Conventional Sinus Research Articles

Maxillary Sinus Floor Elevation and Simultaneous Implant Installation via Osseodensification Drills: A Retrospective Analysis of Bone Gain in 72 Patients Followed for 6 Months.

Background/Objectives: The aim of this retrospective study was to radiographically evaluate the endo-sinus bone gain (ESBG) following osseodensification procedures using CBCT and compare the results to more conventional sinus lifting techniques. Methods: A total of 72 patients underwent crestal sinus floor elevation procedures and were provided with 102 implants with a sand-blasted and acid-etched surface with microthreads (Medentika® Microcone Implants, Hugelsheim, Germany). Patients were divided into two groups; the osseodensification group (OD; n = 36) and the osseodensified augmentation group (ODA; n = 36). Results: The mean residual bone height (RBH) was 5.71 (1.77) and 4.30 (0.94) mm in the OD and ODA groups, respectively. An ESBG of 3.45 (1.18) and 5.74 (1.31) mm was observed in the OD and ODA groups, respectively, and as compared to the baseline RBH, the ESBG was statistically significant in both groups after 6 months (p < 0.001). Conclusions: Within the limits of this retrospective study, crestal sinus lifting with the osseodensification technique seems to be a fast, effective, and safe method. Longer follow-up studies with full intrasinus bone topography and structure analyses are needed to prove the success rate of endo-sinus bone gain.

Otolaryngologist perceptions of AI-based sinus CT interpretation

BackgroundOvercoming non-standardization, vagueness, and subjectivity in sinus CT radiology reports is an ongoing need, particularly in keeping with data-driven healthcare initiatives. Our aim was to explore otolaryngologists' perceptions of quantitative objective disease measures as enabled by AI-based analysis, and determine preferences for sinus CT interpretation. MethodsA multi-methods design was used. We administered a survey to American Rhinologic Society members and conducted semi-structured interviews with a purposeful sample of otolaryngologists and rhinologists from varying backgrounds, practice settings and locations during 2020–2021. Interview topics included sinus CT reports, familiarity with AI-based analysis, and potential requisites for its future implementation. Interviews were then coded for content analysis. Differences in survey responses were calculated using Chi-squared test. Results120 of 955 surveys were returned, and 19 otolaryngologists (8 rhinologists) were interviewed. Survey data revealed more trust in conventional radiologist reports, but that AI-based reports would be more systematic and comprehensive. Interviews expanded on these results. Interviewees believed that conventional sinus CT reports had limited utility due to inconsistent content. However, they described relying on them for reporting incidental extra-sinus findings. Reporting could be improved with standardization and more detailed anatomical analysis. Interviewees expressed interest in AI-derived analysis given potential for standardization, although they desired evidence of accuracy and reproducibility to gain trust in AI-based reports. ConclusionsSinus CT interpretation has shortcomings in its current state. Standardization and objectivity could be aided with deep learning-enabled quantitative analysis, although clinicians desire thorough validation to gain trust in the technology prior to its implementation.

Sinus Lift by Lateral Approach versus Short and Extra-Short Implants: Split-Mouth Case Series

Introduction: The treatment of the atrophic posterior maxilla is a challenge, and there are different techniques for its rehabilitation with dental implants. In the present study we compare two of the most widespread: the classic lateral approach and transcrestal elevation. Material and methods: A retrospective open-mouth pilot study was carried out to evaluate the predictability of the two surgical techniques described above. To this end, patients in whom both techniques were used (one per quadrant) were followed up and a quantification of bone loss and gain over the implant apex was carried out, as well as an estimate of survival in both groups of implants. Results: Five patients were recruited and 13 implants were inserted (8 in conventional sinus lift and 5 in transcrestal sinus lift). The mesial bone loss of the implants studied at the end of the follow-up time was 0.40 mm in the mesial zone (+/- 0.23) and 0.50 mm in the distal zone (+/- 0.34) for implants placed in traditional elevations. For implants inserted in the transcrestal elevation the mesial bone loss of the implants studied at the end of the follow-up time was 0.30 mm in the mesial zone (+/- 0.13) and 0.20 mm in the distal zone (+/- 0.24). There were no statistically significant differences between the mean bone losses of both techniques (p=0.021). Conclusions: Both techniques have proven to be predictable for the treatment of the atrophic posterior maxilla in height. The use of short and extra-short implants and transcrestal elevation requires fewer surgeries and has a priori a lower risk of complications. In the patients of our split-mouth study we found no statistically significant differences between the two procedures.

