bluuebunny/crossref_metadata_2025_split huggingface dataset:
Septectomy and Septal Dermoplasty for the Treatment of Severe Transfusion-Dependent Epistaxis in Patients with Hereditary Hemorrhagic Telangiectasia and Septal Perforation
Authors: Lesnik Gregory T. , Ross Douglas A. , Henderson Katharine J. , Joe John K. , Leder Steven B. , White Robert I. 
Published: June 2007

Background Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant disorder characterized by abnormal angiogenesis with resultant telangiectasia formation in mucocutaneous tissues, visceral organs, and the central nervous system. The most common manifestation of HHT is epistaxis resulting from trauma to thin-walled telangiectasias. Many patients with HHT experience worsened epistaxis due to the presence of a septal perforation. Septal perforation in HHT patients results from aggressive noncartilage sparing treatments such as monopolar cauterization. Although the mainstay of treatment for patients with severe transfusion-dependent HHT remains to be septal dermoplasty (SD), patients with a septal perforation are less likely to have a successful outcome. In this small subset of patients, septectomy (ST) combined with SD is proposed to eliminate this variable to improve skin graft uptake and therefore outcome. This study reviews the indications, procedure, and outcome of nine patients with severe transfusion-dependent HHT and septal perforation who underwent the combined procedure of SD/ST. Methods Nine HHT patients with severe transfusion-dependent epistaxis and septal perforation underwent SD/ST at our institution over a 5-year period. Quality of life, including number of daily events of epistaxis, and transfusion requirements were determined before and after surgery. Technical aspects of the procedure as well as complications were reviewed. Results The combined procedure of SD/ST resulted in a long-lasting subjective improvement in quality of life for all patients. Similarly, transfusion requirements were reduced from 22.61 to 9.57 (p < 0.05). There were no complications or increased morbidity from the procedure. Conclusion Combined SD/ST is a safe and effective treatment for HHT patients with transfusion-dependent epistaxis and septal perforation.
Endoscopic Management of Sinus Disease with Frontal Lobe Displacement
Authors: Stumpe Matthew R. , Sindwani Raj , Chandra Rakesh K. 
Published: June 2007

Background Advanced inflammatory disease of the paranasal sinuses may result in erosion of the skull base with frontal lobe impingement. We present a series illustrating minimally invasive management of this process. Methods We review 15 consecutive cases of advanced sinus inflammatory disease with frontal lobe displacement. Clinical presentation, diagnostic evaluation, and treatment modalities are described. Results Patients ranged in age from 19 to 83 years, and 13/15 were men. Presenting symptoms in all patients included progressive headache (15/15), frontal pressure (15/15), orbital involvement and visual symptoms (6/15), and new-onset seizure (1/15). Implicated diagnoses included mucocele (7/15), classic allergic fungal sinusitis (3/15), and both (5/15). Initially, 14 patients were treated endoscopically, with image-guided navigation in 12 patients. Four patients underwent trephination for combined above/below marsupialization, and three patients also underwent orbital decompression. Two patients failed initial endoscopic management. One of these was salvaged endoscopically and the other required cranialization. Another patient was managed via cranialization in the primary setting. In all cases, mucosa was observed directly against dura. No cerebrospinal fluid leaks were encountered. One patient expired 1 month postoperatively secondary to congestive heart failure. Mean follow-up in the remaining 14 patients was 13.6 months. Follow-up imaging revealed reexpansion of the frontal lobe into the decompressed space. Conclusion Advanced sinus inflammatory disease associated with frontal lobe compression may have indolent presentation but significant morbidity. Minimally invasive techniques averted the need for craniotomy in 13/15 patients in this series.
Comparison of Open versus Endoscopic Resection of Inverted Papilloma
Authors: Sautter Nathan B. , Cannady Steven B. , Citardi Martin J. , Roh Hwan-Jung , Batra Pete S. 
Published: June 2007

