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Cheong RCT, Jawad S, Adams A, Campion T, Lim ZH, Papachristou N, Unadkat S, Randhawa P, Joseph J, Andrews P, Taylor P, Kunz H. Enhancing paranasal sinus disease detection with AutoML: efficient AI development and evaluation via magnetic resonance imaging. Eur Arch Otorhinolaryngol 2024; 281:2153-2158. [PMID: 38197934 PMCID: PMC10942883 DOI: 10.1007/s00405-023-08424-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/18/2023] [Indexed: 01/11/2024]
Abstract
PURPOSE Artificial intelligence (AI) in the form of automated machine learning (AutoML) offers a new potential breakthrough to overcome the barrier of entry for non-technically trained physicians. A Clinical Decision Support System (CDSS) for screening purposes using AutoML could be beneficial to ease the clinical burden in the radiological workflow for paranasal sinus diseases. METHODS The main target of this work was the usage of automated evaluation of model performance and the feasibility of the Vertex AI image classification model on the Google Cloud AutoML platform to be trained to automatically classify the presence or absence of sinonasal disease. The dataset is a consensus labelled Open Access Series of Imaging Studies (OASIS-3) MRI head dataset by three specialised head and neck consultant radiologists. A total of 1313 unique non-TSE T2w MRI head sessions were used from the OASIS-3 repository. RESULTS The best-performing image classification model achieved a precision of 0.928. Demonstrating the feasibility and high performance of the Vertex AI image classification model to automatically detect the presence or absence of sinonasal disease on MRI. CONCLUSION AutoML allows for potential deployment to optimise diagnostic radiology workflows and lay the foundation for further AI research in radiology and otolaryngology. The usage of AutoML could serve as a formal requirement for a feasibility study.
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Affiliation(s)
- Ryan Chin Taw Cheong
- Royal National ENT and Eastman Dental Hospitals, University College London Hospitals NHS, London, UK
| | - Susan Jawad
- Royal National ENT and Eastman Dental Hospitals, University College London Hospitals NHS, London, UK
| | | | | | | | - Nikolaos Papachristou
- Medical Physics and Digital Innovation Laboratory, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Samit Unadkat
- Royal National ENT and Eastman Dental Hospitals, University College London Hospitals NHS, London, UK
| | - Premjit Randhawa
- Royal National ENT and Eastman Dental Hospitals, University College London Hospitals NHS, London, UK
| | - Jonathan Joseph
- Royal National ENT and Eastman Dental Hospitals, University College London Hospitals NHS, London, UK
| | - Peter Andrews
- Royal National ENT and Eastman Dental Hospitals, University College London Hospitals NHS, London, UK
| | | | - Holger Kunz
- University College London, London, UK.
- School of Public Health, Imperial College London, London, UK.
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Feng C, Zhang X, Hong R, Sun X, Chen Q, Tian G. Pneumosinus Dilatans of the Sphenoid Sinus: A Rare Compressive Pathogenesis Leading to Blindness. J Neuroophthalmol 2024; 44:e115-e116. [PMID: 36070575 DOI: 10.1097/wno.0000000000001612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Chaoyi Feng
- Department of Ophthalmology (CF, XS, QC, GT), Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China; Department of Neurosurgery (XZ), Shanghai Dong Lei Brain Hospital, Shanghai, China; Department of Radiology (RH), Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China; and NHC Key Laboratory of Myopia (Fudan University) (XS, GT), Key Laboratory of Visual Impairment and Restoration, Shanghai, China
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Xie JS, Micieli JA. Spontaneous Resolution of Diplopia Related to a Frontal Sinus Mucocele. J Neuroophthalmol 2023; 43:e256-e257. [PMID: 35234688 DOI: 10.1097/wno.0000000000001530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Jim S Xie
- Michael G. DeGroote School of Medicine (JSX), McMaster University, Hamilton, Ontario, Canada; Department of Ophthalmology and Vision Sciences (JAM), University of Toronto, Toronto, Ontario, Canada; Division of Neurology (JAM), Department of Medicine, University of Toronto, Toronto, Ontario, Canada; and Kensington Vision and Research Centre (JAM), Toronto, Ontario, Canada
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Baeza M, Young BD, LaQuaglia KA, Rollins A, Aboellail TA. Computed tomographic imaging of a maxillary sinus mucocele in an 8-year-old French Bulldog. Vet Radiol Ultrasound 2023; 64:E73-E77. [PMID: 37667996 DOI: 10.1111/vru.13297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/19/2023] [Accepted: 08/15/2023] [Indexed: 09/06/2023] Open
Abstract
An 8-year-old male neutered French Bulldog was referred for continued nasal dyspnea following a staphylectomy revision performed one month prior to presentation. The patient had a prior history of skin allergies and underwent brachycephalic airway surgery performed at one year of age. Computed tomography (CT) revealed an osseous-encased, cystic mass arising from the right maxillary sinus. Surgical biopsies were performed and a mucocele with sinusitis and glandular hyperplasia was diagnosed. Based on our systematic review of the literature, maxillary sinus mucocele has not been reported in the dog and should be among the differentials for sinus cystic masses.
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Affiliation(s)
- Mercedes Baeza
- VCA Alameda East Veterinary Hospital, Denver, Colorado, USA
| | | | | | - Amanda Rollins
- VCA Alameda East Veterinary Hospital, Denver, Colorado, USA
| | - Tawfik A Aboellail
- Department of Microbiology, Immunology and Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
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Shi Q, Geng C, Wang M. Maxillary Sinus Mucocele With Fungal Ball. J Craniofac Surg 2023; 34:e759-e760. [PMID: 37594021 DOI: 10.1097/scs.0000000000009632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 06/05/2023] [Indexed: 08/19/2023] Open
Abstract
Mucocele is a benign, expansile, and oppressive lesion, more common in the frontal and ethmoid sinus and less in the maxillary sinus. Sinus mucocele mainly causes cheek swelling pain and nasal obstruction. In some cases, the paranasal mucocele grows large enough to compress periorbital structures and lead to impaired vision. Generally, mucocele is full of simple mucus, but pathogens can be found if co-infected, which means a poor prognosis. Functional endoscopic sinus surgery is an effective treatment for this disease. Here, the authors report a case that a mucocele occurred in the maxillary sinus, and a fungal ball was also found during the operation, which is a result of Paecilomyces farinosus co-infection.
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Affiliation(s)
- Qingyang Shi
- Department of Otorhinolaryngology, Head and Neck Surgery, Peking University People's Hospital, Beijing, China
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Agarwal M, Lobo R, Srinivasan A. Postoperative Imaging Appearances of the Paranasal Sinuses. Semin Roentgenol 2023; 58:248-260. [PMID: 37507167 DOI: 10.1053/j.ro.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/13/2023] [Accepted: 03/19/2023] [Indexed: 07/30/2023]
Affiliation(s)
- Mohit Agarwal
- Department of Radiology, Froedtert and Medical College of Wisconsin, Milwaukee, WI.
| | - Remy Lobo
- Department of Radiology, Division of Neuroradiology, Michigan Medicine, Ann Arbor, MI
| | - Ashok Srinivasan
- Department of Radiology, Division of Neuroradiology, Michigan Medicine, Ann Arbor, MI
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Kotowski M, Szydlowski J. Isolated Sphenoid Sinus Disease in Children. Int J Environ Res Public Health 2023; 20:847. [PMID: 36613169 PMCID: PMC9819992 DOI: 10.3390/ijerph20010847] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 12/17/2022] [Accepted: 12/30/2022] [Indexed: 06/17/2023]
Abstract
The rarity of isolated sphenoid sinus disease (ISSD) and the specificity of pediatric populations meant that a separate analysis was required in this study. This study aimed to present and discuss the results of an analysis of clinical manifestations, radiological findings and surgical methods based on a large series of exclusively pediatric patients. The study group covered 28 surgically treated children (aged 5.5-17.5 years). The medical data were retrospectively analyzed and meticulously discussed with regards to presenting signs and symptoms, radiographic findings, surgical approaches, complications, post-op care, histopathological results and follow-ups. The dominant symptom was a persistent headache (78%). Four children presented visual symptoms, diplopia in two cases, visual acuity disturbances in one case and both of these symptoms in one patient. Sixteen children presented chronic isolated rhinosinusitis without nasal polyps, six suffered from mucocele and one presented chronic sphenoiditis with sphenochoanal polyp. Four patients turned out to exhibit neoplastic lesions and developmental bony abnormality was diagnosed in one case. No fungal etiology was revealed. The transnasal approach was used in 86% of patients. A transseptal approach with concurrent septoplasty was used in four patients. The patient with visual acuity disturbances completely recovered after the surgery. All children with visual symptoms reported improvement in the vision immediately after surgery. No postoperative complications were observed. Fungal etiology was extremely rare in the pediatric population with ISSD. The surgical treatment should be a minimally invasive procedure regarding a limited range of the pathology in ISSD. Emergency surgery should be performed if ISSD produces any visual loss.
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Shirin M, Sultana S, Islam T, Atreya S. Silent Sinus Syndrome: A Case Report. Mymensingh Med J 2022; 31:562-563. [PMID: 35383781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
To describe a case of silent sinus syndrome in the perspective of imaging studies, on 2 January 2020 we present this case of a 26-year-old Bangladeshi man with unilateral right facial asymmetry and no sino-nasal symptoms. He was referred to the Ophthalmology Department with complain of right palpebral ptosis and facial asymmetry for 7 months. On physical examination, painless enophthalmos and hypo globus of the right eye was seen. The computed tomography scan of the paranasal air sinuses showed opacification of the right maxillary sinus along with retraction of the walls of the sinus. Regardless of the clinical doubt, the conclusion can only be given by imaging studies, radiologist play a key role here.
