Surgical treatment of 186 sinonasal inverted papillomas and analysis of the immunohistochemical and molecular features associated with recurrences.

INTRODUCTION: Inverted papillomas (IP) are benign epithelial tumors with a tendency to be locally invasive and with disposition to recur. The aim of our study is to present the results of IP treatment, considering pathological, immunohistochemical and molecular features of recurrence. MATERIAL AND METHODS: From 1978 to 2020, 186 sinonasal IPs surgeries corresponding to 152 patients were treated in our center. We performed a pathology evaluation of all the recurrent cases reviewing the histological diagnosis, the presence of mixed component other than IP, the koilocytic changes, the p16 over expression and HPV-DNA detection. RESULTS: Overall recurrence rate was 19 % (35/186). The 35 IP recurrences correspond to 22 patients, 9 of whom presented a single recurrence (single recurrence group) while 13 of them presented more than one recurrence (multi-recurrent group). Immunohistochemical analysis showed a higher percentage of p16 overexpression (54 % vs 33 % p = 0.415) and HPV-DNA presence (23 % vs 0 % p = 0.240) in the multi-recurrent group compared with single recurrence group. In addition, the revision showed more IP with exophytic papilloma focus (38 vs 22 % p = 0.648) and a higher proportion of IP with koilocytotic changes (61 % vs 22 % p = 0.099) in the multirecurrent group. There is no significant difference between groups in our results. CONCLUSION: The analysis of our patients may differentiate between two groups with recurrent papillomas. A single recurrence group where the cause of recurrence is probably an anatomical problem related to an incomplete resection, and a second pattern, the multi-recurrence group, where HPV infection may be the main cause of recurrence.

"The Accessory Ethmoidal Canal Does Not Necessarily Contain an Arterial Structure".

Introduction: The aim of our study is to describe the prevalence of the accessory ethmoidal artery in endonasal endoscopic cadaver dissections and to identify its intraorbital origin. Material and Methods: From 2018 to 2020, thirty-four nasal dissections were performed in seventeen adult cadaveric heads. We performed a complete ethmoidectomy to identify the ethmoidal canals. Then, we removed the bony canal and the lamina papiracea to verify the injected vessel and to confirm the vascular structure inside the canal. Results: We found the anterior ethmoidal canal (AEC) and the posterior ethmoidal canal (PEC) in 100% of nasal cavities (34/34). We identified 4 accessory ethmoidal canals (AcEC) in the 34 nasal fossae dissected (12%). All AEC contained an arterial vessel. The AcEC contained an arterial vascular structure in 2 cases, a neural structure in other specimen, and in the fourth case no structure could be verified. In 32 of 34 nasal cavities, the PEC contained an artery and only in 2 cases the PEC did not contain any vascular structure. In these specimens, we observed that the AcEC with an arterial vessel inside (6%) was closer to the posterior canal than the anterior canal. Conclusion: According to our findings, we can suggest that the presence of a canal does not necessarily imply the presence of an arterial vessel, and that presence of the accessory ethmoidal artery could be associated with the absence of posterior ethmoidal artery.

Reconstruction of the lower lip after broad oncologic resection by Colmenero flap: a reliable option.

OBJECTIVE: Reconstruction of the lower lip is complex. The Colmenero flap is an effective albeit rarely described method for the repair of medium- to large-sized defects of the lower lip. METHODS: A retrospective review was carried out using data gathered from patients who had undergone Colmenero flap reconstruction of the lower lip at our centre between 2015 and 2020. We analysed demographic, histologic and anatomic variables as well as surgical results. This review assessed flap functionality based on proper mouth closure, absence of microstomia and oral competence. RESULTS: Thirteen Colmenero flaps were performed in 9 patients, with the flap being used bilaterally in four cases. All patients had squamous cell carcinoma of the lower lip. The mean length of the reconstructed defect was 4.1 cm (ranging between 3-7.5 cm). None of the flaps exhibited signs of necrosis. Five patients required minor surgical touch up during the second procedure: two for dehiscence, two for oral leakage and one for esthetic improvement. All patients had excellent functional and aesthetic final outcomes. CONCLUSIONS: The Colmenero flap is a good resource for medium- and large-sized lower lip reconstructions due to its reliability, limited complications, and good aesthetic and functional results.

Management of Patients With Graves Orbitopathy Using Endonasal Endoscopic Techniques.

