Anatomical variations of the ethmoidal roof: differences between men and women.

AIM: During the paranasal sinuses surgery different complications may occur, both vascular and bony. The objective of the present study was to evaluate the ethmoidal roof configuration through the Keros and Yenigun classifications, analyzing results stratified by gender and side. MATERIALS AND METHODS: We retrospectively analyzed 120 high-resolution computed tomography paranasal sinus study images and measured the depth of the cribriform plate in a coronal view and the anterior-posterior length in a cross section. RESULTS: The Keros Type II was the most frequent and no statistically significant difference was found when comparing by gender. Yenigun type I was more prevalent, and a statistically significant difference was found between men and women in types I and II (p = 0.010 and p = 0.049, respectively). Statistical difference was observed in anterior-posterior means in the comparison between both classifications. In both, right and left side for men (p = 0.003 and p = 0.05) and women (p = 0.029 and p = 0.039). CONCLUSION: We demonstrate the morphological variability that exists in this region. Gender differences that must be considered by the surgeon to avoid complications. Further studies are needed to evaluate the value of these findings when predicting surgical complications. A CT before PNS surgery is already widely accepted.

DYSTROPHIC CALCIFICATION OF MAXILLARY SINUS IN PEDIATRIC PATIENTS WITH LIVER TRANSPLANTATION AND PIGMENTATION OF DENTAL ORGAN. / CALCIFICAÇÃO DISTRÓFICA EM SEIO MAXILAR DE PACIENTE PEDIÁTRICO COM TRANSPLANTE HEPÁTICO E PIGMENTAÇÃO DO ÓRGÃO DENTAL.

OBJECTIVE: To report a case of severe dystrophic calcification in maxillary sinus of a child with liver transplantation and dental organs pigmented by hyperbilirubinemia. CASE DESCRIPTION: female patient, 12 years old, with liver transplantation performed at the age of 7 due to extrahepatic biliary atresia (EHBA). The patient was receiving the immunosuppressant tacrolimus (2 mg daily). Intraoral clinical exam showed tooth green pigmentation by bilirubin. Cone-beam volumetric computed tomography (CT) was performed to verify radiographic density of pigmented dental elements. Hounsfield scale measurement did not show changes in radiographic density of dental structures. However, CT scan showed intense dystrophic calcification in the maxillary sinus region. COMMENTS: CT scan indicated relevant radiographic findings, with radiopacity of the maxillary sinus due to fungal or non-fungal sinusitis. This case report highlights the presence of radiographic image associated with acute infectious processes that could compromise the systemic state of immunosuppressed patients.

OBJETIVO: Relatar um caso de calcificação distrófica intensa no interior do seio maxilar em uma criança com transplante hepático e órgãos dentais pigmentados por hiperbilirrubinemia. DESCRIçÃO DO CASO: Paciente do sexo feminino, 12 anos de idade, com transplante hepático efetuado aos 7 anos de vida devido à atresia de vias biliares extra-hepática, uso de tacrolimus imunossupressor (2 mg diários). No exame clínico intrabucal, observou-se a presença de pigmentação esverdeada no órgão dental por bilirrubina. Efetuou-se um exame de tomografia computadorizada volumétrica de feixe cônico para análise da densidade radiográfica dos elementos dentais pigmentados. Mediante interpretação da imagem pela escala de Hounsfield, não foi constatada nenhuma alteração na densidade radiográfica das estruturas do órgão dental. No entanto, a tomografia computadorizada evidenciou a presença de calcificação distrófica intensa em região de seio maxilar. COMENTÁRIOS: A alteração de imagem observada no exame de tomografia computadorizada demonstrou achado radiográfico relevante, com presença de radiopacidades no interior do seio maxilar decorrentes de sinusites fúngicas ou não fúngicas. O relato desse caso é relevante por apresentar alteração de imagem radiográfica exacerbada associada a quadros infecciosos agudos que podem comprometer o estado sistêmico do paciente imunossuprimido.

[Imploding antrum syndrome: three cases with different management approaches]. / Síndrome de implosión maxilar: tres casos y sus diferentes abordajes de tratamiento.

