Primary Endonasal Endoscopic Powered Dacryocystorhinostomy for Low Obstruction of the Lacrimal Excretory System in Adult Patients: A 5-Years Experience

PURPOSE: The aim of this retrospective study was to describe the outcomes of powered endonasal endoscopic dacryocystorhinostomy(DCR) performed for symptomatic low lachrymal obstruction in adult patients over a 5-year period by the same surgeon. METHODS: Retrospective study. PATIENTS: Patients suffering from a low obstruction of the lachrymal system documented by paraclinical investigations treated in the ENT department of CHU UCL Namur between September 2011 and September 2016. RESULTS: In total, 128 procedures were performed for 111 patients. The mean age at the time of surgery was 62.3 years (range: 18.1-93.0 years). There were 93 women and 18 men, and the mean follow-up duration was 40.5 months (range: 12.1-54.47 months. Aetiologies for the lacrimal obstruction included primary acquired nasolacrimal duct obstruction (PANDO; n=123), LeFort fractures (n=3), and radiotherapy/chemotherapy (n=2). Epiphora only (n=98), chronic purulent discharge (n=30), and acute dacryocystitis (n=4)were major symptoms. The stoma remained patent in115 of the 128 (89.8%) procedures, while111 (86.7%) procedures resulted in complete symptom resolution. Persistence of tearing without infection was observed after 17 (13.3%) procedures, with revision surgery performed in 13(10.1%) cases. CONCLUSION: Endoscopic endonasal powered DCR is an effective surgery for primary saccal and post-saccal lachrymal obstruction in adults. The success rate is high and very competitive to that after an external approach. Powered instrumentation is a nice tool to make the resection of the bony part of the frontal process of the maxillary easier and quicker particularly in case of very thick bone. The postoperative morbidity is very low; The rehabilitation is fast. Septoplasty or sinus surgeries can be performed in the same operating setting when required with no deleterious impact on the success rate of DCR

Nasolabial Cysts: Case Series

Nasolabial cyst is a rare, benign soft tissue mass located in the nasolabial fold. It is submucosal and extra osseous. It affects more commonly middle aged women with coloured skin. They can be regularly infected or cause nasal obstruction and alar deformity. Clinical examination, nasal endoscopy and imaging are necessary to make the diagnosis. When symptomatic surgery is the treatment. It may consist of a complete excision via a transoral sublabial incision or a endonasal marsupialization. Both techniques have the same efficacy. We report herein a series of 6 patients treated successfully in the ENT department of the CHU UCL Namur from Belgium

Nasoseptal cyst after septorhinoplasty: late and unusual but preventable complication

Introduction: Formation of a slowly growing cyst following septorhinoplasty is a rare but serious complication. Mucous cyst is more common than foreign body inclusion cyst. Typically, these cysts present as a solitary lesion that develops in the subcutaneous space over the nasal bone along the line of nasal osteotomy several months or years after initial surgery. Rarely, the cyst connects with the nasal septum. Surgery is the treatment of choice and consists of either complete excision of the cyst capsule or marsupialization of the cyst. Case report: A nasoseptal mucous cyst developed in a 46-year-old woman 10 years after septorhinoplasty. We successfully marsupialized the cyst with an endonasal endoscopic approach. Conclusion: Cysts can be removed by either complete resection of the cyst capsule or marsupialization via endonasal endoscopy. To prevent cyst formation, initial surgery must be conducted nontraumatically and tissue remnants cleared to prevent dispersion into subcutaneous spaces

Are bovine pericardium underlay xenograft and butterfly inlay autograft efficient for transcanal tympanoplasty?

