Anatomic misconceptions regarding the agger nasi cell: A preliminary analysis utilizing endoscopic anatomic dissection and three-dimensional computed tomography.

The agger nasi cell is a key anatomic landmark in endoscopic frontal sinus surgery. However, discord amongst authors regarding anatomic definition and prevalence raises questions of its suitability as a surgical landmark. The purpose of this investigation is to evaluate the agger nasi cell using radiographic imaging correlated with endoscopic anatomic dissection to consider the cell's role as a surgical landmark and to explore if three-dimensional computed tomography (3D-CT) technology can provide enhanced insight into this anatomy.

Anosmia following middle nasal concha resection: An anatomic and developmental review with clinical correlation.

Losing the sense of smell can be associated with a significant decrease in quality of life. Fortunately, this occurs infrequently with modern paranasal sinus surgery that has stressed minimally invasive, tissue-sparing principles. However, over time, more extensive surgical applications have emerged that incorporate increased tissue removal.

The Ponticulus Ethmoidalis: A Newly Appreciated Anatomic Landmark in Endoscopic Sinus Surgery.

Introduction: Ethmoid sinus anatomy is so variable it has been referred to as a "labyrinth." Accordingly, this provides a challenge for surgeons performing ethmoidectomy. Identifying consistent anatomic features or landmarks within the ethmoid sinus can aid surgeons performing sinus surgery.

Maxillary sinus angiomyolipoma: A case report and overview.

Otolaryngologists are called upon to evaluate and treat sinonasal masses discovered incidentally on imaging studies. Although common conditions such as sinonasal polyps and mucus retention cysts predominate, it is prudent practice to formulate a differential diagnosis to identify unusual conditions. We present a case of a maxillary sinus mass in a 78-year-old man that was discovered incidentally on brain imaging and subsequently identified on biopsy as an angiomyolipoma (AML).

Fibroblasts isolated from human middle turbinate mucosa cause neural progenitor cells to differentiate into glial lineage cells.

Transplantation of olfactory ensheathing cells (OECs) is a potential therapy for repair of spinal cord injury (SCI). Autologous transplantation of OECs has been reported in clinical trials. However, it is still controversial whether purified OECs or olfactory mucosa containing OECs, fibroblasts and other cells should be used for transplantation.

The frontal intersinus septum takedown procedure: revisiting a technique for surgically refractory unilateral frontal sinus disease.

Objectives/hypothesis: Unilateral frontal sinus obstruction presents a surgical challenge when outflow tract osteoneogenesis or dense scarring is present. Frontal sinus obliteration is often employed as a last resort, but this procedure has potential long-term complications. In some cases, endoscopic modified Lothrop or unilateral drillout procedures may be effective options; however, restenosis rates are often high.

Piezoelectric surgical device in endoscopic sinus surgery: an initial clinical experience.

Revision endoscopic sinus surgery presents special challenges, such as the need to remove thick osteoneogenic bone close to the orbit or skull base. Currently available drills and microdebriders have shortcomings for this task, including risk to the underlying periorbita or dura. Recently, piezoelectric ultrasound technology has been used to remove bone while preserving adjacent soft tissue structures.

Physiologic alterations in the murine model after nasal fungal antigenic exposure.

Objective: To determine whether a recently developed murine model of fungus-induced sinonasal inflammation demonstrated alterations in ciliary activity and expression of inflammatory cytokines.

Study Design: A prospective randomized controlled study of rhinosinusitis after fungal antigenic sensitization was performed with intraperitoneal aspergillus antigen injection followed by intranasal antigen challenge for 4 weeks. Saline solution was used in a parallel fashion for control animals.

Spontaneous CSF leaks: a paradigm for definitive repair and management of intracranial hypertension.

Objective: To report our outcomes with the repair of spontaneous cerebrospinal fluid (CSF) leaks and to demonstrate how management of underlying intracranial hypertension improves outcomes.

Study Design: Retrospective review of spontaneous CSF leaks treated at the University of Pennsylvania Health System from 1996 to 2006. Data collected included demographics, nature of presentation, body mass index (BMI), site of skull base defect, surgical approach, intracranial pressure, and clinical follow-up.

Clinical outcomes of endoscopic and endoscopic-assisted resection of inverted papillomas: a 15-year experience.

Background: The endoscopic resection of sinonasal inverted papillomas (IPs) has been well described. However, the majority of published reports in the literature are small case series with limited clinical follow-up. The aim of this retrospective study was to review the experience with the endoscopic and endoscopic-assisted resection of IPs at a major academic tertiary care facility and assess long-term outcomes.

Radiographic signs of elevated intracranial pressure in idiopathic cerebrospinal fluid leaks: a possible presentation of idiopathic intracranial hypertension.

