Acute proptosis secondary to bilateral pansinus mucopyocele with orbital compartment syndrome: a rare presentation, its management and outcome

2021 ◽  
Vol 14 (7) ◽  
pp. e241972
Author(s):  
Khushboo Chauhan ◽  
Tanya Sharma ◽  
Bhavana Sharma ◽  
Samendra Karkhur
Keyword(s):  
Compartment Syndrome ◽  
Nasal Polyposis ◽  
Signs And Symptoms ◽  
Sinus Surgery ◽  
Rare Presentation ◽  
Diagnostic Dilemma ◽  
Guided Exploration ◽  
Rapid Relief ◽  
Maxillary Sinuses

A 37-year-old Indian female presented with forward protrusion of left eye for one week, associated with progressive diminution of vision. The patient had undergone sinus surgery for nasal polyposis a year ago. On examination, there was severe proptosis and limitation of extraocular movements in all gazes. CT-scan revealed a heterogeneous expansile mass, arising from left fronto-ethmoidal sinus, infiltrating left orbit. MRI showed T2-hyperintense, peripherally enhancing areas in bilateral nasal cavity (right >left), bilateral ethmoidal sinuses and frontal, sphenoidal and maxillary sinuses. Otorhinolaryngology consultation was sought and in view of vision threatening proptosis — with likely orbital compartment syndrome — emergent endoscopic guided exploration and orbital decompression was undertaken. Rapid relief of signs and symptoms was achieved, with normal vision, extraocular movements and resolution of proptosis. Cytology and microbiology ruled out infectious or malignant aetiology and helped in resolving a diagnostic dilemma. Histopathology confirmed the diagnosis of mucopyocele and follow-up period was uneventful.

scholarly journals Bioabsorbable Steroid-Releasing Sinus Implants in the Frontal and Maxillary Sinuses: 2-Year Follow-Up

2015 ◽  
Vol 6 (2) ◽  
pp. ar.2015.6.0117 ◽  
Author(s):  
Keith E. Matheny
Keyword(s):  
Topical Therapy ◽  
Signs And Symptoms ◽  
Sinus Surgery ◽  
Fungal Rhinosinusitis ◽  
Allergic Fungal Rhinosinusitis ◽  
Inflammatory Bowel ◽  
The Right ◽  
Ethmoid Sinuses ◽  
Maxillary Sinuses

Background Mometasone furoate-releasing implants have been approved for use in the ethmoid sinuses following endoscopic sinus surgery (ESS) to reduce the need for medical and surgical intervention postoperatively. Outcomes have not yet been studied when these implants are utilized in other paranasal sinuses after ESS. Objective To present a case in which bioabsorbable steroid-eluting implants were used to maintain patency and to decrease inflammation in the frontal and maxillary sinuses after revision ESS. Methods 52-year-old male with lifelong allergic rhinitis, chronic allergic fungal rhinosinusitis, and inflammatory bowel disease had previously undergone four endoscopic sinus surgeries, subcutaneous injection immunotherapy, and topical therapy with budesonide and amphotericin sinus irrigations. In July, 2012, during revision left frontal sinusotomy and right maxillary antrostomy (the fifth ESS), two bioabsorbable steroid-releasing implants were placed in the left frontal recess and the right maxillary sinus respectively and followed clinically, endoscopically, and radiographically for two years. Results Two year followup demonstrated near complete clinical, endoscopic, and radiographic resolution of the patient's signs and symptoms of chronic rhinosinusitis. Conclusions The steroid-releasing implants during the critical phase of wound-healing appear to have allowed the patient, now over two years postoperatively, to achieve a healthier state and to allow more successful management than the preceding 15–20 years.

scholarly journals Childhood polyarteritis nodosa: A rare presentation

2016 ◽  
Vol 7 (6) ◽  
pp. 94-96 ◽  
Author(s):  
Sandeep Lahiry ◽  
Shouvik Choudhury ◽  
Ayan Mukherjee ◽  
Koustuv Chowdhury
Keyword(s):  
Polyarteritis Nodosa ◽  
Infection Prevention ◽  
Systemic Vasculitis ◽  
Secondary Infection ◽  
Signs And Symptoms ◽  
Pharmacological Therapy ◽  
Medical Sciences ◽  
Rare Presentation ◽  
Skin Ulceration

