bluuebunny/crossref_metadata_2025_split huggingface dataset:
Endonasal Endoscopic Approach to the Orbit (EEAO)
Authors: Karkas Alexandre , Theodosopoulos Philip , Keller Jeffrey T. , Zimmer Lee A. 
Published: August 2013

Objectives:Describe the endoscopic anatomy of medial and inferior orbital walls and present 5 illustrative clinical cases.Methods:Two vessel‐injected cadavers (4 sides) were dissected through endoscopic endonasal transethmoid‐sphenoid‐maxillary approach.Results:Total ethmoidectomy and maxillary antrostomy were performed. Maxillary sinus roof was removed until reaching the infraorbital canal laterally. Anterior and posterior ethmoidal arteries were identified. Lamina papyracea was removed. Transnasal and transethmoidal sphenoidotomies were made. Periorbita was incised along medial and inferior orbital walls. Cavernous carotid artery was exposed and medialized to show oculomotor (CNIII), trochlear (CNIV), ophthalmic (CNV1), maxillary (CNV2), and abducent (CNVI) nerves in cavernous sinus. In superolateral wall of sphenoid sinus, the optocarotid recess was visualized as well as the optic nerve (CNII) and ophthalmic artery (OphA) entering the orbit. Anteriorly, the annulus tendineus of Zinn (ATZ) was found and incised, showing the insertion of superior, medial, and inferior rectus muscles with CNIII and its branches. CNII, nasociliary branch of CNV1, CNVI, and OphA also enter ATZ. Superior and inferior oblique muscles were seen outside ATZ. The anterior limit of dissection was the eye globe. Five clinical cases of EEAO (lymphoma, aspergilloma, hematoma, abscess, Graves’ disease) will be presented.Conclusions:EEAO is ideal for inferior and medial lesions of the orbit. Contrary to craniotomies, EEAO exposes CNII without removing orbital roof and anterior clinoid. Contrary to orbitotomies, EEAO provides excellent visualization with angulated endoscopes. Limits are lesions of superior or lateral part of the orbit or lesions that need manipulation of CNII or a section of medial rectus muscle.
Impact of Increased Postoperative Debridement Frequency following Functional Endoscopic Sinus Surgery
Authors: Manji Jamil , Habib Al‐Rahim , Wang Jay C.C. , Gan Eng C. , Hathorn Iain F. , Javer Amin R. 
Published: August 2013

Objectives:1) Compare sinonasal‐specific quality of life between patients receiving an additional postoperative visit at 14 days compared to a standard of care control group receiving debridements at one, four, and twelve weeks post–functional endoscopic sinus surgery (FESS). 2) Compare endoscopically assessed mucosal edema between the two groups at one and three months post‐FESS to determine if the additional postoperative debridement had an impact on sinus health.Methods:Adult chronic rhinosinusitis patients receiving FESS at a tertiary‐level rhinology center between January 2011 and 2012 were included. Records were retrospectively evaluated for sinonasal outcome test (SNOT‐22) and mucosal edema scores (Philpott‐Javer) at one and three months post‐FESS. Treatment subjects receiving additional debridement fourteen days post‐FESS were compared to control subjects receiving the standard of care. Subjects were matched in terms of baseline disease severity and extent of surgery.Results:The cohort consisted of 48 subjects equally distributed between study groups. SNOT‐22 scores did not differ between the two groups at one and three months post‐FESS. These findings were not statistically significant (p=0.67, 95% confidence interval [CI]: ‐10.05, 15.47; p=0.63, 95% CI: ‐14.54, 8.96). The treatment group presented with greater reduction in mucosal edema between 1 and 3 months, although this was not statistically significant (3.29 vs. ‐0.26; p=0.40, 95% CI: ‐4.83, 11.93).Conclusions:Additional postoperative debridement within the first month following FESS did not provide a significant improvement in quality of life and mucosal edema. However, a clinically significant improvement in mucosal edema was observed with the additional debridement.
Long‐term Outcomes in Sinus Surgery Using New Tools for Measuring Health‐Related Quality of Life
Authors: Remenschneider Aaron K. , D'Amico Laura , Litvack Jamie , Holbrook Eric H. , Gray Stacey T. , Metson Ralph B. 
Published: August 2013

