ndoscopic sinus and skull base surgery (ESSS) is considered the "gold standard" for the treatment of many lesions of the nose, paranasal sinus, and adjacent structures. The manipulation of instruments during these procedures is challenging because of the complex anatomy and proximity to important structures such as the brain, orbital content, carotid arteries, and optic nerve, among others. 1 Long periods of training are traditionallynecessary in order to perform safe and adequate ESSS. Resident training includes anatomic lectures, a video session, cadaver dissection, direct observation of surgeries, and the realization of ESSS supervised by experienced doctors. Unfortunately,in some training hospitals, this process has been impaired by the restricted number of procedures and more difficult dissection pieces.1,2 In order to fulfill this problem, virtual simulators have been developed. These simulators use virtual-reality concepts and direct interactionmechanismswith users, such as simulationof force and feedback of touch sensation on specific structures. 1 .3-5 Unfortunately, these virtual models have some disadvantages, such as the high cost of the equipment, the use of computer-generated virtual images, some with low resolution, and touch-sensitive alterations in some structures. In addition, they do not allow the use of real instruments used on ESSS.

A síndrome de Melkersson-Rosenthal é rara, de etiologia desconhecida e de provável predisposição hereditária. Caracteriza-se pela presença de edema orofacial recidivante, língua plicata e episódios recorrentes de paralisia facial periférica. Após surtos repetidos, déficits permanentes da movimentação facial podem ser responsáveis por transtornos na comunicação, na alimentação e alterações estéticas que determinam danos psíquicos aos pacientes. A abordagem terapêutica da paralisia facial periférica nesta síndrome merece atenção especial e diferenciada das outras etiologias. Nosso objetivo é revisar as características clínicas e discutir as opções terapêuticas existentes na literatura com a desta casuística. Relatamos quatro casos clínicos com paralisia facial periférica e confrontamos os tratamentos instituídos com os dados provenientes da revisão da literatura. Dois dos casos relatados apresentaram evolução favorável da paralisia facial mesmo sem tratamento medicamentoso, os outros dois casos foram submetidos à descompressão do nervo facial. Em um deles, houve recuperação significativa da movimentação facial. O outro mostrou recorrência da paralisia mesmo após a descompressão parcial. Os pacientes com a síndrome de Melkersson-Rosenthal e que exibem paralisia facial com má evolução ou quadros recidivantes, podem ser abordados cirurgicamente.

Surgical approaches to the paranasal sinuses osteoma Resumo / SummaryOs osteomas são os tumores benignos mais freqüentes dos seios paranasais, apresentam crescimento lento e são em sua maioria assintomáticos. O tratamento cirúrgico destes tumores, ainda, é um tema controverso no que tange suas indicações e a escolha da abordagem cirúrgica. Existem diversas opções cirúr-gicas que vão desde as abordagens externas clássicas até as transnasais assistidas por vídeo-endoscopia. Não existem indicações formais para cada uma das abordagens devendo-se sempre levar em conta o tamanho do tumor no momento da escolha da abordagem a ser empregada. Objetivo: Neste estudo apresentaremos seis casos de osteomas dos seios paranasais operados no Hospital Prof. Edmundo Vasconcelos, São Paulo-SP com diferentes abordagens cirúrgicas em função de peculiaridades de cada caso, discutiremos as indicações da cirurgia e também as opções cirúrgicas mostrando as vantagens e desvantagens de cada abordagem. Forma de estudo: Estudo de série.

Introduction:The anatomy of the frontal sinus drainage pathway is extremely variable. The definition of its relations to the agger nasi cell (ANC) greatly facilitates its understanding and, therefore, the planning of surgical approaches to this paranasal sinus. The main objective of this study was to evaluate the endoscopic anatomy of the frontal sinus drainage pathway in human cadavers, having the ANC as the main anatomical landmark. Methods:A descriptive cross-sectional study was carried out, based on the endoscopic dissection of fresh human cadavers performed from April to November 2015. Thirteen cadavers were dissected and analyzed (total of 26 nasal cavities). The procedure began with the external trephination of each frontal sinus. After initial endoscopic dissection and identification of the ANC, 0.5% methylene blue was injected through the external trephine. Its drainage was endoscopically observed in relation to the ANC. Results:Of the dissected cadavers, 9 (69.2%) were males and 4 (30.7%) females. The mean age (± SD) was 65 (± 12.3) years. The presence of 22 frontal sinuses was verified through the external trephination method (84.6%). The ANC was present in 23 nasal cavities (88.4%). The frontal sinus drainage pathways were evaluated in 20 sides (76.9%). In 6 of them (30.0%), the dye drained medial to the ANC; in 5 (25.0%), drainage was posterior; and in the remaining 9 (45.0%), posteromedial. Conclusion:The frontal sinus drainage can preferably occur through 3 different ways (with respective frequencies): medial (30.0%), posterior (25.0%) and posteromedial (45.0%) to the ANC. ways, with the following frequencies: posterior (25.0%), medial (30.0%) and posteromedial (45.0%) to the ANC; b. The ANC was present in 88.4% of the nasal cavities with varying degrees of pneumatization. AknowledgentsNone.

