bluuebunny/crossref_metadata_2025 huggingface dataset:
Factors Contributing to Failure in Endoscopic Skull Base Defect Repair
Authors: Wise Sarah K. , Harvey Richard J. , Neal Jeffrey G. , Patel Sunil J. , Frankel Bruce M. , Schlosser Rodney J.
Published: February 2010

Background

Endoscopic repair of skull base (SB) defects is successful in over 90% of cases. Certain factors may contribute to failure of SB repair techniques or need for secondary repair.

Methods

Five-year retrospective review of endoscopic SB defect repairs performed by a single surgeon.

Results

Eighty-nine patients undergoing 110 procedures to repair 97 SB defects were evaluated. Etiology of defects included surgical/iatrogenic (64%), spontaneous (17%), traumatic (12%), congenital (6%), and idiopathic (1%). Defects occurred in the sella (41%), sphenoid sinus (18%), ethmoid roof (17%), olfactory cleft (16%), frontal sinus/recess (6%), and middle cranial fossa (2%). Sixty-three patients (71%) underwent primary SB defect repair and 26 patients underwent secondary repair (29%). In revision cases, mean number of prior repair attempts was 1.5 (range, 1-4). Factors potentially contributing to need for secondary SB defect repair included inability to localize SB defect (p =0 008), development of new SB defect, prior sinus or SB surgery (p < 0.001), prior craniotomy (p < 0.001), prior radiation therapy (p = 0.002), and intracranial infection (p = 0.023). SB defects were successfully closed in 83 patients overall (93%), with success achieved in 97% of primary patients and 85% of secondary patients. Of failures, 3 patients required craniotomy for defect closure, 2 patients underwent permanent cerebrospinal fluid (CSF) diversion, and 1 patient has persistent CSF rhinorrhea.

Conclusion

Although endoscopic repair of SB defect remains largely successful, certain factors should alert the surgeon to the potential for failure of repair or need for secondary SB defect repair.
Endoscopic Transnasal Transethmoid Ligation of the Anterior Ethmoid Artery
Authors: Camp April A. , Dutton Jay M. , Caldarelli David D.
Published: February 2010

Background

The current otolaryngologic literature is lacking in basic science investigation regarding endoscopic anterior ethmoid artery (AEA) ligation as part of the armamentarium for epistaxis control. This investigation provides the anatomic rationale for endoscopic ligation of the AEA in the surgical treatment of epistaxis. In addition, it provides tools for identification of this vessel during routine endoscopic sinus surgery.

Methods

This descriptive cadaver study investigates the feasibility of endoscopic transnasal transethmoid dissection; anatomic description; and clip ligation within the periorbital space of 16 AEA specimens. A careful assessment for skull base penetration and disruption was performed.

Results

All 16 anterior ethmoid arteries were readily identified and successfully clipped. The anatomy was carefully observed and described for each specimen, and no inadvertent skull base penetration occurred.

Conclusion

This study confirms that endoscopic ligation of the AEA is a safe and feasible technique for the control of epistaxis. Additionally, this anatomic knowledge is beneficial during routine endoscopic sinus surgery if AEA injury should occur. Further evaluation is necessary for clinical application of this technique in the treatment of epistaxis.
Treatment Results of Sinonasal Inverted Papilloma: An 18-Year Study
Authors: Sham C.L. , Woo John K.S. , Van Hasselt C. Andrew , Tong Michael C.F.
Published: February 2010

Background

This article reviews our treatment results of sinonasal inverted papilloma (SNIP) over the past 18 years. A retrospective observational study was performed.

Methods

Fifty-six patients with SNIP seen between 1990 and 2008 with follow-up of >2 years were retrospectively analyzed.

Results

Forty patients (71%) had primary endoscopic resection and 16 patients (29%) had endoscopic-assisted external approaches. Ten patients (18%) had small nasoethmoid residual disease resectable under local anesthesia in the outpatient department. Eight patients (14%) had recurrences requiring revision under general anesthesia, most of which were maxillary and frontal disease requiring additional external approaches. Comparing patients with and without a history of previous surgery (36% versus 64% of all patients), the former had a higher chance of requiring external approaches during the primary resection (45% versus 29%), a higher recurrence rate (45% versus 25%), and a higher chance of external approaches for revision (44% versus 22%). All the first recurrences were at the original tumor site. Eighty-nine percent of the first recurrences were diagnosed within the first 2 years postoperation.

Conclusion

Thirty-two percent of our patients had recurrence after their primary resection. Recurrences in the nasoethmoid area are usually small and resectable endoscopically under local anesthesia in the outpatient department whereas those inside the maxillary and frontal sinuses are likely to require additional external approaches under general anesthesia. A minimum of 2 years of follow-up is recommended for the preliminary report on the treatment results of this condition. Lifelong follow-up is recommended for possible late recurrences and metachronous multifocal disease.
The Utility of Cadaver Dissection in Endoscopic Sinus Surgery Training Courses
Authors: Zuckerman Jodi D. , Wise Sarah K. , Rogers G. Aaron , Senior Brent A. , Schlosser Rodney J. , DelGaudio John M.
Published: February 2010

Background

Understanding paranasal sinus anatomy is crucial for successful outcomes in endoscopic sinus surgery (ESS). This study was designed to evaluate subjective and objective differences in ESS cadaver dissections among participants of varying experience levels in association with the use of image guidance and computer-aided technologies in a physician training cadaver dissection laboratory.

