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Liang N, Qu J, Huang Q, Zhou B. Prelacrimal recess approach for maxillary sinus inverted papilloma: a 15-year experience from a single center. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08551-x. [PMID: 38526576 DOI: 10.1007/s00405-024-08551-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 02/12/2024] [Indexed: 03/26/2024]
Abstract
PURPOSE This large retrospective, single-center, follow-up study investigated the endoscopic prelacrimal recess approach (PLRA) for treating maxillary sinus inverted papilloma (MSIP). METHODS Between January 2007 and November 2022, patients with MSIP treated with PLRA were enrolled. Data on clinical manifestations, imaging, and surgical procedures were collected. The visual analog scale (VAS) scores for maxillofacial numbness and nasal symptoms and the SNOT-22 nasal symptom scores were statistically analyzed. RESULT Of 122 patients (68 males and 54 females) enrolled in the study, with a mean age of 50.75 ± 12.84 years (26-80 years), 111 patients underwent PLRA, nine underwent modified PLRA, one converted to an endoscopic medial maxillectomy (EMM), and one to an endoscopic modified Denker's approach. The average follow-up was 86.60 (13-192) months, the recurrence rate was 3.28%, and 29 patients (23.77%) complained of maxillofacial numbness one month postoperatively, which disappeared in most cases one year after surgery. Five patients (4.10%) experienced mild numbness at the end of the follow-up period. Maxillary sinus ostium contracture or atresia occurred in two cases (1.64%). After surgery, the VAS nasal symptom scores improved significantly (P < 0.001). SNOT-22 indicated that the most common postoperative symptom was thick nasal discharge. CONCLUSION PLRA is a flexible first-choice surgical treatment for maxillary sinus inverted papilloma and can be modified according to the extent of the lesion, the surgeon's experience and technique, and surgical instruments. That can help achieve complete resection and reduce recurrence and surgical complications. Upper teeth numbness, the most common postoperative complication, tends to disappear after 1 year.
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Affiliation(s)
- Na Liang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jing Qu
- Department of Otolaryngology, Beijing Huaxin Hospital, The First Affiliated Hospital of Tsinghua University, Beijing, China
| | - Qian Huang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Bing Zhou
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
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Li H, Cheng Y, Lu J, Zhang P, Ning Y, Xue L, Zhang Y, Wang J, Hao Y, Wang X. Extraction of high inverted mesiodentes via the labial, palatal and subperiostal intranasal approach:A clinical prospective study. J Craniomaxillofac Surg 2023; 51:433-440. [PMID: 37550118 DOI: 10.1016/j.jcms.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 03/04/2023] [Accepted: 04/30/2023] [Indexed: 08/09/2023] Open
Abstract
The aim of this study is to provide criteria for the choice of the surgical approach for extraction of high inverted mesiodens. The operation statistics, life quality of postoperative patients, and the operative injury/recovery were compared and analysed. The laser Doppler blood flowmetry, laser speckle contrast imaging, and electric pulp testing were explored to detect the postoperative pulp and gingiva blood supply of adjacent teeth. For the clinician's primary concerns, the surgical time, the volume of osteotomy, and the amount of bleeding in the labial approach group (The p values are 0.0001, <0.0001, and 0.0131, respectively.) and intranasal approach group (All p values were <0.0001.) were significantly less than that in the palatal approach group. However, from the patient's perspective, the postoperative swelling in the labial approach was far more than that in the intranasal approach group (p =0.0044), with unsurprisingly lower satisfaction (p <0.0001). There were no significant differences in pulp and gingival blood supply of adjacent teeth and jaw development. Trauma was manageable in all patients. Within the limitations of the study it seems that extraction of mesiodens by the intranasal approach achieves a delicate balance between reducing surgical trauma and optimizing postoperative recovery.
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Affiliation(s)
- Huifei Li
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan, 030001, China; Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, 030001, China
| | - Yongfeng Cheng
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan, 030001, China
| | - Jun Lu
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan, 030001, China
| | - Pengfei Zhang
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan, 030001, China
| | - Yi Ning
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan, 030001, China
| | - Lei Xue
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan, 030001, China
| | - Yuan Zhang
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan, 030001, China; Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, 030001, China
| | - Jie Wang
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan, 030001, China; Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, 030001, China
| | - Yujia Hao
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan, 030001, China; Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, 030001, China
| | - Xing Wang
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan, 030001, China; Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, 030001, China.
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Tzelnick S, Rampinelli V, Sahovaler A, Franz L, Chan HHL, Daly MJ, Irish JC. Skull-Base Surgery—A Narrative Review on Current Approaches and Future Developments in Surgical Navigation. J Clin Med 2023; 12:jcm12072706. [PMID: 37048788 PMCID: PMC10095207 DOI: 10.3390/jcm12072706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/10/2023] [Accepted: 03/29/2023] [Indexed: 04/07/2023] Open
Abstract
Surgical navigation technology combines patient imaging studies with intraoperative real-time data to improve surgical precision and patient outcomes. The navigation workflow can also include preoperative planning, which can reliably simulate the intended resection and reconstruction. The advantage of this approach in skull-base surgery is that it guides access into a complex three-dimensional area and orients tumors intraoperatively with regard to critical structures, such as the orbit, carotid artery and brain. This enhances a surgeon’s capabilities to preserve normal anatomy while resecting tumors with adequate margins. The aim of this narrative review is to outline the state of the art and the future directions of surgical navigation in the skull base, focusing on the advantages and pitfalls of this technique. We will also present our group experience in this field, within the frame of the current research trends.