Complications in sinus lifting procedures: Classification and management.

Open and closed sinus lifting procedures are predictable methods to augment the bone needed for appropriate implant placement in the posterior maxilla in cases where available bone is limited. However, these techniques may give rise to complications and associated comorbidities. In the case of open sinus lifting, perforation of the Schneiderian membrane during osteotomy is the most common complication, with an incidence rate of around 20%-25%. Apart from those complications associated with oral surgery in general (such as swelling or hematoma), there are specific complications of open sinus lifting procedures that may arise less frequently (chronic rhinosinusitis, hemorrhage, or ostium blockage by overfilling) but which may nevertheless compromise the viability of the graft and/or the implants and cause substantial discomfort to the patient. Closed sinus lifting is a less invasive approach that allows transcrestal placement of the implants in cases where there is sufficient residual bone height. However, it may also be associated with specific complications, including membrane perforation, benign paroxysmal positional vertigo, and implant displacement to the sinus cavity. New technologies have been proposed to reduce these complications and comorbidities associated with conventional sinus lifting procedures, such as the use of piezoelectric devices and hydraulic sinus lift or reamer burs. The evidence supporting their effectiveness and safety, however, is still lacking. A detailed medical history together with a thorough radiographic and clinical examination are essential prior to any kind of bone regenerative augmentation involving the maxillary sinus. Moreover, it is recommended to employ the most appropriate surgical technique for the specific characteristics of the case and, at the same time, accommodating the experience and skills of the surgeon.

Short Dental Implants (5 to 7 mm) with Expandable Apex in the Posterior Maxilla-Preliminary Results.

The purpose of this study was to examine whether the use of short dental implants with an expandable compressive design could be a proper alternative to the conventional sinus elevation procedure in cases of deficient alveolar ridge height in the posterior maxillary area. Fifty patients with 73 short dental implants with an expandable compressive design who were treated for posterior maxillary alveolar ridges of 5 to 7 mm in the vertical dimension between 2012 and 2018 were included in a retrospective study. All patients had a minimum postrehabilitation period of 1 year. Patient demographics, implant properties, primary stability, and implant success and survival rates were analyzed. The total success rate was 97.2%, with two failed implants at implant uncovering. The mean bone loss was 1.03 mm. No difference in bone loss was found between sexes or age groups. The results of this study suggest that short dental implants with an expandable apical compressive design could be an alternative to sinus elevation procedures in selected cases of vertically deficient maxillary alveolar ridges.

Implant survival after graftless sinus floor augmentation in highly atrophic maxillae: a randomized controlled trial in a split mouth study

PurposeThe success rate of dental implants after graftless sinus augmentation versus conventional sinus augmentation surgery in atrophic maxillae in edentulous patients was investigated.MethodsThis randomized study was performed in ten edentulous patients with marked maxillary atrophy. On the graftless side, the sinus membrane was lifted by a resorbable membrane. The control side was augmented with a mixture of autografts and xenografts. Implant placement followed 6 months postoperatively. Outcomes were implant survival, success of prosthetic rehabilitation and stability of vertical bone gain.ResultsTen patients were included. Postoperative radiology showed sufficient bone gain on both maxillary sides. Follow-up varied from 57 to 88 months. The conventional side showed significant (p = 0.041) more bone gain than the experimental side (respectively, 9.69 mm and 6.20 mm). A total of 59 implants were placed: 30 after conventional, 29 after graftless augmentation. One implant was lost on the conventional side and four on the experimental side. The implant survival was significantly higher on the conventional side (96.7% vs. 86.2%, p < 0.001, RR = 4.14). Prosthetic restoration was functionally successful in all cases.ConclusionBone gain and implant survival were significantly lower in the non-grafted side versus the grafted side. Prosthetic rehabilitation was possible in all ten patients. The non-grafted technique may have some potential for clinical use, although it showed poorer results.Trial registration The Netherlands Trialregister. NTR NL3541 (NTR3696). Registered 20 January 2013, https://www.trialregister.nl/trial/3541.

