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A Mouse Model of Acute and Chronic Rhinosinusitis
Scientific Posters
P184 Experience with the SilMed Nasal Septal Button Gordon S Wood, Jr, MD (presenter) Logan UT
Objectives: Report our experience with a new septal button for the treatment of septal perforations. Report our experience with the standard septal button. Methods: We report our experience with 26 patients who were treated with the SilMed septal button for their septal perforations over a five year period. Results: The Silmed septal button with an oblong post was found to be superior to the septal buttons with a round post. Conclusion: With the septal button with the oblong post there was less movement of the button and was better tolerated and accepted by the patients. The majority of patients have resolution of their symptoms (epistaxis, progressive enlarging of the perforation, crusting, and obstruction). P185 Is Beta-Defensin 2 Raised in Idiopathic and Allergic Rhinitis Showkat Mirza, FRCS (presenter); Nicholas S Jones, BDS, FRCS Newcastle upon Tyne United Kingdom; Nottingham United Kingdom
Objectives: Defensins are a group of antimicrobial peptides that are an important component of the innate immune response at mucosal surfaces. Beta-defensin 2 expression has been shown to be raised in the mucosa in chronic sinusitis with nasal polyposis. Our aim was to analyse the levels of Beta Defensin 1 and 2 expression in the inferior turbinate mucosa of patients with idiopathic rhinitis, and allergic rhinitis as well as normal controls. Methods: We took samples of inferior turbinate from 12 patients with allergic rhinitis, 11 patients with intrinsic rhinitis, and 11 controls with no nasal mucosa disease undergoing a rhinoplasty. Expression of Beta-Defensin 1 and 2 mRNA was investigated by reverse-transcriptase-polymerase chain reaction and their expression level was semi-quantitatively evaluated by dot blot hybridisation. Immunohistochemical analysis was used for the detection of Beta-Defensins 1 and 2 in tissue sections. Results: initis and 5/11 cases of idiopathic rhinitis. Conclusion: Beta-Defensin 2 does not appear to be specifically raised in idiopathic or allergic rhinitis. Whilst BetaDefensin 2 expression is often raised as a result of infection, it appears not to be specifically raised in allergic or idiopathic rhinitis. P186 Endoscopic Resection of an Anterior Fossa Schwannoma with Nasal Cavity Extension Brennan Thomas Dodson, MD (presenter); Todd T Kingdom, MD Denver CO; Denver CO
Objectives: We report a case of endoscopic resection of a large anterior fossa schwannoma that extended into the nasal cavity. Methods: Report of a single case with two year follow-up. Results: A 48 year-old female presented with headache and disequilibrium, a MRI with gadolinium revealed a lesion of the anterior cranial fossa measuring 5cm by 3cm extending into the superior nasal cavity. Office-based biopsy revealed schwannoma. Complete removal of the lesion was accomplished via an endoscopic approach utilizing computer-assisted navigation. After removal, a 22mm by 25mm skull base defect was repaired using septal cartilage and nasal mucosa. A lumbar drain was placed post-operatively for 72 hours and the patient discharged home the following morning after an uneventful course. Two year follow-up revealed no evidence of CSF leak, recurrent tumor, or sinusitis based on nasal endoscopy and MRI. Subjectively the patient has experienced resolution of her headaches. Conclusion: We report a unique case of endoscopic resection of an anterior fossa schwannoma extending into the nasal cavity. The unique features of this case will be discussed and include 1) a minimally-invasive approach to a large anterior cranial base schwannoma avoiding craniotomy, 2) successful repair of a large skull base technique with endoscopic techniques, and 3) minimal patient morbidity with expedited recovery. This case highlights the value of advanced endoscopic techniques of the sinonasal cavities and the evolving role of minimally-invasive approaches in this region. P187 A Mouse Model of Acute and Chronic Rhinosinusitis Byung-Hoon Ahn, MD (presenter); Youn-Ho Park, MD; Dal-Won Song, MD PhD; Sung-Il Nam, MD Daegu South Korea; Deagu South Korea; Deagu South Korea; Daegu South Korea
Objectives: To induce the mouse model of acute and chronic rhinosinusitis employing common bacterial pathogens which causes bacterial rhinosinusitis, Streptococcus pneumoniae (ATCC 49619). Methods: The initial culture of Streptococcus pneumonia was done in Mueller-Hinton broth. As acute model, C57BL6/J mice were divided into control Group with only broth inoculation, Group with S. pneumoniae inoculation. On the sixth day, nasal lavage was done and mucosal neutrophil count was sought by dissecting the mice head from selecting three sections and four randomly selected places from each section. For the chronic model, C57BL/6 mice were used as follows: two normal controls, four sham operated controls, six mice with ostial obstruction alone using Merocel, six mice Merocel plus Streptococcus pneumoniae and six mice Merocel plus S. pneumoniae with 100 times higher amount. Epithelial thickness and goblet cell number were quantified after six weeks.
