Background The inferior turbinate (IT) and nasolacrimal duct (NLD) are often sacrificed while managing the diffuse lesion of maxillary sinus (MS).We report a new approach to MS without ablation of NLD and IT.Methods This retrospective study enrolled 19 hospitalized patients (aged from 42 to 68 years) who underwent endoscopic sinus surgery between 2003 and 2008.Twelve patients had inverted papilloma (IP),two had nasal polyps,two had Kubo's postoperative cyst of MS,one had recurrent bone cyst of maxilla,one had dentigerous cyst and one had bleeding of internal maxillary artery secondary to Caldwell-Luc operation respectively.Two IP patients were excluded from this group since the follow-up time was less than 12 months.The NLD was dissected after removing the anterior bony portion of nasal lateral wall.The prelacrimal recess approach (PLRA) to MS was established when IT-NLD flap was raised medially.The flap was repositioned when MS lesion was removed.Results All the 17 patients had unilateral lesions.Ten MS IP patients were at the T3 Krouse stage.The follow-up ranged from 7 to 60 months.No recurrence was seen in 16 patients.Only one IP patient had a local recurrence in MS.All of them had no any complications.Conclusion The diffuse or severe diseases of MS may be the potential indications for PLRA.

Objective To sum up and analyze the long-term follow-up outcomes of intranasal endoscopic dacryocystorhinostomy(IEDCR) in patients with chronic dacryocystitis. The related factors to clinical effects were discussed. Methods The operative and postoperative data were collected in 275 patients(310 eyes,mean age 28.3 years；range 3 to 76 years)who were undergone IEDCR with chronic dacryocystitis. All patients conceived the preoperative dacryocystography. Surgical intervention was performed under general or local anesthesia and all were done by the same surgeon.The silicon intubation was used according to the size of lacrimal sac. The postoperative follow-up management included endoscopic cleaning,lacrimal duct irrigation and nasal corticosteroid spray. Results The patients with follow-up period less than 1 year were excluded from this group. 211 cases(230 eyes)were followed up over 1 year and the results showed that 75.3％ were cured,11.7％ improved and 13.0％ had no effects. The natural larcimal apparatus was found reopened in 9 cases while their lacrimal rhinostomies were closed with scar. There was no operative complications. Conclusions The long-term outcomes of IEDCR are good. The wide bony rhinostomy,less mucosal damage and closed follow-up debrider should benefit for getting a high operative success rate. After surgical drainage,the inflammaive mucosa of lacrimal sac might return to normal and the function of nasolacrimal apparatus might recover.

OBJECTIVETo report the results of endoscopic transpterygoid intervention of nine patients with meningoencephalocele and cerebrospinal fluid (CSF) leaks within lateral recess of sphenoid sinus (LRSS). The diagnosis, operative techniques and their related problems were discussed.

METHODSNine hospitalized patients with meningoencephalocele and CSF leaks within lateral recess of sphenoid sinus (LRSS) were included in this paper. Six were male and 3 were female, aged from 27 to 56 years old. Two patients had the histories of endoscopic repair. The preoperative orientation of CSF leaks and meningoencephalocele depended on CT scan and MR cisternography. Endoscopic transpterygoid intervention and the repair of skull base defects were undertaken under general anesthesia.

RESULTSAll the operations were successful. One patient had a postoperative intracranial hypertension and Hydrocephalus. Two patients had postoperative ipsilateral facial, upper lip and palatal hypesthesia. One of them had a xerophthalmia. All the symptoms above mentioned relieved gradually 6 months after operation. No recurrence was found during follow -up for 6 to 58 months (mean 25. 6 months).

CONCLUSIONSEndoscopic transpterygoid intervention for meningoencephalocele and CSF leaks within LRSS is a minimally invasive technique and a straightforward approach.

