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Li YT, Huang SS, Ma JH, Hsieh BH, Tsou YA, Lin CD, Tai CJ, Shih LC. Bacteriology of Different Phenotypes of Chronic Rhinosinusitis. Laryngoscope 2024; 134:1071-1076. [PMID: 37477266 DOI: 10.1002/lary.30905] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 07/03/2023] [Accepted: 07/07/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVES Chronic rhinosinusitis (CRS) reduces the health-related quality of life and subsequently causes a tremendous socio-economic impact. Although many studies have been conducted, few have identified a relationship between bacteriological characteristics and different phenotypes or endotypes. Therefore, this study aimed to elucidate the recent trends in bacterial cultures from different types of CRS in the Asian population. METHODS This retrospective case-control study recruited patients diagnosed with CRS who underwent functional endoscopic sinus surgery (FESS) at a tertiary hospital in Taiwan. The patients were classified into those with chronic rhinosinusitis with nasal polyps (CRSwNP)/chronic rhinosinusitis without nasal polyps (CRSsNP), eosinophilic chronic rhinosinusitis (eCRS)/non-eosinophilic chronic rhinosinusitis (NECRS), and central compartment atopic disease (CCAD)/lateral-dominant nasal polyp (LDNP) groups. The demographic data and bacteriological characteristics of the groups were analyzed. RESULTS We included 503 patients, identifying no significant difference between CRSwNP and CRSsNP for several common bacteria in CRS. The number of Staphylococcus epidermidis isolates in culture was significantly higher in the NECRS group (50.46% vs. 32.56%, p = 0.0003) than that in the eCRS group. The number of methicillin-resistant Staphylococcus aureus (MRSA; 8.51% vs. 2.35%, p = 0.0221) positive isolates was significantly higher in the CCAD group than that in the LDNP group. CONCLUSIONS This was the first study in Asia to analyze the relationship between bacteriological characteristics and CCAD. MRSA is significantly higher in the CCAD group than that in the LDNP group. Recognizing the unique microbiology of CRSwNP, eCRS, and CCAD is crucial when selecting antimicrobial therapy to lessen the socio-economic impact. LEVEL OF EVIDENCE 3 Laryngoscope, 134:1071-1076, 2024.
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Affiliation(s)
- Yu-Ting Li
- Department of Otorhinolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Shuang-Shuang Huang
- Department of Otorhinolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Jia-Hung Ma
- Department of Otorhinolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Bing-Han Hsieh
- Department of Otorhinolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Yung-An Tsou
- Department of Otorhinolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Asia University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
| | - Chia-Der Lin
- Department of Otorhinolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
| | - Chih-Jaan Tai
- Department of Otorhinolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
| | - Liang-Chun Shih
- Department of Otorhinolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Asia University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
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Algahtani S, Alhajlah A, Abuharb AI, Alzarroug AF, Almughira AI, Alsywina N, Alahmadi FK, Al-Dubai S. Outcomes of Functional Endoscopic Sinus Surgery in Chronic Rhinosinusitis: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e53952. [PMID: 38468978 PMCID: PMC10925974 DOI: 10.7759/cureus.53952] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2024] [Indexed: 03/13/2024] Open
Abstract
Chronic rhinosinusitis (CRS) is a prevalent health problem that affects many people around the world and can require surgical intervention if conservative therapy fails. Functional endoscopic sinus surgery (FESS) is a minimally invasive surgical procedure commonly used to manage CRS. The success of FESS depends on various factors, and larger studies are necessary to determine its efficacy in managing CRS in this population. This systematic review and meta-analysis of the available literature aims to provide a comprehensive assessment of the effectiveness of FESS in the Middle East. We followed the standards outlined by PRISMA and the Cochrane Handbook for systematic reviews. The primary outcome of interest was the quality of life (QOL), and the secondary outcome was the recurrence of CRS. This systematic review and meta-analysis was conducted, and sensitivity analysis was performed to examine the robustness of the results. Six studies were included. The review found that the QOL significantly improved (p < 0.001). Two studies reported recurrence of CRS after FESS, and data showed that the recurrence of CRS after surgery was 6%. FESS is an effective intervention for CRS, but further research is needed on recurrence rates.
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Affiliation(s)
- Saad Algahtani
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Abdullah Alhajlah
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Abdullah I Abuharb
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | | | | | - Nasser Alsywina
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Faris K Alahmadi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Sami Al-Dubai
- Joint Program of Preventive Medicine Post Graduate Studies, Ministry of Health, Medina, SAU
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Tan CJW, Leow BHW, Tan BKJ, Tan SFJ, Teo NWY, Charn TC. Association Between Smoking and Chronic Rhinosinusitis: A Systematic Review and Meta-Analysis. Laryngoscope 2023. [PMID: 38112394 DOI: 10.1002/lary.31223] [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: 07/31/2023] [Revised: 10/11/2023] [Accepted: 11/21/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVE Chronic rhinosinusitis (CRS) is a prevalent inflammatory disease of the upper airway. The impact of smoking on CRS has not been clearly established. We aim to clarify the association between first-hand cigarette smoking and the prevalence and prognoses of CRS. REVIEW METHODS PubMed, Embase, SCOPUS, and Cochrane Library were searched from inception until May 15, 2022. Three blinded reviewers selected relevant studies, extracted data, and evaluated study bias following a PROSPERO-registered protocol (CRD42022345585). We used random-effects meta-analyses to pool the prevalence of smoking in CRS, association between smoking status and CRS, and association of smoking with quality of life (QOL) before and after functional endoscopic sinus surgery (FESS). We also performed descriptive analyses of olfactory function, CT scores, and endoscopy scores before and after FESS. RESULTS We included 23 cross-sectional studies, 19 cohort studies, two case-control studies, and one prospective clinical trial. The pooled prevalence of ever-smokers was 40% (95% CI = 0.30-0.51) and 33% (95% CI = 0.25-0.43) in patients with and without CRS. Compared to never-smokers, active smokers and past smokers had 1.35 (95% CI = 1.18-1.55) and 1.23 (95% CI = 1.17-1.29) higher odds of having CRS. Among patients with CRS, non-smokers reported higher initial QOL than smokers (standardized mean difference [SMD] = 0.23, 95% CI = 0.11-0.35), although post-FESS QOL was similar (SMD = 0.10, 95% CI = -0.30-0.51). Descriptive analysis found no significant correlations between smoking and post-FESS olfactory function and endoscopy scores. CONCLUSIONS Cigarette smoking is associated with higher prevalence and odds of CRS. Clinicians should be aware that smoking predisposes to CRS, but does not negatively impact the rhinologic outcomes of FESS. Laryngoscope, 2023.
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Affiliation(s)
- Claire Jing-Wen Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Bryan Hao Wei Leow
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Benjamin Kye Jyn Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sean Fong-Jun Tan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Neville Wei Yang Teo
- Department of Otorhinolaryngology-Head & Neck Surgery, Singapore General Hospital, Singapore, Singapore
- Surgery Academic Clinical Program, SingHealth, Singapore, Singapore
| | - Tze Choong Charn
- Department of Otorhinolaryngology-Head & Neck Surgery, Singapore General Hospital, Singapore, Singapore
- Departments of Otorhinolaryngology-Head & Neck Surgery, Sengkang General Hospital, Singapore, Singapore
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Plath M, Sand M, Cavaliere C, Plinkert PK, Baumann I, Zaoui K. Normative data for interpreting the SNOT-22. Acta Otorhinolaryngol Ital 2023; 43:390-399. [PMID: 37814974 PMCID: PMC10773542 DOI: 10.14639/0392-100x-n2279] [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] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 03/05/2023] [Indexed: 10/11/2023]
Abstract
Objectives The Sino-Nasal Outcome Test 22 (SNOT-22) is a validated patient-reported outcome instrument to evaluate the health-related quality of life (HRQoL) in patients with chronic rhinosinusitis (CRS). There are no published normative SNOT-22 scores, limiting its interpretation. Methods Symptom scores from 1,000 SNOT-22 questionnaires were analysed by principal component analysis (PCA) and exploratory factor analyses. Data were derived from a survey with 1,000 healthy Europeans (reference cohort) who were recruited using the Respondi panel for market and social science research. This subsample was quoted to the population distribution of the German Microcensus and selected from a non-probability panel. Results The overall normative SNOT-22 score can be detected to be 20.2 ± 19.44. Male (18.49 ± 19.15) and older (> 50 years old; 18.3 ± 17.49) participants had overall lower SNOT-22 mean results than females (21.8 ± 19.6) and younger (21.4 ± 20.55) participants, indicating higher levels of satisfaction. PCA proposed two SNOT-22 domains ("physiological well-being" and "psychological well-being"), which explained 65% of the variance. Conclusions These are the first published (German) normative scores for the SNOT-22 and provide a clinical reference point for the interpretation of data.
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Affiliation(s)
- Michaela Plath
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Matthias Sand
- GESIS-Leibniz-Institute for the Social Sciences, Mannheim, Germany
| | - Carlo Cavaliere
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Peter K. Plinkert
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Ingo Baumann
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Karim Zaoui
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Heidelberg, Heidelberg, Germany
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Pavlov VE, Polushin YS, Kolotilov LV, Karpishchenko SA. Intraoperative Bleeding Control with Terlipressin in Functional Endoscopic Sinus Surgery. Laryngoscope 2023; 133:3313-3318. [PMID: 37067035 DOI: 10.1002/lary.30702] [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] [Received: 01/05/2023] [Revised: 03/12/2023] [Accepted: 04/02/2023] [Indexed: 04/18/2023]
Abstract
OBJECTIVE To evaluate the use of terlipressin for intraoperative bleeding reduction in functional endoscopic sinus surgery (FESS). METHODS This prospective, randomized, single-center, single-blinded cohort study included 74 cases of FESS performed under general anesthesia (GA). The patients were randomized into two groups: WT (without terlipressin, n = 39) and T (with 200 μg terlipressin, n = 35). Bleeding intensity (BI) was assessed using a 6-point scale. Heart rate (HR), mean blood pressure (MBP), perfusion index (PI), and BI were recorded at 10, 30, and 60 min after surgery. A BI score ≥2 qualified as significant. RESULTS The T group had significantly higher MBP compared with the WT group, but HR values did not differ significantly. PI and BI scores were significantly reduced in the T group compared with the WT group. The risk of significant bleeding in the treatment group was 35.5 times lower (odds ratio [OR], 0.028; 95% confidence interval [CI], 0.006-0.138) at 30 min and 7.1 times lower (OR, 0.140; 95% CI, 0.049-0.402) at 60 min. The prognostic model for significant bleeding at 60 min showed that only terlipressin played a significant role in bleeding control (p < 0.05). The model predicted a 13.9-fold decrease in significant bleeding risk in the T group. CONCLUSION Low doses (200 μg) of terlipressin reduced intraoperative bleeding without decreasing blood pressure during FESS under GA. LEVEL OF EVIDENCE 2 Laryngoscope, 133:3313-3318, 2023.
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Affiliation(s)
- Vladimir E Pavlov
- Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia
| | - Yury S Polushin
- Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia
| | - Leonid V Kolotilov
- St. Joseph University, St. Joseph College of Health and Allied Sciences, Dar es Salaam, Tanzania
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Jiang T, Zhang Q, Li C, Li T, Sun S, Chen A, Ji H, Wan Y, Shi L, Yu L. Clinical Characteristics of Sphenoid Sinus Fungus Ball: A Nine-year Retrospective Study of 77 Cases. Laryngoscope 2023; 133:3292-3298. [PMID: 37022141 DOI: 10.1002/lary.30683] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 03/02/2023] [Accepted: 03/10/2023] [Indexed: 04/07/2023]
Abstract
OBJECTIVE This study aimed to investigate the clinical characteristics of sphenoid sinus fungus ball (SSFB) to help increase the accuracy of diagnosis and efficiency of treatment. METHODS We retrospectively analyzed the data of 77 patients who were histopathologically diagnosed with SSFB. RESULTS The mean age of SSFB patients was 52.4 years (range 25-84), and 47 patients (61.0%) were female. Compared to age-matched and sex-matched chronic rhinosinusitis (CRS) patients, headache was more common in SSFB patients (79.2%; p < 0.0001). SSFB patients also had higher prevalence of diabetes than CRS (p = 0.0420). The features of computed tomography (CT) were sphenoid sinus opacification (100%), sclerosis (93.5%), calcification (76.6%), and bone erosion (41.6%). Functional endoscopic sinus surgery (FESS) was the best treatment option, and the trans-ethmoid (n = 64, 83.1%) was the most commonly used approach. No one experienced a recurrence of SSFB in 44 successfully contacted patients. Six months after FESS, 91.0% of patients (40/44) established proper drainage in the sphenoid sinus. The recovery rates for headache and nasal symptoms were 91.7% (33/36) and 77.8% (7/9) respectively. CONCLUSION SSFB is more prevalent in older women and usually presents as unilateral headache. Diabetes is a potential risk factor for SSFB. CT findings provide evidence for diagnosis and suggestions for surgical approaches. FESS is the optimal treatment for SSFB. After FESS, most patients had good prognosis with no recurrence of SSFB. However, regular endoscopic follow-up is required due to the possibility of the postoperative closure of sphenoid ostium. LEVEL OF EVIDENCE 3 Laryngoscope, 133:3292-3298, 2023.
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Affiliation(s)
- Tianjiao Jiang
- Department of Otorhinolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan, China
| | - Qian Zhang
- Department of Otorhinolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan, China
| | - Chunhao Li
- Department of Otorhinolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan, China
| | - Tong Li
- Department of Radiology, Shandong Provincial ENT Hospital, Shandong University, Jinan, China
| | - Shujuan Sun
- Department of Otorhinolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan, China
| | - Aiping Chen
- Department of Otorhinolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan, China
| | - Hongzhi Ji
- Department of Otorhinolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan, China
| | - Yuzhu Wan
- Department of Otorhinolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan, China
| | - Li Shi
- Department of Otorhinolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan, China
| | - Liang Yu
- Department of Otorhinolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan, China
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Stępiński MJ, Banaszewski J. Intranasal Synechiae as Complications of Rhinosurgical Treatment-A Review of Current Knowledge. J Clin Med 2023; 12:6831. [PMID: 37959296 PMCID: PMC10648208 DOI: 10.3390/jcm12216831] [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: 09/06/2023] [Revised: 10/26/2023] [Accepted: 10/28/2023] [Indexed: 11/15/2023] Open
Abstract
Intranasal adhesions (synechiae) develop as a result of improper healing of the nasal mucosa. Their incidence ranges from 6.8% to 36% of rhinosurgical procedures. The aim of this study was to review the available publications and monographs dealing with intranasal adhesions-both in the context of formation and risk factors. The study used a review of the literature to determine the articles and studies available in the following medical databases: MEDLINE (National Library of Medicine's), PubMed, and Google Scholar. The following search terms were used: synechiae nasal + synechial nasal + intranasal adhesions + nasal adhesions. The time criterion of available materials was not applied. Available filters in the search engines were used to narrow down the search results. Artificial intelligence was not applied. The review indicated that the risk of intranasal adhesions correlates with the type of surgery, the surgical technique, the dressing materials, and wound care in the postoperative period. Every case requires an individualized approach. Nasal septum separators, (self-)dissolving dressings and (in selected cases) Mitomycin C were investigated thoroughly. Further studies are required which may result in a universal classification system for intranasal adhesions.
