RESUMEN

Introduction Juvenile nasopharyngeal angiofibroma (JNA) is a benign vascularized tumor that affects almost exclusively male adolescents. Surgery is the treatment of choice for JNA. Objectives The present study is a 42-year retrospective review of a series of JNA cases treated surgically without previous embolization. Methods The present is a retrospective, descriptive study based on medical records of 96 patients with JNA who underwent microscopic or endoscopic excision without previous embolization from 1978 to 2020 in a single institution. The patients were categorized according to the Andrews et al. stage, and data were collected on age, gender, tumor staging, surgical approach, affected side, and outcome. Results All patients were male, with an average age of 17 years. The predominant tumor stage consisted of type II, with 52.1%. A total of 33.3% of the patients were submitted to the microscopic technique and 66.7%, to the endonasal technique. The rate of intraoperative blood transfusion was of 17.7%. Conclusion The present study reinforces that resection of JNA in various stages is viable without previous artery embolization.

RESUMEN

Introduction The advent of the endoscope has enabled the use of the endonasal approach for a variety of diseases. Studying the ethmoidal canals is important for surgeries of the paranasal sinuses and the anterior base of the skull. Objective To investigate the ethmoidal canals and evaluate their structure, the presence of vessels and nerves, their location, and to perform an anatomopathological study of their contents. Methods We evaluated 20 cadavers (20 left and 20 right nasal cavities) through endoscopic dissection of the anterior base of the skull and exposure of the medial periorbita and dura mater; then, the ethmoidal canals were located and measured in relation to the anterior wall of the sphenoid sinus and between the ethmoidal canals, followed by removal of their content for histological analysis. Results Vessels were present in 75% of the left anterior ethmoidal canals, 70% of the left posterior ethmoidal canals, 75% of the left middle ethmoidal canals, 85% of the right anterior ethmoid canals, and 64.5% of the right posterior ethmoid canals; 50% of the right middle ethmoidal canals contained one vessel. Conclusion The ethmoidal canal does not necessarily contain an ethmoidal artery. Studies with a larger sample should be performed to quantify the correct proportion of arteries and ethmoidal canals.

RESUMEN

Abstract Introduction The advent of the endoscope has enabled the use of the endonasal approach for a variety of diseases. Studying the ethmoidal canals is important for surgeries of the paranasal sinuses and the anterior base of the skull. Objective To investigate the ethmoidal canals and evaluate their structure, the presence of vessels and nerves, their location, and to perform an anatomopathological study of their contents. Methods We evaluated 20 cadavers (20 left and 20 right nasal cavities) through endoscopic dissection of the anterior base of the skull and exposure of the medial periorbita and dura mater; then, the ethmoidal canals were located and measured in relation to the anterior wall of the sphenoid sinus and between the ethmoidal canals, followed by removal of their content for histological analysis. Results Vessels were present in 75% of the left anterior ethmoidal canals, 70% of the left posterior ethmoidal canals, 75% of the left middle ethmoidal canals, 85% of the right anterior ethmoid canals, and 64.5% of the right posterior ethmoid canals; 50% of the right middle ethmoidal canals contained one vessel. Conclusion The ethmoidal canal does not necessarily contain an ethmoidal artery. Studies with a larger sample should be performed to quantify the correct proportion of arteries and ethmoidal canals.

RESUMEN

Abstract Introduction The clinical relevance of the anatomy and variations of the anterior ethmoidal artery (AEA) is outstanding, considering its role as a landmark in endoscopic surgery, its importance in the therapy of epistaxis, and the high risks related to iatrogenic injuries. Objective To provide an anatomical description of the course and relationships of the AEA, based on direct computed-tomography (CT)-based 3D volume rendering. Methods Direct volume rendering was performed on 18 subjects who underwent (CT) with contrast medium for suspected cerebral aneurism. Results The topographical location of 36 AEAs was assessed as shown: 10 dehiscent (27.8%), 20 intracanal (55.5%), 6 incomplete canals (16.7%). Distances from important topographic landmarks are reported. Conclusion This work demonstrates that direct 3D volume rendering is a valid imaging technique for a detailed description of the anterior ethmoidal artery thus representing a useful tool for head pre-operatory assessments.

