scholarly journals Endoscopic Endonasal Transturbinate Approach to the Pterygopalatine Fossa in the Management of Juvenile Nasopharyngeal Angiofibromas

2012 ◽  
Vol 2012 ◽  
pp. 1-3
Author(s):  
Satoru Kodama ◽  
Hideaki Mabuchi ◽  
Masashi Suzuki
Keyword(s):  
Nasal Cavity ◽  
Maxillary Sinus ◽  
Early Stage ◽  
Posterior Wall ◽  
Pterygopalatine Fossa ◽  
Maxillary Artery ◽  
En Bloc ◽  
Transnasal Approach ◽  
Endoscopic Endonasal ◽  
Nasopharyngeal Angiofibroma

Pterygopalatine fossa (PPF) is a difficult-to-access anatomic area located behind the posterior wall of the maxillary sinus. Juvenile nasopharyngeal angiofibroma (JNA) often affects this area, and the management of feeding artery to the tumor is important in the surgery. Endoscopic endonasal approach to the PPF without endangering all other nasal structures is useful in the management of JNA. We describe a new approach to the PPF, endoscopic transturbinate approach, which is effective in the management of JNA. Submucous inferior turbinoplasty was performed, and sphenopalatine artery, the feeder to the tumor, was identified at the sphenopalatine foramen. The posterior wall of maxillary sinus was removed. Internal maxillary artery was identified in the PPF and was ligated with a hemoclip. The tumor in the PPF was pushed into the nasal cavity. These procedures were all performed via submucous turbinate tunnel. Then, the tumor was successfully removed in en bloc from the nasal cavity by transnasal approach without ethmoidectomy. This approach improves accessibility and visualization in the PPF and potential to reduce intraoperative bleeding due to ligation of the feeder safely without touching the tumor. Endoscopic transturbinate approach is effective in the management of early stage of JNA.

Radioanatomic Study of the Greater Palatine Canal Relevant to Endoscopic Endonasal Surgical Landmarks

2017 ◽  
Vol 157 (4) ◽  
pp. 731-736
Author(s):  
Noel Ayoub ◽  
Andrew Thamboo ◽  
Peter H. Hwang ◽  
Evan S. Walgama
Keyword(s):  
Computed Tomography ◽  
Maxillary Sinus ◽  
Sagittal Plane ◽  
Inferior Turbinate ◽  
Posterior Wall ◽  
University Hospital ◽  
Ct Scans ◽  
Endoscopic Endonasal ◽  
Greater Palatine Canal ◽  
Maxillary Sinuses

Objective A radioanatomic study of surgically relevant variations in the greater palatine canal (GPC) on computed tomography (CT) was performed to determine susceptibility during endoscopic endonasal procedures. Study Design Blinded radioanatomic analysis. Setting Tertiary university hospital. Subjects and Methods Fifty consecutive paranasal CT scans (100 sides) were analyzed. Measurements were standardized to landmarks such as the inferior turbinate (IT) and floor of the nasal cavity (FNC) to assess variability and vulnerability of the nerve. Measurements included (1) incidence of maxillary sinus pneumatization posterior to the GPC, (2) distance from the posterior wall of the maxillary sinus to the GPC at the IT and FNC, (3) width of bone containing the GPC, (4) incidence of medial GPC dehiscence, and (5) angle of the GPC extending from the IT to FNC. Results Ninety-one percent of maxillary sinuses were pneumatized posterior to the GPC. The distance from the posterior wall of the maxillary sinus to the GPC was 2.8 ± 1.7 mm (range, –2.3 to 5.9) at the posterior attachment of the IT and 4.1 ± 3.1 mm (range, –6.3 to 11.9) at the FNC. The width of bone containing the GPC was 3.3 ± 1.3 mm (range, 1-8.9), and the medial bony GPC was dehiscent in 38% of cases. In the sagittal plane, the angle of the GPC between the IT and the FNC was 31.9 ± 6.9 degrees (range, 10.8-45). Conclusion The GPC has considerable anatomic variability relative to important surgical landmarks in endoscopic procedures. Preoperative review of CTs to assess vulnerability may prevent postoperative complications.

scholarly journals A rare case of inflammatory myofibroblastic tumour in the maxillary sinus: masquerading a malignancy

