Functional Endoscopic Sinus Surgery Surgery Research Articles

Orbital subperiosteal abscess in adolescents and adults: predictors and outcomes of nonsurgical management and surgical approaches

ABSTRACT Purpose The aim of this study was to assess predictors and outcomes of subperiosteal abscess (SPA) management in adolescents and adults at two tertiary care centers. Methods This retrospective cohort study included cases of SPA from January 1 2000 to October 9 2022 at two institutions. Patients 9 years or older were categorized into surgical and nonsurgical cohorts. Surgical subgroups included those who underwent functional endoscopic sinus surgery (FESS) alone, external (transcutaneous or transconjunctival) orbitotomy alone, or combined FESS and external surgery. The presented features were assessed as potential treatment predictors. Outcomes included length of stay (LOS), final best-corrected visual acuity (BCVA), readmission rate, and reoperation rate. Results Of the 159 SPA cases included, 127 (79.9%) underwent surgery and 32 (20.1%) were managed nonsurgically. The nonsurgical cohort was younger (p = .003) with smaller abscesses (p < .001) that were more likely to be medial (p < .001). The nonsurgical cohort had shorter LOS (p < .001); final BCVA and readmission rates were similarly favorable. Abscess location was correlated with surgical approach. Superior SPA that underwent FESS or external surgery alone had higher reoperation rates (57.1.0% and 58.3%, respectively) than combined (17.9%). External approach and FESS alone resulted in lower reoperation rates (15.4% and 15.0%, respectively) than combined (27.3%) for medial SPA. Subgroup analysis in the sinusitis cohort yielded similar results. Conclusions A trial of nonsurgical management may be safe and effective for select patients aged 9 years and older with sinusitis-derived, medial, and small SPA. When surgery is indicated, approach should be guided by abscess location to minimize reoperation risk.

Ultrasound Guided Maxillary Nerve Block for Perioperative Pain Management for Patients Undergoing Endoscopic Sinus Surgery: Randomized Control Trial

Background: Proper perioperative pain management remains a cornerstone of well-conducted functional endoscopic sinus surgery (FESS). In such a context, proper pain management entails the adequate provision of prolonged postoperative analgesia, the avoidance of overusing opioids, and consequently limiting their unwanted side effects. Objectives: We aimed to evaluate the effect of bilateral ultrasound-guided suprazygomatic maxillary nerve block (MNB) on postoperative pain in patients undergoing FESS. Methods: Patients eligible for FESS were randomized into two groups: the MNB group (n = 30), who underwent bilateral ultrasound-guided suprazygomatic maxillary nerve block after induction of anesthesia, and a control group (n = 30), who received multimodal analgesia, including opioids. Postoperatively, patients were observed for 48 hours. Pain scores were evaluated upon arrival to the sPACU and at 2, 6, 12, 24, 36, and 48 hours postoperatively, particularly at the time of removal of the hemostatic agent after 36 hours postoperatively. Total rescue analgesia, postoperative complications (including nausea and vomiting [PONV], hypotension, bradycardia, headache), and patient satisfaction were also diligently recorded. Results: Sixty patients who were candidates and underwent FESS surgery were enrolled randomly in both groups. The NRS pain score in the MNB group was significantly lower than that of the control group (P &lt; 0.001), especially the NRS during the removal of the hemostatic agent at T10 was significantly lower in the MNB group (P &lt; 0.001). However, at the 24 - hour point post-surgery, there were no significant differences between both groups (P = 0.568). Total rescue analgesia required was significantly lower in the MNB group compared with the control group (P &lt; 0.001) throughout the first 48 hours postoperatively. The percentage of patients with no postoperative complications (nausea, vomiting, and headache) was higher in the MNB group (76.7 %) compared with the control group (40 %). Patient satisfaction was statistically significantly higher in the MNB group (P &lt; 0.001). Conclusions: Bilateral ultrasound-guided suprazygomatic MNB appeared to be safe and advantageous, as its use was associated with a decrease in total analgesic consumption, a reduction in postoperative morbidities such as pain, nausea, and vomiting, and greater patient satisfaction.

