ABSTRACT
BACKGROUND: A possible complication of frontal sinus obliteration with fat is the formation of mucoceles. We studied the prevalence of mucoceles as well as and the need for revision surgery. METHODS: Retrospective case review of forty consecutive patients undergoing frontal sinus obliteration from September 1995 to February 2012 for chronic rhinosinusitis (26), frontal mucocele (12) or frontal osteoma (2) with an average follow up of 80 months (range 15-218). MRI of the paranasal sinuses was performed in all. Outcome measures included MRI signs of mucocele formation in the obliterated frontal sinus, revision surgery, symptom burden. RESULTS: Magnetic resonance imaging (MRI) showed potential postoperative frontal sinus mucoceles in 6/40 patients. In 3 patients (7.5%) a revision operation was performed, revealing mucoceles in two cases. A wait and scan-policy in the other 3 patients confirmed the presence of a mucocele in 1 of these patients. The majority of patients (33/40, 83%) was asymptomatic at the last follow up. CONCLUSION: The prevalence of mucoceles and revision rate in this series was 7.5% (3/40). MRI can improve detection rate and reduce / avoid unnecessary revision surgery after frontal sinus obliteration.
Subject(s)
Frontal Sinus , Magnetic Resonance Imaging/methods , Mucocele , Otorhinolaryngologic Surgical Procedures , Postoperative Complications , Sinusitis/surgery , Abdominal Fat/transplantation , Chronic Disease , Female , Frontal Sinus/diagnostic imaging , Frontal Sinus/pathology , Frontal Sinus/surgery , Humans , Male , Middle Aged , Mucocele/diagnosis , Mucocele/epidemiology , Mucocele/physiopathology , Mucocele/surgery , Netherlands/epidemiology , Otorhinolaryngologic Surgical Procedures/adverse effects , Otorhinolaryngologic Surgical Procedures/methods , Postoperative Complications/diagnosis , Postoperative Complications/epidemiology , Postoperative Complications/physiopathology , Postoperative Complications/surgery , Prevalence , Reoperation/methods , Reoperation/statistics & numerical data , Retrospective Studies , Sinusitis/diagnosis , Tomography, X-Ray Computed/methodsABSTRACT
PURPOSE: To highlight the importance of Magnetic Resonance Imaging (MRI) and the use of propranolol as both a final diagnostic tool and adequate treatment for orbital Infantile Haemangiomas (IHs). METHODS: A retrospective study was conducted using a case series of 5 infants diagnosed with orbital IH. All patients presented with progressive unilateral proptosis and were at high risk of developing amblyopia, some had combined swelling of the eyelid, impaired eye movements or exposure keratopathy. Propranolol was administered in an initial dose of 0.6 mg/kg/day orally divided in three daily doses and increased in 4 days to 2.7 mg/kg/day. MRI was performed in all children. RESULTS: Striking MR characteristics of an IH lesion were seen in each of our 5 cases, including the presence of flow voids, high contrast enhancement, hypo-intense T1W signal, iso- to hyper intense T2W signal, and lobulated appearance. All patients showed a quick clinical response to treatment, resulting in significant reduction in tumour size within a range of 1-3 weeks and almost complete regression of the lesion at the end of the treatment schedule. CONCLUSIONS: Our study adds another 5 cases to the growing body of reports confirming the efficacy and safety - under controlled circumstances - of propranolol therapy in orbital IH management, in which we highlight the use of propranolol as both a final diagnostic tool and as an adequate treatment.
Subject(s)
Hemangioma/drug therapy , Magnetic Resonance Imaging , Orbital Neoplasms/drug therapy , Propranolol/therapeutic use , Vasodilator Agents/therapeutic use , Administration, Oral , Contrast Media , Female , Hemangioma/pathology , Humans , Infant , Male , Orbital Neoplasms/pathology , Retrospective Studies , Treatment OutcomeABSTRACT
INTRODUCTION: There is increasing interest in the underlying bone of the paranasal sinuses as an important player in recalcitrant Chronic Rhinosinusitis. Close inspection of CT scans often reveals areas of increased bone density and irregular thickening of the sinus walls. This osteitic bone could at least partly explain, why inflammation of the mucosa persists. METHODS: We searched PubMed for all relevant studies, using the following text words: chronic rhinosinusitis, sinusitis, bone, osteitis, osteomyelitis, histology, and treatment. Cited references of retrieved articles were also examined. RESULTS: Background, available data, potential diagnostic options, treatment implications, and suggestions for future research are discussed. CONCLUSION: Osteitis is associated with CRS, however its role in the pathogenic process is not well defined. More research is needed.
Subject(s)
Osteitis/etiology , Rhinitis/complications , Sinusitis/complications , Animals , Chronic Disease , Humans , Magnetic Resonance Imaging , Osteitis/diagnostic imaging , Osteitis/pathology , Rhinitis/diagnostic imaging , Rhinitis/pathology , Sinusitis/diagnostic imaging , Sinusitis/pathology , Tomography, X-Ray ComputedABSTRACT
BACKGROUND AND PURPOSE: Routine CT of the brain is traditionally performed with sequential CT. We assessed whether sequential CT can be replaced with thinly collimated multisection spiral CT without loss of image quality. MATERIALS AND METHODS: An observer study was conducted using data from 23 patients who were scanned with both a sequential (collimation, 4 x 5 mm) and a spiral technique (collimation, 4 x 1 mm; pitch, 0.875). Each sequential image was registered with 4 combined spiral CT images at 1.2 mm distance. Two neuroradiologists blindly scored 232 image pairs on 6 aspects: streak artifacts, visualization of brain tissue near skull, visualization of hypoattenuated lesions, gray/white matter differentiation, image noise, and overall image quality. A 5-point scale (range, -2 to 2) was used to score the preferences. The 23 pairs of complete scans were scored likewise. In this case, no registration was performed. RESULTS: Virtually all mean scores were positive (ie, showed a preference for the spiral technique). For the comparison of image pairs, the preferences with respect to streak artifacts (mean score, 1.36), visualization of brain tissue near the skull (mean score, 0.69), and overall image quality (mean score, 0.95) were significant (P < .001). With respect to visualization of hypo-attenuated lesions, image noise, and gray/white matter differentiation (mean scores, 0.18, 0.27, and 0.13), the preferences for spiral CT were not significant. The preferences for the spiral technique were also present at the comparison of the complete scans. CONCLUSION: Thinly collimated multisection spiral CT of the brain with image combining is superior to thickly collimated sequential CT.
Subject(s)
Brain/diagnostic imaging , Tomography, Spiral Computed/methods , Tomography, Spiral Computed/standards , Aged , Aged, 80 and over , Artifacts , Female , Humans , Male , Middle Aged , Observer Variation , Radiographic Image Enhancement/methods , Radiographic Image Enhancement/standards , Radiographic Image Interpretation, Computer-Assisted/methods , Radiographic Image Interpretation, Computer-Assisted/standards , Tomography, Spiral Computed/statistics & numerical dataABSTRACT
During cochlear implantation surgery, we use a mobile C-arm with 3D functionality to acquire per-operative 3D X-ray images. Scanning the multielectrode array is performed once before removal of the stylet and once after full insertion. When dissatisfied with the position of the multielectrode a repositioning is considered which happened occasionally. The major advantage is the extra certainty of the multielectrode array position in the cochlea with low-dose and little extra time. All cochlear implantations are now routinely scanned during surgery.