Sinonasal Quality of Life Outcomes after Endoscopic Endonasal Transsphenoidal Surgery with Posterior Septum Free Mucosal Graft Reconstruction

Objective Quality of life (QoL) outcomes following endoscopic endonasal transphenoidal surgery (EETS) across a variety of reconstructive methods improve by 2 to 6 months. An option for sellar reconstruction, in the absence of a significant intraoperative cerebrospinal fluid (CSF) leak, is a free mucosal graft (FMG) from the posterior septum. We analyze sinonasal QoL outcomes in patients undergoing EETS with FMG reconstruction. Design This study was a retrospective review. Setting This study was conducted at tertiary care academic center. Participants This study group consisted of patients undergoing EETS for pituitary adenomas from 2013 to 2018. Main Outcome Measures Tumor and surgical factors were included, along with postoperative complications. Patients completed Sinonasal Outcome Test-22 (SNOT-22) questionnaires. Pre- and postoperative scores were compared among the entire cohort using linear multilevel regression. A subcohort analysis was performed among patients who completed questionnaires during the preoperative visit and two postoperative visits (within 1 month and between 2 and 3 months, respectively); pre- and postoperative total and individual domain SNOT-22 scores were compared using paired t-tests. Results A total of 243 patients underwent EETS with FMG reconstruction. Four patients (1.6%) developed a postoperative CSF leak requiring reoperation. Among the entire cohort, SNOT-22 scores increased at the first postoperative visit (p < 0.01) but returned to baseline by the second, third, and fourth postoperative visits (p = 0.27, p = 0.18, and p = 0.21). Among 48 patients who completed both preoperative and two postoperative questionnaires, scores increased within the first month (p < 0.01) but returned to baseline at 2 to 3 months (p = 0.67). Conclusion Posterior septum FMG reconstruction of sellar defects is an effective option, demonstrating early recovery of baseline sinonasal QoL by 2 to 3 months.

Ectopic primary olfactory neuroesthesioblastoma originating from the anterior nasal septum

<div class="WordSection1"><p class="abstract">Olfactory neuroestesioblastoma (ONB) is a rare malignant neoplasm of the paranasal sinus. Ectopic growth of ONB outside the region of neuroepithelial cells are exceedingly rare and so far, it has only been reported to arise from the maxillary sinus, sphenoid sinus, posterior septum and the turbinates. None has been reported to originate from the anterior cartilaginous part of the septum. A 31-year-old lady, who was premorbidly well, presented with 2 episodes of spontaneous epistaxis from the left nostril in 1 year. The epistaxis worsened over the one week prior to her visit. Nasoendoscopy showed a vascularised round mass at the anterior part of the left septum. Initial biopsy was reported as possible ectopic squamous cell carcinoma of the salivary gland. A repeat biopsy then confirmed the diagnosis of ONB. Computed tomography scan of the paranasal sinus showed an isolated mass (18×18 mm) arising from the anterior part of the septum. Endoscopic resection of the tumour was done and histopathology report revealed as ONB. Post-operative radiotherapy was given with a total dose of 66. The rarity of ONB poses a challenge during diagnosis. The histological identification is difficult as these tumours may show little or no differentiation. A simple biopsy from the mass is often insufficient and may produce inaccurate results. Isolated growth without involvement of the upper nasal vault is extremely rare. A possible explanation would be the presence of ectopic neuroepithelial cells at the cartilaginous anterior septal area that has failed to degenerate during fetal development.</p></div>

Orbital Cellulitis

Selulitis orbital merupakan penyakit serius yang mengancam jiwa, ditandai dengan infeksi jaringan lunak di bagian posterior septum orbital. melibatkan jaringan lunak orbita. Trombosis sinus kavernosa merupakan tahapan akhir infeksi orbita yang meluas ke intra cranium, ditandai dengan penurunan kesadaran dan gejala rangsangan meningeal. Dipresentasikan tiga kasus selulitis orbital dengan klinis khas yang sangat berbeda. Pilihan terapi diberikan diberikan berdasarkan gejala klinis. Tidak ada kesepakatan tentang antibiotik terbaik untuk digunakan, golongan antibiotik β-laktam selama 4-6 minggu masih direkomendasikan sebagai agen lini pertama, dan untuk kasus thrombosis sinus kavernosus, antibiotik meropenem dan vankomisin selama 6-8 minggu merupakan terapi utama. Observasi lanjutan dan pemeriksaan radiografi dapat dilakukan sesuai indikasi. Manajemen yang tepat dari pasien selulitis orbita memerlukan multidisiplin tim. Diagnosis cepat dan terapi yang tepat diharapkan bermanfaat untuk perbaikan visual dan klinis yang baik, meskipun kadang masih terdapat gejala residual seperti sikatrik kornea dan trichiasis. Selulitis orbital merupakan kasus yang mengancam jiwa, karena penyebaran infeksi yang dapat mencapai intrakranial. Diharapkan dengan diagnosis cepat dan pemberian antibiotik agresif berdasarkan gejala klinis dapat menyelamatkan nyawa pasien.

Comparison between Rescue Flap and Double Flap Technique

Objectives Endoscopic techniques in pituitary surgery lead to inevitable mucosal loss of the sphenoethmoidal recess and posterior nasal septum in the nasal cavity. There is no other comparative study between primary reconstruction of septal perforation and secondary healing in the literature. The aim of this study is to evaluate postoperative patient morbidity with or without posterior septal perforation in endonasal pituitary surgery by comparing two commonly used techniques: rescue and double nasoseptal flaps. Design Prospectively randomized study. Setting Tertiary academic center. Participants Sixty patients underwent endoscopic endonasal pituitary surgery. Main Outcomes and Measures Functional results (breathing) using visual analog scale (VAS), sphenoid sinusitis, presence of synechia, perforation in the posterior septum, and crusting in the sphenoethmoidal recess were assessed. Results Pre- and postoperative mean VAS scores were 71.67 ± 11.47 and 67.67 ± 9.71 mm in the intact septum group and 77.67 ± 14.06 and 62.67 ± 10.48 mm in the posterior septal perforation group. There was a significant difference between pre- and postoperative VAS values in all groups. There was significant worsening in both groups; worsening in VAS values was much higher in the posterior septal perforation group. In the posterior septal perforation group, much more crusting was seen. Conclusions This is the first study to compare the postoperative patient morbidity in endoscopic endonasal pituitary surgery with and without a posterior septal perforation. Reconstruction of the posterior septum along with less mucosal loss yields better postoperative nasal symptom score.