bluuebunny/crossref_metadata_2025_split huggingface dataset:
Access to the Maxillary Sinus via Canine Fossa Trephination
Authors: Tan Neil C. , Hanna Brendan , Bassiouni Ahmed , Cleland Edward , Jardaleza Camille , Wormald Peter J. 
Published: February 2015

Objective1) To assess how much of the maxilary sinus could be accessed through a 5‐mm endoscopic canine fossa trephination (eCFT) in a cadaveric model. 2) Review the clinical benefits as well as co‐morbidities associated with this procedure.MethodA cadaveric study involving 6 fresh‐frozen heads that underwent endoscopic sinus surgery giving 12 sides. eCFT was performed and heads were registered with an image guidance system (IGS). Access to predetermined points in the sinus was assessed by whether the registration probes could reach corners of sinus as demonstrated on the IGS.ResultsInstrumentation access through an eCFT allowed for 89.6% (range, 75%‐100%) of corners within the maxillary sinus to be reached as demonstrated on the IGS. The 0° probe was capable of accessing 97.9% of the posterior face. The anterior face was more difficult to access with only 81.3% of points being reached.ConclusioneCFT is a simple procedure that should be added to the repertoire of the modern endoscopic sinus surgeon. It allows for excellent surgical access to the maxillary sinus, far above what is accessible through the natural ostium alone. Refinements in technique report significantly decreased complication rates when compared to Caldwell‐Luc.
Allergen Extract Compatibilities
Authors: Rekkerth Donna J. , Grier Thomas J. 
Published: February 2015

Objective1) Assess the relative stabilities of extracts at various dilutions and define target allergen recoveries in defined mixtures. 2) Identify stable, risky, and incompatible extract combinations. 3) Recognize the effects of glycerin, time to and temperature on the stability of immunotherapy treatment vials. 4) Design optimal extract mixtures.MethodExamination of target allergen recoveries in extract mixtures at maintenance vial strengths, using laboratory methods (IgE ELISA inhibitor and IgE Immunoblotting) known to be sensitive to changes in overall extract composition, specific allergen concentrations, and total allergen concentrations or extract potencies, 2000 present.ResultsDegradation of some allergens in dilutions or mixtures can be influenced by several factors, including endogenous hydrolytic enzymes, final glycerin concentrations, presence of stabilizers such as human serum albumin, storage times in the refrigerator, and elevated temperature exposures. A working knowledge of the stabilities and compatibilities of various allergens in extract mixtures is essential to optimal formulation of patient vials for subcutaneous immunotherapy. A mixing recommendation chart was created for use in the allergy clinic as a guide to ensure allergen extract compatibility.ConclusionDegradation of allergens in dilutions or mixtures can be influenced by several factors, including presence of endogenous hydrolytic enzymes, final glycerin concentrations, presence of stabilizers such as human serum albumin, storage refrigerator times, and elevated temperature exposures.
Alternate Sliding Technique for a Nasal Septum Perforation
Authors: Ushio Munetaka , Kondo Kenji , Baba Shintaro , Kanaya Kaori , Tamaruya Noriko , Ino Kenji , Yamasoba Tatsuya 
Published: February 2015

ObjectiveA critical point for successful surgical closure of the perforation of a nasal septum is the simultaneous achievement of both sufficient blood supply to the closure site and reduced tension of the flaps. We describe a modified surgical technique, the “alternate sliding technique,” to manage this difficulty.MethodThe procedure starts with the elevation of bilateral mucosal flaps under an endoscopic view. A releasing incision is made across the nasal floor on 1 side and across the lateral cartilage on the other side. The flaps are slid up‐ and downward, respectively. The perforation is then sutured.ResultsNasal septum perforation was successfully fixed with the first surgery in 6 of the 8 patients. Among them, reperforation was not observed during postoperative follow‐up of 3 to 18 months. The symptoms complained of before surgery fully resolved. A patient who had taken corticosteroids for several years and another who had had multiple perforations required the additional closure of a small perforation in our clinic.ConclusionOur alternate sliding technique facilitates a better blood supply from the bipedicled attachment. Each suture is lined by a mucosal flap of the other side. These minimize the risk of reperforation. Our technique is applicable for small to medium perforations.
Can Lacrimal Sac Washout Predict Outcomes of Endoscopic DCR?
Authors: Chin David , Harvey Richard J. , Wilcsek Geoff , Sacks Raymond 
Published: February 2015

