Rare Presentations of Frontal Sinus Fungus Ball: A Systematic Review

Abstract Introduction The sinus fungus ball is an agglomeration of debris and hyphae, mainly caused by Aspergillus fumigatus, within the paranasal sinus, commonly affecting a single sinus, and it only rarely affects the frontal sinus. Objective To identify the state of the art of fungus ball in paranasal sinuses, especially related to the epidemiology of the disease in the frontal sinus. Additionally, this article reports a rare case of fungus ball in the frontal sinus in an adult male, and discusses the variables of this condition related to the patient. Data Synthesis All of the 8 cases of fungus ball in the frontal sinus reported in this study affected male patients: 40% had unilateral disease, and 60%, bilateral disease, contrary to the incidence data of fungus ball in the other paranasal sinuses, which reports unilateral prevalence. However, in the present study, this index changes, with 50% of unilateral and 50% of bilateral incidence regarding frontal sinus involvement. The average age of the patients was 65.36 years (range: 60-74 years). The etiologic agent was Aspergillus spp., and the endonasal endoscopic therapeutic approach corresponded to 80% of cases, while frontal osteoplasty accounted for 20% of cases, reaffirming the prevalence data from other studies. Conclusion Despite being a low-incidence entity, frontal sinus fungus ball should be considered in patients with pain in the frontal region refractory to the usual clinical treatments.

Pansinusopatía complicada. Presentación de un caso / Complicated pansinusopathy. A case Presentation

RESUMEN La sinusitis es una entidad frecuente dentro de las afecciones de los senos paranasales. Es un trastorno inflamatorio de la nariz, y uno o más de los senos paranasales; su diagnóstico es clínico. Las complicaciones de las sinusitis a nivel orbitario, óseo y endocraneal son una circunstancia poco usual, pero de gravedad extrema; en estas, la tomografía computarizada juega un rol indispensable para el diagnóstico y evolución, y en casos puntuales, la resonancia magnética puede ser muy oportuna. Se presenta el caso de un adolescente con edema palpebral derecho, proptosis moderada y signos de desorientación. El resultado de tomografía computarizada de cráneo y órbitas informó evidencias consistentes con complicaciones a causa de una pansinusopatía. La interpretación del estudio imagenológico fue fundamental para los diagnósticos y conducta inmediata.

ABSTRACT Sinusitis is a frequent entity within the conditions of the paranasal sinuses. It is an inflamatory disorder of the nose, and one or more of the paranasal sinuses; its diagnosis is clinical. The complications of sinusitis at the orbital, bone and intracranial levels are an unusual circumstance, but extremely serious; in these, computed tomography plays an important role for diagnosis and evolution; in specific cases, magnetic resonance imaging can be very timely. The case of an adolescent with right eyelid edema, moderate proptosis and signs of disorientation is presented. The result of computed tomography of the skull and orbits reported evidence consistent with complications due to pansinusopathy. The interpretation of the imaging study was essential for the diagnosis and immediate conduct.

Application of organ dose modulation technique in CT scanning of children paranasal sinus / 中国医学影像技术

Objective: To explore the effect of organ dose modulation (ODM) technique on radiation dose of orbit area and image quality in children paranasal sinus CT scanning. Methods: A total of 65 children with suspected paranasal sinus lesions requiring CT scanning were prospectively collected. The children were divided into 2 groups according to the order of visit, i.e.control group (n=27) received conventional CT scanning, and observation group (n=38) received conventional CT scanning with orbital ODM technique. The distribution of tube current in different direction (anterior/left/posterior/right) of orbital region was analyzed, and the differences of contrast to noise ratio of images and effective radiation dose were compared between 2 groups. Results: The tube currents of orbital anterior direction in observation group([127.39±17.98]mA) was lower than that in control group ([141.00±26.46]mA, t=2.47, P=0.02), while no statistical difference of tube current of orbital posterior, left, right direction was found between groups(t=-0.38, -0.90, -0.90, all P>0.05). There was no statistical difference of contrast to noise ratio of images nor effective radiation dose between 2 groups (t=-1.44, 1.21, both P>0.05). Conclusion: Application of ODM technique in children paranasal sinus CT scanning can effectively reduce the local tube current in the anterior direction of orbital region and reduce the radiation dose in the orbital region without affecting image quality.