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Affiliation(s)
- Mateusz J. Stępiński
- Department of Laryngology with Maxillofacial Surgery Subdepartment, Multidisciplinary Regional Hospital, Dekerta 1, 66-400 Gorzow Wielkopolski, Poland
| | - Jacek Banaszewski
- Department of Otolaryngology and Laryngological Oncology, Poznan University of Medical Sciences, Przybyszewskiego 49, 60-355 Poznan, Poland
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Vinciguerra A, Verillaud B, Chatelet F, Attalah S, Le Clerc N, Herman P. Endonasal Lacrimal Transposition to Expand Pre-Lacrimal Medial Maxillectomy Approach. Laryngoscope 2023; 133:2090-2094. [PMID: 36477442 DOI: 10.1002/lary.30493] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 07/18/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 08/11/2023]
Abstract
EPLA lacrimal transposition facilitates management of maxillary sinus/pterygopalatine fossa lesions and overcomes limitations such as the Simmen type I recess or IPMS pedicled on the medial wall, without increasing peri-operative morbidity. Laryngoscope, 133:2090-2094, 2023.
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Affiliation(s)
| | - Benjamin Verillaud
- Otorhinolaryngology and Skull Base Center, AP-HP, Hospital Lariboisière, Paris, France
- Université Paris Cité, Paris, France
- Inserm U1141, Paris, France
| | - Florian Chatelet
- Otorhinolaryngology and Skull Base Center, AP-HP, Hospital Lariboisière, Paris, France
| | - Sara Attalah
- Otorhinolaryngology and Skull Base Center, AP-HP, Hospital Lariboisière, Paris, France
| | - Nicolas Le Clerc
- Otorhinolaryngology and Skull Base Center, AP-HP, Hospital Lariboisière, Paris, France
| | - Philippe Herman
- Otorhinolaryngology and Skull Base Center, AP-HP, Hospital Lariboisière, Paris, France
- Université Paris Cité, Paris, France
- Inserm U1141, Paris, France
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Abstract
OBJECTIVES In this study, we investigated the effect of functional endoscopic sinus surgery (FESS) on gustatory function in patients with chronic rhinosinusitis (CRS). METHODS Forty-three patients with CRS who underwent FESS were included in this study. Prior to FESS and 3 months after surgery, the severity of rhinosinusitis was assessed using the Taiwanese version of the 22-item SNOT (SNOT-22), endoscopic examination, and acoustic rhinometry. The olfactory function was evaluated using the phenylethyl alcohol odor detection threshold test and the traditional Chinese version of the University of Pennsylvania Smell Identification Test, and the gustatory function was evaluated using the whole mouth suprathreshold taste test (WMTT) and the taste quad test (TQT). Subgroup analyses were performed based on CRS phenotypes and endotypes. RESULTS The SNOT-22 significantly improved 3 months after FESS for all patients with CRS. The endoscopic score and olfactory function significantly improved in patients with eosinophilic CRS and in patients with nasal polyps (CRSwNP). The WMTT sweet and bitter scores were significantly lower after FESS in CRSwNP, but the TQT sweet score was significantly higher in patients without nasal polyps. In addition, patients with noneosinophilic CRS had significantly decreased WMTT and salty scores 3 months after FESS. CONCLUSION Our results showed that the effect of FESS on gustatory function of patients with CRS was different with the different testing procedures, the association with nasal polyps, and the underlying inflammatory patterns.
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Affiliation(s)
- Rong-San Jiang
- Department of Medical Research, Taichung Veterans General Hospital, Taichung
- Department of Otolaryngology, Taichung Veterans General Hospital, Taichung
- School of Medicine, Chung Shan Medical University, Taichung
- Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung
| | - Kai-Hsiang Shih
- Department of Otolaryngology, Taichung Veterans General Hospital, Taichung
| | - Kai-Li Liang
- Department of Otolaryngology, Taichung Veterans General Hospital, Taichung
- School of Medicine, Chung Shan Medical University, Taichung
- Faculty of Medicine, National Yang-Ming University, Taipei
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Ghorbani M, Hejazian E, Nikmanzar S, Chavoshi-Nejad M. Traumatic iatrogenic dissecting anterior cerebral artery aneurysms: conservative management as a therapeutic option. Br J Neurosurg 2023; 37:896-898. [PMID: 31983243 DOI: 10.1080/02688697.2020.1713988] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 08/06/2018] [Revised: 12/20/2019] [Accepted: 12/30/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Traumatic iatrogenic intracranial aneurysms (TICAs) are rare, but are important due to their risk of intracranial hemorrhage and complexity of management. METHODS Two adult patients, one with history of chronic sinusitis and nasal cavity polyposis undergoing functional endoscopic sinus surgery (FESS), and second during rhinoplasty, suffered subarachnoid hemorrhage (SAH) due to anterior cerebral artery (ACA) injury during the procedures. RESULTS Two women patients aged 17 and 38 years with SAH after nasal surgery were referred to our institute. Three small dissecting aneurysms were seen involving A2 segment of ACA of two patients. Both were managed conservatively. Follow-up angiography (after 2 months) demonstrated complete occlusion of the aneurysms. There was no rebleeding and the patients had a good outcome at the last follow-up. CONCLUSIONS Conservative management of traumatic iatrogenic dissecting cerebral aneurysms is a reasonable therapeutic option that can lead to favorable angiographic and clinical outcomes.
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Affiliation(s)
- Mohammad Ghorbani
- Division of Vascular and Endovascular Neurosurgery, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ebrahim Hejazian
- Division of Vascular and Endovascular Neurosurgery, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Shahin Nikmanzar
- Division of Vascular and Endovascular Neurosurgery, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Chavoshi-Nejad
- Division of Vascular and Endovascular Neurosurgery, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
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Abstract
BACKGROUND The radiological and surgical anatomy of the frontal sinus should be well-known in all age groups to successfully manage frontal sinus diseases and reduce the risk of complications in sinus surgery. PURPOSE To define frontal sinus and frontal cells according to the International Frontal Sinus Anatomy Classification (IFAC) criteria in pediatrics and adults. MATERIAL AND METHODS A total of 320 frontal recess regions of 160 individuals (80 pediatric, 80 adults) who underwent a computed tomography (CT) scan of the paranasal sinus (PNS) were included in the study. Agger nasi cells, supra agger cells, supra agger frontal cells, suprabullar cells, suprabullar frontal cells, supraorbital ethmoid cells, and frontal septal cells were evaluated in the CT analysis. RESULTS The incidence rates of the investigated cells were determined to be 93.1%, 41.9%, 60.0%, 76.3%, 58.5%, 18.8%, and 0% in the pediatric group, respectively, and 86.3%, 35.0%, 44.4%, 54.4%, 46.9%, 19.4%, and 3.4% in the adult group, respectively. Considering the unilateral and bilateral incidence of the cells, agger nasi cells were highly observed bilaterally in both the pediatric group (89.87%) and the adult group (86.48%). CONCLUSION Our study results show that IFAC can be used as a guide to increase the chance of surgical treatment in the pediatric and adult groups and that the prevalence of frontal cells can be determined radiologically and contributes to the generation of estimations of the prevalence of frontal cells.
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Affiliation(s)
- Ali Köksal
- Department of Radiology, Ankara Bayindir Private Hospital, Ankara, Türkiye
- Department of Radiology, Atılım University, Vocational School of Health Services, Ankara, Türkiye
| | - Berin Tuğtağ Demir
- Departmant of Anatomy, Ankara Medipol University Faculty of Medicine, Ankara, Türkiye
| | - Fatih Çankal
- Departmant of Anatomy, Ankara Medipol University Faculty of Medicine, Ankara, Türkiye
- Departmant of Radiology, Visart Medical Imaging Institution, Ankara, Türkiye
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杜 伟, 赵 闪, 韦 新, 王 剑, 薛 涛, 齐 美, 陈 福. [A prospective study of the effect of functional endoscopic sinus surgery on the recovery of olfactory function in patients with chronic rhinosinusitis with nasal polyposis]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2023; 37:542-549. [PMID: 37549946 PMCID: PMC10570099 DOI: 10.13201/j.issn.2096-7993.2023.07.007] [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] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Indexed: 08/09/2023]
Abstract
Objective:To investigate the efficacy of functional endoscopic sinus surgery(FESS) in the treatment of olfactory dysfunction in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) , at the same time, it provides an evidence for the prognosis evaluation of olfaction and the clinical application of oERPs to evaluate the plasticity of olfaction cortex. Methods:From October 2021 to October 2022, 45 patients with CRSwNP who underwent FESS nine-step standardized treatment in our department were recruited as the research subjects, divided into 22 patients with eosinophilic CRSwNP(ECRS)and 23 patients with non-eosinophilic CRSwNP(nECRS). VAS-olfactory dysfunction (VAS-OD) score, SNOT-22 olfactory score, Sniffin' Sticks test and oERPs collection and processing were performed before the operation. All items were evaluated again 3 months after the operation. Results:VAS-OD and SNOT-22 olfactory score were significantly lower in all CRSwNP patients after the operation than those before the operation[F(1, 43) =357.429, P<0.001; F(1, 43) =185.657, P<0.001], the scores of T, D, I and TDI scores in Sniffin' Sticks test were significantly higher than those before the operation[F(1, 43) =126.302, P<0.001; F(1, 43) =311.301, P<0.001; F(1, 43) =131.401, P<0.001; F(1, 43) =295.885, P<0.001]; The decrease of VAS-OD and SNOT-22 olfactory score in the ECRS group was smaller than that in the nECRS group[F(1, 43) =4.825, P=0.033; F(1, 43) =9.916, P=0.003], T, D and TDI scores were significantly lower in nECRS group than those in nECRS group[F(1, 43) =6.719, P=0.013; F(1, 43) =4.890, P=0.032; F(1, 43) =4.469, P=0.040]; There was a positive correlation between preoperative eosinophil-to-lymphocyte ratio(ELR) and SNOT-22 olfactory score and how much it changes(r=0.455, P=0.002; r=-0.414, P=0.005), a negative correlation between T, TDI score and how much they change respectively(r=-0.431, P=0.003; r=-0.385, P=0.009; r=-0.383, P=0.010; r=-0.316, P=0.035). The latency of P3 was significantly shorter after operation than that before operation in all CRSwNP patients[F(1, 14) =24.840, P<0.001], however, the amplitude has no significant surgical effect. Conclusion:FESS could significantly improve the olfactory function of CRSwNP patients, while changes in plasticity may occur in the olfactory cortex. In addition, the preoperative peripheral blood eosinophil granulocyte level can predict the postoperative olfactory improvement.
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Affiliation(s)
- 伟嘉 杜
- 空军军医大学西京医院耳鼻咽喉头颈外科(西安,710032)Department of Otolaryngology Head and Neck Surgery, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China
| | - 闪光 赵
- 马来亚大学生物医学工程系Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Malaysia
| | - 新 韦
- 西安交通大学Xi'an Jiaotong University
| | - 剑 王
- 空军军医大学西京医院耳鼻咽喉头颈外科(西安,710032)Department of Otolaryngology Head and Neck Surgery, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China
| | - 涛 薛
- 空军军医大学西京医院耳鼻咽喉头颈外科(西安,710032)Department of Otolaryngology Head and Neck Surgery, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China
| | - 美浩 齐
- 空军军医大学西京医院耳鼻咽喉头颈外科(西安,710032)Department of Otolaryngology Head and Neck Surgery, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China
| | - 福权 陈
- 空军军医大学西京医院耳鼻咽喉头颈外科(西安,710032)Department of Otolaryngology Head and Neck Surgery, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China
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S HS, Ramasamy AM, Parameswari A, Kumar Kodali V R, Vakamudi M. Comparison of the Efficacy of Opioid-Free Anesthesia With Conventional Opioid-Based Anesthesia for Nasal Surgeries - A Prospective Randomized Parallel Arm Triple-Blinded Study. Cureus 2023; 15:e42409. [PMID: 37502467 PMCID: PMC10368537 DOI: 10.7759/cureus.42409] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 07/24/2023] [Indexed: 07/29/2023] Open
Abstract
Introduction In the setting of nasal surgeries, the use of opioid-free anesthesia involving the use of dexmedetomidine, and lignocaine is being investigated as a potential alternative to opioids. This combination of drugs provides sympatholysis, pain relief, and sedative properties, thereby aiming at reducing the negative effects commonly associated with opioid usage. The objective of this study is to evaluate and compare the effectiveness of opioid-free anesthesia using dexmedetomidine and lignocaine versus conventional opioid anesthesia with fentanyl for nasal surgeries. The comparison will be based on the primary outcome of postoperative visual analog scale (VAS) scores. Secondary outcomes assessed were the amount of rescue analgesic consumption, intraoperative sevoflurane usage, intraoperative blood loss, hemodynamic stability, postoperative nausea and vomiting (PONV) scores, and postoperative Ramsay Sedation Scores. Methods A triple-blind, prospective, randomized, parallel arm study in which 48 patients planned for elective nasal surgery were allocated randomly to one of two groups. In the study, the population labeled as Group D, comprising 24 participants, received dexmedetomidine at a dosage of 1 mcg.kg-1 via intravenous infusion lasting for a duration of 10 minutes prior to the induction of anesthesia. This was followed by a continuous infusion of 0.6 mcg.kg-1 h-1 throughout the intraoperative period, and intravenous Lignocaine 1.5 mg.kg-1 was administered three minutes prior to induction, subsequently an intraoperative infusion of 1.5 mg.kg-1 h-1. In Group F, consisting of 24 participants, intravenous fentanyl of 2 mcg.kg-1 was administered three minutes before the induction. This was subsequently followed by a fentanyl infusion of 0.5 mcg.kg-1h-1 in the intraoperative period. Results The study findings indicate that Group D had considerably lower postoperative VAS scores from 30 minutes to two hours compared to Group F (p<0.05). The utilization of sevoflurane during the intraoperative period was comparatively reduced in Group D in order to achieve the desired bispectral index (BIS) range of 40-60 (p<0.01). Mean intraoperative blood loss was also lower in Group D (85 ml) compared to Group F (115 ml )(p<0.01). Additionally, Group D had significantly lower rescue analgesic consumption and lower incidence of PONV up to 60 minutes compared to Group F (P-value <0.01). A statistically significant difference was observed between Group D and Group F in terms of lower mean values of both mean arterial pressure (MAP) and heart rate in Group D (p<0.01). The results indicate that the postoperative sedation scores within the first two hours were significantly greater in Group D compared to Group F (p<0.01). Conclusion The usage of opioid-free anesthesia has been found to be superior to a traditional opioid-based approach in various aspects, including the provision of sufficient pain relief after surgery, maintenance of stable hemodynamics during the operation, and reduction in occurrences of postoperative nausea and vomiting.
