Transnasal Endoscopic Approach Research Articles

Endoscopic Transnasal Trans-Sphenoidal Approach for Pituitary Adenomas: A Comparison to the Microscopic Approach Cohort by Propensity Score Analysis

Endoscopic Transnasal Trans-Sphenoidal Approach for Pituitary Adenomas: A Comparison to the Microscopic Approach Cohort by Propensity Score Analysis

Endoscopic Transnasal Odontoidectomy.

Background Odontoidectomy may represent the treatment of choice for symptomatic ventral craniovertebral junction stenosis in selected cases. An endoscopic transnasal approach has been proposed as an alternative to a classic transoral approach. Method We report a case of a patient with a craniovertebral junction stenosis due to the ossification of the posterior ligament. The clinical and radiological records of the patient and a step-by-step description of the surgical technique are presented ( Fig. 1 ). Conclusion Endoscopic transnasal odontoidectomy provides a direct access to the dens and adjacent structures of the anterior upper cervical spine with a less invasive burden on the oropharingeal structures. The link to the video can be found at: https://youtu.be/Ofrk1sFTV9I .

Sellar Floor Bone Flap With a Pedicled Nasoseptal Flap in Endoscopic Transnasal Pituitary Adenoma Surgery.

To explore the clinical effect of sellar floor bone flap with a pedicled nasoseptal flap in endoscopic transnasal pituitary adenoma surgery for skull base reconstruction.Method: This was a retrospective clinical analysis of 30 patients with pituitary adenoma operated by the same neurosurgical team from June 2015 to June 2018. All patients were diagnosed with pituitary adenoma by pituitary magnetic resonance imaging, and the authors confirmed that the sellar floor bone was intact using sphenoid sinus computed tomography. All patients underwent an endoscopic transnasal approach, and the authors created a pedicled nasoseptal flap and sellar floor bone flap intraoperatively and reconstructed the skull base at the end of the surgery. Postoperative complications constituted cerebrospinal fluid leakage, brain tissue herniation, nasal discomfort, decreased sense of smell, and epistaxis. Cerebrospinal fluid leakage occurred in 13 patients (43.3%) intraoperatively; small amounts in 6 patients (20.0%), moderate amounts in 3 patients (10.0%), and large amounts in 4 patients (13.3%). Only 1 patient (3.3%) with large-volume cerebrospinal fluid leakage intraoperatively experienced cerebrospinal fluid leakage postoperatively, and this resolved with lumbar catheter drainage and bed rest. The 6-month postoperative follow-up brain computed tomography findings revealed brain tissue herniation in no patients, nasal discomfort in 3 patients (10.0%), decreased sense of smell in 5 patients (16.7%), and epistaxis in 2 patients (6.7%). Reconstructing the skull base with a sellar floor bone flap and a pedicled nasoseptal flap played an important role in preventing cerebrospinal fluid leakage and brain tissue herniation in endoscopic transnasal pituitary adenoma surgery and did not increase the incidence of postoperative nasal discomfort, decreased sense of smell, or epistaxis.

Quality of Life Evaluation After Trans-Nasal Endoscopic Surgery for Skull Base Tumors.

The excellent surgical results obtained with transnasal endoscopic approach to the anterior skull base (ASB) are universally recognized; less is known about the quality of life of patients after surgery. The aim of this study is to analyze the quality of life of patients after endoscopic transnasal surgery for the treatment of neoplasms of the ASB. We conducted a retrospective review of patients who underwent transnasal endoscopic surgery for treatment of ASB tumors at the Tertiary Referral Center University Hospital of Verona. All patients were asked to complete the Anterior Skull Base Questionnaire (ASBQ), the Skull Base Inventory (SBI), and the Sino-nasal Outcome Test - 22 Items (SNOT-22) after surgical treatment. The study population was divided into subgroups; a statistical analysis of the overall results and of the different questionnaire domains was performed. 51 patients were enrolled in this study. The average score was 3.04 for ASBQ, 4.05 for SBI and 28.88 for SNOT-22. Analysis of the overall results for the ASBQ showed a lower quality of life in patients after recurrent surgery and in female patients. The SBI showed similar results in relation to recurrent surgery and radiotherapy. Similarly, the results for SNOT-22 highlighted the negative impact of recurrent surgery and radiotherapy. Our results confirmed that the endoscopic transnasal approach shows excellent results not only in terms of surgical outcome, but also for the possibility of ensuring a good QoL after treatment. Recurrent surgery and radiation treatments were the most important negative prognostic factors.

