Hallazgos nasosinusales por tomografía computada en dacriocistitis crónica pediátrica

OBJECTIVE

To evaluate the preoperative tomographic characteristics of the nose and paranasal sinuses of children with chronic dacryocystitis.

METHOD

Prospective, observational, cross-sectional, and descriptive study. CT scans of the paranasal sinuses of patients candidates for endoscopic dacryocystorhinostomy were evaluated for two years. Demographic characteristics, radiological findings, inflammatory processes and anatomical variants were identified using the Lund-Mackay classification. Statistic analysis. Stata 10.0, descriptive analysis, Student's t: mean difference and χ². Logistic studies to estimate the probability between variables.

RESULTS

27 men and 11 women (n = 38) were included. Of these, 22 had unilateral and 16 bilateral nasolacrimal duct involvement. Lund-Mackay score range: 2-20. Eleven patients had associated pathology. The most affected were anterior and maxillary ethmoidal sinus (69%), osteomeatal complex (68%), posterior ethmoidal (51%). Patients with severe rhinosinusitis are 12 times more likely to develop dacryocystitis than patients with < 12 points. Men presented greater severity, affectation, and clinical repercussion.

CONCLUSIONS

There is radiological rhinosinusal involvement in dacryocystitis, which must be evaluated and treated preoperatively to avoid postoperative complications or reinfections.

Concha bullosa. A radiological study and a new classification

OBJECTIVE

A pneumatised middle turbinate is called concha bullosa. It has been classified according to its extension in the coronal plane. We propose the first classification according to the axial extension of pneumatisation of the middle turbinate.

MATERIAL AND METHODS

Bulbous concha bullosa was classified in six categories according to the degree of pneumatisation of the body of the middle turbinate in the axial plane.

RESULTS

196 CT sinonasal scans were included. 28.06% of patients had concha bullosa, unilateral in 13.26% and bilateral in 14.79%. The most common concha bullosa found was type I, followed by type III, II, IV and V. There were no statistically significant differences by side, between the patients with or without chronic rhinosinusitis without polyps.

CONCLUSION

Our results support the hypothesis that concha bullosa is not related to chronic rhinosinusitis. Furthermore, type IV and V cells mean posterior aeration of the middle turbinate. Those variations are rare and posterior, so they can easily pass unnoticed during endoscopic sinus surgery. Our classification is also important as a surgical reference, and it can be easily studied on the preoperative CT scan.

[IgG4 related disease with exclusive sinonasal involvement: A case report and literature review]

IgG4 related disease (igG4-RD) is a pathological process which integrates a large number of diseases of unknown pathogenesis, considered as being exclusive to many different organs. Diagnosis is established through histological, radiological and serological criteria. Treatment is based on long term corticosteroids; rituximab being used only in refractory cases. It is unusual for this entity to be found exclusively in the head and neck, without systemic involvement; there are only a few reported cases to date. We present a case of a nasosinusal IgG4-RD orbital tumor with paranasal sinus involvement. The accurate diagnosis made early onset corticosteroid treatment possible and the patient is currently asymptomatic.

[Experience in the surgical treatment of paranasal sinus mucoceles in a university hospital]

BACKGROUND

Mucoceles are benign cystic lesions of the paranasal sinuses. Endoscopic marsupialisation is considered the first choice of treatment, due to its low morbidity and recurrence rates.

OBJECTIVE

To establish the number of patients with recurrence, who were diagnosed clinically or by computed tomography, and who were submitted to surgery in the Ear, Nose and Throat Unit in a tertiary university hospital.

MATERIAL AND METHODS

A clinical, cross-sectional, descriptive, observational and retrospective study was conducted on patients with a mucocele diagnosis operated on in the period from January 2006 to December 2013. A descriptive statistical analysis was performed to obtain the frequencies, ratios and proportions. Measures of central tendency and dispersion were obtained. The recurrence rates of each surgical technique were compared using the Chi-squared test.

RESULTS

Of the 59 patients included in the study, 39 were female and 20 were men. The most common location was in the maxillary sinus (22 patients) followed by frontoethmoidal (20 patients). There was a recurrence of 9% in those submitted to a surgical procedure. The endoscopic approach was used in 51 patients, 8 cases were combined (open plus endoscopic), and there was no open approach. There was a recurrence in 7 of 51 of patients with endoscopic surgery, and one out of 8 patients had a recurrence with a combined technique.

CONCLUSIONS

No statistically significant relationship was found between the type of surgery and recurrence, or between the presence or absence of a predisposing factor and recurrence.

[Clinical analysis and surgical results of 58 paranasal sinus mucoceles]

INTRODUCTION

Mucoceles are slow-growing, benign lesions found in the paranasal sinuses that are locally destructive, causing bony resorption an displacement of adjacent structures. We present our experience in the surgical treatment of these lesions.

METHODS

This was a retrospective review of 58 paranasal sinus mucoceles in 54 patients between 1989 and 2012. We describe patient age and sex, mucocele location, clinical features, surgical approaches employed, recurrence and complications.

RESULTS

The mean age of patients in this series was 59 years; there were 31 males (57%) and 23 females (43%). Thirty-two cases (55%) were located in the frontal or ethmoid-frontal system, 8 (14%) in the ethmoid sinus, 14 (24%) in the maxillary sinus and 4 (7%) in sphenoid sinus. Predisposing factors were present in 55% of the patients and 45% cases were primary. Endoscopic treatment was given to 71% of mucocele patients, while 29% were treated with external or combined approaches. Recurrence appeared in 4 patients (7%), 2 in the endoscopic surgery group and 2 in the external surgery group.

CONCLUSIONS

The procedure of choice for management of paranasal sinus mucoceles is endoscopic drainage. It is a safe approach that gives good results.