History Of Sinonasal Surgery Research Articles

Impact of long-term nasal airflow deprivation on sinonasal structures and chronic rhinosinusitis in total laryngectomy patients.

Total laryngectomy (TL) patients are good models in which to evaluate the effects of nasal airflow cessation on the sinonasal tract. Here, we evaluated changes in sinonasal structures and association with sinus opacification in the computed tomography (CT) images 3 years post-TL. Patients who underwent TL from 2005 to 2017 in a teaching academic center were reviewed retrospectively. Patients with a final follow-up CT taken less than 3 years after TL, tracheoesophageal puncture, inadequate CT image, or history of sinonasal surgery were excluded. The control group included patients who underwent a partial laryngectomy or hypopharyngectomy without requiring a tracheotomy for more than a month. Altogether, 45 TL patients and 38 controls were selected. The volume of all four paranasal sinuses, inferior turbinate soft tissue volume (ITSTV), maxillary sinus natural ostium (MSNO) mucosal width, and Lund-Mackay scores (LMS) were measured on preoperative and postoperative CT scans. The mean duration between surgery and the final CT scan was 6.3 ± 2.4 and 5.5 ± 2.3 years for the TL and control groups, respectively. Neither group showed significant changes in the four paranasal sinuses' volume or MSNO mucosa width. The ITSTV decreased significantly, from 4.6 ± 1.3 to 2.8 ± 1.1 mL (p < .001), in the TL group, regardless of the presence of nasal septal deviation, showing ITSTV reduction on both concave and convex sides. By contrast, the control group showed no significant changes in ITSTV. Postoperative LMS changes in both groups were insignificant. The number of patients with LMS aggravation or alleviation was the same in both groups, regardless of preoperative sinus opacification. Paranasal sinus structures and sinus opacification are not affected significantly by nasal airflow cessation; however, the inferior turbinate mucosa is affected by long-term discontinuation of nasal airflow. 4 (case-control study).

Sinus Symptoms in Cystic Fibrosis Patients and the Role of Interdisciplinary Care

Chronic rhinosinusitis (CRS) is known to occur in most cystic fibrosis (CF) patients. This phenomenon occurs because the genetic mutations in CF cause impaired chloride ion transport, which affects water transport and thus leads to thick mucus that cannot be cleared easily in both the lower and upper airways. While improvements continue to be made in treatment modalities for CF patients in terms of modulator therapies, the effect on sinus disease symptoms and the role of the otolaryngologist (ENT) continues to evolve. This study investigates the sinus symptoms of CF patients with comparison to ENT involvement in their care, the histories of polyps and sinus surgeries of these CF patients, and how their initiation to modulator treatment has affected ENT involvement in their care. A retrospective health records review was conducted including patients from Augusta University Adult Cystic Fibrosis Center with stratification based on demographics, mutations, modulators, ENT clinic visits, history of polyps or nasal surgery, and reported symptoms of headaches, olfactory dysfunction, and sleep problems. 98 patients of the Augusta University Adult Cystic Fibrosis Center met the inclusion criteria of this study. Most of the patients with reported ENT visits in the past 10 years were white and between the ages of 20-29. The most common modulator therapy of the CF patients was elexacaftor-tezacaftor-ivacaftor at 72.22%. More than half of the patients had a history of sinonasal surgery, and almost half had a history of polyps. In comparing ENT visits to the initiation of modulator therapy, 24% of the patients with reported ENT visits saw an ENT after starting modulator therapy. CRS can contribute to morbidity in CF patients with most patients requiring surgical intervention in their lifetime. Additionally, persistent sinonasal symptoms can reduce the quality of life in CF patients. Despite treatment with modulator therapies, otolaryngologists continue to have a role in interdisciplinary CF management.CF- Cystic Fibrosis; CFTR- Cystic Fibrosis Transmembrane Regulator; CRS- Chronic Rhinosinusitis; EMR- Electronic Medical Record; ENT- Otolaryngologist

Prospective evaluation of oral corticosteroid as a predictor of postoperative olfactory recovery after functional endoscopic surgery for nasal polyposis.

