OBJECTIVE To analyze the value of modified sinus CT score in olfactory function evaluation before and after functional endoscopic sinus surgery in chronic rhinosinusitis with nasal polyps(CRSwNP). METHODS Fifty-four patients who underwent functional endoscopic sinus surgery for CRS with nasal polyps were enrolled in this prospective study by inclusion criteria and exclusion criteria. T&T methods and olfactory function VAS were used to analyze the subjective olfactory function and were performed preoperatively and at 6 months after surgery. In modified sinus CT score, middle turbinate and superior turbinate associated olfactory cleft areas were used to evaluate the anterior olfactory cleft score(AOCS) and posterior olfactory cleft score(POCS). Sinus CT scans Lund-Mackay scores were also collected before surgery. The correlation between the status of the olfactory cleft on CT, Lund-Mackay score and the preoperative and postoperative olfactory results were investigated.RESULTS Among 54 patients, there were 36 male and 18 female, with average age of 47.9 years old(from 24 to 67 years). There were 30 patients followed 6 months after surgery. The findings of olfactory cleft opacification and the CT Lund-Mackay scores had a positive correlation with preoperative olfactory results(P<0.001). The olfactory cleft opacification showed a stronger correlation with the preoperative olfactory results than the CT Lund-Mackay score. The AOCS was more significantly correlated with the postoperative olfactory results than the other parameters.CONCLUSION Preoperative CT findings, especially the anterior portion of the olfactory cleft had a statistically significant association with the postoperative olfactory results in patients with CRS with nasal polyps.

OBJECTIVE: To evaluate the prognosis of Draf II b surgery in treating fontal sinus inverted papilloma. METHOD: A retrospective study was carried out among 15 patients diagnosed as fontal sinus inverted papilloma, which had underwent endoscopic Draf II b surgery. The clinical success rate and surgical success rate were calculated by survival analysis. RESULT: In all patients, there were 1 (6.67%) recurrence,1 (6.67%) stenosis, 4 (26.67)% complete closure, and 1 (6.67%) mucocele cyst. The 3-year clinical success rate was 93.3%, and the 3-year surgical success rate was 65.0%. CONCLUSION Draf II b surgery is feasible when the frontal sinus inverted papilloma is involved in the area of the pupil center line, and the frontal neo-ostium stenosis or complete closure is a common complication after surgery. Thus a close follow-up is recommended during the first year after the surgery. Further study is necessary to find a better way to reduce the complication rate.
Constriction, Pathologic ; pathology ; Endoscopy ; Frontal Sinus ; pathology ; Humans ; Mucocele ; pathology ; Nasal Surgical Procedures ; methods ; Neoplasm Recurrence, Local ; Papilloma, Inverted ; surgery ; Paranasal Sinus Neoplasms ; surgery ; Postoperative Complications ; pathology ; Prognosis ; Retrospective Studies ; Survival Analysis ; Treatment Outcome

OBJECTIVE To present the modified intranasal endoscopic dacryocystorhinostomy (MIEDCR) and the clinical results. To discuss the modified operative technique and its purpose. METHODS A total of 31 cases (35 eyes) with chronic dacryocystitis who underwent MIEDCR were included in this study. There were 27 female and 4 male. The age was ranged from 9 to 70 years (mean 31 years). The preoperative dacryocystography was taken in all cases. The follow up time was 6 to 20 months. RESULTS Among the 31 cases with chronic dacyocystitis, 4 patients suffered bilateral chronic dacyocystitis. Dacryocystitis related to nasal endoscopic surgery was found in 2 cases (2 eyes). Four cases (5 eyes) had prior laser lacrimal duct surgery. Two patients had external dacrypcystorhinotomy experience. 34 MIEDCR procedures (97.1 %) were successful. Twenty eight patients (32 eyes) were free of their symptoms and kept stoma patency. The shift of mucosal flap was found in one case when Merocel was removed. The rhinostomy of another 2 cases were closed due to mucosal scar and one of them received revision surgery. There were no operative complications. CONCLUSION The preserved nasal mucosal flap which was replaced over the denuded bone would avoid scar formation and hyperostosis and is benefit to gain a satisfied and good clinical effects of dacryocystorhinostomy.

