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Endoscopic intranasal frontal sinusotomy
1230 first reported case of a mucocele of the pterygomaxillary space, resulting from disruption of antral drainage following a Caldwell-Luc procedure and transantral ligation of the internal maxillary artery for treatment of epistaxis. A portion of mucosa was sequestered from the ostium because of scarring. Treatment consists of complete removal of the mucocele.G.H. SPERBER Reprint requests to Dr Klotch: Division of Otolaryngology, Head and Neck Surgery, Harborside Medical Towers, 4 Columbia Dr, #730, Tampa, FL 33606.
CURRENT LITERATURE and after surgery. Following surgery, the MCA at the nasal valve decreased by 22% to 25% of its preoperative value, which brought the dimensions near critical values for nasal obstruction. CA-3.3 and CA-4.0 decreased by 11% to 13%. The area at 6.4 cm from the nostril and the total volume of the nose decreased, but not significantly. The authors conclude that after surgery, the most anterior dimensions of the nose decreased significantly and more posteriorly, fewer changes were observed. The authors advocate the use of acoustic rhinometry to prevent further decrease of nasal patency in patients at risk and to document the changes.-K.N. CHOW
Pharyngitis: When is Aggressive Treatment Warranted? Bonilla JA, Bluestone CD. Postgrad Med 97:61, 1995 In this, the second of four articles on ENT problems in the May issue, the authors review pharyngitis. They note that most cases of pharyngitis are viral but are nevertheless treated with antibiotics and symptom medications. Most cases occur during colder months, with rhinovirus infections more common in spring and fall, coronavirus infections peaking in the winter months, and streptococcal infections appearing in late winter and early spring. Signs and symptoms of infectious and noninfectious pharyngitis often overlap and it can be difficult differentiating between them. Noninfectious causes include allergy, sinusitis, malignant disease, chemical bums, cigarette smoke, smog, and others. Most common among the bacterial organisms causing pharyngitis is group A beta-hemolytic streptococcus, which can also cause rheumatic fever if untreated. The most common of the fungal organisms causing pharyngitis is Can&u albicans. The authors then review the varying clinical findings between viral, bacterial, and fungal infections, review laboratory testing in the diagnostic process, and various therapies. Aspirin should be avoided in children and teenagers with influenzalike symptoms because of the potential for Reye’s syndrome. Ten days of penicillin therapy is recommended for streptococcal pharyngitis to prevent rheumatic fever. In penicillin-allergic patients, erythromycin or oral cephalosporins may be used, according to the authors. The authors briefly discuss tonsillitis, and recommend tonsillectomy for patients who have had five to seven episodes of infection in one year, five episodes per year for 2 years, or three episodes per year for 3 years.-R.E. ALEXANDER Reprint Requests to Dr Bonilla: Department of Pediatric Otolaryngology, Children’s Hospital of Pittsburgh, 3705 Fifth Ave, Pittsburgh, PA 15213-2583. Reduction Rhinoplasty and Nasal Patency: Change in the Cross-Sectional Area of the Nose Evaluated by Acoustic Rhinometry. Grymer LF. Laryngoscope 105:429, 1995 In this study, acoustic rhinometry, a new method based on acoustic reflections, was used to evaluate the internal dimensions of the nasal cavity. It provides an estimate of the cross-sectional areas of the nose as a function of the distance from the nostril. The study included 37 patients, 24 women and 13 men, who had primary reduction rhinoplasty. Patient age ranged from 17 to 48 years, with a mean of 29 years. Measurements were taken before surgery and 6 months postsurgery. Acoustic rhinometry was used to calculate the total volume of the nose from the nostril to 7 cm posteriorly and the minimal cross-sectional area (MCA). The cross-sectional areas at 3.3 cm (CA-3.3), 4.0 cm (CA-4.0), and 6.4 cm from the nostril were also calculated. The subjective feeling of nasal patency was also recorded both before
Reprint requests to Dr Grymer: Kildegaarden 9, DK 8000 Aarhus C, Denmark. Endoscopic Intranasal cente F. Laryngoscope
Frontal Sinusotomy. 105:440, 1995
Har-El G, Lu-