English

BACKGROUND In recent times, due to advancement in sinus endoscopes and sinus surgery instruments and the acquirement of skills, the variety of sinonasal diseases being treated and the indications for transnasal endoscopic approaches have increased dramatically. They include chronic rhinosinusitis and sinonasal polyposis to sinonasal tumours, skull base and orbital pathology. We wanted to study the role and outcome of endoscopic sinus surgery in the management of sinonasal disease. METHODS A cross sectional study was conducted among 200 patients attending the Department of ENT, Govt. Medical College, Kozhikode, over a period 2 years with sinonasal diseases. Demographic details, ENT examination, CT scan Paranasal Sinuses (PNS) and endoscopic examination of the nasal cavity were performed in all patients. Clinical signs were recorded and classified according to their pathologies. All the patients were subjected to functional endoscopic sinus surgery. Operative methods and results were recorded. RESULTS Among the 200 patients, 144 (72 %) were males and 56 (28 %) were female patients in the present study. Among the 200 patients, 126 (63 %) were in the age group of 21 to 50 years. 40 / 200 (20 %) patients belonged to the age group of 0 to 20 Years. 34 / 200 (17 %) patients belonged to the age group of 51 to 70 years. CONCLUSIONS The diseases of the nose and paranasal sinuses ranged from inflammatory aetiology to neoplasms. Use of conventional tools for diagnosis and management of such a variety of diseases had their own limitations and demerits. Whereas endoscopic view of the disease sites was exceptionally clear and well-illuminated, giving an added edge to the ability to inspect the recesses with angled distal endoscopes. Definition of micro anatomical sites was well defined by the CT scan especially around osteo-meatal complex, and its anatomical variants. Functional endoscopic sinus surgery was an excellent and safe procedure. The prognosis in surgically treating sinonasal pathologies with FESS was good in terms of lesser morbidity and minimal chances of recurrence. KEYWORDS Sinusitis, Endoscopic Sinus Surgery, CT Scan PNS, Skull Base Surgery, Sinonasal Tumours

Excision of a Retrochiasmatic Craniopharyngioma by Transcallosal, Interforniceal Approach With Exoscope Assistance: 2-Dimensional Operative Video.

Retrochiasmatic craniopharyngiomas are difficult to treat due to their close proximity to critical neurovascular structures. Several surgical approaches with distinct advantages and limitations have been described to access these tumors, including extended transnasal endoscopic approach (ETEA), subtemporal, translamina terminalis, and transpetrosal approach.1-3 We present a 51-yr-old male with a large retrochiasmatic craniopharyngioma extending into the third ventricle, causing obstructive hydrocephalus. Preoperative magnetic resonance imaging (MRI) showed a tumor cyst abutting the fornices expanding the space between two internal cerebral veins (ICV). After surgical consent, we decided to take advantage of this corridor to approach the tumor in its long axis. Surgical goal was to achieve cyst decompression with "safe maximal" resection of the solid component at last to preserve the pituitary function. Though the long axis of the tumor could be approached using ETEA, we preferred this approach in view of cyst decompression early in the surgery while completely avoiding risks such as cerebrospinal fluid (CSF) rhinorrhea, internal carotid artery (ICA) injury, and sinonasal complications. We utilized a 3-dimensional 4 K exoscope, which provides an excellent ergonomic position, and a high-resolution immersive view compared to a microscope or endoscope. Cyst decompression and near-total resection of the solid component was achieved. Postoperatively, his headaches improved and he was neurologically intact with intact neuroendocrine function. Approach-related risks may include but not limited to hemorrhage due to the rupture of venous sinuses or ICV, stalk or hypothalamus injury, and memory disturbances due to forniceal injury. To conclude, the transcallosal, interforniceal approach to retrochiasmatic craniopharyngiomas may provide a safe surgical corridor in select cases. Patient consented to the proposed procedure. All radiological images have been anonymized. IRB/ethics committee approval was not required.

