OBJECTIVE To retrospectively analyze the efficacy of endoscopic prelacrimal recess approach(PLRA)surgery for sinonasal inverted papilloma(SNIP)with tumor attachment located in the maxillary sinus,and to evaluate changes in postoperative facial numbness complications.METHODS A total of 69 cases of SNIP classified as Krouse stage T2 and T3 were treated with the PLRA surgery and included in the study.The tumor attachment sites were recorded,and all patients underwent regular follow-up for at least 12 months postoperatively.Recurrence rates and treatment methods were documented.Differences in tumor attachment sites between T2 and T3 cases and the feasibility of complete tumor removal using powered instruments and high-speed drills were analyzed.Subjective scores of facial numbness were recorded using the visual analogue scale(VAS)and compared at 1,3 and 12 months postoperatively.RESULTS The PLRA surgery demonstrated good therapeutic efficacy for Krouse stage T2 and T3 SNIP cases with tumor attachment located in the maxillary sinus,with a recurrence rate of 2.9%.Tumor attachment in T2 cases was more frequently located on the medial wall of the maxillary sinus(P<0.01),while in T3 cases,attachment was more often found on the anterior wall(P=0.001)and posterior lateral wall(P=0.009).The proportion of cases where high-speed drills could be used to remove bony tumor attachment was higher in T2 cases compared to T3 cases(P=0.023).The VAS scores for facial numbness were 6.39±1.69 at 1 month postoperatively,2.83±1.52 at 3 months,and 1.25±0.93 at 12 months.Significant differences were observed between the scores at 3 months and 1 month,as well as between 12 months and 3 months(P<0.01).CONCLUSION For Krouse stage T2 and T3 SNIP with tumor attachment located in the maxillary sinus,the endoscopic PLRA surgery should be the preferred approach to ensure complete tumor resection and removal of mucosa and bone at the tumor attachment site,thereby reducing recurrence rates.Postoperative numbness in the upper lip and gingival regions may occur but gradually diminishes over time,with minimal impact on patients'quality of life.

Objective:To compare the clinical characteristics of nasal NK/T-cell lymphoma（NKTL） and diffuse large B-cell lymphoma（DLBCL） to improve the diagnosis and differential diagnosis of nasal lymphomas. Methods:A retrospective analysis of cases of nasal NKTL and DLBCL was conducted. The clinical symptoms, signs, and imaging features of both groups were compared and statistically analyzed. Results: The DLBCL group showed more symptoms like exophthalmos/diplopia and epiphora compared to the NKTL group （both P=0.040）. NKTL cases were more likely to be misdiagnosed as sinusitis（P=0.007）. In NKTL cases, nasal mucosal swelling（P<0.01）, destruction of nasal structures（P=0.002）, and external nasal structural abnormalities（P=0.003） were more prevalent. In imaging, the DLBCL group more commonly demonstrated worm-eaten destruction of sinus bones （P=0.004）, sinus masses （P=0.018）, and invasion of adjacent structures including the pterygopalatine fossa, infratemporal fossa （P<0.01）, orbit （P=0.039）, and skull base （P=0.011）. NKTL involved the turbinates（P=0.001）, nasal cavity and septum（P=0.016）, nasopharynx（P<0.01）, and "skip" infiltration of external nasal tissues（P=0.042） more frequently. No statistically significant differences were found in other clinical features between the two groups. Conclusion:For patients with nasal obstruction and discharge, it is essential to inquire about systemic B symptoms, such as fever, and eye symptoms, such as periorbital swelling, diplopia, and lacrimation. Lymphoma should be suspected if local examination reveals diffuse nasal swelling, destruction of turbinates or septum, and external nasal structural abnormalities. Worm-eaten bone destruction and "cast-like" changes of the turbinates, septum, and nasal cavity, as well as "skip" infiltration of the external nose, are more common in NKTL. Sinus masses with invasion of the pterygopalatine fossa, infratemporal fossa, skull base, and orbit are more typical of DLBCL.
Humans ; Retrospective Studies ; Lymphoma, Extranodal NK-T-Cell/diagnosis* ; Lymphoma, Large B-Cell, Diffuse/pathology* ; Nasal Cavity/pathology* ; Male ; Diagnosis, Differential ; Female ; Middle Aged ; Nose Neoplasms/diagnosis* ; Adult ; Aged

