RESUMO
Silent sinus syndrome is a rare clinical entity affecting the maxillary sinus, characterized by ipsilateral enophthalmos and hypoglobus. Its etiology and pathophysiology are still debated. It is diagnosed by clinical examination and confirmed with computed tomography. It is commonly managed surgically. We present the case of a 34-year-old woman with silent sinus syndrome treated with a patient-specific implant for orbital reconstruction, functional endoscopic sinus surgery approach, intraoperative scan, and surgical navigation, successfully restoring orbital volume and sinus ventilation.
RESUMO
Adenoid Cystic Carcinoma is a rare and aggressive tumor representing less than 1% of head and neck cancers. This malignancy often arises from the minor salivary glands, being the palate its most common location. Surgical en-bloc resection with clear margins is the primary treatment. However, this location presents a limited line of sight and a high risk of injuries, making the surgical procedure challenging. In this context, technologies such as intraoperative navigation can become an effective tool, reducing morbidity and improving the safety and accuracy of the procedure. Although their use is extended in fields such as neurosurgery, their application in maxillofacial surgery has not been widely evidenced. One reason is the need to rigidly fixate a navigation reference to the patient, which often entails an invasive setup. In this work, we studied three alternative and less invasive setups using optical tracking, 3D printing and augmented reality. We evaluated their precision in a patient-specific phantom, obtaining errors below 1 mm. The optimum setup was finally applied in a clinical case, where the navigation software was used to guide the tumor resection. Points were collected along the surgical margins after resection and compared with the real ones identified in the postoperative CT. Distances of less than 2 mm were obtained in 90% of the samples. Moreover, the navigation provided confidence to the surgeons, who could then undertake a less invasive and more conservative approach. The postoperative CT scans showed adequate resection margins and confirmed that the patient is free of disease after two years of follow-up.
RESUMO
BACKGROUND: Despite technical advances in the tools designed to facilitate endoscopic nasosinusal surgery, the approach used, functional endoscopic sinus surgery, has not undergone major modifications since it was first described in the late 1980s. Centripetal endoscopic sinus surgery (CESS) is a new approach based on taking the medial wall of the orbit and the anterior cranial base as constant dissection landmarks. The aim of this study was to evaluate the long-term outcome of CESS in chronic rhinosinusitis (CRS) by measuring clinical and objective improvement, the need for revision surgery, and the complication rate. METHODS: We reviewed 114 patients with CRS with or without polyps who underwent CESS at our center between May 2006 and December 2011. CRS was assessed using the Lund-Mackay staging system. The follow-up period ranged from 18 to 84 months (May 2013). RESULTS: Of 114 patients, 83 presented CRS with nasal polyposis, 12 had CRS without nasal polyposis, 17 had Samter's triad, and 2 had antrochoanal polyps. Postoperative evaluation of nasal obstruction and olfaction showed a significant and lasting improvement in these symptoms. Only four patients (3.5%) have required revision surgery, to date. CONCLUSION: CESS provided a lasting improvement in patients with CRS, by dramatically reducing the number of reinterventions. This approach is especially indicated in difficult cases, such as recurrent nasal polyposis and massive polyposis, because the dissection is based on constant borders and not influenced by previous surgery or disease extension.
