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Abstract
Mucormycosis is relatively uncommon, fulminant, progressive, life threatening fungal disease which is most often seen in debilitating patients with immunocompromised condition. Mucormycosis cases are seen in patients with the use of systemic steroids in the treatment of severely affected COVID-19 cases and also in the patients with uncontrolled diabetes which causes immunosuppression are being reported with mucormycosis. The main symptoms of this disease include pain on the temporal and the orbital region of the affected side which could be throbbing or lancinating type, mobility of the teeth, jaw pain and often swelling is present which could be extraoral and intraoral both or sometimes only intraorally. The diagnostic approach in such cases is done with the help of clinical diagnosis, histopathology and with advanced imaging like cone beam computed tomography, magnetic resonance imaging and computed tomography. We here used cone beam computed tomography imaging that revealed haziness in the sinuses and breach in cortical bone of the affected area which confirmed the diagnosis of mucormycosis. Early treatment planning like administration of antifungal drugs and surgical debridement will be life saving in such a deadly disease.
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Affiliation(s)
- Dhaman Gupta
- Department of Public Health Dentistry, Sri Aurobindo College of Dentistry, Indore, Madhya Pradesh, India
| | - Tanvi Dosi
- Department of Oral Medicine and Radiology, Sri Aurobindo College of Dentistry, Indore, Madhya Pradesh, India
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2
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Maul XA, Borchard NA, Hwang PH, Nayak JV. Microcurrent technology for rapid relief of sinus pain: a randomized, placebo-controlled, double-blinded clinical trial. Int Forum Allergy Rhinol 2019; 9:352-356. [PMID: 30667597 PMCID: PMC6590214 DOI: 10.1002/alr.22280] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 11/30/2018] [Accepted: 12/18/2018] [Indexed: 11/15/2022]
Abstract
Background Transcutaneous electrical nerve stimulation has proven to be effective in alleviating chronic pain from facial myalgias. We evaluated the efficacy of a novel handheld microcurrent‐emitting device in short‐term, office‐based treatment of patients with sinus pain. This device, which is U.S. Food and Drug Administration (FDA)‐cleared, detects and treats regions corresponding to nerve fibers. Methods Randomized, double‐blinded, placebo‐controlled trial. Seventy‐one participants with facial pain attributed to self‐reported nasal/sinus disease were recruited from a tertiary rhinologic practice and the surrounding community and randomly assigned to either office‐based use of an active (n = 38) or placebo (n = 33) microcurrent emitter. The study device was repetitively applied by each patient to the bilateral periorbital areas for 5 minutes. A visual analogue scale (VAS) for pain severity was administered before, and 10 minutes after, treatment. Results Active microcurrent‐treated patients had a reduction in mean pain score from 5.63 pretreatment to 3.97 posttreatment (mean difference, 1.66; 95% confidence interval [CI], 1.20 to 2.12). Patients using the sham device also reported sinus pain reductions (mean difference, 0.91; 95% CI, 0.61 to 1.21). However, the active device demonstrated a significantly greater reduction in pain compared to sham (0.75‐point difference, p = 0.007). Notably, 23.7% of patients using the active device had a reduction of 3 or more points by VAS compared to 0% of sham device patients (p = 0.003). One minor occurrence of transient facial skin erythema was noted. Conclusion This trial suggests that treatment of rhinologic facial pain using this noninvasive microcurrent device is safe and effective in providing rapid relief of nasal/sinus pain. Additional studies with longer term follow‐up are warranted.
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Affiliation(s)
- Ximena A. Maul
- Division of Rhinology, Department of Otolaryngology–Head and Neck SurgeryStanford University School of MedicineStanfordCA
- Department of OtolaryngologyPontificia Universidad Católica of Chile School of MedicineSantiagoChile
| | - Nicole A. Borchard
- Division of Rhinology, Department of Otolaryngology–Head and Neck SurgeryStanford University School of MedicineStanfordCA
| | - Peter H. Hwang
- Division of Rhinology, Department of Otolaryngology–Head and Neck SurgeryStanford University School of MedicineStanfordCA
| | - Jayakar V. Nayak
- Division of Rhinology, Department of Otolaryngology–Head and Neck SurgeryStanford University School of MedicineStanfordCA
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3
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Abstract
RATIONALE Mucormycosis is a rare fungal infection which mainly develops in compromised hosts and the associated mortality rate is high. PATIENT CONCERNS We report a case of mucormycosis in a 59-year-old woman following routine endoscopic sinus surgery. The patient had a history of diabetes mellitus (DM) and bronchial asthma. DIAGNOSES On follow-up 4 weeks after the first functional endoscopic sinus surgery (FESS), she complained of a severe headache and was readmitted for a second period. Endoscopic examination revealed bony erosion and a whitish discharge on the left middle turbinate, which was confirmed as mucormycosis by endoscopic biopsy. INTERVENTIONS Endoscopic debridement of the necrotic tissue and middle turbinectomy were performed and the patient was treated with intravenous amphotericin B for 3 months (3.5 mg/kg/day). OUTCOMES About 1 month into the second period of hospitalization, left Bell's palsy had occurred. The facial palsy improved naturally after 2 months of hospitalization. One year after endoscopic debridement, follow-up endoscopy showed that there was no residual lesion. CONCLUSION This is the first report of mucormycosis after routine endoscopic sinus surgery. We did not miss headache symptom after FESS surgery, and diagnosed mucormycosis through early endoscopic biopsy, which played an important role in curing the patient. In addition to the importance of medical therapy such as DM control for patients, emotional support and psychiatric treatment are also important factors as these patients require hospitalization for a long period, 3 months in the case of this patient.
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Affiliation(s)
- Cha Dong Yeo
- Department of Otolaryngology-Head and Neck Surgery
| | - Jong Seung Kim
- Department of Otolaryngology-Head and Neck Surgery
- Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital
| | - Sam Hyun Kwon
- Department of Otolaryngology-Head and Neck Surgery
- Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital
| | - Eun Jung Lee
- Department of Otolaryngology-Head and Neck Surgery
- Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital
| | - Min Hee Lee
- Department of Internal Medicine, Division of Allergy and Pulmonology, Presbyterian Medical Center, Jeonju, Republic of Korea
| | - Su Geun Kim
- Department of Otolaryngology-Head and Neck Surgery
| | | | - June Sun Kim
- Department of Otolaryngology-Head and Neck Surgery
| | | | - Ji Seob Ryu
- Department of Otolaryngology-Head and Neck Surgery
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Edriss H, Kelley JS, Demke J, Nugent K. Sinonasal and Laryngeal Sarcoidosis-An Uncommon Presentation and Management Challenge. Am J Med Sci 2018; 357:93-102. [PMID: 30665498 DOI: 10.1016/j.amjms.2018.11.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 11/03/2018] [Accepted: 11/14/2018] [Indexed: 12/23/2022]
Abstract
Sarcoidosis is a chronic inflammatory disease of uncertain etiology characterized by the formation of noncaseating granulomas. The thorax is involved in 95% of cases, but any organ can be involved. Sinonasal or laryngeal involvement is uncommon and can be difficult to diagnose. The reported incidence of sarcoidosis in the upper airway clearly depends on study characteristics, and this creates uncertainty about the actual incidence. In a large prospective study in the United States, upper respiratory tract involvement occurred in 3% of the patients. Some patients have upper airway involvement without thoracic disease, and this presentation may cause delays in diagnosis. These patients have nonspecific symptoms which range from minimal nasal stuffiness to life-threatening upper airway obstruction. Currently, there is no established standard therapy for the management of upper airway sarcoidosis. These patients often respond poorly to nasal and/or inhaled corticosteroids and require long courses of oral corticosteroids. Patients with poor responses to oral corticosteroids or severe side effects may respond to tumor necrosis factor alpha inhibitors. In this review, we will discuss the clinical presentation, pathogenesis, diagnostic tests, drug treatment, surgical management options and the challenges clinicians have managing these patients.
