Search Results (296)

Objective: We aim to construct an artificial intelligence (AI)-assisted nasal endoscopy diagnostic system capable of preliminary differentiation and identification of nasal neoplasia properties, as well as intraoperative tracking, providing an important basis for nasal endoscopic surgery. Methods: We retrospectively analyzed 1050 video data of nasal endoscopic surgeries involving four types of nasal neoplasms. Using Deep Snake, U-Net, and Att-Res2-UNet, we developed a nasal neoplastic detection network based on endoscopic images. After deep learning, the optimal network was selected as the initialization model and trained to optimize the SiamMask online tracking algorithm. Results: The Att-Res2-UNet network demonstrated the highest accuracy and precision, with the most accurate recognition results. The overall accuracy of the model established by us achieved an overall accuracy similar to that of residents (0.9707 ± 0.00984), while slightly lower than that of rhinologists (0.9790 ± 0.00348). SiamMask’s segmentation range was consistent with rhinologists, with a 99% compliance rate and a neoplasm probability value ≥ 0.5. Conclusions: This study successfully established an AI-assisted nasal endoscopic diagnostic system that can preliminarily identify nasal neoplasms from endoscopic images and automatically track them in real time during surgery, enhancing the efficiency of endoscopic diagnosis and surgery. Full article

Nasal carcinomas in dogs are locally invasive neoplasms with a low metastatic rate that pose significant treatment challenges due to their location and aggressiveness. This study evaluates the safety, feasibility, and therapeutic outcomes of computed tomography-guided radiofrequency ablation (CT-guided RFA) in 15 dogs diagnosed with nasal adenocarcinoma. All patients underwent staging and histopathological diagnosis before treatment. CT-guided RFA achieved a significant tumor volume reduction (82.8%) and improvement in clinical signs such as nasal discharge, epistaxis, and respiratory distress, without complications. Post-RFA CT examinations demonstrated a significant decrease in Hounsfield units and tumor volume. This study has shown that CT-guided RFA is an effective cytoreductive option for minimally invasive management of nasal adenocarcinomas in dogs, particularly when traditional therapies like radiation therapy or surgery are not feasible. Full article

Background: Nasal and paranasal sinus masses can arise from a wide range of conditions, both benign and malignant, as well as congenital or acquired. Diagnosing these masses is often challenging, requiring a combination of nasal endoscopy, imaging studies, and histopathological analysis. Initial imaging frequently involves computed tomography or cone beam computed tomography (CBCT) to evaluate the bony anatomy of the nasal cavity and surrounding sinuses, while magnetic resonance imaging (MRI) is typically used for detailed assessment of soft tissues and to aid in differential diagnosis when the findings are inconclusive. Methods: This review examines nasal masses evaluated using CT, CBCT, and MRI, highlighting key imaging features that may assist in differential diagnosis. Results: For non-neoplastic lesions, examples include conditions such as rhinoliths, inverted mesiodens, and septal mucoceles. Benign and borderline tumors discussed encompass lobular capillary hemangioma, inverted papilloma, septal osteoma, chondromesenchymal hamartoma, hemangioma, hemangiopericytoma, antrochoanal polyp, sinonasal angiofibroma, ossifying fibroma, and lipoma. Malignant tumors addressed in this review include adenocarcinoma, esthesioneuroblastoma, non-Hodgkin lymphoma, melanoma, and sarcoma. Conclusions: Diagnosing nasal lesions represent a significant challenge for otolaryngologists. Imaging characteristics of nasal masses play a crucial role in narrowing down differential diagnoses before surgery. However, nasal endoscopy combined with biopsy remains the definitive diagnostic approach. Full article

