Novel titanium constructs for chest wall reconstruction in children

Purpose

We have previously reported the use of the vertical expandable prosthetic titanium rib (VEPTR) for treatment of thoracic dystrophy. This report describes our experience with this device and other novel titanium constructs for chest wall reconstruction.

Methods

This is a retrospective chart review of all children and adolescents undergoing chest wall reconstruction with titanium constructs between December 2005 and May 2010.

Results

Six patients have undergone chest wall reconstruction with VEPTR or other titanium constructs. Four had chest wall resection for primary malignancy, 1 had metastatic chest wall tumor resection, and 1 had congenital chest wall deformity. There were no immediate complications, and all patients have exhibited excellent respiratory function with no scoliosis.

Conclusions

Chest wall reconstruction after tumor resection or for primary chest wall deformities can be effectively accomplished with VEPTR and other customized titanium constructs. Goals should be durable protection of intrathoracic organs and preservation of thoracic volume and function throughout growth. Careful preoperative evaluation and patient-specific planning are important aspects of successful reconstruction.     

Comparison of open and minimally invasive thymectomies at a single institution

Background

Most thymectomies are performed via sternotomy. Minimally invasive thymectomy (MIT) has been described but its potential benefits and drawbacks remain unclear.

Methods

A retrospective chart review comparing thymectomies performed via sternotomy to MIT at a single institution between 2005 and 2009.

Results

Eight patients underwent MIT and 8 patients underwent sternotomy in the management of myasthenia gravis, thymic hyperplasia, or small thymic tumors. There was 1 perioperative death unrelated to the surgical procedure and no morbidity. The surgical time, estimated blood loss, and chest tube output was similar in both groups. The average hospital stay for MIT was 2.4 days compared with 4.3 days for sternotomy. One MIT patient remained on narcotic pain medication 2 weeks after surgery compared with 6 in the open group.

Conclusions

MIT can be performed with similar morbidity and efficacy as transsternal thymectomy. Patients require fewer narcotics and can be discharged earlier.     

Radiographic changes in the diaphragm after repair of congenital diaphragmatic hernia

Background/Purpose

The growth and function of the repaired diaphragm have not been well elucidated, which may contribute to pulmonary function and chest wall deformity. We measured the lower lung diameter at the top of the diaphragm (LLD), diaphragmatic diameter (DD), and diaphragmatic height (DH) on the posteroanterior plain chest radiograph using a picture archive and communication system.

Methods

Thirty-six children aged 10.4 ± 4.8 years with congenital diaphragmatic hernia underwent clinical evaluation, including plain chest radiograph and a lung ventilation/perfusion scan. As a control, chest radiographs of 89 children aged 9.0 ± 5.5 years with minor surgery were analyzed.

Results

The LLD, DD, and DH in controls were significantly correlated with age; each value was then expressed as a percentage of age-based estimated values. Ipsilateral LLD and DD were significantly decreased. The perfusion of the ipsilateral lung was best correlated with ipsilateral DD. Five patients had chest wall deformity, and 7 had scoliosis (Cobb angle >10°). Patients with scoliosis had decreased ipsilateral LLD, DD, and DH. The Cobb angle was correlated with LLD and DD.

Conclusion

The growth of the repaired diaphragm may be impaired, which contributes to decreased perfusion of the ipsilateral lung and scoliosis. The LLD and DD are simple but useful parameters in the follow-up of patients with CDH.     

Clinical impact of optical imaging with 3-D reconstruction of torso topography in common anterior chest wall anomalies

Background

Standard modalities to assist in determining the extent of chest wall developmental deformities in patients include x-ray and computed tomography (CT). The purpose of this study is to describe an optical imaging technique that provides accurate cross-sectional images of the chest, and to compare these with standard CT-derived images of chest wall abnormalities.

Patients and Methods

Ten patients (5 pectus excavatum and 5 pectus carinatum) underwent imaging that included limited CT and optical cross-sectional imaging. Severity indices of the deformity using the standard Haller index (HI) were calculated from CT scans. A similar severity measurement of deformity was derived from the outline of torso cross sections (ie, from skin to skin measurements) obtained from optical images. To assess the severity of carinatum defects, a modified pectus index was derived, which measures the anterior chest protrusion from the central chord of the chest cross section. We performed regression analyses, comparing the indices obtained from CT and optical imaging methodologies.