Anticipating the possibility of olfactory recovery after functional endoscopic surgery (FES) in nasal polyposis (NP) is difficult. The main objective of this study was to assess the predictive factors of recovering the sense of smell after radical bilateral ethmoidectomy. Secondary objectives were to identify other predictors of olfactory recovery. Open prospective study was conducted at the Nantes University Hospital including all patients with NP operated on in the Ear, Nose, and Throat Department between January 2011 and September 2017. These patients underwent functional endoscopic surgery (radical ethmoidectomy) after medical treatment failure. Olfaction was quantified prospectively and systematically during the preoperative consultation using a visual analog scale. Multivariate analysis evaluated the presence of predictive factors of postoperative olfactory recovery. One hundred nineteen patients were included in the study. Overall, olfaction was partially improved after surgery. For patients who presented greater than 50% recovery of olfaction after systemic corticosteroid therapy before surgery, we observed a predictive better rate of olfactory recovery after surgery (p < 0.001). Age over 65years, a history of sinonasal surgery, associated asthma, and bacterial colonization were not associated with less postoperative olfactory recovery. This study identified an objective factor that may influence olfactory recovery after FES using a therapeutic trial for olfactory recovery after oral corticosteroid treatment taken before surgery.

The GALEN rhinosinusitis cohort: chronic rhinosinusitis with nasal polyps affects health-related quality of life.

Chronic rhinosinusitis (CRS) significantly affects health-related quality of life (HRQoL). Few multinational observational studies have evaluated the impact of CRS with nasal polyps (CRSwNP) on patients’ HRQoL. This study aimed to assess HRQoL outcomes (including analyses by disease severity and impact of comorbidities and refractory disease) in CRSwNP patients from a large European database. Data were analysed from the Global Allergy and Asthma European Network (GALEN) Rhinosinusitis Cohort, including sociodemographic data, patient-reported disease severity (visual analogue scale), and scores on the 36-Item ShortForm Health Survey (SF-36) questionnaire. Differences in mean SF-36 scores were evaluated between patients with CRSwNP and population norms and between subgroups of interest (disease severity, comorbidity, and refractory disease, defined by a history of sinonasal surgery). Patients with CRSwNP (N = 445) had significantly lower mean SF-36 Physical Component Summary (PCS) and Mental Component Summary (MCS) scores vs population norms, demonstrating that CRSwNP negatively affects HRQoL. The presence of comorbidities affected HRQoL, as shown by significant differences in PCS scores in patients with asthma or non-steroidal antiinflammatory drug-exacerbated respiratory disease, compared with patients without asthma. Patients with moderate-to-severe disease had significantly lower PCS scores than patients with mild disease. Severe disease had a significant impact on MCS score. History of surgery had a clinically meaningful negative effect on HRQoL compared with no history of surgery. CRSwNP patients have significantly lower HRQoL compared with population norms. The impact is greater in patients with greater disease severity, comorbidities, or refractory disease.

IMPACT OF CHRONIC RHINOSINUSITIS WITH NASAL POLYPOSIS ON QUALITY OF LIFE BY SINO-NASAL SURGERY HISTORY

Introduction Chronic rhinosinusitis with nasal polyposis (CRSwNP) is associated with high symptom burden and poor health-related quality of life (HRQoL). The objective of this study was to assess the impact of CRSwNP on HRQoL among patients with disease refractory to maximal medical treatment, defined by history of sino-nasal surgery. Methods Patients with CRSwNP from 9 European centers in the Global Allergy and Asthma European Network completed a cross-sectional survey measuring HRQoL by the 36-Item Short Form questionnaire (SF-36). SF-36 mean physical component summary (PCS) and mental component summary (MCS) scores were compared with age-adjusted population norms and between groups of patients with and without a history of sino-nasal surgery. Results Patients with CRSwNP (n = 338) with or without a history of sino-nasal surgery had significantly lower mean PCS (−6.3 and −3.5, respectively) and MCS (−4.1 and −2.6, respectively) scores compared with population norms (P ≤ 0.005 for all). Differences in PCS and MCS scores in these patients vs population norms are consistent with differences considered clinically meaningful (≥2 and ≥3, respectively). Patients with sino-nasal surgery history (n = 155), compared with those without history of surgery (n = 183), had similar mean MCS score but significantly lower mean PCS score (−2.8; P = 0.017). Conclusions Patients with CRSwNP have worse physical and mental health than population norms. Patients with CRSwNP with sino-nasal surgery history experience similar mental health but significantly worse physical health than those without surgery history, indicating a greater unmet need in this subgroup.

