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PubMedDate not supplied

Particle deposition of therapeutic aerosols in the nose and paranasal sinuses after transnasal sinus surgery: a cast model study.

BACKGROUND: The topical administration of steroids or antibiotics to the nose and the sinuses is one of the important postsurgical therapies of endoscopic sinus surgery (ESS). METHODS: To investigate the effective deposition of aerosols in the paranasal sinuses after ESS, we restored the human nasosinus model that underwent ESS and studied the particle depositions on the ostiomeatal complex (OMC), maxillary, and ethmoid sinuses quantitatively. RESULTS: A 45 degree nozzle insertion angle significantly increased the particle depositions more than the 30 degree angle (p < 0.05). A computer simulation-assisted analysis shows that the inertial deposition at OMC increased with a nozzle angle of 45 degrees versus 30 degrees. The particles with 5.63 microm in diameter significantly deposit on OMC and maxillary sinus compared with the particles with 16.37 microm (p < 0.05). CONCLUSION: The topical administration of drugs to the paranasal sinuses postoperatively must be performed in consideration with aerodynamics of aerosols.

Administration, Intranasal↗
PubMed2004

[Different treatments of the middle turbinate and maxillary sinus in endoscopic sinus surgery and the curative effect].

OBJECTIVE: To observe the long-term therapeutic efficacy endoscopic sinus surgery with different treatments of the middle turbinate and maxillary sinus. METHODS: Endoscopic sinus surgery was performed in 391 patients with chronic sinusitis and nasal polypi, who were followed up for 0.5 to 2.5 years postoperatively. RESULTS: Of the patients receiving the operation, 328 were cured, 53 showed improvement, and 10 failed to respond to the treatment, with a total efficacy rate of 97.5%. The major complication of this surgery was nasal cavity adhesion. CONCLUSIONS: Appropriate treatment of the middle turbinate and maxillary sinus in endoscopic sinus surgery with postoperative comprehensive therapy may enhance the therapeutic efficacy and reduce postoperative complications.

Adolescent↗
PubMed1995

[Current aspects of frontal sinus surgery. IV: On therapy of frontal sinus osteoma].

Osteomas are the most common benign tumors of frontal sinus. We evaluated 15 patients with osteomas of the frontal sinus who were managed between 1979 and 1992. The average duration of follow-up was 33 months. In 4 cases osteomas were removed completely via the endonasal route using a microscope and endoscope. We recommend performing a frontal sinus drainage-type 3 primarily. Indications are osteomas of the posterior wall of the frontal sinus located close to the infundibulum. For osteomas of the anterior wall and those located laterally or for very large osteomas we prefer the osteoplastic approach. Apart from the excellent exposure this latter procedure also provides good aesthetic results after carefully placed incisions and precise replacement of the bone flap. We recommend the bicoronal incision in patients with large frontal sinuses, women, or in the presence of good hair growth. Incisions are best placed in a frontal crease in patients with hair loss or a, small frontal sinus.

Adult↗
PubMed1995

Medical management of sinusitis: educational goals and management guidelines. The International Conference on sinus Disease.

The primary goal of sinusitis management is resolution of infection, leading to patency of the ostiomeatal complex. Antibiotics and decongestants are the cornerstones of therapy for acute sinusitis. Diagnosis of acute sinusitis is based on the history and physical findings. Sinusitis is considered to be acute or recurrent acute if infection resolves without residual mucosal damage. Choices for first-line antibiotic therapy include adequate dosages of trimethoprim-sulfamethoxazole, loracarbef, and amoxicillin-clavulanate. Decongestants and mucoevacuants may reduce tissue edema, facilitate drainage, and maintain ostial patency. Topical corticosteroids are useful additional therapy in allergic rhinosinusitis and as an aid in the long-term management of chronic sinusitis. Parenteral corticosteroids have no role in first-line management of acute or recurrent acute sinusitis.

Chronic Disease↗
PubMed1995

[Current aspects of frontal sinus surgery. II: External frontal sinus operation--osteoplastic approach].

