Isolated invasive fungal sphenoid sinusitis-induced extensive bone erosion and severe meningoencephalitis: diagnosis and multidisciplinary management.

Invasive fungal sinusitis (IFS) is more common in immunosuppressed patients but can also occur in immunocompetent hosts. While the non-invasive type of fungal sinusitis has usually a good prognosis, IFS is a potentially lethal condition.We report the case of a woman in her 60s presenting an isolated fungal infection by Aspergillus fumigatus of the right sphenoid sinus, causing extensive bone erosion of its walls and complicated by severe meningoencephalitis. She was healthy without any immunosuppressive conditions. Methods of diagnosis, multidisciplinary management, follow-up and outcomes are documented.Early-stage diagnosis of sphenoid sinus pathologies is often delayed because patients are usually asymptomatic. IFS of the sphenoid is more aggressive than other paranasal sinus and carries significant mortality. Early diagnosis and aggressive and multidisciplinary treatment are crucial to reduce sequels and improve patient's survival.

Management Strategy of Intracranial Complications of Sinusitis: Our Experience and Review of the Literature.

Objective: Sinusitis or rhinosinusitis is a very common disease worldwide, and in some cases, it leads to intracranial complications (ICS). These are more common in immunocompromised patients or with underlying comorbidities, but even healthy individuals, can be affected. Nowadays, ICS have become less common thanks to improved antibiotic therapies, radiological diagnostic methods, surgical techniques and skills. Nonetheless, they can still cause significant morbidity and mortality. For this reason, management of these complications requires a multidisciplinary approach to plan and customize treatment options. This paper presents our strategy in the management of a series of intracranial complications induced by acute sinusitis and compares our experience and outcomes with the literature. Study design: Single institute experience, retrospective analysis of cases series and literature review. Methods: Adult and child patients who were treated for ICS in the Department of Otorhinolaryngology at Sion Hospital, in Switzerland from 2016 to 2020 were included. Their symptoms, medical history, clinical and radiological findings, treatment, and outcome were documented. Results: Eight patients (6 males- 2 females) aged from 14 to 88 y.o., were enrolled. None had any previous history of chronic, or recurrent sinusitis. Moreover, very few presented specific rhinological symptoms, but with neurological or other symptoms. Computed tomography (CT) and Magnetic Resonance Imaging (MRI) were used to confirm the diagnosis of all ICS. All types of known intracranial complications were observed in our cohort with a wide range of extension and severity of sinusitis. A multidisciplinary approach with individual treatments was tailored to each patient. Outcomes were favorable in almost all patients with neither recurrence, nor neurological sequels being observed in the follow-up. Only one patient was lost due to fatal complications of advanced lung cancer. Conclusion: ICS remain a challenging clinical problem due to substantial associated morbidity and mortality. The incidence of these complications is relatively low. Therapeutical management guidelines are lacking. Early detection and multidisciplinary approach are key to successful treatment.

Unexpected foreign body induced refractory maxillary sinusitis.

Maxillary sinusitis induced by ipsilateral dental manipulation often carries the risk of sinusal foreign body impaction. Adequate evaluation mandates radiological exploration of the sinus. Management requires complete foreign body removal, surgical drainage of the sinus, and closure of any oroantral communication or fistula.

[Obstructive sleep apnea syndrome : CPAP or Mandibular Advancement Device?] / Syndrome d'apnées obstructives du sommeil : CPAP ou orthèse d'avancement mandibulaire ?

Obstructive sleep apnea syndrome (OSAS) is a respiratory disorder affecting up to 49 % and 23 % of middle to older aged men and women respectively. CPAP (continuous positive airway pressure) is the gold-standard treatment for severe apneas. In mild and moderate forms of OSAS, mandibular advancement devices (MAD) are equally a first line of treatment. Both CPAP and MAD have their advantages and side effects. Patient tolerance to these two therapies varies according to different patient-parameters. In order to guide physicians and patients in choosing between these two treatments, we present a description of both treatment modalities.

Le syndrome d'apnées obstructives du sommeil (SAOS) est un trouble respiratoire du sommeil qui affecte jusqu'à 49 % des hommes et 23 % des femmes d'âge moyen à avancé. La ventilation en pression positive continue (CPAP) est actuellement le traitement de choix pour les cas sévères. Dans les stades léger et modéré de SAOS, l'orthèse d'avancement mandibulaire (OAM) est également un traitement que l'on peut proposer en première intention. La CPAP comme l'OAM ont leurs avantages et leurs inconvénients. La tolérance pour ces deux thérapies varie d'un patient à l'autre. Afin de guider le praticien et le patient dans le choix de ces deux traitements, nous proposons une description des deux modalités thérapeutiques.

