Sinonasal Lesions Research Articles

Sinonasal Ameloblastoma: A Case Report and a Review of Gnathic Lesions That Occur in the Sinonasal Tract

Abstract Primary sinonasal ameloblastomas are rare, benign odontogenic lesions that are locally aggressive. We report a case of a primary sinonasal ameloblastoma in a 65-year-old man who presented with sinonasal obstruction and rhinorrhea. The clinicopathologic features of this entity are discussed, along with the differential diagnosis and other gnathic lesions that present as sinonasal lesions.

Frequency of Anatomical Variants of Paranasal Sinuses (PNS) on Computed Tomography (CT)

Background: The para nasal sinuses be collection of air filled spaces adjoining the nasal cavity. Para nasal sinuses build up as of the primitive choana at 25–28 weeks of gestation. Three projections ascend from the lateral wall of the nose and work as the commencement of the growth of the para nasal sinuses. The Frequency of Anatomical Variants of Para nasal Sinuses (PNS) may be illustrated on Computed Tomography (CT) by using double slice CT machine. Aim: To reveal the anatomy of the para nasal sinuses as shown on the CT along with point out the variants lead to chronic sinusitis and escort obstacles in sino nasal operations. Methodology: This study was conducted in Ibnae-e Sieena Hospital and MMDC Multan during September 2019 to December 2019. In 50 patients without para nasal sinus diseases symptoms, head computed tomography studies were carried out after having consent from them and IRB. Para nasal sinuses coronal sections were taken. The CT studies were performed by using Dual Source multi slice CT Scanner. Results: 50 participants included in the study, 25 men with 25 women. Out of them, 22 having anatomical variants were noticed. Most common anatomical variants found were pneumatisation of center nasal turbinates (30%) then agger nasi cells 25%, Haller’s cells 20%, along with septal deviation 13% and sphenoid sinus septation (12%). Conclusion: This study shows that nasal cavity and para nasal sinuses anatomical variations are common. For the radiologic analysis of the para nasal sinuses, as of diagnosis of the pre and post -surgical evaluation and sino-nasal lesions, CT is the gold standard procedure. It can outline and explain the anatomical variants in para nasal sinuses. CT not only detect the lesion to vital constitutions which lined the para nasal sinuses but also repeated lesions that extra mural cells. CT of the para nasal sinuses has vital importance and should be passably analyze before FESS. Keywords: Para nasal sinuses, Computed tomography, Nasal turbinate, Ostiomeatal complex

English

BACKGROUND Sinonasal masses are commonly seen lesions in ENT practice with multiple aetiological factors. We wanted to study the clinico-pathological features of nasal mass specimens in a tertiary hospital and evaluate the utility of routine histopathological examination of the surgically removed nasal tissue specimens. METHODS All the histologically examined specimens of patients clinically presenting with nasal or sinonasal lesions over a period of one year were retrospectively studied and analyzed. RESULTS Out of total 36 patients with masses, 21 were males (58.3 %) and 15 (41.7 %) were females. The age ranged from 10 to 75 years with a mean age of 31.4 years and maximum patients were in the third decade (37.5 %). The most common presenting clinical symptom was nasal obstruction that was seen in 33 patients (91.6 %). Computed tomography (CT) scan was done in 94.5 % of cases prior to the surgical intervention. One fifth of the sinonasal lesions were neoplastic as per histopathology examination. The clinicopathological agreement percentage for detection of the nature of the nasal mass was 88.9 %. The applied interrater reliability in Cohen's kappa coefficient (κ) showed moderate agreement (0.55). CONCLUSIONS The clinical similarity between the histologically different lesions is common and may lead to improper management; so, correlation of clinical, radiologic and pathologic features is of utmost importance for accurate diagnosis and the policy of discarding a surgically removed nasal lesion which clinically appears unremarkable should be totally avoided. KEY WORDS Nasal Polyp, Pathology, Sinonasal Carcinoma

