Anatomical margins of uncinectomy in endoscopic sinus surgery.

BACKGROUND: Endoscopic sinus surgery is a common and generally safe ENT procedure. Orbital injury is a rare but devastating complication. The distance between the uncinate process and the lamina papyracea is the safety margin to avoid entering the orbital cavity and has not been measured previously. METHODS: The authors reviewed 330 consecutive coronal CT scans of the paranasal sinuses to measure this distance and identify variation. RESULTS: The distance can be as narrow as 0.1 mm and varies between sides. An air cell lateral to the uncinate is not uncommon; it increases the distance considerably p < 0.001 but is frequently unilateral (22%). Gender does not have an effect on this distance p = 0.90. CONCLUSION: It is essential to carefully examine the area on a CT scan especially when performing front-to-back uncinectomy during endoscopic sinus surgery. The variation between the right and left sides should be considered to avoid unsafe assumptions.

Functional endoscopic balloon dilation of sinus ostia for chronic rhinosinusitis.

BACKGROUND: Dilation of sinus ostia using a high-pressure balloon has been introduced as a treatment for chronic rhinosinusitis (CRS) refractory to medical treatment. The efficacy of this technology, however, has not been systematically reviewed. OBJECTIVES: To assess the effectiveness of balloon sinus ostial dilation as a treatment for patients suffering with CRS refractory to medical treatment. SEARCH STRATEGY: We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; CENTRAL; PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ISRCTN and additional sources for published and unpublished trials. The date of the most recent search was 20 December 2010. SELECTION CRITERIA: Randomised controlled trials in patients of any age with rhinosinusitis lasting longer than 12 weeks who have failed a prolonged course of medical treatment. Studies compared either balloon sinus ostial dilation or a hybrid procedure (balloon dilation in conjunction with functional endoscopic sinus surgery (FESS)) versus conventional surgery (e.g. FESS) or a waiting list control. DATA COLLECTION AND ANALYSIS: Two authors independently selected studies for inclusion, extracted data and assessed risk of bias. MAIN RESULTS: One study (34 patients) met our inclusion criteria although it was not yet a peer reviewed publication. The study randomised patients with chronic frontal sinusitis who had failed a prolonged course of medical treatment into two groups: balloon dilatation of the frontal recess (plus conventional FESS of other involved sinuses) versus conventional FESS (Draf type 1/2a procedures on the frontal sinuses). At 12 months follow up there was no statistically significant difference in radiological resolution of frontal sinuses between the two groups. The percentages of directly observed patent frontal recesses at 12 months were 75% in the balloon dilation group versus 63% in the FESS-only group. The authors state that this was statistically significant but details of the analysis were not presented. Indeed the study as a whole suffers from a bias in the way its outcome measures were reported.No major complications were reported. Three patients in the FESS-only group required further revision frontal sinus surgery compared to one in the balloon dilation group, although synechiae were more common in the latter. AUTHORS' CONCLUSIONS: At present there is no convincing evidence supporting the use of endoscopic balloon sinus ostial dilation compared to conventional surgical modalities in the management of CRS refractory to medical treatment. With the escalating use of balloon sinuplasty, there is an urgent need for more randomised controlled trials to determine its efficacy over conventional surgical treatment modalities.

Assessment of the chin in patients undergoing rhinoplasty: what proportion may benefit from chin augmentation?

OBJECTIVE: The chin is an important determinant of the lower third of the face, carrying much significance in an esthetically balanced facial appearance. It is, however, often neglected in patients undergoing rhinoplasty procedures in the UK National Health Service (NHS). The aim of this study was to establish the percentage of a cohort of rhinoplasty patients who may also have benefited from chin augmentation. STUDY DESIGN: A cross-sectional study. SUBJECTS AND METHODS: The digital preoperative pictures of the last 100 patients who underwent rhinoplasty at our institution were retrieved. Four popular methods of assessment were used to assess the chin, that is, those advocated by Silver, Legan, Merrifield, and Gonzales-Ulloa. All analyses were performed on Adobe Photoshop CS4 by two ENT registrars. Values were regarded as positive when there was interobserver agreement. Relevant angles were averaged. RESULTS: A total of 94 photographs were suitable for analysis. There were 58 males. Depending on the method of assessment, the percentage of males who fulfilled criteria for augmentation ranged from 17 to 62 percent and for females the range was 42 to 81 percent. Additionally, 21 percent of males were positive on three or more of the methods utilized. The respective figure was 58 percent for females. CONCLUSION: Surgeons who practice rhinoplasty should consider making an objective assessment of the need for possible chin augmentation. Our study shows that as many as 81 percent of patients may benefit, although this figure varies with the method of assessment. In this study, the necessity for further analysis with a view to chin augmentation was more likely in women.

Point prevalence of barotitis and its prevention and treatment with nasal balloon inflation: a prospective, controlled study.

INTRODUCTION: The most common cause of barotitis is pressure changes induced during descent in aviation. The incidence after air flight has been reported to vary from 8% to 17%. OBJECTIVES: We conducted this study to estimate the incidence of barotitis after flight, to evaluate whether the incidence of barotitis can be reduced by nasal balloon inflation during descent, and, finally, to estimate the effect of nasal balloon inflation in case of negative middle ear pressure after landing. STUDY DESIGN: Aircraft passengers were examined by otoscopy and tympanometry before and after flying and filled in a questionnaire inquiring about ear problems. On half of the flights, the passengers were asked to inflate a nasal balloon during descent, whereas the other half were control flights. RESULTS: A total of 188 passengers filled in the questionnaire. Of these, 134 were examined before and after the flight. Otoscopic signs of barotitis were found in 15% of the ears in the control group compared with 6% in the balloon inflation group. In ears with a negative pressure after flying, the pressure could be equalized by Valsalva's maneuver in 46%. Passengers who were unable to equalize the pressure in this way inflated a nasal balloon, and in 69%, this maneuver cleared the middle ear pressure. CONCLUSION: The incidence of barotitis in this study of aircraft passengers was 14%. This figure could be reduced to 6% in passengers who performed nasal balloon inflation during descent. We recommend nasal balloon autoinflation in aircraft passengers who have difficulty clearing their ears during and after flying.