His pacing program: a 2-year single-centre experience

Abstract Funding Acknowledgements Type of funding sources: None. Background His bundle pacing (HBP) physiologically activates the ventricles by a direct stimulation of the His-Purkinje cardiac conduction system. It was first described in the 1970s, and the initial feasibility studies were reported in the early 2000s. Later on, technological advances led to its widespread adoption and growing evidence base. Purpose This retrospective study aimed to assess implant success rate, feasibility and safety of the His-bundle lead implantation program in our centre. Methods All patients who underwent His-bundle lead implantation in our centre from the start of the HBP program in November 2018 until November 2020 were analyzed. Data were collected from existing hospital electronic medical records. Results A total of 125 patients (64.8 % male, 65.1 ± 13.9 years) were included in the study. Nearly half of patients (47.2 %) had chronic heart failure and 39.2 % had atrial fibrillation. Indications for pacing included antibradycardia pacing (68.8 %) and cardiac resynchronization therapy (31.2 %). His-bundle lead was successfully implanted in 114 patients (91.2 % acute success), while the rest of the procedures were converted into right ventricle lead placement. 32.8 % of all patients had native narrow QRS complexes. Among patients who received HBP for cardiac resynchronization therapy, QRS duration was reduced from 177.5 ± 26.4 at baseline to 145.8 ± 23.9 after HBP (p &amp;lt; 0.001). However, QRS duration slightly prolonged in the antibradycardia group from 118.8 ± 31.9 at baseline to 130.4 ± 25.3 after HBP (p = 0.011). Seven (8.6 %) patients in the antibradycardia group had late lead disfunction/dislodgement and therefore underwent reoperation with the conventional right ventricle lead placement. Two patients (4.7 %) from the resynchronization group had inappropriate resynchronization response and underwent the conventional coronary sinus lead implantation. Only one patient (0.8 %) had a device-associated infection. Conclusion Our data suggest that HBP is a feasible strategy of physiological pacing and resynchronization with an acceptable success and low complication rates. Our His-bundle implantation program results are similar to data available in the current literature.

Intranasal Application of Lactococcus lactis W136 Is Safe in Chronic Rhinosinusitis Patients With Previous Sinus Surgery.

Objective: Modulation of the dysbiotic gut microbiome with “healthy” bacteria via a stool transplant or supplementation is increasingly practiced, however this approach has not been explored in the nasal passages. We wished to verify whether Lactococcus lactis W136 (L. lactis W136) bacteria could be safely applied via irrigation to the nasal and sinus passages in individuals with chronic rhinosinusitis (CRS) with previous undergone endoscopic sinus surgery, and whether this was accompanied by bacterial community flora modification.Study Design: Prospective open-label pilot trial of safety and feasibility.Setting: Academic tertiary hospital center.Subjects and Methods: Twenty-four patients with CRS refractory to previous medical and surgical therapy received a 14-day course of BID sinus irrigations containing 1.2 × 109 CFU live L. lactis W136. Patients were monitored for safety using questionnaire, sinus endoscopy, otoscopy, UPSIT-40 smell testing, and endoscopically-obtained conventional sinus culture and a swab for 16S microbiome profiling.Results: All 24 patients receiving at least one treatment successfully completed treatment. L. lactis W136 probiotic treatment was safe, with no major adverse events or new infections. Treatment was associated with improvement in sinus symptoms, QOL, and mucosal scores, which remained improved during the subsequent 14-day observation period. Microbiome changes associated with treatment were limited to an increase of the pathobiont Dolosigranulum pigrum, a bacteria identified as potentially beneficial in the upper airways. Subgroup analysis suggested differences in microbiomes and responses for CRSsNP and CRSwNP phenotypes, but these did not attain significance.Conclusion: Intranasal irrigation of live L. lactis W136 bacteria to patients with refractory chronic rhinosinusitis was safe, and was associated with effects on symptoms, mucosal aspect and microbiome composition. Intranasal bacteria may thus find a role as a treatment strategy for CRS.Clinical Trials Registration: www.ClinicalTrials.gov. identifier: NCT04048174.

Effect of Medical-Grade Polyurethane Sponges on Sinus Membrane Perforation With a Lateral Window Approach.

The most commonly reported complication during the sinus elevation surgical procedure is the perforation of the Schneiderian membrane. The aim of this retrospective study was to compare the rate of sinus membrane perforation during lateral window augmentation using either conventional sinus curettes or medical-grade polyurethane sponges. This retrospective study included patients who received a lateral window approach for sinus floor elevation. The sinus elevation procedures using medical-grade polyurethane sponges (test) or conventional curettes (control) were recorded and analyzed. All subjects' demographic data and preexisting conditions were evaluated. A total of 38 procedures met inclusion criteria, and those data were evaluated for analysis. There were no statistically significant differences in demographic data or preexisting conditions including age, sex, treatment location, presence and absence of septum, Schneiderian membrane thickness, and residual bone height between test and control groups. The membrane perforation rate was 7% in the test group and 43% in the control group; however, this difference did not reach statistical significance (P = .064). Within the limitations of this study, although there was no statistically significant reduction of sinus membrane perforation with the use of medical-grade polyurethane sponges, the decreased incidence of perforation might be of clinical significance.