The authors discuss intranasal frontal sinusotomy as the procedure of choice for frontal sinus disease requiring surgical management. Between 1988 and 1993, the authors performed endoscopic intranasal frontal sinusostomy on 22 patients (12 men and 10 women), ranging in age from 19 to 63 years. The surgical technique of intranasal frontal sinusotomy involved the use of either a 30” and 70” telescope to determine the exact location and course of the frontal outflow tract (FOT). An ostium probe or a curved blunt suction tip was also used to assist in locating the FOT. Uncinectomy, anterior ethmoidectomy, removal of agger nasi cells, or limited resection of the anterosuperior attachment of the middle turbinate was occasionally required depending on the anatomical variation. The FOT was enlarged anteriorly in 16 patients. Additional anteromedial removal of bone toward the midline and through the superior attachment of the middle turbinate was performed in five patients. Extension through the midline, through the superior aspect of the nasal septum, through the intrasinus septum, and into the contralatera1 frontal sinus was performed in one patient. A Kerrison rongeur was the preferred instrument for bony reduction. Stents were placed in the FOT of all 14 patients with chronic frontal sinusitis and frontal mucocele, two of three patients with acute frontal sinusitis, and one of two patients with recurrent acute frontal sinusitis. These stents were irrigated for approximately 5 to 7 weeks. The follow-up period ranged from 10 to 50 months. In 21 patients, intranasal sinusotomy alone was sufficient to achieve the therapeutic goals. In one patient, simultaneous external trephination was performed. The authors conclude that endoscopic intranasal sinusotomy produces results that are at least as good as those of the external sinusotomy approaches and the osteoplastic flap procedures while avoiding the morbidity related to these procedures.-K.N. CHOW Reprint requests to Dr Har-El: Department of Otolaryngology, Long Island College Hospital, 340 Henry St, Brooklyn, NY 11201. Acute and Chronic 97:45. 1995
Sinusitis.
Ferguson BJ. Postgrad Med
In this, the first first of four articles in the May issue on ENT problems, the author reviews the clinical characteristics, evaluation, and various therapies for acute and chronic sinusitis. Allergic and viral rhinosinusitis must be differentiated from acute or chronic bacterial sinusitis, but some patients can have an allergic or viral sinusitis with a secondary infection. Most cases of sinusitis follow a cold or other viral
CURRENT LITERATURE and after surgery. Following surgery, the MCA at the nasal valve decreased by 22% to 25% of its preoperative value, which brought the dimensions near critical values for nasal obstruction. CA-3.3 and CA-4.0 decreased by 11% to 13%. The area at 6.4 cm from the nostril and the total volume of the nose decreased, but not significantly. The authors conclude that after surgery, the most anterior dimensions of the nose decreased significantly and more posteriorly, fewer changes were observed. The authors advocate the use of acoustic rhinometry to prevent further decrease of nasal patency in patients at risk and to document the changes.-K.N. CHOW
Pharyngitis: When is Aggressive Treatment Warranted? Bonilla JA, Bluestone CD. Postgrad Med 97:61, 1995 In this, the second of four articles on ENT problems in the May issue, the authors review pharyngitis. They note that most cases of pharyngitis are viral but are nevertheless treated with antibiotics and symptom medications. Most cases occur during colder months, with rhinovirus infections more common in spring and fall, coronavirus infections peaking in the winter months, and streptococcal infections appearing in late winter and early spring. Signs and symptoms of infectious and noninfectious pharyngitis often overlap and it can be difficult differentiating between them. Noninfectious causes include allergy, sinusitis, malignant disease, chemical bums, cigarette smoke, smog, and others. Most common among the bacterial organisms causing pharyngitis is group A beta-hemolytic streptococcus, which can also cause rheumatic fever if untreated. The most common of the fungal organisms causing pharyngitis is Can&u albicans. The authors then review the varying clinical findings between viral, bacterial, and fungal infections, review laboratory testing in the diagnostic process, and various therapies. Aspirin should be avoided in children and teenagers with influenzalike symptoms because of the potential for Reye’s syndrome. Ten days of penicillin therapy is recommended for streptococcal pharyngitis to prevent rheumatic fever. In penicillin-allergic patients, erythromycin or oral cephalosporins may be used, according to the authors. The authors briefly discuss tonsillitis, and recommend tonsillectomy for patients who have had five to seven episodes of infection in one year, five episodes per year for 2 years, or three episodes per year for 3 years.