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Affiliation(s)
- Sharon Tzelnick
- Division of Head and Neck Surgery, Princess Margaret Cancer Center, University of Toronto, Toronto, ON M5G 2M9, Canada
- Guided Therapeutics (GTx) Program, TECHNA Institute, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Vittorio Rampinelli
- Unit of Otorhinolaryngology—Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences and Public Health, University of Brescia, 25121 Brescia, Italy
- Technology for Health (PhD Program), Department of Information Engineering, University of Brescia, 25121 Brescia, Italy
| | - Axel Sahovaler
- Guided Therapeutics (GTx) Program, TECHNA Institute, University Health Network, Toronto, ON M5G 2C4, Canada
- Head & Neck Surgery Unit, University College London Hospitals, London NW1 2PG, UK
| | - Leonardo Franz
- Department of Neuroscience DNS, Otolaryngology Section, University of Padova, 35122 Padua, Italy
| | - Harley H. L. Chan
- Guided Therapeutics (GTx) Program, TECHNA Institute, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Michael J. Daly
- Guided Therapeutics (GTx) Program, TECHNA Institute, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Jonathan C. Irish
- Division of Head and Neck Surgery, Princess Margaret Cancer Center, University of Toronto, Toronto, ON M5G 2M9, Canada
- Guided Therapeutics (GTx) Program, TECHNA Institute, University Health Network, Toronto, ON M5G 2C4, Canada
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Samunahmetoglu E, Kurt MH. Assessment of Canalis Sinuosus located in maxillary anterior region by using cone beam computed tomography: a retrospective study. BMC Med Imaging 2023; 23:46. [PMID: 36978007 PMCID: PMC10045502 DOI: 10.1186/s12880-023-01000-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 03/15/2023] [Indexed: 03/30/2023] Open
Abstract
Background The aim of the study is to determine the distribution, location, diameter, and distance measurements of Canalis Sinusosus (CS) in relation with age and sex. Methods 300 Cone-Beam Computed Tomography (CBCT) images were evaluated. The distance between CS and nasal cavity floor (NCF), buccal cortical bone margin (BCM), alveolar ridge (AR), respectively.The presence of CS smaller than 1 mm, and the diameter of CS larger than 1 mm were determined. Accessory canals (AC) were classified according to their position relative to the teeth. Results 435 CS with a diameter of at least 1 mm and 142 CS < 1 mm were identified. The most frequently observed location of CS was the region of the right central incisors. The mean diameter of the canals ( CS ≥ 1) was 1.31 ± 0.19 on the right side and 1.29 ± 0.17 on the left side. No gender differences were found in canal diameter were observed (p > 0.05). There was no significant difference between men and women in the distance between CS and the NCF on the right side, and a significant difference was found in the distance of CS-NCF on the left side (p = 0.047). There were no significant differences between age groups in all parameters. Conclusion CBCT is a useful tool for identifying CS. Location and diameter of ACs could not be associated with a specific age group or sex.
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Affiliation(s)
- Ercin Samunahmetoglu
- grid.7256.60000000109409118Ankara University Faculty of Dentistry, Department of Dentomaxillofacial Radiology, Ankara University, Ankara, Turkey
| | - Mehmet Hakan Kurt
- grid.7256.60000000109409118Ankara University Faculty of Dentistry, Department of Dentomaxillofacial Radiology, Ankara University, Ankara, Turkey
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Serioli S, Agosti E, Buffoli B, Raffetti E, Alexander AY, Salgado-López L, Hirtler L, Rezzani R, Maroldi R, Draghi R, Borghesi I, Calbucci F, Peris-Celda M, Fontanella MM, Doglietto F. Microsurgical transcranial approaches to the posterior surface of petrosal portion of the temporal bone: quantitative analysis of surgical volumes and exposed areas. Neurosurg Rev 2023; 46:48. [PMID: 36745228 DOI: 10.1007/s10143-023-01956-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 01/12/2023] [Accepted: 01/24/2023] [Indexed: 02/07/2023]
Abstract
Different microsurgical transcranial approaches (MTAs) have been described to expose the posterior surface of the petrous bone (PPB). A quantitative, anatomical comparison of the most used MTAs, for specific areas of the PPB, is not available. Anatomical dissections were performed on five formalin-fixed, latex-injected cadaver heads (10 sides). Six MTAs were analyzed: Kawase approach (KWA), retrosigmoid approach (RSA), retrosigmoid approach with suprameatal extension (RSAS), retrolabyrinthine approach (RLA), translabyrinthine approach (TLA), and transcochlear approach (TCA). Surgical volumes and exposed areas of each approach were quantified with a dedicated neuronavigation system (ApproachViewer, part of GTx-Eyes II, University Health Network, Toronto, Canada) and adjuvant software (ITK-SNAP and Autodesk Meshmixer 3.5). Areas and volumes were compared using linear mixed models. TCA provided the best exposure of Trautmann's triangle and the retromeatal, suprameatal, meatal, and premeatal regions. RSAs provided the best exposure of the inframeatal region, with RSAS gaining significant exposure of the suprameatal region. KWA had the highest surgical volume, and RLA the lowest. Transpetrosal approaches offer the widest exposure of PPB proportionally to their invasiveness. Retrosigmoid approaches, which get to the studied region through a postero-lateral path, are paramount for the exposure of the inframeatal and suprameatal region and, given the adequate exposure of the remaining PPB, represent an effective approach for the cerebellopontine angle (CPA). These anatomical findings must be considered with approach-related morbidity and the pathological features in order to choose the most appropriate approach in clinical practice.