2020 ◽  
Vol 6 (7) ◽  
pp. 1370
Author(s):  
E. Siva Kumar ◽  
C. A. Swapna ◽  
Lavanya Karanam ◽  
S. Radhika
Keyword(s):  
Nasal Cavity ◽  
Maxillary Sinus ◽  
Histopathological Examination ◽  
Female Child ◽  
External Carotid ◽  
Maxillary Artery ◽  
Inflammatory Myofibroblastic Tumour ◽  
Rare Presentation ◽  
Artery Ligation ◽  
Pulsatile Mass

<p>Aim establishing the diagnosis of inflammatory myofibroblastic tumour is very challenging due to its varied clinical and radiological manifestations. We report a rare presentation of a 5 years old female child with inflammatory myofibroblastic tumour, which was endoscopically resected with postop steroid therapy. Case report, a 5 years old female child presented to ENT OPD with complaints of right nasal obstruction since, 4 months along with recurrent minor episodes of spontaneous bleeds from the right nasal cavity. On examination a huge fleshy reddish polypoidal and pulsatile mass was seen filling the entire right nasal cavity associated with right eye proptosis. MRI with contrast showed expansion of right maxillary sinus bony walls with internal soft tissue leision measuring 41 mm (TRANS) × 36 mm (AP)×31 mm (CC) seen enhancing with contrast. Vascular supply is from maxillary artery. Under anaesthesia right external carotid artery ligation was done followed by removal of mass from right nasal cavity. Histopathological examination was consistent with inflammatory myofibroblastic tumour. On immunohistochemistry spindle cells showed cytoplasmic positivity for SMA. Inflammatory myofibroblastic tumour though a very unusual tumour, should be considered in the differential diagnoses of tumours in the nasal cavity. A vigilant clinical evaluation and extensive imaging along with histopathological examination can guide us to an early diagnosis and proper treatment resulting in better patient satisfaction.<strong></strong></p>

Posterior Maxillary Sinus Wall: A Landmark for Identifying the Sphenoid Sinus Ostium

2018 ◽  
Vol 128 (3) ◽  
pp. 215-219 ◽  
Author(s):  
Raj D. Dedhia ◽  
Tsung-yen Hsieh ◽  
Yecenia Rubalcava ◽  
Paul Lee ◽  
Peter Shen ◽  
...  
Keyword(s):  
Maxillary Sinus ◽  
Endoscopic Sinus Surgery ◽  
Sphenoid Sinus ◽  
Average Distance ◽  
Posterior Wall ◽  
Sinus Surgery ◽  
Endoscopic Endonasal ◽  
Sinus Wall ◽  
Significant Difference ◽  
Sinus Ostium

Importance: Safe entry into sphenoid sinus is critical in endoscopic sinus and skull base surgery. A number of surgical landmarks have been used to identify the sphenoid sinus ostium during endoscopic endonasal surgery with variable reliability and intraoperative feasibility. Objective: To determine if the posterior wall of the maxillary sinus is a reliable landmark to determine the depth of the sphenoid sinus ostium during anterior to posterior dissection. Design, Setting, and Participants: Prospective study of adult patients undergoing endoscopic sinus surgery between August 2016 and September 2017. Measurements were made intraoperatively between the depth of the posterior maxillary sinus wall and sphenoid sinus ostium. Main Outcomes and Measures: The primary measurement is the distance between the depth of the posterior maxillary sinus wall and sphenoid sinus ostium. Additional data points included age, gender, surgical indication, and primary versus revision endoscopic sinus surgery. Results: Forty-five patients (38% male, 62% female) with an average age of 56 were enrolled, resulting in 88 operated sides. The average distance between the depth of the posterior wall of the maxillary sinus and the sphenoid ostium was 1.5 mm ± 1.4 mm. The most common position of the sphenoid sinus ostium was posterior to the level of the posterior maxillary sinus wall (54%), followed by same level (23%) and anterior (23%). There was no significant difference between different disease states ( P = .75) and between primary and revision cases ( P = .13). Conclusions and Relevance: The posterior wall of the maxillary sinus serves as an adjunctive intraoperative landmark to determine the depth of the sphenoid sinus ostium. While the posterior wall of the maxillary sinus approximates the depth of the sphenoid sinus ostium, the relative position is variable and can be anterior or posterior.