Nasal irrigation using a saline solution is one of the primary treatments for patients with sinonasal inflammatory diseases and folwileyonlinelibrary.com/journal/coa Clinical Otolaryngology. 2018;43:970-971.cycle would be ideal for preventing contamination of these saline solutions.The results presented by Nikolaou et al are encouraging, and our approach should also inspire other researchers to perform similar real-life scenario studies. We hope that such results will contribute to the establishment of disinfection guidelines for saline solutions and irrigation devices.

Objective: The complete or partial obstruction of the lacrimal system is a disorder that manifests clinically by epiphora and/or recurrent dacryocystitis. The recommended treatment for obstructions below the common canaliculus is external or endoscopic transnasal dacryocystorhinostomy (ETDCR). This study aims to evaluate ETDCR as surgical treatment for patients with lower lacrimal system obstruction. Method: This was a retrospective study, performed at the Complexo Hospitalar Edmundo Vasconcelos in the period from 2000 to 2009, with 20 patients showing low obstruction of the lacrimal system unilaterally or bilaterally, which were submitted to ETDCR with a total of 27 queries. Results: A total of 27 procedures were performed in 20 patients (10 male and 10 female, mean age of 1.6 to 81 years). The most common complaint was epiphora, and the most frequent causes were idiopathic (59.2%), followed by congenital (29.6%), iatrogenic (4.5%), and trauma after radiotherapy (3.7%). Two patients had a new blockage in the postoperative period, and only 3 patients remained with Crowcroft probe for a period of 3 months postoperatively. The success rate of ETDCR in our series was 92.5%. Conclusion: ETDCR proved to be a safe technique as a surgical option to treat lower lacrimal system obstruction, with some advantages compared to the external technique, and it can still be accomplished without the use of a stent.

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Objective: To illustrate an transnasal approach (endoscopic assisted transnasal-craniectomy) used for olfactory neuroblatoma treatment and to advocate this method of management followed by radiation therapy for selected cases, based on the Stamm-Kennedy (SK) stage system.Method: A retrospective chart review was performed with 16 patients harboring olfactory neuroblastomas. Patients were categorized secondary to SK staging system. Twelve patients underwent the endoscopic assisted transnasal craniectomy (EATNC) approach, and 4 were submitted to hybrid approach (cranio-endoscopic) between 2000 and 2011 at a tertiary referral center.Results: Seven SK-IVa, 5 SK-II, 2 SK-IVb, 1 SK-I, and 1 SK-V patients, aged 10 to 67 years (9 females and 7 males), were identified. In 10 cases the tumor was bilateral, and in six cases the tumor was unilateral. Twelve patients were submitted to EATNC, 4 patients were submitted to hybrid approach (cranio-endoscopic), and 1 was submitted to endonasal approach without craniectomy. Gross total resection was achieved in 12, and near total was achieved in 4 patients. Twelve patients were submitted to radiotherapy (75%). Four cases needed posterior surgery. Fourteen patients were disease free 5 to 72 months postresection, and 2 patients were lost during followup. Only 4 patients preserved olfactory function (unilateral cases treated without radiotherapy). Conclusion:The EATNC is a promising approach for olfactory neuroblastoma treatment, even for those tumors with intradural extension. Most patients require radiation therapy, and in these cases there is no olfaction preservation. Rhinology/Allergy Method:The EITF was designed for harvest in cadaveric specimens based on the inferior turbinate (IT) artery, a terminal branch of the sphenopalatine artery. The anatomical limits of the EITF were assessed. The arc of rotation and reach for reconstruction of ventral skull base defects were assessed in the cadaver. Results:The average width of the flap was 55.8 ± 4.1 mm. The average length of the flap was 52.5 ± 5.5 mm. The average surface area was 29.3 ± 4.4 cm 2 . The flap was rotated with the turbinate surface at the inferior aspect of the clival defect, and the extended mucosa of the floor was able to cover the upper portion of the defect. Thus, the angle of rotation was smaller when compared to the 180° angle necessary for the traditional ITF to reach the clivus. The EITF was sufficient to cover defects extending between the paraclival internal carotid arteries. Conclusion:The EITF presents an additional option for reconstruction of skull base defects when the nasoseptal flap is unavailable or fails. In contrast to the traditionally described ITF, the EITF provides a greater surface area and better arc of rotation. Objective: Complications related to functional endoscopic sinus surgery are well documented. These complications will, in some instances, lead to claims of medical malpractice. This study seeks to preoperatively identify both patient and procedural characteristics which are more likel...