Endoscopic Transnasal Odontoidectomy.

Objectives The video demonstrates the steps for an endoscopic transnasal approach for resection of the odontoid causing platybasia with basilar invasion. Design The video reviews the clinical presentation, preoperative workup and imaging, patient positioning, technical nuances of the procedure, reconstruction, and clinical outcomes including postoperative imaging. Setting The surgery was performed by a skull base team including otolaryngologists and neurological surgeons at a large regional tertiary care facility. Participants A 59-year-old female with the Chiari I malformation with history of multiple revision cervical spinal surgeries presents with neck pain. Preoperative imaging showed a hypoplastic clivus and platybasia with basilar invasion. Main Outcome Measures The main outcome measures consist of safely removing the odontoid with appropriate closure, reversal of the patient symptoms, and prevention of both operative complications and ventral compression of the brainstem. Results The patient's neck pain improved. There were no intraoperative or postoperative complications besides anterior rightward nasal septal deviation causing unilateral nasal obstruction. A septoplasty was performed to correct the septal deviation 6 months after the initial procedure. Conclusions The endoscopic transnasal approach to the resection of odontoid is a safe and effective treatment to address basilar invasion and ventral compression of the brainstem. The link to the video can be found at: https://youtu.be/m_c3-Vn-l80 .

Endoscopic Transnasal Resection of Midline Skull Base Meningiomas: Tumor Consistency and Surgical Outcomes.

Background The endoscopic transnasal approach (ETA) has proven to be of great value in the resection of midline skull base meningiomas when compared with traditional approaches. Our objective was to assess tumor consistency in relation to surgical outcomes for midline meningiomas (MMs) resected using ETA. Methods Radiological preoperative features, including the tumor to cerebellar peduncle T2-weighted magnetic resonance imaging (MRI) ratio (TCTI), were evaluated. The intraoperative consistency assessment was performed by the surgeon, which determined if the tumor was soft (resectable by suction) or firm (required a cavitation ultrasonic aspirator). Surgical resection and postoperative complications were evaluated in relation to tumor consistency. Results Twenty patients were evaluated; 6 were classified as firm and 14 were classified as soft. The mean TCTI ratio was 1.7 and the median was 1.7 (range: 1.3-2.4). Three firm tumors had a ratio of <1.6. All soft tumors had a ratio of ≥1.6 with three outliers. Additionally, 66.7% of patients with firm tumors had complications compared with 35.7% of patients with soft tumors. Only 33.3% of firm tumors underwent gross total resection (GTR) in comparison to 79.0% of tumors with a soft consistency. Conclusion In our analysis, we found that tumor consistency was significantly related to short-term surgical outcomes in MMs resected using the ETA. The TCTI ratio was found to be the most reliable predictor with a sensitivity of 76.9% and a specificity of 40.0%. Our findings suggest that traditional cranial approaches should be considered as the first surgical option for managing firm MMs.

Cribriform CSF Leak: Endoscopic Surgical Repair Using Free Septal Mucosal Graft Without Postoperative Nasal Packs.

