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Yoshida H, Tanaka F, So K, Kumai Y. Analysis of Magnetic Resonance Imaging in Paranasal Mucocele with Visual Disturbance. ORL J Otorhinolaryngol Relat Spec 2024:1-8. [PMID: 38934175 DOI: 10.1159/000539891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 06/16/2024] [Indexed: 06/28/2024]
Abstract
INTRODUCTION Ocular imaging strategies have evolved to facilitate the diagnosis of optic neuropathy. This study aimed to evaluate the pathogenesis of visual disturbance associated with paranasal mucocele via magnetic resonance imaging (MRI). METHODS A total of 19 patients with mucocele and visual disturbance who underwent endoscopic sinus surgery, orbital MRI, and sinus computed tomography were included. The age, sex, days from onset to surgery, eye pain, and imaging findings were analyzed. The results were compared between two groups: 7 patients with preoperative visual acuity worse than 20/200 (the poor group) and 12 patients with equal or better than 20/200 (the fair group). RESULTS Imaging showed a high compression rate of the orbit in 17 (89.5%) and enlargement of the subarachnoid space around the optic nerve in 15 (78.9%) of 19 patients. Preoperative vision was significantly poor in cases with hyperintense regions in the optic nerve on T2-weighted imaging, indicating the presence of optic neuritis. No cases showed severe inflammation of the cyst or the presence of intraorbital fat tissue. CONCLUSION MRI-based diagnosis proved useful in evaluating pathological factors, such as orbital compression, ischemia, and optic neuritis, in individual cases. It can help in gaining insight into the pathogenesis and developing appropriate treatment strategies for visual disturbances associated with paranasal mucocele.
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Affiliation(s)
- Haruo Yoshida
- Department of Otolaryngology - Head and Neck Surgery, NHO Nagasaki Medical Center, Nagasaki, Japan
| | - Fujinobu Tanaka
- Department of Otolaryngology - Head and Neck Surgery, NHO Nagasaki Medical Center, Nagasaki, Japan
| | - Kenji So
- Department of Otolaryngology - Head and Neck Surgery, NHO Nagasaki Medical Center, Nagasaki, Japan
| | - Yoshihiko Kumai
- Department of Otolaryngology - Head and Neck Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Wucherpfennig L, Becker JKZ, Wuennemann F, Eichinger M, Seitz A, Baumann I, Stahl M, Graeber SY, Zhao S, Chung J, Schenk JP, Alrajab A, Kauczor HU, Mall MA, Sommerburg O, Wielpütz MO. Elexacaftor/tezacaftor/ivacaftor improves chronic rhinosinusitis detected by magnetic resonance imaging in children with cystic fibrosis on long-term therapy with lumacaftor/ivacaftor. J Cyst Fibros 2024; 23:234-241. [PMID: 38218661 DOI: 10.1016/j.jcf.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 01/06/2024] [Accepted: 01/07/2024] [Indexed: 01/15/2024]
Abstract
INTRODUCTION Previous studies using magnetic resonance imaging (MRI) demonstrated early onset and progression of chronic rhinosinusitis (CRS) from infancy to school age, and response to lumacaftor/ivacaftor (LUM/IVA) therapy in children with cystic fibrosis (CF). However, the effect of elexacaftor/tezacaftor/ivacaftor (ELX/TEZ/IVA) on CRS detected by MRI in children with CF and at least one F508del mutation, and potential incremental effects of ELX/TEZ/IVA compared to LUM/IVA in F508del homozygous children have not been studied. METHODS 30 children with CF with at least one F508del mutation underwent three longitudinal paranasal sinus MRI before (MRI1), without (n = 16) or with LUM/IVA therapy (n = 14, MRI2), and with ELX/TEZ/IVA therapy (MRI3, mean age at therapy initiation 11.1 ± 3.4y, range 6-16y). MRI were evaluated using the CRS-MRI score. RESULTS After therapy initiation with ELX/TEZ/IVA, the prevalence and in maxillary and sphenoid sinuses the dominance of mucopyoceles decreased (35% vs. 0 %, p<0.001 and 26% vs. 8 %, p < 0.05, respectively). This leads to a reduction in mucopyocele subscore (-3.4 ± 1.9, p < 0.001), and sinus subscores in MRI3 (maxillary sinus: -5.3 ± 3.1, p < 0.001, frontal sinus: -1.0 ± 1.9, p < 0.01, sphenoid subscore: -2.8 ± 3.5, p < 0.001, ethmoid sinus: -1.7 ± 1.9, p < 0.001). The CRS-MRI sum score decreased after therapy initiation with ELX/TEZ/IVA by -9.6 ± 5.5 score points (p < 0.001). The strength in reduction of mucopyoceles subscore and CRS-MRI sum score was independent of a pretreatment with LUM/IVA from MRI1-MRI2 (p = 0.275-0.999). CONCLUSIONS ELX/TEZ/IVA therapy leads to improvement of CRS in eligible children with CF. Our data support the role of MRI for comprehensive monitoring of CRS disease severity and response to therapy in children with CF.