Objectives:Compare pre‐ and post‐operative outcomes at 3 and 12 months using both disease specific (SNOT‐22, Chronic Sinusitis Survey) and general health related quality of life (EQ‐5D) assessments. Describe baseline Health utility values (HUV) in patients with chronic rhinosinusitis, and calculate the impact of sinus surgery on the HUV at 3 and 12 months.Methods:From February 2011‐2013, prospective pre‐ and postoperative quality of life data were obtained from patients with chronic rhinosinusitis at Massachusetts Eye and Ear Infirmary. Data obtained pre‐operatively were compared to post‐operative results at 3 and 12 months.Results:480 patients enrolled in the study. Three and twelve month response rates have been 73% and 69%, respectively. Patient scores on the SNOT‐22 significantly improved from 48.4 +/‐ 22.0 preoperatively to 22.8 +/‐ 20.3 at 3 months, 95% confidence interval (CI) [22.5, 28.6], and 25.9 +/‐ 20.0 at 12 months, 95% CI [18.8, 26.3]. Patient scores on the CSS similarly fell at 3 and 12 months, with statistically and clinically significant improvement. Baseline health utility values in our population scored at 0.81 +/‐ 0.13, where 0 is a quality of life equal to death and 1 is perfect health. Health utility values improved to 0.89 +/‐0.12, 95% CI [‐0.10, ‐0.06], at 3 months and remained unchanged at 12 months.Conclusions:Long term disease specific and general health related quality of life are significantly improved after endoscopic sinus surgery. Defining changes in health utility values after sinus surgery represents an important first step in meaningful comparative quality of life research.
Optimal Endoscopic Management of Sinonasal Inverted Papilloma: Recurrence‐Free Experience with Twenty‐one Patients
Authors: Okhovat Saleh , Taghi Ali S. , Choudhury Natasha , Saleh Hesham , Kuchai Romana 
Published: August 2013

Objectives:1) Explore developments in endoscopic techniques and their application in the management of Sinonasal Inverted Papilloma (SNIP). 2) Describe 0% recurrence rates with aggressive endoscopic resection of complex SNIP.Methods:Retrospective single‐center patient cohort analysis of twenty‐one cases of SNIP treated by endoscopic resection at Charing Cross Hospital from December 2002 to September 2012. Pre‐operative assessment included tomography or magnetic resonance imaging and biopsies. The origin and extent of the tumor determined the surgical strategy, and a combination of antrostomy, ethmoidectomy, sphenoidotomy, and endoscopic medial maxillectomy (EMM) with the assistance of angled instrumentation were performed. Sub‐periosteal dissection followed by diamond burr drilling of the underlying bone were performed in all cases. All patients were followed up by regular endoscopic surveillance.Results:The study group consisted of 12 (57%) male and 9 (43%) female patients with a mean age of 59 years. Eleven patients (52%) had undergone previous surgery. Association with malignancy was seen in 2 patients (excluded from this study). All patients were treated by pure endoscopic means without adjunctive procedures. Completion surgery was performed on 1 patient with residual disease and histological atypia identified early after the operation. No recurrences were observed after a mean follow‐up of 25 months.Conclusions:Our experience is one of the largest single‐center recurrence‐free case series for SNIP treated by pure endoscopic resection. It further supports the efficacy and safety of this technique even in complex recurrent cases and advocates its use as the gold standard first line surgical strategy.
PET/CT Has Greater Diagnostic Utility in Patients with Sinonasal Malignancy
Authors: Nishtala Arvind , Mercier Gustavo , Grillone Gregory A. , Jalisi Scharukh , Truong Minh‐Tam , Subramaniam Rathan , Devaiah Anand K. 
Published: August 2013

