bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of Conventional Instruments and Mechanical Debriders for Surgery of Patients with Chronic Sinusitis
Authors: Selivanova Oksana , Kuehnemund Matthias , Mann Wolf J. , Amedee Ronald G. 
Published: August 2018

Background This article compares the use of the microdebrider as a form of powered instrumentation designed to decrease mucosal trauma with traditional surgical instruments for endonasal sinus surgery. Methods Surgery was performed with the shaver or conventional instruments using an endonasal approach in 24 patients with bilateral chronic rhinosinusitis. Each patient served as his/her own control, meaning that one side was operated on with conventional instruments and the opposite side was operated on with the microdebrider to evaluate postoperative recovery, healing, and incidence of complications. They were stratified preoperatively and reassessed during 3- and 6-month follow-up and long-term (mean, 13 month) follow-up visits, which included nasal endoscopy, saccharin transport time, assessment of mucociliary transport times and clinical symptoms. Results In this prospective randomized study we were unable to find a statistical difference (p > 0.05) in surgical outcome for patients when using either conventional instruments or mechanical debriders. Conclusion In the literature, mechanical debriders are supposed to provide for mucosal preservation and faster healing. However, for surgical outcome, the use of microdebriders in our study was not better than the results at 3-, 6-, and at 13-month follow-up visits when compared with conventional instruments. Synechia formation, patency of middle meatal antrostomy, and ostial reocclusion were the same in both groups. The incidence of polyposis as a sign of recurrent or persistent infection was similar. Functional results using the saccharin transport time, as a marker of mucociliary function, or episodes of recurrent purulent secretions, again, were identical.
Surgical Techniques for the Removal of Frontal Recess Cells Obstructing the Frontal Ostium
Authors: Wormald Peter John , Xun Chan Steven Zion 
Published: August 2018

Background Cells pneumatizing through the frontal ostium may vary in the degree of frontal sinus penetration. This series describes the use of the axillary flap technique and the endoscopic modified Lothrop procedure (EMLP) for the removal of cells that pneumatize to a varying degree through the frontal ostium into the frontal sinus. Methods Out of a total of 204 patients undergoing endoscopic sinus surgery, 31 patients had a cell on one side and 7 patients had bilateral obstructive cells resulting in 38 sides undergoing an axillary flap approach for the removal of the obstructing cell. In 13 patients, the obstructing cell was deemed inaccessible by conventional technique and these patients underwent an EMLP for removal of the obstructing cell. Results All patients who underwent both the axillary flap approach and the EMLP had a patent frontal ostium confirmed endoscopically at the last follow-up visit. However, 8 of the 38 sides (21%) that underwent the axillary flap procedure had residual minor symptoms with four patients (30%) who underwent an EMLP having a recurrence of minor symptoms Conclusion The axillary flap and the EMLP can be used to remove successfully ethmoidal cells that have pneumatized through the frontal ostium.
Comparison of Feline Nasal Cavity Dimensions Measured by Acoustic Rhinometry and Nasal Casts
Authors: Straszek Sune P. , Mcleod Robbie L. , Hey John A. , Mosekilde Lis , Pedersen Ole F. 
Published: August 2018

Background The goal of this study was to evaluate the relationship between feline nasal cavity geometry determined in vivo by acoustic rhinometry (ARinvivo) and by nasal cavity casts. Cast cross-sectional areas were measured by acoustic rhinometry (ARcast), a fluid-displacement method (FDM), and slicing. A volume comparison between ARinvivo and ARcast was studied in cats with varying degrees of nasal obstruction after application of phenylpropanolamine, saline, or compound 48/80. Method After measurements of ARinvivo, impression material was injected into the nasal cavity to produce casts. Subsequently, the cross-sectional areas of the nasal impressions were measured by ARcast and FDM using ethanol. All casts were weighed to determine exact volume. Six casts also were sliced into segments of equal thickness for determination of cross-sectional area. Results Cast volume determined by ARcast was consistent with results obtained using FDM and weight. Volumes of the first 3 cm determined by ARinvivo ranged between 78 ± 9% of cast volumes determined by ARcast for decongested cavities and 16 ± 15% for congested cavities. Conclusion ARinvivo does not reflect cast geometry, probably because of (1) underestimation by AR because of methodological problems caused by the cavity geometry, (2) deformation of compliant structures within the nasal passageways resulting from the casting procedure, and/or (3) the casting material reaches parts of the nasal cavity not accessible to sound, e.g., sinuses or recesses. Nevertheless, this study does not preclude the use of AR as a sensitive method suited to evaluate relative changes in nasal volume caused by experimental challenges of the nasal mucosa. Compared with ARinvivo, casts still may be of use but it is less sensitive to measure relative changes after experimental challenge.
An Internet Otolaryngology Referral Center: A Preliminary Report
Authors: Baum Eric D. , Becker Daniel G. , Kennedy David W. 
Published: August 2018