ObjectiveHigh success rates for endoscopic dacryocystorhinostomy (END‐DCR) in partial nasolacrimal duct obstruction (NLDO) have been reported, but comparisons with complete NLDO are lacking. This study compares the success of primary END‐DCR with respect to the preoperative nasolacrimal duct patency and reviews factors associated with failure.MethodRetrospective review of END‐DCRs performed at a tertiary referral center. Partial and complete NLDO were defined by the presence or absence of flow into the nose with lacrimal sac washout (SWO), respectively. Intraoperative findings including thickness of bone, level and state of the common canaliculus, state of inflammation, and contents of the lacrimal sac during END‐DCR were recorded. For patients with at least 3 months follow‐up, the outcome of resolution of epiphora (none/partial/complete), postop Jones 1 (J1; positive/ negative) and endoscopy of the neo‐ostium (closed/partially or fully‐open) were defined.ResultsA total of 245 primary END‐DCRs were reviewed (mean age, 63.6 ± 5.3 years, 70% women). Based on SWO, the groups were defined as 39.6% and 60.4% complete NLDO. Overall improvement in epiphora was 95.5%. In cases where symptoms improved, absence of flow into nose on SWO was associated with a higher rate of complete resolution (93.6% vs 84.9%, RR 1.102 [1.001, 1.213]). The ostia were fully open in 93.9% and postop J1 was positive in 97.1% of patients and were not different between groups.ConclusionEND‐DCR is highly successful for both types of NLDO. Preoperative absence of flow into nose on SWO was associated with slightly higher chance of complete resolution.
Cerebrospinal Fluid Leak following LeFort I Osteotomies
Authors: Kroeker Andrew , Edwards Sean , Sullivan Steven , McKean Erin M. 
Published: February 2015

Objective1) Describe an unusual complication of cerebrospinal fluid leak (CSF) following orthognathic surgery through LeFort I osteotomies. 2) Understand the mechanism and incidence of injury and techniques of endoscopic repair. 3) Review the literature regarding skull base defects and CSF leaks following maxillofacial advancement.MethodCase report, single patient, 2012, literature review.ResultsAn 18 year‐old morbidly obese woman presented to the oral maxillofacial surgery clinic with complaints of malocclusion. She underwent bilateral LeFort I osteotomies and was discharged on POD1. She represented 3 days later with headache and nausea. A head CT demonstrated pneumocephalus and a fracture of the dorsal aspect of the right sphenoid sinus causing a communication with the prepontine cistern. The patient subsequently underwent endoscopic repair by the otolaryngology and neurosurgery services, using a vascularized pedicled mucosal nasoseptal flap. She was discharged from the hospital on post‐ operative day 7 and since has had an uneventful recovery.ConclusionPostoperative recognition of CSF leak is imperative in order to ensure timely repair and to prevent further complications. Identification of surgical techniques and patient‐specific factors contributing an increased risk of postoperative CSF leak is vital. Given the prior intranasal and palatal surgery, various preoperative reconstruction options must be considered.
Changes of the Histological Features in Nasal Polyps
Authors: Kim Su Jin , Shin Seung Youp , Lee Kun Hee , Kim Sung Wan , Cho Joong Saeng 
Published: February 2015

ObjectiveDepending on the inflammatory cell infiltration, nasal polyps can be categorized as eosinophilic type or non‐eosinophilic type. There is a geographical difference in the prevalence of a certain pathological type of polyp. More than 80% of polyps in Western people are the eosinophilic type, while this type is rarely found among Eastern people. The periodical change in the prevalence of histological types of polyps was evaluated in this study.MethodTwo hundred total patients, each confirmed to the polyp biopsy, were enrolled between 1993 and 2010. Specimens were fixed in formalin, then made to a paraffin block and H&E stained slide, which was reviewed by 2 authors. The number of eosinophils per high power field (HPF) and other cellular, epithelial, and stromal markers were reviewed.ResultsWe compared the nasal polyp eosinophil count by periods, the average eosinophil count/HPF increased from 7.22 (±1.695) in 1993 to 20.44 (±3.635) in 2010 (P =. 001). Eosinophilic polyp (showing over 5 eosinophils/HPF) increased significantly from 26% in 1993 to 52% in (P =. 000 ‐> P <. 001). Among other histologic markers, lymphocytes, basement membrane thickening, and gland hypertrophy showed significant difference.ConclusionAfter comparative studies between histopathologic findings of nasal polyps from 1993 and 2010 respectively, the percentage of eosinophilic nasal polyp, known to be rare among Asians, including Koreans, have increased significantly.
Chronic Rhinosinusitis and Lacrimal Obstructive Disease
Authors: Matos Teresa O. , Angelo Pedro S. , Ribeiro Helena G. , Costa Tiago , Subtil João , Dinis Paulo Borges 
Published: February 2015

