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Is maxillary sinusitis and radiographic maxillary sinus opacification associated with an altered microbiology of MRONJ? Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 137:345-354. [PMID: 38443234 DOI: 10.1016/j.oooo.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/30/2023] [Accepted: 12/04/2023] [Indexed: 03/07/2024]
Abstract
OBJECTIVE Maxillary sinusitis can be a sequela of medication-related osteonecrosis of the jaw (MRONJ). This study aims to characterize the microbiome of maxillary MRONJ with concurrent maxillary sinusitis and radiographic maxillary sinus opacification to determine if there is a relationship between the microbiome of MRONJ and sinus disease. STUDY DESIGN This retrospective case series was conducted using electronic health records from the University of Pennsylvania and affiliated hospitals. The target population was surgically managed maxillary MRONJ patients. The primary predictor variables were tissue culture results. The primary outcomes were maxillary sinusitis or maxillary sinus opacification. Statistical analysis was performed using chi-squared tests at the 95% confidence interval. RESULTS Thirty-nine subjects were selected: 25 had sinus opacification and 11 had sinusitis. Resident bacteria were present in 90% of subjects, nonresident bacteria in 74%, and opportunistic organisms in 15%. There were significantly more subjects with chronic sinusitis microbes (79%) than without. There were significantly more gram-positive anaerobes, specifically Propionibacterium, as well as the gram-negative facultative anaerobe, Capnocytophaga, in subjects with concurrent sinusitis. CONCLUSIONS Maxillary MRONJ with concurrent maxillary sinusitis may be associated with gram-positive anaerobic species, Propionibacterium, and Capnocytophaga colonization. Maxillary MRONJ patients may benefit from sinus evaluation and concurrent surgical intervention.
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The utility of a “second look” debridement following endonasal skull base surgery in the pediatric population. J Neurol Surg B Skull Base 2023. [DOI: 10.1055/a-2048-7564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background: Sinonasal debridement is typically performed in the weeks following endonasal skull base surgery (ESBS). In the pediatric population, this second look procedure may require general anesthesia, however there is currently little evidence assessing the benefit of this practice.
Methods: This was a multicenter retrospective study of pediatric patients (age <18 years) undergoing a planned second look debridement under general anesthesia following ESBS. Intraoperative findings, interventions performed, and perioperative complications were reviewed. Multivariate regression analysis was performed to identify associations between intraoperative findings and clinical factors.
Results: We reviewed 69 cases of second look debridements (age mean 8.6 ±4.2 years, range 2-18 years), occurring a mean of 18.3 ±10.3 days following ESBS. All abnormal findings were noted in patients age ≤12 years. Synechiae were noted in 8.7% of cases, bacterial rhinosinusitis in 2.9%, and failed reconstruction with CSF leak in 4.5% (2 cases of flap malposition, 1 case of flap necrosis). All failed reconstructions were noted following expanded endonasal cases for craniopharyngioma, and in each case a revision reconstruction was performed during the second look surgery. Synechiae were not significantly associated with younger age, revision cases, or cases with reconstructive flaps. There were no perioperative complications.
Conclusion: Second look debridement under general anesthesia may be useful in the identification and intervention of sinonasal pathology following endoscopic skull base surgery, particularly in children ≤12 years old or those with pedicled flap reconstructions. Larger controlled studies are warranted to validate this practice and refine indications and timing of this second procedure.
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Retrospective Review of Surgical Site Infections after Endoscopic Endonasal Sellar and Parasellar Surgery: Multicenter Quality Data from the North American Skull Base Society. J Neurol Surg B Skull Base 2022; 83:579-588. [PMID: 36393885 PMCID: PMC9653291 DOI: 10.1055/a-1865-3202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 05/26/2022] [Indexed: 10/18/2022] Open
Abstract
Introduction Transnasal access to the anterior skull base provides a minimally invasive approach for sellar and parasellar masses compared with its open counterparts. The unique microbiome of the sinonasal mucosa provides distinct challenges not encountered with other cranial approaches. The use of antibiotics in these cases has not been standardized, and data remain scarce regarding infectious outcomes. Methods We conducted a multicenter retrospective analysis of shared quality data points for the endoscopic endonasal approach (EEA) for pituitary adenomas, along with other sellar and parasellar region masses that were included by participating institutions. Patient and operative characteristics, perioperative and postoperative antibiotic regimens and their durations, intraoperative and postoperative cerebrospinal fluid leak, and onset of postoperative meningitis and sinusitis were compared. Results Fifteen institutions participated and provided 6 consecutive months' worth of case data. Five hundred ninety-three cases were included in the study, of which 564 were pituitary adenomectomies. The incidences of postoperative meningitis and sinusitis were low (0.67 and 2.87% for all pathologies, respectively; 0.35% meningitis for pituitary adenomas) and did not correlate with any specific antibiotic regimen. Immunocompromised status posed an increased odds of meningitis in pituitary adenomectomies (28.6, 95% confidence interval [1.72-474.4]). Conclusions The results show no clear benefit to postoperative antimicrobial use in EEA, with further larger studies needed.
