Paranasal sinus infection causing orbital subperiosteal abscess: Surgical management of this devastating entity

Background: Orbital infection is an uncommon devastating infection and is usually a complication of paranasal sinus infection. Without appropriate treatment, orbital infection may lead to serious complications, even death. Prompt treatment is mandatory to avoid visual loss or intracranial complications. The literature shows that initially, intravenous antibiotics should be administered, and after 48 h, if no improvement appears, the affected orbit and the sinuses must be surgically drained. The authors describe two cases of orbital cellulitis with a brief literature review. Case report: The authors describe two cases of orbital abscess caused by paranasal sinus infection. In case 1, the patient presented a decreased visual acuity associated with ophthalmoplegia of the right eye. In case 2, the patient presented a decreased visual acuity. Thus, administration of intravenous antibiotic combined with surgical drainage was performed. After surgical procedure, eye movements were normalized in case 1, and in both patients, the visual acuity returned to normal parameters. Discussion: The authors recommend early surgical drainage with parenteral antibiotic administration and careful postoperative observations by monitoring the signs and symptoms of the orbital complaint. © 2012 Springer-Verlag.

Osteoma do etmóide com invasão orbitária: relato de três casos e revisão da literatura

São apresentados três raros casos de osteoma do etmóide, com extensão para o quadrante medial da órbita e que apresentavam algumas particularidades que os tornavam ainda mais inusitados, como terem acontecido em mulheres, em faixa etária não usual e com queixa de epífora. Os achados radiográficos foram típicos da afecção e os casos foram operados, com resolução do problema.

Massa paranasal: dacrioestenose congênita? Relato de caso

O objetivo deste é descrever uma criança portadora de massa paranasal, atentando para a importância dos diagnósticos diferenciais. RELATO do CASO: ACS, 6 meses, sexo feminino, desde o nascimento apresentando abaulamento não inflamatório, no canto medial do olho esquerdo, lacrimejamento e hiperemia no olho direito. Ao exame apresentava fenômeno de Bell negativo bilateral, lagoftalmo à direita, ulceração e opacidade corneana à direita; presença de lesão arredondada, de superfície lisa no canto medial do olho esquerdo, sem sinais inflamatórios, medindo aproximadamente 2 cm de diâmetro, não pulsátil. À palpação, a lesão era elevada, de consistência fibroelástica, imóvel, indolor, irredutível. À propedêutica das vias lacrimais, não havia refluxo à compressão, o teste de Milder foi negativo em ambos olhos e as vias apresentavam-se pérvias à dacriocistografia. O exame tomográfico revelou tratar-se de meningocele fronto-etmoidal. COMENTÁRIOS: Os autores chamam a atenção para a adequada semiologia para a investigação das massas paranasais, a fim de se instituir o adequado tratamento.

Noninvasive aspergillosis as a maxillary antrolith: report of a rare case.

Maxillary antrolithiasis is characterized by masses of tissue of endogenous or exogenous origin that calcify within the maxillary sinuses. Aspergillosis is a fungal disease in which the maxillary sinus is a primary site of infection. Aspergillosis mycetoma, its noninvasive form, is the most prevalent modality of the disease in the maxillary sinuses. In approximately half of the cases reported in the literature, calcification of the fungal mycelia, which later became antroliths, was verified. This article reports a rare case of the accidental discovery of a maxillary antrolith associated with noninvasive aspergillosis in an immunocompetent and asymptomatic 56-year-old woman. The diagnosis and therapeutic procedures used in treating the patient are discussed as well as the probable iatrogenic origin of the fungal pathology.

Peripheral osteoma in the ramus of mandible: report of case

The osteomas are benign rare neoplasms, generally asymptomatic which are characterized by the proliferation of a compact or spongy bone. When they are situated in the maxillofacial area, they affect mainly the mandible, the frontal bone and the paranasal sinus. We have described the case of a female caucasian patient who presented an increased volume in the posterior region of the oral vestibule on the left side. During the clinical examination an oral lesion was observed in the region of the left ramus of mandible. This lesion was motionless, consistent, and painless when palpated. In the image obtained from the computed tomography cone–beam (CBCT), we could observe an hyperdense, cylindrical region, with well defined borders, located in the medial surface of the left ramus of mandible, right below the mandibular notch. Based on clinical data and in the obtained images, we could confirm the presence of the peripheral osteoma in the left side of the ramus of mandible region.

Limitations of balloon sinuplasty in frontal sinus surgery

Balloon sinuplasty is a tool that is used to treat selected patients with paranasal sinus pathologies. No studies have investigated the aetiology of failed access to the frontal sinus. The aim of our study was to specify the intraoperative technical failure rate and to analyse the aetiology of the failed access to predict potential technical difficulties before surgery. We retrospectively analysed the charts of patients who underwent balloon sinuplasty from November 2007 to July 2010 at three different ENT-Centres. CT-analysis of the patients with failed access was performed. Of the 104 frontal sinuses, dilation of 12 (12%) sinuses failed. The anatomy of all failed cases revealed variations in the frontal recess (frontoethmoidal-cell, frontal-bulla-cell or agger-nasi-cell) or osteoneogenesis. In one patient, a lymphoma was overlooked during a balloon only procedure. The lymphoma was diagnosed 6 months later with a biopsy during functional endoscopic sinus surgery. In complex anatomical situations of the frontal recess, balloon sinuplasty may be challenging or impossible. In these situations, it is essential to have knowledge of classical functional endoscopic sinus surgery of the frontal recess area. The drawbacks of not including a histopathologic exam should be considered in balloon only procedures.