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Affiliation(s)
- Hariharan S S
- Anesthesiology, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Arul M Ramasamy
- Anesthesiology, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Aruna Parameswari
- Anesthesiology, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Rajesh Kumar Kodali V
- Anesthesiology, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Mahesh Vakamudi
- Anesthesiology, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
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Alromaih SR, Alsayed A, Aloraini NM, Aldajani A, Alrasheed A, Alroqi A, Aloulah M, Alsaleh S. STIMA: Submucosal Temporary Inferior Maxillary Antrostomy: A Cadaveric Controlled Study of a Modification of the Conventional Antrostomy. Ear Nose Throat J 2023:1455613231181713. [PMID: 37648255 DOI: 10.1177/01455613231181713] [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: 09/01/2023] Open
Abstract
Introduction: Inferior meatal antrostomy (IMA) is a safe and easy approach to the maxillary sinus. However, studies have shown disadvantages of conventional IMA, such as disruption of mucociliary transport and injury of the nasolacrimal duct (NLD). Endoscopic middle meatal antrostomy (MMA) has become the standard of care for addressing various maxillary pathologies. It is more functional and physiological but offers limited exposure to certain areas of the maxillary sinus, such as the prelacrimal recess, alveolar recess, and zygomatic recess. We proposed submucosal temporary inferior maxillary antrostomy (STIMA) to improve visualization and accessibility to such difficult-to-access locations. Objectives: To describe our proposed modification, to compare the degree of visualization and ease of accessibility between MMA and STIMA. Methods: This is a descriptive cadaveric study. It was performed on 4 fresh frozen human cadavers, and 8 maxillary sinuses were used to achieve the study's objectives. Different angled rigid nasal endoscopes and suction tubes were used to score the degree of visualization and ease of accessibility between the MMA and STIMA. Result: We demonstrated the superiority of the STIMA over the MMA in the degree of visualization and ease of accessibility in these difficult-to-access locations (P-value was significant, <.05). We did not encounter orbital injury or injury to the NLD in our specimens. Conclusion: STIMA is a relatively easy and safe modification of conventional IMA. It improves the degree of visualization and ease of accessibility to difficult-to-access maxillary sinus locations without the potential complications of conventional IMA.
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Affiliation(s)
- Saud R Alromaih
- Department of Otolaryngology-Head & Neck Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Ahmed Alsayed
- Department of Otolaryngology-Head & Neck Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Nouf M Aloraini
- Department of Otolaryngology-Head & Neck Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Ahmad Aldajani
- Department of Otolaryngology-Head & Neck Surgery, King Saud University, Riyadh, Saudi Arabia
- Department of Otolaryngology-Head & Neck Surgery, University of Jeddah, Jeddah, Saudi Arabia
| | - Abdulaziz Alrasheed
- Department of Otolaryngology-Head & Neck Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Ahmad Alroqi
- Department of Otolaryngology-Head & Neck Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Mohammad Aloulah
- Department of Otolaryngology-Head & Neck Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Saad Alsaleh
- Department of Otolaryngology-Head & Neck Surgery, King Saud University, Riyadh, Saudi Arabia
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Yu AJ, Rice D, Ge M, Wrobel B, Gallagher T, Smith S, Ference E. Unplanned 30-Day ER Visit Rate and Factors Associated With ER Visits After Ambulatory Sinus Surgery. Am J Rhinol Allergy 2023:19458924231174686. [PMID: 37198899 DOI: 10.1177/19458924231174686] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
BACKGROUND Emergency room (ER) visits after surgery can be inconvenient and costly to the patient and the healthcare system. Estimates of the 30-day ER visit rate following ambulatory sinus procedures and their risk factors are largely unknown in the literature. OBJECTIVE To determine the 30-day postoperative ER visit rate following ambulatory sinus procedures and the causes and risk factors associated with ER visits. METHODS This is a retrospective, cohort study using data from the State Ambulatory Surgery and Services Databases (SASD) and the State Emergency Department Databases (SEDD) for California, New York, and Florida in 2019. We identified adult (18 years old) patients with chronic rhinosinusitis who underwent ambulatory sinus procedures from the SASD. Cases were linked to the SEDD to identify ER visits occurring within 30 days after the procedure. Logistic regression models were used to identify patient- and procedure-related risk factors associated with the 30-day postoperative ER visit. RESULTS Among the 23 239 patients, the 30-day postoperative ER visit rate was 3.9%. The most common reason for ER visit was bleeding (32.7%). A total of 56.9% of the ER visits occurred within the first week. In the multivariate analysis, factors associated with ER visits included Medicare (odds ratio [OR] 1.29 [1.09-1.52], P = .003), Medicaid (OR 2.06 [1.69-2.51], P < .001), self-pay/no insurance (OR 1.44 [1.03-2.00], P = .031), chronic kidney disease/end-stage renal disease (OR 1.63 [1.06-2.51], P = .027), chronic pain/opioid use (OR 2.70 [1.02-7.11], P = .045), and a disposition other than home (OR 12.61 [8.34-19.06], P < .001). CONCLUSION The most common reason for ER visit after ambulatory sinus procedures was bleeding. An increased ER visit rate was associated with certain demographic factors and medical comorbidities but not with procedure characteristics. This information can help us identify the patient populations who are at higher risk for ER visits to improve their postoperative recovery.
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Affiliation(s)
- Alison J Yu
- Caruso Department of Otolaryngology Head and Neck Surgery, University of Southern California, Los Angeles, California
| | - Dale Rice
- Caruso Department of Otolaryngology Head and Neck Surgery, University of Southern California, Los Angeles, California
| | - Marshall Ge
- Caruso Department of Otolaryngology Head and Neck Surgery, University of Southern California, Los Angeles, California
| | - Bozena Wrobel
- Caruso Department of Otolaryngology Head and Neck Surgery, University of Southern California, Los Angeles, California
| | - Tyler Gallagher
- Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Stephanie Smith
- Department of Otolaryngology, Northwestern University, Chicago, Illinois
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Brown HJ, Baird AM, Khalife S, Escobedo P, Filip P, Papagiannopoulos P, Gattuso P, Batra P, Tajudeen BA. Histopathological Differences in Adult and Elderly Patients With Chronic Rhinosinusitis. Am J Rhinol Allergy 2023:19458924231172078. [PMID: 37160727 DOI: 10.1177/19458924231172078] [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: 05/11/2023]
Abstract
BACKGROUND Adult and elderly patients with chronic rhinosinusitis (CRS) undergo similar therapeutic management. Few studies have undertaken sinonasal tissue-level comparisons of these groups. This study examines histopathological differences between adults (>18, <65 years) and the elderly (≥65 years) with CRS, with the goal of optimizing medical management. METHODS In a retrospective cohort analysis, demographic factors, comorbidities, and a structured histopathological report of 13 variables were compared across adult and elderly patients with CRS who underwent functional endoscopic sinus surgery. These cohorts of adult and elderly patients included patients with and without nasal polyps (NP). RESULTS Three hundred adult (158 aCRSsNP, 142 aCRSwNP) and 77 elderly (38 eCRSsNP, 39 eCRSwNP) patients were analyzed. Mean age of the adult cohort was 44.4 ± 12.4 years, while that of the elderly cohort was 71.9 ± 5.9 years (P < .001). Significantly more adults compared to elderly individuals demonstrated a positive atopic status (79.7% vs 64.0%, P = .004). Elderly patients exhibited higher rates of comorbid diabetes mellitus than adult patients (21.6% vs 10.3%, P = .009). Adults exhibited more tissue eosinophilia (43.4% vs 28.6%, P = .012) and presence of eosinophil aggregates (25.0% vs 14.3%, P = .029) compared to elderly patients, regardless of NP status. Conversely, the elderly demonstrated significantly more fungal elements (11.7% vs 3.0%, P = .004), and trended toward increased overall inflammation (63.6% vs 55.3%, P = .118) and tissue neutrophilia (35.1% vs 27.3%, P = .117), compared to adults. CONCLUSION Sinonasal tissue of adult and elderly patients with CRS demonstrates clear histopathological differences. Patient comorbidities, in addition to histopathological characterizations, may provide further context for management optimization. LEVEL OF EVIDENCE 2. SHORT SUMMARY Sinonasal tissue samples from adult and elderly patients with CRS demonstrate clear histopathological differences. These patient populations also exhibit unique comorbidities. These distinctions have the potential to inform and optimize management of this condition.
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Affiliation(s)
- Hannah J Brown
- Rush Medical College, Rush University Medical Center, Chicago, IL, USA
| | - Ali M Baird
- Rush Medical College, Rush University Medical Center, Chicago, IL, USA
| | - Sarah Khalife
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Pedro Escobedo
- Rush Medical College, Rush University Medical Center, Chicago, IL, USA
| | - Peter Filip
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Peter Papagiannopoulos
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Paolo Gattuso
- Department of Pathology, Rush University Medical Center, Chicago, IL, USA
| | - Pete Batra
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Bobby A Tajudeen
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, IL, USA
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Khandelwal K, Sen J. A Study of the Effect of Pre-emptive Oral Clonidine on Intraoperative Haemodynamics and Surgical Field Quality During Functional Endoscopic Sinus Surgery Under General Anaesthesia. Cureus 2023; 15:e37918. [PMID: 37223181 PMCID: PMC10202669 DOI: 10.7759/cureus.37918] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 04/21/2023] [Indexed: 05/25/2023] Open
Abstract
Introduction For endoscopic sinus surgery for rhinosinusitis, pre-emptive Alpha 2 agonist clonidine has been used to reduce sympathetic output, which lowers blood pressure and consequently surgical bleeding. The aim of this study was to analyze the effects of oral clonidine premedication in patients undergoing functional endoscopic sinus surgery. Methods This study was performed between December 2020 to November 2022 among two groups of 30 patients each: clonidine (200 μgm oral) and placebo. Parameters were recorded at baseline, 60 mins after administering the drugs, at induction, and at minutes five, 10, 20, 30, 45, 60, 75, 105, and 120. Six-point average category scale for bleeding was studied. IBM SPSS Statistics for Windows, Version 20.0 (Released 2011; IBM Corp., Armonk, New York, United States) was used for statistical analysis, and p < 0.05 was considered significant. Results Demographic criteria were statistically non-significant. Heart rate (HR) and mean arterial pressure (MAP) were statistically non-significant at baseline and the 120th min mark, and were significant at other time intervals. The blood loss grading was less in the clonidine group, and the difference was found to be statistically significant (P < 0.001). Conclusion Pre-emptive oral clonidine 200 mcg 60 min prior to induction was found to reduce surgical bleeding by controlling haemodynamics.
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Affiliation(s)
- Kapil Khandelwal
- Department of Anaesthesia, Jawaharlal Nehru Medical College (Datta Meghe Institute of Higher Education & Research), Wardha, IND
| | - Jayashree Sen
- Department of Anaesthesia, Jawaharlal Nehru Medical College (Datta Meghe Institute of Higher Education & Research), Wardha, IND
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Alrajhi AA, Alghamdi AS, Baali MH, Altowairqi AF, Khan MF, Alharthi AS, Albazee E, Abu-Zaid A. Efficacy of prophylactic pre-operative desmopressin administration during functional endoscopic sinus surgery for chronic rhinosinusitis: A systematic review and meta-analysis of randomised placebo-controlled trials. Clin Otolaryngol 2023; 48:139-150. [PMID: 36536598 DOI: 10.1111/coa.14020] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 06/17/2022] [Revised: 12/03/2022] [Accepted: 12/10/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To examine the efficacy of prophylactic desmopressin versus placebo among patients undergoing functional endoscopic sinus surgery (FESS). DESIGN Systematic review and meta-analysis of randomised controlled trials (RCTs). SETTING The Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, Scopus, and Web of Science databases were screened from inception until 18 March 2022. PARTICIPANTS Patients undergoing FESS. MAIN OUTCOME MEASURES Primary efficacy endpoints comprised intraoperative blood loss, visual clarity, and operation time. Secondary endpoints comprised side effects. The efficacy endpoints were summarised as risk ratio (RR) or mean difference (MD) with 95% confidence interval (CI). RESULTS Five RCTs comprising 380 patients (desmopressin = 191 patients and placebo = 189 patients) were included. Collectively, the included RCTs had an overall low risk of bias. The pooled results showed that the mean intraoperative blood loss (n = 5 RCTs, MD = -37.97 ml, 95% CI [-56.97, -18.96], p < .001), 5-point Boezaart scores (n = 2 RCTs, MD = -.97, 95% CI [-1.21, -.74], p < .001), and 10-point Boezaart scores (n = 2 RCTs, MD = -3.00, 95% CI [-3.61, -2.40], p < .001) were significantly reduced in favour of the desmopressin group compared with the placebo group. Operation time did not significantly differ between both groups (n = 5 RCTs, MD = -3.73 min, 95% CI [-14.65, 7.18], p = .50). No patient in both groups developed symptomatic hyponatremia (n = 3 RCTs, 194 patients) or thromboembolic events (n = 2 RCTs, 150 patients). CONCLUSIONS Among patients undergoing FESS, prophylactic administration of desmopressin does not correlate with significant clinical benefits. Data on safety is limited. Future research may explore the synergistic antihaemorrhagic efficacy and safety of tranexamic acid (TXA) plus desmopressin versus TXA alone among patients undergoing FESS.