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Affiliation(s)
- Simona Serioli
- Division of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Piazza Spedali Civili 1, Spedali Civili of Brescia, 25123, Brescia, Italy
- Unit of Neurosurgery, GVM Care&Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Edoardo Agosti
- Division of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Piazza Spedali Civili 1, Spedali Civili of Brescia, 25123, Brescia, Italy.
| | - Barbara Buffoli
- Section of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Elena Raffetti
- Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden
| | | | | | - Lena Hirtler
- Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Rita Rezzani
- Section of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Roberto Maroldi
- Division of Radiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Riccardo Draghi
- Unit of Neurosurgery, GVM Care&Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Ignazio Borghesi
- Unit of Neurosurgery, GVM Care&Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Fabio Calbucci
- Unit of Neurosurgery, GVM Care&Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | | | - Marco Maria Fontanella
- Division of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Piazza Spedali Civili 1, Spedali Civili of Brescia, 25123, Brescia, Italy
| | - Francesco Doglietto
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Catholic University School of Medicine, Rome, Italy
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Yeap CW, Danh D, Chan J, Parashos P. Examination of Canalis Sinuosus using Cone Beam Computed Tomography in an Australian Population. Aust Dent J 2022; 67:249-261. [PMID: 35285958 DOI: 10.1111/adj.12910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 02/22/2022] [Accepted: 03/09/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Canalis sinuosus (CS) and its relationship with adjacent teeth is relevant for surgery in the anterior maxilla. Therefore, the aim of this study was to report the prevalence, characteristics, and variations of CS. METHODS Cone beam computed tomography (CBCT) scans of the anterior maxilla of 201 patients were reviewed. CS and the adjacent teeth were analysed by age, sex, and scan resolution, using analysis of variance, chi-squared and Fisher's exact tests. The widest and narrowest diameters of CS, and distance to tooth apex (DTA), were compared by quadrant, closest tooth, and location, and the associations were examined statistically with P < 0.05. RESULTS In the 201 scans, 412 CS were identified in 198 patients associated with 395 different teeth. Mean widest diameter was 1.08 ± 0.39 mm (range: 0.42-2.60 mm), while the narrowest diameter was 0.71 ± 0.26 mm (range: 0.25-1.59 mm), and mean DTA of 2.16 ±1.25 mm (range: 0-6.22 mm). CS detection was significantly lower with CBCT taken at resolution size of 0.250 voxels (P = 0.02). CONCLUSIONS CS was very common in the anterior maxilla. Clinicians would be well advised to identify this anatomical structure using CBCT before undertaking any surgery in the anterior maxilla. © 2022 Australian Dental Association.
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Affiliation(s)
- Chee Wei Yeap
- Melbourne Dental School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Victoria, Australia
| | - Dara Danh
- Clayray Dental Radiology, 24 Collins St, Melbourne Victoria, Australia; and Melbourne Dental X-ray, 723 Swanston St, Carlton, Victoria, Australia
| | - Julius Chan
- Clayray Dental Radiology, 24 Collins St, Melbourne Victoria, Australia; and Melbourne Dental X-ray, 723 Swanston St, Carlton, Victoria, Australia
| | - Peter Parashos
- Melbourne Dental School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Victoria, Australia
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Machado A, Briner HR, Schuknecht B, Simmen D. Assessment of the anterior superior alveolar nerve and its impact on surgery of the lateral nasal wall. Rhinology 2021; 59:475-480. [PMID: 34428266 DOI: 10.4193/rhin21.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The anterior superior alveolar nerve (ASAN) plays a major role in innervation of the lateral nasal wall. Its damage during nasal surgery can cause dental paraesthesia and numbness around the upper lip. METHODOLOGY Retrospective evaluation of the computed tomographic (CT) scans of 50 consecutive patients analysing 100 sides. We measured the mean distance from the shoulder of the inferior turbinate to the descending portion of the anterior superior alveolar nerve, to the anterior superior alveolar canal and the anterior-posterior distance between the 'shoulder' of the inferior turbinate and the pyriform aperture. RESULTS The mean distance from the shoulder of the inferior turbinate to the descending portion of the anterior superior alveolar nerve was 6.4 ± 2.33 mm, with no difference between sides The mean relative height of the shoulder in relation to the anterior superior alveolar nerve canal was 4.78 ± 2.31mm with no significant difference between the two sides. The anterior-posterior distance between the 'shoulder' of inferior turbinate and the pyriform aperture was 6.96± 2.28mm, with no significant difference between the two sides. CONCLUSIONS We found the anterior superior alveolar nerve to be a constant landmark in the lateral nasal wall. Therefore, the course of the ASAN should be assessed on a CT scan when a surgical approach through the pyriform aperture or anterior medial wall of the maxillary sinus is planned.
