Glass in the frontal sinus: report of three cases

Endoscopic endonasal retrieval of air gun pellet retained in the frontal sinus: A case report

INTRODUCTION AND IMPORTANCE

Foreign bodies in paranasal sinuses are rarely encountered and most commonly present in the maxillary sinus. Guidelines for managing paranasal sinus object removal are limited due to its rarity. However, there are three major management options: open surgery, endoscopic sinus surgery, and observation.

CASE PRESENTATION

We report a rare case of an 18-year-old boy who underwent extended frontal sinus surgery to retrieve a retained air gun pellet in the right frontal sinus and repair the skull base defect resulting from the air gun pellet.

CLINICAL DISCUSSION

Physicians commonly use endoscopic sinus surgery (ESS) for improving sinus drainage in recurrent chronic and acute infective sinusitis. Extended sinus surgery aims to maximize the communication between the paranasal sinuses and the nasal cavity. This extended communication helps improve access to the sinus, enhance drainage, and improve the delivery of topical medications. In addition, the use of ESS with the modified Lothrop procedure allows for better exposure of the skull base, which can help with the repair of a CSF leak.

CONCLUSION

Based on our experience with this patient and similar literature, ESS should be considered a treatment option for patients with retained foreign objects in the frontal sinus.

An Endoscopic-Assisted Open Removal of a Retained Foreign Body From Frontal Sinus

Facial penetrating injuries can cause retention of foreign bodies in the frontal sinus. This rare condition can remain underdiagnosed for years, since non-specific symptoms, such as headaches and nasal obstruction, can be developed. So far, removal by an endoscopic approach is the most preferred treatment option because it is less invasive with a short recovery time. However, removal by an open surgical approach remains the method of choice for large foreign bodies, especially in cases of coexistent non-reducible fractures of the anterior table of the frontal bone. We present a case where a combined approach - open and endoscopic - was necessary to successfully remove a retained foreign body from a frontal sinus. With the assistance of a transnasal endoscope, the retained stone was mobilized and removed from the open frontal sinus followed by osteosynthesis of the anterior table. Therefore, in special circumstances, a combination of both techniques should be considered for the optimal outcome.

Management of an Unusual Intranasal Foreign Body Abutting the Cribriform Plate: A Case Report and Review of Literature

A 35-year-old man with history of schizophrenia presented 3 weeks after placing a screw in his right nostril. Initial imaging showed a screw in the right ethmoid sinus with the tip penetrating the right cribriform plate. On exam, the patient was hemodynamically stable with purulent drainage in the right nasal cavity but no visible foreign body. While most nasal foreign bodies occur in children and are generally removed at the bedside, intranasal foreign bodies in adults tend to require further assessment. The foreign body in this case was concerning for skull base involvement and the patient was brought to the operating room (OR) with neurosurgery for endoscopic sinus surgery (ESS) and removal of foreign body. The screw was removed and the patient recovered with no signs of cerebrospinal fluid (CSF) leak postoperatively. Any concern for skull base or intracranial involvement should call for a full evaluation of the mechanism of injury and intervention in a controlled environment.

Foreign Body in Paranasal Sinus: A Late Clinical Presentation

The occurrence of foreign bodies in paranasal sinuses is extremely rare. The symptoms are vague and usually discovered after extra/intracranial complications. They may, therefore, go unnoticed if there isn't a strong clinical suspicion. We present a clinical case of a 64-year-old woman with a paranasal sinus microsurgery history more than 30 years ago, who presented with headache and purulent rhinorrhea. A glass tubular structure was discovered in the ethmoid complex. She underwent functional endoscopic sinus surgery. Since glass is an inert material that doesn't cause foreign body reaction, the patient may not present any symptom or sign. However, if there is obstruction in the drainage of the ostiomeatal complex, it can manifest itself as rhinosinusitis, which we believe happened in our case. To the best of our knowledge, this is probably the first reported case of a glass removed from the ethmoidal sinuses, diagnosed with more than 30 years of evolution.

A forgotten foreign body in the frontal sinus

A 46-year-old female patient presented with a discharging wound over the nasal bridge, near the medial end of the right eyebrow of 2 months duration. She did not give any history of trauma or surgery in the past. Wound exploration showed a glass piece in the floor of the right frontal sinus. After showing the glass piece, patient remembered road traffic accident she had at the age of 18 years. Patient was asymptomatic for 28 years.To our knowledge, this is the longest retained case of asymptomatic foreign body in the frontal sinus reported in the world literature. Case report and a review of literature concerning foreign body in the frontal sinus are presented.

Late presentation of a paranasal sinus glass foreign body: a case report

Foreign bodies in the paranasal sinuses are rare and mostly related to maxillo-facial trauma. We treated a 47-year-old man with a late complication arising from a foreign body in the nasoethmoid sinus present for 16 years after a road traffic accident. Patients presenting with maxillo-facial injuries, especially those with lacerations due to glass or car wind-screen trauma should have thorough examination and appropriate imaging of the injury.

Endoscopic management of retained airgun projectiles in the paranasal sinuses

OBJECTIVES/HYPOTHESIS

This article presents 3 cases to illustrate the appropriate management of airgun injuries with retained projectiles in the paranasal sinuses. The indications, techniques, and potential complications of removal of these foreign bodies from the paranasal sinuses are discussed.

STUDY DESIGN

We conducted a case series consisting of 3 patients and a review of the literature.

METHODS

Three consecutive patients who sustained airgun injuries to the face with retained bullets in the paranasal sinuses are presented. Projectiles were present in the maxillary, ethmoid, and sphenoid sinuses. The literature pertaining to this subject is reviewed.

RESULTS

All retained projectiles were removed endoscopically without complications. Stereotactic guidance was used in 2 cases.

CONCLUSIONS

Airgun injuries to the paranasal sinuses are relatively uncommon. Projectiles can safely be removed using endoscopic techniques in selected cases. When possible, foreign bodies in the paranasal sinuses should be removed to prevent long-term sequelae.

Penetrating craniofacial injury in a pediatric patient

Penetrating craniofacial injuries are rare especially in the pediatric age group. They are potentially life-threatening and challenging injuries. We describe an unusual trauma in a 30-month-old child who suffered a craniofacial injury caused by TV antenna. Clinical examination and radiological investigation showed the antenna penetrating the hard palate, left posterior nasal choana, sphenoid sinus, and skull base, up to pituitary fossa. There was no evidence of great vessels injury that confirmed by cerebral angiography. Transpalatal approach was used to remove the antenna and repair the skull base defect. There was no neurological or visual activity deficit postoperatively. The child developed diabetes insipidus that is well controlled using desmopressin.

Air gun dart injury in paranasal sinuses left alone

Patients with paranasal sinus foreign body are not commonly seen in otolaryngological practice and papers dealing with this issue are rare in the English literature. One case of penetrating sinus injury due to air gun dart is presented to illustrate the potentially serious consequences of air gun injuries. The clinical presentation, diagnostic pitfalls and the treatment aspects are discussed.

Transorbital penetrating injury of the paranasal sinuses

Penetrating injuries of the paranasal sinuses due to foreign bodies are rare, especially as a result of a traffic accident. Here we report a patient with a ballpoint pen lodged in his left eye following a traffic accident. The pen extended from the medial aspect of the left orbit, through the left ethmoid sinus and the nasal septum, to the right sphenoid sinus. We removed the pen uneventfully using endoscopic sinus surgery. There are no similar reports in the English literature and we therefore present this case because of its rarity.