Proptosis como presentación inicial de un fibroma osificante etmoidal en edad pediátrica

El fibroma osificante es un tumor óseo benigno poco común, cuya localización más frecuente son los huesos maxilofaciales, pero su origen en el seno etmoidal es raro. La mayor incidencia se describe entre la segunda y la cuarta décadas de la vida. Se efectuó una revisión en la literatura nacional sobre fibromas osificantes etmoidales con extensión orbitaria, y no se encontraron reportes publicados. Se presenta el caso de una paciente de 10 años de edad que fue remitida a consulta de Oculoplastia por notar protrusión ocular izquierda desde hacía tres meses. Se le realizó ultrasonido, tomografía computarizada y resonancia magnética en los que se evidenció una lesión tumoral de seno etmoidal con compromiso de órbita izquierda que ocasionaba proptosis, con características imagenológicas sugestivas de un probable fibroma osificante. La biopsia endoscópica nasal confirmó el diagnóstico.

Ossifying fibroma is an uncommon benign bone tumor, whose most frequent location is the maxillofacial bones, but its origin in the ethmoid sinus is rare. The highest incidence is described between the second and fourth decades of life. A review of the national literature on ethmoid ossifying fibromas with orbital extension was carried out, and no published reports were found. We present the case of a 10-year old female patient who was referred to Oculoplasty consultation for noticing left ocular protrusion for three months. Ultrasound, computed tomography and magnetic resonance imaging showed a tumor lesion of the ethmoidal sinus with involvement of the left orbit causing proptosis, with imaging characteristics suggestive of a probable ossifying fibroma. Nasal endoscopic biopsy confirmed the diagnosis.

Relationship of the anterior ethmoid sinus to the lacrimal sac: a computed tomography study

Abstract Objective: To analyze the anatomical relationship between the lacrimal sac and the agger nasi cell on Computed Tomography (CT); to correlate the right and left sides on each scan. Methods: CT scans of adult patients were reviewed for pneumatization of the agger nasi and its relationship to the lacrimal sac. The degree of agreement between the right and left sides was also evaluated. Results: A total of 130 CT scans were examined. An agger nasi cell was found medial to the lacrimal sac in 59.23% of scans. On 86.15% of scans, pneumatization was similar on both sides. Conclusion: The agger nasi air cell is located medial to the lacrimal sac in more than half of individuals. The right and left sides exhibit the same pneumatization pattern in approximately 80% of cases. Level of evidence: 4.

Radiologic evaluation of the anterior and posterior ethmoidal foramen and optic canal by paranasal sinus computed tomography scan among adult Filipinos

Objective@#To measure the average distances from anterior lacrimal crest (ALC) to anterior ethmoidal foramen (AEF), anterior ethmoidal foramen to posterior ethmoidal foramen (PEF) and posterior ethmoidal foramen to optic canal (OC) using plain paranasal sinus (PNS) computed tomography (CT) scans of adults in a tertiary private hospital in the Philippines. @*Methods@#Design: Retrospective review of plain PNS CT scans. Setting: Tertiary Private Teaching Hospital. Participants: One hundred four (104) plain PNS CT scans from January 2018 to December 2020 were considered for inclusion. @*Results@#Of the 104 PNS CT scans, 35 were excluded - seven for age less than eighteen, six for undistinguishable PEF and twenty-two for chronic rhinosinusitis. The remaining 69 PNS CT scans demonstrated identifiable structures, with overall average distances from ALC to AEF of 23.71 ± 2.43 mm, AEF to PEF of 10.87 ± 2.39 mm and PEF to OC of 7.39 ± 2.28 mm. @*Conclusion@#Our study suggests average distances for localization of vital structures such as the anterior ethmoidal artery, posterior ethmoidal artery and optic nerve among Filipinos. Because of considerable variation between and within sexes, individual measurements should still be obtained for each patient in performing endonasal, skull base and orbital surgery.

Sub Periosteal and Intra Ethmoidal Displacement of Gutta Percha Cone Following Endodontic Intervention of Maxillary First Molar

ABSTRACT: Foreign bodies in the ethmoid sinus are uncommon, and endodontic gutta percha displacement is even more rare. We present and discuss a case of displacement of gutta percha into the ethmoid sinus following root canal intervention of a maxillary first molar which presumably migrated through the maxillary sinus. There have been reports on the displacement of tooth roots or implants into the maxillary sinus. However, we know of only one such report on the migration of a gutta-percha point into the ethmoid sinus.