Methods

Participants in a 2-day cadaver dissection course completed daily predissection surveys evaluating subjective comfort with ESS. Pre- and postdissection computer tomography (CT) scans assessed completeness of dissection. Images were analyzed for maxillary antrostomy, frontal and sphenoid sinusotomy, residual ethmoid cells and partitions, and residual frontal recess cells.

Results

Fifty-one sides were dissected. Participant comfort increased significantly from day 1 to 2 for overall ESS (p = 0.001) and for individual sinuses (p < 0.001 to p = 0.047). Participants with more years in practice had fewer unopened ethmoid cells (p = 0.015) and frontal recess cells (p = 0.014) on dissection day 1. Participants with increased comfort in ethmoid dissection had fewer retained ethmoid partitions on day 1 (p = 0.017). Observed differences on dissection day 1 for unopened ethmoid and frontal recess cells and retained ethmoid partitions were not present on day 2. No significant differences were found based on use of image guidance for any parameter.

Conclusion

Surgeons with increased comfort and more years in practice had more complete endoscopic cadaver dissections initially. Differences among participants diminished on dissection day 2, indicating the ability to review postdissection CT scans may improve surgeon comfort level and completeness of dissection.
Repair of Nasal Septal Perforation with “Cross-Stealing” Technique
Authors: Islam Ahmet , Celik Hatice , Felek Sevim Asian , Demirci Munir
Published: February 2010

Background

The aim of this study was to reveal the efficacy of the “cross-stealing” technique in the repair of nasal septal perforation.

Methods

In a prospective clinical investigation, 10 patients with the complaints of crusting, bleeding, whistling, nasal obstruction, and pain and in whom septal perforation was detected underwent surgery by endonasal approach between April 2006 and January 2008. During surgery, the inferior-based mucoperichondrial flap was prepared on one side, the superior-based mucoperichondrial flap was prepared on the other side of the nasal septum, and they were passed to the opposite side through perforation. Interpositional graft was placed between flaps and sutured. Patients were followed for a minimum of 5 months before the evaluation of the results.

Results

Complete closure was observed in 7 of 10 (70%) patients and partial closure was observed in 1 patient. In 2 patients perforation was not closed and its size remained unchanged.

Conclusion

The cross-stealing technique is advantageous in anterior-located septal perforations in that it can be performed endonasally and it is physiological. Because flaps are prepared in a vertical direction, it can be used only in small and middle-sized perforations, which restricts its use.
Evidence of Association of Interleukin-1 Receptor-Like 1 Gene Polymorphisms with Chronic Rhinosinusitis
Authors: Castano Roberto , Bossé Yohan , Endam Leandra Mfuna , Desrosiers Martin
Published: February 2010

Background

Chronic rhinosinusitis (CRS) is a common complex respiratory disease, with a potential genetic component to its development. The protein encoded by the Interleukin-1 receptor-like 1 (IL1RL1) gene is an important effector molecule of T-helper type 2 responses and may potentially be involved in the persistent inflammatory process observed in CRS. We investigated whether certain polymorphisms in the IL1RL1 gene are differentially present in patients with surgery-unresponsive CRS and in control subjects.

Methods

DNA extracted from an existing population of 206 adult patients with surgery-unresponsive CRS and 196 postal-code-matched controls was used. A set of 15 tagging single nucleotide polymorphisms (SNPs) was selected from the HapMap data set and genotyped. DNA sequencing was performed in a subgroup of 15 CRS patients.

Results

Statistically significant allelic associations with CRS were noted for 5 SNPs (rs10204137, p = 0.04; rs10208293, p = 0.03; rs13431828, p = 0.008; rs2160203, p = 0.03, and rs4988957, p = 0.03). The analysis showed a consistent significant protective effect against CRS for all the SNPs, yielding an odds ratio (OR) ranging from 0.56 to 0.72. The loci rs13431828 showed the highest association with CRS (p = 0.008; OR = 0.56; 95% CI, 0.36–0.86). A subanalysis revealed that the observed associations were stronger among patients with more severe disease. Sequencing identified five additional known nonsynonymous coding SNPs in linkage disequilibrium with genotyped SNPs.

Conclusion

Pending replication of these results, this study suggests that polymorphisms within the IL1RL1 gene may be associated with CRS, conferring a protective effect, particularly among those with severe disease.
Grafting the Olfactory Epithelium to the Olfactory Bulb
Authors: Yagi Sayaka , Costanzo Richard M.
Published: February 2010

Background

Impaired olfactory function leads to a decrease in the quality of life for many patients. Surgical treatment options are limited, especially for those suffering from hyposmia or anosmia after posttraumatic injury to the olfactory nerves. Stem cells located in the olfactory epithelium (OE) have the capacity to grow new neurons, making the OE an ideal candidate for restorative tissue grafting. This study was performed to determine if strips of OE survive transplantation directly to the olfactory bulb (OB).

Methods

Transgenic mice, expressing a green fluorescent protein (GFP), were used to obtain the donor graft tissue. Strips of OE from GFP donor mice were transplanted directly to sites in the OB and cerebral cortex (CC; control sites) of wild-type mice. Graft survival rates at 30 days were determined for transplant sites in the OB and CC.

