Changing concepts in chronic sinusitis.
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Chronic Disease↗
Biomedical subjects
W E Bolger
Publications and source records attributed to W E Bolger.
Lacrimal drainage system injury in functional endoscopic sinus surgery. Incidence, analysis, and prevention.
Injury to the lacrimal drainage system with resultant epiphora is a complication of functional endoscopic sinus surgery. A study of 24 patients was conducted to determine the incidence and significance of lacrimal drainage system injuries during functional endoscopic sinus surgery. Intraoperative testing demonstrated seven occult injuries (15%) in 46 endoscopic procedures. Postoperative testing demonstrated diversion of lacrimal drainage into the middle meatus in two patients and spontaneous healing of the injured lacrimal drainage system with restoration of normal drainage in three of the patients available for follow-up testing. In no patient did epiphora develop. It is concluded that the nasolacrimal drainage system is in close proximity to the dissection cavity during functional endoscopic sinus surgery and, hence, is at risk for inadvertent injury. Occult damage to the nasolacrimal drainage system would appear to be a common event during functional endoscopic sinus surgery; however, the complication of postoperative epiphora is rare.
Child↗
Inverted papilloma: evaluation with MR imaging.
The authors examined the magnetic resonance (MR) appearance of inverted papillomas to determine if this histologically benign lesion could be distinguished from malignancies of the sinonasal cavity. MR images in 10 patients with histologically proved inverted papilloma were retrospectively reviewed. The signal intensity of inverted papillomas on short repetition time (TR) images was iso- to slightly hypertintense to muscle in all 10 patients. Inverted papillomas had intermediate signal intensity on the long TR/echo time (TE) images. The tumors were iso- or slightly hypointense to fat on long TR/short TE images. In the seven patients who received gadopentetate dimeglumine, all inverted papillomas showed solid inhomogeneous enhancement. A review of eight sinonasal malignancies showed no distinctive signal intensity or enhancement characteristics to help differentiate inverted papillomas from various malignant tumors. The authors conclude that there is no signature MR appearance for the benign inverted papilloma. The main utility of MR imaging is in defining the extent of the lesion.
Adipose Tissue↗
Nasal endoscopy in the outpatient clinic.
The introduction of the nasal endoscope has greatly advanced the diagnostic and therapeutic capability of otolaryngologists in the office setting. With continued technologic developments in endoscopic equipment and topical intranasal anesthesia, further advances are expected that undoubtedly will expand endoscopic diagnosis treatment in the office setting. Presently otolaryngologists are beginning to use endoscopes in the evaluation and treatment of nasolacrimal duct obstruction, and we are aware of one case of cerebrospinal fluid leak that has been repaired in the office setting with nasal endoscopic technique. (Lanza D: personal communication, 1991).
Ambulatory Care↗
Paranasal sinus bony anatomic variations and mucosal abnormalities: CT analysis for endoscopic sinus surgery.
Coronal plane computerized tomographic (CT) scanning has dramatically improved the imaging of paranasal sinus anatomy as compared to sinus radiographs. Increasingly, subtle bony anatomic variations and mucosal abnormalities of this region are being detected. Data regarding the "background" prevalence of these findings are needed to determine their clinical relevance. A detailed analysis of coronal plane CT scans of the paranasal sinuses obtained in 202 consecutively imaged patients was conducted. Special attention was directed toward identifying bony anatomic variations and mucosal abnormalities. Anatomic variations studied included pneumatization of the middle turbinate, paradoxical curvature of the middle turbinate, Haller's cells, and pneumatization of the uncinate process. Such bony anatomic variations were detected in 131 (64.9%) of 202 patients and were found with a similar frequency in patients scanned for sinus complaints and in those scanned for nonsinus reasons. Mucosal abnormalities were detected in 168 (83.2%) of 202 patients. For those patients scanned during the evaluation of sinus-like complaints, mucosal abnormalities were noted in 153 (92.2%) of 166 cases, and were predominantly detected in the anterior ethmoid region. For patients scanned during nonsinus evaluations, mucosal abnormalities were detected in 15 (41.7%) of 36 cases, without predilection for the anterior ethmoid region. Discussion regarding the prevalence and clinical significance of paranasal sinus bony anatomic variations and mucosal abnormalities is included as a guide to assist the otolaryngologist and/or radiologist in the evaluation of coronal sinus CT scans.
Adult↗
Upper airway obstruction due to massive gingival hyperplasia. A case report and description of a new surgical treatment.
