Endoscopic Sinus Surgery in Chronic Rhinosinusitis and Nasal Polyposis: A Comparative Study

Nasal polyposis are common presentations in patients of chronic rhinosinusitis and are considered to be associated with more severe forms of disease with poor treatment outcome. The presentation and treatment outcome after endoscopic sinus surgery in patients of chronic rhinosinusitis and nasal polyposis have been analysed in this study. A prospective analysis of 90 patients of chronic rhinosinusitis who were classified into two groups depending on presence and absence of nasal polyps was performed in the study. The two groups were evaluated using subjective (patient complaints) and objective (computed tomography scan and endoscopy scores) criteria. Preoperative data were compared with data obtained 12 months post endoscopic sinus surgery. The study included 38 patients of chronic rhinosinusitis and 52 patients of nasal polyps. The patients of nasal polyp group presented with increased severity of symptoms of nasal blockage, nasal discharge and reduced sense of smell as compared to the chronic rhinosinusitis group who had significantly higher presentation of headache and facial pain. The preoperative CT scan revealed significantly higher bilateral disease with increased involvement of multiple sinuses in nasal polyp group. Post endoscopic sinus surgery both the groups showed significant improvement in their symptoms with the nasal polyp group demonstrating reduction in improvement on 1 year follow up. In our study we have found the patients with chronic rhinosinusitis and nasal polyp have varied severity of symptoms with the nasal polyp group having higher nasal symptoms and increased severity as compared to chronic rhinosinusitis group. Though the universal rationale of management by adequate drainage and ventilation of sinus is similar in both groups, there is a reduction in both objective and subjective scores during 1 year follow up in the nasal polyp group.     

Impact of Anatomical and Radiological Findings for Consideration of Functional Endoscopic Sinus Surgery

Endoscopic sinus surgery is being done more accurately and with better diagnosis and planning with the help of high resolution CT scan. It has played an invaluable role in the delineation of the sinonasal pathology and anatomic variations preoperatively. To correlate the CT scan findings with endoscopic findings with respect to anatomical variants and pathology and evaluation of its impact on surgical planning. A prospective study conducted on 300 patients who presented to the ENT out patient department with sinonasal diseases and underwent Functional endoscopic sinus surgery. There is a need to evaluate and correlate the findings to deduce the extent of relations CT findings have to that of findings observed during endoscopy as they really affect the surgical planning and outcomes.     

Changes in Acoustic Parameters of Voice After Endoscopic Sinus Surgery in Patients with Nasal Polyposis

Our aim was to evaluate acoustic voice analysis of patients diagnosed with nasal polyps before and after endoscopic sinus surgery. Forty-three patients diagnosed with nasal polyposis who had undergone endoscopic sinus surgery were included in this prospective study. Patients were divided into three groups according to the stage of nasal obstruction before the surgery. Acoustic voice analyses were performed on each patient before the endoscopic sinus surgery and six weeks following the surgery with the multi-dimensional voice program. Jitter, shimmer, F₀ frequency, and noise to harmonic ratio (NHR) parameters were obtained for acoustic analysis. Our investigation showed that Jitter, shimmer and NHR values decreased, and F₀ value increased in the postoperative period in patients that had a partial nasal obstruction before the surgery. Non-significant increases were also observed in these four parameters after the surgery in cases with total or near-total nasal obstruction. We also found that the postoperative changes in shimmer values between the Stage III patients and the patients in other stages were statistically significant (P = 0.027). Voice changes that became more marked with increasing stages of the nasal polyposis. According to our results, patients should be informed of the possible alterations in speech following major surgical interventions on the paranasal sinuses.     

鼻内镜技术用于治疗鼻腔鼻窦恶性肿瘤的临床疗效观察

目的 探讨鼻内镜技术治疗鼻腔鼻窦恶性肿瘤的临床疗效.方法 选取80例鼻腔鼻窦肿瘤患者,40例患者鼻内镜下行手术切除(观察组),根据每个肿瘤类型和部位的不同,确定鼻内镜下手术切除范围.另40例患者行传统手术方法(对照组).比较2组手术时间,术中出血量、术后疼痛视觉模拟评分(VAS),术后焦虑自评量表评分(SAS)、术后并发症和复发率情况.结果 观察组的手术时间和术中出血量均明显少于对照组(P＜0.05);观察组术后视觉模拟评分(VAS)和焦虑自评量表评分(SAS)均明显低于对照组(P＜0.05);观察组的并发症和复发率均低于对照组(P＜0.05).结论 鼻内镜技术切除鼻腔鼻窦肿瘤损伤小、手术时间短、出血量少、术后疼痛少,术后焦虑较轻,术后并发症和复发率低,具有较好临床疗效,值得临床推广应用.     