Noncardiogenic pulmonary edema after cardiac surgery is a rare but severe complication. The etiology remains poorly understood; however, the issue may arise from multiple sources. Possible causes include a significant inflammatory response or an autoimmune process. Pulmonary edema resulting from noncardiac etiologies can necessitate extracorporeal membrane oxygenation (ECMO) because most of the cases present a substantial volume of fluid expelled from the lungs and the medical team must manage the inability to achieve effective ventilation. A 64-year-old patient with known heart disease was admitted to our clinic with acute pulmonary edema. His medical history included Barlow’s disease, severe mitral regurgitation (IIP2), moderate–severe tricuspid regurgitation, and moderate pulmonary hypertension. The patient had a coronary angiography performed in a prior hospitalization before the surgical intervention which indicated the absence of coronary lesions. Preoperative screening (nasal, pharyngeal exudate, inguinal pouch culture, and urine culture) was negative, with no active dental infections. The patient was stabilized, and 14 days post-admission, mitral and tricuspid valve repair was performed via a thoracoscopic approach. After being admitted to intensive care post-surgery, the patient quickly developed pulmonary edema, producing a large volume (4.5 L) of yellow secretions through the intubation tube followed by hemodynamic instability necessitating high doses of medications to support circulation but no cardiorespiratory arrest. Due to his worsening condition, the patient was urgently taken back to the operating room, where veno-venous extracorporeal membrane oxygenation (VV-ECMO) was initiated to support oxygenation and stabilize the patient. Full article

Background and Objectives: Orthognathic surgery is used to restore a correct anatomical and functional relationship between the jaws, with postoperative nasal septal deviation (NSD) being a common complication of Le Fort I osteotomy (LF-IO). The aim of this study was to evaluate the occurrence of NSD after LF-IO and to identify possible risk factors. Materials and Methods: Pre- and postoperative cone beam computed tomography (CBCT) scans from 2018 to 2023 of 102 patients after LF-IO were analyzed. After categorizing the preoperative NSDs according to the Mladina classification, the next step was to measure the angle of deviation and classify the severity grades. Pre- and postoperative NSDs were compared using a paired Wilcoxon signed-rank test and postoperative changes in NSD were correlated with surgery-relevant characteristics by calculating Spearman’s correlation coefficients. Results: Postoperatively, an increase in NSD was observed in 62 cases and 35 patients showed a decrease. In both cases with an increase and a decrease in NSD, the preoperatively measured deviations showed a highly significant difference compared to postoperative NSDs (both p < 0.001). Age correlated significantly with increases in deviation (r = 0.28, p = 0.014, CI: −1.0–−0.068) and anterior maxillary displacement showed a significant correlation with a decrease in NSD (r = 0.296, p = 0.042, CI: 0.006–1.0). Gender, cranial and caudal movements of the maxilla had no influence on the results of the NSDs. Conclusions: LF-IO has an influence on NSD and can both intensify and attenuate it. In addition, the risk of an increase in nasal deviation after this surgical procedure rises with the patient’s age and decreases with anterior displacement of the maxilla. Full article

Panfacial fractures are complex fractures involving multiple regions of the facial skeleton and may require multiple surgeries over a relatively short period. They are often associated with polytrauma and other injuries including neurotrauma, which require either immediate (ATLS) airway management, prolonged intubation, or repeated intubations for staged surgeries. The choice of airway for the surgical management of these fractures is difficult, as an assessment of the occlusion is required, and the central nasal complex and/or skull base may be involved, making classical orotracheal or nasotracheal intubation problematic. Submental intubation is increasingly reported as a method of airway management with the aim of avoiding a tracheostomy and its related complications. A review of the different techniques of airway management in the elective treatment of panfacial fractures was performed, focusing on the pros and cons of each method. Most articles were retrospective studies, with only one prospective study comparing submental intubation to tracheostomy in panfacial fractures. An algorithm for the management of the airway in panfacial fractures was presented, based on a sequential assessment of the existing airway, the surgical access required, and the need for prolonged or repeated intubation. Front of neck access, orotracheal and nasotracheal intubation, and submental intubation are all appropriate techniques in different circumstances, and the advantages and disadvantages of each are presented. Full article