Inverted Papilloma in Children

Inverted papilloma (IP) is considered a rare benign sinonasal lesion, which is usually presented in adults. The presentation of IP is usually a unilateral nasal obstruction. IPs in the pediatric age group are quite rare as only a few cases were reported. This review aims to increase the awareness of IP to consider this entity in the diagnosis of unilateral nasal obstruction in children. This study was a review of 10 articles which reported the occurrence of IPs in children. Data include age, presentation, diagnosis, and treatment which were extracted and analyzed. The total number of cases was 12. The mean age of all cases was 10.5 years. The majority were male (66%). The main presenting symptom of all cases was nasal obstruction along with other nasal symptoms. The majority of the patients were treated by surgical excision of the lesion. Most of the cases 6 (50%) used endoscopic sinus surgery, and 5 (41%) of them were managed by lateral rhinotomy with or without medial maxillectomy. Follow-up showed that 7 (58%) of the cases did not document any recurrence of the disease. The reoccurrence occurred in 5 (41%) of the cases within the 1st year after the management. IPs can arise in the pediatric age group and should be considered in the differential diagnosis of unilateral nasal obstruction. It is diagnosed and treated likewise in adults.

Clinical Characteristics and Surgical Outcomes of Sinonasal Lesions Associated With Tumor-Induced Osteomalacia.

To investigate the clinical characteristics and surgical outcomes of sinonasal tumors associated with tumor-induced osteomalacia (TIO). Retrospective case series. Single tertiary center. We studied the clinical characteristics and surgical outcomes of 43 patients (22 male, 21 female) who had lesions in the nasal cavity and paranasal sinus associated with TIO and underwent surgery between August 2006 and November 2019. The mean ± SD duration between the onset of symptoms and surgery was 3.9 ± 2.6 years. The most common tumor site was the ethmoid sinus (76.7%), and the skull base was involved in 12 cases. Phosphaturic mesenchymal tumors were diagnosed in 41 patients, among whom there was 1 multifocal case. Another 2 cases involved odontogenic fibroma and hemangiofibroma, respectively. Serum phosphorus normalized in 39 cases within 4.4 ± 2.3 days, and serum fibroblastic growth factor 23 normalized within 1 day; clinical symptoms, however, gradually improved within several months after the first operation. There was no significant difference in the recovery rate between endoscopic and open surgery (P = 0.639). Two patients with recurrent cases and 2 with nonremission cases recovered after a sinonasal reoperation. The patient with a multifocal case recovered after the resection of the tumors in the ethmoid sinus and mandible. The overall recovery rate was 97.7%. Most sinonasal tumors associated with TIO are located in the ethmoid sinus, and the skull base is involved in some cases. Complete excision of the tumor leads to recovery, and endoscopic surgery could achieve recovery rates similar to those of open surgery.

Sinonasal Inverted Papilloma: A Narrative Review.

Inverted papilloma (IP) is a relatively rare sinonasal benign lesion, peculiar in its etiology, clinical presentation and treatment. Its resemblance to other sinonasal pathologies and varied approaches, makes it an interesting disease. Recently there have been several advances in the management of IP. This article aims to summarize the contemporary developments thus enabling the readers to understand the years of research behind IP. To integrate the available literature on IP and study the current scenario in its management. A comprehensive literature review was done on Google Scholar and PubMed database using the following key words: "inverted papilloma", "Schneiderian", "sinonasal", "medial maxillectomy". Articles published in English were used. Articles published till May 2020 were reviewed. Years of research have aimed to gain more information regarding the epidemiology, histopathology, staging systems and surgical management of IP. To briefly summarize the research so far, it is safe to say that there exists an association between Human Papilloma Virus and IP. The Krouse staging system is the most commonly used. The treatment itself has changed from a conservative approach to a more aggressive excision with or without external approach and with or without chemoradiotherapy. In IP, whether or not associated with SCC, complete surgical removal of the tumour is advocated as the treatment of choice. With the advancements in endoscopic technique, surgeons have been using it to their advantage for the surgical evaluation and cure of IP, depending upon the stage. Endoscopic treatment is preferred, whereas for lesions less accessible endoscopically, or in those with peripheral extension, open surgery is indicated. Every patient requires counselling before discharge and thorough examination during the follow-up to detect any evidence of recurrence.

