Manejo de epistaxis posterior en el Hospital Clínico de la Universidad de Chile entre los años 2013 y 2016 / Treatment of posterior epistaxis in the Clinical Hospital of the University of Chile between the years 2013 and 2016

Introducción: La epistaxis corresponde a una de las causas más frecuentes de consulta otorrinolaringológica en los servicios de urgencia. La epistaxis posterior es menos frecuente pero su presentación más severa. Existen varias alternativas terapéuticas, en las últimas décadas el manejo quirúrgico endoscópico de la arteria esfenopalatina (AEP) ha ido en aumento dado las ventajas en comodidad para el paciente y reducción de costos asociados. Objetivo: Revisar el manejo realizado en los cuadros de epistaxis posterior en el Hospital Clínico de la Universidad de Chile (HCUCh). Material y método: Estudio descriptivo en el Servicio de Otorrinolaringología del HCUCh de pacientes que presentaron epistaxis posterior entre el año 2013 y 2016. Resultados: Se revisó un total de 33 casos. La edad promedio de los pacientes fue 61,6 años siendo las comorbilidades más frecuentes la hipertensión arterial (36,3%) y fibrilación auricular (18,1%). Se realizó tratamiento quirúrgico en 57,6% de los pacientes siendo el clipaje de AEP la intervención quirúrgica más frecuente. Discusión y conclusiones: Tanto el manejo tradicional como las técnicas quirúrgicas presentaron eficacia similar en la serie revisada.

Introduction: Epistaxis corresponds to one of the most frequent causes of otorhinolaryngological consultation in the emergency services. Posterior epistaxis is less frequent but more severe. There are several therapeutic alternatives, in recent decades the surgical endoscopic management of the sphenopalatine artery (AEP) has been increasing given the advantages in comfort for the patient and reduction of associated costs. Aim: To review the management of posterior epistaxis in the Clinical Hospital of the University of Chile (HCUCh). Material and method: Descriptive study in the Otorhinolaryngology Service of the HCUCh of patients who presented posterior epistaxis between the years 2013 and 2016. Results: A total of 33 cases were reviewed. The mean age of the patients was 61.6 years, with the most frequent comorbidities being hypertension (36.3%) and atrial fibrillation (18.1%). Surgical treatment was performed in 57.6% of the patients, with AEP clipping being the most frequent surgical intervention. Conclusion: Both traditional management and surgical techniques presented similar efficacy in the revised series.

Cirugía endoscópica nasosinusal de revisión / Revision endoscopic sinonasal surgery

Introducción y objetivos. La cirugía endoscópica nasosinusal es el procedimiento de elección para tratar la rinosinusitis crónica y poliposis nasosinusal refractarias a tratamiento médico, con un alto porcentaje de éxito (76 a 97,5%). Sin embargo, de 2,5 a 24% de los pacientes requieren cirugía de revisión. En este estudio describimos las características clínicas, anatómicas, radiológicas e histológicas de pacientes sometidos a cirugía de revisión en nuestro centro, en un período de 3 años. Métodos. Revisión retrospectiva de datos clínicos, anatómicos, radiológicos e histopatológicos de pacientes sometidos a revisión entre 2012 y 2014. Resultados. De 299 procedimientos quirúrgicos realizados, 27 (9%) fueron de revisión. La edad promedio de los pacientes fue 46 años, con una relación hombre:mujer de 1,4:1. El diagnóstico preoperatorio y postoperatorio más frecuente fue rinosinusitis crónica poliposa. El tiempo promedio desde la cirugía previa fue de 6,1 años, con 11,9 meses de seguimiento promedio desde esa cirugía. Un 81,5% de los pacientes presentaba antrostomía estenótica durante la revisión, y un 59,3% etmoidectomía anterior incompleta y proceso unciforme persistente. El 70,4% de los pacientes tenía celdillas etmoidales anteriores persistentes en radiología. Se realizó en un 96,3% de los casos antrostomía o ampliación de esta, y en un 66,7% se realizó o se completó la etmoidectomía anterior. Conclusiones. Las causas más frecuentes de revisión fueron los pólipos, antrostomía estenótica y etmoidectomía incompleta, concordante con los procedimientos realizados. Los pacientes tuvieron largos períodos sin seguimiento entre cirugías. Es necesario continuar la investigación para generar medidas que reduzcan el número de cirugías de revisión (AU)

