Management of CRSwNP in Latin America: A multidisciplinary consensus from an expert working group.

Chronic rhinosinusitis with nasal polyps (CRSwNP) is an inflammatory condition of the nasal and paranasal tissues, characterized by the presence of bilateral nasal polyps. While etiology and pathogenetic mechanisms are heterogeneous and complex, in most patients, disease is mediated predominantly through type 2 inflammatory processes. Clinical management is challenging, and a multidisciplinary approach is preferred. Principal treatment approaches are the use of local/systemic corticosteroids and sinonasal surgery, although outcomes can be unsatisfactory. Recent availability of biological therapies targeting underlying inflammatory processes can offer effective treatment options in uncontrolled disease. Specialist guidelines greatly assist clinical decision-making, although as these are chiefly written from a global/international perspective, they may not wholly accommodate disease patterns and clinical practice at a regional level. An expert panel of specialists from Latin America was convened to develop regional guidance on the management of CRSwNP through a consensus approach. The present article presents the chief observations and recommendations which can provide guidance for clinicians in the Latin American region.

An absence of cilia outer microtubules, an etiology not previously recognized in bilateral mucocele.

Most paranasal sinus mucoceles are unilateral and affect one or at most two contiguous sinuses. We describe the case of a 44-year-old woman with bilateral maxillary sinus mucoceles who presented clinically with left malar pain, right-sided swelling, and proptosis of the right eye. The diagnostic workup included computed tomography and magnetic resonance imaging. In addition, because of the atypical bilateral presentation, we analyzed mucosal sinonasal tissue samples by electron microscopy. Microscopic analysis revealed an absence of one of the microtubule doublets in three of the outer doublets of the axoneme, thereby establishing a diagnosis of isolated ciliary dysfunction. To the best of our knowledge, ciliary dysfunction as a cause of bilateral mucoceles has not been previously reported in the literature. The patient underwent successful surgery for removal of the mucoceles, and she exhibited no evidence of recurrence at the 18-month follow-up. When a diagnosis of bilateral mucocele formation is made, we suggest that ciliary dysfunction be considered in the differential diagnosis and that electron microscopy of the sinonasal mucosa be performed in the workup.

Diseminación de una infección odontogénica a espacios periorbitarios / Dissemination of an odontogenic infection to the periorbital space secondary to malpractice

Las infecciones odontogénicas de cabeza y cuello derivadas de patologías pulpares mal manejadas pueden agravarse. Una de las posibles complicaciones son las infecciones orbitarias que a su vez, pueden desencadenar trombosis del seno cavernoso y la muerte del paciente; si aunado a esto el paciente presenta compromiso sistémico, requerirá la modificación de ciertos aspectos del manejo endodóncico. Paciente femenino de 31 años de edad con embarazo de 35 semanas acude de urgencia al Hospital General Manuel GEA González por mal manejo dental, desencadenando absceso bucal, malar y periorbitario izquierdo por lo que se realiza tratamiento farmacológico, apertura y drenaje. A su egreso del hospital acude a la División de Estudios de Posgrado e Investigación UNAM Posgrado de Endodoncia, se realiza diagnóstico de abscesos dentoalveolares crónicos de incisivo lateral, canino y premolar superior izquierdo, se plantea un manejo para la neutralización del contenido séptico y tratamiento integral con diferentes especialidades odontológicas

Odontogenic infections of the head and neck derived pulpar pathology not adequately handles may be aggravated. One of the possible complications are the orbital infections, that in turn, can trigger a thrombosis of the cavernous sinus and the patient´s death, combined with systemic compromise, such as pregnancy, requiring the modification of certain aspects of endodontic treatment. A 31 year old female patient with a 35 week pregnancy was admitted to the emergency Hospital General Manuel GEA González due to a severe buccal, malar y periorbital abscess deriving from an incorrect dental management. The approach was pharmacological treatment, cesarean and drainage. She was then remitted to the Division de Studios de Postgrad e Investigation UNAM Endodontic Graduate Department. The diagnosis was: chronic dentoalveolar abscess of left lateral incisor, canine and first premolar. The treatment focused on neutralization the septic content and a comprehensive treatment including different dental specialties

Manejo de la mucormicosis rino-orbito-cerebral. Estrategias para evitar o limitar afección intracraneal y mejorar la supervivencia / Rhino-orbito-cerebral mucormycosis. Management strategies to avoid or limit intracraneal affection and improve survival

La mucormicosis es una infección rara y oportunista. El objetivo del estudio fue revisar los casos presentados en nuestro servicio con mucormicosis rino-orbitaria y describir el protocolo clínico, diagnóstico y terapéutico empleado en estos pacientes. Se realizó un estudio retrospectivo, longitudinal, descriptivo, en el que se evaluaron expedientes de pacientes con mucormicosis rino-orbitaria del periodo de enero a octubre de 2013. Se encontraron 5 casos, con afección de fosa pterigomaxilar en el 100% de nuestros pacientes. Se realizó tratamiento médico y quirúrgico temprano mediante desbridamiento extenso endoscópico (incluyendo desbridamiento y resección de fosa pterigomaxilar) y exenteración orbitaria a los pacientes que se presentaron con síndrome de ápex orbitario en conjunto con el servicio de oftalmología de nuestro hospital, obteniendo excelentes resultados en la supervivencia (100% de supervivencia) (AU)

Mucormycosis is a rare opportunistic infection. The aim of the study was to review the cases presented in our department with rhino-orbital mucormycosis and to describe the clinical protocol, diagnosis and therapy used in these patients. We conducted a retrospective, longitudinal, descriptive study, in which we evaluated the records of patients with rhino-orbital mucormycosis in the period from January to October 2013. We found 5 cases. Pterigomaxillary fossa disease was found in 100% of our patients. Medical and surgical treatment perfor0med early by extensive endoscopic debridement (including debridement and resection of pterygomaxillary fossa) and orbital exenteration in patients presenting with orbitary apex syndrome in conjunction with the ophthalmology department of our hospital, with excellent results in the survival of our patients (all patients survived) (AU)

Rhino-orbito-cerebral mucormycosis. Management strategies to avoid or limit intracraneal affection and improve survival.

Mucormycosis is a rare opportunistic infection. The aim of the study was to review the cases presented in our department with rhino-orbital mucormycosis and to describe the clinical protocol, diagnosis and therapy used in these patients. We conducted a retrospective, longitudinal, descriptive study, in which we evaluated the records of patients with rhino-orbital mucormycosis in the period from January to October 2013. We found 5 cases. Pterigomaxillary fossa disease was found in 100% of our patients. Medical and surgical treatment performed early by extensive endoscopic debridement (including debridement and resection of pterygomaxillary fossa) and orbital exenteration in patients presenting with orbitary apex syndrome in conjunction with the ophthalmology department of our hospital, with excellent results in the survival of our patients (all patients survived).