Comparative evaluation of direct sinus lift with bone graft and zygoma implant for atrophic maxilla.

Implant rehabilitation of atrophic maxilla is challenging. The aim of this manuscript is to compare the clinical outcome of rehabilitation of atrophic maxilla (long span) by zygomatic implants (ZI) versus conventional sinus lift with augmentation procedures dental implants (SLAP-DI). A retrospective record analysis of a cohort of 25 patients fulfilling the inclusion and exclusion criteria, over a period of 6 years were performed. The patients had been either treated with ZI or SLAP-DI. The outcome measures were: prosthesis, implant and augmentation failures, any complications, patients' number of days with total or partial impaired activity, time to function and number of dental visits, assessed by independent assessors from records. The data was analyzed using SPSS with P ≤ 0.05. There were 16 (64%) men and 11 (44%) had ZI while 14 (56%) underwent SLAP-DI. There were no prosthesis or implant failures in this cohort. Between ZI and SLAP-DI, there was no gender difference (P = 0.648), border line significance in minor complication (P = 0.075), with less complication encountered in SLAP-DI than the ZI. None of the cases had major complications that required hospitalization or severe medical therapy. Of the 14 cases that underwent SLAP, 11 (78.6%) had no augmentation failure (resorption <10%). ZI had older age (P = 0.000), with greater number of teeth missing (P = 0.002), with lesser time for functional loading (P = 0.000), required less number of visit to dentist (P = 0.000), and lesser bone loss at insertion site (P = 0.005). The results are discussed in light of previous pertinent literature. This short term (~ 1 year follow-up) suggest that SLAP-DI and ZI have certain similar features. There is no statistical difference in outcome barring the time needed to functional loading (1.3 days vs. 444.3 days). Relatively more complications were reported for ZI, but had no statistical significance. Long-term and multi-center data are needed to confirm the results.

Is balloon-assisted maxillary sinus floor augmentation before dental implant safe and promising? A systematic review and meta-analysis.

We aimed to assess the complications of minimally invasive balloon-assisted maxillary sinus floor augmentation, compared with the conventional sinus floor augmentation procedures done before placing a dental implant. A structured question was formulated and an electronic search was conducted in three databases (MEDLINE via PubMed, Google Scholar, and Scopus). A separate search of gray literature and a hand search for missing articles were also conducted. Apart from animal studies, in-vitro studies, and case reports, all other types of studies where maxillary sinus floor augmentation was done using a balloon were considered for review. Our review was registered in International Prospective Registration of Systematic Reviews (PROSPERO) under number CRD42018086770. Our search produced 73 articles. However, only eight articles were found eligible to be included in our review (seven case series and one case-control study). Quality check was done using Methodological Index for Non-Randomized Studies (MINORS). Results suggest that balloon-assisted augmentation is associated with low rates of membrane tears (9 out of 272 sinus augmentation attempts), and high follow-up bone gain levels (mean 212.91%, 95% confidence interval 158.07%-267.75%, I2 = 97.62%). Balloon-assisted augmentation seems to be safe. More clinical trials are needed to assess the advantages and disadvantages of balloon-assisted maxillary sinus floor augmentation compared with other procedures.

The role of industry influence in sinus balloon dilation: Trends over time.

