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Viana I, Nucifora ML, Vera L, Vietri AB, Ariovich A. Pott's puffy tumor: A rare complication of sinusitis. A case report. ARCH ARGENT PEDIATR 2024; 122:e202310151. [PMID: 38270557 DOI: 10.5546/aap.2023-10151.eng] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
A rare complication of frontal sinusitis includes Pott's puffy tumor. It manifests as a swelling of the forehead due to the presence of a subperiosteal abscess secondary to osteomyelitis of the frontal bone. A timely diagnosis allows for an early, intensive medical and surgical treatment, which is critical to prevent serious intracranial complications. Here we describe the case of a 12-year-old boy with Pott's puffy tumor as a complication of pansinusitis. This case was a diagnostic challenge; however, a timely treatment allowed for a favorable clinical course.
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Affiliation(s)
- Ignacia Viana
- Clinical Pediatrics; Hospital General de Niños Ricardo Gutiérrez, City of Buenos Aires, Argentina
| | - María L Nucifora
- Clinical Pediatrics; Hospital General de Niños Ricardo Gutiérrez, City of Buenos Aires, Argentina
| | - Luciana Vera
- Department of Adolescence; Hospital General de Niños Ricardo Gutiérrez, City of Buenos Aires, Argentina
| | - Agostina B Vietri
- Clinical Pediatrics; Hospital General de Niños Ricardo Gutiérrez, City of Buenos Aires, Argentina
| | - Alejandra Ariovich
- Department of Adolescence; Hospital General de Niños Ricardo Gutiérrez, City of Buenos Aires, Argentina
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Brar T, Brown A, Miglani A, Lal D, Marino MJ. Outcomes of Frontal Sinus Stenting With Steroid Impregnated Microsponge Versus Steroid-Eluting Implant. Am J Rhinol Allergy 2023; 37:679-685. [PMID: 37408359 DOI: 10.1177/19458924231186901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
BACKGROUND Mometasone-eluting poly-L-lactide-coglycolide (MPLG) is available commercially for frontal sinus ostium (FSO) stenting. An alternative chitosan polymer-based drug delivery microsponge is also available at a lower cost per unit. OBJECTIVE To compare the outcomes of MPLG stents versus triamcinolone-impregnated chitosan polymer (TICP) microsponge in frontal sinus surgery. METHODS Patients who underwent endoscopic sinus surgery from December 2018 to February 2022 were reviewed to identify those with the intraoperative placement of TICP microsponge or MPLG stent in the FSO. FSO patency was evaluated by endoscopy at follow-up. Twenty-two-item sinonasal outcome test (SNOT-22) was also recorded, and complications were noted. RESULTS A total of 68 subjects and 96 FSOs were treated. TICP was first used in August 2021 and MPLG in December 2018. MPLG placement in a Draf 3 cavity was excluded since TICP had not been used during Draf 3 procedure. Both cohorts (TICP 20 subjects, 35 FSOs; MPLG 26 subjects, 39 FSOs) had similar clinical characteristics. At a mean total follow-up of 249.2 days for TICP and 490.4 days for MPLG, FSO patency was 82.9% and 87.1%, respectively (P = .265). At an equivalent follow-up of 130.6 days in TICP and 154.0 days in MPLG, patency was 94.3% and 89.7%, respectively (P = .475). Both groups showed significant reductions in SNOT-22 (P < .001). MPLG demonstrated crusting within the FSO at 1 month (none in TICP). CONCLUSION FSO patency for both stents was similar, although TICP had significantly lower costs per unit. Additional comparative trials may be helpful for guiding clinicians on the appropriate clinical situations for the use of these devices.
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Affiliation(s)
- Tripti Brar
- Division of Rhinology, Department of Otolaryngology, Mayo Clinic in Arizona, Scottsdale, AZ, USA
| | - Adam Brown
- Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USA
| | - Amar Miglani
- Division of Rhinology, Department of Otolaryngology, Mayo Clinic in Arizona, Scottsdale, AZ, USA
| | - Devyani Lal
- Division of Rhinology, Department of Otolaryngology, Mayo Clinic in Arizona, Scottsdale, AZ, USA
| | - Michael J Marino
- Division of Rhinology, Department of Otolaryngology, Mayo Clinic in Arizona, Scottsdale, AZ, USA
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Seresirikachorn K, Sit A, Png LH, Kalish L, Campbell RG, Alvarado R, Harvey RJ. Carolyn's Window Approach to Unilateral Frontal Sinus Surgery. Laryngoscope 2023; 133:2496-2501. [PMID: 36651461 DOI: 10.1002/lary.30569] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 12/13/2022] [Accepted: 01/01/2023] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Due to the complexity and variety of the frontal recess and sinus anatomy, traditional Draf 2a frontal sinus surgery is challenging. The thickness of the nasofrontal beak and anterior-posterior dimensions of the frontal recess contribute to this complexity. Carolyn's window technique eliminates the limitation of anterior-posterior depth to facilitate a Draf 2a frontal sinusotomy. The approach is a 0° endoscope technique and provides an excellent view of the frontal sinus and recess. We describe Carolyn's window approach to frontal sinus surgery and the perioperative outcomes. METHODS Consecutive adult patients in whom Carolyn's window technique was applied for frontal sinus dissection as part of the endoscopic management of both inflammatory and neoplastic disease were assessed. The primary outcome was frontal sinus patency. Secondary outcomes were surgical morbidity, defined as early (<90 days) or late (>90 days). RESULTS Forty-five patients (49.1 ± 17.9 years, 48.9% Female) were assessed. All patients had successful frontal sinus patency (100% [95CI: 92.1%-100%]). Morbidities were adhesion (4.8%), crusting (2.4%), pain (1.2%), and bleeding (1.2%) in the early postoperative period. There were no other morbidities in the early and late postoperative periods. CONCLUSION Carolyn's window approach to frontal sinusotomy is a technique that evolves from previously described approaches. Successful frontal sinus patency with very low morbidities is achieved while still working with a 0° endoscope. The "axillectomy" performed simplifies frontal recess surgery by removing the anteroposterior diameter limitation and the dexterity required in angled endoscopy and instrumentation. The inferior-based lateral wall mucosal flap and free mucosal grafting expedite the mucosal healing process. Laryngoscope, 133:2496-2501, 2023.
