Resolución Quirúrgica para Un Caso de Polisinusitis de Origen Odontogénico / Surgical Resolution for A Case of Polysinusitis of Odontogenic Origin

La celulitis orbitaria es una patología grave que está asociada con sinusitis paranasal. Éstas suelen presentar edema periorbitario, dolor, y movimiento extraocular restringido. La mayoría de los casos presentan pronóstico favorable, asociado a terapia antibiótica o drenaje quirúrgico. Las celulitis de origen odontogénico representan 2 a 5 % de todos los casos; se caracterizan por una diseminación del proceso infeccioso desde los ápices de las raíces, infectando al seno maxilar, llegando a la órbita a través de la fisura orbitaria inferior o a través de un defecto en el piso de la órbita. En el presente estudio se reporta el caso de un paciente masculino de 28 años que consulta por aumento de volumen periorbitario izquierdo con 4 días de evolución, posterior a exodoncia de segundo molar superior izquierdo. Al examen extraoral presenta aumento de volumen izquierdo con eritema periorbitario, proptosis ocular ipsilateral con visión conservada, y salida de líquido purulento por fosa nasal izquierda. En los exámenes de laboratorio e imagenológicos se pesquisa compromiso de seno maxilar, etmoidal y esfenoidal, decidiendo su hospitalización y manejo quirúrgico en tres tiempos operatorios, los cuales permiten acceso a pared anterior del seno maxilar y a espacio pterigoideo. Dentro de los diagnósticos de celulitis orbitaria pueden incluir reacciones alérgicas, conjuntivitis o herpes. Se excluyeron los diagnósticos mencionados debido a que no se observaron alteraciones dermocutáneas periorbitarias. Por el contrario, el compromiso unilateral, movimiento ocular alterado y doloroso indica que el cuadro abarcaba espacios profundos. La infección de senos paranasales posterior a una exodoncia es una complicación poco frecuente. Un diagnóstico temprano adecuado disminuye la morbilidad y mortalidad de esta condición. Debemos estar alertas a complicaciones posteriores en procedimientos realizados, tener conocimiento en diagnóstico y manejo de posibles evoluciones tórpidas en pacientes.

Orbital cellulitis is a serious pathology that is associated with paranasal sinusitis. These medical conditions usually present with periorbital edema, pain, and restricted extraocular movement. Most cases have a favorable prognosis, associated with antibiotic therapy or surgical drainage. Cellulitis of odontogenic origin represents 2 to 5 % of all cases. They are characterized by a spread of the infectious process from the apices of the roots, infecting the maxillary sinus, reaching the orbit through the inferior orbital fissure or through a defect in the floor of the orbit. The present study reports the case of a 28-year-old male patient, who consulted for a volume increase in left periorbital volume with 4 days of evolution, after extraction of the upper left second molar. Extraoral examination showed left volume increase with periorbital erythema, ipsilateral ocular proptosis with preserved vision, and discharge of purulent fluid from the left nostril. The laboratory and imaging tests showed compromise of the maxillary, ethmoid and sphenoid sinus deciding on hospitalization and surgical management in three operative times, which allow access to the anterior wall of the maxillary sinus and the pterygoid space. Diagnoses of orbital cellulitis may include allergic reactions, conjunctivitis, or herpes. These diagnoses were excluded because no periorbital dermocutaneous alterations were observed. In contrast, unilateral involvement, impaired eye movement, and pain indicate that the condition involved deep spaces. Paranasal sinus infection after tooth extraction is a rare complication. An early diagnosis adequately decreases the morbidity and mortality of this condition. We must be alert to subsequent complications in procedures performed, have knowledge in diagnosis and management of possible torpid evolutions in patients.

Clinical characteristics of patients with odontogenic sinusitis underwent endoscopic sinus surgery / 中华耳鼻咽喉头颈外科杂志

Objective: To analyze the clinical features of patients with odontogenic sinusitis (OS) treated by endoscopic sinus surgery (ESS). Methods: A retrospective investigation was carried out in our 27 (16 males and 11 females) cases with OS aged (49.74±14.42) years old. Subjects were hospitalized between January 2018 and November 2020 from Department of Otorhinolaryngology Head and Neck Surgery, Beijing Chaoyang Hospital. The medical history, symptoms, result of nasal endoscopy and paranasal sinus computed tomography (CT) were analyzed statistically by SPSS 19.0. Results: OS mainly occured on unilateral sinuses, with a duration of (8.56±11.79) months. Seventy point four percent (19/27) of the patients had a course within six-month, only 11% was over 12 months (3/27). Symptoms mostly showed as nasal obstruction (88.9%; 24/27), runny nose (81.5%; 22/27), nasal stinks (16/19) and postnasal drip (10/10). Sixty-three percent (17/27) of the OS patients had a dental history. Nasal endoscopic examination revealed a swelling of the ostiomeatal complex (77.8%; 21/27), medial wall interhal displacement of maxillary sinus (55.6%; 15/27), white emulsion-like purulent secretion in the middle meatus (70.4%; 19/27) and nasal polyps (59.3%; 16/27). Etiology of OS included implant-related problems (14.8%; 4/27) and periodontal disease (85.2%; 23/27). Conclusions: OS is usually unilateral sinusitis with a short history. Its clinical features show nasal stinks, white emulsion-like purulent secretion in the middle meatus and imaging findings of unilateral maxillary sinusitis with tooth-related lesions.

