Essentials of Rhinology

Foreword
Preface
Contents
About the Editors
List of Contributors
1: Endoscopic Anatomy and Surgery
1.1 Part A: Anatomy of Nasal Cavity and Paranasal Sinuses
1.1.1 Ethmoid Cells
1.1.2 Frontal Sinus
1.1.3 Maxillary Sinus
1.1.4 Anterior Ethmoid Artery
1.1.5 Sphenopalatine Artery
1.1.6 Cribriform Plate
1.1.7 Sphenoid Sinus
1.1.8 Optic Nerve Relationship with Paranasal Sinuses
1.2 Part B: Local Anesthesia and Regional Blocks in Nasal Surgery
1.3 Part C: General Anesthesia
1.3.1 Preoperative Concerns
1.3.2 Anesthesia Technique
1.3.3 Hypotensive Anesthesia
1.3.4 Acute Normovolemic Hemodilution
1.3.5 Juvenile Nasopharyngeal Angiofibroma with Intracranial Extension
1.3.6 Emergence from Anesthesia
1.3.7 Postoperative Concerns
1.3.8 Emergency Surgical Intervention
1.4 Part D: FESS
1.4.1 Diagnostic Endoscopy
1.4.2 FESS Techniques and Steps
1.4.3 NASAL POLYP and FESS
1.4.4 AFRS and FESS
1.4.5 ESS in Pediatric Age Group
1.4.6 Balloon Sinuplasty
1.4.7 Conclusion
1.5 Part E: Packing Materials for Nose and Paranasal Sinuses
1.5.1 Uses of Nasal Packing
1.5.2 Types of Nasal Packing Material
1.5.3 Non-Absorbable Nasal Packs
1.5.4 Absorbable Nasal Packs
References
2: Rhinoplasty Anatomy and Procedures
2.1 Part A: External Nasal Anatomy, Aesthetics and Photography
2.1.1 Photography and Analysis
2.2 Part B: Open and Close Rhinoplasty and Tip Plasty
2.2.1 Introduction
2.2.2 Approaches
2.2.3 Tip Defining Procedures
2.2.4 Management of the Overprojecting Tip
2.2.5 The Under-Projected Nasal Tip
2.2.6 The Broad Nasal Tip
2.2.7 Complications
2.3 Part C: Nasal Dorsum Correction and Material for Rhinoplasty
2.3.1 Post-Operative Management
2.3.2 Materials for Reconstruction in Rhinoplasty
References
3: Nasal Physiology and Sinusitis
3.1 Part A: Physiology of Nose and Paranasal Sinuses
3.1.1 Introduction
3.1.2 Nasal Secretions and Mucociliary Drainage
3.1.2.1 Nasal Mucosal Lining
3.1.2.2 Contents of Nasal Secretions
3.1.2.3 Mucociliary Drainage Pattern
3.1.2.4 Tests for Mucociliary Clearance
3.1.3 Nasal Breathing
3.1.3.1 Measurement of Nasal Breathing
3.1.3.2 Important Objective Tests of Nasal Breathing
3.1.3.3 References Values for Normal Adults
3.2 Part B: Olfactory Nerve and Olfactory Dysfunctions
3.2.1 Anatomy of Olfactory Nerve
3.2.2 Blood Supply of Olfactory Nerve
3.2.3 Smell Disorders
3.2.3.1 Epidemiology
3.2.4 Management of Smell Disorders
3.2.4.1 Investigations
3.2.4.2 Treatment Options
3.2.5 Bioelectronic Nose
3.2.6 Applications of Bioelectronic Nose
3.3 Part C—Acute and Chronic Rhinosinusitis
3.3.1 Summary
3.3.2 Introduction
3.3.3 Pathophysiology
3.3.4 Diagnostic Work Up
3.3.5 Radiological Staging
3.3.6 Differential Diagnosis
3.3.7 Complications
3.3.8 Treatment
3.3.8.1 Antibiotics
3.3.8.2 Nasal Sprays and Irrigation
3.3.8.3 Oral Steroids and Anti-Histaminics
3.3.9 Surgery
3.4 Part D: Frontal Sinusitis