Metal-Working Fluids Exposure and a Rare Frontoethmoid Lesion

This case report describes a unique nasal mass that was difficult to diagnose clinically and histologically. The patient was a middle-aged man employed as a metalworker, and he presented with a unilateral nasal obstruction and a mass arising from the right middle meatus. After a series of investigations, he underwent right-sided sphenoethmoidectomy with excision of a nasal lesion. The surgical specimen presented a major diagnostic challenge for the pathologists and clinicians involved. A series of discussions amongst two different head and neck expert teams combined with detailed clinicopathological correlation resulted in a diagnosis of a granulomatous lesion or pseudotumour related to the ingestion of water-soluble cutting oils, or “Suds oil,” as they are more commonly called. Although occupational exposures to certain inhalants, such as wood dust and formaldehyde, are well-known risk factors for sinonasal lesions, here we present a rare association between a sinonasal lesion and another inhalant, Suds oil, that has not been previously reported in the literature.

CLINICOHISTOPATHOLOGICAL PROFILE OF NASAL AND SINONASAL LESIONS: A STUDY FROM CENTRAL INDIA

Background: Nasal and sinonasal lesions comprise common as well as rarest rare lesions. This region being a site of histopathologically diverse lesions, interests pathologists.
 Objectives: The study aimed to find out incidence of nasal and sinonasal lesion with frequency of non-neoplastic, neoplastic lesions, to study spectrum of lesions histopathologically along with correlation of clinical and radiology findings.
 Material and methods: It was a 2 year retrospective observational study involving 102 cases from January 2012 to December 2013 carried out at Government medical college, Nagpur.
 Study included all specimens received as nasal and sinonasal lesions. Complete clinical history and radiological findings were correlated with histopathology findings.
 Results: Nasal and sinonasal lesions are rare having 1.07 % incidence rate. Majority of patients of nonneoplastic and benign neoplastic category belonged to 11-20 age group while malignancies were common in 41-50 age group. We encountered more neoplastic lesions (53.92%) compared to nonneoplastic lesion (46.08%). Male to female ratio was 1.5:1. Sensitivity, specificity and diagnostic accuracy of clinical diagnosis was 94.73%, 97.67 % and 96 % respectively while positive predictive value and negative predictive value was 98.18 % and 93.33 %. p value was 0.317. Discordance in clinic-histopathological diagnosis was in 5.88 %
 Conclusion: Though there was good correlation between clinicoradiology findings and histopathology, however in 5.88% discordant cases histopathology diagnosis led to significant alteration of treatment plan proving key role of histopathology diagnosis.
 Keywords: Benign, Central India, Clinicohistopathology, Profile, Malignant, Nasal, Sinonasal.

A comparison of two endoscopic techniques for the treatment of antrochoanal polyps.

SUMMARYAn antrochoanal polyp (ACP) is a benign sinonasal lesion that originates from the mucosa of the maxillary sinus. In order to avoid any recurrence of disease, it is important to choose the best surgical approach for removal of ACP with respect to the site of attachment within the maxillary sinus walls. A retrospective cohort study was carried out by analysing a database of 82 patients who were operated on for ACPs in the Ear, Nose and Throat (ENT) clinics of both Sant’Orsola-Malpighi Polyclinic Hospital and Bellaria Hospital in Bologna, Italy from January 2001 to November 2017 to compare the rate of recurrence of ACPs after surgical removal using two different approaches. The first technique was endoscopic antrochoanal polypectomy with middle meatal antrostomy and the second was endoscopic antrochoanal polypectomy combined with both middle meatal antrostomy and a minimal access through the inferior meatus. A total of 49 patients were operated on with an endoscopic polypectomy with middle meatal antrostomy and 18.4% experienced a recurrence. The remaining 33 patients underwent endoscopic polypectomy with combined middle meatal antrostomy and access through the inferior meatus with a recurrence rate of 3%. The difference between the two groups was statistically significant (p = 0.0441). The strategy of the authors, namely combining medial antrostomy with a small inferior meatus access, was associated with a lower rate of recurrence and no increased morbidity in the short- or long-term.