Results

Strips of OE from transgenic mice survived transplantation to the OB and continued to express the GFP marker protein. The 30-day survival rate in the OB (83%, 5 of 6 grafts) was the same as in the CC (10 of 12 grafts). The morphology of the graft revealed characteristics found in normal OE.

Conclusion

We showed that strips of OE can be successfully grafted to both the OB and CC. Grafts of the OE, if strategically positioned on the ventral surface of the bulb and given access to the nasal cavity, could provide the basis for new surgical treatments to restore olfactory function.
A Model of Airflow in the Nasal Cavities: Implications for Nasal Air Conditioning and Epistaxis
Authors: Bailie Neil , Hanna Brendan , Watterson John , Gallagher Geraldine
Published: February 2010

Background

A friction force is generated when moving air contacts the nasal walls, referred to as wall shear stress. This interaction facilitates heat and mass transfer between the mucosa and air, i.e., air-conditioning. The objective of this research was to study the distribution of wall shear stress within the nasal cavity to identify areas that contribute significantly to air-conditioning within the nasal cavity.

Methods

Three-dimensional computational models of the nasal airways of five healthy subjects (three male and two female subjects) were constructed from nasal CT scans. Numerical simulations of nasal airflow were conducted using the commercial computational fluid dynamics code Fluent 6 (Ansys, Inc., Canonsburg, PA). Wall shear stress was derived from the numerical simulation. Air-conditioning was simulated to confirm the relationship with wall shear stress.

Results

Nasal airflow simulations predicted high wall shear stress along the anterior aspect of the inferior turbinate, the anteroinferior aspect of the middle turbinate, and within Little's area.

Conclusion

The airflow simulations indicate that the inferior and middle turbinates and Little's area on the anterior nasal septum contribute significantly to nasal air-conditioning. The concentration of wall shear stress within Little's area indicates a desiccating and potentially traumatic effect of inhaled air that may explain the predilection for spontaneous epistaxis at this site.
Role of Platelet-Derived Growth Factor in Airway Remodeling in Rhinosinusitis
Authors: Kouzaki Hideaki , Seno Satoshi , Fukui Jun , Owaki Shigehiro , Shimizu Takeshi
Published: February 2010

Background

The purpose of this study was to elucidate the role of platelet-derived growth factor (PDGF) in the pathogenesis of rhinosinusitis.

Methods

Nasal mucosa and polyps were obtained during surgery in patients with allergic rhinitis, chronic rhinosinusitis (CRS) without asthma, and CRS with asthma. PDGF concentrations in nasal discharge were measured, and the histological distribution and expression levels of mRNA for PDGF and PDGF receptors were examined. PDGF-producing cells were determined by double-staining for PDGF and CD68 or major basic protein.

Results

The concentration of PDGF was significantly higher in CRS with asthma. An immunohistochemical study showed that PDGF was localized in epithelial cells, gland cells, vascular endothelial cells, and inflammatory cells. Expression of PDGF increased in epithelial cells in all three diseases, in macrophages in CRS without asthma, and eosinophils in CRS with asthma, and PDGF receptors were detected in epithelial cells and submucosal fibroblasts. Increased expression of PDGF mRNA was found in CRS with asthma.

Conclusion

The results indicate that PDGF is produced by macrophages, eosinophils, and epithelial cells in rhinosinusitis and that it acts on receptors in epithelial cells and fibroblasts. PGDF may be an important cytokine in the pathogenesis of rhinosinusitis by promoting tissue fibrosis and formation of nasal polyps.
Staphylococcal Infection and Toxin Production in Chronic Rhinosinusitis
Authors: Fiky Lobna M. El , Khamis Nagwa , Mostafa Badr El Din , Adly Ahmed M.
Published: February 2010

Background

The association between bacterial colonization and different forms of chronic rhinosinusitis (CRS) has not been well documented. One of the most recent hypotheses is superantigen (SA)-induced inflammation, resulting in up-regulation of lymphocytes to produce cytokines, and other inflammatory mediators that strongly modify the disease. Staphylococcus aureus, frequently encountered in nasal passages, can produce enterotoxins that can act as SAs.

Methods

A prospective case control study was performed. Sixty-four patients diagnosed with CRS (group 1), CRS with nasal polyps (CRSwNP) (group 2), and 15 control subjects were enrolled. Swabs were taken from the middle meatus of all subjects for identification of S. aureus carriers. Positive carriers were analyzed for the presence of toxic shock syndrome toxin (TSST) 1 using reverse passive latex agglutination as well as polymerase chain reaction.

Results

The rate of nasal carriage of

S. aureus in CRS was 42.8%, that of CRSwNP was 45.4%, and that of the control group was 13.3%. The difference between both groups of CRS and the control group was found to be highly significant (p < 0.001). The detection of TSST-1 was significantly higher (p < 0.001) in both groups of CRS patients than in the control group. Finally, the difference in colonization of TSST-1 was highly significant (p < 0.001) between the CRS group 1 and CRSwNP group 2 patients.