Objective:To retrospectively analyze and explore the indications, methods and prognosis of optic nerve decompression (OND) in endoscopic surgery for benign fibro-osseous lesions (FOLs) of the nasal and skull base.Methods:Among 217 cases of craniofacial fibro-osseous lesions from July 2008 to January 2025 who were treated in the Otolaryngology Head and Neck Surgery Department of Beijing Tongren Hospital Affiliated to Capital Medical University, 14 patients (6.45%, 14/217) who underwent endoscopic resection of the lesion and OND under image navigation were included in this study, including 8 males and 6 females, aged from 4 to 28 years old. Among the 14 patients, 8 had fibrous dysplasia, 5 had ossifying fibroma, and 1 had osteoma. Clinical data, imaging data, surgical data and follow-up results were collected. Best corrected visual acuity (BCVA) and other indicators before and after treatment were recorded for analysis. Statistical analysis was conducted using SPSS 26.0 software.Results:Among 14 patients, preoperative visual decline involved 17 eyes (all 8 fibrous dysplasia cases, 2/5 ossifying fibroma cases, and 1 osteoma case). Surgical approaches included: partial resection for fibrous dysplasia (8 cases; bilateral decompression in 5, unilateral in 3); total resection for ossifying fibroma (3 cases; bilateral decompression in 2, unilateral in 1) or partial resection with bilateral decompression (2 cases, including 1 aneurysmal bone cyst); and total resection with unilateral decompression for osteoma (1 case). After the operation, the vision of 10 eyes (58.82%, 10/17) had been improved. Among the 5 eyes with severe visual impairment before the operation (no light perception/light perception/exponential vision), 2 eyes improved (1 eye from no light perception to light perception, and 1 eye from visual perception to exponential vision). Eight cases (10 eyes) of patients with proptosis improved after the operation. The proptosis before and after the operation were (16.60±1.71) mm and (13.60±1.35) mm ( P<0.05). Conclusions:For patients with benign FOLs involving the optic canal at the nasal and skull base who have visual impairment, OND via endoscopic endonasal approach can achieve visual salvage effects. Those with better preoperative residual vision have significant improvement in BCVA, so the operation should be performed as early as possible.

Objective:To retrospectively analyze and explore the indications, methods and prognosis of optic nerve decompression (OND) in endoscopic surgery for benign fibro-osseous lesions (FOLs) of the nasal and skull base.Methods:Among 217 cases of craniofacial fibro-osseous lesions from July 2008 to January 2025 who were treated in the Otolaryngology Head and Neck Surgery Department of Beijing Tongren Hospital Affiliated to Capital Medical University, 14 patients (6.45%, 14/217) who underwent endoscopic resection of the lesion and OND under image navigation were included in this study, including 8 males and 6 females, aged from 4 to 28 years old. Among the 14 patients, 8 had fibrous dysplasia, 5 had ossifying fibroma, and 1 had osteoma. Clinical data, imaging data, surgical data and follow-up results were collected. Best corrected visual acuity (BCVA) and other indicators before and after treatment were recorded for analysis. Statistical analysis was conducted using SPSS 26.0 software.Results:Among 14 patients, preoperative visual decline involved 17 eyes (all 8 fibrous dysplasia cases, 2/5 ossifying fibroma cases, and 1 osteoma case). Surgical approaches included: partial resection for fibrous dysplasia (8 cases; bilateral decompression in 5, unilateral in 3); total resection for ossifying fibroma (3 cases; bilateral decompression in 2, unilateral in 1) or partial resection with bilateral decompression (2 cases, including 1 aneurysmal bone cyst); and total resection with unilateral decompression for osteoma (1 case). After the operation, the vision of 10 eyes (58.82%, 10/17) had been improved. Among the 5 eyes with severe visual impairment before the operation (no light perception/light perception/exponential vision), 2 eyes improved (1 eye from no light perception to light perception, and 1 eye from visual perception to exponential vision). Eight cases (10 eyes) of patients with proptosis improved after the operation. The proptosis before and after the operation were (16.60±1.71) mm and (13.60±1.35) mm ( P<0.05). Conclusions:For patients with benign FOLs involving the optic canal at the nasal and skull base who have visual impairment, OND via endoscopic endonasal approach can achieve visual salvage effects. Those with better preoperative residual vision have significant improvement in BCVA, so the operation should be performed as early as possible.