ObjectiveTo investigate if chronic inflammatory sinus disease has a pathogenic role in the obstructive pathology of the neighboring lacrimal system, including obstruction alone and chronic or recurring dacryocystitis.MethodOne hundred patients were selected for endoscopic DCR because of persistent epiphora and/or chronic or recurrent dacryocystitis. Their sinus CT scans were evaluated using the Lund‐Mackay score.The nonoperated side and a further group of 30 head trauma patients were the control groups.ResultsNo statistically significant differences were found in either presence or absence, or even disease extension or location, of image defined inflammation of the sinuses and obstructive pathology of the lacrimal system, including chronic or recurring dacryocystitis. DCR sides and patients do not have higher scores of sinonasal disease than nonsurgical sides or normal subjects.ConclusionThese results lead to the conclusion that chronic inflammatory sinus disease is a comorbidity that very likely does not play a pathogenic role in any form of obstructive disease of the lacrimal system.
Clinical Trend of Churg‐Strauss Syndrome in Japan
Authors: Arai Chiaki , Iimura Jiro , Wada Kota , Uno Kosuke , Edamatsu Hideo , Moriyama Hiroshi , Ota Fumikazu 
Published: February 2015

ObjectiveThere are a lot of reports that LTRA internal use, steroid medicine, and weight loss are associated with the onset of CSS. Because we experienced 2 cases of CSS that occurred during treatment of eosinophilic sinusitis this time, in addition, we consider some discussion from the literature.MethodWe examined retrospectively 2 eosinophilic sinusitis patients, one with asthma and the other with allergic rhinitis. After these operations, we added wash‐out sinuses and prescribed LTRA and nasal steroids. Depending on the state of intranasal findings, we gave steroid medicine.ResultsWe performed wash‐out sinuses, LTRA internal use, and nasal steroids as postoperative treatment with both cases, and, at the exacerbation of intranasal findings, the intranasal findings improved by administration of steroid medicine. When we took steroid medicine, we did not do it with fixed quantity and the administration method that we did it and reduced. CSS was diagnosed by mononeuritis multipleand polyarthritis and purpuric onset subsequently. We suggested the possibility that LTRA internal use was associated with the onset of the CSS.ConclusionLTRA internal use, steroid medicine, and weight loss may be associated with the onset of the CSS, and it is important to discontinue a causing agent when the otolaryngologist who frequently prescribes these drugs grasps overall status, and suspects CSS.
Comparison of CT and Pathophysiologic Recovery in Sinusitis
Authors: Lee Ki‐Il , Chung Young‐Jun , Mo Ji‐Hun , Lee Sang Joon , Chung Phil‐Sang 
Published: February 2015

ObjectiveTo investigate and understand the difference between clinical and pathophysiologic recovery according to recovery periods in the rabbit sinusitis model.MethodA synthetic sponge was inserted into the right‐side nasal cavities of 15 rabbits. After 2 weeks, the maxillary sinu‐sitis was induced and confirmed by computed tomography (CT) scan. The opacification in CT scan was graded. Then the mucosa was harvested from the maxillary sinus. Ciliary beat frequency (CBF) was measured for evaluating mucosal function. Light microscopic, scanning and transmission electron microscopic (SEM & TEM) examinations were performed. Histopathologic findings in microscopic examinations were scored in a semi‐quantitative measure. Each examination was performed at the time of reopening of maxillary sinus ostium, 4 weeks and 8 weeks after reopening of maxillary sinus ostium.ResultsThe sinus opacification in CT scan and ciliary regeneration in SEM showed significant improvement 8 weeks after reopening of maxillary sinus ostium. But CBF, tissue inflammation score and ciliary wave disorder were not improved significantly 8 weeks after reopening of maxillary sinus ostium.ConclusionClinical, functional, and histopathologic recoveries from sinusitis require different periods of time. Incomplete functional and histopathologic recoveries can be the cause of relapse or recurrence of sinusitis. Therefore, close follow‐up will be necessary after clinical resolution of sinusitis.
Concha Bullosa Mucopyocele Presenting as a Nasal Mass
Authors: Oakley Gretchen M. , Meier Jeremy D. , Error Marc E. 
Published: February 2015

