Diagnosis and management of orbital and cranial complications of pediatric acute rhinosinusitis / 中华耳鼻咽喉头颈外科杂志

Objective: To review the clinical characteristics, to illustrate diagnosis and management experience of orbital and cranial complications of pediatric acute rhinosinusitis. Methods: The clinical data of 24 children with orbital and cranial complications of acute rhinosinusitis who received endoscopic sinus surgery combined with drug treatment in Beijing Children's Hospital from January 2017 to December 2021 were retrospectively reviewed. There were 19 boys and 5 girls. The age varied from 13 to 159 months, with a median 47.5 months. The following diagnoses were obtained: 12 isolated subperiosteal orbital abscess, 2 associated with preseptal abscess, 2 associated with intraorbital abscess, 7 associated with optic neuritis, and 1 associated with septic cavernous sinus thrombosis. Clinical characteristics, organism isolated and outcomes were analyzed through descriptive methods. Results: All 24 patients presented with fever; 9 presented with nasal congestion and purulent discharge. The clinical manifestations of orbital infection included orbital edema, pain, proptosis and displacement of globe in all patients, while visual impairment was recognized in 7 children. Purulent drainage was cultured in 17 patients, among which 12 were positive. All patients underwent nasal endoscopic surgical interventions uneventfully, excluding one patient who required a second surgical procedure. Follow-up period ranged from 5 to 64 months. All patients resolved fully, with the exception of 2 children who got permanent blindness with visual loss preoperative. There was no recurrence or death. Conclusions: Orbital and cranial complications of pediatric acute rhinosinusitis could be severe with an occult onset. For patients with vison impairment, any signs of intracranial complications and a lack of response to conservative management, an urgent endoscopic intervention is needed.

Nasal endoscopic modified mucosal flap technique for repair of congenital choanal atresia in newborns and infants / 中华耳鼻咽喉头颈外科杂志

Objective: To describe and evaluate the surgical effect and prognosis of nasal endoscopic modified mucosal flap technique for repair of congenital choanal atresia in newborns and infants. Methods: The clinical data of 38 newborns and infants with congenital choanal atresia who underwent nasal endoscopic surgery in Beijing Children's Hospital between January 2016 and May 2018 were retrospectively analysed, including 13 males and 25 females. The age ranged from 5 days to 3 years old at the time of operation (15 cases were newborns). The clinical data, imaging data, treatment effect and prognosis were collected. According to the different surgical methods, the patients were divided into the conventional operation group and the modified mucosal flap technique group. The designs of the modified mucosal flap technique were designed according to the type of congenital choanal atresia. The cross-over L-shaped flaps were performed in patients with unilateral atresia, and the mirrored L-shaped flaps were performed in patients with bilateral atresia. All the patients were followed up for 2-3 years, and the follow-up parameters included the times of operations, length of hospital stay, restenosis rate and incidence of complications. Study data was analyzed using SAS version 9.4 statistical software. Results: Sixteen cases underwent conventional operation while 22 patients underwent modified mucosal flap technique under nasal endoscope. The lightest weight (2 200 g) and the youngest age (5 days) of the patients came from the modified mucosal flap technique group. Compared with the conventional operation group under nasal endoscope, the modified mucosal flap technique group had fewer times of operations (1.14±0.47 vs 2.69±1.20, t=5.552, P<0.001), shorter hospital stay ((7.70±3.22) d vs (14.37±19.16) d, t=2.960, P=0.005), lower rate of postoperative restenosis (9.1% vs 43.8%, χ²=6.156, P=0.013), and lower rate of the incidence of complications (13.6% vs 43.8%, χ²=5.955, P=0.015), the differences were statistically significant. Conclusion: The nasal endoscopic modified mucosal flap technique is feasible for repairing congenital choanal atresia in newborns and infants, which can significantly reduce the incidence of postoperative restenosis and complications.