Results

Optical measures of cross-sectional deformities correlated well with standard HI (r² = 0.94) and even better with the modified pectus index (r² = 0.96). Adaptation of the HI for pectus carinatum deformity evaluation was effective, and consistent with the torso surface deformity measures.

Conclusions

Torso models from optical imaging offer 3-D images of the chest wall deformity with no radiation exposure. This preliminary study showed promising results for the use of torso surface measurement as an alternative index of pectus deformities; if validated in larger studies, these measures may be useful for following chest wall abnormalities, using repeated studies in patients.     

Classification of the dysmorphology of pectus excavatum

Background/Purpose

To describe the dysmorphology of pectus excavatum, the most common congenital chest wall anomaly.

Methods

A stratified sample of 64 patients, representative of a patient population with pectus excavatum of the Children's Hospital of King's Daughters in Norfolk, Va, was described and classified. The sample was stratified by sex to represent a 4:1 male-to-female ratio. The sample was further stratified to represent categories of age (3-10, 11-16, and 17 years and older). Preoperative photos and baseline chest computed tomography scans were examined and categorized according to the chief criteria, including asymmetry/symmetry of the depression, localized vs diffuse morphology, sternal torsion, cause of asymmetric appearance, and the length of the depression.

Results

Useful morphologic distinctions in pectus excavatum are localized depressions vs diffuse depressions, short and long length, symmetry, sternal torsion, slope/position of absolute depth, and unique patterns such as the horns of steer depression.

Conclusions

These classifications simplify the diagnosis of pectus excavatum, aid in corrective surgery, and should improve correlation of phenotype and genotype in future genetic analysis.     

Early experience with robot-assisted surgery for mediastinal masses

Background

We report the experience of a single institution with the minimally invasive resection of mediastinal masses using the da Vinci robotic surgical system.

Methods

From August 2001 to June 2003, 14 patients (5 men and 9 women aged from 21 to 77 years) with mediastinal masses were operated on minimally invasively with the da Vinci robotic system. This consisted of 9 thymectomies (6 thymomas, 2 nonatrophic thymic glands, 1 thymic cyst), 3 resections of paravertebral neurinomas, 1 ectopic mediastinal parathyroidectomy, and 1 resection of a lymphangioma.

Results

Complete, extended thymectomy was accomplished in all 9 cases, proven by examination of the thymic bed and resected specimen. In 1 patient with an hourglass-shaped neurinoma, conversion to an open procedure was necessary because the excessive size of the tumor limited vision. The median overall operation time was 166 minutes (range, 61 to 182) including 110 minutes (range, 46 to 142) for the robotic act. There were no intraoperative complications or surgical mortality.

Conclusions

These preliminary results of our series suggest that application of the da Vinci robotic surgical system for resection of selected mediastinal masses is technically feasible and safe. It provides an alternative to open approaches and “conventional” thoracoscopy. Nevertheless, this new technique requires further investigation in larger series and longer follow-up.     

Tension gastrothorax: a case report and review of literature

Background

Tension gastrothorax develops when the stomach, herniated through a congenital diaphragmatic defect into the thorax, is massively distended by trapped air. We report a case of tension gastrothorax and review the literature.

Case Report

A previously healthy 8-month-old female presented with severe respiratory distress, misdiagnosed as tension pneumothorax. Intercostal tube was inserted. The tube was noted to drain food as well as air. The patient was investigated by radio-contrast swallow, which demonstrated the presence of the stomach in the chest. The patient was operated upon, and the stomach, transverse colon, and spleen were reduced back to the abdomen. The defects in the stomach and diaphragm were closed.

Conclusion

Tension gastrothorax is a life-threatening condition leading to acute and severe respiratory distress. The presence of air-filled structure in left hemithorax in a previously healthy child presenting with acute respiratory distress should prompt the inclusion of tension gastrothorax in the differential diagnosis.     

Thoracoscopic diaphragmatic eventration repair in children: about 10 cases

Background and Aim

Recent reports in literature have emphasized the clinical perception of reduced pain, postoperative morbidity, and dysfunction associated with thoracoscopic approach compared with standard thoracotomy.The authors describe a thoracoscopic approach and technical details for diaphragmatic eventration repair in children.

