Clinical Rhinology. An International Journal. Editor-in-Chief Ashok K Gupta.

Transcription

1 January-April 2010 Volume 3 Number 1 ISSN Editor-in-Chief Ashok K Gupta Clinical Rhinology An International Journal Official Publication of All India Rhinology Society

2 Clinical Rhinology An International Journal 1. Aims and Scope Clinical Rhinology: An International Journal is the official triannual publication of the All India Rhinology Society. It is dedicated to disseminating the latest and the most recent guidelines and advancements in the field of rhinology. It assimilates all aspects of rhinologyresearch, basic sciences, investigative rhinology, clinical, radiological and surgical aspects, rhinoneurology and skull base surgery. A peer reviewed journal, each issue of clinical rhinology will serve as an authentic and concise treatise of rhinology for the postgraduates, ENT and skull base surgeons, research students and paramedical personnel. Each issue shall have an amalgamation of invited articles from the authorities in the field of rhinology and free submissions on various interesting rhinology topics from all parts of india and abroad. Each issue of clinical rhinology will serve as a medium of communication and a platform for mutual exchange of ideas among our professional brethren spread across the globe. Each issue shall contain Review articles, interesting case reports, original research articles, information about the various scientific events in india and abroad and radiology quiz. 2. Ethical Considerations Manuscripts submitted for publication must comply with the following ethical considerations: Informed Consent Informed consent of the patients must be taken before they are considered for participation in the study. Patient identifying information, such as names, initials, hospital numbers, or photographs should not be included in the written descriptions. Patient consent should be obtained in written and archived with the authors. Protection of Human Subjects and Animals in Research When conducting experiments on human subjects, appropriate approval must have been obtained by the relevant ethics committees. 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3 Clinical Rhinology An International Journal Editor-in-Chief Ashok K Gupta EDITORIAL BOARD Chairman PS Saharia (Delhi) Members Ramandeep Singh (Chandigarh) Sandeep Bansal (Chandigarh) Anish Gupta (Chandigarh) Patrons Prem K Kakkar (Delhi) VP Sood (Delhi) President Anoop Raj (Delhi) Secretary Achal Gulati (New Delhi) Treasurer Sanjay Sood (New Delhi) President Elect LC Ojha (Allahabad) Vice President Nishit Shah (Mumbai) Past President PSN Murthy (Vijayawada) Governing Body Members Ajay Jain (New Delhi) Aru Handa (New Delhi) Bachi T Hathiram (Mumbai) Dalbir Singh (Patiala) Hemant Chopra (Ludhiana) JC Passey (New Delhi) NK Mahindroo (Shimla) Rijuneeta (Chandigarh) Ravinder Verma (Jalandhar) Editorial Office Room Number 25, Block D, Level 2, Faculty Offices, Nehru Hospital, Postgraduate Institute of Medical Education and Research Chandigarh , India, clinrhinol@gmail.com iii

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5 Editorial Clinical Rhinology is a peer-reviewed scientific journal and the Official Journal of the All India Rhinology Society which provides a forum for clinical researchers, basic scientists, clinicians, and others to publish original research and explore controversies in the medical and surgical management of patients with various rhinologic and skull base disorders. Harold Horace Hopkins, a renowned British physicist, got patented the rod lens system in 1960, which ingeniously changed the row of glass lenses interspersed by air spaces to one of air lenses interspersed by glass spacers. This increased the optical efficiency by about eight fold and brought a revolution in surgery of the nose, the sinuses and the skull base as most of the efforts concentrated on the possibilities of use of endoscope to functionally treat these disorders. Most oncological head and neck surgeons have forsaken endoscopic sinus surgery to focus on their oncological practice and rarely use an endoscope outside of office examinations. This is changing, however, as endoscopic techniques are adopted for the resection of pharyngeal, laryngeal, and thyroid neoplasms. The head and neck oncologist/skull base surgeon are well trained in oncological principles and external approaches to the skull base. In contrast, the rhinologist is facile with the endoscope and rarely performs major head and neck resections. Endoscopic tumor resections are generally reserved for benign neoplasms and small malignancies. There is a concern that rhinologic surgeons may be less aggressive with their resections with an increased potential for residual tumor. Until longer follow-up data is available, there is a risk that recurrence rates may actually rise with the adoption of completely endonasal craniofacial resections. These disparities of training are reflected in the membership of the subspecialty societies and their respective publications. Each pathway of training has its own advantages and disadvantages. It is evident that in the last decade, there has been a paradigm shift linked to developing endoscopic technologies with the introduction of completely endoscopic endonasal approaches to the skull base with promising results. This issue of clinical rhinology has a multitude of articles ranging from routine rhinological stuff to advanced endoscopic skullbase procedures. Ashok K Gupta Professor and Head Department of Otolaryngology and Head and Neck Surgery (Unit II) Postgraduate Institute of Medical Education and Research Chandigarh, India Editor-in-Chief v

