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Abstract Introduction The endoscopic access has reduced the morbidity associated with external approaches in diseases of themaxillary sinus. A reversible endoscopic medialmaxillectomy (REMM) is presented as an alternative for treatment of benign maxillary diseases. Objective To describe the REMM technique and report four cases of patients with benign maxillary sinus conditions treated through this approach. Methods The present study was divided into two parts: anatomical and case series. Two cadaveric dissections confirmed the feasibility of the REMMapproach. The same technique was performed on four consecutive patients with benign maxillary sinus disease. Results The cadaveric dissections confirmed wide exposure to the maxillary cavity, preserving the anatomy of the maxillary sinus. In the patient series, one patient presented with an antrochoanal polyp, one had a silent sinus syndrome, one had a chronic maxillary sinusitis secondary to a gunshot, and the last one had an inverted papilloma in the maxillary sinus. In all of the cases, the REMM approach provided excellent access and adequate resection, as well as preservation of the inferior turbinate, nasolacrimal duct, and lateral wall of the nose (including its osteomucosal component). Finally, all of the patients had an uneventful postoperative course. Conclusion The REMM technique is an excellent surgical approach to benign conditions of the maxillary sinus. It has few limitations and appears to be associated with less morbidity than conventional techniques.
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Introduction The endoscopic access has reduced the morbidity associated with external approaches in diseases of the maxillary sinus. A reversible endoscopic medial maxillectomy (REMM) is presented as an alternative for treatment of benign maxillary diseases. Objective To describe the REMM technique and report four cases of patients with benign maxillary sinus conditions treated through this approach. Methods The present study was divided into two parts: anatomical and case series. Two cadaveric dissections confirmed the feasibility of the REMM approach. The same technique was performed on four consecutive patients with benign maxillary sinus disease. Results The cadaveric dissections confirmed wide exposure to the maxillary cavity, preserving the anatomy of the maxillary sinus. In the patient series, one patient presented with an antrochoanal polyp, one had a silent sinus syndrome, one had a chronic maxillary sinusitis secondary to a gunshot, and the last one had an inverted papilloma in the maxillary sinus. In all of the cases, the REMM approach provided excellent access and adequate resection, as well as preservation of the inferior turbinate, nasolacrimal duct, and lateral wall of the nose (including its osteomucosal component). Finally, all of the patients had an uneventful postoperative course. Conclusion The REMM technique is an excellent surgical approach to benign conditions of the maxillary sinus. It has few limitations and appears to be associated with less morbidity than conventional techniques.
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UNLABELLED: The productive work between otolaryngologists and neurosurgeons has resulted in the emergence of endoscopic endonasal skull base surgery. The goal of the present study is to describe the endoscopic anatomy of the endonasal approach to the sellar region and planum sphenoidale, highlighting the key points of the surgical approach and the neurovascular landmarks. METHOD: Descriptive study of the endoscopic endonasal dissection of 9 fresh cadavers with exposure of the anatomic structures. RESULTS: The endoscopic endonasal ethmoidectomy and sphenoidotomy allows an expanded access to the sellar area and planum sphenoidale. The surface anatomy of the sphenoid sinus is easily identifiable and provides safe landmarks, guiding the intracranial dissection. CONCLUSION: The endoscopic endonasal approach to the skull base by the ENT and neurosurgeon is feasible, but it requires adequate anatomical knowledge and endoscopic skills for its realization, which can be obtained by practicing in cadavers.
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Endoscopia/métodos , Cavidade Nasal/cirurgia , Procedimentos Neurocirúrgicos/métodos , Seio Esfenoidal/cirurgia , Cadáver , Dissecação , Humanos , Cavidade Nasal/anatomia & histologia , Sela Túrcica , Seio Esfenoidal/anatomia & histologiaRESUMO
UNLABELLED: In the last decades, medical care has been increasingly permeated by the concept of evidence-based-medicine, in which clinical research plays a crucial role in establishing diagnostic and treatment. Following the improvements in clinical research, we have a growing concern and understanding that some ethical issues must be respected when the subjects are human beings. Research with human subjects relies on the principles of autonomy, beneficence, no maleficence and justice. Ordinance 196/96 from the National Health Board adds to the Brazilian legislation such renowned bioethical principles. AIM: Discuss the main ethical aspects involved in research with human subjects. MATERIALS AND METHODS: Critical analysis of Ordinance 196/96 and related literature. CONCLUSION: Ordinance 196/96 rules research with human subjects; nevertheless, it requires more in-depth discussions regarding the informed consent, use of placebo, research with vulnerable populations and research in developing countries.
