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Endoscopic endonasal surgery for recurrent cerebrospinal fluid rhinorrhea

Abstract Conclusions: CT and MRI are helpful to detect the precise site of the fistula, which is crucial for carrying out the repair, and transnasal endoscopic surgery is an effective treatment for recurrent cerebrospinal fluid (CSF) rhinorrhea. Objective: To discuss the cause and treatment of recurrent CSF rhinorrhea. Methods: A retrospective study was undertaken to analyze the clinical characteristics of 32 patients with recurrent CSF rhinorrhea. After detailed examination and radiological evaluation by CT and MRI, all of them underwent transnasal endoscopic surgery. Results: Six patients presented a leakage at the posterior wall of the frontal sinus, 12 at the ethmoid roof, and 14 at the sphenoid roof. Four cases with a defect in the frontal sinus and frontal recess were repaired with the DRAF III procedure, four cases with a defect in the sphenoid lateral recess were repaired through transpterygoid intervention and under an image-guided navigation system, while the others were operated by routine endoscopic sinus surgery. No recurrence was found during the follow-up for 14–60 months (mean 36.8) in 31 cases, and 1 case with recurrence recovered well after further surgery.

Effects of septal deviation on the airflow characteristics: Using computational fluid dynamics models

Abstract Conclusions: Computational fluid dynamics (CFD) methods can provide detailed information on airflow characteristics in models of septal deviation. Different locations of septal deviation lead to variation of nasal airflow. Both the location of the septal deviation and the inferior turbinate hypertrophy in the concave side may play an important role in airflow patterns and airflow velocity. Objective: To investigate the airflow patterns and air velocity in different septal deviation models during inspiration, using CFD methods. Methods: Commercial software was used to construct three-dimensional (3D) models of nasal cavities with paranasal sinuses from the computed tomography (CT) scans of 15 patients with septal deviation and 4 controls. Considering the location of the most prominent point of the nasal septum, patients were classified into caudal, anterior, and media deviation groups. Results: Unlike airflow in the controls, airflow in the septal deviation models showed asymmetry in bilateral nasal cavities. The airflow patterns varied in the convex and concave sides in different septal deviation models. Caudal septal deviation models had the maximal peak velocity, while the the minimal peak velocity was found in the media deviation models. The peak velocity was not always located in the convex side, but was sometimes in the concave side.

Expression of survivin and enhanced polypogenesis in nasal polyps.

Background The pathogenesis of nasal polyps still is not clear. This disease is believed to be inflammation related. Previous research has indicated that apoptosis in inflammatory cells is an important factor in the resolution of inflammation. Survivin is regarded as a novel member of the group of inhibitors of apoptosis proteins. It is overexpressed in a number of tumor types. The objective of this study was to investigate the expression of the survivin gene in human nasal polyps. Methods We investigated the expression of survivin in nasal polyps of adult patients with chronic rhinosinusitis. Specimens of nasal polyps were harvested during endonasal sinus surgery (n = 22), and the normal mucosa surrounding the nasal polyp tissues or inferior turbinate tissues served as control (n = 7). Immunohistochemical staining, reverse transcription polymerase chain reaction (RT-PCR), and Western blotting were performed for detecting the expression of survivin in the nasal polyps. Results This study has clearly shown that immunoreactivity of survivin significantly increased in the nasal polyp compared with nasal mucosa specimens surrounding nasal polyps (p < 0.001). The higher expression of survivin Western blotting and RT-PCR also was observed in the nasal polyp but not in normal nasal mucosa. Conclusion With a markedly increased expression of survivin in nasal polyps at both the mRNA and the protein levels, we believe the elevated expression of survivin might play an important role of the development in nasal polyps.

The role of upper and lower airway patency in chronic rhinosinusitis with nasal polyps and asthma

To investigate the role of airway patency and factors associated with airway patency in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) and asthma.

The intranasal endoscopic removal of schwannoma of the pterygopalatine and infratemporal fossae via the prelacrimal recess approach

OBJECTIVE This study was undertaken to analyze the results of a novel surgical method-the endoscopic prelacrimal recess approach (PLRA)-in patients with tumors involving the pterygopalatine fossa (PPF) and infratemporal fossa (ITF). The surgical technique and indications for this approach are also discussed. METHODS The authors analyzed data from 7 cases involving patients who underwent resection of PPF and ITF tumors by means of the endoscopic PLRA from 2004 to 2013. Preoperative and postoperative imaging studies were available in all cases and were reviewed. The surgical specimens were all confirmed to be schwannomas. RESULTS All tumors were completely resected via endoscopic PLRA. There were no recurrences noted over a 28-month follow-up period. In 4 cases, the patients experienced postoperative facial numbness during the first two weeks after surgery, which gradually lessened thereafter. One patient continued to have mild facial numbness at most recent follow-up. The numbness had fully resolved in the other 3 cases. CONCLUSIONS The intranasal endoscopic removal of schwannoma from PPF and ITF via PLRA can spare the whole lateral nasal wall, resulting in a reduction in morbidity. This is a novel minimally invasive surgical method for PPF and ITF tumors.