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7 Guest Editorial The official journal of the All Indian Rhinologic Society, i.e. Clinical Rhinology, faces its first anniversary. In his foreword in the first issue of Clinical Rhinology, (Vol. 1, No. 1, September 2008), Clarence C Sasaki from Yale School of Medicine, truly highlights the crucial evolution of illumination and magnification resulting in a cascade of technical advances in the field of Rhinology. These tools now appear to be fundamental in diagnostic and surgical needs. The high level of expertise in the field of endoscopic sinus surgery in India was obvious at the congress organized by the All Indian Rhinologic Society at Chandigarh in The opportunity to assist endoscopic optic nerve decompression gave me the practical proof of its feasibility and is much alike facial nerve decompression. This operation however reflected skillful observation and great cooperation with the Ophthalmology department. These experiences will undoubtedly lead to a better multidisciplinary understanding and fine-tuning of treatment options of the traumatized optic nerve. We are looking forwards to the future developments in this expanding area of Rhinology. The accurate clinician will not forget that contemporary knowledge in Rhinology has been achieved through great anatomical observers like Zuckerkandl E 1 and others. The more recent work accomplished by Johannes Lang further refines previous knowledge on sinonasal anatomy. 2 The anatomic rhinologic cornerstone is left dead without the visionary experimental work of Professor Messerklinger in Graz taking motion pictures with a 16 mm camera of the mucociliary transport during endoscopic procedures. 3 His early publications in German were ultimately translated to English and only appeared in His pupil Professor Stammberger greatly expanded the indications and applications of the Messerklinger-Technique and brought this knowledge to the forefront with emphasis on the functional aspect of endoscopic surgical procedures. 5 In this way, he made a crucial and revolutionary step in understanding sinus pathology ultimately leading to minimally invasive surgical procedures with regression of the classical radical procedures on mucous membranes. The statement of Professor Wullstein may still be considered actual: The mucous membrane is our best friend in the microsurgery of the cranial airspaces. In 30 years time from the beginning of endoscopic sinus surgery, the surgical area has expanded beyond the sinonasal cavities with the endonasal management of the lacrimal pathways, orbital decompressions, endoscopic approaches to the pituitary gland, and even treatment of malignant sinonasal tumors. The skull base does not represent a surgical limit anymore for the endoscopic surgeons and intracranial extensions are within the reach of sinonasal surgeons with multidisciplinary cooperation with the neurosurgeon. From a two-handed surgery technique now two-surgeon approaches are applied for transnasal endoscopic neurosurgical interventions. Stepping back from this heroic surgery we should not overlook the fact that even simple sinus pathology needs good clinical and anatomical analysis. First case: One patient consulted with persistent left maxillary pain after endoscopic maxillary and inferior antrostomy. CT scan images in coronal and especially axial plane revealed a Haller cell extension lateral to the lacrimal canal in close contact with the maxillary nerve (Figs 1 to 3). Second case: Patient with persistent maxillary pain in the right maxillary sinus after FESS surgery (Figs 4 and 5). Figure 1 Figure 2 Figure 3 vii

8 Guest Editorial Figure 4 Figure 5 The surgical approach can be discussed: Either through the anterior maxillary wall, or through an inferior meatal approach. The challenge is yours! Clinical Rhinology reinforces the importance between clinical and anatomical knowledge. Sharing our experiences help us to treat our patients better. We wish Clinical Rhinology a prosperous life on the occasion of its first anniversary! Stephan Vlaminck MD [President Belgian Rhinologic Society (B-RHINO)] Rhinology Division AZ St-Jean Hospital 8000 Bruges Belgium References [President Belgian Rhinologic Society (B-RHINO)] 1. Zuckerkandl E. Normale und pathologische Anatomie der Nasenhöhle und ihrer pneumatischen Anhänge. Wien W. Braumüller, Johannes Lang. Clinical Anatomy of the Nose, Nasal Cavity and Paranasal Sinuses Thieme Medical Publishers, Messerklinger W. Sekrettransport und Flimmerbewegung in den Nebenhöhlen des Menschen. Farbfilm 16 mm, Magnetton, Messerklinger W. Endoscopy of the Nose. Baltimore: Urban and and Schwarzenberg, Stammberger H. Functional Endoscopic Sinus Surgery. BC Decker Philadelphia, viii JAYPEE

9 Clinical Rhinology An International Journal January-April 2010 Volume 3 Number 1 Contents ORIGINAL ARTICLES Orbital Floor Fractures: Management Protocols Hemant Chopra, Rajinder Mittal, Kapil Dua, Neha Chopra, Vikrant Mittal Fibrous Dysplasia of Skull Base: Is There a Role of Endonasal Endoscopic Approach? Rijuneeta, Ashok K Gupta Cerebrospinal Fluid Rhinorrhea: The Place for Endoscopic Surgery Arvind Soni Forehead Flap for Nasal Reconstruction JS Thakur, NK Mohindroo, DR Sharma Etiopathogenesis of Rhinosinusitis in Relation to Ethmoid Anatomy RG Aiyer, VK Pandya, GB Soni, PJ Dhameja, Rahul Gupta, Mayank Patel Laser Transcanalicular Endonasal DCR Ravi Meher, Anoop Raj, PK Rathore, Kavita Goyal, Parvesh Yadav, Virad Kumar, Aditi Chopra Endoscopic Septoplasty: Advantages and Disadvantages SS Suligavi, MK Darade, BD Guttigoli Giant Esthesioneuroblastoma: Is There Any Scope of Endoscopic Approach? Ashok K Gupta, Mohnish Grover, Ramandeep S Virk, Gogia Grover, Rupa Mehta CASE REPORTS Varied Presentations of Inverted Papilloma S Mallina, Anitha Vivekanandan Extramedullary Plasmacytoma of Nasal Cavity: A Rare Entity Digvijay Singh Rawat, Mohnish Grover, PC Verma Open Safety Pin in Nose: A Tricky Foreign Body Mohnish Grover, Gaurav Gupta, Digvijay S Rawat, PC Verma Late Presentation of Transorbital Maxillary Sinus Foreign Body C Ekambar E Reddy, Ajay Jain, Ashok K Gupta ix

10 Contents Successful Repair of Large Skull Base Defect Following JNA Excision Gaurav Gupta, Alok Thakar, Mohnish Grover Isolated Orbital Aspergillosis in an Immunocompetent Patient Anish K Gupta, Devinder Pal Singh, Kuldip Singh Radiology Quiz x JAYPEE