Endoscopic Two-Port Technique for Orbital Tumors, A Combined Transnasal and Sublabial Approach: A Retrospective Case Study

Background: We investigated the indications for a combined endoscopic transnasal and sublabial transantral approach for the surgical treatment of orbital lesions. Methods: This case study enrolled 10 patients scheduled for endoscopic transnasal surgery for treating orbital lesions from 2009 to 2020. When the tumor was localized to the medial part of the orbit, patients underwent endoscopy with a transnasal mononostril approach. Alternatively, when the tumor was localized to the mediocaudal part of the orbit, and when instrument maneuverability was limited, the transnasal approach was combined with a sublabial transantral approach. This two-port surgery approach was preferred over a trans-septal approach (binostril approach), because the two-port approach could expand the operating field in the medial part of the orbit. Here, we evaluated the indications, complications, and advantages of monoportal and combined two-portal approaches. Results: Among the 10 patients enrolled, 8 (80.0%) underwent surgery with the transnasal mononostril approach, and 2 (20.0%) underwent surgery with the combined transnasal mononostril and sublabial transantral approach. In the two latter cases, visualization of the operation field was excellent, and there was adequate room for manipulating instruments. No dysesthesia in the region of infraorbital nerve was observed postoperatively.Conclusion: The combination mononostril-transantral approach provided the space necessary to maneuver instruments and to visualize the surgical field in treating mediocaudal orbital lesions. This two-portal approach enabled extensive resections of intraconal lesions; thus, it could be considered a suitable alternative to the binostril approach.

Case report of a female child with right nasal chondromyxoid fibroma

Chondromyxoid fibroma; a rarely found tumor, contributing <1% of all primary bone neoplasm. We reported a 4-year female child with a 1-year history of nasal obstruction and facial swelling. Large enhanced lesion with amorphous densities spreading into the right cribriform plate and floor of sphenoid sinus, laterallyinto right lamina papyracea, inferolaterally into medial wall of maxillary sinus, posteriorly into nasopharynx and superior aspect of oropharynx was appreciated in CT scan. Mass was excised by Caldwell Luc’s endoscopic medial maxillectomy via the sublabial approach. CMF was confirmed histologically in post-operative biopsy. Keywords: Chondromyxoid fibroma, benign neoplasm, lamina paprycea. Continuous...

Trans-antral endoscopic assisted excision of odontogenic maxillary cyst

Key points: • Intraoral, sublabial, and transnasal endoscopic approachs are used to manage odontogenic maxillary cysts. • Transnasal endoscopic approach includes inferior meatal antrostomy, middle meatal antrostomy, and endoscopic medial maxillectomy approach. • Trans-antral endoscopic assisted excision of odontogenic maxillary cyst approach have the advantage of direct lesion access of the sublabial approach as well as the advantages of better illumination, magnification, and small access of endoscopic approach. • The trans-antral endoscopic assisted approach co-morbitity seems to be the least comparing to the benefit of complete excision of the cyst within its entire wall in all the cases with minimal injury of the unaffected maxillary sinus mucosa as well as avoidance of injury of any nearby structure if there is defect in the sinus wall.

Radiological diagnostic dilemma in a child with small aggressive facial mass, time to increase the differentials: an inflammatory myofibroblastic tumour

A 5-year-old girl with left facial swelling in the medial maxillary region close to the nasal ala was brought by her parents to our head and neck clinic. They have visited other doctors for similar presentation in the last 6 months, which started as redness and swelling, with occasional epiphora. The redness resolved after medical treatment, with slight regression of swelling, although it did not disappear. CT and MRI showed a locally aggressive, small enhancing soft tissue mass involving the left anteromedial maxillary wall, the nasal bone and the orbital floor. The mass involved the bony course of the nasolacrimal duct, which was the aetiology of the epiphora. The head and neck team performed an incisional biopsy through a sublabial approach. Concurrently, a nasolacrimal duct stent was inserted by an ophthalmologist. Histopathology was consistent with inflammatory myofibroblastic tumour with positive stains for CD68, CD163 and anaplastic lymphoma kinase-1. The tumour was excised and presently the patient is on periodic follow-up with head and neck and ophthalmology clinics.

