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endoscopic surgery and frontal sinus

Griffin D Santarelli, Joseph K Han
Propel and Propel Mini sinus implants are mometasone furoate-coated bioabsorbable stents used as an adjunct in the management of chronic rhinosinusitis after endoscopic sinus surgery. The original sinus implant was deployed in the ethmoid sinuses to provide medialization of the middle turbinate, decrease scarring and mucosal adhesions, limit polyp regrowth, and reduce mucosal inflammation. A structurally smaller version of the Propel, the Propel Mini, was developed and now has been approved for endoscopic placement in the frontal sinuses...
October 19, 2016: Expert Opinion on Drug Delivery
Abib Agbetoba, Amber Luong, Jin Keat Siow, Brent Senior, Claudio Callejas, Kornel Szczygielski, Martin J Citardi
BACKGROUND: Endoscopic sinus surgery represents a cornerstone in the professional development of otorhinolaryngology trainees. Mastery of these surgical skills requires an understanding of paranasal sinus and skull-base anatomy. The frontal sinus is associated with a wide range of variation and complex anatomical configuration, and thus represents an important challenge for all trainees performing endoscopic sinus surgery. METHODS: Forty-five otorhinolaryngology trainees and 20 medical school students from 5 academic institutions were enrolled and randomized into 1 of 2 groups...
October 18, 2016: International Forum of Allergy & Rhinology
Philip G Chen, Jae Murphy, Les M Alloju, Sam Boase, Peter-John Wormald
OBJECTIVES: Nasal irrigation is standard in the management of chronic rhinosinusitis both before and after surgical intervention. Numerous irrigation devices are commercially available. The aim of this study was to compare the efficacy of a handheld pulse irrigation device against the gold standard manual squeeze bottle after endoscopic sinus surgery (ESS). METHODS: Five cadaveric specimens were prepared with video visualization ports into each sinus. Endoscopic sinus surgery was performed on each cadaver from minimal to maximal dissection...
September 29, 2016: Annals of Otology, Rhinology, and Laryngology
Linggai Shi, Jun Liu, Jiqing Ma, Fei Liu, Guangke Wang
Treatment of frontal sinus using surgery is complicated owing to the complex anatomical structure of the sinus region. The aim of the present study was to investigate the efficacy and safety of Draf IIb endoscopic frontal sinus surgery treatment for frontal sinus lesions using the agger nasi approach on 19 patients (28 left or and right nasal cavities). A 10-12 mm excision of the upper frontal maxilla was performed for endoscopic resection between the middle turbinate and lateral nasal wall. No serious complications in frontal sinus surgery treatment for the removal of the frontal sinus were observed...
September 2016: Experimental and Therapeutic Medicine
Michitsugu Kawada, Hidenori Yokoi, Keisuke Maruyama, Yuma Matsumoto, Hidetaka Yamanaka, Tetsuya Ikeda, Yoshiaki Shiokawa, Koichiro Saito
We report a patient who had rhinogenic intracranial complication with postoperative frontal sinus pyocele and inverted papilloma in the nasal cavity. A 72-year-old woman had undergone surgery for frontal sinusitis via external incision at another hospital 13 years previously. Left-sided hemiparesis appeared in the patient and gradually worsened. Five days later, she exhibited disorientation, abnormal behavior, poor articulation, and difficulty in standing. Therefore, she was taken to the neurosurgery department by ambulance...
2016: SAGE Open Med Case Rep
Jessica E Southwood, Todd A Loehrl, David M Poetker
In the standard functional endoscopic sinus surgery (FESS) procedure, the amount of dissection is often determined by the extent of disease with the goal to preserve as much normal mucosa as possible while restoring ventilation and reestablishing mucociliary clearance. A subset of patients with chronic rhinosinusitis with nasal polyposis (CRSwNP), however, may continue to have persistent mucosal inflammatory and aggressive polyp regrowth despite standard FESS and maximal pharmacology therapy, leading to recurrent and recalcitrant disease...