Background Lateral rhinotomy with medial maxillectomy has served as the standard for surgical management of inverted papilloma (IP) in the pre–endoscopic era; since the late 1980s, endoscopic techniques have emerged as the minimally invasive alternative. The objective of this study was twofold: (1) to compare operative parameters, complications, and recurrence rates and (2) predictive factors for recurrence for open versus endoscopic cases of IP resection. Methods Retrospective data analysis was performed on 68 patients with histopathologically confirmed IP treated at a tertiary care medical center from January 1983 to May 2005. Parameters for comparison included operative time (OT), estimated blood loss (EBL), length of hospital stay (HS), complications, and recurrence rate. Predictive factors for recurrence including open versus endoscopic cases, primary versus secondary IP, and tumor by Krouse stage were analyzed. Results The average age at time of presentation was 57.4 years with a male/female ratio of 2.2:1. Forty-nine patients underwent endoscopic resection, 13 patients underwent open resection, and 6 patients underwent limited open resection. Average OT and EBL were statistically similar for the three groups, whereas the average HS was statistically shorter (p = 0.002) for the endoscopic group. Biopsy-proven recurrence was noted in 11 (22%) endoscopic cases, 5 (39%) open cases, and 3 (50%) limited open cases. After reresection, all patients were free of disease. Mean follow-up was 16 months, 56 months, and 69 months for the endoscopic, open, and limited open groups, respectively. Analysis of predictive factors indicated that the surgical approach and primary versus secondary IP, regardless of approach, did not statistically impact recurrence rate. Chi-square analysis illustrated that patients with advanced-stage IP had a higher risk of recurrence (p = 0.002), regardless of surgical technique. Conclusion In this series, endoscopic resection of IP was associated with shorter HS and equivalent EBL and OT compared with the open groups. The overall recurrence rate was lower in the endoscopic group with acceptable morbidity compared with the open and limited open groups. Thus, the endoscopic approach may serve as a superior alternative to the open approaches for successful extirpation of IP.
Telomerase in Nasal Polyps
Authors: Chen Yue-Shih , Westhofen Martin , Lorenzen Johann 
Published: June 2007

Background The aim of this study was to determine the presence and location of telomerase activities and the possible influence of elevated human telomerase reverse transcriptase (hTERT) mRNA levels on the outcome after surgical treatment in nasal polyposis. Methods Telomerase activity in nasal polyps of 21 patients was quantified by measuring the hTERT mRNA contents with one-step real-time polymerase chain reaction. Inferior turbinates of 12 patients served as controls. Immunohistochemistry with specific antibodies was performed against hTERT. The number of hTERT marked cells was determined in 15 randomly selected fields. All patients were followed up after surgery for 60 months. Results Elevated hTERT mRNA expression and number of hTERT+ cells was detected in nasal polyps in comparison with inferior turbinates (p < 0.001). hTERT+ cells were detected in the basal layer of the epithelia, the endothelia, and in some seromucous glands. During follow-up, it was discovered that tissue samples of five patients with recurrent polyposis did not have higher amounts of hTERT when compared with patients without relapse. Conclusion Telomerase activity is elevated in nasal polyps. Elevated hTERT expression does not predict the recurrence of nasal polyposis after surgical treatment.
The Incidence of Complications using New Landmarks and a Modified Technique of Canine Fossa Puncture
Authors: Singhal Deepti , Douglas Richard , Robinson Simon , Wormald Peter-John 
Published: June 2007

Background Canine fossa puncture (CFP) is a technique that improves access to the maxillary sinus and may be required to ensure complete disease removal from this sinus. Traditional approaches through the canine fossa often have resulted in injury to branches of the infraorbital nerve. The aim of this study was to determine the frequency, severity, and duration of complications using recently described landmarks for determining the optimal site for anatomically directed CFP (aCFP) and a new endoscopic retractor and drill guide that enable endoscopically guided canine fossa trephination (eCFT). These complication rates have been compared with those that we have described previously using a standard technique of CFP. Methods A total of 63 patients were included with 36 bilateral procedures giving a total number of 99 procedures performed. Of these, 32 procedures were performed using anatomic landmarks (aCFP) and 67 were performed with additional endoscopic guidance (eCFT). Patients were assessed at a mean time of 12.6 months (range, 3–26 months) after surgery by telephonic survey and their complications were assessed and graded for severity on a 0- to 10-point scale. Results The combined frequency of adverse events after aCFP and eCFT were 45% compared with the previously reported 76% with the traditional technique (p = 0.001). The number of patients complaining of persisting adverse effects was reduced from 29% after CFP to 5% after aCFP and eCFT (p < 0.001). The 67 eCFT technique had a significantly lower frequency of adverse events (40%) than the aCFP technique (53%; p < 0.05). Conclusion The recently described landmarks to site the CFP result in statistically fewer complications. This complication rate is further reduced if CFT is performed under direct endoscopic vision.
Assessment of Predictive Prognostic Factors for Functional Endoscopic Sinus Surgery in a 5-Year Prospective Outcome Study
Authors: Sil Arunesh , Mackay Ian , Rowe-Jones Julian 
Published: June 2007