POSTERS
P258
Otolaryngology– Head and Neck Surgery August 2005
Otolaryngology– Head and Neck Surgery Volume 133 Number 2
P188 Isolated Inverted Papilloma of the Sphenoid Sinus and Endoscopic Sinus Surgery Alaa A-Wahab Hamed, MD (presenter) Cairo Egypt
Objectives: Inverted papilloma is uncommon benign sinonasal epithilial lesion characterized by a potentially invasive nature. Although it is primarily a lateral nasal wall disease, primary inverting papilloma of sphenoid sinus is rare. Histopathological examination of the papilloma and adjacent mucosa is crucial as more serious lesion may be hidden. Methods: This study describes two cases of inverted papilloma isolated to sphenoid sinus. Diagnosis made by ct, endoscopic and histopathological examinations. Transnasal endoscopic large sphenoidotomy for surgical excision. Histopathological study of excised material, with several biopsies from adjacent mucosa to confirm diagnosis and examine for malignancy. Results: Two cases of inverted papilloma with isolated involvement of the sphenoid sinus is presented. Headache, facial pain and diplopia were the presenting complaints and in one patient with left sided hearing loss and secretory otitis media. Both patients underwent transnasal endoscopic large sphenoidotomy to resect the disease including the whole sinus mucosa. No evidence of recurrent disease after one year in one patient and 18 months for the other. Inspection and several biopsies of adjacent areas showed no malignancy in both patients. In one patient with hearing loss there was metaplastic extension toward nasopharynx and left eustachian tube orifice. Conclusion: The clinical presentation of inverted papilloma confined to the sphenoid sinus is nonspecific and may present with visual and auditory symptoms. Transnasal endoscopic large sphenoidotomy remains an effective modality for management of patients with these lesions and facilitates follow-up. Histopathological study of the lesion and adjacent mucosa must be carried out to decrease recurrence and discover any accompanying pathology.
