Sinus Surgery Research Articles

Evagination method for rectovaginal fistulas

AIM: to assess early and late results of the evagination method for the treatment of rectovaginal fistulas (RVF) in patients with anal incontinence due to muscle defect in the anterior semicircle. PATIENTS AND METHODS: the study included 45 patients. The prevailing etiology of RVF was delivery lesion in 19/45(42.2 %). The median follow-up was 6 (4; 8.5) months. On day 30 after surgery, the outcome was assessed clinically. Late outcomes were assessed in all patients 3–12 months including clinical control, transanal ultrasound and sphincterometry. RESULTS: recurrence occurred in 9/45 (20 %) patients. The significant improvement of continence was revealed: in mean pressure in rest (p = 0.004), in maximum contraction pressure (p < 0.0001), in Wexner incontinence score (p < 0.0001). With a fistula opening less than 16 mm, the recurrence risk increases (p = 0.0003). CONCLUSIONS: the evagination method is effective option in extent septal defects and correcting additional analsphincter insufficiency.

Surgical Intervention Outcome for Patients With Acute Vision Loss Due to Allergic Fungal Rhinosinusitis: A Systematic Review and Meta-Analysis.

Allergic fungal rhinosinusitis (AFRS) is a severe type of chronic rhinosinusitis (CRS) characterized by a high risk of acute vision loss resulting from the affection of optic nerves. This vision loss results from direct pressure upon the optic nerve by the sinus tissues and bone degradation. This is why early involvement of a professional is significant so as not to result in a permanent disability. This systematic review and meta-analysis will analyze the efficacy of surgical operations in enhancing visual outcomes in patients with acute vision loss due to AFRS. A systematic search was carried out based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using PubMed, Embase, Cochrane Library, and Scopus with the keywords "acute vision loss," "allergic fungal rhinosinusitis," and "surgical intervention." The studies included patients who developed AFRS-related acute vision loss, those assessing the outcomes of the surgical interventions, and those published in English. Two separate researchers extracted data and conducted quality assessments. The data synthesis process employed the R studio software (Posit, Boston, MA). The identified studies for the review constituted 12 and involved 320 patients. The mean pooled event rate regarding acute vision loss of AFRS patients was 33.1%. Ear, nose, and throat surgeries, including functional endoscopic sinus surgery (FESS) and optic nerve decompression, had a mean pooled success in vision recovery of 68%. Early treatment and utilization of other types of corticosteroids were utilized to enhance the results. Hence, early and proper surgery like FESS, optic nerve decompression, and corticosteroid treatment have better visual prognosis in AFRS patients. Standard early diagnosis and management guarantee the prevention of irreversible blindness, which stresses the need for an interdisciplinary approach and further studies.

Non-Mucosa Sparing (Reboot) Surgery as a Possible Rescue Therapy in Patients Locally Unresponsive to Biologics

Objective: Evaluation of effectiveness of non-mucosa-sparing (eg, reboot) surgery in patients with chronic rhinosinusitis with nasal polyps (CRSwNP), poorly responders to mAb therapy, who failed repeated comprehensive endoscopic surgeries. Methods: Retrospective observational study. Patients who were under mAb for a comorbid condition but still had no control over their CRSwNP were included. Data collected were preoperative tissue eosinophilia, nasal polyp score (NPS), 22-item sinonasal outcome test (SNOT-22), visual analog scale (VAS) for nasal symptoms, Lund–Kennedy score for nasal crusts (LK-c) and synechiae (LK-s), and Lund–Mackay score (LMS). The same data were also collected postoperatively (at 12 months), besides LMS, and compared. Results: Overall, 20 patients were included. Pre-reboot scores were: NPS = 4.95 ± 1.70; SNOT-22 = 63.90 ± 19.15; VAS-global = 7.06 ± 1.50; LM = 19.0 ± 4.01; LK-c = 1.10 ± 0.64; and LK-s = 1.30 ± 0.73. Tissue biopsies revealed a high density of eosinophils in all cases, ≥10/HPF (range 10-60). Mean postoperative outcomes were: NPS = 0; SNOT-22 = 17.90 ± 6.80; VAS-global = 1.91 ± 1.17; LK-c = 1.45 ± 0.51; and LK-s = 1.50 ± 0.61. The difference of mean pre- and postoperative scores was significant for both NPS, SNOT-22 and VAS-global ( P < .001). No differences were observed for LK-c and LK-s ( P > .05). Nasal specimens showed markedly reduced tissue eosinophils (100% of cases). Conclusion: Reboot sinus surgery might be an effective solution for recalcitrant CRSwNP patients unresponsive to mAbs and multiple sinus surgeries.