3.4.1 Summary
3.4.2 Introduction
3.4.3 Pathophysiology
3.4.4 Preoperative Workup
3.4.4.1 Surgical Approaches
3.4.4.2 Open Approaches
3.5 Part E: Complications of Sinusitis
3.5.1 Summary
3.5.2 Introduction
3.5.3 Conclusion
3.6 Part F: Allergic Rhinitis
3.6.1 Introduction
3.6.2 Clinical Manifestations and Differential Diagnosis
3.6.3 Cascading Inflammation of AR Causing Complications and Comorbidities
3.6.4 Management of AR: Therapeutic Options (Fig. 3.18)
3.6.5 Leukotriene Receptor Antagonists
3.6.6 Difficult-to-Treat AR
3.6.7 Allergen Immunotherapy (AIT)
3.6.8 Allergens and Non-Allergic Triggers
3.6.9 SLIT as Food Allergen Immunotherapy
3.6.10 Allergen Avoidance, Complimentary Lifestyle, and Prevention
3.6.10.1 Allergen Avoidance:
3.6.10.2 Complimentary Lifestyle
3.6.10.3 Prevention of Allergy:
3.7 Part G: Vasomotor Rhinitis
3.7.1 Introduction
3.7.2 Pathogenesis
3.7.3 Clinical Features
3.7.4 Diagnosis
3.7.5 Treatment
3.8 Part H: Non-Invasive Fungal Sinusitis
3.8.1 Introduction
3.9 Part I: Invasive Fungal Sinusitis
3.9.1 Clinical Presentations
3.9.2 Diagnosis
3.9.3 Imaging
3.9.4 Pathology
3.9.5 Treatment
3.9.6 Outcome and Follow-Up
References
4: Granulomatous Disease and Faciomaxillary Trauma
4.1 Part A: Granulomatous Disease of the Nose and Paranasal Sinuses
4.1.1 Introduction
4.1.2 Other Granulomatous Pathology
4.2 Part B: Atrophic Rhinitis
4.2.1 Pathology
4.2.1.1 Clinical Features
4.2.1.2 Investigations
4.2.2 Management Aim
4.2.3 Surgical Management
4.3 Part C: Maxillofacial Trauma
4.3.1 Introduction
4.3.1.1 Assessment of a Maxillofacial Trauma Patient
4.3.2 Imaging
4.3.3 Timing of Surgical Intervention
4.3.4 Airway Management During Surgery
4.3.4.1 Mandibular Fractures
4.3.5 Management of Nasal Bone Fractures
4.3.6 Zygomatic Fractures
4.3.7 Fractures of Midface
4.3.8 Orbital Fractures
4.3.9 Postoperative Care
References
5: Diagnostic Method and Instrumentation in Rhinology
5.1 Part A: Diagnosis of Fungal Infections of Nose and Paranasal Sinuses
5.1.1 Introduction
5.1.2 Diagnosis of Invasive FRS
5.1.3 Specimens
5.1.4 Sample Transport
5.1.5 Sample Processing
5.1.6 Culture and Antifungal Susceptibility Testing (AFST)
5.1.7 Serologic Tests
5.1.7.1 Beta-1,3,-Glucan (BDG)
5.1.7.2 Galactomannan Antigen Detection
5.1.7.3 Aspergillus-Specific Lateral Flow Device (LFD)
5.1.7.4 Polymerase Chain Reaction (PCR)
5.2 Part B: Intervention Radiology for Rhinology
5.2.1 Pre-Requisites
5.2.2 Image-Guided Sampling
5.2.3 DSA Assessment of Vascularity and Collateralization
5.2.4 DSA Embolization in Trauma Setting
5.2.5 DSA Embolization in Epistaxis
5.2.6 DSA Embolization in Tumors
5.2.7 DSA Embolization in AVMs
5.2.8 Sclerotherapy for Sinonasal Low-Flow Malformations
5.2.9 Complications
5.3 Part C: Nuclear Medicine Perspective
5.3.1 Introduction
5.3.1.1 Skull Base Osteomyelitis
Three Phase Bone Scintigraphy
