Abstract Introduction Diseases of the paranasal sinuses, nasal cavities, and those related to the skull base can be treated with nasal endoscopic surgery. Anatomical references are essential to ...safely perform these surgeries. Objective To measure and compare the distance from the posterior wall of the maxillary sinus to the anterior skull base in cadavers and on computed tomography (CT) scans to determine a measurement as an anatomical reference in imaging exams for sinus and anterior skull base surgery. Methods In dissections and CT scans, we took measurements from the most upper and medial point of the posterior wall of the maxillary sinus (point A) to the point where the skull base deflects and the anterior sphenoid wall is formed (Δ 90°; point B), in the right and left nasal cavities. We used 51 cadavers aged ≥ 18 years in the present research. Results The measurements obtained from CT scans and dissections were greater than 1.5 cm in all cadavers, and they were positively correlated. The 1-cm increase in the AB-tomography measurement corresponded to the 1.08-cm increase to the right and 1.07-cm to the left in the AB-dissection measurement. Conclusion The CT measurements may be considered a reliable tool to promote safe and effective access to the paranasal sinuses, matching the distance that should be dissected until the anterior base of the skull.
•Olfactory cleft enlargement and opacification suggests hamartoma.•Individualized anatomopathological exam of material from the olfactory cleft.•Material examined by experienced pathologist.•Almost ...half of the patients with Nasal Polyps have hamartomas.
To highlight the prevalence of respiratory epithelial adenomatoid hamartomas in the olfactory cleft of patients with nasal polyposis. To demonstrate characteristics indicative of hamartoma on the CT scans of paranasal sinuses during surgery and in histopathological exams.
Cross-sectional study carried out in Hospital das Clínicas da UFMG and Núcleo de Otorrino BH. We performed 114 nasal endoscopic surgeries for polyposis, between February 2015 and November 2019. We assessed the olfactory cleft width in all preoperative CT scans. Upon seeing an indication of hamartoma on the CT scan, we took a tissue sample from the olfactory cleft during the surgery and sent for histopathological exam. We referred the samples to a pathologist experienced in the anatomopathological diagnosis of respiratory epithelial adenomatoid hamartomas.
Of the 114 patients with polyposis, 54 (47.4%) had olfactory cleft enlargement and, 100% of them had tissue with a dense and hardened polypoid aspect, with a slight cerebriform appearance in this region during the surgery. Histology confirmed a respiratory epithelial adenomatoid hamartoma.
This observation suggests that the presence of hamartomas in polyposis is common, but underdiagnosed.
Step 3 (Level 3).
Introduction
This study aims to evaluate the existence of anatomic abnormalities in the skull base that could contribute to the origin of primary spontaneous cerebrospinal fluid leaks (PSL).
Methods
...Twenty PSL patients were compared with 20 healthy individuals. The following features were measured through an analysis of computed tomography scans: the angles of the petrosal bones and skull base in both the sagittal and coronal planes; the anteroposterior and mediolateral diameters of the anterior skull base, sella, and sphenoid sinus; the depth of the olfactory fossa; the pneumatization of the sphenoid sinus; the position of the crista galli; and the state of the dorsum sellae. Body mass index (BMI) was compared.
Results
There were no differences between the two groups with respect to the angles and diameters of the anterior cranial fossa and the sphenoid sinus or the depth of the olfactory fossa. Pneumatization of the lateral recess of the sphenoid sinus was more frequent in the PSL group (55%) than in the control group (25%,
p
= 0.053). The dorsum sellae were eroded in 30% of the PSL patients but intact in all healthy subjects. PSL subjects showed higher sellae (1.0 versus 0.8 cm,
p
= 0.002). The average BMI of PSL patients was higher than that of the control group.
Conclusion
Global alterations in the skull base of PSL patients were not found. The increase in the height of sellae and the erosion of its dorsum suggest intracranial hypertension. The higher BMI in the case group confirms the relation between obesity and PSL.
Chronic eosinophilic rhinosinusitis with nasal polyps (CRSwNP eosinophilic) is characterised by the formation of benign and bilateral nasal polyps. We aimed to compare the effectiveness of ...azithromycin as an immunomodulator with the use of a placebo in patients presenting with CRSwNP concomitant with asthma and aspirin intolerance after 3 months of treatment and at a 1-year follow-up.
