Hematoma subperiosteal orbitário secundário a barotrauma em aviação civil / Orbital subperiosteal hematoma secondary to barotrauma in civil aviation

RESUMO Os diagnósticos diferenciais que compõem as proptoses agudas são, muitas vezes, desafiadores. A anamnese e o exame clínico exigem do oftalmologista atenção especial aos detalhes que permitem diferenciar quadros relativamente benignos e autolimitados de quadros que evoluirão com incapacidades permanentes. Relatamos o caso de uma paciente de 49 anos que, durante viagem de avião, apresentou dor ocular, hematoma periorbitário e proptose do olho esquerdo súbitos. Referia diplopia aguda incapacitante. Exames de tomografia e angiorressonância magnética confirmaram diagnóstico de sinusopatia do seio etmoidal esquerdo e hematoma subperiosteal da órbita esquerda, associado ao barotrauma. Apesar de raro, o diagnóstico de hematoma subperiosteal não traumático deve ser considerado diferencial em relação a proptoses agudas, sendo a anamnese fundamental para essa elucidação diagnóstica.

ABSTRACT Differential diagnoses of acute proptosis are often challenging. History and clinical examination require from ophthalmologists special attention to details, which make it possible to differentiate relatively benign and self-limited conditions from those that will progress to permanent disabilities. We report a 49-year-old female patient who had sudden eye pain, periorbital hematoma and proptosis of the left eye during a commercial flight. She also complained of disabling acute diplopia. Computed tomography and magnetic resonance angiography imaging confirmed the diagnosis of subperiosteal hematoma of the left orbit, associated with left ethmoid sinus disease. Although rare, non-traumatic subperiosteal hematoma should be considered in differential diagnoses of acute proptosis, and history taking is fundamental to elucidate the picture.

Anatomical variations of the maxillary sinus septa of an Iranian population using cone-beam computed tomography: a retrospective study / Variaciones anatómicas de los tabiques del seno maxilar de una población iraní mediante tomografía computarizada de haz cónico: estudio retrospectivo

This study sought to assess the internal anatomy of the maxillary sinuses and their septa using cone-beam computed tomography (CBCT) in an Iranian population. Materials and Methods: Resorption of alveolar bone decreases the height of the maxillary alveolar ridge. This height reduction may be so severe that it warrants ridge augmentation by a sinus lift. Manipulation of the maxillary sinuses, as in sinus lift surgery, requires adequate knowledge about the sinus anatomy.Results: Maxillary sinus septum, as an anatomical variation, may complicate the surgical procedures and increase the risk of complications such as sinus membrane perforation. In this retrospective study, 366 sinuses, 190 from females and 176 from males, aged between 10 and 65 years old presenting to the Oral and Maxillofacial Radiology Department of School of Dentistry at Hamadan University of Medical Sciences were evaluated by two oral radiologists. The extension of the maxillary sinuses, presence of septa, number of septa and their location were determined. Data were analyzed using the chi square test (level of significance p≤0.001). The coefficient of agreement between the two oral radiologists was calculated based on Cohen kappa. Septa were present in 40.5% of the maxillary sinuses, out of which, 31.6% had one, 7.9% had two and 1% had three or more septa; 38% of the septa were horizontal while 62% had an oblique orientation. In total, 184 septa were found in 183 patients; out of which, 91 septa were 2mm to 5mm long while 93 septa were longer than 5mm. Conclusions: Comprehensive knowledge about the three-dimensional internal anatomy of the maxillary sinuses acquired by CBCT priorto surgical procedures can greatly help to prevent postoperative complications.