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Ética em Pesquisa , Experimentação Humana/ética , Brasil , Experimentação Humana/legislação & jurisprudência , HumanosRESUMO
The productive work between otolaryngologists and neurosurgeons has resulted in the emergence of endoscopic endonasal skull base surgery. The goal of the present study is to describe the endoscopic anatomy of the endonasal approach to the sellar region and planum sphenoidale, highlighting the key points of the surgical approach and the neurovascular landmarks. METHOD: Descriptive study of the endoscopic endonasal dissection of 9 fresh cadavers with exposure of the anatomic structures. RESULTS: The endoscopic endonasal ethmoidectomy and sphenoidotomy allows an expanded access to the sellar area and planum sphenoidale. The surface anatomy of the sphenoid sinus is easily identifiable and provides safe landmarks, guiding the intracranial dissection. CONCLUSION: The endoscopic endonasal approach to the skull base by the ENT and neurosurgeon is feasible, but it requires adequate anatomical knowledge and endoscopic skills for its realization, which can be obtained by practicing in cadavers.
O trabalho cooperativo entre otorrinolaringologistas e neurocirurgiões resultou no aprimoramento das técnicas cirúrgicas e no surgimento da cirurgia endoscópica endonasal da base do crânio. O estudo tem como objetivo descrever a anatomia endoscópica do acesso endonasal da região selar e plano esfenoidal, destacando os pontos fundamentais do acesso cirúrgico e referências neuro-vasculares. MÉTODO: Estudo descritivo da dissecção endoscópica endonasal de 9 cadáveres frescos com exposição das estruturas anatômicas. RESULTADOS: A etmoidectomia e esfenoidotomia endonasal endoscópica permite um acesso estendido à região selar e plano esfenoidal. A anatomia de superfície do seio esfenoidal é facilmente identificada e fornece pontos de referência seguros, guiando a dissecção intracraniana. CONCLUSÃO: O acesso endoscópico endonasal para a base do crânio pelo otorrinolaringologista e neurocirurgião é perfeitamente viável, mas para isso o conhecimento anatômico da região e de seus pontos de referência é essencial, o que pode ser obtido pelo treinamento em cadáveres.
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Humanos , Endoscopia/métodos , Cavidade Nasal/cirurgia , Procedimentos Neurocirúrgicos/métodos , Seio Esfenoidal/cirurgia , Cadáver , Dissecação , Cavidade Nasal/anatomia & histologia , Sela Túrcica , Seio Esfenoidal/anatomia & histologiaRESUMO
In the last decades, medical care has been increasingly permeated by the concept of evidence-based-medicine, in which clinical research plays a crucial role in establishing diagnostic and treatment. Following the improvements in clinical research, we have a growing concern and understanding that some ethical issues must be respected when the subjects are human beings. Research with human subjects relies on the principles of autonomy, beneficence, no maleficence and justice. Ordinance 196/96 from the National Health Board adds to the Brazilian legislation such renowned bioethical principles. AIM: Discuss the main ethical aspects involved in research with human subjects. MATERIALS AND METHODS: Critical analysis of Ordinance 196/96 and related literature. CONCLUSION: Ordinance 196/96 rules research with human subjects; nevertheless, it requires more in-depth discussions regarding the informed consent, use of placebo, research with vulnerable populations and research in developing countries.
Nas últimas décadas, a medicina tem sido cada vez mais permeada pelo conceito de medicina baseada em evidências, na qual a pesquisa clínica possui papel crucial no estabelecimento de diretrizes diagnósticas e terapêuticas. Com o avanço da pesquisa clínica, surgiu a preocupação e o entendimento que certos padrões éticos devam ser obedecidos quando o objeto de estudo é o ser humano. A pesquisa em seres humanos baseia-se nos princípios da autonomia, beneficência, não maleficência e justiça. A Resolução 196/96 do Conselho Nacional de Saúde incorpora à legislação brasileira tais princípios bioéticos consagrados. OBJETIVO: Discutir os principais aspectos éticos envolvidos na pesquisa em seres humanos. MATERIAL E MÉTODO: Análise crítica da Resolução 196/96 do CNS e literatura correlata. CONCLUSÃO: A Resolução 196/96 do Conselho Nacional de Saúde regulamenta a experimentação em seres humanos, no entanto necessita de discussões mais profundas no que diz respeito ao consentimento livre e esclarecido, ao uso de placebo, à participação de pessoas em situação de vulnerabilidade e à realização de pesquisas em países em desenvolvimento.