Conclusion

Identifying SAs and understanding how they elicit the pathogenic condition in CRS will be central in revealing ways to ameliorate their effects and properly treat these conditions.
Effect of L-Ascorbate on Chloride Transport in Freshly Excised Sinonasal Epithelia
Authors: Cho Do-Yeon , Hwang Peter H. , Illek Beate
Published: February 2010

Background

Chronic rhinosinusitis (CRS) occurs at high frequency in patients with cystic fibrosis, suggesting that the cystic fibrosis transmembrane conductance regulator (CFTR) chloride (Cl) ion channel might be involved in the development of chronic sinusitis in the general population. CFTR Cl ion transport controls the hydration of mucosal surfaces and promotes effective mucociliary clearance. Altered ion transport and, hence, disrupted mucociliary function, could play a role in the pathogenesis of sinus disease. L-Ascorbate is a metabolically active component of the nasal and tracheobronchial airway lining fluids and appears to serve as an important biological effector of CFTR-mediated chloride secretion. The purpose of this study was to determine the effects of L-ascorbate on Cl ion transport in freshly excised sinonasal epithelia from normal controls and patients with CRS.

Methods

Four different types of sinonasal tissue (normal sinus mucosa, sinus mucosa from CRS, normal nasal mucosa, nasal mucosa from CRS) were obtained during endoscopic sinus surgery and mounted on sliders with open areas of 0.03–0.71 cm2 between Ussing hemichambers. Short-circuit current (Isc) was continuously recorded, and a serosa-to-mucosa-directed Cl gradient was applied to increase the electrochemical driving force.

Results

L-Ascorbate (500 μM) stimulated Cl currents (DeltaICl, μA/cm2) across sinonasal epithelia from normal and CRS patients. The Cl secretory response to L-ascorbate was effectively blocked by the Cl ion transport inhibitors glibenclamide and bumetanide. A maximal dose of L-ascorbate (at 1 mM) stimulated 53–70% of Cl currents elicited by the cAMP agonist forskolin. CRS sinonasal tissue was characterized by impaired Cl secretory responses to L-ascorbate that were reduced by 33% in sinus epithelial tissue and by 70% in nasal epithelial tissue when compared with normal subjects. In nasal epithelial tissue from normal subjects, Cl secretion was approximately twofold increased when compared with sinus epithelial tissue. In contrast, nasal versus sinus epithelial tissue from CRS patients showed no differences.

Conclusion

Topical administration of L-ascorbate to freshly excised sinus and nasal mucosa enhances chloride secretion. Given that decreased CFTR-mediated Cl secretion may contribute to the development of CRS, L-ascorbate may offer potential as a therapeutic agent for the improvement of mucociliary clearance.
Expression of Glutaredoxin-1 in Nasal Polyps and Airway Epithelial Cells
Authors: Woo Hyun-Jae , Bae Chang Hoon , Song Si-Youn , Kim Yong-Woon , Lee Heung-Man , Kim Yong-Dae
Published: February 2010

Background

Glutaredoxins (GRX)-1 is glutathione-dependent oxidoreductase. However, the role of these enzymes remains unknown in airway inflammatory diseases. Therefore, we aimed to establish the expression pattern of GRX-1 in the nasal polyps (NPs) and to assess the regulatory mechanisms associated with GRX-1 expression in interleukin (IL)-1beta-treated airway epithelial cells.

Methods

The expression of GRX-1 in NPs and normal nasal mucosa were analyzed by reverse-transcription polymerase chain reaction and immunohistochemical staining. IL-1beta–induced reactive oxygen species (ROS) formation and GRX-1 expression in the airway epithelial cells was determined by flow cytometry and immunoassay.

Results

The expression level of GRX-1 in NPs was significantly higher than in the normal nasal mucosa (p < 0.05). GRX-1 was highly expressed in the surface epithelial cells and the submucosal glandular cells in the NPs. IL-1beta increased the intracellular ROS formation and GRX-1 expression in airway epithelial cells. The inhibition of IL-1beta–induced ROS production by N-acetyl-cystein, an ROS scavenger, reduced GRX-1 expression. Diphenyleneiodonium and apocynin, NADPH oxidase inhibitors, did not abolish IL-1beta–induced ROS ormation and GRX-1 expression, whereas budesonide attenuated it.

Conclusion

High GRX-1 expression in NPs might be a primary de ense against chronic in lammatory oxidative stress in nasal mucosa. IL-1beta–induced up-regulation o GRX-1 in airway epithelial cells is probably mediated by ROS. Glucocorticoids can regulate IL-1beta–induced ROS ormation and GRX-1 expression.
Biofilms in Chronic Rhinosinusitis: A Review
Authors: Cohen Michael , Kofonow Jennifer , Nayak Jayakar V. , Palmer James N. , Chiu Alexander G. , Leid Jeff G. , Cohen Noam A.
Published: February 2010

Background

Bacterial biofilms consist of a complex, organized community of bacteria that anchor to both biotic and abiotic surfaces. They are composed of layers of embedded, live bacteria within extruded exopolymeric matrix. This configuration allows for evasion of host defenses and decreased susceptibility to antibiotic therapy while maintaining the ability to deliberately release planktonic bacteria, resulting in recurrent acute infections. Thus, bacterial biofilms were hypothesized to contribute to the progression and persistence of chronic rhinosinusitis.

Methods

This review summarizes several of the seminal papers supporting this hypothesis.

Results

Multiple reports using various imaging modalities have demonstrated the presence of biofilms in sinonasal mucosa of patients with chronic rhinosinusitis. More recently, several studies have correlated the presence of biofilms with poor clinical outcomes in the disease process. Early therapeutic interventions have generated mixed results.

