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1.
Ann Otol Rhinol Laryngol ; 129(3): 209-215, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31631672

RESUMO

OBJECTIVES: Preoperative maxillary sinus imaging findings have been suggested to be associated with complications and outcomes of sinus lift and dental implant procedures; nonetheless the evidence is controversial. The aim of this study was to examine the association between preoperative maxillary sinus imaging findings and outcomes of sinus lift and dental implant procedures in asymptomatic patients. METHODS: We included all patients who underwent maxillary sinus lift and dental implant procedures between 2014 and 2017. Maxillary sinus imaging findings were extracted from pre-procedural dental computed tomography scans, and outcomes of the procedures were assessed. RESULTS: A total of 145 procedures were included. No sinonasal symptoms were reported preoperatively. In 46% of cases maxillary sinus imaging was abnormal. The most common imaging finding was peripheral mucosal thickening (38%). Sinus floor cyst/polyp was identified in 13% of the cases, of which 47% occupied more than 50% of the sinus volume. Partial or complete opacification of the maxillary sinus was documented in 3% of cases. The sinus ostium and ostiomeatal complex were obstructed in 7% and 1%, respectively. Mucosal perforation was documented in 22% of cases and was inversely related to mucosal thickening (P = 0.011). Other minor post-operative complications did not correlate with radiological findings. Post-surgical sinusitis was not observed in any of the patients regardless of pre-surgical imaging findings. CONCLUSIONS: Incidental maxillary sinus imaging findings such as mucosal swelling, cysts or polyps, regardless of their severity or size, and maxillary ostial obstruction may not need to be addressed prior to sinus augmentation and dental implant procedures in asymptomatic patients. Patients with complete sinus opacification should be referred to an otolaryngologist prior to surgery. Further controlled trials, in larger cohorts, are needed to corroborate our findings.


Assuntos
Implantação Dentária , Seio Maxilar/diagnóstico por imagem , Levantamento do Assoalho do Seio Maxilar , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Assintomáticas , Cistos/diagnóstico por imagem , Feminino , Humanos , Achados Incidentais , Masculino , Pessoa de Meia-Idade , Mucosa Nasal/diagnóstico por imagem , Mucosa Nasal/lesões , Obstrução Nasal/diagnóstico por imagem , Pólipos Nasais/diagnóstico por imagem , Osseointegração , Doenças dos Seios Paranasais/diagnóstico por imagem , Cuidados Pré-Operatórios , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Adulto Jovem
2.
Am J Otolaryngol ; 41(1): 102301, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31732306

RESUMO

PURPOSE: Allergic fungal rhinosinusitis (AFRS) forms a subset of chronic rhinosinusitis with nasal polyps (CRSwNP) that is mainly characterized by eosinophilic nasal polyps, allergic mucin detected in the sinuses at surgery, and specific features on computerized tomography. Which biological markers predict disease recurrence in AFRS is still not clear, and the role of blood inflammatory cells in predicting recurrent polyps after surgery has yet to be investigated. The aim of this study was to newly investigate the prognostic role (in terms of recurrence rate) of preoperative blood eosinophil and basophil levels in AFRS. MATERIALS AND METHODS: A consecutive series of 17 adult patients who underwent endoscopic sinus surgery for AFRS was retrospectively assessed. RESULTS: Sinonasal polyps recurred in 7 of 17 patients. Considering the whole cohort, a significant positive correlation emerged between blood eosinophil and basophil counts, but not between blood and tissue eosinophil counts. Statistical analysis found significantly higher blood eosinophil and basophil levels in AFRS patients who relapsed than in those who did not. CONCLUSIONS: Considering the current difficulty of identifying more effective, personalized approaches to postoperative disease management in AFRS, our preliminary data support the impression that blood eosinophil and basophil levels warrant testing in further prospective and larger (preferably multi-institutional) investigations as part of the preoperative work-up for patients with AFRS in order to administer dedicated postoperative medical treatments for patients at higher risk of relapse.


Assuntos
Basófilos , Eosinófilos , Micoses/sangue , Micoses/microbiologia , Rinite Alérgica/sangue , Rinite Alérgica/microbiologia , Sinusite/sangue , Sinusite/microbiologia , Adulto , Doença Crônica , Endoscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mucinas/análise , Micoses/diagnóstico por imagem , Micoses/cirurgia , Pólipos Nasais/sangue , Pólipos Nasais/diagnóstico por imagem , Pólipos Nasais/microbiologia , Pólipos Nasais/cirurgia , Prognóstico , Recidiva , Estudos Retrospectivos , Rinite Alérgica/diagnóstico por imagem , Rinite Alérgica/cirurgia , Sinusite/diagnóstico por imagem , Sinusite/cirurgia , Tomografia Computadorizada por Raios X
3.
Artigo em Chinês | MEDLINE | ID: mdl-31163535

