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Nasal growth after pediatric septoplasty
P114
Otolaryngology-Head and Neck Surgery, Vol 141, No 3S1, September 2009
METHODS: Prospective study on non-acute fungal sinusitis patients with orbital involvement presenting to tertiary hospital between Jan 1999 to Dec 2003. Seventeen IFS and 13 NIFS patients with mean age 27 years (range 7-59) underwent computed tomographic (CT) scan and magnetic resonance imaging (MRI) of paranasal sinuses with contrast. These were operated within one month of doing the scans and had histologically confirmed fungal sinusitis. Outcome measure was characteristics of opacity produced by the diseased tissue on CT scans and MRI. Also studied were side and number of sinuses involved, expansion of sinuses, areas of bone destruction and extra-sinus extension. RESULTS: IFS showed homogenous isodense opacity on CT, isointense signal on T1 and hypointense signal on T2 weighted MR images. Involvement of one/two sinuses only, homogenous contrast enhancement, lack of expansion of sinuses, bone destruction localised to the area of extra-sinus extension and extra-sinus component of the disease was more than the intrasinus component. One or two sinuses only were involved. NIFS showed heterogenous opacities with hyper-attenuation areas on CT, hypointense to signal void on T1 and T2 MR images. Expansion of sinuses, extensive bone destruction, lack of contrast enhancement, multiple sinus involvement and major bulk of disease confined within sinuses. CONCLUSIONS: Characteristic radiological features of IFS are described which are different from NIFS. Late development of mucopyoceles in osteoneogenic skull base Karen Bednarski, MD (presenter); Frederick Kuhn, MD; Christopher Melroy, MD OBJECTIVES: 1) Report a new complication of osteoneogenesis following endoscopic sinus surgery. 2) Be able to recognize the development of mucopyoceles within osteoneogenic bone of the skull base. METHODS: A retrospective review was performed in a tertiary care rhinology practice. Charts were reviewed from 7/1/ 2008 to 3/2/2009 on all patients undergoing endoscopic sinus surgery. Patients having revision surgery were identified. The preoperative computed tomography (CT) scans of these patients were reviewed, with specific attention paid to the skull base and presence of osteoneogenesis. Those patients presenting with significant osteoneogenesis were examined further by reviewing all previous CT scans. The clinical course was noted including all interventions. RESULTS: Eighty-nine patients had endoscopic sinus surgery between 7/1/2008 and 3/2/2009, for a total of 96 procedures. Of these patients, 68 had revision surgery and fifteen (22%) were found to have an osteoneogenic skull base. Of these patients, one group of 11 patients (73.3%) had minimal bony changes, while four patients had massive osteoneogenesis (26.6%). In this second group skull base thickness ranged from 1.2 to 1.8 cm (mean 1.3 cm) and all developed mucopyoceles
within the osteoneogenic bone that sequestered bacteria and/or obstructed the frontal recess. CONCLUSIONS: This study is the first to identify mucopyocele development within osteoneogenic bone following endoscopic sinus surgery and underscores the need to prevent its development. When osteoneogenesis is present, it should be carefully examined for mucopyocele development as a cause of persistent infection. Nasal growth after pediatric septoplasty Ignazio Tasca (presenter); Giacomo Ceroni OBJECTIVES: To assess the effectiveness of septoplasty in children presenting obstructive anterior septum deformity and test the hypothesis that surgery on the growing nasal septum does not adversely affect nasal and midfacial dimensions. METHODS: 40 patients, 22 males and 18 females, aged between 5 and 12 years (average: 8.5 years), who underwent endonasal septoplasty during childhood, were reassessed after a mean follow-up of 9 years (range 5-12 years) by means of nasal endoscopy, morphometric analysis, rhinomanometry, and acoustic rhinometry. Anthropometric recordings were used to identify any growth retardation due to the operation by a comparison with age-specific normative data of North American whites. RESULTS: During the last follow-up, a well aligned nasal septum was recorded in 29 patients, a residual deformity posteriorly displaced in seven patients. In these patients, functional results of rhinomanometry and acoustic rhinometry revealed normal tracings. The remaining four patients manifested a persistent obstructive septum deformity and were scheduled for a revision surgery. Morphometric evaluation did not identify any growth retardation in all patients. CONCLUSIONS: Septoplasty in children may be indicated in selected cases of deformity obstructing the septum, congenital or post-traumatic, and in cases of symptomatic septal alterations that are associated with recurrent inflammatory diseases of the upper airways. Our study documents that pediatric septoplasty using endonasal approach is effective for normalizing nasal respiration and does not exibit any nasal growth retardation in a long-term follow up. Olfactory changes after endoscopic pituitary tumor resection Catherine K Hart, MD (presenter); Lee Zimmer, MD, PhD OBJECTIVES: Given that the transnasal endoscopic approach to the sella involves resection of anatomical structures known to contain olfactory nerve fibers, we evaluated the effect of this approach on olfaction. METHODS: Prospective case series. From October 2007 to December 2008, 50 adults diagnosed with a pituitary mass and