2016: Advances in Oto-rhino-laryngology
Leigh J Sowerby, Sumeer Mann, Yves Starreveld, Trevor Kotylak, Brad Mechor, Erin D Wright
BACKGROUND: Initial descriptions of endoscopic approaches to the sella and pituitary involved resecting the middle turbinate (MT) to help improve access and visualization. Modifications of these procedures to preserve the MT have since been described, one rationale being to reduce the incidence of frontal sinusitis. The objective of this study was to establish the incidence of postoperative frontal sinusitis in MT sparing (MTsp) and MT sacrificing (MTsc) approaches to the sella. OBJECTIVE: A retrospective cohort study that compared radiographic evidence of frontal rhinosinusitis or frontal recess obstruction after skull base surgery in patients who underwent MTsc and MTsp endonasal approaches to the sella...
July 2016: American Journal of Rhinology & Allergy
Adam S DeConde, Timothy L Smith
Endoscopic sinus surgery is an effective intervention at improving quality of life for patients with medically refractory chronic rhinosinusitis. The evidence supporting frontal sinusotomy is limited to single institution case series. However, the data for Draf IIa frontal sinusotomy do demonstrate that most patients experience lasting frontal sinus patency on postoperative endoscopic examination and improvements in quality of life. Salvage endoscopic frontal sinus surgery via a Draf III shows high rates of neo-ostium patency and subjective improvements in symptoms at a 2-year time point in case series...
August 2016: Otolaryngologic Clinics of North America
Zeina R Korban, Roy R Casiano
The mainstay of frontal sinus surgery for chronic rhinosinusitis is to achieve and maintain an adequate frontal outflow tract. Using a stepwise approach and identifying critical endoscopic anatomic landmarks, to minimize complications and obtain long-term good endoscopic surgical results, should achieve this. The goal is to relieve the patient's symptoms, restore functional mucociliary flow, achieve a wide frontal sinus ostium and prevent long-term scarring and stenosis. Meticulous dissection and appropriate use of instrumentation and techniques aids in preventing unnecessary damage to normal mucosa while achieving one's goal of an adequate surgical ostium...
August 2016: Otolaryngologic Clinics of North America
Keng Lu Tan, Woo Hyun Lee, Jeong-Whun Kim
The skull base attachment of the second lamella and suprabullar pneumatization are likely to be consistent landmarks if they are systematically classified. This study aimed to classify the pneumatization pattern according to the second lamella skull base attachment. A total of 202 computed tomography sides of 101 patients who underwent endoscopic sinus surgery were studied. Suprabullar pneumatization was defined as air cells present above the ethmoid bulla between the second and third lamellae. Its pattern was classified according to the air cell number and location as in the frontal cell classification...
July 16, 2016: European Archives of Oto-rhino-laryngology
T Nguyen, D Kuijpers, J Companjen, A Erceg
BACKGROUND: Mucoceles are benign mucous-containing cysts that can occur in the sinuses. They arise as a result of an obstruction of the sinus ostium. There is often a delay in diagnosis because symptoms are so variable. CASE DESCRIPTION: A 52-year-old woman had intermittent swelling of the eyelid. A CT scan of the sinuses showed a mucocele in the frontal sinus with breakthrough to the left orbit. Treatment consisted of marsupialisation by means of functional endoscopic sinus surgery with septum correction...
2016: Nederlands Tijdschrift Voor Geneeskunde
Timothy L Smith, Ameet Singh, Amber Luong, Randall A Ow, Steven D Shotts, Nathan B Sautter, Joseph K Han, James Stambaugh, Aarthi Raman
OBJECTIVES/HYPOTHESIS: To assess safety and efficacy of a steroid-releasing implant in improving surgical outcomes when placed in the frontal sinus opening (FSO) following endoscopic sinus surgery (ESS) in patients with chronic rhinosinusitis (CRS). STUDY DESIGN: Prospective, multicenter, randomized, blinded trial using an intrapatient control design. METHODS: Eighty adult (≥ 18 years) CRS patients who underwent successful bilateral frontal sinusotomy were randomized to receive a steroid-releasing implant in one FSO, whereas the contralateral control side received no implant...
July 1, 2016: Laryngoscope
Jean Anderson Eloy, Alejandro Vázquez, James K Liu, Soly Baredes
Frontal sinus surgery has long been technically challenging in terms of access and chronic disease management. Decades of experience and advances in technology have led to the widespread use of various surgical approaches to the frontal sinus. Modifications to these existing procedures have been described to minimize unnecessarily invasive approaches. The lack of a classification that incorporates the newly described modifications prompts the proposal of a new classification. Eloy I-III incorporates all the previously described approaches as well as 3 recently published, and 1 newly described, procedures...
