Multivariate analysis of clinical and radiological risk factors for revision endoscopic sinus surgery in patients with chronic rhinosinusitis with nasal polyps: can phenotype predict recurrence?

OBJECTIVE: This study aimed to analyse clinical and radiological features (phenotypes) to predict revision risk after functional endoscopic sinus surgery in patients with chronic rhinosinusitis with nasal polyps. METHOD: Phenotype characteristics of the patients with chronic rhinosinusitis with nasal polyps who underwent functional endoscopic sinus surgery were analysed retrospectively. RESULTS: The rates of asthma, aspirin sensitivity, smoking and a positive prick test result were significantly higher in revision functional endoscopic sinus surgery cases (p < 0.001, 0.001, < 0.001 and < 0.001, respectively). Multivariate analysis demonstrated that only gender, pre-operative nasal steroid use, pre-operative systemic steroid use, intra-operative systemic steroid use and smoking were significant risk factors for revision functional endoscopic sinus surgery (p = 0.034, 0.001, 0.010, 0.007 and 0.001, respectively). In addition, only eosinophilia and aspirin sensitivity were significant risk factors for multiple revision functional endoscopic sinus surgery procedures (p = 0.043 and 0.005, odds ratio = 2.4 and 5.2). CONCLUSION: Beyond the endotype of chronic rhinosinusitis with nasal polyps, defining clinical and radiological factors enables a valid prediction of patients at high risk of revision functional endoscopic sinus surgery.

Analysis of patient- and procedure-related risk factors for nasal septal perforations following septoplasty.

OBJECTIVES: To assess the possible relationship between various predictive factors (patient or surgery related) and the development of nasal septal perforations (NSP) with the help of a large study group. METHODS: One hundred and forty-three patients were included in the study. The presence of the following factors was evaluated and compared between the NSP and healthy group: types of surgeries, presence of unilateral or bilateral mucosal tears, concomitant inferior turbinate interventions, smoking, accompanying diabetes mellitus (DM) or allergic rhinitis (AR), types of nasal packings, duration of the surgery (minutes), and the experience of the surgeon (senior/junior). Nasal septal deviations were grouped into two: simple cartilage crests at the septum base and other-more complicated-deviations. RESULTS: NSP was detected in six (4.2%) patients after a mean follow-up of 9.3 ± 3.7 (min: 6 max: 14) months. None of these patients suffered from (AR) or DM. Four of these patients had unilateral and one patient had bilateral mucosal tears during the surgeries. None of the above-mentioned factors-including mucosal tears, type of the deviation or experience of the surgeon-had a significant effect on NSP. CONCLUSION: Untreated bilateral corresponding mucosal tears are the main cause of NSP. When immediately repaired, unilateral or bilateral tears do not affect the development of NSP significantly. Patient-related factors such as age, DM, smoking, AR, and procedure-related factors such as duration, the complexity of the septal deviation, type of the nasal packing, and experience of the surgeon also do not have a significant effect on NSP.

High PI3K/mTOR and low MAPK/JNK activity results in decreased apoptosis and autophagy in nasal polyposis.

INTRODUCTION: Nasal polyposis is a progressive inflammatory disease that reduces the quality of life. The role of apoptotic and autophagic pathways in nasal polyposis pathogenesis is not yet clearly known. OBJECTIVE: In this study we aimed to investigate apoptotic (MAPK/JNK), anti-apoptotic (PI3K/mTOR) and autophagic (LC3) pathways which are related each other in the nasal polyposis tissues. METHODS: Twenty patients with nasal polyps and fifteen patients going through an inferior turbinate reduction were included in this study. Patients with asthma, Samter triad and allergic fungal sinusitis were excluded from the study. The apoptotic and autophagic pathways were investigated in paraffin-embedded nasal tissue sections of 20 NP and 15 samples from inferior turbinate reduction by H&E and immunohistochemistry with h-score. TUNEL method with apoptotic index was used to demonstrate apoptotic cells. RESULTS: Decreased immunoreactivity of P38 MAPK (p < 0.005) and JNK (p < 0.005) were observed in nasal polyposis compared to material from inferior turbinate reduction. This decrease may indicate a downregulation of apoptosis as demonstrated by decreased TUNEL staining in nasal polyposis (p < 0.005). The PI3K (p < 0.002) and mTOR (p < 0.005) immunoreactivities were increased in nasal polyposis. This increase indicates a downregulation of autophagy as demonstrated by decreased LC3 staining in nasal polyposis (p < 0.001). CONCLUSION: Deficient apoptosis and autophagy through MAPK/JNK and PI3K/mTOR pathways may have a role in the pathogenesis of nasal polyposis.

