Advanced sinus surgery

PURPOSE: Intestinal-type adenocarcinoma (ITAC) is a rare sinonasal malignancy. Curative treatment requires multidisciplinary approach, with surgical options consist of the endonasal endoscopic approach (EEA) and external surgery (EXTS). Here, we provide the post-operative and survival results from a single-center long-term follow-up. METHODS: We report long-term follow-up of 92 ITAC cases treated between 1998 and 2018, treated with EEA (n = 40) or EXTS (n = 52)...

We present the case of a 46-year-old man who received ephedrine for hypotension after surgery for a mandibular lesion under intravenous (IV) moderate sedation with dexmedetomidine (DEX) and experienced transient ventricular tachycardia (VT). The patient was scheduled to have cystectomy and multiple apicoectomies for the mandibular periapical infection and the simple bone cyst. Other than obesity, snoring, and a nonalcoholic fatty liver, he denied any other significant medical history, medications, or allergies...

PURPOSE OF REVIEW: The purpose of this review is to provide a comprehensive anatomical appraisal of the neurosurgical anatomy exposed through the endonasal and paranasal sinuses routes, focusing on the most common expanded endonasal approaches (EEAs) as well as recent advances in this surgical field. RECENT FINDINGS: The EEAs are redefining the management of skull base pathology. Neurovascular structures previously considered a limitation, can be now approached through these surgical corridors...

BACKGROUND: Despite advances in surgical techniques, recurrence rates after endoscopic sinus surgery (ESS) for chronic rhinosinusitis with nasal polyps (CRSwNP) remain high and difficult to predict. OBJECTIVE: This study aimed to evaluate the potential role of microRNA 125b (miR-125b) in predicting disease evolution following ESS. METHODS: We conducted a prospective study including patients undergoing first ESS for CRSwNP in our department between January 2020 and November 2021...

BACKGROUND: Patients with rectal cancer who underwent lateral pelvic node dissection might be at a higher risk of postoperative complications derived from technical complexity. However, little is known regarding the long-term complications after lateral pelvic node dissection. OBJECTIVES: The study aimed to investigate the long-term complications of preoperative chemoradiotherapy, followed by total mesorectal excision with lateral pelvic node dissection for locally advanced rectal cancers...

PURPOSE: To investigate the clinical characteristics of the syndrome of inappropriate antidiuretic hormone (SIADH) associated with nasal and paranasal malignant tumors. METHODS: Patients with locally advanced or recurrence/metastatic malignant tumors of the nasal and paranasal sinuses were included. The SIADH was diagnosed according to the diagnostic criteria. The clinical characteristics of SIADH patients were retrospectively analyzed. RESULTS: Six patients (6/188, 3...

Facial feminization surgery includes a series of procedures that aim to attenuate the masculine features of the face and make the face more feminine and harmonic. During the past few years, several feminization techniques have been developed or adapted to this discipline. The current intervention of the forehead for feminization is based on the setback of the anterior wall of the frontal sinus and the remodeling of the supraorbital and glabellar region, associated to brow lift and hairline advancement. Primary forehead feminization yields high patient satisfaction, quality of life, and aesthetic outcomes, with few complications...

BACKGROUND: Orbital structure preservation and avoidance of facial incisions without compromising oncological outcome are key to maintaining function and quality of life in locally advanced sinonasal tumor surgery. A transorbital approach at our institution has proven invaluable during cranioendoscopic skull base tumor resections and there are few descriptions of this in the literature. METHODS: An IRB-approved retrospective chart review was conducted at a tertiary cancer center for patients between 2020 and 2022 undergoing cranioendoscopic tumor resections utilizing a transorbital approach...

PURPOSE OF REVIEW: As the management of ophthalmic and sinus disease advances, it is important to stay abreast of all current management options. This involves knowledge of adjacent anatomy and disease processes, and collaboration between multiple specialties. The authors provide a review of relevant ophthalmic and oculoplastic topics for the rhinologist. RECENT FINDINGS: The scope and surgical skills of oculoplastic and rhinologist specialists have grown in conjunction with medical and technological advancements...

INTRODUCTION: In this retrospective study stabilities of 24 implants simultaneously placed at posterior maxillae with sinuses grafted by advanced platelet rich fibrin (A-PRF) and newly formed bone around them were evaluated. PATIENT AND METHODS: Fourteen augmented maxillary sinuses of 11 patients with a mean residual alveolar bone height of 4.55 mm were involved in this study. Maxillary sinus lifting via lateral window approach and implant site osteotomy were performed, and prepared A-PRF clots were used as sole graft material...

Background: Forehead contouring can be a component of facial feminization surgery (FFS). Its complications have been rarely reported on and are often described as "hypothetical." Methods: A case report of complications from forehead contouring resulting in frontal osteomyelitis and sinusitis. Results: A female patient presented with frontal osteomyelitis, sinusitis, and forehead contour deformity after a type III forehead contouring surgery. She had failed prior treatment including oral antibiotics, IV antibiotics, revision sinus surgery, and revision nasal surgery...