Evaluation of Effectiveness of Sinus Surgery in Chronic Rhinosinusitis Patients using Sinonasal Outcome Index-22, modified Lund Mackay Score and Rhinosinusitis Disability Index

Functional endoscopic sinus surgery (FESS) is done in patients with chronic rhinosinusitis (CRS) not responding to medical therapy. This study aims to evaluate the subjective, objective and overall quality of life improvement in CRS patients following FESS surgery. Sinonasal outcome index-22, modified Lund-Mackay score and Rhinosinusitis Disability Index were used to evaluate subjective, objective and overall quality of life in patients with CRS. The questionnaires were asked before the surgery and three months after surgery. A total of 110 patients were enrolled in the study. All three types of evaluation showed improvement following FESS surgery. FESS in CRS patients refractory to medical management caused significant improvement in symptom intensity, endoscopic score and overall quality of life.

Comparison of Clonidine versus Esmolol in Controlled Hypotension in Patients Undergoing FESS Surgery

Background: FESS has its share of complications which can be a challenge for both the surgeon as well the anesthetist and achieving a bloodless surgical field is essential So the principle of controlled hypotension can be used to combat this issue.&#x0D; Methods: A hospital-based randomized comparative interventional study was conducted on 60 patients to compare Clonidine (2mcg/kg in 10 ml of saline over 10 minutes before induction followed by an infusion of 1mcg/kg/hr during maintenance) and Esmolol (1mg/kg in 10 ml of saline over 10 minutes before induction followed by an infusion of 1mg/kg/hr during maintenance) to assess and compare the hypotensive properties of both the drugs.&#x0D; Results: After the induction of anesthesia, there was a significant difference in the mean heart rate, and mean arterial pressure between the two groups throughout the intraoperative period (p-value &lt; 0.05). Both groups achieved a target mean arterial pressure (MAP) of 65-70 mmHg and improved surgical field quality.&#x0D; Conclusion: This study concluded that clonidine and esmolol both provide hemodynamic stability and a better surgical field in functional endoscopic sinus surgery (FESS). Clonidine also helps in achieving postoperative sedation and analgesia.

Quality of Life Improvement in Concurrent Septorhinoplasty and Endoscopic Sinus Surgery.

Septorhinoplasty (SRPL) and functional endoscopic sinus surgery (FESS) are two frequently performed surgeries to improve quality of life (QoL) in patients with nasal symptoms. It has been demonstrated as a safe combination regarding complication rates, but patient satisfaction in concurrent surgery has not been adequately studied yet. Patients undergoing sole FESS due to chronic rhinosinusitis (n = 57), sole SRPL (n = 148), and concurrent surgery (n = 62) were prospectively evaluated for their disease-specific QoL before and one year after surgery. Each procedure was performed by the same surgeon (OCB). For SRPL, the patient-reported outcome measures Rhinoplasty Outcomes Evaluation (ROE) and Functional Rhinoplasty Outcome Inventory (FROI-17) were utilized, and for chronic rhinosinusitis, the Sino-Nasal Outcome Test-22 (SNOT22). All three groups showed significant improvement in the postoperative QoL measurements (all p < 0.01). The postoperative improvements were slightly smaller in the concurrent surgery group compared with the single surgery groups measured with ROE (combined: +55.2 ± 9.3, single: +58.8 ± 9.8, p = 0.02), FROI total score (combined: +47.6 ± 5.2, single: +49 ± 5.4; p = 0.08) and SNOT22 (combined: +33.1 ± 6.7, single +34.5 ± 7, p = 0.26). SRPL, FESS, and combined surgery improve disease-specific QoL. When applicable, surgeons may offer the benefits of a combined procedure without compromising the QoL gain. 3 Laryngoscope, 134:1239-1245, 2024.

Management of Odontogenic Sinusitis: Results with Single-Step FESS and Dentoalveolar Surgery.

