Evolução clínica e tomográfica da osteomielite frontal: relato de caso / Clinical and tomography evolution of frontal osteomyelitis: case report

INTRODUÇÃO: A osteomielite frontal é uma complicação de rinossinusite que pode ter evolução aguda ou crônica. Há reação inflamatória com aumento da pressão intra-óssea, isquemia e necrose local, levando à formação de abscesso ósseo. Não havendo drenagem, ocorrerá descolamento do periósteo, invasão de partes moles e piora da isquemia com posterior sequestro ósseo. MÉTODO: Relato de caso de um paciente internado em serviço de emergência de outra instituição por complicação de rinossinusite que foi encaminhado para o Serviço de Otorrinolaringologia do Hospital Universitário Professor Edgard Santos da Universidade Federal da Bahia. RELATO DE CASO: Paciente masculino, 16 anos, apresentou-se ao serviço de emergência de outra instituição com cefaleia, vômitos e febre que evoluiu com edema periorbitário e frontal à esquerda, cursando com flutuação palpebral e frontal.Submetido à drenagem de abscesso palpebral e frontal, com antibioticoterapia de amplo espectro sem melhora. Encaminhado para o nosso serviço mantendo edema e flutuação em região frontal e edema leve em região periorbitária esquerda. A endoscopia nasal evidenciou edema em meato médio à esquerda e a tomografia computadorizada mostrou sinusite fronto-etmoidal à esquerda e sinais de osteomielite frontal com sequestro ósseo e empiema epidural.Submetido à cirurgia endoscópica nasossinusal, acesso externo para exérese do osso frontal acometido e drenagem do empiema epidural. Evoluiu com remissão da doença. CONSIDERAÇÕES FINAIS: A falência no diagnóstico e no tratamento das complicações da rinossinusite pode levar a sequelas e complicações fatais.O diagnóstico de osteomielite frontal é firmado pela suspeita clinica e confirmado por exames radiológicos.A cirurgia está indicada quando a evolução for insidiosa, havendo sequestro ósseo ou complicações intracranianas.

INTRODUCTION: The frontal osteomyelitis is a complication of rhinosinusitis which can evolve to acute or chronicle. There is inflammatory reaction by the increasing of intraosseous pressure, ischemia and local necrosis, leading to bone abscess formation. There is no drainage, it will occur detachment of the periosteum, soft tissue invasion and worsening of ischemia with subsequent bone sequestration. METHOD: Case report of an inpatient in an emergency service of another institution by the complication of rhinosinusitis who was referred to the Otorhinolaryngology Service of University Hospital Professor Edgard Santos of Federal University of Bahia. CASE REPORT: Male patient, 16 years-old, presented himself to the ER of another institution with cephalea, vomits and fever which evolved to periorbital edema and frontal to the left, moving to palpebral fluctuation and frontal. Subjected to frontal and palpebral abscess drainage, with broad-spectrum antibiotic therapy with no improvement. He was referred to our service keeping edema and fluctuation in region frontal and light edema in left periorbital region. The nasal endoscopy showed edema in meatus to the left and the computerized tomography showed fronto-ethmoid sinusitis to the left and signs of frontal osteomyelitis with bone sequestration and epidural empyema. Subjected to sinasal endoscopy surgery, external Access or removal of the frontal one affected and epidural empyema drainage. Evolved to the remission of the disease. FINAL CONSIDERATIONS: Failure in the diagnosis and rhinosinusitis complication treatment can lead to sequalae and fatal complications. The diagnosis of the frontal osteomyelitis is confirmed by the clinical suspicion and confirmed by radiological examination. The surgery is indicated when the evolution is insidious, there is bone sequestration and intracranial complications.

Exploring anorganic bovine bone granules as osteoblast carriers for bone bioengineering: a study in rat critical-size calvarial defects

It is known that current trends on bone bioengineering seek ideal scaffolds and explore innovative methods to restore tissue function. In this way, the objective of this study was to evaluate the behavior of anorganic bovine bone as osteoblast carrier in critical-size calvarial defects. MC3T3-E1 osteoblast cells (1x10(5) cells/well) were cultured on granules of anorganic bovine bone in 24-well plates and after 24 h these granules were implanted into rat critical-size calvarial defects (group Biomaterial + Cells). In addition, other groups were established with different fillings of the defect: Blood Clot (negative control); Autogenous Bone (positive control); Biomaterial (only granules) and Cells (only MC3T3-E1 cells). After 30 days, the animals were euthanized and the calvaria were technically processed in order to allow histological and morphometric analysis. It was possible to detect blood vessels, connective tissue and newly formed bone in all groups. Particularly in the Biomaterial + Cells group, it was possible to observe a profile of biological events between the positive control group (autogenous bone) and the group in which only anorganic bovine granules were implanted. Altogether, the results of the present study showed that granules of anorganic bovine bone can be used as carrier to osteoblasts and that adding growth factors at the moment of implantation should maximize these results.

