Sinus Ostium Research Articles

Is palatal cavity volume affected by maxillary sinus pathologies? A CBCT study

AimThis study uses cone beam computed tomography (CBCT) to determine whether pathology in the maxillary sinus (MS) affects the volume of the palatal cavity.Methods188 individuals, 95 women and 93 men, aged between 17 and 63, were included in the study. MS pathology in the patients and the open-closed status of the maxillary sinus ostium (MSO) were recorded. Palatal volume measurements were performed using open-access ITK-SNAP via CBCT images. Statistical analysis of the study was conducted using SPSS v.21 software (IBM. Chicago. IL. USA), and p<0.05 was considered statistically significant.ResultsThe average palatal volume was 1375.29±313.38 mm3 in male patients and 1235.33±250.40 mm3 in females, and it was found to be statistically significant between genders (p=0.001). MS pathology was detected in 114 (60.6%) of the patients. It was determined that the most frequently observed pathology in both the right (n = 58, 30.9%) and left (n = 65, 34.6%) side MS of individuals was mucosal hypertrophy. It was determined that the mean palatal volume was higher when the MSO was closed (p = 0.000). As a result of the correlation analysis, it was shown that the presence of MS pathology had a positive effect in explaining palate volume by 38.6% (R2 = 0.386).ConclusionPalatal cavity volume was affected by maxillary sinus pathologies. Palatal cavity volume increases in the presence of MS pathologies and when MSOs are closed.

A Report of Inadvertent Narrowing of Coronary Sinus Ostium During Surgical Closure of Ostium Secundum Atrial Septal Defect, Identified Perioperatively Using Transesophageal Echocardiography.

A Report of Inadvertent Narrowing of Coronary Sinus Ostium During Surgical Closure of Ostium Secundum Atrial Septal Defect, Identified Perioperatively Using Transesophageal Echocardiography.

A CASE REPORT OF RECURRENT FRONTAL MUCOCOELE

Background: Paranasal sinus mucocele is the epithelium lined mucus filled sac causing enlargement of sinus wall. It can cause bone erosion and displacement of surrounding structures. Mucoceles usually occur due to infection, inflammation, trauma, previous surgeries, and tumours which can potentially obstruct the sinus ostium. Cranio facial trauma is the commonest cause for mucocele formation. Case report: A 50yr old male patient came with chief complaints of swelling on forehead since 1yr. The patient had history of road traffic accident 13yrs ago for which he underwent facio-maxillary reconstruction along with right eye evisceration. Later he developed a swelling above right eye after 7yrs, which was diagnosed as mucocele and was treated by frontal cranioplasty. Now he came with complaint of swelling on forehead which was gradually increasing in size. MRI-PNS was done showing fluid filled space extending anteriorly from cutaneous plane in the frontal region going posteriorly over the orbit pushing the contents of the orbit inferiorly and medially and extending posteriorly up to orbital apex. Patient underwent endoscopic mucocele drainage and DRAF 3. Right orbital exenteration was done to prevent recurrence. Patient was on follow up since then and no symptoms or signs of recurrence is noted. Conclusion: Facial trauma may be one of the reasons for development of mucocele where sinus drainage pathways are deranged. As in our case trauma not only led to development of mucocele, but new spaces also created by the treatment lead to extensive spread of the mucocele.

Relationship of anterior ethmoidal artery with skull base and posterior wall of frontal sinus: a computed tomography-based retrospective clinical study

Background: The close proximity of anterior ethmoidal artery (AEA) to the skull base predisposes the artery to injury during ESS. This study aims to decipher the course of AEA and determine its relationship with the skull base and posterior wall of frontal sinus with the help of computed tomography. Methods: The vertical distance between the skull base and the anterior ethmoidal foramen in the coronal scans, the horizontal distance between posterior wall of frontal sinus ostium and AEA in the sagittal scans and the number of intervening cells between posterior wall of frontal sinus and AEA were analyzed in CT scans of 75 patients over a period of six months. Results: The AEA was lying 2.5-5 cm below the level of skull base in majority of the CT scans analyzed. Most of the CT scans studied demonstrated only a single intervening cell between posterior wall of frontal sinus ostium and AEA on either side. In our study there was a strong positive relationship between the AEA- skull base distance and between the AEA-posterior wall of frontal sinus distance on either side. Conclusions: Distance between the AEA and skull base is variable, but a freely running AEA within a bony canal was a more common variant than skull base variant in our study. AEA-skull base distance and AEA-frontal sinus distance on right side correlated with values of left side indicating symmetrical course of the AEA on either side in an individual.