Cribriform plate is the commonest site of Cerebrospinal fluid (CSF) leak, its fragility and juxtaposition of arachnoid's investment to the bone, where the olfactory nerve pierces the skull, is a vulnerable site for CSF leak. Endoscopic transnasal approach has been the main stay for CSF leak repair over the past 2 decades. The technique and surgical steps of Endoscopic Surgical Repair of Cribriform CSF Leak using Free Septal Mucosal Graft without Postoperative Nasal packs are presented. Transnasal endoscopic CSF leak repair under General anesthesia with free mucosal graft, the critical steps include visualize the site of leak, lateralisation of middle turbinate, defect site cauterised with bipolar cautery. Free mucosal from contralateral side of the septum was placed as overlay technique. Graft stabilised with surgicel after ensuring adequate contact between the graft and the defect site. If the defect site is large then fat harvested from thigh is used as bath plug the defect, then free mucosal graft is kept supported by surgicel. Finally the middle turbinate was medialized and sutured with 3 0' Vicryl with nasal septum to support the graft and also to stabilize the middle turbinate as a quilting stich. No fibrin glue was used in our case series. No nasal packing was done. Patients discharged on 2nd or 3rd postoperative day. This technique provides consistent good results reduced operating time of 40min, no post-operative morbidity, early mobilisation, with 100% success rate and with added advantage of no nasal packing, patient can easily breathing through the nose postoperatively & no recurrence on long follow up.

Transnasal Endoscopic Resection of the Intraconal Metastases From Renal Cell Carcinoma: a Case Report and Review of Literature.

Renal cell carcinoma (RCC) is the most common malignancy to cause metastasis to sinonasal cavity. These metastases can occasional cause invasion into the orbit. Isolated intraconal intraorbital metastasis from RCC is very rare. We hereby describe a case of 72-year-old female, who underwent right nephrectomy for RCC, 8 years back, and now presenting with a space occupying lesion in the right intraorbital intraconal compartment with no involvement of the paranasal sinuses. En bloc resection of the tumor was achieved via transnasal endoscopic approach. This is a rare case where minimally invasive surgery was done for metastatic lesion, with minimal postoperative morbidity.

Transnasal endoscopic approach for orbital apical cavernous hemangiomas: a case report

Transnasal endoscopic approach for orbital apical cavernous hemangiomas: a case report

Juvenile variant ossifying fibroma of sinonasal region

Juvenile variant ossifying fibroma of sinonasal region is an extremely rare benign fibro-osseous lesion which is locally aggressive. A 21-year-old male presented with significant proptosis of right eye with stony-hard lump in the middle upper aspect of the right orbit and base of the nose. CT scan of head revealed a non-enhancing expansile lesion in right ethmoidal cells consistent with chronic ethmoidal mucocele. However Magnetic Resonance Imaging of brain revealed enhancing lesion in right ethmoid and frontal sinus extending up to anterior cranial fossa. He underwent right frontal craniotomy with surgical excision of tumor wherein cystic brown tumor of frontal and ethmoidal sinus was found. The procedure was supplemented with endoscopic transnasal approach. Histopathology report suggested an ossifying fibroma. This case highlights the importance of clinical, imaging and histopathological features of ossifying fibroma occurring in the sinonasal tract for better diagnosis and treatment through a multidisciplinary approach.

Congenital Anterior Skull Base Encephaloceles: Long-Term Outcomes After Transnasal Endoscopic Reconstruction

Congenital intranasal encephaloceles (ECs) are rare malformations of the pediatric age, complex to diagnose and treat, above all if associated with genetic syndromes or concomitant dysmorphisms. The aims of the study were to report our experience in managing nasal ECS in children, to evaluate the efficacy and safety of the transnasal endoscopic repair, and to analyze in an overall way the surgical long-term outcomes. Moreover, we sought to contribute to the debate on pathogenesis of ECs, investigating possible related risk factors described in the literature. A retrospective analysis was performed of pediatric nasal ECs managed with a transnasal endoscopic approach at a tertiary referral center through clinical follow-up and telephone survey. Twenty-three patients with nasal ECs fitted the criteria of the study. Mean age at surgery was 5 years (69 months) and the mean follow-up was 59 months. The clinical presentation is described in detail, with particular emphasis on syndromic cases. Of 23 patients, 17 had an isolated EC, and in 4 patients, a malformation syndrome was associated. EC recurred in 2/23 patients (8.7%) after surgical correction, necessitating a revision procedure. No perioperative complications or long-term sequelae were noted in the entire population. Endonasal endoscopic management of congenital ECs is feasible in children, although regular long-term follow-up is essential. Furthermore, the surgical approach does not seem to affect patients' development and quality of life, although more studies and validated questionnaires are needed. No recurrent risk factors were observed able to justify a certain etiologic relation.