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Determinants of Patient Refusal of Post-Operative Radiation Therapy in Sinonasal Squamous Cell Carcinoma. J Neurol Surg B Skull Base 2022; 84:232-239. [PMID: 37187475 PMCID: PMC10171933 DOI: 10.1055/a-1780-4157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 02/17/2022] [Indexed: 10/19/2022] Open
Abstract
Objectives
Although adjuvant radiotherapy may be indicated in patients with sinonasal squamous cell carcinoma (SNSCC) following primary surgery, some patients choose to forgo recommended post-operative radiation (PORT). This study aimed to elucidate factors associated with patient refusal of recommended PORT in SNSCC and examine overall survival.
Methods
Retrospective analysis of patients with SNSCC treated with primary surgery from the National Cancer Database diagnosed between 2004 and 2016. A multivariable logistic regression model was created to determine the association between clinical or demographic covariates and likelihood of PORT refusal. Unadjusted Kaplan-Meier estimates, log-rank tests, and a multivariable Cox proportional hazard model were used to assess overall survival.
Results
2231 patients were included in the final analysis, of which 1456 (65.3%) were male and 73 (3.3%) refused recommended PORT. Patients older than 74 years old were more likely to refuse PORT than those younger than 54 (OR 3.43, 95% CI: 1.84-6.62). Median survival among the entire cohort, those that received recommended PORT, and those that refused PORT was 83.0 months (95% CI: 74.6-97.1), 83.0 months (95% CI: 74.9-98.2), and 63.6 months (95% CI: 37.3-101.4). Refusal of PORT was not associated with overall survival (HR 0.99, 95% CI: 0.69-1.42).
Conclusions
PORT refusal in patients with SNSCC is rare and was found to be associated with several patient factors. The decision to forgo PORT is not independently associated with overall survival in this cohort. Further study is required to determine the clinical implications of these findings as the treatment decisions are complex.
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International consensus statement on allergy and rhinology: rhinosinusitis 2021. Int Forum Allergy Rhinol 2021; 11:213-739. [PMID: 33236525 DOI: 10.1002/alr.22741] [Citation(s) in RCA: 357] [Impact Index Per Article: 119.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/09/2020] [Indexed: 02/06/2023]
Abstract
I. EXECUTIVE SUMMARY BACKGROUND: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR-RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR-RS-2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence-based findings of the document. METHODS ICAR-RS presents over 180 topics in the forms of evidence-based reviews with recommendations (EBRRs), evidence-based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. RESULTS ICAR-RS-2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence-based management algorithm is provided. CONCLUSION This ICAR-RS-2021 executive summary provides a compilation of the evidence-based recommendations for medical and surgical treatment of the most common forms of RS.
