Hipertrofia de cornetes inferiores: revisión sobre técnicas quirúrgicas actuales / Inferior turbinate hypertrophy: review of current surgical techniques

La obstrucción nasal es un motivo de consulta habitual en otorrinolaringología, siendo una de las causas más frecuentes la hipertrofia de cornete inferior, la que se puede manejar con cirugía cuando falla el tratamiento médico. En las últimas décadas se han desarrollado múltiples técnicas quirúrgicas y tecnología asociada, sin embargo, no hay un consenso establecido sobre cuál es la mejor opción para el manejo de esta patología. Se realizó revisión bibliográfica, se enuncian los métodos quirúrgicos disponibles, teniendo en cuenta beneficios, complicaciones probables y resultados de cada uno. La cirugía de cornete inferior tiene resultados favorables en pacientes con cornetes hipertróficos que no responden a manejo médico. Hasta la fecha la turbinoplastía con microdebridador ha mostrado superioridad en cuanto a resultados a largo plazo y menor tasa de complicaciones. La evidencia disponible hasta la fecha carece de homogeneidad en cuanto a métodos de selección de pacientes, medición de resultados y tiempo de seguimiento, por lo que se necesitan a futuro estudios prospectivos controlados para reevaluar los métodos descritos.

Nasal obstruction is a common complaint, one of the most frequent causes being inferior turbinate hypertrophy, which can be managed with surgery when medical treatment fails. In the last decades, multiple surgical techniques and associated technology have been developed, however, there is no established consensus on what is the best option for the management of this pathology. Literature review, the available surgical methods are stated, taking into account benefits, probable complications and results of each technique. The surgery of inferior turbinate has favorable results in patients with hypertrophic turbinates that do not respond to medical management. To date, microdebrider turbinoplasty has shown superiority in terms of long-term results and lower complication rates. The evidence available to date lacks homogeneity in terms of patient selection methods, measurement of results and follow-up time, so prospective controlled studies are needed in the future to reassess the described methods.

Study of patient outcome in endoscopic dacrocystorhinosomy using a microdebrider in chronic dacryocystitis patients

Background: Endoscopic dacryocystorhinostomy (DCR) has become accepted as a suitable treatment for patients with chronic dacryocystitis. In this study authors did endoscopic dacrocystorhinosomy using a microdebrider, which is a recent advancement tool being used successfully in other endoscopic sinus surgeries also. Limited studies are available as of now on this topic.Methods: A total number of 33 patients (with 40 affected eyes) presenting with complains of epiphora having nasolacrimal duct obstruction were selected. They underwent an endoscopic DCR in which dissection of some nasal mucosa and widening of bony ostium was done using a microdebrider. Silicone stent was passed into the nasolacrimal duct through both punctum. Patient outcome was assessed by using both objective (endoscopy and dye test) and subjective (improved symptoms) criteria. Standard follow up time for clinical course was kept 3 months with weekly visits.Results: Patients which got relief from epiphora in 37 eyes (92.5% cases) had no obstruction on endoscopy and positive dye test. Rest (7.5 % cases) had presence of granulation tissue at rhinostoma site and negative dye test, which was cited as the cause of failure.Conclusions: The use of microdebrider is potentially beneficial in endoscopic endonasal dacryocystorhinostomy. By using such an instrument, the minimal amount of tissue damage occurs, a large fistula is formed, and the recurrence due to the formation of adhesions/synechiae/granulations is prevented/reduced thus reducing the time of surgery, complications and failure rate.

Comparison between curettage adenoidectomy and endoscopic-assisted microdebrider adenoidectomy in terms of Eustachian tube dysfunction / Comparação entre adenoidectomia por curetagem e adenoidectomia por microdebridador assistida por endoscopia, em relação à disfunção tubária

