This document discusses various benign sino-nasal tumors including epithelial tumors like inverted papilloma, vascular tumors like hemangioma, bony tumors like osteoma and ossifying fibroma, and mesenchymatous tumors like glioma, myxoma, leiomyoma and schwannoma. It provides detailed information on inverted papilloma including history, characteristics, clinical presentation, histopathology, staging, diagnostic workup, treatment approaches and challenges in treatment. It also discusses osteoma, hemangioma, fibrous dysplasia, ossifying fibroma and schwannoma - covering their etiology, clinical features, imaging findings, histopathology and management.
This document provides an overview of frontal sinus surgery, including the surgical anatomy, types of procedures, indications, and complications. It describes both open and endoscopic approaches. Open approaches discussed include trephination, frontal sinusotomy, frontoethmoidectomy, cranialization, and ablation. Endoscopic approaches include Draf types I-III and frontal sinus rescue procedures. Complications of both open and endoscopic procedures are also summarized.
Spaces of middle ear and their surgical importanceDr Soumya Singh
one of the imp topics in ENT that should be understood very thoroughly if u want to pursue as an otologist.I tried to simplify the topic with simple diagrams and models for better understanding .
STOMAL RECURRENCE AFTER LARYNGECTOMY-1.pptxSendhil Kumar
Stomal recurrence after laryngectomy occurs in 1.7-15% of patients and is usually fatal. Risk factors include subglottic tumor location, advanced T and N stage, pre-operative tracheostomy, and positive margins. Surgery is the main treatment for localized recurrence, involving wide excision and mediastinal lymph node dissection. Post-operative radiation may prevent recurrence in high risk patients by sterilizing the area. Close follow-up is important to detect recurrence early.
Mucosal folds and ventilation of middle ear AlkaKapil
The document discusses the anatomy and embryology of the middle ear spaces and mucosal folds.
1. The middle ear develops from the tubotympanic recess which buds into sacs including the saccus anticus, medius, superior and posterior. Remnants of mesenchyme become ligaments and blood vessels.
2. The middle ear is divided into several compartments by mucosal folds including the protympanum, mesotympanum, epitympanum, hypotympanum, and retrotympanum.
3. The epitympanum or attic is further divided by mucosal folds into the upper unit above
1. The document discusses the embryology and anatomy of the frontal sinus and frontal recess. It develops from ethmoidal cells that pneumatize into the frontal bone.
2. It describes different surgical approaches to access and drain the frontal sinus including external approaches and various types of endoscopic frontal sinusotomies.
3. Type 1 and 2 endoscopic procedures involve draining the frontal sinus via the frontal recess and removing obstructions. Type 3 is a more extensive procedure that creates a common chamber between the frontal sinus and nasal cavity via an intranasal modified Lothrop procedure.
The nose develops from embryonic tissues and is formed by the fusion of various processes. It has a bony skeletal framework in the upper third and a cartilaginous framework in the lower two-thirds. The nasal cavity contains the nasal septum dividing it into left and right sides, with lateral walls containing turbinates that project into the airway. The paranasal sinuses develop in surrounding bones and drain into the nasal cavity. The nose has complex vascular, lymphatic and nerve supply from surrounding structures.
Middle ear ventilatory pathway and Mucosal folds.pptxSaneeshDamodaran
The document discusses the anatomy and physiology of the middle ear ventilation pathways. It describes the mucosal folds in the middle ear which develop during fetal development from sacs and pouches. Important folds include the tensor tympani fold, malleal folds, and incudal folds. These folds orient the spread of middle ear pathology. The tympanic isthmus and its blockage are also discussed, which can lead to attic dysventilation even with a normally functioning Eustachian tube. Preserving the tensor tympani fold during surgery is important to ensure ventilation of the attic region. A well-aerated mastoid and functioning Eustachian tube also help in maintaining proper middle ear ventilation
This document provides information on acquired laryngotracheal stenosis in pediatrics. It discusses pediatric laryngeal anatomy, history taking, physical examination, imaging studies including CT/MRI, endoscopic evaluation using rigid and flexible bronchoscopy, voice evaluation, considerations prior to laryngeal reconstruction such as medical therapy, and tracheotomy placement. The goal of evaluation and treatment is to determine if laryngeal reconstruction can allow for decannulation. Medical therapy aims to reduce inflammation from conditions like gastroesophageal reflux or eosinophilic esophagitis prior to reconstruction.
This document provides an overview of frontal sinus surgery, including the surgical anatomy, types of procedures, indications, and complications. It describes both open and endoscopic approaches. Open approaches discussed include trephination, frontal sinusotomy, frontoethmoidectomy, cranialization, and ablation. Endoscopic approaches include Draf types I-III and frontal sinus rescue procedures. Complications of both open and endoscopic procedures are also summarized.
Spaces of middle ear and their surgical importanceDr Soumya Singh
one of the imp topics in ENT that should be understood very thoroughly if u want to pursue as an otologist.I tried to simplify the topic with simple diagrams and models for better understanding .
STOMAL RECURRENCE AFTER LARYNGECTOMY-1.pptxSendhil Kumar
Stomal recurrence after laryngectomy occurs in 1.7-15% of patients and is usually fatal. Risk factors include subglottic tumor location, advanced T and N stage, pre-operative tracheostomy, and positive margins. Surgery is the main treatment for localized recurrence, involving wide excision and mediastinal lymph node dissection. Post-operative radiation may prevent recurrence in high risk patients by sterilizing the area. Close follow-up is important to detect recurrence early.
Mucosal folds and ventilation of middle ear AlkaKapil
The document discusses the anatomy and embryology of the middle ear spaces and mucosal folds.
1. The middle ear develops from the tubotympanic recess which buds into sacs including the saccus anticus, medius, superior and posterior. Remnants of mesenchyme become ligaments and blood vessels.
2. The middle ear is divided into several compartments by mucosal folds including the protympanum, mesotympanum, epitympanum, hypotympanum, and retrotympanum.
3. The epitympanum or attic is further divided by mucosal folds into the upper unit above
1. The document discusses the embryology and anatomy of the frontal sinus and frontal recess. It develops from ethmoidal cells that pneumatize into the frontal bone.
2. It describes different surgical approaches to access and drain the frontal sinus including external approaches and various types of endoscopic frontal sinusotomies.
3. Type 1 and 2 endoscopic procedures involve draining the frontal sinus via the frontal recess and removing obstructions. Type 3 is a more extensive procedure that creates a common chamber between the frontal sinus and nasal cavity via an intranasal modified Lothrop procedure.
The nose develops from embryonic tissues and is formed by the fusion of various processes. It has a bony skeletal framework in the upper third and a cartilaginous framework in the lower two-thirds. The nasal cavity contains the nasal septum dividing it into left and right sides, with lateral walls containing turbinates that project into the airway. The paranasal sinuses develop in surrounding bones and drain into the nasal cavity. The nose has complex vascular, lymphatic and nerve supply from surrounding structures.