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Affiliation(s)
- A Machado
- Department of Otolaryngology, Centro Hospitalar Universitario do Porto, Porto, Portugal; Faculdade de Ciencias da Saude, Universidade da Beira Interior, Covilha, Portugal
| | - H R Briner
- ORL-Zentrum - Otorhinolaryngology and Facial Plastic Surgery, Hirslanden Klinik, Zurich, Switzerland
| | - B Schuknecht
- Medizinisch Radiologisches Institut, Zurich, Switzerland
| | - D Simmen
- ORL-Zentrum - Otorhinolaryngology and Facial Plastic Surgery, Hirslanden Klinik, Zurich, Switzerland
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Arosio AD, Valentini M, Canevari FR, Volpi L, Karligkiotis A, Terzakis D, Battaglia P, Georgalas C, Bignami M, Castelnuovo P, Turri-Zanoni M. Endoscopic Endonasal Prelacrimal Approach: Radiological Considerations, Morbidity, and Outcomes. Laryngoscope 2021; 131:1715-1721. [PMID: 33336816 DOI: 10.1002/lary.29330] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/01/2020] [Accepted: 12/06/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE/HYPOTHESIS This study describes a multicentric experience with the use of prelacrimal approach (PLA), focusing on preoperative radiological parameters potentially associated with surgical outcomes and postoperative morbidity. STUDY DESIGN Retrospective case-series. METHODS A retrospective review of patients undergoing PLA in three European referral centers was performed. The post-operative morbidity was analyzed in relation to two radiological parameters: width of prelacrimal recess (WPR) and internal angle of pyriform notch (APN). RESULTS The study included 28 patients affected by Schneiderian papilloma (20 cases), inflammatory disease (6 cases), schwannoma (1 case), and osteoma (1 case). The most reported sequela was paresthesia of ipsilateral anterior superior alveolar process (25% of the cases). An association between post-operative morbidity and APN was observed (P = .047). CONCLUSIONS Preoperative radiological evaluation of WPR is crucial in understanding the feasibility of the approach, while APN measurement may predict postoperative morbidity, which is paramount in the patients' counseling. LEVEL OF EVIDENCE 4 case-series Laryngoscope, 131:1715-1721, 2021.
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Affiliation(s)
- Alberto Daniele Arosio
- Department of Otorhinolaryngology Head and Neck Surgery, University of Insubria, Varese, Italy
| | - Marco Valentini
- Department of Otorhinolaryngology Head and Neck Surgery, University of Insubria, Varese, Italy
| | - Frank Rikki Canevari
- Department of Otorhinolaryngology Head and Neck Surgery, University of Genova, Genova, Italy
| | - Luca Volpi
- Department of Otorhinolaryngology Head and Neck Surgery, University of Insubria, Varese, Italy
| | - Apostolos Karligkiotis
- Department of Otorhinolaryngology Head and Neck Surgery, University of Insubria, Varese, Italy
| | - Dimitris Terzakis
- Endoscopic Skull Base Centre Athens, Hygeia Hospital, Athens, Greece
| | - Paolo Battaglia
- Department of Otorhinolaryngology Head and Neck Surgery, University of Insubria, Varese, Italy
- Head and Neck Surgery and Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Christos Georgalas
- Endoscopic Skull Base Centre Athens, Hygeia Hospital, Athens, Greece
- Department of Otolaryngology Head and Neck Surgery, University of Nicosia, Nicosia, Cyprus
| | - Maurizio Bignami
- Department of Otorhinolaryngology Head and Neck Surgery, University of Insubria, Varese, Italy
- Head and Neck Surgery and Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
- Department of Otolaryngology Head and Neck Surgery, University of Insubria, Como, Italy
| | - Paolo Castelnuovo
- Department of Otorhinolaryngology Head and Neck Surgery, University of Insubria, Varese, Italy
- Head and Neck Surgery and Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Mario Turri-Zanoni
- Department of Otorhinolaryngology Head and Neck Surgery, University of Insubria, Varese, Italy
- Head and Neck Surgery and Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
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Endoscopic Subtemporal Epidural Key-Hole Approach: Quantitative Anatomic Analysis of Three Surgical Corridors. World Neurosurg 2021; 152:e128-e137. [PMID: 34033959 DOI: 10.1016/j.wneu.2021.05.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/14/2021] [Accepted: 05/14/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND The endoscope-assisted subtemporal key-hole epidural approach (ESKEA) has been recently described. The aim of this study was to measure working volumes and exposure of key areas of the middle cranial fossa provided by this approach. METHODS Four fresh frozen cadaver heads were dissected to analyze 3 modular corridors (1A, 1B, and 2) harvested through ESKEA. A step-by-step dissection was performed, and key anatomic landmarks were recorded. A GTxEyesII-ApproachViewer was used to quantify the working volume and exposure of 4 different regions (sphenoorbital, parasellar, superior petrous apex, and squamopetrous). For each corridor, 3 incremental degrees of temporal dural retraction (5, 10, and 15 mm) were tested. RESULTS The working volume of all corridors progressively increased with degree of retraction: Corridors 1A, 1B, and 2 showed a gain in working volume of 21%, 27%, and 19% from 5 mm to 10 mm retraction, respectively, and a gain of 40%, 45%, and 44% from 5 mm to 15 mm retraction, respectively. The sphenoorbital area was exposed (27%-45%) through corridor 1A, and exposure significantly increased with the degree of retraction. Corridor 1B provided optimal exposure of parasellar areas (86%-100%) and superior petrous apex (70%-87%) regardless of the degree of retraction. The squamopetrous area was satisfactorily addressed through corridor 2 (88%) only with the highest degree of retraction. CONCLUSIONS ESKEA can be conceived as a modular approach: the 3 surgical corridors have specific working volumes, which are clearly influenced by the degree of temporal lobe retraction, and provide exposure of different middle cranial fossa areas.