Adult ; Cerebrospinal Fluid Rhinorrhea ; complications ; surgery ; Endoscopy ; methods ; Female ; Humans ; Male ; Meningocele ; complications ; surgery ; Middle Aged ; Skull Base ; surgery ; Sphenoid Bone ; surgery ; Sphenoid Sinus ; Treatment Outcome

OBJECTIVETo report a new approach to maxillary sinus without ablation of nasolacrimal duct and inferior turbinate by endoscopic nasal lateral wall dissection (ENLWD). The preliminary clinical application results, the operative technique and indications were discussed.

METHODSTwelve hospitalized patients, aged from 42 years to 68 years, were enrolled in this paper, 9 patients were male and 3 were female. Among the 12 patients, 8 were inverted papilloma (IP), 2 were nasal polyps, 1 was Kubo's postoperative cyst of maxillary sinus (MS) and 1 was recurrent bone cyst of maxilla. Two IP patients were excluded from this group for the follow-up time was less than 12 months. Preoperative nasal endoscopy and CT scan were done in all patients, 6 patients with tumor also received MRI examination. The operation began with a mucosal incision in front of inferior turbinate (IT) and then the lacrimal duct (LD) was dissected, thus a IT-LD flap was formed. The MS lesion was removed under endoscope when the flap was replaced medially. The inferior antrostomy was performed when the flap was repositioned.

RESULTSAll 10 patients were unilateral lesion. Six MS IP patients were T3 Krouse stage. The tumor was found originating from the every part of the MS wall in the operation, especially from the anterior and medial wall. The same situation was seen in 2 patients with nasal polyps. The follow-up ranged from 7 months to 60 months (average 22 months). The shape of IT was good, and well-epithelized operative cavities were observed. Only 1 patients of IP had a local recurrence in its inferior antrostomy 6 months after operation and no recurrence was seen after local debridement. All of them had no epiphora and other complications.

CONCLUSIONSENLWD is a new and minimally invasive approach not only to MS, in which the lesion can be thoroughly removed, but also to orbital floor and pterygopalatine fossa without ablation of lacrimal duct and IT.

Adult ; Aged ; Endoscopy ; methods ; Female ; Humans ; Male ; Maxillary Sinus ; surgery ; Middle Aged ; Nasal Cavity ; surgery ; Turbinates ; surgery

OBJECTIVETo investigate the status of the quality of life for adolescents and children with chronic sinusitis and its influencing factors.

METHODSEighty-six patients were measured with the General Information Questionnaire and Chronic Sinusitis Quality of Life Scale. Six months after operation, the Chronic Sinusitis Quality of Life Scale was retested. T-test and stepwise regression were used to study the improvement and influencing factors of quality of life.

RESULTSThe preoperative and postoperative quality of life scores showed a significant difference ( all P < 0. 01 ). The main factors influencing the quality of life included symptom scores (P = 0. 003) , family economic status(P = 0. 003) , parents' attitude(P = 0. 009) , extents of pathological changes(P = 0. 019) , regional disparity ( P = 0. 010) and parents' educational level (P = 0. 048).

CONCLUSIONThe children's subjective symptoms should be viewed as an important aspect for surgery selection. The quality of life in adolescent and children was influenced significantly by family economic status, their parents' attitude and the difference of education.

Adolescent ; Child ; Child, Preschool ; Chronic Disease ; Female ; Humans ; Male ; Quality of Life ; Sinusitis ; Surveys and Questionnaires

Objective To observe the histopathological finding of bone remodeling in rabbit sinusitis model at different time and the tendency, and to discuss the effect of bone in the pathogenesis of sinusitis. Methods First, the rabbit sinusitis model was made, then the experimental animals were divided into 3 groups according to the time of infection. There were 8 rabbits in each experimental group, and 4 rabbits in the control group. The sinus specimen were collected, embedded and stained. The bone in the inoculating side and noninoculating side was scored, and the bone in inoculating side was evaluated quantitatively and semiquantitatively. The parameters included the thickness of mucesa, mucoperiosteum, the density of osteoblast, the amount of esteoclast. Results The average bone score in the inoculating side was 2. 250,2.875,2.875 ; in the noninoculating side was 1. 625,2.250,2.500. Between group A and the control group, the difference of all three parameters had statistical significance. Between group B and group A, the difference of the thickness of mucosa and the density of osteoblast had statistical significance. Between group C and group B, none of the three parameters had statistical significance. Conclusions Bacterial sinusitis can lead to bone remodeling, obvious bone destroy can occur at the early phase, then the bone proliferation follows. These results demonstrate that bone remodeling is one of the basic histopathological characters of CRS and might be the reason to lead CRS to a constant and chronic process of inflammation.

