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SP392 – Trans-antral balloon dilation under local anesthesia
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Otolaryngology-Head and Neck Surgery, Vol 141, No 3S1, September 2009
CONCLUSIONS: The results suggest that causative diseases, time until surgery, and optic nerve atrophy were not predictive factors of the post-operative recovery of visual acuity, and that the aggressive selection of surgical treatment is important. SP390 – The tumor origin of sinonasal inverted papilloma Ta-Jen Lee, MD (presenter); Chi-Che Huang, MD; Po-Huang Chang, MD OBJECTIVES: The objective of this study was to determine the characteristics of medially originated inverted papilloma (MOIP) and compare them with laterally originated inverted papilloma (LOIP). METHODS: A retrospective review of the charts for a total of 83 patients with sinonasal inverted papilloma (IP) was conducted. Tumors originating from the nasal septum or the turbinates were categorized as MOIP, while tumors originating from the four sinuses were categorized as LOIP. RESULTS: Twenty-eight (34%) and 55 (66%) cases were categorized as MOIP and LOIP. MOIP from the middle turbinate behaved more aggressively than LOIP from the ethmoid sinus (p ⫽ 0.009), but less aggressively than LOIP from the maxillary medial wall (p ⬍ 0.05). Radical procedures were implemented in 14 patients with LOIP, but not in any patients with MOIP (p ⫽ 0.002). The recurrences rates were comparable in both groups (p ⫽ 0.472). CONCLUSIONS: The categorization of IP on the basis of tumor origin enabled a better surgical design and more accurate excision of the tumor. Although in some cases MOIP may behave more aggressively, radical procedures were only indicated in late Krouse stage LOIP without compromising the recurrence rate. SP384 – Trace elements in nasal polyps Erdogan Okur (presenter); Asiye Gul; Metin Kilinc; M. Akif Kilic, MD; Ilhami Yildirim; Fatma Inanc Tolun; Yalein AN OBJECTIVES: The aim of our study is to evaluate the status of selenium and zinc in nasal polyp tissues and to investigate the possible role of trace elements and antioxidants including superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) in nasal polyps. METHODS: In this study, the antioxidant enzyme and trace element levels measured in polyp tissues of 37 patients were compared with the levels measured in conchal mucosa of 27 control cases. The antioxidant enzyme and trace element levels in tissues were measured with graphite and flame spectrophotometry methods by using Shimatsu UV.1601 spectrophotometer and Perkin Elmer atomic spectrometer. RESULTS: The mean tissue zinc and selenium levels were respectively 2.55 g/g and 30.03 pg/g in patient group; 4.37g/g
and 44.95 pg/g in control group. The mean tissue SOD and GSH-Px levels were respectively 5.18 U/mg protein and 0.69 U/mg protein in patient group; 7.00 U/mg protein and 0.77 U/mg protein in control group. When the measured levels in patients and control cases were compared, there were statistically significant differences between zinc, selenium and SOD levels (P⫽0.001). There was no significant difference between GSH-Px levels (P⫽0.465). CONCLUSIONS: It has been revealed that the levels of zinc, selenium and SOD in nasal polyps were significantly lower, and it may be concluded that this may have a role in the development of nasal polyps. SP417 – Transantral balloon dilatation, plus Yosef Krespi, MD (presenter); Michael Setzen, MD; Victor Kizhner, MD OBJECTIVES: 1) Demonstrate value of balloon dilatation with sublabial dual pucture antrostomy for management of minimal maxillary and ethmoid disease, such as maxillary mucosal cysts (MMC), polyps, limited infections and adhesions around the ostiomeatal complex (OMC). 2) To achieve improved QOL with limited morbidity, using this approach. 