Transnasal endoscopic resection of nasal chondromesenchymal hamartoma in infancy: an analysis of 5 cases

Background Nasal chondromesenchymal hamartomas (NCMHs) are extremely rare benign tumors that most commonly affect children in the first year of life. The purpose of this study was to investigate and summarize the characteristics of NCMH cases and the efficacy of transnasal endoscopic resection of NCMHs. Methods This is a retrospective study including 5 cases of infant diagnosed as NCMH between April 2016 and April 2020. Diagnostic techniques include nasoendoscopy, computerized tomography (CT) scan, magnetic resonance imaging (MRI) with contrast and microscopic and immunohistologic studies. Data collected included patient demographics, patient symptoms, radiographic findings, characteristics of tumor growth, follow-up time, recurrence, and postoperative complications. Results In 5 cases, 3 were males and 2 were females who aged 1, 2, 3, 6 months and 1 year, respectively. The size of the mass measured 1.6 cm*1.9 cm*1.8 cm at its smallest and largest was 4.0 cm*3.5 cm*3.0 cm. All five patients underwent tumor resection via transnasal endoscopic approach. Four tumors were completely removed, and one underwent partial resection, which was completely resected by midfacial degloving operation 13 months after the first surgery. There was no postoperative complication. The current postoperative follow-up period was 1 to 4 years, and no recurrence has been observed. Conclusions Complete surgical resection of NCHM is necessary to resolve the symptoms and prevent recurrence. Transnasal endoscopic approach is a safe and effective choice for pediatric NCMH patients.

Bilateral maxillectomy via mid-facial degloving approach in an extensive case of post-Coronavirus disease invasive fungal sinusitis

<p class="abstract">Coronavirus disease associated invasive fungal sinusitis has affected many and several have succumbed to the disease during the second wave of COVID-19 pandemic. Mucormycosis is a rare, opportunistic, fulminant, angioinvasive fungal infection caused by Rhizopus species of the order Mucorales. It mainly affects immunocompromised individuals, predisposed by diabetes mellitus, corticosteroids, immunosuppressive therapy, haematological malignancies and organ transplantation. We reported here a case of a 45 years old male with past history of Coronavirus disease, presenting with symptoms of invasive fungal sinusitis. With this case we emphasised on use of an alternate approach for bilateral total maxillectomy via midfacial degloving approach instead of a classical external Weber Ferguesen incision in extensive cases with several associated co-morbidities. Mid facial degloving approach is a combination of intraoral and intranasal incisions made to access the midface without any external incision. This approach is advantageous in comparatively having less complication rate, less morbidity and excellent cosmetic outcome.</p>

Midfacial Degloving Approach Facilitated with Endoscope for Nasal, Paranasal & Nasopharyngeal Pathologies

Background: Endoscopic sinus surgery is mostly conducted for the removal of the inflammatory as well as infectious diseases of sinus and malignant or benign nasal, paranasal & nasopharyngeal pathologies. The various surgical approaches that have been used range from transpalatine to a lateral rhinotomy and to mid-facial degloving. Aim: To determine the outcome of mid-facial degloving approach facilitated with endoscope for nasal, paranasal and nasopharyngeal pathologies. Methods: Forty five patients that fulfilled the inclusion criteria were enrolled in the study. All the patients were then underwent surgery by the researcher along with a surgical team under general anesthesia by using Mid-facial degloving approach. The patients were followed - up on 3 & 6 months after the surgery and underwent clinical examination and endoscopic nasal examination to assess the complications, cosmetic outcome and recurrence after the procedure during the follow-up period. Data was entered & analyzed using SPSS v. 23. Results: Mean age of the patients in the sample was 25.47±10.52 years. There were 39(86.7%) male patients and 6(13.3%) female patients. Cosmetic outcome was excellent in 31(68.9%) cases, satisfactory in 12(26.7%) while 2(4.4%) variable comments about the cosmetic effects of the procedure. Bleeding was most common complication 3(6.7%), however recurrence occurred in 3(6.7%) cases. Conclusion: It is concluded that mid-facial degloving approach is a highly successful method for removal of nasal, paranasal or nasopharyngeal pathologies. Key words: Mid-facial degloving, endoscope, nasal, paranasal, nasopharyngeal, pathologies

Antero-medial maxillary sinus angle is an additional predictive factor for enhanced visibility during pre-lacrimal window approach

Pathologies located at the posterior surface of the anterior wall and the floor (alveolar recess) of the maxillary sinus are challen- ging to visualize and access. Open approaches including lateral rhinotomy, Caldwell-Luc procedure or midfacial degloving allow a broad visualization but with a significant likelihood of post-operative morbidity.

Advantages of the open approach in sinonasal tract tumors with midfacial and suprastructure invasion

BACKGROUND. In case of rhinosinusal malignant tumors, it is important to have a unified and simple terminology. The suprastructure refers to the ethmoid sinus, the sphenoid sinus, the frontal sinus and the olfactory area of the nose. The mesostructure includes the maxillary sinus, excepting the orbital wall, and the respiratory part of the nose.MATERIAL AND METHODS. We will present two clinical cases admitted and surgically treated in our department. The first one is a left-side suprastructure mass in a 39-year-old male patient, with a particular evolution. The second one is a left-side midfacial and suprastructure tumor with 3 prior negative biopsies in a 57-year-old patient. In both cases, we performed an external surgical approach.DISCUSSIONS. For an external approach in mesostructure malignant tumors, we propose a combined approach using lateral nasal rhinotomies, sub-labial rhinotomies and midfacial degloving. The external approach in malignant tumors of the supra-structure is centred on a classical incision for the frontal sinus or a hemicoronal or coronal approach. There are some clear advantages of the open approach to be considered.CONCLUSION. The advantages of the external approach are represented by a direct visualization and control of the tumor during the ablative time; a better control for negative margins; a better control of haemostasis; a better chance for en-bloc resection versus piece-meal resection.