Endoscopic Surgery Research Articles

Evaluation of metagenomic next-generation sequencing (mNGS) combined with quantitative PCR: cutting-edge methods for rapid diagnosis of non-invasive fungal rhinosinusitis.

Fungal rhinosinusitis is a significant and growing health concern in arid regions, with an increasing incidence over recent decades. Without timely and appropriate management, it can lead to severe complications, including potential intracranial spread. This study aims to establish efficient and rapid diagnostics for non-invasive fungal rhinosinusitis (FRS), addressing the challenge of its difficult-to-culture diagnosis. Twenty-eight patients suspected of FRS were studied using endoscopic sinus surgery to obtain tissue samples for histopathology, direct microscopy, fungal culture, quantitative PCR (qPCR) and metagenomic next-generation sequencing (mNGS) detection. A patented qPCR targeting prevalent Aspergillus species was evaluated. The patient cohort had a male-to-female ratio of 9:14, with disease duration up to 50 years. Histopathologically, 23 out of 28 cases were positive. Fungal culture exhibited a sensitivity of 21.74%, with one false positive. qPCR and mNGS showed 100% sensitivity and specificity, with a 100% consistency rate for identification at the species level (23/23), and potential detection of cases with co-infections. The most common pathogen was A. flavus, followed by A. fumigatus and A. niger. Two cases involved mixed infections of A. fumigatus and A. flavus. qPCR and mNGS proved effective in rapidly identifying fungi from fresh sinus tissue that are challenging to culture, surpassing conventional methods. However, further evaluation and optimization with a larger cohort of patients are necessary. Histopathology is still recommended to confirm the clinical significance of the detected fungal species.

Perioperative adjuvant therapy with short course of dupilumab with ESS for recurrent CRSwNP.

Chronic rhinosinusitis with nasal polyposis (CRSwNP) is associated with a high rate of disease recurrence following endoscopic sinus surgery (ESS). Type 2 disease is associated with a higher incidence of recurrence and is believed to impact disease resolution via interference with epithelial healing and pathogen immunity. We wished to verify if perioperative control of Type 2 inflammation with an anti-IL4/IL13 targeting monoclonal antibody and during the resolution period following surgery leads to better control of the disease long term. In this prospective, placebo-controlled, double-blinded trial. Thirty adult subjects with recurrent CRSwNP underwent ESS plus or minus 14 weeks of perioperative dupilumab, initiated 4 weeks (two injections) pre-ESS. Subjective and objective parameters of nasal patency, olfaction, quality of life (QoL), and adverse events were monitored up to 52 weeks post-ESS. Microbiological culture was performed to characterize pathogens colonization under both conditions. ESS safely improved subjective and objective measures of nasal patency, olfaction, and QoL in both groups. Olfaction was conserved longer in the dupilumab-treated group, with 33.3% of subjects presenting anosmia at 12 months after ESS in the dupilumab group compared to 50.0% with placebo. This was associated with persistent decreases in serum IgE, which were not seen with placebo treatment. No unusual safety signals were observed. Short-course adjuvant perioperative treatment with dupilumab is associated with improved long-term olfactory outcomes and persistent lowering of serum IgE.

Application of electrospinning and 3D-printing based bilayer composite scaffold in the skull base reconstruction during transnasal surgery

Skull base defects are a common complication after transsphenoidal endoscopic surgery, and their commonly used autologous tissue repair has limited clinical outcomes. Tissue-engineered scaffolds prepared by advanced techniques of electrostatic spinning and three-dimensional (3D) printing was an effective way to solve this problem. In this study, soft tissue scaffolds consisting of centripetal nanofiber mats and 3D-printed hard tissue scaffolds consisting of porous structures were prepared, respectively. And the two layers were combined to obtain bilayer composite scaffolds. The physicochemical characterization proved that the nanofiber mat prepared by polylactide-polycaprolactone (PLCL) electrospinning had a uniform centripetal nanofiber structure, and the loaded bFGF growth factor could achieve a slow release for 14 days and exert its bioactivity to promote the proliferation of fibroblasts. The porous scaffolds prepared with polycaprolactone (PCL), and hydroxyapatite (HA) 3D printing have a 300 μm macroporous structure with good biocompatibility. In vivo experiments results demonstrated that the bilayer composite scaffold could promote soft tissue repair of the skull base membrane through the centripetal nanofiber structure and slow-release of bFGF factor. It also played the role of promoting the regeneration of the skull base bone tissue. In addition, the centripetal nanofiber structure also had a promotional effect on the regeneration of skull base bone tissue.

