Endoscopic Sinus Surgery Techniques Research Articles

Stage Surgery on Inverted Papilloma which Invaded Lacrimal Sac, Periorbita, Ethmoid and Frontal Sinus

Inverted papilloma of the nasal cavity and the paranasal sinuses is a benign epithelial tumor with a high rate of recurrence, local aggressiveness, and malignant transformation. For these reasons, inverted papilloma has been treated like malignant tumors with extensive surgical resection. With the help of endoscopic sinus surgery technique, it is now available to treat inverted papilloma with stage surgery without severe complications which usually resulted from extensive one stage resection. We report a case of stage surgery on inverted papilloma which invaded lacrimal sac, periorbita, ethmoid and frontal sinus. (J Clinical Otolaryngol 2016;27:143-147)

Defining appropriateness criteria for endoscopic sinus surgery during management of uncomplicated adult chronic rhinosinusitis: a RAND/UCLA appropriateness study.

Appropriate indications for endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) are currently poorly defined. The lack of clear surgical indications for ESS likely contributes to the large geographic variation in surgical rates and contributes to reduced quality of care. The objective of this study was to define appropriateness criteria for ESS during management of adult patients with uncomplicated CRS. The RAND/UCLA appropriateness methodology was performed. An international, multidisciplinary panel of 10 experts in CRS was formed and completed 2 rounds of a modified Delphi ranking process along with a face-to-face meeting. A total of 624 clinical scenarios were ranked, 312 scenarios each for CRS with and CRS without nasal polyps. For adult patients with uncomplicated CRS with nasal polyps, ESS can be appropriately offered when the CT Lund-Mackay score is ≥ 1 and there has been a minimum trial of a topical intranasal corticosteroid plus a short-course of systemic corticosteroid with a post-treatment total SNOT-22 score ≥ 20. For adult patients with uncomplicated CRS without nasal polyps, ESS can be appropriately offered when the CT Lund-Mackay score is ≥ 1 and there has been a minimum trial of a topical intranasal corticosteroid plus either a short-course of a broad spectrum/culture-directed systemic antibiotic or the use of a prolonged course of systemic low-dose anti-inflammatory antibiotic with a post-treatment total SNOT-22 score ≥ 20. This study has developed and reported of list of appropriateness criteria to offer ESS as a treatment "option" during management of uncomplicated adult CRS. The extent or technique of ESS was not addressed in this study and will depend on surgeon and patient factors. Furthermore, these criteria are the minimal threshold to make ESS a treatment "option" and do not imply that all patients meeting these criteria require surgery. The decision to perform ESS should be made after an informed patient makes a preference-sensitive decision to proceed with surgery. Applying these appropriateness criteria for ESS may optimize patient selection, reduce the incidence of unwarranted surgery, and assist clinicians in providing high-quality, patient-centered care to patients with CRS.

Long-term follow-up after ESS and balloon sinuplasty: Comparison of symptom reduction and patient satisfaction

Conclusion This is the first controlled study of balloon sinuplasty’s long-term efficacy with the follow-up time over 5 years. The results are in accordance with a previous 2-year-follow-up study. Both techniques retained the efficacy and patient satisfaction on average 6 years after the surgery.Background Endoscopic sinus surgery (ESS) and balloon sinuplasty are considered as a treatment for chronic rhinosinusitis (CRS) after a failure of conservative therapy. High cost and lack of long-term follow-up studies restrain the use of balloon sinuplasty.Objective The aim of this study was to compare long-term efficacy and satisfaction in CRS patients who had undergone maxillary sinus operation with either balloon sinuplasty or ESS technique. Previous or additional sinonasal operations were exclusion criteria.Materials and methods Study patients were recruited from 208 CRS-patients who underwent either ESS or balloon sinuplasty. Patients with nasal polyposis (gradus ≥ 2), previous sinonasal surgery, unilateral disease, or immune deficiency were excluded. Altogether 45 patients in the ESS group and 40 patients in the balloon group were included. Of these, 30 and 28, respectively, answered to a phone interview held on average 6 years after primary surgery. Symptom reduction and long-term satisfaction were evaluated by using symptom scores of 19 parameters altogether.Results Both groups experienced improvement in symptoms and were equally satisfied with the operation. The number of patient-reported acute exacerbations was higher among the balloon dilated patients. Also, the reduction of thick nasal discharge was less evident in the balloon sinuplasty group. Four patients in the balloon sinuplasty group underwent revision surgery. There were no revisions in the ESS group.