OBJECTIVE To evaluate the bone remodeling in rabbits sinusitis model by CT scan and observing the CT manifestations and time sequence related tendency.METHODS Forty white rabbits(New Zealand) were divided into 5 groups and each group had 8 rabbits.After the sinusitis models were made by incomplete ostia-obstructed and inoculated staphylococcus,we choose one group to be detected by CT scan separately at each time point(2,4,6,8 and 12 weeks after operation).The items we are going to evaluate conclude bone destroy,bone proliferation and sclerosis,soft tissue change,homonymy nasal cavity,opposite side and subcutaneous soft tissue change.The main items were bone destroy,bone proliferation and sclerosis.RESULTS The changes in soft tissue,homonymy nasal cavity,opposite side and subcutaneous soft tissue appear in each group.The main bone manifestation of the change in 2weeks and 4weeks group is bone destroy,no evident bone proliferation and sclerosis.Bone destroy,bone proliferation and sclerosis coexist in the 6 weeks,8 weeks and 12 weeks group.The number of bone destroy and bone proliferation in 6weeks,8 weeks and 12 weeks group is 7,7,6 and 3,5,7 separately.There weren't significant difference about other items among the groups.CONCLUSION The CT manifestations of bone remodeling feature in rabbits sinusitis model include bone destroy,bone proliferation and sclerosis.In the early phase,the main manifestation is bone destroy.While in the late phase(no less than 6 weeks),bone destroy and bone proliferation coexist and the bone proliferation become more obvious over time.

[ABSTRACT]OBJECTIVETo compare the aerodynamic differences before and after nasal cavity ventilation expansion techniques in patients with OSAHS. METHODSA total of 30 adult patients with OSAHS were included in this study. Pre-operative upper airway CT of each subject was acquired. Each subject underwent surgery. Postoperative upper airway CT was obtained at least 3 months later. By means of CFD simulation method, numerical simulation was performed to calculate the airflow dynamic indexes of the upper airway. The pre-and post-operative aerodynamic characteristics were compared. RESULTSAfter operation, post-operative negative pressure nephogram of the nasal cavity indicated more smooth variation of pressure gradient, post-operative velocity nephogram of nasal cavity indicated slower airflow velocity. Proper values of flow field indicated the volume of nasal cavity increased significantly (t=4.025,P<0.01), the total nasal airway resistance decreased significantly (t=-2.065,P<0.01). The total negative pressure of the upper airway decreased significantly (t=-2.659,P<0.01) after operation. However, the proper values of flow field increased in 5 patients. CONCLUSIONNasal cavity ventilation expansion effectively increase the volumes of nasal cavity, improve the nasal ventilation, and reduce the air flow velocity of both nasal cavity and pharynx in OSAHS patients, those reduce the pharyngeal negative pressure and the pharyngeal collapse. However, for patients with its narrowest segment at the velopharyngeal level, operation cannot do anything or even aggravate the pharyngeal collapse. Operation should be performed individually.