Most inflammatory diseases of the frontal sinus requiring surgery can now be managed successfully by endonasal procedures. There remain, however, a number of problematic cases in which optimal exposure of the entire frontal sinus is required with possible complete removal of the mucous membrane and sinus obliteration. These remain indications for osteoplastic frontal sinus surgery. Depending on the individual situation, incisions can be chosen that are bicoronal, placed in a frontal crease or positioned below the eye-brow. Surgical techniques are described in detail. Osteoplastic surgery of the frontal sinus with fat obliteration is a reliable and safe method, particularly for management of so-called "difficult" frontal sinuses.

Adipose Tissue↗
PubMed1997

[Chronic unilateral maxillary sinusitis caused by foreign bodies in the maxillary sinus].

Chronic maxillary sinusitis is a common condition. The disease is most often caused by blockage of the sinus ostia or presence of an oroantral fistula. We report two cases of unilateral chronic maxillary sinusitis associated with foreign bodies in the maxillary sinus. In the first case the foreign body consisted of dental amalgam, in the second case of two silastic sponges left behind from a former operation because of "blowout" fracture. In the case of benign chronic maxillary sinusitis and foreign bodies, functional endoscopic sinus surgery (FESS) preceded by a CT-scan is an excellent approach, by which diagnosis as well as treatment can be achieved with minimal surgical trauma.

Adult↗
PubMed1988

Sphenoethmoidal sinusitis complicated by cavernous sinus thrombosis and pontocerebellar infarction.

An unusual case of sphenoethmoidal sinusitis complicated by cavernous sinus thrombosis, meningitis and pontine and cerebellar infarction is described. The patient presented with advanced intracranial complications which in retrospect caused delay in recognition and treatment of the underlying sphenoethmoidal sinusitis. Surgical drainage of the sinusitis was ultimately required. The pathogenesis of these complications is discussed, and the topic of sphenoid sinusitis reviewed in order to emphasize the numerous neurological manifestations of this disease.

Aged↗
PubMed1992

[X-ray computed tomography of the facial sinuses. Results in 198 patients with chronic sinusitis].

The CT studies of 198 consecutive patients with chronic sinusitis were reviewed retrospectively. CT was normal in 47 patients (23.7%). In 151 patients one or many cavities showed abnormalities. In 69 cases (34.9%), the lesions affected one or two sinuses, in 35 cases (17.7%) three to six cavities were abnormal, whereas in 47 cases (23.7%), more than six cavities were abnormal. In 87 cases (57.6%), lesions were observed both in large cavities and ethmoid cells, whereas they were selectively localized in large cavities in 55 cases (36.4%), or in ethmoid cells in 9 cases (6%). Abnormalities were observed in the maxillary sinus in 137 patients (69.2%), in the ethmoid in 96 patients (48.5%), in the frontal sinus in 51 patients (25.8%), and in the sphenoid sinus in 28 patients (14.1%). The most frequent abnormality was hypertrophic mucosa, which was visible in 275 cavities. These results were compared with date of the literature.

Adolescent↗
PubMed1995

Concha bullosa: frequency and appearances on CT and correlations with sinus disease in 308 patients with chronic sinusitis.

The purposes of this study were to determine the prevalence of concha bullosa in patients with chronic sinusitis, to assess the origin of the pneumatisation (from the anterior or posterior ethmoid cells), and to evaluate the significance of the concha bullosa in the genesis of inflammatory sinus disease. We reviewed the CT studies of 308 patients with chronic sinusitis, assigning four grades of pneumatisation: absent, small, medium and large. Unilateral or bilateral concha bullosa was found in 164 patients (53%). In 79% of cases it was pneumatised via the posterior ethmoidal cells and in 21% via the anterior. A small concha bullosa was associated with abnormalities of the maxillary sinus, ethmoidal cells and ostiomeatal unit respectively in 49%, 28% and 34% of cases, whereas with a large concha bullosa the association was 55%, 36% and 41% respectively on the ipsilateral side and 55%, 32% and 41% on the contralateral side. The usually accepted hypothesis that the concha bullosa may contribute to the pathogenesis of inflammatory sinus disease seems doubtful.

Adult↗
PubMed2003

Retrograde flow in the left inferior petrosal sinus and blood steal of the cavernous sinus associated with central vein stenosis: MR angiographic findings.

