Dissertations / Theses on the topic 'Sinus endoscopy'

Introdução: O seio esfenoidal apresenta relações anatômicas extremamente importantes com estruturas neurovasculares. Estas podem apresentar diversas variações, tornando as suas relações com seio esfenoidal bastante complexas e potencialmente associadas a graves lesões durante sua abordagem. Objetivo: O objetivo deste estudo prospectivo foi descrever, através da dissecção endoscópica em cadáveres, os detalhes das variações anatômicas do SE, avaliando a concordância entre os lados e as diferenças dessas variações entre o gênero e a cor da pele. Casuística e Métodos: Quarenta e cinco cadáveres (90 fossas nasais) de ambos os sexos com idade no óbito entre 30 e 83 anos foram submetidos à dissecção endoscópica meticulosa do seio esfenoidal. A distância da parede anterior do SE à espinha nasal anterior; a localização e o formato do óstio do SE, o grau de pneumatização do SE, a presença de células de Onodi, a dominância entre os lados, a inserção de septo interssinusal e de cristas, a presença de proeminências e/ou deiscências da artéria carótida interna, do nervo óptico, do nervo maxilar e do nervo vidiano, assim como a presença de recessos óptico-carotídeo, pterigóide e lateral foram descritos. As prevalências foram comparadas entre o gênero e diferentes cor da pele. Também foi analisada a simetria entre os lados direito e esquerdo. Resultados: O óstio estava localizado medialmente à inserção póstero-inferior da concha superior em 85,6% das fossas nasais estudadas e em 50% apresentava-se com formato arredondado. A distância média do óstio do seio esfenoidal à espinha nasal anterior foi de 68 mm (+- 4,6mm) para ambos os lados. Não havia dominância dos lados direito ou esquerdo em 21 (46,7%) dos cadáveres. Em 17 cadáveres (37,8%) o seio esquerdo se apresentou mais pneumatizado e em 7 (15,6%), o seio esfenoidal direito apresentou dominância em relação ao esquerdo. O tipo selar foi o mais prevalente (53%) seguido do pré-selar (38%). O recesso mais prevalente foi o pterigóide (47,8%). As cristas estivaram presentes em 22,7% dos lados. O septo intersinusal se inseriu no trajeto da artéria carótida interna e do nervo óptico, respectivamente, em 16,7% e 2,2%. A artéria carótida interna esteve proeminente em 48,9% e deiscente em 31,1% das fossas estudadas. O nervo óptico estava proeminente e deiscente em 35,6% e 8,9%, respectivamente. O nervo vidiano foi a estrutura com proeminência mais prevalente (50%). O nervo maxilar esteve deiscente em 5,6% dos lados estudados. Uma célula de Onodi esteve presente em 23 (25,6%) dos lados dissecados. A análise da simetria mostrou concordância perfeita com relação ao grau de pneumatização e se apresentou bastante variável de acordo com a estrutura estudada. Cadáveres do sexo feminino apresentaram de forma estatisticamente significante maior prevalência de deiscência de carótida interna (p=0,002) e do nervo maxilar (p=0,02), assim como proeminência do nervo óptico (p < 0,001). Conclusão: Os dados demonstram a complexa anatomia interna do seio esfenoidal, e o conhecimento desta anatomia é de grande importância para evitar as potenciais complicações cirúrgicas nesta região.<br>Introduction: There are extremely important anatomic relationships between the sphenoid sinus (SS) and neurovascular structures. These structures may have several anatomic variations, which makes their relationship with the sphenoid sinus complex and carries risks of severe injuries during surgery. Objective: This prospective study used endoscopic cadaver dissection to describe details of SS anatomic variations and to evaluate agreement between sides and differences between sexes and ethnic groups. Casuistic and Methods: Fourty-five cadavers (90 nasal fossae) of both sexes ageing between 30 and 83 years underwent careful dissection of the sphenoid sinus. Distance from the SS anterior wall to the anterior nasal spine, the position and shape of the SS, the degree of SS pneumatization, the presence of Onodi cells, the dominance between sides, the insertion of the intersinus septum and crests, the presence of dehiscence and protrusions of the internal carotid artery (ICA), optic nerve (ON), maxillary and vidian nerves, and the presence of optic-carotid, pterygoid and lateral recesses were described. Data were analyzed according to sex, skin color and symmetry between nasal fossae of each cadaver. Results: Ostia were located medially to the posteroinferior insertion of the superior turbinate in 85.6% of the nasal fossae, and were circular in 50% of the cases. The mean distance from the ostium to the anterior nasal spine was 68 mm (+- 4.6 mm) for both sides. No dominance of right or left side was found in 21 (46.7%) of the cadavers. In 17 cadavers (37.8%), the left sinus was more pneumatized, and in 7 (15.6%), the right sphenoid sinus showed dominance over the left sinus. The sellar type was the most prevalent (53%), followed by the presellar type (38%). Pterygoid recesses were the most prevalent (47.8%). Crests were found in 22.7% of the sides. The intersinus septum was inserted on the course of the internal carotid artery and optic nerve in 16.7% and 2.2 % of the cases. ICA protrusions were found in 48.9% of the cases, and dehiscence in 31.1% of the fossae under study. Dehiscence and protrusion of the ON were found in 35.6% and 8.9% of the cases. The vidian nerve was the structure with the most prevalent protrusion (50%). Dehiscence over the maxillary nerve was found in 5.6% of the sides. Onodi cells were found in 23 (25.6%) of the dissected sides. The analysis of symmetry revealed perfect agreement of the degree of pneumatization and was greatly variable depending on the structure analyzed. Female cadavers had a statistically greater prevalence of dehiscence over the internal carotid artery (p = 0.002) and over the maxillary nerve (p = 0.02), as well as greater prevalence of optic nerve protrusion (p < 0.001). Conclusion: Our data showed that the SS internal anatomy is complex, and its knowledge is essential during surgical approaches to the sphenoid sinus.