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Hajem H, Botter C, Al Omani M, Sounthakith V, de Bressieux E, Benkhatar H. Pyriform Aperture Enlargement for Internal Nasal Valve Obstruction in Adults: Systematic Review and Surgical Classification. Otolaryngol Head Neck Surg 2021; 165:745-750. [PMID: 33648407 DOI: 10.1177/0194599821994739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Pyriform aperture enlargement or "pyriplasty" is an uncommonly used procedure for internal nasal valve obstruction in adults besides functional rhinoplasty, inferior turbinate reduction, and septoplasty. A systematic review of the literature was performed to analyze current surgical techniques, their suggested indications, and their related outcome in terms of success and complications. DATA SOURCES The search was performed on PubMed, EMBASE, SCOPUS, and Cochrane databases. REVIEW METHODS The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies on congenital, traumatic, tumoral, or infectious internal nasal valve obstruction were excluded. RESULTS Eight articles were finally included. Three types of pyriplasty have been described according to the level of bone resection: low-level pyriplasty through the sublabial approach, mid-level pyriplasty through endonasal approach, and extended pyriplasty through either approach. Indications included (1) clinically or radiologically narrow pyriform aperture, (2) previously unsuccessful internal nasal valve surgery, (3) lateral nasal wall collapse, and (4) inferior turbinate's head hypertrophy. Subjective improvement of nasal obstruction was reported in these 4 indications. No major complication was encountered. CONCLUSION Pyriplasty for nasal obstruction is a simple and safe procedure that could be effective in selected cases. However, level of evidence is currently low, and success rate may vary with indications and pyriplasty techniques. Moreover, there is no clear definition of normal pyriform aperture dimensions to date. Further prospective studies are thereby necessary and should include radiological analysis of pyriform aperture and validated nasal obstruction measurement tools.
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Affiliation(s)
- Humoud Hajem
- Centre Hospitalier de Versailles, Service d'ORL et chirurgie cervico-faciale, Le Chesnay, France
| | - Charles Botter
- Centre Hospitalier de Versailles, Service d'ORL et chirurgie cervico-faciale, Le Chesnay, France
| | - Mohammad Al Omani
- Centre Hospitalier de Versailles, Service d'ORL et chirurgie cervico-faciale, Le Chesnay, France
| | - Vincent Sounthakith
- Centre Hospitalier de Versailles, Service de Stomatologie et Chirurgie maxillo-faciale, Le Chesnay, France
| | - Eléonore de Bressieux
- Centre Hospitalier de Versailles, Service d'ORL et chirurgie cervico-faciale, Le Chesnay, France
| | - Hakim Benkhatar
- Centre Hospitalier de Versailles, Service d'ORL et chirurgie cervico-faciale, Le Chesnay, France
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Abstract
BACKGROUND Improved understanding of the microanatomy of the paranasal sinuses, including its individual variations, makes a substantial contribution to current progress in endonasal endoscopic microsurgery. Microanatomy of the sinuses is an active field of present scientific investitations. MATERIALS AND METHODS A comprehensive review on microanatomy of the maxillary sinus is presented from the perspective of contemporary endonasal endoscopic microsurgery. RESULTS The range of variation of the individual microanatomy of all sections of the maxillary sinus is presented, in particular to minimize secondary sugical tissue trauma, to avoid complications (e.g. on orbital tissues) and as a basis for the prelacrimal access to the maxillary sinus. CONCLUSION Improved understanding of the range of microanatomical variations reduced the burden on the patient while opimizing the effectiveness of the necessary surgical manipulations.
