Tension pneumocephalus after endoscopic sinus surgery: case report of repair and management in absence of obvious skull base defect

Tension pneumocephalus is a rare complication of functional endoscopic sinus surgery that may lead to rapid neurologic deterioration. Patients typically display symptoms within hours after the operation, and computed tomography reveals the presence of a skull base defect. We report a unique case of subacute tension pneumocephalus with no obvious skull base defect, which was associated with a pupil-involving third-nerve palsy. We discuss management of this complication and preventive measures for avoiding pneumocephalus after functional endoscopic sinus surgery.     

Tension pneumocephalus as a result of endonasal surgery: an uncommon intracranial complication

Tension pneumocephalus (TP) is a clinical entity characterized by continued build-up of air within the cranial cavity, leading to abnormal pressure exerted upon the brain and subsequent neurologic deterioration, due to development of a mass effect and potentially a herniation syndrome. Intracranial complications of endoscopic sinus surgery (ESS) and other endonasal procedures are fortunately very rare, occurring in less than 3 % of cases. We report 4 cases of small bone defects (<3 mm) in the anterior cranial base accompanied by TP, caused by ESS and other endonasal procedures. The pathophysiology and management of this clinical entity is discussed with a pertinent literature. Four patients with small (<3 mm) skull base defects were identified. All patients presented with active cerebrospinal fluid leaks. CT scans showed intracranial tension pneumocephalus. Using image-guided endoscopic techniques, all defects were addressed with multi-layer repair. Closure was achieved in all patients on the first attempt, with an average follow-up of 36 months. Tension pneumocephalus is a rare event that can occur as a result of traumatic or iatrogenic violation of the dura and should be considered in all patients presenting with altered mental status after endoscopic sinus surgery or other surgical and diagnostic procedures that violate either the cranial or spinal dura. Because of the potential for rapid clinical deterioration and death, prompt brain imaging is warranted to rule out the diagnosis, and urgent neurosurgical consultation is indicated for definitive management.     

Optimal duration of macrolide treatment for chronic sinusitis after endoscopic sinus surgery

Objective

The objective is to determine the appropriate duration of postoperative macrolide therapy for chronic rhinosinusitis to obtain a favourable outcome with endoscopic sinus surgery (ESS).

Methods

The effectiveness of postoperative macrolide treatment was examined in patients with chronic rhinosinusitis who underwent ESS, by comparing 3-month (44 patients) and 6-month administration (66 patients) of clarithromycin (CAM) (200 mg/day). Evaluation was made based on subjective symptoms and endoscopic findings at 3, 6 and 12 months after surgery.

Results

Seventeen (3-month CAM group) and 22 (6-month CAM group) subjects were able to be followed up to 12 months after surgery. No difference in effectiveness was observed between the groups until 6 months after surgery, but the 6-month treatment group showed significantly higher disappearance rates and significantly lower visual analogue scale (VAS) scores in the subjective symptoms of rhinorrhea and postnasal drip at 12 months after surgery. The positive finding rate of postnasal drip by endoscopic examination was also significantly lower in the 6-month treatment group at 12 months after surgery. These changes over time indicated gradual deterioration after discontinuation of CAM treatment in the 3-month treatment group, whereas a small improvement was observed after discontinuation in the 6-month treatment group.

Conclusion

The results indicate that chronic sinusitis patients with rhinorrhea or postnasal drip should be treated with macrolides for 6 months after surgery in order to improve the long-term outcome of endoscopic sinus surgery.     

Efficacy of controlling rhinosinusitis on the prevention of complications in pituitary surgery with transsphenoidal approach

Objective

The microscopic transcolumellar transseptal transsphenoidal approach (TSA) is the one of the most widely used methods for the surgical treatment of sellar and parasellar lesions. But nasal and paranasal sinus inflammation is the relative contraindications of TSA. This study was performed to investigate the results of pre TSA treatment options according to the degree of nasal and paranasal sinus inflammation on the paranasal sinus computed tomography scan (PNS CT).