Mucocele: Clinical Characteristics and Outcomes in 46 Operated Patients

Abstract Introduction Paranasal sinus mucocele is a benign, expansive lesion associated with paranasal sinus obstruction. It affectsmostly adults, and ismost common in the frontal and ethmoidal sinuses. Objective To evaluate outcomes in patients undergoing surgical treatment for paranasal sinus mucocele. Methods Retrospective review of medical records of patients treated for paranasal sinus mucocele at the ENT department of a tertiary care hospital between 2005 and 2016. Results Forty-six patients underwent surgical treatment of paranasal sinusmucocele. Themean age was 50.1 years, and 56.5% were male. The most prevalent symptom was pain, and the frontal sinus was most commonly affected. The vast majority of patients (89.1%) underwent endoscopic sinusmarsupialization; 10.9% required combined open and endoscopic access. Seven recurrences occurred. Conclusion Sinus mucocele is an expansive disease that primarily affects the frontal sinus of adult patients. In most cases, endoscopic surgery is an effective treatment modality. (AU)

Clinical effect of ostimeatal complex surgery on chronic sinusitis under nasal endoscope / 中国基层医药

Objective To analyze the clinical effect of ostimeatal complex surgery on chronic sinusitis under nasal endoscope.Methods A total of 270 patients with chronic sinusitis treated in Huzhou Central Hospital from March 2014 to May 2017 were selected.The patients were randomly divided into control group and observation group according to the digital table,with 135 cases in each group.The observation group received ostimeatal complex surgery under nasal endoscope.The control group was treated with local excision,local glucocorticoid injection,and maxillary sinus puncture and irrigation. The patients were followed up for 6 months after surgery, the clinical effect was observed.The life quality of patients was evaluated with 36-items short form health survey (SF-36) and sino-nasal outcome test-20 (SNOT-20).Results At the last follow-up,the cure rate of the observation group was 84.4% , the improvement rate was 13.3% , the cure rate of the control group was 45.2% , and the improvement rate was 20.0%.The clinical efficacy of the observation group was significantly better than that of the control group ( Z =7.291,P<0.001).Three months after treatment,the physiological role score[(69.5 ± 14.1) points] and general health score [(62.9 ± 11.4) points], the total score of 20 items [( 15.5 ± 3.4 ) points] and 5 items [( 8.1 ± 3.7)points] of SNOT-20 scale in the observation group were significantly improved (t=4.881,5.102,20.283, 14.360,all P<0.05).The scores of physiological function,physiological role,body pain,vigor,social function,emotional role,mental health and general health in the observation group were (86.8 ± 11.5) points,(81.0 ± 12.1) points, (82.8 ± 12.7)points,(70.4 ± 11.0)points,(84.5 ± 13.0) points,(73.4 ± 11.6) points,(87.0 ± 12.4)points and (68.7 ± 16.4)points,which were significantly better than those in the control group [(83.8 ± 11.4)points,(69.5 ± 12.4)points,(78.5 ± 13.1) points,(68.4 ± 11.9) points,(74.4 ± 11.7) points,(67.4 ± 11.9) points,(78.9 ± 12.3)points and (64.3 ± 12.9) points],the differences were statistically significant (t =2.153,7.712,2.738, 2.012,6.710,4.195,5.388,2.450,all P<0.05).There were no statistically significant differences in the score of 20 general items and the score of 5 items compared with those at 3 months (all P>0.05).Conclusion The clinical effect of ostimeatal complex surgery on chronic sinusitis under nasal endoscope is satisfactory.The overall symptoms and quality of life of the patients returned to normal,but the 5 major problems such as nasal mucus,mucus nose,bad sleep at night,nasal discharge backstreaming and inattention have not been solved thoroughly.

Lesiones destructivas de la línea media facial secundarias al consumo de cocaína: caso clínico / Cocaine induced midline destructive lesions: report of one case

Vasculitic midline destructive lesions can be a complication of cocaine use. We report a 44-year-old man who presented with a two months history of left facial pain associated with ipsilateral facial paralysis and a cheek phlegmon. Magnetic resonance imaging showed broad soft tissue destruction linked to important cranial nerve involvement. Antibiotic and antifungal therapy was started and multiple surgical debridement procedures were performed, with no clinical improvement. Microbiological analysis was negative. Finally, thanks to the histologic findings corresponding to vasculitis and granuloma formation and the history of cocaine abuse, a cocaine induced midline destructive lesion was diagnosed.