Experimental and numerical investigation of pressure distribution in human upper airway passage before and after maxillary sinus surgery

Sinusitis, a common disease of the maxillary sinus, is initially managed with saline solution and medication, resulting in the resolution of symptoms within a few days in most cases. However, Functional Endoscopic Sinus Surgeries are recommended if pharmacological treatments prove ineffective. This research aims to investigate the effects of maxillary sinus surgery on the airflow field, pressure distribution within the nasal cavity, and overall ventilation. This study utilized a three-dimensional realistic nasal cavity model constructed from CT images of a healthy adult. Virtual surgery including uncinectomy with Middle Meatal Antrostomy, two standard procedures performed during such surgeries, was performed on the model under the supervision of a clinical specialist. Two replicas representing pre- and post-operative cases were created using 3D printing for experimental purposes. Various breathing rates ranging from 3.8 to 42.6 L/min were examined through experimental and numerical simulations. To ensure the accuracy of the numerical simulations, the results were compared to measured pressure data, showing a reasonable agreement between the two. The findings demonstrate that uncinectomy and Middle Meatal Antrostomy significantly enhance the ventilation of the maxillary sinuses. Furthermore, increasing inspiratory rates leads to further improvements in ventilation. The static pressure distribution within the maxillary sinuses remains relatively uniform, except in regions close to the sinus ostium, even after surgical intervention.

Cardiac Hemangioma Located in the Interatrial Septum: A Case Report and Literature Review

Cardiac hemangiomas are extremely rare benign tumors that can occur in any part of the heart. We report the case of an adult female with no history of structural heart disease or symptoms of discomfort. Cardiac ultrasound showed a mass on the right atrial surface of the atrial septum. Intraoperatively, the mass was identified within the atrial septum, at the junction of the inferior vena cava and the ostium of the coronary sinus. The mass did not enter the left or right atrial cavities. The mass was successfully removed, and cardiac hemangioma was confirmed by postoperative pathology. This report discusses the clinical manifestations, diagnostic approaches, and treatment options for cardiac hemangiomas based on an analysis of previously reported cases. Owing to the risk of arrhythmia in patients with hemangiomas in the atrial or ventricular septum, surgical resection is recommended.

Patient and implant-related risk factors for implant failure of one-stage lateral sinus floor elevation: A 2- to 10-year retrospective study.

This retrospective study aimed to evaluate the early and late implant failure rates of one-stage lateral sinus floor elevation (LSFE)and to identify the patient and implant-related risk factors associated with these failures. All patients treated with one-stage LSFE from January 2014 to December 2021 were evaluated for inclusion. A total of 618 patients with 936 implants met the inclusion criteria. Clinical and radiographic information about patient and implants was collected. Univariate and multivariate Cox proportional hazards frailty regression models were performed to identify risk factors for early and late implant failure. The cumulative implant survival rate was 95.62% (95% CI 93.90%-97.68%), with 16 early implant failures and 25 late implant failures. The Cox analysis indicated that ≤3 mm residual bone height (RBH) was associated with a higher early failure rate. For late implant failure, smoking habit, ≤3 mm RBH, and certain implant brand were independent risk factors. Narrow sinus ostium, long infundibulum, and flat thickening of Schneiderian membrane might be non-independent risk factors for late implant failure. No significance was found in other variables, including age, periodontitis history, implant characteristics (position, diameter, length, protrusion length, marginal bone loss), surgeon experience, healing time, opposing dentition, and prosthesis. One-stage LSFE is a predictable treatment for patients with atrophic maxilla. ≤3 mm RBH increased the risk of early implant failure, while smoking habit, ≤3 mm RBH, and certain implant brand were independent risk factors for late implant failure.