Isolated Meningitis and Lacrimal Gland Abscess due to Odontogenic Sinusitis: Case Report / Meningitis Aislada y Absceso de la Glándula Lagrimal debido a Sinusitis Odontogénica: Reporte de un Caso

ABSTRACT: Our objective was report an extremely rare case of isolated meningitis and suppurative dacrioadenitis as consequences of odontogenic sinusitis. We describe the diagnostic tools including imaging and culture, as well as surgical treatment and follow-up. Our final diagnosis was odontogenic sinusitis caused by Streptococcus Anginosus complicated by isolated meningitis and lacrimal gland abscess. Urgent surgical treatment to restore the paranasal sinuses and drainage of the lacrimal gland was performed. Culture from purulent material collected from maxillary sinus indicated the targeted therapy. Clinical assessment and imaging obtained 20 days after surgery demonstrated successful results. This case emphasizes the importance of evaluating intracranial complications of rinosinusitis, the need to search for a dental infection when a maxillary sinusitis is encountered, the key role of a thorough diagnostic workup in order to plan a comprehensive and effective surgical treatment, as well as targeted medical therapy.

RESUMEN: En este estudio se informa un caso extremadamente raro de meningitis aislada y dacrioadenitis supurativa, como consecuencia de sinusitis odontogénica. Describimos las herramientas de diagnóstico que incluyen imágenes y cultivo, como también el tratamiento quirúrgico y el seguimiento. El diagnóstico final fue de sinusitis odontogénica causada por estreptococo anginoso complicado por una meningitis aislada y el absceso de la glándula lagrimal. Se realizó un tratamiento quirúrgico de urgencia para restaurar los senos paranasales y drenar la glándula lagrimal. Se determinó el tratamiento de acuerdo a los resultados de cultivo del seno maxilar. La evaluación clínica y las imágenes obtenidas 20 días después de la cirugía demostraron resultados exitosos. Es importante la evaluación de las complicaciones intracraneales de la rinosinusitis además de la necesidad de considerar una infección dental frente a una sinusitis maxilar. Por otra parte, es clave una evaluación exhaustiva de diagnóstico para planificar un tratamiento quirúrgico completo y efectivo, así como el tratamiento médico.

Diagnóstico y tratamiento de la sinusitis maxilar odontogénica / Diagnosis and treatment of odontogenic maxillary sinusitis

RESUMEN Introducción: La patología sinusal inflamatoria e infecciosa puede comprometer la mucosa sinusal maxilar, etmoidal, esfenoidal o frontal, y su etiología es variada. Se ha observado que la patología odontológica es uno de los factores causales de la sinusitis maxilar, con una incidencia del 10% al 40% según diversas series de casos. El diagnóstico y tratamiento se debe realizar de manera interdisciplinaria entre las especialidades de otorrinolaringología y de cirugía maxilofacial. Se elaboró un documento descriptivo sobre la sinusitis odontogénica y orientador sobre su manejo, de acuerdo a una revisión de la literatura. Se realizaron búsquedas en las bases de datos PubMed, Lilacs y Google Académico, utilizando términos relevantes para la sinusitis odontogénica, con el fin de elaborar el documento. Se utilizaron 43 artículos, todos publicados desde el año 1986 hasta la fecha. Se concluye que la sinusitis odontogénica difiere tanto en la clínica como en la microbiología de otras enfermedades sinusales. El tratamiento se basa en el trabajo interdisciplinario e incluye cirugía endoscópica funcional, realizada por el otorrinolaringólogo, en conjunto con el tratamiento odontológico, siendo fundamental la buena comunicación entre ambos equipos.

