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Endoscopic Transeptal Surgery for Choanal Atresia: A Stentless, Folded-Over-Flap Technique
Otolaryngology– Head and Neck Surgery Volume 133 Number 2
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Endoscopic Transeptal Surgery for Choanal Atresia: A Stentless, Folded-Over-Flap Technique Antonio Cadius Cedin, MD (presenter); Oswaldo Laercio Mendoza Cruz, MD; Reginaldo Raimundo Fujita, MD PhD Sao Paulo Brazil; Sao Paulo Brazil; Sao Paulo Brazil
Objectives: To analyze the results of surgical correction of choanal atresia employing a new technique that eliminates the use of nasal stents and packing, allowing long-term, satisfactory results. Methods: Prospective study analyzing ten patients with age ranging from four days to thirty years. Two patients were male and seven female, three presented bilateral choanal atresia and seven unilateral atresia. The postoperative follow-up was six months to three years. The transseptal endoscopic approach used in our series allowed, under direct vision and adequate instruments, the resection of the posterior portion of the vomer, the atretic plate and part of the medial pterygoids process. It was also possible to fashion flaps from septal, nasal and pharyngeal mucosa in order to cover the raw areas. The flaps were fixed with fibrin glue. Results: All patients were extubated in the immediate postoperative period. Uneventful recovery occurred in all
patients. An adequate functional nasal breathing was maintained during the entire follow-up period. Postoperative analysis included nasal endoscopy and computerized tomograpic. Conclusion: The endoscopic procedure described for choanal atresia correction proved to be safe, allowing atresia repair in a one-step surgery that eliminates nasal stents or nasal packing. Fast and uneventful recovery was observed along with long-term choanal patency with no reduction of functional quality.
9:46
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Biofilm Formation by P Aeruginosa and S Aureus is Associated with an Unfavourable Outcome Martin Y Desrosiers, MD (presenter); Zohra Bendouah; Walid Abou Hamad, MD; Jean Barbeau, PhD Montreal Canada; Montreal Canada; Paris France; Montreal Canada
Objectives: Bacterial biofilms have been demonstrated in inflammatory diseases of the paranasal sinuses, suggesting a possible role in the development or persistence of chronic rhinosinusitis and nasal polyposis. We wished to determine whether the biofilm-forming capacity of bacteria recovered from individuals with chronic sinusitis/sino-nasal polyposis has an impact on persistence of the disease following ESS. Methods: Thirty-one bacterial cultures recovered from 19 patients with chronic rhinosinusitis or nasal polyposis at least one year post-ESS. Evolution of disease was assessed clinically as favourable of unfavourable. The bacteria were cultured on 96-well plates in TSB 0.5% glucose medium. After staining with crystal violet, optical density at 570 nm was measured to quantify biofilm production. Biofilm formation was compared with positive and negative controls. Results: Twenty-four of 31 samples produced a biofilm greater or equal to the positive control. Biofilm was recovered consistently for all three species studied: Pseudomonas Aeruginosa 6/10 samples, coagulase-negative staphylococci 8/11 samples and Staphylococcus Aureus 10/10, where two species had only weak production. Biofilm production was detected in samples from both disorders. Strong biofilm formation was associated with a poor patient evolution for Pseudomonas Aeruginosa and Staphylococcus Aureus, but not coagulase-negative staphylococcus. Conclusion: This in-vitro assessment method demonstrates biofilm-forming capacity in a majority of bacterial samples recovered from individuals with chronic rhinosinusitis and nasal polyposis. The correlation between marked biofilm production by Pseudomonas Aeruginosa and Staphylococcus Aureus and unfavourable evolution of the disease suggests a role for biofilm production in the persistence of chronic sinusitis and nasal polyposis following ESS.
WEDNESDAY
outcome. Statistical analysis was performed using chi-square test, with statistical significance set at p ⬍ 0.05. Results: Facial pain and rhinorrhea were most common in group 1 and least common in group 3 (p ⬍ 0.05), while smell dysfunction was most common in group 3 (p ⬍ 0.05). Environmental allergies, but not asthma, were more prevalent in groups 1 and 2 compared to group 3 (p ⬍ 0.05). There was no statistically significant difference in the prevalence of psychiatric illness among the three groups. Anatomic abnormalities combined were more common in groups 1 and 2 compared to group 3 (p ⬍ 0.05). Group 1 patients were more likely to have chronic rhinosinusitis (CRS) without polyposis, while CRS with polyposis was more likely diagnosis in group 3 (p ⬍ 0.05). There was no difference in the relative prevalence within each group of antral-choanal polyp and mucocele. Patients in group 3 reported more improvement in rhinorrhea following endoscopic sinus surgery (p ⬍ 0.05), but there was no statistically significant difference in the improvement of the other presenting symptoms including facial pain among the groups. Conclusion: Adult patients with an age of 18-39 years who have inflammatory paranasal sinus disease are more likely to present with facial pain and have environmental allergies or anatomic abnormalities. The prevalence of psychiatric illness is comparable among the various age groups. A higher percentage of patients 40 years and older have nasal polyposis and are more likely to report improvement in rhinorrhea following surgery compared to younger patients.