We performed a randomised, double-blind, placebo-controlled trial. Patients received 500 mg azithromycin orally three times/week for 12 weeks. Improvement was evaluated by staging, the Sino-Nasal Outcome Test (SNOT-22), and nasal polyp biopsy. Data collected at pretreatment and 3 months posttreatment were compared. Quality of life was evaluated at the 1-year follow-up.
Twenty-seven and 21 patients were treated with azithromycin and a placebo, respectively. The medication was well tolerated overall. Twenty patients (74%) in the azithromycin group and three patients (14%) in the placebo group were not refer- red for surgery at the end of the 3-month treatment. Regarding subjective improvement, there was a median decrease only in the azithromycin group, and the between-group difference was significant. SNOT-22 improvement was maintained in the azithromy- cin group at the 1-year follow-up.
Azithromycin could be considered a therapeutic option for patients presenting with CRSwNP concomitant with asthma and aspirin intolerance.
Rhinoplasty Complications and Reoperations: Systematic Review Crosara, Paulo Fernando Tormin Borges; Nunes, Flávio Barbosa; Rodrigues, Danilo Santana ...
International Archives of Otorhinolaryngology,
01/2017, Letnik:
21, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Abstract
Introduction
This article is related to complications of rhinoplasty and its main causes of reoperations.
Objectives
The objective of this study is to perform a systematic review of ...literature on complications in rhinoplasty.
Data Synthesis
The authors conducted a survey of articles related to key terms in the literature by using three important databases within 11 years, between January 2002 and January 2013. We found 1,271 abstracts and selected 49 articles to this review.
Conclusion
The main results showed that the number of primary open rhinoplasty was 7902 (89%) and 765 closed (11%) and the percentage of reoperations in primary open complete rhinoplasties was 2.73% and closed complete was 1.56%. The statistical analysis revealed a value of
p
= 0.071. The standardization of terms can improve the quality of scientific publications about rhinoplasty. There is no difference between primary open or closed rhinoplasty techniques in relation to reoperations.
Adenotonsillar hyperplasia (ATH) and allergic rhinitis (AR) are the most common causes of upper airway obstruction in children. Such diseases, by affecting the upper airways, can cause chronic ...alveolar hypoventilation, pulmonary vasoconstriction and pulmonary hypertension, which in some cases, are irreversible.
This cross-sectional study aimed to evaluate the prevalence of pulmonary hypertension in two groups of mouth-breathing (MB) 2–12 years old children with ATH and isolated allergic rhinitis, through Doppler echocardiography.
54 patients with ATH and indications for adenoidectomy and/or tonsillectomy and 24 patients with persistent allergic rhinitis were selected and submitted to Doppler echocardiography. The Systolic Pulmonary Artery Pressure (SPAP) was determined by tricuspid regurgitation and the Mean Pulmonary Artery Pressure (MPAP) was calculated from the SPAP. Similar measurements were carried out in 25 nasal breathing (NB) individuals.
The mean MPAP and SPAP were higher in the MB than in the NB group (17.62±2.06 ATH and 17.45±1.25 AR vs. 15.20±2.36 NB mmHg, p<0.005, and 25.61±3.38 ATH and 25.33±2.06 AR vs. 21.64±3.87 NB mmHg, p<0.005, respectively) and the mean acceleration time of pulmonary flow trace (Act) was higher in the NB than in the MB group (127.24±12.81 RN vs. 114.06±10.63ms ATH and 117.96±10.28 AR MS AR; p<0.0001).
None of the MB children (ATH and AR) met the PH criteria, although individuals with both ATH and isolated AR showed significant evidence of increased pulmonary artery pressure by Doppler echocardiography in relation to NB individuals. No differences were observed between the ATH and AR groups.
A hiperplasia adenotonsilar (HAT) e a rinite alérgica (RA) consistem nas causas mais comuns de obstrução de vias aéreas superiores em crianças. Tais afecções, ao comprometer a via aérea superior, podem ocasionar hipoventilação alveolar crônica, vasoconstrição pulmonar e hipertensão pulmonar, em alguns casos irreversível.
