RESUMO
Objectives Chronic rhinosinusitis (CRS) is the persistent inflammation of the mucosal lining of the paranasal sinuses (PNS). By definition, the inflammatory process persists beyond 12 weeks. One of its subtypes is allergic fungal rhinosinusitis (AFRS), which has a high risk of recurrence, leading to revision surgery. This study aimed to establish the predictive factors for the recurrence of AFRS in post-sinus surgery patients. Methods This single-center retrospective study was conducted in Al-Noor Specialist Hospital, Makkah, Saudi Arabia. The charts of patients with AFRS who underwent surgery in our rhinology clinic between 2000 and 2020 were reviewed. Results Among the 116 patients included in this study, approximately half (53%) were female, with a median age of 24.5 years. Thirty-nine (33.6%) patients had recurrence post-sinus surgery, with 33.3% occurring within six months of follow-up. The results showed that patients with coexisting bronchial asthma were three times more likely to experience recurrence (adjusted odds ratio {AOR}, 3.43; confidence interval {CI}, 1.35-8.71), patients with uncorrected deviated nasal septum (DNS) were three times more likely to experience symptoms again following surgery (AOR, 3.70; CI, 1.14-12.02), and patients who presented with concomitant sinus headaches are 66% less likely to experience recurrence (AOR, 0.34; CI, 0.13-0.86). Conclusion The results showed that 33.62% of patients experienced recurrence following surgery. Bronchial asthma and DNS were strongly associated with recurrence; however, their presence does not always imply the need for additional surgery.
RESUMO
Orbital complications are the second most common complications of endoscopic sinus surgery (ESS), and orbital hematoma is the most frequent orbital complication. An orbital abscess is usually associated with rhinosinusitis, and a few cases of orbital abscesses occurring after orbital trauma have been reported. However, orbital abscess occurring after ESS is rare. Herein, we present a case of a right orbital abscess that developed after bilateral ESS, performed at an outside facility, and decreased vision in the right eye to light perception only. The visual loss persisted for 3 days, after which the patient was referred to our hospital for urgent management. The cause of abscess formation might have been an infected stagnant orbital venous hematoma that occurred as a complication of ESS. A defect in the right lamina papyracea and emphysema were confirmed on computed tomography. Orbital symptoms started immediately after ESS, and vision deteriorated to light perception only and lasted for 3 days, which was considered a high-grade risk factor for irreversible blindness by the ophthalmology team. Urgent endoscopic endonasal orbital decompression was performed to drain the orbital abscess, and maximal medical treatment was initiated, which included intravenous corticosteroids, intravenous broad-spectrum antibiotics, topical intranasal corticosteroids, irrigation, and topical antibiotic eye drops. Close follow-up assessments were performed by the infectious diseases team, and the ophthalmology team performed frequent orbital assessments. The patient recovered from blindness, which was an unexpected outcome.
RESUMO
A 27-year-old female, married with two children, presented to our clinic with a 1-year history of thyroid swelling and pressure symptoms on lying backward and bilateral cervical lymphadenopathy. The patient was a known case of panhypopituitarism for 5 years. Comprehensive patient evaluation including FNAC with papillary thyroid cancer result then she underwent total thyroidectomy and bilateral neck dissection and final histologic examination confirmed papillary thyroid carcinoma in the background of lymphocytic thyroiditis, associated with Langerhans cell histiocytosis (LCH). The draining cervical lymph nodes were also involved by LCH and metastatic papillary thyroid carcinoma. Although the association of LCH with papillary thyroid carcinoma in the thyroid has been reported, their co-existence with LCH in the draining lymph nodes is very uncommon.