ABSTRACT Introduction: Infectious and inflammatory sinus diseases have a varied etiology and can be associated to the maxillary, ethmoidal, sphenoidal and frontal sinuses. Dental pathology can be one of the etiological factors associated to maxillary sinus disease, with frequency rates of 10-40%. Diagnosis and treatment require interdisciplinary work, with participation of otorhinolaryngology and oral and maxillofacial surgery. The development of a descriptive document on odontogenic sinusitis and management guidelines according to literature review. Pubmed, Lilacs and Google Academic database were searched using terms relevant to odontogenic sinusitis, in order to prepare the document. 43 articles were used, all published from 1986 onwards. We conclude that odontogenic sinusitis differs clinically and microbiologically from other sinus pathologies. Treatment modalities are based upon interdisciplinary surgery, including functional endoscopic surgery done by otolaryngologists and dental treatment, being fundamental close communication between the two teams.

Rhino-maxillary aspergillosis in an immunocompetent patient: case report

Introduction: Aspergillosis is the second most frequent opportunistic fungal infection of the pa-ranasal sinuses. It primarily affects the maxillary sinus and occurs mainly in immunocompromi-sed individuals. Infection is caused by inhalation of spores or by an oro-sinusal communication. Aspergillosis is classified into an invasive and non-invasive form or Aspergilloma, which usually affects immunocompetent patients. Violaceous lesions, ulcers, necrosis and tissue destruction can be manifested clinically. Patients may experience pain, paresthesias, increases in the vo-lume of purulent or bloody nasal discharge and congestion. Case report: A 62-year-old female patient, immunocompetent, with a condition evolving for about six years. Condition began after a dental extraction, and consisted of absence of scarring and recurrent episodes of symptoma-tology suggestive of maxillary sinusitis with poor response to antibiotics. The patient was referred to the maxillofacial care unit, presenting an increase of volume in the right genial region, pain and paraesthesia of infraorbital region. The CT scan showed the presence of a radiopaque foreign body in the right maxillary sinus. A surgical procedure was carried out using the Caldwe-ll-Luc technique and biopsy; the case was diagnosed with Aspergillosis. The patient was treated without antifungal therapy because she had a good immune status. Conclusion: Aspergilloma is the most common form of Aspergillosis in immunocompetent individuals. It is usually diagnosed late, as its clinical picture is similar to bacterial sinusitis. In most cases, patients respond well to surgical treatment, and systemic antifungal therapy is not necessary.

Bola fúngica de cavidades paranasales: serie de casos / Fungus ball of the paranasal sinuses: case series

RESUMEN Introducción La bola fúngica (BF) es una sinusitis fúngica no invasiva, con acumulación extramucosa de conglomerados densos de hifas de hongos en cavidades paranasales (CPN), afectando generalmente a mujeres inmunocompetentes. Objetivo Describir la presentación cínica, diagnóstico y tratamiento de una serie de pacientes con diagnóstico de BF de CPN. Material y método Estudio descriptivo retrospectivo de pacientes con diagnóstico histopatológico de BF sometidos a cirugía endoscópica nasal (CEN) en nuestra institución entre 2010 y 2016. Resultados Se incluyeron 20 pacientes (15 mujeres, 5 hombres), con edad promedio al diagnóstico de 64 años (35-86 años), la mayoría inmunocompetente (85%). El síntoma más frecuente fue dolor facial (8/20). Todos los pacientes fueron estudiados con tomografia computarizada (TC) de CPN, presentando calcificaciones en 70%. La ubicación más frecuente fue el seno maxilar (12/20) y luego esfenoidal (6/20). Se realizó CEN en todos los pacientes, combinándolo con Caldwell Luc en 3 de ellos. Los cultivos intraoperatorios resultaron negativos en el 75% de los pacientes. Conclusión La BF tiene presentación cínica inespecifica. Se sospecha en base a hallazgos imagenológicos en la TC de CPN y se confirma histopatológicamente, dado el bajo rendimiento de los cultivos. La CEN es la herramienta diagnóstico-terapéutica de elección, con baja tasa de recidiva local.

ABSTRACT Introduction A fungus ball (FB) is a non-invasive fungal sinusitis, consisting of extramucosal accumulation of dense fungal hyphae conglomerates, located in paranasal sinuses. It generally affects immunocompetent women. Aim To describe the clinical presentation, diagnosis and treatment in a series of patients diagnosed with FB of paranasal sinuses. Material and method Retrospective descriptive study regarding all patients with a histopathologic diagnosis of FB, who underwent endoscopic sinus surgery (ESS) in our institution between 2010 and 2016. Results Twenty patients (15 women, 5 men) were included, with a mean age at diagnosis of 64 years (35-86 years). Most were immunocompetent (85%). Facial pain was the most frequent symptom (8/20). All patients were studied with a sinus CT, finding paranasal calcifications in 70%. It predominantly involved the maxillary (12/20), and sphenoid sinus (6/20). All patients were treated with ESS, with a combined Caldwell Luc approach in only 3 of them. Intraoperative cultures were negative in 75% of patients. Conclusions Sinus FB has a non-specific clinical presentation. CT findings help suspect it, and it is confirmed with a histopathological study, given the poor efficiency of cultures. ESS is the diagnostic-therapeutic procedure of choice, with a low local recurrence rate.