A Case of Nasopalatine Duct Cyst with Cholesterol Granuloma in Maxillary Sinus

Nasopalatine duct cysts are the most common non-odontogenic cysts that occur in the maxilla. Cholesterol granulomas, on the other hand, are commonly found in patients with chronic middle ear disease, but rarely occur in the paranasal sinuses. We report a rare case of a 30-year-old woman who was treated for a nasopalatine duct cyst and cholesterol granuloma at the same time. The patient complained of sudden nasolabial pressure and right nasal obstruction from three weeks ago. A 3 cm sized cystic mass, diagnosed as a nasopalatine duct cyst, was observed in the maxilla and haziness of the right maxillary sinus suspected of chronic rhinosinusitis was detected by computerized tomography. Marsupialization of the nasopalatine duct cyst was performed through the endoscopic transnasal approach. Solid mass in the maxillary sinus, diagnosed with cholesterol granuloma by pathology after surgery, was completely removed by endoscopic sinus surgery. The patient was followed up for 18 months without any recurrence or complications.

Abscess of the clivus in an adolescent with complicated acute rhinosinusitis: a case report

BackgroundComplications of acute sinusitis affecting multiple sites are very uncommon, and generally develop for a delayed diagnosis of the primary infection, with possible severe and life-threatening evolution. Patients can have variable presentations according to the site and extent of the infection. Multiple forms generally include the coexistence of orbital manifestations and intracranial infections. We here present a case with unusual multiple sites locations (i.e.: intraorbital intraconic abscess, sigmoid sinus thrombosis, preclival abscess, multiple splanchnocranium osteomyelitic processes).Case presentationA 13-year-old male presented at our hospital with right progressive orbital oedema with eyesight worsening and signs of meningitis. Computed tomography and magnetic resonance (MRI) demonstrated right intraorbital intraconic abscess, left sphenoidal sinusitis, transverse and sigmoid sinus thrombosis. Ophthalmologic evaluation documented a right optic nerve sufferance. Endoscopic and superior right trans-palpebral surgical decompression was performed, and the abscess was drained. Microbiological analysis revealed the presence of multi-sensitive Streptococcus Intermedius. Subsequent prolonged antibiotic and anti-thrombotic treatments were started. In the following two-weeks the sinusal and ophthalmologic clinical conditions improved, whereas the patients complained of mild to moderate cervical pain and suffered from intermittent pyrexia. Control MRI documented clival abscess extending up to preclival soft tissues posterior to the nasopharynx, associated with mandible osteomyelitis, occipital condyles and anterior part of the temporal bone hyper intensity. Endoscopic trans-nasal surgical approach to the clival compartment with neurosurgery navigation-guided achieved preclival abscess drainage. Complete clinical and radiological recovery was achieved after 45 days of medical treatment.ConclusionsMultiple sites complicated rhinosinusitis is uncommon, and its management is challenging. A proper history and thorough clinical examination along with a radiological evaluation are key factors in the final diagnosis of patients with complicated multiple sites acute rhinosinusitis. A quick multidisciplinary approach is always necessary to avoid unwanted life-threatening complications.

Anterior release without odontoidectomy for irreducible atlantoaxial dislocation: transoral or endoscopic transnasal?