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Affiliation(s)
- Lena Wucherpfennig
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 420, Heidelberg 69120, Germany; Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Im Neuenheimer Feld 156, Heidelberg 69120, Germany; Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik, University Hospital Heidelberg, Röntgenstr. 1, Heidelberg 69126, Germany
| | - Johanna K Z Becker
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 420, Heidelberg 69120, Germany; Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Im Neuenheimer Feld 156, Heidelberg 69120, Germany; Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik, University Hospital Heidelberg, Röntgenstr. 1, Heidelberg 69126, Germany
| | - Felix Wuennemann
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 420, Heidelberg 69120, Germany; Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Im Neuenheimer Feld 156, Heidelberg 69120, Germany; Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik, University Hospital Heidelberg, Röntgenstr. 1, Heidelberg 69126, Germany; Department of Diagnostic and Interventional Radiology and Neuroradiology, Helios Dr. Horst-Schmidt-Kliniken Wiesbaden, Ludwig-Erhard-Straße 100, Wiesbaden 65199, Germany
| | - Monika Eichinger
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 420, Heidelberg 69120, Germany; Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Im Neuenheimer Feld 156, Heidelberg 69120, Germany; Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik, University Hospital Heidelberg, Röntgenstr. 1, Heidelberg 69126, Germany
| | - Angelika Seitz
- Department of Neuroradiology, University Hospital Heidelberg, Im Neuenheimer Feld 400, Heidelberg 69120, Germany
| | - Ingo Baumann
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 400, Heidelberg 69120, Germany
| | - Mirjam Stahl
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin 13353, Germany; German Center for Lung Research (DZL) associated partner site, Berlin, Germany; Berlin Institute of Health (BIH) at Charité-Universitätsmedizin Berlin, Anna-Louisa-Karsch-Str. 2, Berlin 10178, Germany
| | - Simon Y Graeber
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin 13353, Germany; German Center for Lung Research (DZL) associated partner site, Berlin, Germany; Berlin Institute of Health (BIH) at Charité-Universitätsmedizin Berlin, Anna-Louisa-Karsch-Str. 2, Berlin 10178, Germany
| | - Shengkai Zhao
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 420, Heidelberg 69120, Germany; Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Im Neuenheimer Feld 156, Heidelberg 69120, Germany
| | - Jaehi Chung
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Im Neuenheimer Feld 156, Heidelberg 69120, Germany; Division of Pediatric Pulmonology & Allergy and Cystic Fibrosis Center, Department of Pediatrics III, University Hospital Heidelberg, Im Neuenheimer Feld 430, Heidelberg 69120, Germany
| | - Jens-Peter Schenk
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 420, Heidelberg 69120, Germany
| | - Abdulsattar Alrajab
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 420, Heidelberg 69120, Germany
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 420, Heidelberg 69120, Germany; Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Im Neuenheimer Feld 156, Heidelberg 69120, Germany; Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik, University Hospital Heidelberg, Röntgenstr. 1, Heidelberg 69126, Germany
| | - Marcus A Mall
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin 13353, Germany; German Center for Lung Research (DZL) associated partner site, Berlin, Germany; Berlin Institute of Health (BIH) at Charité-Universitätsmedizin Berlin, Anna-Louisa-Karsch-Str. 2, Berlin 10178, Germany
| | - Olaf Sommerburg
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Im Neuenheimer Feld 156, Heidelberg 69120, Germany; Division of Pediatric Pulmonology & Allergy and Cystic Fibrosis Center, Department of Pediatrics III, University Hospital Heidelberg, Im Neuenheimer Feld 430, Heidelberg 69120, Germany
| | - Mark O Wielpütz
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 420, Heidelberg 69120, Germany; Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Im Neuenheimer Feld 156, Heidelberg 69120, Germany; Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik, University Hospital Heidelberg, Röntgenstr. 1, Heidelberg 69126, Germany.