Cierre de fístula oroantral con injerto de hueso vómer / Oroantral fistula with vomer bone graft clouser

Presentamos un caso de fístula oroantral y rinosinusitis maxilar, resuelto por abordaje combinado endoscópico, nasal e intraoral en el cual se utilizó colgajo de mucosa palatina y hueso vómer para el cierre de la misma. Describimos el caso de una paciente femenina de 66 años de edad, que consultó por presentar cacosmia, algia facial izquierda y rinorrea posterior purulenta, 3 semanas posterior a extracción de segundo molar superior izquierdo, la tomograffa axial computarizada (TC) de senos paranasales evidenció velamiento total maxilar izquierdo, parcial etmoidal izquierdo y defecto óseo en reborde alveolar superior izquierdo. Se realizó toma de fragmento de hueso vómer. Seguidamente abordaje de cavidad antral izquierda por vía endoscópica; e intraoral, se concluyó disección, cierre óseo y mucoso de la fístula.

We report a case of an oroantral fistula and maxillary rhinosinusitis, that was resolved by combined approach, in which palatal mucosa flap and vomer bone was used for its closure. We describe the case of a female patient of 66 years old, who consulted for having cacosmia, left facial pain and purulent rhinorrhea, after left second molar extraction. CT-scan sinus showed the total left maxillary sinus, partial left ethmoid opacity and bone defect in left alveolar ridge. A vomer bone graft was taken from the nasal septum; left maxillary sinus surgerywas done by endoscopic approach and intraoral closure of bony and mucosa fístula was concluded.

Endoscopic sinus surgery in individuals with facial pain due to chronic maxillary sinusitis ? a functional controlled study / Cirurgia endoscópica de seio da face em indivíduos com dor facial devida a sinusite maxilar crônica ? um estudo funcional controlado

Objective: To measure the intra-sinus pressure and the maxillary sinus functional efficiency (MSFE) in individuals with chronic facial pain after conservative or conventional endoscopic maxillary surgery, as well as in controls. Method: Sinus manometry was performed 5 times during inhalation. Results: The resemblance of pressure values comparing those treated with minimally invasive surgery and controls was remarkable, while traditional surgery significantly decreased intrasinusal pressures. The MSFE was 100% in the three tested times for controls, close to that in those submitted to minimally invasive surgery (98.3%, 98.8%, and 98.0%) and significantly impaired after conventional surgery (48.8%, 52.1%, 48.5 %, p<0.01). All patients submitted to minimally invasive surgery remained pain-free after three months of surgery, relative to 46.7% of the submitted to conventional surgery (p<0.05). Conclusion: Minimally invasive sinus surgery is associated with functionality of the chambers that resemble what is found in normal individuals. .

Objetivo: Medir a pressão intrasinusal e a eficiência funcional do seio maxilar (EFSM) em indivíduos com dor facial crônica após cirurgia endoscópica maxilar conservadora ou convencional em comparação a pessoas normais. Método: A manometria do seio foi feita 5 vezes durante a inalação. Resultados: A semelhança entre os valores das pressões comparando aqueles tratados com cirurgia minimamente invasiva e os controles foi notável, enquanto que na cirurgia tradicional houve diminuição significativa das pressões intrasinusais. A EFSM foi 100% nas três vezes testadas nos controles, de modo muito semelhante ao que foi observado naqueles submetidos a cirurgia minimamente invasiva (98,3%, 98,8%, e 98,0%) e significativamente diminuída naqueles submetidos a cirurgia convencional (48,8%, 52,1%, 48,5 %, p<0,01). Todos os pacientes submetidos a cirurgia minimamente invasiva mantiveram-se sem dor três meses depois da cirurgia, comparados a 46,7% naqueles submetidos a cirurgia convencional (p<0,05). Conclusão: Cirurgia minimamente invasiva está associada a funcionalidade das câmaras sinusais que se assemelha ao que é observado em indivíduos normais. .