RESUMO

Objective:To analyze the imaging features of respiratory epithelial adenomatoid hamartoma (REAH) in the nasal olfactory clefts. Method:Forty-two patients with REAH in the nasal olfactory clefts confirmed by pathology were enrolled in this study and their imaging features were analyzed. Result:All lesions of the patients were located in bilateral olfactory clefts, accompanied by varying degrees of sinusitis and nasal polyps. CT and MRI of sinuses showed that expanded soft tissue in bilateral olfactory region. The bilateral middle turbinate was extruded laterally. Sagittal images showed "discoid-shaped mass" changes. Conclusion:The imaging manifestations of REAH have certain characteristics, which can provide a basis for clinical diagnosis. Clinical analysis combined with imaging examination can improve the diagnosis of REAH and guide the treatment.


Assuntos
Adenoma , Hamartoma , Pólipos Nasais , Neoplasias Nasais , Adenoma/diagnóstico por imagem , Diagnóstico Diferencial , Hamartoma/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Pólipos Nasais/diagnóstico por imagem , Neoplasias Nasais/diagnóstico por imagem , Seios Paranasais
4.
Neuroradiology ; 61(8): 891-896, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31119344

RESUMO

PURPOSE: Sinonasal angiomatous polyps (SAPs) can be misdiagnosed as malignant tumors due to aggressive clinical behaviors. The purpose of this study was to evaluate the diagnostic accuracy of multiparametric MRI in differentiating SAPs from malignant tumors. METHODS: This retrospective study included 31 patients with pathologically proven SAPs and 36 patients with malignant tumors in maxillary sinus and nasal cavity. All the patients underwent conventional MRI and dynamic contrast-enhanced (DCE) MRI on 3T MR scanners. Diffusion-weighted (DW) MR imaging was performed in 45 patients. All the MR images were retrospectively analyzed independently by two authors. RESULTS: Significant differences were found in T1 homogeneity, T2 signal intensity ratio, peripheral hypointense rim on T2WI, and soft tissue infiltration between SAP and malignant tumors (P = 0.004, < 0.001, < 0.001, and = 0.001, respectively). SAPs usually show heterogeneous signal intensity on T1WI, peripheral hypointense rim on T2WI, and higher T2 signal intensity ratio. The tumor size of SAP (4.01 ± 1.08 cm) was slightly smaller than that of malignant tumors (4.56 ± 1.12 cm) (P = 0.045). There were significant differences in DCE-MRI parameters including Tpeak, CImax, WR, TIC types, and progressive enhancement (P = 0.009, < 0.001, = 0.001, = 0.001, and < 0.001, respectively) between SAPs and malignant tumors. All the 31 SAPs showed progressive enhancement on DCE-MRI, while none of the malignant tumors showed progressive enhancement (accuracy 100%). The mean ADC of SAP (1.75 ± 0.30 × 10-3 mm2/s) was higher than that of malignant tumors (1.18 ± 0.31 × 10-3 mm2/s) (P < 0.001). CONCLUSION: Multiparametric MRI showed high diagnostic performance in differentiating SAPs from malignant tumors. Progressive enhancement on DCE-MRI is the most effective feature of SAP.


Assuntos
Imagem de Difusão por Ressonância Magnética , Pólipos Nasais/diagnóstico por imagem , Pólipos Nasais/patologia , Neoplasias Nasais/diagnóstico por imagem , Neoplasias Nasais/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Meios de Contraste , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
5.
Niger J Clin Pract ; 22(5): 603-608, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31089013

RESUMO

Objective: Although more than a century has passed since antrochoanal polyps (ACPs) were first defined, etiopathogenesis still remains unclear. The aim of this study was to investigate the relationship between ACPs and sinonasal cavity variations. Subjects and Methods: One hundred and forty-four patients with ACP on paranasal sinus computed tomography scans (ACP group) and 160 paranasal sinuses without ACP (control group) were included into the study. The study group was evaluated in respect of the presence of retention cyst in the contralateral maxillary sinus and sinus bone wall sclerosis thickening. Both groups were also compared with respect to the frequency of sinonasal anatomic variations, nasal septal deviation, variations of the uncinate process insertion, concha bullosa, paradoxical middle turbinate, and accessory maxillary sinus ostium. In the ACP group, the cases with septal deviation (SD) were also evaluated whether the deviation convexity was towards the polyp side or the opposite side. In addition, the posterior extension of ACPs were evaluated in three groups as middle meatus, nasopharynx, and oropharynx extension. Results: The prevalence of retention cyst, sinus wall sclerosis thickening, SD, and accessory maxillary ostium was significantly higher in the ACP group. A negative directional correlation was determined between the SD side and ACP side. When the ACP extensions were examined, middle meatus extension was seen in 32.6%, nasopharynx in 56.3%, and oropharynx in 11.1%. Conclusion: Accessory ostium may be an accelerating factor in the transformation of retention cyst to ACP. Furthermore, the changes in the nasal passage airflow on the opposite side suggest that SD contributes to this process.