Iatrogenic Injury to Medial Rectus After Endoscopic Sinus Surgery

Endoscopic sinus surgery (ESS) is the mainstay of the treatment in sinus disorders, to re-establish the drainage of the affected sinus. The close proximity of the orbital structures to paranasal sinuses makes them vulnerable to inadvertent injury during the sinus surgery. Medial rectus (MR) muscle is the most commonly injured extraocular muscle during ESS due to its anatomic proximity to the thin medial wall of the orbit. This is a non-comparative, retrospective, interventional case series of six patients presenting with MR injury after ESS. We discuss the management, outcome and review the published literature. A total of six patients met the inclusion criteria. The presenting complaints were diplopia, squinting and limitation of ocular movements. Two patients underwent surgical exploration of the MR muscle and reattachment of the muscle along with injection botulinum to the antagonist lateral rectus muscle. Two patients who had small angle strabismus and who were able to fuse were advised orthoptic exercises and prisms as management. Remaining two patients were advised surgical intervention to correct strabismus but they declined further surgical intervention. Management of MR injury following ESS is complex, often resulting in suboptimal outcomes. Since early intervention is associated with better outcomes, early referral by otolaryngologists to ophthalmologists would result in better outcome.     

The Importance of Cribriform-Lamella Angle in Endoscopic Sinus Surgery

The aim of this study is to evaluate cribriform-lamella (CL) angle and length of lateral lamella (LL) on CT scan and to correlate CL angle with LL length and Keros classification. Retrospective study analyzing 500 CT scans of PNS was performed at a tertiary care hospital. The CT scan anatomy of anterior cranial base was evaluated for Keros, CL angle and LL length. The relationship between these measurements was studied. Keros type I (75.2%) was the commonest finding in our study. Males have increased depth of olfactory fossa but there were no differences between the sides. Type A angle of CL (66.1%) was the commonest with females having an increased CL angle as compared to males. The LL length was 3.6 mm (± 0.8). There were no significant difference between sex/side of LL. Keros was found to be strongly correlated with the LL length whereas it has mild negative correlation with CL angle. There was no correlation between CL angle and LL length. Keros classification is the commonest criteria used to assess the risk of injury to anterior cranial base. However, we have found that the CL angle has an important role to play in the angulation/slope/level of anterior cranial base during endoscopic sinus surgery. CL angle needs to be considered as an important factor during endoscopic sinus surgery.     

Impact of Functional Endoscopic Sinus Surgery on the Pulmonary Function of Patients with Chronic Rhinosinusitis: A Prospective Study

The study was conducted between September 2007 and March 2009 at Maulana Azad Medical College to compare the pulmonary function of patients with chronic rhinosinusitis presurgically and postsurgically. Thirty patients between 18 and 55 years of age with no prior history of respiratory illness were selected and pulmonary function test was conducted pre and post surgically. There was a significant difference between the pre and postoperative FEV₁ and FEV₁/FVC with the reading taken at 1 and 3 months post-surgically. The improvement in the PFT values signifies a decrease in the bronchial hyperresponsiveness as compared to the pre-operative condition.     

鼻内镜下手术治疗侵及眼眶的鼻腔鼻窦肿瘤

目的： 探讨鼻内镜下手术治疗侵及眼眶的鼻腔鼻窦肿瘤的安全性、临床效果和术式的选择。方法:回顾性分析15例在鼻内镜下行切除手术治疗的侵及眼眶的良性和早期恶性鼻腔鼻窦肿瘤患者的临床资料、手术方法、并发症及治疗预后。结果:全部病例中,11例单纯经鼻内镜下切除肿瘤,4例经鼻腔和鼻外切口双径路手术治疗,其中 1例侵袭性大B细胞淋巴瘤患者术后出现下睑外翻,经治疗后好转;1例鼻腔鼻窦骨瘤患者于鼻内镜下全切骨瘤,术后出现患侧内眦外移;4例良性骨源性病变患者行鼻内镜下病变部分切除术,其余病例均彻底切除肿瘤而无明显并发症,随访6~36月未见复发。结论:鼻内镜下手术治疗侵及眼眶的鼻腔鼻窦肿瘤有其独特的优势,在鼻内镜下单纯经鼻腔或内镜辅助经鼻腔和鼻外切口双径路手术治疗可以取得比较好的临床预后。     

Endonasal Microdebrider Assisted Excision of Congenital Intranasal Nasolacrimal Duct Cyst or Inferior Mucocoele

Objective

Congenital intranasal nasolacrimal duct (NLD) cyst is a rare clinical entity in the newborn whilst inferior mucocoeles are more common. We reviewed our case series of the management of patients presenting with congenital intranasal NLD cysts and inferior mucocoeles treated using powered instrumentation under endoscopic guidance.