OBJECTIVE: To discuss the role of image navigation in resection of the ossifying fibroma of paranasal sinuses and anterior skull base with nasal endoscope. METHOD: Fourteen cases with ossifying fibroma involving paranasal sinuses and anterior skull base were underwent intranasal endoscopic surgery under the guidance of image navigation. Sequential nasal sinuses CT scans were obtained before and after operation. CT scans demonstrated that the nasal septum, orbital wall and anterior skull base were involved in every case. The anterior boundary of the frontal recess cells was involved in 10 cases. The lesions were adjacent to the orbital apex and optic canal in 5 cases. The sella turcica and clivus were invaded in 3 cases and the pterygopalatine fossa was invaded in 2 cases. RESULT: The tumors were thoroughly removed in all cases. The average operative time was 280 minutes and the average registration time of navigation was 9 minutes. Postoperation CT scans demonstrated that the tumors were totally resected. CONCLUSION The image-guided endoscopic surgery of the ossifying fibroma of paranasal sinuses and anterior skull base provided accurate tumor resection, increased surgical effectiveness, decreased overall surgical complications.
Adolescent ; Adult ; Child ; Child, Preschool ; Endoscopy ; methods ; Female ; Fibroma, Ossifying ; surgery ; Humans ; Male ; Middle Aged ; Paranasal Sinus Neoplasms ; surgery ; Paranasal Sinuses ; Skull Base ; Surgery, Computer-Assisted ; Young Adult

OBJECTIVETo analyse the severity of chronic sinusitis osteitis and the correlation factors by global osteitis scoring scale(GOSS).

METHODSThree hundreds and thirty-four patients with chronic rhinosinusitis with or without nasal polyps(CRSwNP/CRSsNP) were enrolled prospectively in a large tertiary referral center. Preoperative sinus CT was analysed by PHILIPS MxLiteView software.Using grading and classification of GOSS, the association between GOSS and gender, age, smoking, CRS course, asthma, skin prick test(SPT), aspirin sensitive asthma (ASA), nasal polyp, Lund-Mackay, Lund-Kennedy, the number of previous sinus surgeries was examined.Finally a marker factors of severity of CRS osteitis was concluded.

RESULTSThere was no association between CRS osteitis and gender(P = 0.542), age(P = 0.092), smoking(P = 0.695), SPT(P = 0.182). Multiple liner regression analysis showed that there was no association between CRS osteitis and nasal polyps, ASA and asthma (all P > 0.05). The severity of CRS osteitis was correlated with the number of previous sinus surgeries, Lund-Mackay scores, Lund-Kennedy scores, CRS course (r1 = 0.528, r2 = 0.170, r3 = 0.193, r4 = 0.146, respectively, all P < 0.01).

CONCLUSIONSOsteitis is an important reason of refractory chronic rhinosinusitis. The number of previous sinus surgeries can be used as an important marker for the severity of the osteitis.

Adolescent ; Adult ; Aged ; Chronic Disease ; Factor Analysis, Statistical ; Female ; Humans ; Male ; Middle Aged ; Osteitis ; etiology ; Rhinitis ; etiology ; Severity of Illness Index ; Sinusitis ; etiology ; Young Adult

OBJECTIVE: To investigate the expression level and significance of osteopontin (OPN) and muscle segment homeobox2 (Msx2) in sinonasal inverted papilloma (SNIP), and the relationship with the process of SNIP malignant transfomation. METHOD: Immunohistochemical method was used to detect the expression of osteopontin and Msx2 in 32 cases of sinonasal inverted papilloma (SNIP), 30 cases of inflammatory nasal polyp paraffin tissue (INP) and 30 cases of sinonasal inverted papilloma with carcinoma. According to the pathology results SNIP were divided into mild dysplasia, moderate dysplasia, severe dysplasia. All the datas were analyzed by SPSS13.0. RESULT: The positive expression of OPN and Msx2 in the SNIP with carcinoma were all 100% (30/30), were significantly higher than the SNIP and INP, and the pairwise comparisons were all statistically significant (P < 0.05). The expression of OPN and Msx2 in the SNIP were divided according to pathological. There was significant difference between mild dysplasia and severe dysplasia group (P < 0.05), while there were not significant difference between light degree of dysplasia and moderate dysplasia group, moderate dysplasia and severe dysplasia group. And the expression of OPN and Msx2 was positively correlated in SNIP (P < 0.01). CONCLUSION OPN and Msx2 may play an important role in the pathway of progression of SNIP, which may be identified as the new therapeutic targets.
Adult ; Female ; Genes, Homeobox ; Homeodomain Proteins ; metabolism ; Humans ; Male ; Middle Aged ; Nose Neoplasms ; metabolism ; pathology ; Osteopontin ; metabolism ; Papilloma, Inverted ; metabolism ; pathology

