The implications of concomitant mucosal inflammation on clinical manifestations and outcomes of sinonasal inverted papilloma.

PURPOSE: This study examines the impact of concomitant mucosal inflammation on clinical manifestations and long-term outcomes of Inverted Papilloma (IP). METHODS: This retrospective cohort study was conducted in five tertiary medical centers. The included patients underwent an attachment-oriented surgical resection for IP with a minimum follow-up of 3 years. RESULTS: Of 185 patients with IP, 65 patients (35.1%) had synchronous mucosal inflammation with polypoid changes. The mean age was 56.7 years, and 69% were males. Most tumors originated from the maxillary sinus. Age, gender, Krouse stage, and tumor attachment site did not differ between the mucosal inflammation and IP-only groups. IP recurrence rate was twofold in the patients with mucosal inflammation (15.4% vs. 7.5%, p = 0.092). However, the difference was not significant, with a similar median time to recurrence between the two groups [15.5 (3-36) months vs. 16(6-96) months, p = 0.712]. In revision cases, IP recurred only in patients with mucosal inflammation (19% vs. 0%, p = 0.07). This group had a significantly worse 5-years recurrence-free survival than revision cases without mucosal inflammation (80.6% vs. 100%, p = 0.04). CONCLUSIONS: IP in the setting of mucosal inflammation might be associated with a higher recurrence rate, predominantly after revision surgery. Otolaryngologists should consider this during these patients' diagnosis, surgical planning, and follow-up.

Is intraoperative margin sampling necessary in inverted papilloma resection?

PURPOSE: To explore the association between intraoperative surgical margin sampling by the frozen sections and recurrence in inverted papilloma surgery. METHODS: A multicenter, retrospective study of patients who underwent attachment-oriented IP resection in four tertiary care medical centers with a minimal follow-up of 36 months. RESULTS: The study included 220 surgeries with a mean follow-up period of 49 months (range 36-204). The endoscopic approach was used in all but 4 cases; 73% of procedures were primary. Overall recurrence was 10.45% (n = 23). Squamous cell carcinoma was found in 5 cases (2.2%). Intraoperative margin sampling was obtained in 145 cases. There was no difference in the recurrence rate between frozen section and no-frozen section groups (p = 0.44). Furthermore, margin sampling in various sites of tumor origin, in cases with concomitant nasal polyps (p = 0.53) and in revision cases (p = 0.08) showed no correlation with recurrence. In 26 cases when the surgery was extended following a positive frozen section, there was a significantly higher recurrence rate (OR = 6.94). CONCLUSIONS: According to our results, intraoperative margin sampling did not affect the recurrence rate of IP, and therefore, its routine use should be questioned.

Endoscopic Inferior Meatal Antrostomy for Antrochoanal Polyps: A Long-Term Follow-Up.

BACKGROUND: Endoscopic middle meatal antrostomy (EMMA) is considered the standard approach for surgical management of antrochoanal polyps (ACPs). Recently, an endoscopic inferior meatal antrostomy (EIMA) approach for clearing lesions in the maxillary sinus was described. In this study, we compared the long-term outcome of patients with ACP following surgical treatment using one of these 2 approaches (EIMA or EMMA). METHODS: The medical charts of all patients treated for ACPs in our institution between January 1, 2009, and July 1, 2020, were reviewed retrospectively. Patients were invited to complete a long-term follow-up assessment. RESULTS: Thirty-eight patients were included in the study: EIMA was the only procedure performed in 25 patients (66%) and EMMA was the only procedure performed in 7 patients (18%). Both procedures were performed in 6 patients (16%): 2 patients (5%) underwent simultaneous EMMA and EIMA for better access and visualization and 4 patients (10.5%) underwent surgical revision consisting of EIMA secondary to failed EMMA at other institutions. Median follow-up was 44 months (range, 6 months-11 years). No evidence of recurrent ACPs, recirculation, synechiae, nasolacrimal duct injury, or bleeding was observed in any of our patients. Small nonobstructing cysts were observed in 2 patients (8%) following EIMA. CONCLUSIONS: EIMA prevents violation of the ostiomeatal complex. It provides access to the anteroinferior aspect of the maxillary sinus and should be considered as an alternative to EMMA in patients with ACPs.

The association between otogenic lateral sinus thrombosis and thrombophilia - A long-term follow-up.

