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Rampinelli V, Ferrari M, Poli P, Lancini D, Mattavelli D, Timpano S, Redaelli de Zinis LO, Badolato R, Padoan R, Berlucchi M. Paranasal mucoceles in children with cystic fibrosis: Management of a not so rare clinical condition. Am J Otolaryngol 2021; 42:103107. [PMID: 34153745 DOI: 10.1016/j.amjoto.2021.103107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Paranasal mucocele (PM) is reported as a complication in children with cystic fibrosis (CF) in up to 4% of patients. The objective of this study was to identify PMs in the personal large series of children with CF and to assess their diagnosis and treatment. MATERIAL AND METHODS Medical records of children with CF and PM who were admitted and treated by means of endoscopic nasal surgery between 2004 and 2020 were retrospectively reviewed. RESULTS Thirty-four patients were included in the study (mean age 7.7 years). CT scan of sinuses showed a total of 53 PMs. Nasal endoscopic findings suggestive for PM were present in almost 80% of patients. PMs were located in the maxillary, ethmoid, and sphenoid sinuses in 29/34 (85.3%, bilateral in 17 cases), 4/34 (11.8%) and 1/34 (2.9%) patients, respectively. Marsupialization of PMs was performed in all patients using an endoscopic transnasal approach. No complications were observed. Resolution of symptoms and normalization of the endoscopic nasal picture was evident in all patients. After a mean follow-up of 85 months, no recurrences were observed. CONCLUSIONS To the best of our knowledge, this is the largest series of CF patients with PMs. Even if not frequently reported in the literature, PMs should not be considered an uncommon finding in patients affected by CF. Routine nasal endoscopy is mandatory to favor early diagnosis. Endoscopic transnasal marsupialization represents the gold standard of care for patients with CF and PM(s).
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Bilateral Ethmoidal Mucocele Causing Proptosis in a Child. J Craniofac Surg 2021; 32:e386-e388. [PMID: 33645952 DOI: 10.1097/scs.0000000000007390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Paranasal sinus mucocele is a benign cystic lesion, lined with respiratory epithelium and filled with mucoid secretions, which is generally seen in the ethmoid or frontal sinuses. Inflammation, trauma, fibrosis, neoplasm, and previous surgery play a role in etiology. Treatment of this condition requires marsupialization and drainage. Endoscopic surgery is the gold standard procedure. METHODS A 2-year-old boy was referred to our clinic with a diagnosis of bilateral ethmoid mucocele causing proptosis in the right eye. General clinical examinations and routine blood analysis revealed normal health condition of the patient and comorbidities such as cystic fibrosis (CF) and/or ciliary dysfunction were excluded. The patient was operated with an endoscopic endonasal approach. RESULTS As far as we know, our article reports the first case of bilateral ethmoidal sinus mucocele with no underlying comorbidity, such as cystic fibrosis or ciliary dyskinesia. CONCLUSIONS Children are rarely affected by mucocele and if present at early age, there is usually an underlying cause. In pediatric patients with signs and symptoms suggestive of a mucocele, it is important to rule out other benign and malignant paranasal sinus pathologies. Marsupialization and drainage via endoscopic endonasal approach is the preferred treatment modality.
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Mohd Slim MA, Dick D, Trimble K, McKee G. Paediatric nasal polyps in cystic fibrosis. BMJ Case Rep 2016; 2016:bcr-2016-214467. [PMID: 27329094 DOI: 10.1136/bcr-2016-214467] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Patients with cystic fibrosis (CF) are at increased risk of nasal polyps. We present the case of a 17-month-old Caucasian patient with CF who presented with hypertelorism causing cycloplegic astigmatism, right-sided mucoid discharge, snoring and noisy breathing. Imaging suggested bilateral mucoceles in the ethmoid sinuses. Intraoperatively, bilateral soft tissue masses were noted, and both posterior choanae were patent. Polypectomy and bilateral mega-antrostomies were performed. Histological examination revealed inflammatory nasal polyposis typical of CF. The role of early functional endoscopic sinus surgery (FESS) in children with CF nasal polyposis remains questionable as the recurrence rate is higher, and no improvement in pulmonary function has been shown. Our case, however, clearly demonstrates the beneficial upper airway symptom relief and normalisation of facial appearance following FESS in a child with this condition.