Assessment of Pulmonary Function before and after Sinus Surgery in Lung Transplant Recipients

Abstract Introduction The association between sinus and lung diseases is well known. However, there are scarce studies regarding the effects of sinus surgery on pulmonary function in lung transplant recipients. The present study describes our experience with sinus surgery in lung transplant recipients with chronic rhinosinusitis. Objectives To assess the impact of sinus surgery for chronic rhinosinusitis on pulmonary function and on inpatient hospitalization days due to lower respiratory tract infection in lung transplant recipients. Methods A retrospective study conducted between 2006 and 2012 on a sample of lung transplant recipients undergoing sinus surgery for chronic rhinosinusitis. Pulmonary function, measured by forced vital capacity (FVC) and forced expiratory volume in the first second (FEV1), as well as inpatient hospitalization days due to lower respiratory tract infection, were compared 6 months before and 6 months after sinus surgery. Results The FEV1 values increased significantly, and the inpatient hospitalization days due to bronchopneumonia decreased significantly 6 months after sinus surgery. The preoperative and postoperative median FEV1 values were 2.35 and 2.68 respectively (p = 0.0056). The median number of inpatient hospitalization days due to bronchopneumonia 6 months before and 6 months after surgery were 32.82 and 5.41 respectively (p = 0.0013). Conclusion In this sample of lung transplant recipients with chronic rhinosinusitis, sinus surgery led to an improvement in pulmonary function and a decrease in inpatient hospitalization days due to bronchopneumonia.

Paciente com proptose ocular associado a mucocele etmoidal: apresentação clínica e tratamento / Patient with ocular properties associated with ethmoidal mucocele: clinical presentation and treatment

Resumo Relato de um caso clínico de proptose ocular relacionado com mucocele etmoidal, o caso é raro e seu acometimento ocular não é comumente relacionado na literatura. Ressaltamos ainda sua apresentação clínica e o tratamento instituído. W.L.S, Paciente do sexo masculino, 27 anos procedente de Fortaleza-CE. Comparece ao ambulatório HUWC com queixa de baixa da acuidade visual percebida há 10 dias em olho direito (OD). Ao exame oftalmológico melhor acuidade visual corrigida de 20/200 OD e 20/20 olho esquerdo (OE), ausência de abdução e elevação do OD com ptose leve (distância margem reflexo 1-2 mm) e diplopia ao olhar para direita. Proptose OD de aspecto axial de grau moderado (24mm). Biomicroscopia lâmpada de fenda sem alterações. Pressão intraocular: 18mmHg OD 12 mmHg OE. Fundo de olho: OD aspecto palidez discreta de disco, sem outras alterações e OE dentro da normalidade. Solicitada tomografia de crânio (TC) que demonstrou presença de lesão arredondada em área do seio etmoidal penetrando parede óssea da órbita do OD sugestiva de mucocele etmoidal. Encaminhado para serviço de otorrinolaringologia do HUWC, sendo submetido a procedimento cirúrgico endoscópico etmoidectomia. Um mês após o procedimento cirúrgico a acuidade visual OD 20/25, movimentos oculares presentes e simétricos, ausência de diplopia e persistência de leve palidez em OD. Expansão da mucocele pode ocorrer ao longo de muitos anos ou rapidamente. Acometimento ocular com baixa da acuidade visual é incomum como primeiro sintoma, quando ocorre merece tratamento imediato. O tratamento cirúrgico é geralmente indicado no caso e deve ser instituído assim que possível para adequada recuperação visual.

Abstract Report of a clinical case of ocular proptosis related to ethmoidal mucocele, the case is rare and ocular involvement is not commonly related in the literature. We also emphasize its clinical presentation and the treatment instituted. W.L.S., male, 27 years old from Fortaleza-CE. He presents to the HUWC outpatient clinic complaining of low visual acuity perceived for 10 days in the right eye (OD). The ophthalmologic exam showed a best corrected visual acuity of 20/200 OD and 20/20 left eye (OS), absence of abduction and elevation of OD with light ptosis (distance margin 1 - 2 mm) and diplopia when looking to the right. Proptose OD of moderate aspect axial aspect (24mm). Biomicroscopy slit lamp without changes. Intraocular pressure: 18mmHg OD 12 mmHg OS. Background of eye: OD discrete pallor disk appearance, no other changes and OS within normality. A CT scan was performed that showed presence of a rounded lesion in the ethmoidal sinus area penetrating the bone wall of the OD orbit suggestive of ethmoidal mucocele. Forwarded to the otorhinolaryngology service of the HUWC, being submitted to endoscopic surgical procedure etmoidectomy. One month after the surgical procedure visual acuity of OD 20/25, present and symmetrical ocular movements, absence of diplopia and persistence of mild pallor in OD. Expansion of mucocele may occur over many years or rapidly. Ocular involvement with low visual acuity is uncommon as the first symptom, when it occurs it deserves immediate treatment. Surgical treatment is generally indicated in the case and should be instituted as soon as possible for adequate visual recovery.

