[The evolution of ideas about cyst-like stretching of the paranasal sinuses. Part I]. / Evolyutsiya predstavlenii o kistovidnom rastyazhenii okolonosovykh pazukh. Chast' I.

Treatment of patients with severe chronic and recurrent forms of sinusitis, complicated by pathological stretching of the paranasal sinuses, is not a trivial task. This is especially true for those clinical cases where a pathological increase in the size of the sinus leads to widespread destruction of its walls and may be accompanied by serious complications from adjacent structures. The paper presents an analytical review of publications on the topic of pathological stretching of the paranasal sinuses. Potential factors influencing the development of this pathology, mechanisms of pathogenesis and classification options are described in detail. Modern approaches are considered in the surgical treatment of this pathology, which can be carried out in one or two stages, depending on the presence of secondary aesthetic defects.

[Effects of different surgical methods on the application of topical hormones in the sinus after operation].

Chronic rhinosinusitis （CRS） is a common chronic inflammatory disease in otorhinolaryngology, in which eosinophilic chronic rhinosinusitis with nasal polyps represents the difficult-to-treat chronic rhinosinusitis （DTCRS） with poor prognosis. DTCRS has a poor prognosis, which seriously affects people's physical and mental health, and is treated with various means, including medication, biotherapy and surgery. In recent years, endoscopic sinus surgery and postoperative local administration of nasal hormones as one of its treatment methods have achieved good results. In this paper, we review the relevant literature at home and abroad and give an overview for the treatment means of surgery, focusing on the effect of endoscopic sinus surgery on the distributable range of postoperative nasal glucocorticosteroids in patients with DTCRS, and then on the postoperative efficacy of the treatment, with a view to providing a reference for the clinical treatment of DTCRS.

["Radical" versus "functional" surgery of the paranasal sinuses-A contradiction?] / "Radikale" vs. "funktionelle" Chirurgie der Nasennebenhöhlen ­ ein Widerspruch?

BACKGROUND AND OBJECTIVE: The terms "functional" and "radical" paranasal sinus surgery were often considered to be different operations which were mutually exclusive. This overview aims to look at the basics of these terms and surgical procedures and to work out the resulting surgical concepts for clinically relevant indications. MATERIAL AND METHODS: Selective literature analysis using the data base PubMed, corresponding textbooks and resulting secondary literature regarding functional and radical or extended paranasal sinus surgery. Similarly, the current literature regarding clinically relevant indications for sinus surgery were analyzed. RESULTS AND CONCLUSION: Modern pathophysiological knowledge, anatomically and pathophysiologically substantiated endoscopic surgical procedures and the usage of up to date technical possibilities have resulted in concepts which combine functional and so-called radical or extended surgery of the paranasal sinuses that complement each other and sometimes even overlap. The preoperative diagnosis and definition of underlying diseases are decisive and should be as precise as possible, as the extent and surgical details mainly depend on them: a sole creation of free drainage pathways, an additional creation of anatomical access for subsequent topical treatment or a complete (radical) removal of a pathological process.

Comparison of intranasal medication delivery devices before and after functional endoscopic sinus surgery using Phacon sinus surgery models.

OBJECTIVE: Functional endoscopic sinus surgery for chronic rhinosinusitis improves sinus drainage and intranasal medication delivery. This study compares medication delivery with commonly used devices in normal and altered anatomy (post functional endoscopic sinus surgery) using sinus surgery models (Phacon). METHODS: Medication delivery was simulated via nasal drops, nasal spray and an irrigation device (Neilmed Sinus Rinse). Coverage was then calculated from endoscopic pictures taken at various anatomical sites in the normal nose and post functional endoscopic sinus surgery. RESULTS: In the normal nose, nasal spray did not penetrate the sphenoid sinus, and drops bypassed the vestibule anteriorly. Neilmed Sinus Rinse provided superior coverage at the sphenoid site following sphenoidectomy and the frontal site following Draf III. After ethmoidectomy, nasal drops overall provided less coverage than the other methods. CONCLUSION: Neilmed Sinus Rinse generally provided the best distribution, followed by the nasal spray and then nasal drops. The type and extent of surgery also affects medication delivery.