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Implementation of a Streamlined Care Pathway to Reduce Cost and Length of Stay for Patients Undergoing Transsphenoidal Pituitary Surgery. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Adenocarcinoma of the Sinonasal Tract: A Review of the National Cancer Database. Skull Base Surg 2018. [DOI: 10.1055/s-0038-1633446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Posttreatment Rhinosinusitis following Endoscopic Resection of Pediatric Craniopharyngioma. Skull Base Surg 2018. [DOI: 10.1055/s-0038-1633657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Extraprimary Local Recurrence of Esthesioneuroblastoma: A Case Series. Skull Base Surg 2018. [DOI: 10.1055/s-0038-1633781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Adenoid Cystic Carcinoma of the Sinonasal Tract: A Review of the National Cancer Database. Skull Base Surg 2018. [DOI: 10.1055/s-0038-1633449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Surgery for Treatment of Primary Sinonasal Mucosal Melanoma in Patients Treated with Systemic Immunotherapy for Distant Disease. Skull Base Surg 2018. [DOI: 10.1055/s-0038-1633782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Cerebrospinal Fluid Leak Repaired with Nasoseptal Flap in a 2-Week-Old Neonate. Skull Base Surg 2018. [DOI: 10.1055/s-0038-1633763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Indocyanine Green Endoscopic Video Angiography to Assess Nasoseptal Flap Vascular Perfusion in Skull Base Reconstruction. Skull Base Surg 2018. [DOI: 10.1055/s-0038-1633735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Unusual Presentation of Nasopharyngeal Angiofibroma in an Elderly Patient. Skull Base Surg 2018. [DOI: 10.1055/s-0038-1633783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Disorders Involving a Persistent Craniopharyngeal Canal: A Case Series. Skull Base Surg 2018. [DOI: 10.1055/s-0038-1633628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Near Infrared Folate-Targeted, Intraoperative Visualization of Pituitary Adenoma. Skull Base Surg 2017. [DOI: 10.1055/s-0037-1600671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Risk Factors in Short Term Mortality in Sinonasal Squamous Cell Carcinoma: A Review of the National Cancer Database. Skull Base Surg 2017. [DOI: 10.1055/s-0037-1600644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Risk Factors for Complications and Long-Term Sequelae in Endoscopic Resection of Pediatric Craniopharyngioma. Skull Base Surg 2017. [DOI: 10.1055/s-0037-1600575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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The Role of 18FDG PET/CT in Routine Surveillance Following Treatment of Sinonasal Neoplasms. Skull Base Surg 2017. [DOI: 10.1055/s-0037-1600641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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for Sinonasal Mucosal Melanoma: A Single-Institution Retrospective Experience. Skull Base Surg 2017. [DOI: 10.1055/s-0037-1600637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Outcomes of Pediatric Craniopharyngioma Resections after Open versus Expanded Endonasal Surgical Approach. Skull Base Surg 2017. [DOI: 10.1055/s-0037-1600559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Ethnic and Socioeconomic Disparities in Sinonasal Malignancy: An Analysis of Readmission Rates and Mortality. Skull Base Surg 2017. [DOI: 10.1055/s-0037-1600645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Quality of Life after Endoscopic Resection of Malignant Sinonasal and Skull-Base Tumors. Skull Base Surg 2017. [DOI: 10.1055/s-0037-1600589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Sinonasal Undifferentiated Carcinoma: A 15-Year Single-Institution Experience. Skull Base Surg 2017. [DOI: 10.1055/s-0037-1600865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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The Impact of Obesity on Hospital Length of Stay and Post-operative Complications after Transsphenoidal Pituitary Surgery: an Analysis of the American College of Surgeons National Surgical Quality Improvement Program Database. Skull Base Surg 2016. [DOI: 10.1055/s-0036-1579845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Surgical Landmarks for the Endoscopic Endonasal Approach to the Medial Intraconal Orbital Apex: A Cadaveric Study. Skull Base Surg 2015. [DOI: 10.1055/s-0035-1546633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Pediatric Endoscopic Endonasal Skull Base Surgery: The Children's Hospital of Philadelphia Experience. Skull Base Surg 2015. [DOI: 10.1055/s-0035-1546524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Pediatric Nasoseptal Flap Reconstruction of Suprasellar Approaches. Skull Base Surg 2015. [DOI: 10.1055/s-0035-1546523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Expanded Endoscopic Endonasal Treatment of Primary Intracranial Tumors within the Paranasal Sinuses. Skull Base Surg 2014. [DOI: 10.1055/s-0034-1370572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Reconstructive Challenges in the Extended Endoscopic Transclival Approach. Skull Base Surg 2013. [DOI: 10.1055/s-0033-1336292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Radiographic Enhancement of the Vascularized Nasoseptal Flap Does Not Predict CSF Leaks. Skull Base Surg 2012. [DOI: 10.1055/s-0032-1312173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Endoscopic, Transnasal, Transclival Resection of a Pontine Cavernoma. Skull Base Surg 2012. [DOI: 10.1055/s-0032-1312226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Decision Analysis: Endoscopic Versus Open Resection of Tuberculum Sellae Meningiomas. Skull Base Surg 2012. [DOI: 10.1055/s-0032-1312073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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R174: Combination Immunotherapy for Murine Squamous Cell Carcinoma. Otolaryngol Head Neck Surg 2007. [DOI: 10.1016/j.otohns.2007.06.759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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