Background The aim of this study was to review our early experience with the UPenn Otolaryngology Referral Center Website, ENTConsult.org. Methods ENTConsult.org is an interactive website that allows a referring physician to select a University of Pennsylvania Health System otolaryngologist and share clinical information, including uploaded pictures, radiographs, and other images via the Internet. Traditional methods of long-distance consultation involve mailing clinical information, which often is slow and unwieldy, thus discouraging consultation. ENTConsult.org seeks to take advantage of Internet functionality to facilitate efficient and timely consultation regardless of any of the participants’ locations. Results In this report we reviewed our initial experience with ENTConsult.org, including an overview of the website functionality and a detailed review of critical logistical considerations. Conclusion The UPenn Otolaryngology Referral Center Website ENTConsult.org offers considerable promise as an avenue for long-distance referral and consultation.
Comparative Karyometric Study of the Glandular Epithelium of Normal Nasal Mucosa and Rhinosinus Polyposis
Authors: Fernandes Atílio Maximino , Anselmo-Lima Wilma , Azoubel Reinaldo 
Published: August 2018

Background Rhinosinus polyposis, characterized by a degeneration of the nasal mucosa of the middle meatus, is poorly understood but probably is correlated with several clinical and etiopathogenic entities. Although not definitely characterized, infectious, atopic, inflammatory, genetic, and other factors are involved. The occurrence of malignant degeneration also has been suggested. Methods To contribute to the elucidation of the etiopathogenicity of rhinosinus polyps, we performed a karyometric analysis of their glandular mucosa compared with the normal mucosa. Results A significant increase in nuclear volume was observed, which was not accompanied by changes in shape. Conclusion The results suggest that nuclear alterations may contribute to the pathogenicity of this condition.
Facial Growth after Middle Turbinate Resection: An Experimental Study in the Rabbit
Authors: Egrilmez Murat , Mutlu Cemil , Unlu H. Halis , Celik Onur 
Published: August 2018

Background The aim of this study was to determine the effects of total middle turbinate resection on midfacial growth through a morphometric analysis on an animal model. Methods Twenty-eight male New Zealand white rabbits were used. The animals were divided into three groups: group 1, elevation and relocation of the nasal bone was performed; group 2, concha resection was performed; group 3, control group with no surgical procedure. The surgery was done at 8–10 weeks of age and the skull of each subject was sampled as they reached maturity. The determined distances then were measured by using landmarks identified on skull. The supplied data were evaluated by using the Mann-Whitney U test. Results Deviation of the nasal axis to the opposite side of the resected concha and an increase in the width of nasal bone were observed only in group 2. In group 1, an increase of nasal bone length and zygomaticonasal distances was determined in both the operated and the unoperated sides of nasal bones. Conclusion This animal experiment showed that operations on the nasal bone or concha resection affected the midfacial growth in rabbits. The effects of middle turbinate resection to midfacial development should be evaluated by additional studies. We recommend only limited, conservative surgical procedures on the middle turbinate, saving all the vital mucosa, periosteum, and bone.
Outcome of Computer-Assisted Sinus Surgery: A 5-Year Study
Authors: Tabaee Abtin , Kacker Ashutosh , Kassenoff Tali L. , Anand Vijay 
Published: August 2018

