Sinus Function Research Articles

Fungal infection among patients with chronic rhinosinusitis who underwent endoscopic sinus surgery

Background: Chronic rhinosinusitis (CRS) involves persistent inflammation of the nasal passages and sinuses, often attributed to Aspergillus species as a primary etiological agent. Effective treatment involves complete eradication of fungal pathogens and restoration of sinus function, commonly achieved through functional endoscopic sinus surgery (FESS). This study aimed to evaluate the clinical and radiological features, assess the prevalence and identify the mycological profile of fungal rhinosinusitis. Methods: This study was a prospective observational analysis involving a cohort of 50 patients treated at the Tirunelveli Medical College between June 2017 and July 2017. Nasal sinus tissues and secretions were collected for mycological and bacteriological analysis. Samples were processed on the same day, with fungal elements identified via KOH mount and cultured on Sabouraud dextrose agar. Bacterial cultures were grown on MacConkey agar and species identification was performed using biochemical tests. Results: Fungal culture results showed that 72% of the patients had a negative culture, while 28% had a positive culture. Among the 50 patients, 36 did not have diabetes or hypertension. All sinuses were involved in 40 patients and 24 had nasal polyps, with bilateral polyps being the most common. The most frequently isolated fungal species was Aspergillus. KOH positivity was strongly correlated with culture positivity, with 9 out of 10 KOH-positive patients also being culture-positive, while KOH negativity was associated with culture negativity in 35 out of 36 patients. Conclusions: CRS significantly affects quality of life, with fungal infections being a notable cause, especially in patients with unilateral sinus involvement. Effective treatment requires endoscopic sinus surgery, followed by antifungal therapy.

Sphenoid Sinus Fungal Ball and Reestablishing Sinus Function.

The aim was to assess the developmental attributes of sphenoid sinuses affected by fungal balls and describe a surgical approach which reestablishes gravity-dependent drainage to compensate for any mucociliary dysfunction. A within-patient case-control analysis was performed on sphenoid sinus dimensions from patients with sphenoid sinus fungal ball (SSFB). Radiological dimensions were assessed to determine the dominant or larger sinus by volume and width. Pneumatization in the sagittal and lateral extent was assessed. The influence of sinus size and pneumatization variants within a patient was analyzed. Patency and the presence of mucostasis from radical reshaping of the sinus cavity were documented at least 3 months after surgery. Complications (bleeding, cerebrospinal fluid leak, and cranial nerve palsy) were recorded. Twenty-three patients (59 ± 19 years, 86% female, 46 sphenoid sinuses) were assessed. Fungal ball was more common in the smaller (non-dominant) sinus, by width (78% vs. 22%, p < 0.01) and by proportion of total sphenoid volume (0.39 ± 0.16 vs. 0.61 ± 0.16, p < 0.01). Pneumatization variants did not influence the development of SSFB within a patient. All patients had patency and the absence of mucostasis or persistent inflammation at last follow-up. No complications were reported. The smaller or nondominant sphenoid sinus is more affected by SSFB. Surgical reshaping of the sphenoid to prevent mucostasis is favorable in managing the smaller affected sinus cavity. 4 Laryngoscope, 134:4888-4892, 2024.

Pipeline embolization device as a standalone curative approach for recurrent sigmoid sinus DAVF.

Dural arteriovenous fistulas (dAVFs) can occur as complications after surgical procedures, especially following the resection of meningiomas near the dural sinus. This case report presents a 74-year-old male who developed a recurrent sigmoid dAVF following meningioma resection. Initially treated with transvenous embolization and middle meningeal artery embolization, the dAVF recurred with worsening clinical symptoms. Conventional treatment options, including sinus sacrifice and transarterial embolization, were unsuitable due to the critical role of the patient's dominant right sigmoid sinus in cerebral venous drainage. Consequently, a reconstructive approach was employed using a pipeline embolization device (PED) construct. The PED successfully occluded the dAVF while preserving the function of the sigmoid sinus. A follow-up angiogram confirmed stable occlusion and normalization of intracranial venous drainage. This case underscores the potential of flow diversion as a viable treatment option for dAVFs, particularly in scenarios where preserving venous sinus function is paramount.