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Yoshida H, Kihara C, Satoh C, Kumai Y. CT analysis of predictors for visual acuity in optic neuropathy with mucocele. Auris Nasus Larynx 2023; 50:895-903. [PMID: 36967263 DOI: 10.1016/j.anl.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 02/15/2023] [Accepted: 03/10/2023] [Indexed: 04/03/2023]
Abstract
OBJECTIVE To evaluate the causative and risk factors for optic neuropathy with mucocele via imaging studies. METHODS We included 21 patients with rhinogenous optic neuropathy with mucocele. We collected data on the sinus involved, age, sex, number of days from the onset of visual impairment to surgery, and computed tomography (CT) imaging findings (bone defects in the lamina papyracea, Onodi cell mucocele, exophthalmos, and optic nerve deviation). The results were compared between two groups, the one having nine patients with pre-operative visual acuity of <0.1 (the poor group) and the other having 12 patients with pre-operative visual acuity of ≥0.1 (the fair group). Whether or not there was a difference in pre-operative visual acuity between patients with and without Onodi cell mucocele was determined. RESULTS After surgery, visual acuity improved in 16/21 (76.2%) patients, and a correlation analysis showed a significant positive correlation between pre-operative and post-operative visual acuity. In imaging, the causative sinuses accounted for 85.7% of both posterior ethmoid and sphenoid sinuses. Bone defects of the lamina papyracea at the optic canal and the vertical downward deviation of the optic nerve at each location, especially in 6/9 patients with Onodi cell mucocele, were characteristic in the poor group. In these conditions, increasing the contact areas of the optic nerve and mucocele can leads to more chances of direct downward compression of the optic nerve and infection occurring, and it may lead to severe pre-operative visual impairment. CONCLUSION Imaging studies of optic neuropathy with mucocele help to determine the risk factors and perform early and precise diagnostic imaging and decision-making for surgery.
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Affiliation(s)
- Haruo Yoshida
- Department of Otolaryngology-Head and Neck Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
| | - Chiharu Kihara
- Department of Otolaryngology-Head and Neck Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Chisei Satoh
- Department of Otolaryngology-Head and Neck Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yoshihiko Kumai
- Department of Otolaryngology-Head and Neck Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Yoo YJ, Kim GT, Park MJ. Sudden Unilateral Visual Loss Due to an Onodi Cell Mucocele. EAR, NOSE & THROAT JOURNAL 2023:1455613231214705. [PMID: 37997617 DOI: 10.1177/01455613231214705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023] Open
Abstract
In a patient whose sudden vision loss is suspected on the side of a previously operated sphenoid or ethmoid sinus, an ischemic insult to the optic nerve may occur due to a compressing mucocele, especially when there is bony dehiscence of the orbital apex. We report a case of a 41-year-old healthy male patient who had a history of previous sinus surgery, and visited the emergency department for an abrupt left ocular pain following visual loss of the affected eye. The patient's left eye's best corrected visual acuity (BCVA) was hand motions with a reduced light reflex. A sphenoethmoidal sinus cell (Onodi cell) mucocele with bone dehiscence in the left orbital apex was seen on computed tomography. Upon suspicion of compressive ischemic optic neuropathy, urgent endoscopy-assisted endonasal marsupialization of the Onodi cell mucocele with high-dose pulse intravenous dexamethasone was performed. The pathology showed an inflamed nasal mucosa, confirming a mucocele. On the second postoperative day, his BCVA slightly improved in counting fingers at 30 cm. However, even though the nasalized Onodi cell remained intact, his eyesight did not show further improvement. The optic nerve may be directly insulted when a mucocele in the Onodi cell takes place, especially when there is bony dehiscence in the orbital apex. Despite accelerated surgical marsupialization and high-dose steroids, the chance of visual recovery remains very low, as demonstrated in our case.