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Affiliation(s)
- Hawa Edriss
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas.
| | - John S Kelley
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Joshua Demke
- Department of Otolaryngology, Facial Plastic & Reconstructive Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Kenneth Nugent
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
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5
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Abstract
Management of invasive aspergillosis of the paranasal sinuses requires sufficient experience to initiate appropriate investigations and then utilize the correct treatment protocol. Computed tomography (CT) or magnetic resonance imaging (MRI) is essential to show the extent of the disease and diagnosis is confirmed by histological analysis. Aspergillus flavus is a ubiquitous soil saprophyte in the Sudan and is responsible for many cases originating from this area. The literature is reviewed and treatment options discussed.
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Affiliation(s)
- P Tierney
- Department of Otolaryngology-Head & Neck Surgery, St Mary's Hospital, London, England
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6
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Qin Y, Lu Y, Zheng L, Liu H. Ghost cell odontogenic carcinoma with suspected cholesterol granuloma of the maxillary sinus in a patient treated with combined modality therapy: A case report and the review of literature. Medicine (Baltimore) 2018; 97:e9816. [PMID: 29443742 PMCID: PMC5839843 DOI: 10.1097/md.0000000000009816] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
RATIONALE Ghost cell odontogenic carcinoma (GCOC) is a rare malignant odontogenic tumor with aggressive growth characteristics. PATIENT CONCERNS A 41-year-old Chinese male visited our hospital in 2013, with a 4-month history of bloody purulent rhinorrhea with a peculiar smell in the right nasal cavity. DIAGNOSES The patient suffered from recurrent GCOC with suspected cholesterol granuloma of the maxillary sinus. The patient was incorrectly diagnosed with a calcifying epithelial odontogenic tumor at his first recurrence. Physical examination, radiological examination, and histopathology were used to identify GCOC. INTERVENTIONS Considering the recurrence of GCOC and poor effects of single surgery, postoperative adjuvant chemotherapy and concurrent chemoradiotherapy were performed after radical surgical excision. OUTCOMES So far, no significant evidence has suggested recurrence or metastasis after a long-term follow-up. LESSONS We advocate wide surgery with clean margins at the first accurate diagnosis. Combined modality therapy could be taken for the recurrent GCOC. We expect to provide a new treatment strategy to prevent the growth of this neoplasm.
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Affiliation(s)
| | | | | | - Hong Liu
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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7
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Seo JH, Kim JA, Choi B, Kim KH, Park HN, Seok H, Sohn TS. Hyperglycemic hyperosmolar state associated with invasive rhino-orbital aspergillosis in a patient with end-stage renal disease. Korean J Intern Med 2017; 32:936-938. [PMID: 26968192 PMCID: PMC5583439 DOI: 10.3904/kjim.2015.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 06/01/2015] [Accepted: 06/16/2015] [Indexed: 11/27/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Tae Seo Sohn
- Correspondence to Tae Seo Sohn, M.D. Department of Internal Medicine, College of Medicine, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea, 271 Cheonboro, Uijeongbu 11765, Korea Tel: +82-31-820-3652 Fax: +82-31-847-2719 E-mail:
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Eloy JA, Setzen M. Frontal Sinus Disease: Contemporary Management. Otolaryngol Clin North Am 2017; 49:xv-xvi. [PMID: 27450622 DOI: 10.1016/j.otc.2016.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Jean Anderson Eloy
- Department of Otolaryngology - Head and Neck Surgery, Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Department of Neurological Surgery, Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, 90 Bergen Street, Suite 8100, Newark, NJ 07103, USA.
| | - Michael Setzen
- Chief Rhinology Section, North Shore University Hospital, Manhasset, NY 11030, USA; Department of Otolaryngology, New York University School of Medicine, New York, NY 10016, USA; Michael Setzen Otolaryngology, PC, 600 Northern Boulevard, Suite 312, Great Neck, NY 11021, USA.
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Prado-Calleros HM, Fajardo-Dolci G, Plowes-Hernández O, Jiménez-Gutiérrez C. [Rhino-Orbital Mucormycosis. Cohort study of its treatment according disease extent and reversion of its pathophysiology]. GAC MED MEX 2016; 152:770-782. [PMID: 27861475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
Mucormycosis is a lethal opportunistic fungal infection, described mostly in immunocompromised patients. A comparative cohort study was conducted to compare the evolution of the study group patients with rhino-orbital mucormycosis, in which a therapeutic protocol was instituted, in which the pterygomaxillary fossa is systematically surgically approached and orbital exenteration is performed or not based on the spreading of the infection to the orbital apex or the orbital fissure, with a historical group where these criteria were not applied. Fifteen cases were included, eight in historic group A and seven in the study group B. Medical treatment was provided with control of the underlying disease (amphotericin B and low molecular weight heparin) as well as surgical treatment with extensive debridement including endoscopic ethmoidectomy and exploration of the pterygomaxillary fossa, also performing orbital exenteration only in patients who presented orbital apex syndrome in group B. In group A, there was a mortality rate of 50%, in group B all patients were clinical cured; however, the two patients with hematologic diseases died of complications not related to the fungal infection. With the standardization of a diagnostic and therapeutic protocol, good results in healing and survival of patients can be obtained.
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Affiliation(s)
| | - Germán Fajardo-Dolci
- Unidad de Educación, Investigación y Políticas de Salud, IMSS, Ciudad de México, México
| | - Olga Plowes-Hernández
- División de Otorrinolaringología, Hospital General Dr. Manuel Gea González, Ciudad de México, México
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10
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Easto R, Shukla R, Williams R. An overview of common diseases of the nasal cavity and paranasal sinuses. J R Nav Med Serv 2016; 102:117-123. [PMID: 29896941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Diseases of the nasal cavity and paranasal sinuses are a common complaint amongst the general population and service personnel. Chronic rhinosinusitis, with or without nasal polyps, and nasal deformity leading to airway obstruction are some of the commonest ear, nose and throat (ENT) conditions encountered. However, hidden within this generally benign group of conditions are some potentially lethal problems that clinicians need to be able to recognise. This article aims to provide an overview of common conditions affecting the nose and paranasal sinuses, including fractured nasal bones, acute rhinosinusitis and its complications, and chronic rhinosinusitis. Epistaxis and sinonasal malignancies are largely outside the scope of this paper. Background information on pathogenesis will be described, along with guidance on diagnosis and management with particular stress on emergency pre-hospital treatment and indications for referral to an ENT specialist.