Radiologic identification of disaster victims: a simple and reliable method using CT of the paranasal sinuses

To assess the reliability of radiologic identification using visual comparison of ante and post mortem paranasal sinus computed tomography (CT).

Bacterial Meningitis After Sinus Surgery in Five Adult Horses.

OBJECTIVE To report meningoencephalitis as a complication after paranasal sinus surgery in 5 horses. STUDY DESIGN Case series. ANIMALS Adult horses (n = 5). METHODS Medical records (2005-2010) of 5 horses that developed neurologic signs after sinus surgery were reviewed to identify potential risk factors, cause(s), or common pathways for infection. RESULTS Underlying diseases were primary (n = 1) and secondary sinusitis (4) because of apical dental infection (1), sinus cyst (2), or masses in the ethmoturbinate region (2). Horses were treated by conventional surgical approaches and aftercare including repeated sinus lavage. Four horses had undulating pyrexia postoperatively despite antimicrobial therapy. All horses developed neurologic signs, eventually unresponsive to treatment. Suppurative meningoencephalitis was diagnosed macro- and/or microscopically on necropsy in all horses. CONCLUSION Meningitis is a rare but fatal complication after sinus surgery in horses.

Monte Carlo evaluation of collapsed-cone convolution calculations in head and neck radiotherapy treatment plans

The presence of air and bone interfaces makes the dose distribution for head and neck cancer treatments difficult to accurately predict. This study compared planning system dose calculations using the collapsed-cone convolution algorithm with EGSnrcMonte Carlo simulation results obtained using the Monte Carlo DICOMToolKit software, for one oropharynx, two paranasal sinus and three nodal treatment plans. The difference between median doses obtained from the treatment planning and Monte Carlo calculations was found to be greatest in two bilateral treatments: 4.8%for a retropharyngeal node irradiation and 6.7% for an ethmoid paranasal sinus treatment. These deviations in median dose were smaller for two unilateral treatments: 0.8% for an infraclavicular node irradiation and 2.8% for a cervical node treatment. Examination of isodose distributions indicated that the largest deviations between Monte Carlo simulation and collapsed-cone convolution calculations were seen in the bilateral treatments, where the increase in calculated dose beyond air cavities was most significant.

Pathology and Tissue Distribution of Turkey Coronavirus in Experimentally Infected Chicks and Turkey Poults

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Tosse, uma visão do otorrinolaringologista.

Persistent cough leads individuals to seek for medical assistance. Clinical investigation, however, may not reveal any alteration within the clinic's sphere of action. Often enough, some professionals treat the symptom as a disease, introducing several medicines, unsuccessfully. The author's experience, as an otolaryngologist, allows to state that many of these professionals ignore the upper aerodigestive tract as a cough-generator site. The present work discusses the alterations on the mentioned tract, which may provoke the cough reflex, reviewing, initially, the cough mechanism and the localization of the specific receptors. Cough is produce by stimulus at the receptor level or far from it. In upper and lower parts of the aerodigestive tract secretions may run to several directions. Secretion from the paranasal sinus is a frequent cause of cough. Acute sinusitis may occur insidiously bringing about the chronification of the inflammation with cough being the only great apparent symptom. Nasal and dental alterations favor sinusal infection. Signs and symptoms, even if minimum, may be detected through an accurate anamnesis. Nasal allergy, laryngitis, post nasal dripping and septal deviation may also produce cough. The ORL examination is, therefore, imperative, and no radiologic examination can substitute for it. An inadequate treatment, particularly of the sinusitis, may bring about a worsening and extension of the initial condition.

Pathology and virus tissue distribution of Turkey Coronavirus (TCoV) in experimentally infected chicks and turkey poults

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Orbital Abscess during Endodontic Treatment: A Case Report

Introduction: Orbital infections may result in permanent morbidity because of the severity of infection. Furthermore, delayed diagnosis or treatment of orbital infections can lead to intracranial complications and even death. The majority of orbital infections develop from paranasal sinus infections, cutaneous infections, and periorbital trauma. Dacryocystitis and odontogenic infection are also accounted as potential etiologies but are scarcely reported in scientific literature. Methods: The patient revealed a history of having endodontic treatment on left maxillary second molar performed 2 weeks previously. Moreover, she exhibited signs of facial pain accompanied by sinusitis symptoms, fever, and nasal obstruction the week after this endodontic procedure. The patient presented proptosis, impairment of ocular motility to the right side, facial tenderness, palpebral erythema, and referred decreased visual acuity. Intraoral exam revealed root fragments of left maxillary first molar and an extensive carious lesion on left maxillary second molar. Computed tomography enabled the observation of frontal sinus, left-sided maxillary, opacity of sphenoidal and ethmoidal sinuses, and apical lesion of left maxillary first and second molars, all suggesting the presence of their apex in the maxillary sinus. In addition, images revealed ocular proptosis and presence of high-density areas suggestive of pus in the medial orbital wall region. Results: The patient was submitted to surgical drainage under general anesthesia approximately 8 hours after the clinical evaluation. Conclusions: Early detection of orbital infection, proper diagnostic tests, and treatment may provide successful outcomes of this rarely occurring disease. (J Endod 2012;38:1541-1543)

Therapy options and long-term results of sinonasal malignancies

Nasal and paranasal sinus malignancies are rare. The most common lesions are located in the nasal cavity and the maxillary sinus, although they also occur in the ethmoid, sphenoid and frontal sinuses. Treatment often combines surgery, radiotherapy and chemotherapy. Endoscopic surgical approaches are increasingly used in order to reduce the morbidity associated with standard open resection. The aim of our study was to analyse the long-term treatment results of sinonasal malignancies (SNM), with a special focus on surgical approaches.