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Affiliation(s)
- Yong Jun Yoo
- Department of Otorhinolaryngology-Head and Neck Surgery, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Gyu Tae Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Marn Joon Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
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Magboul NA, Alzubaidi AA, Abumsmar LA, Alzarei A, Al-Ahmari M, Alshehri MA. Mucocele of the Paranasal Sinuses: Retrospective Analysis of a Series of Eight Cases. Cureus 2023; 15:e41986. [PMID: 37593272 PMCID: PMC10427889 DOI: 10.7759/cureus.41986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Paranasal sinus mucoceles are epithelium-lined cystic masses usually resulting from obstruction of sinus ostia. They most frequently occur in the frontal and ethmoid sinuses. The etiology is not clarified, but the most common identifiable cause of mucoceles following functional endoscopic sinus surgery (FESS), trauma, neoplasms, and allergy. The clinical symptoms of mucocele vary and are not specific, the most common being ophthalmic symptoms and headache, impinging on adjacent orbital structures, and causing ophthalmic sequelae such as double vision, commonly followed by orbital swelling, epiphora, proptosis, and ptosis. All patients in this study had frontal and frontoethmoidal mucocele and initially complained of frontal headache and ophthalmic symptoms. Definitive treatment options for paranasal sinus mucoceles include external approaches and endoscopic marsupialization. Objective: The study aimed to identify the etiology, clinical presentation, most common para nasal sinus affected by mucocele, management, and the rate of recurrence in eight cases with mucocele of the paranasal sinuses. METHODS Eight patients diagnosed with mucocele of the paranasal sinuses were admitted to our institution between 2014 and 2021. There were two females and six males aged between 14 and 67. Initial symptoms, duration, clinical presentation upon admission, location of the mucocele, type of surgical intervention, and outcome have all been studied. Results: The most common symptoms at diagnosis were orbital involvement, retrobulbar, and frontal headache. Most patients were diagnosed with frontal mucocele (40%), and three were frontoethmoidal mucocele at the time of presentation. The rest of the cases were diagnosed with ethmoidal mucocele (25%). The etiology was identified in four patients and was unclear in the rest. All patients underwent endoscopic sinus surgery. The most identifiable postoperative complication was a headache. CONCLUSIONS The endonasal endoscopic approach is a safe and effective treatment for paranasal sinus mucocele and provides adequate drainage with a low recurrent rate.
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Affiliation(s)
| | - Atheer A Alzubaidi
- Otolaryngology - Head and Neck Surgery, Khamis Mushait General Hospital, Khamis Mushait, SAU
| | - Lamya A Abumsmar
- Otolaryngology - Head and Neck Surgery, Aseer Central Hospital, Abha, SAU
| | - Ali Alzarei
- Otolaryngology - Head and Neck Surgery, Aseer Central Hospital, Abha, SAU
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Malik M, Vahdani K, Rose GE. Ophthalmic Presentation and Outcome for Sinonasal Mucoceles. Ophthalmic Plast Reconstr Surg 2023; 39:44-48. [PMID: 35699210 DOI: 10.1097/iop.0000000000002234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE The purpose of this study was to evaluate ophthalmic features and outcomes for patients who present with sinonasal mucoceles expanding into the orbit. PATIENTS AND METHODS Retrospective chart review for patients seen in a specialist orbital clinic over 25 years, with a review of demographics, clinical characteristics, imaging features, and outcomes after treatment. RESULTS Sixty patients (38 males; 63%) presented at a mean age of 51 years (range 3-89). Symptom duration was extremely variable (1 week-15 years) with a mean of 14 months and median of 4 months-the commonest being periorbital swelling (33/62 orbits) or ache (20 orbits), proptosis (30 orbits), and diplopia (19/50 patients without visual impairment; 38%). Of mucoceles affecting orbital function, 60/62 (97%) were of frontal and/or ethmoid sinus origin, and probable predispositions included past trauma (12/62 orbits) or prior ipsilateral sinus surgery (14 orbits). Forty-two of the 59 (71%) patients who underwent sinus surgery had complete resolution of symptoms within 6 months. Of 10 orbits presenting with moderate to severe visual loss (Snellen 20/60 or worse), the acuity improved in 7/10 (70%) of these after sinus surgery. Although 12/62 (19%) of eyes presented with epiphora, this persisted after sinus surgery in 9 orbits, and areas of occult malignant change were found in 3/9 (33%). CONCLUSION Sinus mucoceles expanding into the orbit can cause significant globe displacement, dysmotility, or visual impairment. Symptoms usually resolve within several months after functional sinus surgery, but where symptoms persist (particularly periorbital swelling or epiphora) this might indicate underlying secondary causes, such as occult malignancy.