RESUMEN: Los cuerpos extraños en el seno etmoidal son infrecuentes y el desplazamiento de la gutapercha endodóntica es aún más raro. Presentamos y analizamos un caso de desplazamiento de la gutapercha hacia el seno etmoidal después de la intervención del conducto radicular de un primer molar superior que se presume migró a través del seno maxilar. A pesar de que existen informes sobre el desplazamiento de raíces dentales o implantes hacia el seno maxilar, solo conocemos un informe de este tipo sobre la migración de un punto de gutapercha hacia el seno etmoidal.

In Vivo Computed Tomography Direct Volume Rendering of the Anterior Ethmoidal Artery: A Descriptive Anatomical Study

Abstract Introduction The clinical relevance of the anatomy and variations of the anterior ethmoidal artery (AEA) is outstanding, considering its role as a landmark in endoscopic surgery, its importance in the therapy of epistaxis, and the high risks related to iatrogenic injuries. Objective To provide an anatomical description of the course and relationships of the AEA, based on direct computed-tomography (CT)-based 3D volume rendering. Methods Direct volume rendering was performed on 18 subjects who underwent (CT) with contrast medium for suspected cerebral aneurism. Results The topographical location of 36 AEAs was assessed as shown: 10 dehiscent (27.8%), 20 intracanal (55.5%), 6 incomplete canals (16.7%). Distances from important topographic landmarks are reported. Conclusion This work demonstrates that direct 3D volume rendering is a valid imaging technique for a detailed description of the anterior ethmoidal artery thus representing a useful tool for head pre-operatory assessments.

Origen intraorbitario de las arterias etmoidales: estudio anatómico / Intraorbital origin of the ethmoidal arteries: anatomical study

RESUMEN Introducción: Ramas de la arteria oftálmica contribuyen a la irrigación de diversos territorios de la fosa nasal y de los senos paranasales. Objetivo: El objetivo de nuestro estudio es describir las arterias etmoidales desde su origen intraorbitario, y su relación con las estructuras musculares y nerviosas. Material y Método: Se realizó un estudio anatómico endoscópico en 20 fosas nasales y órbitas de diez cadáveres. Resultados: La disección del plano muscular permitió definir dos espacios de entrada a la órbita. Un primer espacio entre el músculo recto inferior y músculo recto medial (área 1) y otro entre el músculo recto medial y músculo oblicuo superior (área 2). En el área 1, la arteria oftálmica discurrió superior al nervio óptico en el 90%. La arteria etmoidal anterior se observó en todos los casos inferior al músculo oblicuo superior. En el área 2, la arteria etmoidal posterior, se localizó en todos los casos superior al músculo oblicuo superior. No se identificó la arteria etmoidal media en ningún caso. El origen de la arteria supraorbitaria se identificó entre las dos arterias etmoidales. Conclusión: La comprensión anatómica del origen intraorbitario de la arteria oftálmica permite el abordaje de determinada patología intraorbitaria compleja a través de la pared medial de la órbita.

ABSTRACT Introduction: Branches of the ophthalmic artery contribute to the irrigation of various territories of the nasal cavity and paranasal sinuses. Aim: The aim of our study is to describe the intraorbital course of the ethmoidal arteries and their relationship with the muscular and nervous structures. Material and method: We performed twenty nasal cavities and orbital dissections in ten adults cadaveric heads. Results: The dissection of the muscular orbital wall allowed defining two surgical orbital corridors, between the inferior rectus and the medial rectus muscles (area 1) and between the medial rectus and the superior oblique muscles (area 2). In area 1, the ophthalmic artery crosses over the optic nerve in 90% of the cases. The anterior ethmoidal artery was observed inferior to the superior oblique muscle. In area 2, the posterior ethmoidal artery was located superior to the superior oblique muscle in all cavities. No middle ethmoidal artery was identified. The origin of the supraorbital artery was found between the two ethmoidal arteries. Conclusions: The anatomical understanding of the intraorbital origin of the arteries of the ophthalmic artery allows perform two surgical approaches through the media orbital wall.

