Combined external and endonasal approach to fronto-ethmoidal mucocele involving the orbit

Purpose: To present a technique to improve the surgical treatment of frontal sinus mucocele and its recurrence. Methods: Nine procedures performed on eight patients by a team of ENT and Ophthalmic orbital surgeons. Data collected included patient demographics, surgical details, pathological findings and complications. The surgical technique involved an external approach via the upper eyelid skin crease combined with an internal approach with a rigid 4 mm endoscope described below. Following evacuation of the mucocele the sinus was anastomosed to nasal cavity with insertion of silicon stent. All patients had preoperative and postoperative CT scans of the orbit and paranasal sinuses. Result: There were nine operations on eight patients (six males, two female patients, mean age of 57.25: range, 15-71). Two patients had inverted papillomas. All patients presented with non-axial proptosis and diplopia. The mean follow up period was 38.7 months (range 11-99). The only intraoperative complication noted was a cerebrospinal fluid (CSF) leak in a patient with a post traumatic mucocele. Post-operative complications included lid scarring in 2 patients. One of the patients had a fistula overlying the affected sinus at presentation. Both patients underwent dermis fat grafting as a second stage procedure and responded well. One patient presented with asymptomatic superior oblique weakness that could be attributed to trauma to the superior oblique intra operatively. There was no case of recurrence of mucocele in our series. One of the inverted papillomas had an early recurrence (within 6 months) that required repeat surgery. Conclusion: Fronto nasal anastomosis restores the anatomy and reduces the chance of recurrence in our experience. The final cosmetic result is excellent and the patient's satisfaction is high. © 2016 Iranian Society of Ophthalmology

SNOT-22 in a Control Population

AIM: To assess SNOT-22 and its subscales in a non-rhinosinusitis UK-wide population.  METHODOLOGY/PRINCIPLE: This analysis uses data from the 'Chronic Rhinosinusitis Epidemiology Study' (CRES) which recruited from 30 centres across the UK, and the Socioeconomic Cost of ChrOnic Rhinosinusitis study' (SocCoR); 250 volunteers without CRS were recruited as part of these studies. Study-specific questionnaires including demographics, socioeconomic factors and past medical history as well as SNOT-22 and SF-36 were distributed. The control (non-CRS) population had no self-reported nasal problems in the past, no chronic conditions undergoing active treatment and no hospital admissions in the preceding 12 months.  RESULTS: The mean SNOT-22 total score overall was 12.0. The mean was 10.2 for males with a median of 6.5, and a mean of 13.2 for females with a median of 9. Females scored significantly more highly than males on the sleep/fatigue and facial domains.  CONCLUSIONS: Our data demonstrate differences in SNOT-22 amongst males and females. These data can be used in future studies for comparison with different disease populations with rhinosinusitis. This article is protected by copyright. All rights reserved

Tattooing and the Risk of Wrong-Site Ear Surgery

Wrong-site surgery could occur in cases of bilateral pathology or in patients with normal tympanic membranes such as those undergoing stapedectomy. This report highlights the pitfalls in current surgical checklists despite best efforts being put into their design. The practice of marking the earlobe in ear surgery may be less safe than using larger arrows on the neck to indicate the side of surgery