18F-FDG PET/MRI of Rhinosporidiosis of the Upper Airways.

A 41-year-old man from South Asia presented with a several months' history of unilateral nasal obstruction and bleeding. At nasal endoscopy, two strawberry-like, friable, polypoid masses in the upper airways were detected. The patient's clinical trait was compatible with an infectious disease. F-FDG PET/MRI was performed to evaluate the disease extension. Two lesions occupying the nasal cavity and the nasopharynx, slightly hyperintense in T2-weighted sequences, with intense radiopharmaceutical uptake were evidenced. Endoscopic resection was performed with histopathologic diagnosis of rhinosporidiosis, a chronic granulomatous disease caused by Rhinosporidium seeberi. Although rare, rhinosporidiosis should be considered in the differential diagnoses of sinonasal hypermetabolic lesions.

Retrospective evaluation of sinonasal lesions diagnosed in our clinic

Amaç: Nazal kavite ve paranazal sinüslerin başlıca lezyonlarını inflamatuvar özellikteki benign lezyonlar oluştururken, malign lezyonlar oldukça nadirdir. Bu çalışmada, literatür bilgileri eşliğinde, nazal kavite ve paranazal sinüslerde kitle oluşturan lezyonların sıklığının ve dağılımlarının gözden geçirilmesi amaçlanmıştır. Gereç ve Yöntem: Kütahya Sağlık Bilimleri Üniversitesi Evliya Çelebi Eğitim Araştırma Hastanesi Patoloji birimimizde 2013-2018 yılları arasında raporlanan 447 olguya ait, nazal kavite ve paranazal sinüslerde görülen lezyonların histopatolojik tanıları ve yerleşimleri retrospektif olarak incelendi. Bulgular: Çalışmaya 295’i (%65,99) erkek, 152’si (%34,01) kadın olmak üzere 447 olgu dâhil edildi (E/K=1,94). Çalışmaya dâhil edilen olguların yaş ortalaması 43,54 olarak belirlendi. Histopatolojik olarak, 6 (%1,35) lezyon malign, 441 (%98,65) lezyon benign olarak saptandı. Nazal polip lezyonların büyük kısmını oluşturmaktaydı (% 82,78; 370 lezyon). Diğer benign lezyonlar: 30 (%6,72) sinonazal papillom (24 inverted papillom, 6 ekzofitik papillom), 16 (%3,58) piyojenik granülom, 11 (%2,46) mukosel, 3 (%0,68) fibrom, 2 (%0,45) nazoalveolar kist, 1 (%0,22) dev epidermoid kist, 1 (%0,22) glomanjioperisitom, 1 (%0,22) hemanjioendotelyoma, 1 (%0,22) anjioleiomyom, 1 (%0,22) respiratuvar epitelyal adenomatoid hamartom, 1 (%0,22) osteom, 1 (%0,22) fibröz displazi, 1 (%0,22) fibroepitelyal polip ve 1 (%0,22) hiperkeratotik aktinik keratoz olarak belirlendi. Malign lezyonlar ise 3 (%0,68) malign melanom, 2 (%0,45) skuamöz hücreli karsinom ve 1 (%0,22) adenoid kistik karsinom olarak saptandı. Sonuç: Sinonazal bölge lezyonları histopatojik inceleme ile benign ve malign olarak ayırt edilebilmektedir. Bu bölgedeki lezyonlar çoğunlukla benign nitelikte olup, lezyonların büyük kısmını nazal polipler oluşturmaktadır. Sinonazal bölgedeki maligniteler ise agresif tümörler olup, nadir olarak görülmektedir.