Assuntos
Cistos/complicações , Osso Etmoide/anatomia & histologia , Seio Maxilar/anatomia & histologia , Pólipos Nasais/etiologia , Septo Nasal/anormalidades , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Variação Anatômica , Estudos de Casos e Controles , Criança , Cistos/diagnóstico por imagem , Osso Etmoide/diagnóstico por imagem , Osso Etmoide/patologia , Seio Etmoidal/patologia , Feminino , Humanos , Masculino , Seio Maxilar/diagnóstico por imagem , Seio Maxilar/patologia , Pessoa de Meia-Idade , Pólipos Nasais/diagnóstico por imagem , Septo Nasal/patologia , Esclerose/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Conchas Nasais/anatomia & histologia , Adulto Jovem
6.
Ear Nose Throat J ; 98(7): 425-430, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31012343

RESUMO

In this article, we explore the disease spectrum and clinical characteristics of and the diagnosis and endoscopic approach to treating isolated sphenoid sinus disease (ISSD) in children. To these ends, we review a case series of 19 patients (mean age: 8.1 ± 4.9 years, range: 1.1-15 years, median age: 6.7 years, 13 males, 6 females) who underwent surgical treatment at our hospital for ISSD during the 4 years between 2012 and 2016. The symptoms of pediatric sphenoid sinus disease tend to be variable and nonspecific and include atypical headache, nasal congestion, epistaxis, postnasal drip, snoring, and impaired vision. Headache is the presenting symptom in 42% of patients, but headaches occurred in no specific or typical location. Ten patients underwent preoperative endoscopic examination, and abnormalities in the sphenoethmoidal recess were found in 6 (60%) of these 10 patients. All 19 patients underwent ultra-low-dose paranasal sinus computed tomography (CT) imaging, and 9 patients with suspected tumors or sphenoid mucoceles were further examined by magnetic resonance imaging (MRI). The endoscopic transostial approach was performed in all 19 patients: 16 patients received excision of inflammatory sphenoid sinus disorders and benign tumors, including sphenoid sinusitis, sphenoid sinus mucocele, sphenoid sinus polyp, and ossifying fibroma; 3 patients with suspected tumors received biopsies to detect rhabdomyosarcoma, Langerhans cell histiocytosis, and juvenile xanthogranuloma. No intraoperative or immediate postoperative complications were observed. Children with opacified sphenoid sinus identified by radiographic imaging presented a variety of pathologies. The most common lesions were associated with inflammatory disease. Because the symptoms of pediatric sphenoid sinus disease tend to be variable and nonspecific, CT remains the standard for evaluating sphenoid sinus disease, and ultra-low-dose paranasal sinus CT imaging is recommended and can provide images of equal or better quality compared with those obtained by standard dose CT. In addition, MRI is an essential adjunct in the diagnosis and selection of treatment for suspected tumors of the sphenoid sinus. The endoscopic transostial approach was especially suitable for the management of pediatric benign isolated sphenoid sinus lesions.


Assuntos
Endoscopia/métodos , Doenças dos Seios Paranasais/cirurgia , Seio Esfenoidal/cirurgia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Imagem por Ressonância Magnética , Masculino , Mucocele/diagnóstico por imagem , Mucocele/cirurgia , Pólipos Nasais/diagnóstico por imagem , Pólipos Nasais/cirurgia , Doenças dos Seios Paranasais/diagnóstico por imagem , Neoplasias dos Seios Paranasais/diagnóstico por imagem , Neoplasias dos Seios Paranasais/cirurgia , Seio Esfenoidal/diagnóstico por imagem , Sinusite Esfenoidal/diagnóstico por imagem , Sinusite Esfenoidal/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
7.
Ear Nose Throat J ; 98(2): 89-93, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30884997