18F FDG PET/CT
WBC Labeled Imaging
Tumor Imaging
5.4 Part D: Bacteriology and Virology
5.4.1 Introduction
5.4.1.1 Bacteriology of Nose and PNS
5.4.2 Staining Procedures
5.4.3 Culture Media Are Required to Isolate the Bacteria from the Clinical Specimens
5.4.3.1 Storage of Media
5.4.4 Nucleic Acid Amplification Techniques (NAAT)
5.4.5 Antibiotic Sensitivity, Resistance, and Prevention
5.4.6 Viruses in ENT
5.4.7 Laboratory Diagnosis of Viral Diseases
5.4.7.1 Detection Methods for Viruses
5.5 Part E: Advanced Instruments in Rhinology
References
6: Tumours of Nose and Paranasal Sinuses
6.1 Part A: Benign Lesions of Nose and Paranasal Sinuses
6.1.1 Introduction
6.1.2 Clinical Presentation
6.1.3 Benign Tumours of Epithelial Origin Sinonasal Papilloma
6.1.3.1 Inverted Papilloma (Shneiderian Papilloma, Inverting Type)
6.1.4 Clinical Presentation
6.1.5 Schneiderian Papilloma (Oncocytic Type)
6.1.6 Schneiderian Papilloma (Exophytic Type)
6.1.7 Salivary Gland Adenoma
6.1.8 Benign Tumours of Bony and Cartilaginous Origin
6.1.8.1 Osteoma
6.1.8.2 Chondroma
6.1.9 Fibroosseus Lesion
6.1.9.1 Fibrous Dysplasia
6.1.9.2 Ossifying Fibroma
6.1.10 Benign Vascular Tumours
6.1.10.1 Lobular Capillary Haemangioma (Pyogenic Granuloma)
6.1.11 Other Rare Lesions
6.2 Part B: Angiofibroma, Its Medical and Surgical Management
6.2.1 Extensions
6.2.1.1 Staging System
6.2.1.2 Histopathology
6.2.1.3 Treatment
6.3 Part C: Cancer of Nose and Paranasal Sinuses
6.3.1 Aetiology
6.3.2 Patterns of Tumour Spread
6.3.3 Clinical Features
6.3.4 Histopathology
6.3.5 Stage with Description
6.3.5.1 T Staging
6.4 Part D: Nasopharyngeal Carcinoma
6.4.1 Summary
6.4.2 Anatomy of Nasopharynx
6.4.3 Benign Tumours
6.4.4 Nasopharyngeal Carcinoma
6.5 Part E: Pathology of Lesions of the Nose and Paranasal Sinuses
6.5.1 Sinonasal Neoplasms
6.5.2 Carcinomas
6.5.2.1 Squamous Cell Carcinoma (SCC)
6.5.2.2 SMARCB1-Deficient Sinonasal Carcinoma
6.5.2.3 NUT Carcinoma
6.5.2.4 Adenocarcinoma
6.5.2.5 Neuroendocrine Carcinomas (NECs)
6.5.2.6 Sinonasal Undifferentiated Carcinoma (SNUC)
6.5.3 Sinonasal Papillomas
6.5.4 Mesenchymal Neoplasms
6.5.4.1 Rhabdomyosarcoma (RMS)
6.5.4.2 Schwannoma
6.5.4.3 Nasopharyngeal Angiofibroma
6.5.5 Other Malignant Neoplasms
6.5.5.1 Olfactory Neuroblastoma
6.5.5.2 Sinonasal Teratocarcinosarcoma
6.5.5.3 Extranodal NK/T Cell Lymphoma, Nasal Type
6.5.6 Fibroosseous Lesions
6.5.6.1 Ossifying Fibroma
6.5.6.2 Fibrous Dysplasia
6.5.7 Nasal Polyps
6.5.7.1 Inflammatory Nasal Polyp
6.5.7.2 Antrochoanal Polyp
6.5.7.3 Allergic Nasal Polyp
References
7: Extended Procedures
7.1 Part A: Extended Endoscopic Approach
7.1.1 Contraindications of EEAs
7.1.2 Limits of EEAs
7.2 Part B: Anatomy and Surgical Approaches to Pterygopalatine Fossa, Pterygomaxillary Fissure and Infratemporal Fossa
7.2.1 Surgical Approach to PPF and ITF
