Ian S. Mackay

Endoscopic Sinus Surgery in the Treatment of Cystic Fibrosis With Nasal Polyposis

We have performed endoscopic sinus surgery on 46 patients with chronic, polypoid rhinosinusitis since 1989. Follow‐up ranged from 1 month to 6 years(mean, 28.2 months). Overall, our patients had a 50% chance either of their symptoms returning to preoperative severity or of undergoing a second endoscopic sinus procedure, by 18 to 24 months of postoperative follow‐up. Patients with predominantly infective symptoms of mucopurulent rhinorrhea and pain had a significantly better outcome than those with predominantly nasal blockage. The chance of the former group of patients suffering symptom deterioration back to the preoperative state or undergoing a second endoscopic sinus operation was 37% of that of the latter group. The extent of disease on computed tomography scan had no relation to outcome.

Endoscopic fenestration of choanal atresia

We report two cases of unilateral choanal atresia and one of choanal stenosis treated successfully by endoscopic fenestration, with no recurrence at a mean follow-up of 18 months. Rigid endoscopy and axial CT scanning confirm the clinical diagnosis and this technique avoids the need for stenting or prolonged post-operative stay.

Outcome of Endoscopic Sphenopalatine Artery Occlusion for Intractable Epistaxis: A 10‐Year Experience

Objective/Hypothesis: To evaluate the efficacy of surgical sphenopalatine artery occlusion (SAO) for treating intractable epistaxis, and identify factors associated with long‐term success or failure of this procedure.

Endoscopic ligation or diathermy of the sphenopalatine artery in persistent epistaxis

Conventional methods of arterial ligation in persistent epistaxis often involve significant surgical morbidity, as well as failure due to arterial anastomosis. We have performed endoscopic intranasal end ligation or diathermy of 11 sphenopalatine arteries in 10 patients with no complications and with no further episodes of epistaxis, with an average follow-up period of nine months.

The treatment of pharyngeal pouch

A case of carcinoma occurring in a pouch following a Dohlmans operation is reported. The management and complications of ninety-two patients with pharyngeal diverticula are discussed. The average length of hospitalization for patients undergoing diverticulectomy was sixteen days compared with eleven days for those treated by Dohlmans technique. The risk of carcinoma subsequently occurring in a retrained pouch should be considered and external diverticulectomy should be the treatment of choice whenever possible.

Charing Cross CT protocol for endoscopic sinus surgery.

The Charing Cross computerized tomography protocol for imaging the paranasal sinuses uses 2 mm thick slices with table increments of 8 mm: 10 to 12 coronal and two axial images are produced. These provide the necessary information for diagnosis of chronic rhinosinusitis and safe endoscopic sinus surgery. The technique is quicker and cheaper than previously described protocols and exposes the lens of the eye to less radiation.

Multiple submucosal out-fractures of interior turbinates

Nasal obstruction caused by the inferior turbinate is a common clinical problem. There are many surgical procedures which attempt to relieve it, but all of them have associated difficulties. We describe, for the first time, a new method, namely multiple submucosal out-fractures of the inferior turbinates, which is both effective and free from serious complication.

How safe is submucosal diathermy

Submucosal diathermy (SMD) is a common surgical procedure carried out to improve the nasal airway. A case is presented in which it was followed by profuse epistaxis which required transfusion of 28 units of blood, eight units of fresh frozen plasma (FFP) and four units of platelets within 14 days.

Assessment of predictive prognostic factors for functional endoscopic sinus surgery in a 5-year prospective outcome study.

Background Among numerous studies in the literature regarding prognostic factors that might determine outcome in functional endoscopic sinus surgery (FESS), very few have dealt with assessment of their predictive potential regarding outcome, and none have tried to find out the extent of such a prediction. We have developed a composite model to find out the predictive values of various prognostic factors, using an outcome measure based on the need for postoperative medical intervention. Methods One hundred nine patients were recruited for FESS and followed up at regular intervals for 5 years. Ten prognostic factors were identified and were correlated with prospectively recorded outcome measures. A discriminant analysis using SPSS software was performed to identify the prognostic factors that could “predict” the outcome. Results CT scan scores and polyp scores were the strongest predictors. Using our model, the probability to predict correctly the need for postoperative systemic medication was found to be 81.7%. Conclusion We have generated a model to predict the outcome of FESS, with a 5-year follow-up. CT scan scores and polyp scores were found to be the strongest predictors of the need for postoperative systemic medication.

Management of nasal polyps

Nasal polyposisis a single term used to describe a range of prolapsing, inflammatory nasal conditions that may have different causes. Current efforts are directed toward the classification of these varying manifestations to allow for accurate comparison of different therapies and of the same therapies in different series. Attempts are also being made to standardize outcome measures. With standard descriptions and outcomes, the effects of confounding variables can be analyzed. Recent studies of medical therapy have shown that topical corticosteroids are of benefit both before and after polyp surgery. Computer-aided navigation systems for ethmoid sinus surgery have been described, and it has been suggested that these systems will increase safety. Additional features for microdebriders have been developed and have been described as allowing greater surgical precision. Assessment of the effects of these new therapies will improve with accurate classification of chronic polypoid rhinosinusitis.