P190 Sinunasal Mucormycosis: A Report of Three Cases Young-Seok Choi, MD (presenter); Hong-Ryul Jin, MD PhD Cheongju South Korea; Cheongju South Korea
Objectives: Sinunasal mucormycosis a form of invasive fungal infection of the sinonasal track tthat often extends to the orbit, brain, and palate. It is caused by the order Mucorales and commonly associated with immunocompromised conditions such as diabetic ketoacidosis, HIV, and hematologic malignancy. We experienced three cases of sinonasal mucormycosis: rhino-orbital, isolated sphenoid sinus, and palatal mucormycosis. We present our successful management with literature review. Methods: Case 1 : Rhino-orbital mucormycosis. Case 2 : Isolated sphenoid sinus mucormycosis. Case 3 : Mucormycosis invading soft palate. Results: All cases were successfully treated with preferred diagnostic and treatment protocols. Conclusion: Mucormycosis must be included in the differential diagnosis of patients who struggle with acute or chronic headache, sinusitis or orbital cellulitis, even if they do not have any underlying disease. We should always keep in mind that thorough history taking and physical examination including eye, nasal cavity, palate, and brain, are required in high risk patients. An aggressive treatment involving stabilizing underlying disease process, wide surgical debridement, systemic antifungal agent, and other multidimentional therapy should take place. P191 Anatomic Variation of the Sinosal Cavity Antonio Carlos Eva Migueis, MD PhD (presenter); Pedro Melo Freitas, MD; Paula Gouveia, MD Coimbra Portugal; Rua Larga Portugal; Coimbra Portugal
Objectives: The normal anatomy of the nasal cavity and paranasal sinuses includes remarkable anatomic variation due to the wide diversity in pneumatization and development of the paranasal sinuses. Although some anatomic variants are not strictly abnormal, they are able to modify the sinosal physiology, predisposing to obstruction and consequently to retention of secretions. The imaging modalities of the sinosal cavity demand a deep knowledge of these anatomic variants. Methods: CT scan, Helical (Spiral) CT and MRI images. Results: We describe the main anatomic variants of the sinosal cavity, with a systematization focused on anatomic locus emphasizing those with clinical relevance. Conclusion: We confirm the important role of imaging on the functional endoscopic sinus surgery (FESS) on the study of the sinosal cavity. The helical (spiral) CT scan works like a roadmap on FESS, frequently allowing us to understand the causes of decreased mucociliary clearance, the etiology of recurrent sinusitis, and how certain anatomic characteristics are clinically relevant in this context of surgery procedures.
POSTERS
Results: In acute model, mucosal neutorophils revealed a statistically significant increase in Group 2 than control and the nasal lavage showed the more colony count in Group 2. In chronic model, epithelial thickness and goblet cell count were significantly increased in Merocel packing alone group and Merocel with pathogen inoculation group, but no difference was found between them. Also submucosal fibrosis and epithelial disarray, fibrosis were found in experimental group. Conclusion: This study provides the fact of developing an acute and chronic form of rhinosinusitis by using S. pneumoniae. We found no difference to induce the chronic form whether bacterial pathogen instilled or not if appropriate ostial obstruction proceeded.
Scientific Posters P259
P184 Experience with the SilMed Nasal Septal Button Gordon S Wood, Jr, MD (presenter) Logan UT
Objectives: Report our experience with a new septal button for the treatment of septal perforations. Report our experience with the standard septal button. Methods: We report our experience with 26 patients who were treated with the SilMed septal button for their septal perforations over a five year period. Results: The Silmed septal button with an oblong post was found to be superior to the septal buttons with a round post. Conclusion: With the septal button with the oblong post there was less movement of the button and was better tolerated and accepted by the patients. The majority of patients have resolution of their symptoms (epistaxis, progressive enlarging of the perforation, crusting, and obstruction). P185 Is Beta-Defensin 2 Raised in Idiopathic and Allergic Rhinitis Showkat Mirza, FRCS (presenter); Nicholas S Jones, BDS, FRCS Newcastle upon Tyne United Kingdom; Nottingham United Kingdom
Objectives: Defensins are a group of antimicrobial peptides that are an important component of the innate immune response at mucosal surfaces. Beta-defensin 2 expression has been shown to be raised in the mucosa in chronic sinusitis with nasal polyposis. Our aim was to analyse the levels of Beta Defensin 1 and 2 expression in the inferior turbinate mucosa of patients with idiopathic rhinitis, and allergic rhinitis as well as normal controls. Methods: We took samples of inferior turbinate from 12 patients with allergic rhinitis, 11 patients with intrinsic rhinitis, and 11 controls with no nasal mucosa disease undergoing a rhinoplasty. Expression of Beta-Defensin 1 and 2 mRNA was investigated by reverse-transcriptase-polymerase chain reaction and their expression level was semi-quantitatively evaluated by dot blot hybridisation. Immunohistochemical analysis was used for the detection of Beta-Defensins 1 and 2 in tissue sections. Results: initis and 5/11 cases of idiopathic rhinitis. Conclusion: Beta-Defensin 2 does not appear to be specifically raised in idiopathic or allergic rhinitis. Whilst BetaDefensin 2 expression is often raised as a result of infection, it appears not to be specifically raised in allergic or idiopathic rhinitis. P186 Endoscopic Resection of an Anterior Fossa Schwannoma with Nasal Cavity Extension Brennan Thomas Dodson, MD (presenter); Todd T Kingdom, MD Denver CO; Denver CO