Este estudio buscó evaluar la anatomía interna de los senos maxilares y sus septos mediante tomografía computarizada de haz cónico (CBCT) en una población Iraní. Materiales y Métodos: . La resorción del hueso alveolar disminuye la altura de la cresta alveolar maxilar. Esta reducción de altura puede ser tan severa que justifique el aumento de la cresta mediante una elevación de seno. La manipulación de los senos maxilares, como en la cirugía de elevación del seno, requiere un conocimiento adecuado sobre la anatomía del seno. Resultado: El tabique del seno maxilar, como una variación anatómica, puede complicar los procedimientos quirúrgicos y aumentar el riesgo de complicaciones como la perforación de la membrana sinusal. En este estudio retrospectivo, dos radiólogos orales evaluaron 366 senos, 190 de mujeres y 176 de hombres, con edades comprendidas entre 10 y 65 años que se presentaron en el Departamento de Radiología Oral y Maxilofacial de la Facultad de Odontología de Hamadan University of Medical Sciences. Se determinó la extensión de los senos maxilares, la presencia de septos, el número de septos y su ubicación. Los datos se analizaron mediante la prueba de chi cuadrado (nivel de significación p?0.001). El coeficiente de concordancia entre los dos radiólogos orales se calculó en base a Cohen kappa. Los septos estaban presentes en el 40.5% de los senos maxilares, de los cuales, el 31.6% tenía uno, el 7.9% tenía dos y el 1% tenía tres o más septos; El 38% de los septos eran horizontales, mientras que el 62% tenía una orientación oblicua. En total, se encontraron 184 septos en 183 pacientes; de los cuales, 91 septos tenían de 2mm a 5mm de largo, mientras que 93 septos tenían más de 5mm. Conclusion: El conocimiento exhaustivo sobre la anatomía interna tridimensional de los senos maxilares adquiridos por CBCT antes de los procedimientos quirúrgicos puede ayudar en gran medida a prevenir complicaciones postoperatorias.

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.

Atelectasia maxilar crónica bilateral con resolución espontánea / Bilateral chronic maxillary atelectasis with spontaneous resolution

RESUMEN La atelectasia maxilar crónica (AMC) es una condición adquirida y rara que consiste en la disminución persistente y progresiva del volumen del seno maxilar, con retracción centrípeta de sus paredes secundaria a la oclusión completa de tipo valvular del ostium natural. Esta condición genera presión negativa dentro del seno maxilar, conduciendo a atelectasia y colapso de la pared. La fisiopatología es compartida con síndrome de seno silente, por lo que se postula que se podrían englobar a ambas dentro de la misma enfermedad. Presentamos el caso de un paciente con diagnóstico de AMC bilateral por tomografía axial computarizada a la edad de 3 años, que se resolvió en forma espontánea en forma bilateral; el maxilar derecho a los 6 años y el izquierdo a los 10 años.

ABSTRACT Chronic maxillary atelectasis (CMA) is a rare and developed condition that consists in the progressive and persistent decrease volume of the maxillary sinus, with centripetal retraction of the walls secondary to the complete occlusion of the natural ostium. This condition generates negative pressure inside the maxillary sinus, heading to atelectasis and collapse of the walls. It is proposed that the disease includes the silent sinus syndrome, as the physiopathology is shared between them. We present the case of a 3 years old boy with bilateral chronic maxillary atelectasis observed in the CT scan, who evolved with spontaneous bilateral resolution. The right maxillary sinus CMA resolved at 6 years old, and the left at 10 years old.

Caracterización epidemiológica, clínica y tomográfica de pacientes con afecciones no traumáticas de los senos paranasales / Clinical, epidemological and tomographic characterization of patients with non traumatic disorders of the paranasal sinuses

Se realizó una investigación observacional, descriptiva y transversal de 132 pacientes con afecciones no traumáticas de los senos paranasales, atendidos en el Servicio de Otorrinolaringología del Hospital Provincial Docente Saturnino Lora Torres de Santiago de Cuba, desde enero del 2013 hasta diciembre del 2015, a fin de caracterizarles según variables epidemiológicas, clínicas y tomográficas de interés. En la serie predominaron los afectados de 39-58 años de edad (42,4 por ciento), el hábito de fumar (62,1 por ciento) y las infecciones dentarias (59,1 por ciento) como los principales factores de riesgo, así como los procesos inflamatorios sinusales (62,1 por ciento) que afectaron preferentemente el seno maxilar. Se halló coincidencia entre el diagnóstico definitivo y los signos tomográficos en 66 pacientes, con un coeficiente de Kappa de 0,80.

