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Endoscopic training with sino-nasal and skull-base model
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Otolaryngology-Head and Neck Surgery, Vol 141, No 3S1, September 2009
decreases in S100 proteins in CRS epithelium which may lead to diminished innate immune response and barrier function. Increased levels of S100A8/A9 in nasal polyp tissue may reflect neutrophil recruitment and a compensatory mechanism. Future studies will be important to determine whether reduced levels of S100 proteins lead to either decreased antimicrobial responses or defects in barrier function and whether reduced S100 proteins plays an etiologic role in CRS pathogenesis and susceptibility to infectious disease. Endoscopic embolization and resection of JNA: A new approach Michael Bublik, MD (presenter); Jose Ruiz, MD; Bjorn Herman, MD; Ramzi Tamer Younis, MD OBJECTIVES: 1) To report the first cases of endoscopic embolization (EE) of juvenile nasopharyngeal angiofibroma (JNA). 2) Demonstrate the procedure through video and 3D imagery. 3) Describe all outcomes and results. METHODS: Four patients presented to a tertiary care academic medical center with repeated episodes of unilateral epistaxis diagnosed with fiberoptic and radiographic examination as nasal JNA. Subsequently, in conjunction with neurosurgery, endoscopic visualization was provided to perform intratumor needle insertion, through which the liquid embolic agent Onyx was infused to embolize the JNAs under fluoroscopic guidance. The day after EE, endoscopic resection was performed. Operating room time, estimated blood loss (EBL), and other intraoperative and postoperative results are reported and compared to published literature. RESULTS: A total of four patients (all males), had EE of JNA and subsequent endoscopic resection. Average EBL during surgery was 412.5 milliliters (range 150-800) with an average operating room time of 228 minutes (range 95-485). We experienced no bleeding from the tumor or its attachments, only from the approach. Two patients experienced mild numbness in the V2 distribution, which began to resolve one week postoperatively. No other complications were encountered. CONCLUSIONS: This is the first published report of direct endoscopic embolization of JNA. Although further studies are needed, it seems to provide a safe, less invasive alternative to traditional embolization and endoscopic resection, but must be done in cooperation with interventional neurosurgery to maximize its safety profile. Endoscopic training with sino-nasal and skull-base model Joao F Nogueira, MD (presenter); Aldo Stamm, MD, PhD; Maria Silva, MD; Fabio Santos, MD; Thiago Souza, MD OBJECTIVES: Show the development of an endoscopic nasal and skull-base surgery model, discuss the effectiveness in
anatomical knowledge gain, and present major advantages and disadvantages. METHODS: Prospective study with the development of models used by 10 otolaryngologists divided into three groups according to levels of experience. Scores were requested for consistency, tissue color, and identification of anatomical structures. The results were compared and analyzed statistically. RESULTS: The mean score assigned by participants for consistency was 3,2, for a maximum of 4. For the color the overall average was 3,6 (maximum 4). The mean score for identification of anatomical structures was 9,4 (maximum 10). CONCLUSIONS: We presented an endoscopic nasal surgery model, showing the steps of development. 70% of participants reported improvement in anatomical knowledge. The advantages are: Use of instruments similar to the real and no involved biological hazards. The disadvantage was the single dissection at the nasal lateral wall. Epistaxis: Prospective study of merocoele vs rapidrhino Sunil H Vyas, MBChB (presenter) OBJECTIVES: To assess: 1) The efectiveness of merocoele and rapidrhino packs in controlling aterior epistaxis. 2) Associatd patient discomfort. METHODS: 112 patients with anterior epistaxis which failed to respond to silver nitrate cautery were randomised into two groups: Group A (52), packed with merocoele, and group B (60), with rapid-rhino packs. Nasal lidocaine was applied before packing and patient discomfort was assessed, via a Visual Analogu Score (VAS, 0-5, where 5 is the worst pain). Patients that continued to bleed, requiring further treatment, were excluded from the study. Packs were left in for 24-30 hours and patients monitored in the ward. After removal of the packs, discomfort was further assessed using the VAS. Difficulty of insertion (DI, 0-5 scale) of packs, were also assessed. RESULTS: VAS at insertion: Group A (52): 0-2 (12/52, 23.1%). Above 2-3 (34/52, 65.4%). Above 3-5 (6/52, 11.5%). Group B (60): 0-2 (15/60, 25.0%). Above 2-3 (37/60, 61.7%). Above 3-5 (8/60, 13.3%). VAS at removal: Group A (50): 0-2 (40/50, 80.0%). Above 2-3 (8/50, 16.0%). Above 3-5 (2/50, 4.0%). Group B (57): 0-2 (40/57, 70.2%). Above 2-3 (10/57, 17.5%). Above 3-5 (7/57, 12.3%). For DI: Group A (52): 0-2(41/52, 78.9%). Above 2-3 (9/52, 17.3%). Above 3-5 (2/52, 3.8%). Group B (60): 0-2(45/60, 75.0%). Above 2-3 (11/60, 18.3%). Above 3-5 (4/60, 6.7%). Over a 3-month period, there are no significant differences in recurrence rates of epistaxis. CONCLUSIONS: Both merocoele and rapidrhino packs are effective in controlling anterior epistaxis, without any significant differences in patient discomfort, during insertion or removal.
