Anterior Ethmoid Sinus Research Articles

Ectopic olfactory neuroblastoma: report of four cases and a review of the literature

Our objective is to present a short series of four rare cases of ectopic olfactory neuroblastoma. Our methods present four case reports of ectopic olfactory neuroblastoma and a review of the literature for management and treatment of this disease. The results indicate short case series reports of ectopic olfactory neuroblastoma arising from the anterior ethmoidal sinuses, the nasopharynx, the lateral nasal wall and the floor of the nose. The discussion focuses on likely origins of ectopic olfactory neuroblastoma, its clinical features and management. We conclude that ectopic olfactory neuroblastoma is a rare disease. Treatment principles are the same for non-ectopic disease and guided by extension into adjacent structures such as the orbit or anterior cranial fossa and usually involves surgery with or without adjuvant radiotherapy.

Retained Gauze Material in the Nasal Cavity after Functional Endoscopic Sinus Surgery for Ten Years: A Case Report

We report a case of retained packing gauze material in the right nasal cavity for ten years. A 55-year-old woman presented to the emergency service with headache, nasal discharge, and epistaxis from the right nasal cavity. Her past surgical history included a functional endoscopic sinus surgery because of nasal polyposis 10 years ago. In the endoscopic nasal examination, foreign body similar to nasal packing material about 5 cm in length was detected in the right anterior ethmoid sinus. CT of the paranasal sinuses showed only loss of aeration in the right nasal cavity. The nasal packing material was removed under local anaesthesia on the same day. Foreign body left behind after operation is a serious medicolegal issue and is often under-reported.

Sinolith in the ethmoid sinus: report of two cases and review of the literature

We present two cases of sinolith in the ethmoid sinus. The first was a 52-year-old woman who complained of nasal dyspnea, postnasal drip and dry cough. Computed tomography (CT) showed a smooth-margined oval stone embedded in the middle meatus and occupying the bulla ethmoidalis, which was destroyed. The second was a 71-year-old man who had had repeated polypectomies. An oval calcified mass was revealed on CT in the anterior ethmoid sinus adjacent to the left lamina papyracea. All pertinent literature were reviewed and only one further case of ethmoid sinolith was encountered. The etiology, radiological features, differential diagnosis and treatment are discussed.

Etiopathogenesis of Rhinosinusitis in Relation to Ethmoid Anatomy

Abstract Introduction: Rhinosinusitis is one of the most common ENT disorders in the developed and developing world. The quest and identification of factors predisposing to chronic rhinosinusitis is the key for guiding appropriate management. Objectives The purpose of this study was to determine the prevalence of anatomical variations of the ethmoid sinus in patients with rhinosinusitis. This was done to assess and evaluate the significance of the anatomical variations of the ethmoid in the genesis of inflammatory sinus disease. Material and methods We reviewed 50 patients with rhinosinusitis, of which 38(76%) had anatomical variations of ethmoid and the extent of mucosal disease. Results Concha bullosa was found to be the most common anatomic variation and was seen in 25(50%) patients closely followed by variations in the uncinate process, paradoxically bend middle turbinate. The most commonly affected paranasal sinus was maxillary sinus (84%) followed by anterior ethmoidal sinus, posterior ethmoidal sinus, frontal sinus and sphenoid sinus in descending order. Conclusion Anatomical variations of the ethmoid sinuses are important etiological factors in the genesis of inflammatory sinus disease.

Level of Complete Dissection of the Ethmoid Sinuses with a Computed Tomographic Image Guidance System

We sought to determine the adequacy of endoscopic total ethmoidectomy with the use of a computed tomographic (CT) image guidance system. Endoscopic ethmoid sinus dissections were performed on cadavers by otolaryngologists. All cadavers were scanned before dissection. On each side of the cadaver, the ethmoid sinuses were examined independently. A complete endoscopic ethmoidectomy was performed with a CT image guidance system. After the endoscopic ethmoidectomy, the cadaver underwent a postdissection CT scan. The postdissection CT images were then evaluated for the level of complete dissection of the anterior and posterior ethmoid sinuses. There were 18 ethmoid sinuses in the study. One specimen underwent a complete total ethmoidectomy with no residual cells. There were 4 complete anterior ethmoidectomies and 5 complete posterior ethmoidectomies. Overall, the average numbers of residual anterior ethmoid and posterior ethmoid air cells were 1.39 and 1.22, respectively. This difference was not statistically significant. The skull base was dissected more completely than the lamina papyracea, with a significant difference (p = 0.03). There was no difference in terms of residual cells between the left and right ethmoid sinuses (p > 0.05). Even with the use of a CT image guidance system, a complete ethmoidectomy was still difficult to achieve. Residual ethmoid sinus cells were more commonly found along the lamina papyracea than along the skull base.