3) To demonstrate that maxillary cysts localized around OMC, associated with sinonasal symptoms can be managed with minimally invasive procedures, contrary to recent literature. METHODS: A prospective study treating patients with limited maxillary and ethmoid CRS was conducted in an ambulatory or office setting. Sublabial approach with two working channels (dual port), one for an endoscope and the other for balloon dilatation or other surgical instrumentation was created via mini-trephine aimed toward the OMC. Data collected included: demographics, SNOT scores, Lund-Mackay score, facial swelling and pain grading. Direct OMC culture and biopsy was obtained. Post operative intranasal endoscopic findings namely crusting, bleeding, scarring and synechia were recorded. RESULTS: Twenty patients were enrolled. All QOL scores showed statistically significant improvement ( P ⬍ 0.05) CONCLUSIONS: Utilizing a sublabial transantral endoscopic approach for balloon dilatation with treatment of minor maxillary sinus disease, we achieved significant improvement in QOL. Direct visualization of the maxillary sinus via transantral approach without violating the middle turbinate is safe, effective and requires limited postoperative care. Although recent literature recommends not treating MMCs, we strongly believe that MMCs localized around OMC associated with sinonasal symptoms should be managed with minimally invasive procedures. SP392 – Trans-antral balloon dilation under local anesthesia James Stankiewicz, MD (presenter)
Program Poster Presentations
SP407 – Transnasal endoscopic marsupialization for nasolabial cysts Chiang-Wen Chen, MD (presenter); Chi-Che Huang; Ta-Jen Lee, MD; Yi-Wei Chen, MD OBJECTIVES: Nasolabial cyst is a rare condition for which excision using a sublabial approach is a well-known and established procedure. Within the last ten years, transnasal endoscopic marsupialization has developed. Although simple, effective, and less invasive, little evidence exists in the improved outcomes with this procedure. The aim of this study was to evaluate the hospitalization rates and duration of surgery of transnasal endoscopic marsupialization compared to sublabial excision in treating nasolabial cysts. METHODS: Consecutive sample of 57 patients with nasolabial cysts treated January 2000 to February 2008 were enrolled. Sublabial excision in 23 patients (sublabial group) and transnasal endoscopic marsupialization in 34 patients (transnasal group). Of the 57 patients, 47 underwent preoperative computed tomography (CT) scan. RESULTS: The mean operation time period was 91.3 minutes in the sublabial group and 29.5 minutes in the transnasal group (P ⫽ .003). The hospitalization rate was 100% in the sublabial group and 58.9 % in the transnasal group (P ⬍ .001), significantly lower in the latter group. The mean cost was signifi-
cantly lower in the transnasal group than in the sublabial group (P⫽.002). The follow-up period ranged from 6 to 85 months. Both groups of studied patients experienced no major complications or recurrences during follow-ups. CONCLUSIONS: Transnasal endoscopic marsupialization is an effective treatment for nasolabial cysts, less costly and with fewer complications than sublabial excision. SP405 – Two-level turbinate reduction in the narrow nose Andrew J Lerrick, MD (presenter); Alexis M Mandli, PA-C; Seanra Kalil OBJECTIVES: Hypertrophic turbinates cause nasal airway obstruction and disrupt laminar airflow. This condition is especially apparent in patients with congenital, developmental, or acquired narrow nasal passages. Knowledge of the amount to which the inferior and middle turbinates contribute to nasal obstruction optimizes surgical intervention in the event that two-level turbinate reduction is required to achieve a satisfactory airway. METHODS: According to Bernoullis Principle (A1pu1 ⫽ A2pu2) narrowing the nasal airway significantly reduces airflow, which can be measured by rhinomanometry. Reduction of the inferior and middle turbinate bones can correct the obstruction better than reduction of either one alone. Acoustic rhinometry can quantify the narrowing at the level of the inferior and middle turbinates. Standardized norms have been established: the narrowest septal-inferior turbinate distance measures 0.45cm and the narrowest septal-middle turbinate distance measures 1.02cm. Assuming symmetry in the size of the respective turbinates, significant airway improvements are attained by reducing the inferior turbinate by approximately one-half. RESULTS: Bilateral, symmetric, two-level turbinate reduction markedly improves airflow at previously compromised sites. Balanced turbinate reduction establishes laminar flow, which further optimizes nasal