Asunto(s)

Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Arterias/anatomía & histología , Arterias/diagnóstico por imagen , Senos Etmoidales/irrigación sanguínea , Senos Etmoidales/diagnóstico por imagen , Tomografía Computarizada Multidetector/métodos , Tomografía Computarizada por Rayos X/métodos , Aneurisma Intracraneal/diagnóstico por imagen , Estudios Retrospectivos , Base del Cráneo/anatomía & histología , Base del Cráneo/irrigación sanguínea , Base del Cráneo/diagnóstico por imagen , Medios de Contraste , Imagenología Tridimensional

RESUMEN

Introduction The clinical relevance of the anatomy and variations of the anterior ethmoidal artery (AEA) is outstanding, considering its role as a landmark in endoscopic surgery, its importance in the therapy of epistaxis, and the high risks related to iatrogenic injuries. Objective To provide an anatomical description of the course and relationships of the AEA, based on direct computed-tomography (CT)-based 3D volume rendering. Methods Direct volume rendering was performed on 18 subjects who underwent (CT) with contrast medium for suspected cerebral aneurism. Results The topographical location of 36 AEAs was assessed as shown: 10 dehiscent (27.8%), 20 intracanal (55.5%), 6 incomplete canals (16.7%). Distances from important topographic landmarks are reported. Conclusion This work demonstrates that direct 3D volume rendering is a valid imaging technique for a detailed description of the anterior ethmoidal artery thus representing a useful tool for head pre-operatory assessments.

RESUMEN

Abstract Introduction: Functional endonasal endoscopic surgery is a frequent surgical procedure among otorhinolaryngologists. In 2014, the European Society of Rhinology published the "European Position Paper on the Anatomical Terminology of the Internal Nose and Paranasal Sinuses", aiming to unify the terms in the English language. We do not yet have a unified terminology in the Portuguese language. Objective: Transcultural adaptation of the anatomical terms of the nose and paranasal cavities of the "European Anatomical Terminology of the Internal Nose and Paranasal Sinuses" to Portuguese. Methods: A group of rhinologists from diverse parts of Brazil, all experienced in endoscopic endonasal surgery, was invited to participate in the creation of this position paper on the anatomical terms of the nose and paranasal sinuses in the Portuguese language according to the methodology adapted from that previously described by Rudmik and Smith. Results: The results of this document were generated based on the agreement of the majority of the participants according to the most popular suggestions among the rhinologists. A cross-cultural adaptation of the sinonasal anatomical terminology was consolidated. We suggest the terms "inferior turbinate", "nasal septum", "(bone/cartilaginous) part of the nasal septum", "(middle/inferior) nasal meatus", "frontal sinus drainage pathway", "frontal recess" and "uncinate process" be standardized. Conclusion: We have consolidated a Portuguese version of the European Anatomical Terminology of the Internal Nose and Paranasal Sinuses, which will help in the publication of technical announcements, scientific publications and the teaching of the internal anatomical terms of the nose and paranasal sinuses in Brazil.

---

Resumo: Introdução: A cirurgia endoscópica funcional endonasal é um procedimento cirúrgico frequente entre os otorrinolaringologistas. Em 2014, a Sociedade Europeia de Rinologia publicou o "Documento Europeu para Posicionamento sobre a Terminologia Anatômica Interna do Nariz e das Cavidades Paranasais" com o objetivo de unificar os termos na língua inglesa. Ainda não dispomos de uma terminologia unificada na língua portuguesa. Objetivo: Adaptação transcultural dos termos anatômicos do nariz e das cavidades paranasais para o português da "European Anatomical Terminology of the Internal Nose and Paranasal Sinuses". Método: Um grupo de rinologistas de todo o Brasil, com experiência em cirurgia endoscópica endonasal, foi convidado a participar da elaboração desse posicionamento sobre os termos anatômicos do nariz e das cavidades paranasais para o português conforme metodologia adaptada da previamente descrita por Rudmik e Smith. Resultados: Os resultados desse documento foram gerados a partir da concordância da maioria dos participantes conforme as sugestões mais populares entre os rinologistas. Uma adaptação transcultural da terminologia anatômica nasossinusal foi consolidada. Sugerimos que se busque uniformizar termos como "concha inferior", "septo nasal", "porção (óssea/cartilaginosa) do septo nasal", "meato (médio/ inferior) nasal", "via da drenagem do seio frontal", "recesso frontal" e "processo uncinado". Conclusão: Consolidamos uma versão adaptada em português da "European Anatomical Terminology of the Internal Nose and Paranasal Sinuses" que auxiliará a publicação de comunicados técnicos, publicações científicas e o ensino dos termos anatômicos internos do nariz e das cavidades paranasais no Brasil.