Safety of Ethmoid Sinus Drug-Eluting Catheter Insertion

We sought to evaluate an instrument that allows a drug-eluting catheter to be inserted into the ethmoid sinuses and to demonstrate its safety and reproducibility in a cadaver model. A drug-eluting catheter was placed into 12 cadaveric anterior and posterior ethmoid sinuses by use of a trocar-based insertion device. The device's position was analyzed with computed tomographic scans, and postprocedural dissection was performed. The drug-eluting catheter system was successfully inserted in all ethmoid sinuses without injury to the medial orbital wall, skull base, or sphenoid face. The final position of the distal tip of the catheter averaged 8.1 mm (root mean square [RMS], 3.3 mm) from the skull base, 5.6 mm (RMS, 3.5 mm) from the sphenoid face, and 5.0 mm (RMS, 3.5 mm) from the lamina papyracea; the proximal tip was at the face of the ethmoid bulla and 17.1 mm (RMS, 3.5 mm) below the skull base. A trocar-based instrument can relatively safely and reproducibly introduce a drug-eluting catheter into the ethmoid sinuses without injuring the skull base, lamina papyracea, or sphenoid face. This device may allow safe topical drug delivery into the ethmoid sinuses and serve as a vehicle to treat chronic ethmoid sinusitis with direct and sustained topical therapy.

Inverted papilloma with osteogenesis in the anterior ethmoid and frontal sinuses

We report a rare case of new bone formation (osteogenesis) within an inverted papilloma, occurring in the ethmoid and frontal sinuses. The histopathological and radiological findings, differential diagnosis, and treatment of tumour-induced osteogenesis are discussed. A 68-year-old man complained of headache and left-sided, purulent rhinorrhoea of five years' duration. On nasal endoscopy, lesions similar to inflammatory nasal polyps were seen. Pre-operative radiological images demonstrated opacification of the left nasal cavity and anterior ethmoid and frontal sinuses, plus a bone-density lesion. The mass with bony lesion was completely removed endoscopically. The mass was histopathologically diagnosed as an inverted papilloma surrounding bony tissue. Furthermore, the histopathological findings (including immature bony tissue rimmed by osteoblasts) indicated an extremely rare case of inverted papilloma induced osteogenesis. Six months after surgery, no recurrence was detected. This case highlights the importance of clinical awareness of tumour-induced osteogenesis.

Long‐term frontal sinus patency after endoscopic frontal sinusotomy

The frontal recess is the drainage pathway that connects the frontal sinus to the anterior ethmoid sinus. Mechanical obstruction is the primary cause of chronic frontal sinusitis with or without a secondary inflammatory process. Eosinophilic inflammation is one of the underlying causes for chronic rhinosinusitis. OBJECTIVES/HYPHOTHESIS: To evaluate long-term frontal sinus patency after endoscopic frontal sinusotomy in chronic rhinosinusitis patients and to assess the effect of eosinophilic inflammation on frontal sinus patency. Retrospective chart review. Symptom assessment and archived endoscopic photographs were prospectively collected on patients who underwent frontal sinusotomy between 7-1-1999 and 12-31-2000. Subjective symptom improvements were evaluated using the SNOT-20 = 20-item Sino-Nasal Outcome Test. Objective findings of endoscopic frontal sinus patency were documented by archived digital photography. A total of 161 patients with 294 frontal sinuses who underwent endoscopic frontal sinus surgery in the 18 months had an average follow-up of 45.9 months. The patient population was divided into two groups: 58 patients had eosinophilic CRS (ECRS), and 103 patients had CRS without eosinophils (non-ECRS). The mean follow-up for patients with ECRS is 61.6 months and 37.0 months for non-ECRS patients. The non-ECRS patients had a documented endoscopic frontal sinus patency of 90%, and the ECRS patients had an endoscopic frontal sinus patency of 85%. The overall frontal ostium patency rate for all patients was 88.0%. Long-term endoscopic confirmation of frontal ostium patency demonstrates that endoscopic frontal sinusotomy can yield high quality, durable results. There was no significant difference in patency results between ECRS and non-ECRS patients. Laryngoscope, 2009.