Middle ear ventilatory pathway and Mucosal folds.pptxSaneeshDamodaran
The document discusses the anatomy and physiology of the middle ear ventilation pathways. It describes the mucosal folds in the middle ear which develop during fetal development from sacs and pouches. Important folds include the tensor tympani fold, malleal folds, and incudal folds. These folds orient the spread of middle ear pathology. The tympanic isthmus and its blockage are also discussed, which can lead to attic dysventilation even with a normally functioning Eustachian tube. Preserving the tensor tympani fold during surgery is important to ensure ventilation of the attic region. A well-aerated mastoid and functioning Eustachian tube also help in maintaining proper middle ear ventilation
This document provides information on acquired laryngotracheal stenosis in pediatrics. It discusses pediatric laryngeal anatomy, history taking, physical examination, imaging studies including CT/MRI, endoscopic evaluation using rigid and flexible bronchoscopy, voice evaluation, considerations prior to laryngeal reconstruction such as medical therapy, and tracheotomy placement. The goal of evaluation and treatment is to determine if laryngeal reconstruction can allow for decannulation. Medical therapy aims to reduce inflammation from conditions like gastroesophageal reflux or eosinophilic esophagitis prior to reconstruction.
This document discusses procedures related to the frontal sinus. It begins with the anatomy of the frontal sinus, noting its variable size and drainage patterns. It then describes different surgical approaches for treating conditions of the frontal sinus such as inflammatory diseases, trauma, tumors, and malformations. These approaches include endoscopic procedures, external approaches, and cranialization of the frontal sinus. The document provides details on each procedure and highlights key considerations for surgical treatment of various frontal sinus pathologies.
1. Flaps are used in reconstructive surgery to repair structural defects following procedures like cancer surgery. They involve transferring tissue from one part of the body to another while maintaining or reconnecting its blood supply.
2. There are many types of flaps classified by their blood supply, tissue type, and location. Common flaps used in head and neck reconstruction include local flaps like nasolabial and advancement flaps as well as regional and distant flaps like pectoralis major and radial forearm flaps.
3. Proper flap selection and design is important to replace tissue "like with like" and adhere to anatomical borders and units for optimal cosmetic and functional outcomes.
Endoscopic middle ear surgery is an emerging technique that provides several advantages over traditional microscopic surgery, including a wider field of view allowing visualization of hidden areas. While the endoscope provides excellent maneuverability, the learning curve is steep and it requires adaptation to a one-handed technique. Experienced surgeons are using endoscopy for diagnostic evaluation, tympanoplasty, retraction pocket surgery, and minimally invasive approaches. Continued technological advances may further expand the applications of endoscopic ear surgery.
This document discusses phonosurgery techniques including vocal fold injection and laryngeal framework surgery. It provides details on the intrinsic laryngeal musculature and the expansion of phonosurgery over the last 50 years to primarily improve or restore the voice. Type I thyroplasty for vocal fold medialization is described in detail, including indications, surgical technique of making a window in the thyroid cartilage and placing different types of implants, advantages, complications, and pitfalls. The goal of type I thyroplasty is to improve voice and prevent aspiration by medializing the vocal fold to mimic the function of the thyroarytenoid muscle.
- Balloon sinuplasty is a minimally invasive technique for treating sinusitis using balloon catheters to dilate sinus ostia rather than conventional endoscopic sinus surgery.
- Studies show balloon sinuplasty improves symptoms in selected patients with chronic sinusitis and is safe, with minimal adverse effects. However, longer term data is still needed to define its optimal role and indications.
- While initial data is promising for symptom relief and preservation of sinus anatomy compared to traditional FESS, balloon sinuplasty may not eliminate the need for conventional sinus surgery in all patients.
The document discusses surgical approaches for frontal sinus conditions. It describes the anatomy of the frontal sinus and various open and endoscopic surgical procedures for treating chronic sinusitis, trauma, tumors, and other indications. Open approaches include trephination, frontal sinusotomy, and ablation. Endoscopic approaches include DRAF types I-III. Complications and considerations for each procedure are also outlined.
Dr. Sanjay Maharjan's document discusses the history and surgical treatment of otosclerosis. It covers three eras in the evolution of otosclerosis surgery:
1) The mobilization era in the late 1800s, which involved attempts to mobilize the stapes bone.
2) The fenestration era from the 1920s-1950s, marked by the development of techniques like fenestration of the semicircular canals.
3) The stapedectomy era from the 1950s onward, highlighted by the first successful stapedectomy performed by Shea in 1956 using a Teflon prosthesis.
The document provides details on indications, contraindications,
The document discusses the mucosal folds of the middle ear, which develop as the primitive tympanic cavity expands into the middle ear cleft between 3-7 months of fetal development. This forms four primary sacs that enlarge and replace the mesenchyme, with their walls becoming the mucosal lining of the middle ear. Mucosal folds are the planes of contact between neighboring sacs and carry ligaments and blood vessels to the ossicles. There are 10 important mucosal folds described, including the anterior and posterior malleal folds, lateral malleal ligamental fold, and tensor tympani fold. The folds divide the epitympanum (attic) and orient the progression of
Technique of harvesting cartilage graft for cartilage tympanoplasty Dr. M. E...mderami
The document discusses techniques for harvesting cartilage grafts for cartilage tympanoplasty. Cartilage can be harvested from the tragus or concha using various surgical approaches and tools. The tragus is often preferred as it is thinner and flatter than conchal cartilage. Cartilage grafts must be thinned to around 500 microns for optimal acoustic transfer properties and stability. Surgical tools described for thinning grafts include scalpels, clamps, knives, and specialized cutting guides.
The document discusses the anatomy of the sinus tympani, a cavity located in the posterior region of the tympanic cavity. It describes how the sinus tympani was first named and discussed in 1820. It defines the two portions of the retrotympanum based on the position of the facial nerve. It outlines different shapes that the sinus tympani can take, including classical, confluent, partitioned, and restricted, and different types - A, B, and C - based on its extension in relation to the facial nerve. The shapes and types of the sinus tympani can influence the surgical approach used for cholesteatoma surgery.
The document provides an in-depth overview of the anatomy of the deep neck spaces. It discusses:
- The 4 compartments that provide longitudinal organization in the neck - visceral, vertebral, and 2 vascular.
- The 3 layers of deep cervical fascia - superficial, middle, and deep layer. Each layer forms boundaries for various spaces.
- The classifications and boundaries of major deep neck spaces - retropharyngeal, danger, prevertebral, and others.
- Potential spaces that can allow spread of infection between layers if compromised.
- Numbered spaces system of Grodinsky and Holyoke which further subdivides the neck spaces.
This document provides an overview of chronic rhinosinusitis, including its definition, symptoms, epidemiology, pathogenesis, and microbiology. Some key points:
- Chronic rhinosinusitis is defined as inflammation of the nose and paranasal sinuses for more than 12 weeks with symptoms like nasal obstruction and discharge.
