Patient‐reported olfaction improves following outside‐in Draf III frontal sinus surgery for chronic rhinosinusitis

Wong, Eugene; Do, Timothy Q.; Harvey, Richard J.; Orgain, Carolyn A.; Sacks, Raymond; Kalish, Larry

doi:10.1002/lary.27352

Cited by 18 publications

(10 citation statements)

References 23 publications

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“…CRS associated olfactory function has been shown to benefit from ESS 94,109‐111 . Significant olfactory improvement was also observed in recalcitrant CRS by Draf III sinus surgery 112 . Revision ESS has been shown to restore odor identification abilities in nearly half of patients studied 113 .…”

Section: Olfaction Indicates the Degree Of Inflammation And May Be A mentioning

confidence: 99%

Olfaction: Sensitive indicator of inflammatory burden in chronic rhinosinusitis

Xing

Whitcroft

Hummel

2020

Laryngoscope Investig Oto

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Background and Objective: Olfactory dysfunction has a high prevalence in chronic rhinosinusitis (CRS) patients and significantly affects quality of life. CRS is recognized as a complex disorder encompassing heterogeneous inflammatory processes in the nose and paranasal sinuses. Olfactory dysfunction in CRS patients is associated with the level of inflammatory mediators and the efficiency of inflammatory control. Learning about the association between CRS-related inflammation and olfactory function will provide clues to the pathogenesis of CRS. Structure: The first section of this review describes the assessment of olfactory function using various measures, from ratings to MR based imaging. Then, we discuss the conductive and inflammatory mechanisms related to olfactory dysfunction in CRS: olfaction is associated with certain inflammatory patterns and is potentially a marker of CRS subtype. Finally, we review anti-inflammatory therapies including conservative and surgical approaches, and their effectiveness in olfactory dysfunction in CRS. Conclusion: Assessment of olfactory function should be considered in the clinical evaluation of CRS patients, not only for detecting and quantifying patients' symptom, but also because it appears to be useful to objectively assess the efficacy of CRS treatment over time. In addition, olfaction can be expected to expand the library of CRS phenotypes and endotypes and, hence, pave the way for more precise, tailored treatment options.

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Section: Olfaction Indicates the Degree Of Inflammation And May Be A mentioning

confidence: 99%

Olfaction: Sensitive indicator of inflammatory burden in chronic rhinosinusitis

Xing

Whitcroft

Hummel

2020

Laryngoscope Investig Oto

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“…Beginning from a worse baseline, all patients who underwent endoscopic sinus surgery, showed much more improvement in thick nasal discharge (odds ratio [OR] = 4.36), facial pain/pressure (OR = 3.56), and blockage/congestion of nose (OR = 2.76) [23]. Regarding olfaction, a review of 104 patients undergoing Draf 3 was published in 2019 and the mean change in olfaction-subscore was 1.54 points, where the mean change in the same subscore in our study was measured at 0.87 points at first follow-up [24].…”