Endoscopic Study for the Pterygopalatine Fossa Anatomy

The purposes of this study were to locate the constant anatomic landmarks, which are very important and helpful for endoscopic surgery and not well described for the pterygopalatine fossa (PPF) surgery via the middle nasal meatus-sphenopalatine foramen approach to establish a safe surgical mode. Eight cases of adult skull specimens were selected for the simulated surgery. The Messerklinger surgical approach was used under the endoscope. The uncinate process was removed successively, and the anterior ethmoid sinus and posterior ethmoid sinus were opened. The opening of the maxillary sinus was identified and was expanded forward and backward. The ethmoidal crest was found and was used as an anatomic landmark to find the sphenopalatine foramen. The sphenopalatine artery was protected and was used as a guide to enter the PPF region. The sphenopalatine artery was followed conversely to anatomize the blood vessels and nerves in the PPF. It was found that our surgical procedure provides a clear view of the constant anatomic landmark including ethmoidal crest and sphenopalatine foramen. By retrograde dissection, following the sphenopalatine artery, which runs out of the sphenopalatine foramen behind the ethmoidal crest, the internal maxillary artery (IMA) and the branches of the IMA in the PPF were exposed. Posterior to the sphenopalatine artery, the typical Y-shaped structure with the pterygopalatine ganglion as the center was visible when the IMA and its branches were moved downward and outward. The Y structure, which is consisted of the pterygopalatine ganglion, branches of the internal maxillary nerve, vidian nerve, and descending palatine nerve, served as the other anatomic landmark. By following the Y structure, it was easy to locate the pterygoid canal, foramen rotundum, and the infraorbital nerve, and the integrity of the nerve structure could be protected. Endoscopic PPF surgery via the middle nasal meatus-sphenopalatine foramen approach is safe, and the ethmoidal crest, sphenopalatine foramen, and Y structure with the pterygopalatine ganglion in the center are important anatomic landmarks that can be referred to during the surgery.

Experimental study on anatomy of adjacent structures of the optic canal

To provide microanatomical data for optic canal decompression surgery or paranasal sinus surgery through anatomical study on adjacent structures of the optic canal. It was a experimental study. (1) Fifty dry cadaveric adult heads (100 sides) were dissected. The shapes and sizes of ethmoid sinus and sphenoid sinus were observed and measured. (2) The distance between the mid-point of the lateral wall of the sphenoid sinus and the internal carotid artery, the angle between the initial section of the ophthalmic artery and internal carotid artery were observed and measured under both naked eye and microscope. The distance between the medial margin of bilateral optic nerve at the frontal outlet were measured on 15 formalin-fixed wet cadaveric adult heads. The relationships between the optic canal and ethmoid sinus and sphenoid sinus were observed on 6 formalin-fixed cadaveric adult heads by CT scanning; the morphological features and adjacent structures were contrasted and observed on 6 ice-frozen cadaveric head specimens by CT scanning and corresponding applied sectional anatomy. The anterior-posterior diameter of total ethmoid sinus was (39.02 +/- 4.89) mm. The horizontal diameter of anterior ethmoid sinus was (12.26 +/- 2.12) mm. The superior-inferior diameter of anterior ethmoid sinus was (11.89 +/- 2.56) mm. The anterior-posterior diameter of sphenoid sinus was (24.08 +/- 4.87) mm. The distance between the middle part of the lateral wall of sphenoid sinus and internal carotid artery was (1.23 +/- 0.56) mm; the angle between the initial section of ophthalmic artery and internal carotid artery was 54.33 degrees +/- 7.89 degrees . The distance between the medial margin of bilateral optic nerve at the frontal outlet was (14.26 +/- 3.23) mm. (1) When the medial wall of the optic canal is opened inside the sphenoid sinus, the depth shouldn't exceed 13 mm, otherwise it may damage the internal carotid artery and cause severe bleeding even death. (2) The depth should be less than 15 mm and the superior-inferior diameter should be less than 12 mm inside the anterior ethmoid sinus, otherwise the opposite ethmoid sinus or frontal base may be opened accidently. (3) The ophthalmic artery should be specifically protected in order not to cause ocular ischemia and blindness.