Structure of the lateral mass of the ethmoid by curved stacking of endoturbinal elements

ContextAccording to evo-devo theory, the embryonic development of the nasal organ mimics its phylontogenic formation: the lateral masses of the human ethmoid bone develop by curved “onion” stacking of the endoturbinals (the horizontal bone septa of the mammalian olfactory chamber) under the impact of facial and skull-base remodeling, rather than by pneumatization of cavities communicating via ostia. ObjectivesTo assess the frequency of the onion structure on coronal CT. Material and methodsThree independent examiners performed a retrospective descriptive study of coronal CT scans taken ahead of septorhinoplasty between June 2010 and December 2012 in adult patients without history of sinonasal surgery. ResultsFifty patients were included. In the anterior right and left and posterior right ethmoid, an onion arrangement of the endoturbinals was systematically found on at least 1 view, and on 60% of views taking all ethmoid compartments together. Two endoturbinals were generally involved, but a rolling-up of 3 endoturbinals was also observed, significantly more frequently in the posterior compartments (P=0.004 on the right side, P=0.012 on the left). ConclusionThe onion structure of the lateral masses of the ethmoid can be observed on coronal CT scans. This structure confirms evo-devo theory. The ethmoid thus appears fundamentally different from the paranasal sinuses, suggesting that the pathogenesis of nasal polyposis and ethmoidectomy techniques need to be reconsidered.

Destructive Giant Maxillary Sinus Mucocele: A Case Report

Mucoceles of the paranasal sinuses are locally aggressive, cystic, benign lesions. They mainly occur in the frontal or anterior ethmoidal sinuses, and more rarely in the maxillary sinus. Chronic sinus inflammation, trauma, previous surgery and allergic disease are common causes of paranasal mucoceles. Giant mucoceles of the maxillary sinus causing bone destruction are extremely rare in patients with no history of sinonasal surgery. Mucoceles can erode the surrounding walls of the sinus and must therefore be differentiated from malignancies. Treatment of maxillary sinus mucoceles is surgical, Caldwell-Luc being the traditional method. We describe a case of a giant maxillary sinus mucocele with complete obstruction of the right nasal cavity. There were no known etiological factors, and the lesion was treated with endoscopic sinus surgery. The clinical features and radiological aspects of this entity are discussed in the light of the current literature.

Computed tomography imaging study of the superior attachment of the uncinate process.

The superior attachment of the uncinate process (SAUP) is an important landmark in the nasofrontal recess, but its anatomical distribution is still unclear. The objective of this study was to assess the location and number of superior attachments of the uncinate process on computed tomography (CT) images. A cross-sectional, retrospective study conducted at the Department of Radiology, Hospital de Clinicas de Porto Alegre, Brazil. Sinus CT scans of adult patients with no history of sinonasal surgery, craniofacial fractures, malignant neoplasms, or malformations were examined for identification of the site of SAUP. 152 CT scans (304 sides) were assessed. The SAUP was appropriately identified in 292 sides (96%). Six distinct SAUP patterns were identified: to the lamina papyracea or anterior ethmoidal cells (193, 63.48%); to the middle turbinate (19, 6.25%); to the skull base (19, 6.25%); to the lamina papyracea and middle turbinate (29, 9.53%); to the lamina papyracea and skull base (29, 9.53%); and to the skull base and middle turbinate (3, 0.98%). The site of superior attachment of the uncinate process is highly variable, but is in contact with the lateral nasal wall in 82.5% of the cases.

Computed tomography imaging study of the superior attachment of the uncinate process

The superior attachment of the uncinate process (SAUP) is an important landmark in the nasofrontal recess, but its anatomical distribution is still unclear. The objective of this study was to assess the location and number of superior attachments of the uncinate process on computed tomography (CT) images. A cross-sectional, retrospective study conducted at the Department of Radiology, Hospital de Clinicas de Porto Alegre, Brazil. Sinus CT scans of adult patients with no history of sinonasal surgery, craniofacial fractures, malignant neoplasms, or malformations were examined for identification of the site of SAUP. 152 CT scans (304 sides) were assessed. The SAUP was appropriately identified in 292 sides (96%). Six distinct SAUP patterns were identified: to the lamina papyracea or anterior ethmoidal cells (193, 63.48%); to the middle turbinate (19, 6.25%); to the skull base (19, 6.25%); to the lamina papyracea and middle turbinate (29, 9.53%); to the lamina papyracea and skull base (29, 9.53%); and to the skull base and middle turbinate (3, 0.98%). The site of superior attachment of the uncinate process is highly variable, but is in contact with the lateral nasal wall in 82.5% of the cases.