airflow. Rhinomanometry measurements can document the degree of clinical improvement following inferior and middle turbinectomy. CONCLUSIONS: To achieve an adequate nasal airway, the narrow nose may benefit by reduction of both the inferior and middle turbinates. SP386 – Unilateral sinusitis in 154 operated cases Hisayoshi Ishizaki, PhD, MD (presenter); Mikihiro Shamoto, MD; Kanae Nakamura, MD OBJECTIVES: The purpose of this study is to examine the difference of unilateral and bilateral sinusitis, which were detected in radiological examinations and diagnosed to different pathological results after operation. METHODS: We focused 154 cases, which were diagnosed
POSTERS
OBJECTIVES: 1) Assess the durability of balloon dilatation of the ostiomeatal complex (OMC) through 12-month followup. 2) Demonstrate a long-term safety profile of a new medical device designed to treat chronic rhinosinusitis (CRS) using trans-antral, endoscopic visualization and balloon dilatation. METHODS: Subjects with chronic rhinosinusitis and CT evidence of mucosal thickening or an air-liquid level in the maxillary atrum along with a narrow maxillary sinus outflow tract underwent balloon antrostomy of the OMC. Subjects completed symptomatic assessment using the Sino-Nasal Outcome Test (SNOT 20) at 12 months post-procedure and adverse events were monitored through 1-year follow-up. RESULTS: Twenty subjects (36 ostia) underwent dilation of the maxillary sinus ostia and ethmoid infundibulum without the use of general anesthesia and have completed the end of study follow-up requirement at 12 months. During this oneyear period, no serious device-related or procedure-related adverse events or unanticipated adverse device effects were reported. One subject underwent a revision surgery 5.4 months post-procedure to treat left sphenoid sinusitis. The average overall SNOT 20 score at baseline was 3.2 ⫹/- 0.7 and decreased to 0.9 ⫹/- 1.0 (p-value ⬍ 0.0001). CONCLUSIONS: Trans-antral balloon dilatation without general anesthesia is safe and symptomatic improvement subsequent to anatomical remodeling of the boney structures within the OMU due to balloon dilatation as a stand-alone intervention is sustainable through 12 months.
P225
Otolaryngology-Head and Neck Surgery, Vol 141, No 3S1, September 2009
CONCLUSIONS: The results suggest that causative diseases, time until surgery, and optic nerve atrophy were not predictive factors of the post-operative recovery of visual acuity, and that the aggressive selection of surgical treatment is important. SP390 – The tumor origin of sinonasal inverted papilloma Ta-Jen Lee, MD (presenter); Chi-Che Huang, MD; Po-Huang Chang, MD OBJECTIVES: The objective of this study was to determine the characteristics of medially originated inverted papilloma (MOIP) and compare them with laterally originated inverted papilloma (LOIP). METHODS: A retrospective review of the charts for a total of 83 patients with sinonasal inverted papilloma (IP) was conducted. Tumors originating from the nasal septum or the turbinates were categorized as MOIP, while tumors originating from the four sinuses were categorized as LOIP. RESULTS: Twenty-eight (34%) and 55 (66%) cases were categorized as MOIP and LOIP. MOIP from the middle turbinate behaved more aggressively than LOIP from the ethmoid sinus (p ⫽ 0.009), but less aggressively than LOIP from the maxillary medial wall (p ⬍ 0.05). Radical procedures were implemented in 14 patients with LOIP, but not in any patients with MOIP (p ⫽ 0.002). The recurrences rates were comparable in both groups (p ⫽ 0.472). CONCLUSIONS: The categorization of IP on the basis of tumor origin enabled a better surgical design and more accurate excision of the tumor. Although in some cases MOIP may behave more aggressively, radical procedures were only indicated in late Krouse stage LOIP without compromising the recurrence rate. SP384 – Trace elements in nasal polyps Erdogan Okur (presenter); Asiye Gul; Metin Kilinc; M. Akif Kilic, MD; Ilhami Yildirim; Fatma Inanc Tolun; Yalein AN OBJECTIVES: The aim of our study is to evaluate the status of selenium and zinc in nasal polyp tissues and to investigate the possible role of trace elements and antioxidants including superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) in nasal polyps. METHODS: In this study, the antioxidant enzyme and trace element levels measured in polyp tissues of 37 patients were compared with the levels measured in conchal mucosa of 27 control cases. The antioxidant enzyme and trace element levels in tissues were measured with graphite and flame spectrophotometry methods by using Shimatsu UV.1601 spectrophotometer and Perkin Elmer atomic spectrometer. RESULTS: The mean tissue zinc and selenium levels were respectively 2.55 g/g and 30.03 pg/g in patient group; 4.37g/g