An Outline about Endoscopic Sinus Surgery outcome in Management of Chronic Rhinosinusitis

An Outline about Endoscopic Sinus Surgery outcome in Management of Chronic Rhinosinusitis

Developing a virtual Endoscopic Surgery Planning system to optimize surgical outcomes.

Planning and predicting functional outcomes of endoscopic sinus surgeries (e.g., nasal airflow) based solely on visualizing Computerized Tomography (CT) or endoscopy poses a challenge to produce optimal clinical outcomes. Technology development, retrospective case report. A virtual surgery planning (VSP) tool is developed that can load any patient's CT data and allow surgeons to remove obstructive tissue using both visual and haptic feedback endoscopically. Pre-calculated airflow resistance, wall shear stress, pressure drop are displayed on the anatomy to identify potential sites of obstruction. After each virtual surgery, changes in nasal airflow can be computed, and the process is reiterated until an optimal result is reached. As proof-of-concept, a series of isolated or combined procedures were performed on CT of one patient, who had olfactory losses that may involve obstructions blocking the air/odor flow to the olfactory fossa (OF). For this patient, an isolated medial partial middle turbinectomy (PMT) demonstrated the best outcome, better than traditionally performed lateral PMT, while septal body reduction worsened air/odor flow to OF. This proof of concept case report demonstrates the potential usefulness of VSP in preoperative planning based on objective benchmarks and could be a valuable tool for optimizing future surgical outcomes.

Impact of Biologics on Surgery in Chronic Rhinosinusitis with Polyps and Allergic Fungal Sinusitis.

To compare the efficacy of th2-targeted biologic medications (dupilumab, omalizumab, and mepolizumab) on absolute risk reduction (ARR) of functional endoscopic sinus surgery (FESS) in patients with chronic rhinosinusitis with nasal polyposis (CRSwNP) and allergic fungal rhinosinusitis (AFRS). The TriNetX Research Network database was queried for each mAb's market lifespan through March 2024. Adults with CRSwNP were propensity score matched against non-mAb controls based on age, sex, race, and asthma diagnosis. The primary outcome was rate of FESS, with secondary outcomes including inpatient admission, emergency department (ED) visit, and incidence of acute sinusitis. Subgroup analysis was performed for patients with AFRS. All mAbs decreased FESS risk (dupilumab, ARR 11.48%, 95% CI 9.82%-13.15%, p < 0.001; omalizumab, ARR 12.02%, 95% CI 4.36%-19.68%, p = 0.002; mepolizumab, ARR 10.32%, 95% CI 5.24%-15.40%, p < 0.001) in CRSwNP patients. Only dupilumab also reduced risk of inpatient admission (ARR 8.59%, 95% CI 7.04%-10.15%, p < 0.001), ED visit (ARR 5.94%, 95% CI 4.28%-7.61%, p < 0.001), and acute sinusitis (ARR 2.60%, 95% CI 1.09%-4.12%, p = 0.001). In AFRS patients, only dupilumab reduced the risk of all outcomes: FESS (ARR 6.97%, 95 CI 2.86%-11.09%, p = 0.001), inpatient admission (ARR 16.93%, 95% CI 11.30%-22.57%, p < 0.001), ED visit (ARR 13.15%, 95% CI 7.15%-19.14%, p < 0.001), and acute sinusitis (ARR 7.17%, 95% CI 2.18%-12.17%, p = 0.005). Although all mAbs reduced FESS risk in CRSwNP, only dupilumab reduced secondary outcomes as well. Similarly, only dupilumab improved all outcomes in AFRS patients. These data demonstrate the potential of mAbs in reducing disease burden and enhancing patient outcomes in CRSwNP and AFRS. NA Laryngoscope, 2024.

