Orbital and Intracranial Complications of Acute Rhinosinusitis in a Tertiary Center, Saudi Arabia.

Background Rhinosinusitis is an inflammatory condition affecting the nasal cavity's mucosa and paranasal sinuses. In rare cases, acute rhinosinusitis (ARS) might lead to significant orbital and intracranial complications. This study aims to review the patients who presented with orbital or intracranial complications of ARS and to identify the main outcomes of these complications and their prognosis. Methods In this study, a retrospective chart review of patients with orbital or intracranial complications of ARS who presented to the otolaryngology department at King Abdulaziz Medical City, Riyadh, Saudi Arabia from 2016 to 2022 was conducted. Results A total of 43 patients with orbital, intracranial, or both (orbital and intracranial) complications of ARS were included. The most involved sinuses were maxillary sinuses. The most reported orbital complications were subperiosteal abscesses, and the most reported intracranial complications were epidural abscesses. Conclusion Orbital and intracranial complications of ARS are serious and life-threatening if not recognized early and treated effectively. The majority of ARS complications in this study were orbital complications. Fortunately, most of the cases carry a favorable outcome.

Preventive Measures of Middle Turbinate Lateralization After Endoscopic Sinus Surgery: An Updated Review.

INTRODUCTION: The middle turbinate (MT) is the most important anatomical structure inside the nasal cavity and a landmark in the identification of skull base, ethmoid cells, and lamina papyracea. Postoperatively, lateralizationof the MT can cause synechia and obstruction of the middle meatus and the maxillary, ethmoid, or frontal sinuses. OBJECTIVE: To review the current literature about the outcome of different techniques used intraoperatively to prevent lateralization of MT after functional endoscopic sinus surgery (FESS). MATERIALS AND METHODS: This retrospective narrative literature review provides a summary of current and past research publications about different techniques used intraoperatively to prevent MT lateralization after FESS. RESULTS: Many methods have been described to prevent the lateralization of MT and synechiae formation. These methods include controlled synechiae, suture lateralization, metal clips, partial resection of MT, middle meatus implants, and steroid-eluting implants and stents. CONCLUSION: The ideal FESS should include preservation of the MT, reducing its lateralization, and preventing synechia formation.Different techniques have been discovered in an attempt to prevent this complication.

Intranasal Lobular Capillary Hemangioma with Multiple Sites of Origin during Pregnancy: A Case Report and Literature Review.

In the present case report, we describe a 33-year-old pregnant woman in the third trimester with a history of recurrent epistaxis leading to frequent visits to the emergency department. Each episode of epistaxis was managed by anterior nasal packing. During endoscopic examination, a left nasal mass was seen. She was admitted and managed conservatively until she delivered her baby without complication. After delivery, a CT scan was taken, which showed an enhancing mass in the middle and lower meatus of the nasal cavity with no bony erosions. For symptomatic relief and tissue diagnosis, endoscopic surgical removal was advised. An intraoperative examination revealed a red, smooth, and well-circumscribed mass occupying the left nasal cavity and originating from the medial surface of the inferior turbinate and the inferior surface of the posterior part of the middle turbinate. A complete en bloc resection of the mass was performed endoscopically. The mass was sent for histologic analysis, which confirmed the diagnosis of lobular capillary hemangioma. Eventually, upon follow-up at two weeks, one month, three months, and six months postsurgery, no evidence of recurrence was detected.

Safety of intranasal corticosteroid sprays during pregnancy: an updated review.

INTRODUCTION: Rhinitis and rhinosinusitis are commonly encountered in pregnant women. Intranasal corticosteroid (INCS) sprays are generally safe and effective in the treatment of these conditions in the general population. However, the use of some of these INCS sprays during pregnancy is still controversial. OBJECTIVE: To review the current literature about the safety of intranasal corticosteroid sprays during pregnancy. METHODOLOGY: Using different search engines, each type of INCS was reviewed separately (triamcinolone, beclomethasone, budesonide, fluticasone propionate, fluticasone furoate, mometasone, and ciclesonide). A total of 51 full-length articles were examined for eligibility. After applying inclusion and exclusion criteria, a total of three articles were reviewed. RESULTS: No significant association with congenital organ malformations has been linked to intranasal use of beclomethasone, budesonide, fluticasone propionate, fluticasone furoate, or mometasone. Intranasal triamcinolone, however, has been found to have a significant association with respiratory tract defects. Data about the safety of intranasal ciclesonide during pregnancy are not available. CONCLUSION: Lacking sufficient clinical trials on the use of intranasal corticosteroid sprays in pregnancy, we suggest that the intranasal use of fluticasone furoate, mometasone, and budesonide is safe if they are used at the recommended therapeutic dose after a proper medical evaluation. Intranasal fluticasone propionate might be a safe option in the absence of other INCS options due to its questionable efficacy during pregnancy. Risk-benefit ratio should always be considered before prescribing any intranasal corticosteroid sprays during pregnancy.

Oronasal fistula post-septoplasty.

Nasal septal surgery is one of the most common otolaryngology procedures performed, with rare occurrences of major postoperative complications. Oronasal fistula is a rare complication of septal surgery, with only few cases being reported in the literature. It is commonly caused by a congenital cleft palate, cleft palate surgery, traumatic injuries, infections, or neoplasms; however, it does not usually occur post-septal surgery. Here, we report the case of a 55-year-old male who presented with a symptomatic oronasal fistula post-septoplasty. Unlike other reported cases, there were no features of underlying palatal pathologies, and no previous history of other nasal or oral procedures. We described a multilayer surgical closure technique that was utilized in this case, with no recurrence seen during a 6-month follow-up period. Additionally, we reviewed the other 3 reported cases of this complication, and discussed the possible etiology in this case.