and 44.95 pg/g in control group. The mean tissue SOD and GSH-Px levels were respectively 5.18 U/mg protein and 0.69 U/mg protein in patient group; 7.00 U/mg protein and 0.77 U/mg protein in control group. When the measured levels in patients and control cases were compared, there were statistically significant differences between zinc, selenium and SOD levels (P⫽0.001). There was no significant difference between GSH-Px levels (P⫽0.465). CONCLUSIONS: It has been revealed that the levels of zinc, selenium and SOD in nasal polyps were significantly lower, and it may be concluded that this may have a role in the development of nasal polyps. SP417 – Transantral balloon dilatation, plus Yosef Krespi, MD (presenter); Michael Setzen, MD; Victor Kizhner, MD OBJECTIVES: 1) Demonstrate value of balloon dilatation with sublabial dual pucture antrostomy for management of minimal maxillary and ethmoid disease, such as maxillary mucosal cysts (MMC), polyps, limited infections and adhesions around the ostiomeatal complex (OMC). 2) To achieve improved QOL with limited morbidity, using this approach. 3) To demonstrate that maxillary cysts localized around OMC, associated with sinonasal symptoms can be managed with minimally invasive procedures, contrary to recent literature. METHODS: A prospective study treating patients with limited maxillary and ethmoid CRS was conducted in an ambulatory or office setting. Sublabial approach with two working channels (dual port), one for an endoscope and the other for balloon dilatation or other surgical instrumentation was created via mini-trephine aimed toward the OMC. Data collected included: demographics, SNOT scores, Lund-Mackay score, facial swelling and pain grading. Direct OMC culture and biopsy was obtained. Post operative intranasal endoscopic findings namely crusting, bleeding, scarring and synechia were recorded. RESULTS: Twenty patients were enrolled. All QOL scores showed statistically significant improvement ( P ⬍ 0.05) CONCLUSIONS: Utilizing a sublabial transantral endoscopic approach for balloon dilatation with treatment of minor maxillary sinus disease, we achieved significant improvement in QOL. Direct visualization of the maxillary sinus via transantral approach without violating the middle turbinate is safe, effective and requires limited postoperative care. Although recent literature recommends not treating MMCs, we strongly believe that MMCs localized around OMC associated with sinonasal symptoms should be managed with minimally invasive procedures. SP392 – Trans-antral balloon dilation under local anesthesia James Stankiewicz, MD (presenter)
Program Poster Presentations
SP407 – Transnasal endoscopic marsupialization for nasolabial cysts Chiang-Wen Chen, MD (presenter); Chi-Che Huang; Ta-Jen Lee, MD; Yi-Wei Chen, MD OBJECTIVES: Nasolabial cyst is a rare condition for which excision using a sublabial approach is a well-known and established procedure. Within the last ten years, transnasal endoscopic marsupialization has developed. Although simple, effective, and less invasive, little evidence exists in the improved outcomes with this procedure. The aim of this study was to evaluate the hospitalization rates and duration of surgery of transnasal endoscopic marsupialization compared to sublabial excision in treating nasolabial cysts. METHODS: Consecutive sample of 57 patients with nasolabial cysts treated January 2000 to February 2008 were enrolled. Sublabial excision in 23 patients (sublabial group) and transnasal endoscopic marsupialization in 34 patients (transnasal group). Of the 57 patients, 47 underwent preoperative computed tomography (CT) scan. RESULTS: The mean operation time period was 91.3 minutes in the sublabial group and 29.5 minutes in the transnasal group (P ⫽ .003). The hospitalization rate was 100% in the sublabial group and 58.9 % in the transnasal group (P ⬍ .001), significantly lower in the latter group. The mean cost was signifi-