Objective1) Describe the rare case of an adolescent with a concha bullosa mucopyocele presenting as a nasal mass. 2) Review the existing literature discussing mucopyocele of a concha bullosa.MethodCase report of a 14‐year old girl presenting to the emergency department with localized right‐side facial pain, pressure, and headaches. The patient had no rhinorrhea, was afebrile, and had a normal white blood cell count and c‐reactive protein.ResultsSinus CT showed a right‐side intranasal mass with destruction of middle turbinate bone. MRI revealed post‐obstructive fluid throughout the maxillary, ethmoid, and frontal sinuses. The patient was taken to the operating room for biopsy of the presumed mass and drainage of the sinuses. A large, bulging middle turbinate was found on nasal endoscopy and incision into the turbinate revealed a purulent concha bullosa. The concha bullosa was opened and unilateral maxillary antrostomy and anterior ethmoidectomy performed. Literature discussing concha bullosa mucopyocele is limited to only a few case reports.ConclusionThis describes an unusual case of an adolescent girl with a concha bullosa mucopyocele presenting as an obstructing mass of the middle meatus without signs or symptoms of infection. Although rare, an infected concha bullosa can cause significant problems by obstructing the entire osteomeatal complex.
Endonasal Neuroendoscopy
Authors: El‐Guindy Ahmed S. 
Published: February 2015

ObjectiveTo provide a detailed description of the extended endoscopic endonasal approach to the ventral skull base, evaluate its advantages and limitations and to understand better the complex anatomic relationships of the structures involved in the approach from an endoscopic endonasal perspective.MethodAnatomic dissection study from January 2011 to October 2011. Materials: Three fresh, latex‐injected cadaver heads were dissected. Setting: Dissection laboratory, Tanta University School of Medicine. Intervention: An endoscopic endonasal approach was performed on midline skull base. Outcome measurements: Anatomic relationships of endonasal endoscopic skull base approach.ResultsThe extended endoscopic endonasal approach allows surgeons to access the entire ventral midline skull base from the crista galli to foramen magnum. A complete visualization of the carotid and vertebrobasilar arterial systems and of all 12 cranial nerves is obtainable. The major potential advantage of the extended endoscopic endonasal approach to skull base is that it provides a direct anatomic route to the lesion without traversing any major neurovascular structures, obviating brain retraction. The disadvantages of this procedure include the relatively restricted working space and the danger of an inadequate dural repair with a potential for cerebrospinal fluid leakage and meningitis.ConclusionThe extended endoscopic endonasal approach allows surgeons to access the entire ventral midline skull base from crista galli to foramen magnum and deal with a diverse array of intra‐ and extradural lesions through a rostro‐caudal trajectory.
Endoscopic Surgery for Cerebrospinal Fluid Rhinorrhea
Authors: Chen Feng , Gao Xia 
Published: February 2015

ObjectiveTo evaluate the clinical effect of endoscopic surgery for cerebrospinal fluid (CSF) rhinorrhea and discuss the best treatment.MethodRecords of 52 patients aged 19 to 60 years with a mean age of 41.9 years treated by endoscopic surgery in our department between June 2002 to May 2010 were analyzed retrospectively. Eighteen were spontaneous, 34 were traumatic or iatrogenic. Middle turbinate mucosa, fascia lata, and abdominal fat were used in the leak repair. The CSF fistula were closed by the combined multilayer “underlay,” “overlay” or “bath‐plug” techniques.ResultsThe cribriform plate was the most common site of the leak (21/52), followed by the sphenoid sinus (17/52), anterior ethmoid sinus (7/52), posterior ethmoid sinus (4/52), and frontal recess (3/52). Defects ranged in size from 5 to 35 mm (mean, 9.7 ± 3.5mm), 13 cases were >10 mm. Forty‐two cases (80.8%) were repaired successfully at the first transnasal endoscopic surgery, 6 cases succeeded at the second attempt, and 4 cases at the third attempt. The first attempt success rate of patients with large size (>10 mm) leaks (61.5%) was significantly lower than that of patients with small size (<10 mm) leaks (87.2%). One patient had postoperative intracranial infection and one patient had postoperative hydrocephalus. All patients were followed‐up for 6 months to 3 years (mean 1.2 years), and no recurrence was found.ConclusionEndoscopic closure of CSF rhinorrhea represents a minimally invasive and highly successful procedure. Location and size of leak and repair material affect surgical outcome. Abdominal fat is a good repair material to stop the leak for patients with larger (>10 mm) leaks.
Epidemiology of Sinonasal Cancers in the City of São Paulo
Authors: Bezerra Thiago , Michels Fernand , Soter Ana C. , Pinna Fabio D.R. , Godoy Maria Dantas , Latorre Maria do Rosario , Voegels Richard L. 
Published: February 2015