Background The aim of this work was to study the outcome and rate of complications in a cohort of patients who underwent computer-assisted surgery (CAS). A retrospective study was performed of all patients undergoing CAS at a tertiary care teaching hospital over a 5-year period. Methods All patients who underwent computer-assisted sinus surgery with at least 1 year of follow-up were included in the study. Charts were reviewed for indication of CAS, incidence of major complications, and need for revision surgery after CAS. Results A total of 120 patients underwent CAS in the 5-year period. Ten patients were lost to follow-up and were not included in the analysis. Indications for the use of CAS were revision surgery in 85 patients, sphenoid sinus disease in 12 patients, isolated frontal sinus disease in 4 patients, combined sphenoid and frontal disease in 2 patients, and cerebrospinal fluid leak (CSF) leak in 7 patients. The mean postoperative follow-up was 2.6 years. There were no major complications. Fifteen (16.5%) patients required revision surgery: 10 patients required revision endoscopic sinus surgery (1–5 revisions using CAS), 3 patients required an external open procedure, and 3 patients required revision CSF leak closure (one patient required both revision sinus surgery and an external procedure). There were no cases of major intra- or postoperative bleeding, central nervous system damage, CSF leak, or orbital trauma in this study. Conclusion CAS helps in avoiding trauma to the orbit and anterior skull base and has a low incidence of major complications. The need for revision surgery may occur in patients with frontal sinus disease, nasal polyposis, or recurrent CSF leak.
The Bath-Plug Closure of Anterior Skull Base Cerebrospinal Fluid Leaks
Authors: Wormald P. J. , Mcdonogh Mike 
Published: August 2018

Background This study presents the technique and results of cerebrospinal fluid (CSF) leak closure by placement of a fat plug on the intracranial surface of the dura. A prospective cohort study of all consecutive patients undergoing endoscopic closure of an anterior skull base CSF leak using the bath-plug technique was performed at a tertiary care center. Methods Thirty-three patients presented with CSF leaks: 6 were traumatic, 7 were spontaneous, 9 were iatrogenic, and 10 were associated with a meningoencephalocele. The average age of the patients was 40 years and the male-to-female ratio was 1.2:1. All patients underwent the bath-plug technique for closure of CSF leaks. The surgical technique was presented. Results Thirty-one of the 33 patients had a successful primary closure of their CSF leak with 2 patients requiring a repeat procedure. After an average of 28 months follow-up, there were no recurrent leaks in any of the patients. This gives a primary closure success rate of 94% and a secondary closure rate of 100%. Conclusion The bath-plug technique for closure of anterior skull base CSF leaks was a reliable technique for a large variety of causes.
The Risk of Olfactory Disturbance from Conchal Plate Injury during Ethmoidectomy
Authors: Kim Kyung-Su , Choi Yoon-Seok , Kim Hyun Jun , Yoon Joo-Heon 
Published: August 2018

Background Even though the olfactory function usually is improved or unchanged after ethmoidectomy, some patients complain of olfactory disturbance, which may be caused by direct injury to the olfactory nerves. However, the detailed anatomic pathway of the olfactory nerves that leave the olfactory mucosa and after going through the cribriform plate insert into the olfactory bulb is uncertain. In the studies of lateral nasal wall, we referred to the thin bone that connects the middle, superior, and supreme turbinates to the skull base as the “conchal plate.” We undertook this study to determine the anatomic relation between the conchal plate and the olfactory nerve. Methods Ten midsagittal sections from adult cadaver head specimens were used for gross anatomy and the midportion of the conchal plate was taken and fixed in 10% formalin. The microscopic structures of the conchal plate were observed after hematoxylin and eosin staining. Results The olfactory nerves originated from the olfactory mucosa lining the middle and superior turbinates and ran upward within the bone of the conchal plate. These results suggest that the olfactory nerve may be injured inadvertently in the conchal plate during ethmoidectomy and that this injury is likely to be one of the possible causes of olfactory disturbance. Conclusion We propose a possibility that injury to the conchal plate can affect olfactory function. Therefore, care should be taken to avoid damage to the conchal plate during ethmoidectomy.
Evaluation of Telescopes and Forceps for Endoscopic Transnasal Surgery on the Maxillary Sinus
Authors: Hosemann Werner , Scotti Oliver , Bentzien Sabine 
Published: August 2018