Objectives:In sinonasal malignancy, the use of fused positron emission tomography/computed tomography (PET/CT) may help clinicians in decision making more than standard CT +/‐ magnetic resonance imaging (MRI).Methods:A retrospective review of sinonasal malignancy patients undergoing PET/CT imaging between 2005 and 2011 at our institution was performed. Eighteen patients met all inclusion criteria: PET/CT performed with treatment and follow‐up at our institution. Histology, staging, imaging data, imaging reports, treatments, follow‐up, and disease status were compiled. A 6‐variable scoring system (tumor involvement, regional disease detection, distant metastases detection, malignant determination, tumor avidity, change in treatment) to examine imaging utility was devised.Results:In 12 patients (67%), PET/CT was superior to CT/MRI, while the latter was superior in only 3 patients (16%). Neither modality was superior in 3 patients (16%). PET/CT was able to identify regional or distant disease in 8 patients (44%), while CT/MRI did not (0%). CT/MRI showed more potentially involved tissue than in PET/CT. In 8/18 patients (44%), PET/CT could better distinguish between malignant and non‐malignant tissue; 10/18 patients (56%) were equivocal. The use of PET/CT led to a documented change in the patient's treatment plan in 11/18 patients (61%), compared to 1/18 change for CT/MRI (5%). In looking at overall utility of PET/CT vs CT/MRI in the 6 variables, PET/CT scored significantly higher (Chi‐squared, P = 0.02).Conclusions:For sinonasal malignancies, PET/CT better identifies regional and distant involvement, and malignant from non‐malignant tissue. Compared to CT/MRI data, PET/CT has a greater impact on the treatment and management of patients.
SF‐12® for Head‐and‐Neck Keloid Patients: Preliminary Results towards Creating a Keloid‐Specific Scale
Authors: Pattisapu Prasanth , Guy William M. , Brissett Anthony E. 
Published: August 2013

Objectives:1) Compare SF‐12® scores by head and neck keloid patients to U.S. Norms. 2) Contrast SF‐12® scores with keloid symptomatology, including pain, burning, itching, and infection. 3) Discuss the use of keloid‐specific quality of life (QOL) instruments over global health‐related QOL instruments in further research on head and neck keloids.Methods:Patients presenting to a keloid clinic in a tertiary referral institution between April 2012 and February 2013 were administered the SF‐12® during their first three appointments. Mental health and physical health composite scores (MCS and PCS) were calculated from SF‐12® surveys and compared with U.S. general population norm SF‐36® scores using two‐sample t‐tests. Associations between SF‐12® scores and symptoms were evaluated using Spearman's Rho.Results:First, second, and third visits were completed by 24, 16, and 14 patients, respectively. Median age was 29.5 years (range 15‐56), and 17% (4) were male. Average initial‐visit MCS and PCS scores were 52.9 (±7.8) and 55.1 (±5.1). No significant difference was found between MCS scores and national norms (p=0.08), but PCS scores were significantly higher than the norm (p<0.0001). No association was found between MCS or PCS scores and any symptoms, but negative association between pain scores and MCS and PCS scores approached significance (p=0.076 and 0.057, respectively).Conclusions:The goal of disease‐specific QOL measures is to increase measurement range over global health‐related QOL instruments, while increasing specificity to a health problem. We believe our results demonstrate global QOL scales are inadequate for addressing QOL issues faced by keloid patients, highlighting the need for keloid‐specific scales.
The Role of Postoperative Systemic Corticosteroids when Using a Steroid‐Eluting Spacer following Sinus Surgery
Authors: Dautremont Jonathan , Mechor Brad , Rudmik Luke 
Published: August 2013

Objectives:1) Describe the current evidence for middle‐meatal steroid‐eluting spacers in patients with chronic rhinosinusitis (CRS) following endoscopic sinus surgery (ESS) 2) Evaluate the need for postoperative systemic corticosteroids in CRS patients with nasal polyposis when using a steroid‐eluting middle meatal spacer following ESS.Methods:CRS patients with nasal polyposis who failed medical therapy and elected ESS (n=36) were enrolled into this randomized, double‐blind, placebo controlled trial. Patients were randomized into either a treatment arm (postoperative prednisone 30 mg once daily for 7 days; n=18) or placebo arm (placebo pill once daily for 7 days =18). Therapeutic outcomes were evaluated at 1 week, 3 weeks, and 2 months postoperatively. Primary outcome was endoscopic grading using the Lund‐Kennedy scoring system. Secondary outcome included disease‐specific quality of life (QoL) using the SNOT‐22 survey.Results:Both study arms received significant improvement in endoscopic grading and disease‐specific QoL from baseline compared to the two‐month follow‐up (p0.119).Conclusions:Minimizing the use of systemic corticosteroids in patients with CRS may avoid unwanted adverse events. Results from this study suggest that when using a middle meatal steroid‐eluting spacer during ESS for patients with nasal polyposis, postoperative systemic corticosteroids may not significantly improve short‐term endoscopic and disease‐specific QoL.
Topical Triamcinolone Acetonide/Carboxymethylcellulose Foam for Acute Exacerbations of Chronic Rhinosinusitis/Nasal Polyposis
Authors: Chaudhry Ajaz L. , Chaaban Mohamad R. , Woodworth Bradford A. 
Published: August 2013