Prevalence of pneumatisation patterns of Onodi cells among the North-East Indian population

BackgroundThe posterior ethmoid sinuses have a complex anatomy and a highly variable normal structure. The posterior ethmoid Onodi cell needs careful assessment because of its proximity to the optic nerve and the internal carotid artery canal. Recognising the distinctions is essential for optimal pre-op preparation. Sphenoid sinus surgery can now be performed without worrying about compromising vital structures like the internal carotid artery or optic nerve. Preoperative radiological assessment is a quick and easy way to check for ethmoid cell pneumatisation differences.Aim and objectivesTo determine the pneumatisation patterns of Onodi cells among the North-East Indian population using 16-slice multidetector computed tomography (MDCT).ResultsNine-hundred MDCT paranasal sinuses were analysed over a period of 0–2 years, out of which 220 cases showed the presence of Onodi cell. Type I were 89 cases (40.45%, CI 32.00–48.90), Type II were 128 cases (58.18%, CI 49.72–66.63), and 3 cases with Type III cell (1.36%, CI 0.18–2.54).ConclusionThe most prevalent pneumatisation pattern is Type II. The pneumatisation patterns of Onodi cells can be best detected and evaluated by multiplanar MDCT imaging. Sinus surgeons need a firm grasp of pneumatisation patterns to avoid damaging the optic nerve and internal carotid artery canal during operations.

Treatment outcome of modified endoscopic assisted sinus surgery for treating maxillary sinus diseases with three dimensional volumetric analysis

This retrospective study aimed to analyze volumetric changes of the maxillary sinus after modified endoscopic-assisted sinus surgery (MESS) and to assess short-term treatment outcomes. The volumes of the total maxillary sinus, aeration, and sinus pathology were calculated using computed tomography data obtained prior to surgery and six months after surgery. Postoperative radiological improvement was assessed using the Lund–Mackay score. Bone regeneration around the bony window was evaluated during plate removal. A total of 32 patients were evaluated. Compared with before surgery, air and sinus pathology volumes improved significantly (air, increase by 6.0 cm3, p < 0.001; sinus pathology, decrease by 6.4 cm3, p < 0.001). However, there was no statistically significant change in the total maxillary sinus volume after surgery. The preoperative Lund–Mackay score was 2.9, decreasing to 0.4 six months after surgery (p < 0.001). The only predictors of postoperative aeration rate and Lund–Mackay score were preoperative sinus pathology volume (p = 0.049) and Lund–Mackay score (p = 0.015), respectively. The continuity between the bony window and surrounding sinus wall was restored in all patients. The results of this study suggest that MESS can be a successful, effective, and minimally invasive surgical treatment option for treating maxillary sinus diseases.

Efficacy of Fat and Perifascial Areolar Tissue Graft in Refractory Esotropia: A Case Report

Purpose: This case report presents a novel approach for the management of refractory esotropia using adhesiolysis and fat and perifascial areolar tissue (PAT) transplantation.Case summary: A 62-year-old male presented with left eye strabismus fixus following iatrogenic medial rectus (MR) muscle injury and medial orbital wall fracture during endoscopic sinus surgery. One month later, he underwent MR laceration repair and orbital wall reconstruction. Despite three subsequent interventions for exotropia and its subsequent conversion to esotropia, the left eye esodeviation progressively worsened, culminating in strabismus fixus. Initial examination revealed significant left eye esotropia with fixed gaze and 5-mm enophthalmos. Surgery included implant removal, adhesiolysis between the eyeball and surrounding tissues, scar and MR recession, and placement of a fat and PAT graft on the medial aspect of the eyeball to prevent postoperative re-adhesion. Three years of follow-up demonstrated sustained orthophoria in primary gaze with improved extraocular muscle function and enophthalmos.Conclusions: Fat and PAT graft has potential in oculoplastics for preventing re-adhesion and augmenting orbital volume in patients with refractory restrictive strabismus due to multiple surgeries.