Objective To summarize the follow-up outcomes of Draf Ⅱ b frontal sinusotomy and it's modified procedures,and to discuss the surgical indications and prognostic factors.Methods Thirty-two patients treated between 2004 and 2010 were enrolled in this study.There were 15 patients for recurrent frontal inverted papilloma ( IP),6 for mucocele,4 for recurrent frontal sinusitis,3 for osteoma,2 for meningoeneephalocele with cerebrospinal fluid rhinorrhea,1 for meningoencephalocele alone and 1 for acute frontal sinusitis.All patients underwent preoperative paranasal sinus computed tomography (CT) scans.Patients with tumor accepted magnetic resonance imaging (MRI).The patients with meningoencephalocele and cerebrospinal fluid rhinorrhea recieved magnetic resonance cistemography (MRC).The Draf Ⅱ b frontal sinusotomy and it's modified Draf Ⅱ b-1 -3 procedures were applied endoscopically under general anesthesia mainly by high speed bur and power system.The postoperative CT scan was obtained as a base line for follow-up 1 week after the operation.Postoperative follow-up was performed under endoscope.Results Among 19 cases of Draf Ⅱ b,12 were recurrent IP of frontal sinus,4 were mucocele,2 were recurrent frontal sinusitis and 1 were osteoma.Five cases received Draf Ⅱ b-1,2 for each recurrent IP of frontal sinus and recurrent frontal sinusitis and 1 for osteoma. Six cases received Draf Ⅱ b-2, 3 for meningoencephalocele,1 for each IP,acute frontal sinusitis and osteoma.Two cases received Draf Ⅱ b-3 were mucocele.The follow-up ranged from 8 to 73 months.Twenty-two cases of the frontal neoostium were widely opened,7 were stenosis and 3 were closed.Revision surgery was seen in 2 cases with IP.All of them had no complications.Conclusions The Draf Ⅱ b frontal sinusotomy and it's modified procedures are suitable for complex frontal sinus disease,which can be selected according to pathological and anatomical features,and have a good prospect for clinical application.

Objective To sum up the follow-up outcomes of endoscopic modified Lothrop procedure (EMLP) and retrospectively analyze the indications,methods and prognostic factors of EMLP.Methods The collected data of 73 cases who received EMLP with frontal sinus diseases were analyzed in this paper.The mean age was 45.6 (ranging from 14 to 72 years).There were 52 males and 21 females.Only patients with follow-up time greater or equal to 6 months were included.Paranasal sinus CT scan was adopted for all cases and MRI for tumor patients.All patients were followed under endoscope.Results There were 21 inverted papilloma in the frontal sinus,16 chronic sinusitis with asthma,12 frontal sinusitis,9 chronic sinusitis with or without polyps,7 osteoma of the frontal sinus,4 frontal mucocele,3 allergic fungal sinusitis and 1 congenital encephalocele.Sixty-one cases had prior surgical history ( 1.8 times on the average).Their mean follow-up was 25.0 months,(ranging from 6 to 122 months).At the end of follow-up,44 cases (60.3％ ) had well opened frontal drainage pathway.Twenty-five (34.2％ ) was re-stenosed and 4 (5.5％)closed.Seven cases (9.6％ ) underwent revision surgeries.There were no surgical complications.Conclusions EMLP is an effective and salvage procedure in dealing with tumor of frontal sinus and recurrent frontal sinusitis.Combined with medical treatment,EMLP will have a better results for chronic sinusitis with or without polyps and asthma.The degree of diseases,mucosal loss,anatomic variability and prior surgeries are important prognostic factors.