Análisis semántico y gramatical de los términos latinos de los ramos terminales del nervio nasociliar / Semantic and grammatical analysis of latin terms of the terminal branches of the nasociliary nerve

RESUMEN: La necesidad de unificar criterios respecto a los nombres de las estructuras anatómicas ha sido una permanente preocupación de los anatomistas del mundo, de tal manera que a partir de 1895 se inicia un proceso de estandarización y normalización de la terminología anatómica mundial. Se publica la Nomina Anatomica tratando de nominar las estructuras con un solo nombre en latín y se suprime los epónimos y homónimos. En la actualidad la Terminologia Anatomica sustituye a la Nomina Anatomica, con las mismas características, pero con la adición del término en el idioma de cada país. Sin embargo, persisten algunos errores desde la elaboración de la Nomina Anatomica y que se mantienen en Terminologia Anatomica, derivados tanto de la estructura gramatical latina, principalmente en el número y género, así como de la descripción de algunas estructuras anatómicas. Este es el caso de los ramos del nervio nasociliar, específicamente del ramo etmoidal anterior y del ramo infratroclear. Para el efecto se realizó una revisión de la descripción del nervio nasociliar y sus ramos terminales, se compararon entre sí y con los nombres que aparecen en la Terminologia Anatomica, para verificar que tanto la descripción como la construcción gramatical latina sean correctas. Se encontraron errores en la estructuración gramatical y jerárquica del ramo nasal interno, así como la supresión de los ramos palpebrales superior e inferior del nervio infratroclear, por lo que proponemos el cambio del término codificado con A14.2.01.031 a Ramus nasalis internus y la adición de los nombres Ramus palpebralis superior y Ramus palpebralis inferior.

SUMMARY: The need to unify criteria regarding the names of anatomical structures has been a permanent concern of anatomists worldwide. Therefore, and beginning in 1895 a standardization and normalization process of world anatomical terminology was initiated. The Nomina Anatomica is published in an attempt to name the structures with a single name in Latin and the eponyms and homonyms are deleted. Today the Terminologia Anatomica replaces the Nomina Anatomica, with the same characteristics, but with the addition of the term in the language of each country. Nevertheless, some errors persist from the Nomina Anatomica that remain in Terminologia Anatomica, derived from both the Latin grammatical structure, mainly in the number and gender, as well as the description of some anatomical structures. This is the case of the nasociliary nerve branches, specifically the anterior ethmoidal branch and the infratroclear branch. For this purpose, a review of the description of the nasociliary nerve and its terminal branches was made, they were compared between each other, and with the names that appear in the Terminologia Anatomica, to verify that both the description and the Latin grammatical construction are correct. Errors were found in the grammatical and hierarchical structure of the internal nasal branch, as well as the suppression of the upper and lower palpebral branches of the infratrochlear nerve. Therefore, we propose the change of the coded term with A14.2.01.031 to "Ramus nasalis internus" and the addition of the names "Ramus palpebralis superior" and "Ramus palpebralis inferior".

Resección de osteoma fronto-naso-maxilar: desafío anatómico con asistencia de estereolitografía y sistema piezoeléctrico / Resection of fronto-naso-maxillary osteoma: anatomic challenge assisted with stereolithography and piezoelectric system

Los osteomas fronto-etmoidales son los tumores benignos más frecuentes de los senos paranasales, pudiendo evolucionar con complicaciones por compresión de estructuras adyacentes. Se presenta el caso de una paciente de 63 años de edad, que consultó por aumento de volumen nasofrontal, cefalea y diplopía. Tras el examen clínico, se evidenció una asimetría facial con lateralización del bulbo ocular derecho y exoftalmo. La tomografía de los senos paranasales mostró una lesión que ocupa parcialmente el seno frontal, etmoidal y parte de la cavidad nasal. Los cuidados anatómicos y planificación quirúrgica se desarrollaron en un modelo estereolitográfico mientras que la cirugía de exéresis total se realizó con ayuda del sistema piezoeléctrico. El examen histológico confirmó el diagnostico de osteoma. Se obtuvo una reconstrucción exitosa, recuperando totalmente simetría y función ocular.

Fronto-ethmoidal osteomas are the most frequent benign tumors of the paranasal sinuses, and may evolve with complications by compression of adjacent structures. The case is a 63-year-old female patient, who consulted about increased nasofrontal volume, headache and diplopia. After the clinical exam, she presented a facial asymmetry with lateralization of the right eyeball and exophthalmus. Computed tomography of the sinuses showed a lesion that partially occupies the frontal sinus, ethmoidal sinus and part of the nasal cavity. The anatomical care and surgical planning was developed in a stereolithographic model while the total excision surgery was performed with the help of the piezoelectric system. Histological examination confirmed the diagnosis of osteoma. A successful reconstruction is obtained, fully recovering symmetry and ocular function.