Asunto(s)

Humanos , Senos Paranasales/anatomía & histología , Nariz/anatomía & histología , Comparación Transcultural , Terminología como Asunto , Senos Paranasales/cirugía , Brasil , Nariz/cirugía , Estudios Prospectivos , Consenso , Lenguaje , Cavidad Nasal/anatomía & histología , Cavidad Nasal/cirugía

RESUMEN

INTRODUCTION: Functional endonasal endoscopic surgery is a frequent surgical procedure among otorhinolaryngologists. In 2014, the European Society of Rhinology published the "European Position Paper on the Anatomical Terminology of the Internal Nose and Paranasal Sinuses", aiming to unify the terms in the English language. We do not yet have a unified terminology in the Portuguese language. OBJECTIVE: Transcultural adaptation of the anatomical terms of the nose and paranasal cavities of the "European Anatomical Terminology of the Internal Nose and Paranasal Sinuses" to Portuguese. METHODS: A group of rhinologists from diverse parts of Brazil, all experienced in endoscopic endonasal surgery, was invited to participate in the creation of this position paper on the anatomical terms of the nose and paranasal sinuses in the Portuguese language according to the methodology adapted from that previously described by Rudmik and Smith. RESULTS: The results of this document were generated based on the agreement of the majority of the participants according to the most popular suggestions among the rhinologists. A cross-cultural adaptation of the sinonasal anatomical terminology was consolidated. We suggest the terms "inferior turbinate", "nasal septum", "(bone/cartilaginous) part of the nasal septum", "(middle/inferior) nasal meatus", "frontal sinus drainage pathway", "frontal recess" and "uncinate process" be standardized. CONCLUSION: We have consolidated a Portuguese version of the European Anatomical Terminology of the Internal Nose and Paranasal Sinuses, which will help in the publication of technical announcements, scientific publications and the teaching of the internal anatomical terms of the nose and paranasal sinuses in Brazil.

Asunto(s)

Comparación Transcultural , Nariz/anatomía & histología , Senos Paranasales/anatomía & histología , Terminología como Asunto , Brasil , Consenso , Humanos , Lenguaje , Cavidad Nasal/anatomía & histología , Cavidad Nasal/cirugía , Nariz/cirugía , Senos Paranasales/cirugía , Estudios Prospectivos

RESUMEN

OBJECTIVES: The aim of this study was to provide the anatomic rationale for a transnasal approach to the orbital apex and cavernous sinus, and to evaluate its applicability and efficiency. METHODS: One hundred patients with lesions of the orbital apex, cavernous sinus, optic nerve, clivus, parapharyngeal space, infratemporal fossa, or pterygopalatine fossa were reviewed over a 10-year period. All patients underwent an endoscopic transnasal approach to the orbital apex and cavernous sinus. The surgical technique required a standard endoscopic sinus surgery set. The possible complications were recorded and classified as intraoperative or postoperative. RESULTS: There were complications in 8 cases: 4 intraoperative and 4 postoperative. The intraoperative complications included rupture of the internal carotid artery in 1 patient and cerebrospinal fluid leak in 3 patients. All intraoperative complications were resolved during surgery. The postoperative complications were transitory eyelid ptosis in 2 patients (resolved in 6 months) and transitory diplopia with immediate deficit of the medial rectus muscle in 2 patients (completely resolved in 1 month). CONCLUSIONS: With the use of this technique, the surgeon can precisely identify the position of the surgical instrument without losing his or her way, thereby significantly reducing the rate of complications.

Asunto(s)

Seno Cavernoso/cirugía , Cirugía Endoscópica por Orificios Naturales/métodos , Órbita/cirugía , Blefaroptosis/etiología , Pérdida de Líquido Cefalorraquídeo , Rinorrea de Líquido Cefalorraquídeo/etiología , Fosa Craneal Posterior/cirugía , Diplopía/etiología , Humanos , Hipoestesia/cirugía , Infecciones/cirugía , Cirugía Endoscópica por Orificios Naturales/efectos adversos , Nervio Óptico/cirugía , Fosa Pterigopalatina/cirugía , Estudios Retrospectivos , Cráneo/cirugía , Neoplasias Craneales/cirugía , Neuralgia del Trigémino/cirugía , Trastornos de la Visión/cirugía

Asunto(s)

Neoplasias Encefálicas/diagnóstico , Seno Cavernoso , Síndrome de Tolosa-Hunt/diagnóstico , Diagnóstico Diferencial , Femenino , Humanos , Persona de Mediana Edad , Síndrome de Tolosa-Hunt/cirugía

Asunto(s)

Femenino , Humanos , Persona de Mediana Edad , Neoplasias Encefálicas/diagnóstico , Seno Cavernoso , Síndrome de Tolosa-Hunt/diagnóstico , Diagnóstico Diferencial , Síndrome de Tolosa-Hunt/cirugía