Sinus surprise: The rare encounter of frontal mucocele with optic nerve compression

Mucoceles are epithelial-lined cavities filled with sterile mucus that develop due to the obstruction of a sinus ostium. Frontal mucocele is one of the most common among mucoceles. Most of them present with ophthalmic manifestations. Here, we present such a case with ocular symptoms. Despite the absence of thyroid-related symptoms or significant medical history, her examination revealed left eye proptosis, limited ocular motility, optic disc edema, and significant visual loss due to optic nerve compression. Further investigations, including orbital computed tomography, confirmed a frontal mucocele extending into the left orbit. Following endoscopic sinus surgery with mucocele excision, the patient experienced significant improvement in vision, resolution of optic disc edema, and proptosis. This case underscores the importance of considering mucoceles in the differential diagnosis of orbital pathologies. It also highlights the efficacy of endoscopic management in achieving favorable outcomes and emphasizes the significance of interdisciplinary collaboration in optimizing patient care.

The impact of His bundle location and direction on the efficacy and safety of ablation.

The impact of the His bundle location and distance from the ablation site on ablation efficacy and complication risk remains unexplored. We determined the correlation between age, height, body mass index (BMI), and the His bundle location, and whether the distance between the His bundle and ablation target (DHIS-ABL) affects ablation safety and efficacy. Overall, 346 patients with atrioventricular nodal re-entrant tachycardia (AVNRT) and 96 with atrioventricular re-entrant tachycardia (AVRT) were retrospectively analyzed. The distance between the His bundle and the coronary sinus ostium (DHis-CS), the height of the His bundle (HHIS), and DHIS-ABL were measured. Electrocardiograms were obtained 3 months post-ablation to assess recurrence and complications. Multiple linear regression showed that HHIS was negatively correlated with age in both groups. In AVNRT patients, DHIS-ABL was associated with age, height, and BMI; DHIS-CS was only negatively correlated with age. In AVRT patients, there was no significant correlation between the DHIS-ABL and age, height, or BMI. The recurrence rates in the AVNRT and AVRT groups were 0.9% and 8.7%, respectively. Subgroup analysis showed that patients with DHIS-ABL≤10mm had a higher recurrence rate than those with DHIS-ABL>10mm (p=.013). The incidence of third-degree atrioventricular block (AVB) complications was 0.2%. HHIS was negatively correlated with age but not with height and BMI. The DHIS-ABL correlated with age, height, and BMI in AVNRT patients. A short DHIS-ABL led to a higher rate of supraventricular tachycardia recurrence; whether this affects AVB risk warrants further studies with larger sample sizes.

Cardioneural ablation-the first case series without the use of fluoroscopy.

Cardioneural ablation (CNA) and fluoroless ablation (FA) are emerging procedures and movements in contemporary in electrophysiology. Ablation of ganglionated plexus (GP) inputs in the atrium has been successfully targeted as a treatment for symptomatic bradyarrhythmias due to increased parasympathetic tone. As most of these patients are young, avoidance of ionizing radiation is of critical importance to limit potential long term deleterious effects. With widespread use of 3D electroanatomic mapping systems and advanced intracardiac echo (ICE) imaging, fluoroless ablation has become more widely adopted. However, fluoroless CNA has not been widely performed. The objective of this study is to demonstrate that CNA can be done safely and effectively without fluoroscopy. At a single-center, consecutive patients undergoing CNA with a fluoroless approach are described. GP mapping and ablation were performed in both atria. From the right atrium (RA), the right atrium-superior vena cava (RA-SVC GP), the posteromedial ganglionated plexus (PMLGP), which can be accessed from the right atrium-coronary sinus ostium, and the Vein of Marshall GP (VOM-GP) were evaluated. From the left atrium (LA), the superior left atrial ganglionated plexus (LSGP), the left inferior ganglionated plexus (LIGP), the right anterior ganglionated plexus (RAGP), and the right inferior ganglionated plexus (RIGP) were targeted. Over the study period, beginning on January 31, 2021, 30 consecutive subjects (15 females/15 males) aged 42.9 ± 13.6years underwent GP ablation. The average subject had 9.5 (± 9.2) episodes of syncope prior to ablation. The average CHADS2-VA2SC score was zero. The average LVEF was 64.8% (± 4.9). Two of the subjects had concomitant ablations, six failed prior medical therapy, and one had a prior pacemaker placed. All of the procedures were done without fluoroscopy. The average follow-up was 604 (± 366) days. There were 8 patients that did not improve symptomatically postfirst ablation. Four of the eight underwent repeat ablation and have subsequently improved. 26/30 patients symptomatically improved after the 1st or 2nd ablation. There were no complications noted. In comparison to the traditional CNA with fluoroscopy, this proof of concept study reveals fluoroless GP ablation can be performed safely. In addition, the durability and success rate are comparable to other studies of CNA. Given the young age of the cohort and the longitudinal risks of ionizing radiation, fluoroless CNA is a feasible procedure for this patient population.

