ABSTRACT
OBJECTIVE: This study aimed to examine the characteristics of nasal and imaging findings of sinonasal lesions in granulomatosis with polyangiitis (GPA) patients and how these lesions change over time in both the active and remission phases of the disease. METHODS: We retrospectively reviewed GPA patients with sinonasal lesions who were followed up at our department between January 2005 and December 2020. The following data were collected: age, sex, symptoms at initial presentation, anti-neutrophil cytoplasmic antibody (ANCA) type, and histopathological, nasal (initial and follow-up), and imaging (initial and follow-up) findings. RESULTS: This study included 17 patients with GPA aged 30 to 79 years. Computed tomography (CT) of the sinuses showed mucosal thickening in 16 patients, bone thickening in 12, bone destruction in 4, and an orbital invasion mass in 3 at the time of diagnosis. After initiating treatment, mucosal thickening of the sinuses improved in 3 of 16 patients and remained unchanged in 13. Bone thickening at the time of diagnosis remained unchanged in 10 of 12 patients and worsened in 2; 1 patient displayed newly developed bone thickening. Destructive nasal findings on CT were positive for proteinase 3-ANCA. CONCLUSIONS: Our study revealed that mucosal thickening, bone thickening, bone destruction, and orbital invasion mass were major CT findings in patients with GPA. Intranasal findings such as granulations, crusting, and necrosis were seen in the active phase; moreover, saddle nose, loss of turbinate, and nasal septal perforation were subsequently seen in the course of the disease. Sinonasal findings of GPA vary depending on the disease stage and period.
Subject(s)
Antibodies, Antineutrophil Cytoplasmic , Granulomatosis with Polyangiitis , Nasal Mucosa , Tomography, X-Ray Computed , Humans , Middle Aged , Granulomatosis with Polyangiitis/complications , Granulomatosis with Polyangiitis/diagnostic imaging , Granulomatosis with Polyangiitis/pathology , Male , Female , Retrospective Studies , Aged , Adult , Antibodies, Antineutrophil Cytoplasmic/immunology , Nasal Mucosa/pathology , Nasal Mucosa/diagnostic imaging , Paranasal Sinuses/diagnostic imaging , Paranasal Sinuses/pathology , Myeloblastin/immunology , Paranasal Sinus Diseases/diagnostic imaging , Paranasal Sinus Diseases/etiology , Paranasal Sinus Diseases/pathologyABSTRACT
INTRODUCCIÓN: La enfermedad aislada del seno esfenoidal es rara y representa el 1-2% de todas las patologías inflamatorias sinusales y < 0,05% de las lesiones malignas sinusales. Es difícil establecer el diagnóstico debido a la presentación clínica inespecífica. La cefalea frontal y/o retroocular es la principal manifestación. El retraso en el diagnóstico y tratamiento puede resultar en serias complicaciones debido a sus relaciones anatómicas. OBJETIVOS: Presentar nuestra experiencia en lesiones esfenoidales aisladas, analizando sintomatología, etiología, diagnóstico y tratamiento de las mismas...
INTRODUCTION: Isolated sphenoid sinus disease is rare and accounts for1-2% of all inflammatory sinus pathologies and <0.05% of malignant sinus lesions. It is difficult to establish the diagnosis due to its nonspecific clinical presentation. Frontal and/or retro-ocular headache is the main symptom. Delay in diagnosis and treatment can result in major complications due to their anatomical relationships. OBJECTIVE: Present our experience in isolated sphenoid injuries, through the analysis of symptomatology, etiology, diagnosis and treatment of them...
INTRODUÇÃO: a doença isolada do seio esfenoidal é rara e representa entre 1% e 2% de todas as patologias inflamatórias sinusais e menos de 0,05% das lesões malignas sinusais. É difícil estabelecer o diagnóstico devido a apresentação clínica inespecífica. A cefaleia frontal e/ou retro-ocular é a principal manifestação. O atraso no diagnóstico e no tratamento pode causar complicações sérias devido à suas relações anatômicas. OBJETIVOS: Apresentar nossa experiência em lesões esfenoidais isoladas, analisando a sintomatologia, etiologia, diagnostico e o tratamento...
