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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

http://upload.wikimedia.org/wikipedia/en/c/c5/RIMG0279.JPGhttp://upload.wikimedia.org/wikipedia/commons/3/39/RIMG0277.JPG

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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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Dextroscope, 2009, USA

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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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Available at: http://www.sinuscentre.com

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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 medicaltreatment (+/- 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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Gustav Killian, University of Berlin, Germany,1918

Gustav Killian, 1918

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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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Pericranial Flap

Female, 27 years old Female, 27 years old

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Endoscopic transglabelar approach – Skull Base Institute, 2007

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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

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http://www.voxel-man.de/simulator/sinusurg/

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Morita et al. Sinus Simulator, 2008

Morita et al. Sinus Simulator, 2008