Patients and Methods

Ten patients, 4 girls and 6 boys, 1 teenager (14 years old) and 9 children (age range, 6-41 months; average, 17 months), were operated for a diaphragmatic eventration in 3 different pediatric surgery teams, according to the same technique. Symptoms were recurrent infection (7 cases), dyspnea on exertion (2 cases), and a rib deformity (1 case). An elective thoracoscopy was performed, patient in a lateral decubitus. A low carbon dioxide insufflation allowed a lung collapse. Reduction of the eventration was made progressively when folding and plicating the diaphragm. Plication of the diaphragm was done with an interrupted suture (6 cases) or a running suture (4 cases). The procedure finished either with an exsufflation (4 cases) or a drain (6 cases).

Results

A conversion was necessary in 2 cases: 1 insufflation was not tolerated and 1 diaphragm, higher than the fifth space, reduced too much the operative field. Patients recovered between 2 and 4 days. Dyspnea disappeared immediately. Mean follow-up of 16 months could assess the clinical improvement in every patient.

Discussion

Thoracoscopic conditions are quite different between a diaphragmatic hernia repair previously reported and an eventration. Concerning diaphragmatic hernias, reduction is easy, giving a large operative space for suturing the diaphragm. Concerning diaphragmatic eventrations, the lack of space remains important at the beginning of the procedure despite the insufflation into the pleural cavity. The operative ports must be high enough in the chest to allow a good mobility of the instruments. Chest drainage seems to be unnecessary.

Conclusion

Diaphragmatic eventration repair by thoracoscopy is feasible, safe, and efficient in children. Above all, it avoids a thoracotomy. It improves the immediate postoperative results with a good respiratory function.     

Approach to diagnosis and treatment of pediatric primary tumors of the diaphragm

Background/Purpose

Tumors of the diaphragm in the pediatric population are extremely rare. We present 5 cases diagnosed at the Hospital for Sick Children, Toronto, and together with a review of the world literature, provide an approach to the diagnosis and management of these tumors.

Methods

A clinical retrospective review of patients diagnosed as having primary diaphragmatic tumor (PDT) at the Hospital for Sick Children as well as a review of the world literature.

Results

Forty-one cases of PDT in the pediatric population have been described from 1868 to 2005 inclusive. There is an equal incidence in boys and girls, they are found with the same frequency on the left as on the right, and 78% are malignant. Rhabdomyosarcoma is the most commonly occurring malignant tumor. The mean age at diagnosis is 10 years. “Chest-associated” symptoms are more common than “abdomen-associated” symptoms. Imaging often fails to identify the site of origin as the diaphragm. Surgery is the cornerstone of therapy for PDT.

Conclusion

A multidisciplinary team approach is needed for successful treatment and management of PDT.     

Prompt correction of endotracheal tube positioning after intubation prevents further inappropriate positions

Study Objective

To determine whether the timely correction of endotracheal tube (ETT) positioning prevents further inappropriate positions.

Design

Prospective crossover study.

Setting

University-affiliated hospital.

Patients

44 adult, ASA physical status 1, 2, and 3 patients undergoing open or laparoscopic abdominal procedures.

Interventions

ETT positioning was verified by both auscultation and fiberoptic bronchoscopy (FOB), after intubation, and before extubation. In laparoscopic procedures, two additional measurements were performed: after maximal abdominal gas insufflation and with head-down position. An ETT in the bronchus or at the carina was considered an inappropriate placement. An ETT ≤ one cm from the carina was considered a critical placement.

Measurements

The frequency of inappropriate and critical ETT positioning with both auscultation and FOB and the number of ETTs that remained in an incorrect position despite repositioning.

Main Results

FOB detected 5 inappropriately positioned ETTs, 4 of which were also detected by chest auscultation (P = 0.99). Critical positioning was detected by FOB in 6 patients, three of which were also detected by auscultation (P = 0.24). There were 15 other "out-of-desired range” positions (out of the 3-5 cm range) - one placed too high and 14 placed too low, while 18 were placed within the range of positions. All patients with inappropriate ETT positioning were women (P = 0.005). Age, body mass index, Mallampati grade > 3, thyromental distance < 6 cm, or laryngoscopy grade ≥ 2 were not associated with either inappropriate or critical placement. No episodes of inappropriate or critical positioning were detected by FOB or auscultation at the end of surgery.

Conclusions

Early detection and prompt correction of inappropriate ETT positioning after intubation prevented further ETT migration into undesired positions.     