Methods

A retrospective review identified three patients, between 2010 and 2013, who have had microdebrider assisted endoscopic marsupialisation of congenital intranasal NLD cysts under joint ENT and Ophthalmology care.

Results

Diagnosis was made based on intraoperative endoscopic nasal examination carried out during treatment of patients with epiphora. All patients were 2 years old or younger presented with persistent epiphora since birth with sticky eyes. All had normal development with no other past medical history of note. Two patients had unilateral and one patient had bilateral congenital intranasal NLD cysts/inferior mucocoels identified. These were treated by endoscopic incision of the cyst with drainage of pus and excision of excess mucosal tissue using a powered microdebrider to effect marsupialisation and prevent re healing of the floppy redundant flaps of the incised cyst. No silastic tubes were placed. All patients were discharged from clinic 3 months post surgery with complete resolution of symptoms and no complications.

Conclusions

Microdebrider assisted endoscopic marsupialisation is a safe and effective treatment for removal of excess tissue in the treatment for congenital intranasal NLD cyst/inferior mucocoele whilst also obviating the need for silastic intubation and a further general anaesthetic for stent removal.     

A Comparative Study of Radiofrequency Assisted Versus Microdebrider Assisted Turbinoplasty in Cases of Inferior Turbinate Hypertrophy

Nasal obstruction is the most common complaint among patients presenting to otolaryngologists which disturbs the quality of life of the patient. The anterior end of inferior turbinate is in the narrowest part of nasal airway, enlargement of which causes significant nasal obstruction. In our, prospective and interventional, study a comparison was made between the results of bipolar radiofrequency assisted turbinoplasty and microdebrider assisted turbinoplasty in patients with chronic nasal obstruction due to inferior turbinate hypertrophy, not responding to medical treatments. The cases were randomly divided into radiofrequency (RF) and microdebrider (MD) groups, each consisting of 30 cases. Nasal obstruction, sneezing, itching in nose, rhinorrhea, intra operative bleeding, duration of surgery, post operative bleeding, post operative pain and crusting were the parameters recorded preoperative, intra operative and post operatively at 1 week, 1, 3 and 6 months. For bleeding and crusting standard 4-point scale was used. Rest of the symptoms were assessed subjectively on standard visual analogue scale (0–10). The statistical analysis was done by student’s t test. Postoperatively, all the preoperative symptoms were significantly improved up to 6 months in group RF as well as group MD, but there were three cases of recurrence at 6th months of postoperative period in group RF. However, we recommend MD assisted inferior turbinoplasty under local anaesthesia in view of long term symptom relief and lesser recurrence.     

鼻咽癌放射性后鼻孔闭锁内窥镜手术治疗

 目的　探讨鼻咽癌放疗后至后放射性后鼻孔闭锁的治疗。方法　对鼻咽癌放疗后至后鼻孔闭锁 38例手术治疗 ,其中腭间径路后致后鼻孔成形 8例 ,鼻内窥镜下微波治疗 30例。结果　腭间径路组术后 2例鼻腔粘连再狭窄 ,经再次手术治愈 ,余 36例一次性治愈。结论　鼻内窥镜外科后鼻孔成形术 ,术式简单 ,术野清晰 ,创伤小 ,是治疗鼻咽癌放射性后鼻孔闭锁的较好方法.     

鼻腔和鼻窦内翻性乳头状瘤74例分析

１９８０～１９９１年收治鼻腔、鼻窦内翻性乳头状瘤（下称ＩＰ）７４例，全部为单侧发病，平均年龄４５．９岁。采用鼻内或鼻内＋Ｃａｌｄｗｅｌｌ－Ｌｕｃ手术或鼻侧切开术＋液氮冷冻治疗，总复发率３５．２％，其中恶变率为２１．６％（１６／７４），作者认为本病术前应作详细的影像学检查，尔后选择治疗。如病变局限，应在鼻内窥镜下作鼻内保守性手术，病变广泛或复发的病历应作鼻侧切开，内侧上颌骨摘除，术中采用液氮冷冻治疗，术后密切随访。     