Role of Modified Endoscopic Medial Maxillectomy in Persistent Chronic Maxillary Sinusitis

Introduction: Functional endoscopic sinus surgery has a long-term high rate of success for symptomatic improvement in patients with medically refractory chronic rhinosinusitis. As the popularity of the technique continues to grow, however, so does the population of patients with postsurgical persistent sinus disease, especially in those with a large window for ventilation and drainage. In addition, chronic infections of the sinuses especially fungal sinusitis have a higher incidence of recurrence even though a wide maxillary ostium had been performed earlier. This subset of patients often represents a challenge to the otorhinolaryngologist. Objectives: To identify the patients with chronic recalcitrant maxillary sinusitis and devise treatment protocols for this subset of patients. Methods: A retrospective review was done of all patients with persistent maxillary sinus disease who had undergone modified endoscopic medial maxillectomy between 2009 and 2012. We studied patient demographics, previous surgical history, and follow-up details and categorized the types of endoscopic medial maxillectomies performed in different disease situations. Results We performed modified endoscopic medial maxillectomies in 37 maxillary sinuses of 24 patients. The average age was 43.83 years. Average follow-up was 14.58 months. All patients had good disease control in postoperative visits with no clinical evidence of recurrences. Conclusion: Modified endoscopic medial maxillectomy appears to be an effective surgery for treatment of chronic, recalcitrant maxillary sinusitis...

Sinusitis maxilar de origen odontogénica: diagnóstico y tratamiento quirúrgico / Maxillary sinusitis of odontogenic origin. surgical diagnosis and treatment

La sinusitis odontogénica afecta la mucosa de los senos maxilares y puede ser causada por la evolución de una lesión en el diente con formación de pus periapical que avanza en el interior de la cavidad sinusal. Se presenta un caso de un paciente con dens in dente en el diente incisivo lateral superior derecho, que sufrió el proceso de caries evolucionando en la región periapical, contaminando la mucosa sinusal de este lado, lo que causó el dolor, abultamiento y el desplazamiento del diente. La cirugía se realizó a través de acceso de Caldwell-Luc para el curetaje de la lesión, lo que indica la presencia en el diagnóstico histopatológico la presencia de quiste abscedado y sinusitis. Después de 18 meses de control, se observó la regeneración ósea y el reposicionamiento alveolar espontáneo de los dientes implicados. Los autores advierten que cíngulos profundos y dens in dente son las enfermedades de los dientes que merecen atención para el diagnóstico y la prevención de los procesos de caries con el fin de evitar complicaciones mayores.

Odontogenic sinusitis affects mucous membrane of the maxillary sinus and can be caused by the evolution of a tooth injury with formation of periapical abscess that advances into the sinus cavity. We present a patient with dens in dente in the upper right lateral incisor tooth, which suffered carious process and periapical abscess, contaminating the sinus mucosa on this side, which caused pain, bulging and tooth displacement. Surgery was performed via a Caldwell-Luc access for curettage of the lesion, indicating the presence in the histopathological diagnosis of radicular cyst abscess and sinusitis. After 18 months of control, alveolar bone regeneration and spontaneous repositioning of teeth involved was observed. The authors warn that cingulum deep in dens in dente are diseases of the tooth that deserve attention for the diagnosis and prevention of carious processes in order to avoid further complications.

Bola fúngica dos seios paranasais: Relato de dois casos e revisão de literatura / Fungus ball of the paranasal sinuses: Report of two cases and literature review

Introdução: Bola fúngica dos seios paranasais é uma infecção não invasiva que se caracteriza por sua cronicidade, sendo a maioria relacionada com tratamento endodôntico prévio. Acomete principalmente o seio maxilar, embora todos os seios possam ser envolvidos. O principal agente etiológico é o Aspergillus spp. A tomografia computadorizada, devido às apresentações radiológicas características, sugere o diagnóstico que é realizado definitivamente através de análises histopatológicas. O tratamento padrão-ouro é a cirurgia sinusal endoscópica com antrostomia meatal média. Objetivo: Relatar dois casos de bola fúngica dos seios paranasais e ressaltar aspectos importantes desta patologia. Relato dos Casos: Caso 1) Paciente do sexo feminino, 78 anos, apresentou-se com queixas de dor facial há 6 meses e história prévia de tratamento endodôntico. Ao exame físico constatou-se a presença de secreção purulenta em meato médio esquerdo. O Raio X apresentou velamento completo do seio maxilar esquerdo, enquanto a tomografia computadorizada mostrou lesão calcificada neste local. Realizou-se sinusotomia que evoluiu bem. Caso 2) Paciente do sexo feminino, 70 anos, procurou atendimento por história de sinusites de repetição. Ao exame físico não se percebeu nenhuma particularidade. A tomografia computadorizada, assim como a ressonância magnética, detectou espessamento da parede mucosa do seio maxilar esquerdo, além de uma massa calcificada. Realizou-se a mesma sequência de tratamento e a paciente também evoluiu bem. Considerações finais: A infecção fúngica deve ser considerada nos pacientes que se apresentam com sinusite crônica, que não respondem ao uso de antibióticos e que possuem história de manipulação endodôntica...

