yes, we can - sinuscentro.com.brsinuscentro.com.br/lectures/future of rhinology.pdf · endoscrub...
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João Flávio Nogueira, MD SINUS
CENTROTop 87 Bad Predictions about the FuturePublished on 3/28/2006
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Nature, 20:August 1896
Sir Godfrey N. HounsfieldCT – 1967Nobel Prize 1979
British Museum, 2008
Sir Godfrey N. HounsfieldCT – 1967Nobel Prize 1979
British Museum, 2008
Brain study using CT. A tumor is clearlyobservable in the lower transverse slice.Images were presented by David Chesler at theMeeting on Tomographic Imaging in NuclearMedicine, September 15-16, 1972.
British Museum, 2008
3D reconstruction - DICOM files – Imaging Studio Software
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Virtual endoscopy - DICOM files – Imaging Studio Software
Desermeaux 1853
Nogueira JF, et al. Brief History of Otorhinolaryngology. Braz J Otorhinolaryngol, 2007
Karl Storz and Harold Hopkins 1953
Nogueira JF, et al. Brief History of Otorhinolaryngology. Braz J Otorhinolaryngol, 2007 – with permission from Karl Storz company, Tutligen, Germany
Endoscrub –Medtronic, Jacksonville, USA, 2008
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Medtronic XPS 4000 – 2009 - Jacksonville, USA
Olympus/Gyrus drills – Philadelphia, 2009 Image One HD – Karl Storz company, Germany
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Rossie JB.Thephylogenetic significance of anthropoid paranasal sinuses. Anat Rec (Hoboken). 2008 Nov;291(11):1485-98.
Courtesy of Prof. Sheen – Ohio State University
Nogueira JF Jr, Hermann DR, Américo Rdos R, et al. A brief history of otorhinolaryngolgy: otology, laryngology andrhinology. Braz J Otorhinolaryngol. 2007;73(5):693-703.
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Hood CM, Schroter RC, Doorly DJ, Blenke EJ, Tolley NS. Computational modelling of flowand gas exchange in models of the human maxillary sinus.J Appl Physiol. 2009 Jul 16.
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Tailored Approach
Surgery (What type ?)
Maximal Medical Therapy
Inflammatory and Allergic
Nogueira JF, et al. Brief History of Otorhinolaryngology. Braz J Otorhinolaryngol, 2007
1970s 1980s e 1990s
Anselmo-Lima WT, Ferreira MD, Valera FC, Rossato M, de
Mello VR, Demarco RC. Histological evaluation of maxillary
sinus mucosa after functional endoscopic sinus surgery.
Am J Rhinol 2007;21(6):719-24
Anselmo-Lima WT, Ferreira MD, Valera FC, Rossato M, de Mello VR, Demarco RC.
Histological evaluation of maxillary sinus mucosa after functional endoscopic
sinus surgery. Am J Rhinol 2007;21(6):719-24
Conclusion:
Recovery of the maxillary sinus mucosa of patients with CRS, observed by
electron and light microscopy, was incomplete 1 year after
endoscopic surgery.
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1970s 1980s 1990s 2000s
Coronarian stentCoronarian balloon
2004 - Sinuplasty
Evolution of angioplasty and stents
Available at: http://www.acclarent.com Balloon sinuplasty – Frontal sinus – Joao Flavio Nogueira
5F – 7F Fogarty biliary balloon catheters
Temporary ventilation
US$ 85,00
Kieff DA, Busaba NY. Reformation of concha bullosafollowing treatment by crushing surgical technique:Implication for balloon sinuplasty. Laryngoscope; 2009:in press.
Retrospective 10 year follow-upConclusion: CB can reform following crushingtechnique. One may extrapolate that agger nasi andfrontal recess air cells may reform following balloonsinuplasty leading to recurrent obstruction of thefrontal sinus outflow tract.
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Khalil HS, Nunez DA. Functional endoscopic sinus surgery for chronic
rhinosinusitis. Cochrane Database Syst Rev. Jul 2006.
OBJECTIVES: Assess the effectiveness of functional endoscopic sinus surgery
as a treatment for patients with chronic rhinosinusitis.
DATA COLLECTION AND ANALYSIS: Comparisons between FESS versus
medical treatment, FESS versus conventional sinus surgery
MAIN RESULTS: The three included studies were randomised controlled
trials.