Changes in Etiologies and Clinical Characteristics of Operated Unilateral Sinus Diseases: Comparison Study between 2005 and 2015

BACKGROUND AND OBJECTIVES: A considerable proportion of sinus diseases is associated with a unilateral lesion. Unilateral paranasal pathological lesions require precise preoperative diagnosis and histopathological assessment. This study aimed to analyze the changes in etiologies and clinical characteristics of operated unilateral sinus diseases between 2005 and 2015. SUBJECTS AND METHODS: Two hundred eighteen operated cases with unilateral sinus disease in 2005 and 2015 were reviewed to retrospectively analyze the etiologies and clinical characteristics. RESULTS: In 2015 compared with 2005, the proportion of unilateral sinus disease and patient age were increased. The proportions of patients with allergic rhinitis and hypertension were significantly increased in 2015. The leading cause of unilateral sinus lesions was nasal polyp, followed by fungus, tumor, mucocele, anatomical variation, odontogenic sinusitis, and foreign body. This ranking did not change between 2005 and 2015. The number of patients with fungal sinusitis was significantly increased in 2015. The direction of nasal septal deviation had no statistically significant relation with unilateral sinus disease. CONCLUSION: This comparison study of unilateral sinus disease between 2005 and 2015 showed that the proportion of fungal sinusitis, patient age, and patients with underlying disease were increased.

Effects of different doses of dexmedetomidine combined with propofol and remifentanil target controlled infusion on postanesthesia recovery of patients in functional endoscopic sinuses surgery / 中国医师进修杂志

Objective To investigate the effects of different doses of dexmedetomidine combined with propofol and remifentanil target controlled infusion (TCI) on postanesthesia recovery of patients in functional endoscopic sinus surgery. Methods Eighty ASA Ⅰor Ⅱ grade patients, scheduled for the endoscopic sinus surgery, were divided into control group (20 cases) and dexmedetomidine group (60 cases) according to the random digits table method. The patients in dexmedetomidine group were given loading dose dexmedetomidine 0.6 μg/kg, then were given dexmedetomidine of different maintenance doses:0.3 μg/(kg·h) in D1 group, 0.6 μg/(kg·h) in D2 group and 0.9 μg/(kg·h) in D3 group. The patients in dexmedetomidine group were given TCI propofol and remifentanil during the maintenance of general anesthesia, rocuronium was administrated intermittently during operation, and bispectral index (BIS) was controlled at 40 - 50. The changes of hemodynamics 5 - 10 min after entering operation room (T0), before induction (T1), 1 min after intubation (T2), 5 min after intubation (T3), before extubation (T4) and 5 min after extubation (T5) were observed. The spontaneous breathing recovery time, call of eye-opening time, extubation time and adverse reaction after surgery were recorded. Moreover, the visual analogue score (VAS) and Ramsay sedation score were used to evaluate the comfort level of patients. Results The mean arterial pressure (MAP) at T5 in control group and D1 group were significantly higher that in D2 group and D3 group, and there were statistical differences (P0.05). The VAS 15 min after extubation in D1 - D3 group were significantly lower than that in control group: (3.7 ± 0.3), (3.1 ± 0.4) and (3.0 ± 0.5) scores vs. (6.2 ± 0.6) scores, and there were statistical differences (P<0.05). The Ramsay sedation scores in D1 - D3 group were significantly higher than that in control group:(2.5 ± 0.2), (2.7 ±0.2) and (5.3 ± 0.3) scores vs. (1.4 ± 0.3) scores. Moreover, Ramsay sedation score in D3 group was significantly higher than that in D1 group and D2 group, and Ramsay sedation score in D2 group was significantly higher than that in D1 group. There were statistical differences (P<0.05). Four and 2 patients occurred nausea vomiting respectively in control group and D1 group within 24 h after operation. Conclusions Dexmedetomidine combined with propofol and remifentanil TCI can maintain hemodynamic stability and improve anesthesia recovery quality.

