Intranasal endoscopic prelacrimal recess approach for maxillary sinus inverted papilloma.

PURPOSE: This study aims to determine the indications and effectiveness of transnasal endoscopic prelacrimal recess approach (PLRA) in patients with maxillary sinus inverted papilloma (IP). METHODS: We retrospectively analyzed 71 patients treated in our institution for maxillary sinus IP between August 2008 and April 2015. 20 patients underwent endoscopic surgery via PLRA. All the patients who had postoperative follow-up for 3 years were enrolled. Demographic data, surgical technique, location of IP attachment, intra- and postoperative complications, follow-up duration and recurrence were recorded. RESULTS: The outpatient follow-up period was 3-10 years after surgery. Recurrence of IP was seen in 6 (8.5%) of 71 patients, including 1 patient in the PLRA group. The recurrence rate was 5% in the PLRA group. Six of 71 patients experienced postoperative complications, but none was observed in the PLRA group. CONCLUSION: Transnasal endoscopic PLRA is a minimally invasive, safe and effective method for maxillary sinus IP. The indication for PLRA is tumor pedicle located on the antero-inferior or infero-lateral wall or at multiple attachment sites of the maxillary sinus.

Endoscopic surgery of a sinonasal inverted papilloma: Surgical strategy, follow-up, and recurrence rate.

BACKGROUND: Sinonasal inverted papilloma (SNIP) is noted for its high rate of recurrence and malignant transformation. Although many clinical studies have demonstrated the effectiveness of the endoscopic approach for SNIP, the surgical strategy has been the subject of much debate. OBJECTIVE: To evaluate the effectiveness of the endoscopic endonasal approach in SNIP. METHODS: A systematic review of patients with a diagnosis of SNIP and who had surgery at our institution from June 2005 to March 2013 was performed. All the patients who had postoperative follow-up for >2 years were enrolled. Each case was categorized into one of four stages as reported by Krouse. Demographic and tumor date, operative approach, complications, and recurrence rates were collected. RESULTS: A total of 125 patients were included in this study. There were 17 patients in stage 1, 40 in stage 2, 57 in stage 3, and 11 in stage 4. The overall recurrence rate was 8.0%. There was no significant difference in recurrence among the stages (all p > 0.05). Recurrence after endoscopic endonasal approach (8.4%) and a combined endoscopic and open exposure procedure (5.6%) were not significantly different (p > 0.05). The recurrence rate was significantly (p < 0.05) higher in patients with revision (15.6%) than in patients in the primary cases (3.8%). A common site of tumor origin was recorded to be from the maxillary sinus (40.2%). Twenty percent of recurrences were observed up to 5 years after surgery. CONCLUSION: Endoscopic surgery may be preferred for treating SNIP. The elevated recurrence rate after revision emphasized the significance of the first surgery. We encourage a follow-up period of at least 5 years.

[Prevalence of allergic rhinitis and survey analysis of health service needs and utilization in Qingdao area].

OBJECTIVE: To investigate the need and utilization for health services in patients with allergic rhinitis in Qingdao area. METHODS: An investigation was conducted by the method of combining multi-stage sampling and cluster sampling. SPSS 13.0 software was used to analyse the data. RESULTS: Among Two thousand and four hundred questionnaires, two thousand and fifty-two questionnaires were available. The effective rate was 85.5%. The total two-week prevalence in male was 6.5%, while that in female was 6.2%. There was no significant difference between male and female (χ(2) = 0.103, P > 0.05). The total ratio of those who visited doctors was 1.7%. The ratio of those who visited doctors in the first two weeks was 26.7% (35/131). 49.0% of non-users of health service thought it was unnecessary to consult a doctor because of mild symptoms. In the investigation about the allergic rhinitis, 60.2% patients (1235/2052) confessed that they heard of allergic rhinitis, 30.0% patients (616/2052) thought of allergic rhinitis was common cold. CONCLUSIONS: The number of patients treated for allergic rhinitis was less than its prevalence. The primary reason for low attendance was that the majority of patients with mild symptoms thought it was no need to see a doctor. In order to improve the residents' health services utilization, medical education for allergic rhinitis is necessary.

[Observation of neural electrophysiology and morphology in traumatic optic neuropathy in cat model].

OBJECTIVE: To establish the animal model of traumatic optic neuropathy similar to clinical feature by injuring the optic nerve of the pipeline through the ethmoid and sphenoid sinus. The electrophysiology and morphology were observed. METHODS: The optic nerve in 2 cats was anatomically observed. Thirty healthy adult cats were divided into 1 h, 1 d, 3 d, 1 w, 2 w, 4 w injury groups. The right eye was selected as the experiment eye, and the left as the control. The optic canals were damaged by the injury instrument. The changes of optic nerve were observed using light and electron microscope. The pattern reversal visual evoked potential (PR-VEP) was used to determine the succeed model and pupil was monitored. PR-VEP and neural tissue morphology were examined at intervals of 1 h, 1 d, 3 d, 1 w, 2 w, 4 w after trauma. RESULTS: Eight cats had Marcus-Gunn's pupil, and 22 cats did not have after injury. Neural tissue was physaliphorous degeneration in light microscope. The neural fibers swelled gradually and fibers physaliphorous degeneration in the first day after damage. At the seventh day, the bubble enlarged to be a big flat. After two weeks, the big flat bubble came out to be a bigger bubble. Under the electronic microscope, axons were physaliphorous degeneration, crack emerged between axon membrane and myelin sheath and myelin sheath were loose in the first day. At the third day, axon swelled, physaliphorous degeneration rose and myelin sheath were loose obviously. At the seventh day, axon and myelin sheath appeared loop in half cycle and bubble-like broke up. A lot of pieces came out and axon became physaliphorous and uniform. Microtubule and microfilament disappeared. After two weeks, myelin sheath became onion-like. On fourth week, myelin sheaths enlarged and squeezed to center. Axoplasm disappeared and neural tissues collapsed. CONCLUSIONS: This animal model was similar to clinical optic nerve decompression through ethmoid and sphenoid sinus. The change of PR-VEP and neuromorphology were distinct before and after trauma. The pathological changes of optic nerve catching vibrated injury are mainly degeneration, so earlier decompression of optic nerve may improve the visual function.

[Endoscopic optic nerve decompression in traumatic optic neuropathy: analysis of 72 cases].

OBJECTIVE: To review the effects of optic nerve decompression by endoscopic technique in traumatic optic neuropathy. METHODS: Seventy-two patients (73 eyes) with traumatic optic neuropathy which were treated with large dose of glucocorticoid but inefficacious were undergone endoscopic optic nerve decompression. The days from injury to surgery were 1-57 d. Among that, < or = 3 d 15 cases, 4-7 d 37 cases, 8-10 d 9 cases, 11-15 d 5 cases, 16-30 d 5 cases, >30 d 1 cases. The vision of pro-operation: with light perception or higher grades 18 eyes; with no light perception 55 eyes. RESULTS: All patients were followed up for more than 3 months. Fourty-six of 73 eyes had improvements in visual acuity, the total effective rate was 63.01%. Thirty-one of 55 eyes with no light perception had raises in visual acuity (56.36%). Fifteen of 18 eyes with light perception or higher grades had improvements (83.33%). No complication had happened. CONCLUSIONS: Endoscopic optic nerve decompression is an appropriate technique for patients with traumatic optic neuropathy. Even though the patient has injured in longer time and high-dose steroid treatment has failed, optic nerve decompression may improve visual acuity.