- It affects 11-12% of adults in Europe and the US and is associated with reduced quality of life. Chronic rhinosinusitis with nasal polyps specifically has a prevalence of 2.1-4.4% in Europe and 4.2% in the US.
- The osteomeatal complex is a key region for sinus ventilation and drainage, and obstruction in this area
Septoplasty is a surgical procedure to correct a deviated nasal septum. The nasal septum divides the nose into two cavities and provides structural support. Techniques for septoplasty have evolved over time from early excisions of entire septal segments to today's emphasis on preservation and realignment. A standard modern procedure recognizes mucosal preservation as a primary goal and uses a submucosal approach. Septoplasty is indicated when a deviated septum causes nasal obstruction or recurrent infections. Pre-operative testing such as acoustic rhinometry or rhinomanometry can evaluate the airway before septoplasty.
Endoscopic anatomy of nose ,paranasal sinus and anterior skull baseRajat Jain
This document provides an overview of nasal endoscopic anatomy and the endoscopic examination technique. It describes the three passes used in endoscopy to examine the different anatomical structures of the nose and paranasal sinuses. The first pass examines the nasal septum, inferior turbinate, and posterior choana. The second pass examines the superior turbinate, sphenoethmoidal recess, and sphenoid ostium. The third pass examines the middle meatus, uncinate process, bulla ethmoidalis, and maxillary ostium. It also describes important anatomical structures like the turbinates, sinuses, arteries and variations that can be observed during nasal endoscopy.
This document discusses conservative laryngeal surgery techniques for treating laryngeal cancers while preserving laryngeal function. It describes transoral endoscopic laser resection for early glottic cancers, as well as open partial laryngectomies including laryngofissure with cordectomy, vertical partial laryngectomy, supracricoid partial laryngectomy, and their indications. Complications of these procedures are also outlined. The document provides detailed information on surgical approaches for treating different stages of laryngeal cancers in the glottis, supraglottis, and transglottic regions.
This document describes various approaches to the petrous apex, including the middle cranial fossa transpetrous approach. It discusses the landmarks and surgical anatomy relevant to this approach, including exposing the internal auditory canal and petrous apex by drilling bone. It also mentions combining the frontotemporal orbitozygomatic approach with the Kawase approach to access the middle and posterior cranial fossae. Several references are provided with links to videos and papers on these techniques.
Otitis media with effusion (OME), also known as glue ear, is a chronic accumulation of fluid in the middle ear caused by eustachian tube dysfunction and inflammation of the middle ear mucosa. It is characterized by thick, viscous fluid in the middle ear without signs of infection. OME is commonly seen in young children, especially during winter months when upper respiratory infections are more prevalent. Treatment involves initial diagnosis by otoscopy and tympanometry, with surgical intervention of myringotomy with ventilation tube insertion if the effusion persists for more than 3 months. Adenoidectomy may provide additional benefit in resolving OME by removing a source of chronic infection in the nasopharynx.
This document provides an overview of sialendoscopy procedures. It begins with the anatomy of the parotid and submandibular salivary glands. It then discusses sialolithiasis (salivary gland stones), the indications for sialendoscopy including removal of stones and treatment of strictures, and the technique of sialendoscopy including identification of ducts, instrumentation, and methods for removing stones such as grasping, lithotripsy, and extracorporeal shockwave lithotripsy. Complications are also briefly mentioned.
This document provides an overview of head and neck tumors and principles of neck dissection. It discusses the surgical anatomy and outlines seven levels of regional lymph node groups. Common tumor sites include the oral cavity (oral tongue, lip, floor of mouth), salivary glands, and larynx. Risk factors include tobacco, alcohol, and betel nut chewing. Treatment involves surgery, with or without radiation or chemotherapy depending on tumor stage, size, and lymph node involvement. Reconstruction techniques are discussed for different tumor resection defects. Neck dissection principles and specific management of different tumor sites are also reviewed.
This document discusses carcinoma of the hypopharynx. It begins with the anatomy of the hypopharynx and then discusses the epidemiology, etiology, prognostic factors, pathology, patterns of spread, clinical presentation, evaluation and staging, and management. For management, it describes both surgical and radiation therapy approaches. Radiation therapy techniques including simulation, conventional planning, and fractionation are covered in detail.
This document discusses procedures related to the frontal sinus. It begins with the anatomy of the frontal sinus, noting its variable size and drainage patterns. It then describes different surgical approaches for treating conditions of the frontal sinus such as inflammatory diseases, trauma, tumors, and malformations. These approaches include endoscopic procedures, external approaches, and cranialization of the frontal sinus. The document provides details on each procedure and highlights key considerations for surgical treatment of various frontal sinus pathologies.
1. Flaps are used in reconstructive surgery to repair structural defects following procedures like cancer surgery. They involve transferring tissue from one part of the body to another while maintaining or reconnecting its blood supply.
2. There are many types of flaps classified by their blood supply, tissue type, and location. Common flaps used in head and neck reconstruction include local flaps like nasolabial and advancement flaps as well as regional and distant flaps like pectoralis major and radial forearm flaps.
3. Proper flap selection and design is important to replace tissue "like with like" and adhere to anatomical borders and units for optimal cosmetic and functional outcomes.
Endoscopic middle ear surgery is an emerging technique that provides several advantages over traditional microscopic surgery, including a wider field of view allowing visualization of hidden areas. While the endoscope provides excellent maneuverability, the learning curve is steep and it requires adaptation to a one-handed technique. Experienced surgeons are using endoscopy for diagnostic evaluation, tympanoplasty, retraction pocket surgery, and minimally invasive approaches. Continued technological advances may further expand the applications of endoscopic ear surgery.
This document discusses phonosurgery techniques including vocal fold injection and laryngeal framework surgery. It provides details on the intrinsic laryngeal musculature and the expansion of phonosurgery over the last 50 years to primarily improve or restore the voice. Type I thyroplasty for vocal fold medialization is described in detail, including indications, surgical technique of making a window in the thyroid cartilage and placing different types of implants, advantages, complications, and pitfalls. The goal of type I thyroplasty is to improve voice and prevent aspiration by medializing the vocal fold to mimic the function of the thyroarytenoid muscle.
- Balloon sinuplasty is a minimally invasive technique for treating sinusitis using balloon catheters to dilate sinus ostia rather than conventional endoscopic sinus surgery.
- Studies show balloon sinuplasty improves symptoms in selected patients with chronic sinusitis and is safe, with minimal adverse effects. However, longer term data is still needed to define its optimal role and indications.
- While initial data is promising for symptom relief and preservation of sinus anatomy compared to traditional FESS, balloon sinuplasty may not eliminate the need for conventional sinus surgery in all patients.
The document discusses surgical approaches for frontal sinus conditions. It describes the anatomy of the frontal sinus and various open and endoscopic surgical procedures for treating chronic sinusitis, trauma, tumors, and other indications. Open approaches include trephination, frontal sinusotomy, and ablation. Endoscopic approaches include DRAF types I-III. Complications and considerations for each procedure are also outlined.
