Bing Zhou

Objective: This study aims to compare image feature identification and diagnostic performance between artificial intelligence‐aided image‐enhanced endoscopy (using the Storz Professional Image Enhancement System, SPIES) and conventional white‐light endoscopy (WLE) for sinonasal inverted papilloma (SIP). Methods: A total of 163 patients were investigated using Storz Professional Image Enhancement System (SPIES) endoscopy (SPIES Spectral A[SA]/Spectral B[SB]) and WLE. From each patient, one or two images (only in the presence of bilateral lesions) were obtained, and a large number of potential features were extracted from WLE, SA, and SB. Independent t‐tests and LASSO methods were used to feature selection. Machine learning (ML) models were trained and evaluated for each channel of images. Results: The Random Forest (RF) algorithm on SPIES SB mode achieved superior performance: accuracy = 0.86, sensitivity = 0.89, specificity = 0.83, AUC = 0.86, and Kappa = 0.71. SB significantly outperformed SA (accuracy = 0.77) and WLE (accuracy=0.75). ROC analysis confirmed SB's diagnostic superiority (area under curve [AUC]: SB = 0.86 vs. SA = 0.77, WLE = 0.75). Conclusions: SPIES SB mode demonstrated the highest diagnostic accuracy and AUC for SIP identification, highlighting its potential as a superior imaging modality. SPIES endoscopy exhibits superior diagnostic accuracy and predictive performance compared to conventional WLE in the diagnosis of SIP. However, the single‐center design and limited sample size necessitate validation through multicenter studies with larger cohorts.

Background: This study aimed to explore the pterygopalatine fossa (PPF) from a novel bone-preserving perspective and to evaluate the educational value of this approach for otolaryngology trainees in mastering complex PPF anatomy.Methods: Rigid endoscopes were used on three dry skulls (5 sides) to illustrate the bony corridors of the nasal cavity, inferior orbital fissure (IOF), and pterygomaxillary fissure (PMF) to demonstrate the anatomy of the PPF. In addition, three fresh frozen cadaveric heads (5 sides) were dissected to demonstrate the PPF neurovascular contents and bony anatomy and replicate the approach in clinical scenarios via the conventional endoscopic transmaxillary approach (ETMA). The educational outcome was assessed via a trainee questionnaire.Results: The advantage of the endoscopic IOF and the PMF approach is that a complete exposure of the intact bony architecture of the PPF can be performed in dry skulls. Dry skull specimens were rated significantly higher than fresh cadaveric specimens in terms of exposure quality scores, three-dimensional (3D) comprehension, structure identification, learner confidence, reusability, and convenience for clinical teaching.Conclusion: This anatomical study suggests the feasibility of using the IOF and PMF approaches to access the PPF and help surgeons to master the osseous anatomy of the PPF. This method allows for a visual examination of the bony structures within the PPF without destructive dissection. Subjective trainee feedback suggests this method serves as a valuable tool for anatomical education.

Objective: The objectives of this study are: (1) to evaluate the prelacrimal recess‐pterygoid window approach (PLR‐PWA) for treating cerebrospinal fluid leaks and meningoencephaloceles (CSFLME) in the sphenoidal lateral recess (SLR). (2) To investigate the pneumatization of the SLR and its relationship with surrounding structures, including the lateral pterygoid plate and course of the maxillary nerve (V2). Methods: This study retrospectively reviewed 13 patients (mean age [46.53 ± 8.44] years) with spontaneous CSFLME in the SLR who underwent the PLR‐PWA. The primary and secondary outcomes were surgical success rate and complications, respectively. The pneumatization of the SLR was classified according to Rhoton's classification, and its anatomical relationships with surrounding structures were analyzed using CT scans. Results: The PLR‐PWA was utilized in all patients, achieving a 100% surgical success rate at a median follow‐up of 26.8 months. There were 6 (6/13, 54.55%) patients who had immediate postoperative hypoesthesia of the upper lip and face. In all cases, the pneumatization of the SLR extended beyond the lateral aspect of the lateral pterygoid plate, with the full lateral type SLR observed. Notably, in 3 out of 13 cases (23.08%), the V2 coursed below and across the SLR. Conclusion: The PLR‐PWA is indicated for patients with a full lateral type or well‐pneumatized SLR and offers a direct and minimally invasive surgical route to the SLR. The degree of pneumatization of the SLR, the course of the V2, and its anatomical relationship to the SLR are essential factors to be considered when this approach is adopted.