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Affiliation(s)
- M Shirin
- Dr Mahbuba Shirin, Associate Professor, Department of Radiology and Imaging, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh; E-mail:
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李 晴, 史 亚, 王 巍, 张 桂. [A case of blindness caused by mucocele of frontal sinus]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2022; 36:59-60. [PMID: 34979622 PMCID: PMC10128226 DOI: 10.13201/j.issn.2096-7993.2022.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Indexed: 04/30/2023]
Abstract
A case of blindness caused by frontal sinus mucocele was reported. The patient presented with pain and swelling in his left eye and decreased visual acuity with only light sensation for 3 days. Orbital imaging examination suggested a mass of communication in the left frontal sinus and the upper quadrant of left orbit, which was considered as a mucinous cyst involving the left superior orbital wall, surrounding the left lacrimal gland, pushing down the left superior rectus muscle, squeezing the left eyeball and protruding forward and downward. The patient was diagnosed with a left frontal sinus cyst with infection and a left orbital subperiosteal abscess. After admission, frontal sinus drainage was performed urgently, but the vision loss in the left eye was not recovered.
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Affiliation(s)
- 晴晴 李
- 天津市第一中心医院耳鼻咽喉头颈外科 天津市耳鼻喉科研究所 天津市听觉言语与平衡医学重点实验室 天津市医学重点学科(耳鼻咽喉科学) 天津市耳鼻喉质量控制中心(天津,300192)(天津,300192)
| | - 亚男 史
- 天津市第一中心医院耳鼻咽喉头颈外科 天津市耳鼻喉科研究所 天津市听觉言语与平衡医学重点实验室 天津市医学重点学科(耳鼻咽喉科学) 天津市耳鼻喉质量控制中心(天津,300192)(天津,300192)
| | - 巍 王
- 天津市第一中心医院耳鼻咽喉头颈外科 天津市耳鼻喉科研究所 天津市听觉言语与平衡医学重点实验室 天津市医学重点学科(耳鼻咽喉科学) 天津市耳鼻喉质量控制中心(天津,300192)(天津,300192)
| | - 桂敏 张
- 天津市第一中心医院耳鼻咽喉头颈外科 天津市耳鼻喉科研究所 天津市听觉言语与平衡医学重点实验室 天津市医学重点学科(耳鼻咽喉科学) 天津市耳鼻喉质量控制中心(天津,300192)(天津,300192)
- 张桂敏,
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Assiri KS, Alroqi AS. Frequency of the frontal sinus aplasia among Saudi Arabian population. A single-center retrospective case review. Saudi Med J 2021; 42:228-231. [PMID: 33563745 PMCID: PMC7989292 DOI: 10.15537/smj.2021.2.25617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 12/03/2020] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To assess the frequency of frontal sinus aplasia using computed tomography (CT) of the paranasal sinus among Saudi Arabian population. METHODS A retrospective case review of medical records from January 2019 to December 2019 in the Otorhinolaryngology Department, King Abdulaziz University, Riyadh, Saudi Arabia. RESULTS A total of 449 cases were reviewed. The incidence of bilateral frontal sinus aplasia was 3.3%. The incidence of right sinus agenesis was 5.12% and left was 1.33%. The mean age of reviewed patients was 39.15 years. CONCLUSION The frequency of frontal sinus aplasia is low; however, this must be considered before surgical operations related to the sinuses.
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Affiliation(s)
- Kholood S. Assiri
- From the Department of Otorhinolaryngology-Head & Neck Surgery College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Ahmad S. Alroqi
- From the Department of Otorhinolaryngology-Head & Neck Surgery College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
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Bola AS, Andjock YCN, Choffor EN, Nanci E, Esene IN, Djomou F. Bilateral sphenoid sinus mucocele observed in Yaoundé-Cameroon: a case report. Pan Afr Med J 2021; 39:198. [PMID: 34603579 PMCID: PMC8464203 DOI: 10.11604/pamj.2021.39.198.22886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/05/2020] [Indexed: 11/14/2022] Open
Abstract
A mucocele is a cystic and expansive lesion of the sinus cavities. It is uncommon in the sphenoid sinus and its management is quite challenging especially in low to middle income countries like Cameroon. A 43-years-old female was referred to us by a neurologist for chronic headache and visual disturbances. The pain was unresponsive to analgesics. Physical examination was non-remarkable and a head CT scan realized showed a cyst-like lesion in the sphenoid sinus cavity. Surgical endoscopic treatment was proposed and realized with basic endoscopic instruments, consisting of opening the cavity with drainage of the mucocele. A large opening was made on the anterior wall of the sphenoid sinus, in order to ensure continuous drainage and prevent a recurrence. Sphenoid sinus mucocele is a rare condition, and its diagnosis can be difficult. Confirmation requires specific imaging and treatment is presently well established, but it can be managed with basic tools.
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Affiliation(s)
- Antoine Siafa Bola
- Department of Ophthalmology-Otolaryngology-Stomatology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Yves Christian Nkouo Andjock
- Department of Ophthalmology-Otolaryngology-Stomatology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | | | - Eliane Nanci
- Department of Ophthalmology-Otolaryngology-Stomatology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Ignatius Ngene Esene
- Neurosurgery Division, Faculty of Health Sciences, University of Bamenda, Bambili, Cameroon
| | - Francois Djomou
- Department of Ophthalmology-Otolaryngology-Stomatology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
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Abstract
Mucormycosis is relatively uncommon, fulminant, progressive, life threatening fungal disease which is most often seen in debilitating patients with immunocompromised condition. Mucormycosis cases are seen in patients with the use of systemic steroids in the treatment of severely affected COVID-19 cases and also in the patients with uncontrolled diabetes which causes immunosuppression are being reported with mucormycosis. The main symptoms of this disease include pain on the temporal and the orbital region of the affected side which could be throbbing or lancinating type, mobility of the teeth, jaw pain and often swelling is present which could be extraoral and intraoral both or sometimes only intraorally. The diagnostic approach in such cases is done with the help of clinical diagnosis, histopathology and with advanced imaging like cone beam computed tomography, magnetic resonance imaging and computed tomography. We here used cone beam computed tomography imaging that revealed haziness in the sinuses and breach in cortical bone of the affected area which confirmed the diagnosis of mucormycosis. Early treatment planning like administration of antifungal drugs and surgical debridement will be life saving in such a deadly disease.
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Affiliation(s)
- Dhaman Gupta
- Department of Public Health Dentistry, Sri Aurobindo College of Dentistry, Indore, Madhya Pradesh, India
| | - Tanvi Dosi
- Department of Oral Medicine and Radiology, Sri Aurobindo College of Dentistry, Indore, Madhya Pradesh, India
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Arosio AD, Coden E, Valentini M, Czaczkes C, Battaglia P, Bignami M, Castelnuovo P, Karligkiotis A. Combined Endonasal-Transorbital Approach to Manage the Far Lateral Frontal Sinus: Surgical Technique. World Neurosurg 2021; 151:5. [PMID: 33872838 DOI: 10.1016/j.wneu.2021.04.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 04/06/2021] [Accepted: 04/06/2021] [Indexed: 11/18/2022]
Abstract
In recent decades, the ever-expanding use of endoscopes and development of dedicated instrumentation have reshaped the panorama of surgical approaches to the frontal sinus.1 Nonetheless, the far lateral portion of the sinus might still represent a concern, especially in cases with unfavorable or distorted anatomy.2,3 We report the case of a 52-year-old man, referred to our department for recurrent episodes of left orbital swelling and supraorbital headache, 3 months after Draf III frontal sinusotomy for marsupialization of multiple frontal mucoceles. Computed tomography and magnetic resonance imaging scans were consistent with persistent inflammatory tissue in the far lateral left frontal sinus. Revision surgery was performed, adopting a combined endonasal orbital transposition3 and superior eyelid transorbital approach.4,5 The postoperative course was uneventful, and the microbiologic and histologic examinations demonstrated noninvasive Aspergillus fumigatus infection. The radiologic control showed patency of the frontal recess and complete clearance of the sinus. The patient is asymptomatic after 16 months (Video 1). The transorbital approach is effective in managing orbital and frontal sinus diseases,6 and the combination with the endonasal route grants complete access to the frontal sinus, even in cases of high pneumatization and lateral extension.4,7 Multiportal transorbital approaches represent additional techniques in the rhinologist's surgical armamentarium, which can overcome the limits of a single port approach.8,9 Reports on their use providing technical hints and critical considerations are to be encouraged to ease and stimulate the surgical training in this field.
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Affiliation(s)
- Alberto Daniele Arosio
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Insubria, Varese, Italy
| | - Elisa Coden
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Insubria, Varese, Italy.
| | - Marco Valentini
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Insubria, Varese, Italy
| | - Camilla Czaczkes
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Insubria, Varese, Italy
| | - Paolo Battaglia
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Insubria, Varese, Italy; Department of Biotechnology and Life Sciences, Head and Neck Surgery & Forensic Dissection Research Center, University of Insubria, Varese, Italy
| | - Maurizio Bignami
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Insubria, Varese, Italy; Department of Biotechnology and Life Sciences, Head and Neck Surgery & Forensic Dissection Research Center, University of Insubria, Varese, Italy
| | - Paolo Castelnuovo
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Insubria, Varese, Italy; Department of Biotechnology and Life Sciences, Head and Neck Surgery & Forensic Dissection Research Center, University of Insubria, Varese, Italy
| | - Apostolos Karligkiotis
- Department of Otorhinolaryngology-Head and Neck Surgery, ASST Sette Laghi, Varese, Italy
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Ernst BP, Reissig MR, Strieth S, Eckrich J, Hagemann JH, Döge J, Matthias C, Gouveris H, Rübenthaler J, Weiss R, Sommer WH, Nörenberg D, Huber T, Gonser P, Becker S, Froelich MF. The role of structured reporting and structured operation planning in functional endoscopic sinus surgery. PLoS One 2020; 15:e0242804. [PMID: 33253265 PMCID: PMC7703956 DOI: 10.1371/journal.pone.0242804] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 11/09/2020] [Indexed: 12/22/2022] Open
Abstract
Computed tomography (CT) scans represent the gold standard in the planning of functional endoscopic sinus surgeries (FESS). Yet, radiologists and otolaryngologists have different perspectives on these scans. In general, residents often struggle with aspects involved in both reporting and operation planning. The aim of this study was to compare the completeness of structured reports (SR) of preoperative CT images and structured operation planning (SOP) to conventional reports (CR) and conventional operation planning (COP) to potentially improve future treatment decisions on an individual level. In total, 30 preoperative CT scans obtained for surgical planning of patients scheduled for FESS were evaluated using SR and CR by radiology residents. Subsequently, otolaryngology residents performed a COP using free texts and a SOP using a specific template. All radiology reports and operation plannings were evaluated by two experienced FESS surgeons regarding their completeness for surgical planning. User satisfaction of otolaryngology residents was assessed by using visual analogue scales. Overall radiology report completeness was significantly higher using SRs regarding surgically important structures compared to CRs (84.4 vs. 22.0%, p<0.001). SOPs produced significantly higher completeness ratings (97% vs. 39.4%, p<0.001) regarding pathologies and anatomical variances. Moreover, time efficiency was not significantly impaired by implementation of SR (148 s vs. 160 s, p = 0.61) and user satisfaction was significantly higher for SOP (VAS 8.1 vs. 4.1, p<0.001). Implementation of SR and SOP results in a significantly increased completeness of radiology reports and operation planning for FESS. Consequently, the combination of both facilitates surgical planning and may decrease potential risks during FESS.