Vision Loss after Endoscopic Sinus Surgery: A First Case Report Assessed by OCT and VEP

Background: Purpose of this case report is to describe, for the first time in literature assessed by optical coherence tomography (OCT) and visual evoked potentials (VEP), a rare case of partially reversible unilateral vision loss accompanied by retrobulbar optic neuritis symptomatology, after nasal polyps removal using endoscopic sinus surgery (ESS) technique. Case presentation: A 41-year old Greek male developed unilateral vision loss, partially reversible within 72 hours, reduced color vision, superior scotoma and retrobulbar pain on eye movement immediately after recovering from nasal polyp removal with (ESS) technique. He underwent complete ophthalmological examination including optical coherence tomography, fluorescein angiography, visual fields and visual evoked potentials. A magnetic resonance imaging (MRI), neurological examination and laboratory evaluation were also performed revealing no abnormalities. Conclusions: Sinus surgeons and ophthalmologists should be familiar with the possibility of irreversible visual impairment after endoscopic sinus surgery and enhance collaboration for facilitating better recognition and early treatment.

A Case of Frontal Mococele Treated with Transblepharoplasty Approach Combined with Endoscopic Approach

In recent years, endoscopic sinus marsupialization has become the treatment of choice for the treatment of paranasal sinus mucoceles due to its noninvasiveness and successful outcome. However, mucoceles located at the lateral portion of the frontal sinus and protruding into the orbit with erosion of the frontal sinus floor arestill difficult to address with standard endoscopic sinus surgery techniques. Here, we report a case of a mucocele located atthe lateral side of the frontal sinus and successfully marsupialized with a transblepharoplasty approach combined with an endoscopic approach.

Minimally invasive transnasal and transmaxillary approaches to the pterygopalatine fossa

The pterygopalatine fossa is a well-protected region of the skull base, and surgical access for resection of tumors growing in this region can be challenging. Historically, the approach to this anatomical space has been an open transmaxillary technique. This results in disruption of the anterior and posterior walls of the maxillary sinus and numerous postoperative morbidities. More recently, improvements in endoscopic sinus surgery instrumentation and techniques have led to the advent of minimally invasive surgical approaches to the skull base. The use of endoscopes allows for improved visualization and surgical manipulation, as well as reduced postoperative comorbidities. We discuss a graduated, minimally invasive approach to the pterygopalatine fossa.

Comparison of Surgical Conditions During Propofol or Isoflurane Anesthesia for Endoscopic Sinus Surgery

BackgroundThe Anesthesia planning is an important and determining factor in the amount of intraoperative hemorrhage, which can affect the rate of intraoperative and postoperative complications.ObjectivesIn this study we used two different anesthesia techniques in functional endoscopic sinus surgery (FESS) and compared the amount of hemorrhage in the two groups.Patients and MethodsIn a single–blind clinical trial, 44 patients with ASA class I and II candidate for FESS in Amir-Al-Momenin hospital in Rasht were entered the study and divided into two equal groups randomly. In both groups anesthesia was induced with propofol, remifentanil and cis. atracurium and then, infusion of propofol – remifentanil in the first group and isoflurane plus Remifentanil infusion in the second group was used for maintenance of anesthesia. Systolic blood pressure was maintained about 90 mmHg. Then on the basis of maximum allowable blood loss (MABL) formula, we calculated the percentage of hemorrhage. Finally the patients' hemorrhage was categorized into three groups (< 10%, 10-20%, > 20%). The surgeon's satisfaction from surgical field was calculated according to the Visual Analogue Scale. Then the data was statistically analyzed with T- test.ResultsThere were meaningful differences between average of hemorrhage (propofol group = 155cc, and Isoflurane group = 291.3cc; P = 0.003), and surgeon’s satisfaction (propofol group = 1.9 and Isoflurane group = 2.95; P = 0.007).ConclusionsThe amount of hemorrhage in propofol group was less than Isoflurane group and the field condition was better in propofol group than the Isoflurane group.

Complications of vision loss and ophthalmoplegia during endoscopic sinus surgery

ObjectiveTo describe two rare cases of concurrent vision loss and external ophthalmoplegia following powered endoscopic sinus surgery (ESS).DesignObservational case report.ResultsThe records of two patients who underwent powered ESS and developed multiple concurrent ophthalmic complications were retrospectively reviewed for clinical history, neuro-ophthalmologic examination, and imaging findings. Patient 1 developed a retinal vascular occlusion and complete loss of adduction. Patient 2 developed an orbital hemorrhage, optic neuropathy, and a restrictive global ophthalmoplegia. Similar published case reports were also reviewed.ConclusionDespite advances in powered ESS technique and instrumentation, serious ophthalmic complications can still occur. Inadvertent entry into the medial orbital wall can result in a combination of blindness and ocular motility dysfunction. The variety of mechanisms responsible for these complications underscores the importance of thorough pre- and postoperative clinical examination and review of imaging studies.