Abstract Introduction Adenoidectomy can be performed with many ways, including curettage and microdebrider endoscopic-assisted adenoidectomy. Those two techniques have advantages and disadvantages. Objective The objective of this study is to research the effects of curettage adenoidectomy and endoscopic-assisted microdebrider adenoidectomy on the tympanum pressures in pediatric patients with adenoid hypertrophy without otitis media with effusion. Methods This prospective descriptive study was performed with 65 patients who had a normal tympanic membrane and normal tympanogram and then underwent adenoidectomy or adenotonsillectomy for adenoid and tonsil hypertrophy. The subjects were randomly divided into two groups: curettage adenoidectomy group and endoscopic microdebrider-assisted adenoidectomy group. They underwent tympanometry, and the preoperative as well as 1st and 7th day postoperative values of the tympanum pressures were compared within and among the groups. Results There were 32 patients in the curettage adenoidectomy group and 33 patients in the microdebrider adenoidectomy group. Statistically significant differences were observed in the median tympanum pressure on the preoperative and 1st and 7th postoperative days for both the left and right ears with curettage adenoidectomy (p < 0.001, p < 0.001). This difference occurred on the 1st postoperative day, and the value returned to normal on the 7th day. There was no significant difference in the median tympanum pressure on the preoperative and 1st and 7th postoperative days for both the left and right ears in the microdebrider adenoidectomy group (p = 0.376, p = 0.128). Conclusion Postoperative Eustachian tube dysfunction is seen less often with the endoscopic-assisted microdebrider adenoidectomy technique than with the conventional adenoidectomy technique.

Resumo Introdução A adenoidectomia pode ser realizada de várias maneiras, inclusive por curetagem e por microdebridador, assistida por endoscopia. Essas duas técnicas têm algumas vantagens e desvantagens. Objetivo O objetivo deste estudo foi investigar os efeitos da técnica de adenoidectomia por curetagem e da adenoidectomia por microdebridador assistida por endoscopia sobre a pressão timpânica em pacientes pediátricos com hipertrofia adenoideana sem otite média com efusão. Método Estudo descritivo prospectivo feito com 65 pacientes que apresentavam membrana timpânica e timpanograma normais, que foram então submetidos à adenoidectomia ou adenotonsilectomia por hipertrofia adenoamigdaliana. Os pacientes foram divididos aleatoriamente em dois grupos: grupo adenoidectomia por curetagem e grupo adenoidectomia por microdebridador assistida por endoscópio. Todos os pacientes fizeram timpanometria e os valores das pressões do tímpano pré-operatórios e pós-operatórios no 1º e 7º dias foram comparados intragrupos e entre os grupos. Resultados Foram incluídos 32 pacientes no grupo adenoidectomia por curetagem e 33 pacientes no grupo adenoidectomia com microdebridador. Diferenças estatisticamente significantes foram observadas na mediana da diferença entre a pressão timpânica no pré-operatório e no 1º e 7º dias de pós-operatório para ambas as orelhas, direita e esquerda, na adenoidectomia por curetagem (p < 0,001, p < 0,001). Essa diferença ocorreu no 1º dia do pós-operatório e o valor retornou ao normal no 7º dia. Não houve diferença significante na mediana entre pressão timpânica no pré-operatório e no 1º e 7º dias de pós-operatório para as orelhas direita e esquerda no grupo de adenoidectomia com microdebridador (p = 0,376, p = 0,128). Conclusão A disfunção tubária no pós-operatório é observada menos frequentemente com a técnica de adenoidectomia por microdebridador assistida por endoscopia quando comparada com a técnica convencional.

Comparison of Perioperative Collateral Injury, Presence of Residual Adenoid Tissue and Recovery Time in Conventional Versus Microdebrider Assisted Endoscopic Adenoidectomy in Children Less than or Equal to 12 Years.

Introduction: Adenoids together with palatine tonsils tubaltonsils and lingual tonsil form the inner Waldeyer’s ring andits enlargement depends on external factors such as allergy,immunosuppression, passive tobacco smoke but mainlychronic bacterial and viral infection. The study comparesthe effectiveness of certain factors in conventional curettageversus endoscopic adenoidectomy in a tertiary care centrein Trivandrum, Kerala, India. Study was done with theobjectives to study the perioperative collateral injury, presenceof residual adenoid tissue and recovery time in conventionalversus microdebrider assisted endoscopic adenoidectomy inchildren less than or equal to 12 years.Material and methods: An observational study was done ina group of 60 patients of age less than or equal to 12 yearswho satisfied the inclusion criteria who underwent treatmentin department of ENT in Sree Gokulam medical collegeduring a period of 2017 – 2018. Patients were grouped into 2groups of 30 each. Group A underwent conventional curettageand group B underwent microdebrider assisted endoscopicadenoidectomy. Patients were followed up 1 week and 2months following the procedure by post operative nasalendoscopy to assess collateral damage and residual adenoidtissue.Results: The residual tissue in conventional adenoidectomywas 20% and 20 – 50% in 2 cases and more than 50% in 4cases. This was the main cause of persistence of symptomsin conventional adenoidectomy. The mean recovery timewas 4.1 days in conventional and 3.2 days in endoscopicadenoidectomy. In conventional adenoidectomy 3 cases(10%) had collateral damage in which 2 cases had injury toeustacian tube orifice and 1 case had injury to torus tubaris.In the endoscopic microdebrider assisted surgery no collateraldamage was recorded.Conclusion: The study showed that the completeness ofdissection, collateral injury and recovery time was better inthe endoscopic adenoidectomy compared to conventionalcurettage.

