Sinus Surgery Research Articles

Three-dimensional morphometric and volumetric analysis of maxillary sinuses.

The maxillary sinus is a pyramid-shaped cavity with varying shapes, sizes, and capacities. Its dimensions grow gradually and develop until early adulthood. Anatomical knowledge of the maxillary sinus is essential to understanding sinonasal disorders, planning surgical procedures and preventing complications. Awareness of the sinus's proximity to critical structures helps avoid injuries during surgery. The European, Korean, and Sri Lankan population study parameters show varying results and do not necessarily apply to the Indian population. The standard morphometric data of the maxillary sinus is scanty in the Indian population. The study aimed to determine the volume and morphometry of the maxillary sinus along with gender differences in the Eastern population of the Indian. A retrospective cross-sectional study was conducted using cone beam computed tomography data of maxillary sinuses of 100 normal individuals. The data were analysed after the three-dimensional reconstruction of digital imaging and communications in medicine (DICOM) images with the help of DICOM to print and Geomagic freeform software in the Anatomy department. The different linear morphometric variables and volume of the maxillary sinus were studied. SPSS version 27.0. was utilised for statistical analyses. The mean values of Antero-posterior diameter, Transverse diameter, Craniocaudal diameters, the height of ostium from the floor and volume of the maxillary sinus in males on the right side are 36.61 mm, 20.7 mm, 40.31 mm, 26.02 mm and 16055.24 mm³ and on the left side are 37.17 mm, 20.17 mm, 40.73 mm, 26.91 mm and 15712.66 mm³ whereas in females the values on the right side are 38.10 mm, 21.56 mm, 38.96 mm, 25.81 mm and 14687.78 mm³ and on left side are 38.23 mm, 21.53 mm, 38.48 mm, 25.28 mm and 14203.13 mm3 respectively. The side-to-side parameter differences were non-significant within the male and female groups, respectively. The females had significantly (p < 0.05) larger transverse diameters than males in both the right and left maxillary sinuses. The males tend to have a slightly larger mean craniocaudal diameter than females, but the difference was found statistically significant (p < 0.05) only in the left maxillary sinus. The gender differentiation based on the measured parameters of bilateral maxillary sinus accuracy rate was 89.4% in males and 61.8% in females. These parameters serve as a standard or reference point, allowing radiologists and surgeons to compare individual patient scans to population averages and aid in better clinical outcomes. The mean values of different parameters of the maxillary sinus may be utilised to differentiate various suspected sinus pathologies, which is helpful for functional endoscopic sinus surgery. Gender differentiation can be done more accurately by forensic experts using Maxillary sinus transverse diameter bilaterally, followed by craniocaudal diameter of the left side sinus for predicting the gender of an unknown maxilla.

Impact of elexacaftor/tezacaftor/ivacaftor CFTR modulator therapy on rates of endoscopic sinus surgery in cystic fibrosis.

Elexacaftor/tezacaftor/ivacaftor (ETI), a combination cystic fibrosis transmembrane receptor (CFTR) modulator, has demonstrated improved pulmonary outcomes in individuals with cystic fibrosis (CF). However, ETI's impact on functional endoscopic sinus surgery (FESS) remains unclear. The TriNetX Analytics Research Network, consisting of 120 million global de-identified electronic medical records, was queried from 2012 to 2023 for subjects with CF who underwent sinus surgery.1 Patients on ETI prior to FESS (n=6,056) were propensity score matched to control individuals with CF not on CFTR modulators (n=37,906) and those on other FDA-approved CFTR modulators (tezacaftor/ivacaftor, lumacaftor/ivacaftor, and ivacaftor) (n=2437) based on relevant factors. The primary outcome was the absolute risk reduction (ARR) of undergoing FESS. Secondary outcomes included ARR of CF-related pulmonary exacerbations and hospital admission from 0 to 6, 6 to 12, and 12 to 24 months following FESS. ETI use demonstrated a significant ARR for FESS when compared to CF patients not on CFTR modulators (2.12%; 95% confidence interval [CI] 1.5-2.75; p-value<0.0001) and those on other CFTR modulators (4.7%; 95% CI 3.54-5.85; p-value<0.0001). No significant differences occurred in secondary outcomes between ETI and non-CFTR modulator groups, except for reduced CF-related pulmonary exacerbations from 0 to 6 months post-FESS. Additionally, a significant reduction in pulmonary exacerbations was observed at all time points and hospital admissions within 6 months following FESS compared to those using other CFTR modulators. In a large dataset, CF patients on ETI demonstrated significantly reduced risk of FESS, pulmonary exacerbations, and hospital admission compared to patients not on CFTR modulators or those on other CFTR modulators, suggesting improved sinonasal disease and overall health status in CF.

