Intranasal Endoscopic Surgery Research Articles

Application of endoscopic nasopharyngeal enlargement excision in the surgical treatment of oncology in the nasopharyngeal

Objective:To evaluate the clinical indication, technique, effect and cautions of intranasal endoscopic surgery for nasopharyngeal tumor. Methods:Between December 2016 and April 2021, 31 patients who received endoscopic nasopharyngectomy for nasopharyngeal tumors were analyzed retrospectively, 8 benign and 23 malignant cases were included. 8 benign cases included 7 cases with nasopharyngeal fiber hemangioma and 1 case with polymorphic adenoma. Twenty-three malignant cases included 12 cases with recurrent nasopharyngeal carcinoma after chemoradiotherapy and 11 cases with various types of malignancies. All patients underwent endoscopic resection of nasopharyngeal tumors through bilateral transnasal approach. Results:Total resection of the tumor was achieved for all cases without severe surgical complications. 8 cases with benign tumors, with following-up of 5-49 months, showed no recurrence. 23 cases with malignant tumors, with following-up of 6-58 months, 22 cases show no recurrence, 1 recurent nasopharyngeal osteosarcoma, curved after another operation and assisted with chemotherapy, 1 case with nasopharyngeal carcinoma survived with disease after two endoscopic operations. Conclusion:Nasopharyngeal tumor could be completely resected with endonasal endoscopic surgery according to the anatomic structure. Surgery should provide a panoramic view on nasopharyngeal cavity and tumors, protect important structures.

Incision of Hasner's valve under endoscopic intranasal surgery for the treatment of nasolacrimal duct obstruction in children.

To evaluate the effectiveness and safety of a Hasner's valve incision performed under endoscopic intranasal surgery for the management of congenital nasolacrimal duct obstruction. This retrospective study comprised 484 patients with congenital nasolacrimal duct obstruction who underwent incision of Hasner's valve under endoscopic intranasal surgery between April 2000 and October 2016. The primary endpoint was the procedure's functional success rate. The secondary endpoints were Hasner's valve and inferior turbinate anatomical findings, demographic data, complication rate and surgical duration. In patients with no medical history of nasolacrimal duct probing, 91 per cent had a successful result, 5 per cent had a partially successful result, 3.9 per cent showed no change and 0.1 per cent had a worse result following the procedure. Concerning the secondary endpoints, outcomes were more frequently successful in children younger than three years. Only one patient had a post-operative infection. All patients underwent general anaesthesia; no complications related to general anaesthesia were observed. Mean surgical duration was 13.1 ± 5.7 minutes. Incising Hasner's valve after medially displacing the inferior turbinate under nasal endoscopy seems to be an adequate primary surgical treatment for congenital nasolacrimal duct obstruction.

Insights in the treatment of congenital nasolacrimal duct obstruction.

Introduction: Congenital nasolacrimal duct obstruction is one of the most common causes of epiphora in newborns and the main cause of this condition is the persistence of Hasner membrane. Several treatment options are available, like conservative treatment, probing, irrigation, or more complex techniques. Objective: The objective of this paper is to discuss the efficiency of different treatment options addressing congenital nasolacrimal duct obstruction based on trials reported in literature. Methods: Clinical trials were identified on PubMed. The results were discussed regarding patient age, type of treatment and efficiency of the treatment. Results: 41 trials were reviewed. The rate of resolution according to different treatment options was the following: conservative treatment 14.2-96%, probing 78-100%, irrigation 33-100%, silicon tube intubation 62-100%, inferior turbinate fracture 54.7-97%, balloon dacryocystoplasty 77%, endoscopic intranasal surgery 92.72%, and dacryocystorhinostomy 88.2-93.33%. Conclusions: The first choice in uncomplicated cases should be a conservative treatment, which can be followed until the age of 1 year, while in complicated cases other solutions should be considered. Abbreviations: CNDO = Congenital nasolacrimal duct obstruction, DCR = Dacryocystorhinostomy, MCI = Monocanalicular intubation, BCI = Bicanalicular intubation.