Objectives: To develop methods for early detection of natural killer/T‐cell lymphoma, nasal type (nasal NKTL) and to evaluate the use of apparent diffusion coefficient (ADC) measurements from diffusion‐weighted imaging (DWI) for selecting biopsy sites to enhance the positive biopsy rate. Methods: The clinical data of 32 cases of nasal NKTL were retrospectively collected and analyzed. Cases were graded from 1 to 5 based on endoscopic and imaging findings. Biopsy methods included the superficial forceps method and deep incisional method. Data recorded included biopsy method, time to confirmed diagnosis, number of biopsies required, and ADC values of biopsy sites. Results: Both endoscopic and MRI lesion severity did not affect biopsy outcomes ( p = 0.8248, 0.7571). The deep incisional biopsy method had a significantly higher probability of yielding positive pathological results compared to the superficial clamping method [OR (95% CI) = 23.2143 (6.0448, 89.1513) (χ ² = 26.1089, p < 0.0001)]. The ADC value at the site with a positive biopsy result is significantly lower than at the site with a negative result ( p = 0.0003). The diagnostic threshold for ADC value to predict a positive biopsy result was 0.603 × 10 ⁻³ mm ² /s, with a Youden index of 0.43. Conclusions: Nasal NKTL has distinct characteristics distinguishing it from sinusitis and other tumors. Deep incision biopsy under general anesthesia is superior to the superficial method. The location of the positive sampling site can be guided by measuring the ADC value, and the optimal diagnostic threshold of this proposed method is 0.603 × 10 ⁻³ mm ² /s. Level of Evidence: 4 Laryngoscope , 135:1598–1606, 2025

Objective: This study analyzed the causes of sphenoid sinus (SS) infection (SSI) following endoscopic transsphenoidal skull base surgery and determined appropriate treatment methods.Methods: This study included 31 cases of secondary SSI following the endoscopic transsphenoidal approach (ETSA; SSI group) and 246 cases without SSI (non‐SSI group). Data collected included post‐ETSA pathological results, types of artificial skull base reconstruction materials, and SS patency. For the SSI group, data included time from ETSA to symptom onset, endoscopic and imaging findings, intraoperative conditions during the second surgery, and changes in visual analog scale (VAS) scores.Results: The incidence of secondary SSI was 11.19%. In the SSI group, 26 patients (83.87%) reported headaches, and 24 (77.42%) had stenosis or closure of the SS ostium (SSO). The non‐SSI group reported no symptoms, and 236 patients (95.93%) had well‐opened SSOs. Centripetal hyperosteogeny (CHO) in the SS walls was observed in 20 patients (64.5%) in the SSI group. Absorbable materials were used in five cases (16.13%) and 215 cases (87.40%) in the SSI and non‐SSI groups, respectively, while non‐absorbable materials were used in 24 cases (77.42%) and 20 cases (8.13%), respectively. SSI risk was 9.42 times higher with non‐absorbable synthetic materials. VAS scores for SSI symptoms and Lund–Kennedy scores significantly decreased at 3 and 12 months post‐second surgery.Conclusion: Secondary SSI after ETSA can cause persistent symptoms. Non‐absorbable synthetic repair materials should be avoided to prevent secondary SSI. Extended sphenoidectomy and removal of artificial materials can lead to rapid resolution of SSI symptoms.Level of Evidence: 4.

Background: Sinonasal inverted papilloma (SNIP) is a benign epithelial tumor with distinctive histopathological features. However, the role of inflammation in SNIP remains poorly characterized. Objectives: This study aimed to compare the histopathological patterns and inflammatory characteristics of SNIP with those of chronic rhinosinusitis with nasal polyps (CRSwNPs) or normal ethmoid sinus mucosa. Methods: Fifty-eight tissue biopsies were prospectively collected from 38 patients with SNIPs, 12 CRSwNPs, and 8 normal ethmoid sinus mucosae. SNIP was histopathologically divided into four grades based on the extent of epithelial remodeling. The immunohistochemical characteristics of epithelial remodeling (p63, CK5) and infiltration of inflammatory cells (eg, eosinophils, neutrophils, and macrophages) and cytokines (eg, interleukin-1β, interleukin-6, and tumor necrosis factor-α) were analyzed. Results: Among the 38 SNIPs, 21.1%, 36.8%, 23.7%, and 18.4% were grades I, II, III, and IV, respectively. The expression levels of p63 and CK5 were significantly higher in SNIP than in the other two groups (both, p < 0.05). Neutrophil and macrophage infiltration was more pronounced in SNIP and with differences among the four grades. The expression levels of inflammatory cytokines were significantly higher in the SNIP group than in the CRSwNP group. A positive correlation between the expression levels of p63 and inflammatory cytokines was observed in both SNIPs and CRSwNPs. Conclusion: Excessive epithelial remodeling is an important histological feature of SNIP; it is accompanied by sinonasal mucosal inflammation.

