RESUMO
Progress in skull-base endoscopic surgery has improved our knowledge of olfactory cleft (OC) anatomy. This article presents a review of current knowledge concerning the OC roof: descriptive anatomy, radiological exploration, and endoscopic observation. The OC is a narrow area in the most superior part of the nasal cavity. Its roof is the thinnest structure separating the nasal cavities from the brain; it comprises three superimposed tissues: nasal mucosa, ethmoid cribriform plate (ECP), and dura mater. The ECP comprises the anterior ECP containing the ethmoidal slit (ES) medially and the cribroethmoidal foramen (CEF) laterally; and the posterior ECP, comprising the olfactory foramina. The OC roof is bordered anteriorly by the nasal bone roof, laterally by the lateral ethmoid masses, and posteriorly by the jugum and anterior wall of the sphenoid sinuses. Imaging is crucial for analyzing this wall, providing precise detailed information on conformation and anatomic relations with adjacent structures such as the anterior ethmoidal artery. Understanding OC roof anatomy and correct interpretation of imaging are essential for safety in present-day functional endoscopic sinus surgery and anterior skull-base oncologic surgery.
Assuntos
Osso Etmoide , Cavidade Nasal , Humanos , Osso Etmoide/diagnóstico por imagem , Osso Etmoide/cirurgia , Osso Etmoide/anatomia & histologia , Cavidade Nasal/diagnóstico por imagem , Cavidade Nasal/cirurgia , Endoscopia/métodos , Seio Esfenoidal , Procedimentos Neurocirúrgicos/métodos , Base do Crânio/diagnóstico por imagem , Base do Crânio/cirurgiaRESUMO
Diagnosis in rhinology is currently based on the concept of inflammation (chronic rhinosinusitis [CRS]) or the clinical concept of chronic nasal dysfunction (CND). The complementarity between these two approaches can be discussed by a critical review of the literature structured by the analysis of the fundamental and diagnostic bases and the therapeutic implications linked to each. The concept of CRS is based on the anatomical continuity of the nasal and sinus respiratory mucosa and molecular biology data, seeking to analyze the mechanisms of chronic inflammation and to identify proteins and biomarkers involved in the different supposed endotypes of chronic inflammation of this mucosa. The concept of CND seeks to analyze medical, instrumental or surgical diagnostic and therapeutic strategies, taking account of both inflammatory and non-inflammatory causes impacting the anatomy or physiology of each of the three noses (olfactory, respiratory and sinus) that make up the mid-face sinonasal organ of evolution-development (Evo-Devo) theory. Thus, the concept of CRS offers an endotypic approach, based on biological characterization of mucosal inflammation, while the concept of CND offers a compartmentalized phenotypic and pathophysiological approach to sinonasal diseases. The joint contribution of these two concepts in characterizing nasal functional pathology could in future improve the medical service provided to patients.
Assuntos
Pólipos Nasais , Rinite , Sinusite , Humanos , Rinite/diagnóstico , Rinite/terapia , Pólipos Nasais/diagnóstico , Inflamação , Sinusite/diagnóstico , Sinusite/terapia , Nariz , Doença CrônicaRESUMO
PURPOSE: Endoscopic endonasal surgery (EES) is becoming a standard for most malignant sinonasal tumours. Margin analysis after piecemeal resection is complex and optimally relies on accurate histosurgical mapping. Postoperative radiotherapy may be adapted based on margin assessment mapping to reduce the dose to some sinonasal subvolumes. We assessed the use of histosurgical mapping by radiation oncologists (RO). MATERIAL AND METHODS: A French practice survey was performed across 29 ENT expert RO (2 did not answer) regarding integration of information on EES, as well as quality of operative and pathology reportsto refine radiotherapy planning after EES. This was assessed through an electronic questionnaire. RESULTS: EES was ubiquitously performed in France. Operative and pathology reports yielded accurate description of EES samples according to 66.7% of interviewed RO. Accuracy of margin assessment was however insufficient according to more than 40.0% of RO. Additional margins/biopsies of the operative bed were available in 55.2% (16/29) of the centres. In the absence of additional margins, quality of resection after EES was considered as microscopically incomplete in 48.3% or dubious in 48.3% of RO. As performed, histosurgical mapping allowed radiotherapy dose and volumes adaptation according to 26.3% of RO only. CONCLUSIONS: Standardized histosurgical mapping with margin and additional margin analysis could be more systematic. Advantages of accurate EES reporting could be dose painting radiotherapy to further decrease morbidity in sinonasal tumours.