Unmasking colorectal cancer: A high-performance semantic network for polyp and surgical instrument segmentation

Colorectal cancer (CRC) remains a significant health concern, with colonoscopy serving as the gold standard for diagnosis. Accurately segmenting polyps from colonoscopy images is crucial for detecting polyps and preventing CRC. However, challenges such as varying polyp sizes, blurred edges, and uneven brightness hinder segmentation accuracy. Leveraging artificial intelligence (AI) and robot-assisted surgery mechanisms can aid surgeons and physicians in detecting and treating polyps. To address these challenges, we propose a Colorectal Network (CR-Net), an AI-based encoder-decoder network for precise polyp and surgical instrument segmentation. CR-Net incorporates a pre-trained Visual Geometry Group model with 16 convolution layers (VGG16), attention mechanisms, redesigned skip connections, and horizontal dense connections within a U-Net architecture. The VGG16 encoder captures robust visual features, while redesigned skip connections accommodate complex data dimensions, leading to enhanced segmentation outcomes. Horizontal dense connections transfer overlooked features from the encoder to subsequent layers, further improving segmentation accuracy. Additionally, a spatial attention block enhances spatial features and ensures compatibility during upsampling. Evaluation of datasets including the Kvasir segmentation (Kvasir-SEG) dataset, Computer Vision Center Clinic Database (CVC-ClinicDB), Kvasir-Instrument dataset, and University of Washington Sinus Surgery Live (UW-Sinus-Surgery-Live) dataset demonstrates CR-Net's superior performance, achieving Dice Similarity Coefficients of 96.21%, 96.54%, 96.32%, and 92.84%, respectively, surpassing previous methods. These results highlight CR-Net's potential in empowering healthcare professionals through advanced AI-driven engineering applications. By bridging AI techniques with engineering innovations, CR-Net represents a significant advancement in CRC diagnosis and treatment.

Prevalence of concha bullosa in a pediatric population

ObjectiveExisting literature on the prevalence of middle turbinate pneumatization, or concha bullosa (CB), in the pediatric population is limited. CB is an anatomic variant important to identify prior to sinonasal surgery and is often associated with congenital nasal septal deviation (SD). This paper aims to describe the prevalence of CB in the pediatric population on head imaging. MethodsA retrospective chart review was performed for 695 children undergoing CT head for trauma from 2021 to 2022. Nearly equal numbers of males and females were evaluated, with at least 19–20 per year from 0.5 to 18 years. Patients with significant facial fractures, sinusitis, craniofacial syndromes, prior sinus surgery, and sinonasal masses were excluded. Two pediatric neuroradiologists evaluated the CTs. CB was defined as aeration >50 % of the vertical height of the middle turbinate. ResultsIn this study, 384 patients were included. The prevalence of CB was 153 (39.8 %), which was significantly higher in children >4 years (p < 0.0001). Lamellar type CB was the most common, present in 160 out of 768 middle turbinates assessed (20.8 %). SD occurred in 60 (39.2 %) patients with CB and was more commonly contralateral to the CB. ConclusionsThe prevalence of CB in the pediatric population is at the lower range of what is reported in the adult literature. The most common type of CB in patients is lamellar. Similar to previous studies, there is an association between CB and contralateral SD. Finally, there is a positive correlation between the severity of CB and the severity of SD.

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.

Assessing adequacy of surgical extent in CRSwNP: The Completion of Surgery Index.

Endoscopic sinus surgery (ESS) maximized for topical steroid irrigations is highly effective for polyp disease. As extent and completeness of ESS varies widely by situation and practitioner, it is important to understand when revision surgery is appropriate, particularly in the era of biologic treatments. A Completion of Surgery Index (CoSI) was developed to assess operative changes in polyp patients using pre- and postoperative computed tomography scans. The CoSI was then applied and tested in a cohort of consecutive chronic rhinosinusitis with nasal polyps (CRSwNP) patients, and examined within the context of quality-of-life improvements. The CoSI assesses surgical extent on a scale of 0-100, with 100 representing the highest possible degree of surgical completeness. Among 100 consecutive CRSwNP patients undergoing ESS in 2021 with postoperative topical steroid irrigations, including 75 revision surgeries, SNOT-22 scores improved at 6months postoperatively, with durable and consistent improvement at 24months (p<0.001). Preoperative CoSI scores in revision surgery patients were 49.4±26.0, improving to 91.0±8.1 postoperatively. SNOT-22 scores for primary ESS patients and patients with a preoperative CoSI score of less than 70 improved by 26.4 and 28.1 points, respectively, in contrast to patients with a preoperative CoSI of 70 or greater (14.1 points, p=0.029). It is important to define extent of surgery in CRSwNP to stratify postsurgical patients based on likelihood to benefit from revision surgery or alternative medications. The CoSI can be utilized to identify patients who are likely to improve significantly with revision surgical intervention.