Supraorbital Ethmoid Air Cell - Its Role in Sinonasal Pathologies.

The supraorbital ethmoid air cell (SOEC) is an anatomical variation of the ethmoid air cell system that pneumatizes the orbital plate of the frontal bone. It affects the frontal recess configuration by opening posterior and lateral to the frontal sinus ostium. This cross-sectional observational study includes 100 patients with Supra orbital ethmoid air cells including various pathologies. We picked up the first 100 patients who had SOEC in all the CT PNS done for various sinonasal pathologies. The incidence of the cell was about 43%. The most common type was the cell extending up to the medial wall of the orbit which was noted in 37% of the cases. Cribriform plate was low-lying in patients with SOEC and the most common type was Keros 3 in about 49% of the study group. 83 patients had anterior ethmoid artery (AEA) lying away from the skull base hanging freely in the mesentery. The most common pathologies observed in patients with supraorbital ethmoid cells were chronic rhinosinusitis followed by mucoceles. The recurrence rate of sinusitis is high in patients with SOEC. The recurrences were mostly because of mistaking the SOEC to be frontal sinus or incomplete removal of partition between them. study stresses the importance of SOEC and its orientation preoperatively to avoid complications during and after the surgery. Detailed preoperative evaluation with the CT helps the surgeon to identify the cells, their extent and associated anatomical variations thereby preventing damage to AEA, cribriform plate and lateral lamella and can get good results.

A Radiological Study on the Grading System Based on the Position of Frontal Sinus Ostium in Koreans

A Radiological Study on the Grading System Based on the Position of Frontal Sinus Ostium in Koreans

Anatomic-guided ablation of the right ganglionated plexi validated by the automatic fractionation map

Abstract Background and aim Cardiac autonomic modulation through endocardial ablation of atrial ganglionated plexi (GP) is an alternative strategy in selected patients with severe vagal induced bradyarrhythmias. A strictly anatomical approach targeting the right GPs has demonstrated good success rates but is an empirical approach and has yet to be validated. The presence of fractionated electrograms has been associated with the areas of GPs and can be automatically mapped (fractionation map). The aim of this study was to compare the empirical ablated area, to the automatically assessed area of GPs based on the presence of fractionated electrograms (FEs). Methods We studied eight consecutive patients referred for parasympathetic modulation. A high-density map of the left and right atria (LA, RA) in sinus rhythm was performed. The settings for the automatic map were as follows: bipolar high pass filter of 500 Hz, a fractionation threshold of 4, and a width of 5 ms. The ablation was empirically performed by an operator blinded to the results of the fractionation map, as per site protocol. The ablation was aimed at the anatomic locations of the right GPs in the LA and RA. At the anterior and inferior aspect of the right superior pulmonary vein and inferior aspect of the right inferior pulmonary vein on the LA, and posterior RA opposite to the LA RF applications and around the coronary sinus ostium on the RA (Figure). Before ablation, 2 mg of atropine was administered in bolus, and the increase in heart rate was registered and repeated at the end of the procedure. After the operator completed the ablation, access to the fractionation map was available, and additional radiofrequency (RF) applications were applied as needed (Figure). The number of additional RF applications to cover all the areas with FEs was assessed. Success was defined as an absence of response to atropine after the procedure. Results Three patients underwent autonomic system modulation only, and five underwent additional pulmonary vein isolation (PVI). The mean age was 66 (50-77) years, five males. The median mapping time of the LA and RA was 11 (17-7) and 14 (9-18) min. All patients underwent successful parasympathetic modulation. The initial median (Q1-Q3) increase in heart rate with atropine was 34 (23-39)% versus 0 (0-2)% after ablation, p=0.012. The differences between empiric and FEs map-guided ablation are depicted in the Table. The additional number of points was low. However, a median of 9 (5-15) additional points were added. Conclusions A purely anatomic-guided procedure directed only at the atrial right GPs is usually enough as a therapeutic approach for cardiac autonomic modulation, however, the fractionation map tool helped validate the method and ensure success at the first pass.