Dr. Sanjay Maharjan's document discusses the history and surgical treatment of otosclerosis. It covers three eras in the evolution of otosclerosis surgery:
1) The mobilization era in the late 1800s, which involved attempts to mobilize the stapes bone.
2) The fenestration era from the 1920s-1950s, marked by the development of techniques like fenestration of the semicircular canals.
3) The stapedectomy era from the 1950s onward, highlighted by the first successful stapedectomy performed by Shea in 1956 using a Teflon prosthesis.
The document provides details on indications, contraindications,
The document discusses the mucosal folds of the middle ear, which develop as the primitive tympanic cavity expands into the middle ear cleft between 3-7 months of fetal development. This forms four primary sacs that enlarge and replace the mesenchyme, with their walls becoming the mucosal lining of the middle ear. Mucosal folds are the planes of contact between neighboring sacs and carry ligaments and blood vessels to the ossicles. There are 10 important mucosal folds described, including the anterior and posterior malleal folds, lateral malleal ligamental fold, and tensor tympani fold. The folds divide the epitympanum (attic) and orient the progression of
Technique of harvesting cartilage graft for cartilage tympanoplasty Dr. M. E...mderami
The document discusses techniques for harvesting cartilage grafts for cartilage tympanoplasty. Cartilage can be harvested from the tragus or concha using various surgical approaches and tools. The tragus is often preferred as it is thinner and flatter than conchal cartilage. Cartilage grafts must be thinned to around 500 microns for optimal acoustic transfer properties and stability. Surgical tools described for thinning grafts include scalpels, clamps, knives, and specialized cutting guides.
The document discusses the anatomy of the sinus tympani, a cavity located in the posterior region of the tympanic cavity. It describes how the sinus tympani was first named and discussed in 1820. It defines the two portions of the retrotympanum based on the position of the facial nerve. It outlines different shapes that the sinus tympani can take, including classical, confluent, partitioned, and restricted, and different types - A, B, and C - based on its extension in relation to the facial nerve. The shapes and types of the sinus tympani can influence the surgical approach used for cholesteatoma surgery.
The document provides an in-depth overview of the anatomy of the deep neck spaces. It discusses:
- The 4 compartments that provide longitudinal organization in the neck - visceral, vertebral, and 2 vascular.
- The 3 layers of deep cervical fascia - superficial, middle, and deep layer. Each layer forms boundaries for various spaces.
- The classifications and boundaries of major deep neck spaces - retropharyngeal, danger, prevertebral, and others.
- Potential spaces that can allow spread of infection between layers if compromised.
- Numbered spaces system of Grodinsky and Holyoke which further subdivides the neck spaces.
This document provides an overview of chronic rhinosinusitis, including its definition, symptoms, epidemiology, pathogenesis, and microbiology. Some key points:
- Chronic rhinosinusitis is defined as inflammation of the nose and paranasal sinuses for more than 12 weeks with symptoms like nasal obstruction and discharge.
- It affects 11-12% of adults in Europe and the US and is associated with reduced quality of life. Chronic rhinosinusitis with nasal polyps specifically has a prevalence of 2.1-4.4% in Europe and 4.2% in the US.
- The osteomeatal complex is a key region for sinus ventilation and drainage, and obstruction in this area
Septoplasty is a surgical procedure to correct a deviated nasal septum. The nasal septum divides the nose into two cavities and provides structural support. Techniques for septoplasty have evolved over time from early excisions of entire septal segments to today's emphasis on preservation and realignment. A standard modern procedure recognizes mucosal preservation as a primary goal and uses a submucosal approach. Septoplasty is indicated when a deviated septum causes nasal obstruction or recurrent infections. Pre-operative testing such as acoustic rhinometry or rhinomanometry can evaluate the airway before septoplasty.
Endoscopic anatomy of nose ,paranasal sinus and anterior skull baseRajat Jain
This document provides an overview of nasal endoscopic anatomy and the endoscopic examination technique. It describes the three passes used in endoscopy to examine the different anatomical structures of the nose and paranasal sinuses. The first pass examines the nasal septum, inferior turbinate, and posterior choana. The second pass examines the superior turbinate, sphenoethmoidal recess, and sphenoid ostium. The third pass examines the middle meatus, uncinate process, bulla ethmoidalis, and maxillary ostium. It also describes important anatomical structures like the turbinates, sinuses, arteries and variations that can be observed during nasal endoscopy.
This document discusses conservative laryngeal surgery techniques for treating laryngeal cancers while preserving laryngeal function. It describes transoral endoscopic laser resection for early glottic cancers, as well as open partial laryngectomies including laryngofissure with cordectomy, vertical partial laryngectomy, supracricoid partial laryngectomy, and their indications. Complications of these procedures are also outlined. The document provides detailed information on surgical approaches for treating different stages of laryngeal cancers in the glottis, supraglottis, and transglottic regions.
This document describes various approaches to the petrous apex, including the middle cranial fossa transpetrous approach. It discusses the landmarks and surgical anatomy relevant to this approach, including exposing the internal auditory canal and petrous apex by drilling bone. It also mentions combining the frontotemporal orbitozygomatic approach with the Kawase approach to access the middle and posterior cranial fossae. Several references are provided with links to videos and papers on these techniques.
Otitis media with effusion (OME), also known as glue ear, is a chronic accumulation of fluid in the middle ear caused by eustachian tube dysfunction and inflammation of the middle ear mucosa. It is characterized by thick, viscous fluid in the middle ear without signs of infection. OME is commonly seen in young children, especially during winter months when upper respiratory infections are more prevalent. Treatment involves initial diagnosis by otoscopy and tympanometry, with surgical intervention of myringotomy with ventilation tube insertion if the effusion persists for more than 3 months. Adenoidectomy may provide additional benefit in resolving OME by removing a source of chronic infection in the nasopharynx.
This document provides an overview of sialendoscopy procedures. It begins with the anatomy of the parotid and submandibular salivary glands. It then discusses sialolithiasis (salivary gland stones), the indications for sialendoscopy including removal of stones and treatment of strictures, and the technique of sialendoscopy including identification of ducts, instrumentation, and methods for removing stones such as grasping, lithotripsy, and extracorporeal shockwave lithotripsy. Complications are also briefly mentioned.
This document provides an overview of head and neck tumors and principles of neck dissection. It discusses the surgical anatomy and outlines seven levels of regional lymph node groups. Common tumor sites include the oral cavity (oral tongue, lip, floor of mouth), salivary glands, and larynx. Risk factors include tobacco, alcohol, and betel nut chewing. Treatment involves surgery, with or without radiation or chemotherapy depending on tumor stage, size, and lymph node involvement. Reconstruction techniques are discussed for different tumor resection defects. Neck dissection principles and specific management of different tumor sites are also reviewed.