Methods

From January 2005 to September 2010, 145 consecutive patients underwent operation of pituitary lesions through the TSA. The preoperative CT images for these patients were reviewed, and 26 patients were identified with sinus opacification on PNS CT. We then analyzed presenting symptoms, physical and endoscopic examination, Lund–Mackay score on PNS CT and preoperative management of the sinus problem retrospectively.

Results

Twenty-six patients had sinus opacification on PNS CT. Eight patients had the symptoms of sinusitis corresponding to PNS CT finding, so they had therapeutic antibiotics, and had TSA after symptomatic improvement. Three patients had the symptoms of sinusitis and sinus opacification with mean Lund–Mackay score of 5.33, so they underwent endoscopic sinus surgery first, and they got TSA a few months after. One patient underwent endoscopic sinus surgery and TSA simultaneously. No patient had a serious complication including intracranial infection.

Conclusion

TSA is a relatively safe technique, but intracranial complication after surgery may be fatal. Therefore rigorous evaluation and management is mandatory. It is especially important to treat rhinosinusitis issues preoperatively. Our preliminary data may be helpful to evaluate and manage the paranasal sinus inflammation before TSA.     

Management of third branchial pouch anomalies – An evolution of a minimally invasive technique

Objectives

The management of third branchial pouch anomalies has evolved in recent times with the popularisation of the endoscopic diathermy technique to sclerose the pyriform fossa sinus opening. We present our experience in managing 3 children with third branchial pouch anomalies and propose a minimally invasive management algorithm avoiding open neck surgery.

Methods

Retrospective case review of 3 patients including demographics, mode of presentation, investigations, management and complications.

Results

Three children, two male and one female of mean age 9.6 years presented with painful left anterior neck swelling. Axial neck imaging showed a superficial abscess with air locules and a sinus tract leading towards the left pharynx. Diagnosis was confirmed by endoscopic examination of the pyriform fossa revealing a sinus opening. Two patients underwent open excision; one combined with diathermy to the sinus opening. The last patient was diagnosed at his initial presentation and managed with endoscopic diathermy of the sinus opening combined with percutaneous needle aspiration of the neck abscess at the same sitting. One patient had two recurrences, the first after initial open surgery and the second after the first cautery. Two patients developed temporary hoarseness after the procedure, which resolved within two weeks. All patients were free from recurrences at follow-up.

Conclusions

Introduction of the technique of endoscopic diathermy to the pyriform fossa sinus opening in children with third branchial pouch anomalies has revolutionised their management avoiding open and potentially morbid surgery. Our algorithm takes this further by advocating percutaneous needle aspiration of the infective component and performing diathermy to the sinus opening at the first presentation.     

Localization and infliction pattern of iatrogenic skull base defects following endoscopic sinus surgery at a teaching hospital

Objective

Aim of this study is to evaluate the incidence, infliction patterns and management of dural injuries with cerebrospinal fluid (CSF) rhinorrhea following endoscopic sinus surgery at a teaching hospital. We present our results of over 14 years of experience from endoscopic repair of CSF rhinorrhea with long-term follow-up.

Methods

A retrospective study was performed by screening 14 years of sinus surgeries for iatrogenically inflicted CSF leaks of the anterior skull base. Obtained data were analyzed to determine the infliction pattern and location of CSF leaks, surgical closure techniques and outcomes. All incidences were further evaluated with regards to the surgeons training status.

Results

144 patients out of 6908 sinus surgeries were diagnosed with CSF rhinorrhea and underwent subsequent surgical repair. 52 patients had iatrogenic CSF leaks with 32 of the defects inflicted by the department's physician personnel. Average follow-up was 62 months, with a range of 10–168 months. The side distribution was 56.3% to the patient's right side and in 40.6% to the patient's left side. 68.7% became apparent during the initial surgery whereas 31.3% only after surgery. The most common defect location was the anterior ethmoid at the attachment of the medial concha base with 43.7%, followed by the junction between the ethmoid and sphenoid sinus with 21.9%, the frontal sinus aditus with 18.7% and the medial ethmoid region with 9.4%. With increasing training status, surgeons were more prone to cause defects at the frontal sinus aditus whereas surgeons with lesser training status caused more defects at the anterior ethmoid at the medial concha base. The posterior ethmoid and sphenoid sinus was equally prone to defects over all stages of surgical training. Initial endoscopic repair was successful in 87.5% of patients and 95% after revision surgery.