The traditional view of the aortic valve and aortic root as a simple conduit for blood flow between the left ventricle and the aorta is evolving with new insights from anatomy, physiology, cell biology, and advanced imaging techniques. This article provides an overview of the changing understanding of aortic root anatomy, shedding light on the intricate structures that contribute to maintaining unidirectional blood flow and the durability of the aortic valve. From historical perspectives to contemporary microscopic details, the components of the aortic root are explored, including the sinutubular junction, aortic sinuses, valve leaflets, and interleaflet triangles...

PURPOSES: In patients with chronic rhinosinusitis (CRS), we assessed quality of life (QOL) of chronic rhinosinusitis (CRS) patients with different self-reported snoring frequencies after endoscopic sinus surgery (ESS), and explored factors associated with pre-ESS snoring and post-ESS snoring reduction. METHODS: This prospective cohort study was conducted in a tertiary referral center in Chengdu, China. Adult patients with medically recalcitrant CRS receiving initial ESS were engaged...

OBJECTIVES: To evaluate the impact of facility volume on outcomes following primary endoscopic surgical management of sinonasal squamous cell carcinoma (SNSCC). METHODS: The 2010-2016 National Cancer DataBase (NCDB) was queried for patients diagnosed with T1-T4a SNSCC surgically treated endoscopically as the primary treatment modality. Factors associated with overall survival (OS) were evaluated, including facility volume. RESULTS: A total of 330 patients who underwent endoscopic surgical management of SNSCC were treated at 356 unique facilities designated as either low-volume (LVC; treating 1-2 cases; 0-75th percentile), intermediate-volume centers (IVC; 3-4 cases total; 75th-90th percentile), or 144 high-volume (HVC; treating 5+ cases total; >90th percentile) centers...

PURPOSE OF REVIEW: To review the effects of endoscopic sinus surgery and endonasal approaches to the skull base on olfaction. RECENT FINDINGS: Advancements in endonasal endoscopic approaches to the sinuses and skull base allow for direct treatment of a variety of sinonasal and skull base diseases. However, these extended approaches will often require manipulation of normal anatomical structures and the olfactory neuroepithelium. Depending on the planned procedure and extent of disease, the prognosis of olfactory perception can vary significantly among patients...

Large intracardiac masses including tumors, thrombi, and vegetations result in detrimental embolic or obstructive sequelae and present a management dilemma. Open heart surgery, the traditional approach, may not be an option for many patients with a prohibitive surgical risk due to multiple comorbidities. Recently, percutaneous options have emerged with reported success in extracting such intracardiac masses. A 42-year-old female with history of advanced primary sclerosing cholangitis with decompensated liver cirrhosis causing ascites and variceal bleed presented to the emergency department with fatigue, subjective fevers, chills and melena...

BACKGROUND: Sinonasal teratocarcinosarcoma is a rare, aggressive malignancy located almost exclusively in the nasal cavity, paranasal sinuses, or anterior skull base. Histopathological diagnosis can be challenging due to the heterogeneous composition. METHODS: Retrospective analysis of 3 patients with sinonasal teratocarcinosarcoma diagnosed and treated at the University Medical Center Utrecht was conducted. RESULTS: Patients presented with nasal obstruction, epistaxis, headaches, or behavioral changes...

BACKGROUND: Hyperostosis is a common consequence of chronic rhinosinusitis with nasal polyps (CRSwNP) and other chronic rhinosinusitis, affecting mainly structures of the ethmoid labyrinth, frontal and maxillary sinuses. These neo-bones are found in advanced stages of rhinosinusitis causes exacerbation because of ostia outflow blockage. Frequent relapses of the disease due to hyperostosis restenosis, represent a problem in the treatment of chronic frontal sinusitis. We report our cases experience about the treatment of frontal chronic sinusitis because of frontoethmoidal area hyperostosis, treated by modified lothrop procedure, achieving sufficient clinical effect...

PURPOSE: Locally advanced maxillary sinus cancers require radical surgery as a standard treatment, but this often results in significant disfigurement and impairment of function. JCOG1212 seeks to evaluate the safety and efficacy of the superselective intra-arterial infusion of cisplatin and concomitant radiation therapy (RADPLAT) for T4aN0M0 and T4bN0M0 maxillary sinus squamous cell carcinomas. We herein report the results of the efficacy confirmation phase in the T4a cohort. METHODS AND MATERIALS: Patients received 100 mg/m2 cisplatin intra-arterially weekly for 7 weeks with concomitant radiation therapy (total 70 Gy) as determined by the results of the preceding dose-finding phase...

INTRODUCTION: Sphenoid sinuses, air-filled cavities in the sphenoid bone, develop between the 3rd and 4th year and mature by 12 to 16 years. Understanding their anatomy is vital for safe transsphenoidal surgeries because of nearby vital structures. They exhibit variable pneumatization and often have an intersinus septum. This case emphasizes the importance of understanding sphenoid sinus anatomy, particularly in the context of transsphenoidal surgeries. It also introduces a novel case involving a congenital roof defect, previously unreported in medical literature...