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Biomedical subjects

Ralph Metson

Publications and source records attributed to Ralph Metson.

11 recordsLinked to original sources
PubMed2005

Image-guided frontal sinus surgery.

Most patients with inflammatory frontal sinus disease that is un-responsive to medical therapy can be surgically managed with conventional endoscopic techniques; image-guidance technology is not usually necessary.However, in more advanced cases or for revision surgery, a surgical navigation system can be extremely beneficial in preoperative planning and intraoperative localization of complex frontal sinus outflow anatomy. For patients who have failed endoscopic approaches, external procedures, such as frontal sinus obliteration, can also be enhanced through the application of image guidance. Navigation technology has the potential to improve the efficacy and safety of frontal sinus surgery; however, its use is no substitution for proper surgical training and technique.

Frontal Sinus↗
PubMed2005

Image-guided sinus surgery: practical considerations.

The availability and use of image-guidance systems for sinus surgery will probably continue to increase in the years ahead. Surgeons who use this technology must do so with an appreciation of its potential benefits, as well as its possible pitfalls.

Endoscopy↗
PubMed2005

Endoscopic frontal sinus obliteration: a new technique for the treatment of chronic frontal sinusitis.

OBJECTIVES: Patients who fail endoscopic drainage procedures for chronic frontal sinusitis often require obliteration of the frontal sinus with abdominal fat. The purpose of this study was to evaluate an endoscopic technique for frontal sinus obliteration. STUDY DESIGN AND SETTING: Retrospective case-control. Thirty-five patients underwent frontal sinus obliteration using either an endoscopic (n=10) or conventional osteoplastic flap (n=25) technique from 1994 to 2004 at an academic medical center. RESULTS: Patients undergoing endoscopic obliteration had less blood loss (P = 0.006), decreased operative time (P = 0.016), and a shorter hospital stay (P = 0.003) compared to osteoplastic control subjects. All 3 surgical complications occurred in the control group. No patients required additional surgery for frontal sinusitis. CONCLUSIONS: The endoscopic approach to frontal sinus obliteration appears to reduce patient morbidity and should be considered in the surgical management of advanced frontal sinus disease. SIGNIFICANCE: This is the first report of a minimally-invasive technique for frontal sinus obliteration.

Adult↗
PubMed2004

Impact of image guidance on complications during osteoplastic frontal sinus surgery.

OBJECTIVES: To evaluate the impact of image-guidance technology on intraoperative complications during frontal sinus obliteration surgery. STUDY DESIGN AND SETTING: Retrospective case control. Twenty-four patients underwent frontal sinus obliteration with image-guidance technology (n = 15) or conventional instrumentation (n = 9) between 1992 and 2003. The image-guidance system was used to delineate the frontal sinus perimeter and direct cuts through the frontal bone. RESULTS: Intraoperative complications occurred in none of the patients in the image-guidance group and in 3 patients in the control group (P = 0.042). Adverse events included dural tear with CSF leak in 2 patients and exposure of orbital fat in 1 patient. The incidence of postoperative complications was similar between groups (P = 0.326). No patients required revision surgery. Mean follow-up was 5.2 years. CONCLUSIONS: The use of surgical navigation during frontal sinus obliteration appears to improve intraoperative safety. SIGNIFICANCE: This is the first report to document a reduction in the rate of intraoperative complications when image guidance is utilized for frontal sinus surgery.

Case-Control Studies↗
PubMed2004

Endoscopic surgery for frontal sinusitis--a graduated approach.

Contemporary surgical treatment of patients with frontal sinusitis is based on a graduated approach determined by the patient's history and the extent of disease present. Most patients with inflammatory disease of the frontal sinus respond well to an anterior ethmoidectomy and clearing of agger nasi cells encroaching upon the frontal recess. In more advanced cases, a frontal sinusotomy with enlargement of the ostium may be performed to facilitate frontal sinus drainage and ventilation. For patients in whom conventional endoscopic techniques have not been successful, the floor of the frontal sinus is removed with a drill, usually with the assistance of image-guidance technology. Frontal sinus obliteration is reserved for patients with advanced disease for whom endoscopic management has been unsuccessful. Although patients with refractory frontal sinusitis can present a therapeutic challenge, proper surgical management usually results in successful control of symptoms and overall improvement in quality of life.

Drainage↗
PubMed2003

Endoscopic frontal sinus drillout in 100 patients.

OBJECTIVE: To determine the efficacy of frontal sinus drillout surgery for the treatment of chronic frontal sinusitis. DESIGN: Retrospective case-control study. Mean +/- SD follow-up was 4.1 +/- 1.53 years (range, 1.4-6.9 years). SETTING: Academic medical center. PATIENTS: One hundred consecutive patients with chronic sinusitis who underwent frontal sinus drillout surgery. Indications were failed previous frontal sinusotomy (n = 88) and frontal sinus mucocele (n = 12). INTERVENTIONS: Endoscopic removal of the floor of the frontal sinus (unilateral, n = 34; bilateral, n = 66) with a surgical drill. An intraoperative image-guidance system was used in 65 patients. MAIN OUTCOME MEASURES: Frontal sinus patency and improvement of symptoms associated with frontal sinusitis. RESULTS: Frontal sinus patency with control of symptoms was achieved in 80% of patients. There were no intraoperative complications. Postoperative epistaxis occurred in 4% of patients. Of the 20 patients who developed restenosis of the frontal sinus ostium, 11 underwent revision frontal sinus drillout and 9 proceeded to frontal sinus obliteration. The success rate was comparable for the image-guidance and non-image-guidance groups (83.1% vs 74.3%, respectively; P =.56). CONCLUSIONS: Frontal sinus drillout performed with or without an image-guidance system appears to be a safe and effective surgery for the treatment of patients with advanced disease of the frontal sinus. This procedure provides a reasonable alternative to frontal sinus obliteration, which remains a treatment option for patients who fail frontal drillout.