内镜辅助下经鼻蝶入路手术治疗垂体瘤的临床效果分析

目的探讨垂体瘤患者采用内镜辅助下经鼻蝶入路手术治疗的临床疗效。方法选取90例垂体瘤患者,按照随机数字表法分为对照组(经鼻前庭-鼻中隔-蝶窦垂体瘤切除术)与观察组(内镜辅助下经鼻蝶入路手术),各45例。比较两组患者术中出血量、肿瘤残留、肿瘤体积缩小程度及内分泌激素下降比例。结果观察组术中出血量和肿瘤体积缩小程度及内分泌激素下降比例分别为(83.9±11.7)ml、(90.3±12.2)%、(85.9±12.1)%,与对照组[(351.2±42.8)ml、(53.7±7.4)%、(41.9±8.6)%]比较,差异具有统计学意义,P<0.05;观察组肿瘤残留率(4.4%)明显低于对照组(31.1%),差异具有统计学意义,P<0.05。观察组治疗优良率明显高于对照组,而术后并发症明显少于对照组,差异具有统计学意义,P<0.05。结论应用内镜辅助下经鼻蝶入路手术治疗垂体瘤疗效明显优于经鼻前庭-鼻中隔-蝶窦垂体瘤切除术,且具有较高安全性,因此可值得推广应用。     

Cavernous Sinus Thrombosis of Nasal Origin in Children

Cavernous sinus thrombosis is a rare presentation. Early diagnosis and aggressive treatment are required to prevent morbidity and mortality. Nasal infections can give rise to serious intracranial complications. Presented here is a case series of cavernous sinus thrombosis of nasal septic origin. The purpose of this article is to report our experience in pediatric patients with this illness to ascertain a clinical course and outcomes for further clinical application. Eight (08) cases of nasalseptic origin of cavernous sinus thrombosis ata tertiary care teaching hospital in the north India region of India were included in the study. Cases presented with various symptoms like headache, proptosis, ophthalmoplegia and fever. The patients were investigated by doing High Resolution Computed Tomography of nose & PNS and brain with intravenous contrast. The cases were treated with intravenous broad spectrum antibiotics. Eight patients less than 16 years of age (mean age of 11.2 years)diagnosed with cavernous sinus thrombophlebitis due to nasal septic focus over the period of 05 years were reviewed retrospectively. The predisposing infections and causative microorganisms were similar to previous reports in children. A conservative management strategy with antibiotics gave a good prognosis in these cases. There were no deaths. Early recognition of this condition, the appropriate selection of empirical antibiotic therapy, and the awareness of associated complication were the key factors leading to excellent outcome.     

副鼻窦恶性肿瘤术后放化疗的临床观察

目的探讨鼻腔副鼻窦恶性肿瘤术后放化疗的临床效果。方法选取105例鼻腔副鼻窦恶性肿瘤术后放化疗患者,采用Kaplan-Meler法计算患者的生存率,采用Log-rank法进行生存率差异性检验。结果 105例患者放疗结束后,CR 42例,PR 14例,有效率为53.33%(56/105);化疗结束后,CR 55例,PR 23例,有效率74.29%(78/105)。放化疗近期疗效明显优于放疗,差异具有统计学意义(P<0.05)。患者1年生存率明显高于3、5、10年生存率(P<0.05),其中3、5、10年生存率腺癌亦显著高于鳞癌(P<0.05)。单因素分析发现临床分期、病理类型和手术方法是放化疗疗效的影响因素,其中Ⅱ期中位生存时间明显高于Ⅲ~Ⅳ期、腺癌高于鳞癌、微创切除高于广泛性切除,比较差异均有统计学意义(P<0.05);经Cox模型多因素分析发现临床分期、病理类型和手术方法是影响放化疗疗效和预后的独立影响因素。全部患者未出现严重近期并发症,随访发现听视力障碍11例。结论术后放化疗是改善鼻腔副鼻窦恶性肿瘤临床效果的重要环节,临床分期、病理类型是影响术后放化疗疗效的主要影响因素。     

Comparison of Single Incision Endoscopic Nipple-Sparing Mastectomy and Conventional Nipple-Sparing Mastectomy for Breast Cancer Based on Initial Experience