Comparative Study between Dexmedetomidine and Nitroglycerin as a Hypotensive Agent and Their Effects on Bleeding in Functional Endoscopic Sinus Surgery

Abstract Background Rhino-sinusitis is commonly treated with FESS. However, there can be serious complications associated with this procedure during peri-operative period like orbital cellulitis, optic nerve injuries, meningitis, etc. Their incidence increases with excessive bleeding during surgery. So Controlled hypotension is used reducing arterial blood pressure 30-40% below its normal range. Objective Primary aim: Comparing Dexmedetomidine and Nitroglycerine for inducing controlled hypotension in patients undergoing FESS with recording total intraoperative fentanyl consumption and recording of total local vasoconstrictor used by the surgeon. Secondary aim: Assessment of time to full recovery after extubation with recording of time to first analgesic used after recovery and its total dose for the first 24 hours. Materials and Methods In this study we compare Demedetomidine and Nitroglycerine in achieving hypotensive anaesthesia. The study is conducted in Anesthesiology Department, Faculty of medicine, Ain shams University. The study period is 6 months. The sample size is 50 patients divided in two groups randomly (Group I and Group II). Each group has 25 patients. Group I received Demedetomidine. Group II received Nitroglycerine. Results we find that the mean HR was significantly lower in Group I compared to Group II at all the times of measurements. The MAP was significantly lower in Group I compared to Group II after infusion of study drugs, after induction of anesthesia, after intubation and 5 min after intubation. However, the desired MAP for intra-operative induced hypotension could be achieved in all the two groups. Also we find that intra-operative Fentanyl requirement is significantly reduced in the Dexmedetomidine group as compared to the other group. The patients in group I had a longer time to full recovery. We also observe a significant delay in the first postoperative analgesic request in group I as compared to group II. It has been shown that perioperative analgesic requirements are significantly reduced with intra-operative use of Dexmedetomidine infusion. The patients in the Dexmedetomidine group had significantly higher sedation scores compared to group II. The incidence of postoperative shivering was significantly lower in the Dexmedetomidine group. The most frequent reported side-effect with Dexmedetomidine is dry mouth, which can be easily managed. Conclusion Dexmedetomidine provided better hemodynamic stability and comparable operative field visibility to nitroglycerine during FESS. Dexmedetomidine provides an additional benefit of reducing the analgesic requirements and providing postoperative sedation.

The benefit of dupilumab as a postoperative short-term adjuvant therapy for chronic rhinosinusitis with nasal polyps: A preliminary study.

Recent evidence recommends the use of biologics in patients with severe uncontrolled type 2 chronic rhinosinusitis with nasal polyp (CRSwNP) owing to its propensity for recurrence after functional endoscopic sinus surgery (FESS). Among the type 2 biologics used for the treatment of nasal polyps, dupilumab (Dupi, anti-IL-4) exhibited superior efficacy and safety in indirect comparison studies. This study aimed to evaluate the objective and subjective outcomes of patients with CRSwNP treated with and without adjuvant Dupi therapy after FESS. Adult patients with type 2 CRSwNP who underwent FESS with adjuvant Dupi after surgery were enrolled. A matched control group without adjuvant Dupi therapy were recruited during the same period. All patients underwent nasal endoscopy and completed the sinonasal outcome test-22 questionnaire evaluations at baseline and 3 months after surgery. A total of 10 patients who received postoperative adjuvant therapy with Dupi and 20 patients who underwent surgery only were included. Patients with add-on Dupi therapy had significantly higher eosinophil cationic protein levels in the serum, eosinophil counts in peripheral blood, prevalence of asthma, and nasal polyp score at baseline. Both treatments were effective in reducing the patient's symptoms by SNOT-22 at 3 months postoperatively. However, patients with adjuvant Dupi therapy exhibited significantly better endoscopic scores than those with surgery only (p = .022). Surgery plays an important role in treating patients with CRSwNP, and adjuvant Dupi use may facilitate objective mucosal recovery postoperatively. 4.