Transcranial extraventricular endoscopic surgeries: Expanding the role of endoscope in neurosurgery.

Background and Aim: Transcranial endoscopic surgeries are mainly limited to intraventricular lesions. This study aims to elaborate on the various benefits of transcranial endoscopic surgeries in extraventricular regions of the brain. Methods and Materials/Patients: It is a retrospective study of transcranial extraventricular endoscopic surgeries (TEESs) operated between June 2022 to May 2023. The authors described the surgeries done for brain lesions other than intraventricular lesions as extraventricular surgeries. Access to the intracranial region was obtained through the transcranial approach. The transnasal rigid endoscope was used for the surgeries. The surgery was performed as either pure endoscopic surgery or endoscopic-assisted microscopic surgery. Results: The authors have performed 6 microvascular decompressions using an endoscope. Three pineal tumors, 3 craniopharyngiomas, 1 cerebellopontine angle epidermoid cyst, and 1 petrous neurenteric cyst were excised using an endoscope by transcranial approach. One internal carotid artery bifurcation aneurysm was clipped using an endoscope. All patients improved in the postoperative period. Surgeries were done using the 0-degree and 30-degree endoscopes. The endoscopic eye was able to reach the deep-seated area of surgical interest and authors were able to visualize the structures in a wide panoramic view with good illumination and magnification. There was no misinterpretation of structures. Conclusion: Endoscope can reach the deep-seated extraventricular areas of the brain with a narrow corridor, giving good illumination and magnification at the site of surgery. An endoscope can reach beyond the obstructing anatomical structure and visualize the area behind it. It is used as a complimentary to microscope to access the microscopic invisible areas. It has increased the ease of doing surgery, decreased tissue dissection, decreased complications, and improved surgical results. TEES improves the hand-eye coordination of surgeons in transcranial surgeries and it will help in adapting to exoscope easily

Endoscopic Ear Surgery, from the Last Ten to the Next Ten Years: A Critical Perspective

Endoscopic ear surgery has gained increasing popularity starting from the early 2000s, introducing new anatomical, physiological and surgical concepts in ear and lateral skull base surgery. Its development has brought new scientific knowledge, thus improving surgical technique with a minimally invasive attitude. The aim of this perspective is to review and summarize all the steps that brought endoscopic ear surgery from a surgery practiced by a few teams to a worldwide recognized advancement in otology.

Evaluating the efficacy of a cost-effective, fully three-dimensional-printed vertebra model for endoscopic spine surgery training for neurosurgical residents.

A fused deposition modeling three-dimensional (3D)-printed model of the L4-5 vertebra for lumbar discectomy was designed. The model included separately printed dura mater, spinal cord, ligamentum flavum, intervertebral disc (from thermoplastic polyurethane), and bony structures (from polylactic acid), and the material cost approximately US$ 1 per model. A simple plumbing endoscope was used for visualization. Dura mater injury was assessed by painting two layers on the dura mater, which peeled off with trauma. Endoscopic spine surgery is a subject of high interest in neurosurgery given its minimally invasive nature; however, it has a steep learning curve. This study evaluated the effectiveness of a cost-efficient 3D-printed model when teaching this technique to neurosurgery residents. Only a few studies have investigated the efficacy of such a model. Eight residents with >2 years of training participated. Residents performed the procedure bilaterally and twice at 1-week intervals. From the 32 surgeries, four were excluded because of facet removal (as it widened the surgical corridor), leaving 28 surgeries for analysis. Initial surgeries demonstrated a mean operation time of 21 minutes 18 seconds (standard deviation [SD], 2 minutes 32 seconds), which improved to a mean of 6 minutes 45 seconds (SD, 37 seconds) in the fourth surgery (F(3, 17)=19.18, p <0.0001), demonstrating a significant reduction in surgical time over successive surgeries. The median area with the paint removed decreased, from 161.80 (85.55-217.83) to 95.13 mm2 (12.62-160.54), (F(2.072, Inf)=2.04, p =0.128); however, this was not significant. Resident feedback indicated high satisfaction with the educational value of the model. The developed fully 3D-printed model provides a viable and scalable option for neurosurgical training programs, enhancing the learning experience while maintaining low costs. This model may be an excellent stepping stone for learning lumbar spine endoscopy, acclimating to the two-dimensional view, progressing to cadaver models, and, eventually, independent surgery.