7.3 Part C: Pituitary Tumours and Surgical Management
7.3.1 Anatomy
7.3.2 Physiology
7.3.3 Postoperative Care
7.3.4 Pearls of Pituitary Surgery
7.4 Part D: Open Techniques for Nose and Paranasal Sinuses
7.4.1 Indications for Open Approaches
7.4.2 Relative Contraindications for Surgical Resection of Nose/Paranasal Sinus Tumours
7.4.3 Preoperative Work-Up
7.4.4 Classification of Approaches to Nose and PNS
7.4.5 Soft Tissue Approaches
7.4.6 Bony Approaches
7.5 Part E: Open Anterior Skull Base Approaches: Indications and Complications
7.5.1 Diagnostic Work-Up
7.5.2 The Subcranial Approach
7.5.3 Reconstruction
7.5.4 Complications
7.6 Part F: Lacrimal Sac Anatomy and DCR
7.6.1 Pathology—Dacryocystitis
7.6.2 Preoperative Tests/Investigations
7.6.2.1 Surgical Technique for Endoscopic DCR
Surgical Technique of External DCR
Recent Development
Limitations of EndoDCR
7.7 Part G: Sinus Mucocele
7.7.1 Aetiology
7.7.2 Pathology
7.7.3 Clinical Features
7.7.4 Imaging
7.7.5 Treatment
7.7.6 Results
7.7.7 Complications
7.8 Part H: Choanal Atresia and Management
7.8.1 Aetiology
7.8.2 Patho-physiology
7.8.3 Clinical Presentation
7.8.4 Diagnosis and Evaluation
7.8.5 Treatment
7.8.6 Preliminary Airway Management
7.8.7 Definitive Surgical Management
7.8.7.1 Surgical Approaches
7.8.8 Prevention of Restenosis After Surgery
7.8.9 Use of Laser in Surgery
7.8.10 Syndromes Associated with Choanal Atresia
7.9 Part I: Cerebrospinal Fluid Rhinorrhea
7.9.1 Applied Physiology
7.9.2 Applied Anatomy
7.9.3 Classification
7.9.4 Patient Evaluation
7.9.5 Differential Diagnosis
7.9.6 Investigations
7.9.7 Treatment
7.9.8 Grafting Techniques
7.10 Part J: Optic Nerve Anatomy and Management
7.11 Part K: Skull Base Reconstruction in Extended Endoscopic Approaches
7.11.1 Introduction
7.11.2 Principles of Skull Base Reconstruction
7.11.3 Endonasal Mucosal Flaps
References
8: Prevention and Management of Complications
8.1 Part A: Cavity Management
8.1.1 Nasal Packing Post-Surgery
8.1.2 Post-Operative Assessment of Surgical Outcomes
8.1.3 Nasal Douching
8.1.4 Post-Operative Complications and Their Management
8.1.5 Recent Advances
8.1.6 Other Therapies
8.2 Part B: Antifungal Therapy
8.2.1 Introduction
8.2.2 Classification of Antifungals [18]
8.2.3 Antifungal Agents Used for Treatment of Fungal Sinusitis
8.2.4 Antifungal Drug Resistance
8.2.5 Duration of Medical Therapy for Fungal Sinusitis
8.2.5.1 Combination of Antifungal
8.2.5.2 Recent Advances
8.3 Part C: Fess Complications
8.3.1 Nasal Complications
8.3.1.1 Adhesion (Synechiae)
8.3.1.2 Haemorrhage
8.3.1.3 Sinus Ostium Stenosis
8.3.1.4 Mucocele/Pyocele
8.3.1.5 Nasolacrimal Duct Injury
8.3.1.6 Empty Nose Syndrome
8.3.1.7 Olfactory Impairment
8.3.2 Orbital Complications
8.3.2.1 Subcutaneous Emphysema
8.3.2.2 Damage to Lamina Papyracea, Periorbita and Orbital Fat Prolapse
8.3.2.3 Injury to Extraocular Muscles