Conclusion

The obtained data confirm the safety of the endonasal sinus surgery according to Wigand's technique. The incidence of iatrogenic CSF leaks at a teaching hospital is not higher than at specialized rhinology departments. We observed a distinct pattern of inflicted skull base defects with different hot-spot areas, prone to damage in various stages of the surgeon's status of expertise.     

Endoscopic endonasal surgery in the management of selected malignant naso-ethmoidal tumors

Objective

The objective of this study was to report the cases of three patients with sinonasal malignant tumors who underwent en bloc tumor resection using endoscopic endonasal approaches, and to discuss the advantages and limitations of endoscopic endonasal tumor resection.

Methods

Three patients with malignant naso-ethmoidal tumors underwent en bloc resection with endoscopic endonasal approach.

Results

In very carefully selected cases of naso-ethmoidal malignant tumors that were preoperatively evaluated on endoscopic findings and magnetic resonance imaging to be limited to within the nasal cavity and/or ethmoid sinus and to have some safe margins between the tumor and skull base and/or lamina papyracea, tumors were resected en bloc using endoscopic endonasal approaches. A case of cerebrospinal fluid leakage was safely managed with the endoscopic approach.

Conclusions

In selected T1–T2 naso-ethmoidal malignant tumors with some safe margins, endoscopic endonasal surgery may offer a satisfactory alternative to external procedures.     

Nasal pH in patients with chronic rhinosinusitis before and after endoscopic sinus surgery

Purpose

Physiologically acidic nasal pH depends on intact nasal mucosal function. The aim of this study was to determine nasal pH in patients with chronic rhinosinusitis and to investigate the changes in pH related to mucosal healing after endoscopic sinus surgery.

Materials and methods

Normal subjects and the patients with chronic rhinosinusitis who showed no recurrence after endoscopic sinus surgery were enrolled. Using a portable pH meter and a glass-tipped probe, nasal pH was measured in the inferior meatus in normal subjects and patients before and after surgery at 3 months.

Results

The mean (± SD) nasal pH was 6.5 ± 0.5 (5.9 to 7.3) in 19 normal subjects, and 6.7 ± 0.6 (5.3 to 7.6) in 19 CRS patients before surgery, which showed no significant difference between the groups. The nasal pH values were in the range of 3.8–7.7 (mean ± SD 5.7 ± 0.9) at 3 months after surgery, and significantly lower than the preoperative values in patients (P = .004). The patients showing pH lower than 6.0 accounted for 10.5% before surgery, but 68.4% after surgery.

Conclusions

Normal nasal pH was in the slightly acidic range, and the mean nasal pH of patients with chronic rhinosinusitis fell within normal limits as well, which indicates that chronic rhinosinusitis may not disturb the electrolyte milieu of the nasal mucosa. The average nasal pH measured at 3 months after endoscopic sinus surgery exhibited acidity of pH 5.7. The factors causing a fall in nasal pH during the healing period after the sinus surgery remain to be elucidated.     

Endoscopic intraoperative control of epistaxis in nasal surgery

Objective

: Epistaxis represents a dangerous post-operative complication of nasal surgery. The advances of endoscopic procedures have also brought along the possibility of a surgical solution of nasal bleeding. These procedures include endoscopic cautery of the bleeding points, and more difficult techniques of endoscopic ligation of the sphenopalatine artery or the anterior ethmoidal artery. These surgical methods permit avoiding nasal packing, a very annoying procedure for the patient. This study aims to evaluate the advantages of this approach at the end of a nasal surgery to prevent routine nasal packing.

Method

: 133 subjects were operated on by the same surgeon in the Otorhinolaringology Department of University of Foggia (Italy) from March 2006 to March 2007. 17 (12.8%) patients were submitted to septoplasty, 42 (31.5%) to turbinoplasty (in 22 accompanied by septoplasty) and 74 (55.6%) to endoscopic sinus surgery (ESS) for nasal polyposis or nasal tumors.