Effects of Endoscopic Sinus Surgery on Olfactory Function.

PURPOSE OF REVIEW: To review the effects of endoscopic sinus surgery and endonasal approaches to the skull base on olfaction. RECENT FINDINGS: Advancements in endonasal endoscopic approaches to the sinuses and skull base allow for direct treatment of a variety of sinonasal and skull base diseases. However, these extended approaches will often require manipulation of normal anatomical structures and the olfactory neuroepithelium. Depending on the planned procedure and extent of disease, the prognosis of olfactory perception can vary significantly among patients. Endoscopic sinonasal surgical procedures may impact olfaction. Optimizing olfactory function requires proper surgical techniques, gentle handling of tissue, and perioperative care. Surgeons must discuss objectives and manage patient expectations. Routine olfactory assessment is crucial in surgical work-up and follow-up. Preserving anatomical structures while addressing the obstruction of the olfactory cleft helps to prevent decreased olfactory threshold. However, smell identification and discrimination do not always correlate with sinonasal anatomy.

[Pathogenetic approach in the treatment of inflammatory diseases of the nose and paranasal sinuses]. / Patogeneticheskii podkhod v terapii vospalitel'nykh zabolevanii nosa i okolonosovykh pazukh.

In recent years, inflammatory diseases of the nose and paranasal sinuses have been on the rise. In addition to infectious diseases, in the modern world a large percentage of the population suffers from allergic diseases. The approach to therapy and the choice of a drug should take into account the pathogenesis of the inflammatory reaction in the nasal cavity and paranasal sinuses. By exerting its effect, the drug should reduce hyperemia and swelling of the nasal mucosa, reduce the level of mucus secretion, improve the drainage of the paranasal sinuses, i.e. possess vasoconstrictive and anti-allergic properties. As such a drug, you can use the combined intranasal spray Frinozol, which basically contains cetirizine and phenylephrine. The use of Frinozol in the complex treatment of inflammation of the mucous membrane of the nasal cavity and paranasal sinuses contributes to the rapid and pronounced weakening of the symptoms of the disease, and is also the key to successful therapy.

Sheep's Head as an Anatomic Model for Basic Training in Endoscopic Sinus Surgery.

Background and Objectives: This study aims to establish the sheep head as a viable anatomical model for training in functional endoscopic sinus surgery through comprehensive anatomical examination and training-based assessment of participants' satisfaction. Materials and Methods: Participants were divided into three groups according to their prior experience in endoscopic sinus surgery; in total, 24 participants were included. Each participant in the study was assigned to perform the designated procedures on a single sheep's head. Following the completion of the procedures, each participant was provided with a 14-item comprehensive satisfaction questionnaire with a scale attributed from 1 to 5. The normality of distribution was checked by applying the Shapiro-Wilk Test. The Kruskal-Wallis test was applied to compare study group sentiment of agreement towards individual procedures. Results: No significant differences were noted between the answers of the different groups. For the resident group, the average satisfaction score was 4.09 ± 0.54; junior specialist group 4.00 ± 0.55; for the senior specialist group overall satisfaction average score was 4.2 ± 0.77. Conclusions: The sheep's head can be successfully used for learning and practicing manual skills and the use of instruments specific to functional endoscopic sinus surgery. Moreover, the sheep head model can be used for training in other diagnostic or surgical procedures in the field of otorhinolaryngology, such as endoscopy of the salivary glands, open laryngotracheal surgery, or in otologic surgery, but also in other different surgical fields such as neurosurgery, ophthalmology or plastic surgery. Despite the differences between the ovine model and human anatomy, it provides a resourceful and cost-effective model for beginners in endoscopic nasal surgery.

Maxillary ostium preservation in ethmoidectomy.

