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[Functional endoscopic ethmoid bone revision in inflammatory paranasal sinus diseases in childhood]
Insights
Endoscopic ethmoid surgery effectively treats childhood sinusitis and related complications by addressing anatomical variations. This minimally invasive approach significantly improves nasal breathing and resolves inflammation in most young patients.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Rhinosinusitis Research
Context:
- Pediatric rhinosinusitis presents unique challenges due to developing anatomy.
- Recurrent sinusitis, asthma, bronchitis, and orbital complications necessitate effective interventions.
- Anatomical variations in the ethmoid bone are implicated in the pathogenesis of pediatric paranasal sinus disease.
Purpose:
- To evaluate the efficacy of endoscopic ethmoid surgery in treating various pediatric paranasal sinus conditions.
- To assess the impact of addressing anatomical variations on treatment outcomes.
- To determine the effectiveness of this surgical approach in improving sinonasal symptoms and nasal airflow.
Summary:
- Fifty-seven children (5-15 years) underwent endoscopic ethmoid surgery for conditions including recurrent sinusitis, sinusitis with asthma/bronchitis, and early orbital complications.
- Preoperative assessment identified anatomical variations like pneumatized middle nasal concha and turbinate abnormalities contributing to disease.
- Surgery focused on eliminating these obstructions, achieving cure in most cases (except mucoviscidosis) and improving nasal breathing.
Impact:
- Conservative endoscopic ethmoid surgery is a highly effective treatment for pediatric paranasal sinus disease.
- The technique offers a minimally invasive solution with significant improvement in sinonasal health and breathing.
- Early intervention for orbital complications combined with antibiotics shows positive results.
Abstract:
A total of 57 children aged between 5 and 15 years underwent endoscopic ethmoid surgery for recurrent acute or chronic rhinogenic sinusitis, chronic sinusitis associated with bronchial asthma or chronic bronchitis, early rhinogenous orbital complications and paranasal sinus disease associated with mucoviscidosis. The indications for surgical intervention are based on symptoms, the findings on nasal endoscopy and a CT scan of the paranasal sinuses in the coronal plane. The preoperative examination shows that in childhood there are endoscopically detectable anatomical variations of the ethmoid bone (pneumatised middle nasal concha, reversed curvature of the middle turbinate and contact between the uncinate process and the turbinate) that create the conditions for the development of inflammatory paranasal sinus diseases. Careful elimination of these obstructions can accomplish complete cure of the inflammation, and early orbital complications can be treated effectively by combination of surgery with infusion of antibiotics. All surgery was performed under endotracheal anaesthesia using the endoscopic technique described by Messerklinger. The follow-up period was between 6 and 18 months. With the exception of children suffering from mucoviscidosis, cure of the paranasal sinus disease and rhinomanometrically demonstrable improvement of the nasal breathing was achieved in all cases. On the basis of our results a conservative endoscopic approach is recommended as an effective surgical method for the treatment of paranasal sinus disease in childhood.