Introduction: Fungal ball of the sinuses is a not invasive infection that if characterizes for its chronicity, being the majority related with previous endodontic treatment. Affect mainly the breasts to maxillary; even so all the breasts can be involved. The main etiological agent is the Aspergillus spp. The computed tomography, had to characteristic the radiological presentations, suggests the diagnosis that is carried through definitively through histopathological analyses. The treatment standard-gold is the sinus surgery with average meatal antrostomy. Objective: Reporting two cases of fungal ball of the sinuses and to stand out important aspects of this pathology. Story of the Cases: Case 1) Patient of the feminine sex, 78 years old, presented itself with complaints of face pain has 6 months and previous history of endodontic treatment. To the physical examination it was evidenced purulent secretion presence in left average meatus. Ray X presented complete veiling of the breasts to maxillary left, while the computed tomography showed injury calcified in this place. Sinusotomy was become fulfilled that evolved well. Case 2) Patient of the feminine sex, 70 years old, looked attendance for history of sinusitis of repetition. To the physical examination no particularity was not perceived. The computed tomography, as well as the magnetic resonance, detected thickening of the mucous wall of the breasts to maxillary left, beyond a calcified mass. It was become fulfilled same sequence of treatment and the patient also evolved well. Final Considerations: The fungal infection must be considered in the patients who if present with chronic sinusitis, that they do not answer to the antibiotic use and that they possess history of endodontic manipulation...

Comparative study between intranasal antrstomy and antral lavage an experience at CMCH Larkana

To compare the results of intranasal asntrostomy and antral lavage in maxillary sinusitis. This randomized control study was conducted in the department of ENT Chandka Medical College Hospital Larkana during the period from December 2004 to 2007. The overall study of 150 cases was conducted. Out of 150 cases 92 [61.31%] were male and 58 [38.71%] were female and the male / female ratio was 1.6:1. Symptomatology was dominated by PND 95% purulent rhinorrhea 70% headache 52% and nasal obstruction 25%. The overall result of 150 patients x-ray showing mucosal theckining 89 [59.3%] hazzy / opaque sinus 40 [26.6%] and fluid level 14 [9.4%] three times antral lavage was done in all 100 patients. Out of 100 patients 33 got no benefit and underwent for intranasal asntrostomy along with selected 50 patients. Every patient was followed up for 2 weeks. Antral lavage showed 67% benefit and 33% patients got no benefit while intranasal antrstomy followed up patients got 90% benefit and 10% got no benefit This study shows that results of intranal antrstomy is better than antral lavage

The vascularized pedicled bony flap as an access to the maxillary sinus

This study was done to evaluate clinically and radiographically the effect of vascularized pedicled bony flap performed by the reciprocating saw, as an access to the maxillary sinus. This clinical study was carried out on ten patients suffering from chronic maxillary sinusitis as a result of dental implications. The use of the vascularized pedicled bony flap showed rapid healing without tissue intrusion into the sinus and decreased the chance of postoperative infection while preserving the infraorbital bundle. All the radiographs showed gradual improvement in which trabiculation is regained, cloudiness of the antrum disappear, and the clinical findings are of promising results

Técnica de Caldwell-Luc en los últimos 16 años: revisión de sus indicaciones / The Caldwell-Luc procedure in the last 16 years: a review of its clinical indications

Introducción: En una época marcada por el abordaje endoscópico del seno maxilar principalmente en casos de sinusitis crónica, la técnica clásica de Caldwell-Luc ha quedado relegada a una situación casi de 'recuerdo del pasado'. Sin embargo, evidencias recientes llaman a rescatar la utilidad de este procedimiento frente a fracasos de cirugías endoscópicas funcionales sinusales, especialmente relacionadas con una entidad conocida como 'cambios irreversibles de la mucosa'. Objetivo: Reflexionar sobre las indicaciones de esta técnica en nuestro centro, comparándolas con las nuevas perspectivas esbozadas en la literatura mundial. Material y Método: Se presenta una revisión de la literatura al respecto, junto con la casuística del Servicio de Otorrinolaringología del Hospital San Juan de Dios. Resultado: Entre 1992 y 2007 se realizaron 56 cirugías Caldwell-Luc. La principal indicación fue la resolución de sinusitis crónica maxilar, aunque en relación a situaciones que se alejan de los motivos propuestos en la literatura para elegir este procedimiento. Esto, junto a una alta tasa de recidiva sintomática (21,4% de los pacientes operados entre 1997 y 2007 cumplen criterios para sinusitis crónica actual) y elevadas tasas de complicaciones (31,8%) nos llevan a reflexionar sobre el uso que se ha dado a esta técnica en nuestro centro. Conclusión: Se concluye que este procedimiento continúa vigente, y quizás siendo irremplazable, especialmente en el manejo de patología sinusal crónica con cambios irreversibles en su mucosa, concepto sin una definición precisa y sobre el cual comentamos en detalle.