Balloon dilation (BD) is a controversial alternative to conventional sinus surgery. The role of industry on practice patterns remains unknown. The aim of this study was to determine whether industry payments from BD manufacturers influence practice patterns for otolaryngologists and evaluate how these payments change over time. Retrospective cohort study using Medicare Provider Utilization and Payment (PUP) Data and Center for Medicare and Medicaid Services Open Payments (OP) general payment datasets. A total of 294 otolaryngologists identified in the PUP dataset who performed BD procedures from January 1, 2013, to December 31, 2015, were cross-referenced in the OP dataset from January 1, 2014, to December 31, 2016, for BD manufacturer payments. Payments to surgeons performing BD stratified by amount, type, and number of procedures performed were primary outcome measures. Of the 294 otolaryngologists reporting BD procedures, 223 (76%) received payments from a company that manufactures BD devices. Receipt of $2,500 in BD payments was associated with performance of one additional BD procedure, and consulting fees were most positively associated with performing additional BD procedures (P = 0.006). The providers receiving the most in BD payments were more likely to continue to receive the most in payments, regardless of number of BD procedures performed. Performing more BD procedures did not correlate with decrease in other sinus procedures. Payments to otolaryngologists from manufacturers of sinus BD devices are associated with the performance of an increased number of such procedures. Surgeons should consider the impact of interactions with industry when evaluating patients for BD procedures. 4. Laryngoscope, 128:1540-1545, 2018.

Outcomes of revision endoscopic modified Lothrop procedure.

Endoscopic modified Lothrop procedure (EMLP) is used to treat patients who fail conventional sinus surgery. The failure rate of a primary EMLP is reported to be between 5% and 32%. The failure rate of revision EMLP has not been reported. We present our institutions data regarding the outcome of patients requiring revision EMLP. Data was collected prospectively. Patients undergoing primary EMLP between January 2001 and December 2013 with a minimum follow-up of 6 months were included. Information related to demographics, asthma status, aspirin sensitivity, 22-item Sino-Nasal Outcome Test (SNOT-22) score, Lund-Mackay scores, intraoperative findings, and endoscopic ostium assessment were collected. There were 213 primary EMLPs completed with average follow-up of 36 months. The failure rate of primary EMLP was 8.9% (19/213), whereas the failure rate of revision EMLP was 21% (4/19). Risk factors for failure of primary EMLP included the presence of intraoperative pus, more than 5 previous sinus operations and aspirin-exacerbated respiratory disease (AERD). Revision of EMLP was undertaken primarily due to recurrence of nasal polyps or ostium stenosis. Those patients who underwent revision EMLP experienced symptomatic improvement and no major complications following the procedure. The failure rate of revision EMLP is 21% in our series. The majority of revisions were for nasal polyp recurrence. Revision EMLP is a safe and well-tolerated procedure in the small group of patients that require further surgery. Patients with intraoperative pus present at their initial EMLP, more than 5 previous sinus operations, or AERD are at increased risk of failure.

Functional Endoscopic Sinus Surgery and Conventional Surgery in the Management of Chronic Sinusitis

Background &amp; objective: The interest in functional endoscopic sinus surgery (FESS) in the management of chronic sinusitis is increasing day by day. The proponents of FESS for the treatment of chronic sinusitis claim that it is superior to conventional sinus surgery in the management of the disease, but there are limited studies addressing the issue. The present study was undertaken to make a comparative evaluation between FESS and conventional surgery in the treatment of chronic sinusitis.&#x0D; Materials &amp; Methods: This prospective study was conducted between October 2005 to March 2006 in the Department of ENT and Head-Neck Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), and Dhaka Medical College Hospital (DMCH), Dhaka. A total of 60 patients of chronic sinusitis with failed conservative treatment or chronic sinusitis with polyps admitted for surgical treatment were included. Selected patients irrespective of age and sex were randomly assigned to either FESS (n=30) or conventional surgery (n=30) followed by respective interventions. Baseline clinical characteristics, image findings and outcome variables were studied.&#x0D; Result: Majority of the patients (around 70%) in either group was in their second and third decades of life. Males were a bit higher in the FESS group. Nasal obstruction was the predominant complaints (75%) followed by nasal discharge (68.3%) and headache (66.7%). X-ray of paranasal sinuses showed opacity in maxillary antrum and nasal fossa in 90% and mucosal thickening in maxillary antrum in 58.3% cases. CT scan showed isodense shadow in ethmoid region and nasal fossa (86.7%) with blocked osteomeatal complex (OMC) on both sides (73.3%) and mucosal thickening in maxillary antrum (46.7%). The indications for FESS were chronic sinusitis with ethmoidal polyp (73.3%), while that for conventional surgery was chronic sinusitis alone (56.7%). Majority (83.3%) of the FESS group and two-thirds (66.7%) of the conventional group had unilateral operation. Most (90%) of the FESS group required nasal or antral packing during procedure than that of the conventional group (43.3%) (p&lt;0.001). Complete recovery was significantly higher in the former group (70%) than that in the latter group (40%) (p = 0.047). Shorter hospital stay (up to 2 days) was observed in majority of the former group patients (0.001). In terms of complications, periorbital oedema was appreciably lower and numbness of the cheek was completely absent in FESS group than those in the Conventional group (p &lt; 0.001 and p = 0.005 respectively).&#x0D; Conclusion: Functional endoscopic sinus surgery offers higher success and lower morbidity than conventional surgery in the management of chronic sinusitis with or without polyp. However, proper training is mandatory to acquire proficiency in FESS.&#x0D; Ibrahim Cardiac Med J 2014; 4(1): 16-21