Section: Frontal Sinus Surgerymentioning

confidence: 55%

Quality of Life Outcomes in Frontal Sinus Surgery

Georgalas

Detsis

Geramas

et al. 2020

JCM

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Introduction: Although significant experience has been gained in the technical nuances of endoscopic sinus surgery procedures, the patient-reported outcomes of frontal endoscopic sinus surgery procedures are still poorly understood. In this study we used the validated patient outcome measure Sino Nasal Outcome Test-22 (SNOT-22) to assess the preoperative and postoperative quality of life in patients undergoing extended endoscopic frontal sinus surgery (Draf type 2 and Draf type 3 procedures). Methods: Out of a total of 680 patients undergoing endoscopic sinus and skull base surgery and 186 patients undergoing frontal sinus surgery, 99 chronic rhinosinusitis patients with (CRSwNP) or without (CRSnNP) nasal polyps undergoing Draf 2 or Draf 3 were assessed. Results: The mean preoperative SNOT-22 was 45.6 points for patients undergoing Draf 2 and 59 for patients undergoing Draf 3, while the mean radiological Lund–Mackay Score was 14.3 and 14.5, respectively. Mean SNOT 22 improvement was 22.9 points for Draf 2 and 37 points for Draf 3 respectively and remained significant in all time intervals, including at 4 years after surgery. With the exception of loss of smell/taste, all symptoms improved by a far bigger extent in Draf 3 group, despite the considerably worse starting point. Effect size (Cohen / Standard Deviations) of Draf 3 was greatest in the following symptoms: “being frustrated/restless/irritable” (1.63), “nasal blockage” (1.43), “reduced concentration” (1.35), “fatigue” (1.29) “runny nose” (1.26) and “need to blow nose” (1.17). Frontal sinus (neo) ostium was patent (fully or partly) at last follow up in 98% of Draf 2 patients and in 88% of patients following Draf 3. Patients with non-patent frontal (neo-) ostium however had a mean postoperative SNOT 22 score of 43 compared to 20 of those with patent frontal sinus (neo-) ostium, although the difference was not statistically significant. Conclusion: Patients undergoing Draf 3 have a greater burden of disease, including both nasal and emotional/general symptoms compared to Draf 2 patients; surgery results in improvement in both groups, although Draf 3 patients have the greatest benefit, especially in emotional / general symptons. In this way both groups achieve similar postoperative quality of life, despite the different starting points.

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“…The FOF was used as the posterior boundary of the traditional approach of EMLP ( 14 ). It should also be identified as early as possible to reduce the risk of anterior skull-base injury with an outside-in approach according to previous research ( 11 , 15 , 16 ).…”

Section: Discussionmentioning

confidence: 99%

Trans-Nasion-Complex Approach for Endoscopic Modified Lothrop Procedure: Conception, Anatomy, and Technique

et al. 2022

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BackgroundThe endoscopic modified Lothrop procedure (EMLP) is an important procedure used to address frontal and anterior skull-base lesions. Two techniques were established, namely, the inside-out approach and the outside-in approach. The former technique take the frontal recess and the first olfactory filament (FOF) as key landmarks while the latter use the FOF as posterior boundary. In some cases, however, these two landmarks are not available. Therefore, we supplement the outside-in approach and named it trans-nasion-complex approach (TNCA) for EMLP that can be performed without locating these two landmarks.MethodsTwo dry human skulls were used to observe the bony nasion complex. Then, five colored silicon-injected human head specimens were dissected via TNCA for EMLP. Finally, the outcomes of patients who underwent TNCA were reviewed.ResultsThe nasion complex is an osseous complex that consists of the nasion and its adjacent structures, including the bilateral root of nasal bones, nasal process of frontal bones, anterior portion of the perpendicular plate of the ethmoid bone that connects with the inferior aspect of the nasal bones, and portions of the bilateral frontal process of the maxillary bones. Surgical landmarks for TNCA include the anterior superior portion of the nasal septum, anterior margin and axilla of the middle turbinate, frontal process of the maxilla bone, nasal process of the frontal bone and upper part of the nasal bone. These structures form a “mushroom sign” during cadaveric dissection and surgery. Twenty-one patients underwent TNCA, of whom 9 had tumors and 12 had chronic rhinosinusitis with nasal polyps (CRSwNP). None of them had major complications.ConclusionTNCA is expected to be a safe, and direct route for EMLP. Adequate understanding of the nasion complex and “mushroom sign” will be helpful to complete TNCA.

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Patient‐reported olfaction improves following outside‐in Draf III frontal sinus surgery for chronic rhinosinusitis

Abstract: Level 4. Laryngoscope, 2018.

Cited by 18 publications

References 23 publications

Olfaction: Sensitive indicator of inflammatory burden in chronic rhinosinusitis

Olfaction: Sensitive indicator of inflammatory burden in chronic rhinosinusitis

Quality of Life Outcomes in Frontal Sinus Surgery

Trans-Nasion-Complex Approach for Endoscopic Modified Lothrop Procedure: Conception, Anatomy, and Technique

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