RESUMO

BACKGROUND:: There is a medial bulging of the lateral nasal wall in patients with cystic fibrosis (CF). AIMS:: Uncinate process (UP) angulation measurements in patients and controls to objectify this bulging. MATERIALS AND METHODS:: Thirty CF, 17 primary ciliary dyskinesia (PCD), 13 chronic rhinosinusitis with polyps (CRSwp), and 30 controls were included. Angles were measured bilaterally on computed tomography (CT) scans: A, B, C on coronal sections, D and E on axial sections. Angle A was between the UP and the orbit inner wall, whereas the others were between UP and midline. RESULTS:: There was no significant difference between controls, PCD, and CRSwp. However, CF had 3 statistically different angles with controls, 5 with CRSwp, and 4 with PCD. Angle A average value was 126° (±16°) in patients with CF, 138° (±19°) in controls ( P = .007), 145° (±15°) in PCD ( P = .001), and 138° (±14°) in CRSwp ( P = .001). Angle E average value was 35° (±10°) in patients with CF, 20° (±6°) in controls ( P < .001), 21° (±4°) in PCD ( P < .001), and 22° (±6°) in CRSwp ( P < .001). CONCLUSION:: Uncinate process's anatomy is only modified in CF: Angle between UP and inner wall of orbit is closed, and angles between UP and midline are opened. SIGNIFICANCE:: These measures quantify the medial bulging of lateral nasal wall and support nasofibroscopic observations.


Assuntos
Transtornos da Motilidade Ciliar/diagnóstico por imagem , Fibrose Cística/diagnóstico por imagem , Cavidade Nasal/diagnóstico por imagem , Pólipos Nasais/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adolescente , Adulto , Estudos de Casos e Controles , Transtornos da Motilidade Ciliar/patologia , Fibrose Cística/patologia , Seio Etmoidal/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pólipos Nasais/patologia , Adulto Jovem
8.
Artigo em Chinês | MEDLINE | ID: mdl-30909339

RESUMO

Objective: To study the value of olfactory cleft scores through computed tomography (CT) in predicting the oral glucocorticoids (GC) sensitivity in chronic rhinosinusitis with nasal polyps. Methods: Fourty-seven consecutive patients with CRSwNP from the Fifth Affiliated Hospital of Sun Yat-sen University between January and March of 2018 were recruited in this prospective, single-blinded study. There were 28 males and 19 females, with age ranging from 17 to 66 years old. After a course of oral prednisone (30 mg/d for 14 d), these patients were subsequently classified into objectively GC-sensitive and -insensitive subgroup according to the change in nasal polyp size score, or subjectively GC-sensitive and -insensitive subgroup according to the change in total nasal symptom score. The following parameters were compared between GC-sensitive and -insensitve subgroups: Lund-Mackay scores, olfactory cleft scores, and blood eosinophil counts and ratio. T test and χ(2) test were used. Multivariate Logistic regression analysis was used for factor prediction and receiver operating characteristic (ROC) curve was used to analyze the predictive ability of those factors. Results: There were 53.2% (25/47) and 61.7% (29/47) of patients objectively and subjectively sensitive to GC therapy, respectively. All data conformed to normal distribution. The olfactory cleft score and the blood eosinophil counts and ratio in objectively GC-sensitive subgroup were significantly higher than those in objectively GC-insensitive subgroup (3.6±1.0 vs 2.2±1.4, (404.4±200.3)/µl vs (209.5±233.1)/µl, (5.25±2.59)% vs (3.17±3.46)%, t value was 3.98, 3.08, respectively, χ(2)=2.35, all P<0.05). The cleft score, the blood eosinophil counts and ratio also showed the same trend in subjectively GC-sensitive and -insensitive subgroup (3.6±1.0 vs 1.9±1.3, (401.4±213.6)/µl vs (171.1±200.2)/µl, (5.39±2.76)% vs (2.48±2.99)%, t value was 5.05, 3.68, respectively, χ(2)=3.40, all P<0.05). Multivariate Logistic regression revealed that olfactory cleft score was an independent risk factor for objective or subjective GC-sensitivity (OR=2.882, 95%CI: 1.301-6.384; OR=2.508, 95%CI: 1.248-5.039). The olfactory cleft score exhibited comparable accuracy with the blood eosinophil ratio as predictor of objective and subjective GC-sensitivity (Area under curve of olfactory cleft score was 0.775, 0.829, respectively). An olfactory cleft score of 3.5 could act as a reliable indicator for predicting the clinical response to GC therapy in CRSwNP. Conclusion: Olfactory cleft score through CT scan has the potential value in predicting GC-sensitivity in CRSwNP patients.