Advantages of otorhinolaryngologist performed transcervical ultrasonography in the management of peritonsillar abscess.

OBJECTIVES: Peritonsillar abscess (PTA) is a very common infection, in particular in pediatric and adolescent population. A distinction between peritonsillar cellulitis and abscess should be made to determine the appropriate treatment. Nonetheless, the difference cannot always be made on physical examination alone and often requires imaging by computed tomography (CT). Radiation exposure as well as the cost and waiting time question the use of CT in this pathology. We present our experience in the use of Transcutaneous Cervical Ultrasonography for the diagnosis and management of peritonsillar abscess in the adult population. STUDY DESIGN: Clinical-prospective. METHODS: Adult patients were evaluated for suspicion of PTA. Clinical findings were documented and all patients underwent a Transcutaneous Cervical Ultrasonography performed by a second otorhinolaryngology specialist well versed in Ultrasonography without knowing the clinical history, details of the physical examination, or the suspected side. Ultrasonography findings were later compared with the clinical examination and outcome of the medical or surgical management. RESULTS: Eight adult patients (range 18-53 year-old) were enrolled in the study. Six of them, had, ultrasonography findings compatible with a peritonsillar liquid collection underwent surgical drainage that confirmed and drained an abscess. On two patients, the ultrasonography images described an aspect of peritonsillar cellulitis that was managed conservatively and showed a favorable remission. No complications during stay or side effects or intolerance to the ultrasound were recorded. CONCLUSION: Transcutaneous Cervical ultrasonography is a fast, useful tool, better tolerated than the intra-oral ultrasonography in diagnosing PTA. It avoids all irradiation exposure is much cheaper and the waiting time is shorter. Worth noting, is the richness of information pertaining the anatomy, vessels and abscess location and extension, for the surgeon performing the exam just prior to surgery. The efficiency and training of otorhinolaryngology specialists with this technique shows numerous promising benefits and deserves to be further developed.

Refashioned lamb tissue as an animal model for training complex techniques of laryngotracheal stenosis surgery.

Open reconstructive upper airway surgery for laryngotracheal stenosis (LTS), whether for subglottic or tracheal stenosis, constitutes a group of complex approaches. LTS requiring open reconstruction is overall rare and primarily performed at tertiary centres. This poses an obvious challenge for the acquisition and maintenance of surgical skills for this group of complex approaches. In this context, animal models provide a unique opportunity for open reconstructive airway surgery training. Such models ought to take into consideration ethical aspects, be easily available and easy to maintain, and have similar macroscopic anatomical features to the human laryngotracheal frame. Here, we provide a brief surgical guide for the use of refashioned lamb tissue as a training model for surgery of adult and pediatric reconstructive airway surgery. The techniques of laryngotracheal reconstruction, partial cricotracheal resection, tracheal resection with end-to-end anastomosis, and slide tracheoplasty are presented. Proper training in open LTS surgery is challenging, time consuming and its complexity further lengthens the learning curve. The lamb larynx and trachea model is an effective model for practising various airway reclaiming surgeries.

Thoracocervicofacial Emphysema after Heimlich's Maneuvre.

We report an extremely rare example of a thoracocervicofacial subcutaneous emphysema after Heimlich maneuver case.

Revegetation of the acidic, As contaminated Jales mine spoil tips using a combination of spoil amendments and tolerant grasses.

A combination of metal immobilising agents and metal tolerant plants has been utilised in order to reduce the environmental impact of the acidic metal contaminated Jales mine spoil tips. The addition of Beringite (a modified aluminosilicate), steel shots (iron bearing material) and organic matter as spoil amendments resulted in changes in arsenate (As) concentrations and pH of spoil material and improved plant growth. The application of Beringite increased both pH and plant available As concentrations. A 4-year follow up of the spoil analysis demonstrated that the effect of the spoil treatments was stable following treatments, however, the effectiveness did not increase any more after 2 years. The use of metal tolerant grasses in combination with spoil treatments resulted in a rapid and effective revegetation of the As contaminated Jales mine spoils. Colonisation and reproduction of Agrostis castellana and Holcus lanatus was most successful when the substrate contained a combination of all three additives. Plant performances could be enhanced by supplementation of a phosphate fertiliser. The rapid reproduction of the two grass species makes them very suitable for revegetation purposes. Agrostis castellana and Holcus lanatus apparently exhibited a level of metal- and As-tolerance sufficient for survival on untreated spoil, but in the first stages of revegetation the use of spoil amendments was found to be essential. Organic matter in combination with Beringite and/or steel shots resulted in decreased As in the aboveground biomass, protecting possible grazers and predators from undesirable levels of As.