Clinical and surgical treatment of secondary orbital abscess in ethmoidal sinusitis / Tratamento clínico e cirúrgico de abscesso orbital secundário a sinusite etmoidal

The authors report the case of na eighteen years old patient with a clinical picture of orbital abscess caused by ethmoid sinusitis. The decision for surgical intervention results from correlation between clinical findings and from the image diagnosis.

Relato de um caso de uma paciente de 18 anos com um quadro clinico de abscesso orbital causado por sinusite etmoidal. A decisão pela intervenção cirúrgica resultou da correlação entre achados clínicos e do diagnóstico dos exames de imagem.

[Prevalence of infraorbital ethmoid air cell on panoramic radiographs]

Presence of Haller cells with or without disease can narrow the ethmoid infundibulum or ostium of maxillary antrum and result in persistent rhinosinusitis, recurrent sinusitis, and other clinical symptoms, so detection of haller cells in common panoramic radiographs can be useful in diagnosis of the origin of these problems. The purpose of the present study was to determine the prevalence of infraorbital ethmoid cells on panoramic radiographs. Panoramic radiographs of 310 patients were evaluated according to the method of Ahmad et al. to detect infraorbital ethmoid cells. A well defined radiolucency was located medial to infraorbital foramen, wherever most of its border was visible and caused lack of cortication in inferior border of the orbit in the superimposition areas, was interpreted as infraorbital ethmoid cell. The radiographs were interpreted by three observers. the data were analyzed by Binary logistic regression test in SPSS software. Data from 310 panoramic radiographs were analyzed. 37% of radiographs were interpreted as to show infraorbital ethmoid cells. Infraorbital ethmoid cell might be considered as a quite common anatomic landmark, visible on panoramic radiographs. From a clinical point of view, this may be of diagnostic importance, because it has been stated that detection of haller cells may lead to detection of the origin of a number of sinus problems

Use of standard radiography to diagnose paranasal sinus disease of asthmatic children in Taiwan: comparison with computed tomography.

Paranasal sinus disease and bronchial asthma are frequently associated. Computed tomography imaging is currently the most reliable method for confirming the diagnosis of sinusitis. Due to the cost and amount of radiation during computed tomography, our aim was to analyze whether standard radiography, under computed tomography-control, had a reasonable degree of confidence in the diagnosis of sinusitis. Fifty-three asthmatic patients (42 males and 11 females) with a mean age of 9 years (range 4-14) were enrolled. We evaluated the maxillary sinuses, ethmoidal sinuses, frontal sinuses, and sphenoidal sinuses using standard radiography (Waters' view, Caldwell view, and lateral view) and compared with computed tomography (coronal views), the latter served as a standard. Computed tomography (CT) showed paranasal sinusitis in 58% (31/53) of the asthmatic children. Compared with the results of computed tomography, standard radiography revealed a sensitivity of 81.1% and a specificity of 72.7% for maxillary sinusitis. The sensitivity and specificity for ethmoidal, frontal, and sphenoidal sinusitis were 51.8%, 84.8%; 47.3%, 87.2%; and 40.8%, 93.3%, respectively. In 21 (40%) of the 53 patients, discrepancies were seen between the interpretations of standard radiography c and those of CT scans. In patients with maxillary sinusitis, the correlation between standard radiography and CT was good. However, ethmoidal, frontal, and sphenoidal sinusitis were poorly demonstrated using radiography. Standard radiography can be recommended as a screening method for maxillary sinusitis, but it is not recommended for the diagnosis of other paranasal sinusitis.