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Affiliation(s)
- Kachorn Seresirikachorn
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
- Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Endoscopic Nasal and Sinus Surgery Excellence Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Andrea Sit
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
- School of Clinical Medicine, St Vincent's Healthcare Clinical Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Lu Hui Png
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
- Department of Otorhinolaryngology-Head and Neck Surgery, Singapore General Hospital, Singapore
| | - Larry Kalish
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
- Department of Otolaryngology, Head and Neck Surgery, Concord General Hospital, University of Sydney, Sydney, Australia
- Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Raewyn G Campbell
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
- Department of Otolaryngology, Head and Neck Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Raquel Alvarado
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
- School of Clinical Medicine, St Vincent's Healthcare Clinical Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Richard J Harvey
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
- School of Clinical Medicine, St Vincent's Healthcare Clinical Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
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Adnani A, Wawrzyniak M, Eilbert W. Girl with a frontal headache and fever. J Am Coll Emerg Physicians Open 2023; 4:e12994. [PMID: 37304854 PMCID: PMC10257039 DOI: 10.1002/emp2.12994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 05/31/2023] [Indexed: 06/13/2023] Open
Affiliation(s)
- Anis Adnani
- University of Illinois at Chicago Emergency Medicine ResidencyChicagoIllinoisUSA
| | - Michael Wawrzyniak
- Department of Emergency Medicine, University of Illinois at ChicagoCollege of MedicineChicagoIllinoisUSA
| | - Wesley Eilbert
- Department of Emergency Medicine, University of Illinois at ChicagoCollege of MedicineChicagoIllinoisUSA
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Muacevic A, Adler JR, Rengasamy K, Tadinada A. Pott's Puffy Tumor, a Forgotten Complication of Sinusitis: Report of Two Cases. Cureus 2023; 15:e33452. [PMID: 36751264 PMCID: PMC9899488 DOI: 10.7759/cureus.33452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2023] [Indexed: 01/09/2023] Open
Abstract
Pott's puffy tumor (PPT) is a life-threatening complication of infectious sinusitis/osteomyelitis of the frontal bone. It occurs due to infection or trauma and is often seen in late childhood and adolescence. If left untreated for a protracted period, intracranial complications such as epidural abscess, subdural empyema, meningitis, and a cerebral abscess may occur. The diagnosis is often confirmed with CT. Prompt medical and surgical treatment is mandatory as there is the potential for significant morbidity if not quickly diagnosed and treated. This paper presents two cases of PPT manifested in patients with hemi pansinusitis.
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Velasquez N, Strober W, Shaffer A, Stapleton A. Clinical and Radiologic Characterization of Frontal Sinusitis in the Pediatric Population. Ann Otol Rhinol Laryngol 2021; 130:923-928. [PMID: 33435715 DOI: 10.1177/0003489420987969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Frontal sinusitis in the pediatric population is a disease that has not been thoroughly studied or characterized. The goals of this study are to characterize the clinical presentation, radiologic variables, treatment modalities, complications, and prognosis associated with acute and chronic frontal sinus disease in the pediatric population. METHODS IRB-approved retrospective cohort study of pediatric patients who were diagnosed with acute (AFS) or chronic frontal sinusitis (CFS) and underwent frontal sinus surgery at a tertiary level Children's Hospital from 2006 to 2016. Patients with AFS were compared to patients with CFS. Statistical analysis completed using chi-square test or Fisher's exact test, statistical significance set at P < .05. RESULTS A total of 19 patients with AFS and 15 patients with CFS were analyzed. There was a male predominance in AFS and female predominance in CFS (P < .05).AFS patients were less likely to have allergies, prior sinus disease, or significant comorbidities (P < .05).Additionally, AFS patients presented with constitutional, neurologic, and ocular symptoms. The CFS group had predominantly sinonasal symptoms. CT-scan analysis showed that AFS patients had higher prevalence of complex frontal anatomy (Type-II cells, concha bullosa) compared with CFS patients (P < .05). Culture results were positive in 78% of the AFS group, with S. Anginosus (53%), Anaerobes (20%), and normal flora (17%). In the CFS group cultures were positive in 60% of the patients, 56% grew normal flora, 13% H. Influenzae, 6.5% Pseudomonas, and 24.5% other species. CFS patients were more likely to have persistent sinus disease and require repeat sinus procedures (P < .05). CONCLUSION There are 2 distinct presentations of frontal sinus disease in the pediatric population. Patients with AFS vary significantly from those with CFS. Males, ages 13 to 18 years old, who cultured positive for S. Anginosus (former S.Milleri) dominated the AFS subgroup. Whereas as female patients with a history of allergic rhinitis and muco-cilliary disease were more prominent in the CRS subgroup. Correct identification and understanding of these 2 different entities are crucial for the appropriate short and long-term patient management.
