Comparison of the Olfactory Functions in Conventional Endoscopic Sinus Surgery to the Balloon Sinuplasty in Frontal Sinus Surgery.

OBJECTIVE: Balloon sinuplasty is being used worldwide, however the olfactory functions after balloon sinuplasty are underestimated. The authors aimed to study the effects of conventional endoscopic sinus surgery (ESS) compared to the balloon sinuplasty on olfactory function. MATERIALS AND METHODS: Forty-four subjects were randomly divided into 2 groups as ESS and balloon sinuplasty. The olfactory functions of each subject were recorded preoperatively and at the 1st, 3rd, 6th, and 12th months postoperatively. RESULTS: The initial assessments of olfaction were the same in both groups. After the surgery, the olfactory functions were significantly better in those of ESS group (P < 0.05). CONCLUSION: The olfactory function is preserved better in the conventional surgery compared to the balloon catheter dilation of the frontal sinus.

The correlation between the electroencephalographic spectral analysis and salivary cortisol rhythm in insomnia.

OBJECTIVE: Insomnia is a common sleep disorder that affects many adults either transiently or chronically. This study aimed to establish whether there is a relationship between the electroencephalographic (EEG) spectral analysis and salivary cortisol levels in insomnia and compared to healthy controls. MATERIALS AND METHODS: This case-control study included 15 insomnia patients and 15 healthy control subjects. Insomnia was determined according to the International Classification of Headache Disorders III diagnostic criteria. The EEG data were collected and processed with MATLAB software. Blood and salivary samples were taken for hematological and biochemical measurements. Salivary cortisol levels were calculated and compared statistically with the healthy group. RESULTS: The mean age of the patients was 46.5 ± 11 years. The salivary cortisol levels at 18:00 and 24:00 were found higher in the insomnia than in the healthy subjects (respectively, 0.12 (0.11) µg/dl, 0.07 (0.02) µg/dl). But this difference was not statistically significant (p > 0.05). No significant difference was observed in the spectral analysis of patients between the frontal, central, and occipital channel (p > 0.05). However, in the correlation between the frontal channel spectral analysis and at the 24:00 salivary cortisol of patient and control group, DeltaGmax (p = 0.002), DeltaGmean (p = 0.019) and, in the correlation with 18:00 salivary cortisol DeltaGmax (p = 0.010), were positively correlated. CONCLUSION: In this study, no significant difference was found in spectral analysis and salivary cortisol levels in insomnia patients, but at 18:00 and 24:00, cortisol levels were correlated positively with theta and delta waves in EEG spectral analysis in some channels.

[Effect of anatomical changes of frontal recess and frontal sinus on airflow after nasalisation by image reconstruction and numerical simulation].

Objective: To describe the influence of post-operative anatomical structure changes on nasal airflow characteristics by 3D reconstruction and numerical simulation in real cases after nasalisation with Draf Ⅲ so as to explore the correlation between the changes of anatomical structure and subjective symptoms as well as airflow characteristics. Methods: Ten patients underwent nasalization with Draf Ⅲ in Department of Rhinology in Beijing Tongren Hospital from 2006 to 2018 were selected retrospectively. Postoperative follow-up of all patients was more than 1 year. All patients had no abnormalities in their paranasal sinus CT scans and Lund-Kennedy scores were 0 except scar. VAS scores including nasal obstruction, stimulation in frontal sinus, and headache were collected at the same period. The control model was a normal person. Numerical simulation was used for calculating airflow characteristics in deep inspiratory period of both models. Independent sample Mann-Whitney U test and Spearman correlation test were used by software SPSS 22.0. Results: The airflow pressure in frontal sinus ostium was (7.21±1.39)×10(4) Pa (Mean±SD), which was lower than that in normal subjects (8.99×10(4) Pa) under deep inspiratory simulation. But, the velocities in frontal sinus ostium and frontal sinus were (40.10±2.46) m/s and (28.19±1.73) m/s respectively, which were higher than those in normal one (2.70 m/s, 0.73 m/s). The airflow patterns of the two models were basically similar. There was no significant difference in the opening size and volume of frontal sinus between different groups after grouped by three symptoms respectively. No correlation could be found between the opening size and volume of the frontal sinus with the appearance and severity of three subjective symptoms. Conclusions: The airflow pattern and distribution after nasalisation with Draf Ⅲ are like those of normal person. There is no correlation between the changes of anatomy in frontal recess and frontal sinus and nasal airflow characteristics as well as subjective symptoms.

