Fabrizio Ricci Romano

The role of endoscopic surgery in the treatment of nasal inverted papilloma

UNLABELLED The inverted papilloma is a benign neoplasm, prone to malignancy, and bearing a high rate of post-op recurrence. There is much debate in the literature concerning the issue that an endoscopic approach may offer a benefit over an external approach. AIM Demonstrate the efficacy of an endonasal endoscopic approach in the treatment of inverted papilloma. STUDY DESIGN Retrospective. MATERIALS AND METHODS Retrospective analysis of patients with inverted papilloma operated at the University Hospital--FMUSP from 1994 to 2004. RESULTS Twenty-eight patients records were studied. Nine patients (32.1%) had tumor recurrence, one being operated via the endoscopic method and eight by external approach. DISCUSSION Krouses staging system for inverted papillomas can facilitate both treatment planning and comparison of surgical outcomes. The use of the endoscopic approach resulted in fewer relapses than when the external one was used in cases with the same tumor staging. CONCLUSION The use of the endoscope in this type of surgical treatment is an important success factor in the treatment of inverted papilloma.

Nasal contact endoscopy for the in vivo diagnosis of inverted schneiderian papilloma and unilateral inflammatory nasal polyps.

Background Inverted schneiderian papilloma is an entity surrounded by controversies ranging from its etiology to the indication of treatment. Any method that permits histopathological analysis without damage to the tissue studied deserves to be investigated. In this study, we tested a new noninvasive method, i.e., nasal contact endoscopy. Methods The main alterations visible on nasal contact endoscopy were described in 11 patients with inverted papilloma and in 8 patients with unilateral inflammatory nasal polyps. The characteristics showing the differentiation between the two entities were defined and these findings were presented to inexperienced examiners. Results The significant characteristics for differentiation between the two diseases were the presence of vacuolized cells, cellular heterogeneity, cell clusters, a ciliated respiratory epithelium, and vascular patterns. Two of the three examiners showed a statistically significant high rate of correct diagnosis. Conclusion Nasal contact endoscopy may be an effective method for the differential diagnosis between inverted schneiderian papilloma and inflammatory polyps even when the examiner is inexperienced.

Brazilian Academy of Rhinology position paper on topical intranasal therapy

This documents aims at educating those who treat sinonasal diseases - both general practitioners and specialists - about topical nasal treatments. By means of scientific evidence reviews, the Brazilian Academy of Rhinology provides its practical and updated guidelines on the most utilized topical nasal medication, except for the drugs that have topical antibiotics in their formulas.

Rhinosinusitis: evidence and experience. A summary

as Mild, Moderate or Severe. Disease severity isclassified through the Visual Analog Scale (VAS) (Fig. 1), from0 to 10cm. The patient is asked to quantify from 0 to 10 thedegree of discomfort caused by the symptoms; zero meaningno discomfort, and 10, the greatest discomfort. Severity isthen classified as follows: Mild: 0---3 cm; moderate: >3---7 cm;Severe: >7---10cm.

Evaluation of inverted papilloma and squamous cell carcinoma by nasal contact endoscopy.

Background Contact endoscopy (CE) was initially described as a method used in the analysis of uterine and vocal folds histology. The first nasal cavity CE studies achieved promising results regarding its use for the differentiation between benign and malignant lesions, considering that biopsy might cause some complications, especially bleeding. This study described and compared the findings of CE on inverted papilloma and nasosinusal squamous cell carcinoma (SCC) and tested the effectiveness of this exam as a noninvasive method for in vivo differentiation between these tumors. Methods The patients included in this study were divided into group A, patients diagnosed with inverted papilloma, and group B, patients diagnosed with SCC. CE results were compared among themselves. CE images were presented to examiners not experienced with the method. Results Twenty-two patients were examined, 13 in group A and 9 in group B. The main relevant differences in CE findings between those two groups were corkscrew vessels, presence of mitoses, keratinization and nuclear pleomorphism in carcinoma, and vacuolated cells in papilloma. The examiners were capable of defining the diagnosis of these nasal tumors only based on CE images. Conclusion CE may be a useful noninvasive exam to be used in the in vivo diagnosis of inverted papilloma and nasosinusal SCC, which may enable better preoperative planning.

Superior orbital fissure syndrome due to sinusitis: report of two cases.

Background The potential morbidity and mortality of sphenoid sinus infectious processes are related to their proximity to vital structures within the orbit, such as the cavernous sinus and the brain. Involvement of the posterior orbit can result in superior orbital fissure syndrome, a rare entity affecting structures that cross this anatomic region. Early recognition of this syndrome is mandatory. Delays in adequate treatment may compromise the patients prognosis. Methods We present two cases of incomplete superior orbital fissure syndrome due to infectious processes of the posterior ethmoid and sphenoid sinuses. Conclusions In our experience, endoscopic decompression of the lamina papyracea shows complete recovery of extrinsic ocular motility in these patients and should be combined with intravenous antibiotic therapy.