To compare transoral and endoscopic transnasal anterior release without odontoidectomy and posterior reduction and fixation to treat irreducible atlantoaxial dislocation (IAAD). From June 2006 to January 2017, 35 consecutive patients with IAAD underwent transoral (Tr-Oral group) or endoscopic transnasal (Tr-Nasal group) release and posterior fixation and fusion in our department. Clinical neurological recovery (Japanese Orthopedic Association (JOA) score) and radiological reduction parameters including atlantodontoid interval (ADI), space available for the cord (SAC) and cervicomedullary angle (CMA) were analyzed and compared. The operation duration, blood loss, length of intensive care unit (ICU)/hospital stay and complications were recorded. All 35 patients (18 and 17 patients in the Tr-Oral and Tr-Nasal groups, respectively) were followed up for a mean of 36.4months (range, 21-60months). All patients achieved excellent anatomical reduction and clinical neurological recovery, with no significant differences between the two groups. The JOA score, ADI, SAC and CMA were not significantly different between the two groups at various postoperative points. Although the Tr-Oral group had shorter operation time and less blood loss than the Tr-Nasal group, the Tr-Nasal group tended to have a significantly shorter hospital/ICU stay, earlier extubation and earlier oral intake than the Tr-Oral group. The transoral and endoscopic transnasal approaches can achieve equivalent release and reduction effects when treating IAAD. Compared to the transoral approach, the endoscopic transnasal route is less invasive with earlier extubation and oral intake, shorter hospital/ICU stays and lower medical costs, which is conducive to enhancedrecoveryafter surgery.

Anatomical location of the abducens nerves (VI) in the ventral approach of clival tumors.

The aim of this work was to determine reliable anatomical landmarks for locating and preserving the abducens nerves (6th cranial nerves) during trans-facial or trans-nasal endoscopic approaches of skull base tumors involving the clivus and the petrous apex. In order to describe this specific anatomy, we carefully dissected 10 cadaveric heads under optic magnification. Several measurements were taken between the two petro-sphénoidal foramina, from the bottom of the sella and the dorsum sellae. The close relationship between the nerves and the internal carotid artery were taken into account. We defined a trapezoid area that allowed drilling the clivus safely, preserving the 6th cranial nerve while being attentive to the internal carotid artery. The caudal part of this trapezium is, on average, 20mm long at mi-distance between the two petro-sphenoidal foramina. The cranial part is at the sella level, a line between both paraclival internal carotid arteries. Oblique lateral edges between the cranial and caudal parts completed the trapezium.

Endoscopic versus Microscopic Transsphenoidal Hypophysectomy: Comparison of the Endocrine Outcome – An Institutional Experience

BACKGROUND: The transnasal transsphenoidal endoscopic approach to the sella turcica is an overwhelming alternative to the microscopic approach for the past few decades assuming into prominence as a new technique, reaching nearly gold standard for this pathology. The endoscopic approach to the pituitary has redefined accurate visualization of the sella. The panoramic view afforded by the endoscope is unparalleled as compared with the traditional conical view of the microscope.&#x0D; AIMS: This study aims to compare both endoscopic and microscopic technologies, including advantages and disadvantages through the results of endocrine outcome.&#x0D; SETTINGS AND DESIGN: Our retrospective/prospective study included 46 microscopically and 39 endoscopically treated patients during the period of 2010–2018. Tumors were classified according to the diameter and clinical outcomes were evaluated.&#x0D; RESULTS: Our retrospective/prospective study included 46 microscopically and 39 endoscopically treated patients during the period of 2010–2018. Tumors were classified according to the diameter, hormone activity and clinical outcomes were evaluated. Comparison results revealed more efficacious and effective endocrine control and reestablishing the endocrine homeostasis utilizing the endoscopic technique, especially in secretory active macroadenomas. Further, the extension of the resection, which was better in endoscopic approach undouptedly contributed to better endocrine control of the disease. Complication rate, including endocrine, was lower following endoscopy compared with microsurgery.&#x0D; CONCLUSION: This technique evidenced to have a statistically significant reduction in operative time and length of hospital stay, as well as more radical safe resection and complication control. There is also a trend toward improved endocrine outcomes and rate of return of visual defects. These two approaches are still comparable with eloquent advantages and disadvantages, formulated as balanced dialectics. In addition, the use of endoscopes, including multilocular polifilament 3D endoscope, facilitates extended approaches, reaching a delicate skull base lesions that are suprasellar, retrosellar, and parasellar, which permits visualization beyond the abilities of the microscope.

