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Hentati F, Kocharyan A, Muller RG, Ruthberg J, Cabrera CI, D'Anza B, Rodriguez K. The Use of 0° and 70° Endoscopes in Maxillary Antrostomy. Ann Otol Rhinol Laryngol 2022:34894221119306. [PMID: 35983610 DOI: 10.1177/00034894221119306] [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]
Abstract
BACKGROUND AND OBJECTIVES Performing an effective maxillary antrostomy is critical to improving chronic maxillary sinusitis symptomatology. Incomplete dissection of the uncinate process and failure to incorporate the natural drainage pathway may lead to recirculation and need for revision surgery. The purpose of this study is to determine if 70° endoscopes provide added value in determining incomplete dissection or residual disease. METHODS Prospective study of 35 sinuses from 18 patients undergoing FESS for Chronic Rhinosinusitis (CRS) between 11/1/2020 and 4/30/2021. Two fellowship trained Rhinologists initially performed maxillary antrostomies exclusively using a 0° endoscope, then transitioned to a 70° endoscope. Surgeons completed a survey to assess completion of the antrostomy prior to use of 70° endoscope, sino-nasal anatomy, and difficulty of the operation. Intraoperative photographs before and after using a 70° endoscope were evaluated by a third party. Pre-operative CT scans were used to evaluate the sphenoid keel-caudal septum-nasolacrimal duct (SK-CS-NL) angle. RESULTS Of 35 sinuses from 18 patients all 35 sinuses had CRS with 48.5% having nasal polyposis and 42.9% having active infection. There was residual inflammatory tissue in the anterior maxillary sinus, including polypoid tissue and uncinate process prior to using the 70° endoscope in 82.9% of sinuses. The natural drainage pathway was not incorporated into the dissection in 28.6% of sinuses before converting to 70° endoscope. Incomplete dissection with 0° endoscope was not associated with nasal polyposis (P = .086) or uncinate position (0.741). Narrow SK-CS-NL angles were associated with incomplete dissection of the anterior maxillary sinus with 0° endoscope (16.0° ± 3.0° vs 20.6° ± 3.2°; P = .013). CONCLUSION Use of 70° endoscope in maxillary antrostomy may be beneficial in identifying and resecting disease within the anterior maxillary sinus that may otherwise be difficult to find using a 0° endoscope. This is especially true in patients with narrow nasolacrimal duct positioning.
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Affiliation(s)
- Firas Hentati
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Armine Kocharyan
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Richard G Muller
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jeremy Ruthberg
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | - Brian D'Anza
- Case Western Reserve University School of Medicine, Cleveland, OH, USA.,University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Kenneth Rodriguez
- Case Western Reserve University School of Medicine, Cleveland, OH, USA.,University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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Abstract
Introduction Silent sinus syndrome (SSS) is a condition characterized by ophthalmologic
features, such as spontaneous enophthalmos and hypoglobus with ipsilateral
maxillary sinus atelectasis and an otherwise asymptomatic presentation. SSS
has been documented secondary to a number of external causes, including
trauma or surgery, but has less commonly been described in the setting of a
potential mass in the deep masticator space. Case Presentation A 56-year-old woman with a history of chronic headaches with normal prior
sinonasal imaging presented with increasing right-sided facial pain and
headaches that radiated to her occiput, subjective visual changes, sharp ear
pain, and long-standing subjective diminished sense of smell. Physical
examination was normal, while nasal endoscopy demonstrated lateral bowing of
the medial maxillary wall on the right. Magnetic resonance imaging
demonstrated a homogenous 2 × 2 × 2.4 cm T1- and T2-weighted, hyperintense
mass lesion in the deep masticator space splaying the right medial and
lateral pterygoid muscles concerning for a possible lipomatous lesion.
Computed tomography revealed an atelectatic and opacified maxillary sinus
with inward bowing of the posterior maxillary wall and increased orbital
volume on that side. Endoscopic maxillary antrostomy was performed with
biopsy of the retromaxillary space lesion and with near immediate resolution
of the patient’s symptoms. Histologic examination of the mass demonstrated
mature adipose tissue with few aggregates of benign small vessels. Discussion This is an unusual presentation of SSS, with an accompanying enlargement of
the retromaxillary fat pad. We herein review our clinical experience with
SSS and provide a literature review of the presentation, management, and
perioperative considerations for SSS.
