Image guided navigation system-a new technology for complex endoscopic endonasal surgery.

PURPOSE: Endoscopic endonasal surgery (EES) has become the standard practice in sinonasal and anterior skull base surgery. The purpose of this manuscript is to describe experience using a new technology-the image guided navigation system (IGNS)-in complex cases undergoing EES. The advantages and disadvantages of computer aided surgery are discussed. PATIENTS AND METHODS: A total of 165 endoscopic endonasal procedures were performed between April 2001 and January 2003. IGNS was used in 34 patients in whom it was assumed that the ability to identify surgical sites accurately could be compromised by previous surgery, massive recurrent polyposis, or abnormal anatomy, or when biopsies had to be taken from specific anatomic locations (for example, clivus, wall of sphenoid sinus, orbital apex). The precision of the navigation system, total operating room time, surgeon's satisfaction and confidence, and intraoperative and postoperative complications were recorded. RESULTS: In 33 out of 34 patients the surgical procedure was uneventful. One patient with an atelectatic maxillary sinus developed a minor complication of preseptal orbital haematoma. In 94% the IGNS provided accurate anatomical localisation with less than 2 mm localisation error (1.1-2.0 mm, mean 1.6 mm). In all cases the surgical team felt that the system increased the intraoperative safety factor for the patient. The overall operating room time at the end of the study was 15 minutes longer than when regular EES was used. CONCLUSIONS: IGNS enables a new level of efficiency and safety in EES. Nevertheless, it is not advised for surgeons who are not familiar with regular EES. For the experienced endoscopist, however, IGNS is a valuable new tool in complex procedures.

Artifactual thickening of the sinus walls on computed tomography: a phantom model and clinical study.

Measuring sinus wall thickness on computed tomography may be important for distinguishing between acute and chronic inflammation of the paranasal sinuses or in cases of a suspected neoplasm. The objective of this study was to investigate the effects of opacified and aerated sinuses on the appearance of sinus wall thickness. A phantom model consisting of a skull half-immersed in water was scanned, and various slice thicknesses and different windows were used. The sinus walls of the water-immersed side appeared to be thicker than those of the aerated side. Bone windows did not completely eliminate this partial volume effect. It was concluded that comparison between a fluid- or tissue-filled sinus and an air-filled counterpart is not accurate enough for evaluating sinus wall thickness. Bone windows do not completely eliminate the artifactual thickening of the bony wall of a filled sinus.

Computed tomography diagnosis of esophageal bone impaction: a prospective study.

A prospective study was performed on 45 patients for an assessment of the use of computed tomography (CT) in the management of a suspected esophageal fish bone or chicken bone. All patients had negative findings on laryngoscopy; therefore, pharyngeal and hypopharyngeal foreign bodies were excluded from further consideration. The patients underwent radiographic examination with plain films and a cervical CT scan without contrast material. Patients with positive findings were taken to the operating room, where they underwent rigid esophagoscopy under general anesthesia, while those with negative findings remained for observation for 24 hours. Thirty CT scans were positive for an esophageal foreign body, and in all cases but 1, a foreign body was found during the operation. Fourteen of 15 patients with normal CT scan findings managed well with no further intervention. One patient with persistent complaints underwent esophagoscopy, but no foreign body was found. Our conclusion is therefore that CT is a simple and reliable method for diagnosing esophageal bone impaction and may reduce the rate of unnecessary esophagoscopies.

Dermoid cyst of the eustachian tube.

We report a case of dermoid cyst of the Eustachian tube in a 2 1/2 -year-old-girl with CT and MRI imaging. This is the 12th described case of such a pathology. Most of the reviewed previous 11 cases affected females on the left side. The surgical approach and the contribution of CT and MRI are discussed.

Experimental surgical treatment for recurrent epistaxis.

