Fifty-one patients suffering from inverted papillomas of the nose and paranasal sinuses were reexamined in a retrospective study. Thirty-five had undergone surgery by an intranasal endoscopic approach and 16 had undergone surgery by an extranasal approach. The recurrence rate following endoscopic interventions was 17% (6/35), as compared to 19% (3/16) after extranasal operations. Endoscopic surgery proved to be successful even in the treatment of large lesions affecting the posterior ethmoidal sinus, the nasofrontal duct, or the sphenoidal sinus. Its indication thus no longer needs to be restricted to limited lesions of the anterior nasal cavity. Patients with inverted papillomas will benefit from this surgical technique which remains minimally invasive and thus retains the paranasal bony framework, preserves unaffected mucosa capable of recovery, and prevents damage to the patients' cosmetic features.
Twenty-two patients underwent partial or complete ethmoidectomies and were subjected to standardized postoperative follow-ups including endoscopic photography of healing tissues. Sequential biopsies were also taken from the regenerating mucosa and compared with endoscopic findings. On this basis wound healing could be divided into four different phases, allowing for the diagnosis of healing disturbances and clinical planning of stage-dependent therapy. Additionally, a model of wound healing in the maxillary antrum of the rabbit was developed for better understanding the clinical observations. Regeneration of standardized mucosal defects was studied with three-dimensional histomorphological analysis. Circular wounds were found to regenerate concentrically, with wound closure starting by epithelial migration. Within 120 h, granulation tissue covering the wound surface started to become hyperplastic and bone apposition occurred with the formation of osteoid. The systemic application of prednisolone (2 mg/kg per day i.m.) and topical 5% dexpanthenol ointment resulted in an acceleration of late epithelial wound closure together with a reduction in hyperplastic granulation tissue. Local applications of "epidermal growth factor" had no significant effect.
The radical operations of the paranasal sinuses with total removal of the diseased mucosa very often produced postoperative disability due to scar formation and nerve irritation. A new concept of endonasal sinus surgery is based on the reestablishment of paranasal draining, reventilation, and preservation of the lining mucosa. This became possible by a strictly endonasal approach using angle-optic endoscopes for the optical control of manipulations. The principles of endonasal antrostomy, ethmoidectomy, and infundibulotomy are outlined, and their preliminary results are given. The importance of long-range postoperative local treatment is emphasized.
The EMFA is an excellent low-morbidity approach for VS removal with limited cerebellopontine angle extension (2 cm). Specific advantages of the EMFA are the superior internal auditory canal exposure, resulting in an extremely low tumor recurrence rate; best capability for hearing preservation; and minimal incidence of cerebrospinal fluid leaks. Postoperative facial function outcome compares with that of other surgical approaches. The best results are achieved in subjects with small tumors and good hearing, advocating early diagnosis and treatment.
This study reports our indications and limits for endonasal endoscopic closure of dural defects with a cerebrospinal fluid (CSF) leak at the anterior cranial base, and demonstrates our surgical technique. Fifty-three patients with CSF rhinorrhea were reassessed for the success rate of closure of the CSF leak. Surgery was successful in 98%, and 68% of fistulas were closed endoscopically. A free graft of autogenous mucoperiosteum of the inferior turbinate was the most frequently used tissue for defect closure. The endonasal endoscopic route proved relatively safe for the closure of dural tears, irrespective of the cause, up to about 10 x 10 mm. It is characterized by minimal morbidity because of the preservation of sinus ventilation and bony structures, supraorbital nerves, and olfactory fibers. Defects larger in size, predominantly of traumatic origin, were closed via the transfacial approach. The decision on the surgical approach was additionally based on the extent of the facial soft tissue injuries and the localization of the leak.
A detailed preoperative and postoperative examination of the olfactory function of 111 patients with chronic polypoid ethmoiditis was carried out. Eighty-seven patients required a complete endoscopic endonasal sphenoethmoidectomy. In 24 patients an endoscopic partial resection of the ethmoidal cell system was performed. Before surgery a normosmia was ascertained in 39 patients (35%). Thirty-four patients (31%) were hyposmic, and 38 patients (34%) suffered from anosmia. In the postoperative olfactory function test 89 patients (80%) had a normal sense of smell; 13 patients (12%) showed hyposmia, and nine patients (8%) experienced anosmia. Seventy-eight percent of the patients with impaired olfactory function had marked improvement after the operation. Patients who had previously undergone a polypectomy had a less favorable prognosis. None of the preoperatively normosmic patients became hyposmic or even anosmic after endoscopic sinus surgery. The sense of smell of only two of the 34 patients with preexisting hyposmia worsened after surgery. The postoperative size of the middle nasal turbinate did not correlate with the ability to smell. More important was the accessibility of the olfactory cleft.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.