scholarly journals Intraosseous Hemangioma of the Middle Turbinate Misdiagnosed As a Nasal Polyp

2014 ◽  
Vol 2014 ◽  
pp. 1-3
Author(s):  
Tae Hoon Kim ◽  
Eun Jung Lim ◽  
Jun-Ki Lee ◽  
Jin Gul Lee ◽  
Man-Hoon Han
Keyword(s):  
Nasal Cavity ◽  
Bone Tumors ◽  
Vertebral Column ◽  
Middle Turbinate ◽  
Preoperative Embolization ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
En Bloc ◽  
Endoscopic Endonasal ◽  
Intraosseous Hemangioma

Intraosseous hemangiomas account for 1% of all bone tumors and primarily originate from the vertebral column and skull bones. However, intraosseous hemangiomas of the nasal cavity are extremely rare. Here, we report a case of intraosseous hemangioma with a cavernous pattern arising from the middle turbinate that was preoperatively misdiagnosed as chronic rhinosinusitis with polyps. Except for nasal obstruction, there were no specific rhinologic symptoms. The tumor was excised en bloc by the endoscopic endonasal approach without preoperative embolization.

scholarly journals Endoscopic Endonasal Landmarks to the Greater Palatine Canal: A Radiographic Study

2017 ◽  
Vol 79 (04) ◽  
pp. 325-329 ◽  
Author(s):  
Raewyn Campbell ◽  
C. Solares ◽  
Eric Mason ◽  
Daniel Prevedello ◽  
Ricardo Carrau
Keyword(s):  
Maxillary Sinus ◽  
Hard Palate ◽  
Posterior Wall ◽  
Free Edge ◽  
Nasolacrimal Duct ◽  
Anatomical Landmarks ◽  
Endoscopic Endonasal ◽  
Anterior Aspect ◽  
Greater Palatine Canal ◽  
The Mean

Background The palatine neurovascular bundle is at risk during endoscopic surgery. Injury may result in significant blood loss and anesthesia of the ipsilateral hard palate. Nonetheless, its endoscopic anatomy has not been described previously. This article strives to establish landmarks to identify the greater palatine canal; thus, avoiding injury to its contents. Methodology This study comprised 50 deidentified computed tomographic angiograms using landmarks that are immediately visible during endoscopic medial maxillectomy to calculate: the angle of the greater palatine canal to the vertical, the distance from the anteroinferior aspect of the greater palatine canal to the orifice of the nasolacrimal duct, the distance from the anteroinferior aspect of the greater palatine canal to the posterolateral free edge of the hard palate, and the distance from the anterior aspect of the greater palatine canal as it enters the hard palate to the posterior wall of the maxillary sinus. Results The mean angle of the greater palatine canal to the vertical was 23.01 degrees. The mean distance from the anteroinferior aspect of the greater palatine canal to the nasolacrimal duct was 31.52 mm. The mean distance from the anterior aspect of the greater palatine canal to the posterolateral free edge of the hard palate was 7.71 mm and the mean distance from the anterior aspect of the greater palatine canal to the posterior wall of the maxillary sinus was 7.07 mm. Conclusion Accessible anatomical landmarks help ascertain the location of the greater palatine canal intraoperatively; thus, avoiding injury to its contents.

scholarly journals Endoscopic transnasal resection of an anterior planum sphenoidale meningioma

2020 ◽  
Vol 11 ◽  
pp. 93
Author(s):  
Turki Elarjani ◽  
Sami Khairy ◽  
Saad Alsaleh ◽  
Abdulrazag Ajlan
Keyword(s):  
Office Visit ◽  
Optic Chiasm ◽  
Clonic Seizure ◽  
Vascular Supply ◽  
En Bloc ◽  
Transnasal Approach ◽  
Endoscopic Endonasal ◽  
Magnetic Resonance Imaging Mri ◽  
Planum Sphenoidale ◽  
Brain Retraction