The Outcome of Endoscopic Sinus Surgery for Orbital Apex Syndrome Secondary to Sinusitis in a Tertiary Care Center-Our Experience Over 10 Years.

Orbital apex syndrome (OAS) is a rare condition with multiple cranial nerve involvement caused by varied etiologies. It is not only a threat to the patient's vision but also life-threatening due to the intracranial spread of infection, if not diagnosed early and treated accurately. To study the outcome of endoscopic sinus surgery (ESS) for OAS secondary to sinusitis concerning resolution of ptosis, improvement of ophthalmoplegia, visual prognosis, intracranial spread of infection, and mortality. A retrospective review of patients with OAS secondary to sinusitis who underwent ESS from 2011 to 2021 was tabulated and analyzed. Twenty-seven patients (mean age: 55.11+/-16 years; male 62%) were included in this study. At presentation, blurring of vision (81%), headache (66%), diplopia (63%) ptosis (63%) were the most common symptoms, and ophthalmoplegia (100%) was the most common sign. Five patients had no perception of light and the rest had various degrees of vision impairment. The most common etiopathology of sinusitis was fungal sinusitis (12 mucormycosis and four aspergillus). The final visual prognosis at three months follow-up post-ESS showed vision stabilization (no improvement or worsening) in 13 (48%) patients, improvement in seven (26%) patients, and vision deterioration in two (7%) patients. There was a significant improvement in ptosis (70%) and ophthalmoplegia (85%). There was no intracranial spread of infection or recurrence with a mortality rate of 3.7% (one patient). ESS coupled with appropriate antimicrobials effectively treats OAS secondary to sinusitis with decreased morbidity and mortality.

Use of Dexmedetomidine versus Nitroglycerine to Provide Hypotensive Anesthesia in ENT Surgeries (Functional Endoscopic Sinus Surgery)

Abstract Background controlled (deliberate/induced) hypotension is a technique by which the arterial blood pressure is lowered in a controllable manner to reduce surgical blood loss and improve the operative field visibility. There are pharmacological and nonpharmacological techniques for inducing hypotension. The nonpharmacological methods for deliberate hypotension include positioning and positive pressure ventilation to control venous return. Aim of the Work to evaluate the efficacy of dexmedetomidine (DEX) as a hypotensive agent in comparison to nitroglycerin (NTG) in FESS regarding the bloodless field, reduction of mean arterial blood pressure, decrease inhalational anesthetic requirements (MAC), decrease perioperative opioid requirements, increase the time to first postoperative analgesic request and recovery profile and increase hemodynamics stability. Patients and Methods we conducted this study on 20 patients who were planned to perform functional endoscopic sinus surgery and were randomly distributed into 2 equal groups: 10 patients received dexamedotomidine and equal number of patients received nitroglycerine. Serial measurements of mean arterial blood pressure and heart rate were obtained and records between both groups were compared. Results There were statistically significant differences between both groups regarding heart rate as mean values of heart rate were lower among dexamedotomidine group. There were no statistically significant differences between both groups regarding mean arterial blood pressure values at different time points during the operation. Regarding the period after stopping infusion, mean values of heart rate and blood pressure were lower among dexamedotomidine group than nitroglycerine group after 5 minutes and after 10 minutes and the differences had statistically significant differences. Regarding postoperative period, both groups were comparable regarding heart rate and blood pressure immediately postoperative. Conclusion From the results of this study, we could conclude that both Dexmedetomidine and Nitroglycerin can be effectively used in induced hypotensive anesthesia for ENT surgery as FESS. Both groups were comparable with intra operative MAP with no statistically significant differences. This study also show that Dexmedetomidine has added advantages as better haemodynamic stability than Nitroglycerin (No rebound HTN, no tachycardia). Has sedative and analgesic effect, reduce requirement of anesthetic agents and perioperative analgesia. Postoperative recovery score (Time to reach modified Aldert score more than nine significantly higher. Postoperative complication as nausea and vomiting is less.

