Apostolos Karligkiotis

Objectives: Orbital infections of acute rhinosinusitis are commonly classified thanks to the Chandler classification and may lead to vision loss or diplopia if not properly managed. While pediatric cases are well documented and their management is supported by clear evidence, data guiding adult management remain limited and fragmented. This study analyzes a large international cohort of patients that evaluates treatment approaches and outcome predictors for orbital complications ( OCs ) of acute sinusitis in adulthood. Methods: This multicentric retrospective study included adults with OCs of acute sinonasal infections. Patients were classified using the Chandler classification, with an additional subdivision for pre‐septal infections (modified Chandler classification). Clinical, radiologic, and therapeutic data were analyzed, evaluating treatment success, hospital stay, and complications. Predictors of treatment and outcomes were studied ( p < 0.05). Results: Among 213 patients (65.3% male, median age 48), 68.2% required surgery, mainly endoscopic (60.7%). Logistic regression identified the presence of additional complications ( p = 0.015) and modified Chandler classification ( p < 0.001) as the strongest predictors for treatment modality, while sinus opacification and visual impairment lost significance in the multivariate model. Infection resolution after primary treatment was significantly associated with nasal corticosteroid use ( p = 0.037). Despite differences in treatment approach and hospitalization duration across modified Chandler categories, no significant differences were observed in final ophthalmologic outcomes. Conclusion: This study emphasizes the role of the modified Chandler classification for upfront treatment decisions. Abscess‐related and type II OCs often needed surgery, yet all cases achieved similarly optimal ophthalmologic outcomes and final infectious resolution. Level of Evidence: 4.

Background: Choanal atresia is a congenital obstruction of the posterior nasal aperture. Endoscopic endonasal surgery has led to successful choanal atresia repair. This paper describes our surgical technique using septal mucosal flaps without the need for stenting.Methods: This study comprised a multicentre retrospective review of patient notes. A cross-over septal technique is described, whereby bilateral vertical mucosal incisions are made at the posterior third of the septum, and the atretic plate and posterior vomer are removed. One flap is pedicled superiorly and rotated over the bare skull base and sphenoid bone; the contralateral flap is pedicled inferiorly to cover the exposed vomer remnant and hard palate.Results: There were 12 patients from 2013 to 2020, aged 0.07–50 years, with a male to female ratio of 1:5. Ten patients had unilateral and two had bilateral choanal atresia. Nine patients had bony choanal atresia, with the remainder mixed.Conclusion: The cross-over technique for choanal atresia has low morbidity and 100 per cent success in our series. The use of mucoperiosteal flaps to cover exposed bone and minimal instrumentation to the lateral nasal wall reduce post-operative stenosis.

Objective: Petrous apex cholesterol granuloma (PACG) is a lesion that can give rise to different symptoms, and correlations with etiopathology are ambiguous. The aim of this study is to analyze the association between PACG symptoms and radiological findings at presentation, in order to establish a reproduceable pre-operative radiological evaluation and guide the surgical indication. Methods: PACG patients were collected in two tertiary care hospitals. All cases underwent CT/MRI to evaluate the cyst localization and erosion of surrounding structures. Typical and atypical symptoms were then analyzed and compared to radiologic findings established in accordance with the literature. Results: Twenty-nine patients were recruited; the most common symptoms were headache (69%), diplopia (20.7%) and fainting (24.1%), an atypical clinical manifestation related to jugular tubercle involvement. Significant associations between symptoms and radiologic findings were noted in terms of headache and temporal lobe compression (p = 0.04), fainting and jugular tubercle erosion (p < 0.001), vestibular symptoms and internal auditory canal erosion (p = 0.02), facial paresthesia and Meckel’s cave compression (p = 0.03), diplopia and Dorello canal involvement (p = 0.001), and tinnitus and cochlear basal turn erosion (p < 0.001). All patients were treated via an endoscopic–endonasal approach, in which extension was tailored to each case. At a median follow-up of 46 months, 93.1% of patients experienced resolution of symptoms. Conclusions: This clinico-radiological series demonstrates associations between symptoms and anatomical subsites involved with PACG. Hence, it may guide the surgeon at the time of surgical decision, since it asserts that typical and atypical symptoms are actually related to PACG.