Otolaryngology-Head and Neck Surgery, Vol 141, No 3S1, September 2009
METHODS: Prospective study on non-acute fungal sinusitis patients with orbital involvement presenting to tertiary hospital between Jan 1999 to Dec 2003. Seventeen IFS and 13 NIFS patients with mean age 27 years (range 7-59) underwent computed tomographic (CT) scan and magnetic resonance imaging (MRI) of paranasal sinuses with contrast. These were operated within one month of doing the scans and had histologically confirmed fungal sinusitis. Outcome measure was characteristics of opacity produced by the diseased tissue on CT scans and MRI. Also studied were side and number of sinuses involved, expansion of sinuses, areas of bone destruction and extra-sinus extension. RESULTS: IFS showed homogenous isodense opacity on CT, isointense signal on T1 and hypointense signal on T2 weighted MR images. Involvement of one/two sinuses only, homogenous contrast enhancement, lack of expansion of sinuses, bone destruction localised to the area of extra-sinus extension and extra-sinus component of the disease was more than the intrasinus component. One or two sinuses only were involved. NIFS showed heterogenous opacities with hyper-attenuation areas on CT, hypointense to signal void on T1 and T2 MR images. Expansion of sinuses, extensive bone destruction, lack of contrast enhancement, multiple sinus involvement and major bulk of disease confined within sinuses. CONCLUSIONS: Characteristic radiological features of IFS are described which are different from NIFS. Late development of mucopyoceles in osteoneogenic skull base Karen Bednarski, MD (presenter); Frederick Kuhn, MD; Christopher Melroy, MD OBJECTIVES: 1) Report a new complication of osteoneogenesis following endoscopic sinus surgery. 2) Be able to recognize the development of mucopyoceles within osteoneogenic bone of the skull base. METHODS: A retrospective review was performed in a tertiary care rhinology practice. Charts were reviewed from 7/1/ 2008 to 3/2/2009 on all patients undergoing endoscopic sinus surgery. Patients having revision surgery were identified. The preoperative computed tomography (CT) scans of these patients were reviewed, with specific attention paid to the skull base and presence of osteoneogenesis. Those patients presenting with significant osteoneogenesis were examined further by reviewing all previous CT scans. The clinical course was noted including all interventions. RESULTS: Eighty-nine patients had endoscopic sinus surgery between 7/1/2008 and 3/2/2009, for a total of 96 procedures. Of these patients, 68 had revision surgery and fifteen (22%) were found to have an osteoneogenic skull base. Of these patients, one group of 11 patients (73.3%) had minimal bony changes, while four patients had massive osteoneogenesis (26.6%). In this second group skull base thickness ranged from 1.2 to 1.8 cm (mean 1.3 cm) and all developed mucopyoceles
within the osteoneogenic bone that sequestered bacteria and/or obstructed the frontal recess. CONCLUSIONS: This study is the first to identify mucopyocele development within osteoneogenic bone following endoscopic sinus surgery and underscores the need to prevent its development. When osteoneogenesis is present, it should be carefully examined for mucopyocele development as a cause of persistent infection. Nasal growth after pediatric septoplasty Ignazio Tasca (presenter); Giacomo Ceroni OBJECTIVES: To assess the effectiveness of septoplasty in children presenting obstructive anterior septum deformity and test the hypothesis that surgery on the growing nasal septum does not adversely affect nasal and midfacial dimensions. METHODS: 40 patients, 22 males and 18 females, aged between 5 and 12 years (average: 8.5 years), who underwent endonasal septoplasty during childhood, were reassessed after a mean follow-up of 9 years (range 5-12 years) by means of nasal endoscopy, morphometric analysis, rhinomanometry, and acoustic rhinometry. Anthropometric recordings were used to identify any growth retardation due to the operation by a comparison with age-specific normative data of North American whites. RESULTS: During the last follow-up, a well aligned nasal septum was recorded in 29 patients, a residual deformity posteriorly displaced in seven patients. In these patients, functional results of rhinomanometry and acoustic rhinometry revealed normal tracings. The remaining four patients manifested a persistent obstructive septum deformity and were scheduled for a revision surgery. Morphometric evaluation did not identify any growth retardation in all patients. CONCLUSIONS: Septoplasty in children may be indicated in selected cases of deformity obstructing the septum, congenital or post-traumatic, and in cases of symptomatic septal alterations that are associated with recurrent inflammatory diseases of the upper airways. Our study documents that pediatric septoplasty using endonasal approach is effective for normalizing nasal respiration and does not exibit any nasal growth retardation in a long-term follow up. Olfactory changes after endoscopic pituitary tumor resection Catherine K Hart, MD (presenter); Lee Zimmer, MD, PhD OBJECTIVES: Given that the transnasal endoscopic approach to the sella involves resection of anatomical structures known to contain olfactory nerve fibers, we evaluated the effect of this approach on olfaction. METHODS: Prospective case series. From October 2007 to December 2008, 50 adults diagnosed with a pituitary mass and