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P170
P268
Otolaryngology-Head and Neck Surgery, Vol 135, No 2S, August 2006
P168 Ultrastructural Changes in Rhinitis Medicamentosa Stephan Knipping, MD (presenter); Gerrit Goetze; Andreas Riederer, MD Halle/Saale Germany; Munich Germany OBJECTIVES: Topical vasoconstrictors are frequently used in the management of rhinosinusitis. Prolonged application causes rhinitis medicamentosa (RM) due to cytotoxic effects. Nasal obstruction is caused by rebound swelling when the decongestive effect has disappeared. METHODS: The aim of this study was to search for morphological changes in RM. RESULTS: For this retrospective study from March 2003 to April 2005, tissue samples of inferior turbinates from 22 patients with RM were taken during nasal surgery. For electron microscopy the samples were preserved in glutaraldehyde. Ultrathin sections were cut and a standardized procedure was carried out. The findings were photodocumented by using a transmission electron microscope. Biopsies from 10 patients without chronic inflammations of nasal mucosa were used as control. The transmission electron microscopic investigations revealed severe epithelial damage resulting in regions with hyperplastic and metaplastic changes. Loss of ciliated cells was observed. Thickness of basal membrane was increased. In the edematous subepithelial region, ultrastructural changes of the endothelial lining such as gaps and ruptures of basal lamina of capillaries were detected. Prominent endothelial cells were conspicuous. CONCLUSIONS: RM is drug-induced damage of human nasal mucosa associated with overuse of topical nasal decongestants. Loss and destruction of ciliated epithelial cells are the morphological correlation of the disturbed mucociliary clearance. Especially endothelial cells and the basal membranes of capillaries revealed ultrastructural changes. This could be the reason of an increased vascular permeability with consecutive interstitial edema. After withdrawal of local vasoconstrictors, topical corticosteroids should be used to decrease swelling of the nasal mucosa.
P169 Uncinectomy: Stammberger or Swing-Door Technique? Vishwanath Puranik, FRCSEd FRCSI DLO (presenter); Amir Sheka, MD Bangor UK OBJECTIVES: Uncinectomy is the first step performed in FESS. A postal questionnaire was sent to all the practising British otorhinolaryngologists from trainees to the consultant. The aim of this study was to determine which technique of Uncinectomy (Stammberger, swing-door) was advocated by the U.K. otorhinolaryngologists in FESS. METHODS: The study consisted of a comprehensively designed questionnaire posted to 932 members of BAOL. Some 615 members completed questionnaires.
RESULTS: The initial question to the surgeons was whether they performed FESS and if the answer was positive, then they could answer the remaining questions in the questionnaire. They were then questioned about the preference of performing Uncinectomy (Stammberger technique, swing-door technique, combined, or no preference). Questions were asked regarding the easiest technique for Uncinectomy, training, and rate of complications. Of the group, 458 members performed FESS on a regular basis. The Stammberger technique is popular among ENT surgeons, and 87 surgeons had no preference for a technique of Uncinectomy; 207 surgeons found the Stammberger technique to be easier and 58 did not answer. None of them encountered any problem with orbit and nasolacrimal duct. Postoperative bleeding was a frequent problem in 9 respondents. CONCLUSIONS: A significant proportion of U.K. otolaryngologists do not have any preferred technique for performing uncinectomy: 18.9% of the surgeons have no preference of technique for Uncinectomy and 21.17% perform either way (Stammberger or swing-door technique). The Stammberger technique is found to be easier according to most surgeons but there is a significant evolution of the swing-door technique. P170 Sinonasal Haemangiopericytoma: A Case Series and Review Yuk-Hui Ng, MBBS (presenter); Jern-lin Leong, MD; Ian Loh, MD; Jacqueline Hwang, MBBS FRCPA; Christopher Hood-Keng Goh, FRCS (Ed & Glas) Singapore Rep of Singapore OBJECTIVES: 1. To study the presentation, behavior, and management of sinonasal haemangiopericytomas encountered in our institution. 2. To compare the outcomes from open surgery vs. endoscopic management of these tumors. METHODS: Through a search of histological records from 2000 to 2005, all cases of sinonasal Haemangiopericytoma were reviewed. RESULTS: For the time period, Four patients were diagnosed with sinonasal Haemangiopericytoma. All four were in patients over the age of 50 with a female to male ratio of 3:1. CT scans were used for preoperative assessment. Of the four, one was managed by open resection while the rest had their tumor removed endoscopically. There were no recurrences in the three years of follow-up. CONCLUSIONS: It is suggested that endoscopic removal should be attempted in cases when the tumor is limited to the nasal cavity. A review of recent literature of this unusual tumor is also presented. P171 Oculomotor Nerve Palsy Caused by Paranasal Sinus Disease Kenji Takasaki, MD (presenter); Kaori Enatsu, MD; Minoru Hara, MD; Hidetaka Kumagami, MD; Haruo Takahashi, MD Nagasaki Japan
