The use of small intestine in bladder reconstruction

OBJECTIVE: This study was conducted to determine the efficacy of FESS (functional endoscopic sinus surgery) on sinus and asthma symptoms. METHOD: Seventy-nine patients with asthma and medically unresponsive sinusitis were evaluated. Maximal medical therapy was attempted to relieve both sinus and asthma symptoms. The surgical procedures involved standard FESS techniques. Fifty-six percent of patients had undergone a sinus procedure prior to the FESS. Nasal polyposis was noted in 73% of the group. The majority of patients had pansinusitis. RESULTS: Eighty-six percent of patients stated that FESS improved their sinusitis. Nine of 11 sinus symptoms recorded preoperatively diminished significantly (p < .05) following surgery. Eighty percent of patients noted improvement of their asthma following FESS. The factors associated with treatment failure and the unique characteristics of this disease process were evaluated. CONCLUSIONS: FESS is a viable option in the treatment of asthma when medical therapy fails.     

Coronal CT of the paranasal sinuses before and after functional endoscopic sinus surgery

Coronal CT of the paranasal sinuses and the ostiomeatal complex (OMC) was performed before and 12 months after bilateral functional endoscopic sinus surgery (FESS) in 30 patients with sinusitis and 12 patients with nasal polyposis. The extent of sinus mucosal thickening was graded, and the patency of the OMC was evaluated. After FESS, the percentage of open OMCs had increased from 42% to 83% in the sinusitis group, and from 8% to 45% in the polyposis group. There was only a small improvement in mucosal score in sinuses with opened OMC, so that the overall extent of sinus opacification before and after FESS was almost the same. Despite this, 91% of the patients reported clinical relief of symptoms. Preoperative coronal CT of the paranasal sinuses serves as an anatomical map for the surgeon, but there is no benefit of routine postoperative CT.     

Variation in labial shoulder geometry of metal ceramic crown preparations: a finite element analysis

BACKGROUND: The anatomic variation of the frontal sinus and frontal recess can create both a diagnostic and therapeutic challenge. Most cases of frontal sinus disease can now be treated by endoscopic approaches. For refractory cases or those with severe pathology, the microscopically controlled drainage (MCD) operation has at times been successful and spared the patient the morbidity of an external approach. The aim of this study was to evaluate microscopically controlled frontal sinus surgery in these difficult cases. MATERIAL AND METHODS: Prospective analysis was performed on the efficacy of MCD in patients for whom endoscopic sinus surgery had failed or in primary cases with severe pathology or unfavorable anatomy. The technique employs a self-retaining endonasal retractor and a diamond bur under microscopic visualization to remove solid bone (frontal spine) obstructing the sinus drainage and allow a wide opening of the frontal recess while causing minimal mucosal damage. Unilateral drainage (extended frontal sinus drainage operation), and in some cases bilateral drainage (median drainage procedure) is employed. RESULTS: With an average of 23 months of follow-up, over 90% of patients were either free of symptoms or substantially improved after the MCD procedure. Three patients required revision surgery (extend the opening into a median drainage procedure) for adequate relief of symptoms. CONCLUSIONS: The MCD procedure is highly successful in the treatment of frontal recess disease, particularly in those cases of severe pathology or difficult anatomy. It may be used in those cases refractory to standard endoscopic sinus surgery where an external approach and frontal sinus obliteration are contemplated. As with endoscopic sinus surgery, precise knowledge of the frontal recess and neighboring landmarks is critical, and adequate drainage with minimal mucosal disruption should be the goal.     

Needs assessment of non-traditional students in physical and occupational therapy programs

A technique of combined functional endoscopic sinus surgery (FESS) was carried out through the nose to clear up the ostiomeatal complex. A small window was then created in the canine fossa to remove the maxillary sinus pathology under endoscopic control. It aims at the complete removal of maxillary sinus pathology, which cannot be safely removed via the middle meatus while preserving the rest of the mucosa to ensure sinus rehabilitation. It also helps the surgeon in case of difficulty in locating the ostium during FESS. A series of 36 patients was studied over a period of two years, with a follow up, up to two years, post operatively. The present technique proved to be complementary to FESS with no serious complications. It is recommended for cases of recurrent antrochoanal polyps, oroantral fistula, sinusitis of dental origin or fungal infection of the nose and sinuses.     

