Endoscopic turbinoplasty of concha bullosa: long term results.

The aim of this study is to assess the long-term results of our endoscopic turbinoplasty technique for concha bullosa. Thirty-six patients of chronic or recurrent sinusitis who had concha bullosa on CT scan along with mucosal disease in sinuses and underwent turbinoplasty with functional endoscopic sinus surgery were studied. They were followed regularly with endoscopic examination for 7 years and were assessed for immediate or longterm complications of the procedure. Results of 36 patients revealed bilateral concha bullosa in 16 (44.4%) and unilateral concha bullosa in 20 (55.6%) patients. Out of 52 sides of turbinoplasties which were followed for average of 89 months, only 3 sides (5.76%) had synechia between middle turbinate and septum. Only 1 (1.92%) side had adhesions between lateral wall and middle turbinate. There were no other immediate or longterm complications. We conclude from our study that endoscopic turbinoplasty is safe and effective procedure for concha bullosa. It preserves middle turbinate anatomically and physiologically and treats the concha with negligible complications.

Endoscopic 532-nm KTP laser excision of inverted papilloma of the nose and paranasal sinuses: a series of 9 patients.

Over the past 2 decades, the surgical management of inverted papillomas has evolved from extensive radical excision to more conservative surgery. We conducted a study to evaluate the results of our endoscopic approach to tumor excision with the 532-nm potassium titanyl phosphate (KTP-532) laser. Our series included 9 patients with inverted papilloma of the nose and paranasal sinuses who were treated from January 1998 through December 2003 (72 mo). Only 1 patient (11.1%) experienced a recurrence. The recurrence was detected 12 months after initial treatment, and it was successfully managed via the same endoscopic approach; afterward, the patient was still tumor-free at 2.5 years of follow-up. The good results of this endoscopic approach for lesions limited to the nose and paranasal sinuses can be attributed to excellent visualization with the endoscope and to the bloodless dissection achieved with the KTP-532 laser. We emphasize the need for frequent and long-term follow-up of these patients; a thorough endoscopic examination at every visit is extremely important.

Evolution of rhinology.

The study of the nose is as old as civilisation. Various conditions affecting its structure and function has been documented in Edwin Smith Papyrus in hieroglyphic script, an Egyptian writing system of the mid -4th Millennium BC.The major contribution for the complete reconstruction of the nose originated in India by Sushruta in around 600 BC. Writing in Sanskrit in the form of verses he described in detail the technique of total reconstruction, which is still being practiced today as Indian Rhinoplasty. This surgical reconstruction paved the way to modern plastic surgery in Europe and United States in 18th century. Sushruta contributed not only to the plastic surgery of the nose, but described entire philosophy of Head and Neck and other surgery as well. Other notable contributors were Greek physicians, Hippocrate and Galen, and at the birth of the Christianity, Celsus wrote eight books of medical encyclopaedia, which described various conditions affecting nose.Septal and Sinus surgery, in comparison to rhinoplasty did not develop until 17th century. Septal surgery began with total septectomy, sub mucous resection by Killian & Freer in early 20th century and later septoplasty by Cottle in middle of 20th century.Sinus surgery probably originated in Egypt, where instruments were used to remove brain through the ethmoid sinuses as part of the mummification process. In 18th century, empyema of the maxillary sinus was drained through the tooth socket or anterior wall of the sinus, which lead to the evolution of radical procedures of removal of mucous membrane and inferior meatal antrostomy. In the late 20th century, improved understanding of the mucociliary mechanism described by Prof. Messerklinger and Nasal Endoscopy described by Prof. Draf with the development of fibre optics and CT imaging, heralded a new era, which evolved in functional endoscopic sinus surgery. New technology further enhanced the scope of endoscope being used "around and beyond" the nose.

KTP/532 laser excision of trichoepithelioma of the ear.

A rare case of trichoepithelioma of the external ear is presented Conventional excision with cold instruments is likely to result in excessive bleeding increased post-operative morbidity and scar tissue. This case was treated with KTP/532 laser excision almost bloodlessly with practically no post-operative morbidity and unimimal scar tissue.

Routine nasal packing follwoing nasal surgery-Is it necessary?