Predictive model for postoperative unrecovered olfactory function in CRSwNP patients with olfactory disorder.

Olfactory disorder (OD) is a prevalent and challenging symptom in chronic rhinosinusitis with nasal polyps (CRSwNP). This study aims to investigate the risk factors and develop a predictive model for poor olfactory prognosis in CRSwNP patients with OD after endoscopic sinus surgery (ESS). Seventy-eight CRSwNP patients with OD who underwent ESS were enrolled. Preoperative and 6-month-postoperative olfactory function were assessed using Sniffin' Sticks. Receiver operating characteristics (ROC) curves were constructed to set the cutoff points. Risk factors were determined by logistic models. A power analysis was conducted to evaluate the sample size. Overall, 66.7% of CRSwNP patients had unrecovered olfaction after surgery. Patients with unrecovered olfaction displayed higher preoperative threshold-discrimination-identification (TDI) score, lower Questionnaire for Olfactory Disorders-Negative Statements (QOD-NS) score, lower total olfactory cleft score (TOCS), and fewer tissue eosinophils than those of the improved/recovered group. QOD-NS≤5.0, preoperative TOCS≤4.5 and tissue eosinophil count≤8.3 were independent risk factors for unrecovered olfaction. Based on these variables, a predictive model was developed. The area under the ROC curve for the model was 0.845, and the optimal cutoff value was 2.0 points, with a sensitivity of 82.7% and specificity of 80.8%. Low levels of QOD-NS score (preoperative), TOCS (preoperative) and tissue eosinophil count are independent risk factors for short-term unrecovered olfaction in CRS patients with OD postoperatively. The predictive model developed here is practical and convenient for the early identification of poor prognosis of OD, enabling early additional intervention.

ОПЕРАЦИЯ СИНУС-ЛИФТИНГА: ФАКТОРЫ РИСКА ПЕРФОРАЦИИ МЕМБРАНЫ ШНЕЙДЕРА

The number of patients of middle and old age with loss of teeth continues to increase despite the advances in preventive dentistry. The prosthesis on implants is the most predictable rehabilitation method for the patients with various defects in dental rows. This paper presents a modern look at possible risk factors for Schneiderian membrane perforation connected not only to open sinus lifting techniques, but also to anatomical peculiarities of the facial scull bones which shall be taken into account when planning dental implantation in the posterior region of the maxilla.

Extent of Endoscopic Sinus Surgery in Chronic Rhinosinusitis: A Systematic Review and Meta-Analysis.

There is an incomplete understanding regarding the extent of endoscopic sinus surgery (ESS) in managing chronic rhinosinusitis (CRS) and its effect on outcomes. This study aimed to assess and compare limited sinus surgery, full-house, extended and radical ESS for optimizing CRS outcomes. An online search in adherence with PRISMA guidelines was performed. Data were pooled for meta-analysis. Forty-six articles met inclusion criteria. Full-house ESS yielded greater improvements in SNOT-22 and endoscopy scores over limited ESS. Radical ESS improved nasal symptoms and reduced disease recurrence more than full house ESS, while extended ESS decreased revision ESS rates when compared to full-house ESS. Total ethmoidectomy reduced SNOT-22 scores more than limited ethmoidectomy. There was no difference in perioperative complications for all extents of ESS. When compared to limited ESS, full-house ESS yielded better patient symptom outcomes. Radical ESS demonstrated even greater reductions in nasal symptoms, while extended ESS additionally decreased revision surgery rates. Thus, in general, greater extent of ESS leads to better outcomes, while all extents of ESS are relatively safe.