Evaluation of osteomeatal complex by cone-beam computed tomography in patients with maxillary sinus pathology and nasal septum deviation

BackgroundThis study aimed to determine if there is a relationship between the presence of maxillary sinus pathology, nasal septum deviation and various lengths of the osteomeatal complex.MethodsA total of 223 CBCT images were included in the study. The lengths of the osteomeatal complex (maxillary sinus ostium width, infundibulum length, maxillary sinus ostium height) were analyzed. The presence of maxillary sinus pathology, nasal septum deviation, age, sex, right-left, septum deviation level, and the relationship between pathology level and all variables were evaluated.ResultsThe average maxillary sinus ostium width, ostium height and infundibulum length were 3.06 ± 0.70 mm, 30.10 ± 5.43 mm and 8.82 ± 1.86 mm, respectively. Ostium width was significantly higher in the healthy group than in the groups evaluated in the presence of deviation and pathology. A significant difference was found in infundibulum length only between the healthy condition and the condition evaluated in the presence of deviation. No significant difference was observed between the groups in terms of ostium height. In all groups, ostium height and infundibulum length were significantly higher in men than in women. The age group with the highest average ostium height was found in the 35–44 age group (p < 0.001).ConclusionIdentifying normal and abnormal conditions in the osteomeatal complex area is important for diagnosing the cause of a patient's complaint, guiding the surgical procedures to be performed, and preventing possible complications that may arise during surgical procedures.

Accessory Ostium of the Maxillary Sinus and Its Impact on Sinusitis

Background: One of the anatomical variations in the maxillary sinus is the accessory ostium (AO). In the nasal cavity, the lateral wall’s vertical plane is parallel to the form of the AO, which is round or oval in appearance. During a nasal endoscopic examination, AO may be seen in contrast to the normal ostium of the maxillary sinus, which is hidden behind the uncinate process. Methods: The search for recent research articles on AO of the maxillary sinus was done with databases Scopus, PubMed, Medline, and Google Scholar. This review article discusses the prevalence, development, endoscopic examination, clinical significance, surgical importance, relationship with chronic sinusitis, and its management. Results: AO may interfere with ventilation and drainage of the maxillary sinus. Hence, it is important to evaluate the anatomical features of the AO for its relationship with sinus pathology. The development of maxillary sinusitis may be significantly impacted by the anatomical variance known as AO of the maxillary sinus. The middle meatus’s posterior nasal fontanelle is where AO is most frequently observed. The possible mechanism for the formation of AO is obstruction of the natural ostium of the maxillary sinus by sinusitis or due to anatomical and pathological factors in the middle meatus leading to rupture of membranous regions such as fontanelle. Conclusion: Clinicians must have adequate knowledge regarding the anatomical variations of the AO. It frequently appears in the fontanelle, the membranous portion of the middle meatus’ lateral nasal wall that is between the uncinate process and inferior meatus.