Assessment Of Powered (MICRO Debrider) Instruments In Endoscopic Sinus Surgery

Background: Endoscopic Sinus Surgery (ESS) is the surgical practice of alternative for Sinonasal Polyposis (SP). Blood loss throughout Endoscopic Sinus Surgery be able to stop the flow of surgical procedure. The normal instruments grip and rip diseased tissues along with regular tissues causing amplified intra operative bleeding important to decreased visibility and therefore less accurate surgery. Microdebriders be extensively worn now a day in Endoscopic Sinus Surgery. This study is made to assess the advantages of microdebrider in Endoscopic Sinus Surgery in terms of blood loss throughout surgery, visibility of the field during surgery, duration of surgery and post operative healing. Methods: This is a potential study done in GEMS hospital, Srikakulam, over a period of October 2017 to September 2018. Patients who were diagnosed as sinonasal polyposis and underwent endoscopic sinus surgical procedure with microdebrider were taken into study and the outcome were documented and analyzed in terms of blood loss during surgery, visibility throughout surgery, time interval of surgery and post operative healing. Results: Out of 30 patients, majority of the patients had an average blood loss of 180 ml and preoperative visibility of grade 2 and standard duration of surgery of 60 minutes. the majority of the patients had grade Apost operative healing Conclusions: The use of microdebrider leads to contented surgical procedure and decreased rate of intra-operative complications and likely instrument in the practical endoscopic sinus surgery for the management of sinonasal polyposis

Treatment of Severe Pregnancy Rhinitis Using Microdebrider-Assisted Inferior Turbinoplasty: A Case Report

Pregnancy rhinitis is a relatively common condition. It is characterized by the presence of nasal symptoms, especially nasal congestion, not present prior to pregnancy, but typically present during the last 6 or more weeks of pregnancy, without other signs of respiratory tract infection or any known allergic causes, and disappearing completely within 2 weeks after delivery. Nasal saline irrigation, intranasal steroid spray, and oral antihistamines are usually recommended as the first line of treatment for rhinitis. However, most pregnant women refuse medical treatment for pregnancy rhinitis because of the fear of teratogenicity. Severe pregnancy rhinitis increases the risk of snoring, which has been suggested as having adverse effects on the fetus. In cases where the patients are unable to control their symptoms, pregnancy rhinitis can negatively affect the quality of life (QOL) as well as the pregnancy outcome. Therefore, special caution is required for determining the appropriate diagnosis and treatment modalities for pregnancy rhinitis. Here, we report for the first time, the successful treatment of pregnancy rhinitis that was unresponsive to conservative management and medical therapy by using microdebrider-assisted inferior turbinoplasty at the final stages of pregnancy, along with a review of the relevant literature.

Canine fossa puncture in endoscopic sinus surgery: report of two cases / Punção da fossa canina em cirurgia endoscópica sinusal: relato de dois casos

Abstract Introduction: Chronic rhinosinusitis with nasal polyposis is a common chronic disease that often affects maxillary sinus. Endoscopic sinus surgery is the most common procedure for treating the majority of maxillary sinus lesions. Objective: To demonstrate the role of canine fossa puncture during endoscopic sinus surgery procedure in patients with severe maxillary sinus disease. Methods: We present 2 cases where canine fossa puncture has been performed as method to obtain a complete access to the maxillary antrum. Results: According our experience, 2 cases on 296 endoscopic sinus surgery (0.6%) where antrostomy and used of angled microdebrider were not sufficient, canine fossa puncture has been performed as an alternative method to obtain a complete access to the maxillary antrum. Conclusion: Although the advent of endoscopic sinus surgery, our cases support the fact that actually canine fossa puncture is a minimally invasive technique useful in selected cases.