Conclusions

Bacterial biofilms appear to contribute to the progression of chronic rhinosinusitis in a subset of patients, although substantial effort toward therapeutic intervention is still necessary.
When Allergic Rhinitis is not Only Allergic
Authors: Gelardi Matteo , Russo Cosimo , Fiorella Maria Luisa , Fiorella Raffaele , Canonica Giorgio Walter , Passalacqua Giovanni
Published: February 2010

Background

In clinical practice it can be observed that some patients with seasonal allergic rhinitis (AR) continue to have symptoms even when the exposure to allergens is expected to be low or absent. We studied the clinical and cytological characteristics of these atypical forms of (AR) in a large population of patients.

Methods

Consecutive patients with symptoms of rhinitis and with positive skin test to pollens only were interviewed for the duration of symptoms, correlation with sensitization pattern, and presence of reactivity to nonspecific stimuli. All underwent rhinoscopy and nasal scraping for cytology.

Results

Five hundred nineteen patients with AR were studied. Of these 519 patients 60 (11.5%) had an atypical or mixed form of rhinitis, with symptoms independent of the exposure and also elicited by nonspecific stimuli. These patients clearly differed from typical forms, especially for the nasal inflammation. They had a greater number of eosinophils and mast cells out of season (p < 0.05). Moreover, these atypical forms had, more frequently, asthma and eosinophilic polyps.

Conclusion

In ∼12% of patients with AR, other mechanisms of inflammation seem to intervene. Nasal cytology can be helpful in discriminating these atypical forms.
Allergic Rhinitis and Aspirin-Exacerbated Respiratory Disease as Predictors of the Olfactory Outcome after Endoscopic Sinus Surgery
Authors: Katotomichelakis Michael , Riga Maria , Davris Spyridon , Tripsianis Gregorios , Simopoulou Maria , Nikolettos Nikolaos , Simopoulos Konstantinos , Danielides Vasilios
Published: February 2010

Background

Unlike the functional outcomes of endoscopic sinus surgery, which have been thoroughly studied, the effect of the surgery on olfactory performance and the relative predictive factors have not been adequately assessed by literature. Allergic rhinitis and aspirin-exacerbated respiratory disease (AERD) are examined as potential confounding factors of the olfactory outcome in patients with extensive nasal polyposis and rhinosinusitis treated with functional endoscopic sinus surgery (FESS).

Methods

A population of 116 adults with severe nasal polyposis was subjected to FESS after failure of the appropriate medical treatment. The olfactory outcome was quantified by Sniffin’ Sticks at the 1st, 3rd, and 6th postoperative month in relation to the concomitant presence of allergic rhinitis (n = 62) or AERD (n = 18).

Results

Allergic patients seemed to perform worse than nonallergic patients at all time frames. However, when patients with similar olfactory acuity, age, and medical history are compared, allergic rhinitis does not seem to affect the postoperative improvement of the composite threshold-discrimination-identification scores. The same seems to apply for the likelihood of acquiring normosmia after surgery. On the contrary, AERD significantly limits the recovery of olfactory function at all follow-up examinations and patients with AERD are unlikely to become normosmic.

Conclusion

The olfactory recovery after FESS for nasal polyposis is significantly affected by the concomitant presence of AERD. Although allergy seems to have a general negative effect on olfactory acuity, it was not found to affect the extent of the olfactory improvement, when patients with comparable preoperative characteristics are addressed.
Wound Healing in the Rabbit Paranasal Sinuses after Coblation: Evaluation for use in Endoscopic Sinus Surgery
Authors: Rosenthal Laura H. Swibel , Benninger Michael S. , Stone Chad H. , Zacharek Mark A.
Published: February 2010

Background

Bipolar radiofrequency can be used surgically to excise and cauterize tissue simultaneously. It has potential for use in endoscopic sinus surgery (ESS). This study was performed to determine the extent and pattern of injury in the paranasal sinuses with bipolar radiofrequency and evaluate wound healing.

Methods

Eight rabbits underwent Coblation of maxillary sinus mucosa with biopsy immediately, on postoperative day (POD) 3, 7, 14, or 29. Maxillary mucosa was exposed through the nasal dorsum, and a Coblator PROciseXP wand used on a power setting of 7 for 2 seconds. Three of the rabbits also had Coblation of ethmoid mucosa over the lamina papyracea, after extending the maxillary ostomy, with biopsy immediately.

Results

Coblation resulted in immediate loss of surface respiratory epithelium and thermal-type injury to the underlying seromucinous glands. On POD 3, the site showed reepithelialization with squamous metaplastic epithelium. The seromucinous glands underwent coagulative necrosis. At POD 7, there was partial replacement of overlying epithelium by respiratory epithelium. The underlying seromucinous glands were lost and replaced by fibroblastic proliferation, with less fibrosis than the mechanically created ostomy site. The underlying bone had reactive, regenerative changes. On PODs 14 and 29, there was further regeneration of respiratory epithelium. Fibrosis was mild. Coblation resulted in gross violation of the bony wall in one maxillary sinus. There were no histological changes in the orbit.

Conclusion

Rabbit paranasal sinus mucosa heals appropriately after Coblation injury.
Effects of a Dexamethasone-Releasing Stent on Osteoneogenesis in a Rabbit Model
Authors: Beule Achim G. , Steinmeier Elke , Kaftan Holger , Biebler Karl-Ernst , Gopferich Achim , Wolf Eduard , Hosemann Werner
Published: February 2010

Background

This study is an evaluation of wound healing in an animal model for surgery of frontal sinusitis and treatment effect of topically released dexamethasone using a drug-releasing stent with special emphasis of osteoneogenesis.