Unusual ocular manifestations of silent sinus syndrome / Manifestações oculares incomuns na síndrome do seio silencioso

Silent sinus syndrome is an acquired condition in which there is a gradual collapse of the orbital floor and inward retraction of the maxillary sinus (atelectasis of the maxillary sinus). This in turn may cause associated ocular occurrences of enophthalmos and hypotropia. This is a report of an 8 year-old boy with silent sinus syndrome and associated ocular motility disorders. The association between silent sinus syndrome and ocular motility disturbance has been recently described in the literature. However, this is an infrequent association, mainly in childhood.

A síndrome do seio silencioso é uma afecção adquirida em que há colapso gradual do assoalho orbital e do seio maxilar (atelectasia do seio maxilar), o que pode acarretar alterações orbitárias e oculares associadas, como enoftalmia e hipotropia. Relatamos o caso de um paciente de 8 anos de idade com síndrome do seio silencioso e distúrbios da motilidade ocular. A associação entre a síndrome do seio silencioso e alterações da motilidade ocular extrínseca tem sido descrita na literatura. No entanto, esta é uma associação pouco frequente, principalmente na infância.

Stage II Chronic Maxillary Atelectasis Associated with Subclinical Visual Field Defect

Chronic maxillary atelectasis (CMA) is characterized by a persistent decrease in the maxillary sinus volume due to inward bowing of its walls. According to its severity, it may be classified into three clinical-radiological stages. Objective: To report a case of stage II CMA associated with subclinical visual field defect. Case Report: A 34-year-old woman presented with a 15-year history of recurrent episodes of sinusitis and intermittent right facial discomfort for the past 5 years. She denied visual complaints, and no facial deformities were observed on physical examination. Paranasal sinus computed tomography (CT) demonstrated a completely opacified right maxillary sinus with inward bowing of its walls, suggesting the diagnosis of stage II CMA. A computerized campimetry (CC) disclosed a scotoma adjacent to the blind spot of the right eye, indicating a possible damage to the optic nerve. The patient was submitted to functional endoscopic sinus surgery, with drainage of a thick mucous fluid from the sinus. She did well after surgery and has been asymptomatic since then. Postoperative CT was satisfactory and CC was normal. Discussion: CMA occurs because of a persistent ostiomeatal obstruction, which creates negative pressure inside the sinus. It is associated with nasosinusal symptoms but had never been described in association with any visual field defect. It can be divided into stage I (membranous deformity), stage II (bony deformity), and stage III (clinical deformity). The silent sinus syndrome is a special form of CMA. This term should only be used to describe those cases with spontaneous enophthalmos, hypoglobus, and/or midfacial deformity in the absence of nasosinusal symptoms...

Clinical significance of TGF-β1 and VEGF expression in tissues of nasal inverted papilloma / 中国基层医药

ObjectiveTo investigate the clinical significance of transforming growth factor β1 (TGF-β1)and vascular endothelial growth factor (VEGF) expression in tissues of nasal inverted papilloma (NIP).MethodsThe clinical data of patients with NIP underwent surgical resection were retrospectively analyzed.The TGF-β1 and VEGF expression in NIP tissues and nasal polyps tissues were detected by immunohistochemistry method.100 patients with NIP were divided into benign lesions,atypical hyperplasia and malignant group according to result of pathological diagnosis,the nasal polyps was used as the control group.ResultsThe positive expression rate of TGF-β1 and VEGF in the NIP group were 46.0％ and 32.0％,compared with the control group the differences were significant(all P ＜ 0.05 ).In different pathological groups,the results of TGF-β1 and VEGF expression were malignant group ＞ atypical hyperplasia ＞ benign lesions.The positive expression rate of TGF-β1 and VEGF in the NIP group had significantly positive correlation(P ＜ 0.05).ConclusionThe TGF-β1 and VEGF expression were closely related to the the occurrence,development and malignant of NIP.TGF-β1 was highly expressed in the NIP tissues,and could increase the expression of VEGF and promote the formation of neovascularization of NIP.