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Affiliation(s)
- W Hosemann
- Klinik für Hals-Nasen-Ohrenkrankheiten, Kopf- und Hals-Chirurgie, Universitätsmedizin Greifswald, Sauerbruchstraße, 17475, Greifswald, Deutschland.
| | - A Grimm
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Semmelweis Universität, Budapest, Ungarn.,Anatomisches, Histologisches und Embryologisches Institut, Semmelweis Universität, Budapest, Ungarn
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12
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[The maxillary sinus via a prelacrimal approach as a gateway to the retromaxillary space and orbital floor]. HNO 2020; 68:590-597. [PMID: 32405679 DOI: 10.1007/s00106-020-00867-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Endonasal surgery has emerged as the standard procedure for the majority of nasal and paranasal sinus pathologies. However, some pathological changes beyond the maxillary sinus seem to be out of the instrumental range and are addressed by open approaches. The prelacrimal approach to the maxillary sinus published by Zhou and coworkers has stimulated a rapid development of various procedures in this field. In the current work, the possibilities of the prelacrimal approach are illustrated by means of three clinical cases. The prelacrimal approach enables isolated fractures of the orbital floor to be reconstructed without the risk of lower eyelid complications. Meningo- or encephaloceles in the far lateral aspects of the sphenoid sinus are comparatively well reached via endonasal, transantral, and transpterygoid approaches. Until recently, tumors beyond the maxillary sinus were the domain of open surgery, particularly when they extended laterally of the maxillary sinus. The technique of choice was either a Caldwell-Luc or a midfacial degloving approach. Many of these operations can now be performed via the endonasal prelacrimal approach, with lower morbidity and more rapid postoperative healing. The approach described herein is equal if not superior to the traditional approaches in terms of overview and accessibility.
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13
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Nakayama T, Tsunemi Y, Kuboki A, Asaka D, Okushi T, Tsukidate T, Otori N, Kojima H, Haruna SI. Prelacrimal approach vs conventional surgery for inverted papilloma in the maxillary sinus. Head Neck 2020; 42:3218-3225. [PMID: 32639072 DOI: 10.1002/hed.26376] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 02/08/2020] [Accepted: 06/23/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The prelacrimal approach, termed endoscopic modified medial maxillectomy (EMMM), has recently been applied for treatment of inverted papilloma (IP) in the maxillary sinus. EMMM provides wider access to the maxillary sinus while preserving the inferior turbinate and nasolacrimal duct. METHODS We reviewed patients with IP in the maxillary sinus to compare the surgical results obtained by conventional surgery (ie, endoscopic maxillary sinus antrostomy or in combination with the Caldwell-Luc approach) with those obtained by EMMM. RESULTS All patients had a T3 on the Krouse staging system, and the average follow-up time was 46.0 months. Of the 18 patients in the conventional group, recurrence was seen in 3 patients (16.6%). No recurrence was seen in the 27 patients who showed preservation of the inferior turbinate and nasolacrimal duct, and no complications occurred in the EMMM group. CONCLUSIONS EMMM is an effective surgical approach that reduces recurrence with fewer complications.
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Affiliation(s)
- Tsuguhisa Nakayama
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan.,Department of Otorhinolaryngology-Head and Neck Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Yasuhiro Tsunemi
- Department of Otorhinolaryngology-Head and Neck Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Akihito Kuboki
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan.,Department of Otorhinolaryngology-Head and Neck Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Daiya Asaka
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan
| | - Tetsushi Okushi
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan
| | - Toshiharu Tsukidate
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan.,Department of Otorhinolaryngology-Head and Neck Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Nobuyoshi Otori
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan
| | - Hiromi Kojima
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan
| | - Shin-Ichi Haruna
- Department of Otorhinolaryngology-Head and Neck Surgery, Dokkyo Medical University, Tochigi, Japan
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14
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Ferrari M, Schreiber A, Mattavelli D, Rampinelli V, Bertazzoni G, Tomasoni M, Gualtieri T, Nicolai P. How aggressive should resection of inverted papilloma be? Refinement of surgical planning based on the 25-year experience of a single tertiary center. Int Forum Allergy Rhinol 2020; 10:619-628. [PMID: 32108441 DOI: 10.1002/alr.22541] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 01/01/2020] [Accepted: 02/01/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND The technique for transnasal endoscopic resection of inverted papilloma (IP) has evolved considerably during the last 20 years. The aim of the present study is to retrospectively analyze a single tertiary center series, with special emphasis on assessing the value of an "insertion-driven" technique on local control. METHODS Patients undergoing endoscopic resection for IP at the University of Brescia during the period 1991 to 2015 were enrolled. Site of origin and extension of IPs were assessed, together with presence of dysplasia and carcinoma in situ. Patients were divided in 3 cohorts: (1) historical cohort (treated before 2008), (2) contemporary "centripetal" cohort (treated with a traditional technique after 2008), and (3) contemporary "insertion-driven" cohort (treated with insertion-driven resection). Groups were compared considering outcomes and complications. RESULTS The series included 210 patients. Mean follow-up was 77.8 months. Thirty-eight (18.1%) patients showed precancerous changes. Maxillary involvement (p = 0.021) and presence of precancerous changes (p = 0.013) were significantly associated with a higher risk of recurrence. Five-year local control rate before and after 2008 was 95.1% and 90.5%, respectively. The insertion-driven cohort was associated with lower disease control when IPs involved the maxillary sinus. The rate of complications was 11.9%. The insertion-driven cohort was associated with a lower rate of major complications (p = 0.098). CONCLUSION Preoperative evidence of precancerous changes and/or involvement of maxillary sinus should prompt the surgeon to address the disease more aggressively (centripetal resection). Preoperative imaging and biopsy with abundant material may optimize the chance to stratify patients eligible for less or more conservative approaches.