To evaluate the success rate and the surgical procedure of two different transcanal myringoplasty techniques using the Tutopatch(®) (Tutogen Medical, Inc., Alachua, FL, USA), a xenograft produced from bovine pericardium or the butterfly, an inlay tragal cartilage autograft. This is a retrospective study. We studied all cases of transcanal myringoplasty with Tutopatch and butterfly, performed by the same surgeon between April 2005 and May 2013. Perforations were secondary to chronic otitis media without cholesteatoma, perforation post ventilation tube or trauma. They were not exceeding one-third of the tympanic membrane surface for the Tutopatch and one quarter for the butterfly. We evaluated the anatomical success rate, complications and postoperative hearing results in both techniques. A total of 106 myringoplasties were performed: 66 with Tutopatch and 40 with butterfly with a mean follow-up of 16.5 and 5.2 months, respectively. Successful closure rates of Tutopatch and butterfly were 75.8 % (P < 0.0001) and 85.0 % (P < 0.0001), respectively. Myringitis controlled with topical antibiotics treatment occurred in 8 (12.1 %) and 5 (12.5 %) cases. Eighty percent of patients with Tutopatch had a mean residual air-bone gap within 10 dB, compared to 85.0 % in patients with butterfly. When anatomically feasible, a transcanal approach myringoplasty with a Tutopatch(®) graft or butterfly appears to provide good anatomical and functional results. We show that both techniques provide good anatomical and functional results. The butterfly has the advantage to use an autograft, which is surgically easier because it does not require tympanomeatal flap elevation. We recommend the butterfly technique for non-marginal perforation not exceeding one quarter of the tympanic membrane after excision of the perforation edge and Tutopatch for bigger perforation or when standard autografts are not available. Myringitis is the only described complication without specific incidence

Germinal Center- Like Diffuse Large B cell Lymphoma of the Frontal Sinus Misdiagnosed as a Pott’s Puffy Tumor

Non-Hodgkin’s Lymphoma (NHL) of the frontal sinus is very rare and early diagnosis is usually made with some delay because of the non-specificity of the clinical presentation and overlapping with other diseases. We report herein the story of a 40-year-old man who presented to the outpatient clinic with pain and swelling of the forehead. The first diagnosis was a subacute rhinosinusitis mimicking a Pott’s puffy tumor. On the CT scan, there was a partial opacity of the left frontal sinus with osteomyelitis of the anterior and posterior tables of the frontal sinuses. He received broad-spectrum antibiotics and systemic glucocorticosteroids. He responded well to the treatment but the symptoms and signs relapsed at the completion of the treatment. A second CT scan was performed but no significant improvement was found compared with the first CT scan. As there was no pus coming from the middle meatus we decided to take specimen for bacteriological and histopathological examination during a therapeutic window. This was done via a supraciliary incision and frontal trephine. The final diagnosis was a diffuse large B cell lymphoma, germinal center B cell like subtype. He underwent 6 cycles of chemoimmunotherapy with R-CHOP and central nervous system prophyllaxis via intrathecal methotrexate. 2 years after the initiation of the treatment the patient is still free of symptom and disease confirmed by serial PET scans

Chronic maxillary atelectasis and silent sinus syndrome: two faces of the same clinical entity

Chronic maxillary atelectasis (CMA) and silent sinus syndrome (SSS) are rare clinical entities characterized by an implosion of the maxillary sinus that may or may not be associated with sinonasal symptoms, and are complicated by ipsilateral enophthalmos. The objective of this article is to discuss the definitions, physiopathology, clinical and radiographic characteristics, and surgical management of these entities. We retrospectively reviewed 18 patients (7 women, 11 men, aged 12–70 years) diagnosed and treated in the ear, nose, and throat departments of four Belgian teaching hospitals between 2000 and 2015. Nine patients had a history of sinus disease. In all cases, a computed tomography scan showed downward displacement of the orbital floor, increased orbital volume, and maxillary sinus contraction. Five patients met the criteria for grade II CMA and 13 for grade III CMA. Four patients met the criteria for SSS. All patients underwent wide endoscopic middle maxillary antrostomy. There were no orbital complications and all patients experienced resolution or a dramatic reduction of their symptomatology. Only one patient asked for an orbital floor reconstruction to correct a persisting cosmetic deformity. Although CMA and SSS are usually regarded as different entities in the literature, we believe that they lie on the same clinical spectrum. Treatment for both conditions is similar, i.e. middle meatal antrostomy to halt or even reverse the pathological evolution and reconstruction of the orbital floor in the event of persistent cosmetic deformity.SCOPUS: ar.jinfo:eu-repo/semantics/publishe