Purpose
Design a compact, ergonomic, and safe endoscope positioner dedicated to the sino-nasal tract, and the anterior and middle-stage skull base.
Methods
A motion and force analysis of the ...surgeon’s movement was performed on cadaver heads to gather objective data for specification purposes. An experimental comparative study was then performed with three different kinematics, again on cadaver heads, in order to define the best architecture satisfying the motion and force requirements.
Results
We quantified the maximal forces applied on the endoscope when traversing the sino-nasal tract in order to evaluate the forces that the robot should be able to overcome. We also quantified the minimal forces that should not be exceeded in order to avoid damaging vital structures. We showed that the entrance point of the endoscope into the nostril could not be considered, as in laparoscopic surgery, as a fixed point but rather as a fixed region whose location and dimensions depend on the targeted sinus.
Conclusion
From the safety and ergonomic points of view, the best solution would be a co-manipulated standard 6-degree of freedom robot to which is attached a gimbal-like passive remote manipulator holding the endoscope.
Introduction: Surgeons have evolved a lot their surgical procedures in sinus surgery and are now able to resect malignant tumors. These progresses are now leading new difficulties like impairing ...vision (bleeding and LCR flow) and necessity of multiple simultaneous tasks. With the aim of designing a new endoscope-holder, primary step was to characterize the surgeon gesture, the kinematics, and the type of man-machine interface acceptable by the surgeon. Methods: We worked on thirteen sinonasal tracts of cadaver heads. Surgical procedures were: opening all the sinuses, the carotid, the sella turcica, the lamina papyracea and the anterior skull base. We used conventional instruments which were instrumented with a force-torque sensor and a navigation system. Then we have experimentally evaluated robots with three different kinematics and two types of man-machine interfaces. Results: We collected enough position and force data as well as kinematics constraints and interface requirements to specify a robot for endoscopic sinus surgery.
Background
Recurrent parotid pleomorphic adenoma surgery increases the risk of facial nerve injury, and there is also a risk of ulterior recurrence.
Methods
Postoperative results from 62 consecutive ...patients operated for recurrent pleomorphic adenoma were analyzed. It was the first recurrence for 49 patients (79%), the second or more for 13 patients (21%).
Results
Total parotidectomy was performed in 69.4% of cases. Skin resection was performed in 47 patients (75.8%). Resection of a facial nerve branch was performed in seven patients (11.3%). Pathologic examination findings revealed carcinoma ex pleomorphic adenoma in 10/62 cases (16.1%) and microscopic multinodular disease in 39 patients (62.9%). Nine patients had preoperative facial palsy, 95% had postoperative facial paralysis ≥grade II (House–Brackmann scale), and 11.3% still had ≥grade III facial palsy after 1 year. Six patients developed another recurrence after our intervention (9.68%). Moreover, carcinoma was discovered after a new intervention in 40% of these patients. Initial partial parotid surgery hazard ratio (HR) = 8.477,
P
= 0.008, microscopic multinodular recurrent disease (HR = 11.717,
P
= 0.005), and ≥1 recurrence number (HR = 10.608,
P
= 0.01) were associated with increased risk of ulterior recurrence.
Conclusion
Surgery is recommended in pleomorphic adenoma recurrence because of the high rate of carcinoma ex pleomorphic adenoma (16.1%). Nevertheless, a definitive facial paralysis ≥grade III rate of 11.3% is reported after multiple nerve dissection. New recurrence after surgery is less frequent if the initial treatment for pleomorphic adenoma is total parotidectomy.
