Márcio Nakanishi

Stage II Chronic Maxillary Atelectasis Associated with Subclinical Visual Field Defect

Introduction Chronic maxillary atelectasis (CMA) is characterized by a persistent decrease in the maxillary sinus volume due to inward bowing of its walls. According to its severity, it may be classified into three clinical-radiological stages. Objective To report a case of stage II CMA associated with subclinical visual field defect. Case Report A 34-year-old woman presented with a 15-year history of recurrent episodes of sinusitis and intermittent right facial discomfort for the past 5 years. She denied visual complaints, and no facial deformities were observed on physical examination. Paranasal sinus computed tomography (CT) demonstrated a completely opacified right maxillary sinus with inward bowing of its walls, suggesting the diagnosis of stage II CMA. A computerized campimetry (CC) disclosed a scotoma adjacent to the blind spot of the right eye, indicating a possible damage to the optic nerve. The patient was submitted to functional endoscopic sinus surgery, with drainage of a thick mucous fluid from the sinus. She did well after surgery and has been asymptomatic since then. Postoperative CT was satisfactory and CC was normal. Discussion CMA occurs because of a persistent ostiomeatal obstruction, which creates negative pressure inside the sinus. It is associated with nasosinusal symptoms but had never been described in association with any visual field defect. It can be divided into stage I (membranous deformity), stage II (bony deformity), and stage III (clinical deformity). The silent sinus syndrome is a special form of CMA. This term should only be used to describe those cases with spontaneous enophthalmos, hypoglobus, and/or midfacial deformity in the absence of nasosinusal symptoms.

Transillumination-guided study of the endoscopic anatomy of the lacrimal fossa

UNLABELLED Dacryocystorhinostomy is the treatment of choice for the obstruction of the lachrymal apparatus. At the end of last century, the development of the endoscopic instruments for nasosinusal surgery has made it possible to do it through the endoscopic pathway. Nonetheless, anatomical variations make it difficult to have reproducibility endonasaly. AIM study the endoscopic anatomy of the lachrymal fossa through transillumination of the common canaliculus. STUDY DESIGN experimental. MATERIALS AND METHODS we dissected 40 lachrymal pathways from 20 human cadavers, in three stages: 1. identification and dilation of the lachrymal canaliculus. 2 - Optic fiber beam introduction; 3 - endoscopic dissection of the lachrymal sac, describing its position. RESULTS the most frequent position of the lachrymal sac was between the free border of the middle turbinate and its insertion immediately underneath it. The maxillary line was seen in 95% of the cases. Septoplasty was needed in 12.5%, unicifectomy in 35% and middle turbinectomy in 7.5%. CONCLUSION Although the lachrymal sac has a more frequent location, its position varied considerably. The transillumination of the common canaliculus proved useful, solving the problem of the anatomical variability.

Clinic-epidemiological analysis of an otorhinolaryngology emergency unit care in a tertiary hospital

UNLABELLED Emergencies are common in our Otorhinolaringology specialty. However, the clinical and epidemiological features are not very well known. OBJECTIVES To evaluate the clinical and epidemiological profiles of otorhinolaryngological disorders in an emergency unit of a tertiary hospital, and to determine the appropriateness of the level of health care for a tertiary hospital. MATERIALS AND METHODS An analytical study using data records of an otorhinolaryngological emergency unit at a tertiary hospital in the Federal District for a year, full time, and no screening. The age, sex, arrival time and clinical diagnosis were evaluated. The entities were separated into cases of pharingolaryngoesthomatology, otology, rhinology, and head and neck surgery. These were evaluated according to the urgency level, the required care, and the arrival time. RESULTS 26,584 data records were selected, of which 2,001 were excluded. The group comprised 54. 48% women, and 45. 51% men. Otological complaints (62. 27%) prevailed. 61. 26% of cases were considered emergencies. Only 9. 7% of those required medium or high complex resources for resolution. CONCLUSIONS The study showed that 61. 26% of the otorhinolaryngological cases are emergencies, and only 9. 7% required medium or high complexity resources.

Artéria esfenopalatina: desafio cirúrgico na epistaxe

UNLABELLED Knowledge on the anatomy of the sphenopalatine artery (SPA) and its branches is fundamental for the success of the endoscopic treatment of posterior epistaxis. However, the complex anatomical variations seen in the irrigation of the nasal cavity poses a significant surgical challenge. OBJECTIVE This paper aims to describe the endoscopic anatomy of the SPA in human cadavers. MATERIALS AND METHODS This is a contemporary cross-sectional cohort study carried out between April 2010 and August 2011. The presence of the ethmoidal crest on the lamina perpendicular to the palatine bone and the location of the principal sphenopalatine foramen (PSF) and the accessory sphenopalatine foramen (ASF) were analyzed in 28 cadavers, and the branches emerging from the foramens were counted. RESULTS Fifty-six nasal fossae were analyzed. The ethmoidal crest was present in 96% of the cases and was located anteriorly to the PSF in most cases. The PSF was located in the transition area between the middle and the superior meatus in all cases. The ASF was seen in 12 cases. Most nasal fossae (n = 12) presented a single bilateral arterial trunk emerging from the PSF. In other cases, three (n = 8) or two (n = 5) arterial trunks emerged bilaterally from the PSF. In most cases, the SPA emerged as a single trunk from the ASP. CONCLUSIONS The anatomy of the SPA is highly variable. The success of the treatment for severe epistaxis relies heavily on adequate knowledge of the possible anatomical variations of the sphenopalatine artery.