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Affiliation(s)
| | - David Dick
- Department of Ear, Nose and Throat, Royal Victoria Hospital, Belfast, UK
| | - Keith Trimble
- Department of Ear, Nose and Throat, Royal Victoria Hospital, Belfast, UK
| | - Gary McKee
- Department of Ear, Nose and Throat, Royal Victoria Hospital, Belfast, UK
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Aslan G, Ugur MB, Başsüllü N. Giant mucocele originating from the middle concha in a 5-year-old child: a case report. J Med Case Rep 2013; 7:246. [PMID: 24284013 PMCID: PMC4219181 DOI: 10.1186/1752-1947-7-246] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 08/20/2013] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Mucoceles are mucus-filled, epithelial-lined sacs that slowly develop in the paranasal sinuses when sinus or concha bullosa drainage is obstructed by inflammatory processes, trauma, or prior surgery. They are extremely rare in children. Symptoms usually arise from the nasal obstruction or compression of neighboring structures. CASE PRESENTATION This case report describes a 5-year-old Turkish boy with a 3-year history of nasal obstruction. A computed tomography scan showed a well-defined soft tissue density lesion, seemingly originating in the region of the middle concha and was suggestive of a middle concha mucocele. The mass was removed by endoscopic sinus surgery. CONCLUSIONS In the case of a child presenting with nasal obstruction, mucocele should be remembered in the differential diagnosis of intranasal tumors. Computed tomography and magnetic resonance imaging are helpful in making the diagnosis and endoscopic nasal surgery has proven successful in the treatment.
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Affiliation(s)
- Gaffar Aslan
- Department of ENT, Faculty of Medicine, Gazi University, Ankara, Turkey.
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Sih T, Godinho R, Franco LP, Piltcher O. Cystic Fibrosis: Brazilian ENT Experience. Int J Otolaryngol 2012; 2012:204696. [PMID: 22611403 PMCID: PMC3352582 DOI: 10.1155/2012/204696] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Revised: 01/09/2012] [Accepted: 01/30/2012] [Indexed: 12/02/2022] Open
Abstract
Most published studies about Cystic Fibrosis (CF) are European or North American. There are still few publications about the characteristics of fibrocystic populations in developing countries. The incidence of cystic fibrosis (CF) in Brazil varies among different regions (1 : 10,000 in Minas Gerais, 1 : 9,500 in Paraná, 1 : 8,700 in Santa Catarina, and 1 : 1600 in Rio Grande do Sul). The prevalence of the DF508 mutation also varies according to population: 33% in Sao Paulo, 49% in Rio Grande do Sul, 27% in Santa Catarina, and 52% in Minas Gerais. Cough and nasal obstruction are the most common symptoms. The variation in nasal polyposis prevalence may be explained by population genotypic characteristics in a country that spans a continent. Findings on nasal endoscopy and computed tomography (CT) have better correlation than do this information compared with surgical and clinical history. Microbiologic studies suggest a high level of early contamination of the airways. Sensorineural hearing loss (SNHL) occurs in these patients as a result of ototoxic antibiotics. The data compiled in this paper is useful, but also lead to the general agreement that more research would be welcome due to the unique characteristics of this country.