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Affiliation(s)
- Abdullah Abdulaziz Alrajhi
- Department of Otolaryngology and Head and Neck Surgery, Al-Noor Specialist Hospital, Makkah, Saudi Arabia
| | - Abdullah Shakhs Alghamdi
- Department of Otolaryngology and Head and Neck Surgery, Al-Hada Armed Forces Hospital, Taif, Saudi Arabia
| | - Mohammed Hassan Baali
- Department of Otolaryngology and Head and Neck Surgery, King Faisal Medical Complex, Taif, Saudi Arabia
| | - Abdulaziz Fahad Altowairqi
- Department of Otolaryngology and Head and Neck Surgery, King Abdulaziz Specialist Hospital, Taif, Saudi Arabia
| | - Meshal Fahad Khan
- Department of Otolaryngology and Head and Neck Surgery, Al-Noor Specialist Hospital, Makkah, Saudi Arabia
| | - Ahmad Saad Alharthi
- Department of Otolaryngology and Head and Neck Surgery, Al-Hada Armed Forces Hospital, Taif, Saudi Arabia
| | - Ebraheem Albazee
- Kuwait Institute for Medical Specializations, Kuwait City, Kuwait
| | - Ahmed Abu-Zaid
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.,College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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Park WB, Xu Z, Lim HC, Kang P. Successful Management of Late Sinus Graft Infection via Functional Endoscopic Sinus Surgery and Press-fit Block Bone Graft: A Case Report. J ORAL IMPLANTOL 2023:490910. [PMID: 36796056 DOI: 10.1563/aaid-joi-d-22-00112] [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: 04/20/2022] [Revised: 09/18/2022] [Accepted: 12/28/2022] [Indexed: 02/18/2023]
Abstract
The purpose of this case report is to feature an interesting case where a staged approach was used to manage a failed implant site which led to a late sinus graft infection and sinusitis with an oroantral fistula, by using functional endoscopic sinus surgery (FESS) and an intraoral press-fit block bone graft technique. Sixteen years ago, a 60-year-old female patient underwent maxillary sinus augmentation (MSA) with three implants placed simultaneously in the right atrophic ridge. However, #3 and #4 implants were removed due to advanced periimplantitis. The patient later developed purulent discharge from the site, headache, and complained of air leakage due to an oroantral fistula (OAF). The patient was referred to anotolaryngologist for functional endoscopic sinus surgery (FESS) to treat the sinusitis. Two months after FESS, the sinus was re-entered. Residual inflammatory tissues and necrotic graft particles in the oroantral fistula site were removed. A block bone harvested from the maxillary tuberosity was press-fitted to the oroantral fistula site and grafted. After four months of grafting, the grafted bone was well incorporated with the surrounding native bone. Two implants were successfully placed in the grafted site with good initial stability. The prosthesis was delivered six months after implant placement. After the two years of follow-up, patient was functioning well without sinus complications. Within limitation of this case report, the staged approach via FESS and intraoral press-fit block bone graft is an effective method that can be used to successfully manage oroantral fistula and vertical defects at the implant site.
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Affiliation(s)
- Won-Bae Park
- UNITED STATES Private Practice in Periodontics and Implant Dentistry, Seoul, Korea
| | - Zixiang Xu
- UNITED STATES Postgraduate Periodontics Resident, Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, Columbia University College of Dental Medicine, New York, NY
| | | | - Philip Kang
- Columbia University Periodontics 630 West 168th Street PH7E-110 UNITED STATES New York New York 10032
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Lee SE, Ghodke AN, Stepp WH, Kong KA, Chaskes M, Quinsey CS, Ebert CS, Thorp BD, Senior BA, Kimple AJ. Sinonasal complications of severe acute respiratory syndrome coronavirus-2: A single center case series. Laryngoscope Investig Otolaryngol 2023; 8:16-24. [PMID: 36846423 PMCID: PMC9948594 DOI: 10.1002/lio2.1006] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/22/2022] [Accepted: 12/29/2022] [Indexed: 01/21/2023] Open
Abstract
Background The emergence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has resulted in an unprecedented global pandemic. Most infected patients are either asymptomatic or have mild upper respiratory infection symptoms. However, life-threatening sequelae have been observed. In this report, we reviewed nine cases of patients with severe complications from sinonasal disease in the setting of acute SARS-CoV-2 infection. Methods IRB approval was obtained prior to study initiation. A retrospective chart review was performed of patients admitted to a tertiary hospital with complex sinonasal symptoms that required otolaryngologic evaluation and management in the setting of concomitant SARS-CoV-2 infection. Results Nine patients, ranging from ages 3 to 71 years, with sinonasal disease and simultaneous SARS-CoV-2 infection were identified. Initial presentations ranged from asymptomatic infection to mild/moderate disease (nasal obstruction, cough) or more severe sequelae including epistaxis, proptosis, or neurologic changes. SARS-CoV-2 tests were positive from one to 12 days after symptom onset, with three patients receiving SARS-CoV-2-directed treatment. Complex disease presentations included bilateral orbital abscesses, suppurative intracranial infection, cavernous sinus thrombosis with epidural abscess, systemic hematogenous spread with abscess development in four distinct anatomic locations, and hemorrhagic benign adenoidal tissue. Eight of nine patients (88.8%) required operative intervention. Patients with abscesses also required prolonged, culture-directed antibiotic courses. Conclusion Though most SARS-CoV-2 infections are asymptomatic and/or self-limited, there is significant morbidity and mortality in patients with severe disease sequela as outlined in our reported cases. This suggests early identification and treatment of sinonasal disease in this patient population is critical to minimizing poor outcomes. Further research on the pathophysiology of these atypical presentations is needed. Level of Evidence 4 (Case Series).
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Affiliation(s)
- Saangyoung E. Lee
- Department of Otolaryngology/Head and Neck SurgeryUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Ameer N. Ghodke
- Department of Otolaryngology/Head and Neck SurgeryUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Wesley H. Stepp
- Department of Otolaryngology/Head and Neck SurgeryUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Keonho A. Kong
- Department of Otolaryngology/Head and Neck SurgeryUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Mark Chaskes
- Department of Otolaryngology/Head and Neck SurgeryUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Carolyn S. Quinsey
- Department of NeurosurgeryUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Charles S. Ebert
- Department of Otolaryngology/Head and Neck SurgeryUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Brian D. Thorp
- Department of Otolaryngology/Head and Neck SurgeryUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Brent A. Senior
- Department of Otolaryngology/Head and Neck SurgeryUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Adam J. Kimple
- Department of Otolaryngology/Head and Neck SurgeryUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
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21
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汪 文, 王 广, 武 天, 孙 占, 王 卫, 李 世. [Curative effect analysis of radical endoscopic sinus surgery for eosinophilic chronic rhinosinusitis with nasal polyps]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2023; 37:20-24. [PMID: 36597363 PMCID: PMC10128354 DOI: 10.13201/j.issn.2096-7993.2023.01.004] [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] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Indexed: 01/05/2023]
Abstract
Objective:To evaluate the efficacy of functional endoscopic sinus surgery(FESS) and radical endoscopic sinus surgery(RESS) in eosinophilic chronic sinusitis with nasal polyps(EosCRSwNP). Methods:A total of 44 patients diagnosed with EosCRSwNP in the Department of Otorhinolaryngology Head and Neck Surgery, Henan Provincial People's Hospital from July 1st, 2020 to August 1st, 2021 were included, the percentage of eosinophils in leukocytes in all patients included was more than 3.05%. The patients were randomly divided into FESS group and RESS group according to random number table. The visual analogue scale (VAS) score, Lund-Kennedy score and sino-nasal outcome test-22 (SNOT-22) were compared between the two groups before operation, 1 month, 3 months, 6 months and 1 year after operation. Results:At 1 year after operation, the scores of the two groups were significantly improved compared with those before operation, and the differences were statistically significant (P<0.01). There were significant differences in nasal endoscopic score, VAS score and SNOT-22 score between the two groups(P=0.01, P=0.03, P=0.03). The recurrence rate of RESS group was 26.09%(6/23) and that of FESS group was 61.90%(13/21), and the difference was statistically significant(P=0.04). Conclusion:Both RESS and FESS can improve nasal symptoms and promote olfactory recovery in EosCRSwNP patients, but RESS has more advantages in reducing recurrence and improving the prognosis of patients.
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Affiliation(s)
- 文华 汪
- 郑州大学人民医院 河南省人民医院耳鼻咽喉头颈外科(郑州,450003)Department of Otorhinolaryngology Head and Neck Surgery, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, 450003, China
| | - 广科 王
- 郑州大学人民医院 河南省人民医院耳鼻咽喉头颈外科(郑州,450003)Department of Otorhinolaryngology Head and Neck Surgery, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, 450003, China
| | - 天义 武
- 郑州大学人民医院 河南省人民医院耳鼻咽喉头颈外科(郑州,450003)Department of Otorhinolaryngology Head and Neck Surgery, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, 450003, China
| | - 占伟 孙
- 郑州大学人民医院 河南省人民医院耳鼻咽喉头颈外科(郑州,450003)Department of Otorhinolaryngology Head and Neck Surgery, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, 450003, China
| | - 卫卫 王
- 郑州大学人民医院 河南省人民医院耳鼻咽喉头颈外科(郑州,450003)Department of Otorhinolaryngology Head and Neck Surgery, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, 450003, China
| | - 世超 李
- 郑州大学人民医院 河南省人民医院耳鼻咽喉头颈外科(郑州,450003)Department of Otorhinolaryngology Head and Neck Surgery, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, 450003, China
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22
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Huang SK, Hsieh CH, Weng MC, Lai JT, Shen PH. Central Compartment Atopic Disease and Its Surgical Outcomes: Olfactory Changes and Technical Notes. Ther Adv Allergy Rhinol 2023; 14:27534030231217423. [PMID: 38053675 PMCID: PMC10695077 DOI: 10.1177/27534030231217423] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
Background Central compartment atopic disease (CCAD) is a recent, novel phenotype of chronic rhinosinusitis. Only a few studies have assessed olfactory function in patients with CCAD. Objectives We aimed to investigate olfactory function changes after functional endoscopic sinus surgery (FESS) in patients with CCAD and proposed some surgical techniques to enhance the postoperative olfactory outcomes in such patients. Design A retrospective cohort study. Methods We collected data from 23 patients (8 men and 15 women) with CCAD who underwent FESS performed by a surgeon in Taiwan, between June 2018 and December 2021. The demographic data, olfactory function, and serum and tissue eosinophil percentages of the included patients were analyzed. The Top International Biotech Smell Identification Test (TIBSIT; Top International Biotech, Taipei, Taiwan) was used to assess olfactory function. Results Of the 23 patients, most (95%) showed a positive reaction to aeroallergens, and 2 patients (8.7%) had asthma. Ten patients (43.5%) had peripheral eosinophilia, and 9 (39%) had eosinophilic nasal polyps. Moreover, the patients presented with variable olfactory dysfunction; the mean preoperative TIBSIT (pr-TIBSIT) score was 12.8 ± 2.3 (range: 0-43), whereas the mean postoperative TIBSIT (po-TIBSIT) score was 29.2 ± 1.9 (range: 16-44). The po-TIBSIT score was significantly better than the pre-TIBSIT score (paired t test, P < .0001). The improvement in olfactory function was not significantly correlated with the patients' age, serum eosinophil percentages, and nasal polyp eosinophil counts. Conclusion Our findings indicate that CCAD is significantly associated with olfactory dysfunction and that FESS can effectively improve olfactory function. To optimize postoperative olfactory outcomes, precise removal of polyps from the olfactory cleft without damaging the neuroepithelium is recommended. Our study provides valuable insights into the management of CCAD patients undergoing FESS and can guide surgical decision-making to achieve optimal olfactory function outcomes.
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Affiliation(s)
| | | | | | | | - Ping-Hung Shen
- Department of Otolaryngology, Kuang-Tien General Hospital, Taichung, Taiwan
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23
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Park WB, Yoon H, Han JY, Kang P, Lim HC. Endodontic sealer-induced maxillary sinusitis: intraoral surgical approach and implant placement at a site of failed nasal endoscopic surgeries. J ORAL IMPLANTOL 2022; 49:489038. [PMID: 36473179 DOI: 10.1563/aaid-joi-d-21-00266] [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: 09/14/2021] [Revised: 04/21/2022] [Accepted: 07/12/2022] [Indexed: 02/17/2024]
Abstract
A 28-year-old male patient was referred from an otorhinolaryngologist for managing unilateral chronic maxillary sinusitis (MS). The patient had undergone two functional endoscopic sinus surgeries (FESS), although the MS was not resolved. Based on his dental history, endodontic treatment had been done on the symptomatic area. A leak of endodontic sealer and peri-apical lesion on tooth #14 was found on cone-beam computed tomographic examination. Extraction of tooth #14 and the modified Caldwell-Luc operation were performed to remove the endodontic sealer material and relevant inflammatory tissue. The sinus membrane lining was maintained as much as possible during the surgery. Implant placement was performed on the tooth extraction site. All clinical symptoms disappeared after the surgery. Radiographic and endoscopic examination revealed successful osseointegration of the implant and complete resolution of the MS. FESS alone may not be sufficient to treat MS derived from dental origin. For unilateral MS, dental history should be carefully checked.
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Affiliation(s)
| | | | | | | | - Hyun-Chang Lim
- Kyung Hee University Medical Center Periodeontology Kyungheedae-ro 23 KOREA, REPUBLIC OF Dongdaemun-gu Seoul 02447
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24
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Nasrollahi T, Borrelli M, Raskin J, Wrobel BB. A Case of Mediastinal Emphysema Following Functional Endoscopic Sinus Surgery. Ear Nose Throat J 2022; 101:44S-46S. [PMID: 36148716 DOI: 10.1177/01455613221121492] [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: 11/16/2022] Open
Abstract
Mediastinal emphysema is an extremely rare and potentially fatal complication of endoscopic sinus surgery. The case presented involves a 73-year-old man who developed mediastinal emphysema following endoscopic sinus surgery for severe sinonasal polyposis. We describe the multiple etiologies that may have contributed to his condition including possible microtrauma at the time of intubation or during intubation, microfracture of the orbital wall/lamina papyracea, and severe hiccups.