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Affiliation(s)
- Mohsan Malik
- Adnexal Service, Moorfields Eye Hospital, London, United Kingdom
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Wucherpfennig L, Wuennemann F, Eichinger M, Seitz A, Baumann I, Stahl M, Graeber SY, Zhao S, Chung J, Schenk JP, Alrajab A, Kauczor HU, Mall MA, Sommerburg O, Wielpütz MO. Long-term effects of lumacaftor/ivacaftor on paranasal sinus abnormalities in children with cystic fibrosis detected with magnetic resonance imaging. Front Pharmacol 2023; 14:1161891. [PMID: 37101549 PMCID: PMC10123276 DOI: 10.3389/fphar.2023.1161891] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/29/2023] [Indexed: 04/28/2023] Open
Abstract
Introduction: Chronic rhinosinusitis (CRS) usually presents with nasal congestion, rhinorrhea and anosmia impacts quality of life in cystic fibrosis (CF). Especially mucopyoceles pathognomonic for CRS in CF may cause complications such as spread of infection. Previous studies using magnetic resonance imaging (MRI) demonstrated early onset and progression of CRS from infancy to school age in patients with CF, and mid-term improvements of CRS in preschool and school-age children with CF treated with lumacaftor/ivacaftor for at least 2 months. However, long-term data on treatment effects on paranasal sinus abnomalities in preschool and school-age children with CF are lacking. Methods: 39 children with CF homozygous for F508del (mean age at baseline MRI 5.9 ± 3.0 years, range 1-12 years) underwent MRI before (MRI1) and about 7 months after starting lumacaftor/ivacaftor and then annually (median 3 follow-up MRI, range 1-4) (MRI2-4). MRI were evaluated using the previously evaluated CRS-MRI score with excellent inter-reader agreement. For intraindividual analysis ANOVA mixed-effects analysis including Geisser-Greenhouse correction and Fisher's exact test, and for interindividual group analysis Mann-Whitney test were used. Results: The CRS-MRI sum score at baseline was similar in children starting lumacaftor/ivacaftor in school age and children starting therapy at preschool age (34.6 ± 5.2 vs.32.9 ± 7.8, p = 0.847). Mucopyoceles were the dominant abnormality in both, especially in maxillary sinus (65% and 55%, respectively). In children starting therapy in school age the CRS-MRI sum score decreased longitudinally from MRI1 to MRI2 (-2.1 ± 3.5, p < 0.05), MRI3 (-3.0 ± 3.7, p < 0.01) and MRI4 (-3.6 ± 4.7, p < 0.01), mainly due to a decrease in the mucopyoceles subscore (-1.0 ± 1.5, p = 0.059; -1.2 ± 2.0, p < 0.05; -1.6 ± 1.8, p < 0.01; and -2.6 ± 2.8, p = 0.417, respectively). In children starting lumacaftor/ivacaftor in preschool age, the CRS-MRI sum score remained stable under therapy over all three follow-up MRI (0.6 ± 3.3, p = 0.520; 2.4 ± 7.6, p = 0.994; 2.1 ± 10.5, p > 0.999 and -0.5 ± 0.5, p = 0.740; respectively). Conclusion: Longitudinal paranasal sinus MRI shows improvements in paranasal sinus abnormalities in children with CF starting lumacaftor/ivacaftor therapy at school age. Further, MRI detects a prevention of an increase in paranasal sinus abnormalities in children with CF starting lumacaftor/ivacaftor therapy at preschool age. Our data support the role of MRI for comprehensive non-invasive therapy and disease monitoring of paranasal sinus abnormalities in children with CF.