Transantral, Endoscopically Guided Balloon Dilatation of the Ostiomeatal Complex for Chronic Rhinosinusitis under Local Anesthesia

A multicenter study (BREATHE I - Entellus Medical, Inc.) was performed to assess the safety and outcomes of a new, less invasive system that uses direct endoscopic visualization to facilitate balloon dilation of the maxillary sinus ostia and ethmoid infundibulum. General anesthesia was avoided in most subjects to assess feasibility of performing transantral ostial dilatation in an office setting. Subjects with chronic rhinosinusitis of the maxillary sinuses alone or maxillary and anterior ethmoid sinuses underwent baseline evaluation including CT imaging and symptom assessment using the Sino-Nasal Outcome Test (SNOT 20). Subjects underwent transantral balloon dilation and follow-up evaluation at 1 week, 3 months, and 6 months post-procedure. Thirty subjects were treated at three centers. Fifty-five of 58 maxillary ostia were successfully treated for a procedural completion rate of 94.8%. Ninety-seven percent of the procedures were completed under local anesthesia with or without minimal intravenous sedation. There were no device-related serious adverse events or unanticipated adverse device effects. The mean overall SNOT 20 score at baseline was 2.9 +/- 1.0. Mean overall SNOT 20 scores at 1-week, 3-month, and 6-month follow-up were 0.8 +/- 0.8, 0.7 +/- 0.8, and 0.8 +/- 0.9 respectively. Patency at 3-months as confirmed by CT imaging was 95.8%. These results indicate that transantral balloon dilation of the ostiomeatal complex under local anesthesia appears to be a safe technique for managing isolated maxillary or maxillary and anterior ethmoid sinusitis and can potentially be performed safely in an office setting.

Analysis of clinical characteristics of chronic rhinosinusitis in patients with postirradiated nasopharyngeal carcinoma

To study the characters of chronic rhinosinusitis in patients with irradiated nasopharyngeal carcinoma. There were 65 cases of chronic rhinosinusitis after irradiated nasopharyngeal carcinoma (NPC, experimental group) and 65 cases of common chronic rhinosinusitis (CRS, control group) in the study. The visual analogue scale (VAS) was used to evaluate the intensity of subjective symptoms. Endoscopic finding was recorded and CT results were evaluated by Lund-Mackay scoring system. As to the VAS, nasal secretion was significantly more severe in experimental group (7.86+/-1.62), compared with control group (5.12+/-1.32, t=10.541, P<0.01). As to endoscopic finding, middle nasal meatus were clean in 35 (53.8%) cases in experimental group, and 23 cases (35.4%) in control group (chi2=4.483, P<0.05). CT score was (7.03+/-4.63) in experiment group, and (11.42+/-3.32) in control group (t=-6.207, P<0.05). The main reason lays in lower CT score and lower involved rate of ostiomeatal complex, frontal sinus, maxillary sinus, anterior ethmoid sinus. The characters of chronic rhinosinusitis in patients with irradiated nasopharyngeal carcinoma is quite different from the common CRS and different therapeutic measures should be taken.

Pathology Quiz Case 1

A 49-Y E A R-O L D W O M A N P R E S E N T E D with a 6-month history of right-sided epiphora and a slowly enlarging palpable “bump” on the right side of her nasal wall. She had no remarkable medical history and denied any bloody drainage or pain related to her eye or nose. She also denied using alcohol or tobacco. She was in good health otherwise and had no constitutional symptoms. Physical examination revealed a 2-cm firm, smooth, nontender mass at the right nasal side wall. The mass was nonmobile, and there were no overlying ulcerations or skin changes. The patient’s extraocular movements were intact, and there was no afferent pupillary defect. Some ipsilateral epiphora was present. Nasal endoscopy and a head and neck examination revealed no other abnormalities. Computed tomography of the head showed an expansile 2.6-cm soft-tissue mass following the course of the nasolacrimal duct (Figure 1). The mass, which did not cross the midline, expanded into the right anterior ethmoid sinuses, with no evidence of bony destruction. Subsequent magnetic resonance imaging demonstrated slight heterogeneity on T1and T2-weighted sequences, and there was no evidence of invasion into the orbit. Complete surgical excision of the lesion was performed through an extended Lynch incision, without complication. Hematoxylin-eosin staining demonstrated a welldemarcated nodule punctuated with thick-walled vessels (Figure 2). Immunohistochemical stains were positive (brown) for CD31 and CD34 (Figure 3) as well as for smooth muscle actin and muscle-specific actin (Figure 4). No nuclear atypia was seen. What is your diagnosis?