Malignant paranasal sinus schwannoma

1 Graduation (Otorhinolaryngologist, Brasilia University). 2 Graduation (Otorhinolaryngology Medical Resident, Brasilia University). 3 Graduation (Assistant Professor, Department of Otorhinolaryngology and Head and Neck Surgery, Brasilia University). 4 PhD in Sciences, ENT Department, University of Sao Paulo (Adjunct Professor, Department of Otorhinolaryngology and Head and Neck Surgery, Brasilia University). 5 PhD in Surgery, ENT Department, Federal University of Sao Paulo (Adjunct Professor, Department of Otorhinolaryngology and Head and Neck Surgery, Brasilia University). Brasilia University Hospital Department of Otorhinolaryngology Head and Neck Surgery. Send correspondence to: Vitor Yamashiro Rocha Soares. SGAN, Via L2 Norte, Quadra 604/605, Asa Norte, HUB, Anexo III. CEP: 70840-050. Tel: 55 (61) 8130-0972. Email: vyrsoares@yahoo.com.br Paper submitted to the BJORL-SGP (Publishing Management System Brazilian Journal of Otorhinolaryngology) on May 30, 2011; and accepted on October 11, 2011. cod. 7974. CASE REPORT Braz J Otorhinolaryngol. 2012;78(4):135. BJORL

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.

Does ear endoscopy provide advantages in the outpatient management of open mastoidectomy cavities

Objective To evaluate the use of ear endoscopy in the postoperative management of open mastoidectomy cavities, and to test whether ear endoscopy improves inspection and cleaning compared with ear microscopy. Methods Prospective study. Thirty-two ears were divided into two groups: group 1, examination and cleaning of mastoid cavities under endoscopic visualization after microscopic standard ear cleaning; group 2, examination and cleaning of mastoid cavities under microscopic visualization after endoscope-assisted ear cleaning. We assessed the ability of each method to provide exposure and facilitate cleaning, comparing the benefits of microscopy and endoscopy when used sequentially and vice-versa. Results Endoscopy provided additional benefits for exposure in 61.1% of cases and cleaning in 66.7%. Microscopy provided no additional benefits in terms of exposure in any case, and provided added benefit for cleaning in only 21.4% of cases. Discussion For outpatient postoperative care of open mastoidectomy cavities, ear endoscopy provides greater benefit over ear microscopy than vice-versa. In over half of all cases, endoscopy was able to expose areas not visualized under the microscope. Furthermore, in two-thirds of cases, endoscopy enabled removal of material that could not be cleared under microscopy. Ear endoscopy was superior to microscopy in terms of enabling exposure and cleaning of hard-to-reach sites, due to its wider field of vision. Conclusion Ear endoscopy is a feasible technique for the postoperative management of open mastoidectomy cavities. Ear endoscopy provided superior advantages in terms of exposure and aural cleaning compared with microscopy.

A feasible, low-cost, reproducible lamb’s head model for endoscopic sinus surgery training

Objective To describe and standardize a reproducible, viable, low-cost lamb’s head model for endoscopic sinus surgery training. Methods Otorhinolaryngology residents performed the following three endoscopic sinus surgeries using the lamb’s head model: inferior turbinectomy, bullectomy, and maxillary antrostomy. Each student dissected 10 specimens before training these procedures on human patients, and the benefit of the animal model training was evaluated. Results Nineteen resident physicians of comparable academic level participated in training. All participants agreed that the lamb’s head model dissections improved their skills in using surgical and videoendoscopic instruments, 90% agreed that the dissections improved their confidence with respect to training in human patients, and all stated they would recommend the same training to future residents. Discussion Lamb’s heads have been used for training in endoscopic sinus surgery. However, no standardization of this training had been performed to ensure that it is a valuable tool for learning and skill-building. The standardized method described in this study increased resident physicians’ skills and confidence before beginning their training on human patients. Moreover, our results demonstrate the feasibility of the model, considering its low cost and reproducibility. Conclusion Future studies with this model should be conducted to assess whether the resulting increase in skills prevents and reduces medical errors, increases patient safety, reduces surgical costs, and improves the quality of otorhinolaryngological care.