Background Among numerous studies in the literature regarding prognostic factors that might determine outcome in functional endoscopic sinus surgery (FESS), very few have dealt with assessment of their predictive potential regarding outcome, and none have tried to find out the extent of such a prediction. We have developed a composite model to find out the predictive values of various prognostic factors, using an outcome measure based on the need for postoperative medical intervention. Methods One hundred nine patients were recruited for FESS and followed up at regular intervals for 5 years. Ten prognostic factors were identified and were correlated with prospectively recorded outcome measures. A discriminant analysis using SPSS software was performed to identify the prognostic factors that could “predict” the outcome. Results CT scan scores and polyp scores were the strongest predictors. Using our model, the probability to predict correctly the need for postoperative systemic medication was found to be 81.7%. Conclusion We have generated a model to predict the outcome of FESS, with a 5-year follow-up. CT scan scores and polyp scores were found to be the strongest predictors of the need for postoperative systemic medication.
Endoscopically Assisted Strabismus Surgery
Authors: Flanders Michael , Hwang Siew Yoong , Al-Ghamdi Saeed , Codère François , Desrosiers Martin 
Published: June 2007

Background Strabismus surgery involving open exploration of the posterior orbit is difficult. Exploration is sometimes avoided by considering alternative procedures (transposition and weakening other muscles). Although the use of endoscopic sinus surgery (ESS) to retrieve medial rectus (MR) muscles lost in the posterior orbit has been described, the use of an endoscopic approach to the posterior orbit in elective strabismus surgery has never been reported. Methods A patient with thyroid orbitopathy had severe bilateral restrictive strabismus with bilateral esohypotropia, rendering him functionally blind. The MR was inaccessible via the anterior approach. We describe a transnasal endoscopic approach to the posterior orbit where the MR was identified, sectioned, and reattached to the globe. We also describe two other patients who had endoscopic posterior orbit exploration after ESS-related MR injury. Results In patient 1, repositioning of the medial rectus muscles facilitated follow-up conventional strabismus surgery and dramatically improved ocular alignment. In patient 2, the medial rectus muscle was severely disrupted. A temporary traction suture was placed endoscapically. Follow-up transposition strabimus resulted in satisfactory alignment. In patient 3, endoscopic exploration and freeing of adhesions was done in anticipation of follow-up strabismus surgery. Conclusion These cases illustrate the expanding frontiers of ESS. The endoscopic approach to the posterior orbit allows enhanced posterior orbit access in elective strabismus surgery and posttraumatic exploration of the MR.
A Sheep Model for the Study of Biofilms in Rhinosinusitis
Authors: Ha Kien R. , Psaltis Alkis J. , Tan Lorwai , Wormald Peter-John 
Published: June 2007

Background Bacterial biofilms have been shown in chronic diseases such as cystic fibrosis, cholesteatoma, and otitis media with effusion. Recently, their detection on the mucosal tissue of sinusitis patients has implicated them in the pathogenesis of this condition. We present an animal model using sheep experimentally infected with Staphylococcus aureus to study the possible association between biofilm and sinusitis. Methods Twenty-four sheep underwent bilateral endoscopic sinus surgery to identify their frontal ostia. The frontal sinuses were treated in one of the following ways according to preoperative randomization: (1) ostium left patent, (2) ostium left patent and bacteria instilled, (3) ostium occluded, or (4) ostium occluded and bacteria instilled. The frontal mucosa was harvested at day 7 and examined for biofilm presence using confocal scanning laser microscopy (CSLM) as well as scanning electron microscopy (SEM) and transmission electron microscopy (TEM). Results All three modalities showed different rates of biofilm detection. Three-dimensional structures that could be interpreted as biofilms were documented in 86% (n = 36) of the sinuses analyzed using SEM. These structures were seen in all four study groups. The detection rate using the other two modalities was much lower with CSLM, showing biofilms in 48% (n = 20) and TEM in only 29% (n = 12) of the sinuses analyzed. Unlike SEM, these two modalities only detected bacterial biofilms in sinuses randomized to bacterial instillation. Conclusion The demonstration of bacterial biofilms in this animal model of sinusitis further supports the hypotheses that biofilms may play a role in the pathogenesis of this condition. There is an obvious discrepancy in the sensitivity and specificity of biofilm detection using the three modalities mentioned. CSLM appears to be the most objective technique. The inherent flaws, sampling error, and subjectivity involved in SEM and TEM make these less reliable in documenting biofilm existence.
The Role of the Otorhinolaryngologist in the Management of Central Skull Base Osteomyelitis
Authors: Cavel Oren , Fliss Dan M. , Segev Yoram , Zik Daniel , Khafif Avi , Landsberg Roee 
Published: June 2007