Pediatric sinonasal and skull base lesions.

Pediatric skull base lesions are complex and challenging disorders. Safe and comprehensive management of this diverse group of disorders requires the expertise of an experienced multidisciplinary skull base team. Adult endoscopic skull base surgery has evolved due to technologic and surgical advancements, multidisciplinary team approaches, and continued innovation. Similar principles continue to advance the care delivered to the pediatric population. The approach and management of these lesions varies considerably based on tumor anatomy, pathology, and surgical goals. An understanding of the nuances of skull base reconstruction unique to the pediatric population is critical for successful outcomes.

Is Respiratory Epithelial Adenomatoid Hamartoma Related to Central Compartment Atopic Disease?

Respiratory epithelial adenomatoid hamartoma (REAH) is a benign lesion of the sinonasal tract that may mimic more concerning pathology. Clinical factors associated with REAH have not been well characterized. To report our findings on patients with this pathologic diagnosis. A retrospective chart review of patients with REAH between September 2006 and November 2019 was conducted. Data collected included clinical allergic rhinitis and asthma history, additional sinonasal diagnoses, prior sinus surgery, and the location of the REAH within the sinonasal cavity. Twenty-six patients were identified (53.8% male, mean age 62 years [range, 29-93]). Bilateral REAH occurred in 50%. REAH was located at the superior nasal septum in 84.6% cases, with the remainder identified in sinus contents submitted for pathology, making definitive site uncertain. Concurrent sinonasal inflammatory disorders were identified in 18 patients (69.2%), including chronic rhinosinusitis with nasal polyps-not otherwise specified (6), chronic rhinosinusitis without nasal polyps (4), aspirin-exacerbated respiratory disease (2), allergic fungal rhinosinusitis (1), central compartment atopic disease (5), and IgG4-related sclerosing disease (1). Eight patients had isolated REAH. Adequate allergy records were available for 19 patients, of which 18 of 19 (94.7%) had clinical allergic rhinitis. REAH is a benign sinonasal lesion commonly located within the central compartment of the nasal cavity, a site of significant allergen exposure. Affected patients have a high incidence of allergy along with chronic inflammatory conditions. The coexistence of REAH within inflammatory nasal mucosa in a consistent anatomic location, suggests REAH may have a similar etiology to central compartment atopic disease, with resultant respiratory glandular ingrowth within long-standing reactive changes of mucosa derived from ethmoid embryologic origin.

Spectrum of neoplastic sino-nasal lesions at tertiary care centre

Spectrum of neoplastic sino-nasal lesions at tertiary care centre - IJPO- Print ISSN No: - 2394-6784 Online ISSN No:- 2394-6792 Article DOI No:- 10.18231/j.ijpo.2020.020, Indian Journal of Pathology and Oncology-Indian J Pathol Oncol

Computed Tomographic Study of Remarkable Anatomic Variations in Paranasal Sinus Region and their Clinical Importance - A Retrospective Study.

Introduction:With the advent of functional endoscopic sinus surgery and coronal computed tomography (CT) imaging, more attention has been paid toward paranasal region anatomy. Detailed knowledge of anatomic variations in paranasal sinus region is critical for surgeons performing endoscopic sinus surgery as well as for the radiologist involved in the pre- and post-operative assessment. The anatomical variants with some accompanying pathologies would directly influence the success of diagnostic and therapeutic management of paranasal sinus diseases. Our study intends to explore the anatomy of paranasal air sinus through CT and to describe its variants, which may predispose to chronic sinusitis and complications in endoscopic sinonasal surgery.Materials and Methods:This was a retrospective study carried out in a tertiary institution. Two hundred and fifty patients without paranasal sinus symptoms who presented for head CT studies and gave consent for a coronal section scan of the paranasal sinuses to be taken in addition to the axial section of the head were included in the study. The CT examination was performed with GE Hispeed-NX/I Base-2002 Dual Slice Helical CT machine.Results:Among 250 study population, 100 were females and 150 males. Among these 423 cases of anatomical variants were observed. The most common anatomical variants were pneumatization of the middle nasal turbinates 30.73%. This is followed by agger nasi cells 21.64%, Haller's cells 22.91%, septal deviation 21.91%, and sphenoid sinus septation (20.18%).Discussion:CT is the gold standard in the radiologic investigation of the paranasal sinuses, sinonasal lesions, and inflammatory disease or pre- and post-surgical assessment. It has the capability of disclosing in greatest detail any anatomical variations, which could be causing or precipitating the sinusitis.