Background and Objectives: The temporoparietal fascia flap (TPFF) has recently emerged as an option for skull base reconstruction in endoscopic transnasal surgery when vascularized nasal flaps are not available. This study provides a systematic literature review of its use in skull base surgery and describes a novel cohort of patients. Methods: PRISMA guidelines were used for the review. Patients undergoing skull base reconstruction with TPFF in our center from May 2022 to April 2024 were retrospectively included. Data were collected on pre- and post-operative clinical and radiological features, histology, surgical procedures, and complications. Results: Sixteen articles were selected, comprising 42 patients who underwent TPFF reconstruction for treatment of complex skull base pathologies. In total, 5 of 358 patients (0.9%) who underwent tumor resection via endoscopic transanal surgery in the study period in our institution required TPFF. All had been previously treated with surgery and radiation therapy for different pathologies (three chordomas, one giant pituitary neuroendocrine tumor (PitNET), and one sarcoma). Post-operative complications included CSF leak, which resolved after flap revision, and an internal carotid artery pseudoaneurysm requiring endovascular embolization. Conclusions: TPFF is an effective option for skull base reconstruction in complex cases and should be part of the armamentarium of the skull base surgeon. Full article

Background and Objectives: Postoperative recovery from general anesthesia is a multidimensional process, and patient-centered outcome assessment should be considered an important indicator of recovery quality. This study compared the effectiveness of intraoperative lidocaine and magnesium on postoperative recovery in nasal bone fracture surgery, using the quality of recovery-40 questionnaire (QoR-40) to assess recovery quality and pain intensity. Materials and Methods: A total of 74 patients scheduled for elective closed reduction surgery for isolated nasal bone fracture were assigned to the intraoperative infusions of lidocaine or magnesium. Immediately after anesthetic induction, 1.5 mg/kg lidocaine or 20 mg/kg magnesium was administered over 10 min, followed by a continuous infusion of 2 mg/kg/h lidocaine or 20 mg/kg/h magnesium until the end of the surgery. The primary outcome variable was the QoR-40 survey on postoperative day 1. The secondary outcome variables included postoperative pain intensity, sedation score, the incidence of postoperative nausea and vomiting, and other side effects. Results: The global QoR-40 score at postoperatively 24 h was comparable between the intraoperative lidocaine and magnesium groups. Postoperative pain 30 min after surgery was significantly lower in the lidocaine group than in the magnesium group (p = 0.01), along with lower rescue analgesic consumption (p = 0.003), but pain intensity was not different at other time points (2, 6, and 24 h). The incidence of nausea and vomiting and the sedation score in the post-anesthetic care unit were not significantly different between the two groups. Conclusions: Intraoperative lidocaine and magnesium had no difference in the scores of postoperative QoR-40, but lidocaine was associated with lower postoperative pain scores and analgesic requirement in comparison to magnesium in the closed reduction of nasal bone fractures. Full article

Three-dimensional (3D) facial models have been increasingly applied in orthodontics, orthognathic surgery, and various medical fields. This study proposed an approach to reconstructing 3D facial models from standard orthodontic frontal and lateral images, providing an efficient way to expand 3D databases. A total of 23 participants (average age 20.70 ± 5.36 years) were enrolled. Based on the Hifi3D face model, 3D reconstructions were generated and compared with corresponding face scans to evaluate their accuracy. Root mean square error (RMSE) values were calculated for the entire face, nine specific facial regions, and eight anatomical landmarks. Clinical feasibility was further assessed by comparing six angular and thirteen linear measurements between the reconstructed and scanned models. The RMSE of the reconstruction model was 2.00 ± 0.38 mm (95% CI: 1.84–2.17 mm). High accuracy was achieved for the forehead, nose, upper lip, paranasal region, and right cheek (mean RMSE < 2 mm). The forehead area showed the smallest deviation, at 1.52 ± 0.88 mm (95% CI: 1.14–1.90 mm). In contrast, the lower lip, chin, and left cheek exhibited average RMSEs exceeding 2 mm. The mean deviation across landmarks was below 2 mm, with the Prn displaying the smallest error at 1.18 ± 1.10 mm (95% CI: 0.71–1.65 mm). The largest discrepancies were observed along the Z-axis (Z > Y > X). Significant differences (p < 0.05) emerged between groups in the nasolabial, nasal, and nasofrontal angles, while the other 13 linear and 3 angular measurements showed no statistical differences (p > 0.05). This study explored the feasibility of reconstructing accurate 3D models from 2D photos. Compared to facial scan models, the Hifi3D face model demonstrated a 2 mm deviation, with potential for enriching 3D databases for subjective evaluations, patient education, and communication. However, caution is advised when applying this model to clinical measurements, especially angle assessments. Full article