Pediatric nasal neuroglial heterotopia: report of 13 cases / 中华耳鼻咽喉头颈外科杂志

Objective: To summarize clinical features and our experience of the diagnosis and treatment of pediatric nasal neuroglial heterotopia (NGH). Methods: Clinical data of 13 nasal NGH patients in Beijing Children's Hospital from August 2014 to October 2019 were retrospectively reviewed, including 9 boys and 4 girls, aged from 1 to 38 months with median age of 5 months. Radiological workups and excision of nasal NGH under general anesthesia were performed for all patients. B ultra-sound and MRI were performed for all external and mixed lesions, while ultra-low-dose CT scan and MRI for all intranasal type. Surgical approaches were dependent on location and extent of the lesions according to radiographic workup, including extranasal or transnasal endoscopic approach. Patients were followed up regularly after operation to evaluate the effect. Initial presentation, locations, imaging findings, surgical approaches and follow-up results were analyzed through descriptive statistical method. Results: Eight nasal NGH patients presented with an internal nasal mass and nasal obstruction, which belonged to intranasal type. Three patients presented with an external nasal mass which belonged to extranasal type and 2 patients had mixed lesions. The sites included nasal dorsum (n=5), anterior to the middle turbinate (n=5) and olfactory cleft (n=3). Surgical resections were done through median rhinotomy approach (n=5) or transnasal endoscopic approach (n=8). All the operations were successful and no complication occurred. All cases were followed up from 3 to 65 months. No recurrence was encountered. Conclusions: Nasal NGH is a rare lesion with atypical clinical presentation. Preoperative imaging including CT scan and MRI is essential for evaluation of the location, extent of the disease and for making the surgical plan. Treatment requires complete surgical excision.

Endoscopic management of the inverted papilloma involving frontal sinus and its drainage pathway / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>The endoscopic management of inverted papilloma has gained increasing popularity over the last 15 years. However, the appropriate management of lesions involving the frontal sinus and its drainage pathway still has to be determined.</p><p><b>METHODS</b>We performed a retrospective review of the results of the patients with inverted papilloma in the Otolaryngology Head and Neck Surgery department, Beijing Tongren Hospital from 2004 to 2007 to identify the patients with lesions involving frontal sinus and its drainage pathway. By its appearance on nasal endoscopic examination and CT scanning, the tumors were defined using Krouse staging system. Sinus endoscopy was used to screen for disease after endoscopic resection. And their clinical outcomes were analyzed.</p><p><b>RESULTS</b>A total of nine patients (8 males and one female) with inverted papilloma who had frontal sinus and its drainage pathway involvement were identified. All tumors were defined as T3 lesions. Preoperative and postoperative pathologic examinations revealed inverted papilloma as the diagnosis. Four cases with lateral wall of frontal recess attachment underwent endoscopic Draf II A frontal sinusotomy. Three cases with either lateral and posterior walls of frontal recess and frontal infundibulum attachment or medial and posterior walls of frontal recess and frontal infundibulum attachment underwent Draf II B procedure. Two cases with either posterior wall of frontal recess and frontal infundibulum attachment or medial, lateral and posterior walls of frontal recess and frontal infundibulum attachment underwent Draf III procedure. All patients remain disease free with an average follow-up of 13 months.</p><p><b>CONCLUSIONS</b>Extensive inverted papilloma (Krouse T3 lesions) can be treated successfully with an endoscopic approach.</p>