BACKGROUND: Silent sinus or imploding antrum syndrome is a very rare condition, consisting of a usually asymptomatic spontaneous collapse of the sinus walls and floor of the orbit. It is associated with negative pressures, and when this occurs, it presents with manifestations such as enophthalmos, hypoglobus, and tilt flow orbital floor. As its incidence is very low, it is frequently missed as a diagnosis, and in fact there are currently fewer than 150 cases reported in the literature. CLINICAL CASES: Three patients have been identified in our practice over a period of two years, with different symptoms that influenced the decision of the treatment modality, which were: watch and wait, endoscopic sinus surgery, or endoscopic sinus surgery plus orbitoplasty. CONCLUSIONS: Despite being a rare entity, it stills catches the attention of the ENT, OMF surgery and Ophthalmologist. The diagnosis is mainly radiological, due to the late clinical manifestations and symptomatology. The treatment should be individualised and based on the symptoms and the individual decision of each patient, firstly by Functional Endoscopic sinus surgery, and once sinus permeability is restored, it may require augmentation surgery of the orbital floor, either with autologous bone implant, titanium or other material. It is important to be aware of this pathology, to know and to suspect it, avoiding misdiagnosis.

Isolated Xanthoma Of The Sphenoid Sinus: A Rare Presentation.

OBJECTIVE: To present the first case in the English literature of a sphenoid xanthoma. METHODS: Case Report DISCUSSION: A 36 year-old Hispanic female with past medical history of Hashimoto's hypothyroidism and family history of hyperlipidemia that presented with a 1-year history of sporadic left sided epistaxis. A paranasal sinus Computed Tomography (CT) was performed revealing a soft tissue lesion infiltrating the left sphenoid sinus. Patient underwent endoscopic sinus sphenoidotomy with intraoperative findings of a yellow-tan, friable soft tissue mass filling the left sphenoid sinus. Biopsies were taken which exhibited histologically findings consistent with a xanthoma. CONCLUSION: In a patient with hyperlipidemia isolated lesions on paransasal sinuses can be related to xanthoma formation.

Zigomicose rino facial: relato de caso / Rhino facial zygomycosis: case report

A zigomicose é uma doença invasiva, que acomete tanto imunocompetentes como imunocomprometidos, dependendo do tipo da cepa. O diagnóstico é clínico e histopatológico, e o tratamento é baseado em antifúngico e em limpeza cirúrgica. O presente relato de caso é sobre um menino com zigomicose rinofacial invasiva com tratamento final bem-sucedido, após terapias antifúngicas e limpezas cirúrgicas.

Zygomycosis is an invasive disease that affects both immunocompetent and immunocompromised, depending on the type of strain. This disease diagnosis is clinical and histopathological, and its treatment is based on antifungal therapy and surgical cleaning. This paper reports a case of a boy with invasive zygomycosis rinofacial who final treatment was successful after underwent antifungal and surgical therapies.

Rhino facial zygomycosis: case report.

Zygomycosis is an invasive disease that affects both immunocompetent and immunocompromised, depending on the type of strain. This disease diagnosis is clinical and histopathological, and its treatment is based on antifungal therapy and surgical cleaning. This paper reports a case of a boy with invasive zygomycosis rinofacial who final treatment was successful after underwent antifungal and surgical therapies.

Rapid, low-cost MR imaging protocol to document central nervous system and sinus abnormalities prior to pediatric hematopoietic stem cell transplantation.

Patients undergoing bone marrow transplant (BMT) are at risk for infectious complications, including those of the sinus. Central nervous system (CNS) abnormalities related to the chemotherapy or radiation that the patient received for the treatment of underlying malignancy or to transplant-related effects are also commonly seen. The only effective way to differentiate pre- and post-transplant causes is to have a baseline evaluation prior to the admission for transplant. The current method used to evaluate these patients is head CT. However, CT is not accurate to demonstrate CNS abnormalities and exposes the patient to radiation. MRI, despite better sensitivity for white matter abnormalities, has not been routinely used because of the higher cost and longer duration of the exam. Therefore, we designed a fast, low-cost and radiation-free MRI-based protocol to simultaneously evaluate sinus and brain abnormalities.

Diagnosis and treatment of isolated sphenoid sinus disease: a review of 109 cases.

CONCLUSION: Endoscopic transethmoidal sphenoidotomy performed mainly in the early stages of the pathology and by expert hands is [WX1]very effective in treating isolated sphenoid sinus disease. OBJECTIVE: This study aimed to investigate the causes of isolated sphenoid sinus disease identified in 109 patients and report on the most appropriate diagnostic and therapeutic patterns for an earlier diagnosis and a successful treatment of the disease. SUBJECTS AND METHODS: A total of 109 subjects with various isolated sphenoid pathologies were first examined by general objective examination, nasal sinus endoscopy, CT scan of paranasal sinuses, and in some cases with MRI. Then, they underwent medical and/or surgical treatment. RESULTS: Nineteen patients (17.43%) had isolated sphenoiditis, 6 (5.5%) fungal sinusitis, 30 (27.52%) mucocele, 6 (5.5%) fibrous dysplasia, 6 (5.5%) meningoencephalocele, 5 (4.58%) inverted papilloma, 4 (3.66%) epidermoid carcinoma, 10 (9.17%) liquor fistula, 1 (0.9%) rhabdomyosarcoma, 1 (0.9%) chordoma, and 1 (0.9%) had carotid pseudoaneurysm. Evidence of definitive diagnosis by endoscopy was obtained in less than half of the cases. CT scan, however, sometimes in combination with MRI, determined the pathology in all the cases. A follow-up of at least 4 years post-surgery showed good results in all the patients who underwent endoscopic transethmoidal sphenoidotomy.