Introduction and objectives. Endoscopic sinonasal surgery is the procedure of choice in the treatment of chronic rhinosinusitis and sinonasal polyposis refractory to medical treatment, with high rates of success (76% to 97.5%). However, 2.5%-24% of those patients will require revision surgery (RESS). In this study, we present the clinical, anatomical, radiological and histological features of patients receiving RESS in our centre during a 3-year period. Methods. A retrospective review of clinical, anatomical, radiological and histopathological data of patients receiving revision endoscopic sinonasal surgery between 2012 and 2014 was carried out. Results. From 299 surgery procedures performed, 27 (9%) were revision surgeries. The mean patient age was 46 years, with a male/female ratio of 1.4/1. The most frequent preoperative and postoperative diagnosis was chronic polypoid rhinosinusitis. The mean time since the previous surgery was 6.1 years, with 11.9 months of mean follow-up since that surgery. Stenotic antrostomy was found during revision in 81.5% of the patients and incomplete anterior ethmoidectomy and persistent uncinate process, in 59.3%. In radiology, 70.4% of patients had persistent anterior ethmoidal cells. Antrostomy or widening of antrostomy was performed in 96.3% of cases and anterior ethmoidectomy or completion of it was performed in 66.7%. Conclusions. Polyps, stenotic antrostomy and incomplete ethmoidectomy were the most frequent causes of revision surgery, in concordance with the procedures performed. The patients had long periods of time without follow-up between surgeries. Further investigation is necessary to generate measures to reduce the number of revision surgeries (AU)

Revision endoscopic sinonasal surgery. / Cirugía endoscópica nasosinusal de revisión.

INTRODUCTION AND OBJECTIVES: Endoscopic sinonasal surgery is the procedure of choice in the treatment of chronic rhinosinusitis and sinonasal polyposis refractory to medical treatment, with high rates of success (76% to 97.5%). However, 2.5%-24% of those patients will require revision surgery (RESS). In this study, we present the clinical, anatomical, radiological and histological features of patients receiving RESS in our centre during a 3-year period. METHODS: A retrospective review of clinical, anatomical, radiological and histopathological data of patients receiving revision endoscopic sinonasal surgery between 2012 and 2014 was carried out. RESULTS: From 299 surgery procedures performed, 27 (9%) were revision surgeries. The mean patient age was 46 years, with a male/female ratio of 1.4/1. The most frequent preoperative and postoperative diagnosis was chronic polypoid rhinosinusitis. The mean time since the previous surgery was 6.1 years, with 11.9 months of mean follow-up since that surgery. Stenotic antrostomy was found during revision in 81.5% of the patients and incomplete anterior ethmoidectomy and persistent uncinate process, in 59.3%. In radiology, 70.4% of patients had persistent anterior ethmoidal cells. Antrostomy or widening of antrostomy was performed in 96.3% of cases and anterior ethmoidectomy or completion of it was performed in 66.7%. CONCLUSIONS: Polyps, stenotic antrostomy and incomplete ethmoidectomy were the most frequent causes of revision surgery, in concordance with the procedures performed. The patients had long periods of time without follow-up between surgeries. Further investigation is necessary to generate measures to reduce the number of revision surgeries.

Enfermedad de Erdheim-Chester de localización nasosinusal / Erdheim-Chester disease in a sinonasal location

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Fibroangioma extranasofaríngeo de cornete nasal inferior: presentación de un caso / Extranasopharyngeal angiofibroma of the left lower turbinate: A case report

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Cuerpo extraño nasosinusal inusual: presentación de 3 casos / Unusual sinonasal foreign body: Presentation of three cases

Los cuerpos extraños nasosinusales son poco frecuentes. Su presencia en las cavidades perinasales puede originar complicaciones, por lo que su extracción siempre está indicada. Presentamos 3 casos clínicos de cuerpo extraño nasosinusal, exponemos su sintomatología, hallazgos imagenológicos y extracción quirúrgica. A cada uno de los sujetos se le realizó un estudio con tomografía computarizada de cavidades perinasales, endoscopia rígida y cirugía endoscópica nasosinusal. Se confirmó la presencia de cuerpo extraño y se realizó la extracción quirúrgica de este por vía endoscópica transnasal. Los cuerpos extraños nasosinusales son cuadros infrecuentes que requieren su extracción para evitar complicaciones, siendo la cirugía endoscópica transnasal la vía de abordaje más usada (AU)

Sinonasal foreign bodies are rare clinical entities. Their presence in the sinuses can originate complications, so their removal is always indicated. We present 3 cases of sinonasal foreign body, indicating their symptoms, imaging findings and surgical removal. Each patient was assessed with computerized tomography of the sinuses, rigid endoscopy, and then surgical removal. We confirmed the presence of the foreign bodies in all 3 cases and then performed a successful surgical removal by transnasal endoscopy. Sinonasal foreign bodies are infrequent entities that require surgical removal to prevent complications, with transnasal endoscopic surgery being the most commonly used surgical approach (AU)

Unusual sinonasal foreign body: presentation of three cases.