A middle meatal antrostomy fashioned by FESS was also not shown to be
superior to an inferior meatal antrostomy formed by traditional sinus surgery
techniques.
CONCLUSIONS: FESS as currently practiced is a safe surgical procedure. The
limited evidence available suggests that FESS as practiced in the included
trials does not confer additional benefit to that obtained by medical
treatment (+/- sinus irrigation) in chronic rhinosinusitis. More randomised
controlled trials comparing FESS with medical and other treatments, with long-
term follow up, are required.
Free radical (gas)
Produced
Signaling
Vasodilatation
Inflammatory
Host defense
Macrofage
Nogueira JF, et al. Nitric oxide and the paranasal sinuses. Clin Otol, 2009:in press
Endothelial
Vasodilatation
Available at: www.pfizer.com
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When inhaled, NO travels through the
trachea and bronchioles into the alveoli. Paranasal sinus
Producer
NO – mucociliary clearance
High concentration
Compared to mouth, nose, trachea and
airways
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Clinical implications ?
Clinical treatment ?
Surgery ?
Kirihene RK, Rees G, Wormald PJ. The influence of the size of the
maxillary sinus ostium on the nasal and sinus nitric oxide levels.
Am J Rhinol. 2002 Sep-Oct;16(5):261-4.
Methods: Twenty-nine patients who were post-endoscopic sinus
surgery were included with 52 who were maxillary sinus ostia
cannulated. There were 22 large maxillary sinus ostia and 30 small
ostia.
Results: This study shows that enlargement of the maxillary sinus
ostium above its normal size (20 mm2) produces a significant
decrease in both the maxillary sinus and the nasal cavity NO
levels. In addition, the size of the ostium showed a significant
correlation to the sinus NO level.
Hydrodebrider –Medtronic – Jacksonville, USA, 2009
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Hydrodebrider –Medtronic – Jacksonville, USA, 2009 Hydrodebrider –Medtronic – Jacksonville, USA, 2009
SpineJet, USA, 2009 Cohen N, et al. Biofilms in the nasal cavity and paranasal sinuses. Am J Rhinol, 2005
The use of Antimicrobial Active Manuka Honey (MEDIHONEYTM)
Andrew Thamboo, Andrea Thamboo, Carl Philpott, Allan Clark, Amin JaverSt. Paul’s Hospital, Vancouver, BC
The use of Antimicrobial Active Manuka Honey (MEDIHONEYTM)
Andrew Thamboo, Andrea Thamboo, Carl Philpott, Allan Clark, Amin JaverSt. Paul’s Hospital, Vancouver, BC
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STRATUS DEVICEDr. Melroy’s scientific presentation AAO/HNSF 2008 meeting in Chicago, IL.
>20mm
Frontal Spacer
Landmark X – Image Guidance System – Medtronic, Jacksonville, USA, 2009
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Laptop
Camera
Passive navigation
Nogueira JF et al. Novel compact laptop based image guidance system. Laryngoscope, 2009: 534-7 Portable Image Guidance System – Karl Storz, Germany, 2009.
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Tracker Image Guidance System, Stryker, USA, 2009.
ARE WE READY ?
VeriViewer – Augmented Reality System, USA, 2009
VeriViewer – Augmented Reality System, USA, 2009
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FinESS– Entellus, USA, 2009 FinESS– Entellus, USA, 2009
Coblation, ArthroCare, USA, 2009 Penn University – Philadelphia, 2008
Penn University – Philadelphia, 2008
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Prof. Harvey Cushing, 1910
Hadad G, Bassagasteguy, Carrau RL, Snyderman CH, Kassam AB et al; Laryngoscope, Aug 2006 Hadad G, Bassagasteguy, Carrau RL, Snyderman CH, Kassam AB et al; Laryngoscope, Aug 2006
Hadad G, Bassagasteguy, Carrau RL, Snyderman CH, Kassam AB et al; Laryngoscope, Aug 2006
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NOTES, Karl Storz companhy, Germany, 2008
N.O.T.E.S. Surgery
Temporal Bone Simulator, USA & Germany, 2007
Endoscopic Sinus Simulator – Stanford University Endoscopic Sinus Simulator – Stanford University