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Affiliation(s)
- Marco Ferrari
- Unit of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Brescia, Italy.,Department of Neurosciences, Section of Otorhinolaryngology-Head and Neck Surgery, University of Padua, Padua, Italy
| | - Alberto Schreiber
- Unit of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Davide Mattavelli
- Unit of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Vittorio Rampinelli
- Unit of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Giacomo Bertazzoni
- Unit of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Michele Tomasoni
- Unit of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Tommaso Gualtieri
- Unit of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Piero Nicolai
- Department of Neurosciences, Section of Otorhinolaryngology-Head and Neck Surgery, University of Padua, Padua, Italy
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15
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Saraceno G, Agosti E, Qiu J, Buffoli B, Ferrari M, Raffetti E, Belotti F, Ravanelli M, Mattavelli D, Schreiber A, Hirtler L, Rodella LF, Maroldi R, Nicolai P, Gentili F, Kucharczyk W, Fontanella MM, Doglietto F. Quantitative Anatomical Comparison of Anterior, Anterolateral and Lateral, Microsurgical and Endoscopic Approaches to the Middle Cranial Fossa. World Neurosurg 2019; 134:e682-e730. [PMID: 31731015 DOI: 10.1016/j.wneu.2019.10.178] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 10/27/2019] [Accepted: 10/28/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To quantitatively compare different microsurgical and endoscopic approaches to the middle cranial fossa in a preclinical setting with a novel, computer-based research method. METHODS Different approaches were performed bilaterally in 5 head and neck specimens that underwent high-resolution computed tomography scans: 5 transcranial anterolateral (supraorbital, mini-pterional, pterional, pterional-transzygomatic, fronto-temporal-orbito-zygomatic) without and with anterior clinoidectomy; 2 transcranial lateral (subtemporal and subtemporal-transzygomatic); 2 endoscopic transnasal (transpterygoid, transpterygoid to infratemporal fossa); 2 endoscopic transorbital (superior eyelid and inferolateral), and endoscopic transmaxillary. A dedicated navigation system was used to quantify surgical working volumes and exposure of different areas of the middle cranial fossa (ApproachViewer, part of GTx-Eyes II, University Health Network, Toronto, Canada). Statistical analysis was performed using a mixed linear model with bootstrap resampling. RESULTS Endoscopic transnasal and fronto-temporal-orbito-zygomatic approaches with anterior clinoidectomy showed the largest surgical volumes. Endoscopic approaches allowed a wider exposure of medial anatomical surfaces (e.g., the petrous apex) compared with transcranial ones. Transcranial approaches with larger craniotomies allowed the widest exposure of superomedial anatomical structures (e.g., roof of cavernous sinus). The resection of the zygomatic arch allowed exposure of more medial surfaces with an inferior to superior trajectory. CONCLUSIONS This study implemented a novel neuronavigation-based research method to quantitatively compare different approaches to the middle cranial fossa; its results might guide, after consideration of clinical implications, the choice of the neurosurgical approach to different areas of this complex skull base region.
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Affiliation(s)
- Giorgio Saraceno
- Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Edoardo Agosti
- Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Jimmy Qiu
- TECHNA Institute, University Health Network, Toronto, Ontario, Canada
| | - Barbara Buffoli
- Section of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Marco Ferrari
- Otorhinolaryngology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Elena Raffetti
- Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden
| | - Francesco Belotti
- Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Marco Ravanelli
- Radiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Davide Mattavelli
- Otorhinolaryngology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Alberto Schreiber
- Otorhinolaryngology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Lena Hirtler
- Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Luigi F Rodella
- Section of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Roberto Maroldi
- Radiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Piero Nicolai
- Otorhinolaryngology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Fred Gentili
- Department of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Walter Kucharczyk
- Division of Neuroradiology, Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
| | - Marco M Fontanella
- Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Francesco Doglietto
- Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
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16
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Direct approach to the anterior and lateral part of the maxillary sinus with an endoscope. Auris Nasus Larynx 2019; 46:871-875. [PMID: 30955919 DOI: 10.1016/j.anl.2019.03.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 01/09/2019] [Accepted: 03/08/2019] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The Caldwell-Luc (CL) approach with a sublabial incision is used to manipulate the anterior wall of the maxillary sinus. Paresthesia is one of the major complications associated with the CL approach. We developed a new method, "direct approach to the anterior and lateral part of the maxillary sinus with an endoscope" (DALMA), that negates the need for a sublabial incision and minimizes dental paresthesia by reducing the risk of anterior superior alveolar nerve injury. This study aimed to describe how to perform the DALMA technique, and to review its effectiveness and associated complications. METHODS We retrospectively reviewed 10 patients who had received DALMA. RESULTS Ten patients underwent DALMA. The anterior superior alveolar nerve was identified in all patients. Access to the lateral side beyond the infraorbital canal and anterior wall of the maxillary sinus was achieved. CONCLUSIONS DALMA is a simple, effective, and minimally invasive technique that can be used as an alternative to CL with sublabial incision.
