Sphenochoanal polyp - a rare diagnosis in nasal obstruction

One of the most common nasal pathologies to present to an otolaryngologist is polyposis. Two well-recognized forms occur, the common antrochoanal polyp and the rare sphenochoanal polyp. Differentiation between the two is necessary for proper management by endoscopic sinus surgery.     

鼻息肉术后口服糖皮质激素的疗效观察

目的通过观察鼻息肉术后口服糖皮质激素的疗效,探讨鼻息肉术后糖皮质激素的应用及作用机制。方法56例鼻息肉术后患者中随机选取28例为试验组,28例为对照组,试验组术后口服+鼻喷糖皮质激素,对照组术后口服安慰剂+鼻喷糖皮质激素,术后第2、6、12、24周对所有患者症状、鼻腔黏膜及副作用进行观察,比较试验组与对照组的差别。结果①术后第2周,试验组患者鼻腔黏膜水肿、结痂较对照组明显减轻,差异具有统计学意义（P＜0.05）,两组VAS评分差异具有统计学意义（P＜0.05）;②术后第6周及术后第12周,试验组及对照组患者VAS评分、鼻腔黏膜水肿、结痂情况差异均无统计学意义（P均＞0.05）;患者鼻腔黏膜出现上皮化,其中试验组多于对照组;③术后第24周,试验组上皮化时间与对照组比较差异无统计学意义（P＞0.05）,治疗总有效率与对照组比较差异无统计学意义（P＞0.05）;④仅有1例患者口服激素后第4天出现膝关节疼痛,停药后症状逐渐消失,未行特殊治疗,其余患者均未出现睡眠障碍、体重增加及关节疼痛等并发症。结论口服糖皮质激素短期内能安全有效缓解鼻内镜术后鼻息肉患者自我感觉症状及鼻腔黏膜水肿,但停药后其作用不能有效维持。     

Regression of a sphenochoanal polyp in a child

OBJECTIVES: To present an unusual case of a sphenochoanal polyp that regressed and review the etiology of such polyps in comparison to the commoner antrochoanal polyp. STUDY DESIGN: Case study. METHODS: One was incidentally discovered in a girl aged 3 years, 8 months at postnasal mirror examination after adenotonsillectomy. RESULTS: Computed tomography scans 1 month later confirmed the polyp, but three months later, MRI scans only revealed sphenoid sinus opacification. Sphenoidotomy revealed normal sinuses implying inflammation had resolved. CONCLUSION: This patient is believed to be the youngest reported to have sphenochoanal polyp, and the only one where the polyp had completely regressed. This regression suggests that sphenochoanal polyps may be more common than is thought but are mostly asymptomatic.     

Choanal polyp of sphenoidal origin

Sphenochoanal polyp is a rare entity which originates in the sphenoid sinus cavity and extends into the choana via the ostium. It presents in a similar manner to the more common antrochoanal polyp. Radiological examination is necessary to differentiate between these two types. We present a case of sphenochoanal polyp and review the clinical, radiological and pathological features. The role of endoscopic sinus surgery is emphasised. Received: 31 December 1999 / Accepted: 25 February 2000     

Isolated sphenochoanal polyp: A rare clinical entity

Choanal polyps almost always appear as solitary growth and most commonly arise from the maxillary sinus. Isolated polyp originating from the anterior wall of the sphenoid sinus or from its interior and extending as choanal polyp in to the nasopharynx are extremely rare clinical entities. Here we report a 34-year-old male presenting with a history of headache, intermittent nasal discharge and nasal obstruction. A diagnosis of sphenochoanal polyp (SCP) was made on nasal endoscopy and magnetic resonance imaging. The SCP was removed endoscopically via a transnasal sphenoidotomy and histopathologically it was confirmed as inflammatory polyp. In this paper we discuss the clinical presentation and surgical management of this rare clinical entity.     

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.     

蝶窦后鼻孔息肉的鼻内镜治疗(附3例报告)

目的探讨蝶窦后鼻孔息肉的临床特征、诊断和鼻内镜手术治疗效果。方法对3例蝶窦后鼻孔息肉病人术前行冠状位CT扫描并行鼻内镜手术治疗。结果鼻内镜检查和冠状位CT扫描可确定息肉的起源。所有病人均一次治愈,术后随访8~26个月未见复发。结论临床特征、鼻内镜检查和冠状位CT扫描对蝶窦后鼻孔息肉的诊断起重要作用,鼻内镜手术是最佳治疗方法。     

