The guide facilitates the predrilling of screw holes and the initiation of cutting for buccal, lingual and external oblique ridge corticotomy using a piezosurgery device. CONCLUSION: Based on our experience, we think that this guide is a promising new tool to assist BSSO. It helped limit the extent of tissue detachment required and provided the strength necessary for accurate bone cutting and drilling. It also allowed the accurate fixation of preformed plates to obtain occlusion as per virtual planning.

Silent sinus syndrome: A traumatic case.

INTRODUCTION: Silent sinus syndrome is an unusual cause of progressive enophthalmos and hypoglobus due to atelectasia of the maxillary sinus associated with osteolysis of the orbital floor. This syndrome is classically idiopathic, but the term is also used to describe traumatic or iatrogenic (surgical orbital decompression) cases. CASE REPORT: We report the case of a 33-year-old man who presented with a left orbital trauma without functional disorder. Computed tomography (CT) scan revealed a nondisplaced fracture of the left orbital floor. No surgical indication was made. Three months later, the patient presented with progressive enophthalmos. CT revealed a complete lysis of the left orbital floor and a left maxillary sinus atelectasia. DISCUSSION: The original nondisplaced fracture of the orbital floor was not responsible for enophthalmos but the associated fracture of the left uncinate process that induced the closure of the left maxillary sinus infundibulum. This induced in turn hypoventilation of the sinus and a left orbital floor lysis. Treatment consisted in surgical opening of the maxillary sinus ostium and reconstruction of the orbital floor.

Optimal electrode diameter in relation to volume of the cochlea.

The volume of the cochlea is a key parameter for electrode-array design. Indeed, it constrains the diameter of the electrode-array for low-traumatic positioning in the scala timpani. The present report shows a model of scala timpani volume extraction from temporal bones images in order to estimate a maximum diameter of an electrode-array. Nine temporal bones were used, and passed to high-resolution computed tomography scan. Using image-processing techniques, scala timpani were extracted from images, and cross-section areas were estimated along cochlear turns. Cochlear implant electrode-array was fitted in these cross-sections. Results show that the electrode-array diameter is small enough to fit in the scala timpani, however the diameter is restricted at the apical part.