Treatment Options for Recurrent Anterior Skull Base Tumors.

Malignancies of the anterior skull base are rare and recur in 40-80% of treated cases, varying with substantial variance according to histology, stage at primary diagnosis, and other factors. Most recurrences manifest within 2-5 years after primary treatment, but some histologies can relapse even decades after the first presentation. Management of recurrent anterior skull base tumors is challenging and a wide variety of treatment options are available. Similar to the primary setting, surgery is the mainstay of treatment. However, only few patients are likely to be suitable for salvage surgery after restaging. In this scenario, non-surgical options such as re-irradiation with photon or heavy particles may play a role, although the potential toxicity and benefits of treatment needs to be considered on a case-by-case basis. Moreover, stereotactic technologies are emerging as an adjunct valuable tool to minimize side effects. Chemotherapy is acquiring a relevant role in the primary treatment of sinonasal malignant lesions involving the anterior skull base in the neoadjuvant setting or in combination with radiotherapy, but evidence of its efficacy in the treatment of the recurrent/metastatic disease is very limited. The specific drugs employed vary considerably and need to be paralleled with the biology of the different histologies.

Unilateral Sinonasal Masses: Review of Clinical Presentation and Outcome in Ahmadu Bello University Teaching Hospital, Zaria, Nigeria.

Background:Unilateral persistent nasal obstruction may indicate the presence of sinonasal lesion, which could be inflammatory or neoplastic. It is a common practice to assume that unilateral nasal mass in adults is either inverted papilloma or a malignant lesion.Objectives:The objective is to study the pattern of clinical presentation and outcome of treatment of patients managed for unilateral nasal masses at Ahmadu Bello University Teaching Hospital, Zaria.Materials and Methods:The record of patients managed for unilateral nasal masses over 5 years between January 2013 and December 2017 was reviewed. Data obtained for this study included demographic characteristics such as age, sex, occupation, main presenting symptoms, duration of symptoms, histological type, type of treatment given, and current status of patients. The data were analyzed using the Statistical Package for the Social Science version 23.0.Results:A total of 38 cases were reviewed for this study and there were 25 (65.8%) males and 13 (34.2%) females with a sex ratio (male: female) of 1.9:1. The mean age was 50.8 years, with the standard deviation of ± 13.7. Rhinorrhea, nasal blockage and the presence of nasal growth were the most common symptoms at presentation seen nearly in all the patients. Inflammatory polyp 16 (42.1%) was the most common histological type observed in this study. The majority of patients with malignant sinonasal masses had well-differentiated squamous cell carcinoma 5 (13.2%). Most of our patients 29 (76.3%) presented to the hospital within 1–3 years of the onset of the symptoms. The majority of our patients 26 (68.4%) did very well and were discharged from the clinic following resolution of their symptoms. Three (7.9%) had recurrent nasal mass. We recorded three cases of mortality from the 38 patients managed.Conclusion:Inflammatory polyp was the most common unilateral sinonasal mass followed by inverted papilloma. A thorough clinical evaluation of any patients with prolonged nasal symptoms will go a long way in the early detection of these lesions.

Histopathological analysis of sinonasal lesions associated with chronic rhinosinusitis and comparison with computed tomography diagnoses.