儿童慢性鼻窦炎的鼻内镜手术治疗

目的探讨鼻内镜手术治疗儿童慢性鼻窦炎的疗效及影响疗效的相关因素。方法回顾分析1999年1月~2003年4月经鼻内镜手术治疗儿童慢性鼻窦炎72例临床资料。结果随访12个月以上,根据内镜鼻窦手术疗效评定标准(1997·海口),本组72例中,治愈58例,治愈率80.6%,好转13例,好转率18.0%,无效1例,无效率1.4%,总有效率98.6%,未发生严重并发症。结论鼻内镜手术是治疗儿童慢性鼻窦炎的理想方法。但应注意选择手术时机,控制手术范围,加强术后管理。     

鼻内窥镜加柯-陆手术联合进路治疗慢性鼻窦炎

目的：探讨提高慢性鼻窦炎疗效的方法。方法：对１０４例伴有上颌窦病变的慢性鼻窦炎患者行鼻内窥镜和柯－陆手术联合进路鼻窦手术,彻底清除病变。结果：术后随访６～１２个月（平均９个月）,治愈８５例（８１．７％）,好转１５例（１４．４％）,无效４例（３．８％）,总有效率９６．１％。结论：该方法可彻底清除上颌窦病变,恢复上颌窦的生理性引流通道,防止复发,弥补了经鼻内窥镜鼻窦手术在处理上颌窦病变时的局限性。     

Normal wound healing of the paranasal sinuses: Clinical and experimental investigations

Summary Twenty-two patients underwent partial or complete ethmoidectomies and were subjected to standardized postoperative follow-ups including endoscopic photography of healing tissues. Sequential biopsies were also taken from the regenerating mucosa and compared with endoscopic findings. On this basis wound healing could be divided into four different phases, allowing for the diagnosis of healing disturbances and clinical planning of stage-dependent therapy. Additionally, a model of wound healing in the maxillary antrum of the rabbit was developed for better understanding the clinical observations. Regeneration of standardized mucosal defects was studied with three-dimensional histomorphological analysis. Circular wounds were found to regenerate concentrically, with wound closure starting by epithelial migration. Within 120 h, granulation tissue covering the wound surface started to become hyperplastic and bone apposition occurred with the formation of osteoid. The systemic application of prednisolone (2 mg/ kg per day i.m.) and topical 5% dexpanthenol ointment resulted in an acceleration of late epithelial wound closure together with a reduction in hyperplastic granulation tissue. Local applications of epidermal growth factor had no significant effect.     

Thirty years of endoscopic sinus surgery: What have we learned?

Prior to adaptation of endoscopic approaches for sinonasal pathology, patients regularly endured significant morbidity from open approaches to the sinonasal cavity that were often fraught with failure. With improvements in transnasal endoscopy, functional endoscopic sinus surgery subsequently emerged from the work of Messerklinger and other pioneers in the field. The popularity of endoscopic sinus surgery quickly escalated and expanded to pathology other than inflammation. Here, we discuss the evolution of endoscopic sinus surgery as it relates to improvements in understanding disease pathogenesis, improvements in instrumentation and expansion of indications.     

低能量He-Ne激光促进鼻内镜鼻窦手术后黏膜上皮化的临床观察

目的探讨低能量He—Ne激光照射对鼻内镜鼻窦手术后术腔黏膜转归的影响。方法符合标准的64例慢性鼻窦炎患者随机分为治疗组和对照组,治疗组以He-Ne激光术腔照射辅助术后治疗,以术腔黏膜病变情况及术腔上皮化时间为观察指标,与对照组比较评价疗效。结果He-Ne激光治疗组病例术后4周时术腔的囊泡、息肉样水肿、窦腔积脓及粘连均较对照组轻;治疗组平均上皮化时间6.1周,对照组平均上皮化时间8．2周,2组差异有统计学意义（P〈0．05）。结论He—Ne激光照射可促进鼻内镜鼻窦手术后黏膜良性转归。     

改良Wigand式鼻内镜手术治疗慢性鼻窦炎鼻息肉的临床研究

目的探讨改良Wigand式鼻内镜手术对复杂慢性鼻窦炎、鼻息肉的治疗意义。方法回顾性总结87例行改良Wigand式鼻内镜手术的慢性鼻窦炎、鼻息肉患者,手术方式为在鼻内镜下先开放中鼻道,然后从中鼻甲内外侧联合进路扩大蝶窦自然开口,从后向前开放各个鼻窦。结果87例174侧手术,无并发症发生,术后随访3～6月复发病例仅3例。结论改良Wigand式鼻内镜手术是治疗慢性鼻窦炎、鼻息肉的一种安全有效的手术方式。     

变应性真菌性鼻窦炎的临床观察

目的 :探讨变应性真菌性鼻窦炎 (AFS)的诊断及治疗。方法 :8例AFS患者均行鼻内窥镜手术、激素治疗及抗真菌药物冲洗术腔。结果 :随访 13～ 4 0个月 ,2例复发 ,再次接受同样治疗 ,现仍在随访中。结论 :AFS的症状主要表现为变应性鼻炎的症状及骨质吸收 ,需要鼻内窥镜手术、激素及抗真菌药物等综合治疗。AFS易复发 ,长期随访很重要     

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.     