Surgical treatment of pectus excavatum: 30 years 398 patients of experiences

Purpose

The aim of the study is to review the surgical experiences with pectus excavatum (PE) chest deformities at the Department of Pediatric Surgery, West China Hospital of Sichuan University (Sichuan, PR China), during a 30-year period.

Method

Records of 398 PE patients (396 congenital, 2 acquired) who underwent surgical repair between 1975 and 2005 were reviewed. Modified sternal elevation was applied in all patients. Repair was performed with subperiosteal resection of the abnormal cartilages, transverse wedge osteotomy of the anterior sternum, and internal support with a metal strut for 1 year. Five technical details were strictly followed for each case. Three hundred twelve patients (78.39%) were followed up from 1 to 16 years.

Result

There were no deaths. Normal contour of the costal cage was constructed postoperatively in 98.74% (393/398) of the patients. Exercise tolerance was improved, and cardiac function recovered to the healthy level of same age. But pulmonary function recovered slowly after surgery.

Conclusions

The 5 technical details are key principles for sternal elevation. Normal appearance of chest wall can be recovered; normal cardiopulmonary function can be restored by the modified sternal elevation with excellent long-term physiologic, cosmetic results and low rate of complications.     

Evaluation of the Bullard, GlideScope, Viewmax, and Macintosh laryngoscopes using a cadaver model to simulate the difficult airway

Study Objective

To assess the performance and cervical (C)-spine movement associated with laryngoscopy using the Bullard laryngoscope (BL), GlideScope videolaryngoscope (GVL), Viewmax, and Macintosh laryngoscopes during conditions of a) unrestricted and b) restricted C-spine and temporomandibular joint (TMJ) mobility.

Design

Prospective, controlled, randomized, crossover study.

Setting

University teaching hospital.

Subjects

21 cadavers with intact C-spine anatomy.

Interventions

Each cadaver underwent to total of 8 intubation attempts to complete the intubation protocol using all four devices under unrestricted and restricted C-spine and TMJ mobility.

Measurements

Laryngoscopic view was graded using the modified Cormack-Lehane system. Time to best laryngoscopic view and total time to intubation were recorded. C-spine movement was measured between McGregor's line and each vertebra from radiographs taken at baseline and at best laryngoscopic view.

Main Results

During both intubating conditions, the BL achieved the highest number of modified Cormack-Lehane grade 1 and 2A laryngoscopic views as compared to the other three devices (P < 0.05) and had fewer intubation failures than the Viewmax or Macintosh laryngoscopes (P < 0.05). The GVL had superior laryngoscopic performance as compared to the Viewmax and Macintosh laryngoscopes (P < 0.05) and had fewer intubation failures than those two devices (P < 0.05). All devices except the Macintosh laryngoscope in restricted mobility achieved median times to intubation in less than 30 seconds. For both conditions, BL showed the least total absolute movement between Occiput/C1 and C3/C4 of all the devices (all P < 0.05). Most of the difference was seen at C1/C2.

Conclusions

In cadavers with unrestricted and restricted C-spine mobility, the BL provided superior laryngoscopic views, comparable intubating times, and less C-spine movement than the GVL, Viewmax, or Macintosh laryngoscopes.     

Prevention of seroma formation after mastectomy and axillary dissection by lymph vessel ligation and dead space closure: a randomized trial

Introduction

We aimed to reduce the incidence of seroma formation by altering surgical technique.

Methods

Two hundred one breast cancer patients were randomly divided into 2 arms: arm 1 was operated on using an altered surgical technique, which is to ligate all of the tissue connecting axillary vein bundles to the specimen, to suture the anterior edge of the latissimus dorsi to the chest wall, and to fix the skin flap to the underlying muscle by subcutaneous sutures; arm 2 was operated on using the conventional technique.

Results

The drainage volume, in the initial 3 days, for patients in arm 1 was significantly less than that for patients in arm 2 (P < .01). The duration of drainage in arm 1 was shorter than that in arm 2 (P < .01). The incidence of seroma formation in arm 1 (2%) was significantly less than that in arm 2 (14%) (P < .01).

Conclusion

The modified operating technique is an effective approach to reducing the incidence of seroma formation after mastectomy and axillary dissection.     

Gallbladder wall inflammatory cells in pediatric patients with biliary dyskinesia and cholelithiasis: a pilot study

Background/Purpose

Inflammation has been implicated in functional gastrointestinal disorders, including functional dyspepsia and irritable bowel syndrome. This study was undertaken to evaluate gallbladder wall inflammatory cells in children with abdominal pain related to gallstones and biliary dyskinesia to determine the candidate cell types that may be contributing to the pathophysiology of these entities.