Resumo Introdução: A rinossinusite crônica com polipose nasal é uma doença crônica comum que frequentemente afeta o seio maxilar. A cirurgia endoscópica sinusal é o procedimento mais comum para tratar a maioria das lesões do seio maxilar. Objetivo: Demonstrar o papel da punção da fossa canina durante o procedimento de cirurgia endoscópica sinusal em pacientes com doença grave do seio maxilar. Método: Apresentamos dois casos em que a punção da fossa canina foi feita como método para obter acesso completo ao antro maxilar. Resultados: De acordo com nossa experiência, dois casos em 296 cirurgias endoscópicas sinusais (0,6%) nos quais a antrostomia e o uso de microdebridador angular não foram suficientes, a punção da fossa canina foi feita como um método opcional para obter acesso completo ao antro maxilar. Conclusão: Apesar do advento da cirurgia endoscópica sinusal, os nossos casos apoiam o fato de que a punção da fossa canina é uma técnica minimamente invasiva útil em casos selecionados.

A retrospective analysis of CO2 laser and microdebrider for the treatment of severe juvenile on-set recurrent respiratory papillomatosis / 中华耳鼻咽喉头颈外科杂志

Objective@#Juvenile on-set recurrent respiratory papillomatosis (JORRP) can be an aggressive and potentially life-threatening disease. To emphasize the importance of complication prevention in local excision surgery, the single-center experience of RRP treatment in a group of patients with relatively short recurrence-free-interval (>4 times/yrs) was reported.@*Methods@#Data of 49 patients underwent papilloma resection during 2002-2013 were retrospectively analyzed. Combined techniques of laser microsurgery and microdebriders were used to remove papillomas, prevent the formation of scar tissue and improve respiratory distress. Forty-nine cases were followed up for 99.0[74.5; 121.0]months, ranging from 39 to 185 months. The age of disease onset was 2[1; 3] years old. Most of the patients had difficulty in breathing(42 of 49 cases). Seven patients had hoarseness.53.0% patients had subglottic or trachea papillomatosis spreading. The rate of complications, synechia formation, tracheal stenosis, needing for tracheostomy, mortality was recorded. Patients were followed up for at least three years. The characteristics of the patients, improvement in symptoms, recurrence-free interval, and the rate of tracheal extubation were evaluated. Wilcoxon signed ranks test and chi-square test were used for data comparation.@*Results@#Long-term relieve in disease(≤2 surgeries were needed/year) were achieved in 29(59.1%) subjects, in which 8(16.3%) of the subjects did not need surgical treatment for at least 3 years. Long-term relieve had been achieved in 25 of subjects who did not accept tracheostomy. Seven subjects did not need surgical treatment for at least 3 years. The rate of successful tracheal extubation was 53.8% in 13 patients who had undergone tracheostomy. Three cases dead of intrapulmonary spread.@*Conclusions@#Combined techniques of laser microsurgery and microdebriders are effective in improvement in both respiratory distress and voice quality. The combined technique are helpful to avoid inevitable long-term stenotic complications, ultimately affecting the quality of life.

A Case of Paraffinoma Removal Using Endoscope-Assisted Microdebrider

Paraffin has been used illegally in Korea for many years as an oil-soluble substance to augment depressed nasal dorsum. Here we describe the successful management of a case of nasal paraffinoma using an endoscope-assisted microdebrider and primary reconstruction using autologous dermofat and Gore Tex. The patient was placed in the supine position under general anesthesia, and bilateral intercartilaginous incisions were made. The endoscopic views provided an extended image that aided in identifying paraffinoma within the soft tissue. The paraffinoma was removed with a microdebrider. The dorsal defect and irregularities were reconstructed using dermofat and Gore-Tex.At the four-year follow-up, the patient was satisfied with the cosmetic results, and there was no evidence of recurrence.

