A Case Report of 41-Year-Old Female with Fibrous Dysplasia Combined with Ethmoid Mucocele

Fibrous dysplasia (FD) is a non-malignant progressive condition, which replaces normal bone and marrow with fibrous tissue and woven bone. Sinus mucocele is a cystic, expansile, and destructive lesion that occurs as a result of obstruction of the sinus ostium secondary to inflammation, trauma, anatomical variation, previous sinus surgery, tumor or FD. Among them, FD combined with mucocele has been rarely reported. Here we report the first case of FD combined with ethmoid mucocele. The patient underwent endoscopic debulking of FD and marsupialization of mucocele. The mucocele was successfully marsupialized, and the patient’s symptoms were completely resolved. We propose a new hypothesis that nasal mucosa invaginates into FD and forms a mucocele. For the treatment of ethmoid FD combined with mucocele, we recommend an endoscopic transnasal approach for debulking and marsupialization.

Combined external and endoscopic transnasal approach with use of a diamond burr in the removal of a fishing harpoon hook traversing bilateral sphenoid sinuses in a 22-year-old man

A 22-year old construction worker was shot with a fishing harpoon gun on the left side of his face. He consulted at the emergency room 12 days postinjury, stable but with blurring of vision on the right. The shaft of the harpoon was protruding at the left preauricular area; the tip was neither visible nor palpable. Craniofacial CT scan and skull anteroposterolateral radiographs revealed the tip of the harpoon to be at the right orbital apex. A hook attached 1 cm from the tip was lodged in the sphenoid sinus. The hook was dismantled from the shaft via a combined external and endoscopic transnasal approach, enabling the shaft to be gently pulled. The hook, together with the tip, were removed endoscopically. The patient’s visual acuity improved. He was discharged after 2 days on oral antibiotics with no deficits on follow-up.

Retrospective Case Analysis of Transnasal Endoscopic Resection of Benign Orbital Apex Tumors: Some Thoughts on Transnasal Endoscopic Surgery

Purpose. To deeply discuss the patient selection, surgical planning, surgical techniques, and the therapeutic challenge for endoscopic transnasal resection of benign orbital apex tumors (OATs). Methods. We retrospectively analyzed the cases of 18 patients (18 eyes) with orbital apex cavernous hemangioma (OACH) who underwent endoscopic transnasal approach for resection of the tumor in Zhongshan Ophthalmic Center from March 2016 to May 2020. At each follow-up visit, the patients underwent measurement of their best-corrected visual acuity (BCVA), slit-lamp examination, indirect ophthalmoscopy, and visual field testing. Results. There were 18 patients, 7 males and 11 females, with a mean age of 49.9 ± 12.6 years (range: 26 to 70 years). All 18 patients had unilateral tumors. Among the 18 cases, 13 were located in the right orbit and 5 were located in the left orbit. Sixteen patients underwent purely endoscopic transnasal surgery, and the other 2 patients underwent an endoscopic transnasal approach combined with a transcutaneous or transconjunctival surgical approach. Fourteen patients’ OACHs were removed completely, 1 patient’s OACH was partly removed, and 3 patients underwent pure decompression of the optic nerve. Fourteen patients gained improved or stable BCVA after surgery. Three patients showed postoperative vision decline, and 1 patient had no light perception after surgery. Conclusions. Endoscopic surgery is an effective surgical technique for the treatment of benign tumors in the orbital apex. It is necessary to strictly select patients and fully evaluate the benefits and risks of tumor completely or partly removed.

Treatment and diagnostic features of odontogenic maxillary sinusitis

Nowadays, the share of odontogenic maxillary sinusitis according to various authors can reach 40% among all sinusitis. The literature review of the diagnostic and treatment features of odontogenic maxillary sinusitis is done. The use of modern methods of radiation examination allows us to identify the cause of sinusitis and reveal its odontogenic nature. The main thing in the treatment of odontogenic sinusitis is the elimination of the stomatogenic cause of the disease. There are several different types of surgical treatment of maxillary sinus disease: Caldwell–Luke operation, endoscopic transnasal approach with access through the lower and/or middle nasal passage. Our clinical experience of treatment of 36 patients with odontogenic maxillary sinusitis at the ENT department. Odontogenic maxillary sinusitis does not have specific symptoms. There are no recommendations how to choose any approach according to pathology, anatomy, additional diseases etc.