cantly lower in the transnasal group than in the sublabial group (P⫽.002). The follow-up period ranged from 6 to 85 months. Both groups of studied patients experienced no major complications or recurrences during follow-ups. CONCLUSIONS: Transnasal endoscopic marsupialization is an effective treatment for nasolabial cysts, less costly and with fewer complications than sublabial excision. SP405 – Two-level turbinate reduction in the narrow nose Andrew J Lerrick, MD (presenter); Alexis M Mandli, PA-C; Seanra Kalil OBJECTIVES: Hypertrophic turbinates cause nasal airway obstruction and disrupt laminar airflow. This condition is especially apparent in patients with congenital, developmental, or acquired narrow nasal passages. Knowledge of the amount to which the inferior and middle turbinates contribute to nasal obstruction optimizes surgical intervention in the event that two-level turbinate reduction is required to achieve a satisfactory airway. METHODS: According to Bernoullis Principle (A1pu1 ⫽ A2pu2) narrowing the nasal airway significantly reduces airflow, which can be measured by rhinomanometry. Reduction of the inferior and middle turbinate bones can correct the obstruction better than reduction of either one alone. Acoustic rhinometry can quantify the narrowing at the level of the inferior and middle turbinates. Standardized norms have been established: the narrowest septal-inferior turbinate distance measures 0.45cm and the narrowest septal-middle turbinate distance measures 1.02cm. Assuming symmetry in the size of the respective turbinates, significant airway improvements are attained by reducing the inferior turbinate by approximately one-half. RESULTS: Bilateral, symmetric, two-level turbinate reduction markedly improves airflow at previously compromised sites. Balanced turbinate reduction establishes laminar flow, which further optimizes nasal airflow. Rhinomanometry measurements can document the degree of clinical improvement following inferior and middle turbinectomy. CONCLUSIONS: To achieve an adequate nasal airway, the narrow nose may benefit by reduction of both the inferior and middle turbinates. SP386 – Unilateral sinusitis in 154 operated cases Hisayoshi Ishizaki, PhD, MD (presenter); Mikihiro Shamoto, MD; Kanae Nakamura, MD OBJECTIVES: The purpose of this study is to examine the difference of unilateral and bilateral sinusitis, which were detected in radiological examinations and diagnosed to different pathological results after operation. METHODS: We focused 154 cases, which were diagnosed
POSTERS
OBJECTIVES: 1) Assess the durability of balloon dilatation of the ostiomeatal complex (OMC) through 12-month followup. 2) Demonstrate a long-term safety profile of a new medical device designed to treat chronic rhinosinusitis (CRS) using trans-antral, endoscopic visualization and balloon dilatation. METHODS: Subjects with chronic rhinosinusitis and CT evidence of mucosal thickening or an air-liquid level in the maxillary atrum along with a narrow maxillary sinus outflow tract underwent balloon antrostomy of the OMC. Subjects completed symptomatic assessment using the Sino-Nasal Outcome Test (SNOT 20) at 12 months post-procedure and adverse events were monitored through 1-year follow-up. RESULTS: Twenty subjects (36 ostia) underwent dilation of the maxillary sinus ostia and ethmoid infundibulum without the use of general anesthesia and have completed the end of study follow-up requirement at 12 months. During this oneyear period, no serious device-related or procedure-related adverse events or unanticipated adverse device effects were reported. One subject underwent a revision surgery 5.4 months post-procedure to treat left sphenoid sinusitis. The average overall SNOT 20 score at baseline was 3.2 ⫹/- 0.7 and decreased to 0.9 ⫹/- 1.0 (p-value ⬍ 0.0001). CONCLUSIONS: Trans-antral balloon dilatation without general anesthesia is safe and symptomatic improvement subsequent to anatomical remodeling of the boney structures within the OMU due to balloon dilatation as a stand-alone intervention is sustainable through 12 months.
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