- Using the frontal intersinus septal cell to widen the narrow frontal recess LARYNGOSCOPE 2004; 114 (7): 1315-1317
Nebulization of Antibiotics in Management of Sinusitis.
Current infectious disease reports
2004; 6 (3): 187-190
Chronic sinusitis with recurrent acute infections continues to be a significant medical problem. Even after aggressive medical and surgical management, some patients continue to have recurrent infections. These infections are often multidrug-resistant. Topical delivery of medications into body cavities has been practiced for decades. Recently, the use of prescription antibiotic, antifungal, and anti-inflammatory topical medications has increased for sinus patients. This article examines emerging data on nebulized antimicrobials for patients with sinusitis.
View details for PubMedID 15142481
Management of the lateral frontal sinus lesion and the supraorbital cell mucocele
Annual Meeting of the American-Rhinologic-Society
OCEAN SIDE PUBLICATIONS INC. 2004: 83?86
Masses that radiographically appear in the lateral aspect of the frontal sinus can be difficult to access and often are approached through external approaches. Supraorbital ethmoid cells pneumatize the orbital plate of the ethmoid bone to lie posterior and lateral to the frontal sinus. Opacification of a supraorbital cell may radiographically give the appearance of a laterally based frontal sinus lesion. Often, these represent mucoceles, in which their drainage can be achieved through endoscopic techniques and without the need for an external approach.Retrospective review of patients treated for lateral frontal sinus lesions at a tertiary sinus center was performed. Radiology, endoscopic findings, operative reports, and patient symptoms were reviewed.Ten patients were identified with lateral frontal sinus lesions based on radiography of the paranasal sinuses and nasal endoscopy. All patients were determined to be supraorbital mucoceles. These patients underwent surgical drainage using computer-aided endoscopic techniques. Initially, endoscopic drainage of the mucocele was successful in all patients. One patient was lost to follow-up after 3 months and one patient underwent a revision endoscopic surgery with trephination 5 months after the initial drainage. The remaining eight patients remain free of disease by nasal endoscopy and postoperative computed tomography scans (median follow-up of 25 months; range, 8-38 months).Knowledge of the anatomy of the ethmoid complex and presence of various cells within the frontal recess such as supraorbital cells are important in the management of the laterally based frontal sinus lesion. Often, these lesions may represent supraorbital cell mucoceles amenable to endoscopic drainage. Given the nature of mucoceles, long-term follow-up is needed before endoscopic drainage of these lesions can be validated. However, preliminary data suggest that an endoscopic approach provides for adequate drainage and helps avoid external approaches.
View details for Web of Science ID 000221307000003
View details for PubMedID 15152872
Revision endoscopic frontal sinus surgery with surgical navigation
107th Annual Meeting of the American-Academy-of-Otolaryngology-Head-and-Neck-Surgery-Foundation
MOSBY-ELSEVIER. 2004: 312?18
Revision surgery of the frontal sinus remains one of the most difficult operations for the endoscopic surgeon. Most agree that knowledge and recognition of its complex anatomy and sparing of frontal recess mucosa are keys to a successful operation. The use of surgical navigation systems may allow for more precise dissections and greater rates of frontal recess patency.Retrospective review of all patients undergoing revision endoscopic frontal sinus surgery with surgical navigation was performed with a minimum 24-month follow-up.Sixty-seven patients underwent revision endoscopic frontal sinus surgery with surgical navigation. The average follow-up was 32 months. Fifty-eight (86.6%) had a patent frontal recess and significant subjective improvement in symptoms. No patient underwent external frontal sinus obliteration, and there were no major complications.Endoscopic techniques with surgical navigation are effective in revision frontal sinus cases. The dissection of remnant agger nasi, obstructing frontal and supraorbital cells are necessary to widen the anterior-posterior as well as the medial-lateral dimensions of the recess. Computer navigational systems appear to serve as a valuable adjunct in preoperative planning and safe intraoperative dissection.
View details for DOI 10.1016/j.otohns.2003.11.005
View details for PubMedID 15054372
Endoscopic repair of large skull base defects after powered sinus surgery
106th Annual Meeting of the American-Academy-of-Otolaryngology-Head-and-Neck-Surgery
MOSBY-ELSEVIER. 2003: 204?9
To evaluate the management of patients with large skull base defects (> 2 cm) and intracranial injury caused by powered endoscopic sinus surgery. Study design and setting All patients treated for postendoscopic sinus surgery skull base injury over a 4-year period were reviewed.Three patients with skull base defects greater than 2 cm in size and associated intracranial injury from powered ESS were identified. All patients presented with active cerebrospinal fluid leaks. CT scans showed intracranial injury and pathology reports revealed brain tissue removal. Using image-guided endoscopic techniques, all defects were addressed with multilayer repair. Closure was achieved in all patients on the first attempt, with an average follow-up of 27 months.The use of powered instrumentation along the skull base can be dangerous and can result in extensive skull base defects with associated loss of dura and gray matter. Large ethmoid roof defects and significant intracranial injury, however, are not absolute contraindications to endoscopic repair.
View details for DOI 10.1016/S0194-5998(03)00521-7
View details for Web of Science ID 000185438100007
View details for PubMedID 12958568
Use of nebulized antibiotics for acute infections in chronic sinusitis
105th Annual Meeting of the American-Academy-of-Otolaryngology-Head-and-Neck-Surgery
MOSBY-ELSEVIER. 2002: 558?68
Infections in patients with chronic sinusitis after surgery can be difficult to treat. Nebulized antimicrobial therapy was studied as a treatment option. Study Design: Patients with chronic sinusitis, previous sinus surgery, and an acute infection were offered nebulized antibiotics or standard therapy. Cultures were taken and sensitivity testing was performed. Retrospective chart reviews were also performed.Forty-two patients were included. The most common side effects were sore throat and cough. Symptomatic and endoscopic data before and after nebulized therapy showed a longer infection-free period (average, 17 weeks) compared with standard therapy (average, 6 weeks). Improvements in posterior nasal discharge, facial pain/pressure, and emotional consequences were noted.Nebulized therapy was safe and effective in this cohort. Endoscopy and outcome measure changes showed consistent improvements.A novel therapy for acute sinus infections in patients with chronic sinusitis and previous endoscopic sinus surgery is presented.
View details for DOI 10.1067/mhn.2002.129738
View details for Web of Science ID 000180088700011
View details for PubMedID 12501108
Airway complication following functional endoscopic sinus surgery
JOURNAL OF CLINICAL ANESTHESIA
2002; 14 (2): 154-157
Difficulty breathing after upper airway surgery requires immediate evaluation and treatment. We present a case of airway compromise after sinus surgery due to edema of the uvula. The patient was admitted for observation overnight and discharged the next day. A discussion of potential airway changes after sinonasal surgery is presented.
View details for Web of Science ID 000175105100017
View details for PubMedID 11943532