Sinonasal Undifferentiated Carcinoma of Sphenoid Sinus Invading Cavernous Sinus and Optic Nerve: A Case Report and Review of Literature

Sinonasal undifferentiated carcinoma (SNUC) is an extremely rare, highly aggressive malignancy of the nasal cavity and paranasal sinuses. Patients with SNUC usually being asymptomatic until the tumor has extensively progressed therefore frequently present with invasion of the orbit or cranial vault. Most case series of SNUC report very poor prognosis despite aggressive multimodality therapy. We recently experienced a 78-year-old male patient diagnosed as SNUC occurred from the left sphenoid sinus with invasion to the cavernous sinus and orbital content, which was treated intranasal endoscopic debulking surgery combined with curative radiation therapy successfully, and report this case with a review of literature.

Application of the Mimic Valsalva Maneuver with the Help of a Saccule in Cerebrospinal Fluid Rhinorrhea Reconstruction Surgery

Objective: To explore the mimic Valsalva maneuver with the help of a saccule handled by an anesthesiologist in order to locate the leakage channel and repair the fistula during intranasal endoscopic reconstruction surgery of cerebrospinal fluid rhinorrhea. Methods: From 2012 to 2014, 8 patients were diagnosed with cerebrospinal fluid rhinorrhea by medical histories, physical and biochemical examination. All patients were treated with intranasal endoscopic reconstruction surgery of cerebrospinal fluid rhinorrhea. During the surgery, the mimic Valsalva maneuver with the help of a saccule was carried out once or twice by an anesthetist during the operation. Intranasal endoscopy was used to accurately locate the leakage site as shown by the exact fistula. Temporal fascia, fascia lata, middle turbinate mucosa and nasal septum mucosa were all used to repair the fistula. Results: After the surrounding mucosa was removed, the exact leakage sites were accurately found. Fascia materials were used in all 8 patients. All patients were successfully treated after their first operation, and 1 patient was successfully treated by two operations with no complications and recurrences. All the patients were followed up for 1 month to 2 years. Conclusion: The convenient method of the mimic Valsalva maneuver with the help of a saccule handled by an anesthesiologist has a good prospect in cerebrospinal fluid rhinorrhea reconstruction surgery.

内視鏡下経上顎洞法で翼口蓋窩の操作を行った若年性血管線維腫例

内視鏡下経上顎洞法で翼口蓋窩の操作を行った若年性血管線維腫例

A Case of Surgical Treatment of Juvenile Angiofibroma in the Pterygopalatine Fossa with Endoscopic Transmaxillary Surgery Combined with Endoscopic Intranasal Surgery

A Case of Surgical Treatment of Juvenile Angiofibroma in the Pterygopalatine Fossa with Endoscopic Transmaxillary Surgery Combined with Endoscopic Intranasal Surgery

Endoscopic endonasal surgery in orbital decompression and orbital reconstruction

Objectiv The aim of this study was to clarify and evaluate the role and the outcome of endoscopic endonasal surgery in both orbital decompression and orbital reconstruction. Background Traditional external techniques are now known to reduce proptosis significantly, but have the disadvantage of cosmetic morbidity in terms of a cutaneous scar and a high incidence of postoperative complications. Recent advances in endoscopic sinus surgery have extended its applications beyond the nose to the orbit. Orbital decompression, drainage of subperiosteal abscess, optic nerve decompression, and orbital wall reconstruction are performed very safely and effectively by endoscopic intranasal surgery. Patients and methods Fifty-four patients indicated for endoscopic orbital decompression or reconstruction were divided according to the cause into five groups (20 infection, eight inflammatory, eight neoplastic, eight congenital, and 10 traumatic). Preoperative evaluations performed were history taking, physical examination, and computed tomography and MRI of orbit and paranasal sinuses. After creating an endoscopic wide middle meatal antrostomy dealing with the pathology causing extraconal orbital compression and in intraconal compression penetrate the lamina papyracea and periosteum until prolapsed fat fill the ethmoid sinus. Reconstruction was performed by removal of the fractured bone, extraocular muscle reposition with support using Foley's catheter in floor fracture and a silastic sheet with Merocel packing in medial wall fracture. Results There was significant proptosis reduction in all groups, especially in the infection group ( P P Conclusion Endoscopic nasal decompression of the orbit is a safe and effective approach for reducing proptosis and improving vision and ocular motility in cases of orbital compression, which include infection, inflammatory, neoplastic, congenital, and traumatic causes. Endoscopic intranasal reduction of the orbital floor with a Foley's catheter balloon and with a silastic sheet and Merocel packing of the medial orbital wall provided good functional results and definite advantages. Complications were limited.