Polyarteritis nodosa (PAN) is a rare systemic vasculitis characterized by necrotizing arteritis of small to medium-sized arteries. It manifests as skin ulceration, hypertension, abdominal pain, digital gangrene, subcutaneous nodules etc. Childhood polyarteritis nodosa (CPAN) is a rare and often fatal disease. Clinically, CPAN often is part of the spectrum of Kawasaki disease (KD). There is no specific serological marker for diagnosis and confirmation is based on histopathology.  Most common mode of pharmacological therapy includes corticosteroid or cyclophosphamide, along with antimicrobials for secondary infection prevention and plasmapheresis.Here, we present a case of a 16year old boy with multiple skin ulceration, digital gangrene with few non-specific signs and symptoms, diagnosed as a case of PAN, underwent regular therapy and follow-up. Asian Journal of Medical Sciences Vol.7(5) 2016 94-96

Bilateral Antrochoanal Polyp with Diabetes: A Rare Presentation of Cystic Fibrosis

2010 ◽  
Vol 3 (3) ◽  
pp. 173-176
Author(s):  
Monica Gupta ◽  
Manish Gupta
Keyword(s):  
Cystic Fibrosis ◽  
Endoscopic Sinus Surgery ◽  
English Literature ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Adolescent Male ◽  
Antrochoanal Polyp ◽  
Rare Presentation ◽  
First Case

Abstract Bilateral antrochoanal (AC) polyps have been rarely reported in english literature. Here we report the first case of an adolescent male with bilateral AC polyps, cystic fibrosis and diabetes. The case was managed successfully by functional endoscopic sinus surgery (FESS). The patient has been under follow-up for the last six months with no signs of recurrence.

Meticulous endoscopic sinus surgery to prevent recurrence of massive nasal polyposis

2012 ◽  
Vol 126 (8) ◽  
pp. 789-794 ◽  
Author(s):  
S M S Hoseini ◽  
B Saedi ◽  
K Aghazadeh
Keyword(s):  
Endoscopic Surgery ◽  
Endoscopic Sinus Surgery ◽  
Nasal Polyposis ◽  
Demographic Data ◽  
Effective Means ◽  
Sinus Surgery ◽  
Previous Surgery ◽  
Endoscopic Findings ◽  
History Of

AbstractObjective:To evaluate the effect of meticulous endoscopic surgery, including opening of all involved sinus cells, on the subsequent symptoms and endoscopic findings of patients with massive nasal polyposis.Study design and method:One hundred patients with massive nasal polyposis resistant to medical treatment were selected. We documented each patient's demographic data, associated diseases, endoscopic findings, Lund–Mackay score and Sino-Nasal Outcome Test 22 (SNOT22) symptom score. All patients were followed up for at least two years to evaluate any recurrence.Results:Of the 100 patients, 20 per cent had a history of asthma and 27 per cent had undergone previous surgery. All underwent endoscopic sinus surgery. After two years of follow up, 8 per cent had recurrence requiring surgery. Recurrence was significantly associated with a history of asthma (p < 0.001) and the histopathological presence of eosinophilia (p = 0.014).Conclusion:Meticulous endoscopic opening of all involved sinus cells can be a safe and effective means of controlling massive nasal polyposis, with an acceptable recurrence rate.

scholarly journals Myxedema Psychosis: Neuropsychiatric Manifestations and Rhabdomyolysis Unmasking Hypothyroidism

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Sundus Sardar ◽  
Mhd-Baraa Habib ◽  
Aseel Sukik ◽  
Bashar Tanous ◽  
Sara Mohamed ◽  
...  
Keyword(s):  
Thyroid Stimulating Hormone ◽  
Prior History ◽  
Psychomotor Slowing ◽  
Rare Presentation ◽  
Diagnostic Dilemma ◽  
Endocrine Disorder ◽  
Psychiatric Illnesses ◽  
Neuropsychiatric Manifestations ◽  
History Of

