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Common rhinology and facial plastics viva topics
Published in Joseph Manjaly, Peter Kullar, Advanced ENT Training, 2019
Surgery is always indicated: Endoscopic frontal sinus surgery Draf procedureI. I. Uncinectomy and removal of the agger nasi cells to clear frontal recess IIa. Opening of frontal sinus from lamina to middle turbinateIIb. Opening the frontal sinus from lamina to septum (requires drilling)III. Modified Lothrop (drilling out the frontal sinuses removing from the central bony septum) (lamina to lamina across the septum and posteriorly to first olfactory fibres and anteriorly to anterior table)Balloon sinuplasty may be considered in appropriate casesOpen approach
The Frontal Sinus
Published in John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie, Basic Sciences Endocrine Surgery Rhinology, 2018
Introduced in 2006, balloon sinuplasty is proposed to be a minimally invasive approach to the management of CRS involving the frontal sinus. The technique introduces a balloon over a guide wire, which may be illuminated, to confirm its position in the frontal sinus. Once in place, spanning the ostium, the balloon is dilated with a controlled inflation device. In theory, this gently enlarges the ostium by effecting microfactures of the surrounding bone and compressing the soft tissue. Soft tissue injury is suggested to be minimal but the rate of synechia formation is reportedly at least equal to that seen with conventional endoscopic sinus surgery (ESS). Complications include inability to cannulate the sinus, and CSF leak.50,51 Although it is a safe and well tolerated procedure, the evidence in support of its use as an alternative to standard ESS techniques is limited.31,52,53 In many instances balloon dilation is combined with ESS and is termed a hybrid procedure.
Rhinology and Facial Plastics
Published in Adnan Darr, Karan Jolly, Jameel Muzaffar, ENT Vivas, 2023
Adnan Darr, Karan Jolly, Shahzada Ahmed, Claire Hopkins
Management: Multi-disciplinary input: Neurosurgery in event of intra-cranial complications and microbiology in the event of poor response to intravenous therapyConservative: Saline douchingMedical: Topical therapy: Decongestants and steroidsIntravenous antibiotics according to trust anti-microbial guidelines (usually Ceftriaxone with BBB crossover for 6/52)Surgical: Needle aspiration of pus to decompress + for MC&SEndoscopic: Frontal sinus surgery/balloon sinuplastyOpen: Frown line incision and abscess drainageFrontal sinus trephineBi-coronal approach with neurosurgery if intracranial extension: Osteoplastic flap Bicoronal incision with periosteum raisedBone window createdRemoval of frontal sinus mucosa as well as posterior tableCranialization of frontal sinusPericranial flap, fascia or fat to seal off drainage pathway
Endoscopic versus external dacryocystorhinostomy: temporal and regional trends in the United States Medicare population
Published in Orbit, 2019
Rijul S. Kshirsagar, Priscilla Q. Vu, Jonathan Liang
Given the limited understanding of current practice trends in endoscopic compared to external DCR, this study aims to assess the variations of both within the United States (US). The Medicare database has been utilized for analysis of trends of various otolaryngologic procedures including endoscopic frontal sinus surgery and endoscopic balloon sinuplasty.16,17 In the ophthalmology literature, there have been a few studies evaluating trends in orbital surgery.2,18 A recent study evaluated orbital decompression trends in the US and showed increased endoscopic trends that did not necessarily surpass external trends.19 Our study analyzes and compares the temporal and geographic trends of endoscopic and external DCR, which has yet to be reported. By analyzing trends, we can gain a better understanding of practice patterns, which can be of interest to surgeons, patients, and healthcare policy makers.
Koskinen et al. Long-term follow-up after ESS and balloon sinoplasty: comparison of symptom reduction and patient satisfaction. Acta Oto-Laryngol 2016; 136: 532–536
Published in Acta Oto-Laryngologica, 2018
Occlusion of the entrance to paranasal sinuses is a serious problem in infectious or allergic diseases of the nose. Fortunately the rapid development of FESS technology has appreciably reduced the need for open surgery on the paranasal sinuses in both benign and malignant forms. FESS technique also permits selective surgery on one or more of the paranasal sinuses. However, chronic morphological changes in the mucous membranes can persist for a very long time and thus block normal ventilation of the sinuses. Balloon sinoplasty has been introduced during the past decade. This principle of this technique is to dilate the ostium without removing any bone or soft tissue.
In-silico investigation of airflow and micro-particle deposition in human nasal airway pre- and post-virtual transnasal sphenoidotomy surgery
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2022
Khashayar Moshksayan, Hojat Bahmanzadeh, Mohammad Faramarzi, Sasan Sadrizadeh, Goodarz Ahmadi, Omid Abouali
Virtual surgeries can be performed prior to any surgical procedure to identify the potential side effects. As the nasal geometries vary amongst individuals, virtual surgery allows for a personalized approach to optimize surgical procedures (Abouali et al. 2012; Kim et al. 2013). Computational fluid dynamics (CFD) has emerged as a promising tool for simulating fluid flows in the nasal cavity (Keyhani et al. 1995; Wen et al. 2008). CFD was used to show that partial turbinate resection is a better alternative for the turbinectomy surgery to minimize the adverse effects on air ventilation and nasal functions (Pérez-Mota et al. 2018). Also, recently, it was found that nasal conditioning is highly altered for patients undergoing turbinectomy in cold and dry air (Siu et al. 2021). Liong et al. (2018) investigated the flow patterns and pressure drop using a CFD model of a patient with cleft nasal deformity. Other nasal surgeries were computationally modeled to inspect air flow patterns after balloon sinuplasty (Zhu et al. 2014), septal perforation repair surgery (Nomura et al. 2018), endoscopic skull base surgery (Maza et al. 2019), posterior septectomy (Otto et al. 2017), spreader-grafts, J-flap and their combinations (Burgos, Sanmiguel-Rojas, et al. 2018). Chung et al. created a virtual model from computed tomography (CT) images of a patient that developed maxillary sinus polyps years after middle meatus antrostomy to understand the flow patterns and shear stress within the maxilliary sinus (Chung et al. 2018). They performed unsteady respiratory simulations in the nasal cavity using realistic human inhalation and exhalation pressure boundary conditions at the nasopharynx. In a recent work, a stepwise procedure was adopted to investigate the combined effects of inferior turbinectomy and septoplasty surgeries on 2 subjects using CFD (Frank-Ito et al. 2019). They studied the flow and temperature variations within the nasal cavity to find airflow-related variables that correlated with life quality of the patients and compared them with the values for healthy nasal airflows. In a recent work, by using the CFD technique, a new device was evaluated to reduce the risk of infection during aerosol generating procedures for use in COVID-19 surgical tracheotomy (Calmet et al. 2022).