Endoscopic endonasal sinus surgery for post-operative maxillary cysts

Surgical treatment for postoperative maxillary cysts uses a Caldwell-Luc or endonasal approach. Endoscopic endonasal surgery has become the treatment of choice in postoperative maxillary cyst, and many postoperative maxillary cysts have been classified. Due to the importance of cyst medial wall sites, we classified cysts into 4 types by location. Those whose, medial wall was close to the middle meatus, inferior meatus, or nasal lateral wall, we termed middle meatus, inferior meatus, and nasal lateral wall types. When the lateral cyst was not close to the nasal cavity but to another cyst, we termed the cyst continuous. We opened all nasal cavity cysts as far as possible. For continuous types, we determined location of the lateral cyst 3-dimensionally before surgery. We first opened medial cysts and opened the lateral cyst through the medial cyst. The tube was placed the lateral cyst to the nasal cavity. We opened all 45 cysts in 29 patients to the nasal cavity. As of this writing, no cysts connected to the nasal cavity have recurred.     

Implications of endoscopic endonasal surgery for the treatment of postoperative maxillary mucoceles

Recently, endoscopic endonasal surgery has been widely used to treat chronic sinusitis with good results being reported by many investigators. Endoscopic endonasal surgery is a technique available not only for chronic sinusitis but also for other sinus diseases including postoperative maxillary mucoceles. In this report, the indications and limitations of endoscopic endonasal surgery for the treatment of postoperative maxillary mucoceles are discussed based on our experience treating 26 such mucoceles at our clinic. The indications for endoscopic endonasal surgery include mucoceles in close contact with the lateral wall of the inferior nasal meatus and those mucoceles that can be widely opened to the middle nasal meatus. The following cases could not be treated by endoscopic endonasal surgery: mucoceles that were localized in areas distant from the nasal cavity, mucoceles in which the lateral wall of the inferior nasal meatus was bony and intensely thickened, and mucoceles that could not be sufficiently opened to the middle nasal meatus.     

鼻内镜下上颌骨囊肿开放术

目的:探讨鼻内镜下上颌骨囊肿开放术的有效性和可行性。方法:对13例侵犯上颌窦或鼻腔底的上颌骨囊肿在鼻内镜下行上颌骨囊肿开放术,即行鼻内镜下囊肿下鼻道或鼻腔底开放术,囊肿囊壁被全部或部分切除。结果:随访6～36个月,13例患者未出现面部隆起、鼻塞及鼻腔溢液等症状,囊肿无复发。结论:鼻内镜下上颌骨囊肿开放术适用于侵犯上颌窦或鼻腔底的上颌骨囊肿,较传统手术创伤小,简单高效,受侵牙齿可尽量保存。     

Long-term endonasal endoscopic review of successful duraplasty after endonasal endoscopic skull base surgery

BACKGROUND: This study was performed to examine the long-term endonasal endoscopic morphological appearance of successful duraplasty after endoscopic skull base surgery for different pathology. METHODS: This study included 65 patients who underwent endonasal endoscopic surgery for different skull base lesions with successful duraplasty. Forty patients had pituitary adenomas, 25 with macroadenomas and 15 with microadenomas. Twenty patients with cerebrospinal fluid rhinorrhea of different etiologies and three patients with meningoencephalocele were included. There were two patients with skull base meningiomas, 1 with an extensive greater wing meningioma reaching the nasal cavity and the 1 with recurrent olfactory groove meningioma. Different types of autologous materials were used in reconstructing the skull base defect. Clinical follow-up with endoscopic nasal examination was done routinely 1, 3, 6, and 12 months after surgery. CT and MRI were performed when indicated. The follow-up period ranged from 6 months to 8 years. RESULTS: Starting from 3 months after surgery to the rest of the follow-up period, endonasal endoscopic view of the site of duraplasty showed that with small skull base defect (<5 mm), there was neither dural pulsation nor prolapse. With moderate-size defect (5-10 mm) there was dural pulsation without prolapse. With larger defect (>10 mm) there was dural pulsation and prolapse. These findings were constant regardless of the etiology of the lesion and the reconstruction material used. CONCLUSION: This long-term study showed that dural pulsation and prolapse at the site of the successful duraplasty is a function of the size of the bony defect and does not depend on the pathology of the lesion or the autologous material used for reconstruction. For any future endonasal procedure for these patients, the surgeons should be fully aware of the state of duraplasty to avoid any complication.     

鼻内镜手术适应证及并发症

陈文文 （200081上海市第一人民医院分院耳鼻咽喉头颈外科）这次会议上，许庚教授有两点十分精辟的经验之谈，值得大家重视。第一点，他以自己为例：1995年12月，他用鼻内镜检查自己时，发现双侧都长了鼻息肉。CT影像显示上颌窦、筛窦密度增高，充满积液。当年，他利用在广州召开会议的机会，请韩德民教授为他手术。手术在局部麻醉下进行。当时员彭年教授、林尚泽教授在旁一边观看，     

与鼻内镜手术有关的新设备

目的：介绍与鼻内镜手术相关的新设备和技术。方法：综述近年鼻内镜手术新设备的研究进展及与临床应用相关的文献。结果：新设备主要包括三维图象技术、电视导航系统、电动机割吸引器、立体内镜和人工智化设备,这些设备的应用明显提高了手术治疗效果。结论：新设备的应用极大地推动了鼻内镜外科的发展。     