Recombinant human bone morphogenetic protein 2 outcomes for maxillary sinus floor augmentation: a systematic review and meta-analysis.

To study the effect of the recombinant human bone morphogenetic protein 2 (rhBMP-2) on sinus volumetric and histometric changes after sinus floor augmentation compared to a conventional approach of non-biologic bone grafting materials. An electronic search of 4 databases (January 1990-February 2015), including PubMed/MEDLINE, EMBASE, Web of Science and Cochrane Central, and a hand search of peer-reviewed journals for relevant articles were performed. Human clinical trials with data on comparison of sinus volumetric and/or histometric outcomes with and without the use of rhBMP-2 in sinus grafting procedures, with ≥10 augmentation sites in each study group, and with a follow-up period of at least 6months, were included. Random-effects meta-analyses were performed to analyze weighted mean difference (WMD) and confidence interval (CI) for the recorded variables according to PRISMA guidelines. Six randomized controlled trials (RCTs) were included. The results of the meta-analyses showed that the WMD of vertical bone height gain was -0.14mm (95% CI=-1.91 to 1.62mm, P=0.87), the WMD of bone density was -142.42mg/cm3 (95% CI=-310.62-25.78mg/cm3 , P=0.10), the WMD of the percentage of vital bone was -4.59% (95% CI=-11.73-2.56%, P=0.21), and the WMD of the percentage of residual bone grafting materials was -9.90% (95% CI=-26.38-6.58%, P=0.21). The comparison of implant survival rate presented an overall risk ratio of 1.00 (95% CI=0.94-1.07). The two approaches (conventional bone grafting compared to BMPs) demonstrated comparable effectiveness for both clinical and histomorphometric measures. This systematic review revealed that the use of rhBMP-2 in maxillary sinus floor augmentation achieved similar clinical and histometric outcomes when compared to conventional sinus grafting procedures after a healing period of 6-9months. However, previous studies showed the morbidity and other patient-reported outcomes were improved in rhBMP-2 approaches as compared to bone autograft procedures (both intraoral and extraoral bone harvesting because no donor site is required). Long-term studies are required to determine the cost-benefit of sinus floor augmentation procedures for patients requiring implant reconstruction.

Introducer Development for Coronary Sinus Access From Parasternal Mediastinotomy.

Right parasternal mediastinotomy with right atriotomy has been used clinically for pacemaker insertion. A similar approach might facilitate access to the coronary sinus for biventricular pacing and other manipulations when more conventional approaches are not feasible. The primary barrier to this is lack of appropriate introducers and techniques. Anatomically derived introducers were developed in 2 anesthetized domestic pigs using data from computerized axial thoracic tomography. Each digitized tomogram defined a unique introducer shape and was constructed using 3-dimensional (3D) modeling software and printing. Each parent pig then underwent surgery demonstrating coronary sinus lead insertion, using its custom-configured introducer. Next, with institutional review board approval, 65 patients were identified who had undergone conventional endocardial coronary sinus lead insertion followed by thoracic scanning. These tomograms were used to design appropriately curved introducers for human anatomy. Fifty-one introducer paths were defined following anatomic pathways and avoiding bends inconsistent with materials used for commercial peel-away introducers. Each path was defined by a bend and distance toward the coronary sinus ostium and a hook and twist out of plane to align with the local orientation of the coronary sinus. The average dimensions were the following: distance, 67 mm; bend angle, 47 degrees; hook angle, 39 degrees; and twist angle, 20 degrees. A prototype cannula was tested for fit in a fresh frozen postmortem human specimen. Parasternal mediastinotomy access to the coronary sinus for cardiac resynchronization, mitral annuloplasty, and instrumentation is feasible. Human computerized tomographic scans can be used to define curvatures and dimensions for marketed introducers.