Otolaryngology-Head and Neck Surgery, Vol 135, No 2S, August 2006
P168 Ultrastructural Changes in Rhinitis Medicamentosa Stephan Knipping, MD (presenter); Gerrit Goetze; Andreas Riederer, MD Halle/Saale Germany; Munich Germany OBJECTIVES: Topical vasoconstrictors are frequently used in the management of rhinosinusitis. Prolonged application causes rhinitis medicamentosa (RM) due to cytotoxic effects. Nasal obstruction is caused by rebound swelling when the decongestive effect has disappeared. METHODS: The aim of this study was to search for morphological changes in RM. RESULTS: For this retrospective study from March 2003 to April 2005, tissue samples of inferior turbinates from 22 patients with RM were taken during nasal surgery. For electron microscopy the samples were preserved in glutaraldehyde. Ultrathin sections were cut and a standardized procedure was carried out. The findings were photodocumented by using a transmission electron microscope. Biopsies from 10 patients without chronic inflammations of nasal mucosa were used as control. The transmission electron microscopic investigations revealed severe epithelial damage resulting in regions with hyperplastic and metaplastic changes. Loss of ciliated cells was observed. Thickness of basal membrane was increased. In the edematous subepithelial region, ultrastructural changes of the endothelial lining such as gaps and ruptures of basal lamina of capillaries were detected. Prominent endothelial cells were conspicuous. CONCLUSIONS: RM is drug-induced damage of human nasal mucosa associated with overuse of topical nasal decongestants. Loss and destruction of ciliated epithelial cells are the morphological correlation of the disturbed mucociliary clearance. Especially endothelial cells and the basal membranes of capillaries revealed ultrastructural changes. This could be the reason of an increased vascular permeability with consecutive interstitial edema. After withdrawal of local vasoconstrictors, topical corticosteroids should be used to decrease swelling of the nasal mucosa.
P169 Uncinectomy: Stammberger or Swing-Door Technique? Vishwanath Puranik, FRCSEd FRCSI DLO (presenter); Amir Sheka, MD Bangor UK OBJECTIVES: Uncinectomy is the first step performed in FESS. A postal questionnaire was sent to all the practising British otorhinolaryngologists from trainees to the consultant. The aim of this study was to determine which technique of Uncinectomy (Stammberger, swing-door) was advocated by the U.K. otorhinolaryngologists in FESS. METHODS: The study consisted of a comprehensively designed questionnaire posted to 932 members of BAOL. Some 615 members completed questionnaires.
RESULTS: The initial question to the surgeons was whether they performed FESS and if the answer was positive, then they could answer the remaining questions in the questionnaire. They were then questioned about the preference of performing Uncinectomy (Stammberger technique, swing-door technique, combined, or no preference). Questions were asked regarding the easiest technique for Uncinectomy, training, and rate of complications. Of the group, 458 members performed FESS on a regular basis. The Stammberger technique is popular among ENT surgeons, and 87 surgeons had no preference for a technique of Uncinectomy; 207 surgeons found the Stammberger technique to be easier and 58 did not answer. None of them encountered any problem with orbit and nasolacrimal duct. Postoperative bleeding was a frequent problem in 9 respondents. CONCLUSIONS: A significant proportion of U.K. otolaryngologists do not have any preferred technique for performing uncinectomy: 18.9% of the surgeons have no preference of technique for Uncinectomy and 21.17% perform either way (Stammberger or swing-door technique). The Stammberger technique is found to be easier according to most surgeons but there is a significant evolution of the swing-door technique. P170 Sinonasal Haemangiopericytoma: A Case Series and Review Yuk-Hui Ng, MBBS (presenter); Jern-lin Leong, MD; Ian Loh, MD; Jacqueline Hwang, MBBS FRCPA; Christopher Hood-Keng Goh, FRCS (Ed & Glas) Singapore Rep of Singapore OBJECTIVES: 1. To study the presentation, behavior, and management of sinonasal haemangiopericytomas encountered in our institution. 2. To compare the outcomes from open surgery vs. endoscopic management of these tumors. METHODS: Through a search of histological records from 2000 to 2005, all cases of sinonasal Haemangiopericytoma were reviewed. RESULTS: For the time period, Four patients were diagnosed with sinonasal Haemangiopericytoma. All four were in patients over the age of 50 with a female to male ratio of 3:1. CT scans were used for preoperative assessment. Of the four, one was managed by open resection while the rest had their tumor removed endoscopically. There were no recurrences in the three years of follow-up. CONCLUSIONS: It is suggested that endoscopic removal should be attempted in cases when the tumor is limited to the nasal cavity. A review of recent literature of this unusual tumor is also presented. P171 Oculomotor Nerve Palsy Caused by Paranasal Sinus Disease Kenji Takasaki, MD (presenter); Kaori Enatsu, MD; Minoru Hara, MD; Hidetaka Kumagami, MD; Haruo Takahashi, MD Nagasaki Japan