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Affiliation(s)
- Nathalia Velasquez
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - William Strober
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Amber Shaffer
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Amanda Stapleton
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.,Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Maurrasse SK, Hwa TP, Waldman E, Kacker A, Pearlman AN. Early experience with feasibility of balloon sinus dilation in complicated pediatric acute frontal rhinosinusitis. Laryngoscope Investig Otolaryngol 2020; 5:194-199. [PMID: 32337348 PMCID: PMC7178448 DOI: 10.1002/lio2.359] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 01/09/2020] [Accepted: 01/24/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND/OBJECTIVE Complicated acute rhinosinusitis in the pediatric population is an uncommon problem that may affect the orbit or brain and is life-threatening. This condition requires surgical intervention with endoscopic sinus surgery for source control, and prior studies have demonstrated the safety of balloon sinuplasty in chronic frontal sinusitis. METHODS/RESULTS We present our approach with a balloon sinus dilation hybrid procedure to resolve four distinct types of complicated acute frontal sinusitis in pediatric patients, including intracranial manifestations, intraorbital complications, and recurrent disease. All four patients were able to be managed operatively with frontal balloon sinuplasty. CONCLUSIONS Prior efficacy has been demonstrated for chronic frontal sinusitis in the pediatric population. We demonstrate that frontal balloon sinuplasty is also feasible in the proper clinical setting for acute frontal sinusitis, even in the presence of regional complications or recurrent disease. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Sarah K. Maurrasse
- Department of Otolaryngology–Head and Neck SurgeryWeill Cornell Medical CollegeNew YorkNew York
| | - Tiffany P. Hwa
- Department of Otolaryngology–Head and Neck SurgeryWeill Cornell Medical CollegeNew YorkNew York
| | - Erik Waldman
- Department of Otolaryngology–Head and Neck SurgeryYale School of MedicineNew HavenConnecticut
| | - Ashutosh Kacker
- Department of Otolaryngology–Head and Neck SurgeryWeill Cornell Medical CollegeNew YorkNew York
| | - Aaron N. Pearlman
- Department of Otolaryngology–Head and Neck SurgeryWeill Cornell Medical CollegeNew YorkNew York
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Farag A, Rosen MR, Ziegler N, Rimmer RA, Evans JJ, Farrell CJ, Nyquist GG. Management and Surveillance of Frontal Sinus Violation following Craniotomy. J Neurol Surg B Skull Base 2019; 81:1-7. [PMID: 32021743 DOI: 10.1055/s-0038-1676826] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 11/14/2018] [Indexed: 10/27/2022] Open
Abstract
Objectives In the setting of craniotomy, complications after traversing the frontal sinus can lead to mucocele formation and frontal sinusitis. We review the etiology of frontal sinus violation, timeline to mucocele development, intraoperative management of the violated sinus, and treatment of frontal mucoceles. Design Case series in conjunction with a literature review. Participants A total of 35 patients were included in this meta-analysis. Nine of these patients were treated at a tertiary academic medical center between 2005 and 2014. The remaining patients were identified through a literature review for which 2,763 articles were identified, of which 4 articles met inclusion criteria. Main Outcomes Measures Etiology of frontal violation, timeline to mucocele development, and method of management. Results The overall interval from initial frontal sinus violation until mucocele identification was 14.5 years, with a range of 3 months to 36 years. The most common cause of mucocele formation was obstruction of the frontal recess with incomplete removal of the frontal sinus mucosa. The majority of patients were successfully managed with an endoscopic endonasal approach. Conclusions Violation of the frontal sinus during craniotomy can result in mucocele formation as an early or late sequela. Image guidance may help avoid unnecessary frontal sinus violation. Mucoceles may develop decades after the initial frontal sinus violation, and long-term follow-up with imaging is recommended. While the endoscopic endonasal approach is usually the preferred method to treat these lesions, it may be necessary to perform obliteration or cranialization in unique situations.
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Affiliation(s)
- Alexander Farag
- Department of Otolaryngology, The Ohio State University, Columbus, Ohio, United States
| | - Marc R Rosen
- Department of Otolaryngology and Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - Natalie Ziegler
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - Ryan A Rimmer
- Department of Otolaryngology, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - James J Evans
- Department of Otolaryngology and Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - Christopher J Farrell
- Department of Otolaryngology and Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - Gurston G Nyquist
- Department of Otolaryngology and Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
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Liu TC, Yu XF, Gu ZW, Bai WL, Wang ZH, Cao ZW. [Causes and management of frontal sinusitis after transfrontal craniotomy]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2018; 32:187-189. [PMID: 29775018 DOI: 10.13201/j.issn.1001-1781.2018.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Indexed: 11/12/2022]
Abstract
Objective:The aim of this study is to investigate the causes and the strategy of frontal sinusitis after transfrontal craniotomy by endoscopic frontal sinus surgery and traditional surgery with facial incision. Method:A total of thirty-four patients with frontal sinusitis after transfrontal craniotomy were admitted, with the symptom of purulence stuff, headache and upper eyelid discharging. The onset time was 2.6 years on average. The frontal sinus CT and MRI images showed frontal sinusitis. Twenty-seven patients were treated with endoscopic frontal sinus surgery, and seven patient was treated with combined endoscopic and traditional frontal sinus surgery. In the revision surgery, the bone wax and inflammatory granulation tissue were cleaned out in both operational methods. The cure standard was that the postoperative frontal sinus inflammation disappeared and the drainage of the volume recess was unobstructed. Result:Thirty-four patients had a history of transfrontal craniotomy, and there was a record of bone wax packing in every operation. Among twenty-seven patients with endoscopic frontal sinus surgery, Twenty-five cases cured and two cases were operated twice. Seven patients were cured with combined endoscopic and traditional frontal sinus surgery. Conclusion:The frontal sinusitis after transfrontal craniotomy may be related to the inadequate sinus management, especially bone wax to be addressed to the frontal sinus ramming leading to frontal sinus mucosa secretion obstruction and poor drainage. Endoscopic frontal sinus surgery is a way of minimally invasive surgery. The satisfying curative effect can be obtained by endoscopic removal of bone wax, inflammatory granulation tissue, and the enlargement of frontal sinus aperture after exposure to the frontal sinus, and some cases was treated with both operation method.