Installation of percutaneous endoscopic gastrostomy for children. The tactics of a nurse

The article is based on the data and experience of the Blokhin National Medical Research Center of Oncology of the Ministry of Health of the Russian Federation, obtained during endoscopic practice. Currently, the number of pediatric patients requiring installation of a percutaneous endoscopic gastrostomy is significantly increasing, due to the increase in treatment regimens and the expansion of the range of indications for its installation. PEG combines endoscopic and surgical stages. The nurse must know the difference and differences of each stage, as well as have all the basic and advanced knowledge about all indications, contraindications and any complications during and after surgery. Compliance by the nurse with all the rules of asepsis and antisepsis, knowledge of SANPIN, is the foundation of her professionalism. Interest in the process will undoubtedly influence the quality of medical care provided. The nurse must study and know all the instruments, consumables and additional materials for performing endoscopic surgery. Her clear actions and orientation in what is happening guarantees the speed and success of the manipulation. The purpose of this work will be to emphasize the importance of professional development for nurses. To achieve the goal, we use all facets of a nurse’s work: knowledge of the concept of «sterility», orientation in all stages of manipulation from preparing the room to its complete routine cleaning after the intervention, all theoretical knowledge about the reasons for installing a gastrostomy tube and free orientation in any types of complications, etc. All of the above guarantees that the operating room endoscopic nurse is interested in the process, which will undoubtedly affect the quality and convenience of the doctor’s work, and subsequently the patient’s quality of life. The main goal of the entire operating team is to improve the patient’s quality of life. Understanding the meaning of all surgical endoscopic interventions obliges the nurse to constantly improve their skills and engage in self-education.

Preservation of olfactory function following pediatric endoscopic endonasal skull base surgery with nasoseptal flap reconstruction

ObjectiveEndoscopic endonasal surgery is a feasible approach to lesions of the pediatric skull base. Olfactory outcomes following endoscopic endonasal approach (EEA) have been reported in the adult literature, but pediatric outcome data is lacking. The purpose of this preliminary study is to evaluate post-operative olfactory outcomes in pediatric patients who underwent EEA through transsphenoidal and/or transclival corridors. MethodsRetrospective chart review of patients < 18 years of age who underwent EEA with nasoseptal flap skull base reconstruction between March 2019-January 2022. Following their first post-operative debridement and 6 months following surgery, patients were administered the University of Pennsylvania Smell Identification Test (UPSIT) to assess olfactory function. ResultsFifteen patients (7 female, 8 male) with a mean age of 14.9 years met inclusion criteria. Thirteen (86.7%) patients required a transsphenoidal approach and 2 (13.3%) patients underwent a combined transsphenoidal and transclival approach. Mean time between surgical resection and first olfactory testing was 6.3 weeks (range 4.6-7.3 weeks). Nine patients (60.0%) had normosmia following EEA while 3 (20.0%) had mild microsmia, and 3 (20.0%) had moderate microsmia at 6 weeks following surgery. Results improved at their 6 month follow up visits. No patients experienced post-operative severe microsmia or anosmia. ConclusionsOlfactory preservation is possible following pediatric EEA, though 40% of patients will develop some degree of microsmia in the immediate post-operative period and 20% will have some persistent dysfunction at 6 months. Long-term data is necessary to determine if microsmia continues to improve over time.

Access Pain During Transforaminal Endoscopic Lumbar Discectomy for Foraminal or Extraforaminal Disc Herniation.