Subject(s)
Humans , Male , Adolescent , Adult , Sphenoid Sinus , Sphenoid Sinus/surgery , Sphenoid Sinus/pathology , Paranasal Sinus Diseases/etiology , Signs and SymptomsABSTRACT
El mucocele es un tumor pseudoquístico poco frecuente en el seno maxilar y una rara complicación de la cirugía ortognática. El caso reportado describe la presentación de un mucocele que afecta parcialmente el seno maxilar y se presenta clínicamente como un tumor nasal. Se trata de una mujer de 44 años que, luego de 12 años de realizarse cirugías ortognáticas, presenta dolor facial y obstrucción de la fosa nasal derecha. La tomografía axial computarizada de senos paranasales revela una masa de contenido líquido que ocupa la mitad inferior del seno maxilar derecho, extendiéndose a la fosa nasal ipsilateral. La paciente es intervenida por vía endoscópica realizándose una marsupialización intranasal y meatotomía media, evolucionando satisfactoriamente en un seguimiento de dos años.
Mucoceles are not often found in the maxillary sinus, and is a rare surgery complication, in this case, orthognathic. This review describes a mucocele that partially occupies the right maxillary sinus, causing a chronic nasal obstruction. This is the case of a 44 year-old female patient, which after 12 years of several orthognathic surgeries, presents facial pain and right nasal obstruction. The paranasal sinus computed tomography reveals a mass with liquid content that occupies the lower part of the right maxillary sinus and compromises the right nasal cavity. The patient was treated with an intranasal marsupialization and a middle meatotomy with endoscopic nasal approach. Evolution was satisfactory two years after the intervention.
Subject(s)
Humans , Female , Adult , Paranasal Sinus Diseases/diagnostic imaging , Orthognathic Surgical Procedures/adverse effects , Maxillary Sinus/diagnostic imaging , Mucocele/diagnostic imaging , Paranasal Sinus Diseases/surgery , Paranasal Sinus Diseases/etiology , Facial Pain/etiology , Tomography, X-Ray Computed , Nasal Obstruction/etiology , Maxillary Sinus/pathology , Mucocele/surgery , Mucocele/etiologyABSTRACT
ABSTRACT INTRODUCTION: The proximity of the roots to the maxillary sinus can create a variety of risks. OBJECTIVE: To evaluate the relationship between the roots of healthy teeth and the maxillary sinus, as well as the occurrence of sinus pathologies. METHODS: Three radiologists analyzed 109 cone beam computed tomography (CBCT) images. The Kappa test was used to assess the intra- and inter-rater agreement. The chi-squared test and prevalence ratio were used to test the hypothesis that roots of healthy teeth in the maxillary sinus favored the occurrence of sinus pathologies ( p = 0.01). RESULTS: Intra- and inter-rater agreement ranged from good to excellent. The chi-squared test demonstrated a statistically significant difference ( p = 0.006) between the tooth roots in diseased maxillary sinuses (6.09%) and those in normal sinuses (3.43%). The prevalence ratio test showed a statistically significant higher prevalence of tooth roots in diseased sinuses than in normal sinuses ( p < 0.0001). Roots in the maxillary sinus were 1.82 times more associated with diseased sinuses. CONCLUSION: Dental roots in the maxillary sinus are almost twice as likely to be associated with diseased sinuses than normal sinuses. Healthy teeth whose roots are inside the maxillary sinus may induce an inflammatory response in the sinus membrane. It is suspected that dental procedures may exacerbate the condition.
RESUMO INTRODUÇÃO: A proximidade das raízes com o seio maxilar pode criar uma variedade de riscos. OBJETIVO: Avaliar a relação entre as raízes dos dentes hígidos com o seio maxilar, assim como com a ocorrência de doenças sinusais. MÉTODO: Três radiologistas analisaram 109 imagens de tomografia computadorizada de feixe cônico (TCFC). O teste Kappa avaliou a concordância intra e interexaminadores. Os testes de Qui-quadrado e Razão de Prevalência foram utilizados para testar a hipótese de que raízes de dentes hígidos dentro do seio maxilar favorecem a ocorrência doenças sinusais (nível de significância = 0,01). RESULTADOS: A concordância intra e interexaminadores variou de boa a excelente. O teste Qui-quadrado mostrou uma diferença estatisticamente significante (p = 0,006) entre as raízes dentárias dentro do seio maxilar patológico (6,09%) e aquelas dentro do seio normal (3,43%). O teste de Razão de Prevalência mostrou uma ocorrência de raízes dentárias dentro de seios patológicos estatisticamente maior do que dentro de seios normais (p < 0,0001). As raízes dentro do seio maxilar foram encontradas 1,82 vezes mais associadas a seios patológicos. CONCLUSÃO: Raízes dentárias dentro do seio maxilar são quase duas vezes mais associadas a seios patológicos do que a seios normais. Dentes hígidos que têm raízes dentro do seio maxilar podem induzir uma resposta inflamatória da mucosa sinusal. Suspeita-se que procedimentos odontológicos possam agravar tal situação.