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Humanos , Ética em Pesquisa , Experimentação Humana , Brasil , Experimentação Humana/legislação & jurisprudênciaRESUMO
UNLABELLED: Anterior ethmoidal artery (AEA) ligation may be necessary in cases of severe epistaxis not controllable with traditional therapy. Endoscopic endonasal ligation of the AEA is not used frequently; there are few studies in the literature for standardization of the endoscopic technique for this vessel. AIM: To demonstrate the feasibility of periorbital AEA ligation in a transethmoidal endoscopic approach. METHODS: A prospective study where 50 nasal cavities were dissected. After anterior ethmoidectomy and partial removal of lamina papyracea, the periorbital area was carefully dissected along a subperiosteal plane to identify the AEA. The vessel was exposed within the orbit and dissected. RESULTS: Data on technical difficulties, complications, the learning curve and anatomical variations were gathered. CONCLUSION: An endonasal endoscopic approach to the AEA within the orbit was shown to be feasible. Identifying the artery is not difficult, and this technique avoids external incisions. This approach appears to be an excellent alternative for approaching the AEA. Further clinical studies are needed to demonstarte the benefits of this technique.
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Dissecação/métodos , Endoscopia/métodos , Seio Etmoidal/irrigação sanguínea , Cavidade Nasal/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Artérias/anatomia & histologia , Cadáver , Endoscopia/normas , Seio Etmoidal/cirurgia , Estudos de Viabilidade , Feminino , Humanos , Ligadura , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
Ligadura da artéria etmoidal anterior (AEA) pode ser necessária em casos de epistaxe grave refratária ao tratamento tradicional. O uso da ligadura endoscópica endonasal da AEA ainda é bastante limitado. Existem poucos estudos na literatura sobre a técnica de abordagem endoscópica desta artéria. OBJETIVOS: Demonstrar a aplicabilidade técnica da ligadura periorbitária da AEA por via endoscópica transetmoidal. MATERIAL E MÉTODOS: Estudo prospectivo. 50 fossas nasais de cadáveres foram dissecadas. Após a realização de uma etmoidectomia anterior e remoção parcial da lâmina papirácea, a periórbita foi cuidadosamente dissecada até a identificação da AEA. Após sua identificação, a artéria foi exposta e ligada dentro da órbita. RESULTADOS: Todas as dificuldades inerentes ao procedimento, as complicações associadas, a curva de aprendizado e variações anatômicas foram coletados. CONCLUSÕES: A abordagem endoscópica da AEA na órbita de cadáveres mostrou-se factível. A identificação da artéria é fácil e a técnica evita incisões externas. Este acesso parece ser uma excelente alternativa para a abordagem da AEA. Estudos clínicos futuros são necessários para comprovar os benefícios desta técnica.
Anterior ethmoidal artery (AEA) ligation may be necessary in cases of severe epistaxis not controllable with traditional therapy. Endoscopic endonasal ligation of the AEA is not used frequently; there are few studies in the literature for standardization of the endoscopic technique for this vessel. AIM: To demonstrate the feasibility of periorbital AEA ligation in a transethmoidal endoscopic approach. METHODS: A prospective study where 50 nasal cavities were dissected. After anterior ethmoidectomy and partial removal of lamina papyracea, the periorbital area was carefully dissected along a subperiosteal plane to identify the AEA. The vessel was exposed within the orbit and dissected. RESULTS: Data on technical difficulties, complications, the learning curve and anatomical variations were gathered. CONCLUSION: An endonasal endoscopic approach to the AEA within the orbit was shown to be feasible. Identifying the artery is not difficult, and this technique avoids external incisions. This approach appears to be an excellent alternative for approaching the AEA. Further clinical studies are needed to demonstarte the benefits of this technique.