A case of acute unilateral maxillary atelectasis following endoscopic pituitary surgery.

INTRODUCTION: Chronic maxillary atelectasis (CMA) is traditionally described as a rare, acquired condition of persistent and progressive antral wall collapse causing a reduction in maxillary sinus volume. In a handful of cases, CMA has been identified in patients with previously normal computed tomography (CT) imaging. However, maxillary atelectasis occurring rapidly after pituitary surgery, despite a normal pre-operative CT scan, has not previously been described in the literature. PRESENTATION OF CASE: A 29-year-old male presented two months post endoscopic transnasal, transsphenoidal excision of a Rathke's cleft cyst with facial pain and pressure, unresponsive to medical treatment. CT of the paranasal sinuses at five months post-operatively demonstrated evidence of a left CMA, which was not present on pre-operative imaging. He underwent endoscopic uncinectomy and middle meatal antrostomy with complete resolution of symptoms. DISCUSSION: To our knowledge, this is the first case in the literature describing acute development of maxillary atelectasis. While lateralisation of the middle turbinate causing ostiomeatal obstruction may lead to sinus atelectasis, it is typically a slow process and often seen in the context of chronic disease. Review of the literature demonstrates six cases of documented rapid-onset atelectasis of maxillary sinuses. Four of these cases were post-operative, with one involving direct surgery on the affected sinus. CONCLUSION: This case represents the first in the literature of acute, post-operative unilateral maxillary atelectasis following pituitary surgery, where the affected sinus was not directly involved in the initial operation. Consideration should be made to incorporate acute cases into the current classification system.

Use of external orthotic helmet therapy in positional plagiocephaly.

Positional plagiocephaly is the most common type of cranial asymmetry affecting infants. We aimed to investigate the effectiveness of helmet therapy compared to no helmet therapy in treating positional plagiocephaly in infants under the age of 1year. This retrospective review was conducted in an Australian paediatric hospital and included 171 patients recruited from outpatient clinics. Only 30 patients had positional plagiocephaly scores recorded at first and final consultations while 39 patients had diagonal measurements recorded at both visits. The mean age was 7.38months at initial consultation with a mean follow-up duration of 5.85months. Those who had helmet therapy had a significantly greater reduction in diagonal difference than those who did not use helmets (p=0.011). Therefore, there may be a role for helmet therapy in the treatment of severe positional plagiocephaly.