Results

: Only 16 cases (12%) underwent nasal packing, while in the remaining 117 (88%) endoscopic control of bleeding permitted avoiding packing. In 53 (39.8%) patients only an endoscopic cauterization of bleeding points was performed; in 29 (21.8%) cases a sphenopalatine artery ligation was necessary. Only 2 subjects (1.5%) underwent anterior ethmoidal artery ligation. In the remaining 34 (25.5%) patients no procedure was necessary, due to the apparently scarce bleeding in the endoscopic vision at the end of surgery. In this group of non-packed patients, only 8 (6.8%) needed a post-operative tamponade while in the group of packed patients, 2 (12.5%) cases had a re-bleeding and a revisional surgery was necessary.

Conclusion

: Intra-operative precautional packing is therefore not justified during nasal surgery because of the small percentage of post-operative epistaxis. Intra-operative control of bleeding allowed nasal packing to be avoided in a large percentage of cases.     

Does septoplasty improve the quality of life in children?

Objectives

The aim of this study is to evaluate the outcomes of septoplasty and the effects of septoplasty on the quality of life and to determine postoperative patient satisfaction in children using nose obstruction symptom evaluation (NOSE) and visual analog scale (VAS).

Methods

Only pediatric patients who underwent septoplasty were included in the study. Patients who underwent adenoidectomy, endoscopic sinus surgery, or turbinate surgery in addition to septoplasty and total septal reconstruction with open technique septorhinoplasty were excluded from the study. Patients and their parents were inquired about their nasal obstruction symptoms using the NOSE scale before and 3 and 12 months following the surgery. VAS was used to analyze overall satisfaction of the patients and their parents on the outcomes of surgery, at the last follow-up examination 12 months after the surgery.

Results

Thirty-five patients with a mean age of 13.4 ± 2.8 (8–16) were included in the study. There was a very significant improvement in NOSE score at 3 months after septoplasty. The mean subjective satisfaction score measured with VAS at the 12th month postoperatively was 7.9 ± 2.1. Improvement in NOSE score was correlated with patient satisfaction.

Conclusion

Septoplasty is a very effective and satisfactory treatment for nasal obstruction caused by nasal septal deviation in children. The NOSE scale can be used for the evaluation of nasal obstruction symptoms.     

Risk factors for protracted sinusitis in pediatrics after endoscopic sinus surgery

Objectives

The goal of this article is to investigate the factors leading to protracted nasal discharge after pediatric endoscopic sinus surgery.

Methods

A retrospective chart review of all pediatric patients who had received endoscopic sinus surgery for chronic rhinosinusitis between January 2002 and September 2006 was conducted. The patients were assigned to the “protracted” group if they demonstrated persistent mucopurulent nasal discharge for more than 3 months after endoscopic sinus surgery, and otherwise to the “resolved” group.

Results

There were 21 “protracted” patients (39.6%) and 32 “resolved” patients (60.4%). Among these patients, age at diagnosis or operation, time from initial diagnosis to operation, and blood eosinophil count did not differed significantly between the “protracted” and the “resolved” groups. On the other hand, sinonasal polyposis (80.9% vs. 53.1%, P = 0.039), history of allergic rhinitis (52.4% vs. 12.5%, P = 0.002) and gender (male vs. female = 80.9% vs. 43.7%, P = 0.007) were more frequently observed in the “protracted” group than in the “resolved” group. These associations remained significant in a multivariate logistic regression (odds ratio = 9.36, 10.69 and 14.84, respectively).

Conclusion

Sinonasal polyposis, history of allergic rhinitis and gender were significant and independent risk factors for protracted nasal discharge after pediatric endoscopic sinus surgery. These risk factors should be taken into consideration during preoperative counseling.     

Endoscopic partial medial maxillectomy with mucosal flap for maxillary sinus mucoceles

Purpose

To describe a technique of endoscopic medial maxillectomy with mucosal flap for postoperative maxillary sinus mucoceles and to present a case series of subjects who underwent this procedure.

Materials and methods

This case series includes four subjects with postoperative maxillary sinus mucoceles who underwent resection via endoscopic partial medial maxillectomy with a mucosal flap. We will discuss the clinical presentation, imaging characteristics, operative details, and outcomes.