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12
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Xiao J, Chen J, Wang Y. Balloon catheter dilation technology combined with a fibrolaryngoscope to treat a maxillary sinus cyst. Eur Arch Otorhinolaryngol 2015; 273:407-11. [PMID: 25749614 DOI: 10.1007/s00405-015-3588-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 02/26/2015] [Indexed: 11/26/2022]
Abstract
A prospective randomized controlled study was conducted to investigate the effect of balloon catheter dilation technology combined with a fibrolaryngoscope in the treatment of a maxillary sinus cyst. The clinical data of 14 cases (19 maxillary sinuses) with balloon catheter dilation technology combined with a fibrolaryngoscope to remove sinus cysts (balloon group) and 16 cases (23 maxillary sinuses) with conventional nasal endoscopic sinus surgery to remove sinus cysts (conventional group) were analyzed. All cases have completed the preoperative and postoperative SNOT-20, nasal endoscopy and coronal sinus CT scan. Lund-Kennedy endoscopic and Lund-Mackay CT scan staging scores were recorded. All patients were followed up for 24 weeks after the operation. The SNOT-20 scores, Lund-Kennedy endoscopic and Lund-Mackay CT scan staging scores were lower in the balloon group than that in the control group. Balloon catheter dilation technology combined with a fibrolaryngoscope can effectively preserve the function and structures of the nasal cavity and sinus, making it a good choice in the treatment of a retention cyst of the maxillary sinus.
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Affiliation(s)
- Jianxin Xiao
- Department of Otolaryngology, The First People's Hospital of Fosha, Foshan, 528000, People's Republic of China
| | - Junming Chen
- Department of Otolaryngology, The First People's Hospital of Fosha, Foshan, 528000, People's Republic of China
| | - Yuejian Wang
- Department of Otolaryngology, The First People's Hospital of Fosha, Foshan, 528000, People's Republic of China.
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13
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Abstract
Sarcoidosis is a complex disorder that often times involves the head and neck. Despite the presence of strong clinical evidence, tissue diagnosis and imaging is needed for confirmation of the disease. Although typically managed medically, when found in the sinonasal tract or intracranially, it may necessitate the intervention of a rhinologist-skull base surgeon. This article seeks to provide a comprehensive review of head and neck sarcoidosis, as this fascinating disorder often poses a diagnostic and therapeutic challenge. A brief discussion of surgical treatment for pituitary lesions is also provided. Articles from 1997 to 2013 were selected and reviewed by three researchers utilizing the most recent literature regarding sarcoidosis in the head and neck. PubMed searches were conducted using search terms such as "sarcoidosis", "neurosarcoid", and "extra-pulmonary sarcoid", among many others. A large collection of articles was generated and reviewed by the team of authors, and appropriate information was extracted to compose a thorough and expansive review of the subject. 10-15 % of patients with sarcoidosis have head and neck manifestations. Sinonasal and pituitary sarcoidosis presents a diagnostic challenge owing to its non-specific symptoms. Although systemic steroid therapy is often the first time treatment, endoscopic surgery is commonly used to treat advanced pituitary sarcoidosis refractory to medical management. As tissue diagnosis and imaging is key, a multi-disciplinary team approach is advantageous. Our study collates the available literature on head and neck sarcoidosis to provide a comprehensive review of the subject. This provides helpful information to guide all practitioners involved in the care of these challenging patients, namely pathologists, radiologists, otolaryngologists, and skull base surgeons, in the workup and management of head and neck sarcoidosis.
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Affiliation(s)
| | - Sameep Kadakia
- />Department of Otolaryngology/Head and Neck Surgery, New York Eye and Ear Infirmary – Mount Sinai Health System, 310 East 14th Street, 6th Floor, New York, NY 10009 USA
| | - Ricardo L. Carrau
- />Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, New York, NY USA
| | - Codrin Iacob
- />Department of Head and Neck Pathology, New York Eye and Ear Infirmary - Mount Sinai Health System, New York, NY USA
| | - Azita Khorsandi
- />Department of Head and Neck Pathology, New York Eye and Ear Infirmary - Mount Sinai Health System, New York, NY USA
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Chong S, Teh C, Shashinder S, Mun KS, Viswaraja S. Aggressive inflammatory pseudotumor of the maxillary sinus and orbit. Ear Nose Throat J 2014; 93:108-111. [PMID: 24652559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
Inflammatory pseudotumor (IPT) is a rare, locally aggressive, benign neoplasm of unknown etiology. It is uncommon in the head and neck region, particularly in the paranasal sinuses. We present an unusual case of IPT of the maxillary sinus and orbit in a 27-year-old woman who presented with cheek swelling, right orbital swelling, double vision, and associated fever and trismus. Computed tomography identified a mass with radiologic features suggestive of a malignancy of the maxillary sinus and orbit; the mass extended into the infratemporal fossa, parapharyngeal space, anterior antral wall, and surrounding soft tissue. A diagnosis of IPT was established on the basis of histologic and immunohistochemical analysis, which identified a proliferation of bland spindle cells and a mixed inflammatory cell infiltrate. Despite its aggressive appearance, IPT is associated with a good prognosis. Our patient was treated successfully with a combination of surgery, steroid therapy, and methotrexate. Chemotherapeutic agents are generally reserved for recalcitrant cases.
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Affiliation(s)
- Sheldon Chong
- Department of Otorhinolaryngology, Modbury Hospital, 41-69 Smart Rd., Adelaide, SA 5092, Australia.
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15
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Kim KY, Bae JH, Park JS, Lee SS. Primary sinonasal tuberculosis confined to the unilateral maxillary sinus. Int J Clin Exp Pathol 2014; 7:815-818. [PMID: 24551309 PMCID: PMC3925933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Accepted: 12/29/2013] [Indexed: 06/03/2023]
Abstract
Extrapulmonary tuberculosis is not rare and occurs mainly in the head and neck region. Cervical tuberculous lymphadenopathy is the most common form of extrapulmonary tuberculosis. Sinonasal tuberculosis is known to occur very rarely due to the protective functions of sinonasal mucosa. Although some signs of sinonasal tuberculosis may be present, such as associated facial abscesses, the symptoms and signs are usually nonspecific. Clinical suspicion is important for timely diagnosis and proper management of sinonasal tuberculosis due to its rarity and nonspecific clinical presentation. We report a case of tuberculosis confined to the unilateral maxillary sinus that was first misdiagnosed as recurrent rhinosinusitis after endoscopic sinus surgery.