This document discusses carcinoma of the hypopharynx. It begins with the anatomy of the hypopharynx and then discusses the epidemiology, etiology, prognostic factors, pathology, patterns of spread, clinical presentation, evaluation and staging, and management. For management, it describes both surgical and radiation therapy approaches. Radiation therapy techniques including simulation, conventional planning, and fractionation are covered in detail.
Management of sinonasal tract tumors 27082018Varshu Goel
This document discusses the management of sinonasal tract tumors. It begins with the anatomy and lymphatic drainage of the sinonasal tract. It then discusses the clinical presentation, diagnostic workup including imaging, and staging of sinonasal tumors. Finally, it briefly discusses the treatment modalities and follow up for sinonasal tumors.
This document discusses sinonasal tumours, including:
1. It classifies sinonasal tumours by tissue of origin such as epithelial, neuroendocrine, soft tissue, bone, etc. and lists examples of benign and malignant lesions within each tissue.
2. It provides details on specific benign tumours such as inverted papilloma, haemangioma, and juvenile angiofibroma.
3. It also discusses malignant tumours of the sinonasal region like squamous cell carcinoma, adenocarcinoma, olfactory neuroblastoma and haemangiopericytoma.
This document provides information on nasal cavity and paranasal sinus cancers. It discusses the anatomy, etiology, pathology, natural history, clinical presentation, diagnostic workup, treatment recommendations including surgery, radiotherapy, reconstruction and complications of treatment. The most common tumor is squamous cell carcinoma of the maxillary sinus in males. Treatment involves surgical resection with clear margins combined with postoperative radiotherapy to improve outcomes. Advanced techniques like endoscopy, craniofacial resection and reconstruction with flaps are used to maximize tumor removal while preserving function.
Dr. K. Santhosh Kumar Babu presented on radiation oncology in ENT, focusing on head and neck cancers including cancers of the oral cavity, salivary glands, nasal cavity, paranasal sinuses, nasopharynx, hypopharynx, and larynx. The document discussed the epidemiology, risk factors, clinical presentation, histopathology, staging, and management of these cancers with an emphasis on the role of radiation therapy as an adjuvant or primary treatment. It provided detailed information on the various tumor types, treatment approaches based on stage, and surgical procedures for different tumor locations.
This document discusses imaging of the paranasal sinuses. It begins with anatomy of the sinuses and common anatomic variations that can be seen. Radiography, CT, and MRI are described for evaluating the sinuses. Common inflammatory pathologies are then outlined such as acute and chronic sinusitis, allergic sinusitis, and nasal polyps. Imaging findings for these conditions are provided. Complications of sinusitis both local and systemic are also summarized.
This document provides information on sinonasal tumors. It begins with an introduction noting that these tumors are uncommon, accounting for less than 1% of neoplasms. They often cause nonspecific symptoms initially, like rhinosinusitis, leading to delays in diagnosis.
It then covers the epidemiology, finding the incidence is 0.5-1/100,000 per year. The average age is the 5th-6th decades and there is a 2:1 male to female ratio. Common causes include exposure to carcinogenic compounds like wood dust and nickel.
The document then classifies and describes several tumor types found in the sinonasal region, including squamous papilloma, inverted pap
This document provides information on ear carcinoma, including:
1) It describes the anatomy of the external, middle, and inner ear.
2) Diagnostic workup involves CT, MRI, and biopsy to establish diagnosis and determine extent of disease.
3) Treatment depends on location, with early-stage external ear cancers often treated with radiation alone, while surgery plus radiation is recommended for more advanced or middle ear/mastoid cancers.
The retropharyngeal space is a potential space located posterior to the pharynx that contains areolar fat and lymph nodes. It allows for movement of the pharynx during swallowing and respiration. Lesions and fluid collections like abscesses or hematomas can develop in this space. Imaging like CT scans are useful for evaluating these conditions. Retropharyngeal abscesses require prompt treatment with antibiotics and drainage to prevent airway complications. Lymph nodes in this region can metastasize early from cancers like nasopharyngeal carcinoma.
This document provides an outline on sinonasal tumours. It discusses the relevant anatomy, epidemiology, classification, clinical features, investigations, staging, treatment and complications of sinonasal tumours. It notes that sinonasal tumours comprise a diverse group of benign and malignant neoplasms that often present non-specifically, leading to delays in diagnosis and management. The document outlines the different tumour types, their characteristics, staging systems used and multidisciplinary treatment approaches involving surgery, radiotherapy and chemotherapy. Early detection and management is emphasized for improving patient outcomes.
1) Carcinoma of the anal canal most commonly presents as squamous cell carcinoma. Risk factors include HPV infection, HIV/AIDS, immunosuppression, and a history of other anogenital cancers.
2) The standard of care is chemoradiotherapy with concurrent 5-FU and mitomycin C, based on trials showing improved local control over radiation alone. Surgery has a limited role and is reserved for salvage after failed chemoradiotherapy.
3) Bowen's disease, or anal intraepithelial neoplasia, is a precursor lesion caused by HPV that may progress to invasive squamous cell carcinoma in some cases. It is typically treated with local excision or ablative
This document discusses oropharyngeal cancer, including its epidemiology, risk factors, incidence, common anatomical sites, conditions associated with malignant transformation, investigations, TNM staging, clinical features, and treatment approaches. It notes that oropharyngeal cancer is most common in India, associated with tobacco, alcohol, areca nut, and certain viruses. Treatment depends on tumor size and location, and may involve surgery, radiation, or chemoradiation, with the aim of tumor removal and neck node treatment. Reconstruction is often needed for larger resections.
This document discusses malignant tumors of the nose and paranasal sinuses. It begins by covering the epidemiology, risk factors, and common histological subtypes of carcinomas in these areas. It then describes the natural history and spread patterns of tumors originating in different paranasal sinuses. Diagnostic workup, staging, and treatment options such as surgery, radiation, and chemotherapy are outlined. Surgical approaches like craniofacial resection are explained in detail. Prognosis and complications depend on tumor stage, size, and extent of involvement of surrounding structures.
This document provides information on lacrimal gland tumors, including:
1) Lacrimal gland tumors typically present with upper eyelid fullness, alteration of the eyelid contour, and downward displacement of the globe. They can be either epithelial or non-epithelial tumors.
2) Epithelial tumors include pleomorphic adenoma (the most common), adenoid cystic carcinoma, and adenocarcinoma. Pleomorphic adenomas are usually benign but can become malignant. Adenoid cystic carcinoma often invades surrounding bone.
3) Treatment involves complete surgical removal with postoperative radiation for malignant or invasive tumors. Prognosis depends on tumor type, with adenocarcinomas having
This document discusses laryngeal transplantation, including:
1. Pioneering attempts at laryngeal transplantation in the 1960s-1980s faced technical limitations and ethical concerns.
2. Advances in microsurgery, immunosuppression, and organ preservation have made laryngeal transplantation a possibility once deemed too risky.