Methods

A prospective, controlled, randomized, double-blinded animal study was performed. Nineteen New Zealand white rabbits were subjected to surgery via an external approach, a 4-mm circular wound was created on the medial side of the maxillary sinus and the underlying bone was denuded of periosteum. The wound was covered in a randomized fashion with either a silicone foil or a new dexamethasone-releasing stent system. Twelve to 30 days later, the animals were killed and a histological examination was performed.

Results

In comparison with the baseline bony thickness (40 micrometer) obtained in one animal, osteoneogenesis occurred on both paranasal sides but was significantly less if a dexamethasone-releasing stent was applied (117 [95% CI, 116–128]; 52 [95% CI, 43–64]; p < 0.001). Maximal bony thickness was observed in both treatment groups between days 20 and 25 with a tendency toward a higher percentage decrease in the dexamethasone-treated sides (p < 0.08). Using a visual analog scale (0–5) a significantly smoother bony surface was observed for dexamethasone (2 [95% CI, 1.1–1.9]; 2 [95% CI, 1.8–2.2]; p < 0.01).

Conclusion

Using a new drug-releasing stent system, dexamethasone efficiently decreases postoperative osteoneogenesis in a standardized animal wound model for endoscopic sinus surgery. Therefore, the use of this system may be of value to decrease restenosis rates using corticosteroids in selected patients after frontal sinus surgery, especially the endoscopic modified Lothrop procedure.
Effects of Intranasal Steroid Spray in Bacterial Culture of Chronic Rhinosinusitis
Authors: Ho Ching-Yin , Chan Kee-Tak
Published: February 2010

Background

We attempted to determine whether use of a topical intranasal corticosteroid (INCS) preoperatively had an effect on bacterial culture and antibiotic sensitivity in chronic rhinosinusitis with nasal polyposis.

Methods

In a prospective study, patients that were diagnosed with rhinosinusitis with nasal polyposis received INCS for one month before functional endoscopic sinus surgery. Bacterial culture testing, obtained under telescope from a source near the middle meatus, was performed before and after INCS. Antibiotic sensitivity was also performed.

Results

One hundred fifty-six patients were enrolled in the prospective study, and 115 patients completed the procedures. The male-to-female ratio was 83:32 and the age range was 14∼76 years (46.7 ± 2.1). The positive culture rates were 80.9% and 79.1% pre-INCS treatment and post-INCS treatment, respectively. There was no significant difference between pretreatment and posttreatment samples in bacterial culture rate. The single bacterial culture rates were 66.7% and 65.9% pre-INCS treatment and post-INCS treatment, respectively. The drug sensitivities to oxacillin and cephaxolin showed no significant difference in coagulase negative Staphylococcus and Staphylococcus aureus.

Conclusion

INCS did not influence the rate of bacterial culture or antibiotic sensitivity in patients with chronic rhinosinusitis with nasal polyps.
Transseptal Approach for Extended Endoscopic Resections of the Maxilla and Infratemporal Fossa
Authors: Harvey Richard J. , Sheehan Patrick O. , Debnath Nick I. , Schlosser Rodney J.
Published: February 2010

Background

Larger and more extensive lesions of the maxilla and infratemporal fossa are being successfully managed by entirely endoscopic approaches. There are still limitations in access, especially the anterolateral maxilla. The suitability of various surgical approaches was assessed in relation to surgical access achieved.

Methods

Surgical access was compared in 10 cadaver heads. Five zones were defined: zone 1, nasal cavity; zone 2, medial to infraorbital nerve (ION); zone 3, lateral to ION; zone 4, anterior maxilla; and zone 5, premaxillary tissue. Endoscopic maxillary surgery consisted of standard antrostomy, modified medial maxillectomy, or complete medial maxillectomy with lacrimal duct resection. Transseptal and ipsilateral approaches were compared in each surgical state. The degree of angulations and resection zone accessed were recorded from image-guided surgery. The limits of both straight and curved instrumentation were also compared.

Results

Transseptal access improved surgical access by 14.7 ± 2.5° when compared with ipsilateral approaches (p < 0.001) across all situations. The access to zone 3 across all specimens was significantly improved by 63.3–97.6% (χ2 = 20.83; p < 0.001) after all three surgical states. After complete medial maxillectomy, access to zone 4 increased from 25.0 to 85.0% (χ2 = 14.54; p < 0.001) with a transseptal approach.

Conclusion

Extended endoscopic maxillary surgery combined with a transseptal option enables additional access to previously considered challenging locations. Preoperative assessment of skull base tumor, papilloma and angiofibroma extent, and resection margin will dictate surgical approach.
Integration of Patient-Specific Paranasal Sinus Computed Tomographic Data into a Virtual Surgical Environment
Authors: Parikh Sachin S. , Chan Sonny , Agrawal Sumit K. , Hwang Peter H. , Salisbury Curt M. , Rafii Benjamin Y. , Varma Gaurav , Salisbury Kenneth J. , Blevins Nikolas H.
Published: February 2010

Background

The advent of both high-resolution computed tomographic (CT) imaging and minimally invasive endoscopic techniques has led to revolutionary advances in sinus surgery. However, the rhinologist is left to make the conceptual jump between static cross-sectional images and the anatomy encountered intraoperatively. A three-dimensional (3D) visuo-haptic representation of the patient's anatomy may allow for enhanced preoperative planning and rehearsal, with the goal of improving outcomes, decreasing complications, and enhancing technical skills.