Cephalometric Analysis of Maxillary Sinus for Gender Determination Using Lateral Cephalogram: A Novel Retrospective Study in the North Indian Population.

Underlying disorders of the maxillary sinus (MS), including a history of sinus surgeries, chronic sinusitis, or congenital anomalies can potentially impact sinus function and structure, necessitating careful evaluation and management. Moreover, intact sinuses are crucial in gender determination in forensic anthropology. The present study was undertaken to check the accuracy and reliability of MS in gender determination using morphometric parameters. This retrospective study was carried out on 74 lateral cephalograms (37 males and 37 females) aged between 18 to 50 years from the North Indian population. The MS area was measured using a NewTom CBCT machine (NewTom,Imola, Italy) with slicer software. The anatomical landmarks for the sinus were identified, and the area was calculated in square millimeters (mm2). In terms of surface area, females had a mean of 13,210.40 mm2 with a standard error of 713.46. Males, however, exhibited a higher mean surface area of 18,713.82 mm2, but with a significantly larger standard error of 3,371.70. The difference in MS area between males and females was statistically significant (p<0.01). In the receiver operating characteristic (ROC) curve, the area under the curve (AUC) was 0.77, suggesting good discriminative ability. The MS area on lateral cephalograms shows significant sexual dimorphism. Overall, the findings suggest that the MS surface area can be a useful anatomical feature for distinguishing between male and female North Indian subjects, given the statistically significant difference and the good discriminative performance indicated by the ROC curve analysis.

Maxillary sinus unplugged: dealing with foreign bodies in the maxillary sinus

Foreign bodies lodged within the maxillary sinus are rare occurrences, presenting diagnostic challenges and requiring tailored surgical interventions. We report a case of male in his mid-sixties, with a history of chronic sinusitis complaining of broke teeth and asking for replacement or the same. Imaging revealed an ectopic tooth lodged within the right maxillary sinus. Infected Schneiderian membrane was intentionally removed and foreign body was removed from the sinus employing innovative techniques to safely remove the foreign body and a long-standing collagen membrane was used to recreate the sinus floor. Postoperatively, the patient experienced complete resolution of symptoms and restoration of sinus function. This case emphasizes the importance of thorough preoperative evaluation and how dental professionals can effectively manage unique cases in their clinical practice with optimal patient outcome in managing maxillary sinus foreign bodies.

Outcomes of endoscopic management of benign maxillary sinus lesions 5-year experience, non-randomized clinical trials

BackgroundWhen medical therapy fails to control maxillary sinus (MS) disease, surgery is required. There are many advanced MS endoscopic approaches, each one with its anatomical limitations and possible complications. This study aimed to review the outcomes of three endoscopic approaches to the MS (middle meatal antrostomy approach (MMAA), prelacrimal recess approach (PLRA), and canine fossa approach (CFA)) to manage benign MS lesions.MethodsSixty-three patients with diseased MS require surgery. Endoscopic MS approaches used include MMAA, PLRA, and CFA. Each approach was used in 21 patients. The outcome of each approach was measured regarding lesion accessibility and clearance, complications (intraoperative or postoperative), and recurrence.ResultsThe maxillary sinus posterior wall was accessible in all approaches. Other walls and different recesses were also accessible in the case of PLRA and CFA with statistically significant difference between the three approaches. There was no significant difference between patients operated by PLRA and CFA regarding accessibility to different walls and recesses of the MS. Endoscopic and radiological recurrence were found in three (15%) patients who were operated by MMAA. There was no evidence of recurrence in patients operated by the other approaches. Complications like crustations, fascial pain, fascial welling, and fascial hypoesthesia occurred in a few patients.ConclusionBy using a suitable endoscopic approach, the different walls and recesses of the MS were completely accessible, so benign MS lesions that required open surgical approaches can be managed endoscopically while preserving the sinus structure and function.