Methods

Gallbladder specimens from 20 patients with cholelithiasis, 20 biliary patients with dyskinesia, and 12 autopsy controls were evaluated in a blinded fashion. Eosinophil, tryptase-positive, and CD3+ cell densities were determined for the lamina propria and muscularis mucosa layers and compared between groups.

Results

Patients with biliary dyskinesia and cholelithiasis had a 9- to 12-fold increase in mean and peak mast cell densities, respectively, in both layers as compared with controls. Peak (13.7 vs 8.4) and mean (9.2 vs 5.2) CD3+ cell densities were increased in the muscularis mucosae of cholelithiasis specimens as compared with biliary dyskinesia specimens.

Conclusion

Gallbladder wall inflammatory cell densities, particularly mast cells, differ between children with cholelithiasis, children with biliary dyskinesia, and controls. Future studies are warranted to define the roles for specific inflammatory cell types.     

Predicting the need for fundoplication at the time of congenital diaphragmatic hernia repair

Purpose

This study was conducted to examine the preoperative factors predictive of subsequent intervention for gastroesophageal reflux (GER) in children with congenital diaphragmatic hernia (CDH).

Methods

We conducted a retrospective cohort study on children who underwent repair of a CDH between January 1, 1995, and December 31, 2002 with follow-up continuing to September 1, 2005. Excluded in the study were children who died during their first admission, or who underwent fundoplication at the time of CDH repair. Univariate and multivariate logistic regressions were performed to examine preoperative factors predictive of subsequent intervention (fundoplication or gastrojejunal tube placement).

Results

Of 86 children, 13 underwent intervention (fundoplication, 10; gastrojejunal tube, 3) for GER. Univariate predictors included the following: right-sided CDH, use of nonconventional ventilation, liver within the chest, and patch closure of the CDH. However, only liver within the chest and patch closure of the CDH were significant predictors in a multiple variable analysis. The positive and negative predictive values of the multivariate model were 69.2% and 87.7%, respectively.

Conclusions

Infants with CDH who have liver within the chest or require patch closure of their hernia are at increased risk for subsequent intervention for GER. These children may represent a subpopulation that would benefit from fundoplication at the time of CDH repair.     

Thymic transplantation for complete DiGeorge syndrome: medical and surgical considerations

Background/purpose

Complete DiGeorge syndrome results in the absence of functional T cells. Our program supports the transplantation of allogeneic thymic tissue in infants with DiGeorge syndrome to reconstitute immune function. This study reviews the multidisciplinary care of these complex infants.

Methods

From 1991 to 2001, the authors evaluated 16 infants with complete DiGeorge syndrome. All infants received multidisciplinary medical and surgical support. Clinical records for the group were reviewed.

Results

Four infants died without receiving a thymic transplantation, and 12 children survived to transplantation. The mean age at time of transplantation was 2.7 months (range, 1.1 to 4.4 months). All 16 infants had significant comorbidity including congenital heart disease (16 of 16), hypocalcemia (14 of 16), gastroesophageal reflux disease or aspiration (13 of 16), CHARGE complex (4 of 16), and other organ involvement (14 of 16). Nontransplant surgical procedures included central line placement (15 of 16), fundoplication or gastrostomy (10 of 16), cardiac repair (10 of 16), bronchoscopy or tracheostomy (6 of 16), and other procedures (12 of 16). Complications were substantial, and 5 of the 12 transplanted infants died of nontransplant-related conditions. All surviving infants have immune reconstitution, with follow-up from 2 to 10 years.

Conclusions

Although the transplantation of thymic tissue can restore immune function in infants with complete DiGeorge syndrome, these children have substantial comorbidity. Care of these children requires coordinated multidisciplinary support.     

Clinical characteristics of women presenting with skin-only recurrence of breast cancer

Background

Locoregional failure after breast cancer treatment is usually heralded as a significant risk factor for systemic recurrence. However, locoregional recurrence may have different presentations, some of which may represent a more benign course. An example of this is the phenomenon of isolated chest wall recurrence (CWR). Given the paucity of data describing the clinical outcomes of women who recur this way, we sought to review the natural history and prognosis of patients presenting with this specific presentation.