Objectives: We report a case of endoscopic resection of a large anterior fossa schwannoma that extended into the nasal cavity. Methods: Report of a single case with two year follow-up. Results: A 48 year-old female presented with headache and disequilibrium, a MRI with gadolinium revealed a lesion of the anterior cranial fossa measuring 5cm by 3cm extending into the superior nasal cavity. Office-based biopsy revealed schwannoma. Complete removal of the lesion was accomplished via an endoscopic approach utilizing computer-assisted navigation. After removal, a 22mm by 25mm skull base defect was repaired using septal cartilage and nasal mucosa. A lumbar drain was placed post-operatively for 72 hours and the patient discharged home the following morning after an uneventful course. Two year follow-up revealed no evidence of CSF leak, recurrent tumor, or sinusitis based on nasal endoscopy and MRI. Subjectively the patient has experienced resolution of her headaches. Conclusion: We report a unique case of endoscopic resection of an anterior fossa schwannoma extending into the nasal cavity. The unique features of this case will be discussed and include 1) a minimally-invasive approach to a large anterior cranial base schwannoma avoiding craniotomy, 2) successful repair of a large skull base technique with endoscopic techniques, and 3) minimal patient morbidity with expedited recovery. This case highlights the value of advanced endoscopic techniques of the sinonasal cavities and the evolving role of minimally-invasive approaches in this region. P187 A Mouse Model of Acute and Chronic Rhinosinusitis Byung-Hoon Ahn, MD (presenter); Youn-Ho Park, MD; Dal-Won Song, MD PhD; Sung-Il Nam, MD Daegu South Korea; Deagu South Korea; Deagu South Korea; Daegu South Korea
Objectives: To induce the mouse model of acute and chronic rhinosinusitis employing common bacterial pathogens which causes bacterial rhinosinusitis, Streptococcus pneumoniae (ATCC 49619). Methods: The initial culture of Streptococcus pneumonia was done in Mueller-Hinton broth. As acute model, C57BL6/J mice were divided into control Group with only broth inoculation, Group with S. pneumoniae inoculation. On the sixth day, nasal lavage was done and mucosal neutrophil count was sought by dissecting the mice head from selecting three sections and four randomly selected places from each section. For the chronic model, C57BL/6 mice were used as follows: two normal controls, four sham operated controls, six mice with ostial obstruction alone using Merocel, six mice Merocel plus Streptococcus pneumoniae and six mice Merocel plus S. pneumoniae with 100 times higher amount. Epithelial thickness and goblet cell number were quantified after six weeks.
POSTERS
P258
Otolaryngology– Head and Neck Surgery August 2005
Otolaryngology– Head and Neck Surgery Volume 133 Number 2
P188 Isolated Inverted Papilloma of the Sphenoid Sinus and Endoscopic Sinus Surgery Alaa A-Wahab Hamed, MD (presenter) Cairo Egypt
Objectives: Inverted papilloma is uncommon benign sinonasal epithilial lesion characterized by a potentially invasive nature. Although it is primarily a lateral nasal wall disease, primary inverting papilloma of sphenoid sinus is rare. Histopathological examination of the papilloma and adjacent mucosa is crucial as more serious lesion may be hidden. Methods: This study describes two cases of inverted papilloma isolated to sphenoid sinus. Diagnosis made by ct, endoscopic and histopathological examinations. Transnasal endoscopic large sphenoidotomy for surgical excision. Histopathological study of excised material, with several biopsies from adjacent mucosa to confirm diagnosis and examine for malignancy. Results: Two cases of inverted papilloma with isolated involvement of the sphenoid sinus is presented. Headache, facial pain and diplopia were the presenting complaints and in one patient with left sided hearing loss and secretory otitis media. Both patients underwent transnasal endoscopic large sphenoidotomy to resect the disease including the whole sinus mucosa. No evidence of recurrent disease after one year in one patient and 18 months for the other. Inspection and several biopsies of adjacent areas showed no malignancy in both patients. In one patient with hearing loss there was metaplastic extension toward nasopharynx and left eustachian tube orifice. Conclusion: The clinical presentation of inverted papilloma confined to the sphenoid sinus is nonspecific and may present with visual and auditory symptoms. Transnasal endoscopic large sphenoidotomy remains an effective modality for management of patients with these lesions and facilitates follow-up. Histopathological study of the lesion and adjacent mucosa must be carried out to decrease recurrence and discover any accompanying pathology.