Background Skull base osteomyelitis (SBO) typically evolves as a complication of external otitis in diabetic patients and involves the temporal bone. Central SBO (CSBO) mainly involves the sphenoid or occipital bones without coexisting external otitis. We characterized a group of patients with CSBO. The endoscopic nasopharyngeal and clival biopsy technique is described. Methods Medical records of patients diagnosed as having SBO were retrospectively analyzed (from 2001 to 2006). Patients’ symptoms and signs, laboratory findings, imaging characteristics, endoscopic clival and periclival histopathology results, treatment, and outcome were retrieved. Results Of 20 patients with SBO, 6 patients without external otitis were studied (age range, 54–76 years; 5 men; mean follow-up, 21 months). All patients suffered from unilateral headache, three of six patients had serous otitis media (SOM), three of six patients had cranial nerve (CN) palsies, and five of six patients had elevated acute-phase reactants. Computed tomography (CT) findings were clival cortical bone erosion and adjacent soft tissue swelling. Magnetic resonance (MR) findings were texture changes and enhancement of the involved bones and soft tissues. Biopsy specimens revealed chronic inflammation. All six patients were treated with antibiotics for 3–6 months. Headache disappeared in five of six patients, SOM resolved in two of three patients, and CN palsies partially recovered in two of three patients. Imaging findings improved in five of six patients. Conclusion CSBO may mimic malignancy and represents a diagnostic challenge. Typical clinical picture and imaging findings together with a positive response to ciprofloxacin may suffice to establish the diagnosis and obviate the need for biopsies. When in doubt, nasopharyngeal and clival biopsies are performed to rule out malignancy.
A Comparison of Experimental Methods in Molecular Chronic Rhinosinusitis Research
Authors: Ramanathan Murugappan , Lane Andrew P. 
Published: June 2007

Background Research into the molecular pathogenesis of chronic rhinosinusitis (CRS) requires the collection and analysis of sinonasal tissue. Recent gene expression studies have used either surgical tissue specimens or isolated epithelial cell preparations. Here, we compare cultures of nasal epithelial cells, nasal brush biopsy, and whole ethmoid mucosa with respect to expression of innate immune genes. Methods Ethmoid mucosa was collected intraoperatively from 12 CRS and control patients. This tissue either was processed whole for mRNA extraction or was used to generate primary nasal epithelial cell cultures. After 6 weeks, epithelial cells in culture were assessed for multiple innate immune proteins by flow cytometry. In parallel, middle meatal brush biopsy specimens were obtained from the same patients and studied acutely in a similar fashion by flow cytometry. Expression of innate immune genes was determined in whole tissue samples by real-time polymerase chain reaction. Results Flow cytometry revealed that brush biopsy specimens contain 75% epithelial cells, whereas primary nasal epithelial cell cultures were pure. Epithelial cells derived from individual subjects expressed very similar levels of innate immune markers whether studied acutely or after 6 weeks in culture. Whole tissue mRNA levels were variable and not correlated to epithelial expression. Conclusion The choice of experimental methodology can greatly influence the results and interpretation of CRS research. Primary nasal epithelial cells maintain their innate immune receptor expression profile when grown in prolonged culture in vitro. These findings imply that alterations in innate immune gene expression in CRS may be intrinsic to the epithelial cells, even outside of their in vivo microenvironment.
Rehabilitation of Surgically Traumatized Paranasal Sinus Mucosa using Retinoic Acid
Authors: Leung Man-Kit , Hwang Peter H. 
Published: June 2007