Is topical fluorescein that effective in endoscopic CSF leak closure?

PURPOSE: Several diagnostic modalities are used to detect CSF leaks. Intraoperative use of intrathecal fluorescein can help to detect and localize a CSF leak simultaneously. However, it is not FDA approved, the application is invasive and has serious complications. Topical fluorescein is reported to be a safe and sensitive alternative to ITF. In this study, we aimed to evaluate the effectiveness of topical fluorescein in CSF leak closure. METHODS: This retrospective study includes 27 consecutive patients (19 women, 8 men) who underwent endoscopic endonasal CSF leak closure using topical fluorescein, between 2011 and 2017. RESULTS: In two patients, radiologic studies false positively locate the defect. ß2 transferrin and topical fluorescein tests were positive in these patients. Both cases needed a second operation. CONCLUSION: If radiologic studies fail to locate the defect properly, topical fluorescein only confirms the CSF leak, but the defect cannot be located anatomically intraoperatively.

Akt and estrogen receptor expression in nasal polyps.

BACKGROUND: Nasal polyps (NP) is a common chronic inflammatory disease of the mucous membranes in the nose and paranasal sinuses. The underlying mechanisms of pathologic conditions to NP formation remains unclear. The aim of this study is to evaluate the expression of Akt and estrogen receptor (ER) in nasal polyps. MATERIAL AND METHODS: We respectively obtained 20 nasal polyp tissue and 15 concha from patients undergoing endoscopic polyp biopsy and turbinate resection. All samples were fixed in 10% formalin for 24 h and embedding in paraffin was using routine protocol for histological prepation. Sections 5 µm thick were cut and stained H&E. Tissue samples were stained with anti-ER and anti-Akt primary antibody, ER and Akt were evaluated immunohistochemically. There is a relationship between the estrogen receptor and PI3K/Akt signaling pathway in malignansy. In this study, it showed the effect of estrogen on the activation of Akt signaling pathway in nasal polyps. Mann- Whitney-U test was applied to evaluate the statistical differences between nasal polyp and control group, (P < 0.05) was accepted as significant. RESULTS: In H&E stained sections we observed a lot of inflamatory cells and eosinophils in the mucosa, submucosal connective tissue and around the glandular epithelium in nasal polyps. The mucosa and submucosal connective tissue was seen normally in control group in H&E stained. We determined that ER and Akt were intensely expressed in nasal polyps. Expression is localized especially in epithelial and glandular epithelium cells and submucosal connective tissue. In contrast, expression of ER and Akt were mildly expressed in turbinate resection samples. CONCLUSION: The expression of ER and Akt might be important factors in nasal polyp pathogenesis and may shed new light on clinical approaches in nasal polyp treatment.

Infrahyoid Flap, a Convenient Alternative for Reconstruction of Tongue and Floor of Mouth Defects: Case Series.

OBJECTIVE: The aim of this study was to share our clinical experience with the neurovascular myofasiocutan infrahyoid flap (NMIHF), which was used for the reconstruction of the defects after oral cavity cancer surgery. METHODS: Records of five patients who were diagnosed with oral cavity cancer and underwent tumor resection, neck dissection, and defect reconstruction with NMIHF between 2012 and 2017 were analyzed retrospectively. RESULTS: The infrahyoid flap was used in five patients: four males and one female. The mean age of patients was 61.8 years. Four patients underwent tumor resection and bilateral level I-III neck dissection, whereas one patient underwent tumor resection and unilateral level I-III neck dissection. NMIHF was used for the reconstruction of the defects during the same procedure in all the patients. Mean post-operative follow-up was 30.6 months. Partial skin necrosis was observed in two patients, but none of the patients showed total necrosis of the flap. Postoperatively, oral intake was initiated after an average of 12 days in all patients. For two patients who required post-operative radiotherapy (RT), the treatment was started after an average of 50 days. CONCLUSION: NMIHF does not prolong operation time and does not cause additional scar in the neck, and the defect in the donor field can be closed without the use of a graft or flap. This is considered to be a reliable and successful alternative to free flaps for the reconstruction of oral cavity defects.

Clinical Factors Associated with the Diagnosis of Granulomatosis with Polyangiitis.