Agenesia do nariz: relato de caso

Agenesis of the nose (arhinia, congenital nasal atresia) is a rare anomaly with about 20 surviving cases reported in the English literature in the last century. The embryological origin of the defect is thought to be maldevelopment of the paired nasal placodes. The respiratory distress is evident after the birth and requires immediate orotracheal intubation and mechanical ventilation. Herein we report a case of congenital absence of the nose in a male child. Immediately after birth, the baby had difficulty in breathing and developed cyanosis, for which he required orotracheal intubation and tracheotomy, posteriorly. On examination a, a flat bony area replaced the nose, the hard palate was highly arched, and bilateral microphthalmia. The child was also was evaluated by CT (computed tomography) and MRI (magnetic resonance imaging) studies. The CT scan revealed absence of the nose, anterior bony stenosis, absence of the nasal chamber and paranasal sinuses, a high-arched palate, bilateral microphtalmia, and bilateral mucocele of the lachrymal sac. The MRI demonstrated normal configuration and density of the brain.

New Ringer's lactate gel formulation on nasal comfort and humidification

INTRODUCTION The use of saline irrigation for nasal washes is a well established procedure in the treatment of sinonasal inflammation and infection. In addition to saline solutions, Ringers lactate is also an efficient option for nasal washes and humidification. OBJECTIVE To assess the comfort, humidification and tolerance regarding stinging sensation, provided by sodium chloride nasal gel at the concentrations of 4.5mg/g and 6.0mg/g through questionnaires answered by the patients. METHODS A total of 60 patients, 56 females, aged between 22 and 66 years old (mean age of 47) and 4 males, aged between 36 and 66 years (mean age of 49), were included in the study for a period of 17 days (±2 days) treatment. The patients were monitored by a general practitioner throughout the study period. They were instructed to apply each product in both nostrils twice a day during a 7-day period (±2 days). The patients were evaluated prior to the use of the first product at visit 0 (V0), after 7 days of treatment (±2 days) at visit 1 (V1), after 3 days of product discontinuation at visit 2 (V2) and after 7 days (±2 days) of treatment with the second product, in visit 3 (V3). RESULTS A significant difference (5% significance) was observed regarding comfort and stinging sensation between the two different concentrations; comfort was higher and stinging was lower with the 6.0mg/g concentration gel. No difference in humidification was observed between the two treatments. CONCLUSION Ringers lactate at the concentration of 6.0mg/g was superior to that at 4.5mg/g for parameters comfort and stinging sensation. No statistical difference was observed between the two products regarding nasal humidification.

Superior orbital fissure syndrome caused by sinusitis

Abstract Objectives: The potential morbidity and mortality of sphenoid sinus infectious processes are related to its proximity to vital structures within the orbit, such as the cavernous sinus and the brain. Involvement of the posterior orbit can result in superior orbital fissure syndrome (SOFS), a rare entity that comprehends dysfunction of the structures that cross this anatomical region. Early recognition of this syndrome is mandatory. Delays on adequate treatment may compromise the patient’s prognosis. The purpose of this report is to present 2 cases of incomplete superior orbital fissure syndrome due to infectious processes of the posterior ethmoid and the sphenoid sinuses. Methods: Description of 2 cases of incomplete superior orbital fissure syndrome in our department. Results: The 2 cases had excellent clinical evolution after a combined treatment with antibiotics and endoscopic sinus surgery. A complete recovery of extrinsic ocular movements were observed in both cases. Conclusion: In our experience treatment with endoscopic sinus surgery and decompression of the lamina papyracea in these patients had good results and should be associated to intravenous antibiotic therapy.

Intracranial complications of sinusitis: a five-year review of three cases

Objectives: Despite improvements in antibiotic therapies and surgical techniques, sinusitis still carries a risk of serious and potentially fatal complications. In this study, we describe our findings in the patients who had intracranial complications. Methods: We examined the charts of 38 patients who had been admitted to the “Hospital das Clı́nicas da Faculdade de Medicina da USP,” São Paulo, Brazil, between January 1, 1997, and March 31, 2002, for treatment of sinusitis complications. Of these 38 patients, 35 had orbital complications and 3 had intracranial complications. Results: We found one case of epidural abscess, one case of cavernous sinus thrombosis, and one case of frontal osteomyelitis and cerebral abscess. The last two patients did not take antibiotics properly before admitted to our service. All of them had no central signs or symptoms such as seizures, hemiparesia, weakness, and mental confusion. The diagnosis of intracranial complications was only possible by the use of computed tomography. Those patients were treated with intravenous antibiotics and drainage of the affected sinuses by endoscopic surgery, which has been helping to improve outcomes. Neurosurgery was not necessary in any of these, and neither the use of anticoagulant therapy in the case of cavernous sinus thrombosis. Conclusion: Intracranial infections secondary to rhinosinusitis occur sporadically, and although it appears that this cannot be prevented, recognition and management of these patients should be undertaken immediately and are best achieved via a multidisciplinary approach.