Journal of Shahid Sadoughi University of Medical Sciences
Year:2001 | Volume:9 | Issue:3|Papers Count:12

Headache is a very common complaint of patients with many underlying causes .Headaches with sinonasal origin could have no other clinical signs and symptoms and in these cases, role of diagnostic and therapeutic endoscopy with C.Tscan are significant. Many inflammatory and anatomic lesions of the lateral nasal wall and especially middle turbinate could cause severe mucosal contact and the resulting pressure releases substance P, an impotant neuropeptide. Substance P stimulates antidromic (peripheral) and orthodromic (central) impulses; the latter impulse through C fibers reaches brain cortex and causes referal regional pain .Today with the aid of diagnostic functional endoscopy and C.T scan ,the causative factors are diagnosed and then with functional endoscopic surgery the lesions are carefully removed with minimal trauma to heathy tissues, resulting in relief of headache.

Twelve cases of juvenile nasopharyngeal angiofibroma diagnosed by endoscopic examination, computed tomography, and angiography, were selected for endoscopic resection. Tumor staging ranged from stage IA to IIB. Ten patients underwent preoperative selective arterial embolization and in one case selective arterial ligation was employed. In general, the tumors were approached through nasal and oral cavities with 0° and 30° 4mm telescopes without any incision and no packing at their termination. The patients were followed by endoscopy and computed tomography. There was a dramatic decrease in intraoperative bleeding and postoperative morbidity. No early postoperative complications were seen. Two recurrences were observed in twelve patients up to a mean follow-up of 15 months. Minimal bleeding, decreased morbidity, and shorter hospitalization period were the main reasons that prompted us to employ endoscopic technique for the removal of juvenile nasopharyngeal angiofibroma.

Exophthalmos is a sign of Graves" disease which causes ophthalmic complications and predisposes patients to blindness. Therefore it needs special attention to decrease and prevent its morbidities. Many medical, surgical, and Irradiation methods have been suggested, but in cases resistant to medical treatment, orbital decompression is recommended. One accepted method for this purpose is orbital decompression by endoscope through transnasal approach. Due to very low morbidity and no cosmetic problem it seems to be the method of choice.9 patients with Graves" ophthalmopathy were treated by endoscopic orbital decompression between 1997 and 2000. All patients were female and decompression was done bilaterally in all of them. In 8 patients there was no important visual problem, but in the remaining one there was severe visual impairement of the left eye due to optic neuropathy. Results of the 8 patients and the remaining one are presented separately. Prior to surgery, mean visual acuity in the 8 patients was 20/40 , and in the remaining one patient was hand motion in the left eye and 20/80 in the right eye. After surgery, mean visual acuity in the 8 patients was 20/30 , and in the remaining one patient was 20/160 in the left eye and 20/60 in the right eye. Prior to surgery mean exophthalmos was 24.4 mm and after surgery it was 19.3 mm. No patient bad diplopia before surgery although there was extraocular muscl dysfunction in 2patients. After surgery 5 patients acquired mild diplopia who underwent surgical correction of extraocular muscle dysfunction. Fundoscopy was normal in the 8 patients before and after surgery. In the remaining one, there were 2+ disc pallor and positive marcus gun in the left eye before surgery, which improved to 1+ disc pallor and negative marcus gun aftersurger). The right eye"s fundoscopy was normal. It seems that orbital decompression by endoscope through transnasal approach could improve all signs of Graves" ophthalmopathy except extraocular muscle dysfunction. In addition this method poses lesser morbidity ;md complications compared to other methods. It has also no cosmetic problems.

Congenital choanal atresia has an incidence rate of 1 in 8000 live births and is the cause of severe respiratory distress symptoms in new borns especially if bilateral. Occassionally, it is a respiratory emergency which requires immediate intervention. As a newborn can breathe only via the nostrials, choanal atresia leads to obstruction and cyanosis which becomes better when the infant cries. About 60% of congenital choanal atresia are unilateral while the remaining are bilateral. Treatment is surgical which is performed using the transpalatal and the transnasal techniques. Both the techniques can lead to complications which include severe blood loss, (haemorrhage), injury of surrounding neighbouring tissue & disorders of palatine development. Due to recent developments in othe transnasal technique using endoscopy, new instruments, and better view of the surgical field, it is possible to remove the atresic plaques with minimal damage to the surrounding tissue, and lesser complications in shorter period of time. In this report, 5 patients with choanal atresia for the first time in the state of Yazd at the Shahid Rahnemoon hospital were treated using endoscopy with good results and no mortality.