Abstract 15963: A Novel SGK1 Inhibitor (SGK1-I), Prevents Obesity-Related Atrial Fibrillation

Introduction: Obesity is an important risk factor for atrial fibrillation. We have previously demonstrated the protective effect of genetic SGK1 inhibition in a mouse model of obesity-related atrial fibrillation (AF). SGK1-I is a novel and potent SGK1 inhibitor that has been shown to reduce late sodium current and has currently entered clinical trials as a potential treatment of long QT syndrome. Hypothesis: We sought to assess the efficacy of pharmacologic SGK1 inhibition in a mouse model of obesity-related AF. Methods: Wild type C57/Bl6 mice were fed a high fat diet containing 60% cholesterol (by calories) compounded with (HFD-SGK1i) or without (HFD) SGK1-I for 10 weeks. After feeding, the mice were assayed with invasive electrophysiology studies (EPS), optical mapping, and biochemical assays. Results: There were no significant differences in rate of weight gain, final body weight, fasting glucose, glucose tolerance, or tail-cuff blood pressure between the two groups of mice throughout the study. During EPS, there were no differences in nodal (sinus and atrio-ventricular) function or tissue (atrial/ventricular) refractory periods. However, HFD-SGK1i mice were significantly protected from obesity-related inducible AF during EPS, with a lower rate of AF inducibility (5.7% versus 1.5%, p&lt;0.0001) and a lower total AF burden (35±54 versus 5.5±10.7 s, p=0.04). Optical mapping revealed abbreviated right (RA), but not left (LA), atrial action potential duration (APD) and attenuated inter-atrial APD differences in HFD-SGK1i mice as compared to HFD mice. In this context, Western blotting data demonstrated greater RA (versus LA) SGK1 activity/expression resulting from HFD, suggesting that SGK1 signaling may contribute to inter-atrial heterogeneity caused by HFD. Finally, protein expression of NLRP3 inflammasome components, Caspase-1 and ASC, as well as TGF-β expression were decreased in the SGK1-1 group; consistent with anti-inflammatory and anti-fibrotic signaling resulting from SGK1-I treatment. Conclusion: SGK1-I protects mice from obesity-related AF. These data further highlight SGK1 and its inhibition as a compelling target in cardiac arrhythmogenesis.

ANTIBIOTIC-TARGETED CEMENT RODS IN CHRONIC OSTEOMYELITIS: LONG-TERM OUTCOMES FROM A LEVEL ONE SOUTH AFRICAN TRAUMA CENTRE

Fracture related infection, in particular chronic osteomyelitis, requires complex management plans. Meta analyses and systematic reviews have not found a gold standard of treatment for this disease. In 2017 an alternative treatment protocol was undertaken in our institution; whereby staged surgery with the use of cheaply manufactured tailored antibiotic cement rods was used in the treatment of chronic osteomyelitis, secondary to traumatic long bone fractures. Short term outcomes for this protocol demonstrated a 75.7% microbiological resolution to a negative culture and a good clinical outcome of 84.2% overall was demonstrated in terms of sinus resolution, skin changes, pain and function. Our aim now was to assess the long term outcomes of this treatment strategy.A cross-sectional study of patients who had previously undergone the set treatment protocol was performed. Patient satisfaction, effects on activities of daily living, return to work and clinical improvement at 5 years following the intervention were assessed using a patient questionnaire and the validated AAOS lower limb score.The average AAOS lower limb score was 88 which was en par to other similar studies. 80% of patients had returned to some form of work. Ongoing mild pain was a persistent problem for 50% of the patients however 98% of the patients were overall satisfied with the treatment satisfaction at 5 years. Only 1 patient required further treatment. 8 patients could not be located for follow up.Chronic osteomyelitis remains a complex disease to treat. This treatment protocol demonstrates favourable microbiological, serological and clinical short term outcomes and favourable patient satisfaction and functional long term outcomes at 5 years. Our study highlights antibiotic targeted cement rods as a feasible treatment option in managing chronic osteomyelitis.

Structural and functional changes of nasal cavity and maxillary sinus in patients with skeletal class III malocclusion 1year after bimaxillary surgery.