Conservative approach to inflammatory nasofrontal duct disease

Endoscopic data reveal that mucosal disease frequently recurs following the surgical treatment of chronic diffuse hyperplastic frontal sinus and nasofrontal duct disease. However, this group of patients often remains asymptomatic. We present 40 patients who underwent endoscopic sinus surgery with a 4-year mean follow-up. Postoperative endoscopy revealed mucosal disease within the frontal recess in 39 of the 40 (97.5%) patients; however, only 3 of the 40 (7.5%) were symptomatic. Of these 3 patients, 1 underwent revision surgery. Historical information demonstrates the potential for significant nasofrontal duct stenosis associated with such revision surgery. On the basis of our initial results, endoscopic observation and medical therapy seem to be successful in controlling the symptoms associated with this disease process.     

Ovarian surgery in premenarchal girls

OBJECTIVES: Evaluate causes of surgical failure at time of revision endoscopic sinus surgery. STUDY DESIGN: Prospective review of 682 cases that had endoscopic sinus surgery performed between 1991 and 1995. METHODS: In all cases, variables of age, sex, asthma, allergy, computed tomography stage, associated procedures, complications, and operative findings were collected. Those cases that had a failure after a previous endoscopic sinus procedure and not an intranasal procedure or an external procedure were evaluated. RESULTS: Fifty-two patients (7.6%) were identified. The age range was 24 to 70 years. The most common cause of failure was residual air cells and adhesions in the ethmoid area (30.7%), followed by maxillary sinus ostium stenosis in 27%, frontal sinus ostium stenosis in 25%, and a separate maxillary sinus ostium stenosis in 15% of the cases. CONCLUSION: Review of surgical causes of failure in endoscopic sinus surgery patients revealed that residual air cells and stenotic maxillary or frontal sinus ostium were the most common causes of failures.     

Functional endoscopic sinus surgery: results in the young child

Recent studies have addressed the usefulness of functional endoscopic sinus surgery (FESS) in both adult and pediatric patients, but little information is available concerning the long-term followup of young children. During a 31 month period, 57 children, age six years or less had FESS performed by a single surgeon. In each case the child had failed aggressive medical management including long-term oral antibiotics. A coronal sinus CT scan was obtained prior to surgery and showed opacification of the maxillary and/or ethmoid sinuses with obstruction of the ostiomeatal complexes. A similar surgical approach was used in each case. There were no major surgical or anesthetic complications noted during the initial procedure or the followup debridement. To evaluate the results of FESS, a questionnaire was mailed to the parents of each patient. The questionnaires were completed 5 to 36 months after surgery (mean 17.3 months). Ninety-three percent of the children showed improvement based on the observations of their parents. Improvement was judged primarily by reduced symptoms, reduced need for antibiotics, and the need for fewer doctor visits during the followup period. In summary, FESS appears to offer a safe and effective technique to control sinus disease in children who do not respond to aggressive medical management. In skilled hands, this technique is associated with few complications and appears to offer relief even in young patients.     

Recovery of nasal physiology after functional endoscopic sinus surgery: olfaction and mucociliary transport

We assessed the changes in olfaction and mucociliary transport after functional endoscopic sinus surgery (FESS) in 80 patients with chronic paranasal sinusitis. Olfaction was evaluated with the butanol threshold test and mucociliary transport was assessed by saccharin transit time (STT). Postoperative butanol threshold scores were significantly reduced (p < 0.01), and the changes were more profound in severer forms of paranasal sinusitis as graded by ostiomeatal-unit computed tomography. The mean preoperative STT (27 min) which was significantly longer than that of controls (12 min) was significantly reduced 1, 6 and 12 months following FESS (p < 0.01). The results suggest that impairment of olfaction and mucociliary transport in chronic paranasal sinusitis may be significantly improved following FESS.     