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Affiliation(s)
- Nanki Hura
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Omar G Ahmed
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nicholas R Rowan
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Govindaraju R, Cherian L, Macias-Valle L, Murphy J, Gouzos M, Vreugde S, Wormald PJ, Bassiouni A, Psaltis AJ. Extent of maxillary sinus surgery and its effect on instrument access, irrigation penetration, and disease clearance. Int Forum Allergy Rhinol 2019; 9:1097-1104. [PMID: 31343852 DOI: 10.1002/alr.22397] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 06/03/2019] [Revised: 07/04/2019] [Accepted: 07/10/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Middle meatal antrostomy (MMA) provides limited access to the anteromedial and inferior aspect of the maxillary sinus (MS) often resulting in residual disease and inflammatory burden. Newer extended procedures, such as mega-antrostomy (Mega-A) and extended modified mega-antrostomy (EMMA), have been developed to address this limitation. This study assesses the effect of varying extent of MS surgery on irrigation penetration and access of instrumentation. METHODS The MS of 5 fresh-frozen cadavers were sequentially dissected. Irrigation was evaluated with a squeeze bottle (SB) in different head positions and using different volumes of fluid. Surgical reach and visualization were examined using common sinus instruments and different angled endoscopes. A disease simulation was also performed to check for residual debris after instrumentation and irrigations. RESULTS Irrigation penetration improved as antrostomy size increased (p < 0.0001), with a significant difference observed between the extended procedures and MMA. The effect of the volume was significant for SB (p < 0.0001) but head positions appeared irrelevant (p = 0.613). Overall visualization improved for Mega-A and EMMA. A similar trend was seen for the reach of the instruments to all sinus wall subsites. EMMA facilitated the most removal of "sinus disease" in the disease simulation model when compared with both MMA and Mega-A, due to its reach of the anteroinferior aspects of the maxillary sinus. CONCLUSIONS High-volume irrigation using SB achieved good sinus penetration, irrespective of head position. Extended MS procedures appear to further increase irrigation penetration as well as surgical access.
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Affiliation(s)
- Revadi Govindaraju
- Department of Otorhinolaryngology-Head & Neck Surgery, The Queen Elizabeth Hospital, Woodville South, SA, Australia.,Department of Otorhinolaryngology-Head & Neck Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Lisa Cherian
- Department of Otorhinolaryngology-Head & Neck Surgery, The Queen Elizabeth Hospital, Woodville South, SA, Australia
| | - Luis Macias-Valle
- Department of Otorhinolaryngology-Head & Neck Surgery, The Queen Elizabeth Hospital, Woodville South, SA, Australia
| | - Jae Murphy
- Department of Otorhinolaryngology-Head & Neck Surgery, The Queen Elizabeth Hospital, Woodville South, SA, Australia
| | - Michael Gouzos
- Department of Otorhinolaryngology-Head & Neck Surgery, The Queen Elizabeth Hospital, Woodville South, SA, Australia
| | - Sarah Vreugde
- Department of Otorhinolaryngology-Head & Neck Surgery, The Queen Elizabeth Hospital, Woodville South, SA, Australia
| | - Peter John Wormald
- Department of Otorhinolaryngology-Head & Neck Surgery, The Queen Elizabeth Hospital, Woodville South, SA, Australia
| | - Ahmed Bassiouni
- Department of Otorhinolaryngology-Head & Neck Surgery, The Queen Elizabeth Hospital, Woodville South, SA, Australia
| | - Alkis James Psaltis
- Department of Otorhinolaryngology-Head & Neck Surgery, The Queen Elizabeth Hospital, Woodville South, SA, Australia
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Ahuja RB, Chatterjee P, Shrivastava P. A novel route for placing free flap pedicle from a palatal defect. Indian J Plast Surg 2014; 47:249-51. [PMID: 25190923 PMCID: PMC4147462 DOI: 10.4103/0970-0358.138965] [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] [Indexed: 11/05/2022] Open
Abstract
One of the better options available to repair a large palatal defect is by employing a free flap. Almost all the times such free flaps are plumbed to facial vessels. The greatest challenge in such cases is the placement of the pedicle from palatal shelf to recipient vessels because there is no direct route available. As majority of large palatal fistulae are encountered in operated cleft palates there is a possibility of routing the pedicle through a cleft in the maxillary arch or via pyriform aperture. When such a possibility doesn’t exist the pedicle is routed behind the maxillary arch. We describe a novel technique of pedicle placement through a maxillary antrostomy, in this case report, where a large palatal fistula in a 16 year old boy was repaired employing a free radial artery forearm flap. The direct route provided by maxillary antrostomy is considered the most expeditious of all possibilities mentioned above.