The effect of frontal sinus pneumatization on anatomic variants of paranasal sinuses.

PURPOSE: The aim of this study is to determine the effect of frontal sinus pneumatization on various variations of paranasal sinuses on maxillofacial CT. MATERIALS AND METHODS: A total number of 120 patients (62 females, 58 males) were included in this study. Patients were divided into three groups regarding their frontal sinus pneumatization extent on paranasal sinus CT as Type 1 pneumatization (aplasia and hypoplasia), Type 2 pneumatization (medium) and Type 3 pneumatization (hyperplasia). The prevalence of various variations on paranasal sinus CT like pneumatization of upper and middle concha, presence of agger nasi, Haller and Onodi cell, maxillary sinus and sphenoid sinus hypoplasia, pneumatization of anterior clinoid process, pterygoid process and greater wing of sphenoid sinus, dehiscence and protrusion of internal carotid artery and optic nerve and vidian canal types were ascertained and compared within each group. RESULTS: The prevalence of upper and middle concha pneumatization, Haller cell, pneumatization of anterior clinoid process, pterygoid process and greater wing of sphenoid and internal carotid artery dehiscence and protrusion was higher in Type 3 group compared with other groups. CONCLUSION: Excessive pneumatization of frontal sinus has various effects on paranasal sinus variations at maxillofacial CT. Surgeons dealing with endoscopic sinus surgery, maxillofacial and skull base surgery must be vigilant of association between certain variations when analyzing CT scan preoperatively for avoiding complications.

Headache attributed to airplane travel: diagnosis, pathophysiology, and treatment - a systematic review.

BACKGROUND: Headache attributed to airplane travel, also named "airplane headache" (AH) is a headache that occurs during take-off and landing. Today, there are still uncertainties about the pathophysiology and treatment of AH. This systematic review was performed to facilitate identification of the existing literature on AH in order to discuss the current evidence and areas that remain to be investigated in AH. METHODS: The systematic literature search was performed in 3 relevant medical databases; PubMed, Scopus, and Embase. The search yielded 220 papers and the papers were sorted based on inclusion and exclusion criteria established for this study. RESULTS: This systematic review included 39 papers. Main findings revealed that AH attacks are clinically stereotyped and appear mostly during landing phases. The headache presents as a severe painful headache that often disappears within 30 min. The pain is unilateral and localized in the fronto-orbital region. Sinus barotrauma has been considered as the main cause of AH. Nonsteroidal anti-inflammatory drugs and triptans have been taken by passengers with AH, to relieve the headache. CONCLUSIONS: Based on this systematic review, further studies seem required to investigate underlying mechanisms in AH and also to investigate the biological effects of nonsteroidal anti-inflammatory drugs and triptans for alleviating of AH. These studies would advance our understanding of AH pathogenesis and potential use of treatments that are not yet established.

3-D titanium mesh reconstruction of defective skull after frontal craniectomy in traumatic brain injury.