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Affiliation(s)
- Benjamin Philipp Ernst
- Department of Otorhinolaryngology, University Medical Center Mainz, Mainz, Rhineland-Palatinate, Germany
- * E-mail:
| | - Manuel René Reissig
- Department of Otorhinolaryngology, University Medical Center Mainz, Mainz, Rhineland-Palatinate, Germany
| | - Sebastian Strieth
- Department of Otorhinolaryngology, University Hospital Bonn, Bonn, North Rhine-Westphalia, Germany
| | - Jonas Eckrich
- Department of Otorhinolaryngology, University Medical Center Mainz, Mainz, Rhineland-Palatinate, Germany
| | - Jan H. Hagemann
- Department of Otorhinolaryngology, University Medical Center Mainz, Mainz, Rhineland-Palatinate, Germany
| | - Julia Döge
- Department of Otorhinolaryngology, University Medical Center Mainz, Mainz, Rhineland-Palatinate, Germany
| | - Christoph Matthias
- Department of Otorhinolaryngology, University Medical Center Mainz, Mainz, Rhineland-Palatinate, Germany
| | - Haralampos Gouveris
- Department of Otorhinolaryngology, University Medical Center Mainz, Mainz, Rhineland-Palatinate, Germany
| | | | - Roxanne Weiss
- Department of Otorhinolaryngology, University Hospital Frankfurt, Frankfurt, Hessen, Germany
| | - Wieland H. Sommer
- Department of Radiology, LMU University Hospital, Munich, Bavaria, Germany
| | - Dominik Nörenberg
- Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Mannheim, Baden-Wuerttemberg, Germany
| | - Thomas Huber
- Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Mannheim, Baden-Wuerttemberg, Germany
| | - Phillipp Gonser
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Tübingen Medical Center, Tübingen, Baden-Wuerttemberg, Germany
| | - Sven Becker
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Tübingen Medical Center, Tübingen, Baden-Wuerttemberg, Germany
| | - Matthias F. Froelich
- Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Mannheim, Baden-Wuerttemberg, Germany
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15
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Abstract
To assess the prevalence and missed reporting rate of potential clinically-significant incidental findings (IFs) in the neck CTA scans.All consecutive patients undergoing neck CTA imaging, from January 1, 2017 to December 31, 2018, were retrospectively evaluated by a radiologist for the presence of incidental findings in the upper chest, lower head and neck regions. These incidental findings were subsequently classified into 3 categories in terms of clinical significance: Type I, highly significant, Type II, moderately significant; and Type III, mildly or not significant. Type I and Type II IFs were determined as potential clinically significant ones and were retrospectively analyzed by another 2 radiologists in consensus. The undiagnosed findings were designated as those that were not reported by the initial radiologists. The differences in the rate of unreported potential clinically significant IFs were compared between the chest group and head or neck group.A total of 376 potential clinically significant IFs were detected in 1,698 (91.19%) patients, of which 175 IFs were classified as highly significant findings (Type I), and 201 (53.46%) as moderately significant findings (Type II). The most common potential clinically significant findings included thyroid nodules (n = 88, 23.40%), pulmonary nodules (n = 56, 14.89%), sinus disease (n = 39, 10.37%), intracranial or cervical artery aneurysms (n = 30, 7.98%), enlarged lymph nodes (n = 24, 6.38%), and pulmonary embolism (n = 19, 5.05%). In addition, 184 (48.94%) of them were not mentioned in the initial report. The highest incidence of missed potential clinical findings were pulmonary embolism and pathologic fractures and erosions (100% for both). The unreported rate of the chest group was significantly higher than that of the head or neck one, regardless of Type I, Type II or all potential clinically significant IFs (χ = 32.151, χ = 31.211, χ = 65.286, respectively; P < .001 for all).Important clinically significant incidental findings are commonly found in a proportion of patients undergoing neck CTA, in which nearly half of these patients have had potential clinically significant IFs not diagnosed in the initial report. Therefore, radiologists should beware of the importance of and the necessity to identify incidental findings in neck CTA scans.
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Affiliation(s)
- Guangliang Chen
- Department of Radiology, Fujian Medical University Union Hospital
- School of Medical Technology and Engineering, Fujian Medical University, University Town, Fuzhou, China
| | - Yunjing Xue
- Department of Radiology, Fujian Medical University Union Hospital
- School of Medical Technology and Engineering, Fujian Medical University, University Town, Fuzhou, China
| | - Jin Wei
- Department of Radiology, Fujian Medical University Union Hospital
- School of Medical Technology and Engineering, Fujian Medical University, University Town, Fuzhou, China
| | - Qing Duan
- Department of Radiology, Fujian Medical University Union Hospital
- School of Medical Technology and Engineering, Fujian Medical University, University Town, Fuzhou, China
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Chi J, Xu D, Yin S, Li M, Shen L, Ding N, Chen X, Ji Y. Reducing the radiation dose of pediatric paranasal sinus CT using an ultralow tube voltage (70 kVp) combined with iterative reconstruction: Feasibility and image quality. Medicine (Baltimore) 2020; 99:e21886. [PMID: 32846848 PMCID: PMC7447483 DOI: 10.1097/md.0000000000021886] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND As the gold standard for imaging sinus disease, the main disadvantage of computed tomography (CT) of the pediatric paranasal sinus is radiation exposure. Because of this, 1 protocol for CT should reduce radiation dose while maintaining image quality. The aim of this study is to evaluate the image quality of dose-reduced paranasal sinus computed tomography (CT) using an ultralow tube voltage (70 kVp) combined with iterative reconstruction (IR) in children. METHODS CT scans of the paranasal sinus were performed using different protocols [70 kVp protocols with IR, Group A, n = 80; 80 kVp protocols with a filtered back projection algorithm, Group B, n = 80] in 160 pediatric patients. Then, the volume-weighted CT dose index, dose-length product, and effective dose were estimated. Image noise, the signal-to-noise ratio and the diagnostic image quality were also evaluated. RESULTS For the radiation dose, the volume-weighted CT dose index, dose-length product and effective dose values were significantly lower for the 70 kVp protocols than for the 80 kVp protocols (P < .001). Compared with the 80 kVp protocols, the 70 kVp protocols had significantly higher levels of image noise (P = .001) and a lower signal-to-noise ratio (P = .002). No significant difference in the overall subjective image quality grades was observed between these 2 groups (P = .098). CONCLUSION The ultralow tube voltage (70 kVp) technique combined with IR enabled a significant dose reduction in CT examinations performed in the pediatric paranasal sinus while maintaining diagnostic image quality with clinically acceptable image noise.
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Marciniak A, Horaczyńska-Wojtaś A, Mielnik-Niedzielska G. Paranasal sinus disease could be a reason for unsuccessful immunotherapy of inhalant allergy in children. Am J Otolaryngol 2020; 41:102504. [PMID: 32334922 DOI: 10.1016/j.amjoto.2020.102504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 03/08/2020] [Accepted: 04/05/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of this study was to evaluate the role of paranasal sinuses condition assessed in computed tomography on inhalant allergen desensitization effects. MATERIALS & METHODS Retrospective analysis of medical records of children undergoing allergen immunotherapy in outpatient otolaryngology clinic of University Children Hospital in Lublin was performed. Control group consisted of children who underwent allergen immunotherapy and obtained satisfying effects; study group consisted of children who did not experience significant improvement after desensitization therapy. RESULTS Computed tomography of nose cavity and paranasal sinuses exposed numerous pathologic changes affecting both, control and study group. Blockage of ostiomeatal complex was twice more common in children who did not respond adequately to desensitization therapy. In our study group, radiological findings suggesting rhinosinusitis were found in 73% of patients, while retention cysts in maxillary sinuses were discovered in 27% of patients. CONCLUSIONS Pathological findings in paranasal sinuses in computed tomography may arise from uncontrolled allergic rhinitis. If chirurgical management is indicated, allergen immunotherapy should be postponed until total recovery from operational procedure and repeated.