Background and aim: Pathologic examination of the sinus mucosa and titration of inflammatory mediators in the sinus fluid were carried out to characterize inflammation in chronic sinusitis and ...determine whether patients with chronic allergic rhinitis (CAR) and sinusitis differ from patients with chronic nonallergic rhinitis (CNAR) and sinusitis. Methods: Nine control subjects (patients requiring ear, nose, and throat surgery not related to sinusitis), 12 patients with CAR and sinusitis, and 13 patients with CNAR and sinusitis were investigated. Eosinophil cationic protein, tryptase, myeloperoxidase, histamine, and prostaglandin D2 were measured in the sinus lavage fluids, and cells were enumerated. The cellular infiltrate was studied by immunohistochemistry with monoclonal antibodies against eosinophil cationic protein (eosinophils), tryptase (mast cells), neutrophil elastase (neutrophils), CD3 (lymphocytes), CD68 (macrophages), and proliferating cell nuclear antigens. Results: Neutrophils were not increased in sinusitis. In comparison with control subjects, patients with CAR and CNAR with sinusitis showed significant increases in eosinophils and macrophages in biopsy specimens and in eosinophil cationic protein in sinus lavage fluids. In comparison with patients with CNAR, patients with CAR had an increased number of intraepithelial mast cells and lymphocytes. Conclusions: These findings suggest that patients with CNAR and sinusitis can be distinguished from patients with CAR and sinusitis, which resembles nonallergic rhinitis with eosinophilia syndrome. (J ALLERGY CLIN IMMUNOL 1994;94:95-108.)
To evaluate the lack of accuracy in neck staging with the classical technique (i.e., neck dissection and routine histopathology) with the sentinel node (SN) biopsy in oral and oropharyngeal T1-T2N0 ...cancer.
Cross-sectional study with planned data collection.
Tertiary center care.
In 50 consecutive patients, the pathological stage of sentinel node (pSN) was established after analyzing SN biopsies (n = 148) using serial sectioning and immunohistochemistry. Systematic selective neck dissection was performed. The pN stage was established with routine histopathologic analysis of both the non-SN (n = 1075) and the 148 SN biopsies.
The sensitivity and negative predictive value of pSN staging were 100 percent. Conversely, if one considers pSN staging procedure as the reference test for micro- and macro-metastasis diagnosis, the sensitivity of the classical pN staging procedure was 50 percent (9/1; 95% CI 26.9-73.1) and its negative predictive value was 78 percent (95% CI 61.9-88.8). Fifteen patients (30%) were upstaged, including nine cases from pN0 to pSN >or= 1 and six cases from pN1 to pSN2. Two of the pN0-pSN1 upstaged patients died with relapsed neck disease.
The SN biopsy technique appeared to be the best staging method in cN0 patients and provided evidence that routinely undiagnosed lymph node invasion may have clinical significance.
Abstract Background The tumour grading of primary parotid cancers (PPCs) remains controversial. Methods A 20-year standardised single centre treatment has been assessed retrospectively. The ...histological review of 155 consecutively treated parotid malignancies identified 96 suitable cases for univariate and multivariate survival analyses. Results Treatment involved total parotidectomy, neck dissection and post-operative radiotherapy in, respectively, 91.7%, 83.3% and 70.4% of cases. The 5-year overall survival, disease-specific and recurrence-free survival rates were 79.4%, 83.5% and 70.8%, respectively. Univariate analysis confirmed the classical prognostic factors, i.e. age > 60 years, male gender, facial palsy, hardness of the tumour, clinical stage, tumour grade, facial nerve invasion and lymph node metastases. Multivariate analysis identified a three-grade classification just after the clinical stage as the most important prognostic factor. Conclusion This study identifies the prognostic significance of intermediate grade tumours.
Non-traumatic cavernous internal carotid artery (ICA) aneurysms are rare, and favour the occurrence of massive recurrent epistaxis, which is associated with a high mortality rate. We report the case ...of a 67-year-old woman presenting a ruptured ICA aneurysm extending into the sphenoid sinus, revealed by epistaxis. Selective coil embolization of the aneurysm was performed. Flow-diverter stents were deployed in order to utterly exclude the aneurysm and prevent revascularization. Anti-platelet treatment was provided to lower the risk of in-stent thrombosis. A left frontal hematoma associated with a subarachnoid haemorrhage occurred at day 2. Outcome was favourable with no neurological sequelae, and no clinical recurrence of epistaxis occurred. A 4 months follow-up digital subtraction angiography showed a complete exclusion of the aneurysm. In addition, a magnetic resonance cerebral angiography at 16 months showed stable results. Thus, this two-stage endovascular procedure has proven its effectiveness in preventing epistaxis recurrence while preserving the ICA patency.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Objectives: Surgery of recurrent pleomorphic adenoma (RPA) is known to lead to a high facial nerve complication rate. The efficacy of the continuous facial nerve monitoring (CFNM) technique remains ...to be proven in RPA surgery. The goal was thus to evaluate facial nerve palsy rates and the recovery period after parotidectomy for RPA using CFNM by way of continuous electromyography and to compare these rates and the operation time with those of patients who had undergone surgery without facial nerve monitoring.