PurposeEndoscopic breast surgery for patients with breast cancer was introduced for its superior cosmetic outcomes; it was initially studied in the field of breast-conserving surgery and, more recently, in robotic-assisted nipple-sparing mastectomy (NSM). The main purpose of this study was to investigate the feasibility and safety of endoscopic NSM (E-NSM) in patients with breast cancer by comparing E-NSM and conventional NSM (C-NSM).MethodsBetween May 2017 and October 2020, we retrieved the records of 45 patients who underwent NSM with permanent silicone implants and divided them into the E-NSM group (20 patients) and the C-NSM group (25 patients), depending on the use of the endoscopic device. We also analyzed demographic information, pathology, operative time, and complications.ResultsNo significant differences were observed between the 2 groups based on demographic information, postoperative pathological data, mean length of hospital stay, and total number of complications. The mean preparation time for surgery was comparable between both groups. Compared to the C-NSM group, the E-NSM group had a significantly longer mean operative time and, subsequently, a significantly longer mean total operative time and number of complications.ConclusionThe results showed that E-NSM was feasible and safe with a more inconspicuous incision in patients with breast cancer.     

Comparing the Efficacy of Alkaline Nasal Douches Versus Decongestant Nasal Drops in Postoperative Care After Septal Surgery: A Randomised Single Blinded Clinical Pilot Study

To compare the efficacy of alkaline nasal douches and decongestant nasal drops following nasal septal surgery. This was a prospective, randomised, single-blind pilot study. Twenty patients were included in each arm of the study undergoing elective nasal septal surgery. The primary outcome measure was nasal congestion. Secondary outcome measures were anosmia, facial pain, nasal discharge, and sneezing/itching. This study does not show any statistically significant difference between the two treatment groups. Symptoms of nasal congestion (P = 0.3), facial pain (P = 0.932), nasal discharge (P = 0.98), sneezing (P = 0.59) and anosmia (P = 0.208) were analysed before conclusion. Three patients in saline group and one patient in the nasal drops group had poor compliance to follow the advice, scoring 2 on a VAS score but the treatment was tolerated well in majority of the patients. No statistical significant differences were noted on analysing the post operative complications in either group. In this study, both nasal douches and decongestant nasal drop were well tolerated. Both treatments provided good postoperative relief from nasal congestion, nasal discharge, sneezing, facial pain and anosmia as days progressed. The post operative examination of the nose among these patients revealed no significant complications in either of the study arm.     

Endoscopic Endonasal Repair of Sphenoid Sinus Cerebrospinal Fluid Leaks: Our Experience

Endoscopic endonasal approaches are becoming increasingly popular over transcranial approaches for repair of cerebrospinal leak defects. Sphenoid sinus CSF leaks pose a significant challenge and carry the risk of life-threatening intracranial complications. Their management depends upon identifying the leak using imaging techniques followed by intraoperative endoscopic localization. Our experience in the endoscopic endonasal management of sphenoid sinus CSF leaks is reported in this paper.     

Endoscopic Management in Fibrous Dysplasia of Ethmoid Sinus： One Case Report and Literatures Review

Introduction Fibrous dysplasia(FD)is a sporadic skeletal disorder in which normal bone structures and marrow are replaced by fibro-osseous tissue[1].It is classified into three types:monostotic FD,polyostotic FD,and McCune-Albright syndrome[2].The monostotic iS the most commen form of FD.The disease primarily affects the long bones of the patients,and may also develop in the craniofacial region.However,FD in the paranasal sinuses is uncommon.The case in this report was diagnosed as FD in the ethmoid sinus which is a rarely seen case.     

Retrospective Analysis of the Effectiveness of Functional Endoscopic Sinus Surgery in the Treatment of Adult Chronic Rhinisinusitis Refractory to Medical Treatment

Chronic rhinosinusitis (CRS) is a common disease that restricts the quality of life of millions of involved patients. The aim of the study was to evaluate how functional endoscopic sinus surgery (FESS) modifies patients symptom profile and to also confirm that FESS is the modality of treatment in patients with refractory CRS. The study was retrospective analysis. 105 patients with symptoms of CRS were included in the study (between August 2006 to July 2009). Patients were assessed for CRS symptoms preoperatively and postoperatively using grading symptoms. Statistical analysis using Chi square test. Leading symptom of CRS was nasal obstruction followed by headache. Furthermore patients reported of anosmia, facial pressure, postnasal drip, purulent nasal discharge, halitosis, dental pain, cough, earache. None of the patients had fever as their complaint. After a postoperative followup of 6 months there was improvement in the symptoms. All minor symptoms had 100% improvement. Nasal obstruction responded best, next followed by (all symptoms P value <0.001). An overall improvement of 86.66% was recorded. The restriction of quality of life in patients with CRS is mainly caused by these symptoms, which can be improved in excellent fashion by FESS in majority of the patients.