ABSTRACT
OBJECTIVES: To review developmental abnormalities and iatrogenic alterations in sinus anatomy that may predispose patients with congenital craniofacial malformations to chronic rhinosinusitis. STUDY DESIGN: Retrospective study. METHODS: Seven patients with craniofacial malformations who were surgically treated by the senior author were included in the study. All were diagnosed with chronic rhinosinusitis refractory to medical management. Four patients had undergone previous corrective craniofacial surgery, and three of these patients developed iatrogenic sinus disease. Demographic data, diagnoses and anatomical abnormalities were included. RESULTS: Abnormal sinus anatomy was present in all patients, most commonly skull base abnormalities and dehiscent lamina papyracea. All patients underwent successful endoscopic surgical management (n = 7) for their chronic rhinosinusitis. Two patients had adjuvant external procedures. There were no complications and no recurrences after a mean follow up time of 15 months. CONCLUSIONS: Otolaryngologists should be aware of the possibility of chronic rhinosinusitis in patients with craniofacial malformations. Careful preoperative evaluation of radiographic studies should be performed as most of these patients will have abnormal sinus anatomy. In addition, patients who undergo surgery to correct their craniofacial malformations are susceptible to altered sinus anatomy that may predispose them to the development of iatrogenic chronic rhinosinusitis.
Subject(s)
Craniofacial Abnormalities/complications , Facial Bones/abnormalities , Rhinitis/etiology , Sinusitis/etiology , Adult , Child , Child, Preschool , Chronic Disease , Craniofacial Abnormalities/surgery , Facial Bones/anatomy & histology , Female , Follow-Up Studies , Humans , Male , Middle Aged , Retrospective Studies , Rhinitis/therapy , Sinusitis/therapy , Tomography, X-Ray ComputedABSTRACT
OBJECTIVES: To review frontal sinus complications following frontal craniotomy and to describe management strategies. STUDY DESIGN: Retrospective review. METHODS: Retrospective review was made of six patients who had undergone frontal craniotomy and subsequently developed frontal sinus complications. Demographic data, indication for craniotomy, type of reconstruction, average time to development of complications, presenting symptoms, diagnosis, surgical management, follow-up, and outcomes were reported. RESULTS: Complications included unilateral frontal sinus mucoceles in four patients, bilateral frontal sinus mucoceles in one patient, and bilateral frontal sinus mucopyoceles with upper-eyelid abscess in one patient. The average time to presentation of symptoms and development of complications following frontal craniotomy was 14.8 years (range, 1-39 y). Headaches were the most common presenting complaint. All patients underwent endoscopic mucocele marsupialization as part of their management. After an average follow-up period of 9 months, no recurrences were found and no complications occurred. CONCLUSION: A small number of patients develop otolaryngological complications, most commonly, frontal mucoceles, following frontal craniotomy. A high level of suspicion and long-term surveillance are needed to monitor for their occurrence. Endoscopic marsupialization may provide an effective, safe means for management.
Subject(s)
Craniotomy , Frontal Lobe/surgery , Frontal Sinus/surgery , Mucocele/etiology , Postoperative Complications , Adult , Aged , Brain Diseases/surgery , Female , Follow-Up Studies , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Mucocele/diagnostic imaging , Mucocele/pathology , Outcome Assessment, Health Care , Retrospective Studies , Tomography, X-Ray ComputedABSTRACT
OBJECTIVE: To determine if the severity of obstructive sleep apnea syndrome (OSA) differs by racial group. STUDY DESIGN: Cross-sectional retrospective review. SETTING: University-based sleep disorders laboratory. METHODS: The study reviewed the results of 280 adult (>18 y) patients diagnosed with obstructive sleep apnea syndrome by overnight polysomnogram between July 1, 1999, and June 30, 2000. Factors analyzed included age, sex, race, presence of hypertension, body mass index (kg/m2), respiratory disturbance index (RDI), and lowest oxygen saturation level. RESULTS: Blacks with OSA are significantly more obese and have significantly higher rates of hypertension than white subjects with OSA. Black females with OSA are significantly younger than white females at the time of diagnosis (P =.005). Black males with OSA have significantly lower oxygen saturations than white males (P =.025). CONCLUSION: Black males who present to the otolaryngologist-head and neck surgeon for evaluation of sleep-disordered breathing may be at increased risk of severe OSA.