A importância clínica das variações anatômicas dos seios paranasais / The clinical importance of the anatomic variations in the paranasal sinuses

As variações anatômicas dos seios paranasais são achados comuns. A importância dessas variantes predispondo a doenças, em consequência da obstrução do complexo ostiomeatal de drenagem, já foi discutida por vários autores, ainda não sendo tema de consenso. Neste trabalho foram realizadas revisão da literatura e ensaio iconográfico com o objetivo de discutir a importância das principais variantes anatômicas dos seios paranasais. A prevalência das variantes anatômicas dos seios paranasais difere muito entre os estudos e seu papel na gênese das sinusopatias é controverso. Neste artigo são descritas as diferentes variantes que têm apresentado relação com a doença sinusal e como se relacionam com condições patológicas. A maior parte dos estudos confirma o conceito de que as variantes anatômicas estão relacionadas a sinusopatias quando prejudicam as vias de drenagem. O conhecimento dessas alterações e suas relações com condições patológicas é uma habilidade que se espera do radiologista geral.

The anatomic variations of the paranasal sinuses are common findings. The importance of such variations predisposing disease through the obstruction of the drainage pathway has been discussed by several authors, although it is not yet a matter of agreement. The literature was reviewed and a iconographic assay wasprepared aiming the discussion of the importance of the main anatomic variations of the paranasal sinuses. The prevalence of anatomic variations of the paranasal sinuses varies largely amongststudies and its role in sinus disease is controversial. In this article, it is described the different variations associated to paranasal disease and how they relate to pathologic conditions. Most studies confirm the concept that anatomic variations of the paranasalsinuses are related to disease when they obstruct the drainage pathways. The knowledge of such alterations and its relations to pathologic conditions is expected from the general radiologist.

Histological aspects of rhinosinusal polyps.

UNLABELLED: Contemporary cohort cross-sectional study. INTRODUCTION: Despite its importance for an accurate diagnosis, histology differences among nasal polyps and its clinical implications are rarely reported in the literature. The existing papers classify polyp samples without concern for prior treatments, which could influence the results attained. AIMS: carry out a morphological study, through light microscopy, of nasal polyps' structural alterations in the absence of any type of prior treatment and histologically classify it in relation to studies published in the literature. MATERIALS AND METHODS: We studied 89 patients with nasosinusal polyps without prior treatment. Polyp samples were collected by outpatient biopsy and analyzed through light microscopy after dyeing with hematoxylin-eosin. RESULTS: Samples were classified in the following way: Edematous or eosinophilic polyp 65 cases (73%); fibro-inflammatory polyp: 16 cases (18%); Polyp with Sero-mucinose gland hyperplasia: 06 cases (6.7%) and polyp with stroma atypia: 2 cases (2.3%). DISCUSSION: eosinophilic pattern prevailed in the patients with nasosinusal polyps of the population studied. This pattern is similar to the ones found in the major studies, which, however, do not mention prior treatment. CONCLUSION: after analyzing the polyps' histological characteristics, we noticed that the untreated polyps present a predominantly eosinophilic pattern.

Aspectos histológicos do pólipo rinossinusal / Histological aspects of rhinosinusal polyps