Transforaminal endoscopic lumbar discectomy (TELD) under local anesthesia is a promising minimally invasive surgical option for intractable lumbar disc herniation (LDH). However, our understanding of access pain prediction during foraminal pathological procedures is limited. To our knowledge, no predictive rules for access pain have been established during TELD for foraminal or extraforaminal LDH. This study, with its potential for predicting access pain during TELD and discussing strategies for pain prevention and management, could significantly benefit the field of endoscopic spine surgery. This observational study included 73 consecutive patients who underwent TELD for foraminal or extraforaminal LDH between January 2017 and December 2022. Preoperative clinical and radiographic factors affecting significant access pain and the impact of access pain on clinical outcomes were evaluated. The rate of significant access pain was 13.70% (10 of 73 patients). Extraforaminal LDH tended to cause more severe pain than did foraminal LDH during TELD under local anesthesia (p < 0.05). Although the degree of access pain was not related to global clinical outcomes, increased pain was strongly associated with prolonged operative time and length of hospital stay (p < 0.05). TELD could be an effective surgical option for foraminal or extraforaminal LDH under local anesthesia. More access pain might develop during TELD for extraforaminal LDH. The extraforaminal component of LDH could narrow the safe working zone. Significant access pain might prolong the duration of surgery and hospitalization. Thus, a specialized technique is required for the clinical success of TELD.

Correlation between Lund-Mackay computed tomography score and subjective symptoms in Chinese patients with nasal polyps.

The association between objective imaging findings and subjective symptoms remains undefined. To investigate the correlation between objective imaging findings and symptom severity in the overall chronic rhinosinusitis with nasal polyps (CRSwNP) population as well as its subendotypes according to the eosinophilic inflammation. Patients with CRSwNP undergoing endoscopic sinus surgery were included. All participants completed the Sino-Nasal Outcome Test (SNOT-22) questionnaire. The Lund-Mackay (LM) CT scores was also obtained. Spearman correlation analysis was performed to evaluate the correlation between CT scores and SNOT-22 scores. Forty-four non-eosinophilic CRSwNP(neCRSwNP) and 93 eosinophilic CRSwNP (eCRSwNP) patients were recruited. There was significant association between LM total score and nasal subdomain of SNOT-22 in the overall CRSwNP patients. The nasal symptom of SNOT-22 was significantly associated with maxillary, frontal, sphenoid, anterior drainage, and posterior drainage in all CRSwNP patients. In eCRSwNP and neCRSwNP patients, the sense of smell/taste was associated with sphenoid and posterior drainage. Thick nasal discharge was positively correlated with maxillary, frontal, and anterior drainage only in eCRSwNP patients. The high score of sphenoid and posterior drainage may suggest the occurrence of loss of sense of smell/taste, while high score of maxillary sinus may indicate suffering from thick nasal discharge in eCRSwNP patients.

Educational needs of the EAES young surgeons.

Surgical residency programs are facing ongoing challenges since the pandemic. The Young Member (YM) Task Force of the European Association for Endoscopic Surgery (EAES) has been created to support surgical residents and surgeons under 40, promoting activities that could be useful for young surgeons and to improve networking between members of different countries. This project aimed to explore educational needs among European surgical residents to inform the EAES curriculum for young surgeons. Within the EAES surgical society, the YM developed a survey to capture residents' views on their professional needs. Different aspects were considered, from demographic information to the major topics of interest on a professional side. Semi-automatic answers and personal suggestions have been gathered and considered for the analysis. Data were captured from 386 respondents across 57 different countries, major responders were represented by the group of 31-35years old (40%). Considering professional growth, young surgeons rely on scientific research (56%), but they struggle finding adequate support of facilities. In the education and training section, fellowships and hands-on-courses (27%) were the most proficient activities. Mentorships and webinars were important to develop leadership, as well as social events to build up a professional network. This project has identified young surgeons' educational and professional needs that can inform the EAES future projects and activities.

Endoscopic surgery for squamous cell carcinoma in the nasal cavity and ethmoid sinus: A retrospective observational study