Methods

We developed a novel method of automatically constructing 3D visuo-haptic models of patients’ anatomy from preoperative CT scans for placement in a virtual surgical environment (VSE). State-of-the-art techniques were used to create a high-fidelity representation of salient bone and soft tissue anatomy and to enable manipulation of the virtual patient in a surgically meaningful manner. A modified haptic interface device drives a virtual endoscope that mimics the surgical configuration.

Results

The creation and manipulation of sinus anatomy from CT data appeared to provide a relevant means of exploring patient-specific anatomy. Unlike more traditional methods of interacting with multiplanar imaging data, our VSE provides the potential for a more intuitive experience that can replicate the views and access expected at surgery. The inclusion of tactile (haptic) feedback provides an additional dimension of realism.

Conclusion

The incorporation of patient-specific clinical CT data into a virtual surgical environment holds the potential to offer the surgeon a novel means to prepare for rhinologic procedures and offer training to residents. An automated pathway for segmentation, reconstruction, and an intuitive interface for manipulation may enable rehearsal of planned procedures.
Central Nervous System Infection in Patients with Postirradiated Nasopharyngeal Carcinoma: A Case-Controlled Study
Authors: Liang Kai-Li , Jiang Rong-San , Lin Jin-Ching , Chiu Yu-Jung , Shiao Jiun-Yih , Su Mao-Chang , Hsin Chung-Han
Published: February 2010

Background

It has been assumed that postirradiated nasopharyngeal carcinoma (NPC) patients are prone to central nervous system (CNS) infection.

Objective

The purpose of this study was to better understand this clinical entity.

Methods

From September 1989 to May 2006, we conducted a retrospective study of 18 postirradiated NPC patients with CNS infection including brain abscess, cavernous sinus thrombosis, epidural abscess, and meningitis in our institute. During the same period, 18 NPC patients without CNS infection who were matched for tumor stage, age, and gender with the study group were randomly selected from the cancer registry at our hospital and enrolled as the control group. All medical records of these patients were evaluated.

Results

The local tumor relapse rate, nasopharyngeal radiotherapy dose, and skull base osteoradionecrosis were all significantly higher in patients with CNS infection (p = 0.003, 0.011, and 0.001, respectively). Although the incidences of otitis media and chronic rhinosinusitis were higher in patients with CNS infection, there were no significant differences between the two groups (p = 0.469 and 0.568, respectively). The in-hospital mortality was 61.1%, and the overall mortality of CNS infection was 83.3%. There was a significant difference in overall survival rate between the two groups (p = 0.001).

Conclusions

Postirradiated NPC patients with skull base osteoradionecrosis are prone to have CNS infection. CNS infection is an adverse prognostic factor in postirradiated NPC patients.
The Proportion of Self-Rated Olfactory Dysfunction does not Change across the Life Span
Authors: Shu Chih-Hung , Hummel Thomas , Lee Po-Lei , Chiu Cheng-Hung , Lin Shih-Hsiang , Yuan Ben-Chih
Published: February 2010

Background

Previous reports indicated that self-reports of olfactory function are unreliable. The occurrence of measured olfactory dysfunction is ∼20% in the general population and consistently higher than that of self-reported olfactory dysfunction. To further understand the frequencies of self-rated olfactory function in different age groups and its relation with measured olfactory function, a prospective investigation of self-rated and measured olfactory function was performed.

Methods

One thousand five subjects were enrolled from the health care center, where subjects underwent a physical checkup for possible preclinical diseases. The subjects completed a questionnaire about demographic data and medical and surgical histories and self-rated their olfactory function. Then, they received a modified “Sniffin’ Sticks” odor identification test.

Results

The self-rated olfaction function did not correlate significantly with measured olfactory function. The frequencies of self-rated olfactory dysfunction (9–14%) were similar among various age groups. However, the frequencies of measured olfactory dysfunction in the three age groups, i.e., 18 to 35, 36 to 55, and >55 years, were 3.7%, 17.4%, and 35.6%, respectively.

Conclusions

Self-ratings of olfactory function were unreliable at all ages. The frequencies of self-rated olfactory function in various age groups did not differ significantly, in contrast to the decrease of measured olfactory function with age.
A Comparative Study of Brain Perfusion Single-Photon Emission Computed Tomography and Magnetic Resonance Imaging in Patients with Post-traumatic Anosmia
Authors: Atighechi Saeid , Salari Hadi , Baradarantar Mohammad Hossein , Jafari Rozita , Karimi Ghasem , Mirjali Mehdi
Published: February 2010

Background

Loss of smell is a problem that can occur in up to 30% of patients with head trauma. The olfactory function investigation methods so far in use have mostly relied on subjective responses given by patients. Recently, some studies have used magnetic resonance imaging (MRI) and single-photon emission computed tomography (SPECT) to evaluate patients with post-traumatic anosmia. The present study seeks to detect post-traumatic anosmia and the areas in the brain that are related to olfactory impairment by using SPECT and MRI as imaging techniques.

Methods

The study was conducted on 21 patients suffering from head injury and consequently anosmia as defined by an olfactory identification test. Two control groups (traumatic normosmic and nontraumatic healthy individuals) were selected. Brain MRI, qualitative and semiquantitative SPECT with 99mtc-ethyl-cysteinate-dimer were taken from all the patients. Then the brain SPECT and MRI were compared with each other.