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Affiliation(s)
- Lena Wucherpfennig
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Felix Wuennemann
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Helios Dr. Horst-Schmidt-Kliniken Wiesbaden, Wiesbaden, Germany
| | - Monika Eichinger
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Angelika Seitz
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Ingo Baumann
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Mirjam Stahl
- Department of Pediatric Respiratory Medicine, Immunology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
- German Center for Lung Research (DZL), Berlin, Germany
- Berlin Institute of Health (BIH) at Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Simon Y. Graeber
- Department of Pediatric Respiratory Medicine, Immunology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
- German Center for Lung Research (DZL), Berlin, Germany
- Berlin Institute of Health (BIH) at Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Shengkai Zhao
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
| | - Jaehi Chung
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
- Division of Pediatric Pulmonology, Allergy, and Cystic Fibrosis Center, Department of Pediatrics III, University Hospital Heidelberg, Heidelberg, Germany
| | - Jens-Peter Schenk
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Abdulsattar Alrajab
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Marcus A. Mall
- Department of Pediatric Respiratory Medicine, Immunology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
- German Center for Lung Research (DZL), Berlin, Germany
- Berlin Institute of Health (BIH) at Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Olaf Sommerburg
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
- Division of Pediatric Pulmonology, Allergy, and Cystic Fibrosis Center, Department of Pediatrics III, University Hospital Heidelberg, Heidelberg, Germany
| | - Mark O. Wielpütz
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
- *Correspondence: Mark O. Wielpütz,
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Vlaminck L, Pollaris E, Vanderperren K, Tremaine WH, Raes E. Diagnosis and Surgical Treatment of Idiopathic Primary Sino-Nasal Obstruction in Miniature Horse Breeds: Long-Term Follow-Up of Seven Cases. Front Vet Sci 2021; 8:680150. [PMID: 34295933 PMCID: PMC8290127 DOI: 10.3389/fvets.2021.680150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 06/01/2021] [Indexed: 11/13/2022] Open
Abstract
Idiopathic sino-nasal obstruction resulting in retention of large amounts of liquid in the paranasal sinus compartments was diagnosed in seven young (2. 2 ± 0.7 years) miniature-breed horses based on clinical, endoscopic, radiographic, and CT scan examinations. The most prevalent clinical signs included decreased or no airflow from the nostril(s) (7/7) and nasal discharge (6/7). The problem presented bilaterally in six of seven cases. An alternative sino-nasal communication was created through bone flap osteotomy surgery and perforation of the ventromedial floor of the dorsal conchae in all cases, followed by fixation of silicone irrigation tubes/Foley catheters in six of seven cases to keep the newly created ostium patent. This resulted in long-term resolution of the problem with good cosmetic appearance in all animals following a median period of 19 months. Premature loss of fixed tubes was reported in three cases.
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Affiliation(s)
- Lieven Vlaminck
- Department of Large Animal Surgery, Anaesthesia and Orthopaedics, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Elke Pollaris
- Department of Large Animal Surgery, Anaesthesia and Orthopaedics, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Katrien Vanderperren
- Department of Medical Imaging of Domestic Animals and Orthopedics of Small Animals, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | | | - Els Raes
- Department of Medical Imaging of Domestic Animals and Orthopedics of Small Animals, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
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9
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Recurred Sphenoethmoidal Mucocele After Treated With Simple Endoscopic Marsupialization. J Craniofac Surg 2021; 32:e661-e663. [PMID: 34191777 DOI: 10.1097/scs.0000000000007825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT Paranasal sinus mucocele is a mostly benign disease but can cause irreversible complications depending on its location. A sphenoethmoidal mucocele (SEM) can cause compressive neuropathy due to its proximity to the optic nerve. Urgent endoscopic marsupialization is considered the treatment of choice for SEM. However, there is a scarcity regarding recurrence or operative size. Herein, the authors report a case of SEM that recurred after small endoscopic drainage. The patient was reoperated with wide cyst removal and nasal cavity ventilation expansion. Vision was partially resolved, and no recurrence was reported in the 6-month follow-up period.
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10
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Mahfoz TMB, Alnemare AK. Optic neuropathy related to Onodi cell mucocele: a systematic review and meta-analysis of randomized controlled trials. AIMS MEDICAL SCIENCE 2021. [DOI: 10.3934/medsci.2021018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
<abstract><sec>
<title>Background</title>