Presencia de la celdilla supra-órbito-etmoidal: revisión de la literatura a partir de un caso / Presence of supraorbital ethmoid cell: literature review from a case

La celdilla supra-órbito-etmoidal es una variación anatómica que se presenta con diferente frecuencia para las distintas poblaciones. Representa un desafío al realizar cirugía endoscópica funcional del seno frontal debido a que su presencia dificulta el drenaje adecuado del receso del frontal mismo y puede ser confundida con el seno. La celdilla supra-órbito-etmoidal presenta relaciones espaciales constantes con la arteria etmoidal anterior, sirviendo como marcador anatómico confiable para el abordaje quirúrgico. Se destaca la importancia de considerar la presencia de tabiques óseos en el seno frontal en el estudio imagenológico que puedan sugerir la presencia de la celdilla supra-órbito-etmoidal. Se presenta el caso clínico de un paciente que consulta por proptosis del ojo derecho debido a un proceso expansivo por mucocele localizado en dicha variante anatómica.

The supraorbital ethmoid cell its an anatomical variation with different frecuency for diverse populations. It represents a challenge for the endoscopical functional :surgery of the frontal sinus. The supraorbital ethmoid cell presents an estable anatomical relationship with the anterior ethmoidal artery, serving as a dependable anatomical marker for the surgical approach. We stand out the importance to consider the presence of bony septations in the frontal sinus that might suggest the presence of the supraorbital ethmoid cell. We introduce a clinical case from a patient who had an expansive process from a mucocele in the supraorbital ethmoid cell.

Fronto-Ethmoidal Mucocele with Diplopia in Myasthenia Gravis Patient

No abstract available.

Fronto-Ethmoidal Mucocele with Diplopia in Myasthenia Gravis Patient

No abstract available.

Aplasia of Frontal Sinus: CT Study.

Aim: The paranasal sinuses are subject to large variety of lesions. Congenital malformations and normal anatomic variations are important in this region To find out prevalence of frontal sinus aplasia in normal healthy population and to discuss its clinical importance. Materials and Methods: A cross-sectional analysis is performed on CT scans of head & neck region of patients visiting Radio-diagnosis Department of Era’s Lucknow Medical College. Results: Frontal sinus aplasia was observed in 6.6% of target population. Conclusion: It is important for surgeons to be aware of variations in sinuses that may predispose patients to increased risk of intraoperative complications and help avoid possible complications and improve success of management strategies.

Lesiones etmoidales con extensión secundaria: estrategia quirúrgica y complicaciones / Ethmoidal lesions with secondary extension: surgical strategies and complications

Introduction: The removal of ethmoidal tumors with secondary extension to the cranial base and/or facial region involves a high complexity and it is associated to a high morbility. Objective: To determine the results of craniofacial surgery in patient with ethmoid extended tumors. Methods: It was carried out a traverse retrospective descriptive study. The sample was conformed by the patients intervened surgically of anterior cranial base lesions by means of a combined craneofacial surgery during the period: January of the 2009 to January of the 2012 in the National Institute of Oncology and Radiobiology with a 2 year pursuit. Descriptive statistical variables were used. Results: 20 patients were intervened. The age average was of 44,8 years. It prevail the masculine sex (65 percent). Nasal obstruction constitutes the most frequent presentation. Adenocarcinoma and epidermoid carcinoma constituted the most frequent malignant lesions. Inside the benign lesions prevail the invertedpapiloma. The techniques more employees were the bilateral frontal craneotomy and total etmoidectomy. The most frequent complication was the cerebrospinal fluid leak. The 2 years overall survival in patients with malignant lesions was 35 percent. Conclusions: A high number of complications was identified but they didn’t affect the survival neither the quality of life. An acceptable rate of survival was achieved in malignant lesions.