Background &Objective:Chronic rhino sinusitis (CRS) is an inflammatory condition of the paranasal sinuses and the nasal passage lasting more than three months either with or without sinonasal polyps. This study aimed to report the common sinonasal lesions associated with CRS according to the histopathology results, to compare between clinical and histopathological diagnoses, and to compare between radiological and histopathological diagnoses of the sinonasal lesions.Methods:A retrospective study of the electronic records of 82 patients diagnosed with CRS with nasal polyps. All patients underwent endoscopic sinus surgery and histopathological examination of surgical biopsies. The collected data were analyzed using SPSS program. Coparison between clinical and histopathological diagnoses was done. This study was conducted at Alsafwa Consultative Medical center (ACMC) in Almukalla city, Hadhramout province in Republic of Yemen.Results:Out of 82 patients, the ages ranged from 4 to 90 years (mean: 34.48±17.74 years), and 54.88% were females. Inflammatory polyps were the most common lesion (31.4%), then allergic polyps (30.5%). Nasopharyngeal carcinoma (NPC) was reported in 9.8% of the lesions and all were unilateral. The results revealed strong compatibility between clinical and histopathological diagnoses (p<0.001, kappa= 0.215), and significant compatibility between radiological and histopathology diagnoses (p=0.007).Conclusion:Inflammatory and allergic polyps are the most common benign bilateral lesions associated with chronic rhinosinusitis, which can be correctly diagnosed clinically in most cases. Unilateral nasal polyps have high rates of malignancies and should be check carefully by endoscopy and histopathology. Computed tomography has some pitfalls in diagnosing of fungal sinusitis.

Management of Pediatric Sinonasal and Skull Base Lesions

Pediatric sinonasal and skull base lesions are rare and complex disorders. The safe and comprehensive management of this diverse group of pathologies requires the expertise of an experienced multidisciplinary skull base team. With significant evolution and improved outcomes achieved in adult endoscopic skull base surgery (ESBS), similar principles have been applied to the pediatric population. Pediatric endoscopic surgery for sinonasal and skull base tumors has therefore also evolved due to a variety of technologic and surgical advances, multidisciplinary team approaches, and continued innovation. Pediatric sinonasal and skull base tumors require complex multidisciplinary management for optimal outcome. Detailed understanding of the sinonasal anatomy will improve surgical outcomes. The surgical approaches and techniques are dependent on the location of the lesion, the pathology, extent of disease, and surgical goals. Reconstruction following tumor extirpation follows the same principles as adult reconstruction, with the ultimate goal of achieving a watertight seal that separates the nasal cavity from the brain. Complications can be catastrophic and rely on immediate recognition and management to prevent long-term sequelae.

Effects of unilateral sinonasal surgery on sleep-disordered breathing

Aims/objectives: To examine the effects of surgery for unilateral sinonasal lesions on sleep-disordered breathing (SDB).Material and methods: Oxygen desaturation index (3%ODI) as a marker of SDB and bilateral/unilateral nasal resistance were measured before and after surgery for 18 patients with unilateral sinonasal lesions. Various parameters were compared between those who achieved 60% or less decrease of 3%ODI and those who did not.Results: Bilateral nasal resistance as well as that of the surgical side five days after surgery was significantly lower than those of pre-operative value. Preoperative 3%ODI (times/hour) was 10.08 ± 7.32, which significantly decreased to 7.67 ± 5.79 five days after surgery. Even in unilateral patients, sinonasal surgery could reduce the bilateral nasal resistance, resulting in a decrease in 3%ODI. Age was younger and postoperative nasal resistance of the surgical side was significantly lower in the group who achieved 60% or less decrease in 3%ODI than those who did not.Conclusions and significance: SDB is influenced by even unilateral nasal obstruction. Surgery for unilateral lesion can improve the respiration during sleep as well as bilateral nasal resistance. Favorable outcome by surgery could be brought about in younger patients and those for whom sufficient improvement of nasal resistance was expected by surgery.