The paranasal sinuses play a role in producing and storing nitric oxide (NO). NO is a powerful antiviral and antibacterial gas which may be involved in the non-specific immune defenses of the respiratory tract. Conducted by the inspiratory current at the alveolar-capillary membrane, it increases pulmonary venous blood oxygenation. NO is actively released in the form of independent boluses in the respiratory tract, thanks to a sphincter function that can be identified during ethmoidectomy under general anesthesia. Safeguarding paranasal sinus physiology necessarily involves conserving this ostial sphincter function, which is essential to the respiratory role of the paranasal sinuses. Although it has not yet been demonstrated that the destruction of this ostial function has measurable consequences for respiratory function, it makes sense to avoid systematic antrostomy and to preserve this ostial function whenever possible, depending on the clinical conditions. This technical note describes step-by-step how to conserve the maxillary ostium, in the example of radical ethmoidectomy with mucosal ablation for nasal polyposis (nasalization). It is illustrated by two videos. The discussion focuses on the respective indications for ostial preservation and middle meatotomy (antrostomy).

[The predicting role of postoperative changes in self-reported symptoms in patients with recurrence eosinophilic chronic sinusitis with nasal polyps].

Objective:To investigate whether changes in postoperative symptoms and signs in patients can predict the recurrence of ECRS after nasal endoscopic sinus surgery. Methods:A total of 70 adult patients with ECRS were enrolled for ESS surgery from June 2020 to March 2022 in a single center. There were 50 males and 20 females, with an average age of （46.9±14.5） years. Follow-up after ESS was at least 52 weeks. Patients undergo peripheral blood tests, CT of the sinuses, olfactory T&T test, visual analogue scale of symptoms（VAS）, and endoscopic scoring. Results:VAS scores and endoscopic scores were analyzed at preoperative and 6th week, 12th week, 24th week and 52th week postoperative. After 12th week postoperatively, there was a clear correlation between symptom scores and endoscopic scores. Moreover, olfactory disorder and nasal discharge were the two most obvious symptoms. There were differences in the expression of multiple preoperative clinical inflammatory indicators between the symptom-controled group and the symptom-uncontrolled group（previous surgical history, concomitant asthma, nasal smear eosinophil, serum EOS%, total IgE, CT score, olfactory score, and symptom score, all with P<0.05）, while there was no difference in baseline endoscopic score（P>0.05）. At 12th week postoperative, the two groups of patients showed significant differences in both symptom scores and endoscopic scores. The symptoms and endoscopic score at the 12th week point of follow-up were used as predictive indicators for recurrence, with sensitivity and specificity of 62.5% and 83.3%, respectively. Conclusion:The changes in postoperative symptom score and endoscopic score in ECRSwNP patients indicated that the recurred ECRS. In the symptom-uncontrolled group, symptomatic and endoscopic scores showed consistent increased scores; In the symptom-controlled group, conflicting results between increased endoscopic scores and stable symptoms suggest that the presence of asymptomatic recurrence must be considered. The changes in symptoms and signs at the 12th week point of follow-up can serve as clinical indicators for preventing disease recurrence.

Efficient primary surgical treatment of equine infectious sinusitis reduces postoperative aftercare and increases outcome results: a retrospective study of 130 cases.

OBJECTIVE: To document the long-term outcome of surgically treated primary and dental-related sinusitis in horses and to describe a simple protocol for postoperative management. METHODS: All surgically treated sinusitis cases referred between January 2016 and June 2022 were reviewed. Cases diagnosed with primary and dental-related sinusitis and with a follow-up of at least 6 months after hospital discharge were included. Cases with other sinus pathology were excluded. RESULTS: 130 cases met the inclusion criteria. 104 out of 130 were treated with sinoscopy and 26/130 with sinusotomy. 86 out of 130 cases (66.2%) were diagnosed with a dental pathology as a cause of sinusitis that required tooth extraction. Diagnostics were refined with the help of CT in 55/130 (42%) cases. Short-term complications were encountered in 8/130 (6.2%), and full response after initial treatment was successful for 107/130 cases (82.3%). The mean number of postoperative daily flushes was 3.15, and horses were discharged after a mean hospitalization period of 6.4 days. CLINICAL RELEVANCE: Thorough debridement of sinuses affected by primary or dental-related sinusitis followed by a simple aftercare protocol can lead to a positive long-term outcome.