<p>Onodi cells (OC) are important for rhinologists because they contain the optic canal, and are close to the optic nerve and internal carotid artery. Therefore, any pathologic processes within OCs, including infectious or inflammatory sinusitis, fungus ball, inverted papilloma, mucocele, or sino-nasal malignancy can cause devastating ophthalmologic complications. We aimed to define the different optic neuropathy conditions related to isolated OC mucoceles, determine the different symptoms of each condition and its risk factors, and explore the efficacy of the relevant diagnostic tools and treatment strategies.</p>
</sec><sec>
<title>Methodology</title>
<p>A comprehensive electronic search with time and language restrictions was conducted. Several known databases were included: PubMed, The Cochrane Library, and Web of Science from 1990 to 2020. We combined the search terms and limited the study to the English language. We removed duplicates, and the articles were screened based on title, abstract, and full text according to the PRISMA checklist.</p>
</sec><sec>
<title>Results</title>
<p>The electronic search strategy conducted in this review resulted in 409 hits. After removing duplicate studies and studies with inadequate information, 20 case studies were finally included in this analysis, 65% of which presented men (n = 13), and seven presented women (35%). The mean age reported in these studies was 54.75 with a standard deviation of 14.62 years. We found that visual disturbances that can lead to visual loss were present in most cases (75% of cases). Other symptoms included headache (35%) and eye pain (30%). The risk factors for developing optic neuropathy conditions related to OC mucoceles include being Asian and elderly with a history of either nasal or eye conditions. Our findings showed that the mean time between the onset of symptoms and intervention was 16.8 ± 21.8 days. Most patients underwent endoscopic sinus surgery to remove the OC mucocele (18/20; 90%) with a success rate of 77%. Pharmacologic intervention as a solo treatment (IV corticosteroids or /and antibiotic) was used in only six patients, with a success rate of only 33%. Computed tomography (CT) and magnetic resonance imaging (MRI) is the most commonly used diagnostic tools, with diagnostic success rates of 40% and 82.3%, respectively.</p>
</sec><sec>
<title>Conclusion</title>
<p>Optic neuropathy conditions related to OC mucoceles are very rare. However, a higher incidence of these conditions was observed in elderly Asian patients with a history of nasal or optic conditions. Visual disturbances are the most common symptoms accompanying any type of eye condition. Endoscopic sinus surgery is considered an effective and safe intervention for these patients, and the period between the onset of symptoms and surgery does not affect the outcomes of the surgery. Furthermore, treatment with corticosteroids and/or antibiotics cannot replace surgery and it can also worsen the condition. Moreover, MRI is superior to CT scans for demonstrating this abnormality, and both are superior to other diagnostic tools. Finally, further investigations should be conducted to study the causes of the low incidence of these conditions in the eastern region.</p>
</sec></abstract>
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11
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Unilateral Vision Loss Due to Isolated Onodi Cell Mucocele. J Craniofac Surg 2020; 32:e355-e356. [PMID: 33003159 DOI: 10.1097/scs.0000000000007143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Onodi cell mucocele is a rare, benign, cystic, destructive and expansive lesion. While the sphenoid sinus mucocele is 1% to 2%, onodi cell mucocele is very rare. Because of its direct mass compression effect, its proximity to the orbital apex may cause many symptoms such as loss of vision, eye movements, and exophthalmus. Imaging methods have an important priority in diagnosis. It also plays a crucial role in planning treatment quickly and guiding the surgeon. Surgical excision is performed in the treatment, usually with an endonasal approach.
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12
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陶 泽, 左 晶. [The prevention and treatment of complications in endoscopic sinus surgery]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2020; 34:577-581. [PMID: 32791628 PMCID: PMC10133099 DOI: 10.13201/j.issn.2096-7993.2020.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Indexed: 11/12/2022]
Affiliation(s)
- 泽璋 陶
- 武汉大学人民医院耳鼻咽喉头颈外科(武汉,430060)
| | - 晶晶 左
- 武汉大学人民医院耳鼻咽喉头颈外科(武汉,430060)
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13
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Topilow NJ, Tran AQ, Koo EB, Alabiad CR. Etiologies of Proptosis: A review. INTERNAL MEDICINE REVIEW (WASHINGTON, D.C. : ONLINE) 2020; 6:10.18103/imr.v6i3.852. [PMID: 32382689 PMCID: PMC7204542 DOI: 10.18103/imr.v6i3.852] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Proptosis, the protrusion of the eyeball from the orbit, results from a wide variety of pathologies that can be vision- or life-threatening. Clinical history, associated physical exam findings, and imaging features are all crucial in establishing the underlying etiology. The differential diagnosis is broad, and includes infectious, inflammatory, vascular, and neoplastic entities that range from benign and indolent, to malignant and aggressive. While treatment varies significantly based on the disease process, all are aimed at preserving vision, salvaging the globe, preventing disfigurement, and reducing mortality. Both internists and general ophthalmologists should be familiar with the causes of proptosis in order to initiate the work-up for, and appropriately triage, affected patients.
