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Objective:The endoscopic modified Lothrop procedure is mainly used for refractory frontal sinusitis. However, we have used it as an access procedure to facilitate treatment for an extended range of additional frontal sinus pathologies.Methods:A retrospective review of patients who underwent the endoscopic modified Lothrop procedure for ‘alternative’ frontal sinus pathologies was conducted. Patient data were reviewed. The main outcome parameter measured was signs of recurrence.Results:Twelve patients (6 males, 6 females) from a 7-year study period, with a mean age of 45.2 years (range, 16–78 years), were analysed. The surgical indications included frontoethmoidal mucoceles, cerebrospinal fluid leaks within the frontal sinus, cystic fibrosis, frontal sinus osteoma, frontal sinus ossifying fibroma and frontal silent sinus syndrome. The mean follow-up period was 33.3 months. There were no known recurrences.Conclusion:We have used the endoscopic modified Lothrop procedure for a range of frontal sinus pathologies, safely and effectively, with no peri-operative complications.

Objectives To assess olfactory outcomes in patients undergoing septorhinoplasty surgery in our unit. Design Prospective cohort study. Setting The Royal National Throat Nose and Ear Hospital, London. Participants Forty-three patients undergoing functional septorhinoplasty (Males = 26; mean age = 34.1 ± 12.2) were recruited into the study. Main outcome measures The primary outcome of olfactory function was assessed using ‘Sniffin sticks’. Our secondary outcomes were assessment of patient quality of life using the disease specific Sino-nasal Outcome Test-23 questionnaire (SNOT-23) and a visual analogue scale for sense of smell. These measures were repeated at 12 weeks post operatively. Results There was a significant change in the Sniffin’ sticks score post-operatively (8.3 versus 9.6; P

Objectives To assess the reliability of nasal inspiratory peak flow (NIPF) in providing a clinically accurate objective measure following functional septorhinoplasty by comparing it to the validated disease-specific quality-of-life questionnaire, SNOT-22. Studies so far have demonstrated poor correlation between bilateral NIPF and symptom-specific nasal questionnaires following septorhinoplasty. Design To perform a prospective comparative analysis between NIPF and the validated disease-specific quality-of-life questionnaire SNOT-22 and to determine whether a correlation exists following septorhinoplasty surgery. Setting The Royal National Throat Nose and Ear Hospital, London. Participants A total of 122 patients (78 males, 44 females; mean age 33.5 ± 12.2 years) were recruited from the senior authors rhinology clinic and underwent functional septorhinoplasty surgery. Main outcome measures Preoperative and postoperative nasal inspiratory peak flow (NIPF) measurements were performed in addition to the completion of three subjective quality-of-life and symptom assessment tool questionnaires; Sinonasal Outcome Test 22 (SNOT-22), Nasal Obstruction Symptom Evaluation (NOSE) and Visual Analogue Scale (VAS: 0–10). Results The mean preoperative NIPF was 88.2 L/min, and the postoperative value was 101.6 L/min and showed a significant improvement following surgery (P = 0.0064). The mean total SNOT-22 score improved significantly from 48.6 to 26.6 (P

Dacryocystorhinostomy via an endoscopic approach is now widely favored and considered to result in comparable outcomes to similar surgery via an external approach. Such surgery is usually done jointly between ophthalmologists and otolaryngologists. If endoscopic surgery is to be considered, patients should have a complete preoperative assessment to facilitate surgical planning. Clearly, patients with lacrimal obstruction require a comprehensive ophthalmologic assessment to confirm the diagnosis. However, in addition nasal examination should be considered obligatory in such patients, for evaluation of any concurrent intranasal pathology or anatomical variations, and therefore ophthalmologists practicing lacrimal surgery should familiarize themselves with the use of the nasal endoscopes. Examination with a nasal speculum and headlight provides only a limited view of the anterior nasal passages, and therefore rigid nasal endoscopy should be performed as part of the standard preoperative assessment.

Antrochoanal polyps (ACP) are benign, large, inflammatory polyps which originate from within the maxillary sinus and extend through the natural or accessory ostia, into the nasal cavity, with extension into the choana. They are relatively uncommon, accounting for just 3 – 6% of all nasal polyps, although they are much more frequently encountered in children, affecting upto 35% of the paediatric population 1. Even among adults, they usually present at a younger age, as compared with usual nasal polyps with a mean age at diagnosis of 27 and 50 years respectively 2. This article is protected by copyright. All rights reserved.

