The endoscopic approach was performed through a small bone window by the midline of the glabella, with the restoration of the bone support at the end of the surgery using a titanium mesh. Papilloma on nasal septum the surgical staff has a lot of experience in doing the endoscopic transnasal approach, there are some cases where the transnasal route cannot safely solve certain pathologies. This is the reason why the authors wish to illustrate the need of using an approach that will ensure a proper management of any kind of complications that can occur during surgery, specific to these tumors bleeding, cerebrospinal fluid leak.
In this case, the transcranial endoscopic approach was the best solution. Keywords frontal sinus, tumor, external endoscopic approach Rezumat Prezentăm cazul unui pacient, în vârstă de 62 de ani, papilloma on nasal septum o formaţiune tumorală voluminoasă de sinus frontal bilateral, cu sindrom cefalalgic sever şi distrucţia parcelară a laminei papiracee stângi şi a peretelui posterior al sinusului frontal drept.
Abordul endoscopic s-a efectuat printr-o fereastră intersprâncenoasă de mici dimensiuni, cu refacerea suportului osos la finalul intervenţiei utilizând o plasă din titan.
Deşi echipa chirurgicală are o experienţă îndelungată în abordul transnazal endoscopic, există cazuri în care parcursul transnazal nu poate rezolva în deplină siguranţă anumite patologii.
Magdalena Chirila - Referințe bibliografice Google Academic
Autorii doresc să sublinieze necesitatea utilizării unui abord care să asigure managementul corespunzător al papilloma on nasal septum eventuale complicaţii intraoperatorii specifice acestor tumori sângerări, fistulă de lichid cefalorahidianiar în cazul de faţă abordul endoscopic transcranian a reprezentat cea mai bună soluţie.
Cuvinte cheie sinus frontal tumoră abord endoscopic extern A year-old patient, S. Three years ago Mayin another ENT service, the patient underwent a curative surgery for bilateral fronto-ethmoido-sphenoidal rhinosinusitis. According to the medical discharge presented by the patient, the frontal sinus approach used was of the Draf I kind, without exploring the frontal sinus cavity.
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The prolonged evolution led to a lysis of a wall caused by a decubitus injury. This explained the intimate tumoral contact with the dura mater through an 8-mm bone breach in the posterior wall of the right frontal sinus. Also, the tumor protruded through the left orbit by an erosion of the left lamina papyracea, with the appearance of a discrete inferior and external exophthalmia in the left eye.
Transcranian endoscopic approach in a frontal polyposis
The MRI revealed that the dura mater was integral and the orbital periosteum was apparently free Figure 1. Figure 1. Down: partial destruction of the left eye lamina papyracea, bone breach to anterior cerebral fossa The apparent origin located at the posterior wall of the bilateral frontal sinus, the partial exposure of the dura mater and the destruction of the lamina papyracea with the penetration of the tumor into the left orbit led to the decision of an external endoscopic approach.
We underwent the surgery using general anesthesia with OT intubation. Skin incision: 20 mm, bone fenestration with 13 mm horizontal diameter and 10 mm vertical diameter.
A hard tumor was shown upon palpation, with a macroscopic aspect of an inverted papilloma, well-vascularized, that occupied both frontal sinuses and dived through the nasofrontal ducts in the anterior ethmoidal cells.
The apparent origin of the tumor was located at the junction between the posterior wall of the left frontal sinus and the intersinusal septum, in the upper floor of the sinus cavity. There was a partial exposure of the dura mater and the left papilloma on nasal septum periosteum, but there was no signs of penetration at their level.
A Draf II transnasal endoscopic approach was performed for the restoration of ventilation in both frontal sinuses.
Romanian Journal of Rhinology -
Radiofrequency hemostasis — fulfuration 10 W. Efficient hemostasis; did not require nasal package. The integrity of the bone support was restored using a titanium mesh fixed with biocompatible screws Figure 2.
Intradermal skin suture Vicryl 5.
Figure 2. Intraoperative macroscopic aspect — optics. Restoration of bone support using titanium mesh A CT scan using a contrast substance was performed at the end of the surgery Figure 3. It confirmed the complete macroscopic resection papilloma on nasal septum the tumor and a wide ventilation of both frontal sinuses. Figure 3.
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Up: postoperative CT aspect — axial, sagital. IHC revealed the diagnosis of a glandular subtype of sinus inflammatory polyp. We presented this case to point out that there are many situations when the pathology of the frontal sinuses still requires an external approach, even when we consider that the surgical team has a strong experience in transnasal endoscopic surgery. The peculiarity of the case was the small bone-window through which the tumor was resected, the advantage we had being given by the usage of optics and angular tools that made the resection complete and safe for the patient.
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CSF leaks, the frontal sinus osteomas that exceed the diameter of the nasofrontal duct and large solid tumors can be safely managed for the patient through a minimally invasive transcranial endoscopic approach that is lesion-centered.
Note: This article does not contain any references, since it describes a strictly papilloma on nasal septum experience of the authors. Conflict of interests: The authors declare no conflict of interests.