Subject(s)
Adolescent , Adult , Female , Humans , Male , Young Adult , Maxillary Sinus/physiopathology , Maxillary Sinus , Paranasal Sinus Diseases/etiology , Tooth Root , Case-Control Studies , Cone-Beam Computed Tomography , Image Processing, Computer-Assisted/methods , Maxillary Sinusitis/etiology , Maxillary Sinusitis , Molar , Observer Variation , Paranasal Sinus Diseases , Tooth Apex , Tooth SocketABSTRACT
The sphenoidal sinus mucocele is a pseudocystic lesion of paranasal cavity (CPN). These injuries are probably underdiagnosed as they may be asymptomatic or cause nonspecific symptoms. The CT scan and the MRI increase the precision of the preoperative evaluation. We present a case of sphenoid sinus mucocele in a patient of 69 years old, who was admitted at our institution with 1 month evolution of persistent headache. Clinical presentation, diagnosis and treatment of this case are discussed as well as the review of the literature...
Subject(s)
Humans , Male , Aged , Paranasal Sinus Diseases/diagnosis , Paranasal Sinus Diseases/etiology , Mucocele/diagnosis , Mucocele/etiology , Polyps/complications , Sphenoid SinusABSTRACT
La sinusitis aguda es un proceso inflamatorio de la mucosa de los senos paranasales, de etiología bacteriana principalmente. Es más frecuente en las edades escolares y en las épocas de mayor circulación de los virus respiratorios. Se desarrolla cuando se afecta el drenaje normal de los senos y se retienen las secreciones mucosas. Las complicaciones más severas, como celulitis y abscesos periorbitarios, son raras. La celulitis orbitaria es una entidad poco frecuente, cuya importancia radica en que puede asociarse a la pérdida de la visión y otras complicaciones. Se presenta el caso de un paciente de 6 años, afectado con celulitis orbitaria, secundaria a sinusitis, y se comentan las peculiaridades del diagnóstico y el tratamiento, con el objetivo de alertar al pediatra para su diagnóstico temprano, lo que optimizaría su tratamiento(AU)
The acute sinusitis is a inflammatory process of the mucosa of paranasal sinuses, the more important bacterial etiology. It is more frequent in the school ages and in the periods of more circulation of the respiratory viruses, which develops when the normal drainage of the sinuses is involved and there is retention of the mucosa secretions. The more severe complications including cellulitis and periorbital abscesses are rare. The orbital cellulitis is an entity not much frequent, whose significance lie in it may be associated to loss of vision and other complications. Authors present the case of a patient aged 6 presenting with orbital cellulitis, secondary to sinusitis and the particular feature of diagnosis and treatment to alert pediatrician for its early diagnosis, optimizing its treatment(AU)
Subject(s)
Humans , Male , Child , Orbital Cellulitis/diagnosis , Maxillary Sinusitis/complications , Maxillary Sinusitis/therapy , Tomography, Spiral Computed/methods , Paranasal Sinus Diseases/etiologyABSTRACT
Las primeras manifestaciones de algunas vasculitis ocurren en órganos de la cabeza y el cuello; sin embargo, pocos especialistas las diagnostican en forma temprana ya que las infecciones y la alergia son más comunes. Entre ellas, signos y síntomas como epistaxis, obstrucción nasal, rinorrea serosanguinolenta, dolor ardoroso en región nasosinusal, cefalea, pólipos e incluso costras nasales, pueden encontrarse en personas que viven en ciudades con altos índices de contaminación y baja humedad, en pacientes con infecciones como el escleroma respiratorio, en aquellos sometidos a radioterapia y como consecuencia de otras condiciones; sin embargo, bajo las costras pueden crecer microorganismos como Staphylococcus aureus y también pueden hallarse señales que se pueden relacionar con vasculitis activa. El otorrinolaringólogo es uno de los primeros médicos a los que acuden pacientes con estos signos y síntomas, por lo que reconocer estas manifestaciones e integrar diagnósticos más oportunos en colaboración con otros especialistas es importante. Debido a la frecuencia con la que presentan como primeros signos y síntomas los otorrinolaringológicos, seleccionamos tres enfermedades vasculíticas para este artículo: granulomatosis con poliangitis (Wegener), el síndrome de Churg Strauss y la policondritis recurrente (AU)
