ABSTRACT
INTRODUCTION: Inverted papillomas (IP) are benign epithelial tumors with a tendency to be locally invasive and with disposition to recur. The aim of our study is to present the results of IP treatment, considering pathological, immunohistochemical and molecular features of recurrence. MATERIAL AND METHODS: From 1978 to 2020, 186 sinonasal IPs surgeries corresponding to 152 patients were treated in our center. We performed a pathology evaluation of all the recurrent cases reviewing the histological diagnosis, the presence of mixed component other than IP, the koilocytic changes, the p16 over expression and HPV-DNA detection. RESULTS: Overall recurrence rate was 19 % (35/186). The 35 IP recurrences correspond to 22 patients, 9 of whom presented a single recurrence (single recurrence group) while 13 of them presented more than one recurrence (multi-recurrent group). Immunohistochemical analysis showed a higher percentage of p16 overexpression (54 % vs 33 % p = 0.415) and HPV-DNA presence (23 % vs 0 % p = 0.240) in the multi-recurrent group compared with single recurrence group. In addition, the revision showed more IP with exophytic papilloma focus (38 vs 22 % p = 0.648) and a higher proportion of IP with koilocytotic changes (61 % vs 22 % p = 0.099) in the multirecurrent group. There is no significant difference between groups in our results. CONCLUSION: The analysis of our patients may differentiate between two groups with recurrent papillomas. A single recurrence group where the cause of recurrence is probably an anatomical problem related to an incomplete resection, and a second pattern, the multi-recurrence group, where HPV infection may be the main cause of recurrence.
Subject(s)
Nose Neoplasms , Papilloma, Inverted , Papillomavirus Infections , Paranasal Sinus Neoplasms , Respiratory Tract Neoplasms , Humans , Papilloma, Inverted/surgery , Paranasal Sinus Neoplasms/surgery , Paranasal Sinus Neoplasms/pathology , Papillomavirus Infections/surgery , Papillomavirus Infections/pathology , Retrospective Studies , Nose Neoplasms/surgery , DNA , Papillomaviridae/geneticsABSTRACT
ANTECEDENTES Y OBJETIVO: La propagación de una infección a partir de los senos paranasales es poco frecuente pero grave. Entre un 4 y un 20% de las rinosinusitis se pueden complicar; de ellas, las orbitarias (60-75%) son las más prevalentes. La gran mayoría se presentan en la edad pediátrica, si bien en la edad adulta son más graves. Nuestro objetivo es analizar las características epidemiológicas de estos pacientes así como plantear un protocolo de actuación ante esta situación. MATERIALES Y MÉTODOS: Se realizó un estudio retrospectivo de 21 pacientes diagnosticados de una complicación orbitaria en el curso de una rinosinusitis aguda entre 2005 y 2018. El diagnóstico se basó en la historia clínica, la exploración endoscópica y las pruebas de imagen. Todos los pacientes recibieron antibioterapia intravenosa y fueron valorados por oftalmología. Se llevó a cabo un tratamiento quirúrgico urgente en caso de existir un absceso o mala evolución con el tratamiento médico. RESULTADOS: La edad media de los pacientes fue de 24 años. El 52% fueron varones y el 48% mujeres. Según la clasificación de Chandler, el 43% (9/21) fueron celulitis preseptales (7 adultos y 2 niños), el 10% (2/21) celulitis orbitarias (un adulto y un niño), el 43% (9/21) abscesos subperiósticos (2 adultos y 7 niños), hubo un caso de absceso orbitario en un adulto y ningún caso de trombosis de seno cavernoso. Se solicitó una TC a todos los pacientes y se optó por el tratamiento quirúrgico en caso de absceso subperióstico u orbitario, a excepción de 2 abscesos de pequeño tamaño (< 4 mm), subperiósticos mediales y en edad pediátrica (< 4 años) que presentaron una correcta evolución con tratamiento conservador. El abordaje quirúrgico fue por vía endoscópica endonasal: se resecó la lámina papirácea y se mantuvo intacta la periórbita en el caso de abscesos subperiósticos, pero se incidió en ella en el absceso orbitario. Se complementó con un abordaje externo palpebral en los 4 casos que presentaron una colección en el techo de la órbita o en la pared lateral. Dos pacientes adultos jóvenes (10%) presentaron de manera concomitante una complicación intracraneal. CONCLUSIONES: Las complicaciones orbitarias de la rinosinusitis aguda son poco frecuentes pero potencialmente graves. Es importante conocerlas y sospecharlas para actuar con rapidez. El tratamiento multidisciplinar, la localización y la extensión del cuadro son esenciales para el correcto manejo de estas complicaciones. El abordaje quirúrgico se realiza mediante endoscopia endonasal. Su limitación son las colecciones localizadas en el techo de la órbita o en pared lateral, en las que se tendrá que complementar la actuación con un abordaje externo palpebral