ObjectiveReports of endoscopic surgery for squamous cell carcinoma of the nasal cavity and ethmoid sinus are limited. Herein, we present a comprehensive account of the results obtained from performing endoscopic surgery based on the concept of en bloc resection. MethodsThis was a retrospective observational study of patients who underwent nasal endoscopic surgery for squamous cell carcinoma of the nasal cavity and ethmoid sinus at a hospital between July 2018 and December 2021. Primary endpoints were overall survival, relapse-free survival, and local recurrence-free survival. Data on tumor stage, tumor site of origin, postoperative treatment, and papilloma-related status were reviewed. Statistical analyses included the Kaplan–Meier method, Cox regression analysis, and Fisher's exact test. ResultsTwenty-two patients with a median age of 62 (range 27–84) years, comprising 15 male and 7 female, were included in this study, and the median duration of observation was 2.1 (range 0.6–4.3) years. The 2-year overall survival, relapse-free survival, and recurrence-free survival rates were 91.0%, 69.9%, and 79.0%, respectively. Cancer of the nasal cavity was significantly superior to that of the ethmoid sinus in terms of local recurrence-free survival (p = 0.03). The patients who underwent postoperative treatment had significantly worse recurrence-free survival rates than those who did not receive postoperative treatment (p = 0.03). ConclusionsThis study examined the results of the endoscopic treatment for squamous cell carcinoma of the nasal cavity and ethmoid sinus with the concept of en bloc resection. Patients with ethmoid sinus carcinoma had a greater risk for local recurrence, and the prognosis for patients requiring postoperative treatment was poor.

Sinonasal Outcomes after Endoscopic Pituitary Surgery in Patients With Cushing's Disease.

The endoscopic endonasal approach (EEA) has become the preferred treatment for pituitary tumors, with minimal sinonasal morbidity. However, patients with Cushing's disease (CD) may represent a subgroup with prolonged impairment of sinonasal quality of life (QOL). We retrospectively identified patients with CD who underwent EEA at our institution. Control patients with non-functional tumors were matched by age, gender, and extent of EEA. The primary outcome was post-operative 22-item Sino-Nasal Outcome Test (SNOT-22) scores. Ten patients with CD met the selection criteria and 20 controls were selected for comparison. Nine of the CD patients achieved persistent endocrinologic remission post-operatively. Comparing the CD and control groups, there was no difference in post-operative SNOT-22 score at 1 or 3 months. At 6 months, SNOT-22 scores were significantly worse in the CD group (27.4 ± 21.6 vs. 2.8 ± 2.3, P = .039). SNOT-22 scores improved to normal from 1 to 6 months in the control cohort (P = .007), but not in the Cushing's group (P = .726). Morbidity was present across all SNOT-22 domains, but was highest in the sleep domain (P = .023). Only morbidity in the facial domain improved over time (P = .032). Patients with CD have significantly prolonged postoperative sinonasal QOL impairment following EEA compared to patients with non-functioning tumors, who normalize within 6 months. In CD patients, only morbidity in the facial domain, likely related to post-operative pain and nasal packing, improved over time, while the sleep domain was the most affected.

Minimally Invasive Endoscopic Spine Surgery as a Viable Option for Geriatric Patients with High Anesthetic Risk

Minimally Invasive Endoscopic Spine Surgery as a Viable Option for Geriatric Patients with High Anesthetic Risk

Early minimally invasive image-guided endoscopic evacuation of intracerebral hemorrhage (EMINENT-ICH): a randomized controlled trial

BackgroundSpontaneous supratentorial intracerebral hemorrhage is the deadliest form of stroke with mortality rates over 50%. Currently, no sufficiently effective treatment to improve both mortality and functional outcome rates exists. However, it seems that minimally invasive surgery, especially endoscopic surgery, might be beneficial in improving survival and functional outcome rates, yet large confirmatory studies thereof are lacking. The aim of this trial is to compare whether early minimally invasive endoscopic surgery leads to improved functional outcome rates compared to the best medical treatment.MethodsThis is a prospective, parallel-arm, outcome assessor blinded multicenter trial across Switzerland. Endoscopic surgery will be compared to the best medical treatment in a 1:1 randomization over a total time of 12 months. The primary outcome is defined as improved functional outcome (mRS < 3) after 6 months; secondary outcomes include mortality and morbidity rates as well as patient reported outcomes and the temporal evolution of serum biomarkers for brain damage.DiscussionCurrently, large, randomized trials assessing the role and potential effect of early endoscopic surgery in intracerebral hemorrhage are lacking. Potential practical and methodological issues faced in this trial are patient enrollment, adherence to the hematoma evacuation technique used, potential patient cross-over, and the adaptive Bayesian statistical design. Nonetheless, this trial would be among the first to research the effects of early minimally invasive endoscopic surgery for SSICH and can provide class I evidence for future treatment options in intracerebral hemorrhage.Trial registrationClinicalTrials.gov NCT05681988. Registered on January 3, 2023.

