Effect of endoscopic marsupialization of paranasal sinus mucoceles involving the orbit: a review of 27 cases

Ocular Hypertelorism: Principles and Management

Background

Ocular hypertelorism (OH) was initially considered as un-differentiated congenital cranio-facial deformity, however, I.T Jackson mentioned it as teleorbitism, considering it as increase in the inter-canthal width, inter-pupillary as well as inter-orbital distance as a result of lateralization of the orbital complex in total. Furthermore, Sailer further refined it and included the distance from the lateral orbital wall, i.e. he denoted increased inter-orbital distance along with the distance between lateral orbital walls as true hypertelorism. This condition is rare and is seen in association with midline congenital defects affecting the cranio-facial region.

Classification and review of cases

The ideal time for the OH correction is usually between 5 and 8 years of age. However, the management of OH is complex, and several techniques have been described in literature for the same. Here, we describe our classification of OH, along with the evolution of the surgical aspects, the key treatment principles we follow, together with the types of the osteotomies and their indications. Furthermore, we delineate the four main principles that we have set for OH management.

Results

Though the improvement in appearance is seen immediately post-surgery, however, this challenging surgery faces a multitude and common postoperative complications which have been represented in this article. The surgeon needs both the technical expertise and an inclination towards aesthetics for the execution of such procedures.

Conclusion

It is preferred that the management of OH should be individualized as per the stage of the craniofacial growth and the psychosocial needs of the patient and the parents.

Definition and management of odontogenic maxillary sinusitis

Background

Maxillary sinusitis of odontogenic origin, also known as maxillary sinusitis of dental origin or odontogenic maxillary sinusitis (OMS), is a common disease in dental, otorhinolaryngologic, allergic, general, and maxillofacial contexts. Despite being a well-known disease entity, many cases are referred to otorhinolaryngologists by both doctors and dentists. Thus, early detection and initial diagnosis often fail to detect its odontogenic origin.

Main body

We searched recent databases including MEDLINE (PubMed), Embase, and the Cochrane Library using keyword combinations of "odontogenic," "odontogenic infection," "dental origin," "tooth origin," "sinusitis," "maxillary sinus," "maxillary sinusitis," "odontogenic maxillary sinusitis," "Caldwell Luc Procedure (CLP)," "rhinosinusitis," "functional endoscopic sinus surgery (FESS)," "modified endoscopy-assisted maxillary sinus surgery (MESS)," and "paranasal sinus." Aside from the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) trial, there have been very few randomized controlled trials examining OMS. We summarized the resulting data based on our diverse clinical experiences.

Conclusion

To promote the most efficient and accurate management of OMS, this article summarizes the clinical features of rhinosinusitis compared with OMS and the pathogenesis, microbiology, diagnosis, and results of prompt consolidated management of OMS that prevent anticipated complications. The true origin of odontogenic infections is also reviewed.

Hypertelorism Secondary to Mucocele in the Paranasal Sinuses

Ocular hypertelorism was introduced by Greig as an increased interpupillary distance. The paranasal sinus mucoceles are acquired lesions for various reasons; however, their behavior is progressive, capable of eroding the bone and extending to the orbital and intracranial regions. The objective is to present a clinical case of orbital hypertelorism secondary to mucocele in the paranasal sinuses. This is a 72-year-old male patient who came presenting an increase in volume in the right nasoorbitoethmoidal region. The isodense lesion occupying the maxillary and right ethmoidal sinuses was confirmed by an intimate relationship with the ipsilateral frontal and sphenoidal sinus, with osteolytic involvement of the orbit and nasal region. After incisional biopsy with mucocele results, a wide resection plus facial reconstruction was performed with autologous grafts and osteosynthesis material. Currently, the patient has 1 year of evolution, without significant functional commitment. It is important to consider giant mucoceles as part of the differential diagnoses in patients with deformities in the middle and upper third of the face.

Paranasal Sinus Mucocele as a Late Complication of Dacryocystorhinostomy

A 50-year-old female presented with a slowly enlarging painless mass of the right medial canthus. The past surgical history is significant for external dacryocystorhinostomy for acquired nasolacrimal duct obstruction 10 years prior and subsequent endoscopic and external revisions. Imaging revealed a large fronto-ethmoidal sinus mucocele extending into the right medial orbit. On surgical exploration, the right middle turbinate was found to have lateralized, obstructing sinus outflow. The mucocele was evacuated and ethmoidectomy and middle turbinectomy were performed. The patient did well postoperatively without recurrence at 6 months of follow-up. Sinus mucocele formation is a rare, late complication of lacrimal surgery.

[Experience in the surgical treatment of paranasal sinus mucoceles in a university hospital]

BACKGROUND

Mucoceles are benign cystic lesions of the paranasal sinuses. Endoscopic marsupialisation is considered the first choice of treatment, due to its low morbidity and recurrence rates.

OBJECTIVE

To establish the number of patients with recurrence, who were diagnosed clinically or by computed tomography, and who were submitted to surgery in the Ear, Nose and Throat Unit in a tertiary university hospital.

MATERIAL AND METHODS

A clinical, cross-sectional, descriptive, observational and retrospective study was conducted on patients with a mucocele diagnosis operated on in the period from January 2006 to December 2013. A descriptive statistical analysis was performed to obtain the frequencies, ratios and proportions. Measures of central tendency and dispersion were obtained. The recurrence rates of each surgical technique were compared using the Chi-squared test.

RESULTS

Of the 59 patients included in the study, 39 were female and 20 were men. The most common location was in the maxillary sinus (22 patients) followed by frontoethmoidal (20 patients). There was a recurrence of 9% in those submitted to a surgical procedure. The endoscopic approach was used in 51 patients, 8 cases were combined (open plus endoscopic), and there was no open approach. There was a recurrence in 7 of 51 of patients with endoscopic surgery, and one out of 8 patients had a recurrence with a combined technique.

CONCLUSIONS

No statistically significant relationship was found between the type of surgery and recurrence, or between the presence or absence of a predisposing factor and recurrence.