Electrophysiological cardiovascular MR: procedure-ready mesh model generation for interventional guidance based on non-selective excitation compressed sensing whole heart imaging.

Fully CMR-guided electrophysiological interventions (EP-CMR) have recently been introduced but data on the optimal CMR imaging protocol are scarce. This study determined the clinical utility of 3D non-selective whole heart steady-state free precession imaging using compressed SENSE (nsWHcs) for automatic segmentation of cardiac cavities as the basis for targeted catheter navigation during EP-CMR cavo-tricuspid isthmus ablation. Fourty-two consecutive patients with isthmus-dependent right atrial flutter underwent EP-CMR radiofrequency ablations. nsWHcs succeeded in all patients (nominal scan duration, 98 ± 10s); automatic segmentation/generation of surface meshes of right-sided cavities exhibited short computation times (16 ± 3s) with correct delineation of right atrium, right ventricle, tricuspid annulus and coronary sinus ostium in 100%, 100%, 100% and 95%, respectively. Point-by-point ablation adhered to the predefined isthmus line in 62% of patients (26/42); activation mapping confirmed complete bidirectional isthmus block (conduction time difference, 136 ± 28ms). nsWHcs ensured automatic and reliable 3D segmentation of targeted endoluminal cavities, multiplanar reformatting and image fusion (e.g. activation time measurements) and represented the basis for precise real-time active catheter navigation during EP-CMR ablations of isthmus-dependent right atrial flutter. Hence, nsWHcs can be considered a key component in order to advance EP-CMR towards the ultimate goal of targeted substrate-based ablation procedures.

Morphometric Variations of Sphenoidal Air Sinuses in Human Cadavers

Background: The sphenoid sinuses are difficult to approach directly, so a transnasal approach is preferred. Due to the variable extent of pneumatization, there are variations in the size and shape of sphenoid ostium. These sinuses are related to many important structures, and they produce surface impressions on sinus walls. There are very few cadaveric studies that describe sphenoid sinuses morphometrically and their relation to nearby important structures. Hence, this study was undertaken to study the morphological variations of sphenoid sinuses; to measure the dimensions of the sphenoid sinuses; to classify the sphenoid sinuses and to study the variations of relation of important structures along the walls of the sphenoid sinuses. Methodology: The present study was performed on 25 formalin-fixed cadavers (50 hemisections). The morphometric anatomy of the sphenoid sinuses was studied by taking midline sagittal sections of the head, neck, and face regions in cadavers. Anteroposterior depth (infrasellar) and vertical height (presellar) of the sinus were measured. Based on the morphology of the sinus, they were grouped into conchal, presellar, sellar, and postsellar types. Surface impressions made by the carotid artery and optic nerve on the lateral wall of the sinus were observed. Results: The most common type of sphenoid sinuses was the sellar variety (68%), with conchal being the least common (0%). Most of the sinuses (88%) were divided by the intersinus septa. A round-shaped ostium of the sphenoid air sinus was found to be common (56%). Impressions of the internal carotid artery and optic nerve into the lateral wall of the sinus were prominent in highly pneumatized sphenoid sinuses. Conclusions: Variations observed are mainly due to variable pneumatization of the sphenoid bone. The degree of pneumatization will result in protrusion of the surrounding structures such as internal carotid artery and optic nerve into the sinus wall. The extent of pneumatization will determine the degree of protrusion of surrounding structures.

Upper common pathway analysis using late atrial premature depolarization in atrioventricular nodal reentry tachycardia

