Hwang / Kennedy / Orlandi Rhinology

Diseases of the Nose, Sinuses, and Skull Base
2. Auflage 2025
ISBN: 978-1-63853-413-6
Verlag: Thieme
Format: EPUB
Kopierschutz: 6 - ePub Watermark

E-Book, Englisch, 1000 Seiten, ePub

edited by distinguished clinicians Peter H. Hwang, David W. Kennedy, Richard R. Orlandi, and Peter John Wormald brings together the collective wisdom, experience, and vision of preeminent thought leaders in a comprehensive rhinology reference. With approximately 1,000 pages, this tome offers in-depth coverage of all core topics in the subspecialty of rhinology, ranging from rhinosinusitis to endoscopic skull base reconstruction and more. The updated resource reflects the significant growth in knowledge and understanding of anatomy, pathophysiology, medical therapies, surgical techniques, and technological innovations in rhinology that have occurred since the publication of the 2012 edition.

The second edition features a total of 69 chapters—reflecting the evolving depth and breadth of the field. It encompasses the pathogenesis, current thinking, diagnosis, and management of chronic rhinosinusitis, the pathology and management of less common disorders, and the surgical techniques and postoperative management of skull base lesions and sinonasal tumors. Highlights include updated content on olfaction, new material on biologic therapies, enhanced coverage of office-based rhinologic procedures, and an updated section on endoscopic nasopharyngectomy.

Key Features

• Contributions from a who's who of renowned rhinology specialists and surgical experts from across the globe
• A total of 37 videos performed by surgical masters highlight the latest surgical innovations, including 16 that are new to this edition
• New, in-depth reviews of endoscopic transorbital surgery for skull base and orbital pathologies
• An expanded image library of about 1,000 images features illuminating illustrations by medical illustrator Christine Gralapp, alongside high-quality diagnostic and intraoperative imaging

This multimedia resource builds on the widely acclaimed first edition, providing otolaryngologists, rhinologists, and residents in training with detailed information regarding the management of sinusitis, rhinologic conditions, and oncologic disorders affecting this region.

This print book includes complimentary access to a digital copy on https://medone.thieme.com.

Publisher's Note: Products purchased from Third Party sellers are not guaranteed by the publisher for quality, authenticity, or access to any online entitlements included with the product.

Autoren/Hrsg.

Hwang, Peter H.

Kennedy, David W.

Orlandi, Richard

Wormald, Peter John

Fachgebiete

• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Chirurgie Kopf- & Halschirurgie
• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Klinische und Innere Medizin HNO-Heilkunde, Phoniatrie, Audiologie
• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Chirurgie Neurochirurgie

Inhaltsverzeichnis

1 Sinonasal Development and Anatomy
2 Radiologic Imaging of the Paranasal Sinuses and Skull Base
3 Physiology of the Nose and Paranasal Sinuses
4 Objective Measures of Nasal Function
5 Olfaction and Taste
6 Allergic Rhinitis
7 Nonallergic Rhinitis
8 Principles of Allergy Skin Testing and Immunotherapy
9 Unified Airway and Lower Respiratory Diseases
10 Viral Rhinitis
11 Diagnosis of Rhinosinusitis
12 Endotypes and Biotherapeutics in Chronic Rhinosinusitis
13 Health Impact of Rhinosinusitis
14 Etiologic Factors in Chronic Rhinosinusitis
15 Nasal Polyps
16 Microbiology of the Nose in Health and Sinusitis
17 Fungal Rhinosinusitis
18 Anti-Infective Medical Therapies for Rhinosinusitis
19 Medical Therapies for Chronic Rhinosinusitis: Anti-Inflammatory Strategies
20 The Workup and Management of Medically Refractory Chronic Rhinosinusitis
21 Pediatric Rhinosinusitis
22 Sinonasal Manifestations of Systemic Disease
23 Acute Rhinosinusitis
24 Complications of Rhinosinusitis
25 Rhinologic Aspects of Sleep-Disordered Breathing
26 Headache and Facial Pain
27 Office Procedures in Rhinology
28 Biomaterials in Rhinology
29 Surgical Navigation and Intraoperative Imaging
30 Anesthetic Considerations for Endoscopic Sinus Surgery
31 Concepts in Functional Endoscopic Sinus Surgery
32 Preoperative and Intraoperative Conisderations in Sinus Surgery
33 Surgery of the Maxillary Sinus
34 Surgery of the Ethmoid Sinus
35 Surgery of the Sphenoid Sinus
36 Endoscopic Frontal Sinusotomy
37 Surgical Instrumentation and Devices in Sinus Surgery
38 Revision Functional Endoscopic Sinus Surgery
39 Advanced Frontal Surgery Techniques
40 Postoperative Care and Long-Term Management of the Sinus Surgery Patient
41 Clinical Outcomes in the Treatment of Chronic Rhinosinusitis
42 Complications of Endoscopic Sinus Surgery: Prevention and Management
43 Congenital Sinonasal Disorders
44 Benign Sinonasal Tumors
45 Fibro-osseous and Odontogenic Lesions of the Sinuses
46 Malignant Sinonasal Tumors
47 Endoscopic Dacryocystorhinostomy, Orbital Decompression, and Optic Canal Decompression
48 External Approaches to the Paranasal Sinuses
49 Surgery of the Septum and Turbinates
50 Treating Complex Septal Deviations
51 Septal Perforation
52 Surgery of the Nasal Valve
53 Sinonasal Trauma
54 Epistaxis
55 Endoscopic Anatomy of the Skull Base and Parasellar Region
56 Pathology of the Sinonasal Region and Anterior and Central Skull Base
57 Cerebrospinal Fluid Leaks and Encephaloceles
58 Endoscopic Approaches to the Anterior Cranial Fossa
59 Endoscopic Approaches to the Sella and Suprasellar Region
60 Endoscopic Approaches to the Petrous Apex and Cavernous Sinus
61 Endoscopic Approaches to the Clivus and Posterior Fossa
62 Endoscopic Approaches to the Pterygopalatine and Infratemporal Fossae
63 The Nasopharynx
64 Extended Applications of Endoscopic Skull Base Surgery
65 Transnasal Endoscopic Approach for Anterior Decompression of the Craniocervical Junction
66 Endoscopic Approaches to Orbital Tumors
67 Transorbital Approaches to the Skull Base and Sinuses
68 Endoscopic Skull Base Reconstruction
69 Complications of Endoscopic Skull Base Surgery