Objectives:Chronic rhinosinusitis with nasal polyposis (CRS/NP) is a medical disease that is managed more effectively after endoscopic sinus surgery (ESS). Despite topical steroid management, acute inflammatory exacerbations (AEs) are common and typically treated with oral prednisone with well documented side effects. The objective of the current study was to critically evaluate the topical application of triamcinolone acetonide (160mg) in carboxymethylcellulose foam (TA/CMC) for AEs of CRS/NP after ESS.Methods:CRS/NP patients managed with ESS by a single rhinologist over a 5 year period were included in the study. Data were reviewed regarding demographics, number of AEs, revision surgery, Sinonasal Outcomes Test‐22 scores (SNOT‐22), frequency of oral prednisone and/or TA/CMC, and notable side effects.Results:A total of 371 CRS/NP patients were managed with ESS (49.3 weeks follow‐up, range 2‐249). All patients were managed with topical saline irrigations BID containing budesonide (0.5mg) or mometasone (0.6mg). Revision surgery was required in 8 patients. During this time period, 130 patients (46 years, range 28‐48) developed 267 AEs. Prior to initiating use of TA/CMC in 2010, 66 AEs were treated with prednisone. Subsequently, 116 out of 201 AEs were managed with TM/CMC with a sequential decrease in prednisone use over the last 3 years (77%, 39%, and 32%). SNOT‐22 scores (n=33 within 3 weeks) decreased significantly following TA/CMC instillation (1.69+/‐0.86, pre vs. 1.23+/‐0.8, post; P < 0.01).Conclusions:Management of AEs of CRS/NP changed dramatically with the use of TA/CMC in the current evaluation. The treatment appears well tolerated and is a useful tool for CRS/NP AEs in postoperative patient.
Evaluation of Upper Airway in Obstructive Sleep Apnea: Synchronized Imaging and Acoustic Analyses
Authors: Huon Leh‐Kiong , Lo Men‐Tzung , Chang Yi‐Chung , Chen Yun‐Ji , Wang Pa‐Chun 
Published: August 2013

Objectives:Snore signals are produced by soft tissue vibration in the upper airway (UA). To date, there is no gold standard to localize UA narrowing sites in patients with obstructive sleep apnea syndrome (OSAS). In this study, we use a “vocal tract model” to investigate the association between snore acoustic characteristics and UA collapse. Dynamic magnetic resonance imaging (dMRI) was used to provide UA anatomy information.Methods:We report data from 44 polysomnography (PSG)‐confirmed snoring episodes. Dynamics of UA and acoustic manifestations of snore events during natural sleep were recorded with synchronized dMRI and fiber‐optic microphone recording. After the deletion of background dMRI noises, the spectrum envelope was reconstructed by applying a vocal tract model to characterize the snoring patterns. The temporal change of spectrum envelope was analyzed using Gabor transformation to correlate with UA dynamics.Results:The snore events were categorized into 28 none, 7 typical (velopharyngeal), and 9 mixed (velopharyngeal and hypopharyngeal) obstructions. The snore's dominant frequency of envelop spectrum can differentiate none from typical UA obstructions (82.3±16.4Hz vs 101.9±9.1 Hz, p<0.01); and can differentiate mixed from typical obstructions (131.9±19.8 Hz vs.101.9±9.1 Hz, p < 0.05)Conclusions:The dynamics of acoustic patterns derived from the envelope of Gabor spectrogram are unique and characteristics in different types of obstruction with the advantage of low‐cost and easy availability. Therefore, the dynamics of acoustic patterns warrants further investigation to identify the structural changes of the obstruction sites in OSAS patients.
The Impact of Nasal and Sinus Surgery on Obstructive Sleep Apnea
Authors: Friedman Michael , Pott Thomas R. , Cipta Stephanie 
Published: August 2013