Assuntos
Glucocorticoides/administração & dosagem , Pólipos Nasais/tratamento farmacológico , Prednisona/administração & dosagem , Rinite/tratamento farmacológico , Sinusite/tratamento farmacológico , Tomografia Computadorizada por Raios X , Administração Oral , Adolescente , Adulto , Idoso , Doença Crônica , Eosinófilos/citologia , Feminino , Humanos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Pólipos Nasais/sangue , Pólipos Nasais/diagnóstico por imagem , Seios Paranasais/diagnóstico por imagem , Estudos Prospectivos , Curva ROC , Análise de Regressão , Rinite/sangue , Rinite/diagnóstico por imagem , Método Simples-Cego , Sinusite/sangue , Sinusite/diagnóstico por imagem , Olfato , Adulto Jovem
9.
Am J Rhinol Allergy ; 33(3): 310-316, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30674195

RESUMO

BACKGROUND: Allergic fungal rhinosinusitis (AFRS) is characterized by higher revision endoscopic sinus surgery (ESS) rates and unique radiographic features when compared to chronic rhinosinusitis with nasal polyposis (CRSwNP) or chronic rhinosinusitis without nasal polyposis (CRSsNP). OBJECTIVE: We hypothesized that an increased frequency of concha bullosa in AFRS or other radiographic nuances might allow for accumulation of allergic mucin and contribute to increased ESS revision rates. METHODS: A retrospective cohort study was performed. Patient diagnosis (AFRS, CRSwNP, and CRSsNP), basic demographics, and prior ESS rates were collected. RESULTS: A total of 210 consecutive patients were included (AFRS = 70, CRSwNP = 70, and CRSsNP = 70). Pediatric AFRS patients had more unilateral disease (38.1% vs 4.4%; P = .007) and anterior ethmoid skull base erosion (23.8% vs 6.7%; P = .047) than adult AFRS patients. AFRS patients were more likely to be younger (24.9 ± 10.1 years vs 45.6 ± 14.4 years vs 48.7 ± 18.2 years; P < .001), African American (70% vs 14.3% vs 11.4%; P < .001), and have undergone prior ESS (54.3% vs 45.7% vs 31.4%; P = .02) than CRSwNP or CRSsNP patients. Concha bullosa were more prevalent in AFRS patients than CRSwNP or CRSsNP patients across the population (42.9%, 18.6%, and 14.3%; P < .001) and in the setting of no previous surgery (53.1%, 31.6%, and 16.7%; P < .001). CONCLUSION: In this cohort, pediatric AFRS patients had more unilateral disease and anterior ethmoid skull base erosion. Concha bullosa prevalence was significantly higher in AFRS as compared to those with CRSwNP or CRSsNP, despite prior ESS. Surgeons should consider concha bullosa as a potential anatomical subsite to harbor recurrent or residual disease.


Assuntos
Rinite Alérgica/diagnóstico por imagem , Sinusite/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Criança , Doença Crônica , Endoscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Micoses/diagnóstico por imagem , Micoses/patologia , Micoses/cirurgia , Pólipos Nasais/diagnóstico por imagem , Pólipos Nasais/patologia , Pólipos Nasais/cirurgia , Seios Paranasais/diagnóstico por imagem , Seios Paranasais/patologia , Seios Paranasais/cirurgia , Reoperação , Estudos Retrospectivos , Rinite Alérgica/microbiologia , Rinite Alérgica/patologia , Rinite Alérgica/cirurgia , Fatores de Risco , Sinusite/microbiologia , Sinusite/patologia , Sinusite/cirurgia , Adulto Jovem
11.
Auris Nasus Larynx ; 46(4): 641-650, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30545727

RESUMO

We report a rare case of sinonasal inverted papilloma (IP) associated with small cell neuroendocrine carcinoma (SNEC). To our knowledge, this is the first report to describe SNEC found during the treatment of sinonasal IP. Surgery and five cycles of cisplatin plus etoposide with concurrent intensity modulated radiation therapy were performed. Neither local recurrence nor distant metastasis was noted during 6 years of post-diagnostic follow-up. The prognosis of SNEC is very poor. Treatment planning for sinonasal IP should consider a possible association with this rare but aggressive malignancy, whose treatment is completely different from that of squamous cell carcinoma, a malignancy which is commonly associated with IP. We also performed a PubMed review of the literature to identify the incidence and pathological diagnosis of associated malignancy. Among a total of 5286 cases of sinonasal IP (61 studies), the incidence of associated malignancy was 8.02% in squamous cell carcinoma, 0.19% in transitional cell carcinoma, 0.04% in mucoepidermoid carcinoma, 0.02% in verrucous cell carcinoma and 0.02% in adenocarcinoma. The incidence of associated malignancy was significantly higher in East and Southeast Asia (11.0%) and North America (10.4%) than in Europe (3.9%) (p=0.04 and p=0.03, respectively; T-test).