OBJECTIVE: The aim of the authors' study is to show their surgical results in orbital decompression using different endonasal endoscopic techniques. These approaches are according to the degree of proptosis and the presence or not of sight threatening. METHODS: The authors performed 31 orbital decompressions on 20 Graves orbitopathy patients. Average age at surgery was 52 years. There were 5 males and 15 females. Five patients were diagnosed as having severe or for sight-threatening Graves orbitopathy. These included 3 men and 2 women having an average age of 54 years old. Minimum postsurgical follow-up was 12 months in all patients. RESULTS: Orbital decompression was performed in 15 patients for proptosis and in 5 patients for urgent sight threat. Thirteen orbits showed mild proptosis and 18 orbits presented moderate proptosis. In patients without sight threatening reduction of proptosis had a mean value of 2.8 mm as determined by exophtalmometry, being 3.3 mm when measured on magnetic resonance imaging. The mean millimeter in mild proptosis was between 1.5 and 1.7 and between 3.4 and 4.2 in moderate proptosis. In patients having sight threat mean visual acuity after surgery improved from 0.6 to 0.9.Only 1 patient without diplopia preoperative developed diplopia after surgery (17%). In 55% of patients strabismus and/or eyelid surgery were required.In postoperative follow-up, 2 patients developed a mucocele and 1 patient developed corneal erosion. CONCLUSION: The authors recommend the preservation of the periorbital sling and the anterior ethmoido-maxillary angle in patients with mild-moderate exophthalmos and without threatened vision. In case of sight threatening the authors resected the most periorbita as much as possible.Evidence-based medicine Level V.

Endoscopic Medial Maxillectomy With Preservation of Inferior Turbinate: Assessing Results by Acoustic Rhinometry.

BACKGROUND: The aim of this study is to demonstrate the effectiveness of the Endoscopic Medial Maxillectomy technique with the preservation of the nasal anatomy and function of the inferior turbinate. METHODS: From January 2005 to December 2016, the authors performed 27 Endoscopic Medial Maxillectomy with preservation of inferior turbinate on 26 patients. The most frequent pathologies diagnosed were inverted papillomas (13/27) and antrochoanal polyps (7/27). There were 21 primary lesions and 6 patients had been previously treated. There were 19 males and 7 females. On 11 patients the authors could perform an acoustic rhinometry at 4 months postoperatively. RESULTS: The authors did not find any recurrences. In all cases the authors note the presence of the C-notch being the narrowest area of the nasal cavity, on both the surgical and nonsurgical nasal fossa. The mean area for the C-notch in the nonsurgical nasal cavities was 0.50 cm (0.18-0.82) and it was 0.57 cm (0.08-1.06) in the surgical nasal cavities. The increase of the C-notch after nasal decongestion was 0.10 cm in nonsurgical cavities and it was 0.03 cm in the surgical cavities. The mean distance for the C-notch was 2.18 cm and 2.36 cm before and after nasal decongestion in the nonsurgical fossae. In the surgical cavities were 2.31 and 2.37  cm respectively. CONCLUSIONS: The authors' rhinometrics data suggest that Endoscopic Medial Maxillectomy with preservation of inferior turbinate is an effective technique that preserves the anatomic structure and the functions of the inferior turbinate after its resection and reposition.

Tumor de células granulares en músculo masetero / Granular cell tumour in the masseter muscle

No disponible

Surgical Anatomy of the Medial Wall of the Orbit in 14 Human Cadavers.

Objective The aim of our study is to present the anatomical landmarks to perform an endoscopic endonasal approach to the medial wall of the orbit (EEAMO). Material and Methods We performed 14 complete nasal and orbital endoscopic dissections in 7 adult cadaveric heads. Results The EEAMO provides a surgical corridor between the medial rectus muscle superiorly and the inferior rectus muscle inferiorly .The mean distance between the ethmoidal crest and medial rectus muscle was 1.5 cm (range, 1.3-1.9 cm). The width of the medial rectus muscle was 1.2 cm (range, 1-1.5 cm). The main vascular structure in this retrobulbar space was the ophthalmic artery that crosses over the optic nerve in 86% of the cases. In its intraorbital route, the anterior ethmoidal artery and the ethmoidal nerves were situated inferior to the superior oblique muscle in all cases. The posterior ethmoidal artery was found superior to it. We could identify the inferior division of the oculomotor nerve in this surgical approach. Conclusions The EEAMO allows adequate exposure of the space between the medial rectus muscle and the inferior rectus muscle. The location of the ethmoidal crest of the palatine bone, and its relationship with the medial rectus muscle, is a useful anatomical landmark for this surgical approach.

A unilateral septal flap based on the anterior ethmoidal artery (Castelnuovo's flap): CT cadaver study.