Introducción: La remoción de lesiones etmoidales con extensión secundaria a la base cranealy/o región facial, entraña una elevada complejidad y se encuentra asociada a una elevada morbilidad. Objetivo: Determinar los resultados de la cirugía combinada craneofacial en pacientes con neoplasias etmoidales extendidas. Métodos: Se realizó un estudio descriptivo retrospectivo transversal. La muestra estuvo conformada por los pacientes intervenidos quirúrgicamente de lesiones de base craneal anterior mediante un abordaje combinado craneofacial durante el período: enero de 2009 a enero de 2012 en el Instituto Nacional de Oncología y Radiobiología con un seguimiento de 2 años. Se emplearon variables estadísticas descriptivas. Resultados: Fueron intervenidos 20 pacientes. El promedio de edad fue de 44,8 años. Predominó el sexo masculino (65 por ciento). La obstrucción nasal constituyó la presentación más frecuente. El adenocarcinoma y el carcinoma epidermoide constituyeron las lesiones malignas más frecuentes. Dentro de las lesiones benignas predominó el papiloma invertido. Las técnicas más empleadas fueron la craneotomía frontal bilateral y la etmoidectomía total. La complicación más frecuente fue la fístula de líquido cefalorraquídeo. La supervivencia global a los 2 años en los pacientes con lesiones malignas fue del 35 por ciento. Conclusiones: Se identificó un elevado número de complicaciones pero no afectaron la supervivencia ni la calidad de vida. Se logró una aceptable tasa de supervivencia en lesiones malignas.

Acute Severe Eye Pain and Epistaxis in a 16-year-old Male Teenager ‐ What Clinical Clues May Aid a GP In Diagnosing Acute Sinusitis?

A 16-year-old teenager presented with acute severe eye pain and mild epistaxis. The family physician diagnosed an ophthalmologic emergency requiring evaluation. Acute sinusitis was not entertained. Subsequently, ENT evaluation and CT scan confirmed maxillary and anterior ethmoidal sinusitis. This lead to a search for criteria to improve diagnosis of acute sinusitis in the GP setting. Two or more of these symptoms ‐ mucopurulent rhinorrhoea, nasal obstruction/congestion, facial pain/pressure and decreased sense of smell increase its likelihood. Other important issues discussed include differential diagnosis of eye pain associated with epistaxis, potential orbital complications of sinusitis and causes of the quiet, non-red eye.

Biometría etmoidal, del complejo osteomeatal y sus variantes anatómicas: estudio en cadáveres / Ethmoidal and osteomeatal complex biometry and its anatomical variations: cadavers study

La anatomía del etmoides y del complejo osteomeatal ha sido la base fundamental de muchos avancescientíficos especialmente en el campo de la cirugía endoscópica. Por ello el objetivo del presente trabajo es describir la anatomía etmoidal, del complejo osteomeatal y sus variantes anatómicas en los cadáveres del anfiteatro de la Universidad del Rosario, un estudio observacional descriptivo tiposerie de casos donde se tomaron 20 cabezas, se hicieron disecciones y mediciones en ellas. Se evaluó la concordancia interobservador e intraobservador en las variables numéricas con el paquete SPSSversión 11.5, se halló el coeficiente de correlación intraclase (CCI), el intervalo de confianza (IC) tomando significativo CCI > 0.6; y para las variables categóricas el test de concordancia Kappa, a un nivel de significancia de cinco por ciento (0.05). De los resultados finales, se encontraron promedios para la apófisis Crista Galli de longitud ancho yprofundidad. Para la lamela lateral se encontró mayor frecuencia el Keros II en 45% seguida de Keros I (42,5%) y en menor frecuencia Keros III en 12,5%. Se halló el promedio de la longitud antero-posterior y supero-inferior de los cornetes superior, medio y supremo. Se describieron seis variantes anatómicas de la forma del cornete superior y se encontraron cinco variantes anatómicas de la forma del cornete medio. El cornete supremo se encontró en el 15% de los especímenes y se encontraron dosformas del mismo. Fueron observadas 10 variantes anatómicas de la inserción superior de la apófisis unciforme y ocho tipos de inserción inferior del mismo. Se creó una clasificación de la inserción inferior de la apófisis unciforme con respecto al ostium del seno maxilar...