[Repair methods of complex facial defect wounds involving paranasal sinuses and their clinical effectiveness].

Objective: To explore the repair methods of complex facial defect wounds involving paranasal sinuses and their clinical effectiveness. Methods: A retrospective observational study was conducted. From January 2020 to May 2022, 5 patients admitted to the Department of Burns and Plastic Surgery of Xiangya Hospital of Central South University and 4 patients admitted to the Department of Burns and Plastic Surgery of Chenzhou First People's Hospital with complex facial defect wounds involving paranasal sinuses met the inclusion criteria, including 6 males and 3 females, aged 35-69 years, including 4 patients with titanium mesh exposure combined with paranasal sinuses injury and 5 patients with tumor involving paranasal sinuses. After an adequate assessment of the damage by a multiple discipline team, titanium mesh removal, paranasal sinus debridement, and paranasal sinus mucosa removal were performed in patients with exposed titanium mesh, and radical tumor resection was performed in patients with tumors, with postoperative skin and soft tissue defects areas of 5.0 cm×2.5 cm to 18.0 cm×7.0 cm, anterior paranasal sinus wall defects/absence areas of 3 cm×2 cm to 6 cm×4 cm, and sinus cavity depths of 1 to 4 cm. Depending on the perforator course of the descending branch of the lateral circumflex femoral artery, the anterolateral femoral chimeric flap or anterolateral femoral myocutaneous flap (with flap area of 9 cm×4 cm to 19 cm×8 cm, muscle size of 5 cm×3 cm×3 cm to 11 cm×6 cm×3 cm) was transplanted to repair the defect, and the donor site wound was sutured directly. The type of tissue flap transplanted, the blood vessel of the recipient area, and the vascular anastomosis way during the operation, the recovery of the donor and recipient areas and the occurrence of complications after operation were observed. The appearance and blood supply of the recipient area and the recurrence of ulcers and tumors were followed up. Results: The anterolateral femoral myocutaneous flap transplantation was performed in 6 patients, and the anterolateral femoral chimeric flap transplantation was performed in 3 patients. The blood vessels in recipient areas were facial arteries and veins in 3 cases and superficial temporal arteries and veins in 6 cases. The superficial temporal arteries and veins were bridged with blood vessels in tissue flaps by flow-through way in 2 patients, and end-to-end anastomosis of blood vessels in donor and recipient areas was performed in 7 patients. After operation, all the tissue flaps survived, and the facial defect wounds were well repaired without cerebrospinal fluid leakage or paranasal sinus secretion leakage, no intracranial infection occurred, and the wounds in donor areas were healed well. Follow-up of 6-35 months after operation showed that all the patients had good blood supply in the recipient area, and the shape was acceptable; 4 patients with exposed titanium mesh had no recurrence of ulceration, and 5 patients with tumor had no local tumor recurrence or metastasis. Conclusions: Based on an adequate assessment of the extent of paranasal sinuses involved in the facial wound and the nature of the defect, good clinical effects can be achieved by using the anterolateral femoral muscle flap or the anterolateral femoral chimeric flap transplantation to repair complex facial defect wounds with open paranasal sinuses.

A comparison of effectiveness between Posisep and Merocel nasal packing after endoscopic sinus surgery: Findings from a randomized, double-blinded, controlled trial.