Background: Planum sphenoidale meningiomas comprise about 2% of all primary intracranial tumors. More often, they carry a significant surgical challenge due to their relation to the surrounding vital neurovascular structures. Endoscopic endonasal approach to such tumors holds multiple advantages to the transcranial counterpart in terms of coagulating the vascular supply, minimal brain retraction, and the ability to fully expose the tumor with the affected dura. Case Description: In this surgical video, we are presenting a case of a 28-year-old male, who presented to our hospital after he had one episode of a generalized tonic-clonic seizure that was controlled with an antiepileptic medication. Neurological examination was unremarkable including optic and olfactory nerves. Magnetic resonance imaging (MRI) showed a large anterior skull base mass located at the planum sphenoidale anteriorly. The patient underwent an endoscopic transnasal approach, drilling of the planum sphenoidale, and en bloc total resection of the tumor. In the follow-up office visit, the patient had no more seizures with preserved olfaction; MRI revealed no tumor residual. Conclusion: Planum sphenoidale meningiomas are surgically challenging due to its close proximity to important structures, such as pituitary gland, internal carotid arteries, and optic chiasm. Respecting the arachnoid plane and generous coagulation of vascular supply from the ethmoid arteries facilitate safe removal.

scholarly journals CT scan pitfalls and angiography’s role in juvenile nasopharyngeal angiofibroma: A case report

2021 ◽  
Vol 06 (03) ◽  
pp. 188-193
Author(s):  
Prasetyo Sarwono Putro ◽  
Meutia Apriani ◽  
Muchtar Hanafi ◽  
Vania Puspitasari
Keyword(s):  
Case Report ◽  
Ct Scan ◽  
Nasal Cavity ◽  
Nasal Congestion ◽  
Tumor Location ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
Maxillary Artery ◽  
Nasopharyngeal Angiofibroma ◽  
Posterior Lesion ◽  
The Right

Diagnosis to treatment of Juvenile Nasopharyngeal Angiofibroma (JNA) required a multidisciplinary approach. CT scan works by combining multi-slice imaging from a device that rotates around the object. The potential of missing certain parts in the scanning process can occur. Angiography was the option to cover the CT scan pitfalls. In this case, we discussed CT scan pitfalls that can be overcome by angiography through JNA case report by showing clearer picture of the JNA and its feeding artery. 14 years old child complained of nasal congestion. On physical examination, the lesion expanded the anterior side of nasal cavity. The patient underwent a synonasal CT scan without contrast. It was obtained a heterogeneous solid mass in the nasopharynx extending to the concha and right and left maxillary sinuses. However, until the preparation of angiography, the actual size of the tumor, as well as the entire vasculature, is not yet known. The angiographic features suggested that the right side (seen in the right maxillary artery) was more dominant than the left side. However, both the right and the left finding reassured that the tumor location was more dominant in the anterior nasal cavity. The posterior lesion was also seen but did not predominate in comparison to the anterior. These findings helped clinicians in planning operative action in order to evacuate the tumor.

Combined Anterior Transmaxillary (Caldwell-Luc) With an Endoscopic Endonasal Transpterygoid Approach for Resection of a Large Juvenile Nasopharyngeal Angiofibroma: 2-Dimensional Operative Video

2020 ◽  
Author(s):  
Salomon Cohen-Cohen ◽  
Lucas P Carlstrom ◽  
Jeffrey R Janus ◽  
Jamie J Van Gompel
Keyword(s):  
Nasal Congestion ◽  
Infratemporal Fossa ◽  
Stage Iv ◽  
Video Production ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
Preoperative Embolization ◽  
Maxillary Artery ◽  
Endoscopic Endonasal ◽  
Nasopharyngeal Angiofibroma ◽  
The Right

Abstract Juvenile nasopharyngeal angiofibroma (JNA) is a highly vascular benign tumor that originates in the sphenopalatine foramen and often spreads to adjacent compartments.1 Microsurgical resection with preoperative embolization remains the treatment of choice.2 We present a case of a large JNA involving multiple compartments. The patient is a 20-yr-old male who presented with long-term right nasal congestion. The MRI demonstrated a large enhancing mass that extended from the right nasal cavity and nasopharynx into the right pterygopalatine fossa (PPF), infratemporal fossa (ITF), and parapharyngeal space. Preoperative angiogram for embolization showed a highly vascular tumor with blood supply mainly from the internal maxillary artery and about 10% from a persistent mandibular branch of the internal carotid artery. Based on the UPMC JNA staging system, this tumor was a stage IV.2 A combined anterior transmaxillary (Caldwell-Luc) with an endoscopic endonasal transpterygoid approach was performed. The addition of the anterior transmaxillary approach increases the surgical freedom for traditional bipolar devices and improves the view and trajectory to more lateral structures like the PPF and ITF.3 Gross total resection was achieved without complications. The patient was discharged home with a partial V2 numbness (right superior gum) that improved with time. The endoscopic endonasal approach is a safe and effective technique even for large JNA. A multidisciplinary team consisting of an interventional radiologist, a skull base neurosurgeon, and an otorhinolaryngologist with expertise in endoscopic surgery may play a role for optimal surgical results. The patient consented for the procedure and for the video production.