Mucosal melanoma of the nasal cavity and paranasal sinuses

Mucosal melanoma of the nasal cavity and paranasal sinuses is a rare disease, but its incidence appears to be increasing. The mean age at diagnosis is between 65 and 70years. Unilateral nasal obstruction and epistaxis are the most common presenting complaints. Melanoma arises in the septum or lateral wall of the nasal cavity in the great majority of cases. The histological diagnosis is based on specific immunohistochemical labelling and is usually established at an advanced stage of disease: stage T3 or T4 tumours according to the 7th edition of the American Joint Committee on Cancer (AJCC) classification of tumours. First-line treatment consists of surgery. The place of intranasal endoscopic surgery remains controversial due to the difficulty of controlling surgical margins and should be reserved for experienced teams. Adjuvant radiotherapy is usually performed due to its efficacy on local and regional disease control. Five-year overall survival of mucosal melanoma of the nasal cavity and paranasal sinuses in the most recent series does not exceed 40%. Local recurrence is observed in about 50% of cases and metastatic disease is common. The quality of initial tumour resection with negative surgical margins is the most important prognostic factor for tumours confined to the nasal cavity. Hopes for improvement of survival are based on early diagnosis, progress in radiotherapy techniques and cell and gene therapy that are currently under evaluation.

Sinonasal mucous cyst: A rare complication of septorhinoplasty

IntroductionSeptorhinoplasty is a common performed surgery. Late complications of septorhinoplasty are uncommon but may be serious and difficult to manage. Nasal septal mucous cyst is a rare post-operative complication. ObjectivesWe aim for discussing the etiological theories and suggesting strategies to prevent this complication. Case reportWe report a case of septal nasal cyst developed 15years after a closed septorhinoplasty procedure. It was a 68-year old man presenting with a chronic progressive headache with intermittent rhinorrhea. Rhinologic examination revealed a prominent bulge in the posterosuperior wall of bilateral nasal fossa. CT scan and MRI helped make the diagnosis of a sinonasal mucous cyst. Complete removal of this formation was performed using an intranasal endoscopic surgery. ConclusionIt seems that the proliferation of entrapped fragments of epithelial tissue is the cause of this phenomenon. To avoid such a complication, procedures of septorhinoplasty should be performed appropriately and mucosal lining should be kept intact.

Clinical presentation and treatment of primary and secondary paranasal mucoceles

Background: This retrospective study was conducted to describe and compare the clinical characteristics of primary mucoceles occurring in patients without a previous history of sinus surgery, the cause of mucoceles and secondary mucoceles resulting as a complication following endoscopic sinus surgery, and the Caldwell-Luc operation. Materials and Methods: This study reviewed 18 cases of primary mucoceles and 21 cases of secondary mucoceles, who were diagnosed and had received surgical intervention between 1995 and 2012. Results: The most common presenting symptoms in primary mucoceles were: Visual disturbance (18.6%), nasal obstruction (12.5%), and headache (12.5%). In secondary mucoceles, the most common symptoms were: Nasal obstruction (27.5%), rhinorrhea (15%), and postnasal drip (12.5%). The most common sites of origin for primary mucoceles were the ethmoid sinus (31.5%) and sphenoid sinus (31.5%). In secondary mucoceles, the maxillary sinus was the most common site of origin (40.7%), followed by the ethmoid sinus (29.6%). All patients with secondary mucoceles had a history of sinus surgery. Conclusions: Mucoceles are benign lesions of the paranasal sinus. Cases of secondary mucoceles that occur following sinus endoscopic surgery develop more frequently in the ethmoid sinus compared to those following the Caldwell-Luc procedure. Endoscopic intranasal surgery of mucoceles is a reliable therapeutic measure with a favorable long-term outcome.