Odontogenic sinusitis (OS) is a well-known and important border of specialties in otorhinolaryngology and dentoalveolar surgery. Odontogenic sinusitis can develop due to iatrogenic harm or odontogenic infection. The gold standard diagnostic method is clinical and radiological-CBCT (cone beam computed tomography)-examination. The treatment of this condition requires collaboration between ENT and dentoalveolar surgery specialists and can be non-surgical or surgical based on staging. This paper aims to share the results of our clinical study whereby complex therapy was administered by a dentoalveolar surgeon and an otorhinolaryngologist in cooperation. We conducted a retrospective study comprising 111 OS patients who underwent complex therapy between 2016 and 2023 at Semmelweis University, Budapest, Hungary. All patients were treated with concurrent FESS (functional endoscopic sinus surgery) and dentoalveolar surgery. Follow-up was based on symptoms, clinical examination and CBCT imaging. Of the 111 patients, 107 were successfully treated with concurrent FESS and dentoalveolar surgery, and only 4 had further symptoms following the complex therapy and needed retreatment. The complex, single-session therapy involving FESS and oral surgery is an effective treatment method, which is less invasive and associated with fewer complications compared to previous interventions, such as the Luc-Caldwell procedure.

Efficacy functional endoscopic sinus surgery (FESS) for the treatment of chronic rhinosinusitis

Objective: To assess the efficacy and quality of life after functional endoscopic sinus surgery (FESS) in individuals who have chronic rhinosinusitis. Methods: This prospective study was held in the department of ENT of Aziz Bhatti Shaheed Teaching Hospital and ENT, Head and Neck Surgery department, Pak International Medical College and Peshawar Institute of Medical Sciences (PIMS), Hayatabad Peshawar for the duration from September 2021 to September 2022. The study had 80 patients in total who underwent FESS surgery. Inclusion criteria: radiographically and clinically suggested disease of the paranasal sinuses and nose, such as rhinosporidiosis, nasal polyposis, chronic recurrent acute sinusitis and patients who are not improving after receiving the proper surgical care (antral lavage) and medical care. Exclusion criteria: Nasal and paranasal sinus Malignant conditions. Patients with acute sinusitis who have been diagnosed with intracranial complications and patients with intracranial complications. The data was analyzed with SPSS 21.0. Results: There were 80 patients in total. In this study, ethmoid polyps were operated in 30 (37.5%) patients, chronic rhinosinusitis in 23 (28.8%), Antrochoanal polyps in 12 (15%) patients, rhinosporidiosis in 10 (12.5%) patients, and in 5 (6.2%) patients with inverted papilloma’s were operated.

Effect of oral premedication with ivabradine on surgical field and intraoperative bleeding during functional endoscopic sinus surgeries: A prospective, randomized, and placebo-controlled study

Background: Ivabradine is an effective drug to prevent abnormal increase in heart rate (HR). Aims and Objectives: The aims of this study were to determine if a pre-operative oral dose of ivabradine (2.5 mg) reduces intraoperative bleeding during functional endoscopic sinus surgery (FESS) and improves visualization of operative field. Materials and Methods: A prospective, randomized, and placebo-controlled study was carried out in 30 patients of ASA grade I and II, aged between 18 and 60 years undergoing FESS surgeries. The patients were randomly allocated into two groups. Group I – received 2.5 mg of tablet ivabradine and Group P – received a placebo (vitamin tablet) 1 h before surgery. Blood loss and hemodynamic parameters (HR, systolic, diastolic, and mean blood pressure) were assessed perioperatively. Surgical field was graded by operating surgeon using Fromme – Boezaart score (FBS) at the end of procedure. Post-operative monitoring for any complications was also done. Results: Mean final blood loss in Group I was 165.73±43.48 mL and in Group P was 246.25±30.76 mL. There was a significant difference in mean final blood loss (mL) between two groups with P&lt;0.001. In Group I – 13.33% had FBS 1 and 86.67% had FBS 2, whereas in Group P – 6.67% had FBS 2, 86.67% had FBS 3, and 6.67% had FBS 4. Thus, Group I had lower FBS scores than Group P and was statistically significant. Conclusion: Pre-operative oral ivabradine helps in reducing intraoperative bleeding in FESS surgery and provides good surgical field compared to placebo.