An animal model for endoscopic endonasal surgery and dacryocystorhinostomy training: uses and limitations of the lamb's head

Structured training in endoscopic sinus surgery is essential, considering the serious potential complications. We have developed a detailed endoscopic endonasal surgery training programme, using a lamb's head model. This study aimed to assess the possibilities of using such a model for endoscopic dacryocystorhinostomy training. Dacryocystography was performed on lamb's head models, which were then meticulously dissected, both macroscopically and endoscopically, to assess the nasolacrimal system. Dacryocystography showed the absence of a lacrimal sac in all the lamb's heads dissected. This result was confirmed by dissection. Lamb's heads are excellent models with which to teach endoscopic sinus surgery techniques. However, this study clearly demonstrated the absence of a lacrimal sac in all such models dissected. Thus, this animal model is inappropriate for endoscopic dacryocystorhinostomy training.

Simultaneous inferior and middle meatus antrostomies in the treatment of the severely diseased maxillary sinus

Although the majority of the maxillary pathology can be eradicated through the enlarged middle meatus antrostomy (MMA), some patients have extensive disease that is difficult to cope with. The aim of this study was to estimate the usefulness of simultaneous middle and inferior meatal antrostomies (MIMAs) in cases with severely diseased maxillary sinus by comparing the subjective and objective outcomes between patients that underwent MIMA and those who experienced maxillary clearance through conventional MMA. A prospective study was performed on patients with nasal polyps and severely diseased maxillary sinus (Lund-Mackay CT score = 2). All diseased sinuses were addressed with the same endoscopic sinus surgery technique; the only difference consisted of the management of the maxillary sinus: 34 patients underwent MIMAs and in 38 cases maxillary sinus was approached solely through the MMA. After 12 months of follow-up, outcomes consisted of the visual analog scale (VAS) for the main symptoms, the Lund-Mackay and maxillary sinus endoscopic scores, and the percent of airspace occluded by inflammatory mucosal thickening on CT. Subjective improvement in VAS scores for nasal obstruction, facial pain, and nasal discharge/retronasal drip was significantly better in the MIMA group. The mucosal thickening as expressed by the CT scan and maxillary endoscopic score was significantly reduced in the MIMA group. The MIMA technique is useful for removing severe disease that can not be reached through the MMA and yields both better subjective and better objective outcomes. The additional inferior antrostomy most likely improves drainage and ventilation in the postoperative period.

Functional endoscopic sinus surgery chopstick technique

We describe a functional endoscopic sinus surgery (FESS) technique that involves the simultaneous use of endoscope and suction in the nondominant hand that bears resemblance to chopstick use. The FESS chopstick technique reduces time for suction and improves operative field visualization.

Basic technique of Endoscopic Sinus Surgery ^|^mdash;How to use forceps and devices^|^mdash;

Basic technique of Endoscopic Sinus Surgery ^|^mdash;How to use forceps and devices^|^mdash;

Endoscopic Management of Orbital and Frontal Sinus Fractures

Endoscopic Management of Orbital and Frontal Sinus Fractures

Stirnhöhlenfraktur: aktuelle Kontroversen zur Therapie

The surgical treatment of frontal sinus fractures is foreshadowed by fears of late complications. Complications such as meningitis and mucoceles should be prevented by cranialization or obliteration of the frontal sinus. These procedures are still standard treatment despite of recent developments over the last two decades in endoscopic sinus surgery, in medical imaging and surgical instrumentation. Nowadays the role of cranialization and obliteration is challenged by refined endoscopic frontal sinus surgery techniques, the widely-used image-guided systems and the multiplanar high-resolution computed tomography along with new data about postoperative complications. This overview summarizes the current literature, taking into account the existing evidence in the treatment of frontal sinus fractures.