The role of revision sinus surgery in the initiation of dupilumab therapy: A real-world study of molecular and cellular features.

A persistent type 2 endotype signature exists in recalcitrant chronic rhinosinusitis with nasal polyps mucosa on dupilumab. Revision sinus surgery immediately prior to dupilumab reduces long-term interleukin (IL)-4/IL-13 tissue mRNA. Pre-dupilumab revision surgery is associated with reduced tissue eosinophils and GATA-3+ cells.

A study on neutrophilic versus eosinophilic predominance in chronic rhinosinusitis patients

Background: Rhinosinusitis is defined as a multifactorial disorder with persistence of symptoms caused by inflammation of the sinonasal mucosa for 12 or more weeks with confirmation by diagnostic nasal endoscopy and computed tomography. The main aim of this study is to analyze the neutrophilic or eosinophilic predominance among CRS patients with histopathological examination for appropriate management, and to understand the association between the endotypes of CRS and blood parameters. Materials and methods: A prospective cohort study was conducted on 137 patients over a period of two years at a tertiary centre. Diagnostic nasal endoscopy (DNE), computed tomography of the nose and paranasal sinus (CT PNS), complete haemogram (CBC), absolute eosinophil count (AEC), erythrocyte sedimentation rate (ESR), immunoglobulin E(IgE) was done. Patients were planned for functional endoscopic sinus surgery (FESS) and specimen was sent for histopathological examination. Results: The comparison between DNE and AEC groups showed statistical significance and so did the comparison between CT and IgE. When we compared the groups of CRS with and without polyps with DNE and CT, there was no statistical significance. Also 64.2% of patients had an eosinophilic predominance. Conclusion: It has also been reported that CRS are highly eosinophilic, also have substantial levels of neutrophils. Importantly, tissue neutrophilia has been associated with a poor response to corticosteroid therapy in patients with CRS with nasal polyps. Keywords: nasal polyp; eosinophils; neutrophils; sinusitis; allergy; asthma; inflammation

Evaluation of ultrasound-guided suprazygomatic maxillary nerve block in functional endoscopic sinus surgery for postoperative pain relief: A randomised controlled trial.

Postoperative pain can impede functional recovery and delay hospital discharge after functional endoscopic sinus surgery (FESS). The study aimed to assess the efficacy of ultrasound (USG)-guided suprazygomatic maxillary nerve block (SZMNB) for postoperative pain in FESS. Forty-eight adult patients between 18 and 65 years of age with American Society of Anesthesiologists physical status I and II and scheduled to undergo FESS were enroled in this randomised controlled study. Patients were randomly allocated to either receive USG-guided SZMNB with general anaesthesia (n = 24) or general anaesthesia alone (n = 24). The numerical rating scale (NRS) pain score in the immediate postoperative period was recorded as the primary outcome. A total of 24 h postoperative rescue analgesic consumption, surgeon satisfaction score, postoperative haemodynamics, and postoperative complications were noted as secondary outcomes. The median (interquartile range) of the NRS pain score in the immediate postoperative period was 0 (0-0.25)[95% confidence interval (CI): 0, 0.08] in the block group compared to 2 (1.75-3) [95% CI: 1.60, 2.40] in the control group, P < 0.001]. Pain scores were significantly reduced at all time intervals till 24 h after surgery (P < 0.001). None of the patients required rescue analgesia in the block group. In contrast, eight patients required diclofenac 75 mg intravenous as rescue analgesia within 1 h of surgery and ten patients within 1-6 h of surgery in the control group. Other secondary outcomes were comparable between groups (P > 0.05). The USG-guided SZMNB provides excellent postoperative analgesia for patients undergoing FESS without significant side effects.

Anatomical Measurement as a Reference for Functional Endoscopic Sinus Surgery Based on CT Scans and Dissections.