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Affiliation(s)
- Kyung Yeon Kim
- Department of Otolaryngology-Head and Neck Surgery, Ewha Womans University School of Medicine Seoul, Korea
| | - Jung Ho Bae
- Department of Otolaryngology-Head and Neck Surgery, Ewha Womans University School of Medicine Seoul, Korea
| | - Jee Soo Park
- Department of Otolaryngology-Head and Neck Surgery, Ewha Womans University School of Medicine Seoul, Korea
| | - Seung-Sin Lee
- Department of Otolaryngology-Head and Neck Surgery, Ewha Womans University School of Medicine Seoul, Korea
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16
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Kirsten AM, Watz H, Kirsten D. Sarcoidosis with involvement of the paranasal sinuses - a retrospective analysis of 12 biopsy-proven cases. BMC Pulm Med 2013; 13:59. [PMID: 24070015 PMCID: PMC3850727 DOI: 10.1186/1471-2466-13-59] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Accepted: 09/23/2013] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Extrapulmonary involvement by sarcoidosis is observed in about 30-40% of patients with sarcoidosis. Little is known about the frequency and clinical characteristics of sinonasal sarcoidosis. METHODS We retrospectively analyzed 12 cases of biopsy-proven sinonasal sarcoidosis. Patients were identified from a patient population of 1360 patients with sarcoidosis at the Outpatient Clinic for Sarcoidosis and Rare Lung Diseases at LungClinic Grosshansdorf, a tertiary care hospital for respiratory medicine. RESULTS The most frequent signs and symptoms were nasal polyps (4 cases), epistaxis (3 cases), nasal crusts (8 cases) and anosmia (5 cases). Pulmonary sarcoidosis of the patients was staged as stage I (n = 1) and stage II (n = 11) on chest radiographs. Spirometry was normal in 11 patients. 7 patients had a diffusion capacity of the lung for carbon monoxide of less than 90% of predicted. Other organs were affected in 8 patients. All patients received systemic corticosteroid treatment and most patients received topical steroids. 5 patients received steroid sparing agents. Repeated sinus surgery had to be performed in 4 patients. CONCLUSIONS Sinonasal involvement is a rare disease manifestation of sarcoidosis with a frequency slightly lower than 1% in our patient population. The clinical course of sinonasal sarcoidosis can be complicated by relapse despite systemic immunosuppressive treatment and repeated sinus surgery.
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Affiliation(s)
- Anne-Marie Kirsten
- Pulmonary Research Institute at LungClinic Grosshansdorf, Airway Research Centre North, Member of the German Center for Lung Research, Grosshansdorf, Germany
| | - Henrik Watz
- Pulmonary Research Institute at LungClinic Grosshansdorf, Airway Research Centre North, Member of the German Center for Lung Research, Grosshansdorf, Germany
| | - Detlef Kirsten
- Outpatient Clinic for Rare Lung Diseases and Sarcoidosis at LungClinic Grosshansdorf, Airway Research Center North, Member of the German Center for Lung Research, Grosshansdorf, Germany
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17
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Manrique K, Martín C, Sánchez-Vilar O, Aragón C, Cazorla A, Rovira A. Rhinomucormycosis and type 1 diabetes mellitus. Endocrinol Nutr 2013; 60:149-151. [PMID: 22521299 DOI: 10.1016/j.endonu.2012.01.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Revised: 12/13/2011] [Accepted: 01/09/2012] [Indexed: 05/31/2023]
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Gu Q, Li J, Fan J, He G. [Report of 6 orbital apex syndrome caused by sinus diseases]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2013; 27:67-69. [PMID: 23650702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To investigate the diagnostic and therapeutic methods of orbital apex syndrome caused by sinus diseases and to achieve earlier diagnosis and timely treatment. METHOD Clinical data of 6 cases in our department from January 2008 to March 2012 were retrospectively analyzed. RESULT All cases had surgical treatment. All cases were preoperatively diagnosed by CT, MRI or intranasal endoscopy. The postoperative pathology showed 2 cases with fungal sphenoiditis, 2 cases with ethmoid mucocele and 2 cases with sphenoid mucocele. CONCLUSION Orbital apex syndrome caused by sinus diseases is very rare. The possible causes of misdiagnosis are low incidence of the disease, nonspecific eye symptoms, and unawareness of the doctor, especially ophthalmologist. CT, MRI or intranasal endoscopy can greatly improve the diagnosis of the disease. Endoscopic sinus surgery is a safe and effective method for orbital apex syndrome caused by sinus diseases,which is the primary therapy for the disease.
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Affiliation(s)
- Qingjia Gu
- Department of Otorhinolaryngology, Sichuan Provincial People's Hospital, Chengdu, 610072, China
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Schlosser RJ. To balloon or not to balloon? Arch Otolaryngol Head Neck Surg 2012; 138:1080-1081. [PMID: 23165384 DOI: 10.1001/jamaoto.2013.614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Rare brain infection avoided with safe sinus irrigation. Mayo Clin Health Lett 2012; 30:4. [PMID: 22649815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Viterbo S, Fasolis M, Garzino-Demo P, Griffa A, Boffano P, Iaquinta C, Tanteri G, Modica R. Management and outcomes of three cases of rhinocerebral mucormycosis. ACTA ACUST UNITED AC 2011; 112:e69-74. [PMID: 21862361 DOI: 10.1016/j.tripleo.2011.04.048] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2011] [Accepted: 04/19/2011] [Indexed: 11/18/2022]
Abstract
Mucormycosis is a rare opportunistic infection caused by fungi belonging to Mucorales order. The infection usually starts in the middle or inferior nasal meatus and then spreads to the paranasal sinuses and the orbit. Then it reaches the brain through the ethmoid and the orbit apex and can lead to lethargy, paralysis, and death. The majority of cases of rhinocerebral mucormycosis are diagnosed in patients with immunologic and metabolic disorders. Early diagnosis is fundamental, and so is medical therapy with amphotericin B along with surgical toilet of the compromised tissues. This article presents and discusses the management of 3 cases of rhinocerebral mucormycosis with different onsets, progressions, and outcomes.
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Affiliation(s)
- Stefano Viterbo
- Division of Maxillofacial Surgery, Head and Neck Department, San Giovanni Battista Hospital, University of Turin, Turin, Italy
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Izadi S, Khooshabeh R. Sarcoidosis presenting as imploding antrum syndrome. Orbit 2011; 30:7-9. [PMID: 21281069 DOI: 10.3109/01676830.2010.510361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
We present a case of a male patient who presented with facial asymmetry and epiphora. A diagnosis of imploding antrum syndrome secondary to sarcoidosis was made on the basis of characteristic computerised tomography features, elevated serum ACE and histopathological findings. We suggest that chronic inflammation within the sinus cavities, due to sarcoid, had caused osteolysis of the sinus walls, subsequently leading to the typical presentation of imploding antrum syndrome.
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Affiliation(s)
- Shahrnaz Izadi
- Department of Ophthalmology, Stoke Mandeville Hospital, Mandeville Road, Aylesbury
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Abstract
INTRODUCTION To report a case of idiopathic orbital sclerosing inflammation (ISOI) with intranasal extension. MATERIAL AND METHODS The patient presented with a 6-month history of epiphora, upper eyelid swelling, ptosis and mild orbital pain. Ophthalmologic examination, CT, MRI and biopsy with surgical debulking were performed. RESULTS MRI revealed a homogeneously enhancing diffuse right orbital mass in the inferonasal quadrant of the orbit, which extended to the nasal cavity up to inferior nasal concha, maxillary and ethmoid sinuses. Histological analysis showed dense collagenous tissue with sparse infiltration of mixed inflammatory cells. Inmunohistochemical analysis confirmed polyclonality. The diagnosis of idiopathic sclerosing orbital inflammation was made and 80 mg/day of oral prednisolone was prescribed. At last follow up, one year later, there was no clinical evidence of recurrent orbital disease. CONCLUSION ISOI can present with extraorbital extension. Corticosteroids are a reasonable first-line treatment, until the pathogenesis is better understood.