Adult↗
PubMed2003

Image-guided sinus surgery: lessons learned from the first 1000 cases.

OBJECTIVE: To study physician utilization and experience with image-guidance technology for sinus surgery. STUDY DESIGN AND SETTING: Retrospective review of the first 1000 image-guided sinus operations performed by 42 surgeons at an academic medical center. RESULTS: Utilization of image-guidance systems showed a dramatic increase in both number of cases performed and surgeons who used this equipment (70.6% and 92.8%, respectively) during the first 2 years of its availability. Surgical volume subsequently decreased by a mean of 9.3% per year, whereas the number of surgeons using this technology plateaued. The majority of surgeons continued to perform image-guided surgery throughout the study period for selected cases. The knowledge base gained from this experience can best be summarized as a series of lessons learned. CONCLUSION: It is likely that the availability and utilization of image-guidance systems for sinus surgery will continue to increase in the future. Physicians who learn to use this new technology must do so with an appreciation for both its potential benefits and pitfalls.

Academic Medical Centers↗
PubMed2003

Symposium: masters in otolaryngology--update in rhinology.

The past few years have witnessed several noteworthy advances in the field of rhinology in general and in the treatment of chronic sinusitis in particular. Many of these advances can be classified into three major trends: technology, techniques, and tissue eosinophilia.

Chronic Disease↗
PubMed2002

Reduction of diplopia following endoscopic orbital decompression: the orbital sling technique.

OBJECTIVE: Although endoscopic orbital decompression has become the surgical treatment of choice for patients with proptosis from Graves disease, postoperative diplopia requiring corrective eye muscle surgery can occur in up to 63% of patients. The purpose of the study was to evaluate a new technique intended to reduce the incidence of diplopia following endoscopic orbital decompression. STUDY DESIGN: Case-control. METHODS: Endoscopic orbital decompression was performed on 58 orbits in 37 patients with proptosis from Graves disease. The orbital sling technique, which makes use of a horizontal strip of periorbital fascia to prevent prolapse of the medial rectus muscle, was used on 20 orbits in 13 patients. Conventional endoscopic decompression was performed in 24 control subjects. The mean duration of follow-up was 3.3 +/- 1.3 years (range, 1.7-5.1 y). RESULTS: The incidence of new-onset or worsened diplopia following endoscopic decompression was significantly lower for the orbital sling group compared with control subjects (0% vs. 29.2%, respectively [ =.038]). No patients in the orbital sling group developed new-onset diplopia following surgery. Of the eight patients with pre-existing diplopia from the orbitopathy, double vision improved in four patients (50%) and was unchanged in the remaining four patients (50%). The mean reduction in proptosis was comparable for the orbital sling and control groups (5.1 +/- 1.1 mm vs. 5.0 +/- 1.9 mm, respectively [ P=.98]). CONCLUSIONS The preservation of a fascial sling overlying the medial rectus muscle during endoscopic orbital decompression appears to reduce the incidence of postoperative diplopia, while still allowing for a satisfactory reduction in proptosis. This modification of the standard decompression technique should be considered for the treatment of patients with proptosis.

Adult↗
PubMedDate not supplied

Image-guided resection of fibro-osseous lesions of the skull base.

BACKGROUND: Endoscopic resection of sinonasal fibro-osseous lesions remains a technical challenge because of the loss of anatomic landmarks and the frequent need to resect bone along the skull base. The purpose of this study was to evaluate the usefulness of image-guidance systems for the resection of these lesions. METHODS: Endoscopic surgery was performed in 10 patients with fibro-osseous lesions of the sinuses and skull base (six fibrous dysplasias and four osteomas). Indications for surgical intervention were recurrent infection (7), facial pain (3), mucocele (1), and compressive optic neuropathy (1). All surgeries were performed with an image-guidance system, which included an integrated high-speed drill system. RESULTS: Anatomic localization was accurate to within 1 mm when monitoring the depth of bone removal along the skull base. Complete resection of the fibro-osseous lesion was possible in six patients (60%) and partial removal was possible in four patients (40%). In the latter group, a margin of dysplastic bone was preserved along the ethmoid roof to prevent dural exposure. There were no intraoperative complications. Surgery resulted in resolution of infection and facial pain in nine patients (90%). Additional surgery was required in one patient (10%) who developed recurrent optic neuropathy because of continued dysplastic bone growth. Mean follow-up was 34 months (range, 13-67 months). CONCLUSION: Image-guidance technology appears to be ideally suited for the treatment of patients with fibro-osseous lesions of the sinonasal cavity. Real-time monitoring of the depth of bone removal relative to the skull base may enhance the safety and efficacy of such surgery.

Adult↗