August 2016: Otolaryngologic Clinics of North America
Gretchen M Oakley, Henry P Barham, Richard J Harvey
The frontal sinus can present a challenging surgical dissection for the endoscopic surgeon. Image guidance as a surgical adjunct has become widely accepted for surgeries in this area. It can help verify vital structures and manage disorienting surgical conditions, improving surgeon confidence in performing safer and more complete surgery. It is relied upon heavily for placement of limited external frontal sinusotomies for disease beyond the endoscopic reach, and for mapping the frontal sinus for osteoplastic flap bony cuts...
August 2016: Otolaryngologic Clinics of North America
Ashleigh A Halderman, Janalee Stokken, Raj Sindwani
BACKGROUND: During sinus surgery, partial or complete resection of the middle turbinate (MT) is sometimes necessary because of polypoid changes or demineralization. Topical drug delivery to the paranasal sinuses is an integral component in managing chronic rhinosinusitis (CRS) with and without nasal polyposis. The purpose of this study was to examine the role of the MT and MT resection in topical drug distribution into the sinuses via nebulization. We report on a novel technique of quantitatively evaluating the delivery of nebulized dye in cadavers...
June 3, 2016: International Forum of Allergy & Rhinology
Haribalan Kumar, Ravi Jain, Richard G Douglas, Merryn H Tawhai
Endoscopic surgery is performed on patients with chronic inflammatory disease of the paranasal sinuses to improve sinus ventilation. Little is known about how sinus surgery affects sinonasal airflow. In this study nasal passage geometry was reconstructed from computed tomographic imaging from healthy normal, pre-operative, and post-operative subjects. Transient air flow through the nasal passage during calm breathing was simulated. Subject-specific differences in ventilation of the nasal passage were observed...
2016: PloS One
Bijan Beigi, Deepak Vayalambrone, Mohsen Bahmani Kashkouli, Peter Prinsley, Jan Saada
PURPOSE: To present a technique to improve the surgical treatment of frontal sinus mucocele and its recurrence. METHODS: Nine procedures performed on eight patients by a team of ENT and Ophthalmic orbital surgeons. Data collected included patient demographics, surgical details, pathological findings and complications. The surgical technique involved an external approach via the upper eyelid skin crease combined with an internal approach with a rigid 4 mm endoscope described below...
March 2016: Journal of Current Ophthalmology
Malgorzata Seredyka-Burduk, Pawel Krzysztof Burduk, Malgorzata Wierzchowska, Bartlomiej Kaluzny, Grazyna Malukiewicz
INTRODUCTION: The proximity of the paranasal sinuses to the orbit and its contents make the possibilities of injury both in primary or revision surgery. The majority of orbital complications are minor. The major ones are seen in 0.01-2.25% and some of them could be serious, leading to permanent dysfunction. OBJECTIVE: The aim of this study was to find the risk and type of ophthalmic complications among patients operated because of chronic rhinosinusitis. METHODS: We performed a retrospective study of 1658 patients who underwent endoscopic sinus surgery for chronic rhinosinusitis with or without polyps or mucocele...
May 4, 2016: Brazilian Journal of Otorhinolaryngology
John R Craig, Dmitriy Petrov, Sammy Khalili, Steven G Brooks, John Y K Lee, Nithin D Adappa, James N Palmer
INTRODUCTION: Cerebrospinal fluid (CSF) leak occurs in 1-11% of endoscopic Draf III, or endoscopic modified Lothrop, procedures. CSF leak can occur during surgery during a superior nasal septectomy. This study investigated whether the posterior edge of the nasofrontal beak (NFB) at the level of the internal frontal ostium is a safe landmark to use to avoid skull base injury when beginning the superior septectomy. METHODS: Preoperative computed tomography maxillofacial scans were reviewed from 100 patients from the University of Pennsylvania sinus surgery data base...
May 2016: American Journal of Rhinology & Allergy
Richard C Allen
PURPOSE OF REVIEW: Classical orbital approaches in skull base surgery have involved large incisions with extensive bone removal resulting in prolonged recovery with associated morbidity and mortality. The purpose of this review is to explore recent advances in skull base surgery that are applicable to the orbital surgeon. RECENT FINDINGS: Transnasal endoscopic surgery provides access to the medial 180 degrees of the orbit. Access to the lateral 180 degrees may be obtained using transmaxillary and transcranial techniques...
September 2016: Current Opinion in Ophthalmology
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