Supraglotoplastía asistida con microdebridador en pacientes con síndrome de Pierre Robin y laringomalacia severa / Assisted endoscopic microdebrider supraglottoplasty in patients with Pierre Robin syndrome and severe laryngomalacia

Se presenta el caso de una paciente recién nacida de término portadora de un síndrome de Pierre Robin asociada a laringomalacia severa que requirió resolución quirúrgica para estabilización de su vía aérea superior Se presenta la experiencia clínica en el uso de microdebridador para realización de supraglotoplastía como una novedosa alternativa en el tratamiento quirúrgico de este tipo de pacientes y se realiza revisión de la literatura respecto de esta técnica.

Pierre Robin syndrome is a triad formed by micrognathia, and cleft palate glossoptosis. His association with laryngomalacia is not set however determining the coexistence of these two diseases and their severity is of utmost importance as they condition the prognosis of a patient with Pierre Robin syndrome. Currently one of the surgical techniques used in patients with severe laryngomalacia, is assisted endoscopic microdebrider supraglottoplasty. In the ENT unit of the Hospital Luis Calvo Mackenna, this procedure is being implemented in order to give our patients a safe and effective treatment option for their pathology.

The Long Term Efficacy of Microdebrider Assisted versus Coblation Assisted Inferior Turbinoplasty / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The study aimed to evaluate the long term efficacy of micro-debrider assisted inferior turbinoplasty (MAIT) compared to coblation assisted inferior turbinoplasty (CAIT) for hypertrophic inferior turbinates. SUBJECTS AND METHOD: From January 2008 to December 2008 inclusively, 96 patients with persistent hypertrophic inferior turbinates mucosa refractory to medical therapy were enrolled into this study. All patients were suffering from nasal obstruction and related symptoms. Overall, 56 patients were treated with microdebrider assisted inferior turbinoplasty (MAIT group) and 40 patients were treated with coblation assisted inferior turbinoplasty (CAIT group). Postoperative changes in degree of nasal obstruction, sneezing, rhinorrhea, minimal cross sectional area (MCA), and nasal volume from the nostril to 7 cm posteriorly (V7), operation time, duration of crust formation, intraoperative bleeding and delayed bleeding were compared between the two surgical methods prospectively in the 1st and 6 months, and in the 1st and 2nd years after the procedure. Also patient's satisfaction with procedure was evaluated. RESULTS: The nasal obstruction and related nasal symptoms improved significantly in MAIT group and persisted within the periods of 2 years after surgery, while in CAIT group the significant improvements took place in the 1st and 6th months after surgery but no significant improvements from 1 to 2 years after were noted. Nasal patency (MCA and V7) also showed more improvement and persistence in MAIT group than CAIT group. There were no significant differences in operation time and intraoperative bleeding and delayed bleeding but the duration of crust formation was significantly shorter in MAIT group. And patient satisfaction in the MAIT group was higher than that in the CAIT group. CONCLUSION: From the analysis of this study, it can be said that MAIT is more effective and satisfactory for the long term relief of nasal obstruction, related nasal symptoms and reduction of hypertrophic inferior turbinate mucosa than CAIT.

Myxoma of the Maxillary Sinus : A Case Report / 대한이비인후과학회지

Myxomas of the maxillary sinus are uncommon benign tumors arising from primitive mesenchyme. They are usually manifested by slow, painless bony expansion with resultant facial deformity. The standard treatment for myxoma is radical excision. Although incomplete primary removal of tumor may result in high recurrence rates, complete radical resection may result in a significant functional and aesthetic defect. Therefore, a radical resection of the tumor with maximal preservation of surrounding anatomic structure is necessary. We describes a case of maxillary myxoma in a 31 year old male who underwent piece-meal surgery following debridement with microdebriders via intranasal endoscopic approach and Caldwell-Luc's approach for maximal preservation of anatomical structure.

A Case of Retrobulbar Hemorrhage after Endoscopic Sinus Surgery with Microdebrider

Retrobulbar hemorrhage is one of the major complications following endoscopic sinus surgery (ESS) with a microdebrider. Symptoms and physical findings include temporary blindness, ophthalmoplegia, mydriasis, ptosis, proptosis and eyelid ecchymosis. Recently, we experienced a case of retrobulbar hemorrhage after an ESS with a microdebrider resulting from anterior ethmoid artery rupture. We hereby present this case with an emphasis on the importance of prevention, identification and management of retrobulbar hematoma.