副鼻腔嚢胞手術症例の臨床検討

This study retrospectively analyzed the clinical features of patients with paranasal sinus cysts. Between April 1995 and March 2008 at Hyogo College of Medicine, we performed sinus surgery on 218 patients with paranasal sinus cysts. There were 125 men and 93 women with the mean age of 57.5 years (17-85 years old). Diagnosis was based on the preoperative endonasal and radiological findings as well as surgical findings. The patients were followed for 6 months or more after surgery. Of 218 patients, postoperative cysts were observed in 173 patients (79.4%), and idiopathic cysts were found in 45 patients (20.6%). In postoperative cysts, the maxillary sinus was the most common lesion (124/173 patients, 71.7%). Most patients (53.8%) presented with cheek swelling and pain. The mean interval between the first and most recent surgery was 31.2 years (4-55 years). Among idiopathic cysts, anterior ethmoid sinus (19/45 patients, 42.2%) and frontal sinus (15/45 patients, 33.3%) were common lesion sites. More than a half of them (53.3%) presented with ophthalmologic symptoms. For treatment, endoscopic sinus surgery (ESS) was performed on 206 patients. The navigation system for ESS was utilized in 6 patients (2.8%). External approaches were required in 23 patients (10.6%). The Caldwell-Luc procedure for maxillary sinus cysts and Killian's procedure for frontal sinus cysts were performed on 18 and 5 patients, respectively. Dacryocystorhinostomy (DCR) with the endonasal approach was additionally performed on 4 patients with epiphora due to postoperative maxillary sinus cysts. Recurrence of cysts was observed in 5 patients (2.3%) at the mean interval of 25 months after surgery, comprising three patients with maxillary sinus cysts, one patient with a frontal sinus cyst, and one patient with a sphenoid sinus cyst. In conclusion, most paranasal sinus cysts (approximately 80%) occurred postoperatively. Symptoms were predominantly ophthalmologic. Selecting an endoscopic and/or an external approach is critical, considering minimally invasive surgery and risk of recurrence.

眼症状を呈した副鼻腔疾患の手術例の検討

This study reviewed the clinical features of patients with paranasal sinus diseases initially demonstrating ophthalmologic manifestations. Between April 1995 and March 2008 (13 years), we performed sinus surgeries in 100 patients with paranasal sinus diseases presenting with ophthalmologic symptoms at Hyogo College of Medicine. There were 54 men and 46 women, aged 56.0 years (10-86 years). The diagnosis was based on the preoperative findings of ophthalmologic, endonasal and radiological examinations, and operative findings. The patients were followed-up for 6 months or more after surgery. Patients with symptoms due to tumor or trauma were excluded in this study. Majority of them (64/100 patients, 64%) were initially referred to ophthalmologists. Of the 100 patients, loss of visual acuity was most frequently observed in 39 patients (39%). Other ophthalmologic symptoms were eyelid swelling (27%), ocular pain (24%), diplopia (19%), constriction of the visual field (9%), exophthalmos (11%), epiphora (7%), pressure behind the eye (7%), external ophthalmoplegia (2%), and ptosis (2%). Symptoms associated with paranasal sinus cysts were mostly found in 65 patients (65%) with compression of the adjacent orbita, those occurring in bacterial sinusitis in 33 patients (33%), and those in fungal sinusitis in 2 patients (2%). Forty patients (40%) were diagnosed with rhinogenic optic neuropathy. Major lesions were observed in the posterior (35%) and anterior (32%) ethmoid sinus. For treatment, an intranasal approach (endoscopic sinus surgery, ESS) was performed in 89 patients (89%), whereas an external approach was required in 11 patients (11%). During the postoperative course, reoperation (ESS) was required in 3 patients (3%) because of recurrence in the sphenoid sinus, whereas the other 97 patients followed an uneventful course. In conclusion, pre- and long-term postoperative observation by not only otolaryngologists but also ophthalmologists is recommended in order to perform minimally invasive surgery and avoid recurrence.