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American Academy of Family Physicians. Patient information. Saline nasal irrigation for sinus problems. Am Fam Physician 2009; 80:1121. [PMID: 19908403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Celik H, Islam A, Felek SA, Yüksel D. A very rare complication of acute sinusitis: subgaleal abscess. Kulak Burun Bogaz Ihtis Derg 2009; 19:155-158. [PMID: 19857195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
A 12-year-old girl presented with a swollen right eye with three days of pain and a diffused swollen frontal region and head lasting for one day. On the computed tomography with contrast, diffused collection was detected in the subgaleal regions and subperiosteal of the right orbita. It was observed that she had bilateral maxillary, ethmoidal, and frontal sinusitis and an infected bilateral middle concha bullosa in the right side. No symptoms of intracranial complication and osteomyelitis in the frontal or other calvarial bones were determined. This case presentation is thought to be the first one in literature that is an acute sinusitis without an intracranial complication and osteomyelitis, but with a diffused subgaleal abscess resulting from a subperiosteal abscess.
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Affiliation(s)
- Hatice Celik
- Department of Otolaryngology, Ankara Training and Research Hospital, Ankara, Turkey.
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26
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Kim HY, Dhong HJ, Min JY, Jung YG, Park SH, Chung SK. Postoperative maxillary sinus mucocoele: risk factors for restenosis after surgery and preventive effects of mytomycin-C. Rhinology 2009; 47:79-84. [PMID: 19382501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To evaluate the clinical factors associated with restenosis after the surgery for treating postoperative maxillary sinus mucocoele and the preventive effect of topically applied mytomycin-C (MMC) on the restenosis. METHODS This double-blinded randomized controlled prospective study included 38 cases of postoperative maxillary sinus mucocoeles. The patients underwent inferior meatal antrostomy with or without Caldwell-Luc operation, and cotton-pledgets soaked with MMC or normal saline were applied to the antrostomy sites for 5 minutes. The degree of narrowing of the opening and its correlation with the preoperative characteristics, including age, gender, allergy, presence of polyps, interval between previous surgery and computed tomography findings were evaluated. RESULTS Three months after the surgery, the openings were patent in 24 cases, narrowed in 5 cases and stenotic in 9 cases. MMC application, septation of mucocoele and concurrent inflammation at the lesion side all had a significant effect on stenosis of the antrostomy site at 3 months after the surgery (p < 0.05, Chi-square test). CONCLUSIONS MMC has a favorable effect in preventing narrowing of the opening after surgery for maxillary sinus mucocoeles. The presence of septa in the mucocoeles or concurrent inflammation in the ipsilateral sinuses has an effect to promote restenosis.
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Affiliation(s)
- Hyo Yeol Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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27
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Shoman N, Gheriani H, Flamer D, Javer A. Prospective, double-blind, randomized trial evaluating patient satisfaction, bleeding, and wound healing using biodegradable synthetic polyurethane foam (NasoPore) as a middle meatal spacer in functional endoscopic sinus surgery. J Otolaryngol Head Neck Surg 2009; 38:112-118. [PMID: 19344620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVE To compare NasoPore (Stryker Canada, Hamilton, ON, Canada) and a traditional middle meatal spacer (MMS) composed of Merocel ((Medtronic Xomed, Mississauga, ON, Canada) placed in a vinyl glove finger in functional endoscopic sinus surgery (FESS) with regard to postoperative bleeding, wound healing, and patient comfort. DESIGN A prospective, double-blind, randomized trial of 30 consecutive adults (age > 16 years) with chronic or recurrent acute rhinosinusitis undergoing bilateral FESS, excluding patients with significant difference in their sinus disease bilaterally using preoperative computed tomographic scan assessment (Lund-McKay scores > 2). SETTING Tertiary hospital, Vancouver, British Columbia. METHODS Preoperatively, all patients were randomized and blinded to receive NasoPore (Stryker Canada) on one side and Merocel on the other. Patients completed a questionnaire during their first postoperative week relating to their subjective assessment of pain, pressure, nasal blockage, swelling, and bleeding. Patients were evaluated 1 week postoperatively for packing removal and debridement, and associated discomfort and bleeding with the removal, as well as overall preference for either pack. A clinician blinded to the randomization process objectively assessed the healing status of the nasal cavities at 4 and 12 weeks postoperatively. MAIN OUTCOME MEASURES Patient satisfaction, bleeding, and wound healing postoperatively. RESULTS Thirty patients were enrolled. There was no significant difference between the Lund-Mackay scores in both groups preoperatively (p = .80). Postoperatively, there was no significant difference between both groups with regard to patients' pain, pressure, blockage, swelling, bleeding, or discomfort on packing removal (p > .05). There was no statistical difference in the amount of bleeding associated with packing removal (p = .32). Mucosal grading at 4 weeks was significantly better for the traditional MMS (p = .03), but this difference disappeared at the 12-week visit (p = 1.00). CONCLUSIONS The absorbable pack did not significantly reduce the risk of bleeding or patient discomfort compared with a traditional nonabsorbable MMS and was associated with significantly slower mucosal healing initially, an effect that disappeared after 3 months postoperatively. There was no significant patient preference for either pack.
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Neyt P, Jorissen M. Diagnosis of isolated sphenoid lesions. B-ENT 2009; 5:213-224. [PMID: 20163047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
Isolated lesions of the sphenoid sinus are rare, and diagnosis is difficult because of the non-specific symptoms and clinical signs. The pathology of these lesions can be divided into three groups: inflammatory lesions, tumoural lesions, and a small group of so-called miscellaneous lesions. In a retrospective study, we evaluated the diagnosis and underlying pathology of 49 consecutive isolated sphenoid lesions all subjected to diagnostic and/or therapeutic endoscopic sinus surgery. The diagnosis of isolated sphenoid lesions based on clinical history and clinical examination, including nasal endoscopy, was not reliable because of the non-specific symptoms and clinical signs. A definitive diagnosis could be made only by radiological imaging and/or surgical exploration. The largest group of patients suffered from inflammatory lesions (29 patients), followed by tumoural lesions in 17 patients. Two patients had a sphenoidal cerebrospinal fluid leak, and one patient had a cholesterol granuloma. The outcome for patients who underwent a therapeutic endoscopic surgical procedure was favorable in 22% and perfect in 67%. There were no complications during or after endoscopic surgery.