BACKGROUND AND OBJECTIVE: The spread of an infection from the paranasal sinuses is rare but severe. Between 4% and 20% of all rhinosinusitis can become complicated, orbital involvement being the most frequent (60-75%). Orbital complications are more common in children but more severe in adults. We aim to analyse the epidemiological characteristics of these patients and to propose a management algorithm. MATERIALS AND METHODS: We carried out a retrospective review of 21 patients with orbital complications of acute rhinosinusitis diagnosed in the same institution from 2005 to 2018. The diagnosis was based on clinical history, endoscopic examination and imaging tests. All patients received an intravenous antibiotic and were assessed by ophthalmology. An immediate surgical treatment was performed in the case of an abscess or poor response to medical management. RESULTS: The average age was 24 years. Fifty-two percent were males and 48% females. According to Chandler's classification, 43% (9/21) had preseptal cellulitis (7 adults and 2 children), 10% (2/21) orbital cellulitis (one adult and one child), 43% (9/21) subperiosteal abscess (2 adults and 7 children), there was one case of orbital abscess in an adult and there were no cases of cavernous sinus thrombosis. A CT scan was performed in all patients and the cases of subperiosteal or orbital abscess were treated surgically, except 2 paediatric patients (< 4 years) with a small and medial subperiosteal abscess (< 4 mm) who responded well to medical treatment. The surgical approach is performed by endonasal endoscopy, perforating the lamina papyracea in cases of subperiosteal abscess and also opening the periorbita in orbital abscess. It was combined with an external palpebral approach in the 4 cases that presented a superior or lateral abscess. Two young adults (10%) presented an intracranial complication concomitantly. CONCLUSION: Orbital complications of acute rhinosinusitis are rare but potentially severe. It is important to be aware of and suspect them in order to act quickly. It is essential to define the location and extension of the infection for correct management, as well as multidisciplinary treatment. The surgical approach is performed by endonasal endoscopy. It is limited by abscesses located on the roof of the orbit or on the lateral wall, when a combined external palpebral approach is required
Subject(s)
Humans , Male , Female , Young Adult , Adult , Sinusitis/epidemiology , Rhinitis/epidemiology , Orbital Diseases/epidemiology , Sinusitis/complications , Rhinitis/complications , Orbital Diseases/etiology , Sinusitis/therapy , Rhinitis/therapy , Acute Disease , Retrospective Studies , Algorithms , Spain/epidemiologyABSTRACT
BACKGROUND AND OBJECTIVE: The spread of an infection from the paranasal sinuses is rare but severe. Between 4% and 20% of all rhinosinusitis can become complicated, orbital involvement being the most frequent (60-75%). Orbital complications are more common in children but more severe in adults. We aim to analyse the epidemiological characteristics of these patients and to propose a management algorithm. MATERIALS AND METHODS: We carried out a retrospective review of 21 patients with orbital complications of acute rhinosinusitis diagnosed in the same institution from 2005 to 2018. The diagnosis was based on clinical history, endoscopic examination and imaging tests. All patients received an intravenous antibiotic and were assessed by ophthalmology. An immediate surgical treatment was performed in the case of an abscess or poor response to medical management. RESULTS: The average age was 24 years. Fifty-two percent were males and 48% females. According to Chandler's classification, 43% (9/21) had preseptal cellulitis (7 adults and 2 children), 10% (2/21) orbital cellulitis (one adult and one child), 43% (9/21) subperiosteal abscess (2 adults and 7 children), there was one case of orbital abscess in an adult and there were no cases of cavernous sinus thrombosis. A CT scan was performed in all patients and the cases of subperiosteal or orbital abscess were treated surgically, except 2 paediatric patients (<4 years) with a small and medial subperiosteal abscess (<4mm) who responded well to medical treatment. The surgical approach is performed by endonasal endoscopy, perforating the lamina papyracea in cases of subperiosteal abscess and also opening the periorbita in orbital abscess. It was combined with an external palpebral approach in the 4 cases that presented a superior or lateral abscess. Two young adults (10%) presented an intracranial complication concomitantly. CONCLUSION: Orbital complications of acute rhinosinusitis are rare but potentially severe. It is important to be aware of and suspect them in order to act quickly. It is essential to define the location and extension of the infection for correct management, as well as multidisciplinary treatment. The surgical approach is performed by endonasal endoscopy. It is limited by abscesses located on the roof of the orbit or on the lateral wall, when a combined external palpebral approach is required.