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Affiliation(s)
- T C Liu
- Department of Otorhinolaryngology, Shengjing Hospital, China Medical University, Shenyang, 110004, China
| | - X F Yu
- Department of Otorhinolaryngology, Shengjing Hospital, China Medical University, Shenyang, 110004, China
| | - Z W Gu
- Department of Otorhinolaryngology, Shengjing Hospital, China Medical University, Shenyang, 110004, China
| | - W L Bai
- Department of Otorhinolaryngology, Shengjing Hospital, China Medical University, Shenyang, 110004, China
| | - Z H Wang
- Department of Otorhinolaryngology, Shengjing Hospital, China Medical University, Shenyang, 110004, China
| | - Z W Cao
- Department of Otorhinolaryngology, Shengjing Hospital, China Medical University, Shenyang, 110004, China
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Qiu XP, Wang JP, Yang Y, Wang B, Cao H, Wang X. [Evaluation of the frontal recess cells with image-guided system]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2018; 30:791-794;797. [PMID: 29798055 DOI: 10.13201/j.issn.1001-1781.2016.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Indexed: 11/12/2022]
Abstract
Objective:To investigate the value of image-guided system in identifying the frontal recess cells.Method:We collected 30 cases that underwent image-guided frontal sinus surgery from November 2014 to December 2015. These frontal recess cells were devided into 2 groups based upon their locations in the frontal sinus ostium. Group A consists of the agger nasi cells, type Ⅰfrontal cells, type Ⅱ frontal cells and suprabullar cells; group B consist of type Ⅲ frontal cells, type Ⅳ frontal cells, frontal bullar cells, interfrontal sinus septal cells and supraorbital ethmoid cells. Visual analogue scale (VAS) was used to evaluate the degree of demand of image guide system on the location of frontal recess cells, and then analyzed the value of image guided system on the frontal recess cells.Result:In all 30 patients the imageguided frontal sinus surgery was successfully completed.The demand degree of image-guided system on frontal recess cells by VAS was slight for the agger nasi cells, type Ⅰfrontal cells, type Ⅱ frontal cells and suprabullar cells; the demand degree was general for the frontal bullar cells and interfrontal sinus septal cells; the demand degree was obvious for type Ⅲ frontal cells, type Ⅳ frontal cells and supraorbital ethmoid cells. Frontal recess cells of group B were more depended on image guided system than those of group A, and the difference was signicant(P <0.01).Conclusion:Imageguided system is valuable in distinguishing for type Ⅲ frontal cells,type Ⅳ frontal cells supraorbital ethmoid cells and interfrontal sinus septal cells.Furthermore,it is significantly helpful for accurate removal of these frontal recess cells in endoscopic frontal sinus surgery.
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Affiliation(s)
- X P Qiu
- Department of OtorhinolaryngologyHead and Neck Surgery, the People's Hospital of Shanxi, Xi'an, 710068, China
| | - J P Wang
- Department of OtorhinolaryngologyHead and Neck Surgery, the People's Hospital of Shanxi, Xi'an, 710068, China
| | - Y Yang
- Department of OtorhinolaryngologyHead and Neck Surgery, the People's Hospital of Shanxi, Xi'an, 710068, China
| | - B Wang
- Department of OtorhinolaryngologyHead and Neck Surgery, the People's Hospital of Shanxi, Xi'an, 710068, China
| | - H Cao
- Department of OtorhinolaryngologyHead and Neck Surgery, the People's Hospital of Shanxi, Xi'an, 710068, China
| | - X Wang
- Department of OtorhinolaryngologyHead and Neck Surgery, the People's Hospital of Shanxi, Xi'an, 710068, China
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Zhou JB, Liang C, Xiao XP, Wang JH, Chen Y. [Functional frontal recess surgery under 70 degree endonasal endoscopy]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2018; 30:988-990. [PMID: 29771070 DOI: 10.13201/j.issn.1001-1781.2016.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Indexed: 11/12/2022]
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Simonin A, Passaplan C, Rusconi A, Colin V, Erard V, Stauffer E, Maestretti G, Otten P. Pott's puffy tumor presenting as a frontal swelling under a Swiss army helmet. Clin Neurol Neurosurg 2018; 173:115-117. [PMID: 30107355 DOI: 10.1016/j.clineuro.2018.06.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 05/07/2018] [Accepted: 06/30/2018] [Indexed: 11/25/2022]
Abstract
In this report, we describe an uncommon presentation of a Pott's puffy tumor, which is defined as a subperiosteal abscess related to a chronic frontal sinusitis. This condition has become rare in our part of the world because of the widespread use of antibiotics. Clinical history, investigations, and management are presented.