Spiral computed tomography analysis of fronto-ethmoidal cells in normal subjects / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>The purpose of this study was to determine the prevalence of frontoethmoidal cells in normal Chinese subjects.</p><p><b>METHODS</b>Two hundred and two Chinese subjects without symptoms of frontal sinus disease were undergone spiral computed tomography (CT). The multiplanar reconstruction images were evaluated using a standard triplanar reconstruction protocol on a computer workstation.</p><p><b>RESULTS</b>There were 121 males and 81 females. The mean age was (39.4 +/- 13.5) years. Of all the frontal cells identified in 159 sides (39.4%) of frontal recesses, the prevalence of type I, type II, type III and type cells were 24.3% (98 sides), 6.9% (28 sides), 8.2% (33 sides) and 0% (0 side) respectively. Suprabulbar cell, supraorbital ethmoid cells, and frontal bulbar cell were identified in 148 sides (36.6%) Jian-hu, 22 sides (5.4%), and 36 sides (8.9%) respectively. While the interfrontal septal cells was found in 25 patients (12.4%). The prevalence of agger nasi cell was 94. 1% (380 sides). Two hundred and forty-four uncinate processes (60.4%) had one superior attachment for each uncinate process; the other 160 uncinate processes (39.6%) had two superior attachments for each uncinate process. The single superior attachment of the uncinate process into the surrounding structures was identified to have the following distribution: 53.0% (n=214) to the lamina papyracea, 5.2% (n=21) to the middle turbinate, 2.2% (n=9) to the skull base. Most of the uncinate process' two superior attachments were either into the lamina papyracea and the skull base (27.5%, n=111) or into the lamina papyracea and the middle turbinate (8.7%, n=35). The other 14 uncinate processes (3.5%) superiorly attached to the skull base and the middle turbinate. The prevalence of recessus terminalis was 89.1% (n=360).</p><p><b>CONCLUSION</b>The result demonstrated the normal frontal recess pneumatization patterns in normal Chinese.</p>

CT evolution of nasal steroid management of chronic rhinosinusitis / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy of topical steroid treatment of nonpolypoid chronic sinusitis.</p><p><b>METHODS</b>Two cohorts of adult and children with nonpolypoid chronic sinusitis were investigated. The first cohort consisted of 11 pediatric patients [mean age, (11.8 +/- 3.2) years] with a mean Lund score of 10.3 +/- 5.7 (x +/- s). The second cohort consisted of 13 adult patients [mean age, (36.7 +/- 11.0) years] with a mean Lund score of 12.2 +/- 5.7. The mean duration of the nasal budesonide (Rhinocort) treatment was (7.5 +/- 3.2) weeks for adult patients (256 microg/d) and (7.0 +/- 3.4) weeks for pediatric patients (128 microg/d). Each Lund score and the patient's assessment of nasal symptoms were evaluated after treatment.</p><p><b>RESULTS</b>The average Lund score was significantly decreased to 6.5 -/+ 7.5 (t = 3.82, P < 0.01) in adult patients and to 2.6 +/- 3.7 (t = 5.08, P < 0.01) in pediatric patients after treatment. Thirty-eight percent of the adult patients and 73% of the pediatric patients were cured on CT images. The patient's self-assessment of efficacy was positively correlated with pretreatment Lund score in adult patients (r = 0.676, P < 0.05), but not so in pediatric patients.</p><p><b>CONCLUSIONS</b>These findings demonstrate that most of patients with nonpolypoid chronic sinus did well with topical steroid treatment. Therefore, surgery was required in few patients.</p>

Computed tomographic and endoscopic analysis of the supraorbital ethmoid cell anatomy / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To understand the anatomy of the supraorbital ethmoid cell and its relationship with the frontal sinus drainage pathway.</p><p><b>METHODS</b>Five patients (5 sides) who had supraorbital ethmoid cell underwent endoscopic frontal sinus surgery. Computed tomographic (CT) scans of the sinuses were obtained in coronal and axial views. The frontal sinus ostium and the supraorbital ethmoid cell were endoscopically identified respectively.</p><p><b>RESULTS</b>On coronal CT scans, the supraorbital ethmoid cell was a separate cell lateral to the frontal sinus. And on axial CT scans, it was lateral and posterior to the frontal sinus drainage pathway. Under endoscope, its opening was lateral and posterior to the frontal sinus ostium.</p><p><b>CONCLUSIONS</b>The supraorbital ethmoid cell extended superolateral the boundaries of the lamina papyracea and the roof of the ethmoid to pneumatize the orbital plate of the frontal bone.</p>