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18
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Ferrari M, Schreiber A, Mattavelli D, Lombardi D, Rampinelli V, Doglietto F, Rodella LF, Nicolai P. Surgical anatomy of the parapharyngeal space: Multiperspective, quantification-based study. Head Neck 2018; 41:642-656. [DOI: 10.1002/hed.25378] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 04/09/2018] [Accepted: 05/28/2018] [Indexed: 12/16/2022] Open
Affiliation(s)
- Marco Ferrari
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health; University of Brescia; Brescia Italy
| | - Alberto Schreiber
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health; University of Brescia; Brescia Italy
| | - Davide Mattavelli
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health; University of Brescia; Brescia Italy
| | - Davide Lombardi
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health; University of Brescia; Brescia Italy
| | - Vittorio Rampinelli
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health; University of Brescia; Brescia Italy
| | - Francesco Doglietto
- Unit of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health; University of Brescia; Brescia Italy
| | - Luigi Fabrizio Rodella
- Section of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences; University of Brescia; Brescia Italy
| | - Piero Nicolai
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health; University of Brescia; Brescia Italy
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19
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Doglietto F, Ferrari M, Mattavelli D, Belotti F, Rampinelli V, Kheshaifati H, Lancini D, Schreiber A, Sorrentino T, Ravanelli M, Buffoli B, Hirtler L, Maroldi R, Nicolai P, Rodella LF, Fontanella MM. Transnasal Endoscopic and Lateral Approaches to the Clivus: A Quantitative Anatomic Study. World Neurosurg 2018; 113:e659-e671. [PMID: 29499424 DOI: 10.1016/j.wneu.2018.02.118] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 02/18/2018] [Accepted: 02/19/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Transnasal endoscopic approaches to the clivus have been established recently. Comparative analyses with classic lateral approaches are limited. In this study, we compared transnasal endoscopic and lateral approaches to the clivus, quantifying the exposure and working volume of each approach in the anatomy laboratory. METHODS High-resolution computed tomography scans were performed on 5 injected specimens (10 sides). In each specimen, transnasal endoscopic approaches (i.e., paraseptal, transrostral, extended transrostral, transethmoidal, and extended transclival without and with intradural hypophysiopexy) and lateral approaches (i.e., retrosigmoid, far-lateral, presigmoid retrolabyrinthine and translabyrinthine) to the clivus were performed. An optic neuronavigation system and dedicated software (ApproachViewer; Guided Therapeutics Program, University Health Network, Toronto, Ontario, Canada) were used to quantify the working volume and exposed clival area of each approach. Statistical evaluation was performed with the Kruskal-Wallis test and Steel-Dwass-Critchlow-Fligner post hoc test. RESULTS Endoscopic transnasal transclival approaches showed higher working volume and larger clival exposure compared with lateral approaches. Incremental volumetric values were evident for transnasal approaches; presigmoid approaches provided less working volume than retrosigmoid approaches. A transnasal transclival approach with hypophysiopexy provided significant exposure of the upper clivus (84.4%). The transrostral approach was the first transnasal approach providing satisfactory access to the midclivus (66%); retrosigmoid and far-lateral approaches provided exposure of approximately one half of the midclivus. The lower clivus was optimally exposed with endoscopic transclival approaches (83%), whereas access to this region was limited with lateral approaches. CONCLUSIONS This quantitative anatomic study shows that endoscopic transnasal approaches to the clivus provide a larger working volume and wider exposure of the clivus compared with lateral approaches.
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Affiliation(s)
- Francesco Doglietto
- Department of Neurosurgery, Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
| | - Marco Ferrari
- Department of Otorhinolaryngology-Head and Neck Surgery, Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Davide Mattavelli
- Department of Otorhinolaryngology-Head and Neck Surgery, Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Francesco Belotti
- Department of Neurosurgery, Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Vittorio Rampinelli
- Department of Otorhinolaryngology-Head and Neck Surgery, Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Hussein Kheshaifati
- Department of Neurosurgery, Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy; Department of Neurosurgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Davide Lancini
- Department of Otorhinolaryngology-Head and Neck Surgery, Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Alberto Schreiber
- Department of Otorhinolaryngology-Head and Neck Surgery, Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Tommaso Sorrentino
- Department of Otorhinolaryngology-Head and Neck Surgery, Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Marco Ravanelli
- Department of Radiology, Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Barbara Buffoli
- Department of Anatomy and Physiopathology, Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Lena Hirtler
- Department of Systematic Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Roberto Maroldi
- Department of Radiology, Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Piero Nicolai
- Department of Otorhinolaryngology-Head and Neck Surgery, Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Luigi Fabrizio Rodella
- Department of Anatomy and Physiopathology, Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Marco Maria Fontanella
- Department of Neurosurgery, Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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Kennedy DW. Quality improvement in rhinology. Int Forum Allergy Rhinol 2017; 7:935-936. [PMID: 28887831 DOI: 10.1002/alr.22017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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