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Affiliation(s)
- P Neyt
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
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Kariuk IA. [Algorithm of early diagnosis and treatment of nasal cavity and accessory sinuses of the nose in students of educational establishments of the water-borne transport system]. Vestn Otorinolaringol 2009:37-39. [PMID: 19365362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
An algorithm of early diagnosis and treatment of nasal cavity and accessory sinuses of the nose in students of educational establishments of the water-borne transport system has been developed. Inclusion of such methods as screening diagnosis of inflammatory diseases of paranasal sinuses, original roentgenologic and zonographic imaging of paranasal and frontal sinuses made it possible to substantially improve the quality of diagnosis, shorten duration of the examination, and reduce radiation exposure of the patients. The proposed algorithm was used to provide therapeutic and rehabilitation services to 260 patients admitted to the Clinical Hospital No 1 of the federal state institution <<Medical Centre of the Southern Federal District>>, Russian Agency for Health Care.
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Bailhache A, Dehesdin D, François A, Marie JP, Choussy O. Rhinoscleroma of the sinuses. Rhinology 2008; 46:338-341. [PMID: 19146007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Rhinoscleroma is a rare chronic, granulomatous disease of the respiratory tract. OBJECTIVE The aim of this paper was to report 2 unusual cases of rhinoscleroma and to review the literature. MATERIAL We present two cases of sinus rhinoscleroma diagnosed and treated at the ENT Department of a French University hospital. RESULTS AND CONCLUSION Rhinoscleroma primarily affects the nasal cavity but the nasopharynx (18%-43%), larynx (15%-40%), trachea (12%) and bronchi (2% to 7%) can also be involved. However, the paranasal sinuses are usually free of disease. Rhinological signs are generally the first reported by patients. CT scan and MRI are useful for diagnosis. Diagnosis of rhinoscleroma was based on histological characteristics and presence of Klebsiella rhinoscleromatis on biopsy cultures. In most cases treatment involves prolonged antibiotic therapy with aesthetic surgical reconstruction when necessary. However, rhinoscleroma is difficult to eradicate and its recurrence rate is high.
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Affiliation(s)
- Axelle Bailhache
- Department of Otorhinolaryngology, Rouen University Hospital, Rouen, France
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31
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Sinha BK, Adhikari P. Sphenoid sinus mucocele with blindness: a rare presentation. Nepal Med Coll J 2008; 10:204-206. [PMID: 19253868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Isolated sphenoid sinus mucocele is a rare entity. Here we report a case of isolated sphenoid sinus mucocele in a 9 years old girl presenting with unilateral blindness and without any sinonasal complaints. C.T. scan revealed an isolated sphenoid sinus mucocele which was managed endoscopically. A brief review of literature is also included.
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Affiliation(s)
- B K Sinha
- Department of ENT and Head and Neck Surgery, T.U. Teaching Hospital, Kaihmandu, Nepal.
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32
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Chandra RK. Estimate of radiation dose to the lens in balloon sinuplasty. Otolaryngol Head Neck Surg 2008; 137:953-5. [PMID: 18036428 DOI: 10.1016/j.otohns.2007.09.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2007] [Revised: 08/20/2007] [Accepted: 09/05/2007] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To estimate radiation dose to the lens during fluoroscopy-assisted balloon dilation of sinus ostia and to estimate the length of fluoroscopy time that will be tolerated. METHODS Radiation dose to the lens per unit fluoroscopy time was extrapolated from published data in fluoroscopically-guided balloon dacrocystoplasty. RESULTS Mean exposure varies from 0.041 (right eye) to 0.284 (left eye) mGy/sec (P = 0.037) because the left eye is closer to the radiation source during the lateral projection. Threshold for lenticular opacity has been estimated as 500 mGy, which would be attained in the left eye after approximately 29 minutes of fluoroscopy. CONCLUSIONS The lens may tolerate <30 minutes of fluoroscopy during balloon sinuplasty. The left eye receives a potentially greater radiation dose because of its proximity to the source in the lateral projection. Dedicated studies are indicated to specifically examine this issue during balloon sinuplasty.
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Affiliation(s)
- Rakesh K Chandra
- Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
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Abstract
BACKGROUND The sinonasal system is rarely involved in the clinical picture of sarcoidosis. In the absence of pulmonary disease, sinonasal sarcoidosis is extremely rare. PATIENTS AND METHODS Four patients with isolated sarcoidosis of the nose and the sinuses are reported; in one of these patients the histological evidence was found in the mucosa of the nasopharynx. RESULTS None of these patients was found to have a pulmonary illness or any other extrapulmonary manifestation of sarcoidosis. Retrospectively, two patients fulfilled the more specific diagnostic criteria for sinonasal sarcoidosis reported in the literature. CONCLUSION Sarcoidosis should be considered in the differential diagnosis of inflammatory sinonasal disease, especially if the mucosa shows signs of granulation, but it should also be considered when an incidental finding of rhinosinusitis is recorded. Rhinosurgical intervention seems to be an appropriate therapy in terms of improving the symptoms of the disease, despite the prolonged period of postoperative healing and the necessity for individual treatment with medication. Following histological confirmation of the diagnosis, adequate medication and further appropriate diagnostic procedures drawing on internal medicine are essential.
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Affiliation(s)
- D Kleemann
- HNO-Klinik, Müritz-Klinikum GmbH, Weinbergstr. 19, 17192 Waren, Müritz.
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Svatko LG, Krasnozhen VN, Pokrovskaia EM. [A method for the combined treatment of chronic cystic sinusitis]. Vestn Otorinolaringol 2008:7-9. [PMID: 19156109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
A pathogenetically substantiated method is proposed for the combined treatment of chronic cystic sinusitis that includes sparing surgical intervention and postoperative treatment with ximedone, a regenerator drug with immunotropic activity.
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35
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Davis BM, Cofer SA, Aulino JM, Frangoul HA, Boulos FI, Turner KM. Langerhans cell histiocytosis of the frontal sinus mimicking Pott's puffy tumor in a child. Otolaryngol Head Neck Surg 2007; 137:515-7. [PMID: 17765789 DOI: 10.1016/j.otohns.2007.03.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2007] [Accepted: 03/20/2007] [Indexed: 11/25/2022]
Affiliation(s)
- Bryan Matthew Davis
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN 37232-8605, USA.
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36
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Kamoshima Y, Sawamura Y, Iwasaki Y, Hamada S, Izumi N, Okugawa S. [Case of invasive sino-orbital aspergillosis developing orbital apex syndrome]. No Shinkei Geka 2007; 35:1013-1018. [PMID: 17969338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Sino-orbital invasive aspergillosis has been regarded as a lethal disease. The authors report a case with a successful treatment result. A 65 year-old woman, with mild diabetes mellitus, presented progressive right visual disturbance, diplopia, ptosis, and severe periorbital pain over a period of 2 weeks. MR images with gadolinium contrast showed a heterogeneously enhanced mass extending from the right orbital apex to the cavernous sinus. Despite steroid pulse therapy, her symptoms progressed. An open biopsy revealed invasive sino-orbital aspergillosis. Intravenous and oral antifungal agents were administered, but the aspergilloma gradually expanded. Her general status deteriorated due to intractable periorbital pain that was resistant to narcotic analgesics. By a craniotomy, the aspergilloma involving the orbit and cavernous sinus was radically removed leaving the internal carotid artery intact and simultaneously rhizotomy of the trigeminal nerve was carried out. The postoperative course was uneventful and the pain was remarkably ameliorated. Three years after the surgery, she has been well, receiving voriconazole and experiencing no relapse of the disease.
