Extended draf IIb procedures in the treatment of frontal sinus pathology.

OBJECTIVES: Draf IIb approach provides wide, unilateral access to the frontal sinus. This approach can be extended without destruction of the contralateral frontal sinus drainage pathway, performed during Draf III (modified Lothrop) procedure. There is limited data in the literature regarding the use of modified Draf IIb procedures. METHODS: Patients treated with extended Draf IIb procedures in a single center were retrospectively assessed. RESULTS: Ten patients were identified, including 2 cases of osteoma, 1 inverted papilloma, 1 carcinoma, 5 mucoceles, and 1 chronic rhinosinusitis patient. Six patients had undergone prior surgery, including external procedures in 3 cases. Modifications of Draf IIb were classified as the following: removal of the anterosuperior nasal septum adjacent to the nasal beak, removal of the intersinus septum, and a combination of the above-mentioned methods (upper nasal septum and intersinus septum removal). There were 3 patients operated on with type 1 modification, one patient with type 2 modification, and 6 patients with type 3 modification. There were no perioperative complications. CONCLUSION: In selected cases, extended Draf IIb procedures are safe and effective in the treatment of frontal sinus disease.

Hidden unilateral aplasia of the frontal sinus: a radioanatomic study.

BACKGROUND: Hidden unilateral frontal sinus aplasia is the absence of 1 frontal sinus with increased pneumatization of contralateral sinus toward the aplastic side. It may give the false impression of the presence of 2 separate frontal sinuses, creating potential for complications during the surgery. The aim of this study was to evaluate the prevalence and morphology of this anatomical variation using multiplanar reconstruction of computed tomography (CT) results. METHODS: A total of 305 CT examinations were analyzed. Hidden unilateral frontal sinus aplasia was defined as lack of pneumatization of 1 frontal sinus beyond the level of the orbital roof, with increased pneumatization of the contralateral sinus, extending to the sagittal plane, crossing the lamina papyracea on the side of the aplastic sinus. RESULTS: Eleven patients (3.6%) with hidden unilateral frontal sinus aplasia were identified, 5 on the left and 6 on the right side, in 5 female and 6 male patients. Twenty-four (7.8%) patients with "regular" frontal sinus aplasia (without hyperplastic contralateral frontal sinus) were found, 4 with bilateral aplasia and 20 with unilateral aplasia. CONCLUSION: Hidden unilateral aplasia of the frontal sinus is a relatively uncommon anatomical variation. Its presence should be considered during routine preoperative CT evaluation because it poses the risk of intraoperative complications.

Asymmetry of the anterior skull base at the level of frontal ostium, a radioanatomical study.

BACKGROUND: Radioanatomical studies have shown that the ethmoid roof is asymmetric in 10 to 40% of individuals. The right ethmoid roof has been found on average to be lower compared to the left. The aim of this study was to extend existing results by assessing asymmetry between the right and left anterior skull base at the level of the frontal ostium. METHODOLOGY: Curved multiplanar reconstruction was used to analyse 247 consecutive paranasal sinus CT scans. The corresponding left and right parasagittal profiles of the skull base marked from the anterior ethmoidal artery to the level of the orbital roof were superimposed and compared. RESULTS: Asymmetry greater than 1 mm was found in 87% of patients, greater than 2 mm in 40.5% of patients, and greater than 3 mm in 8% of patients. The prevalence of the patients with lower skull base on the right side was greater than those with lower skull base on the left side at a ratio of more than 2:1. CONCLUSION: Skull base asymmetry in the region of the frontal ostium is observed in a large percentage of the population and may be a potential source of complications during endoscopic sinus surgery.

Endoscopic transnasal management of sinonasal malignancies - our initial experience.