Thoracoscopic and endoscopic cooperative surgery for esophageal gastrointestinal stromal tumor: a case report

BackgroundEsophageal gastrointestinal stromal tumors (GISTs) are relatively rare, accounting for 2–5% of all GISTs. Typically, the treatment is surgery in nature. However, no standard procedure established for esophageal GISTs, and in many cases, subtotal esophagectomy or local resection via thoracoscopy or mediastinoscopy is performed. Thoracoscopic and endoscopic cooperative surgery (TECS) is a surgical approach similar to laparoscopic and endoscopic cooperative surgery used for gastric GIST; however, no reports of its use for esophageal GIST have been published to date. We herein report such a case along with a review of past literature.Case presentationThe patient was a 60-year-old man. Upper gastrointestinal contrast imaging revealed a subepithelial lesion in the esophagus. An 18 × 17 mm subepithelial lesion was identified in the left wall, 35 cm from the upper incisors, during upper gastrointestinal endoscopy, and was diagnosed as a GIST through endoscopic ultrasound-guided fine needle biopsy. TECS was therefore performed. The patient was placed in a prone position with his face to the left. After confirming the lesion under endoscopy and left thoracoscopy, the periesophageal area of the lesion was dissected under thoracoscopy. Subsequently, an endoscopic full-layer resection was performed. Finally, the excision site of the lesion was sutured under thoracoscopy. The operation took a total of 3 h and 22 min, with a blood loss of 50 mL.ConclusionsThe appropriate surgical procedure for esophageal GIST should be considered according to the location and size of the lesion. TECS ensures that the resection margins are secured using an endoscopic or thoracoscopic approach. Furthermore, TECS is minimally invasive, avoiding esophagectomy and reconstruction, which makes it a potential surgical option for esophageal GISTs.

Extent of Endoscopic Sinus Surgery for Odontogenic Sinusitis of Endodontic Origin with Ethmoid and Frontal Sinus Involvement.

Background/Objectives: Odontogenic sinusitis (ODS) is the most common cause of unilateral maxillary sinus opacification. Initial treatment consists of intranasal steroids and antimicrobial therapy. In case of persistence of the disease, endoscopic sinus surgery (ESS) is advised. It is still not clear what extension of ESS is required and whether frontal sinusotomy or ethmoidectomy is justified in ODS with frontal sinus involvement. Methods: Adult patients presented with uncomplicated recalcitrant bacterial ODS due to endodontic-related dental pathology were evaluated by an otolaryngologist and a dentist and scheduled for ESS. Sinus CT scan demonstrated opacification of maxillary sinus and partial or complete opacification of extramaxillary sinuses ipsilateral to the side of ODS. Patients were undergoing either maxillary antrostomy, antroethmoidectomy, or antroethmofrontostomy. Preoperative and postoperative evaluations were done with nasal endoscopy, dental examination, subjective and radiological symptoms. Results: The study group consisted of 30 patients. Statistically significant decreases in values after surgery were found for SNOT-22, OHIP-14, Lund-Mackay, Lund-Kennedy, and Zinreich scale. Tooth pain was present in 40% cases during the first visit and in 10% during the follow-up visit. Foul smell was initially reported by 73.3% and by one patient during follow-up visit (3.3%). Significantly longer total recovery time and more crusting was marked for antroethmofrontostomy when compared to maxillary antrostomy. Conclusions: ESS resolved ODS with ethmoid and frontal involvement in almost every case. Minimal surgery led to improved overall clinical success in the same way as antroethmofrontostomy without risking the frontal recess scarring and stenosis.

Providing Insight for Pediatric Ear Surgery: Analysis of Middle Ear Development via HRCT.

Providing insight for pediatric ear surgery via investigations on the development patterns of ossicles, mastoid, and external auditory canal (EAC). This retrospective study analyzed high-resolution computed tomography (HRCT) scans of 191 healthy temporal bones ranging from infants to adults. Subjects were grouped by 1-year intervals for developmental regression models and 3-year intervals for stage comparisons using t-tests or Mann-Whitney U tests. The size of auditory ossicles and tympanic cavity (TC) remained stable during development, while the minimum diameter of the tympanic sinus (TS) entrance was reduced. Regarding mastoid pneumatization, the air cells can be observed at birth, became pronounced at 2 years old, and were fully developed around the age of 5, with subsequent growth primarily involving radial expansion. Furthermore, the EAC demonstrated significant growth with age: the width of EAC increased linearly ( = 0.12x + 4.01, R2 = 0.85), while the length of EAC followed a polynomial growth pattern ( = -0.03x2 + 1.15x + 6.25, R2 = 0.96). Ossicles and TC remain stable during development. Furthermore, mastoid air cells may have developed in the early stages of life, while their diameter increases synchronously with EAC. All in all, ossicular chain reconstruction surgery and endoscopic ear surgery can be performed in babies. NA Laryngoscope, 2024.