An observational, descriptive and cross-sectional investigation of 132 patients with non traumatic disorders of the paranasal sinuses, assisted in the Otolaryngology Service of Saturnino Lora Torres Teaching Provincial Hospital in Santiago de Cuba, was carried out from January, 2013 to December, 2015, in order to characterize them according to clinical, epidemiological and tomographic variables of interest. In the series there was a prevalence of the affected patients aged 39-58 (42.4 percent), the smoking habit (62.1 percent) and dental infections (59.1 percent) as the main risk factors, as well as the sinusal inflammatory processes (62.1 percent) that preferably affected the maxillary sinus. There was a coincidence between the definitive diagnosis and the tomographic signs in 66 patients, with a Kappa coefficient of 0.80.

Mucocele maxilar secundario a cirugía ortognática: reporte de un caso / Maxillary mucocele after an orthognathic surgery: case report

El mucocele es un tumor pseudoquístico poco frecuente en el seno maxilar y una rara complicación de la cirugía ortognática. El caso reportado describe la presentación de un mucocele que afecta parcialmente el seno maxilar y se presenta clínicamente como un tumor nasal. Se trata de una mujer de 44 años que, luego de 12 años de realizarse cirugías ortognáticas, presenta dolor facial y obstrucción de la fosa nasal derecha. La tomografía axial computarizada de senos paranasales revela una masa de contenido líquido que ocupa la mitad inferior del seno maxilar derecho, extendiéndose a la fosa nasal ipsilateral. La paciente es intervenida por vía endoscópica realizándose una marsupialización intranasal y meatotomía media, evolucionando satisfactoriamente en un seguimiento de dos años.

Mucoceles are not often found in the maxillary sinus, and is a rare surgery complication, in this case, orthognathic. This review describes a mucocele that partially occupies the right maxillary sinus, causing a chronic nasal obstruction. This is the case of a 44 year-old female patient, which after 12 years of several orthognathic surgeries, presents facial pain and right nasal obstruction. The paranasal sinus computed tomography reveals a mass with liquid content that occupies the lower part of the right maxillary sinus and compromises the right nasal cavity. The patient was treated with an intranasal marsupialization and a middle meatotomy with endoscopic nasal approach. Evolution was satisfactory two years after the intervention.

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.

Aspergillosis of the paranasal sinuses: diagnostic significance of the computed tomography

Aspergillosis of the paranasal sinuses appears to be relatively rare in occurrence, but there is a growing incidence of it in accordance with the increasing use of antibiotics, steroid hormones, anticancer drugs, and radiation therapy. We have seen 15 cases of aspergillosis of the paranasal sinuses in which computed tomography (CT) was helpful for diagnosis. The characteristic feature of CT findings was the intermixture of high and low density areas in the affected paranasal sinuses, apparently caused by increased X-ray absorption due to calcification. These findings indicate that CT is useful in the preoperative diagnosis of aspergillosis of the paranasal sinuses.

Aspergillosis of the paranasal sinuses: diagnostic significance of the computed tomography

Aspergillosis of the paranasal sinuses appears to be relatively rare in occurrence, but there is a growing incidence of it in accordance with the increasing use of antibiotics, steroid hormones, anticancer drugs, and radiation therapy. We have seen 15 cases of aspergillosis of the paranasal sinuses in which computed tomography (CT) was helpful for diagnosis. The characteristic feature of CT findings was the intermixture of high and low density areas in the affected paranasal sinuses, apparently caused by increased X-ray absorption due to calcification. These findings indicate that CT is useful in the preoperative diagnosis of aspergillosis of the paranasal sinuses.

Radiological study of the paranasal sinuses in lepromatous leprosy.

Thirty patients of lepromatous leprosy have been studied by radiological investigation for affection of paranasal sinuses. It has been found that leprosy involves all groups of sinuses and maxillary antrum is found to be more commonly affected. Diffuse hypertrophy type of lesion is more commonly recorded in maxillary antrum, in x-ray of paranasal sinuses. The clinical significance and importance of extension of disease in the sinuses is discussed in the light of available literature.