Introduction. Since the introduction of the endoscopic approach to the maxillary sinus, Caldwell-Luc's classic technique has been relegated to an almost 'memory of the past' category. Yet, recent evidence urges to rescue this procedure in view of its usefulness in cases of failed functional endoscopic sinus surgery especially related to an entity known as 'irreversible mucosa changes'. Aim. To review the indications for this technique in our department, comparing our data with that from recent literature. Results. We present 56 Caldwell-Luc procedures and a literature review on the subject. The procedures were performed between 1992 and 2007 at the ENT Department of San Juan de Dios Hospital. Chronic sinusitis remained the main indication, but within scenarios that differ from those regarded in the current literature as indicative of the technique. This, along with a large symptomatic relapse rate (21.4% of patients operated between 1997 and 2007 met criteria for current chronic sinusitis), and high complications rate (31.8%) within our cases, lead us to question the indications for the procedure in our department. Conclusion. We conclude that this procedure remains in force, and is perhaps even irreplaceable, particularly in the management of chronic sinus disease with irreversible mucosa changes, an ill-defined concept, which we discuss in detail.

Reporte clínico: diagnóstico endoscópico e histológico de Aspergilosis Sinusal no invasiva en paciente inmunocompetente / Clinical report: an endoscopic and histologic diagnosis of a non invasive sinusal aspergillosis in an immunocompetent patient

Se describe un caso basado en un diagnóstico clínico, radiológico, endoscópico e histológico de una sinusitis crónica no invasiva en un paciente femenino de 40 años, con historia de rinorrea purulenta unilateral derecha de varios años de evolución. El TAC mostró velamiento del seno maxilar y calcificaciones con diagnóstico probable de infección micótica, sin embargo, no se solicitaron cultivos micológicos. Se indicó cirugía del seno maxilar mediante antrotomía media bajo endoscopia. El diagnóstico histológico reveló abundantes hifas septadas ramifi-cadas no invasivas de la mucosa sinusal con la presencia de algunas estructuras morfológicas asexuales que orientaron hacia un grupo taxonómico específico; Aspergillus sección Fumigati (posiblemente A. fumigatus). La evolución postoperatoria fue rápida y satisfactoria, sin requerir uso de antifúngicos, sólo aseos frecuentes de la cavidad operada hasta obtener una mucosa indemne y ventilada.

A case based on a clinical, radiologic, endoscopic and histologic diagnosis of a chronic non invasive sinusitis in a female 40 aged patient suffering from a purulent unilateral right rhinorrea which had been developing for several years is herein described. TAC revealed acertain masking of the maxilar sinus and calcifications which denoted a probable micotic infection yet mycological cultivations were not demanded. Surgery on the maxilar sinus by means of a medium antrotomy under endoscopy was indicated. The histologic diagnosisrevealed abundant non invasive septated, branched hyphae in the sinusal mucosa as well as some asexualmorphological structures which pointed to a particular taxonomic group; Aspergillus section Fumigati (possiblyA.fumigatus). Postoperatory evolution was fast and satisfactory since there was no need of using antifungaldrug, just frequent washing of the operated cavity until an undamaged and ventilated mucosa could be reached.

Bilateral SUNCT syndrome associated to chronic maxillary sinus disease

A síndrome SUNCT (short lasting unilateral neuralgiform headache with conjuntival injection and tearing) é definida como curtos ataques de dor periorbital unilateral, acompanhada de lacrimejamento e hiperemia conjuntival ipsilateral. Apresentamos um raro caso de SUNCT com dor bilateral com evolução de cinco anos e iniciado após uma infecção de seio maxilar que evoluiu para sinusite crônica. Esta associação foi descrita em poucos casos de SUNCT, porém pouco esclarecida. O paciente era um homem de 58 anos que preencheu um diário de dor que demonstrou o típico padrão circadiano da síndrome, com pioras matinais e vespertinas, e apresentou melhora com uso de gabapentina. Submetido a cirurgia endoscópica funcional em seio maxilar e evoluiu com modulação da dor, sugerindo um potencial efeito benéfico após tratamento da sinusopatia.Na revisão de literatura encontramos 21 casos de SUNCT bilateral, cinco dos quais apresentavam história de sinusite; no entanto, a relação entre as duas entidades permanece ainda incerta.