RESUMEN

OBJECTIVES: My aim in this article is to report 26 years of experience in order to evaluate the applicability and efficiency of centripetal dissection in intranasal ethmoid sinus surgery. METHODS: I performed a retrospective review of 2,500 patients treated in the Felippu Institute, São Paulo, over the 26-year period from 1984 to July 2010. All of the patients underwent intranasal ethmoid sinus surgery with the centripetal technique. Before surgery, an otolaryngological examination, nasal endoscopy, and computed tomographic scans with axial, coronal, and sagittal projections were performed. All surgeries were carried out under general anesthesia and with the help of a surgical microscope or (after 1997) a rigid 30 degrees endoscope. The surgical technique required a standard endoscopic sinus surgery set. The complications of intranasal ethmoid sinus surgery were recorded and classified as intraoperative, short-term, or long-term. RESULTS: I observed an intraoperative complication (cerebrospinal fluid leak) in 4 patients. There were no cases of periorbital damage. I recorded no short-term or long-term complications. All of the intraoperative complications were resolved during surgery. CONCLUSIONS: With the use of this technique, the surgeon can precisely identify the position of the surgical instrument without losing his or her orientation, and thereby significantly reduce the risk of complications.

Asunto(s)

Senos Etmoidales/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Endoscopía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Otorrinolaringológicos/métodos , Estudios Retrospectivos , Resultado del Tratamiento

RESUMEN

CONCLUSIONS: In our experience, the technique described can be applied independently according to the specific patient's anatomy and disease, allowing simple, easy, and safe identification of the anterior ethmoidal artery (AEA). OBJECTIVES: The aim of this study was to provide the anatomic rationale for endoscopic cauterization of the AEA and to present our surgical approach to AEA in the treatment of severe nasal bleeding. METHODS: A retrospective study reviewed 300 endoscopic transnasal AEA cauterizations, over a 20-year period from 1991 to July 2010, at the Instituto Felippu, Sao Paolo, Brazil. All surgeries were carried out under general anesthesia and with the help of a rigid 30° endoscope. RESULTS: The AEA was identified in all the patients treated. In 299 patients we found the AEA located at the level of the horizontal portion of the frontal bone into the anterior ethmoidal canal; in 88 (29.4%) of these patients the canal bone was partially open and in 211 (70.6%) it was completely closed. In only one patient, we found a dehiscent AEA. No patients presented short-term failure and/or long-term failure.

Asunto(s)

Electrocoagulación , Epistaxis/cirugía , Hemostasis Endoscópica , Adulto , Anciano , Anciano de 80 o más Años , Arterias/cirugía , Femenino , Humanos , Ligadura , Masculino , Persona de Mediana Edad , Nariz/irrigación sanguínea , Estudios Retrospectivos

RESUMEN

CONCLUSION: Endoscopic transethmoidal sphenoidotomy performed mainly in the early stages of the pathology and by expert hands is [WX1]very effective in treating isolated sphenoid sinus disease. OBJECTIVE: This study aimed to investigate the causes of isolated sphenoid sinus disease identified in 109 patients and report on the most appropriate diagnostic and therapeutic patterns for an earlier diagnosis and a successful treatment of the disease. SUBJECTS AND METHODS: A total of 109 subjects with various isolated sphenoid pathologies were first examined by general objective examination, nasal sinus endoscopy, CT scan of paranasal sinuses, and in some cases with MRI. Then, they underwent medical and/or surgical treatment. RESULTS: Nineteen patients (17.43%) had isolated sphenoiditis, 6 (5.5%) fungal sinusitis, 30 (27.52%) mucocele, 6 (5.5%) fibrous dysplasia, 6 (5.5%) meningoencephalocele, 5 (4.58%) inverted papilloma, 4 (3.66%) epidermoid carcinoma, 10 (9.17%) liquor fistula, 1 (0.9%) rhabdomyosarcoma, 1 (0.9%) chordoma, and 1 (0.9%) had carotid pseudoaneurysm. Evidence of definitive diagnosis by endoscopy was obtained in less than half of the cases. CT scan, however, sometimes in combination with MRI, determined the pathology in all the cases. A follow-up of at least 4 years post-surgery showed good results in all the patients who underwent endoscopic transethmoidal sphenoidotomy.