Assuntos
Carcinoma Neuroendócrino/complicações , Carcinoma de Células Pequenas/complicações , Neoplasias do Seio Maxilar/complicações , Pólipos Nasais/complicações , Neoplasias Nasais/complicações , Papiloma Invertido/complicações , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma Neuroendócrino/diagnóstico por imagem , Carcinoma Neuroendócrino/patologia , Carcinoma Neuroendócrino/terapia , Carcinoma de Células Pequenas/diagnóstico por imagem , Carcinoma de Células Pequenas/patologia , Carcinoma de Células Pequenas/terapia , Cisplatino/administração & dosagem , Etoposídeo/administração & dosagem , Feminino , Humanos , Neoplasias do Seio Maxilar/diagnóstico por imagem , Neoplasias do Seio Maxilar/patologia , Neoplasias do Seio Maxilar/terapia , Obstrução Nasal/etiologia , Pólipos Nasais/diagnóstico por imagem , Pólipos Nasais/patologia , Pólipos Nasais/cirurgia , Neoplasias Nasais/diagnóstico por imagem , Neoplasias Nasais/patologia , Neoplasias Nasais/cirurgia , Procedimentos Cirúrgicos Otorrinolaringológicos , Papiloma Invertido/diagnóstico por imagem , Papiloma Invertido/patologia , Papiloma Invertido/cirurgia , Radioterapia de Intensidade Modulada
12.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi ; 53(11): 842-846, 2018 Nov 07.
Artigo em Chinês | MEDLINE | ID: mdl-30453404

RESUMO

Objective: To investigate the correlation between postoperative recurrence and clinical parameters in patients with chronic rhinosinusitis with nasal polyps (CRSwNP), and to study predicitve value of total scores of eosinophils (EOS) and sinus CT for postoperative recurrence. Methods: A retrospective analysis of 264 patients with CRSwNP who were admitted to the First Affiliated Hospital of Wenzhou Medical University from June 2013 to December 2015 was performed. The patient was subjected to a visual analogue scale (VAS) score, a skin prick test, a peripheral blood cell count, a sinus CT score, and a nasal polyp EOS count. All patients underwent endoscopic surgery and were followed up for at least 2 years. The demographic characteristics of the nasal polyps recurrence group and the non-recurrence group were compared with other clinical indicators. Quantitative data were compared by t test or Mann-Whitney U test, qualitative data were compared by chi-square test, and Logistic regression analysis was used for Logistic regression analysis. The risk factors for recurrence were assessed. The best cut-off value was determined by using the receiver operating characteristic (ROC) curve. The predictive value of the parameters was determined by area under curve (AUC). The difference was statistically significant at P<0.05. Results: The recurrence rate of the study patients was 43.56% (115/264). Sex, olfactory VAS score, total sinus CT score, peripheral blood neutrophil ratio, peripheral blood EOS absolute value and proportion, and tissue EOS absolute value and proportion were associated with postoperative recurrence of nasal polyps (χ(2)=5.241, t=-3.146, t=-7.441, χ(2)=180.617, t=-5.313, χ(2)=100.067, t=-7.471, χ(2)=258.916, all P<0.05), and the tissue EOS ratio and total sinus CT scores have higher predictive value for recurrence of nasal polyps (AUC values were 0.793, 0.767, respectively, all P<0.001). With the EOS ratio of nasal polyps >0.032, the sensitivity of predicting recurrence was 83.48%, the specificity was 56.38%. With the total score of sinus CT>15, the sensitivity of predicting recurrence was 51.30% and the specificity was 87.25%. The combined sensitivity of predictive recurrence was 92.00% and the specificity was 49.20%. Conclusion: The percentage of EOS in nasal polyps and the total score of sinus CT in patients with CRSwNP have better predictive diagnostic value for recurrence of nasal polyps.


Assuntos
Eosinófilos/citologia , Pólipos Nasais/cirurgia , Rinite/cirurgia , Sinusite/cirurgia , Doença Crônica , Humanos , Contagem de Leucócitos , Pólipos Nasais/sangue , Pólipos Nasais/diagnóstico por imagem , Pólipos Nasais/patologia , Neutrófilos/citologia , Seios Paranasais/diagnóstico por imagem , Valor Preditivo dos Testes , Curva ROC , Recidiva , Análise de Regressão , Estudos Retrospectivos , Rinite/sangue , Rinite/diagnóstico por imagem , Rinite/patologia , Sinusite/sangue , Sinusite/diagnóstico por imagem , Sinusite/patologia , Tomografia Computadorizada por Raios X , Escala Visual Analógica
13.
J Otolaryngol Head Neck Surg ; 47(1): 67, 2018 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-30409178

