Ge Wt

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.

Computed tomographic and endoscopic analysis of supraorbital ethmoid cells

Objectives The aim of this study is to look at the incidence of supraorbital ethmoid cells (SOEC) in normal Chinese subjects by using spiral computed tomography (CT) scanning. In addition, subjects with chronic rhinosinusitis with SOEC were reviewed for endoscopic analysis. Methods A total of 202 normal Chinese subjects underwent spiral CT. Meanwhile, a retrospective review of patients who had undergone endoscopic sinus surgery over a 1-year period was conducted. Results SOEC showed an incidence of 5.4% (22 sides), and all of them arose from the anterior ethmoid cells. On coronal CT, an SOEC might give the appearance of multiple frontal sinuses, type III frontal cells, suprabullar cells, frontal bullar cells, inter-frontal septal cells, or that there was a septation present within the frontal sinus. Meanwhile, 11 chronic rhinosinusitis patients with 12 SOEC were identified. Conclusion A thorough knowledge of endoscopic anatomy and CT of the frontal recess and various fronto-ethmoid cells were required for safe dissection of the SOEC and frontal ostium.

Endoscopic management of the inverted papilloma with attachment to the frontal sinus drainage pathway

Conclusion. Extensive inverted papilloma (Krouse T3 lesions) with attachment to the frontal sinus drainage pathway can be treated successfully using an endoscopic approach. Objectives. The endoscopic management of inverted papilloma (IP) has gained in popularity over the last 15 years. However, the appropriate management of lesions involving the frontal sinus and its drainage pathway still has to be determined. Patients and methods. We performed a retrospective review of the results for patients with IP in the Otolaryngology, Head and Neck Surgery Department, Beijing Tongren Hospital from 2004 to 2007 to identify those patients with lesions involving the frontal sinus and its drainage pathway. By their appearance on nasal endoscopic examination and by computed tomography scanning, the tumors were defined using the Krouse staging system. Sinus endoscopy was used to screen for disease after endoscopic resection and the clinical outcomes were analyzed. Results. A total of nine patients (eight males and one female) were identified in which IP involved the frontal sinus and its drainage pathway. Preoperative and postoperative pathological examinations revealed IP as the diagnosis. All tumors were defined as T3 lesions. Four cases with lateral wall of frontal recess tumor attachment underwent an endoscopic Draf IIA frontal sinusotomy. Three cases with either lateral and posterior walls of frontal recess and frontal infundibulum attachment, or medial and posterior walls of frontal recess and frontal infundibulum attachment underwent a Draf IIB procedure. Two cases with posterior wall of frontal recess and frontal infundibulum attachment, or medial, lateral, and posterior walls of frontal recess and frontal infundibulum attachment underwent a Draf III procedure. All patients remain disease-free after an average follow-up period of 15 months.

Anatomical and computed tomographic analysis of the interaction between the uncinate process and the agger nasi cell

Conclusions. The agger nasi cell, together with the postosuperior portion of the uncinate process, was the key that unlocked the frontal recess. Objectives. To investigate the anatomical interaction between the upper portion of the uncinate process and the agger nasi cell. Materials and methods. Twenty-one skeletal skulls (42 sides) were studied by spiral computed tomography (CT) and endoscopy, and one cadaver head (2 sides) was studied by collodion-embedded sectioning in the coronal plane. Results. The endoscopic view of the entrance of the middle meatus showed the middle part of the uncinate process and the middle part of the middle turbinate fused together as the axilla of the middle meatus. The middle portion of the uncinate process attached to the frontal process of the maxilla in all of the skeletal nasal cavities, as well as the lacrimal bone in 33 sides of the skeletal nasal cavities. On CT scans, the agger nasi cell was present in 38 sides of the skeletal nasal cavities. The agger nasi cell was medially, superiorly and inferiorly bounded by the uncinate process. The superior portion of the uncinate extended into the frontal recess and may insert into the lamina papyracea (33%), skull base (10%), middle turbinate, and a combination of these (57%).

Multiplanar computed tomographic analysis of the frontal recess region in Chinese subjects without frontal sinus disease symptoms.

The purposes of this study were to determine the prevalence of frontal-ethmoidal cells and to evaluate variation in the superior attachment of the uncinate process in Chinese subjects. 202 normal Chinese subjects (404 sides) underwent spiral computed tomography and multiplanar reconstruction images were evaluated. Agger nasi cells showed a prevalence of 94.1%. Of all the frontal cells identified in 159 sides (39.6%) of frontal recesses, the prevalence of type I, type II and type III cells was 24.4, 7.0 and 8.2%, respectively. Suprabullar, frontal bullar and interfrontal septal cells were identified in 148 sides (36.6%), 36 sides (9.0%) and 25 subjects (12.4%), respectively. 244 uncinate processes (60.4%) had 1 superior attachment and the remainder (39.6%) had 2 superior attachments. The prevalence of terminal recesses was 89.1%. Our results characterized normal frontal recess pneumatization patterns in Chinese subjects. That, together with variation in the superior attachment of the uncinate process, emphasized the role of agger nasi cells and the uncinate process in endoscopic frontal sinus surgery.