Introduction Diseases of the paranasal sinuses, nasal cavities, and those related to the skull base can be treated with nasal endoscopic surgery. Anatomical references are essential to safely perform these surgeries. Objective To measure and compare the distance from the posterior wall of the maxillary sinus to the anterior skull base in cadavers and on computed tomography (CT) scans to determine a measurement as an anatomical reference in imaging exams for sinus and anterior skull base surgery. Methods In dissections and CT scans, we took measurements from the most upper and medial point of the posterior wall of the maxillary sinus (point A) to the point where the skull base deflects and the anterior sphenoid wall is formed (Δ 90°; point B), in the right and left nasal cavities. We used 51 cadavers aged ≥ 18 years in the present research. Results The measurements obtained from CT scans and dissections were greater than 1.5 cm in all cadavers, and they were positively correlated. The 1-cm increase in the AB-tomography measurement corresponded to the 1.08-cm increase to the right and 1.07-cm to the left in the AB-dissection measurement. Conclusion The CT measurements may be considered a reliable tool to promote safe and effective access to the paranasal sinuses, matching the distance that should be dissected until the anterior base of the skull.

Efficiency of Different Approaches in Functional Endoscopic Sinus Surgery for Chronic Rhinosinusitis: A Comparative Study

ABSTRACT Objective: Current research compared traditional FESS, balloon sinuplasty, and powered instruments for CRS efficiency. Methods: A prospective comparison analysis of 150 CRS patients who received FESS. The surgical method divided the patients into three groups: Group A (conventional FESS, n = 50), Group B (balloon sinuplasty, n = 50), and Group C (powered instrumentation, n = 50). Primary outcome measures included symptom alleviation, measured preoperatively and six months postoperatively using the “22-item Sino-Nasal Outcome Test (SNOT-22)”. Preoperative and six-month postoperative “Short Form 36 (SF-36)” Health Surveys assessed postoperative complications and the quality of life. Results: Balloon sinuplasty relieved symptoms better than FESS and powered instrumentation. Mean SNOT-22 scores reduced by 62.1% in the balloon sinuplasty group, much higher than the standard FESS and powered instrumentation groups (49.1% and 45.8%, respectively) (P &lt; 0.001). Balloon sinuplasty had fewer postoperative problems than FESS and powered instrumentation, including bleeding, infection, and synechia. Conclusion: Balloon sinuplasty treats CRS better than FESS and powered instrumentation and has fewer postoperative sequelae. These data imply that balloon sinuplasty may be a preferred FESS surgical strategy for CRS, but patient-specific characteristics and disease severity must be considered. Current findings need to be confirmed by larger studies with longer follow-up periods to determine the best FESS surgical strategy for CRS.

Dupilumab as an emerging treatment for refractory allergic fungal rhinosinusitis: a case series and literature review

Background: Allergic Fungal Rhinosinusitis (AFRS) is a chronic, inflammatory, non-invasive fungal disease of the nose, sinuses, and paranasal sinuses. Dupilumab is an emerging biological therapy with promising outcomes in the treatment of patients with refractory AFRS. In this case series, we aimed to assess the effectiveness and safety of dupilumab in the treatment of refractory AFRS. Case description: Our case series included seven patients, all of whom met the inclusion criteria. Of these, four were male (57.1%) and three were female (42.9%). The ages of the patients ranged from 20 to 44 years, with a mean of 30.4. For post-treatment Sinonasal Outcome Test-22 (SNOT-22) scores, six patients (85.7%) reported improvement by one category (two from severe to moderate and four from moderate to mild). Only one patient (14.2%) reported an improvement by two categories (severe to mild). Post-treatment IgE levels ranged from 39 to 590 IU/mL, with a mean of 301.8 IU/mL. There was a significant decrease in the mean IgE level by 93% after dupilumab administration. The average number of surgeries in the included patients ranged from 2 to 4, with a mean of 2.7 surgeries. Post-treatment, none of the patients required revision surgery or steroids after three months of dupilumab therapy. Conclusions: Dupilumab is an emerging biological therapy with promising benefits in the treatment of refractory AFRS. It can be used if functional endoscopic sinus surgery and steroid treatment do not improve symptoms.