INTRODUCTION: Decompressive craniectomy (DC) is a treatment strategy used to reduce intracranial pressure in patients with traumatic brain injuries. However, this procedure has a number of shortcomings, such as excessive sinking of the skin flap, which can lead to cerebral compromise and negatively affect the appearance of the patient. The reconstruction of skull defects has been proposed as a means to overcome these disadvantages. Few previous studies have reported the reconstruction of frontal skull defects using titanium mesh. The aim of this study was to provide a comprehensive review of aesthetic and surgical outcomes associated with this procedure and to list the complications encountered during the repair of frontal skull defects using three-dimensional (3-D) titanium mesh. METHODS: A retrospective review was conducted using records from seven adult patients (32-60 years of age) who received titanium mesh implants at a university hospital in Taiwan between January 2011 and June 2012. Aesthetic outcomes, the function of cranial nerves V and VII, and complications (hardware extrusions, meningitis, osteomyelitis, brain abscess, and pneumocephalus) were evaluated. RESULTS: An algorithm capable of accounting for bifrontal skull defects and median bone ridges was developed to improve computer-assisted design/manufacturing (CAD/CAM) of one-piece 3-D titanium mesh implants, thereby making it possible to repair bifrontal skull defects in a single operation. Following this procedure, aesthetic and functional outcomes were excellent and the implants in all patients appeared stable. However, extended healing times in two of the patients resulted in subclinical infections, which were resolved by administering antibiotics over a period of 2 weeks. No patients suffered trigeminal or facial dysfunction. CONCLUSIONS: Our findings support the use of 3-D titanium mesh in frontal skull reconstruction. Few complications were encountered, the contours of the forehead were faithfully rendered, and the cosmetic appearance of patients was excellent. For patients with bifrontal skull defects, the use of one-piece implants in a single operation provides numerous advantages over conventional staged surgeries. This application helps to reduce operating time, which is particularly beneficial for elderly patients and those requiring bifrontal cranioplasties.

Planejamento pré-operatório utilizando reconstruções 3d e endoscopia virtual para a localização do seio frontal / Preoperative planning using 3d reconstructions and virtual endoscopy for location of the frontal sinus

Introdução: Reconstruções tridimensionais (3D) geradas de tomografias computadorizadas (TCs) permitem a observação de cavidades e estruturas anatômicas de nosso corpo com riqueza de detalhes. Em nossa especialidade já houve tentativas da realização de endoscopias e laringoscopias virtuais. Entretanto, estas aplicações foram praticamente abandonadas devido à complexidade e necessidade de computadores com alto poder de processamento gráfico. Objetivo: Demonstrar a confecção de reconstruções 3D a partir de TCs de pacientes em computador pessoal, com programa específico gratuito e compará-las às imagens endoscópicas reais da cirurgia. Método: Estudo prospectivo em que os arquivos próprios das TCs de 10 pacientes foram reconstruídos com programa Intage Realia, versão 2009, 0, 0, 702 (KGT Inc, Japão). As reconstruções foram realizadas antes das cirurgias e uma endoscopia virtual foi feita para se avaliar a região do recesso e seio frontal. Após este estudo, a cirurgia foi realizada e armazenada digitalmente. As imagens endoscópicas reais da região do recesso e seio frontal foram comparadas às imagens virtuais. Resultados: A reconstrução 3D e endoscopia virtual foram realizadas nos 10 pacientes submetidos à cirurgia. As imagens virtuais apresentavam grande semelhança visual com as imagens das cirurgias reais. Conclusão: Demonstramos a possibilidade, com ferramentas relativamente simples e computador pessoal, de se gerar reconstruções 3D e endoscopias virtuais. O conhecimento pré-operatório da localização do caminho de drenagem natural do seio frontal pode vir a gerar benefícios durante a realização das cirurgias. Entretanto, mais estudos devem ser desenvolvidos para a avaliação do real papel destas reconstruções 3D e endoscopias virtuais.

Introduction: Computed tomography (TC) generated tridimensional (3D) reconstructions allow the observation of cavities and anatomic structures of our body with detail. In our specialty there have been attempts to carry out virtual endoscopies and laryngoscopies. However, such application has been practically abandoned due to its complexity and need for computers with high power of graphic processing. Objective: To demonstrate the production of 3D reconstructions from CTs of patients in personal computers, with a free specific program and compare them to the surgery actual endoscopic images. Method: Prospective study in which the CTs proper files of 10 patients were reconstructed with the program Intage Realia, version 2009, 0, 0, 702 (KGT Inc., Japan). The reconstructions were carried out before the surgeries and a virtual endoscopy was made to assess the recess and frontal sinus region. After this study, the surgery was digitally performed and stored. The actual endoscopic images of the recess and frontal sinus region were compared to the virtual images. Results: The 3D reconstruction and virtual endoscopy were made in 10 patients submitted to the surgery. The virtual images had a large resemblance with the actual surgical images. Conclusion: With relatively simple tools and personal computer, we demonstrated the possibility to generate 3D reconstructions and virtual endoscopies. The preoperative knowledge of the frontal sinus natural draining path location may generate benefits during the performance of surgeries. However, more studies must be developed for the evaluation of the real roles of such 3D reconstructions and virtual endoscopies.