Otolaryngology-Head and Neck Surgery, Vol 141, No 3S1, September 2009
decreases in S100 proteins in CRS epithelium which may lead to diminished innate immune response and barrier function. Increased levels of S100A8/A9 in nasal polyp tissue may reflect neutrophil recruitment and a compensatory mechanism. Future studies will be important to determine whether reduced levels of S100 proteins lead to either decreased antimicrobial responses or defects in barrier function and whether reduced S100 proteins plays an etiologic role in CRS pathogenesis and susceptibility to infectious disease. Endoscopic embolization and resection of JNA: A new approach Michael Bublik, MD (presenter); Jose Ruiz, MD; Bjorn Herman, MD; Ramzi Tamer Younis, MD OBJECTIVES: 1) To report the first cases of endoscopic embolization (EE) of juvenile nasopharyngeal angiofibroma (JNA). 2) Demonstrate the procedure through video and 3D imagery. 3) Describe all outcomes and results. METHODS: Four patients presented to a tertiary care academic medical center with repeated episodes of unilateral epistaxis diagnosed with fiberoptic and radiographic examination as nasal JNA. Subsequently, in conjunction with neurosurgery, endoscopic visualization was provided to perform intratumor needle insertion, through which the liquid embolic agent Onyx was infused to embolize the JNAs under fluoroscopic guidance. The day after EE, endoscopic resection was performed. Operating room time, estimated blood loss (EBL), and other intraoperative and postoperative results are reported and compared to published literature. RESULTS: A total of four patients (all males), had EE of JNA and subsequent endoscopic resection. Average EBL during surgery was 412.5 milliliters (range 150-800) with an average operating room time of 228 minutes (range 95-485). We experienced no bleeding from the tumor or its attachments, only from the approach. Two patients experienced mild numbness in the V2 distribution, which began to resolve one week postoperatively. No other complications were encountered. CONCLUSIONS: This is the first published report of direct endoscopic embolization of JNA. Although further studies are needed, it seems to provide a safe, less invasive alternative to traditional embolization and endoscopic resection, but must be done in cooperation with interventional neurosurgery to maximize its safety profile. Endoscopic training with sino-nasal and skull-base model Joao F Nogueira, MD (presenter); Aldo Stamm, MD, PhD; Maria Silva, MD; Fabio Santos, MD; Thiago Souza, MD OBJECTIVES: Show the development of an endoscopic nasal and skull-base surgery model, discuss the effectiveness in
anatomical knowledge gain, and present major advantages and disadvantages. METHODS: Prospective study with the development of models used by 10 otolaryngologists divided into three groups according to levels of experience. Scores were requested for consistency, tissue color, and identification of anatomical structures. The results were compared and analyzed statistically. RESULTS: The mean score assigned by participants for consistency was 3,2, for a maximum of 4. For the color the overall average was 3,6 (maximum 4). The mean score for identification of anatomical structures was 9,4 (maximum 10). CONCLUSIONS: We presented an endoscopic nasal surgery model, showing the steps of development. 70% of participants reported improvement in anatomical knowledge. The advantages are: Use of instruments similar to the real and no involved biological hazards. The disadvantage was the single dissection at the nasal lateral wall. Epistaxis: Prospective study of merocoele vs rapidrhino Sunil H Vyas, MBChB (presenter) OBJECTIVES: To assess: 1) The efectiveness of merocoele and rapidrhino packs in controlling aterior epistaxis. 2) Associatd patient discomfort. METHODS: 112 patients with anterior epistaxis which failed to respond to silver nitrate cautery were randomised into two groups: Group A (52), packed with merocoele, and group B (60), with rapid-rhino packs. Nasal lidocaine was applied before packing and patient discomfort was assessed, via a Visual Analogu Score (VAS, 0-5, where 5 is the worst pain). Patients that continued to bleed, requiring further treatment, were excluded from the study. Packs were left in for 24-30 hours and patients monitored in the ward. After removal of the packs, discomfort was further assessed using the VAS. Difficulty of insertion (DI, 0-5 scale) of packs, were also assessed. RESULTS: VAS at insertion: Group A (52): 0-2 (12/52, 23.1%). Above 2-3 (34/52, 65.4%). Above 3-5 (6/52, 11.5%). Group B (60): 0-2 (15/60, 25.0%). Above 2-3 (37/60, 61.7%). Above 3-5 (8/60, 13.3%). VAS at removal: Group A (50): 0-2 (40/50, 80.0%). Above 2-3 (8/50, 16.0%). Above 3-5 (2/50, 4.0%). Group B (57): 0-2 (40/57, 70.2%). Above 2-3 (10/57, 17.5%). Above 3-5 (7/57, 12.3%). For DI: Group A (52): 0-2(41/52, 78.9%). Above 2-3 (9/52, 17.3%). Above 3-5 (2/52, 3.8%). Group B (60): 0-2(45/60, 75.0%). Above 2-3 (11/60, 18.3%). Above 3-5 (4/60, 6.7%). Over a 3-month period, there are no significant differences in recurrence rates of epistaxis. CONCLUSIONS: Both merocoele and rapidrhino packs are effective in controlling anterior epistaxis, without any significant differences in patient discomfort, during insertion or removal.