PURPOSE: Otogenic lateral sinus thrombosis (OLST) is an intracranial, potentially life-threatening complication of acute and chronic otitis media. Since congenital thrombophilic disorders are risk factors for cerebral venous thrombosis, OLST may be related to thrombophilia. The aim of our study was twofold: to evaluate whether patients who suffered from OLST in childhood also have thrombophilia, and whether these patients experienced thromboembolic episodes in future years. STUDY DESIGN: Retrospective case series. METHODS: The medical charts of all children hospitalized for OLST at Soroka University Medical Center of Israel, a tertiary referral hospital, from January 1983 to September 2014 were reviewed. The patients were invited for a follow-up visit and comprehensive medical history was taken along with a physical examination and laboratory work-up for thrombophilia. MAIN FINDINGS: Seven patients were included in the study. Of these, 3 (43%) had results suggesting thrombophilic disorders manifested by elevated levels of factor IX and decreased levels of protein S activity (n = 1), decreased levels of proteins C and S activity (n = 1), and elevated levels of antibodies to cardiolipin (n = 1). No patients experienced clear thrombophilic events; however, 2 patients (29%) with later proven thrombophilia suffered neurologic sequelae, possibly suggesting thrombophilic events. CONCLUSIONS: Pediatric OLST secondary to acute otitis media and mastoiditis may reflect an underlying thrombophilia. Laboratory work-up for thrombophilia should be performed, and anticoagulant treatment may be warranted in managing these patients.

Bilateral orbital abscess secondary to pediatric acute rhinosinusitis: a case report and literature review.

A 13-month-old boy presented with bilateral periorbital swelling accompanied by rhinorrhea and fever. Nasal endoscopy revealed middle meatus edema and purulent discharge. He was diagnosed with bilateral preseptal cellulitis and treated with intravenous antibiotics. Continuous fever and new-onset proptosis with extraocular muscle restriction the next day prompted imaging, which revealed sinusitis with bilateral subperiosteal abscesses. He underwent endoscopic sinus surgery with bilateral abscess drainage and recovered uneventfully. Bilateral orbital complications of acute sinusitis are exceedingly rare occurrences and nearly always require surgical treatment.

Endoscopic treatment of ectopic teeth in the maxillary sinus.

BACKGROUND: Ectopic teeth in maxillary sinus is rare and are usually removed via sub-labial trans-canine fossa approach (SLCFA). The aim of our study was to present our experience with extraction of ectopic teeth in the maxillary sinus via transnasal endoscopic approach (TEA). MATERIAL AND METHODS: Rhinologists were asked to share their experience in the management of ectopic teeth in the maxillary sinus. Data were reviewed retrospectively. RESULTS: Eleven cases were reported in 10 patients from 2010 to 2019, six males and four females with a mean age of 33.5 +/-17 years (range 16 to 61). Seven patients complained of sinonasal symptoms, two were diagnosed incidentally during routine dental work-up, and one had oro-antral fistula. In eight patients, a cyst coexisted within the maxillary sinus. Teeth were located arbitrarily within the sinus. All cases were operated by TEA. One patient had self-limited periorbital emphysema, one had transient cheek numbness, and one had early post-operative bleeding that stopped after endoscopic cauterization. Long-term follow-up revealed good clinical outcomes. CONCLUSIONS: Transnasal endoscopic removal of ectopic teeth from the maxillary sinus is a feasible and rational approach when SLCFA is contraindicated. Key words:Ectopic teeth, dentigerous cyst, endoscopic sinus surgery, Caldwell-Luc.

Can Computed Tomography Findings Predict the Recurrence of Sinonasal Inverted Papilloma?

OBJECTIVE: To evaluate the correlation between the ability to predict the attachment site of sinonasal inverted papilloma by computed tomography and the long-term surgical outcome. STUDY DESIGN: Retrospective cohort study. SETTING: Five tertiary medical centers. METHODS: Study patients underwent attachment-oriented resection of inverted papilloma. The primary outcome was tumor recurrence. RESULTS: Among 195 patients eligible for the study, focal hyperostosis was recognized on computed tomography in 65% (n = 127), in 71% of primary cases (n = 101), and in 50% of revision procedures (n = 26). There was a trend for a higher incidence of squamous cell carcinoma among the patients without detectable hyperostosis (P = .051). Location of hyperostosis coincided with the actual tumor attachment site in 114 patients (90%). Discordance between these parameters did not differ significantly (P = .463) between 11 primary and 2 revision cases. The overall rate of recurrence was 9.7% (n = 19), with a mean time to recurrence of 20 months (range, 7-96 months). The rate of recurrence did not correlate with any of the following: tumor stage, surgical approach, presence of squamous cell carcinoma, whether the surgery was primary or revision, and the presence or location of focal hyperostosis on computed tomography. Inverted papilloma recurred significantly more often (38.5%) when the intraoperative findings of the tumor attachment site did not match the location of hyperostosis observed on computed tomography (odds ratio, 6.5; 95% CI, 1.78-23.66). CONCLUSION: Detectability of focal hyperostosis on preoperative computed tomography does not affect the long-term outcome of inverted papilloma resection.