3. The first reported successful human laryngeal transplantation was in 1998, where the patient regained voice function and swallowing abilities over time despite facing some complications.
This document discusses hypopharyngeal cancer. Some key points:
- Hypopharyngeal cancers arise from the mucosa of the hypopharynx and are often advanced at diagnosis due to few symptoms. They have an unfavorable prognosis.
- Risk factors include smoking, alcohol use, poor nutrition. Over 90% of patients have a history of tobacco use. Genetic factors may also play a role.
- The hypopharynx is located posterior to the larynx and above the esophagus. It contains the pyriform sinuses, postcricoid area, and posterior pharyngeal wall.
- Presentation includes sore throat, dysphag
Maxillary sinus carcinoma arises from the maxillary sinus and can spread locally and to lymph nodes. Diagnosis involves physical exam, CT/MRI imaging, and biopsy. Staging evaluates tumor size, lymph node involvement, and distant spread. Treatment depends on stage but may include surgery such as maxillectomy, radiation therapy such as IMRT, and chemotherapy such as cisplatin for locally advanced cases. The goal of treatment is a complete resection with negative margins or effective control with radiation with or without chemotherapy while minimizing side effects to nearby structures like the optic nerves and chiasm. Outcomes depend on stage, with earlier stages having higher survival rates treated with surgery or surgery plus radiation.
Similar to Inverted Papilloma and Other Benign Sino-Nasal Tumors (20)
Obstructive sleep apnea is a common disorder characterized by recurrent collapse of the upper airway during sleep, causing disrupted breathing and fragmented sleep. It is diagnosed through a sleep study showing apneic episodes and oxygen desaturation. Risk factors include obesity, enlarged tonsils, and craniofacial abnormalities. Treatment involves lifestyle changes, oral appliances, CPAP, surgery, or a combination. Surgeries aim to enlarge the airway through procedures of the nose, palate, tongue, or jaw.
1. Adenotonsillectomy is a surgical procedure to remove the adenoids from the nasopharynx and tonsils from the oropharynx.
2. The operative procedure involves positioning the patient, preparing them, and the surgeon operating to remove the tissues. Instruments such as mouth gags, adenoid curettes, and tonsil forceps are used.
3. The adenoids are removed by shaving the tissue with a curette through the mouth. The tonsils are removed by incising the mucosa, dissecting with retractors and dissectors, and cutting with snares or cautery. Complications can include bleeding, injury to nearby structures, and
The facial nerve arises from the pons and exits the skull through the internal acoustic meatus and facial canal. It has both motor and sensory components that innervate muscles of facial expression and provide parasympathetic innervation to glands. The nerve gives off several branches within the facial canal and parotid gland before terminating as five branches that innervate specific facial muscles.
This document summarizes vocal cord paralysis, including:
1. The anatomy of the vocal cords and their nerve supply. Recurrent laryngeal nerve paralysis can cause vocal cords to assume different positions, from paramedian to cadaveric.
2. Causes of vocal cord paralysis include trauma, iatrogenic injury from surgery, and tumors. Signs and symptoms depend on whether it is unilateral or bilateral paralysis.
3. Various surgical techniques are used to treat vocal cord paralysis, such as medialization procedures, arytenoidectomy, cordotomy with laser, and nerve reinnervation procedures.
This document discusses complications that can arise from rhinosinusitis. It begins by defining rhinosinusitis and its complications. It then classifies complications as either local or distant, and acute or chronic. Several local complications are described in detail, including mucoceles, osteomyelitis, orbital cellulitis, subperiosteal abscesses, and cavernous sinus thrombosis. The pathogenesis, signs/symptoms, investigations, and treatment are outlined for each complication. Intracranial complications are also briefly mentioned.
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8. Histopathology
• Epithelium is hyperplastic (5 -
30 cell layers in thickness)
• may be of squamous,
transitional or respiratory type
• Transmigrating neutrophils and
neutrophilic microabscesses
may be seen
• Stroma may have edema or
chronic inflammation
• Seromucinous gland in the
lamina propria is commonly
decreased or absent
9. Staging (Krouse staging)
T1: confined to nose without sinus extension
T2: Involves OMC/ medial maxillary sinus/ ethmoids
T3: Involving other areas of maxillary sinus/ sphenoid and/or frontal
sinus
T4: Extranasal/Extrasinus extension
12. Nasal Endoscopy
• Pale, polypoid lesion with a
papillary appearance
• Lesion protrudes from the
middle meatus
13. • Small red bumps (granular
mulberry appearance)
• Has undulations
• Firmer than polyp
• More vascular than polyp
• Not smooth like – polyp
14. Imaging Target
• AIM: extent and three-dimensional configuration of the lesion and to
disclose its relationship with surrounding structures
• Methods:
MRI with gadolinium enhancement
CT
19. Viral Infection : HPV
• 1st reported in 1980
• Correlation ranges from 0% - 100%
• Subtypes associated with IP: 6, 11, 16, 18
• Pathogenesis: HPV induces promoting agent in pathogenesis of
papilloma, which leads to gene alteration (p53) resulting in
development of IP
20. Chronic Inflammation
• IP is end stage of chronic inflammatory condition NOT A TRUE
NEOPLASM
• HPE shows more inflammatory cells in IP compared to other sino-
nasal papillomas
21. Environmental exposure
• Dietmer et al. 1996, case – control study
47 cases and 47 controls, found higher degree of occupational
exposure to smoke, dust, aerosol
• Sham et a. 2010, case – control study
50 cases and 150 controls found outdoor and industrial exposure
were associated with IP
22. Recurrence – Factors
1. Location of attachment
2. Completeness of resection in primary surgical resection
3. Increased chance of recurrence in revision cases: 18.1% vs 4.1%
complicated by scar tissue, absence of bony landmarks, residual
disease
24. Rate of recurrence on basis of Surgical
Technique
• Meta-analysis comparing contemporary endoscopic (1992–2004)
versus external approaches (1970–1995) demonstrated an improved
recurrence rate in the endoscopic group (12% vs. 20%, respectively).
25.