This study aimed to analyse changes in the nasal cavity and maxillary sinus structure and function in patients with skeletal class III malocclusion 1 year after bimaxillary surgery. In this study, cone-beam computed tomography (CBCT) images of 20 patients (10 men and 10 women; mean age 24.3± 3.4 years) with skeletal class III malocclusion who underwent Le Fort I osteotomy and bilateral sagittal split osteotomy were obtained before and 1 year after the surgery. CBCT data were stored opened with element 3D (E3D) to establish a nasal airway model (the paranasal sinus includes only the maxillary sinus). Ansys (ANSYS) software is used for simulation and analysis. The maxillary sinus and nasal cavity volumes decreased significantly 1 year after the surgery. After surgery, the volume of nasal cavity decreased by 13.5%, and the average volume of maxillary sinus decreased by 7.8%. There was no significant difference in the degree of deviation of the septum and nasal cavity resistance, and air distribution in the maxillary sinus did not change. The nasal cavity wall shear stress change was similar to that before surgery. The maxillary sinus volume and nasal cavity volume of patients with skeletal class III malocclusion changed significantly after bimaxillary surgery, but there was no significant change in nasal ventilation function 1 year after surgery.

Fungal sinusitis invading intra as well as extracranial- A rare case report

The primary complaint of a 48-year-old male patient in an Indian hospital was pain in the upper left rear region of the jaw. The patient appeared to be in good health until one and a half months ago, when he began experiencing pain over the upper left back side of his jaw. The patient was taken to the hospital two months ago after testing positive for COVID-19. He was maintained on oxygen for 10 days while receiving Remdesivir injections and steroid therapy. The patient has had diabetes mellitus and hypertension for five years and is currently on medication for both. An MRI of the brain and orbit was performed on the patient. The patient had functional endoscopic sinus surgery (FESS), which is a minimally invasive procedure that restores sinus ventilation and function. The patient was admitted to the hospital for 20 days and given injections of Amphotericin-B(12 doses).

Refined Topical 5-Fluorouracil Technique for the Targeted Treatment of Odontogenic Keratocysts

An innovation in the treatment of odontogenic keratocysts (OKCs) is the adjunctive application of 5-fluorouracil (5-FU). Although the original approach remains effective, it may often be a challenge for the patient to return postoperatively and/or tolerate non-resorbable packing removal. The purpose of the present study is to determine whether our refined approach, where we directly apply 5-FU-coated absorbable gelatin sponge to the surgical cavity, would be an effective treatment for OKCs with similar efficacy as with our original approach. A retrospective case series studying the treatment efficacy of our refined topical 5-FU approach on OKCs was reviewed. The study population was composed of all patients presenting for evaluation and management of OKCs with our refined technique between September 1, 2017 and July 1, 2022 at Stony Brook University Hospital. The primary outcomes included 1) time to OKC recurrence, and 2) incidence of trigeminal nerve injury following OKC treatment with the refined topical 5% 5-FU technique. Other study variables included age, gender, tumor location, and tumor size. Data analyses included descriptive statistics reported as median [interquartile range], and Kaplan-Meier survival analysis for time to OKC recurrence. Thirteen patients with 15 OKCs were reviewed (6 women and 7 men). There were no OKC recurrences with a median follow-up time of 28.5 (24) months. Normal bony healing was observed in all cases and there were no adverse local or systemic events, no alterations in sinus function, and no incidences of infraorbital or inferior alveolar nerve paresthesia. Our case series demonstrates that this refinement further increases technical ease, decreases operating time, and precludes the need for packing removal, with similar efficacy as the original approach.

Ambulatory atrioventricular synchronous pacing over time using a leadless ventricular pacemaker: Primary results from the AccelAV study