Mucoceles form as a result of obstruction of the sinus ostia, with accumulation of mucus. Nine patients with ethmoidal mucoceles who presented mostly with orbital symptoms underwent endoscopic surgery with the assistance of CO2laser. Under intravenous sedation, a o-degree endoscope and a CO2 laser probe were introduced. The anterior wall of mucocele was removed using laser cutting mode with power of 5 to 10 watts. There was minimal intraoperative bleeding, with no need for packing. Nasal endoscopy was performed at 2 weeks, 3 months, 6 months and one year postoperatively. The ethmoid cavity was patent in all cases. Laser-assisted endoscopic Surgery can be used to treat.

Juvenile nasopharyngeal angiofibroma (JNA) is a rare aggressive tumor among of head & neck. This tumor is benign but aggressive and destructive. Many surgical procedures have been described for resection of this tumor. Endoscopic surgery in recent years has revolutionized its treatment. Endoscopic surgery is usually used after embolization of the tumor In this paper we emphasize on new method of Endoscopic Surgey of JNA without embolization. Here we describe 16 patients with JNA that have been treated using the Endoscopic surgery with transnasal approach. In 3 patients, resection of tumor was done without arterial embolization. Mean of patients age was 16.5 years and patients were in stages (I-III), and 3 patients that were not embolized were in stage (II). Mean follow-up time in patients was 22.5 m, and there were no recurrences in this group. There was no morbidity in the patients. Various staging systems and results have been described for this tumor, which is presented in table 1. Endoscopic surgery is a safe, successful and reliable method for treatment of JNA. Results of endoscopic surgery are successful and comparable with exterrnal approaches. Although there are recurrences in stages III and IV with endoscopic surgery, this is also a problem with external approaches. With direct visualiaztion of tumor origin, surgeon could be confident of tumor resection from its origin. It seems that endoscopic surgery is a more successful method than its external Approach counterparts.

Primary headaches (migraine, cluster, Tension-type) are common disorders that have been speculated to be unrelated to sinonasal abnormalities. A group of patients with chief complaint of headache and no known sinus disease nor significant sinonasal symptoms, have mucosal contact points in sinonasal area as the origin of their symptoms. Mucosal contact can cause headache via substance P release from the nasal mucosa. We present 18 patients suffering from refractory primary headaches in the absence of significant sinus symptoms. A sinonasal abnormality was detected on endoscopy and /or computed tomography scan in all patients. These abnormalities included concha bullosa, medialized uncinate process, and paradoxic middle turbinate. All patients underwent endoscopic sinonasal surgery. Resection of lateral portion of concha bullosa, uncinectomy and resection of anterolateral portion of the paradoxic middle turbinate were performed, respectively. After endoscopic sinonasal surgery, 14 patients experienced reduction in intensity and frequency of headaches. Endoscopic surgical management of contact point headaches could alleviate the patients" symptoms.

A case of primary meningioma of the frontal sinus of a 54 year old man is described. The occurance of primary meningiomas within the paranasal sinuses is rare and probably related to the transformation of embryonic arachnoid cell remnants or ectopic meningocytes derived from pluripotential mesenchymal cells. A search of the literature disclosed 31 further cases of the meningiomas primarih involing the paranasal sinuses of which primary frontal sinus meningioma was even more rare and there was only 1 case of ethmoid sinus meningioma which were ,operated endoscopically.

Inflammatory debris can coalesce in the lacrimal system and form a dacryolith. Only removal of the dacryolith can not eradicate the disease because the nasolacrimal duct obstruction and chronic dacryocystitis that have resulted in dacryolith formation will persist. Dacryocystorhinostomy has to be accomplished as a complementary and essential stage in treatment of dacryoliths. With the advent of modern rigid endoscopes, endonasal approaches to the lacrimal sac are gaining widespread acceptance among surgeons. Laser assists the endoscopic surgery and augments its efficacy. We present a 39 year old man with a longstanding history of epiphora and purulent discharge from left medial cantus. Dacryolith was successfully removed via a laser-assisted endonalendoscopic approach and dacryocystorhinostomy was done simultaneously.