Localized forms of rhinoscleroma

Surgical management of scleromatous laryngotracheal stenosis

OBJECTIVE

Scleroma is a chronic specific granulomatous disease of the upper respiratory tract caused by Klebsiella Rhinoscleromatis. It usually affects the subglottic region and upper trachea resulting in various degrees of stenosis. Patients with laryngotracheal stenosis may present with stridor, shortness of breath or exercise intolerance and may be tracheostomy dependent. In this work, we presented the experience of our Institute in the management of patients with scleromatous laryngotracheal stenosis using the already designed procedures for traumatic laryngotracheal stenosis.

PATIENTS AND METHODS

The study was a non controlled prospective study. It was conducted in Oto-Rhino-Laryngology and Head and Neck Surgery Department of Zagazig University Hospitals, Egypt. It included 38 patients with scleromatous subglottic stenosis and/or upper tracheal stenosis. The patients were classified into four grades according to Myer-Cotton's scale. The surgical treatment modalities included endoscopic CO2 laser surgery with dilatation, laryngotracheal reconstruction, and partial cricotracheal resection with thyrotracheal anastomosis.

RESULTS

The average follow-up period was 32.1 months. Twenty four patients (63%) had an excellent outcome. Nine patients (24%) had a good outcome. Five patients (13%) were still tracheostomy dependent. Eleven patients (29%) developed postoperative granulation tissue. The overall success rate was 87%.

CONCLUSION

Scleromatous laryngotracheal stenosis is considered a challenging surgical problem. It requires a multidisciplinary approach by well-trained personnel. The surgical techniques designed for cases of laryngotracheal stenosis of a traumatic etiology can be applied for cases of scleroma with approximately the same success rates.

Rhinoscleroma with exophthalmos: a case report

This is a report of a 20-year-old Nigerian man with a 15-year history of exophthalmos and nasal blockage caused by rhinoscleromatous. The diagnosis was made by histopathological examination of a biopsy specimen taken from the nasal passages. Despite protracted antibiotic therapy the patient experienced recurrent exophthalmos. Computerised axial tomography and sinus films showed the lesion to have invaded through the sinus passage into the orbit. Further histopathological examination of tissue removed at the time of surgical decompression also revealed rhinoscleroma. This appears to be the third report of rhinoscleromatous spread to the orbit.

Scleroma (rhinoscleroma) in a Nigerian maxillo-facial practice. Review and case reports

Scleroma (rhinoscleroma), a chronic granulomatous disease of the upper respiratory tract, is endemic within a confined distribution of geographic foci. Sporadic cases and those arising in poorly defined foci may be unexpected and difficult to diagnose. Three cases from a maxillo-facial unit in northern Nigeria are described, of which two simulated intranasal neoplasms and the third had atypical clinical features. These cases form the first substantial description of scleroma in Nigeria, a country that is part of an indefinite focus of the disease. The epidemiology, clinical features, pathology and diagnosis of scleroma are reviewed.

Scleroma affecting the middle ear cavity with report of three cases

Scleroma has especial predilection to the mucous membranes particularly of the nose and larynx. Other sites are rarely affected such as the pharynx, lacrimal sac, sinuses, bone and skin. However, no case of middle ear involvement is mentioned. Among 300 patients examined during the last few years, only three cases showed scleromatous involvement of the middle ear cavity. 1) A patient developed right facial nerve paralysis two days after an operation of tympanoplasty. Exploration showed granulomatous tissue present surrounding the bony facial canal and filling the middle ear, mastoid and attic regions. Biopsy proved to be scleroma. 2) During one tympanoplasty, excessive vascular granulations were observed and biopsy revealed scleroma. 3) A 24-year-old patient had advanced rhinopharyngoscleroma and bilateral chronic suppurative otitis media with granulations. An exploratory operation of the right ear was done and vascular granulations were found infiltrating the middle ear, attic, antrum and mastoid air cells. Biopsy was scleroma. As one of the three cases had rhinopharyngoscleroma, this raises the possibility of direct spread through the submucosa. However the other two cases show no nasal or pharyngeal affections. Scleroma can invade the facial bony canal and cause nerve paralysis as demonstrated in one patient.