Antrochoanal polyps (ACPs) are benign lesions that originate from the mucosa of the maxillary sinus, and extend into the nasal cavity to reach the choana and nasopharynx. The treatment of ACPs is surgical, with a number of different surgical techniques having been described. We describe the first case series of ACPs from the UK and the endoscopic surgical technique that we have employed. A retrospective case note review of patients with ACPs managed under the care of the senior author was conducted. Demographic and clinical data for all patients were reviewed. The main outcome parameter measured was any sign of recurrence. A total of 29 consecutive patients were included for analysis from a 5-year study period, with 19 males and 10 females, and a mean age of 37.4 ± 13.6 years. Four patients within our group were referred to us with recurrent ACPs for revision surgery. All patients underwent surgery via the same endoscopic technique. The mean follow-up period was 14.7 ± 16.9 months, with an average follow-up of 22.5 months for the four revision cases. There were no recurrences in any of our patients. We describe the first reported series of endoscopic sinus surgery for antrochoanal polyps in the UK, and the largest worldwide series described for endoscopic management of ACPs in adults. We have had no recurrent cases, with a mean follow-up period of 14.7 months.

Nasal vestibular stenosis can result in a challenging cosmetic deformity, for which a variety of techniques have been described, including scar excision and replacement with local flaps, composite or cartilage grafts, with or without stents. We describe the Z-plasty technique to widen the alar base and assess patient satisfaction from the surgery. A retrospective review of patients who underwent Z-plasty to the alar subunit for nasal vestibular stenosis over a 4-year period was conducted. Demographic data and patient satisfaction were evaluated using pre- and postoperative visual analog scores and Rhinoplasty Outcome Evaluation questionnaires. Eight patients underwent the procedure, and all confirmed significant improvement in their esthetic outcome. We describe our Z-plasty technique to the alar base and review patient satisfaction.

Silent sinus syndrome (SSS) is a rare and interesting clinical condition that is associated with spontaneous, painless, unilateral enophthalmos and hypoglobus resulting from downward bowing of the orbital floor, in the absence of any symptomatic sinonasal disease. It generally affects younger patients between the third and fifth decades of life. The pathogenesis of silent sinus syndrome is based on chronic maxillary sinus obstruction, related to occlusion of the maxillary infundibulum which results in a hypoventilated sinus and negative pressures. Endoscopic sinus surgery to create a wide maxillary antrostomy with or without orbital floor reconstruction is considered the gold standard treatment of choice.

Nasal examination should be obligatory in any patient who is being considered for lacrimal surgery. Preoperative assessment should include nasal endoscopy to allow evaluation of any concurrent intranasal pathology or anatomical variations. Furthermore, lacrimal surgery itself is now widely practiced via an endoscopic approach and therefore ophthalmologists performing lacrimal surgery should familiarize themselves with the use of nasal endoscopes.

Objectives:1) Explore developments in endoscopic techniques and their application in the management of Sinonasal Inverted Papilloma (SNIP). 2) Describe 0% recurrence rates with aggressive endoscopic resection of complex SNIP.Methods:Retrospective single-center patient cohort analysis of twenty-one cases of SNIP treated by endoscopic resection at Charing Cross Hospital from December 2002 to September 2012. Pre-operative assessment included tomography or magnetic resonance imaging and biopsies. The origin and extent of the tumor determined the surgical strategy, and a combination of antrostomy, ethmoidectomy, sphenoidotomy, and endoscopic medial maxillectomy (EMM) with the assistance of angled instrumentation were performed. Sub-periosteal dissection followed by diamond burr drilling of the underlying bone were performed in all cases. All patients were followed up by regular endoscopic surveillance.Results:The study group consisted of 12 (57%) male and 9 (43%) female patients with a mean age of 59 years. El...

Objectives:Nasal vestibular stenosis results in significant functional impairment and cosmetic deformity. Various techniques can be used, including excision of the deformed segment and replacement with healthy tissue using local flaps, composite or cartilage grafts, with or without stents. W-plasty, Z-plasty, and double-cross plasty techniques have also been described. We aimed to evaluate the following outcome measures: 1) Describe our modified Z-plasty technique to widen the ala base. 2) Report patient satisfaction with respect to functional and cosmetic improvement.Methods:A retrospective study over a 4-year period was conducted on patients who underwent modified Z-plasty of the ala. This is performed under general anaesthetic, with infiltration of 2% lignocaine, and 1:80,000 adrenaline to the lateral alar margin and adjacent soft tissue, overlying the piriform aperture margin. A Z-plasty incision is made around the lateral ala and anterior nasal process of maxilla. The two triangular flaps are transpo...