scholarly journals Smell Preservation following Unilateral Endoscopic Transnasal Approach to Resection of Olfactory Groove Meningioma: A Multi-institutional Experience

2019 ◽  
Vol 81 (03) ◽  
pp. 263-267
Author(s):  
Carolyn A. Orgain ◽  
Edward C. Kuan ◽  
Raquel Alvarado ◽  
Nithin D. Adappa ◽  
Benjamin P. Jonker ◽  
...  
Keyword(s):  
Olfactory Bulb ◽  
Early Stage ◽  
Olfactory Function ◽  
Transnasal Approach ◽  
Endoscopic Endonasal ◽  
Olfactory Groove ◽  
Olfactory Bulb Volume ◽  
Institutional Experience ◽  
Endoscopic Transnasal Approach ◽  
Mild Impairment

Introduction Olfactory groove meningiomas (OGMs) are often associated with loss of smell following resection. Loss of smell has a measurable impact on quality of life. Smell preservation has been previously described in open approaches for early stage or unilateral OGMs. Evidence of smell preservation in endoscopic approaches is lacking. Design A multi-institutional retrospective review was performed on consecutive patients who underwent unilateral endoscopic endonasal resection of OGM. A gross total resection was achieved with preservation of the contralateral olfactory cleft and bulb. Olfactory function was assessed with a six-point olfactory symptom score and the Sniffin' Sticks 12-item smell identification test (SS-12). Contralateral olfactory bulb volume was measured on postoperative magnetic resonance imaging. Results Four patients (age 42.0 ± 7.5, 75% female) were assessed. Olfactory function was assessed at 21.8 ± 5.6 months following surgery. All patients reported some degree of smell preservation (75% described a slight/mild impairment in smell or better). Olfactory identification was preserved with an SS-12 score of 9 ± 1.4 (anosmia defined as ≤6). The olfactory bulb volume was calculated to be 47.4 ± 15.9 mm3 (normal >40 mm3). Conclusion Smell preservation is possible following unilateral endoscopic endonasal resection of carefully selected OGM.

Modification of endoscopic medial maxillectomy: a novel approach for inverted papilloma of the maxillary sinus

2015 ◽  
Vol 129 (2) ◽  
pp. 159-163 ◽  
Author(s):  
A Ghosh ◽  
S Pal ◽  
A Srivastava ◽  
S Saha
Keyword(s):  
Computed Tomography ◽  
Nasal Cavity ◽  
Maxillary Sinus ◽  
Inverted Papilloma ◽  
En Bloc ◽  
Presenting Symptoms ◽  
Novel Approach ◽  
Computed Tomography Scanning ◽  
Medial Maxillectomy ◽  
Enhanced Computed Tomography

AbstractObjective:To describe modification to endoscopic medial maxillectomy for treating extensive Krouse stage II or III inverted papilloma of the nasal and maxillary sinus.Method:Ten patients with inverted papilloma arising from the nasoantral area underwent diagnostic nasal endoscopy, contrast-enhanced computed tomography scanning of the paranasal sinus and pre-operative biopsy of the nasal mass. They were all managed using endoscopic medial maxillectomy and followed up for seven months to three years without recurrence.Results:Most patients were aged 41–60 years at presentation, and most were male. Presenting symptoms were nasal obstruction, mass in the nasal cavity and epistaxis. In each case, computed tomography imaging showed a mass involving the nasal cavity and maxillary sinus, with bony remodelling. The endoscopic medial maxillectomy approach was modified by making an incision in the pyriform aperture and removing part of the anterolateral wall of the maxilla bone en bloc.Conclusion:Modified endoscopic medial maxillectomy providing full access to the maxillary and ethmoid sinuses is described in detail. This effective, reproducible technique is associated with reduced operative time and morbidity.

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