‐ Surgical repair is required for persistent CSF leaks due to trauma or following endoscopic skull base resections ‐ The endoscopic endonasal approach is associated with low morbidity and high success rates; 90% at first attempt and overall in 97% ‐ A variety of materials are used for the reconstruction and closure of CSF leaks with no overall consensus; the multilayered approach to defect closure is currently deemed best practice ‐ The anterior ethmoid septal flap can be successfully utilized for frontal CSF leak repair ‐ Anterior ethmoid flap is conveniently located for frontal sinus defects; and so provides excellent final layer of multilayer reconstruction when septum is intact

Objectives/Hypothesis: The aim of the present study is to validate and compare four of the most widely used staging systems for juvenile angiofibroma on a homogeneous cohort of patients.Study Design: Retrospective case series.Methods: A retrospective review of patients treated with endoscopic or endoscopic‐assisted surgical resection between 1999 and 2020 was carried out. Each case was classified according to the following staging systems: Andrews‐Fisch (1989), Radkowski (1996), University of Pittsburgh Medical Center (2010), and Janakiram (2017). Spearman's rank correlation test and areas under the curve of receiver operator curves were used to assess the correlation between outcomes of interests (blood loss, surgical time, need for transfusion, and persistence of disease) and stage of disease.Results: Seventy‐nine patients were included, with a median follow‐up time of 25 months (range 12–127 months). Median surgical time was 217 minutes (range 52–625). Median blood loss was 500 mL (range 40–5200) and 27 patients (34.2%) required blood transfusions. Seven patients (8.9%) showed persistence of disease. All classification systems showed a similar association with blood loss, surgical time, persistence of disease, and need for transfusion.Conclusions: Involvement of the infratemporal fossa and intracranial extension was identified as red flags for surgical planning and preoperative counseling, as associated with increased risk for transfusion and persistent/recurrent disease, respectively. No classification system was found to be better than the others in predicting the most important outcomes. Therefore, the simplest and most easily applicable system would be the preferred one to be used in clinical practice.Level of Evidence: 4 Laryngoscope, 132:1160–1165, 2022

Objective/Hypothesis: This study describes a multicentric experience with the use of prelacrimal approach (PLA), focusing on preoperative radiological parameters potentially associated with surgical outcomes and postoperative morbidity.Study Design: Retrospective case‐series.Methods: A retrospective review of patients undergoing PLA in three European referral centers was performed. The post‐operative morbidity was analyzed in relation to two radiological parameters: width of prelacrimal recess (WPR) and internal angle of pyriform notch (APN).Results: The study included 28 patients affected by Schneiderian papilloma (20 cases), inflammatory disease (6 cases), schwannoma (1 case), and osteoma (1 case). The most reported sequela was paresthesia of ipsilateral anterior superior alveolar process (25% of the cases). An association between post‐operative morbidity and APN was observed (P = .047).Conclusions: Preoperative radiological evaluation of WPR is crucial in understanding the feasibility of the approach, while APN measurement may predict postoperative morbidity, which is paramount in the patients' counseling.Level of Evidence: 4 case‐seriesLaryngoscope, 131:1715–1721, 2021

Paranasal sinus,nasal cavity,benign tumor,endoscopic surgical procedure,salivary gland,pleomorphic adenoma

Squamous cell carcinoma of nasal vestibule and pyramid is rare, thus classification, treatment protocol, and indications for elective neck treatment are still controversial. Nasal reconstruction is challenging, as well, and prosthesis is still used. Retrospective cohort study. Retrospective review of patients surgically treated from 2010 to 2018 in a single Institution. Advanced tumors were further treated with adjuvant irradiation. Reconstruction strategy included grafts, locoregional and free flaps, and was customized on layers removed. Forty-five patients were enrolled. The 5-year overall survival and disease-free survival were 81.9% ± 7.45% and 61.9% ± 9.09%, respectively. Wang's classification, site of origin, extent of surgery and margins status significantly correlated with prognosis and recurrence rate. Regional recurrences occurred in patients affected by advanced tumors who did not receive any form of elective neck treatment. Multidisciplinary management and a proper reconstructive algorithm are recommended. Adjuvant irradiation and elective neck treatment should be advocated for advanced stage high-risk patients. 4. Laryngoscope, 2020.