Ethmoidal and osteomeatal complex anatomy had been fundamental base of several scientific advances, especially in endoscopic sinus surgery. The objective of this study is to describe ethmoidal anatomy, osteomeatal complex and its anatomical variations in corpse´s anphitheater of the Rosario University; in an observational descriptive studytype case series. Twenty heads (20) were evaluated with interobserver and intraobserver measures in numercial variables with SPSS version 11.5, it was obtained the intraclass correlation coefficient (ICC), the confidence interval (CI) with significance ICC>0,6 and categorical Kappa variable test with levelof significance of five percent (0.05).Of the final outcomes, Crista galli process wide and depth length was obtained. Lateral lamella was more frequent Keros type II (45%) than type I (42,5%) and type III (12,5%). For the superior, supreme and middle turbinates was found its length and incidence. Six anatomical variations of the superior attachment of the uncinate process and five anatomical variations of the form of middle turbinate weredescribed. The supreme turbinate was found in 15% of the specimens and there were two forms of it. Ten anatomical variations of the superior attachment of the unciform process and eight types of its inferior attachment were found. It was created a new classification of inferior attachment of uncinate process with relation to the maxillary ostia...

Transarterial embolization of dural arteriovenous fistula of the anterior cranial fossa / 中国脑血管病杂志

Objective: To evaluate the safety and efficacy of the transarterial embolization of dural arteriovenous fistula (DAVF) of the anterior cranial fossa. Methods: Seven cases of DAVF of anterior cranial fossa were treated with transarterial embolization during the interval from 2001 to 2009 in Changhai hospital, Second Military Medical University. Six patients were grade IV and the other patient grade III according to the Cognard grade. Five patients presented with intracranial hemorrhage and the other 2 patients with ophthalmic disorders. Embolization was performed through the ethmoidal arteries. 10% or 15% NBCA were used in 2 cases and Onyx-18 were used in the recent 5 cases. Result: The DAVF was totally obliterated in 5 patients through a single feeding artery, 4 of which were embolized with Onyx-18, and 2 catheterations were assisted with balloon. In the other 2 cases, the initial injection of NBCA and Onyx did not result in adequate permeation of the fistula and multiple catheterations eventually resulted in nearly total obliteration one week and one month after the first embolization respectively. Two flow-related aneurysms of the feeding artery were coiled before the procedure, one of which was the source of hemorrhage. One patient complicated with decreased visual acuity as a consequence of excessive permeation of NBCA into the contralateral ophthalmic artery. All patients were followed up (6-107 months), the modified Rankin Scale score 0 to 1 in 5 cases, 2 in 1 case and 3 in 1 case. Angiographic follow up was obtained in 4 cases, and no fistula was observed. Conclusion: It is safe and effective to embolize the DAVFs of the anterior cranial fossa through transarterial approach. In order to prevent complications, reflux must be controlled while injecting the liquid embolic agent, and excessive permeation must also be avoided concerning the dangerous anastomosis.

A importância da investigação de variações anatômicas das células etmoidais através da tomografia computadorizada no planejamentoda cirurgia endoscópica nasal: [revisão] / The importance of investigation of anatomic variations in the ethmoid cells by computerized tomography in the planning of endoscopic nasal surgery: [review]

As células etmoidais compreendem diversas cavidades que podem apresentar variações anatômicasnos indivíduos. Algumas variações merecem atenção quando associadas a sinusopatias e à necessidade de intervenção cirúrgica. A tomografia computadorizada, considerada padrão-ouro na investigação de doenças da cavidade nasal e no mapeamento anatômico dos seios paranasais, oferece informações acerca da anatomia das células etmoidais, essenciais para a minimização dos riscos cirúrgicos. O presente trabalho tem o objetivo de, mediante revisão bibliográfica, avaliar aimportância da tomografia computadorizada na investigação de variações anatômicas das célulasetmoidais para o planejamento pré-cirúrgico. Células não recorrentes, como as células de Haller, célula de Onodi e a aeração do agger nasi, permitem que a abordagem endoscópica seja planejada com cautela. A avaliação do teto etmoidal resulta em maior segurança quanto aos limites superiores da fossa nasal. O tamanho e o nível de pneumatização da bolha etmoidal, da crista etmoidal e da concha nasal média são importantes ao se avaliar os acessos endoscópicos, a gravidade dadoença, e até mesmo sua origem.

The ethmoidal cells comprise many cavities that show many anatomicalvariations. Some of these variations deserve special attention when associated with sinusitis and the need of surgery. Computed tomography, considered a gold standard on the pathological investigation of the nasal cavity and the anatomic descriptionof paranasal sinus, offers informations about these cells, essential to minimize the surgical risks. The authors present a bibliographic revision of the importance of computed tomography on the investigation of anatomic variations of ethmoid cells. Not recurrent cells in all individuals, like Haller's cells, Onodi's cells and pneumatization of agger nasi, will do the endoscopic approach withprecaution. The ethmoidal roof evaluation will result in more safetyon the upper limits of the nasal cavity. The size and pneumatization level of ethmoidal bulla, ethmoidal crest, and middle nasal concha are important on the evaluation of the endoscopic accesses and the gravity of the striked pathology and even diagnose your origin.