Microbiologia dos seios maxilar e etmoidal em pacientes com rinossinusite crônica submetidos à cirurgia funcional endoscópica dos seios paranasais / Microbiology of the maxillary and ethmoid sinuses in patients with chronic rhinosinusitis submitted to functional endoscopic sinus surgery

Estudos da microbiologia da rinossinusite crônica mostram a presença de microorganismos aeróbicos, anaeróbicos, fungos e vírus e sua incidência varia de acordo com cada estudo. Estes estudos nos guiam para a escolha do antimicrobiano mais adequado para eliminar o processo infeccioso, ajudando a restaurar a mucosa nasossinusal. FORMA DE ESTUDO: Clínico prospectivo. OBJETIVO: O objetivo deste trabalho foi estudar a microbiologia dos seios maxilar e/ou etmoidal de pacientes com rinossinusite crônica e com indicação de cirurgia funcional endoscópica dos seios paranasais. MATERIAIS E MÉTODOS: Durante a cirurgia coletamos, em 41 pacientes, secreção e/ou fragmento de mucosa dos seios maxilar e/ou etmoidal para realização de bacterioscopia, pesquisa direta de fungos, cultura para microorganismos aeróbios, anaeróbios e fungos. RESULTADOS: Identificou-se a presença de microorganismos aeróbios em 21 pacientes (51,2 por cento), anaeróbios em 16 (39 por cento) e fungos em 1 (2,4 por cento). Na população estudada, apenas em 12 (29,2 por cento) o microorganismo isolado foi considerado patogênico quando analisado junto à contagem semiquantitativa de leucócitos. O Staphylococcus coagulase-negativo e o Staphylococcus aureus foram os microorganismos mais freqüentes, em 5 (12,1 por cento) e em 4 pacientes (9,75 por cento) respectivamente. CONCLUSÃO: Este estudo revela que o Staphylococcus coagulase-negative e o Staphylococcus aureus foram os microorganismos mais freqüentes isolados nos pacientes com rinossinusite crônica.

Tratamento endoscópico do cisto odontogênico com extensão intra-sinusal

Cistos odontogênicos são lesões pouco comuns que podem ocorrer após inflamação da polpa dentária. A abordagem terapêutica destes cistos é realizada em consultórios odontológicos e, dependendo de sua extensão, pode ocasionar a formação de fístula oroantral e rinossinusite crônica. O objetivo deste trabalho é propor o tratamento videoendoscópico do cisto odontogênico com expressão em seio maxilar. Realizou-se um estudo retrospectivo de quatro casos de cistos de origem dentária, com extensão intra-sinusal, complicados com fístula oroantral e sinusite crônica de seio maxilar após curetagem em consultório odontológico. Utilizamos a técnica videoendoscópica via transmaxilar para acessarmos o cisto intra-sinusal. Os quatro pacientes apresentaram resolução do quadro infeccioso e cicatrização da fístula oroantral, sem recidiva durante o seguimento. A cirurgia videoendoscópica é um método seguro e efetivo para tratamento do cisto odontogênico descrito, podendo contribuir para prevenir a formação de fístula oroantral e supuração de seio maxilar.

Microbiologia dos seios maxilar e etmoidal em pacientes com rinossinusite crônica submetidos à cirurgia funcional endoscópica dos seios paranasais / Microbiology of the maxillary and ethmoidal sinuses in patients with chronic rhinosinusitis sbmitted to funcional endoscopic sinus surgery

O objetivo deste estudo foi verificar a microbiologia dos seios maxilar e etmoidal em pacientes com rinossinusite crônica com indicação de cirurgia funcional endoscópica dos seios paranasais. Durante a cirurgia coletamos secreção e/ou fragmento de mucosa dos seios maxilar e/ou etmoidal em 41 pacientes. Identificou-se a presença de microorganismos aeróbios em 21 (51 por cento) dos pacientes, anaeróbios em 16 (39 por cento) e fungos em um (2,4 por cento). Os microorganismos mais isolados foram o Staphylococcus coagulase-negativo em cinco pacientes (12por cento) e Staphylococcus aureus em quatro (9,75 por cento). /The aim of this work is to study the microbiology of the maxillary and/or ethmoid sinuses in patients suffering from chronic rhinosinusitis with indication of functional endoscopic sinus surgery. During surgery, we collected secretion and/or fragment of the maxillary and/or ethmoid sinuses mucosa from 41 patients. We identified aerobic microorganisms in 21 patients (51.2 per cent), anaerobic microorganisms in 16 (39 per cent) and fungus in one (2.4 per cent). In the population studied, the most isolated microorganisms were Staphylococcus coagulase negative, found in five patients (12.18 per cent), and Staphylococcus aureus, found in four patients (9.75 per cent)...

Sinusite recorrente de causa incomum / Chronic recurrent sinusitis of rare etiology

The authors present a case of chronic recurrent sinusitis of rare etiology in a man submitted previously to a facial peeling. The computed tomography and the sinusal endoscopy revealed periorbital fat in the maxilary sinus. There was a history of old orbital floor fracture