Nasal congestion and obstruction are reported in the majority of continuous positive airway pressure users and are frequently cited as reasons for noncompliance. Baseline inflammation due to allergic ...rhinitis could increase or exacerbate the inflammatory effect of high airflow in the nasal cavity as the result of continuous positive airway pressure and lead to greater continuous positive airway pressure intolerance. In this setting, intranasal steroids would be expected to counteract the nasal inflammation caused by allergic rhinitis and/or continuous positive airway pressure.
The aim of the present study is to evaluate the effects of topical corticosteroid use on nasal patency after acute exposure to positive pressure.
Ten individuals with allergic rhinitis were exposed to 1h of continuous airway pressure (15cm H2O) in the nasal cavity, delivered by a continuous positive airway pressure device. Visual analog scale, nasal obstruction symptom evaluation scale, acoustic rhinometry and peak nasal inspiratory flow were performed before and after the intervention. After 4 weeks topical nasal steroid (budesonide) application, positive pressure exposure was repeated as well as the first assessments.
Patients reported a statistically significant improvement both on the visual analog (p=0.013) and obstruction symptom evaluation scales (p<0.01). Furthermore, objective measurements were improved as well, with increased nasal cavity volume on acoustic rhinometry (p=0.02) and increased peak nasal inspiratory flow (p=0.012), after corticosteroid treatment.
In patients with allergic rhinitis, intranasal corticosteroid therapy improved objective and subjective parameters of nasal patency after acute exposure of the nasal cavity to positive pressure.
Abstract
Introduction
The frontal sinus (FS) is the most complex of the paranasal sinuses due to its location, anatomical variations and multiple clinical presentations. The surgical management of ...the FS and of the frontal recess (FR) is technically challenging, and a complete understanding of its anatomy, radiology, main diseases and surgical techniques is crucial to achieve therapeutic success.
Objectives
To review the FS and FR anatomy, radiology, and surgical techniques.
Data Synthesis
The FS features a variety of anatomical, volumetric and dimensional characteristics. From the endoscopic point of view, the FR is the point of greatest narrowing and, to have access to this region, one must know the anatomical limits and the ethmoid cells that are located around the FR and very often block the sinus drainage. Benign diseases such as chronic rhinosinusitis (CRS), mucocele and osteomas are the main pathologies found in the FS; however, there is a wide variety of malignant tumors that can also affect this region and represent a major technical challenge to the surgeon. With the advances in the endoscopic technique, the vast majority of diseases that affect the FS can be treated according to Wolfgang Draf, who systemized the approaches into four types (I, IIa, IIb, III).
Conclusion
Both benign and malignant diseases that affect the FS and FR can be successfully managed if one has a thorough understanding of the FS and FR anatomy, an individualized approach of the best surgical technique in each case, and the appropriate tools to operate in this region.
•The agger nasi is medial to the lacrimal sac in most patients.•The agger nasi can be considered an anatomical key point in endoscopic DCR.•The right and left sides of each patient have similar ...anatomy.
To analyze the anatomical relationship between the lacrimal sac and the agger nasi cell on Computed Tomography (CT); to correlate the right and left sides on each scan.
CT scans of adult patients were reviewed for pneumatization of the agger nasi and its relationship to the lacrimal sac. The degree of agreement between the right and left sides was also evaluated.
A total of 130 CT scans were examined. An agger nasi cell was found medial to the lacrimal sac in 59.23% of scans. On 86.15% of scans, pneumatization was similar on both sides.
The agger nasi air cell is located medial to the lacrimal sac in more than half of individuals. The right and left sides exhibit the same pneumatization pattern in approximately 80% of cases.
4.
Abstract
Introduction
The endoscopic access has reduced the morbidity associated with external approaches in diseases of the maxillary sinus. A reversible endoscopic medial maxillectomy (REMM) is ...presented as an alternative for treatment of benign maxillary diseases.
Objective
To describe the REMM technique and report four cases of patients with benign maxillary sinus conditions treated through this approach.
Methods
The present study was divided into two parts: anatomical and case series. Two cadaveric dissections confirmed the feasibility of the REMM approach. The same technique was performed on four consecutive patients with benign maxillary sinus disease.