BACKGROUND AND PURPOSE: We attempted to identify the cause of abnormal venous flow seen during arterial MR angiography in the inferior petrosal sinus by use of in three female patients (aged 51, 48, and 70 years, respectively). METHODS: Arterial 3D time-of-flight MR angiography was performed with a tilted optimized nonsaturating excitation pulse sequence (TR/TE, 31/7; flip angle, 20 degrees; section thickness, 65 mm; effective thickness, 1 mm; number of sections, 1 to 2); no magnetization transfer pulse sequence was used. Contrast-enhanced 3D MR angiography of the neck was performed with a 3D fast low-angle shot pulse sequence (TR/TE, 4.6/1.8; flip angle, 40 to 45 degrees; section thickness, 80 mm; intersection gap, 1.5 mm; acquisition matrix, 180 x 256; acquisition time, 27 s) on a system with a whole-body coil. RESULTS: In all three patients, 3D time-of-flight MR angiography revealed abnormal vascular signal originating from the left cavernous sinus, continuing through the inferior petrosal sinus, and ending in the proximal internal jugular vein at the jugular bulb level. Abnormal vascular signal at the jugular bulb, sluggish flow and flow-related enhancement in the left internal jugular vein, and signal void in the contralateral jugular vein were noted. Contrast-enhanced delayed-phase MR angiography showed stenosis in the left brachiocephalic vein in all patients. CONCLUSION: High signal intensity noted at the inferior petrosal sinus resulted from retrograde flow. Retrograde flow was due to blood stealing from the internal jugular vein toward the cavernous sinus because of venous stenosis in the brachiocephalic vein.

Aged↗
PubMed2002

Navigational risks associated with sinus surgery and the clinical effects of implementing a navigational system for sinus surgery.

OBJECTIVE: To evaluate the clinical effects of implementing the use of a navigational system in sinus surgery in a community hospital setting. STUDY DESIGN: Retrospective record review. METHODS: The hospital records of 800 patients who had undergone sinus surgery performed by 7 physicians at one institution over 11 years were reviewed and tabulated. The information was recorded in 2 groups of 400 with those in group A being treated before the availability of an electromagnetic sinus navigational system and those in group B being treated after the unit had been installed. The following data were collected: date, age, gender, informed consent, physician, additional procedures, sinuses entered, use of navigational system, revision status, setup time, operative time, and complications. The results of the two groups were analyzed statistically, and comparisons were made. RESULTS/CONCLUSIONS: The patient populations in groups A and B were determined to have similar demographic profiles. Significantly more sinuses, specifically in the frontal location, were entered in group B compared with group A. Adjusted for the number of sinuses treated, the median operative times did not differ significantly between groups. Major and minor complication rates were similar in both groups and were consistent with the published literature. In a community hospital setting, once an electromagnetic guidance system became available, it was used in 92% of the cases performed by sev-eral otolaryngologists.

Adult↗
PubMed1993

Lysozyme and lactoferrin in human maxillary sinus mucosa during chronic sinusitis. An immunohistochemical study.

Immunohistochemistry was used to study the localization of lysozyme (LZ) and lactoferrin (LF) in the human sinus mucosa during recurrent and chronic sinusitis. Serous cells of submucosal mixed glands and polymorphonuclear leukocytes both displayed a strongly positive staining reaction to both LZ and LF in the normal mucosa. A positive though weak staining for LZ and LF could also be found occasionally within goblet cells. In the mucosa from patients with recurrent or chronic sinusitis, the staining reaction to LZ appeared to intensify in goblet cells. Furthermore, an increased immunoreactivity of glands vis-à-vis LZ and LF was also noted occasionally. Atypical glands were frequently found in mucosa from patients with chronic sinusitis. The epithelium of these latter glands often showed an intense staining reaction to LF, but a rather weak reaction to LZ. The results of the present study suggest that the observed increase in LZ and LF secreting activity of goblet cells, epithelial cells and newly formed atypical glands may play a part in the defense mechanism of the sinus mucosa during the course of chronic sinusitis.

Adult↗
PubMed2002

[Sinus node dysfunction with intermittent sinus arrest and AV-nodal escape rhythm as initial manifestation of pheochromocytoma].