Frontal mucocoele secondary to nasal polyposis: an unusual complication.

The incidence of mucocoeles associated with a non-surgically treated nasal polyposis is rare. We report a rare case of nasal polyposis with asymptomatic frontal mucocoeles in a 28-year-old Malay man who presented with bilateral nasal obstruction with anosmia. Physical examination revealed bilateral grade III nasal polyps causing obstruction. Computed tomography revealed paranasal polyposis with a large polyp extending and expanding the posterior table of the frontal sinus causing erosion and thinning of its wall. Marsupialisation of the mucocoele and nasal polypectomy were done. Endoscopic sinus surgery and marsupialisation should be the treatment of choice for asymptomatic frontal mucocoele.

Transfistula endoscopic closure of frontocutaneous fistula: a novel approach.

A fistula of the anterior table of the frontal sinus is an uncommon complication of acute frontal sinus abscess. Various methods to close a frontocutaneous fistula have been described. We present the second reported transfistula endoscopically assisted primary closure of a frontocutaneous fistula, which eliminated the need for major surgical intervention. We also review the etiology, pathogenesis, diagnosis, and management of frontocutaneous fistula.

Frontal sinus pneumocoele: a rare cause of orbital emphysema.

Sudden onset nonaxial proptosis and diplopia is alarming and orbital haemorrhage or a rapidly expanding orbital tumour should be excluded. We present a case of a young man aged 15 years who attended the Accident and Emergency Department with a 6-h history of sudden onset proptosis and diplopia in whom the aetiology was orbital emphysema.

Delayed development of frontal mucocele after fronto-orbital advancement in a child with craniosynostosis.

BACKGROUND: Sinus mucoceles rarely develop as a consequence of inadequate sinus ventilation that arises due to inflammation, allergy, polyps, tumors, surgery, and trauma. The development of frontal sinus is delayed until older than 6 years. Therefore, the development of the mucocele in the frontal sinus after fronto-orbital advancement surgery in young children with craniosynostosis may provide essential information for the development of the frontal sinus. CASE DESCRIPTION: We report a rare case of a 22-year-old man presenting with a frontal mucocele manifested by dull headache, proptosis, and diplopia, and which developed 16 years after fronto-orbital advancement surgery for craniosynostosis. Magnetic resonance imaging demonstrated that a multiple cystic mass extended from the frontal sinus to the retro-orbital space along the optic nerve. During surgery, we found that the cyst consisted of mostly thin, yellow mucosa, which developed from an anomalously overdeveloped frontal sinus containing yellow pus-like intracystic fluid. There was no gross local invasion by the cyst. We easily dissected and removed the mucosal cyst from the large frontal sinus completely with frontal sinus obliteration. We cranialized the anomalously large frontal sinus by removal of the posterior wall of the frontal sinus and then widening the ethmoidal drainage with endoscopic ethmoidectomy. CONCLUSION: We report the first case of a frontal sinus mucocele that developed after fronto-orbital advancement surgery in the literature and suggest that the mucocele development after fronto-orbital advancement supports the hypothesis of frontal bone-inducing role in frontal sinus development.

Mucocele frontal lateral, tratamiento combinado endoscópico y externo: caso clínico / Frontal lateral mucocele, combined endoscopic and external treatment: clinical case

El mucocele frontal es la ubicación más frecuente de los mucoceles de senos paranasales, sin embargo aún no hay consenso respecto a la técnica quirúrgica adecuada para su tratamiento. El presente trabajo muestra un caso clínico de un mucocele frontal lateralizado, que desplaza el globo ocular y lóbulo cerebral frontal. Se muestra la técnica quirúrgica empleada (vía externa combinada con vía endoscópica). Se exponen las distintas técnicas de imagenología diagnóstica y técnicas computacionales que ayudan en el procedimiento quirúrgico.

Recurrent bilateral fronto-ethmoidal mucocoele with intracranial extension: a case report.

