Etmoiditis complicada con celulitis orbitaria en un lactante / Complicated ethmoiditis with orbital cellulitis in a nursling

Se define la etmoiditis como la inflamación e infección de la mucosa de las celdas etmoidales. Se diagnostica clínicamente con la presencia de edema en el ángulo medial del ojo, que se extiende a las estructuras adyacentes. Estudios imagenológicos son necesarios para verificar la presencia de complicaciones, entre las que se citan el absceso orbitario, subperióstico, epidural, subdural, cerebral, tromboflebitis del seno cavernoso, meningoencefalitis y la muerte del paciente. Streptococcus pneumoniae, Staphylococcus aureus y Haemophilus influenzae son microorganismos frecuentemente responsables de este cuadro. Las complicaciones orbitarias en las etmoiditis, necesitan el diagnóstico y tratamiento precoz para evitar secuelas irreversibles. Se presenta el caso de un lactante masculino, de 1 mes y 26 días de nacido, que ingresa con fiebre, rinorrea serosa y rechazo al alimento. Evolutivamente se constata marcada obstrucción nasal, edema periorbitario izquierdo, rubor, calor, protrusión del globo ocular e irritabilidad, y se diagnostica etmoiditis complicada con celulitis orbitaria. Se realiza tomografía axial computarizada que informa seno etmoidal izquierdo ocupado por contenido de densidad líquida con celularidad (15-25 UH), engrosamiento de partes blandas de la pared interna de la órbita que abomba, comprime y desplaza la musculatura orbitaria, y se extiende al párpado y al ala izquierda de la nariz desviando tabique blando; así como ligera proptosis, y disminución de la densidad ósea de la pared interna de la cavidad orbitaria. Se toma muestra para cultivo y se aísla Staphylococcus aureus meticillin resistente. Se comentan los elementos diagnósticos y su tratamiento, con el objetivo de llamar la atención de los pediatras para lograr el diagnóstico y tratamiento oportuno.

Ethmoiditis is the inflammation and infection of the ethmoidal cell mucus. It is clinically diagnosed after observing edema in the medial angle of the eye extending into the adjacent structures. Imaging studies are required to verify complications such as orbital, subperiostic, epidural, subdural, cerebral abscess; thrombophlebitis of the cavernous sinus, meningoencephalitis and finally death of the patient. Streptococcus pneumoniae, Staphylococcus aureus and Haemophilus influenzae are frequently responsible for this health picture. The orbital complications seen in ethmoiditis require early diagnosis and treatment to avoid irreversible sequelae. This is the case of a male nursling aged one month and 26 days, who was admitted to the hospital with fever, rhinorrea serosa and rejection to feeding. As his condition progresses, it was observed that he presented with marked nasal obstruction, left periorbital edema, blushing, heat, eyeball protusion and irritability. He was finally diagnosed as complicated ethmoiditis with orbital cellulitis case. Computer axial tomography revealed left ethmoidal sinus filled with fluid content having cellularity rate of 15-25 UH, thickening of soft parts of the internal wall of the orbit that juts out, compresses and shifts the orbital musculature and extends into the eyebrow and to the left wing of the nose, thus deviating the soft septum in addition to slight proptosis and reduction of the bone density of the internal wall of the orbital cavity. A sample was taken for culturing, which resulted in isolation of methicillin-resistant Staphylococcus aureus. The diagnostic elements and the treatment of this disease were explained in order to call the pediatricians´attention to timely diagnose and treat these patients.

A Case Report of Orbital Cellulitis

Orbital cellulitis is a septic process between the ethmoid and orbitary tissue representing the most frequent cause of unilateral exophthalmos, Orbital cellulitis is an uncommon infectious process in which patient may present with pain, reduced visual acuity, compromised ocular motility and significant proptosis, The close cooperation between ophthalmologists and ENT specialists is required both for diagnosis and treatment.

Expression of RANTES mRNA in Early Recurrent Nasal Polyps / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: RANTES is a powerful chemotactic and activating factor to some inflammatory cells including eosinophils, which represent the most abundant cell type among the numerous cellular infiltrates of nasal polyps. RANTES may have an important role in the recruitment of inflammatory cells during the development of nasal polyps. The purpose of this study is to investigate RANTES mRNA expression in nasal polyps, ethmoiditis mucosa and in the early recurrent nasal polyps in order to identify its role as a chemoattractant in recurrent nasal polyps. MATERIALS: Tissue samples of nasal polyps, ethmoiditis mucosa, and early recurrent nasal polyps were obtained from an endoscopic sinus surgery. For these samples, light microscopic examination for histopathology and RT-PCRs for RANTES mRNA expression were performed. Three normal ethmoidal mucosa and four hypertrophied inferior turbinates were also evaluated. RESULTS: Tissue infiltration of eosinophils observed under the light microscope was in the following order: early recurrent nasal polyps (91%), nasal polyps (60%), and ethmoiditis mucosa (40%). About 97% of early recurrent nasal polyps showed RANTES mRNA expression, but nasal polyps and ethmoiditis mucosa showed 60% and 56% of expression rates. CONCLUSION: The results suggest that RANTES may play an important role in the development of early recurrent nasal polyps undergoing active inflammatory reactions and the recruitment of some inflammatory cells including eosinophils. Further investigations for other chemokines related to eosinophils will provide better understanding of the mechanism in the formation of nasal polyps.

Ultrastructural Changes of Mucous Blanket in Chronic Ethmoiditis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: he mucous blanket as a smooth layer riding on the top of cilia in the respiratory mucosa provides the airway fluidity and protection from exogenous materials. However, the depth of the periciliary fluid layer is critical for the interaction between the cilia and mucus as decreased depth of the periciliary fluid layer could disturb the mucociliary transport. The purpose of this study is to investigate the ultrastructural changes of mucous blanket in the inflammatory mucosa of posterior ethmoid. MATERIALS AND METHODS: We evaluated the ultrastructural changes of ethmoid mucous blanket using the transmission electron microscope (5 normal posterior ethmoid sinus mucosa and 5 posterior ethmoiditis mucosa). RESULTS: Normal ethmoid maintained two layers of mucous blanket, but the mucous blanket from posterior ethmoiditis showed decreased periciliary fluid layer and increased mucous layer. CONCLUSION: Decreased periciliary fluid layer due to increased mucous layer in posterior ethmoiditis cause inactive ciliary beat and therefore can impair mucociliary transport. On the other hand, early drainage of mucus secretion in posterior ethmoiditis may improve the mucociliary transport.