Endoscopic Transnasal Odontoidectomy

Background Odontoidectomy may represent the treatment of choice for symptomatic ventral craniovertebral junction stenosis in selected cases. An endoscopic transnasal approach has been proposed as an alternative to a classic transoral approach. Method We report a case of a patient with a craniovertebral junction stenosis due to the ossification of the posterior ligament. The clinical and radiological records of the patient and a step-by-step description of the surgical technique are presented (Fig. 1). Conclusion Endoscopic transnasal odontoidectomy provides a direct access to the dens and adjacent structures of the anterior upper cervical spine with a less invasive burden on the oropharingeal structures.The link to the video can be found at: https://youtu.be/Ofrk1sFTV9I.

Endoscopic Transnasal Odontoidectomy

Objectives The video demonstrates the steps for an endoscopic transnasal approach for resection of the odontoid causing platybasia with basilar invasion. Design The video reviews the clinical presentation, preoperative workup and imaging, patient positioning, technical nuances of the procedure, reconstruction, and clinical outcomes including postoperative imaging. Setting The surgery was performed by a skull base team including otolaryngologists and neurological surgeons at a large regional tertiary care facility. Participants A 59-year-old female with the Chiari I malformation with history of multiple revision cervical spinal surgeries presents with neck pain. Preoperative imaging showed a hypoplastic clivus and platybasia with basilar invasion. Main Outcome Measures The main outcome measures consist of safely removing the odontoid with appropriate closure, reversal of the patient symptoms, and prevention of both operative complications and ventral compression of the brainstem. Results The patient's neck pain improved. There were no intraoperative or postoperative complications besides anterior rightward nasal septal deviation causing unilateral nasal obstruction. A septoplasty was performed to correct the septal deviation 6 months after the initial procedure. Conclusions The endoscopic transnasal approach to the resection of odontoid is a safe and effective treatment to address basilar invasion and ventral compression of the brainstem.The link to the video can be found at: https://youtu.be/m_c3-Vn-l80.

Endoscopic Transnasal Resection of Midline Skull Base Meningiomas: Tumor Consistency and Surgical Outcomes

Background The endoscopic transnasal approach (ETA) has proven to be of great value in the resection of midline skull base meningiomas when compared with traditional approaches. Our objective was to assess tumor consistency in relation to surgical outcomes for midline meningiomas (MMs) resected using ETA. Methods Radiological preoperative features, including the tumor to cerebellar peduncle T2-weighted magnetic resonance imaging (MRI) ratio (TCTI), were evaluated. The intraoperative consistency assessment was performed by the surgeon, which determined if the tumor was soft (resectable by suction) or firm (required a cavitation ultrasonic aspirator). Surgical resection and postoperative complications were evaluated in relation to tumor consistency. Results Twenty patients were evaluated; 6 were classified as firm and 14 were classified as soft. The mean TCTI ratio was 1.7 and the median was 1.7 (range: 1.3–2.4). Three firm tumors had a ratio of <1.6. All soft tumors had a ratio of ≥1.6 with three outliers. Additionally, 66.7% of patients with firm tumors had complications compared with 35.7% of patients with soft tumors. Only 33.3% of firm tumors underwent gross total resection (GTR) in comparison to 79.0% of tumors with a soft consistency. Conclusion In our analysis, we found that tumor consistency was significantly related to short-term surgical outcomes in MMs resected using the ETA. The TCTI ratio was found to be the most reliable predictor with a sensitivity of 76.9% and a specificity of 40.0%. Our findings suggest that traditional cranial approaches should be considered as the first surgical option for managing firm MMs.