Spiral computed tomographic analysis of frontal recess regions / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>The purpose of the study was to determine the prevalence of frontal recess cells in Chinese patients who did not have frontal sinus disease related symptoms.</p><p><b>METHODS</b>Forty-nine Chinese patients without frontal sinus disease symptoms were undergone spiral computed tomography (CT). Then multiplanar reconstruction images were evaluated using a standard triplanar reconstruction protocol on a computer workstation.</p><p><b>RESULTS</b>The prevalence of agge rnasi cell was 94% (92/98). Sixty-four uncinate processes (65%, 64/98) had one superior attachment for each uncinate process, the other thirty-four uncinate processes (35%, 34/98) had two superior attachments for each uncinate process. The uncinate process' single superior attachment into the surrounding structures was identified to have the following distribution: 53% (52/98) to the lamina papyracea, 9% (9/98) to the middle turbinate, 3% (3/98) to the skull base. Most of the uncinate process' two superior attachments were either into the lamina papyracea and the skull base (24%, 23/98) or into the lamina papyracea and the middle turbinate (10%, 10/98). Only one uncinate process (1%) superiorly attached to the skull base and the middle turbinate. The prevalence of recessus terminalis was 87% (85/98). Of all the frontal cells identified in 32 sides (33%) of frontal recesses, the prevalence of type I, type II, type II and type IV cells were 23% (23 sides), 2% (2 sides), 7% (7 sides) and 0% (0 side) respectively. Supra bullar cell, frontal bullar cell and interfrontal septal cell were identified in 30 sides (31%), 7 sides (7%) and 7 patients (14%) respectively.</p><p><b>CONCLUSIONS</b>The result characterized normal frontal recess pneumatization in Chinese. That, together with the variations of the uncinate process' superior attachment emphasized the roles of agger nasi cell and the uncinate process in endoscopic frontal sinus surgery.</p>

Endoscopic frontal sinus surgery through agger nasi cell approach / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the access to the frontal recess by identifying the agger nasi cell and uncinate process.</p><p><b>METHODS</b>Forty-seven patients (85 sides) who underwent endoscopic frontal sinus surgery in our department constituted the study population. Computed tomographic (CT) scans of the sinuses were obtained in coronal and axial views. The frontal ostium was identified by using agger nasi cell approach or identifying the uncinate process.</p><p><b>RESULTS</b>The frontal sinus ostium was identified in 100% of patients (85 sides). After an average follow-up of 9 months, 41 sides of 49 sides (84%) had endoscopically healed sinuses by using agger nasi cell approach. And 21 sides of 36 sides (81%) had endoscopically healed sinuses by identifying the uncinate process.</p><p><b>CONCLUSIONS</b>The agger nasi cell approach to the frontal recess gives an access and allows identification of the frontal ostium. In addition, it provides direct visualization with a 0 degree endoscope into the frontal recess.</p>

Anatomical and computed tomographic analysis of the interaction between uncinate process and agger nasi cells / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the anatomical interaction between uncinate process and agger nasi cell to better understand the anatomy of the frontal sinus drainage pathway by endoscopy, spiral computed tomography (CT) and sectioning.</p><p><b>METHODS</b>Twenty-one skeletal skulls (forty-two sides) and one cadaver head (two sides) were studied by spiral CT together with endoscopy and collodion embedded thin sectioning at coronal plane. The sections with the thickness of 100 microm were stained with hemotoxylin and eosin.</p><p><b>RESULTS</b>Under endoscopy, a leaflet of bone to the middle turbinate, which is given off by uncinate process, forms the anterior insertion of the middle turbinate onto the lateral nasal wall. The middle portion of the uncinate process attached to the frontal process of the maxilla in all of the skeletal nasal cavities, as well as the lacrimal bone in 78.6% of the skeletal nasal cavities. On CT scans, the agger nasi cell is present in 90.5% of the skeletal nasal cavities. While the lateral wall of the agger nasi cell is formed by lacrimal bone, the medial wall of the agger nasi cell is formed by uncinate process. And the anterior wall is formed by the frontal process of the maxilla. The superior portion of the uncinate process forms the medial, posterior and top wall of the agger nasi cells. The superior portion of the uncinate extends into the frontal recess and may insert into lamina papyracea (33.3%), skull base (9.5%), middle turbinate, combination of these (57.2%).</p><p><b>CONCLUSIONS</b>The agger nasi cell is the key that unlocks the frontal recess.</p>