BackgroundAnatomic and electrophysiologic findings suggest that the actual circuit of atrioventricular nodal reentrant tachycardia (AVNRT) involves the perinodal atrium. However, occasional instances in which the atrium is dissociated from the AVNRT have led to the concept of an upper common pathway (UCP). ObjectiveWe aimed to assess the prevalence of UCP in AVNRT using a late atrial premature depolarization (LAPD) maneuver. MethodsPatients who were diagnosed with typical AVNRT by electrophysiologic studies were enrolled. For evaluation of the presence of UCP, an LAPD was given at the coronary sinus ostium (osCS) during AVNRT, and then pacing was repeated incrementally every 10 ms. Electrograms in the earliest retrograde atrial activation site (ERAS) near the proximal His were mapped and recorded during the pacing. Results were interpreted as follows: absence of UCP—an LAPD from the osCS can reset the tachycardia without depolarizing the ERAS; presence of UCP—an LAPD from the osCS can depolarize the ERAS without resetting the tachycardia; and indeterminate—an LAPD from the osCS either resets the ERAS and tachycardia simultaneously or does not reset both. ResultsThe LAPD maneuver was performed in 126 patients with AVNRT. It demonstrated an absence of UCP in 121 (96.0%) patients and the presence of UCP in 3 (2.4%) patients; the result was indeterminate in 2 (1.6%) patients. ConclusionThe LAPD maneuver revealed that the presence of UCP is indicated in only rare cases of AVNRT. In most AVNRT cases, the atrium is involved in the reentry circuit.

Prelacrimal recess approach for maxillary sinus inverted papilloma: a 15-year experience from a single center.

This large retrospective, single-center, follow-up study investigated the endoscopic prelacrimal recess approach (PLRA) for treating maxillary sinus inverted papilloma (MSIP). Between January 2007 and November 2022, patients with MSIP treated with PLRA were enrolled. Data on clinical manifestations, imaging, and surgical procedures were collected. The visual analog scale (VAS) scores for maxillofacial numbness and nasal symptoms and the SNOT-22 nasal symptom scores were statistically analyzed. Of 122 patients (68 males and 54 females) enrolled in the study, with a mean age of 50.75 ± 12.84years (26-80years), 111 patients underwent PLRA, nine underwent modified PLRA, one converted to an endoscopic medial maxillectomy (EMM), and one to an endoscopic modified Denker's approach. The average follow-up was 86.60 (13-192) months, the recurrence rate was 3.28%, and 29 patients (23.77%) complained of maxillofacial numbness one month postoperatively, which disappeared in most cases one year after surgery. Five patients (4.10%) experienced mild numbness at the end of the follow-up period. Maxillary sinus ostium contracture or atresia occurred in two cases (1.64%). After surgery, the VAS nasal symptom scores improved significantly (P < 0.001). SNOT-22 indicated that the most common postoperative symptom was thick nasal discharge. PLRA is a flexible first-choice surgical treatment for maxillary sinus inverted papilloma and can be modified according to the extent of the lesion, the surgeon's experience and technique, and surgical instruments. That can help achieve complete resection and reduce recurrence and surgical complications. Upper teeth numbness, the most common postoperative complication, tends to disappear after 1year.

The optimal slow pathway ablation site in atrioventricular nodal reentrant tachycardia cases with an inferiorly located His bundle.

The optimal slow pathway (SP) ablation site in cases with an inferiorly located His bundle (HIS) remains unclear. In 45 patients with atrioventricular nodal reentrant tachycardia, the relationship between the HIS location and successful SP ablation site was assessed in electroanatomical maps. We assessed the location of the SP ablation site relative to the bottom of the coronary sinus ostium in the superior-to-inferior (SPSI), anterior-to-posterior (SPAP), and right-to-left (SPRL) directions. The HIS location was assessed in the same manner. The HIS location in the superior-to-inferior direction (HISSI), SPSI, SPAP, and SPRL were 17.7±6.4, 1.7±6.4, 13.6±12.3, and -1.0±13.0mm, respectively. The HISSI was positively correlated with SPSI (R2=0.62; P<.01) and SPAP (R2=0.22; P<.01), whereas it was not correlated with SPRL (R2=0.01; P=.65). The distance between the HIS and SP ablation site was 17.7±6.4mm and was not affected by the location of HIS. The ratio of the amplitudes of atrial and ventricular potential recorded at the SP ablation site did not differ between the high HIS group (HISSI≥13mm) and low HIS group (HISSI<13mm) (0.10±0.06vs. 0.10±0.06; P=.38). In cases with an inferiorly located HIS, SP ablation should be performed at a lower and more posterior site than in typical cases.