Methods

Women who previously underwent primary treatment for breast cancer and subsequently developed an isolated CWR were identified. Histologic and treatment data as it related to their primary diagnosis and demographic data were obtained by chart review. Modalities of treatment for isolated CWR were also collected.

Results

We identified 17 patients who experienced an isolated CWR from January 1987 to May 2005. The median age at original diagnosis was 61 years (range 33-94 years). Median time to isolated CWR was 20 months (range 6-134). Eleven patients were treated with primary resection, 12 with radiotherapy, and 3 with a combination of hyperthermia and electron beam radiation. Ten patients went on to receive endocrine therapy, 6 received chemotherapy, and 2 were observed. Ten of these patients (58%) experienced a second event and for this group the median time to second event was 24 months (range 8-109). Median overall survival was 80 months (range 3-134) for the entire cohort.

Conclusions

Patients experiencing a chest wall recurrence may have a benign course suggesting this may be an indolent presentation of local regional recurrence. The proper therapy of these patients may require further study.     

Urethroplasty for strictures after phallic reconstruction: a single-institution experience

Background

Treatment recommendations for strictures after phalloplasty are lacking.

Objective

Our aim was to evaluate the outcome of urethroplasty for strictures after phalloplasty and to provide treatment recommendations based on this experience.

Design, setting, and participants

One hundred and eighteen urethroplasties were performed in 79 patients. Mean patient age was 37.6 yr. Mean follow-up was 39 mo.

Intervention

Different types of urethroplasty were used: meatotomy, Heineke-Mikulicz principle (HMP), excision and primary anastomosis (EPA), free graft urethroplasty (FGU), pedicled flap urethroplasty (PFU), two-stage urethroplasty (TSU), and perineostomy followed by urethral reconstruction (PUR).

Measurements

Stricture recurrence was defined as the need for additional instrumentation or surgery.

Results and limitations

Mean stricture length was 3.6 cm. Stricture location was at the meatus, phallic urethra, anastomosis, fixed part, and different locations in 18, 28, 48, 15, and 9 urethroplasties, respectively. Stricture recurrence was observed in 44 urethroplasties (41.12%). Stricture recurrence rate for meatotomy, HMP, EPA, FGU, PFU, TSU, and PUR was 25%, 42.11%, 42.86%, 50%, 40%, 30.3%, and 61.9%, respectively.

Conclusions

The main stricture location after phalloplasty is the anastomosis between the phallic and the fixed part. Urethroplasty for strictures after phalloplasty is associated with a relatively high recurrence rate.

Trial registration

EC UZG 2007/434.     

Clinical value of office-based endoscopic incisional biopsy in diagnosis of nasal cavity masses

Objective

To evaluate clinical features and the diagnostic accuracy of office-based endoscopic incisional biopsy in patients with nasal cavity masses.

Study Design

Diagnostic test assessment with chart review.

Setting

Tertiary referral center.

Subjects and Methods

From January 1997 to August 2006, preoperative diagnosis was achieved using endoscopic incisional biopsy in 521 patients. Cytopathologic and histologic findings were categorized as malignancy, benign neoplasm, or non-neoplastic lesion. Preoperative imaging was done in 462 patients (computed tomography: 438 cases; magnetic resonance imaging: 24 cases). We investigated the accuracy of endoscopic incisional biopsy and preoperative imaging by comparing it with pathologic results from tumor resection as the “gold standard.”

Results

Most of the patients had unilateral nasal symptoms (e.g., nasal obstruction, unilateral epistaxis, unilateral facial pain), and the clinical symptoms were of little diagnostic value in the differentiation of tumor and inflammatory lesion. The sensitivity and specificity of endoscopic incisional biopsy were 43.7 and 98.9 percent, respectively, for the diagnosis of nasal cavity malignancies, and 78.2 and 96.2 percent, respectively, for the diagnosis of benign neoplasms. The sensitivity and specificity of preoperative imaging were 78.3 and 97.5 percent, respectively, for the diagnosis of nasal cavity malignancies and 66.4 and 86.3 percent, respectively, for the diagnosis of benign neoplasms. Combining the two modalities increased diagnostic accuracy in nasal cavity masses.

Conclusion

Endoscopic incisional biopsy alone did not ensure accurate diagnosis of nasal cavity tumors, but in combination with preoperative imaging it was helpful for the diagnosis of nasal cavity malignancies.