Objective To determine the predictive value of nasal endoscopic findings and symptoms in the diagnosis of granulomatosis with polyangiitis (GPA). Study Design A cross-sectional study. Setting A tertiary university hospital. Subjects and Methods A total of 116 adults were enrolled in the study: 19 patients with GPA, 29 patients with other rheumatic diseases, and 68 healthy volunteers. All patients were examined with a flexible endoscope, and nasal endoscopic images were recorded and evaluated blindly. The medical history of each patient was taken by a physician blinded to the patient's diagnosis. Results Univariate analysis indicated a statistically significant difference in rhinorrhea ( P = .002), postnasal drip ( P = .015), epistaxis ( P < .001), and saddle nose ( P = .017). However, binary logistic regression analysis demonstrated that only history of epistaxis ( P = .012; odds ratio, 5.6) was statistically significant in predicting GPA. Univariate analysis showed a statistically significant difference in nasal secretion ( P = .028), nasal septal perforation ( P < .017), nasal crusting ( P < .001), nasal adhesion ( P < .001), nasal granuloma ( P = .017), and hemorrhagic fragile nasal mucosa ( P < .001). A binary logistic regression analysis demonstrated that only hemorrhagic fragile nasal mucosa ( P < .001; odds ratio, 52.9) was a statistically significant predictor of GPA. Conclusions Given the results of this study, we believe that hemorrhagic fragile nasal mucosa and history of recurrent epistaxis may put patients at risk for GPA and should be investigated accordingly.

Management of thyroid gland invasion in laryngeal and hypopharyngeal squamous cell carcinoma.

The objective of this study was to determine the incidence of thyroid gland invasion in laryngeal and hypopharyngeal squamous cell carcinoma; and the association between clinicopathological parameters and thyroid gland invasion. Medical records of 75 patients with laryngeal and hypopharyngeal squamous cell carcinoma who underwent total laryngectomy with thyroidectomy were reviewed, retrospectively. Preoperative computed tomography scans, clinical and operative findings, and histopathological data of the specimens were evaluated. There were 73 male and two female patients with an age range of 41-88 years (mean 60.4 years). Hemithyroidectomy was performed in 62 (82.7 %) and total thyroidectomy was performed in 13 patients (17.3 %). Four patients had histopathologically proven thyroid gland invasion (5.3 %). In three patients, thyroid gland involvement was by means of direct invasion. Thyroid gland invasion was significantly correlated with thyroid cartilage invasion. Therefore, prophylactic thyroidectomy should not be a part of the treatment policy for these tumors.

Chicken or the egg: the dilemma of allergic rhinitis versus adenoid hypertrophy.

BACKGROUND: There is no consensus as to whether allergic rhinitis (AR) is a cause of adenoid hypertrophy (AH). This study evaluated the role of allergy in AH, and it explored the role of nasal endoscopy and the history of diagnosing AR in children empirically. MATERIALS AND METHODS: This study enrolled 155 children consecutively in Izmir Behcet Uz Children`s Hospital between January and September 2013. RESULTS: Of the patients, 101 (65.2%) had a positive skin prick test. Multiple allergen sensitivity was identified in 76 (75.2%) of these patients. The history items of itching and sneezing had predictive value for empirically diagnosing AR in children. Of the nasal examination findings, only the nasal secretion characteristics had significant predictive value. AH and AR had a significant negative correlation. CONCLUSION: In this study, AH and AR were inversely related. The characteristics of the nasal secretions, itching, sneezing, were predictors of AR in children.

A new method of identifying the posterior inferior nasal nerve: implications for posterior nasal neurectomy.

INTRODUCTION: Posterior nasal neurectomy is an effective way of treating recalcitrant rhinitis. The aim of this study is to describe the anatomic relationship between the posterior inferior nasal nerve (PINN) and the structures that might be important for posterior nasal neurectomy. MATERIALS AND METHODS: An anatomic study was conducted in a university hospital dissection laboratory with 15 formalin-fixed, sagittally cut adult cadaver heads. The distance between PINN and (1) nasal sill, (2) maxillary sinus ostium, (3) posterior fontanel, (4) torus tubarius, and (5) crista ethmoidalis was measured and the location of PINN with respect to the sphenopalatine artery was assessed to define the exact location of PINN. RESULTS: The mean distance between PINN and nasal sill (56.4 mm), maxillary sinus ostium (27 mm), posterior fontanel (12.5 mm), torus tubarius (13 mm), and crista ethmoidalis (8 mm) was determined. PINN was found consistently posterior to the sphenopalatine artery where the inferior turbinate attaches to the lateral nasal wall. CONCLUSION: Instead of finding PINN around the sphenopalatine foramen, PINN can be located more easily posterior to the sphenopalatine artery where the inferior turbinate attaches to the lateral nasal wall without cauterizing the sphenopalatine artery.