Results

Four subjects are included in this study. The average age at the time of medial maxillectomy was 52 years (range 35–65 years). Three subjects (75%) were female. One subject (25%) had bilateral postoperative maxillary sinus mucoceles. Two subjects (50%) had unilateral right sided mucoceles, and the remaining subject had a unilateral left sided mucocele.All subjects had a history of multiple sinus procedures for chronic sinusitis including Caldwell–Luc procedures ipsilateral to the postoperative mucocele. All subjects underwent endoscopic medial maxillectomy without complication and were symptom free at the last follow up appointment, average 24 months (range 3–71 months) after medial maxillectomy.

Conclusions

For postoperative maxillary sinus mucoceles in locations that are difficult to access via the middle meatus antrostomy, we recommend endoscopic medial maxillectomy with mucosal flap. Our preliminary experience with four subjects demonstrates complete resolution of symptoms after this procedure.     

Unilateral pathological lesions of paranasal sinuses removed by endoscopic surgery

Introduction

The aim of this study was to analyze the incidence and nature of unilateral pathological lesions of paranasal sinuses in patients who had endoscopic sinus surgery performed in ENT. Materials and methods: In the years 2006–2011 endoscopic sinus surgery for unilateral pathological lesions of paranasal sinuses was performed in 1847 patients (838 women and 1009 men). The enrollment of patients was based on the findings of otolaryngological clinical and subjective examinations, assessment of the paranasal sinuses on three-dimensional CT scans, and laboratory examinations. Based on the analysis of medical history data, including gender, age, the type of surgical procedure performed, and histopathological findings the cases were finally analyzed.

Results

Pathological lesions of the paranasal sinuses were localized on the left side in 132 (57%) patients, and on the right side in 100 (43%) patients. Of the 232 patients with unilateral pathological changes, 41.8% subjects underwent endoscopic sinus surgery for polypotic changes in the ethmoid and maxillary sinuses; 28.4% for the maxillary sinus; 10.8% for the ethmoid, maxillary and frontal sinuses; and 8.6% patients for all paranasal sinuses on one side. The number of operations of only one sinus was considerably lower: sphenoid sinus, 4.7%; ethmoid sinus, 2.2%; and frontal sinus, 1.7% patients. The histopathological analysis of unilateral pathological lesions removed by endoscopic surgery showed chronic paranasal sinusitis with polyps in 56.5% patients; chronic paranasal sinusitis in 22.8% patients; and maxillary sinus cyst was confirmed in 11.6% patients. In 5.1% patients inverted papilloma was diagnosed and in 2.2% patients the presence of osteoma was found.

Conclusions

Unilateral paranasal pathological lesions, leaving aside rather typical maxillary sinus cysts, require a particularly thorough pre-operative diagnosis and a precise histopathological assessment.     

Endoscopic endonasal transseptal approach for localized sphenoid sinus diseases

Objective

Surgery for localized sphenoid sinus disease can be performed in different ways. Direct (transnasal) and indirect (transethmoidal) approaches are now prevalent in endoscopic endonasal sinus surgery (ESS) because they are safe and effective. However, the identification or treatment of a sinus is occasionally difficult due to the anatomical variation, postoperative changes, or other reasons. In such difficult cases, we currently used an endoscopic endonasal transseptal approach (EETA) to the sphenoid sinus. The indications, procedures, and outcomes of this surgical method are presented here.

Patients and methods

Six of 11 patients with localized sphenoid sinus disease (mycetoma, n = 1; mucocele, n = 5) were treated using EETA. Surgery was performed under local anesthesia in all subjects. Following endoscopic conventional septoplasty, the sphenoid sinus was opened by perforating the anterior wall through the septoplasty wound. The sphenoid disease was treated through this opening, and then drained to the nasal cavity.

Results

The patients operated on using EETA had no surgical complications or disease recurrence, and the use of navigation or fluoroscopy systems was not required. The mean follow-up period of the patients was 27.7 months (range 18–48 months). Follow-up management included endoscopic examination and computed tomography.

