Effectiveness of Functional Endoscopic Sinus Surgery in Surgical Management of Ethmoid Polyps

Background: Aim: To assess efficacy of functional endoscopic sinus surgery in surgical management of ethmoid polyps.Methods:One hundred twelve adult patients age ranged 18- 38 years of either gender with ethmoid polyps underwent FESS under general anesthesia. The extent of surgery was decided based on the findings in pre-operative CT scan of paranasal sinuses. Anterior ethmoidectomy, posterior ethmoidectomy, middle meatus antrostomy and clearance of frontal recess were performed in all the patients. Five functional criteria were evaluated as nasalobstruction , anosmia, rhinorrhea, post nasal drip, head ache and facial pain.Results:Pre- operative nasal obstruction percentage was 3.42 and post- operative ercentage was 2.10, Anosmia percentage was 2.14 and 1.15, Rhinorrhea percentage was 3.56 and 2.08 and ocular problem in 1 and synechia in 4 cases.Conclusions:Functional endoscopic sinus surgery found to be effective in management of ethmoid polyps and hence can be the treatment of choice.

Maxillary Antrostomy Patency Following Intraoperative Use of Spray Cryotherapy

Objectives/Hypothesis: Stenosis of the middle meatus antrostomy (MMA) represents a major cause of recurrent disease following endoscopic sinus surgery (ESS). Various strategies have been developed to prevent the occurrence of MMA stenosis. The aim of the present study was to evaluate the effects of spray cryotherapy (SC) on nasal wound healing following ESS. Methods: This is a prospective within-subject, randomized, and controlled trial. Twenty-six patients submitted to bilateral ESS with chronic rhinosinusitis without polyps were included. Following surgery, patients were randomized to receive SC on one side and saline contralaterally. Outcomes were represented by MMA diameter and area, histology of nasal mucosa, and nasal symptoms. Variables were assessed at 3 and 12 months postoperatively. Results: The MMA size in the SC group at 3 and 12 months (area—0.578 ± 0.1025 cm2, diameter—0.645 ± 0.1024 cm; 0.605 ± 0.1891 cm2, 0.624 ± 0.0961 cm, respectively) was significantly larger (p = 0.000) than in the control group. Histology established that cell infiltration, goblet cells, edema, and epithelial hyperplasia were prominent and persistent in the control side compared to the SC side. Nasal obstruction and discharge were significantly improved in the SC group compared to the control group. Conclusion: SC is a promising therapy following ESS, since it precludes MMA stenosis and decreases inflammation, edema, and goblet cell hyperplasia.

Chronic maxillary atelectasis (including silent sinus syndrome) can present bilaterally

ObjectiveChronic maxillary atelectasis is a rare and underdiagnosed condition in which there is a persistent and progressive decrease in maxillary sinus volume secondary to inward bowing of the antral walls. Chronic maxillary atelectasis is typically unilateral. Simultaneous bilateral chronic maxillary atelectasis is extremely uncommon.MethodsA retrospective review was performed of patient data collected by the senior clinician over a three-year period (2015–2018). A comprehensive literature search was conducted to locate all documented cases of chronic maxillary atelectasis in English-language literature. Abstracts and full-text articles were reviewed.ResultsThree patients presented with sinonasal symptoms. Imaging findings were consistent with bilateral chronic maxillary atelectasis. The literature review revealed at least nine other cases of bilateral chronic maxillary atelectasis. Management is typically via endoscopic middle meatus antrostomy.ConclusionChronic maxillary atelectasis was initially defined as a unilateral disorder, but this description has been challenged by reports of bilateral cases. Further investigation is required to determine the aetiology and pathophysiology of the disease.

Comparative Study of Septoplasty Alone and with FESS in Maxillary Sinusitis with Septal Deviation

ABSTRACT Introduction The study was conducted to asses if septoplasty is adequate for the management of chronic maxillary sinusitis. Chronic maxillary sinusitis is not uncommonly associated with deviated nasal septum (DNS). The randomized study was conducted on 40 cases of medically unmanageable and HRCT proven chronic maxillary sinusitis with DNS. Materials and methods The study was conducted in 40 cases of HRCT (PNS) proven chronic maxillary sinusitis which were not cured with medical treatment. The patients were divided randomly in two groups. Group A underwent septoplasty and group B septoplasty along with FESS in the form of uncinectomy and middle meatus antrostomy. Patients having other anatomical factors for example concha were excluded. Results Both procedures produced significant improvement in symptomatology and on HRCT (PNS) findings as compared to preoperative status (p-value less than 0.001). Septoplasty was found to be effective in chronic maxillary sinusitis, however, when polyps were present in maxillary sinus, then septoplasty with FESS was found to be better. Discussion In cases of chronic maxillary sinusitis with DNS, septoplasty is adequate, however if the maxillary sinus shows polyps on HRCT (PNS) scan then septoplasty should be combined with FESS. How to cite this article Goel AK, Yadav SPS, Ranga R, Gulia JS, Goel R. Comparative Study of Septoplasty Alone and with FESS in Maxillary Sinusitis with Septal Deviation. Clin Rhinol Int J 2012;5(1):19-24.

Partial Endoscopic Middle Turbinectomy Augmenting Functional Endoscopic Sinus Surgery

Endoscopic sinus surgery has gained acceptance in the otolaryngologic community as an effective and safe method of treating inflammatory disease of the paranasal sinuses. At our institution, partial endoscopic middle turbinectomy has become a standard component of the procedure and our experience is reported. Middle turbinectomy enhances surgical exposure, specific anatomic anomalies are more completely corrected, and subpopulations of patients at risk for failure because of their underlying disease enjoy decreased rates of synechiae formation and closure of the middle meatus antrostomy when followed over time. Photodocumentation of the surgical technique and a discussion regarding the impact of middle turbinectomy on normal nasal physiology are presented. It is reported that the procedure is safe, and no complications directly attributable to middle turbinectomy (including atrophic rhinitis) are reported in a series of 298 patients.