A 25-year-old male student complained about episodic palpitations, dizziness, nausea and headache 5 years prior to presentation. No otorhinolaryngic, neurologic or gastrointestinal causes were identified. Several ECG recordings revealed sinus node dysfunction with intermittent sinus arrest and AV-nodal escape rhythm. The patient was given a permanent DDD-pacemaker. Six months later, the clinical symptoms were unchanged. During an attack, physical examination revealed paleness, diffuse sweating and an arterial blood pressure of 250/130 mmHg, which decreased to 120/80 mmHg within a few minutes. Abdominal ultrasound and abdominal computed tomographic scan demonstrated the presence of a large (6.4 x 5.5 cm) left-sided adrenal mass. Two 24-h-urinary collections demonstrated elevated noradrenaline (mean 315 micrograms/24 h, normal < 80 micrograms/24 h) and adrenaline (mean 268 micrograms/24 h, normal < 20 mg/24 h) levels. Blood samples, which were drawn during excessive blood pressure rise, revealed elevation of plasma catecholamines (6.793 pg/ml for adrenaline (normal 50-150 pg/ml) and 10.424 pg/ml for noradrenaline (normal 200-500 pg/ml), so that the diagnosis of pheochromocytoma was considered established. The tumor was successfully removed during laparascopic surgery. After surgery, the patient remained well and normotensive. Three months later, several long-term ECG recordings showed sinus arrhythmia with no evidence of sinus arrest or AV-nodal escape rhythm, so that the DDD pacemaker was turned off. This case underlines that sinus node dysfunction with intermittent sinus arrest and AV-nodal escape rhythm is a potential early manifestation of a pheochromocytoma. These changes seem to disappear after successful removal of the tumor.

Adrenal Gland Neoplasms↗
PubMed1993

Comparison of effects of propranolol versus pindolol on sinus rate and pacing frequency in sick sinus syndrome.

Beta blockers in patients with sick sinus syndrome (SSS) may prevent supraventricular arrhythmias, systemic hypertension and myocardial ischemia, but may cause excessive depression of sinus node function. In 8 patients with SSS and a permanent pacemaker, the effect of chronic oral pindolol on sinus rate and pacing frequency was compared with that of propranolol in a double-blind crossover trial. In all patients the pacemaker was programmed to a rate of < or = 50 beats/min. Holter monitors, obtained at baseline and on each drug, were used to calculate peak ambulatory sinus rate, number of paced beats per day, maximal number of paced beats per hour, and percentage of hours with paced beats. The peak sinus rate with pindolol therapy was 24% higher than with propranolol (p = 0.001). During pindolol therapy, the number of paced beats per day and maximal paced beats per hour were reduced 54% (p = 0.04) and 61% (p = 0.02), respectively, compared with propranolol. Patients with SSS who require beta-blocker therapy for tachycardia, systemic hypertension or angina pectoris may have less bradycardia when treated with pindolol rather than propranolol. Beta blockers like pindolol, which cause less sinus node depression, may obviate the need for prophylactic permanent pacemakers in patients with SSS, and may help to prevent chronotropic incompetence and pacemaker syndrome in patients already treated with a VVI device.

Administration, Oral↗
PubMed1984

Sinus node function after autonomic blockade in normals and in sick sinus syndrome.

Electrophysiologic studies were performed in 10 normals and 33 patients with sick sinus syndrome before and after total autonomic blockade with propranolol and atropine. In normals both corrected sinus node recovery time (SNRT) and sinoatrial conduction time (SACT) decreased significantly after autonomic blockade. In patients with sick sinus syndrome the corrected SNRT was abnormal (greater than 450 msec) in 16 (48.5%) cases before and 25 (76%) cases (greater than 285 msec) after autonomic ablation (P less than 0.02). Thirteen of 21 patients (62%) with normal intrinsic heart rate and all 12 cases with abnormally low intrinsic rate after autonomic blockade had abnormal corrected SNRT (greater than 285 msec). Mean SACT measured in 19 patients also shortened significantly following pharmacologic denervation. During control it was prolonged (greater than 226 msec) in 8 patients (44%). After autonomic blockade 2 of 13 patients with normal intrinsic heart rate and 3 of 6 with low intrinsic rate showed abnormal SACT (greater than 151 msec). The data suggest that the majority (76%) of patients with sick sinus syndrome have intrinsic abnormality of sinus node automaticity while in a minority (24%) disturbed autonomic regulation is the pathogenetic mechanism. Patients with normal intrinsic heart rate usually have normal intrinsic SACT, while a significant proportion of those with low intrinsic rate have abnormal perinodal conduction. Subjects with abnormal intrinsic heart rate have more severe disturbances of sinus node function than those with normal intrinsic rate.