Maxillary Sinusitis of Odontogenic Origin in Relation to Ectopic 2.8 Associated with Follicular Dentigerous Cyst – Combined Transnasal and Oral Endoscopic Approach: A Case Report

Purpose: To describe the management of orosinusal pathology by combined transnasal and oral endoscopy. Methods: The 54-year-old patient underwent a dental and otolaryngological evaluation for left odontogenic maxillary sinusitis in relation to plausible dental follicular cyst of ectopic element 2.8. The symptoms reported at the time of access to the hospital were nasal obstruction and nocturnal rhonchopathy. In the ENT evaluation by videorhinoscopy with rigid optics, complex deviation of the nasal septum was revealed, without any evident formation or pathological secretion. On inspection of the oral cavity, the mucous membranes appeared unscathed. The previously extracted aleveolus of 1.6 was evident. The radiological examination, facial CT, revealed the left maxillary sinus almost completely occupied by a cystic appearance, with thin calcified walls and homogeneous content that had a dental element, probably the 2.8, which fenestrates the vestibular cortex of the lateral wall of the maxillary sinus. This lesion erodes the medial wall of the sinus, obliterating the ostiomeatal complex and imprinting the ipsilateral ethmoidal cells. Biohumoral tests showed normal coagulation parameters, indices of renal function, liver and ionemia. The patient under general anesthesia and oral intubation with a combined intervention of the left anterior FESS, intrasulcular flap from dental elements 2.7 to 2.3 with mesial releasing incision, moderate osteotomy, ectopic 2.8 extraction and enucleation of the cystic lesion with simultaneous closure of the orosinusal communication with advancement of the Bichat fat pad and closure by first intention. In the same session, the ENT moment is carried out transnasally for total left uncinectomy, medium antrostomy with the union of the natural ostium and the accessory ostium. Bilateral lower turbinoplasty with bipolar forceps. The patient was then controlled after 15 days and then six months, showing good healing and no signs of recurrence at the rhinoscopic check on the physical examination of the oral cavity. Results: Based on the clinical and radiological aspect, the diagnosis of a follicular dentigerous cyst (WHO 2017) covered by a multi-layered non-keratinized paving epithelium, with moderate chronic inflammation, including gigantocellular and cholesteric crystals, is reached from the microbiological and histological examination. Necrotic amorphous material coexists including rare hyphae and fungal spores, with mycotic and actinomycotic superinfection. Conclusions: The combined oral and nasal intervention, allowed by the collaboration between the oral surgeon and ENT, has made it possible to shorten the healing time and resolve the pathology without recurrence.

Clinical characteristics and surgical treatment analysis of paranasal ossifying fibroma

Objective:To analyze the clinical features and discuss the treatment of ossifying fibroma in the nasal cavity and sinuses. Method:The patients were performed surgical treatment after admission. 6 cases were treated by endoscopic transnasal approach with image guidance system to resect the mass, 8 cases were operated by simple endoscopic approach, tumor resection was performed via endoscopic surgery with external approach in 2 cases, and endoscopic surgery combined with modified Caldwell-Luc procedure in 1 case. 1 patient was operated through labiolingual groove approach. Result:The intraoperative blood loss of ossified fibroma patients was large, with an average blood loss of 550ml. All the patients were followed up for 6 months to 8 years, 15 patients with complete resection had no recurrence after surgery, and 3 patients with partial resection survived with tumor. Conclusion:Ossifying fibroma in the nasal cavity and sinuses can be completely resected by nasal endoscopic surgery with less trauma and good effect. Transnasal endoscopic surgery assisted by image navigation system can protect important structures in lesions involving orbital cardboard and anterior skull base. Nasal endoscopic surgery combined with small eyebrow incision approach is feasible for ossifying fibroma invading frontal sinus. Ossifying fibroma, which requires adequate preoperative evaluation and blood preparation is prone to bleeding, and lesions with rich blood supply need preoperative interventional therapy.