Frequency of the odontogenic maxillary sinusitis extended to the anterior ethmoid sinus and response to surgical treatment.

OBJECTIVES: Odontogenic sinusitis usually affects the maxillary sinus but may extend to the anterior ethmoid sinuses. The purpose of this study is to determine the percentage of odontogenic maxillary sinusitis extended to the anterior ethmoid sinuses and determine also the surgical resolution differences between odontogenic maxillary sinusitis and odontogenic maxillary associated to anterior ethmoidal sinusitis. STUDY DESIGN: This is a retrospective cohort study performed on 55 patients diagnosed of odontogenic sinusitis and treated surgically by functional endoscopic sinus surgery. RESULTS: This study showed that 52.7% of odontogenic maxillary sinusitis spreads to anterior ethmoid, causing added anterior ethmoid sinusitis. We found that 92.3% of the odontogenic maxillary sinusitis (who underwent middle meatal antrostomy) and 96.5% of the odontogenic maxillary sinusitis extended to the anterior ethmoid (treated with middle meatal antrostomy and anterior ethmoidectomy) were cured. CONCLUSION: Ethmoid involvement is frequent in maxillary odontogenic sinusitis. The ethmoid involvement does not worsen the results of "functional endoscopic sinus surgery" applied to the odontogenic sinusitis.

[Infraorbital lesion after scuba diving with chronic sinusitis: diagnosis and treatment of reverse block]. / Infraorbitalisläsion nach Sporttauchen bei chronischer Sinusitis: Diagnostik und Therapie der Umkehrblockierung.

A 32-year-old diver repeatedly reported pain in the right side of the face after diving. He felt strong pain on pressure over the right face combined with hypaesthesia of the infraorbital nerve. In addition, he reported nasal breathing obstruction and problems regulating pressure in the middle ear. ENT consultation revealed a septal deviation to the right side of the nasal cavity. CT diagnosis showed the typical picture of chronic pansinusitis with total transfer of the right frontal sinus, subtotal transfer of the right ethmoid and subtotal transfer of the right maxillary sinus. Following successful functional sinus surgery (FESS), combined with septal surgery, the patient was able to dive again symptom-free.

Bilateral subdural empyemas with meningitis secondary to acute barosinusitis.

INTRODUCTION: Intracranial complications of acute rhinosinusitis are rare, but may turn life-threatening. CASE SUMMARY: We report a healthy 30-year-old male who complained of frontal headache, which developed while on a plane. A brain CT showed a low-density lesion on the left frontal convexity with right maxillary and ethmoid sinusitis. Despite receiving intravenous antibiotics, a follow-up brain CT showed two lesions with adjacent dural and leptomeningeal enhancement. A paranasal sinus CT revealed aggravated left frontal sinusitis and right maxillary sinusitis. The patient underwent craniotomy and brain abscess removal along with endoscopic sinus surgery. Seventeen days after the surgery, the patient was discharged with no neurological sequelae. CONCLUSION: To the best of our knowledge, this case is the first report regarding the association between barotrauma and intracranial complications of acute rhinosinusitis. A high index of suspicion and well-timed surgical evacuation may ensure a full recovery.

Orbital cellulitis after faden operation on the medial rectus.

BACKGROUND: Orbital cellulitis after strabismus surgery is uncommon, may cause blindness and may lead to death. Very few cases have been described in detail due to the low incidence of this complication. METHODS: We report the first case of orbital cellulitis following Faden operation on the medial rectus muscle. We believe that the infection was due to asymptomatic ethmoid sinusitis. Our case is compared with other cases previously reported. RESULTS: A two-year-old boy was surgically treated for residual esotropia after two botulinum toxin A injections. Two days after surgery, signs of orbital cellulitis developed in his right orbit. CT-scan disclosed right ethmoid sinusitis that spread to the orbit after surgery. After intravenous antibiotic treatment, the infection resolved with full restoration of visual acuity and ocular motility. CONCLUSION: Despite adequate measures to prevent infection, orbital cellulitis may complicate strabismus surgery. Patients must be instructed to recognize early symptoms of this severe infection and call the surgeon immediately. Diagnosis may be confirmed by CT-scanning of the orbits. Prompt treatment with intravenous antibiotics usually leads to full recovery.

[Recurrent bacterial meningitis in a case of Crouzon syndrome after craniofacial surgery].