Background Contemporary endonasal surgical treatment of chronic hyperplastic paranasal sinusitis strives for microsurgical excision of all spots of irreversibly diseased hyperplastic mucosa. However, anatomy of the maxillary sinus reveals distinct hidden areas and niches that pose problems to optical and instrumental control. Methods The specific range of view of common telescopes (30, 45, and 70°) inside the maxillary sinus after generous middle meatal antrostomy is analyzed in three different-sized anatomic specimens. The examinations are paralleled by investigations on the range of action of 14 surgical instruments. The results are visualized by means of a three-dimensional computed tomograph of all specimens. Results The different telescopes and surgical tools that are introduced via the middle meatal antrostomy reveal a specific overlap in the range of view and in the range of action, respectively. Anatomic areas that are difficult to reach e.g., are the medial and anterior parts of the sinus and the alveolar recess. An additional inferior antrostomy offers minor benefits with respect to control of the prelacrimal recess. Conclusions Routine surgery on the maxillary sinus in case of chronic hyperplastic pansinusitis via middle meatal antrostomy does not cover all hidden niches of the sinus. The most important area that is out of sight and control is the prelacrimal recess.
A Superantigen Hypothesis for the Pathogenesis of Chronic Hyperplastic Sinusitis with Massive Nasal Polyposis
Authors: Bernstein Joel M. , Ballow Mark , Schlievert Patrick M. , Rich Gary , Allen Cheryl , Dryja Diane 
Published: August 2018

Background The pathogenesis of chronic hyperplastic sinusitis with massive nasal polyposis is still an enigma; however, the molecular biology of this disease is beginning to become unraveled and the proinflammatory cytokines and the message and the product of these cytokines have all been identified in nasal polyps. However, the initial trigger that causes inflammation of the lateral wall of the nose to up-regulate lymphocytes and eosinophils is still unknown. Methods Thirteen patients with massive polyposis were studied. The mucus of the nasal cavities surrounding the nasal polyps was studied for both bacterial and fungal species. The lymphocytes of the nasal polyps were extracted and evaluated for the T-cell receptor, particularly, the variable β region of this receptor. Enterotoxins (superantigens) of the bacteria were studied. Finally, the histopathology of nasal polyps was studied. Results Fifty-five percent of the patients had toxin-producing Staphylococcus aureus in the nasal mucus adjacent to the polyps. Three different enterotoxins were isolated, including Staphylococcus enterotoxin A, Staphylococcus enterotoxin B, and toxic shock syndrome toxin 1. The variable B specificity for these superantigens was identified also in the polyp lymphocyte T-cell receptor. Conclusion A superantigen hypothesis for massive polyposis is suggested because the most common bacterial species found in the nasal mucus is Staphylococcus aureus. These bacteria produce enterotoxins in all of the cases studied and the corresponding variable β region of the T-cell receptor also was up-regulated in the polyp lymphocytes in cases studied thus far. These data taken together suggest that the initial injury to the lateral wall of the nose may be the result of toxin-producing Staphylococci. Superantigens (enterotoxins) may up-regulate lymphocytes to produce cytokines that are responsible for the massive up-regulation of lymphocytes, eosinophils, and macrophages, the three most common inflammatory cells found in massive nasal polyposis.
Objective and Subjective Evaluation of Endoscopic Nasal Surgery Outcomes
Authors: Giger Roland , Landis Basile Nicolas , Zheng Chunquan , Malis Didier-David , Ricchetti Alma , Kurt Anne-Marie , Morel Denis R. , Lacroix Jean Silvain 
Published: August 2018

Background Chronic rhinosinusitis (CRS) symptoms include nasal obstruction, rhinorrhea, and facial pain associated with rhinosinusitis disability. When resistance to medical treatment is associated with endonasal anomalies, endoscopic nasal surgery (ENS) can be proposed. However, objective and subjective assessment criteria regarding the evaluation of ENS outcomes remain unclear. The aims of this study were to evaluate the correlation between the inflammation in the nasal mucosa, objective recordings of nasal airway resistance (NAR), subjective evaluation of symptom intensity, and the impact of ENS on patient-perceived rhinosinusitis disability. Methods Sixty-one consecutive patients (35 men and 26 women; mean age, 37.5 years) suffering from CRS were monitored at 4 months and 2 years after ENS. All middle turbinate mucosa were analyzed for the density of nonspecific inflammatory cells. All patients scored their own subjective rhinosinusitis symptoms and complaints of rhinosinusitis disability. An active anterior rhinomanometry was performed. Results A good correlation was observed between subjective and objective NAR (p < 0.001). We found a significant correlation between the density of inflammatory cells in the nasal mucosa, subjective nasal obstruction, and the rhinosinusitis disability score (p < 0.001). Recurrent CRS was seen only in subjects with moderate to severe inflammation of the middle turbinate mucosa sampled at the first surgical intervention. Subjective rhinosinusitis symptoms, objective NAR, and rhinosinusitis disability improved significantly after ENS. Conclusion The degree of inflammation seems to be a good prognostic indicator regarding CRS recurrence. Long-term outcome after ENS for CRS showed significant improvement in subjective rhinosinusitis-specific symptoms, objective NAR, and rhinosinusitis disability.
The Percutaneous Columellar Strut
Authors: Bloom David C. , Cupp Craig L. 
Published: August 2018