Adolescent↗
PubMed1990

Morphology of the region of the coronary sinus in respect to coronary sinus rhythm.

The arterial supply to the region of the coronary sinus and the interatrial septum was examined in 18 normal canine hearts. In 13 of a further 18 dogs, coronary sinus rhythm was evoked by the ligation of atrial arteries, subsequent to which the arteries were visualized by injection of latex. A stable coronary sinus rhythm is evoked by producing ischaemia in an extensive area of the right atrium, including the sinus node, the interatrial septum and Bachmann's bundle, but preserving from ischaemia the posteroinferior part of the right atrium. Microscopical examination of the hearts with coronary sinus rhythm, and comparison with 9 control hearts, failed to demonstrate any morphological centre, in the form of nodal cells, which might have been responsible for the abnormal rhythm. In the posterior part of the right atrium, the ischaemic changes failed to affect the approaches of the atrioventricular node. The approaches were predominantly composed of cells poor in myofibrils mixed to a variable degree with cells of the working myocardium. We discuss the possibilities of the development of coronary sinus rhythm and "circus movement" with regard to the participation of the approaches to the atrioventricular node.

Animals↗
PubMed2006

The clinical significance of sinus membrane perforation during augmentation of the maxillary sinus.

PURPOSE: Augmentation of the maxillary sinus floor is a well-documented technique and is generally accepted as a pure implantology procedure to facilitate placement of dental implants in the posterior atrophic maxilla. The objective of this report was to evaluate the significance of the sinus membrane perforations on the incidence, complications, and success rate of this procedure. PATIENTS AND METHODS: Patients who received sinus floor augmentation and simultaneous placement of dental implant were included in this study. Subgroup I consisted of patients who had their sinus membrane perforated and repaired during the procedure with resorbable membrane. Subgroup II consisted of patients whose Schneiderian membrane was not perforated during the procedure. The patients were followed between 1 to 4 years after augmentation. RESULTS: All perforations were classified as class II or III. The success rate of the implants in the perforation group was 94.4%, and that for the nonperforation group was 93.9%. The difference between the 2 study groups was statistically not significant. A significant statistical correlation was found between the residual ridge height and the membrane perforation (P < .01). CONCLUSIONS: Mainly due to technical difficulties, maxillary sinus membrane perforation occurs more frequently with a small height of residual alveolar bone. In this study, no statistical difference was observed in the success rate of the immediate implants placed with sinus bone grafting in patients whose membrane was perforated versus those patients in whom an intact membrane was maintained.

Alveolar Ridge Augmentation↗
PubMed1999

Localized sinus inflammation in a rabbit sinusitis model induced by Bacteroides fragilis is accompanied by rigorous immune responses.

We evaluated inflammatory and immune responses against Bacteroides fragilis in a rabbit sinusitis model. Bacteroides was inoculated into the left maxillary sinus, and inflammatory (histology, cell number/cytology, lactose dehydrogenase, and apoptosis) and immune responses in the sinus, airway, and peripheral blood (PB) were determined for up to 4 weeks. In the inflamed sinus, the lactose dehydrogenase level was markedly elevated, with neutrophilic infiltration, severe tissue inflammation, and increased apoptosis. Low-grade tissue inflammation was present in the contralateral and sham-operated sinuses, but other parameters remained unchanged, and so did those in the airway and PB in the inoculated rabbits. Serum IgG antibody levels increased rapidly, were highest at 3 weeks, and began to decline at 4 weeks. Cellular immune responses (proliferation and interferon-gamma mRNA expression) against Bacteroides were detected in the PB of all inoculated rabbits. Vigorous immune responses against Bacteroides may have localized but failed to terminate inflammation in the sinus, indicating importance of microenvironmental factors.

Animals↗