Previous studies demonstrated that accelerometer-based, mechanically timed atrioventricular synchrony (AVS) is feasible using a leadless ventricular pacemaker. The purpose of this study was to determine the performance of a leadless ventricular pacemaker with accelerometer-based algorithms that provide AVS pacing. AccelAV was a prospective, single-arm study to characterize AVS in patients implanted with a Micra AV, which uses the device accelerometer to mechanically detect atrial contractions and promote VDD pacing. The primary objective was to characterize resting AVS at 1 month in patients with complete atrioventricular block (AVB) and normal sinus function. A total of 152 patients (age 77 ± 11 years; 48% female) from 20 centers were enrolled and implanted with a leadless pacemaker. Among patients with normal sinus function and complete AVB (n = 54), mean resting AVS was 85.4% at 1 month, and ambulatory AVS was 74.8%. In the subset of patients (n = 20) with programming optimization, mean ambulatory AVS was 82.6%, representing a 10.5% improvement (P <.001). Quality of life as measured by the EQ-5D-3L (EuroQol Five-Dimensions Three-Level questionnaire) improved significantly from preimplant to 3 months (P = .031). In 37 patients with AVB at both 1 and 3 months, mean AVS during rest did not differ (86.1% vs 84.1%; P = .43). There were no upgrades to dual-chamber devices or cardiac resynchronization therapy through 3 months. Accelerometer-based mechanical atrial sensing provided by a leadless pacemaker implanted in the right ventricle significantly improves quality of life in a select cohort of patients with AV block and normal sinus function. AVS remained stable through 3 months, and there were no system upgrades to dual-chamber pacemakers.

Efficacy and safety of traditional Chinese medicine nasal irrigation on chronic rhinosinusitis recovery after endoscopic sinus surgery: A protocol for a systematic review and meta-analysis.

Continuous comprehensive treatment is still needed after endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) to promote the recovery of sinus mucosal morphology and function. Traditional Chinese medicine (TCM) nasal irrigation is a promising external treatment of TCM, but at present, the application of TCM nasal irrigation after ESS for CRS has not been recommended by the guidelines. Therefore, this article aims to develop a systematic overview and meta-analysis protocol to assess the effectiveness and safety of Chinese herbal nasal rinse for CRS recovery after ESS. Seven databases shall be retrieved from their inception until December 2021. Eligible randomized controlled trials will be covered in the study. The outcome indicators of the survey will consist of efficacy, visual analogue scale score, Lund-Kennedy score for nasal endoscopy, Lund-Mackay score for sinus computed tomography and other secondary outcome indicators. The selection of literature, extraction of data, and methodological quality evaluation of literature shall be conducted by two researchers separately. If there is any dispute, it can be discussed and solved by a third researcher. Review Manager 5.3 software will be applied to data analysis. The article will make a detailed research programme to explore the efficacy and safety of TCM nasal irrigation on CRS recovery after ESS. This protocol is suitable for evaluating the effectiveness and safety of TCM nasal rinse for CRS recovery after ESS, and can provide corresponding evidence-based medical evidence. Open Science Framework Registration DOI: 10.17605/OSF.IO/ZV73Q.

Mitral valvuloplasty with left atrial appendage closure and pacemaker implantation in a dog with severe myxomatous mitral valve degeneration: a case report

BackgroundMitral valvuloplasty (MVP) has been widely recognized as a treatment option for myxomatous mitral valve disease (MMVD). However, postoperative complications such as thromboembolism, arrhythmia, and pancreatitis in some cases have resulted in death. We treated a dog with severe MMVD complicated by impaired sinus function with MVP and pacemaker implantation. Also, due to an intrinsic procoagulant state and severe arrhythmia after the MVP, left atrial appendage (LAA) closure was performed to reduce the postoperative risk of thrombosis.Case presentationAn 11-year-old castrated 7.5-kg male Miniature Schnauzer with a history of congestive heart failure was brought to Shiraishi Animal Hospital for MMVD surgical treatment. Echocardiography revealed an enlarged left atrium and ventricle secondary to MMVD. Sinus arrest with 2 to 3-second periods of asystole was identified by electrocardiogram. Mitral valvuloplasty was performed with cardiopulmonary bypass to treat the MMVD. After coronary reperfusion, there was no spontaneous electrical activity. Cardiac arrest continued. Based on this surgical outcome, a permanent pacemaker was implanted. In addition, LAA closure with an AtriClip was performed to prevent intra-atrial thrombus formation. Cardiac remodeling and congestion were ameliorated after surgery. Sinus rhythm was restored 5 days postoperatively; however, the patient continued pacemaker dependent. All cardiac drugs were discontinued 3 months after surgery. The owner reported no postoperative complications (i.e., thrombosis), and the patient was brought for a check-up 4 months after the operation in good health.ConclusionsFor surgical MMVD cases complicated with impaired sinus function, the chances of spontaneous sinus rhythm are low, requiring pacemaker implantation. LAA closure may be considered to protect against decreased atrial function after mitral valvuloplasty and prevent intra-atrial thrombus formation.