Twenty-nine cases of intranasal endoscopic open surgery on the frontal process of maxilla fracture reduction

鼻骨骨折、上颌骨额突骨折是耳鼻咽喉头颈外科最常见的鼻外伤性疾病之一,通常在鼻黏膜表面麻醉下行鼻内镜下闭合式鼻骨骨折、上颌骨额突骨折复位术,但仍然在操作上存在着一定的盲目性,因而导致鼻骨骨折及上颌骨骨折复位不理想、鼻腔黏膜粘连等并发症[1].针对上述情况,本研究采用了鼻内镜下开放式上颌骨额突骨折复位术,有效地避免了上述并发症的发生,取得了良好效果,现总结报道如下.

Endoscopic intranasal surgery for congenital nasolacrimal duct obstruction—A new approach

ObjectiveCongenital nasolacrimal duct obstruction can be treated with a spectrum of techniques, starting with conservative massage to more invasive dacryocystorhinostomy. There has been controversy regarding the optimal treatment procedure. We introduced a unique technique to treat congenital nasolacrimal duct obstruction and analyzed its success rate and complications. MethodsIn a retrospective study, we introduced the results of our technique. This technique consisted of endoscope guided inspection of the Hasner valve area, trial of irrigation, incision of the imperforate Hasner valve and irrigation again. If these maneuvers were not effective, more invasive procedure, probing under endoscopic control was done. Results48 children (55 eyes) were included in the study. Complete improvement was achieved in 51/55 eyes (92.72% success rate). We did not encounter any early or late complication. ConclusionsThe great majority of the congenital nasolacrimal duct obstruction stem from Hasner valve area pathologies. The endoscopic intervention of this area is very effective and safe way of treatment. This technique should be added to the armamentarium of the congenital nasolacrimal duct obstruction treatment.

Orbital chondrosarcoma arising from paranasal sinuses

Orbital chondrosarcoma arising from paranasal sinuses or from the nasal cavity with orbital extension is highly unusual. The aim of this report is to describe our multidisciplinary experience in the treatment of three patients with extensive sino-orbital chondrosarcomas. The patients were aged 43, 75 and 63years, and the tumors originated from the maxillary, sphenoidal, and ethmoidal sinuses, respectively. Magnetic resonance imaging studies showed homogeneously hypointense lesions on T1-weighted scans, which were hyperintense on T2-weighted images. Intranasal endoscopic surgery alone or in combination with other conventional surgical approaches was the main therapeutic choice. Two patients had recurrences treated with wider surgical removal. Fractionated stereotactic radiotherapy was used in two cases. Two patients had histopathological grade I tumor and one had grade III chondrosarcoma. No patient had regional spread or distant metastasis. All patients were disease-free at 4, 2, and 3years, respectively, following their last therapeutic interventions. Endoscopic surgery results in lesser morbidity for chondrosarcomas arising from paranasal sinuses and extending into posterior parts of the orbit. However, because control of surgical margins may not be complete, recurrences may occur justifying more radical approaches.

A massive adenoid cystic carcinoma of nasal septum progressed into the skull base

Adenoid cystic carcinoma (ACC) is a malignant tumor commonly occurring in the major salivary glands. ACC of the nasal septum is exceeding rare. The case of a 42-year-old woman with ACC of the nasal septum is presented. Her chief complaint was nasal obstruction and dysosmia for two month. CT and MRI demonstrated a massive mass occupying the nasal septum infiltrating the palate, vomeronasal, anterior skull base, and dura mater. Combined anterior cranial surgery, endoscopic intranasal surgery, and transpalatal surgery were selected due to the size and location of the tumor. A negative surgical margin was achieved without cosmetic deformity or functional disorder. She had postoperative radiotherapy with no recurrence or distant metastasis during the follow-up period. The tumor location and the perineural spread pattern should be considered to determine the treatment plan for septum ACC. Post operative radiation is now generally recommended. ACC has a high incidence of local recurrence and distant metastasis rate; therefore, long-term follow-up is necessary.

Surgical Analysis of Sinonasal Inverting Papilloma with Recurrence: Endoscopic Approach and Lateral Rhinotomy

Objective: The evolution of endoscopic sinus surgery has led to a paradigm shift in the management of sinonasal and anterior skull base tumors in the past decade. The purpose of this study is to investigate the effectiveness of intranasal endoscopic surgery of sinonasal inverting papilloma with recurrence.