P190 Sinunasal Mucormycosis: A Report of Three Cases Young-Seok Choi, MD (presenter); Hong-Ryul Jin, MD PhD Cheongju South Korea; Cheongju South Korea
Objectives: Sinunasal mucormycosis a form of invasive fungal infection of the sinonasal track tthat often extends to the orbit, brain, and palate. It is caused by the order Mucorales and commonly associated with immunocompromised conditions such as diabetic ketoacidosis, HIV, and hematologic malignancy. We experienced three cases of sinonasal mucormycosis: rhino-orbital, isolated sphenoid sinus, and palatal mucormycosis. We present our successful management with literature review. Methods: Case 1 : Rhino-orbital mucormycosis. Case 2 : Isolated sphenoid sinus mucormycosis. Case 3 : Mucormycosis invading soft palate. Results: All cases were successfully treated with preferred diagnostic and treatment protocols. Conclusion: Mucormycosis must be included in the differential diagnosis of patients who struggle with acute or chronic headache, sinusitis or orbital cellulitis, even if they do not have any underlying disease. We should always keep in mind that thorough history taking and physical examination including eye, nasal cavity, palate, and brain, are required in high risk patients. An aggressive treatment involving stabilizing underlying disease process, wide surgical debridement, systemic antifungal agent, and other multidimentional therapy should take place. P191 Anatomic Variation of the Sinosal Cavity Antonio Carlos Eva Migueis, MD PhD (presenter); Pedro Melo Freitas, MD; Paula Gouveia, MD Coimbra Portugal; Rua Larga Portugal; Coimbra Portugal
Objectives: The normal anatomy of the nasal cavity and paranasal sinuses includes remarkable anatomic variation due to the wide diversity in pneumatization and development of the paranasal sinuses. Although some anatomic variants are not strictly abnormal, they are able to modify the sinosal physiology, predisposing to obstruction and consequently to retention of secretions. The imaging modalities of the sinosal cavity demand a deep knowledge of these anatomic variants. Methods: CT scan, Helical (Spiral) CT and MRI images. Results: We describe the main anatomic variants of the sinosal cavity, with a systematization focused on anatomic locus emphasizing those with clinical relevance. Conclusion: We confirm the important role of imaging on the functional endoscopic sinus surgery (FESS) on the study of the sinosal cavity. The helical (spiral) CT scan works like a roadmap on FESS, frequently allowing us to understand the causes of decreased mucociliary clearance, the etiology of recurrent sinusitis, and how certain anatomic characteristics are clinically relevant in this context of surgery procedures.
POSTERS
Results: In acute model, mucosal neutorophils revealed a statistically significant increase in Group 2 than control and the nasal lavage showed the more colony count in Group 2. In chronic model, epithelial thickness and goblet cell count were significantly increased in Merocel packing alone group and Merocel with pathogen inoculation group, but no difference was found between them. Also submucosal fibrosis and epithelial disarray, fibrosis were found in experimental group. Conclusion: This study provides the fact of developing an acute and chronic form of rhinosinusitis by using S. pneumoniae. We found no difference to induce the chronic form whether bacterial pathogen instilled or not if appropriate ostial obstruction proceeded.
Scientific Posters P259