The practice of routine nasal packing after nasal surgery is usually customary and not evidence based. Post operative complications, while uncoumon, are sometimes pack related. A retrospective analysis of 110 patients who underwent a variety of nasal operations was performed to determine the incidence of complications when nasal packs were not routinely inserted 9 cases (8.2%) [6 out of these were revision surgeries] needed nasal packing for haemostasis at the end of surgery. 4 cases (3.6%) required to be packed in the immediate post operative period. One patient who required nasal packing developed a unilateral adhesion. No patient developed septal hematoma. The need for routine nasal packing is not supported. Packing should be indicated where there continuous bleeding at.

Laser surgery in the management of sinonasal disease.

Better understanding of the pathophysiology of sinus disease, and improved technology and imaging modalities have changed nose and sinus surgery in recent years. Precise surgery of the ethmoid sinuses is now possible, improving ventilation and drainage of the sinuses. Newer technology has enhanced the scope of surgery and helped make sinus surgery safer.

Primary mucoepidermoid tumor of the middle ear and mastoid.

Mucoepidermoid tumors are salivary gland neoplasms located mainly in the parotid gland. We present an unusual case of such a tumor arising from the middle ear and mastoid cavity successfully treated by surgery and post-operative radiotherapy.

Long-term results of KTP/532 laser uvulopalatopharyngoplasty.

The symptom of snoring is no longer one of humorous content and with the ever increasing awareness of its detriments, it has become even more important to find a treatment that would be immensely beneficial to the patient. We would like to present our experiences with the use of the KTP/532 Laser in performing the UP3. This study is significant as it presents a long term four year follow up of cases based on the patients' assessments. The technique itself is tailor made to suit the individual patient, ensuring optimal results which revealed that most patients i.e.; 84% were extremely pleased with the operation. The series also showed minimal morbidity and no intra or post-operative complications which reiterates the need for meticulous, atraumatic technique and judicious, discriminate selection of patients.

Wedge Resection of the Middle Turbinate-An Adjunct to Functional Endoscopic Sinus Surgery (FESS).

A simple technique of wedge resection of the anterior part of the middle turbinate allows a better access to the Osteo meatal complex (OMC) during FESS procedure. In post-operative period it facilitates proper ethmoid cavity care, mandatory to the success of the endoscopic sinus surgery. The technique keeps the middle turbinate away from the lateral wall of the nose and helps reducing the synechia formations. It also exteriorises the apparent and occult pneumatised middle turbinate. It is a simple and safe procedure to perform with minimal trauma to the middle turbinate without complications attributable to the technique. During functional endoscopic sinus surgery this technique affords improved exposure to the OMC in patients with high deviated septum, narrow nasal vault, a large concha bullosa and paradoxical turbinate.

Pre- and postoperative mucociliary clearance in functional endoscopic sinus surgery.

The advent of functional endoscopic sinus surgery (FESS) has revolutionized the treatment of chronic sinusitis over the last decade. Although it has been well-established that FESS is more efficacious than conventional surgery, the lack of a quantifiable means of assessing results remains one of the major shortcomings of the technique, and hence a source of criticism. Since the pathophysiology of chronic sinusitis is intimately related to the mucociliary mechanism of the nose and sinuses, it seems logical to use this parameter as a yardstick of success. We undertook a prospective, controlled study of 40 patients and measured their "saccharin times" before and after surgery. The results show a marked reduction in clearance times postoperatively, corresponding well with improvement in symptom profile. We therefore propose this technique as a simple, safe and reliable method of assessing the results of surgery. Furthermore, the method could act as a preoperative indicator of ciliary motility disorders, as the prognosis in these patients is distinctly poor.

The role of CT in functional endoscopic sinus surgery.

The intricate anatomy of the paranasal sinus unit (sinus/nasal cavities and ostia) and its relations to the orbit and anterior cranial fossa make accurate pre-operative evaluation of disease in this region mandatory before undertaking functional endoscopic sinus surgery (FESS). Plain radiography often fails to provide vital information in cases of chronic rhinosinusitis, especially of the ethmoid labyrinth, which is a key area of the paranasal sinus unit. Computerized tomography has significantly enhanced the scope of endoscopic sinus surgery by offering the surgeon hitherto inaccessible information regarding the sinus status. In this article, we review the pros and cons of the two imaging modalities, and present our experience fo 70 CT scans in patients of FESS. We also propose a surgical classification of CT findings. All in all, plain radiographs prove to be of little value for pre-operative assessment in FESS, while CT scans are an essential tool.