Acesso endoscópico para tratamento do papiloma nasossinusal: um estudo clínico retrospectivo / Endoscopic treatment of sinonasal papilloma: a retrospective clinical study

Introdução: Papiloma nasossinusal é um tumor benigno com origem no epitélio schneideriano da parede nasal lateral. Sua incidência é rara e de acordo com a literatura responde por 0,5 a 4% de todos os tumores nasais. Objetivo: Reportar a experiência da nossa instituição no tratamento do papiloma nasossinusal invertido utilizando acesso endoscópico e comparar os resultados obtidos com os relatos da literatura. Método: Estudo retrospectivo de todos os pacientes com papiloma nasossinusal que realizaram tratamento cirúrgico puramente endoscópico no ambulatório de Otorrinolaringologia do Hospital das Clínicas da Universidade Federal da Bahia (UFBA), no período de janeiro de 2004 a maio de 2010. Resultados: Um total de 12 pacientes foi incluído neste estudo. O seguimento médio foi de 23 meses. Houve 1 caso de recidiva. Não ocorreu transformação maligna nestes casos. Conclusão: O tratamento do papiloma nasossinusal tem sido amplamente beneficiado com o avanço das técnicas endoscópicas, com taxas de recorrência equivalentes àquelas reportadas por acesso externo. Exames de imagem são fundamentais no planejamento pré-operatório e na decisão da técnica cirúrgica. Um seguimento regular e de longo prazo é essencial para um bom acompanhamento da evolução desta patologia.

Introduction: Sinonasal Papilloma is a benign tumor originating from the epithelium schneiderian lateral nasal wall. Its incidence is rare and according to literature accounts for 0.5 to 4% of all nasal tumors. Objective: To report our institution's experience in the treatment of sinonasal inverted papilloma using endoscopic approach and compare the results with the literature. Methods: A retrospective study of all patients with sinonasal papillomas who underwent a purely endoscopic surgery in the Otorhinolaryngology, Hospital das Clinicas, Federal University of Bahia (UFBA), from January 2004 to May 2010. Results: A total of 12 patients were included in this study. The median follow-up was 23 months. There was one case of recurrence. Malignant transformation has not occurred in these cases. Conclusion: The treatment of sinonasal papilloma has been largely benefited from the advances in endoscopic techniques, with recurrence rates equivalent to those reported for external access. Imaging exams are essential in preoperative planning and the decision of surgical technique. A regular follow-up and long term is essential for a good monitoring of the evolution of this pathology.

A Surgical Correction of Pneumosinus Dilatans of Maxillary Sinus by Segmental Zygoma Ostectomy and Maxilloplasty

Pneumosinus dilatans is defined as an abnormal enlargement of paranasal sinuses containing only air. The frontal sinus is most commonly affected, but the maxillary sinus is rare. The surgical aims of pneumosinus dilatans are to re-establish a permanent pressure equilibrium in the involved sinus and to correct possible facial deformity. Generally, pneumosinus dilatans of maxillay sinus is corrected by ostectomy of anterior wall of maxillary sinus and repositioning of removed bony fragment. Despite correction of anterior facial contour asymmetry, asymmetry of facial width remains to be a problem. Therefore, the authors present a technique for correction of pneumosinus dilatans of maxillary sinus by segmental zygoma ostectomy and maxilloplasty. A 16-year-old girl with a slowly enlarging mass in the right side of the face was referred to our department. No history of sinusitis, nasal obstruction or facial trauma were noted. CT scan presented an abnormal enlargement of right maxillary sinus. Surgery was delayed for 2 years until maturation of facial bone. Surgical correction was accomplished through circumferential osteotomy with repositioning of maxillary segment and segmental zygoma ostectomy. Postoperatively, the patient's facial contour was improved with equal malar height and width and no significant complication was noted.

Clinical Features and Treatments of Odontogenic Sinusitis

PURPOSE: The aim of this study was to investigate how clinical features such as sex, age, etiologic factors, and presenting symptoms of odontogenic sinusitis are differentiated from other types of sinusitis. Also, this study was designed to find methods for reducing the incidence of odontogenic sinusitis. MATERIALS AND METHODS: A retrospective chart analysis was completed on twenty-seven patients with odontogenic sinusitis. They were all treated at Kangbuk Samsung Hospital between February 2006 and August 2008. The study protocol and informed consent forms were approved by the institutional review boards for human beings at Kangbuk Samsung Hospital. RESULTS: Ten patients (37.0%) had dental implant related complications and 8 (29.6%) had dental extraction related complications. Unilateral purulent nasal discharge was the most common symptom (66.7%). The therapeutic modality included transnasal endoscopic sinus surgery in 19 (70.4%) patients, and a Caldwell-Luc operation in two (7.4%) patients. CONCLUSION: In our study, there was no significant difference in the incidence between genders. The average age of the patients was 42.9 years. The incidence was highest in the fourth decade. There were no significant differences between the symptoms of odontogenic sinusitis and that of other types of sinusitis. However, almost all of the patients with odontogenic sinusitis had unilateral symptoms. Iatrogenic causes, which include dental implants and dental extractions, were the most common etiologic factors related to the development of odontogenic sinusitis. Therefore, a preoperative consultation between a rhinologist and a dentist prior to the dental procedure should be able to reduce the incidence of odontogenic sinusitis.