Asunto(s)

Enfermedades de los Senos Paranasales/diagnóstico , Enfermedades de los Senos Paranasales/cirugía , Seno Esfenoidal , Adolescente , Adulto , Estudios de Cohortes , Encefalocele/diagnóstico , Encefalocele/terapia , Endoscopía , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Meningocele/diagnóstico , Meningocele/terapia , Persona de Mediana Edad , Mucocele/diagnóstico , Mucocele/terapia , Enfermedades de los Senos Paranasales/patología , Pólipos/diagnóstico , Pólipos/terapia , Fístula del Sistema Respiratorio/diagnóstico , Fístula del Sistema Respiratorio/terapia , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Adulto Joven

RESUMEN

After the surgical treatment for early glottic carcinoma, the patients end up with voice disturbances in different grades. The aim of this study was to characterize the laryngeal configuration regarding the anterior commissure synechia and its relationship to the perceptual vocal quality. Twenty-five patients underwent frontolateral vertical partial laryngectomy and reconstruction with bipedicle sternohyoid muscle flap resulting from T1b/T2 glottic squamous cell carcinoma from January 1996 to December 2004. Of the 25 patients, 24 were male with a median age of 61 years. The patients were free of disease and the evaluation was performed after a minimum postoperative period of 12 months. Measurements of the anterior commissure synechia and the free border of both vocal folds were simultaneously performed with the perceptual analysis of the voice through GRBAS scale. We calculated the mathematical proportion between the midsagittal dimension of the synechia of the anterior commissure and the measurement of the free border of the intermembranous region of each vocal fold. The higher the relative measurement of the anterior commissure synechia, the worse the overall grade of hoarseness (G) for both vocal folds (P<0.001), the worse the roughness (R) for both vocal folds (P<0.001), and the worse the strained quality (S) for both the reconstructed (P=0.0086) and the preserved (P=0.0026) vocal folds. These results suggest that the relative measurement of the anterior commissure synechia is a crucial factor worsening voice quality and that the perceptual analyses score has a strong correlation to the synechia's impact.

Asunto(s)

Glotis/patología , Laringectomía/efectos adversos , Calidad de la Voz , Carcinoma de Células Escamosas/cirugía , Femenino , Humanos , Neoplasias Laríngeas/cirugía , Masculino , Persona de Mediana Edad , Proyectos Piloto , Estudios Retrospectivos

RESUMEN

Introduçäo: A importância da compreensäo da anatomia interna do seio esfenoidal deve-se à sua peculiar localizaçäo no centro do crânio, com estruturas vizinhas de nobreza indiscutível, e por transparecer estas relaçöes anatômicas em suas delgadas paredes internas. Forma de estudo: Anatômico. Material e método: No presente estudo foram dissecados endoscopicamente 52 seios esfenoidais, sendo suas saliências e depressöes internas analisadas, correspondentes aos relevos internos produzidos pela artéria carótida interna, nervo óptico, nervo maxilar, e nervo vidiano. Resultado: Em 88,5 por cento dos casos a artéria carótida interna apresentou-se saliente, e o nervo óptico o fez em 55,8 por cento. O nervo vidiano e o nervo maxilar mostraram-se visíveis em 25 por cento e 30,8 por cento dos casos, respectivamente. Conclusäo: Tais dados nos chamam a atençäo para a rica e frágil anatomia interna do seio esfenoidal que, devido ao avanço dos métodos de cirurgia endoscópica, está progressivamente mais próxima e vulnerável a manobras e procedimentos cirúrgicos. Assim, sua compreensäo torna-se essencial quando se trata de cirurgia endoscópica endonasal e seu horizonte de recursos técnicos

RESUMEN

En el presente trabajo se muestra la experiencia del autor en el manejo de las epistaxis severas. Inicialmente muestra la localización probable de los sangrados, dividiéndolos en superiores y posteriores. Los tipos de tratamiento los clasifica en taponajes nasales y cauterizaciones nasales dando los pro y los contra de cada una de estas instancias terapéuticas. Luego toca el tema de las ligaduras arteriales dando cada uno de los diferentes tipos de ligadura con las ventajas y desventajas que estas puedan ocasionar. Luego plantea el protocolo de atención propuesta por el autor que divide en si el paciente viene con sangrado activo o sin sangrado activo, si es que está localizado o no el punto de sangrado y deja como idea fundamental en el manejo de su equipo la electrocauterización de estos tipos de epistaxis severa.

---

This paper summarizes the author is expertise in management of severe epistaxis. Initially, probable localization of bleeding is presented, classifying the in upper and lower bleedings. Treatment options include: nasal occlusion nasal cauterizations, mentioning pros and cons inn each kind of treatment. Arterial ligations are discussed, mentioning advantages and disadvantages of each kind of ligation. Later, the author proposes a treatment protocol for cases with active and non-active bleeding, localized or diffuses bleeding points. The author emphasizes the importance o electrocauterization by endoscopy to solve these cases of severe epistaxis.

Asunto(s)

Humanos , Epistaxis/cirugía , Epistaxis/diagnóstico , Epistaxis/terapia