xRead - Nasal Obstruction (September 2024) Full Articles

20426984, 2021, 3, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/alr.22741 by Stanford University, Wiley Online Library on [01/07/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License

590

International consensus statement on rhinosinusitis

Benefit: Lengthening of time to recurrence of NPs, possible improvement in olfaction, improved endoscopy scores. Harm: Loss of landmark for revision surgery, lead ing to increased risk of intraoperative compli cations. Possibly increased risk of postoperative bleeding. Cost: No additional cost beyond those associated withESS. Benefits-Harm Assessment: Most of the potential risks and benefits postulated for MT resection have conflicting support in the literature, complicating a definitive assessment. Value Judgments: MT resection may improve access to the ethmoid cavity during ESS, however, thoughtful consideration must be given to alter natives in removing a non-diseased structure to improve access. The vast majority of the literature purported to support both MT resection and MT preservation is low level and most shows no effect in aggregate. Policy Level: Option. Intervention: MT resection may be employed dur ing ESS, especially in cases of CRSwNP. XII.D.4 Use of Image Guidance for Sinus Surgery Image-guided surgery (IGS) technology has found sup port among sinus surgeons seeking to improve clinical outcomes. 2072 In addition to preoperative imaging review, IGS incorporates surgical navigation, which permits sur geons intraoperatively to localize specific points in the operating field against pre-operative imaging data sets. 2073 Since 2002, the American Academy of Otolaryngology Head and Neck Surgery’s position statement on IGS has emphasized the technology for complex procedures of the paranasal sinuses and skull base, at the discretion of the operating surgeon. 2074 Originally developed for the operating rooms setting, IGS is now used in office settings. 1787,2075 It must be remembered the use of IGS is associated with more extensive surgery, presumably due to the benefits of using the technology. 2076–2078 Both in practice and in pub lished reports, ESS cases performed with IGS tend to be more complex than those cases performed without IGS; thus, a bias exists when interpreting some of the literature on the use of IGS and its benefits.

Surgical navigation requires a target registration error (TRE), informally referred to as “accuracy,” of 2 mm or less. 2079 For ENT technology, reported TREs include 2.28 + / − 0.91 mm for headset-based, automatic registration; 2080 1.4 mm (range of 0.61-1.95) for paired anatomical points; 2081 2.4 + / − 0.7 mm for laser sur face registration; 2082 and 0.3-0.4 mm for laser/touch registration. 2083 Hardy et al., compared fiducial, landmark and surface/contour registration in a cadaveric model, and reported TREs of 0.47 + / − 0.36 mm, 3.10 + / − 0.44mmand 1.05 + / − 0.10 mm, respectively. 2084 Automatic mapping of fiducials is at least as good as manual mapping. 2085 Glicks man et al., reported a novel registration system based upon photo recognition. 2086 TRE reflects 3 independent factors (1) error of localizing an instrument/sensor; (2) CT scan quality; and (3) robustness/fidelity of registration software algorithm. 2087 The distribution of fiducial points influences TRE. 2088,2089 Also, surgeons tend to achieve better TRE as they acquire additional experiences with the registration process. 2090 Most publications emphasize physician confidence in the technology, suggesting a level of practically-achievable TRE that is clinically meaningful. Failures of registration and surgical navigation have been well categorized. 2091 IGS does seem to increase operative time. 2076,2081,2092–2095 This increase may reflect the time for IGS set-up. Alternatively, case selection bias may adversely influence operative time. In contrast, IGS does not seem to be associated with increased intraoperative blood loss. 2077,2092 Numerous publications have examined complication rates. 2096 In a comparison of 400 patients whose ESS was performed with IGS and a historical cohort of patients in whom IGS was not employed, Reardon showed compa rable complication rates, despite more extensive surgery in the IGS patients. 2076 Fried et al. were able to asso ciate a reduced complication rate with the use of IGS through a comparison of a patient cohort of ESS cases performed with ESS and historical controls; of note, the IGS patients had greater surgical complexity. 2077 Amore recent publication also associated reduced rate of compli cations with IGS. 2094 Most authors have not detected dif ferences in complications with IGS. 2097,2098 A 2013 system atic review, by Ramakrishan et al. concluded that the peer reviewed literature does not support conclusions that IGS reduces complications and improves clinical outcomes; these authors recommend IGS as an option, because the consensus of practicing surgeons and expert opinion con firm the utility and acceptance of IGS technology. 2098 Smith et al., have estimated that such a study designed to detect differences in complication rates would require as many 35,000 enrolled patients. 2099 Dalgorf et al., in an