Results of decompression with middle cranial fossa approach or traumatic intratemporal fascial nerve injury.

OBJECTIVE: To present the results of the traumatic intratemporal facial nerve injury that have undergone facial nerve decompression by using middle cranial fossa (MCF) approach. STUDY DESIGN: A retrospective study SETTING: Tertiary referral center PATIENTS AND METHODS: In this study, 13 patients who developed facial paralysis due to temporal bone trauma and undergone decompression by using MCF approach in Department of Otorhinolaryngology of Izmir Katip Celebi University Research and Training Hospital between January 1993 and December 2012 were presented retrospectively. Patients were assessed in terms of side, etiology, fracture type, House-Brackmann (HB) grade, electroneuronography (ENOG), electromyography (EMG), hearing loss, operation time, and the region of the injury. RESULTS: The fracture was at the right side in 7 (53.8%) and at the left side in 6 patients (46.1%). The type of temporal bone fracture was longitudinal in 6 (46.1%), transverse in 2 (15.3%), and mixed in 5 patients (38.4%). Total axonal degeneration in EMG and ENOG were seen in all patients, who were HB grade 6 at preoperative assessment. Mean operation time was 30 days. The lesion in all patients was at the region of geniculate ganglion. There was conductive hearing loss in 7 patients (53.8%), sensorineural in 4 (30.7%), and mixed in 1 patient (7.6%); hearing was normal in 1 patient (7.6%). Seven patients (53.8%) improved to HB grade 2. CONCLUSION: In the light of the information obtained from HRCT, ENOG, and EMG, we believe that better results can be achieved with facial nerve decompression that is performed before 1 month, and geniculate ganglion region may be better controlled by MCF approach.

A rare complication of septoplasty: tension pneumocephalus without rhinorrhea.

This paper describes a tension pneumocephalus without cerebrospinal fluid leak, a rare complication of septoplasty. We present a case of tension pneumocephalus without cerebrospinal fluid leak 1 month after a septoplasty operation. Although endoscopic sinus surgery can be utilized for repair of the defect, intracranially displaced ethmoid bone fragment makes an open approach more feasible. His postoperative course was uneventful and postoperative CT scan revealed no signs of pneumocephalus. Absence of cerebrospinal fluid leak made this case unique in presentation and caused a delay in diagnosis. Severe headache after septoplasty should alert the surgeon to investigate possible intracranial complications.

Effects of Type 2 Diabetes on Otoacoustic Emissions and the Medial Olivocochlear Reflex.

OBJECTIVE: To demonstrate if cochleopathy in patients with type 2 diabetes with normal audiometric hearing threshold can be detected with otoacoustic emissions or medial olivocochlear (MOC) reflex measurements. STUDY DESIGN: Cross-sectional study. SETTING: Tertiary university teaching hospital. METHODS: The study involved 40 type 2 diabetic patients and 24 healthy volunteers. All participants who showed normal otoscopic findings, hearing thresholds, and acoustic admittance were included. Cochlear activity of participants was evaluated by means of distortion product otoacoustic emissions (DPOAEs) and transient otoacoustic emissions (TOAEs). The MOC reflex was evoked with contralateral acoustic stimulation and recorded with DPOAEs and TOAEs. RESULT: A comparison of DPOAE and TOAE levels with a t test between patient and control groups revealed no significant difference (P > .05). A comparison of the MOC reflex response between the 2 groups also revealed no statistically significant difference (P > .05). CONCLUSION: Although decreased OAE amplitude levels were found in diabetic patients, there was no statistically significant difference in OAEs and MOC reflex. Additional studies are needed to evaluate the role of OAEs and MOC reflex in normal-hearing patients with diabetes.

The return of the jedi: comparison of the outcomes of endolaser dacryocystorhinostomy and endonasal dacryocystorhinostomy.