PURPOSE: To evaluate a new technique of submucosal supraperichondrial (SMSP) dissection of the nasal septum and its subsequent effect on the vascularity of the mucosa. A reduction may decrease the rate of recurrent anterior epistaxis. MATERIALS AND METHODS: The procedure was performed on one side of the nasal septum of 16 laboratory rabbits. After healing occurred 3 months later, the animals' septa were excised and stained. Both sides were then compared by using standardized microscopic field analysis. RESULTS: The reduction in both the number of blood vessels on the operated side of the septum and the proportion of area occupied by these vessels was statistically significant (P < .004). CONCLUSION: This technique led to a reduction in the vascularity of the nasal septal mucosa, 3 months after dissection was performed. Healing, which occurs by a process of fibrosis, yielded a less vascularized tissue. Although further laboratory and clinical assessment is recommended, this technique may prove valuable in reducing the rate of recurrent anterior epistaxis.

Clinical update on type II first branchial cleft cysts.

OBJECTIVE: To describe clinical and radiological signs of type II first branchial cleft cyst in order to facilitate diagnosis. METHOD: Report of three cases of first branchial cleft cyst type II (one of them in association with ipsilateral agenesis of the parotid gland) and review of the literature. RESULTS: Two clinical signs are described: the location of the sinus opening in the neck, which is situated in a triangle limited by the external auditory canal above, the mental region anteriorly, and the hyoid bone inferiorly, and the presence in some cases of a myringeal web that runs from the floor of the external auditory canal to the umbo. In addition, imaging with computed tomography and magnetic resonance of the parotid area may be helpful in confirming the diagnosis.

Fibrosarcoma of the thyroid in a man exposed to fallout from the Chernobyl accident.

Since the Chernobyl accident in April 1986, a dramatic increase in the incidence of thyroid carcinoma has been described, especially in children. A case of sarcoma of the thyroid in a man exposed to the Chernobyl fallout is presented. Sarcoma of the thyroid is a rare finding. The present patient lived in a region that is known to be one of the most exposed to Chernobyl fallout. The case suggests a high probability of a relationship between the sarcoma of the thyroid and the exposure to radiation.

Aural myiasis caused by flesh fly larva, Sarcophaga haemorrhoidalis.

During the years 1990 to 1993, four cases of aural myiasis in children, caused by the flesh fly larvae of Sarcophaga haemorrhoidalis, are reported. The patients were admitted to the Emergency Room complaining of discharging ear, otalgia, and itching. Flesh fly larvae were removed after local treatment and identified as Sarcophaga haemorrhoidalis. These cases are discussed with a review of the literature.

Novel parameters of human sperm hypoosmotic swelling test and their correlation to standard spermatogram, total motile sperm fraction, and sperm penetration assay.

OBJECTIVE: To improve the accuracy of human sperm hypoosmotic swelling test by introducing new morphological evaluation parameters for this test. DESIGN: Individual semen samples were processed, and the standard spermatogram, total motile sperm fraction, sperm penetration assay (SPA), and hypoosmotic swelling test were performed. SETTING: Male infertility clinic and andrologic laboratory in a university medical center. PATIENTS: One hundred eighteen subfertile men undergoing an infertility work-up. MAIN OUTCOME MEASURES: The results of hypoosmotic swelling test were subdivided into four groups (hypoosmotic swelling test 1, 2, 3, 4) according to the different shapes of hypoosmotically affected spermatozoa tails. RESULTS: The hypoosmotic swelling test 3 had the best correlation with the different sperm parameters: motility, total motile sperm fraction, concentration, and SPA. The hypoosmotic swelling test 1 showed a satisfactory interrelation for concentration and for total motile sperm fraction but no correlation for motility and SPA. The hypoosmotic swelling test 2 and the hypoosmotic swelling test 4 demonstrated no correlation at all with motility, concentration, morphology and SPA. CONCLUSIONS: The precision of hypoosmotic swelling test may be improved by using the hypoosmotic swelling test 3 type of spermatozoa tail shape as the parameter for a normally functioning spermatozoa.