Diferencias en la sensibilización a aeroalergenos en pacientes con poliposis nasosinusal / Different patterns of sensitization to airborne allergens in patients with nasal polyposis

Introducción: La poliposis nasosinusal (PN) es una enfermedad inflamatoria crónica de la mucosa. Apoyado en los hallazgos clínicos, histológicos e inmunológicos, se postula a la alergia como un factor etiopatogénico, lo cual no ha sido plenamente demostrado. Objetivo: Evaluar la presencia de hipersensibilidad a aeroalergenos en pacientes con PN y compararla con pacientes normales. Material y método: Se realizó prick test a aeroalergenos a todos los pacientes utilizando 30 alérgenos frecuentes en el área metropolitana de Santiago, incluyendo pólenes de árboles, malezas y pastos, ácaros, epitelio de animales y hongos habituales. Este test se amplió con el uso de tres hongos habitualmente no evaluados (Stemphyllium, Pullularia, Helminthosporium). Se utilizó la prueba de Chi cuadrado con una significancia de 0,05. Resultados: El 71 por ciento de los pacientes con PN (n =73) y el 66 por ciento del grupo control (n =44) presentaban un test cutáneo positivo, sin diferencia estadística significativa. El patrón de sensibilización a aeroalergenos fue similar, salvo para los alérgenos fúngicos: los pacientes con PN estaban sensibilizados en 40 por ciento a Pullularia, 30 por ciento a Stemphyllium, y 10 por ciento a Helminthosporium. En tanto que los controles no presentaron sensibilización a estos hongos no habituales. Discusión y conclusiones: Existe una alta tasa de sensibilización a aeroalergenos en pacientes normales y con PN, lo que sugiere un probable rol de la alergia en la patogénesis de la poliposis nasal. Destaca un patrón diferente de sensibilización a alérgenos fúngicos, cuya relevancia clínica debe ser evaluada a futuro.

Introduction: Nasal polyposis (NP) is a chronic inflammatory disease that leads to tissue oedema and eventually polyps. The pathogenesis of NP has not been fully understood yet, but there are clinical, histological, and immunological findings that suggest that allergy plays a role. Aim: The aim of this study was to find out the prevalence of airborne allergen hypersensitivity in patients with nasal polyposis. Material and method: Skin prick test (SPT) was performed to patients with NP and to a control group (CRS). Thirty frequent airborne allergens of the Santiago de Chile metropolitan area, including tree, grass and weed pollens, house dust mites, animal dander and common fungal allergens were tested. This SPT was extended by using three fungal allergens that usually are not evaluated (Stemphyllium, Pullularia, Helminthosporium). Chi square test was used to compare both groups of patients. Results: 71 percent of NP patients (n=73) versus 66 percent of the controls (n=44) had a positive SPT, although there was no statistical significance. The only difference in sensitization was for fungal allergens. In NP patients, sensitization to Pullularia was about 40 percent>, 30 percent> to Stemphyllium, and 10 percent to Helminthosporium. CRS patients were not sensitized to uncommon fungal allergens. Conclusions: We found a high frequency of sensitization to airborne allergen in CRS and NP patients that suggest a probable role of allergic inflammation in the pathogenesis of nasal polyposis. Stands out a different pattern of sensitization to fungal allergens in the NP group; the clinical relevance of this finding awaits future evaluation.

Uso tópico da adrenalina em diferentes concentrações na cirurgia endoscópica nasal / Topical use of adrenaline in different concentrations for endoscopic sinus surgery

