RESUMEN
BACKGROUND: Accidental injury of lamina papyracea (LP) remains one of the most common complications reported in endoscopic sinus surgery (ESS) even in most recent studies. The purpose of this study was to categorize the LP position radiologically and from an endoscopic perspective. METHODS: A total of 207 computed tomography (CT) scans (414 sides) including both diseased and control groups were retrospectively reviewed by 2 examiners. Inferior turbinate attachment to the lateral nasal wall and the inferior margin of the planned middle meatal antrostomy (MMA) were identified anteriorly. Position of LP in relation to the vertical line passing through MMA inferior margin was reported. LP was categorized to lie either within 2 mm on either side of the MMA inferior margin (type I), more than 2 mm medial to the MMA line (type IIa: 2 to 4 mm; type IIb: >4 mm), or more than 2 mm lateral to the MMA line (type IIIa: 2 to 4 mm; type IIIb: >4 mm). RESULTS: Of the 221 sides in the control group, 69.7% were classified as type I, 24.9% as type II, and 5.5% as type III. Among the 193 diseased operated sides examined, 60.1% were classified as type I, 20.2% as type II, and 13.5% as type III. Weighted kappa coefficient showed good interexaminer reliability. Five sides (2.6%) in the case group had accidental LP penetration intraoperatively, 4 of them were type II and type III LP. CONCLUSION: This study improves surgeons' awareness of LP variations in the endoscopic field and can be of help for residents in training.
Asunto(s)
Endoscopía , Hueso Etmoides/anatomía & histología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Hueso Etmoides/diagnóstico por imagen , Hueso Etmoides/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Adulto JovenRESUMEN
Ameloblastomas are rare, slowly growing and locally invasive tumours with high recurrence rate, if not treated they can grow to enormous size; we report five such cases in our article and discuss their surgical management. We report five cases of giant ameloblastoma presented in our institute between 2007 and 2010, we treated them surgically with wide margin of resection. It is widely reported that recurrence of ameloblastoma in many cases reflects the inadequacy or failure of the primary surgical procedure. We treated all our cases with radical excision with free flap reconstruction with no recurrence in any of our patients in 2 years follow-up. Radical excision of these benign but locally invasive lesions, which grows to giant size with reconstruction using micro vascular free flaps forms the best modality of treatment.