Pre- and postoperative mucociliary clearance in functional endoscopic sinus surgery

The advent of functional endoscopic sinus surgery (FESS) has revolutionized the treatment of chronic sinusitis over the last decade. Although it has been well-established that FESS is more efficacious than conventional surgery, the lack of a quantifiable means of assessing results remains one of the major shortcomings of the technique, and hence a source of criticism. Since the pathophysiology of chronic sinusitis is intimately related to the mucociliary mechanism of the nose and sinuses, it seems logical to use this parameter as a yardstick of success. We undertook a prospective, controlled study of 40 patients and measured their "saccharin times" before and after surgery. The results show a marked reduction in clearance times postoperatively, corresponding well with improvement in symptom profile. We therefore propose this technique as a simple, safe and reliable method of assessing the results of surgery. Furthermore, the method could act as a preoperative indicator of ciliary motility disorders, as the prognosis in these patients is distinctly poor.     

Role of nasosinusal endoscopic surgery in the treatment of headache and facial pain of rhinogenic origin

Headaches and facial pain are common complaints. In many cases patients are referred to an otolaryngologist to determine if head pain is sinus related. In the absence of other nasal or sinus symptoms, some rhinogenic headaches can be overlooked or misdiagnosed. A complete history and thorough ENT examination, including nasal endoscopy, with or without coronal CT scans, is the key to the correct diagnosis. Subtle exploratory findings such as minimal inflammatory changes or anatomic abnormalities of the ostiomeatal complex area may cause pressure resulting in facial pain. When medical treatment fails to produce sustained relief, surgery may be considered. Current worldwide thinking firmly supports the endoscopic endonasal approach as a safe and effective form of treatment in patients with nasal and sinus disease. We prospectively assessed 67 patients who underwent FESS for rhinogenic facial pain in the absence of other nasal or sinusal symptoms. The overall success rate was 93%. Only 5.9% of our cases had some minor complications. No major complications occurred.     

Post-operative care for functional endoscopic sinus surgery

In summary, functional endoscopic sinus surgery has become a widespread tool for the treatment of chronic sinus conditions. Within the office, under local anesthesia, aggressive post-operative care can greatly diminish the need to return to the operating room for revision endoscopic sinus surgery. Under local anesthesia, most limited procedures performed in the operating room can also be performed in the office. Effective post-operative care is critical to obtain the best possible results. Any and all means necessary must be taken to assure expert, detailed, and timely post-operative care.     

Nasal polyps of olfactory sulcus

To explore the origin of olfactory sulcus polyp (OSP) and observe the recovery of olfaction after functional endoscopic sinus surgery, fifty-nine olfactory sulcus polyps in 31 patients were reviewed. The origin of OSP was carefully observed. In these patients 69.5% (41 sides) originated from the mucosa of posterior ethmoid sinus, including the superior meatus (23 sides) and ethmoid cells near the ostia (18 sides). OSP originated from middle turbinate (8 sides) and superior turbinate (4 sides). Six OSP originated from the mucosa of both ethmoid and sphenoid sinus. Olfactory changes were dynamically observed after endoscopic sinus surgery in 26 patients. The smell improved significantly in 26 sides (52.0%) within three months. The olfaction improved slowly in those patients with recurrent polyps and polysinusitis associated with polyps. We suggest that minimal endoscopic sinus surgery is the treatment of choice for OSP.     