Fluconazole induced herpes labialis-like lesions in an adult male

Fluconazole is a bistriazole commonly prescribed for the treatment of various fungal infections caused by yeasts and dermatophytes. However, there have been several reports of rare Adverse Drug Reactions (ADRs) like Fixed Dose Eruption (FDE), Toxic Epidermal Necrolysis and Stevens Johnson Syndrome following oral administration of fluconazole. We report a rare case of fluconazole induced oral mucosal lesions, mimicking herpes labialis, in a 34 year old male patient receiving oral fluconazole for the treatment of allergic fungal sinusitis. Case report A 34 year old man presented with multiple, painless, shallow erosions, measuring about 1 cm in diameter, over the mucosal surface of the upper lip and the outer surface of the lower lip along with burning, itching and crusting. The erosions developed from painful vesicles characteristic of localised herpes simplex. Tzanck test for herpes simplex infection was negative. The patient suffered from perennial allergic rhinosinusitis for one year which was treated with topical steroids, antibiotics and antihistaminics leading to intermittent remission of symptoms. A CT scan of the paranasal sinuses showed opacification of both the maxillary and anterior ethmoid sinuses with diffuse intrasinus area of increased attenuation, suggesting fungal sinusitis. Hence, oral fluconazole 150mg once daily was started presumptively for a week. History revealed that fluconazole treatment was concomitantly associated with the development of herpes labialis-like vesicles. The first episode of blistering started after the intake of the third tablet of fluconazole. There were no other constitutive symptoms. Therefore, a Fixed Dose Eruption (FDE) to fluconazole was suspected. Oral provocation test with fluconazole 150mg was performed in the following week with the patient’s consent. The patient developed burning sensation and erythema on the mucosal aspect of both the lips, developing into herpes-like vesicles at the same site on the very next day and painful erosions by the fourth day, mimicking the earlier episode. (Figure 1)The erosions healed within a week of stopping fluconazole and the patient continued receiving treatment for allergic rhinosinusitis. The ADR was reported to the peripheral pharmacovigilance centre of the state under the National Pharmacovigilance Programme India.

S290 – Sinonasal Pathology and Severity of Bronchiectasis

Objectives 1) To investigate the prevalence of nasal symptoms, nasal polyposis, and sinusal opacification in patients with bronchiectasis. 2) To investigate the association between the degree of sinusal opacification and the bronchiectasis extension. Methods 88 consecutive patients with stable non-cystic bronchiectasis were prospectively evaluated for nasal symptoms (RASP, 0–3), polyp size (nasal endoscopy, 0–3), sinusal occupation (CT, 0–24), and chest HRCT (0–18). Results Following EP3OS criteria, 77% of patients presented had chronic rhinosinusitis (CRS). Nasal congestion (incidence: 90%; score: 1.6±0.1) Anterior (99%; 1.9±0.1) and posterior (91%; 1.8±0.1) rhinorrhea, were reported by patients as the major complaints. Nasal polyps (NP) of a mild-moderate size (1.6±0.3) were found in 25% of patients. Sinonasal CT was abnormal in patients with CRS, with a CT score of 8.4±0.4, with predominance in maxillary sinus (2.1±0.1), anterior ethmoid sinus (1.9±0.1), and ostiomeatal complex (2.2±0.2). Patients with CRS had significantly worse scores on chest HRCT (CRS: 3.7±0.7; no CRS: 7.2±0.5). Conclusions More than 75% of patients affected with BQs fulfil EP3OS criteria of CRS and 25% of patients presented NP. Patients with CRS presented more affectation on chest HRCT scan. We conclude that patients with bronchiectasis should be evaluated to assess the presence of chronic rhinosinusitis and nasal polyposis.