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Affiliation(s)
- Aleksandra Marciniak
- Chair and Department of Paediatric Otolaryngology, Phoniatrics and Audiology, Medical University of Lublin, Antoni Gębala Street No. 6, 20-093 Lublin, Poland.
| | - Anna Horaczyńska-Wojtaś
- Chair and Department of Paediatric Otolaryngology, Phoniatrics and Audiology, Medical University of Lublin, Antoni Gębala Street No. 6, 20-093 Lublin, Poland
| | - Grażyna Mielnik-Niedzielska
- Chair and Department of Paediatric Otolaryngology, Phoniatrics and Audiology, Medical University of Lublin, Antoni Gębala Street No. 6, 20-093 Lublin, Poland
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18
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Moldovan MA, Rotaru H, Roman CR. Giant follicular cyst with maxillary sinus and pterygomaxillary space extension. Ann Ital Chir 2020; 9:S2239253X20032983. [PMID: 32588835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Dentigerous, follicular, cysts are developmental odontogenic cysts of reduced adamantine epithelium origin, associated with an impacted tooth. They are the second most frequent cystic pathology after inflammatory cysts. Although the frequency of dentigerous cysts associated with upper third molars is far lower than the mandibular ones, their complications are nothing but ordinary. Most of the times asymptomatic, being discovered during routine x-ray examinations, maxillary follicular cysts can grow to important size, altering the position of adjacent teeth, producing osteolysis of the nearby bone structures, as well as infectious complications, antral and orbital pathology. CASE REPORT The present manuscript describes the clinical, radiological, pathological and therapeutical aspects of a giant follicular cyst with antral and pterygomaxillary extension, associated with an impacted upper third molar. CONCLUSION The most efficient treatment of maxillary follicular cysts consists in the surgical removal of the lesion along with the involved tooth. Complete excision is mandatory to prevent recurrence. Extension into adjacent structures might complicate the surgery Preoperative evaluation and rigorous planning are essential, especially in large-sized lesions. Pathological examination is outmost importance in order to exclude aggressive transformations. KEY WORDS Dentigerous follicular cyst, Maxillary sinus extension, Pterygomaxillary space.
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Abstract
There have been few studies on congenital nasal dermoid and sinus cysts (NDSCs) in infants.This study was performed to obtain clinical data for the diagnosis and treatment of NDSCs in infants.We performed a retrospective analysis of 11 infants admitted with NDSCs between 2014 and 2019. Patient demographics, lesion site, preoperative radiological findings, surgical technique, intraoperative findings, and postoperative sequelae were analyzed.In total, 11 infants (average age, 19 months; lowest age, 10 months) were included in this study. All patients presented with a nasal root mass, 2 patients also had nasal tip fistula, and only 1 case had a history of preoperative infection. Preoperative enhanced computed tomography (CT) examination showed nasal surface lesion (type I) in 3, nasal intraosseous (type II) in 5, intracranial epidural (type III) in 2, and intracranial dural (type IV) in 1 patient. The main surgical methods included direct resection with a vertical midline incision (9 patients), vertical incision + transnasal endoscopic resection + skull base repair (1 patient), and transverse incision of the lower margin of the left eyebrow (1 patient). All wounds healed well without serious complications.Using the 4-type classification method in combination with the preoperative CT findings to analyze the extent of NDSC in infants is helpful for formulating the surgical plan. Using vertical incision approach alone or combined with nasal endoscopy for minimally invasive surgery can meet the needs of complete resection and reconstruction.Our results provide clinical data that can help establish standardized criteria for the diagnosis and treatment of NDSCs in infants.
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Affiliation(s)
- Kun Ni
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University
| | - Xiaoyan Li
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University
| | - Limin Zhao
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University
| | - Jiali Wu
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University
| | - Xiaojun Liu
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University
| | - Haibo Shi
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
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Harreld JH, Kaufman RA, Kang G, Maron G, Mitchell W, Thompson JW, Srinivasan A. Utility of Pre-Hematopoietic Cell Transplantation Sinus CT Screening in Children and Adolescents. AJNR Am J Neuroradiol 2020; 41:911-916. [PMID: 32273266 DOI: 10.3174/ajnr.a6509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 03/03/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND PURPOSE The clinical benefit of pre-hematopoietic cell transplantation sinus CT screening remains uncertain, while the risks of CT radiation and anesthesia are increasingly evident. We sought to re-assess the impact of screening sinus CT on pretransplantation patient management and prediction of posttransplantation invasive fungal rhinosinusitis. MATERIALS AND METHODS Pretransplantation noncontrast screening sinus CTs for 100 consecutive patients (mean age, 11.9 ± 5.5 years) were graded for mucosal thickening (Lund-Mackay score) and for signs of noninvasive or invasive fungal rhinosinusitis (sinus calcification, hyperattenuation, bone destruction, extrasinus inflammation, and nasal mucosal ulceration). Posttransplantation sinus CTs performed for sinus-related symptoms were similarly graded. Associations of Lund-Mackay scores, clinical assessments, changes in pretransplantation clinical management (additional antibiotic or fungal therapy, sinonasal surgery, delayed transplantation), and subsequent development of sinus-related symptoms or invasive fungal rhinosinusitis were tested (exact Wilcoxon rank sums, Fisher exact test, significance P < .05). RESULTS Mean pretransplantation screening Lund-Mackay scores (n = 100) were greater in patients with clinical symptoms (8.07 ± 6.00 versus 2.48 ± 3.51, P < .001) but were not associated with pretransplantation management changes and did not predict posttransplantation sinus symptoms (n = 21, P = .47) or invasive fungal rhinosinusitis symptoms (n = 2, P = .59). CONCLUSIONS Pre-hematopoietic cell transplantation sinus CT does not meaningfully contribute to pretransplantation patient management or prediction of posttransplantation sinus disease, including invasive fungal rhinosinusitis, in children. The risks associated with CT radiation and possible anesthesia are not warranted in this setting.
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Affiliation(s)
- J H Harreld
- From the Departments of Diagnostic Imaging (J.H.H., R.A.K.),
| | - R A Kaufman
- From the Departments of Diagnostic Imaging (J.H.H., R.A.K.)
| | | | | | - W Mitchell
- Bone Marrow Transplantation and Cellular Therapy (W.M., A.S.), and
| | - J W Thompson
- Surgery (J.W.T.), St. Jude Children's Research Hospital, Memphis, Tennessee
- Department of Otolaryngology (J.W.T.), University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - A Srinivasan
- Bone Marrow Transplantation and Cellular Therapy (W.M., A.S.), and
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Wolf A, Koele W, Ratschek M, Lang-Loidolt D, Tomazic PV. Endoscopic surgery of an extensive aneurysmatic bone cyst of the paranasal sinuses in a 12-year-old patient. Braz J Otorhinolaryngol 2019; 85:803-808. [PMID: 27237617 PMCID: PMC9443026 DOI: 10.1016/j.bjorl.2016.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 04/07/2016] [Accepted: 04/14/2016] [Indexed: 11/30/2022] Open
Affiliation(s)
- Axel Wolf
- Medical University of Graz, Department of Otorhinolaryngology, Graz, Austria
| | - Wolfgang Koele
- Medical University of Graz, Department of Otorhinolaryngology, Graz, Austria
| | - Manfred Ratschek
- Medical University of Graz, Institute for Pathology, Graz, Austria
| | - Doris Lang-Loidolt
- Medical University of Graz, Department of Otorhinolaryngology, Graz, Austria
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Michailidis G, Kyriazi S, Maravelia A, Tourna E, Couvaris CM, Kalampoukas K, Pantazis I, Lazaris P, Geroulanos S, Kalogerakou K, Bontozoglou N. Chronic maxillary atelectasis under the wrappings of an Egyptian mummy. Ann Otol Rhinol Laryngol 2019; 128:1165-1169. [PMID: 31569952 DOI: 10.1177/0003489419879716] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES In the context of a joint Mummy Research Project of the National Archaeological Museum, the Hellenic Institute of Egyptology and the Athens Medical Centre, an Egyptian mummy of the mid-Ptolemaic Period was transferred to our hospital and was thoroughly investigated with Computed Tomography. METHODS The mummy was carefully removed from its coffin and scanned in a 64-detector row computed tomographic scanner. Multiplanar and anthropometric measurements were obtained using advanced software. RESULTS The mummy appeared to be well-preserved and belonged to a young male adult. Among the findings, the most interesting and uncommon one was the asymmetry of the maxillary sinuses and the orbits. There were no signs of trauma. CONCLUSIONS Computed Tomography revealed in a non-destructive way a rare, based on the published data, facial deformity in an Egyptian mummy attributed to chronic maxillary atelectasis.
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Affiliation(s)
| | | | - Alicia Maravelia
- Hellenic Institute of Egyptology & People's University of Athens, Athens, Greece
| | - Eleni Tourna
- Department of Prehistoric, Egyptian, Cypriot and Near Eastern Antiquities, National Archaeological Museum of Athens, Athens, Greece
| | | | | | - Ioannis Pantazis
- CT and MR Department, Athens Medical Centre Clinic, Athens, Greece
| | - Panagiotis Lazaris
- Department of Prehistoric, Egyptian, Cypriot and Near Eastern Antiquities, National Archaeological Museum of Athens, Athens, Greece
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Costa F, Emanuelli E, Franz L, Tel A, Sembronio S, Robiony M. Fungus ball of the maxillary sinus: Retrospective study of 48 patients and review of the literature. Am J Otolaryngol 2019; 40:700-704. [PMID: 31239183 DOI: 10.1016/j.amjoto.2019.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 06/15/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Maxillary fungus ball (FB) is the most frequent paranasal localization. OBJECTIVE To review clinical presentation, surgery and results of treatment in our series of patients with maxillary FB. To review the literature concerning treatment of maxillary FB. PATIENTS AND METHODS 48 patients with a diagnosis of maxillary FB were treated with endoscopic sinus surgery (ESS) alone or in association with external approaches. Before surgery all patients received computed tomography (CT), nasal endoscopy and dental examination. All the patients were followed for 1 year after surgery. Studies concerning surgical treatment of maxillary FB from 2006 were reviewed. RESULTS The mean age of patients was 53.6 ± 11.9 years. 20 patients (41.6%) did not present any symptom, 19 patients (39.7%) had nasal symptoms, 3 patients (6.2%) had facial pain, 6 patients (12.5%) had a combination of both. Endoscopic examination was positive in 31 patients (64.6%), 17 patients (35.4%) showed negative findings. Logit regression model demonstrated that clinical symptoms contribute to the prediction of a positive endoscopic examination. 25 patients (52.1%) presented odontogenic factors. Complete clinical and radiological resolution of FB was observed in 46 patients (95.8%). CONCLUSIONS Comparing our sample to the studies reviewed we may concluded that odontogenic factors were frequently reported and should be treated at the same time of maxillary FB. ESS alone or in association with external approaches is an effective treatment for patients with maxillary FB.