First manifestations of vasculitis can appear on the head and neck, still few physicians are aware of these diseases, as they are unspecific and because other conditions like infections and allergies are more frequent. Among them, signs and symptoms like epistaxis, nasal obstruction, discharge, burning pain of sinonasal region, headache, sinus polyps and crusts, the latter found in people who live in highly polluted cities with low humidity, in patients with respiratory scleroma, atrophy, those receiving local radiotherapy, and due to other conditions. Under the crusts, many infectious agents, like Staphylococcus aureus may grow and, in addition, other signs related to active vasculitis may be found. The ENT specialist is one of the first physicians visited by patients with these signs and symptoms. Their recognition is important to readily diagnose these diseases. We have selected three vasculitidies for discussion in this paper: granulomatosis with polyangiitis (Wegener), Chrug-Strauss syndrome and relapsing polychondritis, since these three diseases present initial ENT problems with high frequency (AU)
Subject(s)
Humans , Physician's Role , Otolaryngology , Systemic Vasculitis/complications , Systemic Vasculitis/diagnosis , Systemic Vasculitis/pathology , Systemic Vasculitis/therapy , Paranasal Sinus Diseases/diagnosis , Paranasal Sinus Diseases/etiology , Churg-Strauss Syndrome/diagnosis , Churg-Strauss Syndrome/therapy , Diagnosis, Differential , Diagnostic Techniques, Otological , Diagnostic Techniques, Respiratory System , Granulomatosis with Polyangiitis/diagnosis , Granulomatosis with Polyangiitis/therapy , Laryngeal Diseases/diagnosis , Laryngeal Diseases/etiology , Nasal Obstruction/diagnosis , Nasal Obstruction/etiology , Oral Ulcer/diagnosis , Oral Ulcer/etiology , Polychondritis, Relapsing , Salivary Gland Diseases/diagnosis , Salivary Gland Diseases/etiologyABSTRACT
Se presentan dos casos clínicos del Servicio de Otorrinolaringología (SORL) del Hospital Barros Luco Trudeau (HBLT) con diagnóstico de Pneumosinus dilatans (PD). El PD es una rara condición, que se presenta como una dilatación anormal de uno o varios senos paranasales (SP) sin evidencia de compromiso óseo ni mucoso, que se asocia a dolor y deformidad facial. La tomografía computada (TC) permite hacer el diagnóstico; el tratamiento es quirúrgico y está orientado a descomprimir el o los SP comprometidos; con lo anterior se logra la erradicación del dolor, pero la deformidad facial persiste.
Two clinical cases with a diagnosis of pneumosinus dilatans (PD) from the Servicio de Otorrinolaringología (SORL) of Hospital Barros Lucos-Trudeau (HBLT) are presented. PD is a rare condition in which an abnormal enlargement of one or several paranasal sinuses (PS) is present, with no evidence of bone or mucosa involvement. It is associated with facial pain and deformity. Diagnosis is based on CT scan; treatment is surgical and it is oriented to decompress the PS involved, eradicating pain but with a persisting facial deformity.
Subject(s)
Humans , Male , Female , Adult , Aged , Dilatation, Pathologic/surgery , Dilatation, Pathologic/diagnosis , Paranasal Sinus Diseases/surgery , Paranasal Sinus Diseases/diagnosis , Dilatation, Pathologic/etiology , Paranasal Sinus Diseases/etiologyABSTRACT
O diagnóstico das doenças dos seios paranasais tem sido elucidado mais claramente nos últimos anos com a juda da endoscopia nasal e tomografia computadorizada. O objetivo dos autores é chamar a atençäo para a importância do diagnóstico causal de origem rinogênica nos pacientes portadores de sinisites de repetiçäo. A necessidade do tratamento da causa básica nesses casos é indiscutível, evitando-se assim a instalaçäo de processos sinusais crônicos e suas complicaçöes
Subject(s)
Humans , Child , Sinusitis/diagnosis , Paranasal Sinus Diseases/etiology , Recurrence , Sinusitis , Sinusitis/etiologyABSTRACT
We present a case of aspergilosis of the paranasal sinuses in a female patient, who is otherwise in good health (AU)