Low-grade Papillary Nasopharyngeal Adenocarcinoma: A Clinicopathologic Series of 35 Cases.

Low-grade nasopharyngeal papillary adenocarcinoma (LGNPPA) is a rare neoplasm originating from the surface mucosal epithelium in the nasopharynx. To clarify its clinicopathologic, immunohistochemical, and molecular features, we retrospectively enrolled 35 patients diagnosed with LGNPPA between May 2016 and March 2024. Our cohort consisted of 14 male and 21 female patients aged 11 to 71 years (median: 37y). The most common symptoms were rhinorrhea and nasal obstruction. Most tumors originated from the roof of the nasopharynx and were clinically staged as T1N0M0. None of the patients had a history of thyroid tumors. Microscopically, most of the LGNPPA were composed of irregular papillary structures covered with single-layer columnar or cuboidal epithelium. Eighteen cases (18/35, 51.4%) showed squamous epithelium coverage, and 9 cases (9/35, 25.7%) showed the characteristic transformation of squamous epithelium into neoplasm. Squamous differentiation and a significant spindle cell component were noted in 9 cases (9/35, 25.7%) and 26 cases (26/35, 74.3%), respectively. All cases were positive for thyroid transcription factor-1 protein, CK7, EMA, and Galectin-3 but negative for thyroglobulin, PAX8, and Napsin A. Ki-67 labeling was low and ranged from 2% to 5%. The Epstein-Barr virus or human papilloma virus infection and BRAF V600E mutation were not detected in any of the cases. All patients underwent endoscopic surgical resection, and 4 patients received radiotherapy followed by endoscopic surgery. Complete follow-up data were available for 33 patients. All patients had no recurrent or metastatic disease in the last follow-up (3 to 88mo). A definitive diagnosis depends on histopathology and immunohistochemistry studies. The optimal treatment for patients with LGNPPA is total excision. Given the extremely indolent biological behavior of LGNPPA, it may be more appropriate to classify it as a primary papillary epithelial tumor rather than an adenocarcinoma of the nasopharynx.

Predictive value of tooth and sinuses radiological characteristics in managing odontogenic sinusitis of endodontic origin.

One of the most common causes of bacterial odontogenic sinusitis (ODS) is endodontic disease with periapical lesions (PAL). Referrals between otolaryngologists and dental specialists are indispensable for proper diagnosis and treatment. If the disease does not resolve after medical and root-canal treatment (RCT), tooth extraction, endoscopic sinus surgery (ESS) or both are the ways of management.The aim was to clarify the predictive value of disease's radiological characteristics for the further surgical intervention. 68 symptomatic patients evaluated by an otolaryngologist and dental specialist were included to this prospective observational cohort study. Patients who failed medical treatment of sinusitis (intranasal steroids, saline rinses and antibiotics) and RCT were treated either with ESS, tooth extraction or both at the same time. 87% of patients required surgical intervention. 12% improved after tooth extraction alone, 47% after ESS and 31% required both procedures. The degree of maxillary sinus' (MS) opacification was not correlated with the need of invasive procedures implementation, as opposed to ostiomeatal complex' patency (p&lt;0.001). Cortical bone destruction towards the MS and multiple tooth roots involvement suggested ODS resolution only after combined surgical approach (p=0.041). Radiological characteristics of causative tooth and patency of ostiomeatal unit correlate with the evolution of ODS and need for either ESS and/or tooth extraction. Patients with multiple roots affected, shorter distance to the MS floor and PAL's with visible bone destruction may require tooth extraction and ESS to resolve ODS completely. Radiological data may help in earlier diagnosis and treatment of ODS with PALs for both otolaryngologists and dental specialists.