A 29-year-old woman, who was diagnosed as Crouzon syndrome for which two cranio-facial surgeries had been performed as a child and at the age of 19, developed high fever, headache, and confusion for two days. She was admitted to our hospital. She was diagnosed as bacterial meningitis by cerebrospinal fluid examinations, and her condition was immediately improved by antibiotics. At the age of 23, she also suffered from bacterial meningitis caused by otitis media and sinusitis, and recovered by antibiotics with no sequela. Her cranial computed tomography showed sphenoid and ethmoid sinusitis, and bone deformation and hypertrophy with no fistula connecting intracranial space and sinus. Dead space by cranio-facial surgeries might cause the development of chronic or recurrent sinusitis leading to bacterial meningitis. Our patient is the second case of recurrent bacterial meningitis with Crouzon syndrome to our knowledge. We should recognize that recurrent sinusitis with Crouzon syndrome after cranio-facial surgery is a risk of recurrent meningitis.

[Fever of unknown origin--pyelonephritis? Pneumonia? Mastoiditis? Ethmoiditis?]. / Goraczka o nieustalonej przyczynie --pyelonephritis? Pneumonia? Mastoiditis? Ethmoiditis?

Fever of unknown origin is alarming phenomenon in childhood. Diagnostic procedures should be focused on severe bacterial infection: pyelonephritis, pneumonia and other respiratory tract infections such as mastoiditis and sinusitis in particular ethmoiditis. The principles of treatment and diagnostics were discussed depending on age and general status of the child.

[Olfactory neuroblastoma removed under endoscopic guidance]. / Nabloniak nerwowy z komórek wechowych usuniety endoskopowo.

INTRODUCTION: Olfactory neuroblastoma is a rare tumour associated with high rates of recurrence and mortality. Treatment includes surgery, radiotherapy, chemotherapy, or a combination. The ideal treatment modality has yet to be determined. MATERIAL AND METHODS: 46-years old male underwent bilateral endoscopic ethmoidectomy due to chronic sinusitis. During surgery, a 5 mm in diameter tumour was identified in the left superior nasal meatus. On histopathological examination the diagnosis of esthesioneuroblastoma was established and confirmed by immunohistochemistry. The tumour was classified according to Kadish as stage A, according to Biller as T1. MR scans performed two months later disclosed pathological tissues in the left ethmoid region. RESULTS: Multiple biopsies taken on subsequent frontosphenoethmoidectomy did not contain tumour cells. The patient declined radiotherapy. He has been asymptomatic over the 12 monthsí follow-up period. CONCLUSIONS: The exclusively surgical treatment proved effective due to early stage of the tumour and no evidence of infiltration of the frontal skull base. This strategy, however, requires frequent follow-up visits.

[Causes and revision endoscopic sinus surgery for recurrent sinusitis].

OBJECTIVE: To investigate the causes of revision endoscopic sinus surgery (RESS), and to evaluate the clinical effect and experience of RESS in the patients with recurrent sinusitis. METHODS: Before the revision surgery, 168 patients (225 sides) with recurrent sinusitis were examed by CT scans and nasal endoscopy. All patients were operated by revision endoscopic sinus surgery. RESULTS: Among the 168 patients, 95 cases (121 sides) had incomplete middle turbinate, 51 cases (75 sides) had maxillary sinus ostium stenosis, 85 cases (117 sides) had nasal cavity adhesion, 48 cases (57 sides) had uncinate process residual, 38 cases (65 sides) had ethmoid hyperostosis, and 25 cases had nasal septum deviation. One hundred and six patients (134 sides) were cured, 40 patients (56 sides) were improved, useful 22 patients (35 sides) were ineffective. CONCLUSION: The most common surgical causes of failures in endoscopic sinus surgery are the disease area remnant, nasal cavity adhesion, maxillary sinus ostium stenosis, uncinate process residual, ethmoid hyperostosis, and nasal septum deviation. Revision endoscopic sinus surgery is a useful way to treat recurrent sinusitis. Preoperative CT scan, correct choice of the anatomic marks of orientation and direction function are the key to operation successful.

Paediatric nasal polyps in cystic fibrosis.

Patients with cystic fibrosis (CF) are at increased risk of nasal polyps. We present the case of a 17-month-old Caucasian patient with CF who presented with hypertelorism causing cycloplegic astigmatism, right-sided mucoid discharge, snoring and noisy breathing. Imaging suggested bilateral mucoceles in the ethmoid sinuses. Intraoperatively, bilateral soft tissue masses were noted, and both posterior choanae were patent. Polypectomy and bilateral mega-antrostomies were performed. Histological examination revealed inflammatory nasal polyposis typical of CF. The role of early functional endoscopic sinus surgery (FESS) in children with CF nasal polyposis remains questionable as the recurrence rate is higher, and no improvement in pulmonary function has been shown. Our case, however, clearly demonstrates the beneficial upper airway symptom relief and normalisation of facial appearance following FESS in a child with this condition.