Sinonasal foreign bodies are rare clinical entities. Their presence in the sinuses can originate complications, so their removal is always indicated. We present 3 cases of sinonasal foreign body, indicating their symptoms, imaging findings and surgical removal. Each patient was assessed with computerized tomography of the sinuses, rigid endoscopy, and then surgical removal. We confirmed the presence of the foreign bodies in all 3 cases and then performed a successful surgical removal by transnasal endoscopy. Sinonasal foreign bodies are infrequent entities that require surgical removal to prevent complications, with transnasal endoscopic surgery being the most commonly used surgical approach.

Manejo endoscópico de mucoceles de senos paranasales: experiencia en 46 pacientes / Endoscopic management of paranasal sinus mucoceles: experience with 46 patients

Objetivo: El propósito de este estudio es determinar los cambios en el tratamiento quirúrgico de los pacientes con diagnóstico de mucocele paranasal manejados en un hospital terciario de Latinoamérica. Nuestra hipótesis es que en los últimos ocho años la cirugía endoscópica endonasal ha emergido como la principal opción de tratamiento para esta patología. Material y métodos: Estudio retrospectivo descriptivo de todos los pacientes que fueron diagnosticados y tratados por mucocele de seno paranasal en el Departamento de Otorrinolaringología y Cirugía de Cabeza y Cuello de nuestro hospital durante los años 2002 al 2010. Se registraron datos demográficos de los pacientes, localización del mucocele, síntomas, abordaje quirúrgico y complicaciones. Resultados: Se incluyeron un total de 46 pacientes (27 de sexo masculino y 19 femenino). Esta serie comprendió 29 pacientes con mucocele frontal o frontoetmoidal (63%), 14 con mucocele maxilar (30,4%) y 3 pacientes con mucocele esfenoidal (6,5%). El 95% de los pacientes fueron tratados con cirugía endoscópica endonasal. Sólo 7 casos presentaron complicaciones (15,2%).Conclusiones: Este estudio confirma que en los últimos 9 años ha ocurrido un cambio significativo en el tratamiento quirúrgico de los mucoceles de cavidades paranasales, con un aumento de la cirugía endoscópica de un 34% a más de un 90%, siendo la primera opción de tratamiento (AU)

Objective: The purpose of this study was to determine changes in the surgical treatment of patients with the diagnosis of paranasal mucoceles managed in a Latin American hospital. We hypothesised that endonasal endoscopic surgeries had emerged as the main treatment option for this disease in the last five years. Methods: A retrospective chart review of all patients who were diagnosed with paranasal sinus mucoceles and treated at the Otorhinolaryngology Head and Neck Department of our hospital from 2002 to 2010 was performed. Patient demographic data, mucoceles location, symptoms, surgical approach and complications were recorded. Results: A total of 46 patients were included (27 males; 19 females). This series include 29patients (63%) with frontal or frontoethmoidal mucoceles, 14 (30.4%) with maxillary and 3 (6.5%) with sphenoid mucoceles. Ninety-five percent of the patients were treated with intranasal endoscopic surgery. Complications occurred only in 7 cases (15.2%). Conclusions: This study confirms that over the last 9 years significant changes have occurred in the surgical treatment of paranasal mucocele in our hospital, as endoscopic surgeries increased from 34% to over 90% as the first option of treatment for mucoceles (AU)

[Endoscopic management of paranasal sinus mucoceles: experience with 46 patients]. / Manejo endoscópico de mucoceles de senos paranasales: experiencia en 46 pacientes.

OBJECTIVE: The purpose of this study was to determine changes in the surgical treatment of patients with the diagnosis of paranasal mucoceles managed in a Latin American hospital. We hypothesised that endonasal endoscopic surgeries had emerged as the main treatment option for this disease in the last five years. METHODS: A retrospective chart review of all patients who were diagnosed with paranasal sinus mucoceles and treated at the Otorhinolaryngology Head and Neck Department of our hospital from 2002 to 2010 was performed. Patient demographic data, mucoceles location, symptoms, surgical approach and complications were recorded. RESULTS: A total of 46 patients were included (27 males; 19 females). This series include 29 patients (63%) with frontal or frontoethmoidal mucoceles, 14 (30.4%) with maxillary and 3 (6.5%) with sphenoid mucoceles. Ninety-five percent of the patients were treated with intranasal endoscopic surgery. Complications occurred only in 7 cases (15.2%). CONCLUSIONS: This study confirms that over the last 9 years significant changes have occurred in the surgical treatment of paranasal mucocele in our hospital, as endoscopic surgeries increased from 34% to over 90% as the first option of treatment for mucoceles.