Contemporary Trends in Frontal Sinus Balloon Sinuplasty: A Pilot Study

Introduction Balloon sinuplasty (BSP) is a common treatment modality used in the management of chronic rhinosinusitis (CRS). Although it has gained popularity, minimal self-reported data on its utilization and complications have been reported. The goal of this study was to describe current practices and complications experienced during frontal sinus BSP. Methods An anonymous 20-question online survey was distributed to members of the American Osteopathic Colleges of Ophthalmology and Otolaryngology-Head and Neck Surgery from August 1, 2022, to August 30, 2022. The questions were listed as multiple choice or percentage sliding bars, and data were collected using a commercial online survey service site. Results were reported as frequencies, means, and percentages. Results Forty-two respondents participated in the survey, with the majority practicing in the following hospital settings: community (34, 80.95%), hybrid (5, 11.90%), and academic (3, 7.14%). The southeast had the largest proportion of respondents (13, 30.95%), versus the midwest (12, 28.57%), southwest (10, 23.81%), northeast (5, 11.90%), and northwest (2, 4.76%). On average, 50.52% of cases were performed in the hospital setting, 48.50% in-office, and 42.40% in surgery centers. Respondents who primarily used BSP, reported a yearly average of 35.72 cases, a median of 12 cases, and a range of 0-361 cases. Respondents who used BSP with functional endoscopic sinus surgery (FESS), reported a yearly average of 48.62 cases, a median of 31 cases, and a range of 0-189 cases. Nasal packing was utilized both intraoperatively (11.72%) and postoperatively (3.62%). Early complications included postoperative headaches (9.86%), acute bacterial sinusitis (ABRS) (3.52%), and tooth/facial numbness (0.86%). Reported long-term complications included postoperative synechiae (5.10%), orbital complications (0.14%), and skull base complications (0.10%). A previously unreported complication was identified through this study, accidental sphenopalatine fossa dilation. Conclusions This study contributes to the growing body of literature on frontal sinus BSP by characterizing utilization and complications from a large otolaryngologic academy.

Endoscopic Integrated Multipoint Laser System to Perform Quantitative Measurements for Anterior Skull Base Defects.

Measurements in endoscopic sinus surgery (ESS) are usually obtained with variable accuracy. We aimed to validate endoscopic multipoint integrated laser systems (EIMLS) for use in ESS, which can acquire measurements within one-hundredth of a millimetre. A 4.4 mm flexible endoscopic EIMLS projecting 49 laser points into the view was used to assess simulated anterior skullbase defects. Antero-posterior and lateral measurements were obtained and repeated 20 times by two surgeons. These were compared to measurements with surgical callipers. Intra and inter-observer reliability was assessed. Eighty measurements were obtained of simulated skullbase defects by each otolaryngology surgeon and compared to manual measurements. The mean difference shown was 0.56 cm. Bland-Altman plot shows low bias (0.044) but wide 95% limits of agreement (-1.8-1.9). EIMLS allows reliable and easy to obtain measurements within a simulated ESS environment. Translation of this technology offers promise in a future clinical setting but will require further refinement to improve accuracy.

Cholesterol granuloma of the maxillary sinus: a case report

BackgroundCholesterol granuloma is not a common entity in the paranasal sinuses. It is a foreign body reaction to the cholesterol crystal deposition. Mostly associated with chronic middle ear diseases.Case presentationThis article reports a case of cholesterol granuloma in the maxillary sinus. A 23-year-old Asian man presented with cough, nasal obstruction, and postnasal discharge. On endoscopy, there was a mass protruding from the right maxillary ostium. On computed tomograpy imaging, there was a polypoidal mass in the right maxillary sinus. Endoscopic sinus surgery was performed, the cholesterol granuloma was removed from the right maxillary sinus, and the tissue was submitted for histopathological examination, which showed foreign body giant cell reaction to cholesterol crystals.ConclusionCholesterol granuloma of maxillary sinus is not common and often missed by clinicians. It is necessary to consider the cholesterol granuloma of maxillary sinus in the differential diagnosis sinonasal lesions. Histopathological analysis is required for confirmation and should be removed surgically. This case may help as a reference for clinician to approach these kinds of cases.

Utility of Navigation Technology in Functional Endoscopic Sinus Surgery

Utility of Navigation Technology in Functional Endoscopic Sinus Surgery