26. Other Risk Factors for Recurrence
• Tobacco usage
• Histological parameters
hyperkeratosis
hyperplasia
mitotic index
IHC markers
27. Treatment Goals
• Resection of tumor including tumor base
• Removal of bone/ burring the base
• NO NON-SURGICAL TREATMENT MODALITY
• Radiotherapy:
Incase of malignant transformation
Incompletely resectable tumors
Multiple recurrent tumors
28. Surgical Approaches
• Transnasal approach (without endoscopes)
• Open approach (Radical Surgery) – Try to get around the tumor
Medial Maxillectomy + Lateral Rhinotomy
+ Sublabial degloving
• Endoscopic
29. Open approaches Advantages
• Possibility of en-bloc resection
• Access areas with difficult endoscopic instrumentation
Anterior maxillary sinus
Region of Nasolacrimal duct
superior and lateral frontal sinus
32. Drawbacks of Open Approaches
• Cosmetic
• CSF Leak
• Orbital Injury
enophthalmos, ectropion, diplopia, orbital hemorrhage, rarely
blindness
• Lacrimal Injuries
epiphora, dacryocystitis,
• Mucocele
• Bleeding
33. Endoscopic approach advantages
• Improved precision for resection of involved areas
• Realization that site of attachment may be small and other structures
can be spared
• Greatly improved visualization to determine site of attachment before
resection is complete
• Improved follow up in office to detect and resect recurrences early
34. Contraindications for endoscopic approach
• massive involvement of the mucosa of the frontal sinus and/ or of a
supraorbital cell
• transorbital extension
• concomitant presence of a malignancy that involves critical areas
• presence of significant scarring and anatomic distortion from previous
surgery
35. Types of Endoscopic Approach
• Type 1: IP involving middle meatus, ethmoid, superior meatus,
sphenoid sinus, or a combination of these structures; even lesions
that protrude into the maxillary sinus without direct involvement of
the mucosa are amenable to this approach
36. • Type 2: which corresponds to an endoscopic medial maxillectomy, is
indicated for tumors that originate within the naso-ethmoid complex
and secondarily extend into the maxillary sinus or for primary
maxillary lesions that do not involve the anterior and lateral walls of
the sinus. The nasolacrimal duct can be included in the specimen to
increase the exposure of the anterior part of the maxillary sinus.
37. • Type 3: (endonasal denker / Sturman-Canfield operation)
entails removal of the medial portion of the anterior wall of the
maxillary sinus to enable access to all the antrum walls. It is therefore
recommended for inverted papillomas that extensively involve the
anterior compartment of the maxillary sinus
44. Drawbacks of EMM
1. Empty nose syndrome
2. Decreased efficiency of nasal heating and humidification in CT-
based computational fluid dynamic
3. Impaired stimulation of trigeminal cold receptors, involved in
perception of nasal patency (eg, the TRPM8 receptor) in the
mucosa by mucosal cooling
45. Complications
• Bleeding
Most common: Greater Palatine artery
Management/ Prevention:
Locate and bipolarize
Low threshold for SPA ligation
Bipolarize posterior end of anterior IT remanent
• Epiphora
Management/ Prevention:
Do divide cleanly ,
Do not leave bone fragments around lacrimal duct
• Parasthesia
Palatal/ Teeth/ Infraorbital skin
47. Prelacrimal Approach
(Endoscopic Modified Medial Maxillectomy)
• Access similar to that of EMM along with anterior maxillary sinus
visualization
• Preservation of nasal morphology
48.
49.
50. Surgical Queries
How to decide what resection to do? Physical examination
Imaging
What approach to use? Tumor base access
Surgeon preference
51. Challenges – Frontal Sinus IP
• Incidence: 1 – 16%
• Approach:
• Recurrence: 22.4% (Walgama et al 2012)
Approach Location of IP
Modified Lothrop Inferomedial
Osteoplastic Flap Lateral, superior wall
52.
53. Lothrop Procedure
• Traditional Procedure: first described in 1914, uses a combined
external and transnasal approach to resect the median frontal
sinus floor, superior nasal septum, and intersinus septum to
drain the frontal sinus.
• Modified Lothrop: Also known as draf III
Remove entire sinus floor, including AS septum
56. Challenges – Sphenoid Sinus IP
• Attachment over Optic Nerve, Carotid Artery - 4.76times greater risk
of recurrence
• Intracranial Extension
• Orbital involvement
57. Invasion
• Intracranial: 17 patients studied by Wright, with 49.2 years of mean
age, 60% had recurrent disease, with commonest side of invasion
from frontal sinus and cribriform plate
• Orbital: 10 patients studied by Elner, with mean age 62 years, 100%
with malignant transformation, 80% orbital exenteration, 30%
intracranial extension
58. Prognostic Markers
• Increased risk of recurrence if involvement of sphenoid sinus,
frontal sinus or maxillary sinus walls other than medial or
extrasinus extension
• Major cause of recurrence is incomplete resection
• Risk of malignant transformation is ~9% in inverted papilloma
(range: 5 - 15%)
59. • Endoscopic rate of recurrence ~ 12%
• Open procedure rate of recurrence ~18%
• Involvement of maxillary sinus floor and lateral recess required
additional sublabial approach
61. Indications for EMM
• Impaired Mucociliary function
CF/ Wegeners disease/ Prior Caldwell-Luc with impaired mucocilary
clearance
• Postoperative obstruction of normal ostium
Osseo neogenesis in normal ostium from surgery/ prior orbital
decompression of normal ostium
• Access in difficult airways
Odontogenic infection/ Foreign bodies/ AC polyp with attachment in
anterior or lateral wall
• Destroyed medial wall
extensive mucocele with destruction of medial wall/ allergic fungal
sinusitis
63. • Benign, slow growing, osteoblastic lesion
• Incidence: 1% of population undergoing radiographs,
3% of population undergoing CT for Sinus symptoms
• Age: 2nd to 5th decade of life
• Male preponderance
• Site: Frontal > Ethmoid > Maxillary sinus > Sphenoids
64. • Gross appearance:
hard, white, multilobulated mass,
• Types:
Ivory: lobulated, made of compact dense bone, and contains a
minimal amount of fibrous tissue without evidence of haversian ducts.
Mature : spongy, mature bone with bony trabeculae divided by a
conspicuous amount of fibrous tissue; the lesion contains fibroblasts in
different stages of maturation and a great number of collagen fibers, and the
connective tissue may often contain distended thin-walled vessels.
Mixed
65. • Theories for development
Embryogenic Theory: osteoma develops at the junction between
the embryonic cartilaginous ethmoid and the membranous frontal
bone
Traumatic Theory: development of osteoma with a previous
trauma
Infective Theory: local inflammation may alter adjacent bone
metabolism by activating osteogenesis
66. • Imaging: CT Scan: Shows features of cortical bone, tapering to ground
glass appearance in periphery
• Management:
1. Wait and watch in case asymptomatic
2. Excision: in case producing symptoms because of
Obstruction of sinus clearance
Compression on orbital structures/ optic nerve
encroaching anterior skull base causing CSF leak,
pneumocele, etc
71. • It is a genetical developmental anomaly of the bone-forming
mesenchyme with a defect in osteoblastic differentiation and
maturation, leading to replacement of normal bony tissue by fibrous
tissue of variable cellularity and immature woven bone.
• Fibrous dysplasia, lacks capsule and has presence of more immature
bone without osteoblastic activity.
• Psammomatoid ossifying fibroma, is a variant, with numerous small
ossicles in stroma, resembling psammoma bodies.