Olfactory Change Pattern After Endoscopic Sinus Surgery in Chronic Rhinosinusitis Patients.

BackgroundChronic rhinosinusitis (CRS) is a chronic inflammation of the sinonasal mucosa that is clinically associated with sinus pressure, nasal congestion, rhinorrhea, and a decreased sense of smell that lasts more than 12 weeks. Endoscopic sinus surgery (ESS) for medically refractory CRS is mainly undergone to improve sinus function and access to topical medicinal treatments. However, olfactory changes after ESS can be unpredictable.AimThe current study aimed to assess olfactory change patterns after endoscopic sinus surgery in patients with chronic rhinosinusitis.MethodsA record-based retrospective study was conducted in Aseer Central Hospital (ACH) ear, nose, and throat outpatient (ENT OPD) department and Khamis Mushayt General Hospital from August 15, 2021, to December 15, 2021. Data were collected using pre-structured data extraction sheet to avoid errors. Data extracted and collected included patients’ biodemographic data, CRS-associated symptoms, and endoscopic surgery-related data, including duration since surgery, presurgical medications, and duration of surgery. Also, postsurgical complications were extracted, especially olfactory complications.ResultsA total of 168 patients with chronic rhinosinusitis (CRS) and who had undergone endoscopic sinus surgery in the Aseer region were included. Patient ages ranged from 10 to 61 years, with a mean age of 39.8 ± 12.4 years old. Regarding the associated symptoms and complaints of the study patients, 110 (65.5%) complained of sinusitis, and 86 (51.2%) had allergic RS. The postsurgical complications of patients with CRS who had undergone endoscopic sinus surgery were olfactory dysfunction (OD) in 32 (19%), no complications in 115 (68.55%), and other nonspecific complications, such as headache, drowsiness, nose dryness, and bleeding, in 21 (12.55%). Also, 71 (42.3%) reported that they hardly perceive the fragrance in perfumeries.ConclusionIn conclusion, olfactory impairment is a frequent clinical presentation in patients with CRS. In this study, olfactory dysfunction was improved, except among nearly one out of each five patients after ESS. Olfactory dysfunction was more among patients who had undergone recent surgery and those with chronic rhinosinusitis with nasal polyps (CRSwNP). Also, among patients who reported no complications, olfactory function did not return to normal in most patients as they hardly perceive fragrance.

Role of permanent pacing for sinus node dysfunction related to percutaneous coronary intervention of the proximal right coronary artery

There are few case reports relating to sinus node arrest resulting from percutaneous intervention of the proximal right coronary artery with majority showing resolution of normal sinus function within 7 days. Some reports have been published with prolonged recovery time of up-to 40 days [1,2]. The Sinoatrial (SA) node is supplied by the Sinoatrial Nodal (SAN) artery which originates from proximal Right Coronary Artery (RCA) in approximately 68% of patients, from left circumflex artery in 22.1% and from left main artery in 2.7% [3]. SAN artery is usually a single vessel in 95.5% hearts and duplication is seen in 4.3% [3]. Percutaneous Coronary Intervention (PCI) of the proximal RCA has been shown to cause side branch occlusion of the SAN artery in 17.5% of patients with sinus arrest and junctional escape rhythm in 28.6% of those patients [4]. We report long term outcome (3 years) of a patient with prolonged sinus node dys- function after stenting of the proximal RCA and insights into sinus node function recovery through pacemaker interrogations.