BACKGROUND: External dacryocystorhinostomy (DCR) is considered to be the gold standard treatment of primary acquired nasolacrimal duct obstruction. A better understanding of the endoscopic anatomy of the lacrimal sac has increased the success rate of endonasal DCR. Laser DCR has become popular in recent years and has a success rate comparable with those of other endonasal techniques. The aim of this study was to compare the surgical results of endonasal DCR (EDCR) and endonasal laser DCR (ELDCR). METHODS: Fifty-four patients treated with ELDCR and 42 patients treated with EDCR for nasolacrimal duct obstruction from 2009 to 2012 with at least 1.5 years of follow-up were retrospectively enrolled in this comparative study. Lack of patient complaints and irrigation testing were used as subjective and objective assessment tools, respectively. RESULTS: Both groups were similar in terms of age and sex. ELDCR had a success rate of 85.2%, and EDCR had a success rate of 92.9%. The difference between the 2 procedures was not statistically significant. ELDCR had a significantly shorter operative time than did EDCR (16.9 vs 24.4 minutes, respectively; p < 0.001). CONCLUSION: Endonasal procedures have the advantage of no scar formation and do not disturb the pumping mechanism of the lacrimal sac. Their success rates are comparable with those of external DCR. Surgery is quicker, and with use of a laser, even less time is spent in the operating room. In selected cases, ELDCR can be a good alternative method with a high success rate.

Beyond Rieger's original indication; the dorsal nasal flap revisited.

INTRODUCTION: Few reconstructive options are available for nasal defects measuring >2 cm. Staged procedures are often utilized for nasal defect reconstruction, but they are not feasible in some patients. METHODS: Out of 92 patients operated upon for nasal skin lesions between 2009 and 2011, patients who received reconstructive surgery with a dorsal nasal flap, nasal skin lesions located in lower half of nose (≤5 mm from the alar rim), defect diameter ≥3 cm were included in this study. RESULTS: Patients with nasal lesions larger than 3 cm who refused a staged procedure and were prone to compromised follow up underwent dorsal nasal flap reconstruction. Clear margins were obtained and no flap loss occurred. Minor complications occurred, such as flap dehiscence. CONCLUSION: The dorsal nasal flap can be effectively utilized for selected lesions as a surrogate for staged procedures that use various local flaps, such as the paramedian flap.

Factors confusing the diagnosis of laryngopharyngeal reflux: the role of allergic rhinitis and inter-rater variability of laryngeal findings.

The objective of the study was to determine the inter-rater variability in assessment of laryngeal findings and whether diagnosing laryngopharyngeal reflux based on the laryngeal findings and history alone without considering allergic rhinitis leads to the overdiagnosis and overtreatment of laryngopharyngeal reflux. Patients with positive and negative skin prick tests were recruited from an allergy clinic in a tertiary teaching university hospital. All subjects completed the Reflux Symptom Index (RSI) and underwent laryngeal examinations by three physicians blinded to the skin prick test results and the Reflux Finding Score (RFS) was determined. RFS >7 or RSI >13 was considered reflux positive. Fleiss' kappa (κ) was used to measure inter-rater agreement. The inter-rater agreement was low for pseudosulcus vocalis (κ = 0.078), ventricular obliteration (κ = 0.206), diffuse laryngeal edema (κ = 0.204), and posterior laryngeal hypertrophy (κ = 0.27), intermediate for laryngeal erythema/hyperemia (κ = 0.42) and vocal fold edema (κ = 0.42), and high for thick endolaryngeal mucus (κ = 0.61). Although the frequency of allergy was high, there was no significant difference between allergy-positive and laryngopharyngeal reflux-positive patients. On logistic regression analysis, thick endolaryngeal mucus was a significant predictor of allergy (p = 0.012, odds ratio 0.264, 95 % confidence interval 0.093-0.74). The laryngeal examination for reflux is subject to marked inter-rater variability and allergic laryngitis was not misdiagnosed as laryngopharyngeal reflux. The presence of thick endolaryngeal mucus should alert physicians to the possibility of allergic rhinitis/laryngitis.

Searching for the cheese: does ethmoid pneumatization affect the location of the anterior ethmoid artery?