Background: Traditionally, idiopathic cerebrospinal fluid (CSF) leaks have been associated with normal intracranial pressure (ICP). We speculate that at least one subset of these leaks may be associated with elevated ICP, more specifically, idiopathic intracranial hypertension (IIH). We sought to identify radiographic manifestations suggestive of elevated ICP in 14 patients with idiopathic CSF leaks who clinically and epidemiologically resembled patients with IIH.

Gene expression analysis in sinonasal polyposis before and after oral corticosteroids: a preliminary investigation.

Objective: To characterize gene expression in sinonasal polyps and to gain insight into change in expression after oral corticosteroid treatment.

Study Design And Methods: Nasal polyps were obtained before and after oral corticosteroid treatment and gene expression was analyzed with a focused gene array technique.

Results: Pretreated sinonasal polyps demonstrated high gene expression for chemokine and leukotriene receptor genes (CCR2, CCR5, CX3CL1, and LTB4R) in all patients.

Safety and outcomes of balloon catheter sinusotomy: a multicenter 24-week analysis in 115 patients.

Objective: The aim of this study was to further evaluate the safety and effectiveness of balloon catheter devices to dilate obstructed sinus ostia/perform sinusotomy.

Methods: Through a prospective, multicenter evaluation, safety was assessed by rate of adverse events, patency was determined by endoscopic examination, and sinus symptoms were determined by the Sino-Nasal Outcome Test (SNOT 20).

Results: At the conclusion of the 24-week analysis, endoscopy determined that the sinusotomy was patent in 80.

Spontaneous cerebrospinal fluid leaks: a variant of benign intracranial hypertension.

Objectives: Previous reports indicate that elevated intracranial pressure (ICP) may cause spontaneous cerebrospinal fluid (CSF) leaks. In this study we examined the clinical diagnosis of benign intracranial hypertension (BIH) in this population using the modified Dandy criteria.

Methods: We performed a retrospective review of clinical data and measurements of ICPs after surgical repair.

Catheter-based dilation of the sinus ostia: initial safety and feasibility analysis in a cadaver model.

Background: Over the past 20 years, many patients have benefited from endoscopic sinus surgery and its ability to relieve sinus obstruction. However, problems still occur with surgery, thereby leaving room for innovation. Recently, catheter-based technology has provided new options for treating cardiac, vascular, and urologic diseases.

Endoscopic management of cerebrospinal fluid rhinorrhea.

Cerebrospinal fluid rhinorrhea and meningoencephaloceles extending into the nasal cavity from the anterior, middle, and posterior cranial fossae often are managed by otolaryngologists. A thorough understanding of the underlying pathophysiology, management principles, and treatment options is essential to achieve optimal outcomes. Surgical and medical management is highly individualized and depends on many factors, including etiology, anatomic site, and underlying intracranial pressure.

Safety and feasibility of balloon catheter dilation of paranasal sinus ostia: a preliminary investigation.

Objectives: Endoscopic sinus surgery (ESS) is an effective option for managing patients in whom medical therapy for rhinosinusitis fails. However, ESS is not always successful, and serious complications can occur. New techniques and instrumentation that improve outcomes and reduce complications would be seriously welcomed.

Development of a murine model of chronic rhinosinusitis.

Objective: The aim of this study was to develop a mouse model of chronic eosinophilic rhinosinusitis.

Study Design: Mice were sensitized to Aspergillis fumigatus (Af) extract by intraperitoneal injection. The animals subsequently received nasal challenges with Af extract 3 times per week for 12 weeks.

Management of cerebral vascular structures during endoscopic treatment of encephaloceles: a clinical report.

Objectives: Otolaryngologists are increasingly being called upon to treat patients with cerebrospinal fluid leak and encephaloceles. The endoscopic approach to the skull base through the nose and paranasal sinuses has proven effective and is well tolerated by patients. With its more widespread and frequent use, unusual cases and potential complications are becoming more apparent.

Endoscopic management of inverted papilloma.

Purpose Of Review: Inverted papillomas are uncommon benign tumors that may occur in the sinonasal tract. Because of their tendency towards recurrence and their potential for malignant transformation, complete en bloc resection has been the standard treatment modality. With the application of minimally invasive surgical techniques in the management of sinonasal disease processes, transnasal endoscopic removal of inverted papillomas is gaining in acceptance.

Outcomes for endoscopic resection of sinonasal squamous cell carcinoma.

Objectives: Preliminary data suggest efficacy for the endoscopic approach for sinonasal malignancy. The purpose of this study is to evaluate the effectiveness of the endoscopic approach for the resection of sinonasal squamous cell carcinoma (SCC).

Study Design: Retrospective analysis of patients undergoing endoscopic resection of sinonasal SCC from August 1996 to May 2004.