Estudo de coorte contemporânea com corte transversal. As diferenças histológicas dos pólipos nasais e a sua possível implicação clínica são escassas em literatura, apesar de sua importância para um diagnóstico preciso. Os trabalhos existentes classificam amostras de pólipos sem a preocupação quanto à influência de tratamentos prévios, o que influenciaria o resultado obtido. OBJETIVO: Estudar morfologicamente, através da microscopia ótica, as alterações estruturais do pólipo nasal na ausência de qualquer tratamento prévio e classificá-lo, histologicamente, correlacionando com os estudos de literatura. MATERIAL E MÉTODOS: Foram estudados 89 pacientes com polipose rinossinusal sem tratamento prévio. As amostras dos pólipos foram colhidas por biópsia ambulatorial e analisadas através de microscopia ótica após coloração com hematoxilina e eosina. RESULTADOS: As amostras foram classificadas da seguinte forma: pólipo Edematoso ou Eosinofílico: 65 casos (73 por cento); pólipo Fibroinflamatório: 16 casos (18 por cento); pólipo com Hiperplasia de Glândulas Seromucinosas: 06 casos (6,7 por cento) e pólipo com Atipia de Estroma: 2 casos (2,3 por cento). DISCUSSÃO: O padrão eosinofílico predominou nos pacientes com polipose rinossinusal na população estudada. Este padrão assemelha-se com os principais estudos que, no entanto não mencionam sobre tratamentos prévios. CONCLUSÃO: Após análise das características histológicas dos pólipos, observou-se que pólipos não tratados apresentam um padrão predominantemente eosinofílico.

Contemporary cohort cross-sectional study. Introduction: Despite its importance for an accurate diagnosis, histology differences among nasal polyps and its clinical implications are rarely reported in the literature. The existing papers classify polyp samples without concern for prior treatments, which could influence the results attained. AIMS: carry out a morphological study, through light microscopy, of nasal polyps' structural alterations in the absence of any type of prior treatment and histologically classify it in relation to studies published in the literature. MATERIALS AND METHODS: We studied 89 patients with nasosinusal polyps without prior treatment. Polyp samples were collected by outpatient biopsy and analyzed through light microscopy after dyeing with hematoxylin-eosin. RESULTS: Samples were classified in the following way: Edematous or eosinophilic polyp 65 cases (73 percent); fibro-inflammatory polyp: 16 cases (18 percent); Polyp with Sero-mucinose gland hyperplasia: 06 cases (6.7 percent) and polyp with stroma atypia: 2 cases (2.3 percent). DISCUSSION: eosinophilic pattern prevailed in the patients with nasosinusal polyps of the population studied. This pattern is similar to the ones found in the major studies, which, however, do not mention prior treatment. CONCLUSION: after analyzing the polyps' histological characteristics, we noticed that the untreated polyps present a predominantly eosinophilic pattern.

Odontogenic keratocyst in maxillary sinus with invasive behaviour.

Odontogenic keratocyst is a cystic lesion characterized by a high rate of recurrence. This report describes a rare case of ciliated epithelium-lined odontogenic keratocyst in the maxilla of a 27-year-old female. Panoramic radiography showed a lytic lesion on the right maxilla associated with an impacted molar tooth. Computerized tomography image revealed the involvement of the lesion with the right maxillary sinus, destroying the sinus floor. Histopathologically, the typical keratinized epithelial-lined cyst of odontogenic keratocyst abruptly changed into a ciliated epithelium, suggesting the fusion of both these epithelia rather a metaplastic transformation. The biological behaviour of odontogenic keratocysts is discussed.

Estudo retrospectivo de dez anos em endoscopia das cavidades nasais de pacientes com hanseníase / A ten-year historic study of paranasal cavity endoscopy in patients with leprosy

A hanseníase é uma doença infecciosa de evolução crônica, causada pelo Mycobacterium leprae. Acomete com freqüência a mucosa das cavidades nasais, independentemente da forma clínica, antes mesmo do aparecimento de lesões na pele ou em outras partes do corpo, na presença ou não de queixas clínicas. OBJETIVO: Mostrar a eficácia da endoscopia nasal na identificação de lesões mucosas endonasais e a importância do especialista Otorrinolaringologista no diagnóstico e no acompanhamento dos pacientes com hanseníase. FORMA DE ESTUDO: Clínico retrospectivo. MATERIAL E MÉTODO: Realizou-se estudo retrospectivo de 173 prontuários de pacientes, sem tratamento prévio, durante o período de 1990 a 2000, no Serviço de Otorrinolaringologia do Instituto de Pesquisa Clínica do Hospital Evandro Chagas Fiocruz. RESULTADOS: Todos os pacientes apresentaram lesões nasais, sendo 121 com e 52 sem queixas clínicas. DISCUSSÃO: O exame endoscópico das cavidades nasais não só permitiu identificar precocemente alterações da mucosa em pacientes com hanseníase como também permitiu identificar a evolução das lesões. Este tipo de exame também auxilia na instituição do tratamento local. CONCLUSÃO: Justificam-se a avaliação e o acompanhamento de todos os pacientes com hanseníase pelo Otorrinolaringologista junto à equipe multidisciplinar, oferecendo ao paciente a precocidade no diagnóstico e o tratamento específico.

A ten-year historic study of paranasal cavity endoscopy in patients with Leprosy.