Rhinocerebral invasive mycosis: occurrence in immunocompetent individuals.

We report the computed tomographic appearance of invasive fungal disease of the paranasal sinuses in 13 patients. Coronal and axial computed tomographic images were obtained in each patient and data were analysed. Eight patients had Aspergillus flavus infection, four had Mucormycosis, and one had mixed Candida and Mucor. Our experience was different from that of other workers in many respects. All of our patients were immunocompetent. On radiological imaging by computed tomography, ethmoid sinuses were involved in 85% of our patients. In previously reported series maxillary sinuses were most frequently affected. Calcification in the inflammatory mass was not encountered in any of our patients, whereas this feature was present in many reported cases. Features in our patients that were similar to other studies were contrast enhancement, extension of the disease into the orbit and cranial cavity and a high mortality. The clinical course and radiological features of invasive mycosis simulate malignancy. Certain features that may help to differentiate invasive fungal infection from malignancy are discussed. We conclude that invasive fungal infection can affect immunocompetent individuals and should be considered in the differential diagnosis in appropriate clinical settings.

Comparison of inflammatory cell profile and Th2 cytokine expression in the ethmoid sinuses, maxillary sinuses, and turbinates of atopic subjects with chronic sinusitis.

Chronic sinusitis is a common disease characterized by persistent inflammation of the sinus mucosa. This study was undertaken to investigate immunopathologic findings in biopsy specimens from the ethmoid sinuses, maxillary sinuses, and inferior nasal turbinates of 14 allergic subjects with chronic sinusitis. The composition of the inflammatory infiltrate in the three tissue sites was examined by immunocytochemistry with anti-CD3 (total T cells), anti-CD4 (helper T cells), anti-CD8 (suppressor T cells), anti-MBP (eosinophils), antitryptase (mast cells), and antichymase (mast cells) antibodies. These revealed a significant increase in the T-cell helper/suppressor ratio and eosinophils in the ethmoid sinus mucosa compared with those in the maxillary sinus mucosa and the inferior turbinate. Eosinophil numbers were also higher in the maxillary sinus than in the inferior turbinate. Mast cells were present in significantly higher numbers in the ethmoid sinus and inferior turbinate biopsy sections than in the maxillary sinus. With antisense, radiolabeled riboprobes, we used in situ hybridization to examine the expression of interleukin-4 and interleukin-5 transcripts. The density of cells expressing interleukin-4 transcripts was significantly higher in the inferior turbinate biopsy sections than in those from the ethmoid and maxillary sinuses. In addition, the number of interleukin-4 mRNA-positive cells was higher in the ethmoid than in the maxillary sinus mucosa. The density of interleukin-5 mRNA-positive cells was significantly higher in the ethmoid and maxillary sinuses than in the inferior turbinate. The results of this study indicate (1) a more intense inflammatory response in the ethmoid sinus than in the maxillary sinus and inferior turbinate in allergic chronic sinusitis and (2) different inflammatory responses in the upper airways that are dependent on the anatomic site. These findings have potential implications in the design of new therapeutic interventions for allergic chronic sinusitis.

Rhinocerebral mucormycosis and internal carotid artery thrombosis in a previously healthy patient.

Mucormycosis is a very serious fungal infection caused by habitual saprophytes of the human organism, in many cases concomitant with various pathological conditions marked by immunodepression. The rhinocerebral variant habitually accompanies ketoacidotic diabetes. We report a case of rhinocerebral mucormycosis in a subject free from immunodepression and non-diabetic, in apparently normal health. Following treatment with amphotericin B combined with 5-fluorocytosine and surgery, remission of the disease was finally secured and about one year after the last operation there are no sign of resumption.

Pediatric ethmoidectomy.

The ethmoid sinuses play a key role in the health or disease of the entire paranasal sinus complex. Multiple underlying inflammatory processes may easily obstruct the narrow ostia of each ethmoid air cell, leading to infection. By virtue of its unique anatomic position and relationship to the ostiomeatal complex, the ethmoid labyrinth becomes the key to treatment of acute and chronic sinusitis. Surgical intervention for sinus disorders in children has grown in popularity. This article reviews the anatomy and pathophysiology of ethmoid sinusitis and discusses the role of surgery for these disorders.