Endoscopic Sinus Surgery, Anatomy, Three-Dimensional Reconstruction, and Surgical Technique

Endoscopic Sinus Surgery, Anatomy, Three-Dimensional Reconstruction, and Surgical Technique

Endoscopic Endonasal Management of Medial Orbital Blowout Fractures

This study demonstrated that endoscopic endonasal sinus surgery is a successful technique for reducing medial orbital blowout fractures and does not cause complications. Twenty-three patients with isolated medial blowout fractures that did not involve the inferior wall underwent reduction surgery using the endoscopic endonasal approach. Surgery was indicated if the patient experienced persistent diplopia, ocular motility limitation, or enophthalmos. Septoplasty and submucous resection of the inferior turbinate bone were performed to access the fracture site safely in 3 and 15 patients, respectively. The bone fragments entrapping the orbital content or adhesions between the orbital contents and the sinus mucosa were dissected carefully from the fracture site. An ophthalmologist used the eye traction test to verify improvement in ocular motility. A temporary Silastic sheet was applied in three patients, but no permanent supporting material was used in any patient. No surgical or late complications were seen. Preoperative symptoms were resolved in 22 of the 23 (95.5%) patients 6 months after surgery. We concluded that the endoscopic endonasal reduction based on endoscopic endonasal sinus surgery techniques is safe, accurate, and an appropriate surgical intervention for medial orbital blowout fractures.

Comprehensive surgical management of the aerosinusitis patient

Provide a comprehensive overview of the pathophysiology and surgical management strategies of sinus barotrauma with attention to recent advancements in endoscopic surgical technique. New endoscopic frontal sinus surgery techniques have been shown to be highly effective with rhinosinusitis management, but these techniques have not been evaluated with sinus barotrauma management. We discuss the surgical goals and expectations with sinus barotrauma and contrast these to those with chronic rhinosinusitis (CRS). Sinus barotrauma surgery requires anatomic patency of involved sinuses whereas CRS patients are satisfied with a lack of symptoms from any residual mucosal disease.

Sinus Surgery in Patients With Previously Repaired Cerebrospinal Fluid Leaks

To explore surgical technique and outcomes of revision endoscopic sinus surgery (ESS) in patients with previously repaired cerebrospinal fluid (CSF) leaks. A case series of 13 patients with previously repaired iatrogenic CSF leaks who underwent revision ESS for recurrent sinus disease; a review of the preoperative workup, intraoperative findings, and postoperative outcomes. Two academic medical centers. Patients were included if they had a history of previously repaired skull base defect and iatrogenic CSF leak in the vicinity of the planned revision ESS. Revision ESS was performed in the vicinity of the previously repaired CSF leak. Dissection was carefully performed to avoid a recurrent CSF leak. Preoperative workup, intraoperative findings, surgical technique, and complications were reviewed. The study population consisted of 7 men and 6 women. Surgical navigation was used for all cases. Intrathecal fluorescein was not used in any case. In no instances was an active preexisting CSF leak identified or a new leak created. No minor or major postoperative complications arose in any of the study patients. All patients were discharged home within 24 hours. The mean (SD) follow-up was 26.0 (16.7) months. Previous skull base injury with CSF leak is not a contraindication to revision ESS. Safe ESS in this setting can be performed and may be recommended to such patients with symptomatic recurrence of their sinus disease.

Canine fossa approaches in endoscopic sinus surgery - our experience.

To define the role of canine fossa approach when standard endoscopic endonasal sinus surgery technique fails. Retrospective review of all endoscopic sinus surgeries performed from 1992 to 2007. Out of 1612 endoscopic sinus surgeries for various indications, CFA was used in 80 patients (4.96%) and among this 15 had bilateral procedure.The various diseases which required CFA were allergic fungal sinusitis (AFS), Fungal ball, Chronic invasive aspergillosis,antro choanal polyp, inflammatory polyp, Mucocoele and Maxillary cyst,inverted papilloma and Juvenile Nasopharyngeal Angiofibroma (JNA). Eight patients had minor complications (cheek swelling-6, facial pain-2 ) which resolved in 5 days. Canine fossa approach offers an ancillary approach to failed standard endoscopic endonasal technique thereby avoiding other more invasive procedures.

Long-Term Microscopic and Tissue Analytical Findings for 2 Frontal Sinus Obliteration Materials

Certain difficult conditions of the frontal sinus necessitating radical surgery can be successfully treated by endonasal or nasofrontal duct reconstruction procedures.1-4 Surgery of the frontal sinus continues to pose technical challenges to head and neck surgeons. Frequent infections, inflammatory disorders, traumatic conditions, and tumors affecting this prominent esthetic location present unique requirements for successful surgical treatment. Indications for frontal sinus obliteration include problematic conditions that cannot be resolved with functional endoscopic sinus surgery techniques due to irreversibly damaged natural drainage (Fig 1).