Outcomes of frontal mucoceles treated with conventional endoscopic sinus surgery

Conclusion: Conventional endoscopic sinus surgery (CESS) is useful for frontal mucoceles. A patient with short anterior–posterior distance and bone thickening may need an axillary flap, Draf type IIb, or Draf type III procedure. Objective: To present outcomes of frontal mucoceles treated with CESS and predict risk factors for poor outcomes to help define surgical indications. Methods: A consecutive clinical series was reviewed retrospectively. The authors performed CESS without agger nasi resection (Draf type IIa) for 13 frontal sinus mucoceles in 12 patients between October 2011 and July 2013. Patient age, sex, blood eosinophil count, history of operation and co-existence of acute infection were compared. For the condition of the frontal sinus, anterior–posterior distance and width of frontal recess, bone thickening of the frontal recess, bone absorption due to continuous pressure by mucocele and anatomy of the frontal recess was noted. Results: All operations were done without a navigation system. The post-operative course was uneventful in all 12 patients, and all symptoms gradually receded. Among 13 mucoceles, one frontal sinus (7.7%) closed during follow-up.

Balloon catheter dilation technology combined with a fibrolaryngoscope to treat a maxillary sinus cyst.

A prospective randomized controlled study was conducted to investigate the effect of balloon catheter dilation technology combined with a fibrolaryngoscope in the treatment of a maxillary sinus cyst. The clinical data of 14 cases (19 maxillary sinuses) with balloon catheter dilation technology combined with a fibrolaryngoscope to remove sinus cysts (balloon group) and 16 cases (23 maxillary sinuses) with conventional nasal endoscopic sinus surgery to remove sinus cysts (conventional group) were analyzed. All cases have completed the preoperative and postoperative SNOT-20, nasal endoscopy and coronal sinus CT scan. Lund-Kennedy endoscopic and Lund-Mackay CT scan staging scores were recorded. All patients were followed up for 24 weeks after the operation. The SNOT-20 scores, Lund-Kennedy endoscopic and Lund-Mackay CT scan staging scores were lower in the balloon group than that in the control group. Balloon catheter dilation technology combined with a fibrolaryngoscope can effectively preserve the function and structures of the nasal cavity and sinus, making it a good choice in the treatment of a retention cyst of the maxillary sinus.

Functional Endoscopic sinus surgery &amp; conventional sinus surgery in Inflammatory Sinonasal diseases

Background: Functional endoscopic sinus surgery is a minimally invasive technique used to restore sinus ventilation and normal function. The most suitable candidates for this procedure have recurrent acute or chronic infective sinusitis, and an improvement in symptoms of up to 90 per cent may be expected following the procedure. Objective: The study has been designed to compare the clinical outcome of functional endoscopic sinus surgery and conventional surgery in the management of inflammatory sinonasal diseases. Study design: This was a prospective study. A combine of both quantitative and qualitative methods was used in conducting the study. Method: Here, a survey method was used to obtain quantitative data from the patients and complication of the operation was observed to obtain qualitative data. Data was collected from a sample that was determined through a semi-purposive method. Results: In the series 9% had synaechia during post operative period and it was 3.3% for FESS and 26.7% for conventional surgery. FESS procedure shows better relief of obstruction, better pain relief and quicker relief of clot than Conventional surgery. In FESS, 56.7% patients reported complete recovery and 43.3% were found symptoms free while in conventional surgery only very few of the patients reported complete recovery. and rest of the patients (93.3%) were symptoms free. Conclusion: The study had shown significant benefits from FESS over conventional surgery. DOI: http://dx.doi.org/10.3329/bjo.v20i1.22011 Bangladesh J Otorhinolaryngol; April 2014; 20(1): 8-14

The applications of endoscopic surgery in department of otorhinolaryngology-head and neck surgery

Endoscopic surgery has developed dramatically in the last few decades in otorhinolaryngology - head and neck surgery. Conventional sinus surgery with an external approach has been replaced by endoscopic sinus surgery, with endoscopic surgical techniques applied on structures of the sinus, including the nasal septum, orbit, and skull base. Endoscopic ear surgery was introduced with diagnostic methods initially, and has transformed surgical concepts in recent years. Endoscopic upper airway surgery was popularized in the 1970s, and its applications have been extended while minimizing morbidity. Endoscopic thyroidectomy is currently performed in some patients with large benign thyroid tumors or micropapillary carcinomas. The applications of endoscopic surgery will be extended to other parts of otorhinolaryngology - head and neck surgery in the near future.