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Affiliation(s)
- Alexandre Simonin
- Neurosurgery and Orthopedic surgery, Cantonal Hospital of Fribourg, Switzerland.
| | - Caroline Passaplan
- Neurosurgery and Orthopedic surgery, Cantonal Hospital of Fribourg, Switzerland
| | - Angelo Rusconi
- Neurosurgery and Orthopedic surgery, Cantonal Hospital of Fribourg, Switzerland
| | - Victor Colin
- Otorhinolaryngology, Head and Neck Surgery, Cantonal Hospital of Fribourg, Switzerland
| | | | | | - Gianluca Maestretti
- Neurosurgery and Orthopedic surgery, Cantonal Hospital of Fribourg, Switzerland
| | - Philippe Otten
- Neurosurgery and Orthopedic surgery, Cantonal Hospital of Fribourg, Switzerland
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Podolsky-Gondim GG, Santos MV, Carneiro VM, Pires Augusto L, Da Costa Pacheco Neto R, Santos de Oliveira R. Neurosurgical Management of Pott's Puffy Tumor in an Obese Adolescent with Asthma: Case Report with a Brief Review of the Literature. Cureus 2018; 10:e2836. [PMID: 30131929 PMCID: PMC6101458 DOI: 10.7759/cureus.2836] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Pott’s puffy tumor is a rare and severe complication of frontal sinusitis, characterized by the progressive swelling of the frontal soft tissues secondary to a subperiosteal abscess. Radiological imaging with ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) are important diagnostic tools in establishing diagnosis and treatment planning. Early surgery along with intravenous antibiotics are required in order to achieve a good recovery. The authors report a case of Pott’s puffy tumor in an obese 14-year-old male, with a previous history of asthma and a chronic use of steroids, treated with neurosurgical debridement followed by a combined course of intravenous (IV) and oral antibiotics, who had a favorable outcome upon long-term follow-up. In addition, a brief review of the current medical literature was performed for a discussion on the diagnostic and therapeutic features of this pathology.
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Affiliation(s)
- Guilherme G Podolsky-Gondim
- Division of Neurosurgery, Department of Surgery and Anatomy, Ribeirão Preto Clinics Hospital, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, BRA
| | - Marcelo V Santos
- Division of Pediatric Neurosurgery, Department of Surgery and Anatomy, Ribeirão Preto Clinics Hospital, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, BRA
| | - Vinícius M Carneiro
- Division of Neurosurgery, Department of Surgery and Anatomy, Ribeirão Preto Clinics Hospital, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, BRA
| | - Lucas Pires Augusto
- Division of Pediatric Neurosurgery, Department of Surgery and Anatomy, Ribeirão Preto Clinics Hospital, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto , BRA
| | - Romilto Da Costa Pacheco Neto
- Division of Pediatric Neurosurgery, Department of Surgery and Anatomy, Ribeirão Preto Clinics Hospital, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, BRA
| | - Ricardo Santos de Oliveira
- Division of Pediatric Neurosurgery, Department of Surgery and Anatomy, Ribeirão Preto Clinics Hospital, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, BRA
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14
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Gitomer SA, Zhang W, Marquez L, Chandy BM. Reducing Surgical Revisions in Intracranial Complications of Pediatric Acute Sinusitis. Otolaryngol Head Neck Surg 2018; 159:359-364. [PMID: 29582700 DOI: 10.1177/0194599818765160] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective (1) To describe the demographics and clinical course of children with intracranial complications of sinusitis. (2) To elucidate factors that predict revision surgery in this population, such as type of initial surgery. Study Design Case series with chart review. Setting Tertiary care academic children's hospital. Subjects and Methods A 15-year retrospective review identified 71 patients with intracranial complications of acute sinusitis. Primary outcome was need for revision surgery. Secondary outcomes were readmission, length of hospitalization, and long-term complications. Results This study is the largest to date examining this disease process. Overall, 69 (97%) patients had surgery; 33 (46%) required revision surgery. Half of the patients with frontal sinus opacification underwent frontal sinus surgery at presentation (endoscopic, trephination, or cranialization). There was no difference in revision surgery between patients who had frontal sinus surgery and those who did not. Patients with frontal sinus surgery did not have a higher rate of complications or chronic sinusitis ( P > .05). Subdural abscess was associated with multiple surgical procedures (odds ratio, 20.0; P < .01). Thirty-four patients (49%) required neurosurgery. These patients had a longer length of stay (odds ratio, 11.0; P < .01) and a higher readmission rate ( P = .02). During the mean 92-month follow-up, 22 patients (33%) had long-term complications, and there was 1 death (1.4%). Conclusion Almost half of this cohort required multiple surgical procedures. In particular, patients with subdural abscess had significantly higher rates of revision surgery. Type of frontal sinus surgery was not correlated with need for revision surgery and was not associated with an increased rate of complications.