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Affiliation(s)
- Rajeev B Ahuja
- Department of Burns and Plastic Surgery, Lok Nayak Hospital and Associated Maulana Azad Medical College, New Delhi, India
| | - Pallab Chatterjee
- Department of Burns and Plastic Surgery, Lok Nayak Hospital and Associated Maulana Azad Medical College, New Delhi, India
| | - Prabhat Shrivastava
- Department of Burns and Plastic Surgery, Lok Nayak Hospital and Associated Maulana Azad Medical College, New Delhi, India
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Van Rompaey J, Bush C, Khabbaz E, Vender J, Panizza B, Solares CA. What is the Best Route to the Meckel Cave? Anatomical Comparison between the Endoscopic Endonasal Approach and a Lateral Approach. J Neurol Surg B Skull Base 2013; 74:331-6. [PMID: 24436933 DOI: 10.1055/s-0033-1342989] [Citation(s) in RCA: 8] [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] [Received: 05/10/2011] [Accepted: 08/10/2011] [Indexed: 10/27/2022] Open
Abstract
Background Traditionally, a pterional approach is utilized to access the Meckel cave. Depending on the tumor location, extradural dissection of the Gasserian ganglion can be performed. An endoscopic endonasal access could potentially avoid a craniotomy in these cases. Methods We performed an endoscopic endonasal approach as well as a lateral approach to the Meckel cave on six anatomic specimens. To access the Meckel cave endoscopically, a complete sphenoethmoidectomy and maxillary antrostomy followed by a transpterygoid approach was performed. For lateral access, a pterional craniotomy with extradural dissection was performed. Results The endoscopic endonasal approach allowed adequate access to the Gasserian ganglion. All the relevant anatomy was identified without difficulty. Both approaches allowed for a similar exposure, but the endonasal approach avoided brain retraction and improved anteromedial exposure of the Gasserian ganglion. The lateral approach provided improved access posterolaterally and to the superior portion. Conclusion The endoscopic endonasal approach to the Meckel cave is anatomically feasible. The morbidity associated with brain retraction from the open approaches can be avoided. Further understanding of the endoscopic anatomy within this region can facilitate continued advancement in endoscopic endonasal surgery and improvement in the safety and efficacy of these procedures.
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Affiliation(s)
- Jason Van Rompaey
- Department of Otolaryngology, Georgia Health Sciences University School of Medicine, Georgia Skull Base Center, Augusta, Georgia, United States
| | - Carrie Bush
- Department of Otolaryngology, Georgia Health Sciences University School of Medicine, Georgia Skull Base Center, Augusta, Georgia, United States
| | - Eyad Khabbaz
- Department of Otolaryngology, Georgia Health Sciences University School of Medicine, Georgia Skull Base Center, Augusta, Georgia, United States
| | - John Vender
- Department of Neurosurgery, Georgia Health Sciences University School of Medicine, Augusta, Georgia, United States
| | - Ben Panizza
- Queensland Skull Base Unit, University of Queensland, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - C Arturo Solares
- Department of Otolaryngology, Georgia Health Sciences University School of Medicine, Georgia Skull Base Center, Augusta, Georgia, United States
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