Polymorphisms in the IL22RA1 Gene and Chronic Rhinosinusitis

Nasoseptal Flap Takedown in Endoscopic Skull Base Surgery Adam Mikial Zanation, MD (presenter); Carl H Snyderman, MD; Ricardo L Carrau, MD; Kassam Amin, MD OBJECTIVE: 1) Understand the importance of the nasoseptal flap in endoscopic skull base reconstruction. 2) Learn the techniques and limitations of nasoseptal flap takedowns and reuse during second stage and revision endoscopic skull base surgery. METHODS: Prospective consecutive analysis of CSF leak outcomes with nasoseptal flap takedown and reuse during endoscopic skull base surgery at a tertiary care skull base center. RESULTS: 16 consecutive cases of nasoseptal flap takedown and reuse for endoscopic endonasal intradural tumor surgery were collected prospectively and evaluated for CSF leak outcomes. 10 of these cases were planned second-stage surgeries and 6 were for revision or recurrent tumors. All 16 cases had intradural tumor extension and intra operative CSF leak. 15 of 16 had successful skull base reconstruction without postoperative CSF leak. One patient required revision endoscopic CSF leak repair and bolstering of the defect with a fat graft on post operative day 3. No flap deaths occurred. Endoscopic skull base reconstructive techniques and limitations of flap takedowns are discussed. CONCLUSIONS: As the limits of endoscopic skull base surgery increases, the limits of endoscopic skull base reconstruction must also increase. The pedicled nasoseptal flap has shown great promise (4% leak rate in over 300 nasoseptal flap skull base reconstructions) at the time of the initial resection. This report illustrates the ability to takedown and reuses the nasoseptal flap in revision cases with great success (94%) and minimal additional nasal morbidity. Novel Approach to the Sphenoid Sinus Joao-Flavio Nogueira, MD (presenter); Larry Hilton Kalish; Diego Rodrigo Hermann, MD; Maria Silva, MD; Richard J Harvey, BSc(Med), MBBS, FRACS; Eduardo De Arnaldo Silva Vellutini, MD; Aldo Eden Cassol Stamm, MD, PhD OBJECTIVE: Transnasal approaches to the pituitary and beyond are increasingly being utilized. Surgical access to the sphenoid sinus is the first step in any of these approaches. In order to allow a binostril approach, the posterior septum is removed, resulting in a large posterior septal perforation. Another consideration in many cases is harvesting material for repair of any cerebrospinal fluid (CSF) leak. We describe a novel endoscopic transseptal approach using a posterior nasal septal mucosal flap that allows a binostril approach for the

P79 surgeons, can cover skull base defects, and avoids posterior nasal septal perforations. METHODS: Retrospective chart review of endoscopic pituitary surgery patients, in a tertiary referral center between 2006 and 2008, was performed. Relevant post-operative complications of CSF leak, epistaxis, crusting, synechiae and septal perforation were documented. RESULTS: 20 consecutive patients undergoing pituitary surgery were reviewed: 12 males and 8 females aged 24 to 76 years old. No early perioperative complications were encountered. Surgical time was not increased. Two minor postoperative complications: 1 epistaxis and 1 partial flap retraction were noted. There were no CSF leaks and no septal perforations. CONCLUSIONS: The approach has the advantage of allowing two surgeons to manipulate surgical instruments and a more robust pedicled flap is raised to assist the closure of a skull base defect. The nasal septal mucosa from one side is preserved, avoiding a nasal septal perforation. There is minimal additional morbidity. Outcome of Endoscopic Sinus Surgery Yahya Nasser Al Badaai MBBch (presenter); Mark Samaha, MD OBJECTIVE: 1) Determine the effect of surgical therapy for Chronic Rhinosinusitis (CRS) on patient quality of life in a tertiary care centre in Quebec. 2) Compare the outcome of endoscopic sinus surgery on patients with different comorbidities. METHODS: Prospective cohort study. Subjects were consecutive patients with a diagnosis of CRS who failed medical treatment and were undergoing Endoscopic Sinus Surgery (ESS). General health (SF-12 v2) and disease-specific (chronic sinusitis survey (CSS)) outcomes questionnaires were filled out pre-operatively and postoperatively. RESULTS: 152 patients were enrolled in a 7-month period. 120 patients completed the postoperative surveys. The most common co-morbidity was asthma (40%). 72% had clinical improvement, 12% worsened, and 15% were unchanged. The average improvement of CSS scores was 17%. CONCLUSIONS: Significant improvement in quality of life was achieved after ESS for patients with CRS. Polymorphisms in the IL22RA1 Gene and Chronic Rhinosinusitis Leandra Mfuna Endam, MSc (presenter); Yohan Bosse´; Chantale Cormier, MD; Pierre Boisvert, MD; Louis-Philippe Boulet, MD; Thomas J. Hudson, MD; Martin Desrosiers, MD OBJECTIVE: Recently, a pooling-based genome wide association (pGWAS) scan idenfied the interleukin-22 receptor alpha 1 (IL22RA1) gene as a promising candidate for chronic