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Affiliation(s)
- Tasha Nasrollahi
- Sinus Center of Excellence, 22494Cedars-Sinai Sinus Center, Los Angeles, CA, USA.,Sinus Center of Excellence, Cedars-Sinai Division of Otolaryngology, Los Angeles, CA, USA
| | - Michela Borrelli
- Sinus Center of Excellence, 22494Cedars-Sinai Sinus Center, Los Angeles, CA, USA.,Sinus Center of Excellence, Cedars-Sinai Division of Otolaryngology, Los Angeles, CA, USA
| | - Jonathan Raskin
- Sinus Center of Excellence, 22494Cedars-Sinai Sinus Center, Los Angeles, CA, USA.,Sinus Center of Excellence, Cedars-Sinai Division of Otolaryngology, Los Angeles, CA, USA
| | - Bozena B Wrobel
- Sinus Center of Excellence, 22494Cedars-Sinai Sinus Center, Los Angeles, CA, USA.,Sinus Center of Excellence, Cedars-Sinai Division of Otolaryngology, Los Angeles, CA, USA.,USC Caruso Department of Otolaryngology Head and Neck Surgery, 5116University of Southern California, Los Angeles, CA, USA
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25
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Bhalerao PM, Kuttarmare SM, Joshi S, Naik SV. Perioperative Challenges in the Management of Rhino-Orbital Cerebral Mucormycosis: An Observational Study from a Tertiary Care Hospital. Anesth Essays Res 2022; 16:331-335. [PMID: 36620102 PMCID: PMC9814004 DOI: 10.4103/aer.aer_83_22] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/23/2022] [Accepted: 08/29/2022] [Indexed: 12/14/2022] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) pandemic is the biggest threat of the century. Associated with this disease, are a number of rhino orbital cerebral mucormycosis cases seen as post COVID sequelae. Amphotericin B and surgical debridement are the treatment modalities. Aims This study aimed to describe the clinical characteristics and perioperative outcomes of patients with ROCM. Settings and Design This was a prospective, observational study. Materials and Methods We carried out a study of 238 patients with confirmed ROCM posted for functional endoscopic sinus surgery, craniotomies, maxillofacial surgeries, and orbital exenteration under general anesthesia and the perioperative challenges therein. Statistical Analysis Used Data were entered in the excel sheet. Descriptive statistics were used to summarize the data. Analysis was done using the Statistical Package for the Social Sciences (SPSS) version 27:0. Categorical variables were expressed as counts and percentages. Results 78% had diabetes mellitus, 64% had received steroids, 59% had a preoperative oxygen saturation of less than 90%, 86% had a 4-6 zone involvement on chest radiograph, and more than 50% had an anticipated difficult airway. Postsurgery, 13% of patients required intensive care. The 15-day mortality rate was 3% among the operated cases. Conclusion Post-COVID ROCM is challenging in terms of preoperative poor general condition, difficult airway, intraoperative concerns due to pathophysiology of the disease and its effect on organ systems, and the requirement of postoperative vigilant monitoring.
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Affiliation(s)
- Pradnya Milind Bhalerao
- Department of Anaesthesiology, B. J. Medical College and Sassoon General Hospital, Pune, Maharashtra, India
| | - Shital Mahendra Kuttarmare
- Department of Anaesthesiology, B. J. Medical College and Sassoon General Hospital, Pune, Maharashtra, India
| | - Shweta Joshi
- Department of Anaesthesiology, B. J. Medical College and Sassoon General Hospital, Pune, Maharashtra, India
| | - Sanyogita Vijay Naik
- Department of Anaesthesiology, B. J. Medical College and Sassoon General Hospital, Pune, Maharashtra, India
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26
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Lee S, Fernandez J, Mirjalili SA, Kirkpatrick J. Pediatric Paranasal Sinuses- Development, Growth, Pathology & Functional Endoscopic Sinus Surgery. Clin Anat 2022; 35:745-761. [PMID: 35437820 PMCID: PMC9544638 DOI: 10.1002/ca.23888] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/16/2022] [Accepted: 04/17/2022] [Indexed: 11/27/2022]
Abstract
The paranasal sinuses (maxillary, frontal, ethmoid, and sphenoid sinuses) are complex anatomical structures. The development and growth of these have been investigated utilizing a number of different methods ranging from cadaveric analysis to modern cross sectional imaging with 3D modeling. An understanding of normal pediatric paranasal sinus embryology and development enables us to better determine when pathology may be affecting the normal developmental process. Cystic fibrosis, chronic sinusitis, deviated nasal septum and cleft lip and palate are some of the conditions which have been shown to effect paranasal sinus development to varying degrees. Functional endoscopic sinus surgery (FESS) is becoming increasingly common and an understanding of sinus anatomy together with when periods of rapid growth occur during childhood is important clinically. Although concerns have been raised regarding the impact of FESS on facial growth, there is limited evidence of this in regards to either changes in anthropomorphic measurements or clinical assessments of symmetry post operatively.
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Affiliation(s)
- Sophie Lee
- Department of Anatomy and Medical Imaging, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Justin Fernandez
- Auckland Bioengineering Institute, University of Auckland, New Zealand
| | - S Ali Mirjalili
- Department of Anatomy and Medical Imaging, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Joshua Kirkpatrick
- Department of Anatomy and Medical Imaging, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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27
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Shi LL, Xiong P, Zhen HT. Management Strategies of Fibrous Dysplasia Involving the Paranasal Sinus and the Adjacent Skull Base. Ear Nose Throat J 2022:1455613221088728. [PMID: 35418265 DOI: 10.1177/01455613221088728] [Citation(s) in RCA: 1] [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] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Current management of fibrous dysplasia (FD) involving the paranasal sinuses and the adjacent skull base is currently controversial. This study aims to present our experience in the management strategy of FD that involves the paranasal sinuses and the adjacent skull base. METHODS Twenty three patients from 2006 to 2019 with monostotic fibrous dysplasia (MFD), polyostotic fibrous dysplasia (PFD), or McCune-Albright syndrome (MAS) involving the paranasal sinuses and the adjacent skull base were retrospectively reviewed. This study series was divided into 3 groups based on management strategies: the observation group, the surgery group, and the optic nerve decompression group. RESULTS The observation group included 9 patients with asymptomatic MFD with stable condition during the follow-up period of 15 to 164 months. The surgery group included 10 symptomatic patients with MFD who had personalized endoscopic endonasal surgery. The symptoms of the patients were relieved after surgery. The optic nerve decompression group included 4 patients with visual loss, who underwent endonasal endoscopic optic nerve decompression (EOND) with the aid of image-guided navigation. Their vision improved after surgery. CONCLUSIONS Clinical observation and periodic computed tomography (CT) scan are adopted for asymptomatic patients. Surgery is indicated in symptomatic patients. Optic nerve decompression is recommended as soon as possible if the patient has visual loss, whereas prophylactic decompression is not recommended if the optic nerve is encroached by FD without visual loss. Navigation plays an important role in endoscopic surgery involving the paranasal sinuses and the adjacent skull base, especially in FD resection and optic nerve decompression.
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Affiliation(s)
- Li-Li Shi
- Department of Otolaryngology-Head and Neck Surgery, 66375Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
| | - Peng Xiong
- Department of Pediatrics, 66375Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Hong-Tao Zhen
- Department of Otolaryngology-Head and Neck Surgery, 66375Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
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28
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Conley W, Cox RE, Robey T. Rhinocerebral Mucormycosis Associated With Anterior Skull Base Actinomyces Osteomyelitis in a Pediatric Patient With Type 1 Diabetes. Cureus 2022; 14:e24311. [PMID: 35607550 PMCID: PMC9123382 DOI: 10.7759/cureus.24311] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2022] [Indexed: 11/05/2022] Open
Abstract
Rhino-orbital-cerebral mucormycosis (ROCM) is a fulminant, often fatal, angioinvasive fungal infection commonly transmitted through inhalation of fungal spores and traumatic inoculation. While the literature has documented rare cases of infection in immunocompetent patients, the vast majority of case fatalities are noted in immunosuppressed populations. Common predisposing factors to infection include immunosuppressive therapies, hematologic malignancies, and most notably, uncontrolled diabetes. Actinomycosis is a subacute to chronic bacterial infection stemming from non-spore-forming anaerobic/microaerophilic bacteria of the genus Actinomyces. Infection with Actinomyces species has been documented across numerous anatomical sites; however, literature on concurrent infection with ROCM in pediatric patients is sparse. We document a case of a 17-year-old male with uncontrolled type 1 diabetes who presented to the emergency department with combined ROCM and actinomycotic infection of his anterior skull base.
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Affiliation(s)
- William Conley
- Department of Otolaryngology-Head and Neck Surgery, Medical College of Wisconsin, Milwaukee, USA
| | - Ronald E Cox
- Department of Otolaryngology-Head and Neck Surgery, Medical College of Wisconsin, Milwaukee, USA
| | - Thomas Robey
- Department of Otolaryngology-Head and Neck Surgery, Medical College of Wisconsin, Milwaukee, USA
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29
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Shih LC, Hsieh BH, Ma JH, Huang SS, Tsou YA, Lin CD, Huang KH, Tai CJ. A comparison of central compartment atopic disease and lateral dominant nasal polyps. Int Forum Allergy Rhinol 2022; 12:1387-1396. [PMID: 35347864 DOI: 10.1002/alr.22996] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 12/16/2021] [Revised: 02/24/2022] [Accepted: 03/07/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND The characteristics and surgical outcomes of central compartment atopic disease (CCAD) vary by region and race. Therefore, we aimed to identify the risk factors, symptom severity, and prognosis of CCAD in the Asian population. METHODS This case-control study recruited patients diagnosed with chronic rhinosinusitis with nasal polyps who underwent functional endoscopic sinus surgery (FESS) at a tertiary hospital in Taiwan. Patients were classified into CCAD and lateral-dominant nasal polyp (LDNP) groups based on endoscopic and computed tomography imaging findings. The demographic data, symptom severity scores, and surgical outcomes of the 2 groups were analyzed. RESULTS Our study included 442 patients (CCAD group: n = 51; LDNP group: n = 391). We found that CCAD was strongly related to both asthma (9.8% vs 3.5%, p = 0.04) and allergic rhinitis symptoms (43.3% vs 26.6%, p = 0.01). Higher eosinophil counts were detected in blood serum (5.8% vs 2.8%, p < 0.01) and histopathologic profiles (57.0 vs 17.3, p < 0.01) among patients with CCAD. Improvements in 22-item Sino-Nasal Outcome Test (SNOT-22) score and mucociliary clearance time (MCT) after surgical intervention revealed that the CCAD group had a better response to FESS (SNOT-22 score: -31.82 vs -22.66, p < 0.01; MCT: -233.06 vs -191.93 seconds, p = 0.03). The revision FESS rate was not different between the 2 groups. CONCLUSION Polyps originating from the central compartment were found to be related to asthma and allergic rhinitis in Taiwanese patients. A higher eosinophil count was suggested in both serum and local nasal tissue from patients with CCAD. FESS serves as an effective treatment for symptom relief in patients with CCAD.
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Affiliation(s)
- Liang-Chun Shih
- Department of Otorhinolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan.,Department of Otorhinolaryngology-Head and Neck Surgery, Asia University Hospital, Taichung, Taiwan.,Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
| | - Bing-Han Hsieh
- Department of Otorhinolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Jia-Hung Ma
- Department of Otorhinolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Shuang-Shuang Huang
- Department of Otorhinolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Yung-An Tsou
- Department of Otorhinolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan.,Department of Otorhinolaryngology-Head and Neck Surgery, Asia University Hospital, Taichung, Taiwan.,School of Medicine, China Medical University, Taichung, Taiwan
| | - Chia-Der Lin
- Department of Otorhinolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan.,Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan.,School of Medicine, China Medical University, Taichung, Taiwan
| | - Kuang-Hua Huang
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - Chih-Jaan Tai
- Department of Otorhinolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, China Medical University, Taichung, Taiwan.,Department of Health Services Administration, China Medical University, Taichung, Taiwan
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30
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Pandrangi VC, Detwiller KY, Geltzeiler M, Mace JC, Farrell NF. Analysis of internet search trends for balloon sinuplasty: A cross-sectional study. Int Forum Allergy Rhinol 2022; 12:1307-1309. [PMID: 35196421 DOI: 10.1002/alr.22989] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 02/01/2022] [Accepted: 02/18/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Vivek C Pandrangi
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Kara Y Detwiller
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Mathew Geltzeiler
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Jess C Mace
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Nyssa Fox Farrell
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
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31
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Pavlov VE, Polushin YS, Kolotilov LV, Karpishchenko SA. [Beta-blockers for reducing intraoperative bleeding during rhinosinusosurgical operations in elderly and senile patients.]. Adv Gerontol 2022; 35:510-517. [PMID: 36401859] [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] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
With the ineffectiveness of conservative therapy of chronic rhinosinusitis in all age groups of patients, functional rhinosinusosurgical endoscopic interventions are now often used to do. The minimal bleeding is a necessary condition for their realization. There are reports of the use of beta-blockers for reducing surgical bleeding, but the possibility of their intravenous use in older patients has not been sufficiently studied. The aim of the work was to evaluate the effectiveness of intravenous metoprolol to reduce the bleeding intensity (BI) during rhinosinusosurgical interventions under general anesthesia in elderly and senile patients. The BI was assessed on the Fromme-Boezaart Score scale at different stages of the operation from the 10th to the 60th minute in two groups of patients: without (WM) and using metoprolol (M). It was shown that at the 30th minute of the operation BI was significantly lower in M group. Multivariate analysis of hemodynamic parameters demonstrated a direct relationship between heart rate (HR) and the development of bleeding. In the WM group, the probability of significant bleeding was 8,6 times higher. It has been shown that intraoperative intravenous use of metoprolol reduces the intensity of local bleeding during endoscopic rhinosinusosurgical operations.