Endoscopic sinus surgery is a widely used technique in otolaryngologic practice. To avoid complications, the locations of important anatomical structures, such as the anterior ethmoid artery (AEA), should be determined preoperatively. We want to evaluate the effect of ethmoid cavity pneumatization on the location of the AEA and to determine consistent landmark(s) for locating the AEA. 524 consecutive patients undergoing sinus CT scans between February and October 2012 were reviewed retrospectively. After the exclusion criteria were applied, 150 CT scans (300 sides) were selected for the study. A statistically significant positive correlation was found between ethmoid pneumatization and the distance of the AEA to the attachment of the inferior turbinate to the lateral nasal wall (Spearman's rho = 0.305; p < 0.001). Likewise, a statistically significant positive correlation was found between ethmoid pneumatization and the distance between the AEA and the frontonasal junction (Spearman's rho = 0.219; p < 0.001). We found that the artery was located mostly between the second and third lamellae [n 211 (71 %) cases]. There was no statistically significant correlation between ethmoid pneumatization and AEA location in terms of the lamellae. Increased ethmoid volume increases the distance of the AEA from the frontonasal junction and the lateral attachment of the inferior turbinate. However, increased pneumatization of the ethmoid cavity did not affect AEA localization in terms of the lamellae. Based on our findings, we suggest that using the lamellae to locate the AEA is reliable.

Postintubation laryngotracheal stenosis: assessing the success of surgery.

OBJECTIVE: This study evaluated the outcome in adult patients with laryngotracheal stenosis (LTS) and assessed the effect of procedures on their quality-of-life scores. METHODS: The study included 15 adult patients with LTS (11 males [73.3%], 4 females [26.7%]; mean age, 32 years [range, 10-52 years]) treated at the Department of Otolaryngology Head and Surgery Clinic, Izmir Atatürk Research Hospital, Turkey, from 1997 to 2008. Success of the surgery is evaluated by decanullation rate, Short form-36 (SF-36), and the Medical Research Council dyspnea scale. RESULTS: The etiology of the LTS was intubation related in 14 cases (93.3%) and idiopathic in 1 case. According to the Myers-Cotton classification, 2 (13%), 8 (54%), and 5 (33%) patients were at stages 2 to 4, respectively. Fourteen patients had a mean follow-up of 57 months (range, 24-256 months). The stenotic segment involved 1 to 3 cm (mean, 1.7 cm) of trachea, and 2 to 5 tracheal rings (mean, 3.1) were resected. Postoperative decannulation was achieved in 13 patients (86.6%). In the short form-36 questionnaire, all of the parameters except for "role-emotional" were found to be significant (P < 0.01). The Medical Research Council dyspnea scale assessment revealed a significant (P < 0.001) decrease postoperatively. CONCLUSIONS: Segmental resection with primary anastomosis is an effective method and can be used as the first option in selected cases of advanced stenosis.

[Our endoscopic transcanalicular multidiode laser dacryocystorhinostomy results through bicanalicular silicone tube intubation]. / Bikanaliküler silikon tüp entübasyonu ile endoskopik transkanaliküler multidiod lazer dakriyosistorinostomi sonuçlarimiz.

OBJECTIVES: This study aims to evaluate the results of transcanalicular multidiode laser dacryocystorhinostomy (TMDL-DCR) through bicanalicular silicone tube intubation (BSTI). PATIENTS AND METHODS: Between September 2011 and March 2012, treatment-naïve 43 eyes of 43 patients (24 males, 19 females; mean age 53.6±4.1 years; range 37 to 69 years) who presented with the complaint of watery eyes with a nasolacrimal duct obstruction and underwent TMDL-DCR through endoscopic silicone tube were included. Patients were assessed postoperatively. During follow-up, changes from baseline in signs and symptoms and the duration of intubation were recorded. RESULTS: The mean age of the patients was 53.6 years (range, 37 to 69 years). The mean follow-up was 19.4±2.2 months (range, 18 to 23 months). The mean duration of surgery was 16.5 min (range, 11 to 32 min). Epiphora was seen in seven patients following surgery. Nasolacrimal duct was open in 36 patients. The success rate was 83.7%. CONCLUSION: Transcanalicular multidiode laser DCR through BSTE is an effective and safe method in the management of nasolacrimal stenosis.

Computed tomography findings of an unusual maxillary sinus mass: brown tumor due to tertiary hyperparathyroidism.

Brown tumor is a non-neoplastic bone lesion that develops secondary to hyperparathyroidism and it is very rare in the maxillofacial region. We report the case of a 59-year-old man who presented with pain and a swelling in the left cheek. Computed tomography (CT) demonstrated an expansile and radioluscent lesion in the left maxillary sinus. Incisional biopsy was performed, and the diagnosis was Brown tumor. Brown tumor must be considered in the differential diagnosis of expansile lesions of maxillary sinus.