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Affiliation(s)
- Tania Sih
- Faculty of Medicine, Laboratório de Investigações Médicas (LIM), Number 40, Universidade de São Paulo, São Paulo, Rua Mato Grosso, 306/1511, 01239-040 São Paulo, SP, Brazil
| | - Ricardo Godinho
- Health and Biological Sciences Institute, Department of Medicine, Pontifical Catholic University of Minas Gerais-PUC Minas, Rua Dr Chassim 208, 35700-018 Sete Lagoas, MG, Brazil
| | - Leticia Paiva Franco
- Department of Otorhinolaryngology, School of Medicine, Universidade Federal de Minas Gerais, Avenida Alfredo Balena 180, 30000-000 Belo Horizonte, MG, Brazil
| | - Otávio Piltcher
- Department of Otorhinolaryngology, College of Medicine, Universidade Federal do Rio Grande do Sul, Avenida Bento Gonçalves 8083, Casa 2, 91540-000 Porto Alegre, MG, Brazil
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Franco LP, Camargos PAM, Becker HMG, Guimarães RES. Nasal endoscopic evaluation of children and adolescents with cystic fibrosis. Braz J Otorhinolaryngol 2010; 75:806-13. [PMID: 20209279 PMCID: PMC9446041 DOI: 10.1016/s1808-8694(15)30541-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2008] [Accepted: 06/22/2009] [Indexed: 01/04/2023] Open
Abstract
The main otorhinolaryngological manifestations of CF are chronic rhinosinusitis and nasal polyposis, with different clinical presentations. Aim To characterize children and adolescents with cystic fibrosis through a questionnaire, an ENT clinical examination and nasal endoscopy. Study design Cross-sectional clinical descriptive. Material and Method Assessment of 100 children and adolescents with cystic fibrosis through a specific questionnaire, ENT physical examination, nasal endoscopy and endoscopic staging of nasal polyps. Results The most frequent symptoms were: cough (45%), oral breathing (44%), sleep disorders (42%) and nasal obstruction (37%). Twenty-eight patients (28%) had purulent nasal discharge, and 41% had medial bulging of the nasal lateral wall. Nasal polyps were identified in only 14% of cases, none were obstructing. Conclusion The questionnaire, clinical examination and especially nasal endoscopy lead to a detailed assessment of the nasal characteristics of children and adolescents with cystic fibrosis. Some findings were discordant with the literature, particularly the low prevalence of nasal polyps, and appear to be related to specific characteristics of the population studied. The best characterization of this group of patients, from the ENT standpoint, contributes to an appropriate multidisciplinary approach.
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Abstract
This is a case of an 11-year-old male with an ethmoid sinus mucocele who presented to our emergency department with an orbital mass. This mucocele was most likely related to an ipsilateral orbital subperiosteal abscess that required endoscopic drainage 9 years ago. Mucoceles are mucus-filled, epithelial-lined sacs that slowly develop in the paranasal sinuses when sinus drainage is obstructed by inflammatory processes, trauma, or prior surgery. They are rare in children and should be suspected in patients with progressive headache or orbital complaints.
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Jaswal A, Jana AK, Sikder B, Jana U, Nandi TK. Paranasal sinus mucoceles: a comprehensive retroprospective study in Indian perspective. Indian J Otolaryngol Head Neck Surg 2008; 60:117-22. [PMID: 23120518 DOI: 10.1007/s12070-007-0116-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Paranasal sinus mucoceles are the most common expansile lesion of the paranasal sinuses. Hereby we present a comprehensive retroprospective study on the paranasal sinus mucoceles in our geographic area which is very significantly lacking till now which we hope would immensely help comparative analysis and management in near future.