Scientific Session—Wednesday P185
9:38
AM
Endoscopic Transeptal Surgery for Choanal Atresia: A Stentless, Folded-Over-Flap Technique Antonio Cadius Cedin, MD (presenter); Oswaldo Laercio Mendoza Cruz, MD; Reginaldo Raimundo Fujita, MD PhD Sao Paulo Brazil; Sao Paulo Brazil; Sao Paulo Brazil
Objectives: To analyze the results of surgical correction of choanal atresia employing a new technique that eliminates the use of nasal stents and packing, allowing long-term, satisfactory results. Methods: Prospective study analyzing ten patients with age ranging from four days to thirty years. Two patients were male and seven female, three presented bilateral choanal atresia and seven unilateral atresia. The postoperative follow-up was six months to three years. The transseptal endoscopic approach used in our series allowed, under direct vision and adequate instruments, the resection of the posterior portion of the vomer, the atretic plate and part of the medial pterygoids process. It was also possible to fashion flaps from septal, nasal and pharyngeal mucosa in order to cover the raw areas. The flaps were fixed with fibrin glue. Results: All patients were extubated in the immediate postoperative period. Uneventful recovery occurred in all
patients. An adequate functional nasal breathing was maintained during the entire follow-up period. Postoperative analysis included nasal endoscopy and computerized tomograpic. Conclusion: The endoscopic procedure described for choanal atresia correction proved to be safe, allowing atresia repair in a one-step surgery that eliminates nasal stents or nasal packing. Fast and uneventful recovery was observed along with long-term choanal patency with no reduction of functional quality.
9:46
AM
Biofilm Formation by P Aeruginosa and S Aureus is Associated with an Unfavourable Outcome Martin Y Desrosiers, MD (presenter); Zohra Bendouah; Walid Abou Hamad, MD; Jean Barbeau, PhD Montreal Canada; Montreal Canada; Paris France; Montreal Canada
Objectives: Bacterial biofilms have been demonstrated in inflammatory diseases of the paranasal sinuses, suggesting a possible role in the development or persistence of chronic rhinosinusitis and nasal polyposis. We wished to determine whether the biofilm-forming capacity of bacteria recovered from individuals with chronic sinusitis/sino-nasal polyposis has an impact on persistence of the disease following ESS. Methods: Thirty-one bacterial cultures recovered from 19 patients with chronic rhinosinusitis or nasal polyposis at least one year post-ESS. Evolution of disease was assessed clinically as favourable of unfavourable. The bacteria were cultured on 96-well plates in TSB 0.5% glucose medium. After staining with crystal violet, optical density at 570 nm was measured to quantify biofilm production. Biofilm formation was compared with positive and negative controls. Results: Twenty-four of 31 samples produced a biofilm greater or equal to the positive control. Biofilm was recovered consistently for all three species studied: Pseudomonas Aeruginosa 6/10 samples, coagulase-negative staphylococci 8/11 samples and Staphylococcus Aureus 10/10, where two species had only weak production. Biofilm production was detected in samples from both disorders. Strong biofilm formation was associated with a poor patient evolution for Pseudomonas Aeruginosa and Staphylococcus Aureus, but not coagulase-negative staphylococcus. Conclusion: This in-vitro assessment method demonstrates biofilm-forming capacity in a majority of bacterial samples recovered from individuals with chronic rhinosinusitis and nasal polyposis. The correlation between marked biofilm production by Pseudomonas Aeruginosa and Staphylococcus Aureus and unfavourable evolution of the disease suggests a role for biofilm production in the persistence of chronic sinusitis and nasal polyposis following ESS.
WEDNESDAY
outcome. Statistical analysis was performed using chi-square test, with statistical significance set at p ⬍ 0.05. Results: Facial pain and rhinorrhea were most common in group 1 and least common in group 3 (p ⬍ 0.05), while smell dysfunction was most common in group 3 (p ⬍ 0.05). Environmental allergies, but not asthma, were more prevalent in groups 1 and 2 compared to group 3 (p ⬍ 0.05). There was no statistically significant difference in the prevalence of psychiatric illness among the three groups. Anatomic abnormalities combined were more common in groups 1 and 2 compared to group 3 (p ⬍ 0.05). Group 1 patients were more likely to have chronic rhinosinusitis (CRS) without polyposis, while CRS with polyposis was more likely diagnosis in group 3 (p ⬍ 0.05). There was no difference in the relative prevalence within each group of antral-choanal polyp and mucocele. Patients in group 3 reported more improvement in rhinorrhea following endoscopic sinus surgery (p ⬍ 0.05), but there was no statistically significant difference in the improvement of the other presenting symptoms including facial pain among the groups. Conclusion: Adult patients with an age of 18-39 years who have inflammatory paranasal sinus disease are more likely to present with facial pain and have environmental allergies or anatomic abnormalities. The prevalence of psychiatric illness is comparable among the various age groups. A higher percentage of patients 40 years and older have nasal polyposis and are more likely to report improvement in rhinorrhea following surgery compared to younger patients.
Scientific Session—Wednesday P185