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Affiliation(s)
- Sarah A Gitomer
- 1 Department of Pediatric Otolaryngology, Texas Children's Hospital, Houston, Texas, USA
| | - Wei Zhang
- 2 Department of Outcomes and Impact Service, Texas Children's Hospital, Houston, Texas, USA
| | - Lucila Marquez
- 3 Division of Pediatric Infectious Diseases, Texas Children's Hospital, Houston, Texas, USA
| | - Binoy M Chandy
- 1 Department of Pediatric Otolaryngology, Texas Children's Hospital, Houston, Texas, USA
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15
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Shih LC, Patel VS, Choby GW, Nakayama T, Hwang PH. Evolution of the endoscopic modified Lothrop procedure: A systematic review and meta-analysis. Laryngoscope 2017; 128:317-326. [PMID: 28921539 DOI: 10.1002/lary.26794] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 06/02/2017] [Accepted: 06/16/2017] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Since first described in the 1990s, the endoscopic modified Lothrop procedure (EMLP) has been the subject of a growing body of literature. We performed a review to compare indications and outcomes of EMLP in an early cohort of publications (1990-2008) versus a contemporary cohort (2009-2016) and compare outcomes associated with follow-up ≥2 years versus <2 years. DATA SOURCES PubMed, SCOPUS and Cochrane databases. REVIEW METHODS An English-language search of the PubMed and Ovid databases was conducted to identify publications from 1990 to 2016 reporting clinical outcomes of EMLP. Meta-analysis was performed using Statistical Analysis System 9.4. RESULTS A total of 1,205 patients were abstracted from 29 articles with a mean follow-up of 29.1 ± 10.3 months. The overall rate of significant or complete symptom improvement was 86.5% (95% confidence interval [CI]: 84.2%-88.7%). The overall patency rate was 90.7% (95% CI: 89.1%-92.3%), with a revision rate of 12.6% (95% CI: 10.6%-14.3%). Compared to the early cohort, patients in the contemporary cohort underwent EMLP more often for tumors (P < .001), had higher rates of complete or significant symptom improvement (90.0% vs. 82.6 %, P < .001); and trended toward greater patency rates (92.1% vs. 88.6%, P = .052). Compared to the short-term follow-up cohort, the long-term cohort showed no differences in symptom improvement or patency, but the revision rate was higher (14.5% vs. 9.2%, P = .016). CONCLUSIONS In the last decade, EMLP has been performed more frequently for tumors. Recent studies have demonstrated improved symptom outcomes and a trend toward improved patency rates. The revision rate increased significantly when follow-up exceeded 2 years. Laryngoscope, 128:317-326, 2018.
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Affiliation(s)
- Liang-Chun Shih
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, U.S.A.,Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Vishal S Patel
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, U.S.A
| | - Garret W Choby
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, U.S.A
| | - Tsuguhisa Nakayama
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, U.S.A.,Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan
| | - Peter H Hwang
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, U.S.A
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16
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Abstract
Background: Pott’s puffy tumour is characterized by a fluctuate swelling of the frontal region as a result of osteomyelitis of the frontal bone. This inflammatory lesion may propagate endocranially, resulting in acute meningitis, epidural abscess, subdural empyema, cavernous sinus trombophlebitis, cerebritis, and frontal lobe abscess of the brain. Case Report: We present an unusual case of a 33-year-old man suffering from Pott’s puffy tumour whose condition was further complicated by a draining epidural-cutaneous fistula and an epidural abscess. We confirmed the diagnosis by contrast-enhanced computed tomography scanning and magnetic resonance imaging of the head. After intense antibiotic treatment, we performed a combined endoscopic and external surgical approach with drainage of abscesses, evacuation of pus and bone sequestrate and excision of fistulous lesion. The treatment was prolonged with four weeks’ antibiotic administration. Conclusion: Subperiosteal abscess of the frontal bone is an extremely rare complication of frontal sinusitis. This lesion may propagate endocranially, resulting in dangerous intracranial inflammatory lesions. Early diagnosis, medication and surgical therapy are very important in reducing morbidity and mortality.
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Affiliation(s)
- Aleksandar Perić
- Department of Otorhinolaryngology, Military Medical Academy School of Medicine, Belgrade, Serbia
| | - Milanko Milojević
- Department of Otorhinolaryngology, Military Medical Academy School of Medicine, Belgrade, Serbia
| | - Dražen Ivetić
- Department of Neurosurgery, Military Medical Academy School of Medicine, Belgrade, Serbia
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17
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Foy JP, Khonsari RH, Bertolus C, Espitalier F, Ferron C, Corre P, Faure A. 'Canalization' of the frontal sinus: a functional approach for the management of post-traumatic sinusitis with lateral bony septa. Report of two cases and long-term follow-up. Int J Oral Maxillofac Surg 2016; 45:884-6. [PMID: 26922495 DOI: 10.1016/j.ijom.2016.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Revised: 12/11/2015] [Accepted: 01/26/2016] [Indexed: 10/22/2022]
Abstract
The patency of the naso-frontal duct is a key issue in the surgical management of chronic frontal sinusitis. Most of the current operative techniques only provide access to the paramedian portions of the frontal sinus. A canalization approach that allows a functional frontal sinus to be maintained while providing good access to the most lateral areas of the sinus is described herein. Two cases of severe post-traumatic frontal sinusitis, operated on successfully by canalization method based on the conservation of the frontal sinus and the maintenance of the patency of the naso-frontal duct, using both open and endonasal approaches, are reported. One patient was followed-up for 8 years and the other for 7 months. Canalization requires validation in a larger series. This approach provides an alternative to both cranialization and strictly endoscopic methods in lateralized frontal sinus retentions and allows mucocele to be avoided.