Purpose This large retrospective, single-center, follow-up study investigated the endoscopic prelacrimal recess approach (PLRA) for treating maxillary sinus inverted papilloma (MSIP). Methods Between January 2007 and November 2022, patients with MSIP treated with PLRA were enrolled. Data on clinical manifestations, imaging, and surgical procedures were collected. The visual analog scale (VAS) scores for maxillofacial numbness and nasal symptoms and the SNOT-22 nasal symptom scores were statistically analyzed. Result Of 122 patients (68 males and 54 females) enrolled in the study, with a mean age of 50.75 ± 12.84 years (26–80 years), 111 patients underwent PLRA, nine underwent modified PLRA, one converted to an endoscopic medial maxillectomy (EMM), and one to an endoscopic modified Denker’s approach. The average follow-up was 86.60 (13–192) months, the recurrence rate was 3.28%, and 29 patients (23.77%) complained of maxillofacial numbness one month postoperatively, which disappeared in most cases one year after surgery. Five patients (4.10%) experienced mild numbness at the end of the follow-up period. Maxillary sinus ostium contracture or atresia occurred in two cases (1.64%). After surgery, the VAS nasal symptom scores improved significantly (P < 0.001). SNOT-22 indicated that the most common postoperative symptom was thick nasal discharge. Conclusion PLRA is a flexible first-choice surgical treatment for maxillary sinus inverted papilloma and can be modified according to the extent of the lesion, the surgeon's experience and technique, and surgical instruments. That can help achieve complete resection and reduce recurrence and surgical complications. Upper teeth numbness, the most common postoperative complication, tends to disappear after 1 year.

Background: Sinonasal neoplasms, whether benign and malignant, pose a significant challenge to clinicians and represent a model area for multidisciplinary collaboration in order to optimize patient care. The International Consensus Statement on Allergy and Rhinology: Sinonasal Tumors (ICSNT) aims to summarize the best available evidence and presents 48 thematic and histopathology‐based topics spanning the field.Methods: In accordance with prior International Consensus Statement on Allergy and Rhinology documents, ICSNT assigned each topic as an Evidence‐Based Review with Recommendations, Evidence‐Based Review, and Literature Review based on the level of evidence. An international group of multidisciplinary author teams were assembled for the topic reviews using the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses format, and completed sections underwent a thorough and iterative consensus‐building process. The final document underwent rigorous synthesis and review prior to publication.Results: The ICSNT document consists of four major sections: general principles, benign neoplasms and lesions, malignant neoplasms, and quality of life and surveillance. It covers 48 conceptual and/or histopathology‐based topics relevant to sinonasal neoplasms and masses. Topics with a high level of evidence provided specific recommendations, while other areas summarized the current state of evidence. A final section highlights research opportunities and future directions, contributing to advancing knowledge and community intervention.Conclusion: As an embodiment of the multidisciplinary and collaborative model of care in sinonasal neoplasms and masses, ICSNT was designed as a comprehensive, international, and multidisciplinary collaborative endeavor. Its primary objective is to summarize the existing evidence in the field of sinonasal neoplasms and masses.

Background: Frontal sinus surgery remained a challenge of restenosis or obliteration of the drainage pathway caused by the scarring and neo-osteogenesis after mucosal stripping and bone drill-out. The pedicled or free nasal mucosal flap is typically used to repair the exposed bone surface to avoid or reduce recurrence. Objective: This study aimed to explore the histopathological mechanism of mucosal flaps repairing bare bone after mucosal resection and bone drill-out in the rabbit model. Methods: Thirty New Zealand white rabbits were used. Sixteen rabbits were selected as the experimental group, and Staphylococcus aureus was used to establish the CRS model (CRS group). Fourteen healthy rabbits were allocated to the control group (NCRS group). Each group was divided into two subgroups with or without mucosal flap repair (CRS-FLAP, CRS-NFLAP, NCRS-FLAP, and NCRS-NFLAP, respectively). The bony anterior and lateral walls of the maxillary sinus of each rabbit were abraded by the drill. The bare bone was then covered with a flap in FLAP subgroups. Bone remodeling and mucosal morphological changes were observed and compared by histopathological hematoxylin and eosin and Masson staining. Results: In the CRS-NFLAP subgroup, the regenerated epithelium lacked typical structure, accompanied by numerous inflammatory cell infiltration and collagen deposition. Conversely, the inflammatory reaction was mild in the CRS-FLAP subgroup, and there was less collagen deposition. The restored mucosal structure was like the normal mucosa. The epithelium in the NCRS-NFLAP subgroup was partially exfoliated, with few cilia, goblet cells, and glandular structures. Compared with the NCRS-NFLAP subgroup, the CRS-NFLAP subgroup showed significant bone remodeling with enhanced activity of osteoblast and osteoclast cells. Conclusions: Pedicled mucosal flap repair could significantly reduce local mucosal and bone remodeling in a rabbit model of CRS.