OBJECTIVE: We describe our experience for repair septal perforation with a septal flap and we analyse the route of the septal branch of the anterior ethmoidal artery (AEA) in the septum area with a radiological anatomy study in order to perform this flap. STUDY DESIGN: We carry out a prospective analysis with computed tomography scan in the cadaver heads and we perform an endoscopic technique in the patients. METHODS: Ten nasal cavities were analysed in five adult cadaveric heads and two patients diagnosed with anterior septal perforation were surgically treated. Measurements in the cadaveric heads were obtained from a sagittal plane of the nasal septum. The anterior point corresponds to the projection of the anterior insertion of the middle turbinate in the frontal process of the maxilla over the nasal septum. The posterior point was obtained with a vertical line passing through the entrance of the AEA in the nasal septum. RESULTS: The mean distance between the anterior point and the posterior point was 7.35 mm with a standard deviation of 0.95 mm. The lowest value was 5.5 mm and the highest value was 8.7 mm. We observed good epithelialisation and closure of the perforation in all patients. CONCLUSION: The unilateral septal flap pedicle by anterior ethmoidal artery may be used for small and medium perforations with a pedicle smaller than 1 cm posterior to the axilla.

Análisis clínico y resultados quirúrgicos en 58 mucoceles nasosinusales / Clinical analysis and surgical results of 58 paranasal sinus mucoceles

Introducción: Los mucoceles son lesiones benignas que afectan a los senos paranasales, de crecimiento lento, con capacidad de reabsorción ósea. Exponemos nuestra experiencia en el tratamiento quirúrgico de estas lesiones. Métodos: Se realizó un estudio retrospectivo de 58 mucoceles nasosinusales diagnósticados en 54 pacientes entre los años 1989-2012. Se analizaron las diferentes localizaciones, distribución por edad y sexo, características clínicas, tipo de abordaje quirúrgico, recidivas y complicaciones. Resultados: La edad media de los pacientes en el momento del diagnóstico fue de 59 años. El 57% de los pacientes (31/54) fueron varones y el 43% (23/54) mujeres. En el 55% de los casos (32/58) el mucocele estaba localizado en el seno frontal o en la región frontoetmoidal, un 14% (8/58) en el seno etmoidal, un 24% (14/58) en el seno maxilar y un 7% (4/58) en seno esfenoidal. En el 55% de los casos se identificó algún factor predisponente, siendo el 45% mucoceles primarios. El 71% de los pacientes fueron tratados con un abordaje endonasal endoscópico y en el 29% se realizó un abordaje abierto o combinado. Observamos un total de 4 recidivas (7%), 2 en el grupo abordaje endonasal endoscópico y 2 en el grupo tratado con cirugía abierta. Conclusiones: El tratamiento de elección de los mucoceles nasosinusales es la arsupialización por vía endonasal endoscópica, siendo una técnica segura y con buenos resultados (AU)

Introduction: Mucoceles are slow-growing, benign lesions found in the paranasal sinuses that are locally destructive, causing bony resorption an displacement of adjacent structures. We present our experience in the surgical treatment of these lesions. Methods: This was a retrospective review of 58 paranasal sinus mucoceles in 54 patients between 1989 and 2012. We describe patient age and sex, mucocele location, clinical features, surgical approaches employed, recurrence and complications. Results: The mean age of patients in this series was 59 years; there were 31 males (57%) and 23 females (43%). Thirty-two cases (55%) were located in the frontal or ethmoid-frontal system, 8 (14%) in the ethmoid sinus, 14 (24%) in the maxillary sinus and 4 (7%) in sphenoid sinus. Predisposing factors were present in 55% of the patients and 45% cases were primary. Endoscopic treatment was given to 71% of mucocele patients, while 29% were treated with external or combined approaches. Recurrence appeared in 4 patients (7%), 2 in the endoscopic surgery group and 2 in the external surgery group. Conclusions: The procedure of choice for management of paranasal sinus mucoceles is endoscopic drainage. It is a safe approach that gives good results (AU)

[Clinical analysis and surgical results of 58 paranasal sinus mucoceles]. / Análisis clínico y resultados quirúrgicos en 58 mucoceles nasosinusales.

INTRODUCTION: Mucoceles are slow-growing, benign lesions found in the paranasal sinuses that are locally destructive, causing bony resorption an displacement of adjacent structures. We present our experience in the surgical treatment of these lesions. METHODS: This was a retrospective review of 58 paranasal sinus mucoceles in 54 patients between 1989 and 2012. We describe patient age and sex, mucocele location, clinical features, surgical approaches employed, recurrence and complications. RESULTS: The mean age of patients in this series was 59 years; there were 31 males (57%) and 23 females (43%). Thirty-two cases (55%) were located in the frontal or ethmoid-frontal system, 8 (14%) in the ethmoid sinus, 14 (24%) in the maxillary sinus and 4 (7%) in sphenoid sinus. Predisposing factors were present in 55% of the patients and 45% cases were primary. Endoscopic treatment was given to 71% of mucocele patients, while 29% were treated with external or combined approaches. Recurrence appeared in 4 patients (7%), 2 in the endoscopic surgery group and 2 in the external surgery group. CONCLUSIONS: The procedure of choice for management of paranasal sinus mucoceles is endoscopic drainage. It is a safe approach that gives good results.