Prediction of Postoperative Pulmonary Complications in Patients Undergoing Functional Endoscopic Sinus Surgery: A Cohort Study

Introduction: Considering the pathophysiology of nasal obstruction, changes in certain parameters such as Peripheral Blood Eosinophil Count (PBEC), bedside pulmonary function test, Peak Expiratory Flow Rate (PEFR), and Electrocardiography (ECG) may have some correlation with postoperative pulmonary complications such as upper airway obstruction, loss of pharyngeal muscle tone, and postobstructive pulmonary oedema. Aim: To observe and analyse the changes in PBEC, bedside pulmonary function test, PEFR, and ECG in patients undergoing Functional Endoscopic Sinus Surgery (FESS). Materials and Methods: A prospective cohort study was conducted at Bharati Hospital, Pune, Maharashtra, India over a two-year duration from December 2020 to October 2022. A total of 50 patients aged above 18 years undergoing FESS surgery were included in the study. The statistical analysis was performed using the Chi-square test and student’s t-test. After thorough preoperative evaluation, the aforementioned predictors were recorded. General anaesthesia management for FESS surgery was done according to the standard protocol. Vigilant intraoperative monitoring of vital parameters including peak airway pressure and plateau pressure was performed. After shifting the patients to the recovery room, they were observed for: 1) Hypoxia; 2) Hypercarbia; 3) Laryngospasm; 4) Bronchospasm; and 5) Pulmonary oedema. Results: A total of 50 patients aged between 18 years and 65 years with the mean age was 41.7±15.4 years were included in the study, with 32 males and 18 females. Only 24% of the study population showed postoperative hypoxia, while the rest of the complications were not observed in any patient. Changes in eosinophil count, PEFR, and ECG did not have any correlation with postoperative hypoxia and were statistically insignificant. Bedside pulmonary function tests, including the Sabrasez breath-holding test and the Sabrasez single breath count test, showed changes in 30% and 76% of patients, respectively. Forced Expiratory test change was seen in 72% of patients. Among these, 19.4% showed hypoxia. Out of the 12 cases showing postoperative hypoxia, seven had a disease duration of less than six months. Conclusion: The Sabrasez breath-holding test and Sabrasez single breath count are good predictors for postoperative hypoxia in patients undergoing FESS surgery. Shorter duration of nasal obstruction also showed postoperative hypoxia.

ASSESSMENT OF TOTAL INTRAVENOUS ANAESTHESIA BY PROPOFOL AND INHALATIONAL ANAESTHESIA WITH ISOFLURANE FOR CONTROLLED HYPOTENSION IN FUNCTIONAL ENDOSCOPIC SINUS SURGERY

Objective: The key objective of the study is to compare the Propofol-based total intravenous anaesthesia (TIVA) with Isoflurane-based inhalational anaesthesia for controlled hypotension during functional endoscopic sinus surgery (FESS). Materials and Methods: This is a prospective randomized, controlled single-blinded clinical study. The study involved 40 patients posted for elective FESS surgery, selected randomly from the ENT department. Anesthesia was induced with Inj. Midazolam 2 mg, Inj. Fentanyl 2 µg/kg, Inj. Propofol 2 mg/kg, Inj. Vecuronium 0.1 mg /kg and ventilated using oxygen, air, and Isoflurane (FiO2 of 0.5) in isofurane group patients. Injections of 2 mg of midazolam, 2 µg/kg of fentanyl, 2 mg/kg propofol, and 0.1 mg /kg vecuronium, as well as oxygen and air for ventilation, were used to induce anaesthesia (FIO2 of 0.5) in TIVA group patients. Fromme boezaart scale was used as an evaluation scale for surgical site bleeding. Results: The average blood loss in the isoflurane group was 134.25 ± 4.65ml and in the propofol group was 66.95 ± 4.28ml. The quality of the surgical field in the propofol group is (3.13 ± 0.9), and the isoflurane group is (3.13 ± 0.8). The results are significant. Conclusion: Total intravenous anesthesia using propofol provides notable advantages over the traditionally used inhalational anesthetic technique using isoflurane in surgical field conditions and intraoperative blood loss.