8.3.2.4 Orbital Hematoma
8.3.2.5 Injury to Optic Nerve
8.3.3 Intracranial Complications
8.3.3.1 CSF Fistula
8.3.3.2 Meningitis
8.3.3.3 Pneumocephalus
8.4 Part DA: Biofilms: Its Composition, Detection Methods and Role in Human Infections (Microbiologist Aspect)
8.4.1 Introduction of Biofilms
8.4.2 Composition of Biofilms
8.4.3 Biofilms Formation
8.4.3.1 Attachment
8.4.3.2 Growth of Colonies
8.4.3.3 Detachment
8.4.4 Biofilms and Antibiotic Resistance
8.4.5 Role of Biofilms in Human Infections
8.4.6 Biofilms Detection Methods
8.4.7 Methods to Control Biofilms [87]
8.4.8 Future Aspects of Biofilm
8.5 Part DB: Biofilms: Surgeon’s Aspect
8.5.1 Treatment
8.6 Part E: Empty Sinus Syndrome
8.6.1 Introduction
8.6.2 Pathophysiology
8.6.3 Diagnosis
8.6.4 Management
8.6.5 Conclusion
References
9: Septum, Adenoid, and Epistaxis
9.1 Part A: Nasal Septum, Septal Correction, and Septal Perforation
9.1.1 Introduction
9.1.2 Anatomy
9.1.2.1 Blood and Nerve Supply
9.1.3 Development
9.1.4 Pathology
9.1.5 Classification of DNS
9.1.6 Surgical Management
9.1.6.1 Steps of Surgery
Modifications
Complications [4]
9.1.7 Nasal Septal Perforation
9.2 Part B: Adenoid Hypertrophy and Management
9.2.1 Clinical Grading of Adenoid
9.2.2 Radiological Staging
9.2.3 Management
9.2.4 Indications
9.2.5 Surgical Techniques
9.2.6 Complications of Adenoidectomy
9.3 Part C: Epistaxis and Management
9.3.1 Causes
9.3.1.1 Local
9.3.1.2 General
9.3.2 Risk Factors
9.3.3 Management
9.3.4 Surgical Management
9.3.4.1 Endoscopic Sphenopalatine Artery (SPA) Ligation
9.3.4.2 Anterior Ethmoidal Artery Ligation
9.3.4.3 Maxillary Artery Ligation
9.3.4.4 External Carotid Artery Ligation
9.3.4.5 Internal Carotid Bleeding
9.3.4.6 Medical Management for Epistaxis
9.3.4.7 Hereditary Hemorrhagic Telangiectasia
References
10: Radiotherapy, Chemotherapy, and Quality of Life
10.1 Part A: Radiation Therapy in Nasal Cavity, Paranasal Sinus, and Nasopharyngeal Tumors
10.1.1 Introduction
10.1.2 Radiation in Nasal Cavity Tumors
10.1.3 Indications of Radiotherapy in Paranasal Sinus Tumors
10.1.4 Radiation Therapy for Nasopharyngeal Cancer
10.1.5 External Beam Radiotherapy Planning
10.1.6 Time, Dose, and Fractionation
10.1.7 Techniques of Radiation
10.1.8 Radiation Toxicities
10.1.9 Radiotherapy in Specific Histological Subtype
10.1.10 Radiotherapy in Benign Tumors
10.1.11 Future Directions
10.2 Part B: Chemotherapy Perspectives in Nasal and Paranasal Sinus Tumors
10.2.1 Summary
10.2.2 Strategies for Chemotherapies in Head and Neck Cancers
10.2.3 Chemotherapy in Different Tumors of Nose and Paranasal Sinuses
10.3 Part C: Perioperative and Postoperative Measures to Improve Quality of Life After Nasal Surgery
10.3.1 Quality Indicators
10.3.2 Preoperative Measures
10.3.3 Perioperative Measures
10.3.4 Postoperative Measures
10.3.5 Follow-Up
10.4 Conclusion
References