Value of endonasal endoscopic surgery in the treatment of sphenoid cerebrospinal rhinorrheas. 15 cases

Surgical management of cerebrospinal fluid leaks (CSFL) has improved these few past years with the development of paranasal sinus surgery under optical guidance. CSFL localized in the sphenoid sinus represent only 5 to 15% of all CSFL. The authors have analyzed a serie of 15 patients having undergone surgery from 1992 to 1999 for CSFL: 10 cases followed pituitary gland surgery realized through sublabial-transsphenoidal approach, 2 cases followed head trauma, 1 case followed a secondary neurosurgical procedure following recurrence of a rathke's cleft cyst, 1 case followed medical treatment of a bulky pituitary gland adenoma and 1 case was associated to an empty sella syndrome. The surgical procedure has relied on sphenoid sinus approach through the sphenoethmoidal recess (SER) (n = 8), transethmoidal approach (TE) (n = 2) or transseptal approach (TS) (n = 7) followed by a filling of the defect by a graft of fat with biological glue (n = 17). Sometimes it was associated to a cartilagenous graft (n = 7) when there was a bone defect. The average period of hospitalisation was 5.2 days (4-21), mean follow-up was 2.9 years (6 months-7 years). RESULTS: The success rate was 80% (3 failures were observed), 2 patients underwent secondary procedures by TS approach with success. Our results combined with the literature data led us to propose an alternative surgical strategy adapted to each case. Endonasal surgery under optic guidance compared to the transrhinoseptal approach represents an attractive alternative with less undesirable iatrogenic consequences.     

内镜经鼻颅底外科在实践中发展

谈到内镜经鼻颅底外科大多数外科医生联想到的是其微创的特点和有限的适应证.如20世纪90年代开展的内镜经鼻垂体腺瘤切除[1]、视神经减压和脑脊液鼻漏修补术等,以其微创、安全、疗效好的特点得到越来越多的耳鼻咽喉头颈外科、神经外科和眼科专家们的认可.     

Antrochoanal polyp: a comparative study of endoscopic endonasal surgery alone and endoscopic endonasal plus mini-Caldwell technique

Antrochoanal polyp (ACP) originates in the maxillary sinus. To diminish the regrowth rate of choanal polyp, a complete removal of the antral portion and its attachment is necessary. There are several methods for this purpose, but in this study two techniques were comparatively investigated. This retrospective study was conducted by analyzing the database of 40 operated patients for ACP, 19 of whom underwent an endoscopic endonasal removal of polyps and 21 experienced endoscopic endonasal surgery with mini-Caldwell operation. The two techniques were compared with regard to their complications and regrowth rate. It emerged that post-operative complications (bleeding, synechia, ostia stenosis) in both groups were mild and there was not any significant difference between the two groups. Out of 19 cases in the endoscopic endonasal surgery group, 4 had recurrences, while in the mini-Caldwell group we had no recurrence. (P = 0.042)). This result implies that, in order to prevent incomplete excision and recurrences, combined approaches (endoscopic endonasal surgery and mini-Caldwell) should be considered, particularly when the attachment site of the antral part of ACP is undetected.     

鼻内镜手术治疗上颌骨囊肿的临床分析

目的 探讨鼻内镜下经鼻-上颌窦进路切除上颌骨囊肿的手术方法及临床效果。 方法 回顾性分析自2014年3月至2019年4月收治的上颌骨囊肿患者21例,均为囊壁突入上颌窦内者,根据影像学检查明确囊肿的大小、范围以及与上颌窦各壁的位置关系,内镜下经鼻腔行扩大上颌窦自然口或联合泪前隐窝进路并下鼻道开窗引流,尽可能切除突入上颌窦腔的囊肿囊壁,使囊肿壁与上颌窦壁融合成共腔,建立囊肿-上颌窦-鼻腔相通的引流通道。 结果 所有患者术后随访6~24个月,术腔黏膜均上皮化良好,鼻面部症状消失或明显缓解,囊腔与上颌窦引流通畅,无复发病例。 结论 经鼻-上颌窦进路切除或开放上颌骨囊肿联合下鼻道开窗引流,可以彻底切除病变或建立充分的引流通道。相对于传统手术进路刮除或开放囊肿,该进路损伤轻微、恢复快、复发率低,符合微创手术的理念,值得临床推广。     

Simulation-based training in endoscopic endonasal surgery: Assessment of the cyrano simulator

PurposeEndoscopic endonasal surgery requires many skills: a learning program was developed with progressive steps, on a surgical simulator (Cyrano) designed to train junior surgeons in the acquisition of basic endoscopic surgery skills and to assess their progress. The main objective of this study was to establish the construct validity of these exercises and to refine objective criteria to establish students’ level.Material and methodsThirty volunteers with varying experience in endoscopic endonasal surgery were blindly evaluated on 4 modules according to objective and subjective criteria.ResultsTen beginner, 11 intermediate and 9 expert level participants were included. For each exercise, at least one criterion was discriminant for level of expertise. Weighted scores succeeded in discriminating groups. Interpretation of a single criterion must remain cautious and evaluation should rather rely on composite scores, which better reflect the participants’ level. Useful criteria and their reference values are specific of each exercise. Face and content validity were rated at 3.92/5 and 4.59/5 respectively (5-level Likert scale).ConclusionThe construct/face/content validity of the proposed modules have been verified. Most of the modules tested here were physically not realistic, but they were all rated as highly relevant for surgical training by the participants.