CLONIDINE 100MCG VERSUS 200 MCG AS THE MAIN STAY FOR CIRCULATORY MANIPULATION IN FUNCTIONAL ENDOSCOPIC SINUS SURGERY: A RANDOMISED COMPARATIVE STUDY

Background: Functional endoscopic sinus surgery (FESS) is most widely recognized surgery done for management of chronic sinusitis. The aim of this study was to compare the optimization of operating conditions produced by either 100 μg or 200 μg oral tablet clonidine as the mainstay for circulatory manipulation during Functional Endoscopic Sinus Surgery. Method: A double-blind randomized comparative study was done in 60 cases divided into two groups. Group 1(n=30) patients were given 100 μg tablet clonidine; group 2(n=30), patients were given 200 μg of tablet clonidine orally 1 hour 30 minutes before surgery with 75ml water. Hemodynamic monitoring (HR, NIBP, SBP, DBP, MAP, SPO , ETCO ). Quality of bloodless surgical eld created intraoperatively was assessed2 2 by Fromme-Boezzart scale, Likert's scale at the end of procedure. Postoperatively, patients were assessed using Brussel's sedation score, and adverse effects like Bradycardia, Somnolence, Delayed recovery were recorded. Result: No statistically signicant difference seen in age, weight, gender, and ASA grading in both groups. Comparison of quality of surgical eld created, assessment through Fromme-Boezzart grading system and Surgeon's satisfaction using Likert scale between both the groups was not statistically signicant between the groups (P-value &gt;0.05). We infer that both doses of clonidine tablets were equally effective in creating bloodless surgical eld. Conclusion: Non inferiority of 100microgram oral clonidine compared with 200 microgram oral clonidine for induction of hypotension during FESS surgery with less side effects and creating an intraoperative blood less surgical eld.

Rhino-orbital-cerebral mucormycosis in times of COVID-19: A neurosurgical experience.

Background: The gravity of “second wave” of COVID-19 has effaced many new challenges in India; mucormycosis being a recent one. Diabetes mellitus (DM) is a known significant risk factor for mucormycosis. Here, we present our experience with rhino-orbital-cerebral mucormycosis (ROCM) during the “second wave of COVID-19” at a tertiary health care centre in North India.Methods: This case series includes four cases of ROCM that were managed by our neurosurgical team in view ofcerebral involvement.Results: All the cases with an exception of one (Case 1), had a history of treatment for COVID-19 pneumonia. Case 2, 3 had undergone functional endoscopic sinus surgery (FESS) and orbital decompression before the onset of cerebral involvement; Case 4 underwent FESS and cranial surgery in the same sitting. All the patients had a history of DM and all the cases treated for COVID-19 pneumonia had a history of treatment with corticosteroids. Two patients underwent surgery with the exception of one patient, who did not provide consent for the same. One patient expired before surgical excision could be attempted.Conclusion: Regular and intensive follow-up is the key in swift detection and management of ROCM in post-COVID patients. While surgical excision is advisable in the fungal lesion, it must be borne in mind that radical excision of cerebral lesions is associated with morbidity, delayed recovery, and prolonged ICU stay. Culture and sensitivity-based antibiotics should be used judiciously as fever is a common postoperative complication. Blood sugar monitoring and control of DM are paramount in this condition. Steroids should be avoided in the management of cerebral edema with judicious use of hypertonic saline or mannitol.