-R.E. ALEXANDER Reprint Requests to Dr Bonilla: Department of Pediatric Otolaryngology, Children’s Hospital of Pittsburgh, 3705 Fifth Ave, Pittsburgh, PA 15213-2583. Reduction Rhinoplasty and Nasal Patency: Change in the Cross-Sectional Area of the Nose Evaluated by Acoustic Rhinometry. Grymer LF. Laryngoscope 105:429, 1995 In this study, acoustic rhinometry, a new method based on acoustic reflections, was used to evaluate the internal dimensions of the nasal cavity. It provides an estimate of the cross-sectional areas of the nose as a function of the distance from the nostril. The study included 37 patients, 24 women and 13 men, who had primary reduction rhinoplasty. Patient age ranged from 17 to 48 years, with a mean of 29 years. Measurements were taken before surgery and 6 months postsurgery. Acoustic rhinometry was used to calculate the total volume of the nose from the nostril to 7 cm posteriorly and the minimal cross-sectional area (MCA). The cross-sectional areas at 3.3 cm (CA-3.3), 4.0 cm (CA-4.0), and 6.4 cm from the nostril were also calculated. The subjective feeling of nasal patency was also recorded both before
Reprint requests to Dr Grymer: Kildegaarden 9, DK 8000 Aarhus C, Denmark. Endoscopic Intranasal cente F. Laryngoscope
Frontal Sinusotomy. 105:440, 1995
Har-El G, Lu-
The authors discuss intranasal frontal sinusotomy as the procedure of choice for frontal sinus disease requiring surgical management. Between 1988 and 1993, the authors performed endoscopic intranasal frontal sinusostomy on 22 patients (12 men and 10 women), ranging in age from 19 to 63 years. The surgical technique of intranasal frontal sinusotomy involved the use of either a 30” and 70” telescope to determine the exact location and course of the frontal outflow tract (FOT). An ostium probe or a curved blunt suction tip was also used to assist in locating the FOT. Uncinectomy, anterior ethmoidectomy, removal of agger nasi cells, or limited resection of the anterosuperior attachment of the middle turbinate was occasionally required depending on the anatomical variation. The FOT was enlarged anteriorly in 16 patients. Additional anteromedial removal of bone toward the midline and through the superior attachment of the middle turbinate was performed in five patients. Extension through the midline, through the superior aspect of the nasal septum, through the intrasinus septum, and into the contralatera1 frontal sinus was performed in one patient. A Kerrison rongeur was the preferred instrument for bony reduction. Stents were placed in the FOT of all 14 patients with chronic frontal sinusitis and frontal mucocele, two of three patients with acute frontal sinusitis, and one of two patients with recurrent acute frontal sinusitis. These stents were irrigated for approximately 5 to 7 weeks. The follow-up period ranged from 10 to 50 months. In 21 patients, intranasal sinusotomy alone was sufficient to achieve the therapeutic goals. In one patient, simultaneous external trephination was performed. The authors conclude that endoscopic intranasal sinusotomy produces results that are at least as good as those of the external sinusotomy approaches and the osteoplastic flap procedures while avoiding the morbidity related to these procedures.-K.N. CHOW Reprint requests to Dr Har-El: Department of Otolaryngology, Long Island College Hospital, 340 Henry St, Brooklyn, NY 11201. Acute and Chronic 97:45. 1995
Sinusitis.
Ferguson BJ. Postgrad Med
In this, the first first of four articles in the May issue on ENT problems, the author reviews the clinical characteristics, evaluation, and various therapies for acute and chronic sinusitis. Allergic and viral rhinosinusitis must be differentiated from acute or chronic bacterial sinusitis, but some patients can have an allergic or viral sinusitis with a secondary infection. Most cases of sinusitis follow a cold or other viral