Osteoma gigante do seio etmoidal / Giant osteoma of the ethmoidal sinus

Introdução: Os osteomas são lesões ósseas com crescimento lento e assintomático que na maioria das vezes é um achado em exames radiológicos solicitados por outro motivo. É a neoplasia benigna mais frequente dos seios paranasais. Os osteomas localizam-se, sobretudo no seio frontal (57 a 80%), seguido dos seios etmoidais (20%), maxilares e raramente no seio esfenoidal. Apresenta discreta predominância no sexo masculino 1,5 e sua incidência é maior nas 3ª e 4ª décadas de vida. O tratamento é cirúrgico independente do tamanho. Objetivo: Descrever um caso de osteoma gigante do seio etmoide mais uma breve revisão da literatura. Relato do Caso: JDA, masculino, 33 anos, apresentava obstrução nasal constante a direita há 01 ano. Ao exame, apresentava assimetria facial à custa da lateralização do globo ocular direito. A tomografia computadorizada dos seios paranasais mostrava lesão com densidade de partes moles ocupando parcialmente à fossa nasal direita, seio etmoide e maxilar direito. O paciente foi submetido à cirurgia com exérese total da lesão. O exame anatomopatológico confirmou osteoma. O paciente evoluiu sem evidências de recorrência da lesão. Comentários Finais: Os osteomas situados no seio etmoidal, independentemente do tamanho, e devidos o risco de complicações, devem ser operados.

Introduction: The osteomas are osseous lesions with slow and asymptomatic growth that most of the times is a finding in radiological exams requested for other reason. It's the most common benign neoplasm of the paranasal sinuses. The osteomas are located mainly in the frontal sinus (57% to 80%), followed by the ethmoidal sinuses (20%), maxillary sinuses and rarely in the sphenoid sinus. It has a discreet predominance in the male sex 1.5 and its incidence is higher in the 3rd and 4th decades of life. The treatment is surgical no matter the size. Objective: To describe a case of giant osteoma of the ethmoidal sinus including a brief literature review. Case Report: JDA, male, 33 years old, presented with a right constant nasal obstruction for 01 year. Upon exam, he presented with facial asymmetry with lateralization of the right ocular globe. The computed tomography of the paranasal sinuses showed a lesion with density of soft parts occupying partially the right nasal cavity, ethmoid sinus and right maxillary. The patient was submitted to surgery with full exeresis of the lesion. The anatomopathological exam confirmed osteoma. The patient evolved without evidences of the lesion recurrence. Final Comments: The osteomas in the ethmoidal sinus, irrespectively of the size and due to the risk of complications, must be operated.

Embolization through the Ophthalmic Artery with Onyx in Bilateral Ethmoidal Dural Arteriovenous Fistula: A Case Report / 대한뇌혈관외과학회지

Endovascular treatment of ethmoidal dural arteriovenous fistula (DAVF) has not been widely performed because of the technical difficulty of the procedure and the potential risk of central retinal artery occlusion. We report the case of a patient who underwent Onyx embolization through the ophthalmic artery in bilateral ethmoidal DAVF; to our best knowledge this is the first report.

Orbital abscess secondary to ethmoidal sinusitis in neonates / 国际眼科杂志(Guoji Yanke Zazhi)

A subperiosteal abscess is a form of orbital cellulitis characterized by a collection of fluid and pus confined by the periosteal lining of the orbit. In neonates, orbital abscesses are extremely rare. We present a case of a 26-day-old baby girl with severe orbital cellulitis in the right eye. A computed tomography (CT) scan of the orbits and paranasal sinuses revealed right orbital cellulitis with medial subperiosteal and retro-orbital abscess. The growth of Staphylococcus aureus was found in eye discharges. The patient was started on intravenous ceftriaxone and intravenous metronidazole. Urgent drainage of the abscess was performed via functional endoscopic sinus surgery (FESS). She recovered well after intravenous antibiotics and surgical drainage. Surgical drainage via endoscopic technique is the preferred treatment to prevent further complications.