Functional endoscopic sinus surgery (FESS) with navigation system in childhood – our experience. Presentation of clinical cases

Introduction: Functional endoscopic sinus surgery (FESS) is the gold minimally invasive standard in diagnosing and surgically treating many diseases of the nose and paranasal cavities. An advantage of FESS is the possibility of application in all age groups. Materials and methods: We observed pediatric patients attended the Otorhinolaryngology Clinic in the University Hospital “Dr. Georgi Stranski” – Pleven in 2021. FESS surgery was performed in the “Integrated interdisciplinary operating unit with navigation and telesurgery systems” at the Center of competence on personalised medicine, 3D and telemedicine, robotic and minimally invasive surgery „Leonardo da Vinci” in Medical University – Pleven. Clinical cases: Case 1: A 7-year-old male patient with orbital complication of rhinosinusitis, with left orbital preseptal cellulitis, without ophthalmoplegia or loss of vision, + ptosis of the eyelid and data on pansinuitis from CT images. Performed FESS found lysis of lamina papyracea with involvement of anterior and posterior ethmoidal cells. Postoperative treatment was done with Ceftriaxone 1g/12h i.v. for 7 days, nasal glucocorticoids and antihistamines. Case 2: A 17-year-old female patient with suggested primary ciliary dyskinesia with a recurrent rhinosinusitis, persistent nasal obstruction, and thick viscous secretions that did not respond to conservative treatment. Sweat test for cystic fibrosis (-). FESS reshaping of the natural openings of the maxillary sinuses and anterior ethmoidectomy were performed bilaterally. Conclusion: FESS is a minimally invasive method, which is suitable for application in pediatric patients. When applied by trained professionals, FESS with an integrated navigation system is optimal for the diagnosis and surgical treatment of chronic and acute rhinosinusitis in children.

Role of Pterygopalatine Fossa Block on Intra-Operative Heart Rate and Blood Pressure During Endoscopic Sinus Surgery at a Tertiary Care Centre

Background: Functional Endoscopic Sinus Surgery (FESS) is a physiological and also well accepted surgical treatment for chronic sinus disease that is unresponsive to medical treatment. The most frequent intraoperative complication is bleeding. Various methods are being tried to reduce the bleeding during FESS. But, none of these methods consistently provide the desirable bloodless field for the surgeons. Blockage of Pterygopalatine Fossa (PPF) through the greater palatine foramen is an alternative approach to reduce blood loss during ESS, which is an easy procedure, associated with little complication. Pterygopalatine Fossa Block (PPFB) along with general anaesthesia is effective in patients undergoing FESS surgery. Aims and Objectives: To assess the effect on and the difference in heart rate and blood pressure after pterygopalatine fossa block during FESS surgery. Materials and Methodology: 25 Patients with bilateral nasal pathology undergoing FESS were selected from ENT wards after a written informed consent. The PPFB was done only on one side, while the opposite nostril acted as control, thus each case acted as their own control. Various vital parameters like – heart rate (HR), blood pressure [(BP) systolic and diastolic] were calculated every 15 mins and their average noted. Surgery on the first side was completed and then followed by surgery on the second side. Applying paired-t Test, results were obtained. Results and Conclusion: There was a significant fall in heart rate and blood pressure. There was a positive correlation between these factors. "p value” was found to be highly significant in both the parameters tested. Pterygopalatine fossa block is an effective adjunct to general anaesthesia for controlling heart rate and blood pressure during FESS surgery.

A CT Scan Study Showing Prevalence of Haller Cells in Patients with Sinonasal Complaints

Background: Anterior ethmoid cells that extend into the maxillary sinus roof are known as Haller cells. They are commonly seen on the floor of the orbit. They may cause sinusitis symptoms by blocking the infundibulum, may get infected and also sometimes complicate the Functional Endoscopic Sinus Surgery (FESS). The present study was undertaken to determine the prevalence of Haller cells on CT scans in patients having sino-nasal complaints. Subjects and Methods : This was a descriptive observational study carried out on 150 patients who presented with various sino-nasal complaints and underwent a CT Scan in the Department of Radiodiagnosis, Bangur Institute of Neurosciences, Kolkata. Their CT scans were studied retrospectively for the presence of Haller cells. Radiological variations data were summarized by routine descriptive statistics namely counts and percentages for categorical variables. Fisher’s Exact Tests and were applied to calculate the ‘p’ value to find out any statistically significant difference between males and females. Results: Haller cells were found in 12% (18 cases) in the present study, 5.33% in males and 6.67% in females. ‘p’ value in this case was 0.616 on applying Fisher’s Exact test. Conclusion: Anatomical variations of the paranasal sinus region like Haller cells are quite common and they must be searched for by the surgeons planning any endoscopic sinus surgery. This study attempted to provide the prevalence of the Haller cells in Eastern India which will definitely help the FESS surgery and its outcomes.