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Affiliation(s)
- Fabio Costa
- Maxillofacial Surgery Unit, Azienda Ospedaliero Universitaria of Udine, Udine, Italy.
| | - Enzo Emanuelli
- Department of Otorhinolaryngology and Otologic Surgery, Azienda Ospedaliera - Policlinico of Padova, Padova, Italy
| | - Leonardo Franz
- Azienda Ospedaliera - Policlinico of Padova, Padova, Italy
| | - Alessandro Tel
- Azienda Ospedaliero Universitaria of Udine, Udine, Italy
| | - Salvatore Sembronio
- Maxillofacial Surgery Unit, Azienda Ospedaliero Universitaria of Udine, Udine, Italy
| | - Massimo Robiony
- Azienda Ospedaliero Universitaria of Udine, Department of Medical and Biological Science, University of Udine, Udine, Italy
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Hung K, Montalvao C, Yeung AWK, Li G, Bornstein MM. Frequency, location, and morphology of accessory maxillary sinus ostia: a retrospective study using cone beam computed tomography (CBCT). Surg Radiol Anat 2019; 42:219-228. [PMID: 31456002 DOI: 10.1007/s00276-019-02308-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 08/20/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the reliability of cone beam computed tomography (CBCT) imagining in the assessment of the frequency, location, and morphological characteristics of accessory maxillary ostia (AMOs), and to analyze a potential association with sinus and dentoalveolar pathologies. METHODS CBCT scans with bilateral maxillary sinuses that were acquired from September 2016 to September 2018 were initially screened. A total of 160 CBCT scans (320 sinuses) that fulfilled the inclusion criteria were included for further analysis. The presence, location, and morphological characteristics of the AMOs were evaluated in axial, coronal, and sagittal CBCT views. The findings were correlated with age, gender, sinus, and dentoalveolar pathology to assess for potential influencing factors on AMOs. RESULTS An AMO was present in 151 (47.2%) of the 320 sinuses. Most of the AMOs were located within the region of the nasal fontanelle or hiatus semilunaris (81.1%) presenting with an ovaloid (48.4%) or a round shape (39.0%). The average length of the AMOs was 2.33 ± 1.42 mm, occupying an area of 3.43 ± 4.51 mm2, respectively. Morphological changes of the maxillary sinus mucosa were positively associated with length and area of AMOs. Furthermore, the status of the dentition in the posterior maxilla seemed to be an influencing factor on AMO shape. CONCLUSIONS Nearly half of the maxillary sinuses assessed in the present study population had an AMO. Pathologies of the maxillary sinus seem to have an impact on AMOs, which is demonstrated here by morphological changes of the sinus mucosa being associated with an increase in length and area of accessory ostia.
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Affiliation(s)
- Kuofeng Hung
- Oral and Maxillofacial Radiology, Applied Oral Sciences and Community Dental Care, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Carla Montalvao
- Oral and Maxillofacial Radiology, Applied Oral Sciences and Community Dental Care, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Andy Wai Kan Yeung
- Oral and Maxillofacial Radiology, Applied Oral Sciences and Community Dental Care, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Gang Li
- Department of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Michael M Bornstein
- Oral and Maxillofacial Radiology, Applied Oral Sciences and Community Dental Care, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China.
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Cai X, Cai H, Gan Q, Chang W, Yuan F, Luo W, Sun J, An J. Case Report: Rare Presentation of Multivisceral Echinococcosis. Am J Trop Med Hyg 2019; 100:1204-1207. [PMID: 30860020 PMCID: PMC6493931 DOI: 10.4269/ajtmh.18-0673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 01/21/2019] [Indexed: 02/02/2023] Open
Abstract
Cystic echinococcosis (CE) is a common, chronic, and endemic zoonotic disease usually localized in a single organ; multivisceral cases are rare, especially outside the liver or lung. Here, we describe an unusual case of a 43-year-old Tibetan man with echinococcosis of the infratemporal fossa, heart, liver, pancreas, abdomen, and pelvic cavity. He only presented with diminished vision of the left eye, especially when chewing. Computed tomography and magnetic resonance imaging revealed multivisceral CE. The patient underwent surgery for the excision of a cyst in the infratemporal fossa, as well as chemotherapy, and the diagnosis was confirmed by histopathological examination. The diagnosis, clinical features, treatment, and follow-up in this case are discussed. In areas with high echinococcosis prevalence, examination by full imaging is necessary for an accurate diagnosis, especially in cases of atypical localization. Chemotherapy for treatment, as well as prophylaxis against recurrence, can be effective when surgery is not possible.
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Affiliation(s)
- Xiao Cai
- Department of Otolaryngology Head and Neck Surgery, People’s Hospital of Qinghai Province, Xining, China
| | - Huixia Cai
- Department of Parasite Control, Qinghai Province Institute for Endemic Diseases Prevention and Control, Xining, China
| | - Qing Gan
- Department of Otolaryngology Head and Neck Surgery, People’s Hospital of Qinghai Province, Xining, China
| | - Wenxu Chang
- Department of Otolaryngology Head and Neck Surgery, People’s Hospital of Qinghai Province, Xining, China
| | - Fang Yuan
- Department of Otolaryngology Head and Neck Surgery, People’s Hospital of Qinghai Province, Xining, China
| | - Wei Luo
- Department of Otolaryngology Head and Neck Surgery, People’s Hospital of Qinghai Province, Xining, China
| | - Jie Sun
- Department of Otolaryngology Head and Neck Surgery, People’s Hospital of Qinghai Province, Xining, China
| | - Jing An
- Department of Otolaryngology Head and Neck Surgery, People’s Hospital of Qinghai Province, Xining, China
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Bornstein MM, Yeung AWK, Tanaka R, von Arx T, Jacobs R, Khong PL. Evaluation of Health or Pathology of Bilateral Maxillary Sinuses in Patients Referred for Cone Beam Computed Tomography Using a Low-Dose Protocol. INT J PERIODONT REST 2019; 38:699-710. [PMID: 30113608 DOI: 10.11607/prd.3435] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The aim of this study was to evaluate the health or pathology of bilateral maxillary sinuses using cone beam computed tomography (CBCT) with a low-dose protocol, and to analyze potential influencing factors. The study included only CBCT scans with complete visualization of bilateral maxillary sinuses. The scans were taken using a medium to large field of view and a low-dose protocol, as indicated by the manufacturer. CBCT images were analyzed with regard to the morphology of the sinus membrane and surrounding bone twice by one observer. Influencing factors such as age, sex, or status of the remaining dentition in the posterior maxilla, including periodontal and endodontic parameters, were evaluated. The study included 134 CBCT scans (268 maxillary sinuses). Using a low-dose protocol, intraobserver reliability of the measurements was almost perfect (kappa value range 0.875 to 1). More than half the sinuses evaluated (63.1%) did not show visible morphologic changes. The most frequently identified pathologic appearance was a flat, shallow thickening of the sinus membrane of > 2 mm (47 positive findings [17.5%]). Only 15 (5.6%) sinuses were associated with teeth with endodontic treatment and/or pathology, and 10 (3.7%) with teeth exhibiting periodontal pathology. CBCT scans with a low-dose protocol can be recommended as a feasible adjunctive tool to evaluate health or pathology of the maxillary sinuses prior to surgical interventions such as sinus floor augmentation. Of all morphologic changes seen, only a small portion of the cases were considered to need further medical diagnosis/treatment.
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Munhoz L, Abdala Júnior R, Abdala R, Arita ES. Diffusion-weighted magnetic resonance imaging of the paranasal sinuses: A systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 126:521-536. [PMID: 30143461 DOI: 10.1016/j.oooo.2018.07.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 06/29/2018] [Accepted: 07/07/2018] [Indexed: 01/05/2023]
Abstract
OBJECTIVES This was a systematic review of studies on the use of diffusion-weighted imaging (DWI) for paranasal sinus diseases. The applications of DWI were analyzed along with the main results, and conclusions were obtained by the investigators. STUDY DESIGN Databases were searched using the keyword "diffusion" combined with "sinonasal," "paranasal sinus," "maxillary sinus," "frontal sinus," "ethmoid sinus," and "sphenoid sinus," including only articles that were published from 2008 to 2018. Only original English language studies with sinonasal disease samples were selected. RESULTS Sixteen studies about various sinonasal diseases were included. The main objectives of most of the studies were related to the use of the apparent diffusion coefficient (ADC) in the differentiation of benign lesions and malignant neoplasms. We concluded that the ADC for malignant neoplasms is lower. Histologic features of samples evaluated in the studies were heterogeneous. CONCLUSIONS The ADC may improve the quality of the diagnostic hypothesis, particularly in differentiating benign and malignant diseases. Furthermore, the differences between certain types of lesions could be determined by using the ADC. However, further studies focusing on inflammatory diseases should be performed. Overall, DWI and the ADC are promising methods that can be incorporated into routine evaluations.
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Affiliation(s)
- Luciana Munhoz
- Department of Stomatology, School of Dentistry, São Paulo University, São Paulo, SP, Brazil.
| | - Reinaldo Abdala Júnior
- Department of Stomatology, School of Dentistry, São Paulo University, São Paulo, SP, Brazil
| | - Rogério Abdala
- CDB - Centro de Diagnósticos Brasil, São Paulo, SP, Brazil
| | - Emiko Saito Arita
- Department of Stomatology, School of Dentistry, São Paulo University, São Paulo, SP, Brazil
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Kitsche M, Terai N. [Orbital cavity tumor with macular folds]. Ophthalmologe 2018; 114:1031-1033. [PMID: 27933400 DOI: 10.1007/s00347-016-0416-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A 40-year-old patient presented with an orbital tumor of the right eye accompanied by visual impairment and macular folds. The diagnosis of mucocele was made through clinical and radiological investigations. The excision of the mucocele was performed immediately. As early as 8 weeks after the operation, an obvious increase in visual acuity was noticed. At this time, the macular folds were no longer detectable.
