International forum of allergy & rhinology
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Int Forum Allergy Rhinol · Jun 2014
Case ReportsModified subtotal-Lothrop procedure for extended frontal sinus and anterior skull-base access: a case series.
The endoscopic modified Lothrop procedure (EMLP) is well established for resistant frontal sinus disease and anterior skull base (ASB) exposure. However, this technique may be unnecessarily aggressive by removing avoidable sinonasal structures in select cases. Previously, in a cadaveric study, we proposed a modification of the EMLP, termed the modified subtotal-Lothrop procedure (MSLP), to access the ASB and to address complex frontal sinus disease, for which access to the bilateral frontal sinus posterior table is required. This study provides a step-by-step description of this technique, and presents our experience in 5 patients who underwent this approach. ⋯ The MSLP is a feasible approach for exposure of the ASB and accessing complex frontal sinus pathology. This modification provides adequate ASB exposure and surgical maneuverability similar to the EMLP, while preserving one frontal sinus recess. This modification was successful in providing adequate exposure and maneuverability as well as maintaining frontal sinus patency in this small cohort.
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Int Forum Allergy Rhinol · May 2014
Outpatient endoscopic sinus surgery in cystic fibrosis patients: predictive factors for admission.
An increasing number of adult patients with cystic fibrosis (CF) are becoming candidates for elective endoscopic sinus surgery (ESS). We sought to identify perioperative factors in this patient population that were predictive of postoperative admission. ⋯ Although over 50% of adult CF patients can successfully undergo ESS on a same-day discharge basis, it is prudent to have contingent plans for potential inpatient observation postoperatively. Multivariate analysis suggests that preoperative demographics and pulmonary status cannot predict the need for postoperative admission, whereas higher pain scores in the postanesthesia care unit are predictive of the necessity for inpatient observation.
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Int Forum Allergy Rhinol · May 2014
Comparative StudyComplications from office sclerotherapy for epistaxis due to hereditary hemorrhagic telangiectasia (HHT or Osler-Weber-Rendu).
The aim of this study was to identify and evaluate adverse clinical outcomes following office-based sclerotherapy using sodium tetradecyl sulfate (STS) for epistaxis due to hereditary hemorrhagic telangiectasias (HHT or Osler-Weber-Rendu). ⋯ Conventional therapies used in the management of HHT-related epistaxis, such as laser coagulation, septodermoplasty, selective arterial embolization, and Young's occlusion each have specific associated complications, including worsened epistaxis, septal perforation, foul odor, nasal crusting, and compromised nasal breathing. STS is a safe office-based treatment option for HHT-mediated epistaxis that is associated with exceedingly few of the aforementioned serious sequelae.
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Int Forum Allergy Rhinol · Mar 2014
Case ReportsMalodorous consequences: what comprises negligence in anosmia litigation?
Our objectives were to evaluate factors raised in malpractice litigation in which plaintiffs alleged that physician negligence led to olfactory dysfunction. ⋯ Olfactory dysfunction can adversely affect quality of life and thus is a potential area for malpractice litigation. This is particularly true for iatrogenic causes of anosmia, especially following rhinologic procedures. Settlements and damages awarded were considerable, making an understanding of factors detailed in this analysis of paramount importance for the practicing otolaryngologist. This analysis reinforces the importance of explicitly including anosmia in a comprehensive informed consent process for any rhinologic procedure.
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Int Forum Allergy Rhinol · Mar 2014
Angioedema of the upper aerodigestive tract: risk factors associated with airway intervention and management algorithm.
Angioedema of the upper aerodigestive tract can lead to significant airway obstruction. To date no articles have delineated risk factors for progression after initial evaluation. ⋯ In this large series of patients managed for aerodigestive angioedema we demonstrate risk factors associated with airway intervention, and risk factors associated with clinical progression on serial examination to airway intervention. In addition, we demonstrate a successful management algorithm for patients with aerodigestive angioedema.