A concentração ideal de adrenalina tópica a promover hemostasia adequada sem toxicidade ainda é motivo de controvérsia. OBJETIVO: Comparar soluções tópicas de adrenalina em diferentes concentrações. DESENHO DO ESTUDO: Prospectivo, duplo-cego, seleção aleatória. MATERIAIS E MÉTODOS: 49 pacientes submetidos à cirurgia endoscópica nasal, divididos em 3 grupos usando exclusivamente adrenalina tópica, nas concentrações de 1:2000, 1:10.000 e 1:50.000. Comparou-se o tempo operatório, o sangramento, as concentrações plasmáticas de adrenalina e noradrenalina e a variação dos parâmetros cardiovasculares. RESULTADOS: O tempo operatório por procedimento foi menor no grupo que utilizou adrenalina 1:2000, assim como o sangramento (p < 0,0001). As concentrações plasmáticas de adrenalina subiram em todos os 3 grupos, porém mais no grupo que utilizou adrenalina 1:2000. Houve uma tendência de aumento dos níveis tensionais nos pacientes que usaram adrenalina 1:2000 e 1:10.000, com maior ocorrência de picos hipertensivos. Discussão: Os benefícios do uso da solução de adrenalina mais concentrada foram evidentes, principalmente em relação ao sangramento. A tendência de aumento dos níveis tensionais pode ter ocorrido por não termos utilizado técnica anestésica intravenosa exclusiva. CONCLUSÃO: Analisando os prós e contras, sugerimos o uso de solução de adrenalina tópica 1:2000; mais pesquisas que corroborem nossos achados são necessárias.

The ideal adrenaline concentration remains unknown. AIM: Compare topical adrenaline solutions in different concentrations. STUDY DESIGN: Prospective, double blind, randomized trial. PATIENTS AND METHODS: 49 patients divided in 3 groups underwent endoscopic sinus surgery, using only topical solutions of adrenaline in different concentrations (1:2,000, 1:10,000 and 1:50,000). We compared the duration of surgery, intra-operative bleeding, plasmatic levels of catecholamines, hemodynamic parameters and changes in heart rhythm. RESULTS: Surgery time was shorter in the group using adrenaline 1:2,000, which also showed less bleeding in all evaluations (objective and subjective - p < 0.0001). Plasmatic levels of epinephrine rose in all groups, more sharply in the 1:2,000 group. There was a trend towards elevation of blood pressure in the groups using adrenaline 1:2,000 and 1:10,000, with a greater occurrence of hypertensive peaks. DISCUSSION: We found a very significance bleeding difference favoring the 1:2,000. The blood pressure elevation in the 1:2,000 and 1:10,000 groups was progressive but very slow throughout the procedure, which could be associated with the anesthesia technique. CONCLUSION: We favor the use of topical adrenalin 1:2,000 due to a clear superiority in hemostasis. Further investigation is needed to corroborate our findings.

Isolated sphenoid sinus inflammatory disease / 中国耳鼻咽喉头颈外科

OBJECTIVE To add to the current bodyof knowledge on isolated sphenoid sinus inflammatorydisease in order to promote early diagnosis and prompttreatment to prevent critical complications. METHODS A retrospective analysis was performed on 23 clinical cases of isolated sphenoid sinus inflammatory disease. The clinical features,radiological features,treatment and follow-up results were reviewed in the light of relevant literature. RESULTS The most common symptoms of the disease were headache and visual disturbance. All patients were treated by endoscopic sinus surgery and followed-up for 6-14 months. No recurrence was observed. CONCLUSION Diagnosis of isolated sphenoid sinus inflammatory disease at its early stages is difficult to ascertain because of the non-specificity of its symptoms. The widespread use of nasal endoscopy and CT examination makes early pre-operative diagnoses possible. Managing sphenoid sinus inflammatory disease with functional endoscopic sinus surgery is the preferred method of treatment.

The Long Term Follow-up of Maxillary Sinus Retention Cyst / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Retention cyst of the maxillary sinus is a common incidental finding on Waters' view. The purpose of this study is to evaluate the fate of maxillary sinus retention cyst after at least 3-year follow-up. MATERIALS AND METHOD: Twenty-five patients diagnosed to have maxillary sinus retention cyst on Waters' view between 1997 to 1999 were asked to revisit for the follow-up Waters' view at least 3 years later. Nine patients complied with the request. Medical records, endoscopic nasal findings, and radiological data of nine patients were reviewed. Cyst size was measured by the 2-dimensional milimeter scale and the relative percentage of the total antral area. RESULTS: The cyst was located in the right maxillary sinus in 4 patients, left in 4, and bilateral in 1. Nine out of ten cysts appeared to arise from the floor of the sinus. The area of the cysts ranged in size from 232 mm2 (ratio 36.4%) to 370 mm2 (55.3%), as measured on Waters' view. Six of the cysts resolved spontaneously, three showed no change in size and only one has enlarged twice the size of initial cyst. The patient with enlarged cyst didn't complain of any specific symptoms. CONCLUSION: The majority of cysts (90%) decreased in size or spontaneously resolved after 3 years. Thus, `wait and see' policy may be appropriate unless associated with specific symptoms.