Este estudo transversal objetivou avaliar a prevalência de hipertensão arterial pulmonar em dois grupos de crianças respiradoras orais (RO): com HAT e rinite alérgica isolada, de 2 a 12 anos, por meio de exame ecodopplercardiográfico.
Foram selecionados e submetidos à ecodopplercardiografia 54 pacientes com HAT com indicação de adenoidectomia e/ou tonsilectomia e 24 pacientes com rinite alérgica persistente. A pressão sistólica da artéria pulmonar (PSAP) foi determinada pela regurgitação tricúspide e a pressão média da artéria pulmonar (PMAP) foi calculada a partir da PSAP. Determinações similares foram realizadas em 25 respiradores nasais (RN).
As médias da PMAP e da PSAP foram maiores nos grupos de RO do que nos RN (17,62±2,06 HAT e 17,45±1,25 RA vs. 15,20±2,36 RN mmHg; p<0,005; e 25,61±3,38 HAT e 25,33±2,06 RA vs. 21,64±3,87 RN mmHg; p<0,005; respectivamente) e a média do tempo de aceleração do traçado do fluxo pulmonar (TAc) foi maior nos RN que nos grupos de RO (127,24±12,81 RN vs. 114,06±10,63 ms HAT e 117,96±10,28 RA MS RA; p<0,0001).
Nenhuma criança respiradora oral (HAT e RA) preencheu os critérios de HP, embora tanto os portadores de HAT quanto de RA isolada apresentaram evidências significativas de aumento da pressão arterial pulmonar pela ecodopplercardiografia em relação aos respiradores nasais. Não se observou diferença entre os grupos HAT e RA.
Diseases of paranasal sinuses, nasal cavity, and skull base can be treated by endonasal operations using a nasal rigid endoscope. When conducting this kind of surgery, anatomical references are ...critical for safety.
To measure the distance from the posterior wall of the maxillary sinus to the skull base, according to socio-demographic characteristics, and to detail an anatomical reference point for paranasal sinus operations and for an access to the anterior skull base, comparing anatomical variations between right and left sides, gender, height, weight, age, and ethnicity in cadavers.
Measures were taken from the 90° angle (the starting point where deflection of the skull base begins to form the anterior wall of the sphenoid, also known as Δ90°) to the upper, middle, and lower points of the posterior wall of the maxillary sinus. This study used 60 cadavers aged over 17 years, and evaluated these bodies with respect to age, height, BMI, weight, gender, and ethnicity, comparing measurements of right and left sides.
The measurements were >1.5cm in all cadavers and did not vary with age, height, weight, gender, and ethnicity on their right and left sides. The lack of association between the measurement from Δ90° to the upper, middle, and lower posterior walls of the maxillary sinus (categorical or quantitative) is noteworthy, considering the characteristics studied.
The methodology defined the nasal point of reference, considering an absence of variation in the cadavers’ characteristics.
Doenças dos seios paranasais, cavidades nasais e doenças da base do crânio podem ser tratadas com operação endonasal utilizando-se endoscópio rígido nasal. Referências anatômicas são importantes para a segurança durante a realização dessas operações.
Medir a distância da parede posterior do seio maxilar à base anterior do crânio de acordo com características sócio-demográficas. Detalhar um ponto de referência anatômico para operações dos seios paranasais e acesso à base anterior do crânio comparando variações anatômicas entre os lados direito e esquerdo, gênero, altura, peso, idade e etnia em cadáveres.
Medidas do ângulo de 90° (ponto onde inicia a deflexão da base do crânio para formar a parede anterior do esfenoide, chamado de ângulo de 90° – Δ90°) aos pontos superior, médio e inferior da parede posterior do seio maxilar. Foram utilizados 60 cadáveres com idade acima de 17 anos, e avaliados com idade, altura, peso IMC, gênero e etnia, comparando-se as medidas dos lados direito e esquerdo.
As medidas foram maiores que 1,5 cm em todos os cadáveres e não variaram com a idade, altura, peso, gênero e etnia nos lados direito e esquerdo dos cadáveres. Destaca-se falta de associação entre a medida do Δ90° à parede posterior superior; média e inferior do maxilar (categórico ou quantitativo) com as características estudadas.