Sabe-se que uma das atuais tendências na bioengenharia óssea é procurar um carreador ideal e explorar métodos inovadores para restaurar a função do tecido. Desta forma, nosso objetivo foi avaliar o comportamento do osso bovino inorgânico como carreador de osteoblastos em defeitos ósseos de tamanho crítico em calvária de ratos. Osteoblastos da linhagem MC3T3-E1 (1x10(5) células/poço) foram cultivadas em grânulos de osso bovino inorgânico sob placas de 24 poços e após 24 h esses grânulos foram implantados em defeitos ósseos de tamanho crítico em calvária de ratos. Além deste grupo experimental (Biomaterial + Células), foram estabelecidos outros grupos com diferentes preenchimentos do defeito crítico: coágulo sanguíneo (controle negativo); osso autógeno (controle positivo); Biomaterial (apenas grânulos) e Células (apenas células MC3T3-E1). Após 30 dias, os animais foram eutanasiados e as calvárias foram processadas histotecnicamente, a fim de permitir a análise histológica e morfometria. Nossos resultados mostraram que em todos os grupos avaliados foi possível detectar vasos sanguíneos, tecido conjuntivo e osso neoformado. Em especial para o grupo tratado com Biomaterial + Células, foi possível observar um perfil de eventos biológicos intermediário ao grupo controle positivo (osso autógeno) e o grupo de biomaterial (apenas grânulos inorgânico bovino). Ao todo, nossos resultados mostraram que os grânulos de osso bovino inorgânico podem ser usados como carreador de osteoblastos e que a adição de fatores de crescimento no momento em que ocorre o implante deve maximizar os resultados.

Morgagni Stewart Morel syndrome--additional features.

A case of Morgagni Stewart Morel syndrome with progressive depression in frontal bone, headache, transient monoparesis, obesity; imbalance, neuropsychiatric symptoms and recurrent disc prolapse with absent right radial pulse is discussed. This syndrome was first mentioned 235 years back, but till now exact pathology is not known. Balance assessment using dynamic posturography was done, which revealed abnormal vestibular function. To our knowledge this is the first case examined for Dynamic Posturography.

Cavernous haemangioma of the frontal bone

A 28-year-old female presented with a progressive right frontal mass. CT scan and plain films showed an osteolytic lesion in the right frontal bone. Surgery consisted of total resection of the lesion and cranioplasty. The postoperative source was uneventful. Histological examination revealed a cavernous haemangioma of the diploe. In view of this observation and the literature review, aetiology, clinical, radiological and therapeutic aspect of this rare entity are discussed

CT and Pathologic Findings of A Case of Subdural Osteoma

A 43-year-old female presented with persistent headache and dizziness which had first occurred two years earlier. The physical and neurological findings at admission were unremarkable, though plain radiography revealed the presence of a dense calcified mass in the left frontal area, and CT showed that a homogeneous high-density nodule was attached to the inner surface of the left frontal skull. The hard bony mass found and excised during surgery was shown at histopathologic examination to be a subdural osteoma. We describe the clinicopathologic findings of this entity and discuss the radiological features which suggest its subdural location.

Primary ectopic meningioma.

Primary ectopic meningiomas are rare. A case of a 16-year-old male who presented with a large mass in temporofrontal region is reported. X-ray skull showed soft tissue shadow with hyperostosis of frontal and temporal bone. CT scan of brain demonstrated a markedly enhancing lesion and bony hyperostosis with no intracranial component. Total excision of tumour with hyperostotic bone was done. Patient is well without any evidence of recurrence two years after surgery. Relevant literature is reviewed.

Osteomielite frontal pós-sinusite frontal / Osteomyelitis complicating frontal sinusitis

A osteomielite frontal é uma complicaçäo de sinusite rara após o advento da antibioticoterapia. Neste trabalho säo apresentados e discutidos aspectos do quadro clínico, diagnóstico e tratamento de sete casos de osteomielite frontal