[Pneumosinus dilatans frontalis. Etiology, symptoms and surgical technique]

Rare Diseases of the Nose, the Paranasal Sinuses, and the Anterior Skull Base

Due to their low incidence and thus resulting limited diagnostic criteria as well as therapeutic options, rare diseases of the nose, the paranasal sinuses, and the anterior skull base are a significant challenge. The value as of which a disease has to be considered as rare amounts to a maximum of 5 patients per 10 000 people. Within these diseases, however, there are extreme differences. Some rare or orphan diseases like for example the inverted papilloma belong to regularly diagnosed and treated diseases of larger departments of oto-rhino-laryngology whereas other rare diseases and malformations have only been described in less than 100 case reports worldwide. This fact emphasizes the necessity of bundling the available experience of diagnostics and therapy. The present article gives an overview about rare diseases of the nose, the paranasal sinuses, and the anterior skull base from the field of diseases/syndromes of the olfactory system, malformations of the nose and paranasal sinuses, ventilation and functional disorders as well as benign and malignant tumors. The classification and data on diagnostic and therapeutic options were established based on the current literature.

Pneumosinus dilatans and hypercalcification of the falx and ligamentum petroclinoideum in myotonic dystrophy 1

OBJECTIVES

Pneumosinus dilatans (PSD) is a rare condition characterized by abnormally enlarged aerated sinuses, but normal thickness and preserved integrity of the sinus walls. PSD occurs most commonly in young men. Its etiology remains elusive but has been associated with various conditions, such as hydrocephalus, trauma, Dyke-Davidoff syndrome, meningocele, arachnoidal cyst, meningioma, neurofibromatosis 2, and neurolemmoma. PSD has not been reported in myotonic dystrophy type 1 (MD1).

CASE REPORT

We present a 43-year-old man with MD1 because of a CTG-expansion of 1333 repeats in the DMPK gene. A computed tomography scan of the cerebrum, carried out for assessment of central nervous system involvement in MD1, surprisingly demonstrated PSD. Because PSD was asymptomatic no surgical treatment was recommended to the patient. Whether PSD was a manifestation of MD1 or a mere coincidence remains elusive.

CONCLUSION

This case shows that PSD may occur together with MD1. Whether this association is causal or coincidental remains to be elucidated. It also remains speculative whether PSD contributes to the facial dysmorphism frequently present in MD1 patients. If PSD becomes symptomatic surgical intervention should be considered.

Pneumosinus dilatans and multiplex: report of three rare cases and review of the literature

Pneumosinus dilatans is a term used to describe a localized abnormal dilatation of one or more paranasal sinuses without radiological evidence of localized bone destruction, hyperostosis or mucous membrane thickening. The involvement of all paranasal sinuses and mastoid air cells has been named pneumosinus dilatans multiplex. Although the involvement of one or more paranasal sinuses has been reported widely, all paranasal sinuses and the concomitant involvement of mastoid air cells has been reported in only one case. Herein, we present three unusual cases of pneumosinus dilatans (one is a second case of pneumosinus dilatans multiplex in English literature, another is the first reported case of a frontal pneumosinus dilatans case associated with frontoethmoidal meningocele, mental retardation and facial asymmetry and the third one is pneumosinus dilatans with a huge arachnoid cyst) along with the review of relevant literature.

Pneumocele as a rare differential diagnosis in trigeminal irritation

A case of a pneumocele concerning the maxillary sinus causing trigeminal irritation is presented. Pneumoceles are rare conditions of an abnormal dilatation of a paranasal sinus containing only air, lined by unremarkable mucosa, and associated with a bony defect. Symptoms, diagnostic findings, therapy, possible causes, and pathogenesis are discussed.