Mucus extravasation into the orbit during frontal sinus irrigation.

During minitrephination and irrigation of the frontal sinus, mucus extravasated into the orbit through a defect in the sinus floor. The mucus incited a foreign body reaction and became encapsulated within the orbit necessitating excision via an anterior orbitotomy.

Aerosinusitis: pathophysiology, prophylaxis, and management in passengers and aircrew.

Patients presenting before flight with an upper respiratory infection are at risk for aerosinusitis. Prophylaxis of this condition consists of an oral decongestant before flight and nasal decongestant spray during the flight just prior to descent. Evaluation of the patient presenting with aerosinusitis consists of a careful physical exam with emphasis on diagnosing treatable nasal and sinus pathology. Categorization of the patient into the Weissman classification is important for determining prognostic factors for recovery. Management of this condition is based on the Weissman stage. Stage I or II lesions are generally treated conservatively with a 1-wk course of topical sprays, analgesics, a tapering course of steroids, and oral decongestants. Use of antibiotics is reserved for those cases initiated by bacterial sinusitis. Additionally, antihistamines are reserved for cases where allergies were the inciting cause. Stage III lesions are rarely seen in civilian air travelers due to the relatively low fluctuations in ambient air pressure. Aircrew that suffer Stage III aerosinusitis are at risk for recurrent sinus barotrauma that may require an expertly performed functional endoscopic sinus surgery to successfully manage it.

Long-term comparison between submucosal cauterization and powered reduction of the inferior turbinates.

OBJECTIVES/HYPOTHESIS: To evaluate the results of powered turbinoplasty and to compare these with submucosal cauterization of the inferior turbinates. STUDY DESIGN: Prospective, randomized, comparative surgical trial. METHODS: Nineteen patients with medication-resistant chronic nasal obstruction caused by inferior turbinate hypertrophy were randomized to undergo powered turbinoplasty on one side and submucosal cauterization on the other. For each side, an extensive assessment (symptom scoring, endoscopic scoring, and acoustic rhinometry) was recorded preoperatively and on week 1, week 3, month 3, year 1, and year 5 postoperatively. RESULTS: Powered turbinoplasty was superior to submucosal cauterization on all aspects of the assessment. A significant difference (P < .05) was noted for postoperative crusting, endoscopical scoring of turbinate size, and acoustic rhinometry measurements of nasal cavity volume and mean area at the level of the nasal valve. In addition, the results of powered turbinoplasty were still apparent on long term follow-up, whereas submucosal cauterization was associated with a recurrence of turbinate hypertrophy. CONCLUSION: Performing a powered turbinoplasty leads to decreased patient morbidity during the postoperative healing and to a better control of long-term results when compared with submucosal cauterization.

The effect of insulin-like growth factor 1 incorporated into a hyaluronic acid-based nasal pack on nasal mucosal healing in a healthy sheep model and a sheep model of chronic sinusitis.

BACKGROUND: Endoscopic sinus surgery (ESS) is the accepted surgical treatment for chronic refractory rhinosinusitis. Prolonged healing and adhesion formation remain common problems. This study investigates the use of a hyaluronic acid-based pack impregnated with insulin-like growth factor (IGF) 1 to facilitate more rapid and effective healing after ESS in a healthy sheep model and a sheep model of chronic sinusitis. METHODS: This study used 12 healthy sheep and 9 sheep with chronic sinusitis. In each sheep one side (computer randomized) was used as a control. Under endoscopic guidance, mucosal injuries and adhesions were created on both sides and were either packed with a hyaluronic acid pack impregnated with IGF-1 or left unpacked as a control. Serial biopsies were performed for 4 months. RESULTS: In the healthy sheep there was a statistically significant (p < 0.05) improvement in reepithelialization in IGF-1 packed wounds at day 28 (89% for IGF-1 versus 44% for controls). In both healthy sheep and sheep with sinusitis there was no significant difference in mucosal reepithelialization at any of the other measured time points. In the sinusitis group, there was a significant decrease in ciliary regeneration at day 56 in the Merogel/IGF-1 group compared with the control group: 59.20% versus 77.68% (p < 0.01) and at day 112, 69.70% versus 87.26% (p < 0.01). CONCLUSION: Hyaluronic acid impregnated with IGF-1 improved reepithelialization in the healthy sheep but not in the sheep with chronic rhinosinusitis. These packs had a detrimental effect on mucosal ciliary regeneration in the sheep with chronic rhinosinusitis.

The effect of a hyaluronic acid-based nasal pack on mucosal healing in a sheep model of sinusitis.

BACKGROUND: A hyaluronic acid-based nasal pack has been shown previously to have a beneficial effect on mucosal healing in a healthy sheep model. However, endoscopic sinus surgery (ESS) usually is performed in the presence of infection and inflammation. The aim of this study was to examine the efficacy of hyaluronic acid-based nasal packing on mucosal healing in a sheep model of chronic sinusitis. METHODS: A standardized sheep model of chronic sinusitis was used. Full-thickness mucosal injuries were performed under endoscopic guidance with a microdebrider. Adjacent wounds were created between the lateral nasal wall and the ethmoid turbinate. Then, the injuries were either packed with a dissolvable hyaluronic acid-based pack or left unpacked to serve as a control. Serial biopsies of the healing mucosa were performed at days 28, 56, 84, and 112 postsurgery, and the presence or absence of adhesions between the ethmoid turbinate and lateral nasal wall was noted. The biopsy specimens were assessed for reepithelialization and epithelial height using light microscopy, and for reciliation using scanning electron microscopy. RESULTS: There was no significant difference in reepithelialization or relative epithelial height between the packed sides and the control sides at any time point. There was a statistically significant difference in reciliation between the two groups at day 112 but this was not deemed clinically significant. The packing had no significant effect on adhesion formation. CONCLUSION: In the sheep model of chronic sinusitis, a dissolvable hyaluronic acid-based pack did not have any significant effect on mucosal healing or adhesions formation after ESS, as assessed by examining reepithelialization, epithelial height, reciliation, and the presence of adhesions.