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Affiliation(s)
- M Kitsche
- Augenklinik der Medizinischen Fakultät "Carl Gustav Carus", Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland.
| | - N Terai
- Augenklinik der Medizinischen Fakultät "Carl Gustav Carus", Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
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29
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Affiliation(s)
- Manjul Tripathi
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Sandeep Mohindra
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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30
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Fockens MM, Kox D. [A woman with purulent rhinorrhoea after bathing in the sea]. Ned Tijdschr Geneeskd 2018; 162:D2847. [PMID: 30040319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
A 59-year-old woman was referred because of nasal discharge with stones and sand. Some months earlier, a rip current had thrown her over while bathing in the sea. CT showed bilateral stones in the maxillary sinus. A right maxillary sinus rinse was performed, which revealed six small stones.
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Affiliation(s)
- M Matthijs Fockens
- Vijf Meren Kliniek, afd. Keel-, Neus-, en Oorheelkunde, Haarlem/Hoofddorp
- Contact: M.M. Fockens
| | - Dennis Kox
- Vijf Meren Kliniek, afd. Keel-, Neus-, en Oorheelkunde, Haarlem/Hoofddorp
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Abstract
Background Cystic fibrosis (CF) patients often have widespread inflammatory paranasal sinus disease with an increased incidence of frontal, maxillary, and sphenoid hypoplasia. The most common genetic defect in CF is the delta F508 mutation. The effect of specific CF genotypes on phenotypic sinus development and infections is not well understood. The purpose of this study was to determine whether the homozygous delta F508 mutation is associated with an increased incidence of sinus hypoplasia when compared with other mutations. Methods This study is a retrospective review of all adult patients seen at our CF center from 1996 to 2005. Patients ≥18 years old with a CF diagnosis using genetic and sweat chloride testing and sinus CT scans were included. Frontal sinus aplasia/hypoplasia and maxillary and sphenoid sinus hypoplasia were documented using published criteria. Data collected included patient demographics, genetic mutations, and prior sinus surgeries. Results Forty-five patients were identified with an average age of 32 years (range, 18–48 years). Thirty-one patients had prior sinus surgeries. Delta F508 homozygotes (n = 25) had a significantly increased frequency of underdeveloped frontal (98%), maxillary (70%), and sphenoid (100%) sinuses (p < 0.001) when compared with other mutations (69, 8, and 50%, respectively). Conclusion CF patients homozygous for the delta F508 mutation have a greater incidence of hypoplastic or underdeveloped sinuses. Whether this is secondary to an increased frequency of sinus infections or a phenotypic expression of the genetic mutation itself remains an area for further investigation.
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Affiliation(s)
- Bradford A Woodworth
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.
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Lombardo N, Ferrise P, Piazzetta GL, Bruzzichessi D, Testa D, Viola P, Pelaia C, Motta G. Maxillary sinus mucocele with orbital complications. Ann Ital Chir 2018; 7:S2239253X18028190. [PMID: 29661986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Maxillary sinus mucocele is an unusual clinic entity (incidence of 3-10%), represented by mucous secretion lined by respiratory stratified pavemented epithelium and its origin is mainly secondary to infections, inflammations, surgery, trauma or neoplasia. CASE REPORT We present a case of maxillary sinus mucocele. Subject of the study is a 74 aged patient referring positive anamnesis for nasal cavity surgery. His symptoms appeared six months ago and he complainted vertical ocular diplopia and ocular tension sensation, without rhinologic complaints. Oculistic examination confirmed an isolated left inferior rectus palsy, and CT showed mucous secretion occupying left maxillary sinus, with bone erosion to the orbital floor until orbital muscles. MRI is the gold standard for differential diagnosis with neoplastic lesions but the patient refused to perform this radio-diagnostic exam. He underwent to Endoscopic sinus surgery, consisting in middle meatal antrostomy and removal of the mucocele. Four months later the endoscopic follow-up showed regular maxillary cavity and regular ocular motility. CONCLUSION In our opinion the rebuilding of the eroded bone is not mandatory if the integrity of the maxillary upper wall mucosa is respected, and antrostomy with drainage allows to recover ocular and paranasal sinus function. KEY WORDS:, Diplopia, Endoscopic sinus surgery.
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Martel A. Septic thrombosis of cavernous sinus extended to the ipsilateral internal jugular vein and transversal sinus with favorable outcome: Clinical and radiological features of a Lemierre syndrome. Orbit 2018; 37:94-96. [PMID: 29040036 DOI: 10.1080/01676830.2017.1383458] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
An 86-year-old patient was hospitalized for fever and left acute orbital syndrome (red eye with moderate visual impairment, chemosis, ophthalmoplegia without proptosis, or any fundus involvement). CT scan showed superior ophthalmic vein and cavernous sinus enlargement complicating ipsilateral sphenoidal sinusitis. Magnetic resonance imaging (MRI) demonstrated the left cavernous sinus thrombosis extended to the ipsilateral jugular vein and transversal sinus (Lemierre syndrome). Intravenous broad-spectrum antibiotics and curative anticoagulation were prescribed. Blood cultures allowed the identification of Streptococcus intermedius and Staphylococcus warneri species. Evolution was favorable and the patient was discharged 3 weeks after. Antibiotics and anticoagulation were carried out for a total duration of 4 and 12 weeks, respectively. Lemierre syndrome is a potentially life-threatening emergency rarely encountered; thus, ophthalmologists should be cognizant of clinical and radiological features. Broad-spectrum antibiotics are the mainstay of treatment. Curative anticoagulation may be added if no blood coagulation disorder nor bleeding on neuroimaging has been identified.
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Affiliation(s)
- Arnaud Martel
- a Department of Ophthalmology , University Hospital of Nice , Nice , France
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34
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Lajmi H, Hmaied W, Ben Jalel W, Ben Romdhane K, Chelly Z, El Fekih L. Unilateral proptosis revealing a fronto-ethmoidal mucocele. Tunis Med 2017; 95:449-451. [PMID: 29512802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
UNLABELLED Backgroud: The fronto-ethmoidal mucocele is a benign condition leading commonly to limited eye movement or ocular pain but it could also induce visual acuity impairment by compressing the optic nerve Aim: To discuss, through a case report, different ophthalmologic manifestations of the fronto-ethmoidalmucocele. Reported case: A 46-years-old man with no general history consulted for a bilateral ocular redness and itching. He reported, however, a mild protrusion of his left globe evolving for oneyear. The clinical examination revealed a unilateral proptosis in the left eye with a discrete limitation of theadduction. A brain and orbital computer tomography (CT)and a magnetic resonance imaging(MRI)revealed a grade I exophthalmos caused by an oval formation of fluid density in the left anterior and posterior ethmoidal cells in addition to the frontal sinus,driving theeyeball and internal oculomotor muscles back and out.The patient was referred to otorhinolaryngology department for a precocious surgical management. CONCLUSION The ophtalmologic manifestations of the disease depend on the location, the size of the formation and involvement of adjacent structures. The loss of vision and the apex syndrome due to the compressionof the ocular globe are the most serious complications.
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Tojima I, Kikuoka H, Ogawa T, Shimizu T. Severely infected pneumoceles of the frontal sinus in patients with mental retardation and brain atrophy treated by endoscopic sinus surgery. Auris Nasus Larynx 2017; 45:362-366. [PMID: 28511889 DOI: 10.1016/j.anl.2017.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 04/03/2017] [Accepted: 04/12/2017] [Indexed: 11/19/2022]
Abstract
We herein present three cases of abnormally expanded frontal sinuses (pneumoceles) with severe infection in patients with mental retardation and brain atrophy. Two patients previously underwent laryngotracheal separation surgery, and bacteriological examinations of purulent nasal discharge revealed infections caused by drug-resistant bacteria such as Pseudomonas aeruginosa and Acinetobacter baumannii. As conservative medical treatments were ineffective, all three patients were treated by computed tomography-guided endoscopic sinus surgery. This navigation system is useful for safer surgery in the area of anatomic deformity. The clinical findings, possible etiologies and surgical treatment of these cases are discussed.
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Affiliation(s)
- Ichiro Tojima
- Department of Otorhinolaryngology, Shiga University of Medical Science, Otsu, Japan.
| | - Hirotaka Kikuoka
- Department of Otorhinolaryngology, Shiga University of Medical Science, Otsu, Japan
| | - Takao Ogawa
- Department of Otorhinolaryngology, Shiga University of Medical Science, Otsu, Japan
| | - Takeshi Shimizu
- Department of Otorhinolaryngology, Shiga University of Medical Science, Otsu, Japan
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Iqbal J, Rashid S, Darira J, Shazlee MK, Ahmed MS, Fatima S. Diagnostic Accuracy of CT Scan in Diagnosing Paranasal Fungal Infection. J Coll Physicians Surg Pak 2017; 27:271-274. [PMID: 28599686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 05/29/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To assess the diagnostic accuracy of CTscan in detecting paranasal sinus fungal infections. STUDY DESIGN Cross-sectional, observational study. PLACE AND DURATION OF STUDY Department of Radiology, Ziauddin University Hospital, Karachi, from April to September 2014. METHODOLOGY Patients with clinical suspicion of fungal sinusitis were included in this study. Patients with already diagnosed or history of recurrent fungal infections were excluded. All these patients underwent CTscan examination of paranasal sinuses. Findings were recorded. Final diagnosis was based on smear analysis for fungal culture. Accuracy analysis was conducted for CTdiagnosis using smear analysis as the gold standard. Kappa analysis was conducted to determine agreement. RESULTS Out of the 120 patients, 71 (59%) were male. The sensitivity, specificity, positive predictive value and negative predictive value of CTwere 96.19%, 93.33%, 99.01%, 77.77%, respectively. The diagnostic accuracy was 95.83%. Kappa statistics showed 82% agreement beyond chance. CONCLUSION CTscan is highly accurate in diagnosing and characterizing fungal infection of paranasal sinuses. It also determines the extent of disease which eventually aids in deciding the surgical approach to be used.