Evaluation the quality of life of patient’s with cyst maxillary sinus after endoscopical sinusotomy with different approaches

Topicality: The radical treatment for patients with cysts of the paranasal sinuses is only surgery. There are different approaches used for sinusotomy. Objective: Comparison of the impact on the quality of life of patients performing maxillofacial surgery with different options for surgical approaches. Methods and materials: 110 patients who underwent endoscopic sinus surgery for maxillary sinus cysts removing were examined. They were divided into 3 groups, according to the selected approach: 1st group – sublabial approach (35 people), 2nd group – anthrostomy through the middle nasal meatus (35 people), 3rd group – infraturbinal approach (40 people). To evaluate the quality of life of patients, we used our validated Ukrainian language version of the SNOT-22 questionnaire. Results and discussion: In the early period after maxillofacial surgery there was a significant deterioration in the quality of life of patients, which was more pronounced in groups 1 and 2 and was respectively Ʃsublab 45.3 ± 1.3 and Ʃantrostomy 42.1 ± 1.2 a in patients of group 3 it was significantly lower – Ʃinfr 21.4 ± 0.9 (p <0.05). The total score of ear/facial symptoms on the 3rd day after sublabial sinusotomy was 7.3 ± 1.9 points, which is 1.7 times higher than in the second and 6 times higher than in the 3rd group. According to rhinological symptoms, the greatest impact on the quality of life of patients was observed in patients for whom anthrostomy was chose nasal approach (12.3±1.7 points), which is 1.8 times more than in maxillary microsinusotomy and 2.3 times more than in infraturbinal approach. Conclusions: Infraturbinal approach sinusitis compared with sublabial and anthrostomy according to the SNOT-22 survey has a smaller impact on the quality of life of patients. According to the results of the SNOT 22 survey in the early postoperative period after endoscopic maxillary sinusomy with approach through the antrostomy, there is deterioration in the quality of life of patients mainly due to rhinological complaints, while with sublabial approach – due to ear/facial.

A modified longitudinal incision via transoral sublabial approach for removal of the nasal vestibular cyst: a clinical observation

ObjectiveThe aim of this study was to investigate the clinical effect of the removal of nasal vestibular cysts through a modified longitudinal incision via a transoral sublabial approach.MethodIn 28 cases, a nasal vestibular cyst was removed through a modified longitudinal incision via a transoral sublabial approach. A visual analogue scale score was used to evaluate the numbness of the nasal alar and upper lip. Post-operative complications were recorded. Medical photographs were used for assessment.ResultsFor all patients, incisions reached clinical primary healing one week after surgery. All patients were free of post-operative haematoma, infection, oronasal fistula and malformation. In the first week and the first month after surgery, numbness of the nasal alar and upper lip was recorded in few cases. The patients were followed up for 2–57 months without recurrence.ConclusionRemoval of nasal vestibular cysts via a transoral sublabial approach with a modified longitudinal incision is a minimally invasive and simple surgical method with few complications and a quick recovery.

Surgical treatment of nasolabial cysts in a single institute

ObjectivesTo analyse the results of treatment for nasolabial cysts according to whether an intraoral sublabial or endoscopic transnasal approach was used, and to determine the recent surgical trend in our hospital.MethodsTwenty-four patients with a histopathologically and radiologically confirmed nasolabial cyst between January 2010 and December 2017 were enrolled in this study.ResultsNasolabial cysts were predominant in females (91.7 per cent) and on the left side (54.2 per cent). Treatment involved an intraoral sublabial approach in 12 cases (48.0 per cent) and a transnasal endoscopic approach in 13 cases (52.0 per cent). In 13 cases (52.0 per cent) surgery was performed under local anaesthesia, while in 12 cases (48.0 per cent) it was conducted under general anaesthesia. The most common post-operative complications were numbness of the upper lip or teeth (n = 9, 36.0 per cent). Only one patient (4.0 per cent), who underwent a transnasal endoscopic approach, experienced a reoccurrence.ConclusionSurgical resection through an intraoral sublabial or transnasal endoscopic approach is the best treatment for a nasolabial cyst, showing very good results and a low recurrence rate. The recent surgical trend in our hospital is to treat nasolabial cysts using a transnasal endoscopic approach under local anaesthesia.

A Complicated Case of Congenital Nasal Pyriform Aperture Stenosis: Use of a Long-term Unilateral Nasal Stent

This case describes a full-term baby with pyriform aperture stenosis who failed intranasal dexamethasone and reflux therapy. She underwent repair via a sublabial approach and inferior turbinate reduction. Symptoms initially improved but she was unable to be weaned from intranasal steroids. Three subsequent surgeries ensued, including lysis of synechiae, further turbinate reduction, and placement of custom nasal stents, which failed as they became clogged frequently and were easily dislodged, leading to increased intranasal manipulation and postprocedural inflammation. She was eventually fitted and discharged with a large, unilateral stent. After 8 weeks, the stent was removed; she was tolerating full oral feeds. This case highlights the limitations of surgical repair and describes nontraditional uses of stenting.