S276 – Nasal Sinus Diseases Demonstrating Ophthalmologic Symptoms

Objectives This study reviewed the clinical features of paranasal sinus diseases demonstrating ophthalmologic manifestations. Methods Between April 1995 and December 2007, we performed endoscopic sinus surgery (ESS) in 106 patients with paranasal sinus diseases presenting with ophthalmologic symptoms. There were 57 men and 49 women, aged 56.4 years (10 − 86 years). Diagnosis was based on the pre- and intraoperative findings. Patients with symptoms due to tumors were excluded from this study. Results Of 106 patients, loss of visual acuity was most frequently observed in 40 patients (37.7%). Other symptoms were eyelid swelling (28.3%), diplopia (18.9%), constriction of the visual field (13.2%), exophthalmos (13.2%), ocular pain (12.3%), external ophthalmoplegia (3.8%), and epiphora (1.9%). The symptoms involved in paranasal sinus cysts were found in 67 patients (63.2%), those in bacterial sinusitis in 36 patients (34.0%), those in fungal sinusitis in 2 patients, and those in Wegener's granulomatosis in 1 patient. The 38 patients (35.8%) were diagnosed as rhinogenic optic neuropathy, and most of them (32/38 patients, 78.9%) initially referred to ophthalmologists. Major lesions were observed in anterior and posterior ethmoid sinus (40 patients, 37.7%). For the treatment, external approaches were required in 11 patients (10.4%). During the postoperative course, reoperation (ESS) was required in 3 patients (2.8%) because of recurrence in the sphenoid sinus, whereas the other 103 patients had an uneventful course. Conclusions Pre- and postoperative observation by not only otolaryngologists, but also ophthalmologists, is recommended in order to perform minimally invasive surgery and to avoid recurrence.

Safety of Ethmoid Sinus Drug-Eluting Catheter Insertion

Problem The objective is to develop an instrument which allows a drug-eluting catheter to be safely and reproducibly inserted into the ethmoid sinuses. Methods A trochar-based insertion device was designed to allow delivery of a drug-eluting catheter into the anterior and posterior ethmoid sinuses. It was inserted into 12 cadaveric ethmoid sinuses under endoscopic and fluoroscopic guidance. CT scans were performed pre-, intra-, and post-procedure. The device's position was analyzed and the proximity to the skull base, lamina papyracea, and ethmoid face was measured. The specimens were then dissected and evaluated for skull base, sphenoid face, or lamina papyracea injury. Results The drug eluting catheter system was successfully inserted into the ethmoid sinuses of all 12 cadaver sides without injury to either the medial orbital wall or the skull base as confirmed by post-procedure CT scan and dissection. The final position of the distal tip of the stent averaged 8.1mm (RMS = 3.3) from the skull base, 5.6mm (RMS=3.5) from the sphenoid face, and 5.0mm (RMS=3.5) from the lamina papyracea; the proximal tip was at the face of the ethmoid bulla and 17.1mm (RMS=3.5) below the skull base. Conclusion This study demonstrates that a trochar-based instrument can safely and reproducibly introduce a drug-eluting catheter into the ethmoid sinuses without skull base or lamina papyracea injury. This device may allow safe topical drug delivery into the ethmoid sinuses and provide chronic ethmoid sinusitis patients an alternative to ethmoidectomy. Significance The primary surgical therapy for chronic ethmoid sinusitis is ethmoidectomy; topical therapy has been widely used in the management of chronic ethmoid sinusitis only after ethmoidectomy. This study shows a drug-eluting catheter can be safely and reliably inserted into virgin ethmoid sinuses in order to allow the topical elution of medications into the ethmoids without ethmoidectomy. Support Acclarent supplied cadaveric specimens.

Ethmoid sinus mycology of chronic rhinosinusitis

This goal of this study was to demonstrate whether fungi were present in the ethmoid sinus in patients with chronic rhinosinusitis. Before surgery, swab specimens were collected from the middle meatus for conventional fungal cultures, and lavaged fluid was collected from the nasal cavity for fungal cultures by Ponikau's method. During surgery, tissue specimens were taken from the inferior turbinate and the anterior ethmoid sinus for conventional fungal cultures and detection of fungal DNA by polymerase chain reaction. The ethmoid sinus mucosa with coating mucus was also collected for fungal cultures by Ponikau's method. Among 53 specimens, three middle meatal specimens and 27 lavaged specimens (50.9%) grew fungi. Inferior turbinal mucosa did not grow fungi, but three ethmoid sinus specimens grew fungi by the conventional fungal culture method and by Ponikau's method. Alternaria DNA was detected in 42 inferior turbinal specimens (79.3%) and in 39 ethmoid sinus specimens (73.6%). Our study showed that although fungi were rarely cultured from the ethmoid sinus Alternaria DNA was detected in most of the ethmoid sinus mucosa.