Mucocoeles of the paranasal sinuses are relatively uncommon and rarely bilateral, the frontal and ethmoidal sinuses being most commonly affected. Rarely, fronto-ethmoidal mucocoeles expand and extend into the anterior cranial fossa producing mass effect. We report a 66-year-old woman, who presented with a 20-year history of recurrent bilateral progressive proptosis and supra orbital swellings with blindness in the left eye. Ultrasound scan of the left eye showed a large cystic mass in the orbit due to extension of ipsilateral frontal mucocoele. Computed tomographic brain scan showed large bilateral fronto-ethmoidal mucocoeles, erosion of the right orbital roof, right posterior and left anterior sinus walls, and extension of the right frontal sinus into the anterior cranial fossa with mass effect. The patient had a bicoronal craniotomy and bilateral fronto-ethmoidectomy with direct drainage of independent right mucocoele and left mucopyocoele. This case illustrates complications that may result from chronicity and treatment failure in patients with sinus mucocoeles.

Frontal ostium neo-osteogenesis and restenosis after modified endoscopic Lothrop procedure in an animal model.

All patients who undergo a modified endoscopic Lothrop procedure have postoperative narrowing of the enlarged frontal ostium. The aim of this study is to evaluate neo-osteogenesis and restenosis of the frontal ostium and its effect on mucociliary clearance. Fourteen sheep underwent an endoscopic modified Lothrop procedure. Pre- and postoperative nuclear medicine gamma scintigraphy of the frontal sinuses was performed. The sizes of the frontal ostia were measured and biopsies taken from the bone of the frontal ostium. Histological evidence of new bone formation was found in 56% of biopsies. The average preoperative mucociliary clearance half times (T1/2) at 15 and 30 min were 70 and 74 min, respectively, and postoperatively were 50 and 67 min. There was a non-significant trend towards poorer clearance in sinuses with neo-osteogenesis. The average size of the frontal ostium decreased by 28%. There was no relationship between the size of the ostium and neo-osteogenesis. Neo-osteogenesis was seen in 56% of biopsies with a 28% reduction in size of the frontal ostium after 224 days. Mucociliary clearance did not alter significantly.

Frontal sinus repair with free autologous bone grafts and fibrin glue.

BACKGROUND: The authors describe a technique for repairing the frontal sinus with autologous bone grafts removed during craniotomy and fibrin glue. METHODS: This technique was used in 12 patients who underwent craniotomy for aneurysms (n = 9), brain tumors (n = 2), and acute epidural hematoma (n = 1). RESULTS: The repair was successful in all cases. There were no instances of postoperative infection or leakage of cerebrospinal fluid. No complications from the repair have occurred over a mean follow-up of 51 months. CONCLUSION: This technique is simpler than others used to seal a frontal sinus.

Coronal computed tomography analysis of frontal cells.

BACKGROUND: Described by Schaefer in 1916, frontal cells have been implicated as a cause of frontal recess obstruction. In this cross-sectional study, we determine the prevalence of frontal cells and other anatomic variants and examine their relationships. METHODS: Coronal computed tomography scans of the sinuses performed from January 2000 to June 2001 were evaluated for frontal cells, other anatomic variants, and sinus disease. Of 1009 scans evaluated, 768 scans were included for data collection. Frontal cells were classified. RESULTS: In this population, 20.4% of individuals had frontal cells (14.9% had type I, 3.1% had type II, 1.7% had type III, and 2.1% had type IV). The presence of frontal cells was positively associated with hyperpneumatization of the frontal sinus (p = 0.01) and negatively associated with hypopneumatization of the frontal sinus (p < 0.01). Individuals with frontal cells had an increased prevalence of concha bullosa compared with individuals without frontal cells (41.4% versus 24.1%, p < 0.01). The prevalence of frontal mucosal thickening was increased in individuals with type III and type IV cells compared with individuals without frontal cells (38.5 and 69.0% versus 17.1%, p = 0.04 and p < 0.01). CONCLUSION: The prevalence of frontal cells among a population undergoing sinus computed tomography is 20.4%. Frontal cells are associated with other variants of sinonasal pneumatization and should be suspected when these variants are noted. The presence of frontal cells does not invariably lead to frontal sinusitis but may contribute to the mechanical obstruction of the frontal recess and should be appropriately addressed during the surgical management of frontal sinusitis.