Nasal Glioma: An Unusual Presentation in Adult

ABSTRACTThe nasal glioma is a rare congenital nasal abnormality, which manifests as a mass of extracranial cerebral tissue unconnected with the brain. The clinical entity is challenging for several reasons. Their diagnosis may not be immediately obvious at presentation. It is important to exclude an intracranial extension, and for this some have suggested a craniotomy. We report a case of extranasal glioma with intracranial extension was removed successfully by combined extracranial and endoscopic approach without craniotomy. Intranasal endoscopic surgery is a less invasive and safe procedure for the management of nasal glioma and does not result in postoperative facial scarring and deformity. Endoscopic techniques provide excellent visualization and are preferable to the classic frontal craniotomy to exclude intracranial extension of nasal glioma. In this report, the management and the benefits of endoscopy in cases with nasal glioma are discussed.How to cite this articleKalsotra G, Gupta AK, Bansal S, GuptaR. Nasal GliomaAn Unusual Presentation in Adult. Clin Rhinol Int J 2012;5(1):49-52.

Intranasal endoscopic surgery combined with adjuvant radiation therapy for olfactory neuroblastoma

Olfactory neuroblastoma, also known as esthesioneuroblastoma, is a rare malignant head and neck tumor. Olfactory neuroblastoma accounts for approximately 3–5% of all malignant nasal tumors. We present a case of olfactory neuroblastoma in a 61-year-old man who underwent endoscopic surgery followed by postoperative irradiation. Right neck metastasis was diagnosed about 6 months after endoscopic surgery. Supraomohyoid dissection of the right side of the neck was performed, but right parotid metastasis was identified about 3 months later. Boost radiotherapy was applied to the right metastatic parotid. There was no evidence of recurrence on head and neck magnetic resonance imaging and endoscopic examination during the 2-year follow-up.

Endoscopic Management of Paranasal Sinus Mucoceles: Experience With 46 Patients

ObjectiveThe purpose of this study was to determine changes in the surgical treatment of patients with the diagnosis of paranasal mucoceles managed in a Latin American hospital. We hypothesised that endonasal endoscopic surgeries had emerged as the main treatment option for this disease in the last five years. MethodsA retrospective chart review of all patients who were diagnosed with paranasal sinus mucoceles and treated at the Otorhinolaryngology Head and Neck Department of our hospital from 2002 to 2010 was performed. Patient demographic data, mucoceles location, symptoms, surgical approach and complications were recorded. ResultsA total of 46 patients were included (27 males; 19 females). This series include 29 patients (63%) with frontal or fronto-ethmoidal mucoceles, 14 (30.4%) with maxillary and 3 (6.5%) with sphenoid mucoceles. Ninety-five percent of the patients were treated with intranasal endoscopic surgery. Complications occurred only in 7 cases (15.2%). ConclusionsThis study confirms that over the last 9 years significant changes have occurred in the surgical treatment of paranasal mucocele in our hospital, as endoscopic surgeries increased from 34% to over 90% as the first option of treatment for mucoceles.

Manejo endoscópico de mucoceles de senos paranasales: experiencia en 46 pacientes

Objective The purpose of this study was to determine changes in the surgical treatment of patients with the diagnosis of paranasal mucoceles managed in a Latin American hospital. We hypothesised that endonasal endoscopic surgeries had emerged as the main treatment option for this disease in the last five years. Methods A retrospective chart review of all patients who were diagnosed with paranasal sinus mucoceles and treated at the Otorhinolaryngology Head and Neck Department of our hospital from 2002 to 2010 was performed. Patient demographic data, mucoceles location, symptoms, surgical approach and complications were recorded. Results A total of 46 patients were included (27 males; 19 females). This series include 29 patients (63%) with frontal or frontoethmoidal mucoceles, 14 (30.4%) with maxillary and 3 (6.5%) with sphenoid mucoceles. Ninety-five percent of the patients were treated with intranasal endoscopic surgery. Complications occurred only in 7 cases (15.2%). Conclusions This study confirms that over the last 9 years significant changes have occurred in the surgical treatment of paranasal mucocele in our hospital, as endoscopic surgeries increased from 34% to over 90% as the first option of treatment for mucoceles.