The present study analyzed the results of a new video-assisted minimally invasive technique for the treatment of sacrococcygeal pilonidal disease (E.P.Si.T: endoscopic pilonidal sinus treatment). From May 2013 to June 2015 a total of 85 consecutive patients (68M, 17F), mean age 27.5 years referred to our surgical department. 75 patients had a primary sacrococcygeal pilonidal sinus, 10 patients had a recurrent pilonidal sinus and all underwent to E.P.Si.T. A fistuloscope is introduced through the external opening and the sinus cavity is completely ablated under direct vision. Patients' postoperative complications, wound infection rate, recurrence rate, time until return to work and satisfaction score were recorded during follow-up or at the last interview. Clinical data were obtained at 7 days, 15 days, 30 days, 6 month and 12 months following surgery. RESULT: All patients were followed up. Mean operative time was 18 min (range 12-30 min). The mean hospital stay was 6,5h (range 5-9) and mean time to return to work was 5 days. Mean follow-up was 16,8 (range 4-29) months. Mean healing time was 32,7 days. There were no major complications and infection; 5 recurrences. Overall satisfactory rate 98%. CONCLUSION: The ideal surgical treatment for pilonidal sinus disease must be simple and effective. In our experience, E.P.Si.T can be performed as a day care surgery with early return to work. This technique is also associated with a low recurrence rate and postoperative morbidity rate and a good aesthetic result INTRODUCTION Pilonidal sinus (PS) is a common health problem of the sacrococcygeal region mainly in young men (1), it is associated with obesity, sedentary occupation, local irritation (2) and hirsutism (3). Actually PS is considered an acquired disease due to the obstruction of hair follicles in the natal cleft (4). The symptoms are variable, ranging from asymptomatic pits to acute abscess to chronic cyst. This pathology has an important impact in quality of life causing absenteeism from work and school. The surgical treatment of PS still remains challenging and a lot of surgical treatment have been proposed. Recurrence rates vary with the technique. The aims of treatment of PS are eradication of the sinus tract, complete healing, prevention of recurrence and a good aesthetic result. Open excision and healing by secondary intention is used in the treatment of PS but this technique offers a poor quality of life and close observation as reported in a lot of study (5). Several authors propose excision of PS with primary closure using different technique like midline closure or flap-based procedure (4). These surgical modalities have low rates or efficacy and a prolonged postoperative wound healing. Enriquez-Navascues et al. (6) in a meta-analysis reported recurrence for every surgical approach range from 0 to 40% and concluded that in the treatment of PS “less is more”. In the last years, some authors developed new minimally invasive technique in the treatment of PS: Gupta et al. (7) proposed radio-surgery, Isik et al. (8) used fibrin glue without surgery, Meinero et al. (9), in a small series, proposed the use of a fistuloscope with an operative channel to destroy the sinus cavity and sinus tracts under direct vision, Milone et al. (10) proposed a similar technique using a hysteroscope. The present observational prospective study analyzed the results of E.P.SI.T (Endoscopic Pilonidal Sinus treatment) technique in treating PS.

Bibliography: leaves 109-125. This thesis validated the use of sheep as a suitable animal model to study endoscopic sinus surgery (ESS) and to evaluate factors that may play a role in the healing of nasal epithelium after surgery. Nasal packing was shown to cause a significant injury and should be used by ESS surgeons with caution. Full-thickness wounds should be avoided in the nose where possible as the re-ciliation was significantly reduced when compared to partial-thickness wounds. In addition the healing of the nose took significantly longer than previously thought and was incomplete 84 days after surgery. Scanning electron microscopy was shown to be an important outcome measure for the healing of the nasal mucosa after ESS and a new technique for measuring the re-ciliation was validated.