两种鼻内镜额窦手术方式的临床评价

目的对鼻内镜额窦手术Wormald术式与筛泡前径路术式进行临床比较与评价。方法慢性额窦炎行功能性鼻内镜额窦手术患者50例70侧。随机分为2组：A组（Wormald术式）24例32侧;B组（筛泡前径路术式）26例38侧。结果所有患者均随访6-12个月。①Wormald术式组有效率90．63％（29／32）,筛泡前径路术式组有效率84．21％（32／38）,2组比较P〉0．05。②额窦开放术后随访3个月,以额窦口直径〉0．5cm为标准,A组84．38％（27／32）,B组78．95％（30／38）,两组比较P〉0．05。③手术时间为A组平均54．32min,B组平均58．51min。④手术并发症为A组鼻泪管损伤1例;B组筛前动脉损伤1例,术后下眼睑瘀斑2例。结论对于2种手术径路的临床应用,可以依据鼻窦解剖、术者经验和手术器械的不同而定。但就鼻窦解剖特点而言,如鼻丘气房发育良好或钩突上端附着判断困难,则采取Wormald术式较好;如钩突上端附着于眶内壁或鼻丘气房发育小,则采取筛泡前径路术式较好。手术中如能将两者有机结合应用则更好。     

Functional endoscopic sinus surgery results in 69 patients

Sixty nine patients with sinonasal symptoms were subjected to diagnostic endoscopy. Functional endoscopic sinus surgery was done subsequently for chronic sinusitis in 42 patients, for ethmoidal polypi in 18 patients and for antrochoanal polypi in 9 patients. A follow up of 18 to 36 months ( mean 27 months) reveals a success rate of 84% in the overall study, 81.5% in patients with chronic sinusitis alone, 87.5% in ethmoidal polypi and 100% in patients with antrochoanal polyps.     

Anatomical Changes of the Ethmoid Cavity After Endoscopic Sinus Surgery

Objective: Alteration of the bony architecture of the sinus cavities has been observed in chronic sinusitis. Plasticity of the ethmoid sinus framework after endoscopic surgery, however, is a newly described entity. The objective of this study was to determine the incidence and extent of changes in ethmoid size after ethmoidectomy. Study Design: Retrospective review performed at an academic medical center. Methods: Computed tomography scans performed from 2006 through 2007 at the Massachusetts Eye and Ear Infirmary (n = 5,131) were reviewed to identify 100 consecutive patients who underwent sinus surgery and met inclusion criteria. Seven dimensions were measured for each pre‐ and postoperative scan (n = 200) using Voxar 3D software. Results: Computed tomography scans performed before and 2 to 37 months after ethmoidectomy demonstrated a decrease of 1.1 ± 1.6 mm in mean ethmoid cavity width at the level of the cribriform plate and posterior globe after surgery (P < .0001). Twenty‐five patients (25%) had >1 mm decrease in mean ethmoid width, and six patients (6%) had a decrease of >2 mm (mean 3.1 ± 0.9 mm). These findings seemed to be the result of postoperative bowing of the medial ethmoid walls with a corresponding increase in orbital volume. These volumetric changes resulted in a postoperative subclinical retrodisplacement (enophthalmos) of the globes (mean 0.2 ± 0.8 mm, P = .008). The extent of surgery, including performance of frontal recess dissection (P = .007) and total ethmoidectomy (P = .021) were found to be independent predictors of the observed changes in sinus dimensions. Conclusions: Postsurgical plasticity of the ethmoid cavity is a new concept supported by observed changes in sinus dimensions after ethmoidectomy. These changes may reflect a loss of internal structural support and forces of contracture during the postoperative healing period.     

79例复发性鼻窦炎修正性鼻内镜手术

目的探讨慢性鼻窦炎鼻息肉术后复发的原因及影响修正性鼻内镜手术疗效的相关因素。方法对79例(105侧)复发性鼻窦炎鼻息肉患者实施修正性鼻内镜手术,并对所有患者进行围手术期用药及术后鼻内镜定期复查。结果 79例(105侧)患者,术后经12个月以上随访,治愈55例(70侧),好转14例(22侧),无效10例(13侧),治疗总有效率87.34%,无严重的并发症发生。结论术前CT检查、术中有效的止血及找准解剖标志是手术成功的关键。