Dr. Ahila's Conchal Crusher for Concha Bullosa.

Endoscopic Sinus Surgery is evolving day by day, there is a constant need for improvisation in terms of instrumentation with clear bloodless surgical field and good postoperative results. The applications of Dr. Ahila's Conchal Crusher for managing Concha bullosa in Functional Endoscopic Sinus Surgery (FESS) Surgery are presented. The creation/innovation of Dr. Ahila's conchal crusher will prevent rawmucosal surface area, bleeding and scope fogging with blood during FESS surgery after traditional conchoplasty. This new instrument makes it easy to reduce concha bullosa during nose and sinus surgery creating a bloodless field, no risk of destabilization or fracture of middle turbinate hence no postoperative synechiae which may otherwise lead to iatrogenic frontal sinusitis. Surgical instruments represent a major financial asset to the healthcare facility. Single instrumentation is essential to avoid costly replacements, surgeon satisfaction, reduce costs and delays in the Operating room and enhance patient safety. Dr. Ahila's conchal crusher may facilitate the performance of concha bullosa surgery and advance the art of Endoscopic Sinus surgery to a better level.

Role of Hypotensive Anaesthesia in Functional Endoscopic Sinus Surgery in Private Practice

Background: Functional endoscopic sinus surgery (FESS), effective control of bleeding is essential to maintain a clear operative field and to minimize complications. Intraoperative bleeding is one of the major problems in endoscopic surgery of sinuses. Controlled hypotension is a technique used to limit intraoperative blood loss to provide the best possible field for surgery.&#x0D; Objective: The objective of study was role of Hypotensive Anaesthesia in Functional Endoscopic Sinus Surgery and designed to compare intraoperative hemorrhage and the visibility of the operative field during normotension and hypotension anesthesia.&#x0D; Methods: Prospective randomized study includes a total of 60 ASA I-II patients who underwent elective FESS surgery. Patients randomly assigned in two groups the hypotension group (Group A) and the normotension group (Group B). Intraoperative mean arterial pressure (MAP), heart rate (HR) were recorded.&#x0D; Results : This study shows the mean ages of the patients of group A group B were 33.36±7.61 and 32.46±7.73 years respectively. No statistically significant difference was observed among groups at 0.05 level in term of age. The mean heart rate pre-anaesthesia and preoperative among the patients of different groups in different follows up period. Significance differences were observed among groups in term of heart rate at 5 minute, 15 minute, 30 minute, 45 minute and 60 minute. The mean arterial mean blood pressure before pre-anaesthesia and preoperative estimation among the patients of different groups in different follows up period. Significance differences were observed among groups at 5 minute, 15 minute, 30 minute, 45 minute and 60 minute.&#x0D; Conclusion: This study demonstrated that Controlled hypotension can be achieved equally and effectively by nitroglycerin and labetalol reduced significantly intraoperative hemorrhage and produce hypotensive anesthesia. Both are equally effective in providing ideal surgical field during functional endoscopic sinus surgery (FESS).&#x0D; Bangladesh J Otorhinolaryngol; April 2018; 24(1): 8-13

The surgical combination between functional endoscopic sinus surgery and septorhinoplasty as a procedure for nasal polyps treatment: a case report