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Affiliation(s)
- V E Pavlov
- I.P.Pavlov First Saint-Petersburg State Medical University, 6-8 Lev Tolstoy str., St. Petersburg 197022, Russian Federation, e-mail:
| | - Y S Polushin
- I.P.Pavlov First Saint-Petersburg State Medical University, 6-8 Lev Tolstoy str., St. Petersburg 197022, Russian Federation, e-mail:
| | - L V Kolotilov
- St. Joseph's University, St. Joseph's College of Health and Allied Sciences, Dar es Salaam, Tanzania, e-mail:
| | - S A Karpishchenko
- I.P.Pavlov First Saint-Petersburg State Medical University, 6-8 Lev Tolstoy str., St. Petersburg 197022, Russian Federation, e-mail:
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Liu CW, Cheng PW. Transient Unilateral Lateral Gaze Palsy after Sphenopalatine Ganglion Block. Ear Nose Throat J 2021:1455613211066672. [PMID: 34969295 DOI: 10.1177/01455613211066672] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Chia-Wei Liu
- Department of Otolaryngology Head and Neck Surgery, 46608Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Po-Wen Cheng
- Department of Otolaryngology Head and Neck Surgery, 46608Far Eastern Memorial Hospital, New Taipei, Taiwan
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马 瑞, 郑 国, 鄂 殿, 胡 真, 娄 淼, 佟 振, 王 玉, 郭 刚, 王 波, 张 亚. [Study on changes of nasal resistance based on 3D printing transparent nasal cavity models]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2021; 35:1101-1106. [PMID: 34886624 PMCID: PMC10127642 DOI: 10.13201/j.issn.2096-7993.2021.12.009] [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] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Indexed: 06/13/2023]
Abstract
Objective:To investigate the causal relationship between the minimum cross-sectional area of nasal cavity and nasal resistance. Methods:Thirty transparent detachable 3D printing nasal cavity models were made. The airway was completely blocked with sealing material at different anatomical sections. Then ventilatable nasal drainage tubes with different cross-sectional areas were used to pass through the nasal cavity. Nasal resistance was measured. SPSS was used for statistical analysis. Results:①The postoperative nasal resistances of patients and 3D printing nasal cavity models were (0.38±0.15)Pa· s/mL and (0.39±0.02)Pa· s/mL respectively. There was no statistical difference between the two groups.The preoperative nasal resistance of patients was (0.56±0.09)Pa· s/mL, and the postoperative nasal resistance of the models was significantly descreased by 31% compared with preoperative nasal resistance of the patients, with statistically significant difference(P<0.05). ②When the ventilatable nasal drainage tubes with a cross-sectional area of 3.14 square millimeters was located in the the upper part of common meatus and the nasal valve area, the nasal cavity is moderately blocked, and the nasal resistances were (1.80±0.30) times and (2.02±0.36) times of that before the obstruction respectively. When the ventilatable nasal drainage tube was located in the lower part of common meatus,the nasal resistance was (1.68±0.28) times of that before the obstruction. ③When the ventilatable nasal drainage tubes with a cross-sectional area of 6.28 square millimeters and were located in the lower part of common meatus, the upper part of common meatus and nasal valve area, the nasal resistances were (1.44±0.23) times, (1.50±0.25) times and (1.60±0.27) times of those before obstruction, respectively. ④When the ventilatable nasal drainage tubes with a cross-sectional area of 9.42 square millimeters were located in the above areas, nasal ventilation was nearly normal without obvious nasal obstruction. The nasal resistances were (1.17±0.18) times, (1.26±0.21) times and (1.33±0.24) times of those before obstruction, respectively. ⑤The nasal resistance was statistically significant correlated with the cross-sectional area of the ventilation tubes and the obstruction sites. The correlation coefficients were -0.895 and 0.339, respectively (P<0.05). Conclusion:①3D printing can quickly and accurately replicate anatomical structure of the nasal cavity, and can be used as a research method for quantifitative measurement of nasal resistance. ②The minimum cross-sectional area of nasal cavitiy is the main determinant of nasal resistance. ③The obstruction site is the secondary determinant of nasal resistance. When the degree of nasal obstruction is the same , the nasal resistance in the nasal valve area is sightly higher than that in the common meatus.
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Affiliation(s)
- 瑞萍 马
- 西安交通大学第二附属医院耳鼻咽喉头颈外科(西安,710004)Department of Otolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China
| | - 国玺 郑
- 西安交通大学第二附属医院耳鼻咽喉头颈外科(西安,710004)Department of Otolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China
| | - 殿玉 鄂
- 江西理工大学 江西省颗粒系统仿真与模拟重点实验室Jiangxi University of Science and Technology, Key Laboratory of Jiangxi Provincial Particle System Simulation
| | - 真真 胡
- 西安交通大学第二附属医院耳鼻咽喉头颈外科(西安,710004)Department of Otolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China
| | - 淼 娄
- 西安交通大学第二附属医院耳鼻咽喉头颈外科(西安,710004)Department of Otolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China
| | - 振博 佟
- 东南大学能源与环境学院 能源热转换及其过程测控教育部重点实验室School of Energy and Environment, Southeast University, Key Laboratory of Energy Thermal Conversion and Control of Ministry of Education
| | - 玉升 王
- 西安交通大学第二附属医院耳鼻咽喉头颈外科(西安,710004)Department of Otolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China
| | - 刚 郭
- 东南大学能源与环境学院 能源热转换及其过程测控教育部重点实验室School of Energy and Environment, Southeast University, Key Laboratory of Energy Thermal Conversion and Control of Ministry of Education
| | - 波涛 王
- 西安交通大学第二附属医院耳鼻咽喉头颈外科(西安,710004)Department of Otolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China
| | - 亚 张
- 西安交通大学第二附属医院耳鼻咽喉头颈外科(西安,710004)Department of Otolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China
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Xu Y, Yang W, Song Y, Cheng D, Cao M, Huang J, Ren J, Lee JW, Hueniken K, Chen Y, Brown C, Zhang Y, Qiu K, Xu W, Zhao Y, Liu G. Association of gastro-oesophageal reflux disease and quality of life in patients with chronic rhinosinusitis. Acta Otorhinolaryngol Ital 2021; 41:450-460. [PMID: 34734581 PMCID: PMC8569665 DOI: 10.14639/0392-100x-n1491] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 07/29/2021] [Indexed: 02/08/2023]
Abstract
Objective We determined the influence of gastro-oesophageal reflux disease (GERD) on quality of life (QOL) before and after functional-endoscopic-sinus-surgery (FESS) for chronic rhinosinusitis (CRS). Methods Medically-recalcitrant CRS patients were recruited prior to FESS. GERD was diagnosed endoscopically. QOL was compared between patients with vs without GERD at baseline and one-year post-FESS. Results Of 187 CRS patients receiving FESS, 40 had GERD. Pre-operative QOL was significantly worse in CRS patients with vs without GERD. Pre-operative GERD health-related QOL (GERD-HRQL) and reflux symptom index (RSI) scores were both correlated with pre-operative SNOT-22 scores. Compared with non-GERD CRS patients, GERD patients demonstrated larger SNOT-22 improvements after FESS, such that post-operative SNOT-22 values were no longer significantly different between GERD and non-GERD groups. However, post-FESS, in patients with CRS without nasal polyps (unlike those with nasal polyps), the GERD (vs non-GERD) group suffered from greater sleep dysfunction and otologic/facial symptoms. Conclusions Compared to CRS patients without GERD, those with GERD experienced poorer pre-operative QOL and greater QOL improvement after FESS.
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Affiliation(s)
- Yang Xu
- Department of Otorhinolaryngology Head and Neck Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China.,Medical Oncology and Medical Biophysics, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Wen Yang
- Department of Otorhinolaryngology Head and Neck Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Yao Song
- Department of Otorhinolaryngology Head and Neck Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Danni Cheng
- Department of Otorhinolaryngology Head and Neck Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Min Cao
- General Affairs Office of Logistic Department, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jingyue Huang
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Jianjun Ren
- Department of Otorhinolaryngology Head and Neck Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China.,Medical Oncology and Medical Biophysics, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jong Wook Lee
- Department of Otolaryngology Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Katrina Hueniken
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Yao Chen
- Department of Gastroenterology, Chengdu First People's Hospital, Chengdu, Sichuan, China
| | - Catherine Brown
- Medical Oncology and Medical Biophysics, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Yuke Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Ke Qiu
- Department of Otorhinolaryngology Head and Neck Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Wei Xu
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Yu Zhao
- Department of Otorhinolaryngology Head and Neck Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Geoffrey Liu
- Medical Oncology and Medical Biophysics, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada.,Medicine and Epidemiology Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Becker S, Gonser P, Haas M, Sailer M, Froelich MF, Betz C, Löwenheim H, Hirt B, Sommer WH, Holderried M, Ernst BP. ENT Residents Benefit from a Structured Operation Planning Approach in the Training of Functional Endoscopic Sinus Surgery. Medicina (Kaunas) 2021; 57:1062. [PMID: 34684099 DOI: 10.3390/medicina57101062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 09/22/2021] [Accepted: 10/02/2021] [Indexed: 01/11/2023]
Abstract
Background and Objectives: Preoperative planning utilizing computed tomographies (CT) is of utmost importance in functional endoscopic sinus surgery (FESS). Frequently, no uniform documentation and planning structures are available to residents in training. Consequently, overall completeness and quality of operation planning may vary greatly. The objective of the present study was to evaluate the impact of a structured operation planning (SOP) approach on the report quality and user convenience during a 4-day sinus surgery course. Materials and Methods: Fifteen participant were requested to plan a FESS procedure based on a CT scan of the paranasal sinuses that exhibited common pathological features, in a conventional manner, using a free text. Afterwards, the participants reevaluated the same scans by means of a specifically designed structured reporting template. Two experienced ENT surgeons assessed the collected conventional operation planning (COP) and SOP methods independently with regard to time requirements, overall quality, and legibility. User convenience data were collected by utilizing visual analogue scales. Results: A significantly greater time expenditure was associated with SOPs (183 s vs. 297 s, p = 0.0003). Yet, legibility (100% vs. 72%, p < 0.0001) and overall completeness (61.3% vs. 22.7%, p < 0.0001) of SOPs was significantly superior to COPs. Additionally, description of highly relevant variants in anatomy and pathologies were outlined in greater detail. User convenience data delineated a significant preference for SOPs (VAS 7.9 vs. 6.9, p = 0.0185). Conclusions: CT-based planning of FESS procedures by residents in training using a structured approach is more time-consuming while producing a superior report quality in terms of detailedness and readability. Consequently, SOP can be considered as a valuable tool in the process of preoperative evaluations, especially within residency.
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Zhang L, Yu Y, Xue J, Lei W, Huang Y, Li Y, Sun J. Effect of Deliberate Hypotension on Regional Cerebral Oxygen Saturation During Functional Endoscopic Sinus Surgery: A Randomized Controlled Trial. Front Surg 2021; 8:681471. [PMID: 34568412 PMCID: PMC8456080 DOI: 10.3389/fsurg.2021.681471] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 08/10/2021] [Indexed: 01/13/2023] Open
Abstract
Background: Deliberate hypotension can reduce bleeding and improve visualization of the surgical field during functional endoscopic sinus surgery (FESS). However, hypotension may cause brain hypoperfusion and subsequent ischemic injuries, such as delayed awakening, stroke, postoperative delirium, and postoperative cognitive dysfunction. Near-infrared spectroscopy (NIRS) can be used to monitor real-time regional cerebral oxygen saturation (rSO2) levels to estimate brain perfusion. The present study aimed to evaluate the change in rSO2 induced by deliberate hypotension during FESS, and assess the impact of deliberate hypotension on the surgical process. Material and Methods: A randomized controlled trial was registered with the Chinese clinical trial registry (ChiCTR2000039846). A total of 40 patients were enrolled and randomly divided into the control and intervention groups, and finally, 39 patients were analyzed. Deliberate hypotension was induced in the intervention group using nicardipine and esmolol, whereas the control group received general anesthesia without deliberate hypotension. We recorded mean arterial pressure (MAP), saturation of pulse oximetry (SpO2), rSO2, and heart rate (HR) before induction of anesthesia (T0), immediately after induction of anesthesia (T1), at the beginning of the operation (corresponding with the establishment of deliberate hypotension) (T2), 10 min (T3) and 20 min (T4) after the operation began, at the end of the operation (corresponding with the end of deliberate hypotension) (T5), and 5 min (T6) and 15 min (T7) after the operation. The partial pressure of end-tidal carbon dioxide (PetCO2) was recorded at T1, T2, T3, T4, T5, and T6. The duration of surgery, intraoperative blood loss, tracheal extubation time, and the number of patients that experienced cerebral desaturation events (CDEs) were recorded. The surgical field was estimated postoperation based on the Fromme score. Results: A 30% decrease from the baseline MAP resulted in a decrease of intraoperative bleeding, improvement in the quality of the surgical field, and the shortening of the duration of surgery during FESS in the intervention group compared with the control group. In addition, rSO2 was reduced and no CDEs were experienced in the intervention group. Linear regression analysis demonstrated a correlation between the decline in rSO2 and that in MAP. Conclusions: A decrease in MAP to a certain level will cause a decrease of rSO2 in patients undergoing FESS under general anesthesia. Based on our findings, we recommend that the deliberate hypotensive target indicated by MAP be reduced by 30%, while PetCO2 is maintained at 35–40 mmHg and HR is maintained at about 60 beats per minute during FESS.
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Affiliation(s)
- Ling Zhang
- The Fourth Clinical Medical College, Zhejiang Chinese Medical University School of Medicine, Hangzhou, China
| | - Yang Yu
- The Fourth Clinical Medical College, Zhejiang Chinese Medical University School of Medicine, Hangzhou, China
| | - Juan Xue
- The Fourth Clinical Medical College, Zhejiang Chinese Medical University School of Medicine, Hangzhou, China
| | - Weiping Lei
- Department of Anesthesia, Hangzhou First People's Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou, China
| | - Yaqin Huang
- Department of Anesthesia, Hangzhou First People's Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou, China
| | - Yong Li
- Department of Anesthesia, Hangzhou First People's Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou, China
| | - Jianliang Sun
- The Fourth Clinical Medical College, Zhejiang Chinese Medical University School of Medicine, Hangzhou, China
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Pagella F, Emanuelli E, Benazzo M, Pusateri A, Ugolini S, Melegatti M, Ciorba A, Pelucchi S. Are sinonasal dissection courses a valid instrument for endoscopic sinus surgeons? A report on 7-years of experience. ACTA ACUST UNITED AC 2021; 40:415-420. [PMID: 33558769 PMCID: PMC7889255 DOI: 10.14639/0392-100x-n0705] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 05/30/2020] [Indexed: 11/23/2022]
Abstract
Sinonasal dissection courses have been reported to be effective in teaching sinonasal anatomy to trainees, and in improving surgical skills for trained surgeons. Between 2013 and 2019, a standardised structured questionnaire was handed out to 130 participants of 8 sinonasal dissection courses. Each questionnaire included questions about the medical equipment the surgeons were fitted, and the problems encountered during the dissection.The majority of the participants, regardless of their experience and age, considered uncinectomy and anterior ethmoidectomy as the simplest parts of the dissection, whereas the most complicated step was the approach to the frontal sinus. All participants considered the dissection course as a useful way to improve their medical skills while performing an endoscopic surgery procedure, such as their anatomical knowledge, and confidence with instrumentation and the dissection. Sinonasal dissection courses can be considered to be useful for both trainees and trained surgeons. Improving anatomical knowledge can reduce the occurrence of complications, especially in endoscopic surgery.