Effect of maxillary surgical movement on nasal cavity and maxillary sinus dimensions and function after Le Fort I osteotomy

This study was designed to evaluate the effects of different maxillary movements performed in Le Fort I surgery on the anatomy of the nasal cavity and maxillary sinus, occurrence of rhinosinusitis, and nasal airflow. Patients were divided into three groups: group I underwent pure advancement, group II underwent advancement with yaw rotation, and group III underwent advancement with impaction movements. All evaluations were performed using pre- and postoperative computed tomography images and surveys. Twenty-eight patients were enrolled. The mean pre- and postoperative nasal air volumes in group I were 22.74 ± 6.32 cm3 and 25.17 ± 6.19 cm3, respectively, showing a significant increase (P = 0.041). The mean pre- and postoperative maxillary sinus air volumes were 33.94 ± 13.72 cm3 and 26.28 ± 14.12 cm3 in group II and 35.29 ± 9.58 cm3 and 28.65 ± 8.42 cm3 in group III, respectively, showing significant reductions (P = 0.028 and P = 0.007, respectively). For all movements, the occurrence of septum deviation and nasal airflow impairment was not statistically significant. Pure maxillary advancement movement enhanced nasal cavity air volume. The yaw rotation movement significantly increased quantitative clinical rhinosinusitis symptoms. The risk of airflow impairment following Le Fort I surgery is low.

Frontal Sinus Fractures.

Management of frontal sinus fractures is controversial with no universally accepted treatment protocol. Goals of management are to correct aesthetic deformity, preserve sinus function when it is deemed salvageable, prevent sequela related to the injury, and minimize complications associated with intervention. Studies suggest that frontal sinus injuries, including disruption of the nasofrontal outflow tract (NFOT), can be managed nonoperatively in many cases. Advances in the utilization of endoscopic techniques have led to an evolution in management that reduces the need for open procedures, which have increased morbidity compared with endoscopic approaches. We employ a minimally disruptive protocol that treats the majority of fractures nonoperatively with serial clinical and radiographic examinations to assess for sinus aeration. Surgical intervention is reserved for the most severely displaced and comminuted posterior table fractures and unsalvageable NFOTs utilizing endoscopic approaches whenever possible.

Mirror and Circular Symmetry of Autofocusing Beams

This article demonstrates the crucial importance of the symmetrization method for the formation of autofocusing beams. It is possible to impart autofocusing properties to rather arbitrary distributions, for example, truncated and inverted classical modes (such as Hermite–Gaussian, Laguerre–Gaussian, and Bessel modes) or shift the fundamental Gaussian beam by inserting mirror or circular symmetry. The most convenient for controlling autofocusing characteristics is the truncated sinus function with a power-law argument dependence. In this case, superlinear chirp beams (with power q &gt; 2) exhibit sudden and more abrupt autofocusing than sublinear chirp beams (with power 1 &lt; q &lt; 2). Comparison of the different beams’ propagation is performed using fractional Fourier transform, which allows obtaining the field distribution in any paraxial region (both in the Fresnel and Fraunhofer diffraction regions). The obtained results expand the capabilities of structured beams in various applications in optics and photonics.

Obliteration and Contouring of Comminuted Anterior Wall Frontal Sinus Fracture Using Pericranial Flaps.

Summary:One of the common postoperative complications of comminuted fractures of frontal sinus are contour deformity, hardware extrusion, adherence and/or palpability, and skin thinning. We are presenting our novel technique with pericranial flaps to decrease these complications. The study was performed from January 2019 to January 2020, on 40 cases of comminuted fractures of anterior wall of frontal sinus, 28 men and 12 women, with an average age of 41 years. Injury resulted from motor vehicle crashes (n = 25), motorcycle crashes (n = 11), and falling from heights (n = 4). Our novel technique involves the use of two anteriorly based pericranial flaps; one flap is used for obliteration of the frontal sinus and the other is used to overlay the hardware used to restore forehead contouring and to eliminate the possibility of early extrusion or late plates or mesh palpability. Two patients had postoperative minimal disruption of forehead lacerations healed with secondary intention and minimal scarring. Excellent patient compliance without any complaint of mesh palpability. No adherence occurred and no skin thinning. This technique (two anteriorly based pericranial flaps) may be more reliable to obliterate the frontal sinus also overlaying the hardware used to improve forehead contour and decrease the incidence of mesh palpability and skin adherence than using hardware without flap coverage.