Antero-medial maxillary sinus angle is an additional predictive factor for enhanced visibility during pre-lacrimal window approach

Pathologies located at the posterior surface of the anterior wall and the floor (alveolar recess) of the maxillary sinus are challen- ging to visualize and access. Open approaches including lateral rhinotomy, Caldwell-Luc procedure or midfacial degloving allow a broad visualization but with a significant likelihood of post-operative morbidity.

Current trend of surgery in juvenile nasopharyngeal angiofibroma: a hospital based retro-prospective study

<p class="abstract"><strong>Background:</strong> The aim of the present study was to know the current trends of surgery, to determine the surgery of choice according to stage and complications, rate of recurrence of following surgery.</p><p class="abstract"><strong>Methods:</strong> Retro-prospective study was carried out from August 2004 to July 2014, in which 31 prospective and 8 prospective cases were included. All the details of patients like general examination, ENT examination, computed tomography or magnetic resonance imaging scan finding, staging, and approach of surgery, complications, and recurrence rate were recorded. </p><p class="abstract"><strong>Results:</strong> In our study all the patients were male and the mean age was 15.74 years (age ranged 11 to 22 years). Most frequent sign and symptoms were epistaxis (92.4%), nasal blockage (90%), and facial swelling (18%). Most common surgical approach was ‘trans palatine approach’ (51% cases) belongs to stage IIa, IIb, IIc, IIIa, IIIb and ‘lateral rhinotomy approach’ used in 35% cases. And by endoscopic approach (only 5.1% cases) were operated due to lack of embolization technique. Overall recurrence was about 29% (66% cases belonged to stage III). Postoperative complications were septal perforation 33%, palatal perforation 9.5%, facial disfiguration 9.5% and 9.5% hypertrophic scar.</p><p class="abstract"><strong>Conclusions:</strong> Our study we concluded that, 92% of patients age group 11 to 20 years and all were males. Epistaxis and nasal obstruction were the most common symptoms. Most of the recurrent tumor belonged to stage III tumor. Most appropriate surgical approach for stage I, IIa and IIb was transpalatine approach and for stage IIc and IIIa was lateral rhinotomy. Complete excision of intracranial extension of tumor was difficult and causes recurrence of diseases.</p>

A Case Report of Inverting Papilloma of Lacrimal Sac

Purpose To report a rare case of Inverting Papilloma originating from the Lacrimal Sac in Tertiary Hospital. Method Case report. Results Inverting papilloma is uncommon in lacrimal sac. More often presents in Maxillary sinus, Ethmoid sinus and lateral wall of nasal cavity. This case of 69 years old, Filipino male, who presented with a two-year history of gradually enlarging left medial canthal mass, and tearing. There were no ophthalmoplegia, visual disturbances, proptosis or pain but there was globe displacement superolaterally. Other ophthalmologic examinations were unremarkable at that time of examination. Orbital CT-scan revealed: Heterogenously enhancing mass extending to ipsilateral nasolacrimal canal and nasal cavity causing mass effect. There was note of a suspicious area of hyperostosis. Patient was referred to the Department of Otolaryngology Head and Neck Surgery for co-management. Punch biopsy was done and histopathology revealed Inverting papilloma. Combined surgical management of anterior Maxillectomy via lateral Rhinotomy approach and Dacryocystectomy was done. Intraoperatively, there was note of adhesions to bone in the area of the Lacrimal Sac corresponding to the area of hyperostosis on CT-scan. Post-operative recovery was unremarkable with unchanged visual acuity and extraocular muscle movement. Conclusions This is a case of an inverting papilloma involving the lacrimal sac and nasolacrimal duct that was managed with combined anterior maxillectomy via Lateral Rhinotomy approach and dacryocystectomy for complete resection. We recommended complete resection of the tumor to minimize recurrence. Origin in the Lacrimal Sac area was confirmed by intraoperative findings which correlated with CT- scan findings.

Lateral Rhinotomy for a Large, Infected Haller Cell Causing Proptosis

Objective: To report a case of a large sinus Haller cell that presented with chronic rhinosinusitis and proptosis and its surgical management. Method: Design: Case Report Setting: Tertiary Government Hospital Participants: One (1) Results: A 34-year-old lady with proptosis and secondary sinusitis due to a giant infected Haller cell was successfully treated by lateral rhinotomy approach and clearance of all diseased mucosa therein into the nasal cavity. Conclusion: Approach to diseased sinonasal structures via lateral rhinotomy is an alternative to endoscopic sinus surgery in the presence of an unusually large Haller cell. Keywords: Haller cell. proptosis. maxillary sinusitis. lateral rhinotomy.

Maxilectomía medial en carcinoma nasosinusal. ¿Cuándo, cómo y por qué?

Existe controversia respecto al abordaje en el manejo de tumores sinonasales benignos o malignos. Dado que nos encontramos en la era de la cirugía endoscópica mínimamente invasiva, se podría pensar que los abordajes abiertos hoy día no tienen cabida. Sin embargo, la maxilectomía medial por rinotomía lateral ha sido el tratamiento de elección para la mayoría de lesiones que comprometen la pared nasal lateral, y el perfeccionamiento de la técnica ha permitido una disminuciónconsiderable de la morbilidad. Este abordaje permite una excelente exposición, la oportunidad de ampliación en caso de encontrar extensión a regiones adyacentes y la remoción en bloque de las neoplasias. Presentamos un paciente masculino de 83 años, con obstrucción nasal unilateral, epistaxis y masa exofítica en la fosa nasal derecha; se realizó estudio imagenológico con tomografía computarizada y resonancia magnética, y diagnóstico histopatológico de carcinoma escamocelular moderadamente diferenciado, T2N0M0. Recibió manejo quirúrgico mediante maxilectomía medial, a través de rinotomía lateral, y se obtuvieron adecuados márgenes de resección. No hubo complicaciones intraquirúrgicas ni posquirúrgicas. Se logró resección completa del tumor, con adecuado resultado funcional y cosmético. En la actualidad el paciente no presenta recidiva tumoral.MEDPOR). The surgical approach in the management of benign and malignant sinonasal tumors is controversial. Ever since we are in the endoscopic minimally invasive surgery era, it might exist the perception that open approaches do not have place anymore. However, the lateral rhinotomy and medial maxillectomy have been the treatment of choice for most lesions involving the lateral nasal wall due to its improvement in technique and decreasing morbidity. This approach provides excellent exposure to adjacent regions and allows removal of neoplasms in block. We report 83 years old male with unilateral nasal obstruction, epistaxis, and an exophitic mass in theright nasal cavity. The diagnostic of squamous cellular carcinoma with moderate differentiation, T2N0M0 was made thru tomography, resonance and histopathology studies. The patient was treated with maxillectomy trough lateral rhinotomy with complete tumor resection and negative borders. There were no intraoperative or postoperative complications. Adequate functional and cosmetic result were achieved. Currently, the patient do not have tumor recurrence.