Analysis of Complications after Endoscopic Maxillary Sinus Surgery with Canine Fossa Puncture and Microdebrider / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: In patients with extensive polyposis of maxillary sinus or antrochoanal polyp, it is very difficult to remove entire diseased mucosa through middle meateal antrostomy and often require the procedure of canine fossa puncture. The aim of this study was to analyze the complications associated with this procedure. MATERIALS AND METHOD: We performed a prospective study and questionnaire about complications on 56 patients who had undergone a canine fossa puncture and removal of diseased mucosa with microdebrider. RESULTS: A total of 91 canine fossa punctures were performed in 56 patients. Twenty five patients (44.6%) experienced more than one adverse effect. The most common complaint was facial or cheek swelling (29.7%) followed by facial or cheek pain (24.8%), facial bruise (17.9%), facial numbness (11.9%), dental numbness (7.9%), tingling sensation (5.9%) and infection of puncture site (1.9%). Most complications (94.1%) resolved within 4 weeks after surgery. Only one patient (0.9%) had persistent facial numbness even at 14 months after the procedure. CONCLUSION: Removal of extensive polyposis and diseased mucosa of the maxillary sinus with microdebrider through canine fossa puncture is a very useful technique. However, a significant number of patients experience temporary or permanent complications after surgery. Surgeons should be aware of these side effects and inform the patients before performing the surgical procedure.

Comparative Study on the Long-Term Effectiveness between Coblator- and Microdebrider-Assisted Partial Turbinoplasty / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Various surgical methods have been tried to relieve the symptoms of nasal obstruction in patients with inferior turbinate hypertrophy. Recently, coblators that use radiofrequency and microdebriders are increasingly used in turbinate surgery. The aim of this study was to compare the long-term postoperative outcome between the coblator-assisted and microdebrider-assisted partial turbinoplasty. SUBJECTS AND METHOD: We selected 60 patients who had nasal obstruction and hypertrophied turbinate mucosa that was refractory to medical treatment. Thirty patients were treated with coblator (group 1) and 30 patients were treated with microdebrider (group 2). Postoperative changes in degree of nasal obstruction were evaluated prospectively at 3, 6 and 12 months after the procedure. Cross-sectional area of second notch and volume of nasal cavity were compared at 12 months after operation. Operation time, duration of crust formation, postnasal drip and postoperative bleeding were also compared. RESULTS: Nasal obstruction was improved significantly in both groups. However, statistical significance of improvement and rate of patient's satisfaction at 12 months after surgery was higher in group 2. There were no significant differences in the degree of postnasal drip, operation time and duration of crust formation between two groups. CONCLUSION: This study suggests that microdebrider-assisted partial turbinoplasty is more effective and satisfactory in long-term relief of nasal obstruction and reduction of mucosal volume in the anterior head of inferior turbinate.

Limited Septoplasty Under Nasal Endoscopy / 上海第二医科大学学报

Objective To compare the outcomes of powered-assisted septoplasty with CO_ 2 laser-assisted septoplasty. Methods Thitry patients with limited deviation of nasal septum were analyzed retrospectively. Among 30 patients, 18 underwent powered-assisted septoplasty and the rest underwent CO_ 2 laser-assisted septoplasty. The surgical results were assessed by the visual analogue scale (VSA) and acoustic rhinometry. Results VSA scores significantly improved in both groups after surgery (P

Injury of the Medial Rectus Muscle by Using a Microdebrider During Endoscopic Sinus Surgery : A Case Report / 영남의대학술지

A microdebrider is increasingly used in endoscopic sinus surgery. Although it has many advantages over conventional instruments, it has been associated with severe complications. We treated a case of rupture of the left medial rectus muscle after use of a microdebrider during endoscopic sinus surgery in a 50 year-old female patient who complained of binocular diplopia and exotropia. The patient showed marked limitation on adduction and about 40 prism diopters of left exodeviation. The orbital computed tomography showed a bony defect at the left medial orbital wall, and injury of the medial rectus muscle. The exodeviation was corrected after ophthalmologic surgery. We report a case of the rupture of the medial rectus muscle after use of a microdebrider during endoscopic sinus surgery and review the medical literature.