Results
The cadaveric dissections confirmed wide exposure to the maxillary cavity, preserving the anatomy of the maxillary sinus. In the patient series, one patient presented with an antrochoanal polyp, one had a silent sinus syndrome, one had a chronic maxillary sinusitis secondary to a gunshot, and the last one had an inverted papilloma in the maxillary sinus. In all of the cases, the REMM approach provided excellent access and adequate resection, as well as preservation of the inferior turbinate, nasolacrimal duct, and lateral wall of the nose (including its osteomucosal component). Finally, all of the patients had an uneventful postoperative course.
Conclusion
The REMM technique is an excellent surgical approach to benign conditions of the maxillary sinus. It has few limitations and appears to be associated with less morbidity than conventional techniques.
Abstract
Introduction
It has been hypothesized that increasing the interstitial hydrostatic pressure within the sinonasal mucosa of patients with nasal polyposis (NP) might decrease the size of ...nasal polyps.
Objective
To evaluate the effects of positive airway pressure, delivered by a continuous positive airway pressure (CPAP) device, in patients with NP and in control subjects.
Methods
Twelve patients with NP and 27 healthy subjects were exposed to CPAP (20 cm H2O) for 2 hours. Visual analog scale (VAS), Nasal Obstruction Symptom Evaluation (NOSE) scale, acoustic rhinometry (AR), peak nasal inspiratory flow (PNIF) and nasal endoscopy (NE—Meltzer polyp grading system) were performed before and after the intervention, for all patients.
Results
The control group showed a significant worsening in nasal obstruction symptoms, as measured by VAS and NOSE (
p
< 0.01), and a significant decrease in nasal patency, as measured by the PNIF and AR (
p
< 0.01). For the NP group, VAS, NOSE, and AR did not differ significantly (
p
= 0.72,
p
= 0.73, and
p
= 0.17, respectively), but PNIF values worsened (
p
= 0.04) after exposure to CPAP. There was a statistically significant reduction in the nasal polyps' size (
p
= 0.04).
Conclusions
Positive pressure worsened the nasal obstruction symptoms and decreased objective parameters of nasal patency in control subjects. In patients with NP, exposure to CPAP reduced the nasal polyps' size, and the nasal patency, as measured by PNIF. However, it had no significant effects in AR and in nasal obstruction symptoms.
Craniopharyngioma Stamm, Aldo C; Vellutini, Eduardo; Balsalobre, Leonardo
Otolaryngologic clinics of North America,
08/2011, Letnik:
44, Številka:
4
Journal Article
Recenzirano
Craniopharyngiomas are rare epithelial tumors arising along the path of the craniopharyngeal duct; therefore, they occur in the sellar or suprasellar regions. These tumors commonly lead to ...neurologic, endocrinological, or visual symptoms. Radical surgery is the treatment of choice in craniopharyngiomas. The transnasal/transsphenoidal endoscopic approach offers the possibility of removing the tumor without retracting brain and optic pathways, with good results. The rate of cerebrospinal fluid fistula has improved due to the use of vascularized mucosal flaps for cranial base reconstruction.
The purpose of this study was to describe the endoscopic combined "transseptal/transnasal" approach with a pedicled nasoseptal flap for pituitary adenoma and skull base reconstruction, especially ...with respect to cerebrospinal fluid (CSF) fistula.
Ninety-one consecutive patients with pituitary adenomas were retrospectively reviewed. All patients underwent the endoscopic combined "transseptal/transnasal" approach by the single team including the otorhinolaryngologists and neurosurgeons. Postoperative complications related to the flap were analyzed.
Intra- and postoperative CSF fistulae were observed in 36 (40%) and 4 (4.4%) patients, respectively. Among the 4 patients, lumbar drainage and bed rest healed the CSF fistula in 3 patients and reoperation for revision was necessary in one patient. Other flap-related complications included nasal bleeding in 3 patients (3.3%).
The endoscopic combined "transseptal/transnasal" approach is most suitable for a two-surgeon technique and a pedicled nasoseptal flap is a reliable technique for preventing postoperative CSF fistula in pituitary surgery.
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