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Affiliation(s)
- Abhishek Jaswal
- Department of Otorhinolaryngology, Calcutta National Medical College, Kolkata, 700 084 India
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Nicollas R, Facon F, Sudre-Levillain I, Forman C, Roman S, Triglia JM. Pediatric paranasal sinus mucoceles: etiologic factors, management and outcome. Int J Pediatr Otorhinolaryngol 2006; 70:905-8. [PMID: 16293319 DOI: 10.1016/j.ijporl.2005.10.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2005] [Accepted: 10/06/2005] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To study the local and general etiological factors of paranasal sinus mucoceles in the pediatric population and to evaluate and discuss the clinical management and the results of endonasal marsupialization. DESIGN Retrospective study. PATIENTS AND METHODS A series of 10 cases of paranasal sinus mucocele in children were managed. For imaging, CT-scan and, sometimes MRI were performed. An ophthalmologic evaluation was performed preoperatively in all cases, and post-operatively in case of preoperative trouble. All patients were treated with endoscopic surgical procedure. Authors also looked for etiological factors. RESULTS Cystic fibrosis was found in 6 cases out of 10. Others etiological factors were trauma and inflammatory process; one case was strictly idiopathic. Three patients out of 10 had ophthalmologic trouble related with the mucocele. With a mean follow-up of 17 months, neither recurrence nor complication were noted. All patients with ophthalmologic complain were free of trouble after surgery. CONCLUSION Paranasal sinus mucoceles in children are still rare. In our experience, 9 out of 10 patients had predisposing factors, especially cystic fibrosis. Imaging with CT-scan and MRI allow the physician to rule out other tumors such as meningoceles or rhabdomyosarcoma. Endoscopic endonasal surgery is nowadays the gold standard for the treatment of paranasal sinus mucoceles.
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Affiliation(s)
- R Nicollas
- Department of Pediatric Otolaryngology Head and Neck Surgery, La Timone Children's Hospital, 264 Rue Saint Pierre, 13385 Marseille Cedex 05, France.
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Varghese L, John M, Kurien M. Bilateral Asymmetric Mucoceles of the Paranasal Sinuses: A First Case Report. EAR, NOSE & THROAT JOURNAL 2004. [DOI: 10.1177/014556130408301216] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Bilateral paranasal sinus mucoceles are rare. To date, only 5 cases have been reported in the English-language literature. All were bilaterally symmetrical. We present a patient with bilateral asymmetric mucoceles. This patient had a symptomatic mucocele of the right ethmoid sinus with orbital extension and an asymptomatic mucocele involving the left maxillary sinus with retroorbital extension. The latter was an incidental finding on radiologic evaluation. This is the first case report of bilateral mucoceles with asymmetric involvement of the paranasal sinuses.
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Affiliation(s)
- Lalee Varghese
- Department of ENT, Christian Medical College, Vellore, Tamilnadu, India
| | - Mary John
- Department of ENT, Christian Medical College, Vellore, Tamilnadu, India
| | - Mary Kurien
- Department of ENT, Christian Medical College, Vellore, Tamilnadu, India
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Sciarretta V, Pasquini E, Farneti G, Ceroni AR. Endoscopic treatment of paranasal sinus mucoceles in children. Int J Pediatr Otorhinolaryngol 2004; 68:955-60. [PMID: 15183588 DOI: 10.1016/j.ijporl.2004.01.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2003] [Revised: 01/22/2004] [Accepted: 01/26/2004] [Indexed: 10/26/2022]
Abstract
In this study, we have pointed out the effectiveness of the endoscopic approach for the treatment of three children affected by mucoceles. Two patients complained of visual disturbances while one complained of persistent bitemporal headache. None of these cases was affected by cystic fibrosis. The endoscopic treatment consisted mainly of drainage and marsupialization of the mucocele. These young patients were free of any recurrence and symptoms at 36, 30, and 16 months of follow-up, respectively.
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Affiliation(s)
- Vittorio Sciarretta
- ENT Department, University of Bologna, Sant'Orsola-Malpighi Hospital, Via Massarenti 9, 40138 Bologna, Italy
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Abstract
In this review, recently identified hepatitis viruses (hepatitis C, hepatitis D, hepatitis E, hepatitis F, hepatitis G, transfusion transmissible virus) are described, and the implications for paediatric liver disease discussed.
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Affiliation(s)
- D Kelly
- Birmingham Children's Hospital and University of Birmingham, UK.
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