Objective To investigate the clinical application of global osteitis score system(GOSS)in patients with chronic rhinosinusitis(CRS).Methods Three hundreds and thirty-four patients with CRS were enrolled prospectively in a large tertiary referral center.The paranasal sinus bone Hounsfield unit (Hu),thickness,scope were measured by PHILIPS MxLiteView software.Nasal endoscopy Lund-Kennedy score was analyzed in all patients.Sinus CT scans of all patients were analyzed for Lund-Mackay score and for osteitis using the GOSS.Association between GOSS and Lund-Mackay,Lund-Kennedy was analyzed by SPSS 16.0 software.Results The incidence of osteitis in patients with CRS was 53.9％(180/334).The incidence of osteitis(more than grade 2)in patients with CRS was 33.8％(113/334).Average GOSS score of osteitis was 7.51 ± 7.27.The highest incidences of osteitis were in the maxillary and anterior ethmoid sinuses.The left anterior ethmoid sinuses was 37.2％.The right anterior ethmoid sinuses was 32.8％.The left maxillary sinuses was 46.1％.The right maxillary sinuses was 42.2％.GOSS score were significantly correlated with Lund-Mackay and Lund-Kennedy scores(r value were 0.497 and 0.409 respectively,all P ＜ 0.001).Conclusion GOSS can define and evaluate the extent and the severity of osteitis in patients with CRS by using CT,and can also reflect the extent and the severity of CRS.

BACKGROUNDAdenoid hypertrophy (AH) is associated with pediatric chronic rhinosinusitis (pCRS), but its role in the inflammatory process of pCRS is unclear. It is thought that innate immunity gene expression is disrupted in the epithelium of patients with chronic rhinosinusitis (CRS), including antimicrobial peptides and pattern recognition receptors (PRRs). The aim of this preliminary study was to detect the expression of innate immunity genes in epithelial cells of hypertrophic adenoids with and without pCRS to better understand their role in pCRS.

METHODSNine pCRS patients and nine simple AH patients undergoing adenoidectomy were recruited for the study. Adenoidal epithelium was isolated, and real-time quantitative polymerase chain reaction (RT-qPCR) was employed to measure relative expression levels of the following messenger RNAs in hypertrophic adenoid epithelial cells of pediatric patients with and without CRS: Human β-defensin (HBD) 2 and 3, surfactant protein (SP)-A and D, toll-like receptors 1-10, nucleotide-binding oligomerization domain (NOD)-like receptors NOD 1, NOD 2, and NACHT, LRR and PYD domains-containing protein 3, retinoic acid-induced gene 1, melanoma differentiation-associated gene 5, and nuclear factor-κB (NF-κB). RT-qPCR data from two groups were analyzed by independent sample t-tests and Mann-Whitney U-tests.

RESULTSThe relative expression of SP-D in adenoidal epithelium of pCRS group was significantly lower than that in AH group (pCRS 0.73 ± 0.10 vs. AH 1.21 ± 0.15; P = 0.0173, t = 2.654). The relative expression levels of all tested PRRs and NF-κB, as well as HBD-2, HBD-3, and SP-A, showed no statistically significant differences in isolated adenoidal epithelium between pCRS group and AH group.

CONCLUSIONSDown-regulated SP-D levels in adenoidal epithelium may contribute to the development of pCRS. PRRs, however, are unlikely to play a significant role in the inflammatory process of pCRS.

Adenoids ; cytology ; Antimicrobial Cationic Peptides ; metabolism ; Child ; Epithelial Cells ; metabolism ; Female ; Humans ; Immunity, Innate ; genetics ; physiology ; Male ; Receptors, Pattern Recognition ; metabolism ; Sinusitis ; metabolism ; Toll-Like Receptors ; metabolism