Clinical Results of Endoscopic Dacryocystorhinostomy using a Microdebrider

PURPOSE: The success rate of endoscopic dacryocystorhinostomy has been increasing with the development of better instruments and techniques. We conducted this study to evaluate the clinical results of endoscopic dacryocystorhinostomy using a Microdebrider, which has also been used for functional endoscopic sinus surgery. METHODS: We selected 76 patients (with a total of 84 affected eyes) who had been diagnosed with a nasolacrimal duct obstruction. These patients underwent an endoscopic dacryocystorhinostomy using a Microdebrider, which removed both nasal mucosa and lacrimal sac mucosa and also trimmed the margins of the ostotomy site. We assessed patients' outcomes on an anatomical basis using a dye test and endoscopy, which were used to define the anatomical success. We also arbitrarily defined functional success as whether the subjective epiphora was absent. At a four to 18 month follow-up, we monitored the clinical course to examine any recurrent episodes. RESULTS: The symptoms were alleviated in 72 eyes, with a primary success rate of 85.7%. On nasal endoscopy, a functional failure was seen in four eyes. In these four eyes, the orifice was narrowed by the presence of either granulation tissue or conjunctivochalasis. By contrast, surgical outcomes were the anatomical failure in eight eyes. In these eight eyes, the orifice was obstructed by the presence of granulation tissue as well as the adhesion of nasal mucosa. CONCLUSIONS: Endoscopic dacryocystorhinostomy using a Microdebrider enabled us to make the large fistula while minimizing the damage of adjacent tissue. It might be the recommended surgery that reduces the complications and enhances the success rate.

Clinical Efficiency of Adenoidectomy Using Microdebrider / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Remnant adenoid tissue after adenoidectomy or immoderate procedure result in various complications such as bleeding, damage to the mucosa of posterior nasopharyngeal wall or orifice of Eustachian tube. The purpose of this paper is to compare conventional adenoidectomy with microdebrider-assisted adenoidectomy based on postoperative outcome and intraoperative effectiveness. MATERIALS AND METHOD: We performed a prospective study comparing thirty cases of adenoidectomy using conventional approach with fifteen cases of transoral microdebrider adenoidectomy using an indirect laryngeal mirror. Skull lateral radiographs and a symptom scale were used to evaluate preoperative and postoperative states. RESULTS: There was no significant difference in the improvement of symptoms and postoperative outcome between the conventional group and the microdebrider adenoidectomy group. However, it was found that more adenoid tissue could be removed in the microdebrider group. Postoperative nasopharyngeal endoscopic views revealed that microdebrider removed adenoid tissue precisely and preserved the posterior nasopharyngeal wall better when compared to the conventional group. CONCLUSION: Compared with the conventional procedure, adenoidectomy using the transoral microdebrider with an indirect laryngeal mirror was similar in achieving symptom improvement and postoperative outcomes, but removed more adenoid tissue with higher precision. From this study, we suggest that using microdebrider with indirect laryngeal mirror is another valuable method of adenoidectomy in the aspect of precision.

Transoral Endoscopic Adenoidectomy with the Microdebrider / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Surgeons have tried various methods of adenoidectomy from the conventional transoral ad- enoidectomy using curettes or adenotomes to the newly developed transnasal endoscopic adenoidectomy using microdebriders. However, surgeons still face a great difficulty in achieving complete adenoidectomy due to the unfavorable anatomic structure and a narrow operating field. This study aims to introduce and try to establish a better way of performing transoral endoscopic adenoidectomy using microdebriders. MATERIALS AND METHODS: Thirty patients who underwent transoral endoscopic adenoidectomy using rnicrodebriders were prospectively randomized. Skull lateral radiographs and endoscopic photographs were obtained to analyze the surgical outcome of transoral endoscopic adenoidectomy using a microdebrider. RESULTS: There were no specific postoperative complications such as hemorrhage or infection. Nasal obstruction disappeared within 7 postoperative days, and mouth breathing and snoring were simultaneously improved. CONCLUSION: Transoral endoscopic adenoidectomy using a microdebrider can be considered as one of the most effective methods for more complete adenoidectomy to relieve nasal obstruction and to reduce mouth breathing and snoring.