Assuntos
Endoscopia , Neoplasias dos Seios Paranasais , França , Humanos , Neoplasias dos Seios Paranasais/diagnóstico por imagem , Neoplasias dos Seios Paranasais/radioterapia , Neoplasias dos Seios Paranasais/cirurgia , Inquéritos e QuestionáriosRESUMO
The endoscope and microscope can be used conjointly in certain sites, such as middle ear cholesteatoma or for resection of cerebellopontine angle tumours. Petrous apex tumours are classically accessed via a lateral otological approach, or, for the most anterior tumours, via an endonasal endoscopic approach. Surgical access via a lateral incision is limited inferiorly by the superior bulb of the internal jugular vein, medially by the labyrinth, facial nerve and internal auditory canal, superiorly by the dura mater, and laterally by the internal carotid artery. Via an anterior endonasal approach, the corridor formed by the internal carotid artery and the paraclival dura limits access to the posterior part of the petrous apex, restricting this approach to certain cholesterol granulomas or small cholesteatomas. None of these approaches, on its own, is sufficient in the case of an extensive petrous apex lesion. The objective of this technical note is to describe the combined microscopic/endoscopic approach comprising sequential use of the microscope and the endoscope via a lateral approach for the management of large petrous apex lesions.
Assuntos
Endoscopia/métodos , Microcirurgia/métodos , Osso Petroso/cirurgia , HumanosRESUMO
Frontal sinus cerebrospinal fluid leaks are rare and their surgical management is difficult. Up until recently, they could only be treated by open surgery with an osteoplastic flap. With the development of endoscopic surgery, less invasive techniques such as an exclusive endoscopic approach can now be used, ensuring a simpler postoperative course. However, these techniques require a thorough knowledge of frontal sinus anatomy and endoscopic CSF leak repair. This knowledge is essential both to ensure closure of the CSF leak and to preserve frontal sinus patency.
Assuntos
Vazamento de Líquido Cefalorraquidiano/cirurgia , Endoscopia , Seio Frontal , Endoscopia/métodos , Humanos , Seleção de PacientesAssuntos
Achados Incidentais , Nervo Laríngeo Recorrente/anormalidades , Feminino , Humanos , Imageamento Tridimensional , Pessoa de Meia-Idade , Radiografia , Nervo Laríngeo Recorrente/diagnóstico por imagem , Artéria Subclávia/anormalidades , Artéria Subclávia/diagnóstico por imagem , Nódulo da Glândula Tireoide/cirurgia , TireoidectomiaRESUMO
The stapedial artery is an embryonic artery which disappears during the tenth week in utero, in human species. During its short life, this artery shapes the stapes and transforms the middle meningeal artery from the internal carotid artery to a branch of the external carotid system. Nevertheless, a persistent stapedial artery is seen in 0.2-4.8 per thousand of human adults. This persistence is usually asymptomatic but can sometimes cause pulsatile tinnitus or conductive hearing loss. Despite the risk of facial palsy, hearing loss and even hemiplegia argued by several authors, some surgeons have succeeded in coagulation without side effects. Reviewing the literature, we seek to enlighten the actual knowledge about the persistent stapedial artery to evaluate the risk to coagulate it. Embryologic studies explain the four types of persistent stapedial arteries: the hyoido-stapedial artery, the pharyngo-stapedial artery, the pharyngo-hyo-stapedial artery and aberrant internal carotid with persistent stapedial artery. Phylogenetic studies show that the stapedial artery persists in adulthood in many vertebrates. Its disappearance is therefore either a random effect or an adaptative convergence. This adaptation could be partially linked to the negative allometry of the stapes. Practically, the risk to coagulate a stapedial artery seems limited thanks to anastomoses, for example with the stylomastoid artery. The risk of hemiplegia reported is in fact an extrapolation of variation in rats' embryos. A persistent stapedial artery can therefore reasonably be coagulated, with special attention to the facial nerve, because the facial canal is always dehiscent where the artery penetrates.
Assuntos
Perda Auditiva Unilateral/diagnóstico , Artéria Maxilar/anormalidades , Artérias Meníngeas/anormalidades , Estribo/irrigação sanguínea , Malformações Vasculares/diagnóstico por imagem , Adulto , Feminino , Humanos , Incidência , Angiografia por Ressonância Magnética/métodos , Masculino , Artéria Maxilar/diagnóstico por imagem , Artéria Maxilar/embriologia , Artérias Meníngeas/diagnóstico por imagem , Artérias Meníngeas/embriologia , Otoscopia/métodos , Filogenia , Medição de Risco , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Malformações Vasculares/epidemiologia , Malformações Vasculares/cirurgia , Procedimentos Cirúrgicos Vasculares/métodosRESUMO
Paraganglioma are uncommon neuroendocrine tumours arising from extra-adrenal chromaffin cells of the autonomic nervous system. In the head and neck region, these neoplasms most commonly arise from the carotid body, the vagus nerve, and the jugulotympanic area. We present the case of a 69-year-old woman who suffered from dyspnoea and dysphonia for six months. A biopsy diagnosed a laryngeal haemangioma and a resection of the tumour was performed using supraglottic pharyngolaryngectomy. Definitive histopathological examination revealed a laryngeal paraganglioma. Laryngeal paraganglioma and haemangioma must be evoked when confronted with a submucosal vascular laryngeal tumour. In such cases biopsies should be avoided. Exhaustive imaging is a key factor in the diagnosis and should include an MRI and an arteriography in order to rule out other differential diagnoses. To our knowledge this is the first case focusing on this issue.