Background Understanding tip support mechanisms is essential for nasal surgery, especially for preservation or augmentation of tip projection. Methods Support of the nasal tip often is improved by the use of struts placed between the medial crura. The percutaneous columellar strut is a technique that provides additional tip support during septoplasty and closed rhinoplasty. The strut is placed via a small vertical columellar incision. Results The advantage of easy and simple insertion outweighs the minor potential disadvantage of a small, visible vertical columellar scar. It is useful in addressing tip ptosis when trauma, surgery, or aging has reduced the contribution of the septum to tip support. Conclusion A detailed description of the percutaneous columellar strut technique and results of its application are presented.
Intravenous Antibiotics for Refractory Rhinosinusitis in Nonsurgical Patients: Preliminary Findings of a Prospective Study
Authors: Anand Vijay , Levine Howard , Friedman Michael , Krespi Yosef , Panje William , Schettino Raymond , Stankiewicz James , Tichenor Wellington , Kacker Ashutosh , Horn Corinne 
Published: August 2018

Background Some patients with persistent chronic sinusitis have either had unsuccessful surgery or have simply refused surgery. In nonsurgical candidates, when oral antibiotics and traditional therapy are unsuccessful, home intravenous (i.v.) antibiotics present an effective alternative. Methods Forty-five patients were assessed before treatment using a semiquantitative scoring system and visual analog scales to measure major and minor symptoms of rhinosinusitis. Computed tomography (CT) scans were assessed using the Lund-MacKay staging system; nasal endoscopic findings were documented. Seven patients had nasal endoscopy and CT results. Medical diseases known to be associated with rhinosinusitis were documented. Endoscopic-guided culture and sensitivities were obtained. After successful insertion and radiological placement confirmation, home i.v. antibiotics were administered via a peripherally inserted central catheter line. Antibiotic choice was based on the culture and sensitivity reports. Treatment continued for 6 weeks; subsequent cultures were obtained at weeks 3, 6, and 9. Nasal endoscopy was performed, and rhinosinusitis symptoms were assessed at weeks 3, 6, and 9. Follow-up CT scans were obtained at week 12 in a subset of patients. Results Significant improvement in symptom analysis was seen in patients receiving home i.v. antibiotics when previous oral antibiotic treatment and/or surgery had failed. Conclusion Home i.v. antibiotics provide an excellent alternative to surgery for patients who have either had unsuccessful surgery or who have refused surgery.
Objective Assessment of Lower Airway Involvement in Chronic Rhinosinusitis
Authors: Ragab Ahmed , Clement Peter , Vincken Walter 
Published: August 2018

Background When associated with lower airway involvement, the morbidity and the cost of chronic rhinosinusitis (CRS) can increase. The aim of this prospective study was to assess the clinical and radiological characteristics of the upper airways in CRS patients scheduled for functional endoscopic sinus surgery and to correlate these findings with the functional changes of the lower airways. Methods Twenty-five adult patients with CRS were subjected to clinical and endoscopic assessments, computed tomography scan, and allergic assessments using validated scoring systems. Lower airways were assessed by clinical history, pulmonary function test, histamine bronchial provocation test, and chest x rays. Results Sixty percent of CRS patients were shown to have associated lower airway involvement, i.e., 24% had asthma and 36% had small airway disease (SAD). Nasal congestion and nasal polyps were the most common clinical findings in both of these subgroups of patients. In addition, there was a negative correlation between computed tomography scan findings of the sinuses and the obstructive parameters on pulmonary function test in SAD but not in the asthma subgroup. Conclusion These results showed that different kinds of lower airway involvement frequently could be associated with CRS. Some are manifest such as asthma and some are hidden such as SAD and histamine bronchial hyperresponsiveness.