Background: This study aims to evaluate the efficacy and safety of mepolizumab in the treatment of severe uncontrolled CRSwNP with or without comorbid asthma in a real-life setting over the first six months of therapy. Methods: A total of 45 patients with nasal polyps with or without comorbid asthma were treated with mepolizumab (100 mg q4w) for 6 months. The following outcomes were assessed before therapy (V⁰), and after 6 months (V¹): endoscopic nasal polyp score (NPS), nasal congestion score (NCS), sinonasal outcome test (SNOT-22), visual analog scale (VAS), nasal flow rate (PNIF), olfactory test (SS-I), and asthma control test (ACT). Blood eosinophil count, oral steroid intake, and rescue surgery were also measured. Results: We found a statistically significant improvement in NPS, NCS, SNOT-22, overall VAS, PNIF, SS-I, and ACT. In addition, we observed a decrease in blood eosinophils count. Mepolizumab was well tolerated, and no patients interrupted the treatment during the follow up. Conclusions: Our real-life study confirmed the efficacy and tolerance of mepolizumab prescribed for CRSwNP with or without asthma. The safety profile of mepolizumab was consistent with previous reports. Full article

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a common inflammatory disorder whose complex immunopathogenesis has yet to be fully elucidated. Endotype-2 CRSwNP is the most common form of disease where eosinophils are the main drivers of inflammation. Traditional treatments for CRSwNP have centered around intranasal or systemic corticosteroids and endoscopic sinus surgery (ESS). However, recent advancements in targeted therapies have introduced novel biological agents that specifically target key inflammatory mediators such as IL-4, IL-5, and IL-13. These biologics offer promising options for patients with CRSwNP, particularly those who do not respond adequately to conventional treatments. Nonetheless, some patients do not satisfactorily respond to these drugs because of an insufficient blockade of the inflammatory process. The mast cell (MC) is another important (and somehow neglected) actor in the pathogenesis of CRSwNP, and the latest clinical and translational evidence in this field has been reviewed in the present paper. Full article

Bardet–Biedl syndrome (BBS) is a genetic disease caused by mutations of the BBS genes that encode proteins involved in cilia functioning. It can present with major and/or minor clinical manifestations, such as rod–cone dystrophy, polydactyly, obesity, speech delay, anosmia, congenital heart disease and genital and renal abnormalities. Diagnosis of this rare disease is based on clinical criteria and can be confirmed with molecular genetic testing. Although BBS is a ciliopathy, nasal polyposis has never before been reported in patients with this condition. This article presents the case of a 12-year-old male patient admitted with symptoms of retinopathy, development delay, anosmia, bifid epiglottis and recurrent nasal polyposis. After several clinical, imaging and genetic examinations, the patient was diagnosed with BBS. His nasal symptoms were treated with functional endoscopic sinus surgery and long-term antibiotic therapy, whereas courses of topical antibiotics as well as topical and systemic corticosteroids had no effect. As a conclusion, it is a rare case that presents new clinical manifestations (nasal polyps) that can be related to BBS and possible effective treatments. Full article