Objective:To evaluate the diagnostic value of image enhancement endoscopy (IEE) for sinonasal malignant tumors.Methods:Patients with nasal neoplasms at the Department of Otorhinolaryngology Head and Neck Surgery at Beijing Tongren Hospital from January 2019 to December 2021 were examined using white light endoscopy (WLE) and IEE. Targeted biopsy was performed after image collection, and the images were analyzed by two blinded observers. Pathological diagnosis was compared with endoscopic findings. Diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated, and P<0.05 was statistically significant. Kappa(k) was employed to assess consistency between endoscopic and histopathological diagnoses. The vascular patterns of sinonasal malignancy were compared with Ni endoscopic classification.Results:This study ultimately included 193 patients with nasal tumors, and 41 cases (21.24%, 41/193) were comfirmed histopathologically with sinonasal malignancies. WLE correctly diagnosed 18 cases (43.90%, 18/41), while IEE diagnosed 28 cases (68.29%, 28/41). Among the 41 malignancies, 28 cases (68.29%, 28/41) showed patchy/punctate patterns and tortuous vessels (Ni type Ⅴ). All 14 squamous epithelium-derived malignancies (34.15%, 14/41) had Ni type Ⅴ vessels. Of 27 non-squamous malignancies, 14 cases (34.15%, 14/41) were Ni type Ⅴ, 7 cases (17.07%, 7/41) were false negatives, 6 cases (14.63%, 6/41) that their vessels were obscured by necrotic tissue. Compared to WLE, IEE had higher sensitivity (80.00% vs 51.42%), specificity (98.68% vs 96.69%), PPV (93.33% vs 78.26%), NPV (95.51% vs 89.57%), diagnostic consistency (95.16% vs 88.17%), and κ value (0.832 vs 0.554). Conclusions:IEE improves the endoscopic diagnosis of sinonasal malignancies. Ni type Ⅴ is suitable for the diagnosis of malignant tumors of squamous epithelial malignant tumors.

Objective:To evaluate the diagnostic value of image enhancement endoscopy (IEE) for sinonasal malignant tumors.Methods:Patients with nasal neoplasms at the Department of Otorhinolaryngology Head and Neck Surgery at Beijing Tongren Hospital from January 2019 to December 2021 were examined using white light endoscopy (WLE) and IEE. Targeted biopsy was performed after image collection, and the images were analyzed by two blinded observers. Pathological diagnosis was compared with endoscopic findings. Diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated, and P<0.05 was statistically significant. Kappa(k) was employed to assess consistency between endoscopic and histopathological diagnoses. The vascular patterns of sinonasal malignancy were compared with Ni endoscopic classification.Results:This study ultimately included 193 patients with nasal tumors, and 41 cases (21.24%, 41/193) were comfirmed histopathologically with sinonasal malignancies. WLE correctly diagnosed 18 cases (43.90%, 18/41), while IEE diagnosed 28 cases (68.29%, 28/41). Among the 41 malignancies, 28 cases (68.29%, 28/41) showed patchy/punctate patterns and tortuous vessels (Ni type Ⅴ). All 14 squamous epithelium-derived malignancies (34.15%, 14/41) had Ni type Ⅴ vessels. Of 27 non-squamous malignancies, 14 cases (34.15%, 14/41) were Ni type Ⅴ, 7 cases (17.07%, 7/41) were false negatives, 6 cases (14.63%, 6/41) that their vessels were obscured by necrotic tissue. Compared to WLE, IEE had higher sensitivity (80.00% vs 51.42%), specificity (98.68% vs 96.69%), PPV (93.33% vs 78.26%), NPV (95.51% vs 89.57%), diagnostic consistency (95.16% vs 88.17%), and κ value (0.832 vs 0.554). Conclusions:IEE improves the endoscopic diagnosis of sinonasal malignancies. Ni type Ⅴ is suitable for the diagnosis of malignant tumors of squamous epithelial malignant tumors.

Objective:To investigate the efficacy and safety of endoscopic resection of infratemporal fossa mass and to determine the indications for surgery.Methods:A retrospective case series study was conducted, including a total of 29 patients who underwent endoscopic surgery to treat infratemporal fossa mass in the Department of Rhinology of Beijing Tongren Hospital, Capital Medical University, from April 2008 to December 2021. Ten males and 19 females were included in the study, with age of (46.5±13.7) years. Pre-and post-operative sinus CT, sinus or nasopharyngeal enhanced MRI were evaluated, respectively. The main outcome measurements were the total resection of mass and the incidence of surgery-related complications.Results:Among the 29 cases of infratemporal fossa mass, 22 were schwannomas, 3 were cysts, 2 were neurofibromas, 1 was pleomorphic adenoma and 1 was basal cell adenoma. Preoperative imaging showed well-defined lesion boundaries, and postoperative pathology confirmed the benign nature of all cases. The endoscopic transnasal approach was used in 28 patients, while the combination of the transnasal approach and the transoral approach was used in 1 patient. Complete tumor removal was achieved in all cases with a 100% resection rate. The average follow-up time was 38 months (7-168 months), and no tumor recurrence was observed.Conclusions:The Endoscopic transnasal approach is a safe and effective surgical approach for the treatment of benign tumors or masses in the infratemporal fossa.

