Alfredo Naser

Manejo endoscópico de mucoceles de senos paranasales: experiencia en 46 pacientes

OBJECTIVE The purpose of this study was to determine changes in the surgical treatment of patients with the diagnosis of paranasal mucoceles managed in a Latin American hospital. We hypothesised that endonasal endoscopic surgeries had emerged as the main treatment option for this disease in the last five years. METHODS A retrospective chart review of all patients who were diagnosed with paranasal sinus mucoceles and treated at the Otorhinolaryngology Head and Neck Department of our hospital from 2002 to 2010 was performed. Patient demographic data, mucoceles location, symptoms, surgical approach and complications were recorded. RESULTS A total of 46 patients were included (27 males; 19 females). This series include 29 patients (63%) with frontal or frontoethmoidal mucoceles, 14 (30.4%) with maxillary and 3 (6.5%) with sphenoid mucoceles. Ninety-five percent of the patients were treated with intranasal endoscopic surgery. Complications occurred only in 7 cases (15.2%). CONCLUSIONS This study confirms that over the last 9 years significant changes have occurred in the surgical treatment of paranasal mucocele in our hospital, as endoscopic surgeries increased from 34% to over 90% as the first option of treatment for mucoceles.

Fibroangioma extranasofaríngeo de cornete nasal inferior: presentación de un caso

We present the case of a 9-year-old male patient, lacking morbid antecedents, referred to our service due to 2 episodes of massive epistaxis. The first one was selflimiting, while the second required anterior nasal packing. Physical examination revealed a tumour in the left nostril, with a vascularised appearance. The initial diagnosis was nasopharyngeal angiofibroma, due to the appearance of the tumour and to the episodes of massive epistaxis. The initial nasal endoscopy revealed abundant blood content associated with a vascular-appearing tumour mass from the lateral wall of the left nostril. It was impossible to visualise the nasopharynx in this study because the examination was not tolerated. Due to the vascular appearance of the mass, the suspected diagnosis was nasopharyngeal angiofibroma. Computed tomography (Fig. 1) revealed an ovoid lesion adhered to the cartilaginous part of the nasal septum, with soft tissue density, lacking significant contrast uptake. Bone tissue was not compromised and the pterygopalatine fossa

Cuerpo extraño nasosinusal inusual: presentación de 3 casos

Sinonasal foreign bodies are rare clinical entities. Their presence in the sinuses can originate complications, so their removal is always indicated. We present 3 cases of sinonasal foreign body, indicating their symptoms, imaging findings and surgical removal. Each patient was assessed with computerized tomography of the sinuses, rigid endoscopy, and then surgical removal. We confirmed the presence of the foreign bodies in all 3 cases and then performed a successful surgical removal by transnasal endoscopy. Sinonasal foreign bodies are infrequent entities that require surgical removal to prevent complications, with transnasal endoscopic surgery being the most commonly used surgical approach.

Cirugía endoscópica nasosinusal de revisión

INTRODUCTION AND OBJECTIVES Endoscopic sinonasal surgery is the procedure of choice in the treatment of chronic rhinosinusitis and sinonasal polyposis refractory to medical treatment, with high rates of success (76% to 97.5%). However, 2.5%-24% of those patients will require revision surgery (RESS). In this study, we present the clinical, anatomical, radiological and histological features of patients receiving RESS in our centre during a 3-year period. METHODS A retrospective review of clinical, anatomical, radiological and histopathological data of patients receiving revision endoscopic sinonasal surgery between 2012 and 2014 was carried out. RESULTS From 299 surgery procedures performed, 27 (9%) were revision surgeries. The mean patient age was 46 years, with a male/female ratio of 1.4/1. The most frequent preoperative and postoperative diagnosis was chronic polypoid rhinosinusitis. The mean time since the previous surgery was 6.1 years, with 11.9 months of mean follow-up since that surgery. Stenotic antrostomy was found during revision in 81.5% of the patients and incomplete anterior ethmoidectomy and persistent uncinate process, in 59.3%. In radiology, 70.4% of patients had persistent anterior ethmoidal cells. Antrostomy or widening of antrostomy was performed in 96.3% of cases and anterior ethmoidectomy or completion of it was performed in 66.7%. CONCLUSIONS Polyps, stenotic antrostomy and incomplete ethmoidectomy were the most frequent causes of revision surgery, in concordance with the procedures performed. The patients had long periods of time without follow-up between surgeries. Further investigation is necessary to generate measures to reduce the number of revision surgeries.