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Affiliation(s)
- J-P Foy
- Service de Chirurgie Maxillo-Faciale et Stomatologie, GH Pitié Salpêtrière, Paris, France
| | - R H Khonsari
- Service de Chirurgie Maxillo-Faciale et Stomatologie, GH Pitié Salpêtrière, Paris, France.
| | - C Bertolus
- Service de Chirurgie Maxillo-Faciale et Stomatologie, GH Pitié Salpêtrière, Paris, France
| | - F Espitalier
- Service d'Otorhinolaryngologie et Chirurgie Cervico-Faciale, CHU Nantes, Nantes, France
| | - C Ferron
- Service d'Otorhinolaryngologie et Chirurgie Cervico-Faciale, CHU Nantes, Nantes, France
| | - P Corre
- Service de Chirurgie Maxillo-Faciale et Stomatologie, CHU Nantes, Nantes, France
| | - A Faure
- Service de Neurotraumatologie, CHU Nantes, Nantes, France
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18
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Abuzeid WM, Mace JC, Costa ML, Rudmik L, Soler ZM, Kim GS, Smith TL, Hwang PH. Outcomes of chronic frontal sinusitis treated with ethmoidectomy: a prospective study. Int Forum Allergy Rhinol 2016; 6:597-604. [PMID: 26879467 DOI: 10.1002/alr.21726] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Revised: 11/24/2015] [Accepted: 12/22/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND In medically refractory chronic frontal sinusitis, ethmoidectomy without instrumentation of the frontal ostium may resolve frontal disease. Our aim was to determine the efficacy of ethmoidectomy alone for the treatment of chronic frontal sinusitis. METHODS Adults with chronic rhinosinusitis prospectively enrolled in a multicenter study who demonstrated frontal sinusitis on computed tomography were divided into 2 groups: (1) endoscopic sinus surgery (ESS) incorporating ethmoidectomy, but excluding frontal sinusotomy; and (2) ESS incorporating frontal sinusotomy. The primary outcome was improvement in 22-item Sino-Nasal Outcome Test (SNOT-22) scores. Secondary outcomes included endoscopic scores and use of corticosteroids and antibiotics. RESULTS A total of 196 cases undergoing frontal sinusotomy and 30 cases treated with ethmoidectomy without frontal sinusotomy were analyzed and were comparable demographically. The prevalence of nasal polyps, previous ESS, asthma, and aspirin intolerance was more common in the frontal sinusotomy group (p < 0.050). Preoperative endoscopy and computed tomography scores were higher in the frontal sinusotomy group (p ≤ 0.001). Postoperatively, both groups showed comparable SNOT-22 scores with worse endoscopy scores in the frontal sinusotomy group (p = 0.038). Postoperative improvement in SNOT-22 total and subdomain scores was comparable between groups. Nasal endoscopy scores improved to a greater degree in the frontal sinusotomy group (p = 0.023). Duration of postoperative topical steroid use was higher in the frontal sinusotomy group (p = 0.007). Revision surgery was needed in 2.6% of frontal sinusotomy patients and 0% of patients without frontal sinusotomy. CONCLUSION The treatment of chronic frontal sinusitis through ethmoidectomy is a potential alternative to frontal sinusotomy achieving similar quality of life (QOL) improvements in patients manifesting less severe sinus disease.
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Affiliation(s)
- Waleed M Abuzeid
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Jess C Mace
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology, Oregon Health and Science University, Portland, OR
| | - Milena L Costa
- Department of Otolaryngology, Medical School of the University of Sao Paulo, Sao Paulo, Brazil
| | - Luke Rudmik
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Zachary M Soler
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Grace S Kim
- Department of Otolaryngology-Head and Neck Surgery, Stanford University Medical Center, Stanford, CA
| | - Timothy L Smith
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology, Oregon Health and Science University, Portland, OR
| | - Peter H Hwang
- Department of Otolaryngology-Head and Neck Surgery, Stanford University Medical Center, Stanford, CA
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19
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Hathorn IF, Pace-Asciak P, Habib ARR, Sunkaraneni V, Javer AR. Randomized controlled trial: hybrid technique using balloon dilation of the frontal sinus drainage pathway. Int Forum Allergy Rhinol 2014; 5:167-73. [PMID: 25360863 DOI: 10.1002/alr.21432] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 06/28/2014] [Accepted: 08/28/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND The objectives of this study were as follows: (1) to evaluate frontal sinus ostial patency following balloon dilation with the Ventera Sinus Dilation System, compared with frontal sinusotomy (Draf 2a); and (2) to compare mean blood loss and mean surgical time for frontal sinusotomy using balloon dilation compared with traditional surgical methods. METHODS A single blinded, randomized, controlled, prospective study was performed at St. Paul's Sinus Center, Vancouver, a tertiary referral rhinology center. Thirty patients undergoing functional endoscopic sinus surgery (FESS) for chronic rhinosinusitis (CRS) were randomized to a hybrid approach with exposure of the frontal recess using standard instrumentation and then balloon dilation of 1 frontal sinus drainage pathway and traditional frontal sinusotomy for the opposite side. Blood loss and surgical time for opening the frontal sinus drainage pathway was recorded for each side. Patients acted as their own controls. Ostial patency and size were assessed 5 weeks and 3 months postoperatively using endoscopy. Ostial patency was also recorded at 1 year following surgery. RESULTS All frontal sinus ostia in both groups (n = 30) were successfully opened and were patent with both techniques 3 months postoperatively. All frontal sinus ostia assessed at 1 year (73%) remained patent and none required revision frontal surgery. Balloon dilation showed a mean surgical time of 655 seconds compared to 898 seconds for traditional FESS (p = 0.03). Mean blood loss was less with balloon dilation (58 mL vs 91 mL; p = 0.008). CONCLUSION A hybrid balloon technique successfully dilates the frontal sinus drainage pathway with reduced blood loss. Also, short-term patency appears to be comparable to traditional frontal sinusotomy.