Background: The malar bone provides an anchorage point for zygomatic implants, avoiding invasive reconstructive surgeries in the fixed rehabilitation of fully edentulous and severely atrophic maxillae. The limited bone volume, however, requires precise implant placement to prevent complications related to nearby anatomical structures. This observational cross-sectional study aims to measure the malar and zygomatic arch bones and their distances from critical anatomical landmarks to guide surgeons in safe zygomatic implant placement. Methods: Dissections were performed bilaterally on 29 heads from human donated bodies in a cross-sectional observational study. Key landmarks evaluated include the infraorbital foramen (IF), pyriform nasal aperture (PNA), infraorbital margin (IM), zygomaticofacial foramen (ZFF), anterior end (A), and the most protruding point of the zygomatic arch (B). Measurements included IF-PNA, IF-IM, IF-ZFF, ZFF-IM, A-B, and orbital floor depth (OFD). Results: Significant findings showed IF-PNA was greater in males (18.66 ± 2.63 mm, p = 0.001), and IF-ZFF varied between sides (26.72 ± 8.7 mm, p = 0.002). ZFF-IM was larger in males (7.43 ± 2.09 mm, p < 0.001). Heights and thicknesses were also assessed, with significant side differences observed. Conclusions: These findings underscore the importance of understanding precise anatomical distances for successful implant placement. The study provides essential data to enhance surgical planning and training, ensuring safer procedures and minimizing the risk of complications. Full article

Background: There is a notable lack of protocols addressing extubation techniques in transoral robotic surgery (TORS) for obstructive sleep apnea (OSA). Methods: This retrospective cohort study enrolled patients who underwent TORS for OSA between March 2015 and December 2021 and were managed with different extubation approaches. The patients were divided into two groups: high-flow nasal cannula (HFNC) therapy and conventional oxygen therapy. The use of an airway exchange catheter (AEC) was investigated. Results: The application of HFNC use versus conventional oxygen therapy led only to a statistical reduction in extubation time (p = 0.024); length of stay in the intensive care unit (ICU) and the episodes of desaturation below 95% were reduced, but data are non-statistically significant. Similarly, the application of an AEC led to a reduction in extubation time in hours (p = 0.008) and length of stay in the ICU (p = 0.024). Conclusions: In patients with OSA who underwent TORS, the use of an HFNC, with or without an AEC, resulted in a significant reduction in extubation time without major adverse events. Additionally, HFNC utilization may decrease desaturation episodes during extubation. Despite limitations, based on the findings of this preliminary investigation, the combination of an HFNC and an AEC emerges as a promising strategy for enhancing the safety and efficacy of extubation protocols in this patient population. Full article

Background: Biphenotypic sinonasal sarcoma (BSNS) is a low-grade tumor of the sinonasal tract with frequent extension to the orbit and skull base. Due to its rare incidence and recent histopathological and molecular characterization, little data are available in regard to its natural history, treatment and surveillance protocol. Methods: A comprehensive literature review in Embase online electronic databases on BSNS was made. The analyzed factors included the patients’ sex and age, presenting symptoms and signs, anatomical origin and pattern of growth of the tumor, immunohistochemical and molecular features, time to treatment, type of treatment, surgical approach, extent of resection, peri- and post-operative complications, adjuvant therapies, clinical outcome, recurrence and overall survival rates. Results: This literature review involved 34 studies for an overall series of 149 cases of BSNS. The female (66.9%) and middle-aged populations (median 54.88 years old) were mainly affected. The most frequent clinical onset was nasal obstruction (81%), followed by facial discomfort (44%), epistaxis (15.5%) and ocular impairment (14.3%). Ethmoid sinus (67.8%) and nasal cavity (45.4%) were the most common anatomical site of tumor origin, while an extension to the orbit and skull base was registered in 28.7% and 24.5% of cases. Surgery was the main treatment, especially in the form of endoscopic endonasal approach (56.9%), and allowed for gross total resection in 79% of cases. The recurrence rate was 26.2%; three cases of tumor-related death were reported. Median follow-up was 4.6 years. Conclusions: Biphenotypic sinonasal sarcoma is a rare and unique tumoral entity in terms of biological and clinical behavior. Based on the current knowledge, surgery plays the leading role in treatment, accounting for gross total tumor resection in most cases, allowing for clinical symptom and sign resolution and presenting a low rate of perioperative complications. The type of approach and the aim of surgery should be assessed case by case according to patient and pathology features and the surgeon’s experience, as well as the aim of the treatment. Further studies including large surgical series and with long follow-up are required to define prognostic factors and guidelines of treatment for this peculiar pathological entity. Full article