BACKGROUND: The effectiveness of nonabsorbable and biodegradable nasal packing is still controversial, and the choice of nasal packing type can alter the outcome of endoscopic sinus surgery. This study compared the effectiveness of Posisep and Merocel as nasal packing materials with regard to hemostasis, adhesion, wound healing, patient's satisfaction and health-related quality of life after endoscopic sinus surgery (ESS). METHODS: A prospective, randomized, double-blinded, controlled trial was conducted in patients with chronic rhinosinusitis refractory undergoing symmetrical bilateral ESS. At the completion of surgery, a nasal packing (either Merocel or Posisep) was randomly chosen and placed into the middle meatus of each nasal cavity. All patients were scheduled for follow-up visits at 24 hours, 5 days, 3 weeks, and 5 weeks days after surgery. Health-related quality of life was measured using the Sino-Nasal Outcome Test (SNOT-22). The overall inflammatory burden of chronic rhinosinusitis was measured by the Lund-Mackay postoperative endoscopic score (LMES). RESULTS: Among 62 patients included in data analysis (n = 31 for each group), the mean age was 42.4 years and 54.8% were females. Patients with Posisep after ESS had more improvement and better symptoms measured through SNOT-22 and LMES at 24 hours, 5 days, and 3 weeks than those with Merocel after ESS. While some aspects measured by LMES such as discharge and scarring were still better until 5 weeks after surgery, all symptoms measured by SNOT-22 were similar between the 2 groups 5 weeks after surgery. CONCLUSION: Posisep containing chitosan provided patients with a better quality of life throughout the early recovery period compared with Merocel. Although more studies are needed, our findings support the use of Posisep after ESS.

Anatomical findings in patients with chronic rhinosinusitis without nasal polyps requiring revision surgery.

OBJECTIVES: For the treatment of chronic rhinosinusitis functional endoscopic sinus surgery is a well-established therapy with high initial success rates. However, a significant proportion of patients have persistent disease requiring revision surgery. To date, studies including data of large patient collectives are missing. In this study, we aimed to identify anatomic factors increasing the need for revision surgery in a large patient collective with chronic rhinosinusitis without nasal polyps. METHODS: Data were collected retrospectively on patients with recurrent or persistent chronic rhinosinusitis without nasal polyps requiring revision surgery. The patients' symptomatology, endoscopic and radiographic findings were analyzed. Preoperatively, patients were evaluated with endoscopic examination of the nose and paranasal sinuses. In all individuals computed tomography of the sinuses was performed. Images were evaluated according to the Lund-Mackay system. Information was also collected intraoperatively. RESULTS: 253 patients were included. The most common anatomic factor was incomplete anterior ethmoidectomy (51%), followed by residual uncinated process (37%), middle turbinate lateralization (25%), incomplete posterior ethmoidectomy (20%), frontal recess scarring (19%), and middle meatal stenosis (9%). Other factors such as persistent sphenoid pathology was less frequent. CONCLUSION: Iatrogenic causes with inadequate resection of obstructing structures seem to be a principal risk factor for recurrent chronic rhinosinusitis and the need for revision sinus surgery. Meticulous attention in the area of the ostiomeatal complex during surgery with ventilation of obstructed anatomy as well as avoidance of scarring and turbinate destabilization may reduce the failure rate after primary endoscopic sinus surgery. LEVEL OF EVIDENCE: 2b.

[Combined method of treatment of synechiae of the nasal cavity]. / Kombinirovannaya metodika lecheniya sinekhii polosti nosa.

Diseases of the nasal cavity and paranasal sinuses lead to the development of clinical symptoms, among which difficulty in nasal breathing is among the most common complaints of patients in the practice of otorhinolaryngologists. To prevent the development of synechiae of the nasal cavity in surgery, the following principles are defined: 1) to reduce tissue injury, which is achieved by using modern equipment (endoscopic, laser, radio frequency, etc.); 2) to create a barrier between nearby areas of the nasal mucosa by introducing various intranasal splints; 3) to improve the process of tissue regeneration with the help of medicines (regenerants, reparants, etc.). Currently, there is no single approach to the surgical treatment of synechiae of the nasal cavity. The high frequency of postoperative relapses indicates the need to develop effective methods for the prevention of synechiae of the nasal cavity. The choice of surgical tactics is usually carried out taking into account the localization and extent of synechiae of the nasal cavity. All known methods of surgical treatment, depending on the instruments used for excision of synechiae of the nasal cavity, can be conditionally divided into cold and hot. The Sverzhevsky Research Clinical Institute of Otorhinolaryngology has developed a method of complex treatment and prevention of synechiae of the nasal cavity using laser technologies, silicone splints and a hydrogel material based on sodium alginate with derinate.

Remission: does it already exist in chronic rhinosinusitis with nasal polyposis?