RESUMO

BACKGROUND: Chronic rhinosinusitis (CRS) affects up to 16% of the population. When medical treatment fails, endoscopic sinus surgery (ESS) is considered. The value of resecting the middle turbinate to optimize surgical outcomes has been hypothesized but remains controversial and unproven. Whether the middle turbinate should be left in place or resected is controversial. Our objective is to determine if middle turbinectomy improves objective surgical outcomes after ESS. METHODS: Sixteen patients (15 men, 15 primary surgery) undergoing bilateral complete ESS for CRS with nasal polyposis were recruited. Nasal cavities were randomized so that middle turbinectomy was performed on one side while the middle turbinate was preserved on the other. Each participant acted as their own control. Nasal cavities were compared using Perioperative Sinus Endoscopy (POSE) and Lund-Kennedy (LKES) scores pre-operatively, and at 1, 3 and 6 months after ESS. Results were analyzed using Wilcoxon signed-rank test. RESULTS: Pre-operatively, the POSE (12.4 ± 2.9 vs 12.8 ± 2.6, p = 0.33, for the preserved side and the resected side, respectively) and LKES (5.0 ± 1.0 vs 4.8 ± 1.2, p = 0.33) scores were similar between sides. During follow up, resection was associated with more crusting at 1 month following ESS (1.0 ± 0.7 vs 0.4 ± 0.6, p = 0.02). There was a small, but statistically significant, difference between the nasal cavities at 3 months, where the resected side showed better endoscopic appearance (2.0 ± 2.2 vs 3.4 ± 2.8, p = 0.01). No difference was found at 6 months. Frontal sinus scores were similar between sides at 6 months (0.7 ± 0.5 vs 0.7 ± 0.5, p = 1.00). CONCLUSION: Our results show no sustained objective endoscopic benefit of routine middle turbinectomy, at least within the first six postoperative months, in patients undergoing primary ESS for CRS with polyposis. TRIAL REGISTRATION: NCT, NCT02855931 . Registered 16 August 2016.


Assuntos
Endoscopia/métodos , Pólipos Nasais/cirurgia , Rinite/cirurgia , Sinusite/cirurgia , Conchas Nasais/cirurgia , Adulto , Idoso , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pólipos Nasais/diagnóstico por imagem , Seios Paranasais/cirurgia , Cuidados Pós-Operatórios/métodos , Prognóstico , Estudos Prospectivos , Rinite/diagnóstico por imagem , Medição de Risco , Sinusite/diagnóstico por imagem , Estatísticas não Paramétricas , Centros de Atenção Terciária , Resultado do Tratamento
15.
Comput Biol Med ; 102: 180-190, 2018 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-30300763

RESUMO

Flow behavior in the maxillary sinus where polypoid changes develop was investigated using computational fluid dynamics. A nasal cavity model was constructed, after performing a virtual polypectomy based on computed tomography images of a patient, using a computer-aided design software to artificially remove polypoid changes inside the maxillary sinus. Local flow characteristics in the maxillary sinus were examined for one full respiration period. The results showed that the epithelial surfaces where polypoid changes occur are located in the lower part of the maxillary sinus which contains a protruding zone of the sinus and are characterized by stagnation of air during the entire respiration period. Due to the geometric characteristics, a very slow recirculating motion was found to occur in the bulging area for approximately half of the respiration period as a result of interaction with a larger-scale, counter-rotating vortex filling the middle of the maxillary sinus. With a much smaller velocity inside the maxillary sinus compared to that typically found in the airway passage through the middle meatus, both wall shear and pressure changes were found to be vanishingly small along the epithelial surface of the maxillary sinus where polypoid changes were found.


Assuntos
Seio Maxilar/diagnóstico por imagem , Seio Maxilar/fisiopatologia , Pólipos Nasais/diagnóstico por imagem , Pólipos Nasais/fisiopatologia , Respiração , Idoso , Algoritmos , Simulação por Computador , Humanos , Hidrodinâmica , Masculino , Seio Maxilar/cirurgia , Modelos Biológicos , Cavidade Nasal , Pólipos Nasais/cirurgia , Pressão , Resistência ao Cisalhamento , Software , Estresse Mecânico , Tomografia Computadorizada por Raios X
16.
Rev Esp Patol ; 51(4): 262-266, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30269780

RESUMO

Antrochoanal polyps (ACPs) are an infrequent clinical entity. Cholesterol granulomas (CGs) are commonly associated with chronic middle ear disease but are rare in the paranasal sinuses. We describe a case of a 10-year-old girl with a concomitant CG in an ACP which was surgically excised by nasosinusal endoscopic surgery. To our knowledge, there are only five previously published cases of CGs in ACPs and of these, only two were pediatric cases. We describe a third case in the youngest patient yet reported. Increased intrasinus pressure may affect venous and lymphatic drainage, leading to hemorrhages with hemolysis and deposition of cholesterol crystals and their esters initiating the formation of granulomas in the polyp. In addition, the insufficient lymphatic drainage prevents the complete elimination of lipids, contributing to the formation of cholesterol granulomas. The treatment and the outcome of an ACP associated with a CG are the same as for usual ACPs.