Results

Semi-quantitative assessment of the brain perfusion SPECT revealed frontal, left parietal, and left temporal hypoperfusion as compared with the two control groups. Eighty-five percent of the anosmic patients had abnormal brain MRI. Regarding the MRI, the main abnormality proved to be in the anterior inferior region of the frontal lobes and olfactory bulbs.

Conclusions

The findings of this study suggest that damage to the frontal lobes and olfactory bulbs as shown in the brain MRI and hypoperfusion in the frontal, left parietal, and left temporal lobes in the semiquantitative SPECT corresponds to post-traumatic anosmia. Further neurophysiological and imaging studies are definitely needed to set the idea completely.
Effect of Chronic Rhinosinusitis on Liver Transplant Patients
Authors: Moon Byoung Jae , Han Ju Hee , Jang Yong Ju , Lee Bong-Jae , Chung Yoo-Sam
Published: February 2010

Background

The use of immunosuppressant after liver transplantation makes transplant recipients susceptible to infections. Most infections that can alter mortality after liver transplantation are wound infections, urinary infections, and pneumonias. There is no evidence, however, that chronic rhinosinusitis can alter mortality in patients awaiting liver transplantation. We have therefore assessed the association of rhinosinusitis with mortality and prognosis after liver transplantation.

Methods

The clinical records of 996 patients who received liver transplants between January 1995 and March 2005 were reviewed and the collected data were analyzed.

Results

Of the 996 patients who received liver transplants between January 1995 and March 2005, 28 (2.8%) had pretransplant rhinosinusitis. Of the latter, 5 patients were treated medically, 1 patient had endoscopic sinus surgery, and 22 patients had no treatment before liver transplantation. Untreated rhinosinusitis before liver transplantation was associated with aggravated rhinosinusitis after transplantation but did not contribute to an increase in infectious mortality or overall mortality rate.

Conclusion

Pretransplant chronic rhinosinusitis does not contribute to mortality in patients undergoing liver transplantation.
Changes in the Maxillary Sinus Volume and the Surgical Outcome after the Canine Fossa Puncture Approach in Pediatric Patients with an Antrochoanal Polyp: Results of a Minimum 3-Year Follow-Up
Authors: Lee Jae Yong , Baek Byoung Joon , Kim Dong Wook , Byun Jang Yul , Lee Seung Won , Hong Hyun Sook
Published: February 2010

Background

An antrochoanal polyp (ACP) originates from the maxillary antrum and simple excision results in high recurrence rates. Canine fossa puncture (CFP) has been proposed as an alternative method of accessing the entire maxillary antrum. To investigate the long-term effects of the CFP approach on changes in the maxillary sinus volume in pediatric patients with an ACP, we compared the sinus volume on the operated and normal sides, using preoperative computed tomography (CT), and postoperative CT performed at least 3 years after the procedure. The surgical outcomes were also assessed using endoscopic and CT findings.

Methods

Seven patients met the inclusion criteria and the ACP was removed via the CFP approach. After a mean follow-up period of 43.9 months, we compared the changes in the maxillary sinus volume between the operated and normal sides, using the pre- and postoperative CT data.

Results

No contractures or decrease in the maxillary sinus volume on the diseased side were observed in any of the patients on postoperative CT, and the average volume of both maxillary sinuses was greater on postoperative CT compared with the preoperative scans. None of the patients showed evidence of recurrence on the endoscopic and CT examinations.

Conclusion

CFP did not affect the maxillary sinus volume in pediatric patients with an ACP and led to a successful surgical outcome in all of the patients. Based on these results, we recommend CFP as a safe, effective method for the treatment of ACP.
Inferior Turbinate Pedicle Flap for Endoscopic Skull Base Defect Repair
Authors: Harvey Richard J. , Sheahan Patrick O. , Schlosser Rodney J.
Published: February 2010

Background

Endoscopic skull base reconstruction (ESBR) is an important advance in the management of skull base defects. Large dural defects usually require the use of pedicled mucosal flaps for successful repair and prevention of cerebral spinal fluid leak. Planning for pedicled flaps is important because raising the flap is often required before tumor removal or initial surgical access. The potential utility of the inferior turbinate pedicled flap (ITPF) in ESBR is assessed.

Methods

The ITPF was raised in nine cadaver heads. The most anterior extent reached on the anterior cranial fossa (ACF) and inferior limit on the posterior cranial fossa (PCF) were recorded with image-guided surgery. Measurements were calculated as a percentage of ACF or PCF length from easily reproducible measurements from preoperative radiology. The width was defined as the widest measurement in the distal third. The length-to-height ratio of the skull base was also assessed as a confounding factor.

Results

Mean length for the ITPF was 54.0 ± 4.9 mm with a width of 22.1 ± 3.7 mm. The mean reach was 112 ± 21% (range, 90–150%) of the PCF. The ACF was less accessible with a mean reach of 67 ± 9.9% (range, 52–84%). The skull base proportions did not have a strong association on utility (p = 0.74 and 0.29).

Conclusion

ITPF presents one option for ESBR of larger skull base defects. It has several limitations with access to the anterior ACF. The ITPF may be an excellent salvage flap when previous septectomy has been performed or with septal involvement by tumor. Careful preoperative assessment of potential defect can estimate the reach of the ITPF.