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Affiliation(s)
- Yuuta Kamoshima
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, 15-7 Kita-ku, Sapporo 060-8638, Japan
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Abstract
We describe the histopathologic findings of perineural invasion in orbital mucormycosis in a man with diabetes in ketoacidosis. Linear enhancement on MRI beginning at the orbital apex was correlated with fungal tracking of the trigeminal and lacrimal nerves. Mucormycosis can spread considerable distances from its primary focus of infection along peripheral nerves, a phenomenon that can be identified clinically with contrast-enhanced MRI.
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Affiliation(s)
- Curtis E Margo
- Department of Ophthalmology, James A. Haley Veterans Hospital, Tampa, Florida, USA.
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38
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Collins EN. [Acupuncture in ear, nose and throat medicine: part 2. Diseases of the nose, paranasal sinuses and ears]. HNO 2007; 55:245-53. [PMID: 17333045 DOI: 10.1007/s00106-006-1520-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The second part of the article deals with the use ear and body acupuncture for disorders of the nose, the paranasal sinuses and the ear, including the cerebral structures of the hearing system. It is pointed out that acupuncture must be based on orthodox medical diagnosis. The reader will learn when acupuncture may serve as a "stand alone" method, when it may be an additional option supporting orthodox therapy and when it must not be applied.
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Knipping S, Holzhausen HJ, Koesling S, Bloching M. Invasive aspergillosis of the paranasal sinuses and the skull base. Eur Arch Otorhinolaryngol 2007; 264:1163-9. [PMID: 17534639 DOI: 10.1007/s00405-007-0336-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2006] [Accepted: 05/01/2007] [Indexed: 11/24/2022]
Abstract
Invasive aspergillosis (IA) originating from the paranasal sinuses can cause an intracranial growth mainly along the skull base and larger vessels. This study reports our experience in the diagnosis and treatment of a series of patients with IA. A retrospective chart review of four patients with chronic invasive intracranial aspergillosis was performed. Clinical signs, physical examinations, radiographs, histological samples, and outcome were demonstrated. The patients demonstrated different symptoms like exophthalmus, ophthalmoplegia, loss of vision, and hypaesthesia of the ophthalmic and maxillary nerve. Computed tomography and MRI revealed extensive sino-orbital and skull base lesions. The patients were treated with aggressive endonasal debridement, intravenous antifungal agents and daily irrigations with antimycotic suspensions. Furthermore, we applied hyperbaric oxygenation. Two patients died from complications due to subarachnoidal hemorrhage and accompanied complications respectively. Despite the high mortality rate patients with an invasive aspergillosis can be effectively treated in some cases by an early and rigorous treatment schedule using all surgical and conservative therapeutic options.
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Affiliation(s)
- Stephan Knipping
- Department of Otorhinolaryngology Head and Neck Surgery, Martin Luther University Halle-Wittenberg, Magdeburger Str 12, Halle/Saale, Germany.
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40
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Affiliation(s)
- Roland A Barrowman
- Oral and Maxillofacial Surgery, Royal Dental Hospital of Melbourne, Melbourne, VIC, Australia.
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Solares CA, Citardi MJ, Budev M, Batra PS. Management of frontal sinus mucoceles with posterior table erosion in the pretransplant cystic fibrosis population. Am J Otolaryngol 2007; 28:110-4. [PMID: 17362816 DOI: 10.1016/j.amjoto.2006.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2006] [Revised: 06/15/2006] [Accepted: 07/30/2006] [Indexed: 12/16/2022]
Abstract
BACKGROUND Chronic rhinosinusitis has been described as a universal finding in cystic fibrosis (CF). Much of the literature has focused on pediatric population with a relative paucity of data on adult CF patients. In this report, we review our experience with management of frontal sinus mucoceles with posterior table (PT) erosion diagnosed by imaging in asymptomatic adult CF patients presenting for pretransplant evaluation. STUDY DESIGN Retrospective chart analysis. MATERIALS AND METHODS Adult CF patients presenting with frontal sinus mucoceles from January 2003 to December 2005 comprised the focus of the study. Charts were reviewed for age, sex, clinical presentation, culture results, complications, and outcome. RESULTS Fifty-nine CF patients undergoing lung transplant evaluation were seen in the outpatient rhinology clinic. Among these, 3 patients presented with asymptomatic frontal sinus mucoceles with PT erosion. The average age was 28.7 years (range, 23-38 years) and male-female ratio was 1:2. Two patients were managed with computer-aided endoscopic frontal sinusotomy during the pretransplant period. In the third patient, surgery was performed post transplantation when the patient was clinically stable. Intraoperative cultures grew Pseudomonas aeruginosa in all cases. No intraoperative surgical complications were encountered. One patient required overnight ventilatory support and was extubated successfully after 24 hours. Endoscopic patency of the frontal sinusotomy was confirmed at mean follow-up of 12.7 months (range, 4-22 months). CONCLUSIONS This preliminary report describes asymptomatic frontal sinus mucoceles with PT erosion in CF patients presenting for transplant evaluation. A high index suspicion must be maintained to avoid an inordinate delay in diagnosis given the potential risk of intracranial complications with this clinical entity.
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Affiliation(s)
- C Arturo Solares
- Section of Nasal and Sinus Disorders, Head and Neck Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
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42
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Lazard DS, Prulière-Escabasse V, Papon JF, Escudier E, Coste A. [Injury and epithelial wound healing: a pathophysiologic hypothesis for nasal and sinus polyposis]. Presse Med 2007; 36:1104-8. [PMID: 17306500 DOI: 10.1016/j.lpm.2007.01.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Nasal polyposis (NP), asthma, and chronic bronchitis are chronic inflammatory diseases of the upper airways. They may be caused by injury to the respiratory epithelium in a chronic inflammatory environment. Several studies show that during NP nasal epithelial cells are involved in the overexpression of cytokines and growth factors. Among these, transforming growth factor beta1 (TGF-beta1) appears to play a major role in the genesis of NP. Differentiated respiratory epithelium, obtained from in vivo or in vitro models, is used to study wound healing in inflammatory environments, to elucidate the pathophysiology of NP, and to improve understanding and management of upper airway inflammatory diseases.
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Affiliation(s)
- Diane S Lazard
- Unité Inserm U651, Créteil, Service ORL et chirurgie cervicofaciale, Hôpital Foch, Suresnes.
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Passali D, Bellussi L. [Revision of the European Position Paper on Rhinosinusitis and Nasal Polyposis (EP3OS) with particular attention to acute and recurrent rhinosinusitis]. Acta Otorhinolaryngol Ital 2007; 27:1-21. [PMID: 17702374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Affiliation(s)
- D Passali
- Clinica ORL, Università di Siena, Italy.