Background Paranasal sinus mucosa that regenerates after surgical stripping is characterized by sparse, dysmorphic cilia. Although such dysfunctional mucosal changes are thought to be irreversible, the potential rehabilitation of deciliated mucosa by topical therapies has not been explored. This study evaluated the effect of topical retinoic acid (RA) in rehabilitating deciliated sinus mucosa that has regenerated after surgical stripping. Methods Twelve New Zealand rabbits underwent bilateral maxillary sinus mucosal stripping and were allowed to remucosalize for 10 days. In the first treatment arm (n = 6), 0.01% RA was applied to the regenerated mucosa of the left maxillary sinus and an aqueous control was placed contralaterally. In the second treatment arm, the regenerated mucosa was surgically restripped bilaterally before applying RA and control. After 14 additional days, mucosa was harvested and examined by scanning electron microscopy for ciliary density, orientation, and morphology. Results In the first treatment arm, no significant differences in ciliary density, orientation, or morphology were noted between RA-treated sinuses and controls. In the second arm, RA-treated sinuses showed improved ciliary density, morphology, and orientation compared with controls. Conclusion RA does not appear to significantly enhance ciliogenesis when applied after mucosal regeneration has occurred. However, if deciliated mucosa is restripped and allowed to regenerate in the presence of RA, ciliary ultrastructural features may be enhanced. RA may have therapeutic value in rehabilitating deciliated sinus mucosa when applied before mucociliary differentiation of regenerating mucosa.
The Impact of Septorhinoplasty and Anterior Turbinoplasty on Nasal Conditioning
Authors: Rozsasi Ajnacska , Leiacker Richard , Kühnemann Stephan , Lindemann Jörg , Kappe Thomas , Rettinger Gerhard , Keck Tilman 
Published: June 2007

Background Septorhinoplasty and turbinoplasty is a frequently performed operation in facial plastic surgery. The aim of this study was to investigate nasal conditioning after septorhinoplasty and inferior turbinoplasty in patients with internal and external nasal deformities and hypertrophy of the inferior turbinates and to determine its relation to nasal patency. Methods Ten patients and 10 volunteers as controls were enrolled into this study. Measurement of nasal conditioning and active anterior rhinomanometry were performed before and 4–6 months after functional-esthetic septorhinoplasty and inferior turbinoplasty. Results Nasal airflow was significantly higher postoperatively than preoperatively. The preoperative nasal temperature (TEMP) and heat increase (HI) was lower in the patients compared with the controls. The postoperative TEMP, HI, total water content, and water gradient were significantly higher than the preoperative values. Conclusion Based on this relatively small series, functional-esthetic septorhinoplasty in combination with inferior turbinoplasty may be associated with improved nasal conditioning.
The Expression of MUC5AC and MUC5B Mucin Genes in the Mucosa of Chronic Rhinosinusitis and Nasal Polyposis
Authors: Ding Guo Qiang , Zheng Chun Quan 
Published: June 2007

Background The aim of this study was to investigate the expression of MUC5AC and MUC5B messenger RNAs (mRNAs) and localization of these proteins in human sinus mucosa of chronic rhinosinusitis (CRS) and CRS with nasal polyposis (CRS/NP). Methods Maxillary sinus ostia mucosa was harvested from patients undergoing endoscopic sinus surgery for CRS, CRS/NP, and non-CRS pathologies (control). Then, sinus mucosa was analyzed using reverse-transcription polymerase chain reaction to detect mRNA of MUC5AC and MUC5B. Hematoxylin and eosin staining and immunofluorescent staining were used to localize MUC5AC and MUC5B proteins in the sinus mucosa. Results mRNAs of MUC5AC and MUC5B in the sinus mucosa of CRS and CRS/NP were significantly increased compared with that in normal sinus mucosa (p < 0.01), and no significant difference was found between the mucosa of CRS and that of CRS/NP (p > 0.05). MUC5AC protein was expressed mainly in the goblet cells, and MUC5B expression was located in the submucosal glands cells and the epithelia of sinus mucosa. ARPC in staining of MUC5AC and MUC5B were found no different between the CRS group and the CRS/NP group (p > 0.05), whereas they were significantly lower in the normal group compared with the other two groups, respectively (p < 0.05). Conclusion This study showed that MUC5AC and MUC5B mucin genes were up-regulated in sinus mucosa of CRS and CRS/NP. MUC5AC and MUC5B may play an important role in the pathogenesis of CRS and NP.