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Affiliation(s)
- Fabio Pagella
- ENT Department, I.R.C.C.S. Policlinico San Matteo-University of Pavia, Italy.,ENT Department, University of Pavia, Italy
| | - Enzo Emanuelli
- Department of Neuroscience, Institute of Otorhinolaryngology, University Hospital of Padova, Italy
| | - Marco Benazzo
- ENT Department, I.R.C.C.S. Policlinico San Matteo-University of Pavia, Italy.,ENT Department, University of Pavia, Italy
| | - Alessandro Pusateri
- ENT and Skull-Base Surgery Department, Department of Neurosciences, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Sara Ugolini
- ENT Department, I.R.C.C.S. Policlinico San Matteo-University of Pavia, Italy.,ENT Department, University of Pavia, Italy
| | - Michela Melegatti
- ENT & Audiology Unit, Department of Neuroscience and Rehabilitation, University Hospital of Ferrara, Italy
| | - Andrea Ciorba
- ENT & Audiology Unit, Department of Neuroscience and Rehabilitation, University Hospital of Ferrara, Italy
| | - Stefano Pelucchi
- ENT & Audiology Unit, Department of Neuroscience and Rehabilitation, University Hospital of Ferrara, Italy
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Park WB, Kim YJ, Park JS, Han JY, Lim HC. Complication and Salvage of Sinus Floor Elevation in the Maxillary Sinus With Asymptomatic and Noncalcified Fungus Colonization: A Case Report. J ORAL IMPLANTOL 2021; 47:242-248. [PMID: 32663302 DOI: 10.1563/aaid-joi-d-20-00127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/22/2022]
Abstract
The present study aimed to report (1) the sequela of sinus floor elevation (SFE) in the posterior maxilla with severe sinus membrane thickening and an undiagnosed fungal colonization but a patent ostium and (2) a treatment course without implant removal. A 73-year-old woman underwent dental implant placement in the left posterior maxillary area. Although the patient was asymptomatic, severe sinus membrane thickening with Haller cells was observed on a radiographic examination, but the ostium was patent. After SFE and simultaneous implant placement, the patient developed acute sinusitis and was referred to an otolaryngologist. Functional endoscopic sinus surgery (FESS) was performed, resulting in resolution of the infection and salvage of the augmentation and the implant. The histopathologic examination revealed the fungal ball that could not be diagnosed on preoperative dental radiography. During the 2 years after the delivery of the final prosthesis, a significant reduction in membrane thickness was observed. The implants were functioning well. Clinicians should recognize fungal colonization as an etiology of sinus membrane thickening and provide proper pre- and postoperative management, including FESS.
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Affiliation(s)
- Won-Bae Park
- Department of Periodontology, School of Dentistry, Kyung Hee University, Private Practice in Periodontics and Implant Dentistry, Seoul, Korea
| | - Young-Jin Kim
- Nowon Eulji Medical Center, Eulji University, Private Practice in Otorhinolaryngology Clinic, Seoul, Korea
| | - Jung Soo Park
- Department of Periodontology, Korea University Anam Hospital, Seoul, Korea
| | - Ji-Young Han
- Department of Periodontology, Division of Dentistry, Hanyang University, College of Medicine, Seoul, Korea
| | - Hyun-Chang Lim
- Department of Periodontology, Periodontal-Implant Clinical Research Institute, School of Dentistry, Kyung Hee University, Seoul, Republic of Korea
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Tsai T, Shih LC, Lee IT, Ng TY, Wang JY, Hsu CL, Bau DAT, Tai CJ. Older Age Is Associated With Better Compliance With Follow-up in Taiwan After Functional Endoscopic Sinus Surgery. In Vivo 2021; 34:2571-2576. [PMID: 32871786 DOI: 10.21873/invivo.12074] [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] [Received: 05/28/2020] [Revised: 06/25/2020] [Accepted: 06/27/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND/AIM Functional endoscopic sinus surgery (FESS) is frequently conducted for restoring sinus ventilation and function. Postoperative care is critical for success. However, loss to follow-up is disturbing. The specific aim of this study was to identify critical factors contributing to loss of patients to follow-up and how to improve it. PATIENTS AND METHODS A total of 221 patients with chronic rhinosinusitis undergoing FESS were enrolled. Patients were divided into three groups according to their follow-up after surgery: Less than 1 month (short-term), 1-3 months (medium-term) and more than 3 months (long-term). The gender, age, smoking status, comorbidities, laterality, Lund-Mackay score, 22-question Sinonasal Outcome Test, nasal obstruction Visual Analogue Scale and mucociliary clearance were evaluated for their contribution to better compliance in follow-up. RESULTS The results revealed that older patients had better compliance in follow-up compared with younger ones (p=0.0093). Other factors were not contributory (p>0.05). CONCLUSION In contrast to the US, older patients in Taiwan have better compliance in postoperative follow-up, while younger ones require more education on the importance of follow-up.
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Affiliation(s)
- Tammy Tsai
- Department of Otorhinolaryngology, China Medical University Hospital, Taichung, Taiwan, R.O.C
| | - Liang-Chun Shih
- Department of Otorhinolaryngology, China Medical University Hospital, Taichung, Taiwan, R.O.C.,Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan, R.O.C
| | - Ivan T Lee
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, U.S.A
| | - Teik-Ying Ng
- Department of Otorhinolaryngology, China Medical University Hospital, Taichung, Taiwan, R.O.C.,School of Medicine, China Medical University, Taichung, Taiwan, R.O.C
| | - Jong-Yi Wang
- Department of Health Services Administration, China Medical University, Taichung, Taiwan, R.O.C
| | - Che-Lun Hsu
- Department of Otorhinolaryngology, China Medical University Hospital, Taichung, Taiwan, R.O.C
| | - DA-Tian Bau
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan, R.O.C. .,Terry Fox Cancer Research Laboratory, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan, R.O.C.,Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan, R.O.C
| | - Chih-Jaan Tai
- Department of Otorhinolaryngology, China Medical University Hospital, Taichung, Taiwan, R.O.C. .,School of Medicine, China Medical University, Taichung, Taiwan, R.O.C.,Department of Health Services Administration, China Medical University, Taichung, Taiwan, R.O.C
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Witkowska A, Szczygielski K, Jurkiewicz D. Endoscopic medial maxillectomy in patients treated at the Otorhinolaryngology and Laryngological Oncology Clinic of Military Institute of Medicine in Warsaw in the years 2008-2018. Otolaryngol Pol 2021; 74:25-30. [PMID: 32636346 DOI: 10.5604/01.3001.0014.0867] [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: 11/13/2022]
Abstract
<b>Introduction:</b> Endoscopic medial maxillectomy (EMM) refers to surgical resection of the medial wall of the maxillary antrum. The primary indications for EMM are recalcitrant maxillary sinusitis, ablation of malignant and specific benign diagnoses such as Schneiderian Papilloma. Maxillectomy is potentially complicated by injuries to the orbital contents, lacrimal apparatus, optic nerve, ethmoidal arteries that may be accompanied by brisk bleeding. <br><b>Aim:</b> The purpose of this paper is to conduct a retrospective analysis of patients treated with EMM surgery at the Otorhinolaryngology and Laryngological Oncology Clinic of Military Institute of Medicine in Warsaw in the years 2008-2018. <br><b>Material and methods:</b> The retrospective analysis was conducted on patients who underwent EMM treated at the the Otorhinolaryngology and Laryngological Oncology Clinic of Military Institute of Medicine in Warsaw in the years 2008-2018. The research included 18 patients aged 15-94; 8 women and 10 men. <br><b>Results:</b> Out of 18 patients, 8 had been operated before EMM. 16 of them presented with histological examinations, though 5 of which were not confirmed with postoperative histological result. The most common indication for the operation was inverted papilloma. <br><b>Conclusion:</b> Endoscopic surgical approach is effective and precious way to manage tumors which involve the neighboring structures especially medial maxillary sinus. EMM itself is a safe surgical method in managing maxillary sinus disorders and is favored for its decreased invasiveness and avoidance of the deformity of face.
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Affiliation(s)
- Agnieszka Witkowska
- Wojskowy Instytut Medyczny, Klinika Otorynolaryngologii i Laryngologii Onkologicznej z z Klinicznym Oddziałem Chirurgii Czaszkowo-Szczękowo-Twarzowej, Warszawa
| | - Kornel Szczygielski
- Wojskowy Instytut Medyczny, Klinika Otorynolaryngologii i Laryngologii Onkologicznej z z Klinicznym Oddziałem Chirurgii Czaszkowo-Szczękowo-Twarzowej, Warszawa
| | - Dariusz Jurkiewicz
- Wojskowy Instytut Medyczny, Klinika Otorynolaryngologii i Laryngologii Onkologicznej z z Klinicznym Oddziałem Chirurgii Czaszkowo-Szczękowo-Twarzowej, Warszawa
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Mahajan L, Singh AP, Chawla S, Gill S. Premedication for Induced Hypotension in Functional Endoscopic Sinus Surgeries: Intravenous Dexmedetomidine Infusion vs Oral Metoprolol vs Placebo: A Comparative Study. Anesth Essays Res 2021; 14:578-583. [PMID: 34349323 PMCID: PMC8294423 DOI: 10.4103/aer.aer_19_21] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 02/15/2021] [Accepted: 03/01/2021] [Indexed: 11/09/2022] Open
Abstract
Background: Controlled hypotension has been used to reduce bleeding and the need for blood transfusions and provide a satisfactory bloodless surgical field. In this double-blind, randomized controlled trial, we are comparing intravenous (i.v.) dexmedetomidine infusion and oral metoprolol as a premedication for controlled hypotension in functional endoscopic sinus surgery (FESS) for evaluating surgical field visibility. Subjects and Methods: A total of 90 patients undergoing FESS were randomly divided into three groups of 30 each. Group A received intraoperative i.v. infusion of dexmedetomidine (loading 1 μg.kg−1 over 10 min followed by the maintenance of 0.2–0.5 μg.kg−1.h−1), Group B received oral metoprolol 50 mg on night and 2 h before surgery as a premedication, and Group C was taken as a control group and patients received oral placebo tablet as premedication and intraoperative normal saline infusion. General anesthesia was given using sevoflurane. Intraoperative target mean arterial blood pressure was set 55–65 mmHg. Various parameters were recorded and statistically compared. Results: The three groups were statistically comparable in demographics. Quality of surgical field was better in Group A compared to other two groups. Total blood loss was also less in Group A. The incidence of adverse reactions was more in Group A. Conclusion: Dexmedetomidine provides a better surgical field compared to oral metoprolol in FESS along with the desired hemodynamics with lesser blood loss and better outcome.
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Affiliation(s)
- Lakshmi Mahajan
- Department of Anaesthesiology and Critical Care, SGRD Medical College and Hospital, Amritsar, Punjab, India
| | - Arvinder Pal Singh
- Department of Anaesthesiology and Critical Care, SGRD Medical College and Hospital, Amritsar, Punjab, India
| | - Sunil Chawla
- Department of Anaesthesiology and Critical Care, SGRD Medical College and Hospital, Amritsar, Punjab, India
| | - Sukhman Gill
- Department of Anaesthesiology and Critical Care, SGRD Medical College and Hospital, Amritsar, Punjab, India
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Karpishchenko SA, Alekseenko SI, Kopylov VV, Baranskaya SV. [ Functional endoscopic sinus surgery in a patient with cystic fibrosis after lung transplantation]. Vestn Otorinolaringol 2021; 86:73-78. [PMID: 34499452 DOI: 10.17116/otorino20218604173] [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: 06/13/2023]
Abstract
Cystic fibrosis is genetic multisystem disorder with a predominant lesion of the respiratory tract. The duration and quality of life of these patients depends on the state of respiratory function. Progressive lung dysfunction is still the leading cause of mortality patients with cystic fibrosis. End-stage lung diseases in patients with cystic fibrosis, lung transplantation is a viable method of treatment. It has the ability to prolong life of these patients. Survival in cystic fibrosis has steadily increased medical treatment and post-transplant. Chronic rhinosinusitis (with nasal polys and without) impacts almost all cystic fibrosis patients, leading to significant reductions in quality of life. Chronic rhinosinusitis with nasal polyps is prevalent in the cystic fibrosis patients, and it is often a recalcitrant infection with multidrug resistant organisms. Medical therapies such as nasal irrigations, nasal steroids, and antibiotics are critical for managing symptoms, but functional endoscopic sinus surgery is necessary for refractory cases. The unified airway hypothesis suggests that sanitation bacterial infection in the upper airway can also decrease bacterial burden in the lungs. The article presents a clinical case of successful endoscopic sinus surgery in a 15-year-old patient with chronic rhinosinusitis with nasal polyps and cystic fibrosis after lung transplantation. The intervention was performed under General anesthesia and controlled hypotension. Bilateral antrostomy, ethmoidectomy and Draf IIb frontal sinusotomy were performed by endoscopic endonasal approach. There were no intra - and post-operative rhinosurgical or lung complications. The follow-up period was 18 months. At present, there is no relapse of chronic polypous rhinosinusitis, and there are no indications for revision intervention.
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Affiliation(s)
- S A Karpishchenko
- Saint-Petersburg Research Institute of Ear, Throat, Nose and Speech the Ministry of Health, St. Petersburg, Russia
- First Pavlov State Medical University of Saint Petersburg, St. Petersburg, Russia
| | - S I Alekseenko
- Children's multidisciplinary clinical center of high medical technologies named after K.A. Rauhfusa, St. Petersburg, Russia
- North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russia
| | - V V Kopylov
- Children's multidisciplinary clinical center of high medical technologies named after K.A. Rauhfusa, St. Petersburg, Russia
- North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russia
| | - S V Baranskaya
- First Pavlov State Medical University of Saint Petersburg, St. Petersburg, Russia
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Abstract
OBJECTIVES The most common type of noninvasive fungal rhinosinusitis is fungus ball (FB), which usually involves a solitary paranasal sinus. Multiple fungus balls (MFBs) are rarely reported in literature. The purpose of this study was to analyze and compare the clinical features of MFBs and solitary fungus ball (SFB). METHODS We retrospectively investigated consecutive cases of FB between 2001 and 2018 and compared the clinical records of SFB with MFBs with respect to demographics, clinical features, location, radiological findings, and operative outcome. RESULTS A total of 440 SFB and 43 MFBs cases were included in the study. The mean age was 55.3 ± 13.3 and 60.6 ± 10.9 years, respectively (P = .011). The incidence of MFBs obviously increased from 2001 to 2018. The clinical symptoms and laboratory examination were similar. On computed tomography images, complete opacification, septal deviation, Haller cells, and obstruction of ostiomeatal complex were more common (P < .05). The incidence of SFB on the left and right sides was similar, while MFBs were seen to involve both sides in 74.4%. CONCLUSIONS Compared with SFB, MFBs showed some special characteristics. The MFBs affected older patients showed wide range of lesions and complex anatomy. Surgical technique is very important. Much more attention should be paid to this not so uncommon disease during the perioperative period.