Leseproben

1 Sinonasal Development and Anatomy

Sarah K. Wise, Richard R. Orlandi, and John M. DelGaudio

Abstract

Thorough knowledge of sinonasal anatomy and its variants provides a foundation for safe, appropriate, and comprehensive sinus surgery. This chapter begins with sinonasal development, including the embryology of the nasal cavity and the four paired paranasal sinuses. Utilizing a series of structured figures to facilitate understanding of sinonasal anatomy and relationships, a discussion of paranasal sinus anatomy follows. The ethmoid complex is initiallfy discussed, followed by the maxillary, frontal, and sphenoid sinuses. The relationships of these sinuses to surrounding structures is emphasized throughout, as are anatomic variants, tips for the endoscopic sinus surgeon, and potential areas where surgical complications may arise. This chapter also highlights anatomy adjacent to the paranasal sinuses such as olfactory structures, the skull base and orbit, optic nerve, named arteries, the sella and pituitary complex, and the lacrimal system.

1.1 Sinonasal Development

Performing thorough and safe sinonasal surgery requires a firm understanding of the anatomy of the nose, paranasal sinuses, and surrounding structures. Knowledge of the embryologic development of the nasal cavity and paranasal sinuses allows for better comprehension of its anatomy and many of the disease processes that affect this region.

The bony anatomy of the nasal cavity and paranasal sinuses is a primary contributor to the shape and dimensions of these structures. The nasal septum develops from four sources: the perpendicular plate of the ethmoid bone, the maxillary bone (crest), the vomer, and the quadrangular cartilage. The primary bones from which the paranasal sinuses develop are the maxillary, ethmoid, sphenoid, and frontal bones. There are also lesser contributions to paranasal sinus development from the lacrimal and zygomatic bones. Development of the nasal cavity and four sets of paired paranasal sinuses is discussed in detail in the following sections.

1.1.1 Nasal Cavity Development

Early development of the sinonasal cavity begins during the 8th week of fetal life. At this time, the nasal septum can be seen dividing the right and left sides of the structure that will eventually be the nasal cavity. At 8 weeks’ gestation, the nasal septum is a mesenchymal structure that is partially differentiated into cartilage. ? [1] Also beginning at 8 weeks, several ridges begin to develop along the lateral nasal wall; these ridges are the earliest signs of the developing turbinates. ? [2] Surrounding the embryologic nasal cavity a cartilaginous capsule forms, and at 9 to 10 weeks the cartilaginous capsule contributes finger-like projections to the developing turbinates. ? [2] Between 9 and 12 weeks’ gestation, a separate cartilaginous and soft tissue bud forms between the developing middle and inferior turbinates. ? [1], ? [2] This bud will eventually become the uncinate process ( ? Fig. 1.1).

The ridges along the lateral nasal wall will eventually develop into the nasal turbinates. However, interestingly, among various authors there is some disagreement regarding the origin of the turbinates. In 1895, Killian described the inferior turbinate as originating from the maxillary process and termed this developing structure the maxilloturbinal. ? [3] Killian described the more superiorly located ethmoturbinals as forming the middle and superior turbinates, with a small nasoturbinal forming the agger nasi region. Stammberger supports the maxilloturbinal origin of the inferior turbinate, but notes some subtle differences in the ultimate development of the five ethmoturbinals. ? [4] In Stammberger’s text, approximately four of the ethmoturbinals are noted to remain throughout development and eventually form the agger nasi region (superior portion of first ethmoturbinal or nasoturbinal), middle turbinate (second ethmoturbinal), superior turbinate (third ethmoturbinal), and supreme turbinate (fourth and fifth ethmoturbinals). ? [4] In contrast to Killian and Stammberger, Bingham et al ? [2] have described the inferior turbinate as arising from the cartilaginous nasal capsule along with the middle and superior turbinates; they do not support separate maxilloturbinal terminology.