INTRODUCTION: Malignant tumors of the paranasal sinuses are traditionally managed through external approaches. Advances in endoscopic transnasal surgery have allowed for the endoscopic treatment of some of these tumors. AIM: To present the results of treatment of a series of patients with paranasal sinus malignancies treated with an endoscopic approach at a single institution. MATERIAL AND METHODS: The data on tumor type, operative technique, perioperative complications and postoperative course were analyzed. RESULTS: Eleven patients meeting the inclusion criteria were identified. The histopathology was as follows: malignant melanoma in 3 patients, squamous cell carcinoma in 2, adenocarcinoma in 2, poorly differentiated carcinoma in 1, hemangiopericytoma in 1, adenoid cystic carcinoma in 1 and fibrosarcoma in 1. There were no severe perioperative complications with the exception of 1 case of cerebrospinal fluid leak, which was successfully closed. The mean observation period was 13.5 months. One of the patients died of disease, another was lost to follow-up, and one was reoperated on due to recurrence. The remaining 8 patients are alive with no signs of recurrence. CONCLUSIONS: Our initial experience seems to confirm results obtained by other authors indicating that in selected cases endoscopic surgery of sinonasal malignancies is similarly effective as external approach surgery.

Endoscopic transnasal management of inverted papilloma involving frontal sinuses.

Inverted papilloma is a benign locally aggressive tumor of paranasal sinuses which has been traditionally managed with external surgical approaches. Advances in tumor imaging, surgical instrumentation and intraoperative visualization have led to a gradual shift to endonasal attachment-oriented surgery. Involvement of both frontal sinuses by inverted papilloma is rare. There are scant reports in the literature regarding this topic. We present 2 cases of the tumor involving both frontal sinuses removed by median drainage (Draf III procedure) under endoscopic guidance without any additional external approach. The whole cavity of both frontal sinuses was easily inspected at the end of the procedure. No early or late complications were observed. No recurrence was seen in 1-year or 2-year follow-up. Management of frontal sinus inverted papilloma with the endoscopic median drainage approach is feasible and seems to be effective.

[Draf III procedures: the ENT Department, Medical University of Warsaw experience]. / Operacje z dostepu Draf III w materiale Kliniki Otolaryngologii WUM.

UNLABELLED: During last decades Draf III procedure gained popularity in treatment of different pathologies of the frontal sinus such as chronic sinusitis or benign tumors. We present a series of 10 patients treated with this procedure from a 2-year-period. Indications included: chronic rhinosinusitis--four patients, frontal sinus mucocele--four patients (one with destruction of the posterior table), osteoma--one patient (stage 3 according to Kennedy's grading system), and inverted papilloma--one patient (Krouse T3 lesion). Observation period ranged from 4 months to 2 years. RESULTS: There were no early complications. Gradual narrowing of the created ostium was observed in all of the patients. This led to total obstruction in two, and stenosis (not allowing for passing with 4 mm endoscope) in another two patients. The patient after inverted papilloma removal showed no recurrence in 11 months follow-up. CONCLUSION: Draf III procedure is alternative for external approach that can be used for treatment of chronic rhinosinusitis and benign frontal sinus tumors of different size.

[Successes and failures of ozena's medical treatment]. / Sukcesy i porazki zachowawczego leczenia ozeny.

Ozena belongs to the primary atrophic rhinitis of unknow etiology. The incidence of this disease has markedly decrease in the last decades. We treated 4 patients with ozena between 2000-2005. The diagnosis was confirmed by physical and ENT examination, culture from the nose and CT scan of perinasal sinusis. Ciprofloxacin was aministrated orally in a dose 1,0-0,5 g daily to all patients. Also they were instructed how to clean the nose regularly with an isotonic saline solution and to moisteurse nosa by wotery spray. The treatment with ciprofloxacin was maintained for 4-6 weeks. In 3 causes the result was very good after 2-4 y observation. 1 patient, 16 y. old girl, didn't cooperate therapy propely - she stoped nasal rinsing after some improvement. The second course of treatment seems to get good result (3 months observation). Our and some other authors conclusion is: ciprofloxacin seems to be a promising drug for the treatment of ozena. For good results cleanising the nose regularly is importent as well as antibiotic.

[The role of immunological factors in Meniere's disease]. / Rola czynników immunologicznych w chorobie Meniere'a.

Involvement of the immunological mechanisms in the pathogenesis of Meniere's disease has been discussed over the past two decades. Nevertheless, we lack well-defined laboratory tests that might confirm the autoimmune background of the disorder. Therefore the diagnosis is often based solely on the patient's clinical profile and the positive response to the immunosuppressive therapy. In this article we present a case of 44 year-old woman with Meniere's disease successfully treated with systemic glucocorticoids. The pathogenesis, diagnosis and management of immune-mediated cases of Meniere's disease are reviewed.