OBJECTIVE: Analyzing the prognostic factors in endoscopic surgery of juvenile nasopharyngeal angiofibromas (JNA). METHOD: Forty-seven records of JNA, treated with the endoscopic, from 2002 to 2008 were reviewed retrospectively. Previous surgery in other hospitals, sites involved, whether selective embolization was performed before surgery, feeding vessels, operative techniques and follow-up results were recorded. Evaluated factors include previous surgery for resection of JNA, vascular supply from carotid artery, surgery after selective embolization, involvement of cavernous bone in the root of pterygoid process, greater wing of sphenoid bone, interpterygoid fossa, infratemporal fossa and orbit. Chi-square test was used. RESULT: Operations were done under general anesthesia. The follow-up time was 12 to 87 month (median 35 month). During follow up, six patients presented recurrent lesions. Chi-square test showed that deep invasion of the cavernous bone in the root of pterygoid process was related to recurrence (P<0.05). There was no statistically significant difference between other factors and recurrence. Imaging examination showed that recurrent tumor was around the root of pterygoid process. CONCLUSION Deep invasion of the cavernous bone in the root of pterygoid process which was related to recurrence deserve close attention before and after endoscopic surgery.
Adolescent ; Adult ; Angiofibroma ; diagnosis ; pathology ; surgery ; Child ; Endoscopy ; Humans ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; diagnosis ; pathology ; surgery ; Prognosis ; Recurrence ; Retrospective Studies ; Treatment Outcome ; Young Adult

OBJECTIVETo evaluate the impact of nasal function after Draf III frontal sinus surgery (Draf III) or the modified endoscopic Lothrop procedure (EMLP).

METHODSIt was a prospective study with self-control. The pre-operative clinical data of 30 patients (from 2010 to 2013, Beijing Tongren Hospital) who underwent Draf III surgery, with the testing results of T&T olfactory testing, acoustic rhinometry and rhinomanometry before and 1 year after operation in these patients were collected in this study. All patients complete visual analogue scale (VAS), a telephone follow-up questionnaire of olfactory function used by Wormald and Lund-Kenndy endoscopy score simultaneously with testings above. Most of 30 patients were chronic rhinosinusitis (CRS) with recurrent nasal polyps or systemic risk factors like asthma and aspirin-intolerance, called refractory rhinosinusitis. SPSS 19.0 software was used to analyze the data.

RESULTS89.3% (25/28) of these patients improved in nasal obstruction 1 year after operation, and the cure rats was 57.1% (16/28, VAS = 0). The level of improvement in nasal obstruction was significantly correlated with pre-operative nasal obstruction severity (r = 0.909, P < 0.01). 76.7% (23/30) improved in olfactory function 1 year after operation in all 30 patients, and 88.2% improved in patients with nasal polyps (CRSwNP). It was also found that olfactory function 1 year after operation was significantly related to Lund-Kennedy endoscopy scores (r = 0.671, P < 0.01), but was not correlated with VAS scores of nasal obstruction (P = 0.349).

CONCLUSIONThe Draf III frontal sinus surgery has a significantly positive effect on olfactory and ventilation function post-operatively, especially on refractory rhinosinusitis.

Animals ; Asthma ; Chronic Disease ; Endoscopy ; Frontal Sinus ; surgery ; Humans ; Nasal Obstruction ; Nasal Polyps ; Paranasal Sinuses ; Prospective Studies ; Rats ; Retrospective Studies ; Rhinomanometry ; Rhinometry, Acoustic ; Risk Factors ; Sinusitis ; Smell ; Treatment Outcome