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Affiliation(s)
- Nicole J Topilow
- Bascom Palmer Eye, Institute, University of Miami Miller School of Medicine, Miami, FL 33136
| | - Ann Q Tran
- Bascom Palmer Eye, Institute, University of Miami Miller School of Medicine, Miami, FL 33136
| | - Eubee B Koo
- Bascom Palmer Eye, Institute, University of Miami Miller School of Medicine, Miami, FL 33136
| | - Chrisfouad R Alabiad
- Bascom Palmer Eye, Institute, University of Miami Miller School of Medicine, Miami, FL 33136
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14
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Hosokawa Y, Omura K, Aoki S, Miyashita K, Akutsu M, Tsunemi Y, Kashiwagi T, Haruna S, Otori N, Tanaka Y. Predictors of Visual Acuity and Usefulness of a Treatment Algorithm in Rhinogenous Optic Neuritis. EAR, NOSE & THROAT JOURNAL 2019; 100:162-166. [PMID: 31550936 DOI: 10.1177/0145561319865490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rhinogenous optic neuritis, which causes neuropathy associated with visual dysfunction, greatly reduces patient quality of life and requires suitable early treatment. This study aimed to analyze visual outcome predictors in patients with rhinogenous optic neuritis and to develop and investigate the usefulness of an algorithm to facilitate early treatment. Prospective and retrospective investigations were conducted at the Department of Otorhinolaryngology. The visual outcomes after sinus surgery of 24 of 53 patients suspected of having rhinogenous optic neuritis were analyzed. Furthermore, the usefulness of the treatment algorithm was evaluated in 27 of these 53 patients. Data from 24 patients who underwent surgery were included in a multiple regression analysis to investigate the associations between visual outcomes and concomitant symptoms and the time from symptom onset to surgery. The mean time from the initial examination to a request for otorhinolaryngological examination to assess the usefulness of the treatment algorithm was compared in 27 patients who did not undergo an initial otorhinolaryngological examination. Visual acuity improved in 23 participants who underwent surgery. Multivariate analysis identified the time from onset to surgery and headache as significant predictors of postoperative visual acuity. The mean time from the initial examination to a request for otorhinolaryngological examination was significantly shorter after the algorithm was introduced (1.13 days, 8 patients; P = .008). Early surgical treatment is essential to avoid further postoperative visual acuity decreases in patients with rhinogenous optic neuritis. Patients who experience headache may have poorer postoperative outcomes.
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Affiliation(s)
- Yu Hosokawa
- Department of Otorhinolaryngology, 365086Dokkyo Medical University Saitama Medical Center, Saitama, Japan.,Department of Otorhinolaryngology, 12839the Jikei University School of Medicine, Tokyo, Japan
| | - Kazuhiro Omura
- Department of Otorhinolaryngology, 365086Dokkyo Medical University Saitama Medical Center, Saitama, Japan.,Department of Otorhinolaryngology, 12839the Jikei University School of Medicine, Tokyo, Japan
| | - Satoshi Aoki
- Department of Otorhinolaryngology, 365086Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Keisuke Miyashita
- Department of Otorhinolaryngology, 365086Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Makoto Akutsu
- Department of Otorhinolaryngology and Head and Neck Surgery, 365086Dokkyo Medical University, Tochigi, Japan
| | - Yasuhiro Tsunemi
- Department of Otorhinolaryngology and Head and Neck Surgery, 365086Dokkyo Medical University, Tochigi, Japan
| | - Takashi Kashiwagi
- Department of Otorhinolaryngology and Head and Neck Surgery, 365086Dokkyo Medical University, Tochigi, Japan
| | - Shinichi Haruna
- Department of Otorhinolaryngology and Head and Neck Surgery, 365086Dokkyo Medical University, Tochigi, Japan
| | - Nobuyoshi Otori
- Department of Otorhinolaryngology, 12839the Jikei University School of Medicine, Tokyo, Japan
| | - Yasuhiro Tanaka
- Department of Otorhinolaryngology, 365086Dokkyo Medical University Saitama Medical Center, Saitama, Japan
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15
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Mizushima Y, Mumo T, Yasui T, Ito K. Paranasal sinus mucocele with visual disturbances whose causative legion was hardly identified on computed tomography imaging: A case report. ACTA OTO-LARYNGOLOGICA CASE REPORTS 2019. [DOI: 10.1080/23772484.2019.1589376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Yu Mizushima
- Department of Otolaryngology and Head and Neck Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Takashi Mumo
- Department of Otolaryngology and Head and Neck Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Takuya Yasui
- Department of Otolaryngology and Head and Neck Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Ken Ito
- Department of Otolaryngology and Head and Neck Surgery, Teikyo University School of Medicine, Tokyo, Japan
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16
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Krouse JH. Highlights from the Current Issue: November 2017. Otolaryngol Head Neck Surg 2018; 157:743-744. [PMID: 29090644 DOI: 10.1177/0194599817733666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- John H Krouse
- 1 School of Medicine, University of Texas Rio Grande Valley, Edinburg, Texas, USA
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