Expression of Innate Immunity Genes in Epithelial Cells of Hypertrophic Adenoids with and without Pediatric Chronic Rhinosinusitis: A Preliminary Report

Background: Adenoid hypertrophy (AH) is associated with pediatric chronic rhinosinusitis (pCRS), but its role in the inflammatory process of pCRS is unclear. It is thought that innate immunity gene expression is disrupted in the epithelium of patients with chronic rhinosinusitis (CRS), including antimicrobial peptides and pattern recognition receptors (PRRs). The aim of this preliminary study was to detect the expression of innate immunity genes in epithelial cells of hypertrophic adenoids with and without pCRS to better understand their role in pCRS. Methods: Nine pCRS patients and nine simple AH patients undergoing adenoidectomy were recruited for the study. Adenoidal epithelium was isolated, and real-time quantitative polymerase chain reaction (RT-qPCR) was employed to measure relative expression levels of the following messenger RNAs in hypertrophic adenoid epithelial cells of pediatric patients with and without CRS: Human &bgr;-defensin (HBD) 2 and 3, surfactant protein (SP)-A and D, toll-like receptors 1–10, nucleotide-binding oligomerization domain (NOD)-like receptors NOD 1, NOD 2, and NACHT, LRR and PYD domains-containing protein 3, retinoic acid-induced gene 1, melanoma differentiation-associated gene 5, and nuclear factor-&kgr;B (NF-&kgr;B). RT-qPCR data from two groups were analyzed by independent sample t-tests and Mann-Whitney U-tests. Results: The relative expression of SP-D in adenoidal epithelium of pCRS group was significantly lower than that in AH group (pCRS 0.73 ± 0.10 vs. AH 1.21 ± 0.15; P = 0.0173, t = 2.654). The relative expression levels of all tested PRRs and NF-&kgr;B, as well as HBD-2, HBD-3, and SP-A, showed no statistically significant differences in isolated adenoidal epithelium between pCRS group and AH group. Conclusions: Down-regulated SP-D levels in adenoidal epithelium may contribute to the development of pCRS. PRRs, however, are unlikely to play a significant role in the inflammatory process of pCRS.

Impact of airflow communication between nasal cavities on nasal ventilation.

Objective: To investigate the impact of airflow communication between bilateral nostril sides on nasal ventilation. In addition, we try to validate the efficacy of the Draf III procedure from the aerodynamics perspective. Methods: One health model and two disease models were constructed. These included 2 patients with nasal septum perforation and 1 patient who received the Draf III procedure. With the computational fluid dynamics method, indices such as airflow velocity and wall shear stress in the nasal cavity were detected and compared among the 3 subjects. Results: The main pathway for airflow in the nasal cavity is the common meatus. Little airflow exchange occurred in the patient who underwent the Draf III procedure, and the wall shear stress around the communication site was as low as in the adjacent areas. However, when airflow communication occurred in the lower part of the nasal cavity, the airflow velocity and wall shear stress were obviously altered, and the ventilation function of the nasal cavity was impaired. Conclusion: Airflow communication in the upper part of the nasal cavity has little impact on nasal ventilation. Nonetheless, airflow communication occurring in the lower part of the nasal cavity disturbs the overall airflow distribution and a repair procedure is necessary.

Juvenile psammomatoid ossifying fibroma in paranasal sinus and skull base.

Abstract Conclusion: The endoscopic transnasal approach with IGS is a safe and effective technique, allowing completely resection of JPOF, with minimal morbidity and recurrence. Objectives: JPOF is a benign but locally aggressive fibro-osseous lesion. This study presents a series of JPOF cases, involving anterior skull base and orbit, treated by endoscopic transnasal approach with image guidance system (IGS) to resect the mass completely. Method: This study retrospectively reviewed the clinical presentations, surgical procedures, and complications of 11 patients with JPOF who were treated by endoscopic approach from May 2009 to April 2014. All patients were followed by endoscopic and CT scan evaluations during follow-up. Results: All of the 11 cases were boys, with a mean age of 11.8 years (range = 6–17 years). The size of mass in the paranasal sinus ranged from 2.5–4.6 cm in greatest dimension (mean = 3.7 cm), and the medial orbital wall and cranial base were involved in all patients. All 11 patients received successful operation and were relieved from symptoms without mortality and major complications. During follow-up (range from 17–67 months; mean follow-up = 25.8 months), only one patient was recurrent in local position. The skull base partial resected during surgery was found to rebuild after 1 year.

Evaluating bone remodeling by measuring Hounsfield units in a rabbit model of rhinosinusitis: is it superior to measuring bone thickness?: Bone remodeling by HU in rhinosinusitis model

The traditional method of evaluating bone remodeling in chronic rhinosinusitis is to measure bone thickness. The objective of this study was to determine the feasibility of measuring the computed tomography (CT) value in Hounsfield units (HU) as an method and explore whether it is superior to measuring bone thickness.

Resection of Inverted Papilloma of the Maxillary Sinus via a Prelacrimal Recess Approach: A Multicenter Retrospective Analysis of Surgical Efficacy

Background The intranasal endoscopic prelacrimal recess approach (PLRA) access to all aspects of the maxillary sinus while preserving the inferior turbinate and nasolacrimal duct and its use have been reported in the treatment of many maxillary sinus and lateral skull base diseases. Objective To retrospectively assess the effectiveness of a 10-year multicenter follow-up for the resection of inverted papilloma of the maxillary sinus (IPMS) via a PLRA. Methods A total of 71 patients were admitted and underwent IPMS excision via an intranasal endoscopic PLRA from 2003 to 2013. All patients underwent high-resolution computed tomography scanning of the nasal sinus, and some also underwent magnetic resonance imaging examination. Results Based on the Krouse staging system, all 71 patients belong to T3 staging. The PLRA was employed to remove IPMS in 71 patients. The postoperative pathological examination of the excised tissue revealed inverted papilloma, and cancerization was identified in 3 patients. The median follow-up time was 37.3 months (range: 13–134 months). Of the 71 patients, reoccurrence was seen in 5 patients (7.04%); 5 patients (7.04%) experienced numbness of the upper lid and the ala of the nose and 4 (5.63%) experienced mild collapse of the ala of the nose. Conclusions These multicenter follow-up results demonstrated that the PLRA is a safe and effective method for the excision of primary or recurrent IPMS with lower postoperative complications and recurrent rate.