The advent of functional endoscopic sinus surgery (FESS) has revolutionized the treatment of chronic sinusitis over the last decade. Although it has been well-established that FESS is more efficacious than conventional surgery, the lack of a quantifiable means of assessing results remains one of the major shortcomings of the technique, and hence a source of criticism. Since the pathophysiology of chronic sinusitis is intimately related to the mucociliary mechanism of the nose and sinuses, it seems logical to use this parameter as a yardstick of success. We undertook a prospective, controlled study of 40 patients and measured their “saccharin times” before and after surgery. The results show a marked reduction in clearance times postoperatively, corresponding well with improvement in symptom profile. We therefore propose this technique as a simple, safe and reliable method of assessing the results of surgery. Furthermore, the method could act as a preoperative indicator of ciliary motility disorders, as the prognosis in these patients is distinctly poor.
Over the past 2 decades, the surgical management of inverted papillomas has evolved from extensive radical excision to more conservative surgery. We conducted a study to evaluate the results of our endoscopic approach to tumor excision with the 532-nm potassium titanyl phosphate (KTP-532) laser. Ourseries included9patients with inverted papillomaofthe nose and paranasal sinuses who were treated from January 1998 through December 2003 (72 mojo Only 1 patient (11.1%) experienced a recurrence. The recurrence was detected 12 months after initial treatment, and it was successfully managed via the same endoscopic approach; afterward, the patient was still tumor-free at 2.5 years offollow-up. The good results of this endoscopic approach for lesions limited to the nose and paranasal sinuses canbeattributed to excellent visualization with theendoscope and to the bloodless dissection achieved with theKTP-532 laser. Weemphasize the need for frequent and long-term follow-up of these patients;a thorough endoscopic examinationat everyvisit is extremely important.
The aim of this study is to assess the long-term results of our endoscopic turbinoplasty technique for concha bullosa. Thirty-six patients of chronic or recurrent sinusitis who had concha bullosa on CT scan along with mucosal disease in sinuses and underwent turbinoplasty with functional endoscopic sinus surgery were studied. They were followed regularly with endoscopic examination for 7 years and were assessed for immediate or longterm complications of the procedure. Results of 36 patients revealed bilateral concha bullosa in 16 (44.4%) and unilateral concha bullosa in 20 (55.6%) patients. Out of 52 sides of turbinoplasties which were followed for average of 89 months, only 3 sides (5.76%) had synechia between middle turbinate and septum. Only 1 (1.92%) side had adhesions between lateral wall and middle turbinate. There were no other immediate or longterm complications. We conclude from our study that endoscopic turbinoplasty is safe and effective procedure for concha bullosa. It preserves middle turbinate anatomically and physiologically and treats the concha with negligible complications.
The study of the nose is as old as civilisation. Various conditions affecting its structure and function has been documented in Edwin Smith Papyrus in hieroglyphic script, an Egyptian writing system of the mid -4th Millennium BC.The major contribution for the complete reconstruction of the nose originated in India by Sushruta in around 600 BC. Writing in Sanskrit in the form of verses he described in detail the technique of total reconstruction, which is still being practiced today as Indian Rhinoplasty. This surgical reconstruction paved the way to modern plastic surgery in Europe and United States in 18th century. Sushruta contributed not only to the plastic surgery of the nose, but described entire philosophy of Head and Neck and other surgery as well. Other notable contributors were Greek physicians, Hippocrate and Galen, and at the birth of the Christianity, Celsus wrote eight books of medical encyclopaedia, which described various conditions affecting nose.Septal and Sinus surgery, in comparison to rhinoplasty did not develop until 17th century. Septal surgery began with total septectomy, sub mucous resection by Killian & Freer in early 20th century and later septoplasty by Cottle in middle of 20th century.Sinus surgery probably originated in Egypt, where instruments were used to remove brain through the ethmoid sinuses as part of the mummification process. In 18th century, empyema of the maxillary sinus was drained through the tooth socket or anterior wall of the sinus, which lead to the evolution of radical procedures of removal of mucous membrane and inferior meatal antrostomy. In the late 20th century, improved understanding of the mucociliary mechanism described by Prof. Messerklinger and Nasal Endoscopy described by Prof. Draf with the development of fibre optics and CT imaging, heralded a new era, which evolved in functional endoscopic sinus surgery. New technology further enhanced the scope of endoscope being used "around and beyond" the nose.
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