Drug-induced gingival hyperplasia is a frequent complication of phenytoin anticonvulsant therapy. In severe cases, gingival hyperplasia can cause marked cosmetic deformity, phonatory abnormalities and significant occlusal changes which severely restrict masticatory function. Airway obstruction has not been previously reported with this condition. We describe a unique case of massive phenytoin-induced gingival overgrowth causing glossoptosis and subsequent upper airway obstruction. Possible medical and surgical treatment options, including laser wedge resection of the base of the tongue, are discussed.
Airway Obstruction↗
Preoperative hemostatic assessment of the adenotonsillectomy patient.
Intraoperative or postoperative hemorrhage in the patient who has undergone an adenotonsillectomy because of an unrecognized hemostatic defect may increase morbidity and can be potentially life-threatening to the patient in what should be a "routine" procedure. Preoperative identification of occult hemostatic abnormalities, coupled with perioperative management directed at correcting the effects of the defects, should serve to reduce the incidence of this distressful complication. Routine use of preoperative laboratory screening tests for this purpose has been discouraged recently as a result of concerns over cost-effectiveness and the low predictiveness of the tests for bleeding. Our experience with the routine use of a comprehensive hemostatic laboratory screening panel--which includes a bleeding time test--in the adenotonsillectomy patient population demonstrated that 11.5% of our patients had abnormal initial screening laboratory tests; these results were ultimately attributable to occult hemostatic defects. Clinical history, the universally recommended method of preoperative hemostatic assessment, failed to detect any previously unrecognized coagulation disorder. Laboratory screening improved preoperative detection of occult hemostatic defects and allowed for appropriate alterations in perioperative care. Our results with this approach are presented, along with illustrative case histories and a discussion of the current recommendations for preoperative laboratory screening of the hemostatic system, as found in a review of the literature.
Adenoidectomy↗
Maxillary sinus hypoplasia: classification and description of associated uncinate process hypoplasia.
Maxillary sinus hypoplasia is an anomaly of the paranasal sinuses occasionally encountered by otolaryngologists. Although this entity has been previously reported, an association between maxillary sinus hypoplasia and anomalies of other paranasal sinus structures, such as the uncinate process, has not yet been described. Additionally, the literature lacks a system by which the various types of maxillary sinus hypoplasia can be classified using computerized tomographic (CT) imaging. Two hundred and two consecutive coronal sinus computerized tomographic scans from patients undergoing evaluation at our institution were analyzed to determine the prevalence of MSH and associated paranasal sinus anomalies. The overall prevalence of maxillary sinus hypoplasia was 10.4%. Three distinct patterns of hypoplasia were evident. Type I, characterized by a normal uncinate process, a well-defined infundibular passage, and mild sinus hypoplasia, occurred in 14 patients (6.9%). Type II, characterized by absence or hypoplasia of the uncinate process, an ill-defined infundibular passage, and soft-tissue density opacification of a significantly hypoplastic sinus occurred in 6 patients (3.0%). Type III, characterized by absence of the uncinate process and a profoundly hypoplastic, cleft-like sinus, occurred in 1 patient (0.5%). Recognition of associated anomalies of the uncinate process in patients with maxillary sinus hypoplasia undergoing sinus surgery is of utmost clinical significance because the uncinate process serves as a key landmark during functional endoscopic sinus surgery. Failure to recognize hypoplasia or absence of the uncinate process could lead to inadvertent intraoperative damage to the adjacent medial orbital wall.
Abnormalities, Multiple↗
CT demonstration of pneumatization of the uncinate process.
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Female↗
Functional endoscopic sinus surgery in aviators with recurrent sinus barotrauma.
Recurrent sinus barotrauma in an aviator is difficult to treat successfully. Exacerbations frequently result in marked aviator discomfort, cycles of temporary restriction from aviation duties, or even permanent disqualification for flying duties. Medical management and standard sinus operations are often ineffective, seldom curative, and have a disappointing record in returning the aviator to flying duties. Detailed computerized tomographic scanning of the paranasal sinuses coupled with the functional endoscopic sinus surgery approach directs treatment at the causative pathology. Sinus ventilation is improved while making possible a return to active flight status without recurrence of sinus barotrauma. Initial experience with the functional endoscopic sinus surgery technique in such a patient population is reported. A discussion of recurrent sinus barotrauma, paranasal sinus anatomy, and the theory of endoscopic surgical management for sinus disease is included.
Adult↗