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Abbas Z, Jafri W, Rasool S, Abid S, Hameed I. Mucormycosis in patients with complicated cirrhosis. Singapore Med J 2007; 48:69-73. [PMID: 17245519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
INTRODUCTION Rhino-orbito-cerebral mucormycosis is a rapidly progressive and fatal disease that mostly occurs in patients with diabetes mellitus and immunocompromised status. Antifungal therapy with surgical debridement is the standard of care. Patients with cirrhosis of liver are more prone to develop different infections. Many of these also show glucose intolerance or frank diabetes mellitus. Little is known about the clinical presentation and outcome of mucormycosis in patients with cirrhosis. Treatment is difficult due to underlying coagulopathy and hepatic dysfunction. METHODS Medical records of the past five years were searched for the cirrhotic patients admitted with associated diagnosis of mucormycosis or fungal infection. Six patients with mucormycosis were identified. RESULTS Out of six patients, five were male. Age range was 15-57 years. Cause of cirrhosis was hepatitis C in four patients, hepatitis B in one patient and autoimmune hepatitis in one patient. Two patients had hepatocellular carcinoma. Four patients had diabetes mellitus, of which one patient was also on steroids for the autoimmune liver disease. Four patients had spontaneous bacterial peritonitis at the time of admission. All six patients presented with rhino-orbitocerebral mucormycosis with nasal discharge and upper motor neuron signs. Diagnosis of mucormycosis was made by culture of biopsy and scrapings taken from the palate and nasal sinuses. These patients received amphotericin B. Four patients died while in the hospital, while two patients died within next few days after discharge. CONCLUSION Mucormycosis in cirrhosis is not very common and has a poor prognosis. Patients with advanced cirrhosis and diabetes mellitus are at risk of developing infection.
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Affiliation(s)
- Z Abbas
- Department of Medicine, The Aga Khan University Hospital, Stadium Road, Karachi 74800, Pakistan.
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Tysome JR, Saleh HA. Sphenochoanal polyp presenting with concomitant nasal polyps. Ear Nose Throat J 2007; 86:50-2. [PMID: 17315837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023] Open
Abstract
A sphenochoanal polyp is a rare lesion that originates in the sphenoid sinus. It occurs most often in adolescents and young adults. We present what to the best of our knowledge is the first reported case of a sphenochoanal polyp associated with concomitant nasal polyps. The patient was a 54-year-old man who presented with bilateral nasal obstruction, possible obstructive sleep apnea, and an altered voice, all of which had likely been caused by the presence of a massive left sphenochoanal polyp and bilateral grade III anterior and posterior ethmoid polyps. Because the patient had dilated cardiomyopathy, he was not a good candidate for general anesthesia. Therefore, the polyps were removed endoscopically under local anesthesia. The sphenochoanal polyp measured 7.5 cm in its greatest dimension and weighed 41 g. The patient remained symptom-free at the 1-year follow-up. The presentation of a sphenochoanal polyp is similar to that of the more common antrochoanal polyp, but the two can usually be differentiated on computed tomography. Endoscopic sinus surgery allows for complete removal of the polyp, including its site of origin, which minimizes the risk of recurrence.
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Affiliation(s)
- James R Tysome
- Department of Otorhinolaryngology, Charing Cross Hospital, London, UK.
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Kiselev AB, Chaukina VA. [Elimination therapy for diseases of the nose and paranasal sinuses]. Vestn Otorinolaringol 2007:56-57. [PMID: 18217286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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Virk RS, Arora P. Chronic sinonasal aspergillosis with associated mucormycosis. Ear Nose Throat J 2007; 86:22. [PMID: 17315828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023] Open
Affiliation(s)
- Ramandeep S Virk
- Department of Otolaryngology-Head and Neck Surgery, Virk Indus ENT and Endoscopy Institute, Mohali, Punjab, India
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Abstract
BACKGROUND Over the past 20 years, many patients have benefited from endoscopic sinus surgery and its ability to relieve sinus obstruction. However, problems still occur with surgery, thereby leaving room for innovation. Recently, catheter-based technology has provided new options for treating cardiac, vascular, and urologic diseases. We speculated that catheter technology also might offer new treatment options for sinusitis patients. The purpose of this investigation was to explore the feasibility and safety of catheter-based technology to relieve sinus ostial obstruction. METHODS Anatomic models and human cadaver specimens were used initially to design and iterate catheters to open sinus ostial drainage pathways. Thereafter, the safety of balloon-catheter dilation was evaluated in six human cadaver heads. CT scan obtained before and after catheter ostial dilation was analyzed for evidence of catheter-induced trauma. Dilated ostia also were examined by endoscopy and gross anatomic dissection for unwanted catheter-induced trauma. RESULTS Catheters successfully dilated 31 of 31 ostia, including 9 maxillary, 11 sphenoid, and 11 frontal ostia/recesses. CT scan, endoscopy, and gross anatomic dissection revealed that such dilation did not cause trauma to surrounding structures such as the orbit or skull base. Mucosal trauma imparted by catheter dilation appeared to be less than that normally seen with standard endoscopic instruments. CONCLUSION This initial study suggests that catheter technology can be used to dilate sinus ostia safely. Mucosal preservation and ease of use make catheters an attractive minimally invasive treatment strategy. Additional testing in patients is indicated to gain additional safety information and to explore the usefulness of catheter-based technology.
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Christmas DA, Mirante JP, Yanagisawa E. Endoscopic view of balloon catheter dilation of sinus ostia (balloon sinuplasty). Ear Nose Throat J 2006; 85:698, 700. [PMID: 17168140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Affiliation(s)
- Dewey A Christmas
- Department of Otolaryngology, University of South Florida College of Medicine, Tampa, Fla, USA
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Pinzer T, Reiss M, Bourquain H, Krishnan KG, Schackert G. Primary aspergillosis of the sphenoid sinus with pituitary invasion - a rare differential diagnosis of sellar lesions. Acta Neurochir (Wien) 2006; 148:1085-90; discussion 1090. [PMID: 16855812 DOI: 10.1007/s00701-006-0811-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2005] [Accepted: 04/25/2006] [Indexed: 11/27/2022]
Abstract
Aspergillosis belongs to the group of mycotic diseases of paranasal sinuses. The invasive forms, and particularly the fulminant forms, are potentially fatal. Isolated aspergillosis of the sphenoid sinus or the clivus is a difficult diagnosis, since the often misleading clinical manifestations of this rare disease develop late. These patients become apparent by neurological signs such as cavernous sinus syndrome, pseudotumor of the pituitary or the orbit. Diagnosis is often made intra-operatively or on histological examination. We report a case of invasive aspergillosis uniquely involving the sellar area revealed by clinical features suggesting a pseudotumor of the pituitary. Although such lesions are almost always seen in immune suppressed subjects, in our case, the patient was immune competent and had no past history of sinusitis.The question of whether, and when to perform limited or extensive surgery remains an issue for discussion, owing to the rarity of this disease honed by lack of experience. It depends on several factors: the kind of disease, the immunity, the subtype of invasive fungal sinusitis and the degree of tissue invasion.
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Affiliation(s)
- T Pinzer
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Dresden, Dresden, Germany
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