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Affiliation(s)
- Iain F Hathorn
- St. Paul's Sinus Center, St. Paul's Hospital, Vancouver, British Columbia, Canada
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20
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Ting JY, Wu A, Metson R. Frontal sinus drillout (modified Lothrop procedure): long-term results in 204 patients. Laryngoscope 2013; 124:1066-70. [PMID: 24114727 DOI: 10.1002/lary.24422] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 07/22/2013] [Accepted: 09/05/2013] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS To determine the long-term results of frontal sinus drillout (also known as modified Lothrop procedure) for the treatment of advanced frontal sinus disease. STUDY DESIGN Retrospective review. METHODS The records of patients who underwent frontal sinus drillout by a single surgeon at an academic medical center from June 1995 through November 2011 were reviewed. Patient demographics and perioperative clinical findings were analyzed for their impact on surgical outcome. Failure was defined as restenosis of the frontal drainage pathways, necessitating additional frontal sinus surgery. RESULTS A total of 204 patients underwent frontal drillout surgery (143 bilateral procedures) over the 16-year period. Mean follow-up was 10.2 years (range 0.9-17 years). Symptomatic re-obstruction of the frontal sinus requiring revision surgery occurred in 61 (29.9%) patients. Drillouts performed for a diagnosis of mucocele or tumor had significantly higher failure rate (38.9%, odds ratio [OR] = 2.9, P = 0.022 and 58.3%, OR = 5.3, P = 0.020, respectively). The majority of surgical failures (61%) occurred within 2 years of surgery, but delayed failures were observed up to 12 years after drillout. Clinical outcome did not correlate with a history of smoking, asthma, nasal allergy, aspirin sensitivity, prior sinus surgery, nasal polyposis, or the presence of eosinophilic mucin. CONCLUSION For the majority of patients who undergo frontal sinus drillout, patency of the frontal sinus outflow tract appears to be maintained for more than a decade; nevertheless, almost one-third of patients who undergo this procedure will ultimately require additional frontal sinus surgery.
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Affiliation(s)
- Jonathan Y Ting
- Department of Otolaryngology, Indiana University School of Medicine, Indianapolis, Indiana
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21
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Abstract
For chronic sinusitis surgery, the Draf III approach provides a common median drainage pathway for bilateral frontal sinuses from orbit to orbit. The Draf IIb provides unilateral drainage from orbit to septum. In several cases, inclusion of the nasal and frontal sinus septum in a Draf IIb was advantageous without extension to the opposite frontal recess. The proposed nomenclature is Draf IIc. This study was designed to (1) develop a surgical option for chronic frontal sinusitis where access to one frontal recess is limited or unnecessary and (2) minimize unnecessary surgical manipulation of uninvolved areas. Revision endoscopic frontal sinus surgery was performed on two patients with persistent frontal sinus opacification. Surgery crossed midline including one frontal recess with resection of the superior nasal septum. The surgical result was assessed on endoscopy and computed tomography (CT). The postoperative course was unremarkable with relief of frontal pressure. Postoperative CT scan showed well-aerated frontal sinuses with a widely patent common drainage pathway. Postoperative nasal endoscopy revealed normal mucosa with no exposed bone or edema. The Draf IIc extends the Draf IIb across the midline, without including the opposite frontal recess. This can be accomplished most easily using an interfrontal sinus septal cell or an eccentric interfrontal sinus septum. The Draf IIc is a surgical option in cases of chronic or recalcitrant frontal sinus diseases, including unilateral or bilateral obstruction, where access to the ipsilateral frontal recess is limited or favorable anatomy allows drainage with reduced manipulation of an uninvolved side.
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Affiliation(s)
- Mohammed K Al Komser
- Department of Otolaryngology-Head and Neck Surgery, University of California at San Francisco, San Francisco, California
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22
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Abstract
Treatment of frontal sinus disease represents one of the most challenging aspects of endoscopic sinus surgery. Frontal sinus mucocele drainage may be an exception to the rule because in many instances, the expansion of the mucocele widens the frontal sinus recess and renders surgical drainage technically undemanding. Recently, there has been an increased interest in in-office procedures in otolaryngology because of patient satisfaction and substantial savings of time and cost for both patients and physicians. Similarly, the past few years have witnessed an increased use of balloon dilation devices in sinus surgery. Previously, we have described the in-office use of this device in treating patients who failed prior conventional frontal sinusotomy in the operating room. In this report, we describe our step-by-step in-office experience using this tool for drainage of a large frontal sinus mucocele.
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Affiliation(s)
- Jean Anderson Eloy
- Departments of Otolaryngology-Head and Neck Surgery and ; Neurological Surgery, ; Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, and
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