SCI. ORALS

Scientific Oral Presentations

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Otolaryngology-Head and Neck Surgery, Vol 139, No 2S1, August 2008

rhinosinusitis (CRS). The relevance of this gene in CRS is also substantiated by previous biological studies 1) that stimulation of the gene product increases the innate immune responses in some inflammatory diseases, and 2) a reduced level of the gene transcript in patients with recalcitrant CRS with nasal polyposis. We explore whether single nucleotide polymorphisms (SNPs) in the IL22RA1 gene are associated with CRS. METHODS: DNA extracted from a population of 206 patients with severe CRS and 196 postal-code matched controls was used. The 23 tagging SNPs in the IL22RA1 gene were selected from positive results in the pGWAS and completed with tagging SNPs from the CEU HapMap dataset and genotyped in our population. The haploview software was used to determine association. RESULTS: 22 SNPs were genotyped successfully with a genotype distribution in agreement with the Hardy-Weinberg equilibrium. Seven (rs10751768, rs10794665, rs16829225, rs3936073, rs4292900, rs4648936, rs7418238) out of 22 genotyped-SNPs were significantly associated with CRS (p-value: 0.0009 to 0.0337; OR: 1.44 to 1.76). CONCLUSIONS: Polymorphisms in the IL22RA1 gene are associated with severe CRS. This may help better understand the pathophysiology of CRS and identify new targets for therapy. Replication in a second population with CRS is in progress to validate these findings. Postoperative Hemorrhage after Endoscopic Sinus Surgery Troy D. Woodard, MD (presenter); James A Stankiewicz, MD OBJECTIVE: 1) Identify complication rates of patients that underwent endoscopic sinus surgery and developed postoperative hemorrhage. 2) Determine if there is a correlation of preoperative variables with the development of this complication. METHODS: Retrospectively review patients who had functional endoscopic sinus surgery and developed postoperative hemorrhage from 1987 to 2007 in an university tertiary care facility. Analyze baseline characteristics and preoperative clinical variables for significant correlations. RESULTS: 29 of 5000 endoscopic cases resulted in postoperative hemorrhage (.58% complication rate). The mean age of the patients was 50 years old and there were equal proportions of male and female patients. While the extent of surgery demonstrated no significant difference among the patients, hemorrhage was most likely to occur in patients with previous surgery. An overwhelming majority of patients required a surgical procedure to control the bleeding. Hemorrhage was primarily isolated on the patient’s right side and involved the sphenopalatine or posterior septal arteries. CONCLUSIONS: Endoscopic sinus surgery has vastly increased in popularity. However, there still is a paucity of

information in the literature on complications associated with endoscopic sinus surgery, particularly postoperative hemorrhage. The results from this study provide identifying characteristics that predispose patients to develop this complication and what methods can be successfully utilized to treat this complication. Radiologic Staging System for Allergic Fungal Rhinosinusitis Gamwell A Rogers, MD (presenter); Sarah K Wise, MD; Mark D Ghegan, MD; Richard J Harvey, BSc(Med), MBBS, FRACS; John M DelGaudio, MD; Rodney J Schlosser, MD OBJECTIVE: (1) To develop an objective method for quantifying radiologic bone erosion in allergic fungal rhinosinusitis (AFRS). (2) To assess the utility of the newly developed AFRS CT staging system in differentiating AFRS patient groups. METHODS: Patients from two tertiary care rhinology practices with classic AFRS and available CTs (2001-2007) were included for retrospective review. CTs were scored by trained graders not involved in the patients’ care as the primary treating surgeon. The following novel assessment scale was used: Each paranasal sinus wall with expansion/erosion was scored 1 point, with a maximum of 3 points possible for each frontal sinus, 2 points for each ethmoid complex, 3 points for each sphenoid sinus, 3 points for each maxillary sinus, 1 point for the frontal intersinus septum, and 1 point for the sphenoid intersinus septum, yielding a maximum of 24 possible total points. RESULTS: 111 CTs were reviewed. Mean score across all patients was 7.8 (range 0-24). Males scored significantly higher than females (mean 9.3 vs 5.6, p ⬍ 0.001). African Americans scored significantly higher than Caucasians (mean 9.6 vs 5.0, p ⬍ 0.001). There was also a trend towards younger patients exhibiting higher scores (p ⫽ 0.07). CONCLUSIONS: A radiologic grading system for bone erosion/expansion in AFRS is presented, which is easy to apply and may objectively stratify disease severity. Males and African Americans with AFRS demonstrate significantly more bone erosion. Additional analysis of disease course will assess the potential utility of this staging system in predicting outcomes. Surgeon Radiation Exposure in ESS Using Balloon Catheters Ford D Albritton, IV, MD (presenter); Joseph L. Smith, II, MD; Fazlur R. Zahurullah, MD, MBA; Michael Armstrong, Jr, MD; Don A Duplan MD; James A Gershow, MD; Frederick A Kuhn, MD OBJECTIVE: Less invasive instruments such as balloon cath-