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Affiliation(s)
- Hui Li
- Department of Otorhinolaryngology Head and Neck Surgery, 71185Peking University People's Hospital, Beijing, People's Republic of China
| | - Yu-Xiao Wu
- Department of Otorhinolaryngology Head and Neck Surgery, 71185Peking University People's Hospital, Beijing, People's Republic of China
| | - Min Wang
- Department of Otorhinolaryngology Head and Neck Surgery, 71185Peking University People's Hospital, Beijing, People's Republic of China
| | - Zhi-Min Xing
- Department of Otorhinolaryngology Head and Neck Surgery, 71185Peking University People's Hospital, Beijing, People's Republic of China
| | - Lin Han
- Department of Otorhinolaryngology Head and Neck Surgery, 71185Peking University People's Hospital, Beijing, People's Republic of China
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Zhou L, Yuan H. [Causes and treatment of delayed bleeding after functional endoscopic sinus surgery]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2020; 34:1040-1042. [PMID: 33254329 PMCID: PMC10133138 DOI: 10.13201/j.issn.2096-7993.2020.11.020] [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: 06/15/2019] [Indexed: 11/12/2022]
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Zhang W, Meng Y, Wang C, Cao F, Zhang L. Self-reported course of olfactory impairment determines outcome for successful surgical intervention in nasal polyps with anosmia. Acta Otolaryngol 2020; 140:1021-1027. [PMID: 32808847 DOI: 10.1080/00016489.2020.1805508] [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: 10/23/2022]
Abstract
BACKGROUND Olfactory impairment is one of important symptoms of Chronic rhinosinusitis with nasal polyps (CRSwNP). However, the relationship between course of olfactory impairment and postoperative symptom improvement was still unclear. OBJECTIVE The aim of this study was to assess the relationship between the self-reported course of olfactory loss and the degree of improvement in olfaction to determine the timing for successful surgical intervention in improving olfaction in patients with CRSwNP. MATERIALS AND METHODS A total of 86 CRSwNP patients with loss of smell and undergoing functional endoscopic sinus surgery (FESS) were recruited consecutively. The self-reported course of smell lose before treatment was recorded. Olfactory function was recorded before and after FESS using T&T Olfactometry. RESULTS Fifty-seven patients demonstrated recovery of olfaction and 29 patients no-recovery. The average recovery time of smell loss in the study was 2.6 weeks. The course of smell loss showed moderate accuracy as a marker for determining the timing for successful FESS; with up to 4.5 years of self-reported smell loss being the cut-off point for recovery of smell following FESS. CONCLUSION This study suggests that FESS in CRSwNP patients with self-reported significant olfactory impairment for less than 4.5 years may lead to improvement in olfaction. SIGNIFICANCE FESS in CRSwNP patients with self-reported significant olfactory impairment persisting for less than 4.5 years may lead to considerable improvement in olfaction in these patients.
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Affiliation(s)
- Wei Zhang
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - Yifan Meng
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Chengshuo Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Feifei Cao
- Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Luo Zhang
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
- Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China
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Khoury H, Bellamkonda N, Benharash P, Lee JT, Wang MB, Suh JD. National Analysis of 30-Day Readmission Following Inpatient Sinus Surgery for Chronic Rhinosinusitis. Laryngoscope 2020; 131:E1422-E1428. [PMID: 33098341 DOI: 10.1002/lary.29117] [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] [Received: 05/24/2020] [Revised: 08/01/2020] [Accepted: 09/03/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To characterize the incidence, causes, risk factors, and costs of 30-day readmission after inpatient functional endoscopic sinus surgery (FESS) for patients with chronic rhinosinusitis. STUDY DESIGN Retrospective cohort study. METHODS The Nationwide Readmissions Database was used to characterize readmission after inpatient sinus surgery for chronic rhinosinusitis from 2015 to 2017. International Classification of Disease codes were used to identify the patient population, which included 5,644 patients. Incidence, causes, costs, and predictors of readmission were analyzed and determined. RESULTS Among 6,386 patients who underwent inpatient FESS, 742 (11.6%) were readmitted within 30 days of discharge. On univariate analysis, patients who were readmitted were more commonly older than 70 years (23.3% vs. 16.2%); had a higher burden of comorbidities including chronic kidney disease (15.0% vs. 7.8%), diabetes (25.6% vs. 20.4%), and hypertension (13.5% vs. 8.5%); had a greater rate of postoperative complications (20.7% vs. 12.2%); and had a longer length of stay (12.4 vs. 6.9 days) compared to patients who were not readmitted. Readmissions cost an additional $27,141 per patient. On multivariable analysis, age greater than 70 years, Medicaid insurance, several comorbidities, prolonged length of stay, postoperative neurologic complications, and lower hospital volume were independent predictors of 30-day readmission. The most common cause for readmission was infection (36.3%). CONCLUSION Readmission following inpatient FESS is not uncommon. Identification and management of preoperative comorbidities, optimized patient selection for inpatient surgery, and thorough postoperative discharge care may improve patient outcomes and decrease healthcare expenditures. LEVEL OF EVIDENCE 3 Laryngoscope, 131:E1422-E1428, 2021.
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Affiliation(s)
- Habib Khoury
- Department of Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, U.S.A
| | - Nikhil Bellamkonda
- Department of Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, U.S.A
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratory (CORELAB), University of California Los Angeles, Los Angeles, California, U.S.A
| | - Jivianne T Lee
- Department of Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, U.S.A
| | - Marilene B Wang
- Department of Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, U.S.A
| | - Jeffrey D Suh
- Department of Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, U.S.A
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Nwosu OI, Rubel KE, Alwani MM, Sharma D, Miller M, Ting JY, Payner T. Use of Adenosine to Facilitate Localization and Repair of Internal Carotid Artery Injury during Skull Base Surgery: A Case Report and Literature Review. Ann Otol Rhinol Laryngol 2020; 130:532-536. [PMID: 33030046 DOI: 10.1177/0003489420956373] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 11/17/2022]
Abstract
BACKGROUND Internal carotid artery (ICA) injuries represent a rare, potentially fatal complication of endoscopic endonasal skull base surgery (EESBS). The use of adenosine to induce transient hypotension and facilitate management of high-flow, high-pressure arterial lesions has been well-documented in neuro-endovascular literature. A similar setting in which adenosine-induced hypotension may prove beneficial is during the management of major vascular injury encountered during EESBS. METHODS A case of ICA injury and subsequent repair during EESBS is presented. RESULTS A 74-year-old female underwent endoscopic transsphenoidal resection for a recurrent pituitary adenoma. During suprasellar resection, the right cavernous ICA was inadvertently injured resulting in brisk bleeding. Immediate vascular tamponade was applied, and a crushed muscle graft was obtained. Two intravenous doses of adenosine were administered in quick succession to produce transient hypotension and facilitate repair of the injury with the graft. Neurovascular imaging revealed a small pseudoaneurysm which remained stable throughout the postoperative course. The patient underwent definitive stent embolization of the pseudoaneurysm 1 month following discharge. CONCLUSION Prompt repair of ICA injury during EESBS is crucial, but often limited by poor visualization. Adenosine-induced hypotension has demonstrated great efficacy as an adjuvant in neurovascular clipping of intracranial aneurysms and remains a valuable tool for the endoscopic skull-base surgeon as well. In cases with high risk for ICA injury, adenosine should be readily available.
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Affiliation(s)
- Obi I Nwosu
- Indiana University School of Medicine (IUSM), Indianapolis, IN, USA
| | - Kolin E Rubel
- Indiana University School of Medicine (IUSM), Indianapolis, IN, USA.,Department of Otolaryngology-Head & Neck Surgery, Indianapolis, IN, USA
| | - Mohamedkazim M Alwani
- Indiana University School of Medicine (IUSM), Indianapolis, IN, USA.,Department of Otolaryngology-Head & Neck Surgery, Indianapolis, IN, USA
| | - Dhruv Sharma
- Indiana University School of Medicine (IUSM), Indianapolis, IN, USA.,Department of Otolaryngology-Head & Neck Surgery, Indianapolis, IN, USA
| | - Michael Miller
- Indiana University School of Medicine (IUSM), Indianapolis, IN, USA
| | - Jonathan Y Ting
- Indiana University School of Medicine (IUSM), Indianapolis, IN, USA.,Department of Otolaryngology-Head & Neck Surgery, Indianapolis, IN, USA.,Department of Neurological Surgery, Indianapolis, IN, USA
| | - Troy Payner
- Indiana University School of Medicine (IUSM), Indianapolis, IN, USA.,Goodman Campbell Brain and Spine, Carmel, IN, USA
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Abstract
BACKGROUND The prelacrimal recess approach, is frequently preferred in creating a minimally invasive surgical corridors. OBJECTIVE The aim of this study was to evaluate the Prelacrimal recess (PLR) anatomy using Cone Beam Computed Tomography in patients with Maxillary Sinus Hypoplasia. METHODS The paranasal Cone Beam Computed Tomography series of 84 adults were analyzed retrospectively. The antero-posterior and mesio-distal widths of the PLR and the antero-posterior width of the naso-lacrimal duct were measured. The patients were divided into three groups according to the antero-posterior width of PLR to evaluate the feasibility of prelacrimal recess approach as Type 1 (0-3 mm), Type 2 (>3-7 mm) and Type 3 (>7 mm). RESULTS The mean antero-posterior width of PLR was 3.11 ± 1.49mm in the patients and 4.77 ± 1.76 mm in the controls. The mean mesio-distal width of PLR was 7.64 ± 1.49 mm in the patients and 3.17 ± 2.05 mm in the controls. The mean antero-posterior width of naso-lacrimal duct was 9.58 ± 2.80 mm in the patients and 9.46 ± 2.42 mm in the controls. CONCLUSIONS The width of the antero-posterior PLR in patients with Maxillary Sinus Hypoplasia was found to be significantly lower in comparison to individuals with normal maxillary sinuses in the measurements performed on paranasal Cone Beam Computed Tomography scans. Hence, while planning a Functional Endoscopic Sinus Surgery with prelacrimal recess approach for maxillary sinus, the anatomical structure of the naso-sinusoidal region should be carefully analyzed, and individual anatomical variations such as Maxillary Sinus Hypoplasia should not be ignored.
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Affiliation(s)
- Suayip Burak Duman
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Inonu University, Malatya, Turkey
| | - İsmail Gumussoy
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Sakarya University, Sakarya, Turkey
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Abstract
Pott’s puffy tumor, typified by a subperiosteal abscess underlying the frontal bone, is an uncommonly encountered clinical entity that can occur in the setting of local trauma or secondary to frontal sinusitis. Diagnosis can be challenging, as cultures may be sterile, and the condition must be differentiated from neoplasm and superficial and soft tissue infection. Although more common in the pediatric population, Pott’s puffy tumor must remain on the differential with a high index of suspicion in adult patients who fit the clinical picture. Early diagnosis with CT or MRI and therapeutic medical and surgical intervention are crucial as intracranial complications, such as abscess and empyema can occur and may be fatal. We present an adult patient with a history of inhaled drug abuse who presented with Pott’s puffy tumor with meningitis and bifrontal epidural abscesses at presentation. There is evidence in the literature that management of sinus-related intracranial epidural abscess with antibiotic therapy and adequate surgical or endoscopic surgical drainage may bypass the need for neurosurgical intervention, as was the case here.
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Affiliation(s)
- Michael W Song
- Infectious Diseases, Rutgers New Jersey Medical School, Newark, USA
| | | | | | - Shaza Khalid
- Infectious Diseases, Rutgers New Jersey Medical School, Newark, USA
| | - Jerrold Ellner
- Infectious Diseases, Rutgers New Jersey Medical School, Newark, USA
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Xu H, Li X, Yang B, Shen Z, Li W, Zhou Y, Jiang J, Chen X, Gu Y, Pei Z, Li J. Effects of preconditioning by nasal splint and mouth breathing on emergence delirium after functional endoscopic sinus surgery in Chinese adults: a study protocol for a randomised controlled trial. BMJ Open 2020; 10:e033803. [PMID: 32847900 PMCID: PMC7451479 DOI: 10.1136/bmjopen-2019-033803] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Emergence delirium (ED) is a common adverse manifestation after general anaesthesia and may result in undesirable consequences. Its causes and mechanisms are diverse and complex, and it is still unavoidable in clinical work. There is a high incidence of ED after otorhinolaryngology surgery, which may result from the sudden loss of functional senses and discomfort of surgical organs. This study aims to test a non-invasive, non-drug treatment modality of nose clamping and mouth-breathing training before surgery to reduce ED. METHODS AND ANALYSIS This prospective randomised controlled trial (RCT) will include 200 patients who undergo functional endoscopic sinus surgery (FESS) at Shanghai General Hospital, China. Study participants will be randomly assigned in two groups with a 1:1 ratio. The pretreatment group (P-group) will receive an intervention by nasal splint and mouth-breathing training before surgery, while the control group (C-group) will not receive any intervention; following which both groups will undergo FESS under general anaesthesia in accordance with the same anaesthesia scheme. After surgery, we will perform a single-blinded assessment of ED occurrence with stratification. IBM SPSS Statistics V.20 statistical software will be used for statistical analyses. A X2 test will be used to compare the two groups, and t-tests will determine the statistical significance of continuous variables. ETHICS AND DISSEMINATION This RCT was designed in accordance with the principles of the Declaration of Helsinki and has been approved by the Ethics Committee of Shanghai General Hospital, ID: 2019KY039.We expect to release the original data in February 2022 on the ResMan original data sharing platform (IPD sharing platform) of the China clinical trial registry, which can be viewed at the following website:http://www.medresman.org.cn/pub/cn/proj/projectshow.aspx?proj=6293. TRIAL REGISTRATION NUMBER ChiCTR1900024925.
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Affiliation(s)
- Hongjiao Xu
- Department of Anaesthesiology, Shanghai Jiaotong University First People's Hospital, Shanghai, China
| | - Xiang Li
- Department of Anaesthesiology, Shanghai Jiaotong University First People's Hospital, Shanghai, China
| | - Bin Yang
- Department of Anaesthesiology, Chongqing University Cancer Hospital, Chongqing, China
| | - Zhenyuan Shen
- Medical department, Mellon community health service center, Shanghai, China
| | - Weiwen Li
- Department of Anaesthesiology, Shanghai Jiaotong University First People's Hospital, Shanghai, China
| | - Yachun Zhou
- Department of Anaesthesiology, Shanghai Jiaotong University First People's Hospital, Shanghai, China
| | - Jihong Jiang
- Department of Anaesthesiology, Shanghai Jiaotong University First People's Hospital, Shanghai, China
| | - Xia Chen
- Department of Anaesthesiology, Shanghai Jiaotong University First People's Hospital, Shanghai, China
| | - Yuyu Gu
- Department of Anaesthesiology, Shanghai Jiaotong University First People's Hospital, Shanghai, China
| | - Zhi Pei
- Department of Anaesthesiology, Shanghai Jiaotong University First People's Hospital, Shanghai, China
| | - Jinbao Li
- Department of Anaesthesiology, Shanghai Jiaotong University First People's Hospital, Shanghai, China
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