ObjectiveEvaluate epidemiology of nose and paranasal sinus cancer in the city of São Paulo.MethodThis was a study based on population cancer registry data of São Paulo from 1997 to 2006. We extracted data of 628 patients (CID‐10 C30, C31.x) from a total of 388.950 diagnosed with cancer among all tumors. We aggregated data into the morphologic groups according to ICD‐O.ResultsThe overall estimated incidence of nose and sinus tumors was 0.6 out of 100,000 and it was higher in men (0.7/100,000 vs 0.5/100,000). They are more frequent among fifth and eighth decades. The most common site was maxillary sinus (37.1%) followed by nasal cavity (33.3%). Isolated diagnosis of other sinus cancer was very rare and the most common was from ethmoid sinus (2.5%) The most common morphologic groups were squamous cell (followed by adenoid cystic carcinoma and esthesioneuroblastoma). The epidemiology of each site and each morphology were analyzed in detail.ConclusionSinonasal cancers in São Paulo have an incidence comparable to described previously. The analysis of sinonasal cancers from reliable population based registry was not commonly reported and this information can provide us more knowledge about this disease, besides the large case series of large health services.
Inferior Turbinate Surgery for Severe Allergic Rhinitis
Authors: Kojima Yusuke , Tsuzuki Kenzo , Oka Hideki , Takebayashi Hironori , Sakagami Masafumi 
Published: February 2015

ObjectiveInferior turbinate surgery, an outpatient surgery, is used to treat severe allergic rhinitis that is unresponsive to medication. The purpose of this study was to determine the clinical effects of outpatient inferior turbinate surgery (OITS) on patients with severe allergic rhinitis.MethodBetween January 2008 and December 2011, we performed OITS bilaterally under local anesthesia for 216 patients with severe allergic rhinitis. Two kinds of cautery device, high‐frequency electrocautery and argon plasma coagulation, were used. Nasal symptoms and intranasal findings were evaluated pre‐ and postoperatively at 3 months or more after OITS.ResultsOn average, scores for sneezing, nasal discharge, and nasal obstruction significantly improved from 1.3 to 0.8, from 1.7 to 1.1, and from 2.6 to 1.2 (P <. 001, n = 216), respectively. Overall, improvement of symptoms was found in 73% (157/216 patients) postoperatively. Congestion of inferior turbinates also improved in 74% (160/216 patients).ConclusionThese data indicate that the OITS had an effect on more than 70% of patients with severe allergic rhinitis.
Mini‐Nasoseptal Flap for Recalcitrant Sphenoid Sinusitis
Authors: Thompson Christopher F. , DeConde Adam S. , Chiu Alexander G. , Suh Jeffrey D. 
Published: February 2015

ObjectiveTo describe the use of a modified nasoseptal flap for select cases of chronic sphenoid sinusitis.MethodDescription and illustration of the surgical technique and indications for the modified nasoseptal flap for chronic sphenoid sinusitis. We report 3 cases of recurrent sphenoid fungal sinusitis treated with revision endoscopic sinusotomy and a mini‐nasoseptal flap.ResultsThe mini‐nasoseptal flap was used successfully in all cases without evidence of restenosis in the follow‐up period. There were no complications related to flap harvest or inset.ConclusionInflammatory sphenoid lesions such as fungal balls may increase the risk of postoperative ostial stenosis especially in cases when postoperative surveillance or debridement is difficult or impossible. The mini‐nasoseptal flap may expedite healing and decrease the risk of restenosis after sphenoid sinusotomy by avoiding cicatricial scarring.