Assuntos
Hemangioma/diagnóstico , Doenças da Laringe/diagnóstico , Neoplasias Laríngeas/diagnóstico , Paraganglioma/diagnóstico , Idoso , Angiografia , Biópsia , Diagnóstico Diferencial , Disfonia/etiologia , Dispneia/etiologia , Feminino , Humanos , Neoplasias Laríngeas/cirurgia , Laringectomia , Laringoscopia , Laringe/patologia , Imageamento por Ressonância Magnética , Paraganglioma/cirurgia , Sensibilidade e EspecificidadeAssuntos
Branquioma/diagnóstico , Neoplasias de Cabeça e Pescoço/diagnóstico , Abscesso Retrofaríngeo/diagnóstico , Índice de Apgar , Região Branquial , Branquioma/congênito , Branquioma/cirurgia , Cesárea , Diagnóstico Diferencial , Feminino , Seguimentos , Neoplasias de Cabeça e Pescoço/congênito , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Recém-Nascido , Imageamento por Ressonância Magnética/métodos , Abscesso Retrofaríngeo/cirurgia , Medição de Risco , Resultado do TratamentoRESUMO
INTRODUCTION: Isolated hypoglossal nerve palsy is rare, and etiological diagnosis is difficult. We report a case of isolated hypoglossal compression by a cervical osteophyte in the hypoglossal canal exit. CASE STUDY: An 86-year-old woman with history of cervical spondylotic myelopathy consulted for a lesion of the free edge of the tongue with impaired elocution. Clinical examination found a bite lesion on the right free edge of the tongue with right lingual amyotrophy and associated left deviation on retraction. Isolated right hypoglossal palsy was diagnosed. Skull base CT found a cervical osteophyte compressing the hypoglossal nerve at the exit from the right hypoglossal canal. Surgery was contra-indicated by the patient's general health status. No motor recovery was observed at 6 months' follow-up, but the elocution disorders regressed under speech therapy. CONCLUSION: Hypoglossal palsy is infrequent, but generally a sign of skull base pathology. History-taking and careful examination guide rational selection of the radiological examinations required for etiological diagnosis.
Assuntos
Vértebras Cervicais , Doenças do Nervo Hipoglosso/etiologia , Osteófito/complicações , Doenças da Coluna Vertebral/complicações , Idoso de 80 Anos ou mais , Feminino , HumanosRESUMO
Benthic macroinvertebrates of the Palo Verde wetland, Costa Rica. Palo Verde, Costa Rica, is one of the most important wetlands in the region now recovering from some invasive plants, especially Typha domingensis, and monitoring programs were started, including studies on the aquatic macoinvertebrate fauna. We sampled benthic macroinvertebrates monthly for more than a year with artificial substrates, and identified 116 taxa from 57 families and 18 orders, with 90 morfospecies of insects. The highest abundances were in the class Conchostraca (typical in seasonal wetlands) and in the family Chironomidae (Diptera, Insecta), which together represent almost half of all individuals collected. In contrast, 97 taxa were less than 1% of total abundance each. Number of individuals and number of species were higher at lower water levels (dry season). Cumulative species curves indicate that more species would be found if sampling had continued for more time. Rev. Biol. Trop. 57 (Suppl. 1): 275-284. Epub 2009 November 30.
El humedal de Palo Verde es uno de los más importantes de Centro America para aves acuáticas. Durante el período 2002 y 2005, se llevaron a cabo actividades de manejo para controlar la invasión de Typha domingensis. Con el fin de establecer una línea base para monitoreos futuros, en el 2003 se realizó una evaluación de macroinvertebrados acuáticos. Se efectuó un muestreo mensual durante un año, usando el método de sustratos artificiales. Se identificaron 116 táxones pertenecientes a 47 familias y a 18 órdenes. La mayor abundancia se encontró en la clase Conchostraca y la familia Chironomidae que juntas representaron casi la mitad de todos los individuos colectados. En contraste, el 97% de los táxones tuvieron, cada uno, menos del 1% del total de la abundancia. La diversidad de táxones, así como la abundancia de individuos y el número de especies, fueron mayores en la época seca que en la lluviosa. La curva acumulada de especies indicó que se hubiera registrado una mayor cantidad de táxones si los muestreos se hubieran extendido por más tiempo. Con este trabajo damos a conocer la primera lista de macroinvertebrados para el humedal de Palo Verde.