Design: Cohort study.
Patients: Forty‐seven patients were referred for RPA (1981–2003). Among them, 32 (18 unmonitored and 14 monitored) patients displayed no preoperative facial palsy, and histologic analyses revealed evidence of recurrence. The operation time and the extent and duration of postoperative facial nerve palsy were examined in both groups (monitored vs. unmonitored). Both groups had a similar clinical appearance distribution.
Results: Facial nerve paralysis was estimated using the House‐Brackmann grading scale. CFNM reduced the intensity of facial nerve paralysis independently of the kind of surgery performed. The complete deficit rates were 0% for the monitored group and 5.6% for the unmonitored group. Postoperative facial nerve paralysis was significantly lower (P = .01) in the monitored group than in the unmonitored group. CFNM improved the duration of facial paralysis (P = .001) in the monitored group. The operation time was significantly lower in the monitored group than in the unmonitored group (P = .001).
Conclusions: Routine use of CFNM during RPA surgery improves the surgical outcome. The facial nerve deficit can be reduced, and the recovery of facial nerve function is faster.
Endoscopic treatment of antrochoanal polyps BOZZO, Corrado; GARREL, Renaud; MELONI, Francesco ...
European archives of oto-rhino-laryngology,
02/2007, Letnik:
264, Številka:
2
Journal Article
Recenzirano
The antrochoanal polyp (Killian polyp) is an infrequent, benign neoplasm, which arises from the maxillary sinus to reach the ipsilateral choana. The treatment of this disease is essentially surgical, ...by means of a wide antrostomy. The aim of the study was to compare the results obtained on 23 consecutive cases of antrochoanal polyps endoscopically treated between February 1997 and January 2000 with those reported in the literature, with particular regard to the surgical technique adopted, the histological features, the patterns of its development and the clinical outcomes. The histology revealed in most of the cases a cystic aspect surrounded by edematous stroma. In all cases the polyp emerged from the middle meatus, mostly starting from the upper-lateral (zygomatic) wall of the antrum. All patients were endoscopically followed-up for an average period of 39 months (17-61). We observed two recurrences, both in pediatric cases who evidently underwent an incomplete surgical removal of antral mucosa at its inferior aspect, probably due to the fear of damaging the teeth buds. We did not observe any postsurgical complication. Our data indicate the endoscopic middle meatal antrostomy as the optimal approach, also for the revision cases and in children.
Nasal packing is commonly used to control postoperative bleeding in patients undergoing endonasal surgical procedures. Bleeding and pain on packing removal are frequently reported. The principal ...objective of this study was to investigate the efficacy and safety of Algosteril to control post-operative nasal bleeding. The secondary objective was to assess nasal bleeding and pain on packing removal, and to evaluate the endoscopic appearance of nasal mucosa 9 days after the procedure. This open, multicenter, randomized, controlled study was conducted on 50 patients undergoing partial bilateral inferior turbinectomy, packed with Algosteril on one side versus Polyvinyl acetal tampon (Merocel) on the other side following a left/right randomization. Both nasal packs effectively prevented post-operative bleeding. However, bleeding on packing removal was statistically less frequent and less severe with Algosteril than with Polyvinyl acetal (p = 0.016). In addition, pain was statistically lower with Algosteril than with Polyvinyl acetal (p = 0.0001). A trend to a better healing of the wound on day 9 was observed with Algosteril, leading us to further investigations. Algosteril nasal packing is as effective as Polyvinyl acetal in preventing postoperative bleeding following partial inferior turbinate resection. Its removal, however, is less traumatic for the nasal mucosa and less painful for the patient, therefore improving patient's comfort.
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