Antrochoanal polyps (ACPs) are benign lesions that originate from the mucosa of the maxillary sinus, and extend into the nasal cavity to reach the choana and naso- pharynx. The treatment of ACPs is surgical, with a num- ber of different surgical techniques having been described. We describe the first case series of ACPs from the UK and the endoscopic surgical technique that we have employed. A retrospective case note review of patients with ACPs managed under the care of the senior author was con- ducted. Demographic and clinical data for all patients were reviewed. The main outcome parameter measured was any sign of recurrence. A total of 29 consecutive patients were included for analysis from a 5-year study period, with 19 males and 10 females, and a mean age of 37.4 ± 13.6 years. Four patients within our group were referred to us with recurrent ACPs for revision surgery. All patients under- went surgery via the same endoscopic technique. The mean follow-up period was 14.7 ± 16.9 months, with an average follow-up of 22.5 months for the four revision cases. There were no recurrences in any of our patients. We describe the first reported series of endoscopic sinus surgery for antro - choanal polyps in the UK, and the largest worldwide series described for endoscopic management of ACPs in adults. We have had no recurrent cases, with a mean follow-up period of 14.7 months.

The conventional treatment for patients with acute upper airway obstruction is tracheostomy, which is a safe, definitive procedure in most hands. Alternatively, a debulking procedure can be considered but this requires both surgical and anaesthetic skill and expertise. However, where possible, it provides a good alternative with the advantages of removing the cause of obstruction and yielding tissue for histopathological analysis, and avoiding the need for a tracheostomy, with its associated morbidity. We evaluated all patients who presented with acute upper airway obstruction and underwent endoscopic laser debulking surgery performed by the senior author, over a three and a half year period. We recorded patient demographic data, their underlying pathologies, complication rates associated with laser debulking surgery and the conversion to tracheostomy. Thirty patients were identified, including 19 males and 11 females, with a mean age of 57.10 ± 17.20 years (19–93 years). All patients underwent debulking procedures with carbon dioxide laser under general anaesthetic. All patients had their underlying diagnosis confirmed from their debulking surgery. Twelve patients were found to have benign pathology and 18 had malignant airway obstruction. There were no laser-associated complications. One patient required conversion to emergency tracheostomy, during their debulking surgery. Endoscopic laser assisted debulking surgery has successfully been used to establish a safe airway. It allows obtaining tissue specimens, to confirm the underlying diagnosis, thus avoiding the need for further biopsies under anaesthetic. For all malignant cases, patients were subsequently able to proceed to definitive treatment. It has obviated the need for emergency tracheostomy in almost all of the cases in our patient cohort.

Objective: 1) Ascertain whether CT findings correlate with surgical need for access septoplasty during endoscopic sinus surgery. Evaluated due to risk of litigation from patients not consented for septoplasty who require it, despite having a “straight septum” on CT. 2) Establish whether site of septal deviation affects the requirement for septoplasty.Method: We retrospectively studied 129 endoscopic sinus surgery procedures. The preoperative CT report was recorded. Blinded to the report, 2 independent observers commented on evidence and site of septal deviation and predicted the need for access septoplasty. The operative notes were used to record the surgical outcome.Results: Septal deviation was reported by radiologists in 57 of the 129 patients (44%). Both observers agreed on septal deviation being present in 85 patients (66%). Thirteen of 87 patients who were predicted not to need access septoplasty underwent the procedure (15%). A confidence interval (CI) of 95% gives a range of 9%-24% for patients un...

Branchiootoic syndrome is part of the spectrum of brachiootorenal disorders. Brachiootorenal disorder is a rare autosomal dominant condition, characterized by malformations of the outer, middle, and inner ear, which are associated with branchial and renal anomalies. We describe a case of bilateral branchiootoic syndrome and discuss the anatomy of second branchial cleft fistulae and the surgical management of this uncommon condition. We report the case of a 6-year-old girl referred to our department with bilateral intermittently discharging neck swellings. Clinical examination revealed bilateral branchial fistulae and preauricular sinuses, on a background of a positive family history of branchial fistulae. A magnetic resonance imaging scan confirmed the diagnosis of bilateral second branchial cleft fistulae. In view of her symptoms, she underwent bilateral branchial fistula excision and tonsillectomy with an uneventful postoperative recovery.