Isolated Meningitis and Lacrimal Gland Abscess due to Odontogenic Sinusitis: Case Report / Meningitis Aislada y Absceso de la Glándula Lagrimal debido a Sinusitis Odontogénica: Reporte de un Caso

ABSTRACT: Our objective was report an extremely rare case of isolated meningitis and suppurative dacrioadenitis as consequences of odontogenic sinusitis. We describe the diagnostic tools including imaging and culture, as well as surgical treatment and follow-up. Our final diagnosis was odontogenic sinusitis caused by Streptococcus Anginosus complicated by isolated meningitis and lacrimal gland abscess. Urgent surgical treatment to restore the paranasal sinuses and drainage of the lacrimal gland was performed. Culture from purulent material collected from maxillary sinus indicated the targeted therapy. Clinical assessment and imaging obtained 20 days after surgery demonstrated successful results. This case emphasizes the importance of evaluating intracranial complications of rinosinusitis, the need to search for a dental infection when a maxillary sinusitis is encountered, the key role of a thorough diagnostic workup in order to plan a comprehensive and effective surgical treatment, as well as targeted medical therapy.

RESUMEN: En este estudio se informa un caso extremadamente raro de meningitis aislada y dacrioadenitis supurativa, como consecuencia de sinusitis odontogénica. Describimos las herramientas de diagnóstico que incluyen imágenes y cultivo, como también el tratamiento quirúrgico y el seguimiento. El diagnóstico final fue de sinusitis odontogénica causada por estreptococo anginoso complicado por una meningitis aislada y el absceso de la glándula lagrimal. Se realizó un tratamiento quirúrgico de urgencia para restaurar los senos paranasales y drenar la glándula lagrimal. Se determinó el tratamiento de acuerdo a los resultados de cultivo del seno maxilar. La evaluación clínica y las imágenes obtenidas 20 días después de la cirugía demostraron resultados exitosos. Es importante la evaluación de las complicaciones intracraneales de la rinosinusitis además de la necesidad de considerar una infección dental frente a una sinusitis maxilar. Por otra parte, es clave una evaluación exhaustiva de diagnóstico para planificar un tratamiento quirúrgico completo y efectivo, así como el tratamiento médico.

Treatment and prognostic factors of papillary thyroid microcarcinoma.

OBJECTIVE: To discuss the prognostic factors and outcomes of treatment in patients diagnosed with papillary thyroid microcarcinoma. DESIGN: Retrospective observational case review. SETTING: Department of Otorhinolaryngology of the tertiary referral teaching hospital of Parma. PARTICIPANTS: Ninety-seven patients diagnosed with PTMC and surgically treated between January 1998 and December 2007. MAIN OUTCOME MEASURES: Clinical and histopathological characteristics of the study group were identified and statistically analysed. RESULTS: No cancer-related deaths were registered. Incidence of recurrent disease was 9% after a 43 month mean follow-up (range 12-120). Univariate analysis detected that metastases in neck lymph nodes at diagnosis (p = 0.025), a tumour >5 mm in size (p = 0.011), the presence of bilateral tumoural foci (p = 0.007), the presence of capsular invasion (p = 0.001), and the presence of vascular invasion (p = 0.004) were related to recurrent disease. On multivariate analysis, the presence of bilateral tumoural foci (p = 0.030), and the presence of capsular invasion (p = 0.005) were significantly related to tumour recurrence. CONCLUSION: The prognosis for patients with papillary thyroid microcarcinoma in this series was excellent, with a 100% survival rate and minimal surgical-related morbidity. Nevertheless, approximately 10% of patients developed recurrent disease; aggressive treatment may be justified depending on the presence or absence of prognostic risk factors.

The role of surgery in children with head and neck rhabdomyosarcoma and Ewing's sarcoma.

Rhabdomyosarcoma and Ewing's sarcoma are relatively common malignant tumours in paediatric population. In the past, surgery was the mainstay of treatment and survival rates were poor. Afterwards, the development of multi-agent chemotherapy protocols during the past four decades resulted in a dramatic improvement in long-term survival. As a consequence, the significance of surgery has been the subject of critical discussion in the literature. Nowadays the standard treatment of rhabdomyosarcoma and Ewing's sarcoma consists in a multimodal therapy involving chemotherapy, radiotherapy and surgery. Nevertheless, the role of surgery still remains controversial. In particular, the cure of head and neck localizations presents debatable aspects since defined criteria to establish the risks and the benefits of surgical treatment do not exist at this time. This article reviews the role of surgery in children with head and neck rhabdomyosarcoma and Ewing's sarcoma. Indications, feasibility and timing criteria of surgical treatment have been reviewed and extracted from literature. Our case series is also presented.

Nasal septal abscess complicating isolated acute sphenoiditis: case report and literature review.

This report presents an extremely rare case of nasal septal abscess complicating acute sphenoiditis in a non-immunocompromised adult patient. A 56-year-old woman came to our emergency service with a 2 wk history of nasal obstruction, headache, and facial pain. A nontraumatic nasal septal abscess complicating acute isolated sphenoiditis was diagnosed. Under general anaesthesia, we drained the septal abscess and performed an endoscopic transnasal sphenoidotomy. Bacteriological cultures revealed viridans streptococci in the septal abscess and sphenoid cavity. We discuss the patient's diagnosis, possible complications, and treatment. There are limited reports in the literature on this subject. Our report emphasizes the need to determine whether an infection is associated with a non-traumatic nasal septal abscess. The incidence of severe complications is directly related to delays in diagnosis and treatment. Therefore, a prompt and correct diagnosis immediately followed by appropriate treatment is necessary.

Role of an anti-acetonemic diet in reducing the need for tonsillectomy in children with recurrent tonsillitis.

OBJECTIVE: The aim of this study was to investigate the effectiveness of an anti-acetonemic diet in reducing the need for tonsillectomy especially in the first years of life in children with recurrent tonsillitis. METHODS: From 2002 to 2005 we carried out a prospective randomized study enrolling 1200 children aged 2-10 who were referred to our outpatient services complaining of recurrent tonsillitis. Children were randomly assigned to the case group or to the control group. In case children, clinical signs of persistent ketosis were investigated and a hypolipidic anti-acetonemic diet was prescribed. We compared the mean age of children who underwent tonsillectomy and evaluated the association between an anti-acetonemic diet and avoidance of tonsillectomy. RESULTS: The association between an anti-acetonemic diet and avoidance of tonsillectomy was statistically significant; the mean age of case children who underwent tonsillectomy resulted significantly higher than that of control children. CONCLUSION: By prescribing an appropriate dietetic regimen we obtained a significant decrease in the number of tonsillectomies for recurrent tonsillitis and an increase in the mean age of the children treated surgically.