Objectives:Evaluate the impact of combined endoscopic sinus surgery (ESS) and nasal surgery on the objective measurements of obstructive sleep apnea (OSA) by comparing polysomnography (PSG) data before and after combined ESS and nasal surgery. Design: Retrospective review of medical records.Methods:Fifty‐one OSA patients with chronic sinusitis were identified who underwent combined ESS and nasal surgery as well as pre‐ and postoperative PSG. Clinic charts were reviewed and data collected. Pre‐ and postoperative PSG data were compared to determine whether combined ESS and nasal surgery improved apnea‐hypopnea index (AHI) and oxygen saturation.Results:Postoperative AHI did not change significantly following combined ESS and nasal surgery (P > 0.05). Change in AHI ranged from an increase of 51 events/hr to a decrease of 52.1 events/hr. 43% of patients had an improvement or worsening in postoperative AHI within 5 events/hr, and 80% had a change in AHI within 20 events/hr. There was no significant correlation between preoperative AHI, body mass index (BMI) and change in AHI (p > 0.05). Combined ESS and nasal surgery did not cure any of the patients’ OSA.Conclusions:There does not appear to be a significant change in AHI following combined ESS and nasal surgery in patients with chronic sinusitis and OSA. Combined ESS and nasal surgery can lead to an improvement, worsening, or lack of change in AHI. This study showed that BMI and preoperative AHI cannot be used to determine whether combined ESS and nasal surgery will impact their sleep apnea.
A Simplified Approach to Microvascular Head and Neck Reconstruction: A 17‐Year Experience with 1416 Cases
Authors: Seth Rahul , Nabili Vishad , Blackwell Keith E. 
Published: August 2013

Objectives:Free flap failure is a dreaded complication that significantly affects both patient postoperative morbidity and surgeon anguish. This presentation aims to 1) familiarize the audience with a simplified and highly reliable approach to microvascular head and neck reconstruction; and 2) discuss the surgical principles and perioperative management fundamental to achieving flap success greater than 99%.Methods:Retrospective chart review performed at a tertiary care academic center. 1416 consecutive free flaps were performed for head and neck defect reconstruction between 1995 and 2012. Patient demographics, defect and free flap characteristics, and postoperative flap survival were examined.Results:Fibula, radial forearm, subscapular system, anterolateral thigh, and rectus abdominis flaps accounted for 99% of procedures performed. Since 2005, the anterolateral thigh flap largely replaced the rectus abdominis flap. The rate of successful free flap transfer was 99.5%, with only 8 flap failures. Increased risk of free flap failure was encountered in fibula flaps (8 out of 614, 1.8%) versus all others (0 out of 802, 0%), p<0.01. Flap failures occurred more frequently in women (7 out of 478, 1.5%) than in men (1 out of 938, 0.1%), p<0.01.Conclusions:A simplified approach to microvascular reconstruction of the head and neck facilitates success rates in excess of 99%. Surgical principles attentive to selecting reliable flap donor sites, large caliber recipient vessels, non‐redundant and kink‐free pedicle geometry, and use of simple perioperative care measures enable high success. These principles are paramount in reducing flap loss, associated patient morbidity, and microvascular surgeon burnout.
Usefulness of Sleep Endoscopy in Predicting Positional Obstructive Sleep Apnea
Authors: Victores Andrew J. , Hamblin John S. , Gilbert Janet , Takashima Masayoshi 
Published: August 2013

Objectives:1) Evaluate the ability of drug‐induced sleep endoscopy (DISE) to identify patients with positional obstructive sleep apnea (OSA) and 2) assess the effects of body position on the upper airway during sleep. Study Design. Prospective, controlled study. Setting. Academic tertiary care center.Methods:Twenty patients with OSA were enrolled. They were equally divided into two groups depending on presence of positional OSA on polysomnogram. Positional OSA was defined by non‐supine 50% reduction in apnea‐hypopnea index. Patients were placed in both lateral and supine sleep positions and DISE performed. Upper airway collapse was compared between the sleep positions and between the two groups.Results:Most patients (80%) demonstrated multilevel obstruction on DISE. All positional OSA patients demonstrated at least a partial improvement in collapse while in the lateral sleep position. Most of the reduction in collapse involved the tongue base and epiglottis (P <. 05). Sleep position did not alter the upper airway morphology of patients without positional OSA. Tongue base and epiglottic obstruction while supine was significantly greater in positional as compared to non‐positional OSA patients (P <. 05). Apnea‐hypopnea index and body mass index were not significantly different between the two groups.Conclusions:Sleep position changes the upper airway morphology of positional OSA patients on DISE. Hypopharyngeal collapse was the primary site that improved with change in position. DISE in multiple sleep positions should be considered as part of a minimally invasive approach to surgical therapy of OSA.