BACKGROUND: Remission, defined as absence of symptoms and objective markers of disease, is emerging as the penultimate goal in the management of several chronic diseases. The concept of remission, well-established in Rheumatology as well as Gastroenterology, is currently emerging in Respiratory Medicine for asthma. It is interesting to consider whether the disease remission concept might successfully be applied to Otolaryngology-Head and Neck Surgery in the management of chronic rhinosinusitis with nasal polyposis (CRSwNP). OBJECTIVE: The purpose of this letter is to explore the evidence supporting the concept of remission under continued medical therapy in chronic rhinosinusitis with nasal polyposis. METHODS: The authors reviewed the literature and summarized studies in chronic rhinosinusitis with nasal polyposis evaluating for evidence of clinical, biochemical, and endoscopic remission. RESULTS: Findings of the studies revealed that endoscopic sinus surgery with continued medical therapy achieved remission in approximately 50% of all patients. CRSwNP patients after primary endoscopic sinus surgery were able to achieve remission in 72% of instances, however this drops to 42% for patients having revision sinus surgery. For CRSwNP patients with co-morbidities such as asthma and aspirin exacerbated respiratory disease, remission rate drops to 23% and 23.5%, respectively compared to non-asthmatic CRSwNP patients who present a remission rate under continued medical therapy of 60%. CONCLUSION: Remission of symptoms and evidence of disease under medical therapy is indeed a concept achievable in patients with CRSwNP, as demonstrated by studies in the literature. Various co-morbidities, notably asthma, apparently influence rate of remission. Better defining this outcome through consensus-based definitions will allow for the development of strategies in CRSwNP care that can help affected patients attain complete relief from clinical, biochemical, and endoscopic markers of CRS with judicious use of medication and surgery. Future efforts will attempt to improve on these outcomes by achieving symptomatic and endoscopic control of disease following cessation of therapy, potentially paving the way towards clinical remission or a 'cure' in CRS.

Anatomical Variants of Internal Carotid Artery-Results from a Retrospective Study.

Background and Objectives: The internal carotid artery (ICA) is a vascular structure that can be easily injured during sinus endoscopic procedures, and surgeons should be familiar with its anatomic variants. The aim of this study was to describe the anatomical variations in the internal carotid artery in relationship to sphenoidal sinuses, using computed tomography (CT). Materials and Methods: In this retrospective study, we evaluated the variations of the ICA in relationship to sphenoidal sinuses in a cohort of 600 patients who were assessed between January 2020 and December 2022 in 'Saint Spiridon' Emergency Hospital, Iasi, Romania. Descriptive statistics were used to characterize our data. Results: The most prevalent anatomical variant was represented by intrasinusal septa with posterior insertion on the ICA (58.6%), followed by procident ICA (58%) and dehiscent ICA (52%). We could not find any statistical significance regarding demographic characteristics among groups. Conclusions: A thorough CT examination should be performed before functional endoscopic sinus surgery, with the identification of anatomical variants of the ICA, in order to prevent its injury with potentially fatal consequences.

A Preoperative Imaging Evaluation to Avoid Orbital Complications in Functional Endoscopic Sinus Surgery.

Functional endoscopic sinus surgery has become popular worldwide. However, serious complications have been reported with it. A preoperative imaging evaluation is thus essential to avoid complications. The authors compared 0.5 mm slice computed tomography (CT) images reconstructed from sinus CT data with conventional 2 mm slice CT images. The authors evaluated patients who underwent endoscopic surgery. Data regarding age, sex, history of craniofacial trauma, diagnosis, operative procedure, and CT findings of eligible patients were extracted from medical records and retrospectively reviewed. One hundred twelve patients underwent endoscopic surgery during the study period. Six patients (5.4%) had orbital blowout fractures, and half of them could only be identified by 0.5 mm slice CT images. The authors presented the usefulness of 0.5 mm slice CT images in the preoperative imaging evaluation of functional endoscopic sinus surgery. Surgeons should also recognize that a small number of patients have "stealth" (asymptomatic and unrecognized) blowout fractures.