UNLABELLED: Leprosy is an infectious condition that has a chronic evolution caused by the Mycobacterium leprae. It very often attacks the nasal cavities mucosa independent of its clinical form, even before skin lesions or lesions to other parts of the body arise, in the presence or not of clinical complaints. AIM: To show the efficiency of nasal endoscopy to identify endonasal mucosa lesions and the importance of the Otorhinolaryngologist in the diagnosis and follow-up of Leprosy patients. STUDY DESIGN: Clinical history study. MATERIAL AND METHOD: A historic study was performed with 173 patient's records without previous treatment from 1990 to 2000 at the Otorhinolaryngology Services, Instituto de Pesquisas Clinicas Hospital Evandro Chagas, Fiocruz. RESULTS: All of the patients showed nasal lesions, 121 with and 52 without clinical complaints. DISCUSSION: Nasal cavities endoscopy exam enabled early identification of the mucosa alteration in Leprosy patients as well as how to identify the evolution of the lesions. This type of exam also helps to establish local treatment. CONCLUSION: The evaluation and follow-up of Leprosy patients by the Otorhinolaryngologist in a multidisciplinary team are justified and offer the patient early diagnosis and specific treatment.

Eosinophilic angiocentric fibrosis of the sinonasal tract: report on the clinicopathologic features of a case and review of the literature.

BACKGROUND: Eosinophilic angiocentric fibrosis (EAF) is a rare fibroinflammatory lesion of the sinonasal tract that occurs mainly in young to middle-aged female patients. Only two previous cases affecting male patients have been reported, and its etiopathogenesis remains unknown. The authors report on the third case of the entity in a male patient and review the 12 previously reported cases. CASE REPORT: A 52-year-old male patient was initially seen with a 15 years history of allergic rhinitis, progressive nasal obstruction, and left-sided hearing loss. All laboratory tests were unremarkable, except the nasal discharge eosinophil count that showed a conspicuous eosinophilia. The video-assisted-nasofibroscopic examination and CT scans disclosed a thickened deviated nasal septum with a subjacent infiltrative lesion. The histologic analysis of the nasal septum showed a variable mixed inflammatory cellular infiltration mainly composed of eosinophils, plasma cells, and histiocytes with a perivascular distribution; in other areas, an angiocentric fibrosing lesion with a peculiar perivascular onion-skin pattern was observed. The patient had a partial resection of the lesion with symptomatic control. CONCLUSIONS: The presence of rhinitis and nasal eosinophilia in our case associated with the clinical aspects of the previously reported cases further support an allergic cause for EAF.

Polipose sinonasal: avaliaçäo por tomografia computadorizada / Sinonasal polyposis: evaluation by computed tomography

Foram analisados, neste trabalho, os aspectos clínicos e tomográficos observados em 30 pacientes com polipose sinonasal, estudados no Hospital Universitário Clementino Fraga Filho da UFRJ, no período de dezembro de 1995 a agosto de 1997. Os sintomas clínicos mais comuns foram obstruçäo nasal e rinorréia. Os principais achados tomográficos observados foram massas polipóides na cavidade nasal, alargamento do infundíbulo, atenuaçäo das trabéculas ósseas das células etmoidais e opacificaçäo pansinusal parcial ou completa. Na polipose sinonasal, a tomografia computadorizada auxilia na escolha da modalidade de tratamento adequada, embora näo possa fazer diagnóstico histológico específico

Endoscopic sinus surgery: 4-year follow-up on the first 100 patients.

Endoscopic sinus surgery has been reported to be successful, but lack of a standardized classification system hampers comparison of results between studies, and long-term results of surgery have not been reported in a series of consecutive patients. The results of our first 100 endoscopic sinus surgery procedures, reported previously after an average 9-month follow-up, were reviewed with the application of a new classification scheme and in light of a longer (4-year) follow-up. Surgery was successful in all patients whose sinus symptoms resulted from anatomical variations or suppurative infection, but failed in some patients with hyperplastic disease or polyps. In addition, the presence of reactive airway disease or the acetylsalicylic acid (ASA) triad was a bad prognostic sign. The overall success of the procedure in relieving sinus symptoms decreased from 98% at early follow-up to 91% at 4-year follow-up. Sixty-six percent were successful after one procedure and 25% required more than one procedure to achieve success. The decline in success since our first report in 1990 was mostly attributable to late failure in patients with recurrent symptomatic polyposis. Because symptoms may not recur in these patients for up to 3 years, long-term results of surgery for this disorder are necessary. Symptoms of recurrent polyposis can be controlled medically or by revision surgery.