Conclusions

A transseptal approach to the sphenoid sinus with a sublabial incision was once frequently performed in pituitary surgery. We modified the transseptal approach as EETA with the use of an endoscope and endonasal incision. This approach is practical and reliable for ESS, and may serve as an alternative for difficult-to-manage sphenoid sinus disease. EETA can be performed in the office as it can be achieved under local anesthesia without a navigation system.     

Long-term symptom control after endoscopic laser-assisted diverticulotomy of Zenker's diverticulum

Objective

To assess the long-term outcome after endoscopic laser-assisted diverticulotomy.

Methods

The medical files of patients who underwent endoscopic Zenker's diverticulum (ZD) surgery were reviewed retrospectively. Patients were interviewed using a questionnaire which assessed symptoms, other relevant disorders and satisfaction after the surgery.

Results

Mean follow-up period from 62 surgeries was 100 months (range 11–216 months). Follow-up data were obtained from 34 patients (response rate: 55%) in total. The surgery resulted in a significant reduction of symptoms (regurgitation, dysphagia and globus sensation). In four cases (12%) a postoperative impairment of swallowing solid food was reported, whereas, persisted difficulty of swallowing liquids was observed in two patients (6%). There was no reported case of impairment associated with everyday habits. The majority of patients were satisfied with the overall outcome of the surgery (n = 31, 91%).

Conclusion

The endoscopic laser-assisted diverticulotomy is an effective method of treating Zenker's diverticulum. The presented long-term results confirm that this technique offers a very high degree of symptom relief and patient's satisfaction.     

Craniofacial resection for malignant nasal and paranasal sinus tumors assisted with the endoscope

Background

Craniofacial resection is regarded as the treatment of choice for paranasal malignant tumors invading the skull base. Even with this approach, the surgical view remains obscured when tumors in the deep nasal and paranasal sinuses are resected. Endoscopy provides a wide and clear surgical view in the deep and narrow nasal cavity. We report two patients who underwent craniofacial resection assisted with endoscope.

Methods

Two patients with malignant paranasal sinus tumor invading the anterior skull base underwent endoscope-assisted craniofacial resection.

Results

To avoid a limited surgical view in the sinonasal cavity, we performed craniofacial resection with endoscopic osteotomy and several procedures in the nasal cavity. The neurosurgeon performed anterior skull base osteotomy at an appropriate site from above, while the otolaryngologist provided illumination with the endoscope from below and preserved the adjacent structures. The patients recovered uneventfully and the endoscopic examinations of both patients 18 months after the surgery showed no recurrence.

Conclusions

Endoscopes were useful for the craniofacial resection at osteotomy, providing illumination from below and at the several procedures in the deep part of the nasal cavity. If a lateral rhinotomy incision is made, the combined transfacial and transnasal approaches avoid the limited working angle associated with the transnasal approach alone. Although an endoscopic approach is useful for treating sinonasal tumors, we should recognize its advantages and limitations.     

The price of doing pediatric sinus procedures (a look at cost)

Objective

Display the cost savings of minimal sterile covers and preparatory time while still maintaining optimal outcomes for sinus procedures.In-office non-sterile endoscopic sinus procedures have not shown a difference in infections and complications. Institutions continue to employ more “traditional” sterile preparation with similar procedures in the operating room. Multiple studies have also shown no significant difference in postoperative course when preoperative antibiotics are administered for sinus procedures.

Methods

Endoscopic sinus procedures were selected (58 patients) to analyze itemized sterile costs. Drapes, gloves, gowns, and antibiotics were then tallied and compared to the same items for cochlear implants (14 procedures). The “sterile-prep” time was also analyzed and compared between the two procedures. Cost difference was analyzed.

Results

Comparing the supplies used for sinus procedures (56) and cochlear implants, our average sinus cost was $10.19, compared to $34.64, with a difference of $24.45. This equated to a savings of $1418.00 in sinus procedure supplies that year. The difference in draping and scrubbing time showed a difference of 20 min between groups, equaling a value of $1760 difference/case. This calculated to a savings of $10,2080 for sinus operating room time. There was no difference in patient outcomes with this surgical preparatory approach.

Conclusion

Our analysis showed a large cost savings over a fiscal year in operative time and supplies. This did not compromise any patient outcomes given the already non-sterile nature of endoscopic sinus surgery. This practice can be adopted to greatly enhance efficiency without sacrificing surgical results.     