Assessment of Quality of Life after Functional Endoscopic Sinus Surgery for Chronic Rhinosinusitis

Abstract Background: Chronic rhinosinusitis is the most common otolaryngologic disease that has a great impact on patient’s quality of life. Patients refractory to medical therapy require functional endoscopic sinus surgery (FESS). Aim: To evaluate and compare the disease specific quality of life in patients of chronic rhinosinusitis pre operatively and after FESS using the Sino Nasal Outcome Test 22 (SNOT 22). Patients and Methods: This prospective longitudinal study was conducted on 30 patients with chronic rhinosinusitis. History, clinical, diagnostic sinonasal endoscopy and radiological findings were recorded. For assessing the quality of life, the SNOT-22 questionnaire was used preoperatively and after 1 week, 1 month and 3 months after undergoing FESS. Results: About 43.3% of the patients were males and 56.7% were females. Seventy percentage were between 18 and 30 years. Nasal obstruction was the most common presenting symptom (96.6%), followed by nasal discharge (80%). Diagnostic sinonasal endoscopy and non-contrast computed tomography scan of paranasal sinuses reflected the extent of the disease. The mean pre-operative SNOT-22 score was 40.4 ± 12.06 and a decrease in mean post-operatives scores was observed during their post-operative visits at 1 week (11.77 ± 3.39), 1 month (4.67 ± 2.77) and 3 months (2.47 ± 1.28) which were statistically significant. Conclusion: Chronic rhinosinusitis patient’s refractory to medical treatment showed statistically significant improvement in their quality of life after undergoing FESS.

Modified Nishida procedure in managing medial rectus injury following endoscopic sinus surgery

To report a case of large-angle exotropia with adduction limitation that resulted from medial rectus injury following functional endoscopic sinus surgery and was successfully managed by transposing both vertical recti nasally using modified Nishida procedure combined with lateral rectus recession.

Real-World Evaluation of Asthma Severity Following Endoscopic Sinus Surgery in Chronic Rhinosinusitis Patients.

This study aimed to evaluate the impact of endoscopic sinus surgery (ESS) on asthma severity up to 12 months after surgical intervention. Retrospective cohort. Tertiary care center. Patients with a history of asthma and Chronic Rhinosinusitis (CRS) who underwent ESS between 2013 and 2023 were included. Asthma severity was assessed according to current Global Initiative for Asthma (GINA) guidelines, classifying patients into mild, moderate, and severe based on medication requirements. Asthma severity was evaluated up to 3 months prior to ESS and 1-year post-ESS. Patients with aspirin-exacerbated respiratory disease (AERD) were excluded. Statistical analysis was performed using McNemar test and Wilcoxon signed-rank test to assess differences in asthma severity, medication doses, and number of medications. Sixty-five patients were included, of which 44 (67.7%) had CRS with nasal polyps (CRSwNP) and 21 (32.3%) had CRS without nasal polyps (CRSsNP). No significant differences were found in asthma severity pre- and post-ESS (P = .175). Similarly, no differences were found in ICS doses (P = .999), total number of prescribed medications (P = .157) or presence of exacerbations before and after ESS (P = .078). However, a significant increase in time from last rescue inhaler use was noted after ESS, increasing from a median of 6.71 to 23.1 weeks (P = .004). This study is the first to assess the impact of ESS on asthma severity in a real-world setting. Our findings suggest that ESS does not impact asthma severity classification. However, it might provide relief of asthma symptoms in the early postoperative period.

Development of a Machine Learning-Enabled Virtual Reality Tool for Preoperative Planning of Functional Endoscopic Sinus Surgery.

Objectives Virtual reality (VR) is an increasingly valuable teaching tool, but current simulators are not typically clinically scalable due to their reliance on inefficient manual segmentation. The objective of this project was to leverage a high-throughput and accurate machine learning method to automate data preparation for a patient-specific VR simulator used to explore preoperative sinus anatomy. Methods An endoscopic VR simulator was designed in Unity to enable interactive exploration of sinus anatomy. The Saak transform, a data-efficient machine learning method, was adapted to accurately segment sinus computed tomography (CT) scans using minimal training data, and the resulting data were reconstructed into three-dimensional (3D) patient-specific models that could be explored in the simulator. Results Using minimal training data, the Saak transform-based machine learning method offers accurate soft-tissue segmentation. When explored with an endoscope in the VR simulator, the anatomical models generated by the algorithm accurately capture key sinus structures and showcase patient-specific variability in anatomy. Conclusion By offering an automatic means of preparing VR models from a patient's raw CT scans, this pipeline takes a key step toward clinical scalability. In addition to preoperative planning, this system also enables virtual endoscopy-a tool that is particularly useful in the COVID-19 era. As VR technology inevitably continues to develop, such a foundation will help ensure that future innovations remain clinically accessible.