At 15 to 16 weeks’ gestation, the inferior, middle, and superior turbinates are clearly formed and easily visible in embryologic sections. ? [2] Developmental histologic sections demonstrate that the middle and superior turbinates arise from precursors of the ethmoid bone, whereas the inferior turbinate bone is independent, receiving contributions of its final adult structure from the cartilaginous nasal capsule and the bone of the maxilla. ? [2]

Fig. 1.1 Illustration of cartilaginous nasal capsule at 9 to 12 weeks of fetal development.

The primary furrows lie between the ethmoturbinal ridges; these primary furrows will form the recesses and meatuses that separate the adult turbinates. ? [4], ? [5], ? [6] The first and second ethmoturbinals are separated by the first primary furrow, which becomes the middle meatus, ethmoid infundibulum, hiatus semilunaris, and part of the frontal recess in the adult. The superior and supreme meatuses are derived from the second and third primary furrows, respectively. The extent of adult paranasal sinus pneumatization and development differs greatly from person to person. This is thought to result from the extent of invagination and evagination between the developing turbinates and their intervening furrows. ? [5]

1.1.2 Sinonasal Mucosa and Olfactory Development

In a histologic study of human fetal heads, Wake et al ? [1] described the development of the sinonasal mucosa. As the nasal cavity begins to develop at 8 weeks’ gestation, a hypercellular mesenchymal capsule forms around the developing nasal structures. Although most of the nasal cavity contains undifferentiated cells or stratified cuboidal cells, the nasal septum is partially differentiated into cartilage at this time, and olfactory epithelium is seen in the superior aspect of the nasal cavity. By 9 to 10 weeks, the cartilaginous nasal capsule is fully differentiated, ciliated pseudostratified columnar or cuboidal epithelium is seen on the septum and inferior turbinate, and primitive blood vessels are present. At 11 to 12 weeks, the septal epithelium is differentiated into characteristic ciliated respiratory epithelium and secretory goblet cells are present, but the lateral nasal wall mucosa is not yet as differentiated as the nasal septum. The cribriform plate is present in cartilaginous form at 14 to 16 weeks, with neurovascular bundles penetrating it, and olfactory epithelium is present throughout the superior portion of the nasal cavity. Also, at 14 to 16 weeks, stratified squamous epithelium with hair follicles can be seen in the nasal vestibule. The mucosal lining of the developing paranasal sinuses remains spherical or cuboidal with few cilia and glands. By 17 to 18 weeks, the lateral nasal wall and ethmoid sinus mucosa mature to form respiratory epithelium, with higher concentrations of goblet cells anteriorly and ciliated cells posteriorly. At 20 to 24 weeks, secretory cells are more evenly distributed and vascular structures are present throughout the lamina propria, resembling postnatal anatomy. Postnatally, there is partial regression of the olfactory epithelium such that it occupies only the area of the cribriform plate and superior turbinate.

1.1.3 Ethmoid Sinuses

In the fetus, the ethmoid sinuses are the first to develop into a structure that resembles a paranasal sinus cavity. Around 11 to 12 weeks of fetal life, early anterior ethmoid cells, including the cartilaginous beginnings of the ethmoid bulla, form as a result of budding from the middle meatus. ? [1], ? [7] At 14 to 16 weeks some anterior ethmoid cells are formed, and by 17 to 18 weeks the posterior ethmoid buds begin to develop from the superior meatus. ? [1] Ossification of the ethmoid sinuses and lamina papyracea occurs by 20 to 24 weeks’ gestation. ? [1], ? [7]

At birth the ethmoid sinuses are the most mature of the paranasal sinuses, being completely developed in the number of cells but not in size. ? [8], ? [9] In the newborn, the ethmoid complex is 8 to 12?mm long, 1 to 3?mm wide, and 1 to 5?mm in height. The ethmoid sinuses undergo significant growth during the first decade of life. Wolf et al, ? [8] along with Vaid and Vaid, ? [9] note the most rapid expansion of the ethmoid complex between 1 and 4 years of age, whereas Shah et al ? [10] report that the most rapid anteroposterior expansion of the ethmoid sinuses occurs between 3 and 8 years of age. By the age of 12, the ethmoid sinuses have essentially reached their adult dimensions. ? [8], ? [9], ? [10] The ethmoid cells can, however, expand beyond the boundaries of the ethmoid bone to extend into the frontal recess (supra agger cells, supra bulla cells, supra bulla frontal cells), ? [11] sphenoid bone (sphenoethmoid [Onodi] cell), and maxillary bone (infraorbital ethmoid [Haller] cell, retromaxillary cell). In addition, other structures are...