Fully endoscopic resection of juvenile nasopharyngeal angiofibroma – Own experience and clinical outcomes

Objectives

The treatment of choice in juvenile nasopharyngeal angiofibroma (JNA) is surgery – nowadays endoscopic techniques. The aim of the study was to present the results of endoscopic treatment in patients diagnosed with juvenile angiofibroma.

Materials and methods

In this retrospective case series, 10 patients with a diagnosis of JNA treated at the Department of Otolaryngology of the Medical University in Poznań from 2006 to June 2013 were included. The age of patients were between 11 and 19 years old (14.6 on average). In 9 out of 10 patients the treatment was preceded by embolization. The surgery used the endoscopic approach through one nostril and the four-handed technique.

Results

Total resection was possible in all cases. Blood loss ranged from 100 to 250 ml. Post-operative hospitalization lasted from 3 to 5 days (3.3 days on average). Recurrence was reported in one patient. The observation lasted from six months to seven years (3.55 on average).

Conclusions

Endoscopic resection of juvenile angiofibroma is safe for the patient. Moreover, if the evaluation of the tumour size and staging is correct, the ability of total removal of the tumour is very high. It is also connected with small blood loss, short hospital stay and good cosmetic effects.     

Brodawczaki odwrócone nosa i zatok przynosowych w materiale własnym

Introduction

The aim of this work was to analyze the occurrence of inverted papilloma within the nose and paranasal sinuses, the extent of lesions and the clinical course in the patients who underwent endoscopic surgery.

Materials and methods

Between the years of 2006–2012, at the Department of Otolaryngology and Laryngological Oncology, 2295 patients were subjected to surgery due to paranasal sinus diseases. The material was based on their past medical histories. The analysis includes the age and gender of the patients, the type of surgery, and results of histopathological examinations. A surgical procedure covered the paranasal sinuses with lesions diagnosed in CT. The qualified patients had inverted papilloma in histopathological results.

Results

Among 2295 patients who were operated because of chronic inflammatory changes, inverted papilloma was histopathologically diagnosed in 49 cases. In 16 patients with inverted papilloma, inflammatory changes were present on one side only, while in 33 cases inverted papilloma was confirmed histopathologically on one side. The analysis of age and gender of the study group showed that the highest occurrence of inverted papilloma was in patients over 50 years of age. In the majority of the studied cases, inverted papilloma spread in the middle nasal concha and the maxillary or ethmoid sinus.

Conclusions

In surgery, the endoscopic technique allows for an effective removal of inverted papilloma from the nose and paranasal sinuses. According to the authors, endoscopy is the most valuable method for post-operative monitoring of recurrent inverted papilloma.     

Submucous inferior turbinotomy cooperating with combined antrostomies for endonasal eradication of severe and intractable sinusitis

Objective

This paper aims to prove the usefulness of submucous inferior turbinotomy cooperating with the combined middle and the inferior antrostomies in endoscopic endonasal sinus surgery (ESS), enabling the eradication of severe maxillary sinusitis without extranasal approaches. The long-term surgical outcomes of 22 adult patients are presented together with details of this procedure.

Methods

Subjects comprised 22 adult patients with severe unilateral maxillary sinusitis, showing total opacification on computed tomography and failure of medical treatments preoperatively. Patients who could be managed using conventional ESS methods were excluded. Endoscopic submucous resection of the inferior turbinate bone including the uncinate process was first performed. The procedure aimed to make both the middle and the inferior nasal meatus wide enough to eradicate the sinus disease, cooperating with combined antrostomies.

Results

Pathology comprised multiple massive polyposis including antrochoanal polyps in 6 and fungal ball in 16 patients. Neither surgical complications nor recurrent disease was seen postoperatively in any patient. Postoperative endoscopic management via both openings was easy and facilitated the restoration of mucosal lining in the sinus.

Conclusion

We proved our new surgical procedure was useful in ESS without any extranasal approaches, although applied to unilateral lesions in the current study. Postoperative management via the middle and the inferior meatal openings helped to facilitate postoperative mucosal healing.