73. • CT Scan: associated with degree of mineralization of the tissue
Early – High density of fiberous tissue,
Lesion: Radiolucent to lytic appearance
Late – Ground glass to sclerotic appearance
• MRI: T1 – Hypointense
T2 – Variable
CE - non homogeneous enhancement
74. • Management: Resection to relieve symptoms
Resection: Partial vs Radical
• Medical Management: Bisphosphonates – inhibit osteoclastic activity
76. • Occurrence: 3rd and 4th decade of life
• Race: more common in black women
Psammomatoid variant affects young men more commonly with
aggressive local behavior
• Presents as SOL in nasal cavity on endoscopy
• CT: well defined, multiloculated lesion, bordered by peripheral
eggshell-like dense rim
• MRI: T2: Hyperintense
T1: central part : intermediately intense to hyperintense
outer shell : hypointense
77. • Management: Radical resection i/v/o high rate of relapse, with local
destruction and invasion of adjacent structures
79. • Neurogenic tumor arising from schwann cells of sheath of myelinated
nerves
• Age: 6 years to 78 years
• No sex predisposition
• Origin: V2 and V3,
Sympathetic fibers of carotid plexus
Parasympathetic fibers of pterygopalatine ganglion
80. • Well delineated, unencapsulated
globular, firm to rubbery, yellow
– tan mass
• polypoid mass filling the left
nasal cavity with network of
capillaries on the surface of the
lesion, suggesting a diagnosis of
hypervascularized tumor.
81. • HPE: cellular Antoni A areas with
Verocay bodies and hypocellular
myxoid Antoni B areas
• IHC: S 100 protein
82. • Imaging
CT: Non diagnostic
MRI: shows histologic features
of lesion
lesions with a prevalent Antoni
A component have an
intermediate signal on both T1-
and T2-weighted
predominant Antoni B pattern,
which is related to a loose
myxoid stroma, hyperintensity
is observed on T2-weighted
images
• Management:
Radical surgery
83. References
• Scott Brown Ed 6-8
• Jatin P Shah
• Cummings
• Mohan Bansal
• Hazarika
• AIIMS ENT
• Global ENT Outreach
• Sydney ENT Clinic: Prof Richard Harvey
• Seattle science foundation
• Pathology outlines
Editor's Notes
Increased interest cuz of refinement in imaging and application of endoscopic sx.
Classification by WHO: epithelial, soft tissue tumor, tumor of bone and cartikage
Symptom: usual nasal obstruction except osteoma, which has incidental CT finding
Imaging: MRI and CT, MR differentiates secretions from tumor
INVERSION OF NEOPLASTIC EPITHELIUM INTO UNDERLYING STROMA RATHER THAN OUTWARD PROLIFERATION
1st mc SN tumor: osteoma
Lateral nasal wall at fontanelle area
Epiphora/ Proptosis/ Diplopia/ Headache: advanced lesion involving, orbit/ skull base
Hyperplastic ribbons of basement membrane enclosed epithelium that grows endophytically into underlying stroma
INVERSION OF NEOPLASTIC EPITHELIUM INTO UNDERLYING STROMA RATHER THAN OUTWARD PROLIFERATION
endophytic growth of epithelial nests with smooth outer contour.
Endoscopy of the nose usually shows a that
MRI better than CT for better differentiating tumor from inflammatory mucosal changes and disclosing the cerebriform-columnar pattern
Mass in right maxillary sinus extending into nasal cavity
Destruction of medial maxillary wall
Bony sclerotic spicule: s/o hyperostosis – mc site of attachment
CT Hyperostosis : corresponds to tumor base in 89% patients (nipple sign)
Nipple sign
On T1/T2 Images: convulated cerebriform pattern, - roughly parallel lines of high and low intensity
Alternation of highly-cellular metaplastic epithelium with underlying stroma
LIMITATION: lesions that completely fill the maxillary, sphenoid, or frontal sinus and in differentiating inverted papillomas that grow inside the sinus but arise from a small area of insertion from those that extensively involve the mucosa.
According to Dr Satish Jain, Recurrence is an incorrect terminology, it is rather regr
RoR on basis of site of location of tumor based on Cannady Classification
Busquets JM, Hwang PH. Endoscopic resection of sinonasal inverted papilloma: a meta-analysis. Otolaryngol Head Neck Surg 2006;134:476–482
Surgical Risk Factors for Recurrence of Inverted Papilloma, Healyhigher RoR after mucosal striping as IP is embedded in bone and can not be just removed by stripping confirmed by Chiu
(Radiographic and Histologic Analysis of the Bone Underlying Inverted Papillomas)
IP occupies the haversian system of the bone.
Resected 1-2 cm of bone wedges underlying IP and examined under light microscopy
Bony surface under IP was irregular, Arrow shows embedded mucosa in bone
Hyperkeratosis: increased thickness of stratum corneum
Mitotic index: Number of cells undergoing mitosis / total number of cells
IHC markers: ki67, PCNA, p53
DOI for hyperkeratosis: 10.1007/s12105-009-0136-z Histopathological parameters of recurrence and malignant transformation in sinonasal inverted papilloma
Recurrence: Transnasal : 40-80% Open approach : 20% Endoscopic: 12%
Anterior maxillary sinus: can be accessed by endoscopic denkers approach, remove part of piriform aperture
Mucocele: epithelium lined cystic space. Formed due to chronic sinus obstruction, resulting in accumulation of secretions, expanding and destroying sinus walls. Further due to cystic dilatation of mucus glands of sinus mucosa due to duct obstruction.
AIM: Go lateral to the tumor.
Maxillary antrostomy – enlarge maxillary antrum posteriorly till posterior wall of sinus is encountered
Remove inferior turbinate leaving behind a stump posteriorly which is cauterized
Raise the mucosal flap:
Cut 1 – along parallel to posterior maxillary wall
2 – cut behind hasners valve
Elevate the mucosal flap
Flap is elevated and bony medial maxillary wall is seen
Drill the medial maxillary wall
Using back biter remove the bone beneath hasners valve
Place the mucosal flap back to cover the exposed bone
Enter through prelacrimal recess
Drill anterior to
A, Mucosal incision of the lateral nasal wall.
B,C, The nasal mucosa is elevated from the lateral wall.
D-F, The conchal crest of the maxillary body is identified (black arrowhead), and the junction of the inferior turbinate bone is cut.
G, The nasolacrimal duct is exposed, and
H, the bone is removed.
I, The nasal mucosa and nasolacrimal duct can be displaced medially together.
J, The anterior wall of the maxillary sinus,
K, the prelacrimal recess can be accessed using a 70 endoscope.
Procedure for frontal sinus, ESS, Principle: to unobstruct and preserve outflow on frontal recess.
Simple drainage by ethmoidectomy
2A Remove sinus floor from lamina to MT
2B Remove sinus floor from lamina towards septum
3. B/l 2B with septum removal.
Disseminated aka McCune Albright Syndrome
visual impairment as a result of compression of the optic nerve, or to correct aesthetic deformities
Pathological D/D: neurofibroma, solitary fibrous tumor, leiomyoma, fibrous histiocytoma, and fibrosarcoma
Verocay body at center showing palisading of nuclei