Assuntos
Colesterol/análise , Granuloma/patologia , Seio Maxilar/patologia , Pólipos Nasais/patologia , Doenças dos Seios Paranasais/patologia , Adenoidectomia , Criança , Diagnóstico Diferencial , Endoscopia , Feminino , Granuloma/diagnóstico por imagem , Granuloma/metabolismo , Granuloma/cirurgia , Humanos , Seio Maxilar/diagnóstico por imagem , Seio Maxilar/cirurgia , Pólipos Nasais/química , Pólipos Nasais/diagnóstico por imagem , Pólipos Nasais/cirurgia , Nasofaringe/patologia , Nasofaringe/cirurgia , Doenças dos Seios Paranasais/diagnóstico por imagem , Doenças dos Seios Paranasais/cirurgia , Pólipos/química , Pólipos/diagnóstico por imagem , Pólipos/patologia , Pólipos/cirurgia , Tomografia Computadorizada por Raios X
17.
Int J Pediatr Otorhinolaryngol ; 113: 204-207, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30173986

RESUMO

OBJECTIVES: To investigated the correlation between sinonasal computed tomography (SNCT) findings and sinonasal symptoms, genotype, chronic colonization by Pseudomonas aeruginosa, forced expiratory volume in the first second (FEV1), body mass index (BMI), Shwachman-Kulczycki (SK) score, and Bhalla score in patients with cystic fibrosis. METHODS: We retrospectively reviewed the medical records of 61 patients aged 2-16 years who received care at the Pediatric Cystic Fibrosis Center of our institution over a 10-year period. SNCT findings were graded using the Lund-Mackay scoring system. For patients who had SNCT scans performed at two different time points, the findings from both examinations were compared. RESULTS: Patients with chronic P. aeruginosa colonization and patients with atelectasis had higher Lund-Mackay scores (p = 0.04 and p = 0.01, respectively). There was no difference in Lund-Mackay scores between sinonasal symptomatic and asymptomatic patients (p = 0.45). Among patients who had two SNCT scans available (n = 11), those with no evidence of bronchiectasis on chest CT had decreased Lund-Mackay scores compared to those with evidence of bronchiectasis, who had an increase in their scores (p = 0.03). Variations in the Bhalla score were positively and variations in the SK score were negatively correlated with variations in the Lund-Mackay score (r = 0.74, p = 0.01; and r = -0.85, p < 0.01). CONCLUSIONS: Associations between SNCT findings, chronic P. aeruginosa colonization, SK score, and chest CT findings were demonstrated. Further studies with larger sample sizes are needed to evaluate patient follow-up and assess the benefits of the sinonasal treatment strategy adopted for patients who exhibit pulmonary deterioration despite controlling for other factors associated with exacerbation.


Assuntos
Fibrose Cística/complicações , Seios Paranasais/diagnóstico por imagem , Adolescente , Bronquiectasia/diagnóstico por imagem , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Masculino , Obstrução Nasal/etiologia , Pólipos Nasais/diagnóstico por imagem , Seios Paranasais/microbiologia , Pseudomonas aeruginosa/isolamento & purificação , Atelectasia Pulmonar/diagnóstico por imagem , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
18.
Int J Pediatr Otorhinolaryngol ; 114: 87-91, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30262373

RESUMO

OBJECTIVE: To review the clinical features of pediatric patients affected by antrochoanal polyps (ACPs) and surgically treated at three University settings. METHODS: Retrospective study. The present research includes the clinical data of subjects affected by ACPs, aged <18 years and referred to three ENT Departments, between January 1st 2003 and September 30th 2016. All patients underwent nasal endoscopy and sinonasal imaging; all subjects have been treated surgically. RESULTS: Fifty-eight patients underwent functional endoscopic sinus surgery (FESS) for ACPs removal, under general anesthesia. There were no major intraoperative complications. Recurrence occurred in 12 cases (20.5%). CONCLUSIONS: FESS was the first-choice treatment for APCs in the present series; our recurrence rate was similar to that of other reports available in literature. Recurrences of ACPs in children still represent a clinical challenge; it is likely that an improved comprehension of ACPs biology could help in better understanding the pathophysiology of this disease.


Assuntos
Pólipos Nasais/cirurgia , Anestesia Geral , Criança , Endoscopia , Feminino , Humanos , Masculino , Seio Maxilar/diagnóstico por imagem , Seio Maxilar/cirurgia , Pólipos Nasais/diagnóstico por imagem , Recidiva , Estudos Retrospectivos
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