Effects of functional endoscopic sinus surgery on maxillary sinus mucosa

OBJECTIVE: To compare the preoperative and postoperative changes on ciliary surface of maxillary sinus mucosa in patients treated with functional endoscopic sinus surgery. DESIGN: The maxillary mucosa of both the superolateral wall and the ostium were sampled during the operation and 6 to 12 months (mean duration, 7.6 months) after the operation. Ciliary surface was determined using scanning electron microscopy in combination with an image analyzer and was expressed in terms of ciliary area, which is the percentage of mucosal surface occupied by cilia. SETTING: The samples were taken at a hospital-based clinic. An electron microscopic study was performed at Mie University School of Medicine, Mie, Japan. PATIENTS: Sixteen patients (20 maxillary sinuses) undergoing functional endoscopic sinus surgery for treatment of chronic sinusitis. RESULTS: The mean (+/-SD) ciliary area before the surgery was 60.7%+/-28.8% and 39.9%+/-21.5% in the superolateral wall of the maxillary sinus and the ostium of the maxillary sinus, respectively. The ciliary area of the superolateral wall was significantly higher than that of the ostium (P<.001). The mean (+/-SD) postoperative ciliary area value was 74.3%+/-22.6% in the superolateral wall and 51.3%+/-16.1% in the ostium. These postoperative values were significantly higher than the preoperative values (P<.001). CONCLUSIONS: This study showed that the maxillary sinus mucosa in chronic sinusitis is capable of regeneration, and the damaged ciliated epithelium could return toward normal with the improvement of ventilation and drainage of the maxillary sinus following functional endoscopic sinus surgery.     

Pediatric functional endoscopic sinus surgery: postoperative care

An effective postoperative care regimen is vital for a successful outcome. Children pose special postoperative challenges due to small anatomy, differences in underlying causes of sinus disease, and difficulties encountered with sinonasal cleansing and debridement. This article provides the clinician with a chronologic guide on how to manage the child after functional endoscopic sinus surgery.     

Endonasal frontal sinus surgery with permanent implantation of a place holder

BACKGROUND: Endonasal frontal sinus surgery is well established. It is not yet clear what degree of enlargement of the frontal sinus neoostium is required to achieve permanent drainage or whether stenting improves the results. PATIENTS AND METHODS: Prospective survey with two groups: Group 1. included 10 patients (15 operations) who underwent endonasal sinus surgery because of chronic polypoid sinusitis with stenting of the frontal sinus neoostium for 6 months. Group 2. included 11 patients (21 operations) without stenting. INTERVENTION: Endonasal frontal sinus surgery with extended drainage Draf Type II (NFA II according to May) with (group 1) and without (group 2) long-term stenting of the neoostium for 5 months using a silicone stent. MAIN OUTCOME MEASURE: 12-16 months postoperatively: flexible endoscopy of nose and frontal sinus; computed tomography; magnetic resonance tomography; Wilcoxon-Mann Withney-Test. RESULTS: With stenting: neoostium endoscopically patent in 80% (including 20% with edematous swelling only at the opening to the frontal sinus), occluded by scar tissue in 6.7%, occluded by polyps in 13.3%. Endoscopy and CT/MRT together: normal mucosa and aeration in 93.3%, complete opacification in 6.7%. Without stenting: neoostium endoscopically patent in 33%, occluded by scar tissue in 48%, occluded by polyps in 19%. Endoscopy and CT together: normal mucosa and aeration in 71.4%, aeration and mucosal swelling in 14.3%, complete opacification in 14.3%. With stenting of the frontal sinus neoostium for six months endoscopic evaluation of the frontal sinus was possible in a significantly higher proportion of cases (p = 0.0416). CONCLUSION: Long-term stenting of the frontal sinus significantly reduces the rate of recurrent stenosis of the frontal neoostium and is recommended in all cases where an extended frontal sinus drainage is necessary. The optimal design for such a stent has not yet been clearly defined.     

