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)

An Emergent Entity: Indolent Mucormycosis of the Paranasal Sinuses. A Multicenter Study

Abstract Introduction Indolent or chronic mucormycosis is a rare entity that affects both immunosuppressed and immunocompetent individuals. Additionally, its clinical evolution is nonspecific and there is no standardized treatment for this condition. Objective To describe the clinical characteristics and management of patients with indolent mucormycosis. Methods In the project of study with chart review in the Interinstitutional secondary care centers, patients with evidence of indolentmucormycosis, defined as pathological confirmation of nasal/paranasal sinus mucormycosis for more than 1 month, were included. All patients underwent complete laboratory workup, imaging studies, surgical treatment and adequate follow-up. No evidence of disease status was defined when patient had subsequent biopsies with no evidence of mucormycosis. Results We included seven patients, three female and four male subjects. The mean age was 53.14 years. Four patients were immunosuppressed and three immunocompetent. Among the immunosuppressed patients three had diabetes and one had dermatomyositis. The symptomswere nonspecific: facial pain/headache, mucoid discharge and cacosmiawere the ones most frequently reported. Maxillary sinus involvement was present in all patients. Two immunosuppressed subjects received amphotericin. Posaconazole was the only treatmentinoneimmunosuppressedpatient. Allimmunocompetent patientshadsingleparanasal sinus disease and received only surgical treatment. All patients are alive and free of disease. Conclusion Indolent mucormycosis is a new and emerging clinical entity in immunosuppressed and immunocompetent patients. Single paranasal sinus disease is a frequent presentation and should not be overlooked as a differential diagnosis in these patients. Immunocompetent patients should only be treated surgically. (AU)

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.

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.

Prevalence of anatomic variation demonstrated on screening sinus computed tomography and clinical correlation.

Screening sinus computed tomography (SCCT) of 133 patients performed from March 2003 to February 2004, were retrospectively reviewed, concerning anatomic variation at ostiomeatal unit (OMU) and nasal septal deviation. Six patterns of inflammatory sinus disease were designated: maxillary infundibulum, nasofrontal duct, OMU, sphenoethmoidal recess, polyposis and sporadic. The most common anatomic variation was concha bullosa (14.3%), followed by Haller cell (9.4%), large Agger nasi cell (7.9%) and paradoxical middle turbinate (5.3%). Nasal septal deviation was presented in 75 patients (56.4%). Inflammatory sinus disease was presented in 181 lateral nasal walls (68%) and maxillary infundibular pattern was the most common (33.1%). There was significant correlation between large Agger nasi cell and nasofrontal duct pattern (p < 0.05). The remaining anatomic variations and nasal septal deviation had no significant correlation to the inflammatory sinus disease. Overall, the anatomic variation which can compromise the mucociliary drainage was frequently observed, however, only the large Agger nasi cell had significant correlation to the inflammatory sinus disease.

Doença nasossinusal em pacientes HIV positivos / Naso-sinus sickness in HIV positive patients

A doença nasossinusal é extremamente prevalente em pacientes com sorologia positiva para o vírus da imunodeficiência humana (HIV +), por isso a necessidade de que muitos estudos sejam realizados sobre esta doença, principalmente com o advento das novas drogas anti-retrovirais. Foi realizado um estudo de revisão bibliográfica buscando razões para justificar esta alta prevalência, sendo determinada a alteração da imunidade humoral e celular, distúrbios da mobilidade ciliar e alterações anatômicas prévias como fatores etiológicos. Verificou-se que o diagnóstico é eminentemente clínico e a conduta terapêutica inicial é semelhante a da população não infectada. Nestes pacientes se faz necessário um acompanhamento mais criterioso e atenção especial deve ser dada ao nível de linfócitos T helper (CD4), pois tem se verificado casos de dificil manejo terapêutico e aparecimento de complicações nasossinusais em pacientes com níveis de células CD4 abaixo de 200 por milímetro cúbico(mm3). Os autores relatam que a ausência de resposta ao tratamento clínico após punção, lavagem e cultura da secreção dos seios maxilares determina a indicação do tratamento cirúrgico que, na maioria dos casos, melhora a qualidade de vida destes pacientes.