Background: Concurrent functional endoscopic sinus surgery (FESS) and septorhinoplasty are performed either for cosmetic reasons or for a medical condition. Many patients are not satisfied with their nose shape or have breathing problem. These problems usually occur as a result of nasal fracture, obstruction, chronic sinusitis, or polyps. Case presentation: The present case was a 45-year-old non-smoker Saudi male patient, who presented to King Abdullah medical city outpatient clinic with a history of chronic right nasal obstruction for 15 years. A computerized tomography scan of a paranasal sinus with navigation protocol showed bilateral nasal polyps. Endoscopic sinus surgery was performed under general anesthesia. After FESS surgery, rhinoplasty by inverted C-shape incision, and elevation of the flap was done. The patient showed improvement and was discharged with monthly follow-up. Conclusion: These procedures are safe and cost effective. It minimizes hospital stay and can treat functional complaints, such as nasal obstruction, sinus problems, septum deviation, and polyps’ removal at the same time.

Retrospective study of corticosteroid role in decreasing intraoperative bleeding during FESS surgery for chronic rhinosinusitis

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The objective of the study was to assess the role of corticosteroid given preoperatively in decreasing intraoperative bleeding during functional endoscopic sinus surgery (FESS) for chronic rhinosinusitis.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This is a retrospective study conducted in a tertiary care hospital for patients undergoing FESS for chronic rhinosinusitis from January 2016 to December 2016. In this study 120 patients of FESS were enrolled. Their data was analyzed for preoperative corticosteroid given and intraoperative grade of bleeding. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; There were 62 patients out of 120 who received preoperative corticosteroid. Among these 41 had grade 0-1 bleeding and 21 had grade 2-5 bleeding. Similarly in non-corticosteroid group 30 had grade 0-1 bleeding and 28 had grade 2-5 bleeding. Based on these p values was calculated using fisher exact test which showed that to be non-significant.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Preoperative corticosteroids do not have control on intraoperative bleeding during FESS. They help in reducing the size of polyp and thus more effective in cases of CRSwNP.&lt;/p&gt;

Trend in otolaryngological surgeries in an era of super-aging: Descriptive statistics using a Japanese inpatient database

ObjectiveTo reveal the age distribution and capture the longitudinal trend in otolaryngological surgeries performed in Japan, where society is rapidly aging. MethodsUsing the Diagnosis Procedure Combination database, we extracted data on patients who were hospitalized and underwent any type of otolaryngological surgery in departments of otolaryngology or head and neck surgery from fiscal year 2007 to fiscal year 2013. Type of surgery, patient’s age, and fiscal year were compared. We categorized >200 types of surgeries into eight specialties: ear surgery, functional endoscopic sinus surgery (FESS), other types of paranasal surgery (except for malignancy), head and neck cancer surgery, benign tumor surgery, upper airway surgery (including pharynx and larynx), removal of foreign body, and other. ResultsIn total, 558,732 patients were included. The proportions of patients in each age category formed two peaks in middle age and in children aged ≤9years. The proportion of all surgeries made up by FESS, other paranasal surgery, benign tumor surgery, and head and neck cancer surgery gradually increased with age, forming a peak in patients in their 60s. The proportion of ear surgery was highest in patients aged ≤9years (34.0% of all surgeries, mostly myringotomy and transtympanic ventilation tube insertion) and formed a gradual peak in patients in their 60s (mostly tympanoplasty). The proportion of upper airway surgery (tonsillectomy and adenoidectomy) was highest in patients aged ≤9years (25.3% of all surgeries). The proportion of foreign body removal was highest in patients aged ≤9years (52.2% of all surgeries) and increased slightly with age. In 2013, compared with 2007, those aged 65–74 years and ≥75years made up a larger percentage of patients undergoing each specific surgery, including tympanoplasty, stapedectomy/stapedotomy, FESS, head and neck cancer surgery, pharyngolaryngectomy, total/subtotal glossectomy, thyroid lobectomy, parotidectomy (for a benign tumor), submandibular gland resection, tonsillectomy, and vocal fold polypectomy. ConclusionThe age distribution of otolaryngological surgeries varied by specialty. We found an increased proportion of patients aged 65–74 and ≥75years in most specific surgeries.