Bilateral ethmoid sinusitis with unilateral proptosis as an initial manifestation of metastatic prostate carcinoma.

This article presents a case of bilateral ethmoid sinusitis with unilateral proptosis as a presenting sign of an unsuspected prostate carcinoma. A 59-year-old Hispanic male presented to his primary care physician with nasal congestion and rhinitis. He was treated with antibiotics and antihistamine decongestants for 3 weeks without improvement. A trial of steroids resulted in brief improvement followed by a rapid onset of nasal obstruction with proptosis. A computed tomography scan revealed opacification of the ethmoid sinus with right proptosis. The presumptive diagnosis was orbital cellulitis secondary to chronic ethmoid sinusitis. Endoscopic sinusotomy and bilateral ethmoidectomies were performed. Biopsy results returned as metastatic adenocarcinoma, probably of prostate origin. Urological work-up and evaluation with biopsy confirmed the diagnosis of prostatic carcinoma. The patient was treated with chemotherapy and radiation therapy. He died 7 months later with disseminated disease.

Molten aluminium inhalation in the nose and ethmoid sinus. Report of an unusual case.

Accidental nasal inhalation of molten aluminium can occur during the industrial production of aluminium in spite of stringent safety precautions. In this case, believed to be the first reported in the literature, the initial evaluation of damage to the nasal mucosa was underestimated, because, in addition to a large nugget of aluminium in one nasal fossa, smaller fragments had penetrated deep into the middle meatus. These smaller fragments, undetected because of the poor radiopacity of aluminium, were responsible for extensive tissue damage which caused ethmoiditis and secondary maxillary sinusitis.

Breast cancer metastasis presenting as ethmoiditis.

Metastasis from primary tumours to the paranasal sinuses is infrequent. We report an unusual case of breast cancer metastasis presenting as ethmoiditis in MRI. MRI changes are unspecific and sometimes inflammatory lesions can not be distinguished from neoplastic lesions. Inflammatory changes in the paranasal sinuses are also frequently noted on MRI even in normal persons without disease. A high index of metastasis suspicion in any patient with breast cancer must be kept in mind.

[Rhinocerebral mycoses caused by Mucoraceae species (mucormycosis). Case report and literature review]. / Uber rhinozerebrale Mykosen durch Mucorazeen-Arten ("Mucormykosen"). Fallbericht und Literaturübersicht.

According to the literature and on the basis of the case reported in this paper of rhinocerebral mucoraceae mycosis we summarize the characteristic features as follows: mucoraceae--mycoses--common, but wrong term: "mucormycoses"--are a group of infections caused by members of the family mucoraceae (Mucor, Rhizomucor, Rhizopus, Absidia species)--most frequently by Rhizopus species. Primarily the fungi enter the pharynx or nose, local infections or trauma being a prerequisite. The most important predisposing factor is diabetes mellitus. Invading the tissue and causing vascular thrombosis the infection frequently takes an acute, often fulminating and fatal course. Acute sinusitis accompanied by swelling of the cheek and protrusion of the eye in a diabetic, particularly with acidosis, are pathognomonic. Diagnosis is confirmed by microscopic examination of infected tissue (unstained smear or histologically). Since systemically administered antifungals have not proved very effective in these myoses, mainly because an adequate tissue level can hardly be achieved, the most effective and curative treatment is surgical removal of infected tissue, simultaneous control of diabetes being mandatory.

A rare foreign body impaction: a case report.

A case of unusual foreign body impaction of 6 years' duration is reported. The foreign body was retained in the right infraorbital region, extending to the ethmoid sinus. The importance of careful history taking and clinical examination and the problems encountered in evaluation of relatively radiolucent foreign bodies with magnetic resonance imaging are discussed.

[Sarcoidosis of the ethmoid sinus. Apropos of a case]. / Ethmoïdite sarcoïdosique. A propos d'un cas.

We report the case of a 78 year old man with unilateral persistent headache and associated bilateral kerato-conjunctivitis and minor skin lesions. Chronic ethmoiditis was diagnosed on a CT scan, and endoscopically controlled endonasal ethmoidal biopsy gave the diagnosis of sarcoid and hence the treatment. A nodular type isolated pulmonary lesion, atypical for sarcoidosis, also disappeared on steroid therapy. A review of the literature showed this to be an exceptionally rare form of the disease.