Effectiveness of Endoscopic Sinus Surgery for Chronic Rhinosinusitis with Nasal Polyps: Follow-Up on Nasal Obstruction and Recurrence Rates

Effectiveness of Endoscopic Sinus Surgery for Chronic Rhinosinusitis with Nasal Polyps: Follow-Up on Nasal Obstruction and Recurrence Rates

Effectiveness of the piezoelectric knife as a tool for nasal beak reduction in patients with chronic rhinosinusitis – a pilot study

&lt;b&gt;&lt;br&gt;Aim:&lt;/b&gt; The aim of this study was to evaluate the safety and efficacy of the piezoelectric knife as a new tool for frontal beak surgery in patients with chronic rhinosinusitis (CRS) both in terms of imaging and perception of symptoms’ outcomes.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Materials and methods:&lt;/b&gt; The study involved 28 patients with CRS who underwent endoscopic sinus surgery (ESS) using a piezoelectric knife in the frontal recess region. Assessment of sinus imaging and patients’ quality of life (QoL) was performed before and after surgery with the Lund-Kennedy and Lund-Mackay systems and the 22-item Sino-Nasal Outcomes Test (SNOT-22).&lt;/br&gt; &lt;b&gt;&lt;br&gt;Results:&lt;/b&gt; Median scores on the Lund-Kennedy and Lund-Mackay systems decreased within 24 weeks after surgery with piezo knife assistance by 4 and 5 points, respectively. QoL improved with SNOT-22 scores decreasing by 35.5 points.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Conclusions:&lt;/b&gt; ESS with the piezoelectric knife used for frontal beak reduction turned out to be a safe procedure. In the studied group of patients, the improvement was observed in terms of imaging, patients’ perceptions of symptoms, and QoL outcomes. Therefore, the piezoelectric knife might be a valuable supporting tool in ESS in patients with CRS, although further observation is needed.&lt;/br&gt;

Factors influencing residual plus moist HS-W calcium alginate packing material after endoscopic sinus surgery

ObjectiveThis study aims to evaluate the presence of residual Plus Moist HS-W (PM), a novel calcium alginate packing material, during the initial postoperative visit following endoscopic sinus surgery. The research aims to identify factors that influence the quantity of remaining PM. MethodsA retrospective review of medical records was conducted for patients who underwent middle meatus packing with PM. ResultsA total of fifty-two patients (representing 92 sides of paranasal sinuses) were included in the analysis. The remaining PM was classified as follows: absent (0) in 41 out of 92 cases, minimal (1) in 22 out of 92 cases, moderate (2) in 15 out of 92 cases, and substantial (3) in 14 out of 92 cases. Notably, all three patients who underwent Draf III surgery exhibited a significant amount of PM during their initial visit, with two patients classified as grade 2 and one patient as grade 3. Other factors investigated were found to be unrelated to the persistence of PM. Removal of all PM was achieved effortlessly using suction under flexible endoscopy. ConclusionThis study highlights the efficacy of PM in post-endoscopic sinus surgery care. It is important to limit an amount of PM, particularly in Draf III procedures.

Diagnostic accuracy of double density sign on CT scan of para-nasal sinuses for fungal sinusitis taking microbiology culture as gold standard.

To compare double-density sign on non-contrast computed tomography scan of paranasal sinuses with fungal sinusitis on histopathology. This prospective study was conducted at the Shifa International Hospital, Islamabad, Pakistan, from July 1, 2021, to June 30, 2023, and comprised patients of either gender aged 20-60 years who were set to undergo functional endoscopic sinus surgery. Demographic characteristics and non-contrast computed tomography scan findings were recorded preoperatively, while microbiological and histopathology results were recorded post-operatively. The microbiological finding was taken as the gold standard. Data was analysed using SPSS 23. Of the 201 patients, 123(61.2%) were males and 78(38.8%) were females. The overall mean age was 41.62±8.52 years. The diagnostic accuracy of a double-density sign on computed tomography scan showed sensitivity 90%, specificity 90.8%, positive predictive value 84%, and negative predictive value 94.4%. A higher rate of sensitivity and specificity indicated that non-contrast computed tomography scan was an effective modality that could be used for the diagnosis of fungal sinusitis.