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Affiliation(s)
- Junaid Iqbal
- Department of Radiology, Ziauddin University Hospital, Karachi
| | - Sadia Rashid
- Department of Radiology, Ziauddin University Hospital, Karachi
| | - Jaideep Darira
- Department of Radiology, Ziauddin University Hospital, Karachi
| | | | | | - Sumayya Fatima
- Department of Radiology, Ziauddin University Hospital, Karachi
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Jiang Y, Gao J, Su W. [Significance of differential diagnosis for sinonasal mass by CT value]. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2017; 42:55-59. [PMID: 28216498 DOI: 10.11817/j.issn.1672-7347.2017.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To explore whether CT value is useful in identifying different disease in tumors of rhinosinus parenchyma.
Methods: The data of preoperation noncontrast CT in 277 patients were retrospectively reviewed. The final diagnosis and classification were based on the result of surgical histopathological examination. The CT value range for different classification was calculated and was compared. All patients were re-diagnosed according to CT value range combined with pathological results by the same doctor team. The diagnosis rates according to CT value range were compared.
Results: The CT value was (25.3±3.5) Hu in nasal polyp, (7.9±3.5) Hu in serous cyst, (42.2±4.7) Hu in mucocele, (40.7±5.3) Hu in papilloma, (112.3±10.9) Hu in fungus ball, (41.7±4.8) Hu in hemangioma, (51.2±9.9) Hu in malignant melanoma, and (47.1±9.9) Hu in squamous carcinoma. The CT value in nasal polyp is significantly higher than that in serous cyst, which was significantly lower than that in mucocele, papilloma, fungus ball, hemangioma, malignant melanoma and squamous carcinoma (all P<0.05); the CT value in serous cyst was significantly lower than that in other classification diseases (all P<0.05); the CT value in fungus ball was significantly higher than that in other classification diseases (all P<0.05); there was no significant difference in CT value among mucocele, papilloma, hemangioma, malignant melanoma, squamous carcinoma (all P﹥0.05). The diagnosis rate was elevated (from 71.1% to 92.4%) according to CT value range, with significant difference (χ2=42.150, P<0.01).
Conclusion: CT value in nasal polyp, serous cyst, fungus ball is different from other diseases, and the 3 diseases can be distinguished only by CT value range; the CT value in mucocele, papilloma, hemangioma, malignant melanoma and squamous carcinoma is similar, and their differential diagnosis should combine with imaging data and other clinical characters. The diagnosis rates can be improved when the CT value range is taken into account.
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Affiliation(s)
- Yan Jiang
- Department of Otolaryngology Head and Neck Surgery, First Affiliated Hospital of Xiamen University, Xiamen Fujian 361000, China
| | - Jing Gao
- Department of Otolaryngology Head and Neck Surgery, First Affiliated Hospital of Xiamen University, Xiamen Fujian 361000, China
| | - Wenling Su
- Department of Otolaryngology Head and Neck Surgery, First Affiliated Hospital of Xiamen University, Xiamen Fujian 361000, China
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Christmas DA, Mirante JP, Yanagisawa E. Endoscopic view of balloon dilation for excision of a sphenoid cyst. Ear Nose Throat J 2017; 96:12. [PMID: 28122095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Affiliation(s)
- Dewey A Christmas
- Section of Otolaryngology, Halifax Medical Center, Daytona Beach, FL, USA
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Balikci HH, Gurdal MM, Celebi S, Ozbay I, Karakas M. Relationships among concha bullosa, nasal septal deviation, and sinusitis: Retrospective analysis of 296 cases. Ear Nose Throat J 2016; 95:487-491. [PMID: 27929597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
We aimed to investigate the relationships among concha bullosa (CB), nasal septal deviation (NSD), and sinus disease. We retrospectively reviewed paranasal sinus computed tomography scans obtained from 296 patients-132 men and 164 women, aged 17 to 76 years (median: 39)-who had been evaluated over a 19-month period. CBs were classified as lamellar, bulbous, and extensive. In cases of bilateral CB, the larger side was designated as dominant. In all, 132 patients (44.6%) exhibited pneumatization of at least one concha, 176 (59.5%) had NSD, and 187 (63.2%) had sinus disease. Some 89 of 106 patients with unilateral or one-side-dominant CB (84.0%) had NSD, 89 of 132 patients with CB (67.4%) had sinus disease, and 109 of the 176 patients with NSD (61.9%) had sinus disease. We found a statistically significant relationship between CB and contralateral NSD, but no significant relationship between CB and sinus disease or NSD and sinus disease. While CB is a common anatomic problem that may accompany NSD, a causal relationship between CB or NSD and sinus disease is dubious.
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Affiliation(s)
- Hasan H Balikci
- Department of Otorhinolaryngology, Burdur Devlet Hastanesi, Kulak Burun Bogaz Klinigi, 15030, Burdur, Turkey.
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Chavez-Montoya R, Araujo-Ramírez O, Castillo-López IY, Govea-Camacho LH. [Imploding antrum syndrome: three cases with different management approaches]. CIR CIR 2016; 85:529-534. [PMID: 27773365 DOI: 10.1016/j.circir.2016.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Revised: 08/25/2016] [Accepted: 08/25/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Silent sinus or imploding antrum syndrome is a very rare condition, consisting of a usually asymptomatic spontaneous collapse of the sinus walls and floor of the orbit. It is associated with negative pressures, and when this occurs, it presents with manifestations such as enophthalmos, hypoglobus, and tilt flow orbital floor. As its incidence is very low, it is frequently missed as a diagnosis, and in fact there are currently fewer than 150 cases reported in the literature. CLINICAL CASES Three patients have been identified in our practice over a period of two years, with different symptoms that influenced the decision of the treatment modality, which were: watch and wait, endoscopic sinus surgery, or endoscopic sinus surgery plus orbitoplasty. CONCLUSIONS Despite being a rare entity, it stills catches the attention of the ENT, OMF surgery and Ophthalmologist. The diagnosis is mainly radiological, due to the late clinical manifestations and symptomatology. The treatment should be individualised and based on the symptoms and the individual decision of each patient, firstly by Functional Endoscopic sinus surgery, and once sinus permeability is restored, it may require augmentation surgery of the orbital floor, either with autologous bone implant, titanium or other material. It is important to be aware of this pathology, to know and to suspect it, avoiding misdiagnosis.
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Affiliation(s)
- Ramiro Chavez-Montoya
- Servicio de Otorrinolaringología, Cirugía de Cabeza y Cuello, Hospital de Especialidades, Centro Médico Nacional de Occidente Guadalajara, Jalisco, México
| | - Osvaldo Araujo-Ramírez
- Servicio de Otorrinolaringología, Cirugía de Cabeza y Cuello, Hospital de Especialidades, Centro Médico Nacional de Occidente Guadalajara, Jalisco, México.
| | - Irma Yolanda Castillo-López
- Servicio de Otorrinolaringología, Cirugía de Cabeza y Cuello, Hospital de Especialidades, Centro Médico Nacional de Occidente Guadalajara, Jalisco, México
| | - Luis Humberto Govea-Camacho
- Servicio de Otorrinolaringología, Cirugía de Cabeza y Cuello, Hospital de Especialidades, Centro Médico Nacional de Occidente Guadalajara, Jalisco, México
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Affiliation(s)
- I H Chen
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, Taoyuan Hsien, Taiwan
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Abstract
Purpose: In patients with cystic fibrosis (CF) the prevalence of paranasal sinus affection approaches 100%. We hypothesized that the hyperviscous mucus reducing mucociliary clearance in CF patients could give sinonasal inflammatory patterns different from those in non-CF patients. We wanted to compare the extent and distribution of paranasal sinus disease and the inflammatory patterns in these two groups of patients. Material and Methods: One-hundred-and-eight CF patients (3-54 years old) and 79 controls (7-51 years old) with paranasal sinus disease confirmed at coronal CT were compared. The extent of disease was noted for each sinus and summed for all sinuses. Inflammatory patterns were identified and classified into: 1) routine surgery group (sporadic, infundibular and ostiomeatal complex (OMC) patterns) and 2) complex surgery group (sinonasal polyposis and sphenoethmoid recess (SER) patterns). Results: CF patients had more widespread sinonasal inflammatory changes and more advanced disease for each sinus. Most CF patients displayed sinonasal polyposis and SER patterns while most controls displayed sporadic, infundibular or OMC patterns. As a result, 67% of CF patients were classified to the complex surgery group, compared to only 19% of controls. Conclusion: The impaired mucociliary clearance in CF causes widespread inflammatory paranasal sinus disease, with inflammatory patterns more often requiring extensive surgery, with a higher risk of cerebrospinal fluid leak or bleeding, or involving areas that are more difficult to reach with the endoscope.
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Affiliation(s)
- Heidi B Eggesbø
- Department of Radiology, Aker University Hospital, University of Oslo, NO-0514 Oslo, Norway
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Wolff C, Mücke T, Wagenpfeil S, Kanatas A, Bissinger O, Deppe H. Do CBCT scans alter surgical treatment plans? Comparison of preoperative surgical diagnosis using panoramic versus cone-beam CT images. J Craniomaxillofac Surg 2016; 44:1700-1705. [PMID: 27567358 DOI: 10.1016/j.jcms.2016.07.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 06/16/2016] [Accepted: 07/27/2016] [Indexed: 02/07/2023] Open
Abstract
Cone beam CT and/or panoramic images are often required for a successful diagnosis in oral and maxillofacial surgery. The aim of this study was to evaluate if 3D diagnostic imaging information had a significant impact on the decision process in six different classes of surgical indications. MATERIAL AND METHODS Records of all patients who had undergone both panoramic X-ray and CBCT imaging due to surgical indications between January 2008 and December 2012 were examined retrospectively. In February 2013, all surgically relevant diagnoses of both conventional panoramic radiographs and CBCT scans were retrieved from the patient's charts. It was recorded whether (1) 3D imaging presented additional surgically relevant information and (2) if the final decision of surgical therapy had been based on 2D or 3D imaging. RESULTS A total of 253 consecutive patients with both panoramic radiographs and CBCT analysis were eligible for the study. 3D imaging provided significantly more surgically relevant information in cases of implant dentistry, maxillary sinus diagnosis and in oral and maxillofacial traumatology. However, surgical strategies had not been influenced to any significant extent by 3D imaging. CONCLUSION Within the limitations of this study it may be concluded that CBCT imaging results in significantly more surgically relevant information in implant dentistry, maxillary sinus diagnosis and in cases of oral and maxillofacial trauma. However, 3D imaging information did not alter significantly the surgical plan that was based on 2D panoramic radiography. Further studies are necessary to define indications for CBCT in detail.