A metodologia empregada definiu o ponto de referência nasal por não variar com as características dos cadáveres.
The Sino-Nasal Outcome Test 22 (SNOT-22) is an important tool in assessing the quality of life (QoL) of patients with chronic rhinosinusitis with a validated version in Brazil. The eosinophilic nasal ...polyposis (ENP) represents most of the cases of nasal polyposis (85–90%) and belongs to the group of chronic rhinosinusitis. It is a chronic inflammatory disease that impacts the QoL of patients, not only causing localized symptoms, but also resulting in a general malaise. The standard treatments (corticosteroids and nasal endoscopic surgery) lead to partial control of symptoms, but relapses are frequent. Macrolide acting as an immunomodulator is a promising tool for more effective control of this disease. Studies are still lacking to assess the real impact on the QoL in patients treated with macrolides.
To evaluate the improvement of QL, evaluated using SNOT-22, in patients with PNSE treated with immunomodulatory dose azithromycin.
This is a paired experimental study in patients with ENP. Comparison of pre-treatment and post-treatment with azithromycin was performed. Patients completed the SNOT-22 questionnaire before the start of treatment and returned for evaluation after eight weeks of treatment. Azithromycin was prescribed at a dose of 500mg, orally, three times a week, for 8 weeks.
SNOT-22 score decreased 20.3 points on average. There was a significant decrease in the SNOT-22 (difference greater than 14 points) in 19 patients (57.6%). There was no significant difference in improvement in SNOT in subgroups with or without asthma/aspirin intolerance.
Azithromycin resulted in significant improvement of QoL, assessed by SNOT-22, in the studied population.
O Sino-Nasal Outcome Test 22 (SNOT-22) está entre os principais instrumentos na avaliação da qualidade de vida dos pacientes com rinossinusite crônica, com versão validada no Brasil. A polipose nasossinusal eosinofílica (PNSE) representa a maioria dos casos de polipose nasossinusal (85% a 90%) e pertence ao grande grupo das rinossinusites crônicas. É uma doença inflamatória crônica que impacta sobremaneira a qualidade de vida (QV) dos pacientes, não só pelos sintomas locais, mas também por resultarem em um quadro de mal-estar geral. Os tratamentos padronizados (corticosteroides e cirurgia endoscópica nasal) levam ao controle parcial dos sintomas e as recidivas são frequentes. Os macrolídeos usados como imunomoduladores são uma promissora ferramenta para um controle mais eficaz dessa doença. Ainda faltam estudos para avaliar o real impacto na QV dos pacientes tratados com macrolídeos.
Avaliar a melhora da QV do paciente portador de PNSE tratado com azitromicina em dose imunomoduladora baseando-se questionário SNOT-22.
Trata-se de estudo experimental autopareado em pacientes com PNSE. Foi realizada a comparação dos pacientes pré-tratamento e pós-tratamento com azitromicina. Os pacientes preencheram o questionário SNOT-22 antes do início do tratamento e no retorno após as oito semanas de tratamento. Foi prescrita azitromicina na dose de 500 mg, VO, três vezes por semana, durante 8 semanas.
O valor do índice SNOT-22 dos pacientes reduziu 20,3 pontos, em média. Houve diminuição significativa do SNOT-22 (diferença maior que 14 pontos) em 19 pacientes (57,6%). Não houve uma diferença significativa na melhora do SNOT nos subgrupos com ou sem asma/intolerância à aspirina.
A azitromicina resultou em melhora significativa da QV, avaliada pelo questionário SNOT-22, na população estudada.
Intrathecal fluorescein has been effective for topographic diagnosis of rhinoliquorrhea. Nonetheless, there are no reports on the study of cerebral spinal fluid (CSF) after use of intrathecal ...fluorescein.
A prospective study attempting to evaluate CSF through chemical and cytological analysis, after injection of fluorescein.
Prospective analysis of 24 samples of CSF after intrathecal injection of fluorescein for topographic diagnosis of CSF fistulae, collected at the time of puncture and after 24 and 48h, divided by cellularity: Group 1, up to five cells, and Group 2, with more than five cells.