Objective:To analyze the efficacy of endoscopic surgery for frontal sinus meningoencephalocele and cerebrospinal fluid (CSF) leaks, and to explore endoscopic surgical strategy.Methods:A total of 35 patients with frontal sinus meningoencephalocele and CSF leaks who underwent endoscopic transnasal surgery at Beijing Tongren Hospital, Capital Medical University between May 2007 and December 2023 were enrolled in this retrospective case series, including 29 males and 6 females, with the age of (35.23±15.76) years. High-resolution sinus CT and magnetic resonance cisternography were undertaken before surgery. The primary outcome measure was the success rate of endoscopic surgical repair. Statistical analysis was conducted using SPSS 27 and GraphPad Prism 8 software.Results:Of the 35 cases, 21 (60.0%) were traumatic, and 14 (40.0%) were non-traumatic. The most common defect was in the posterior frontal sinus wall (24 cases, 68.6%), with a defect size of (10.4±4.8) mm 2. Twenty-six cases (74.3%) underwent endoscopic transnasal Draf Ⅱa-Ⅲ frontal sinusotomy, and 9 cases (25.7%) underwent endoscopic transnasal Darf Ⅱb-Ⅲ frontal sinusotomy combined with frontal trephination. The average follow-up time was (84.72±57.42) months. The success rate of one-time endoscopic repair was 97.1% (34/35). One patient required a second procedure, resulting in an overall success rate of 100%. Thirty-three patients had a widely patent frontal sinus ostium postoperatively, while two experienced stenosis. Conclusions:Endoscopic surgery is effective for treating frontal meningoencephalocele and CSF leaks while preserving frontal sinus drainage. Combined frontal trephination is recommended for defects that are difficult to repair using the conventional transnasal approach.

OBJECTIVE To retrospectively summarize the CT and enhanced MRI imaging characteristics of common unilateral benign nasal and sinus lesions and to outline key points for differentiation from malignant lesions.METHODS A total of 134 cases of unilateral benign nasal and sinus lesions were included in this study,with preoperative sinus CT and enhanced MRI examinations performed.The imaging characteristics of CT and MRI,the extent of the lesions,and the involvement and destruction of surrounding bone and structures were recorded and summarized for each type of lesion.RESULTS Unilateral lesions on CT appeared as generally homogeneous soft tissue density shadows.The affected sinus bones showed internal calcification,localized bone hyperplasia of the sinus wall,extensive uniform centripetal bone hyperplasia and thickening of the sinus wall,expansive destruction of the sinus wall bone,and worm-eaten destruction of the sinus wall bone in 33,13,29,9,and 5 cases,respectively.On MRI T1WI,the lesions appeared as generally homogeneous isointense shadows.Enhanced T1 images showed mild,moderate,and significant enhancement in 3,10,and 108 cases,respectively,with 55 cases presenting as mixed signals.CONCLUSION The imaging manifestations of unilateral benign lesions vary.CT can clearly present high-density shadows such as calcifications within unilateral lesions and changes in surrounding bone.Enhanced MRI of the sinuses provides richer information about the different components within the lesions.Careful differentiation of unilateral lesions should be performed by combining the imaging characteristics of sinus CT and enhanced MRI.

OBJECTIVE To compare the clinical characteristics of natural killer/T-cell lymphoma(NKTL),and chronic rhinosinusitis(CRS),analyzing key points for differential diagnosis.METHODS Data from 29 nasal NKTL cases and 54 CRS cases were collected and compared,including medical history,clinical presentations,and imaging data.RESULTS The NKTL group had a shorter duration of symptom appearance(P<0.001)and more frequent symptoms of bloody nasal discharge(P=0.002).There was diffuse mucosal swelling of the turbinates and nasal septum(P<0.001),and signs of structural destruction within the nasal cavity(P=0.024).MRI more frequently showed involvement of the inferior turbinate(P=0.034),nasal septum(P<0.001),nasopharynx(P=0.002),and skull base(P=0.024),with cast-like changes or extranasal infiltration.The CRS group more frequently reported symptoms of olfactory reduction(P<0.001),swelling in the middle nasal meatus,and nasal masses(P<0.001).CT more commonly showed sinus bone hyperplasia(P=0.002).CONCLUSION Compared to CRS,nasal NKTL has a shorter symptom duration,commonly presents with diffuse nasal swelling and structural destruction both inside and outside the nasal cavity.MRI frequently shows involvement of the inferior turbinate,nasal septum,nasopharynx,and skull base,along with cast-like features and skip infiltration.