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Affiliation(s)
- Carolina Wolff
- Department of Oral and Craniomaxillofacial Surgery, Technical University of Munich, Klinikum rechts der Isar, Germany.
| | - Thomas Mücke
- Department of Oral and Craniomaxillofacial Surgery, Technical University of Munich, Klinikum rechts der Isar, Germany.
| | - Stefan Wagenpfeil
- Institute for Medical Biometry, Epidemiology and Medical Informatics, University of Saarland, Homburg/Saar, Germany.
| | - Anastasios Kanatas
- Leeds Teaching Hospitals and St James Institute of Oncology, Leeds General Infirmary, LS1 3EX, UK.
| | - Oliver Bissinger
- Department of Oral and Craniomaxillofacial Surgery, Technical University of Munich, Klinikum rechts der Isar, Germany.
| | - Herbert Deppe
- Department of Oral and Craniomaxillofacial Surgery, Technical University of Munich, Klinikum rechts der Isar, Germany.
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Greenberg G, Eyal A, Yakirevitch A, Wolf M, Migirov L. Cholesteatoma and coexisting findings diagnosed incidentally on MRI. Ear Nose Throat J 2016; 95:E17-E20. [PMID: 27304447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
The explosive growth in the use of diffusion-weighted magnetic resonance imaging (MRI) in the pre- and postoperative evaluations of patients with cholesteatoma has led to a concomitant increase in the number of incidental findings in this population. We describe our retrospective examination of MRI studies in cholesteatoma patients to look for the presence of other coexisting abnormalities. We examined the brain MRIs of 103 patients-45 males and 58 females, aged 3 to 81 years (mean: 31.9 ± 21.3)-who had undergone pre- or postoperative imaging during the management of a cholesteatoma. The MRIs revealed the presence of at least one other anomaly in 79 of these patients (76.7%)-36 males and 43 females, aged 3 to 81 years (mean: 43.5 ± 18.2). These 79 MRIs detected a total of 124 lesions that had been coexisting with cholesteatomas; some of these lesions had overlapped with the cholesteatoma. The two most common findings were sinonasal mucoperiosteal thickening and polyposis (n = 66) and white-matter changes (n = 29). Our results establish the need for routine skilled interpretation of brain MRIs by expert neuroradiologists to ensure that findings coexisting with cholesteatoma are detected so that appropriate management can be provided.
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Affiliation(s)
- Gahl Greenberg
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, 5262l, Israel
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Brown SM, Sadoughi B, Cuellar H, von Jako R, Fried MP. Feasibility of near real-time image-guided sinus surgery using intraoperative fluoroscopic computed axial tomography. Otolaryngol Head Neck Surg 2016; 136:268-73. [PMID: 17275552 DOI: 10.1016/j.otohns.2006.09.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2006] [Accepted: 09/25/2006] [Indexed: 11/15/2022]
Abstract
Objective One of the main limitations of image-guided surgery is that navigation relies on the use of a CT scan obtained before surgery and is unable to be updated during the procedure. A software addition has been developed to allow reconstruction of CT-like images from a series of fluoroscopic scans and integrate these into an image-guided system (GE Healthcare Surgical Navigation, Lawrence, MA). We report our initial experience with a series of patients undergoing intraoperative fluoroscopic navigation in sinus surgery. Study Design and Settings After institutional review board clearance, we prospectively studied 14 consecutive patients undergoing image-guided sinus surgery with the use of intraoperative fluoroscopy. Results All patients had preoperative and postoperative fluoroscopic images reconstructed into CT-like images. By the conclusion of the study, images were adequate in quality and accurate navigation was achieved. Conclusion Real-time image-guided sinus surgery using fluoroscopy is feasible. Future studies will need to focus on defining the procedures that could benefit, such as tumor resection, to enhance patient safety during these operations.
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Affiliation(s)
- Seth M Brown
- Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, NY 10467, USA.
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Abstract
Objectives The aim of study was to describe the histopathology in patients with unilateral sinus opacification and to identify variables that may predict neoplastic pathology. Study Design A retrospective review of paranasal sinus CT scans performed between 2000 and 2003 was conducted to identify patients with unilateral sinus opacification. Results Twenty-eight of 1118 CT scans showed unilateral sinus opacification. Twelve patients had neoplastic disease, 13 had inflammatory disease. Nasal discharge was more common in inflammatory than neoplastic disease (P = 0.009). A polyp or mass lesion was more common on nasendoscopy in neoplastic than inflammatory disease (P = 0.01). Bony erosion was only identified in malignant disease. Conclusion A wide variety of pathologies present with unilateral sinus opacification on CT scanning. In our series, neoplastic disease was more associated with a visible polyp or mass lesion and less with nasal discharge. Bony erosion on CT scan was only seen in malignant disease. Histologic confirmation remains obligatory for diagnosis.
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Affiliation(s)
- F Ahsan
- Grampian University Hospitals NHS Trust, Aberdeen Royal Infirmary, Aberdeen, Scotland
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47
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Lee JH, Jeong HM. Simultaneous occurrence of maxillary and sphenoid sinus fungus ball. Ear Nose Throat J 2016; 95:E45-E46. [PMID: 26991231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Affiliation(s)
- Jae-Hoon Lee
- Department of Otolaryngology, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Chonbuk, South Korea
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48
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Frączek M, Kolator M, Kręcicki T. The usefulness of free dicom viewers in rhinologic practice. Wiad Lek 2016; 69:597-601. [PMID: 28478434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
UNLABELLED Indroduction: The planning of the course of surgery in patients with paranasal sinus disorders requires the meticulous evaluation of computed tomography (CT) scans. However, ENT doctors still often receive unsatisfactory DICOM images, which require multiplanar reconstruction (MPR). THE AIM The objective of the present study was to evaluate and test DICOM viewers with MPR function currently available on the Internet for free. MATERIAL AND METHODS Detailed Internet searches and analysis of databases were carried out to find the maximum number of browsers. Available software was downloaded to assess, qualitatively and quantitatively, the parameters and functions useful in rhinologic practice. Additionally, a questionnaire was developed in order to ascertain the expectations and habits of ENT doctors in relation to DICOM browsers and CT scan evaluation. RESULTS AND CONCLUSIONS Among the hundreds of browsers, 17 programs were chosen to be included in the final comparison. The outcomes of the survey proved that many free DICOM tools are effective alternatives to commercially available programs. However, the results do not enable us to predict precisely which tool will meet the needs of each physician. The survey among ENT doctors highlighted their limited awareness of software with MPR functions, in particular those that scored best in the test.
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Affiliation(s)
- Marcin Frączek
- Department of Otolaryngology, Wroclaw Medical University, Poland
| | - Mateusz Kolator
- Department of Otolaryngology, Wroclaw Medical University, Poland
| | - Tomasz Kręcicki
- Department of Otolaryngology, Wroclaw Medical University, Poland
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49
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Nguyen T, Kuijpers D, Companjen J, Erceg A. [Intermittent swelling of the eyelid]. Ned Tijdschr Geneeskd 2016; 160:D92. [PMID: 27405576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Mucoceles are benign mucous-containing cysts that can occur in the sinuses. They arise as a result of an obstruction of the sinus ostium. There is often a delay in diagnosis because symptoms are so variable. CASE DESCRIPTION A 52-year-old woman had intermittent swelling of the eyelid. A CT scan of the sinuses showed a mucocele in the frontal sinus with breakthrough to the left orbit. Treatment consisted of marsupialisation by means of functional endoscopic sinus surgery with septum correction. CONCLUSION Breakthrough of a mucocele to the orbit should be considered in the differential diagnosis in patients with an intermittent swelling of the eyelid.
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50
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Frączek M, Kolator M, Kręcicki T. The usefulness of free dicom viewers in rhinologic practice. Wiad Lek 2016; 69:597-601. [PMID: 27717953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
UNLABELLED Indroduction: The planning of the course of surgery in patients with paranasal sinus disorders requires the meticulous evaluation of computed tomography (CT) scans. However, ENT doctors still often receive unsatisfactory DICOM images, which require multiplanar reconstruction (MPR). THE AIM The objective of the present study was to evaluate and test DICOM viewers with MPR function currently available on the Internet for free. MATERIAL AND METHODS Detailed Internet searches and analysis of databases were carried out to find the maximum number of browsers. Available software was downloaded to assess, qualitatively and quantitatively, the parameters and functions useful in rhinologic practice. Additionally, a questionnaire was developed in order to ascertain the expectations and habits of ENT doctors in relation to DICOM browsers and CT scan evaluation. RESULTS AND CONCLUSIONS Among the hundreds of browsers, 17 programs were chosen to be included in the final comparison. The outcomes of the survey proved that many free DICOM tools are effective alternatives to commercially available programs. However, the results do not enable us to predict precisely which tool will meet the needs of each physician. The survey among ENT doctors highlighted their limited awareness of software with MPR functions, in particular those that scored best in the test.
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Affiliation(s)
- Marcin Frączek
- Department of Otolaryngology, Wroclaw Medical University, Poland
| | - Mateusz Kolator
- Department of Otolaryngology, Wroclaw Medical University, Poland
| | - Tomasz Kręcicki
- Department of Otolaryngology, Wroclaw Medical University, Poland
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