The yellow-greenish color of CSF remained after 48h in 36%, evidencing permanence of fluorescein. No changes in protein and glucose levels were observed between 0–24h and 0–48h. In group 2, an increase in cell count was observed between 24h and 48h (p=0.019). In both groups, there was an increase of neutrophils between 0 and 48h (p=0.048) and a decrease between 24 and 48h (p=0.05).
Intrathecal fluorescein provoked discreet meningeal reactions, such as an increase of cells between 24 and 48h and an increase of neutrophils at 24h, with a subsequent decrease at 48h with no correlation with symptomatology.
A fluoresceína intratecal tem sido efetiva no diagnóstico topográfico da rinoliquorréia. Entretanto, não há estudos no líquor após o uso de fluoresceína intratecal.
Estudo prospectivo visando avaliar o líquor, através de análise química e citológica, após injeção de fluoresceína.
Análise prospectiva de 24 punções após injeção intratecal de fluoresceína para diagnóstico topográfico de fístula liquórica, coletado no momento da punção, 24 e 48 horas, divididos pela celularidade: grupo 1, com até 5 células e grupo 2 com mais de 5 células.
A coloração amarelo-esverdeada do líquor permaneceu após 48 horas em 36%, evidenciando permanência de fluoresceína. Observou-se ausência de mudanças no nível de proteína e glicose entre 0–24 horas e 0–48 horas. No grupo 2, um aumento na contagem celular foi observado entre 24 e 48 horas (p=0,019). No dois grupos juntos, observou-se um aumento de neutrófilos entre 0 e 48 horas (p=0,048) e uma diminuição entre 24 e 28 horas (p=0,05).
Fluoresceína intratecal provocou discretas reações meníngeas, como o aumento de células entre 24 e 48 horas e aumento dos neutrófilos em 24 horas com uma subsequente diminuição em 48 horas sem correlação com sintomas.
Inflammatory conditions of the nose and paranasal sinuses are very prevalent in the general population, resulting in marked loss of quality of life in affected patients, as well as significant work, ...leisure, and social activity losses. These patients require specific and specialized treatment. A wide range of oral medications are available.
The present document is aimed to clarify, for professionals treating patients with inflammatory sinonasal diseases, both specialists and general practitioners, specific oral therapies in noninfectious nasal inflammatory conditions.
The methodology used to create this article included the search for the key words: oral corticosteroids, antihistamines, antileukotrienes, rhinitis, rhinosinusitis in the MEDLINE and EMBASE databases in the last 5 years. Since no relevant article was found for the text on the subject of interest in the last 5 years, the search was extended for another 5 years, and so on, according to the authors’ needs.
Relevant literature was found regarding the use of antihistamines, antileukotrienes and oral corticosteroids in these conditions. The Brazilian Academy of Rhinology emphasizes, after extensive discussion by the collegiate, key points in the treatment with these drugs.
There is support in the literature for the use of these drugs; however, final considerations about the role of each of them have been made.
As afecções inflamatórias do nariz e seios paranasais são muito prevalentes na população geral, causam acentuada perda de qualidade de vida dos pacientes afetados, gerando perdas significativas das atividades de trabalho, lazer e sociais. Estes pacientes necessitam de tratamento específico e especializado e uma ampla gama de medicações orais estão disponíveis.
O presente documento tem por objetivo esclarecer àqueles que tratam das doenças nasossinusais inflamatórias, tanto especialistas quanto generalistas, sobre as terapêuticas orais nas afecções inflamatórias nasais não infecciosas.
A metodologia utilizada para elaboração deste artigo incluiu a busca das palavras chave: corticosteroides orais, anti-histamínicos, antileucotrienos, rinite, rinossinusite nos bancos de dados MEDLINE e EMBASE nos últimos 5 anos. Não sendo encontrado artigo relevante para o texto sobre o assunto de interesse nos últimos 5 anos, a busca poi extendida por mais 5 anos, e assim por diante, de acordo com a necessidade dos autores.
Literatura relevante foi encontrada com relação ao uso dos anti-histamínicos, antileucotrienos e corticosteroides orais nestas afecções. A Academia Brasileira de Rinologia resalta, após amplo debate do colegiado, pontos-chave no tratamento com estes medicamentos.
Há respaldo na literatura para o uso destes medicamentos, entretanto considerações finais acerca do papel de cada deles foram feitas.
PDF