Update on sinonasal imaging: anatomy and inflammatory disease

Functional endoscopic sinus surgery, now the standard of care for surgical treatment of chronic and recurrent sinusitis, has changed current concepts of sinus health and disease. Interpretation of the CT scan must reflect this focus on anatomy and function. This article seeks to provide a clear understanding of sinonasal drainage. The normal frontal recess, ostiomeatal unit, and sphenoethmoid recess are considered along with the anatomic variations that distort their appearance and predispose the patient to developing sinus disease. The spectrum of uncomplicated and complicated sinonasal inflammatory disease is discussed.     

Examining the safety of nasogastric tube placement after endoscopic sinus surgery

Several cases of intracranial injury during the placement of nasogastric tubes have been reported, usually in the setting of anterior skull base fractures. The fovea ethmoidalis and sphenoid sinus are often exposed after endoscopic sinus surgery, so that these structures are potentially placed in the line of contact during nasogastric tube placement. In order to evaluate the ability of the fovea ethmoidalis and roof of the sphenoid sinus to withstand penetration from possible contact during nasogastric tube placement, 12 fresh cadaver heads were studied. After complete endoscopic ethmoidectomy and wide sphenoidotomy, standard 18F and 16F nasogastric tubes were inserted to produce deliberate direct contact with both the fovea ethmoidalis and the sphenoid sinus roof. No penetrations of the fovea occurred in 20 specimen sides with the 18F tube; penetration did occur with the 16F tube in 1 of 13 sides (7.7%). With respect to the sphenoid sinus, no intracranial penetrations occurred in 16 and 11 sides for the 18F and 16F tubes, respectively. The sphenoid sinus was easily entered even in the presence of an intact middle turbinate. These data suggest that although intracranial penetration during nasogastric intubation after endoscopic sinus surgery is an unlikely event, there is a non-negligible risk of such injury. Nasogastric intubation should be performed with caution in patients with a history of sinus surgery.     

Endoscopic resection of the intranasal frontal sinus floor

The current accepted treatment for chronic frontal sinus disease unresponsive to medical management and endoscopic surgery is an external approach to either obliterate the sinus or restore communication to the nasal cavity. Here reported is an endoscopic approach for resection of the intranasal frontal sinus floor, a modification of a procedure first described by Lothrop in 1899. Eleven patients underwent this operation from April 1993 to December 1993. One complication, a cerebrospinal fluid leak treated successfully endoscopically, has occurred. Of the 7 patients followed up 3 months or longer after surgery, only 1 has developed symptoms of recurrent frontal sinusitis. On the basis of this limited preliminary experience, the endoscopic Lothrop procedure shows promise as an effective operation designed to establish a physiologic communication between the frontal sinus and the nasal cavity in selected patients who would otherwise be candidates for an external approach.     

Ubiquity of omnivores in natural ecosystems

A preliminary analysis was published in 1993 of 100 cases of endoscopic sinus surgery (ESS) carried out in our service following a protocol that included sinusitis, nasal polyps, and other endoscopic nasal procedures. Another 100 cases of ESS were analyzed for the present study and compared with the 1993 group. Comparative analysis showed improved results in the second series, with fewer minor complications and no major complications. These findings confirm the general opinion that endoscopic sinus surgery requires an adequate training period before optimal results are obtained.     

Computed tomography of the anterior ethmoid sinuses and its adjacent structures for endoscopic sinus surgery

Forty adult cadavers were examined by computed tomography (CT) imaging with special attention to the pneumatization of the anterior ethmoid sinus for endoscopic sinus surgery. The study of the specimen was done using coronal section and axial section, sagittal reconstructed images were obtained from the data acquired in the axial plane. The cells of anterior ethmoid sinus were classified into four sub-groups, namely, the pre-infundibular cell (appearance rate 87.5%), the lateral infundibular cell (82.7%), the post-infundibular cell (86.3%) and the bulla cell (100.0%), and the anterior ethmoid sinus was classified into two types, namely, intraethmoid type (71.2%) and extraethmoid type (28.8%). The results shows that CT can display the sub-group and the type of the anterior ethmoid sinus and its adjacent structures clearly. The significance of endoscopic sinus surgery was discussed.