Background. Hypothyroidism is a prevalent endocrine disorder, often presenting with a spectrum of symptoms reflecting a hypothyroid state. It is also generally linked to causing mood swings, psychomotor slowing, and fatigue; however, in rare instances, it may lead to or induce acute psychosis, a condition referred to as myxedema psychosis (MP). We report a case of myxedema psychosis and present a literature review discussing its presentation, diagnosis, management, and prognosis. Case Presentation. A 36-year-old lady presented with one-week history of persecutory and paranoid delusions, along with visual and auditory hallucinations. She had no prior history of psychiatric illnesses. She underwent total thyroidectomy three years before the current presentation due to papillary thyroid cancer. She was not on regular follow-up, nor any specific therapy. On examination, she was agitated and violent. There were no signs of myxedema, and the physical exam was unremarkable. The initial workup showed a mild elevation in serum creatinine. Additional investigations revealed a high thyroid-stimulating hormone (TSH) of 56.6 mIU/L, low free T4<0.5 pmol/L, elevated creatine kinase of 3601 U/L, and urine dipstick positive for blood, suggestive of myoglobinuria. MRI of the head was unremarkable. We diagnosed her as a case of myxedema psychosis and mild rhabdomyolysis. She was started on oral thyroxine 100 mcg/day, fluoxetine 20 mg daily, and as-needed haloperidol. She was closely followed and later transferred to the Psychiatry Hospital for further management. Within one week, her symptoms improved completely, and she was discharged off antipsychotics with additional scheduled follow-ups to monitor TFTs and observe for any recurrence. Discussion and Conclusion. Myxedema psychosis is a rare presentation of hypothyroidism—a common endocrine disorder. Scarce data are describing this entity; hence, there is currently a lack of awareness amongst clinicians regarding proper identification and management. Moreover, the atypical nature of presentations occasionally adds to a diagnostic dilemma. Thus, any patient with new-onset psychosis should be screened for hypothyroidism, and awareness of this entity must be emphasized amongst clinicians and guideline makers.

Allergic Rhinitis and Aspirin-Exacerbated Respiratory Disease as Predictors of the Olfactory Outcome after Endoscopic Sinus Surgery

2009 ◽  
Vol 23 (3) ◽  
pp. 348-353 ◽  
Author(s):  
Michael Katotomichelakis ◽  
Maria Riga ◽  
Spyridon Davris ◽  
Gregorios Tripsianis ◽  
Maria Simopoulou ◽  
...  
Keyword(s):  
Allergic Rhinitis ◽  
Respiratory Disease ◽  
Endoscopic Sinus Surgery ◽  
Nasal Polyposis ◽  
Sinus Surgery ◽  
Olfactory Acuity ◽  
Aspirin Exacerbated Respiratory Disease ◽  
Negative Effect ◽  
Time Frames

Background Unlike the functional outcomes of endoscopic sinus surgery, which have been thoroughly studied, the effect of the surgery on olfactory performance and the relative predictive factors have not been adequately assessed by literature. Allergic rhinitis and aspirin-exacerbated respiratory disease (AERD) are examined as potential confounding factors of the olfactory outcome in patients with extensive nasal polyposis and rhinosinusitis treated with functional endoscopic sinus surgery (FESS). Methods A population of 116 adults with severe nasal polyposis was subjected to FESS after failure of the appropriate medical treatment. The olfactory outcome was quantified by Sniffin’ Sticks at the 1st, 3rd, and 6th postoperative month in relation to the concomitant presence of allergic rhinitis (n = 62) or AERD (n = 18). Results Allergic patients seemed to perform worse than nonallergic patients at all time frames. However, when patients with similar olfactory acuity, age, and medical history are compared, allergic rhinitis does not seem to affect the postoperative improvement of the composite threshold-discrimination-identification scores. The same seems to apply for the likelihood of acquiring normosmia after surgery. On the contrary, AERD significantly limits the recovery of olfactory function at all follow-up examinations and patients with AERD are unlikely to become normosmic. Conclusion The olfactory recovery after FESS for nasal polyposis is significantly affected by the concomitant presence of AERD. Although allergy seems to have a general negative effect on olfactory acuity, it was not found to affect the extent of the olfactory improvement, when patients with comparable preoperative characteristics are addressed.

scholarly journals Respiratory epithelial adenomatoid hamartoma presenting as a mass in nasal cavity: a case report

2020 ◽  
Vol 6 (5) ◽  
pp. 992
Author(s):  
Visweswara Rao Suraneni ◽  
Vineela Gaddipati ◽  
Anusha Allena
Keyword(s):  
Nasal Septum ◽  
Rare Case ◽  
Nasal Polyposis ◽  
Histopathological Examination ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Rare Presentation ◽  
Respiratory Epithelial Adenomatoid Hamartoma ◽  
The Past ◽  
Respiratory Epithelial

<p>This article aims to report a rare case of respiratory epithelial adenomatoid hamartoma (REAH) arising from nasal septum that initially presented as bilateral sino nasal polyposis. A 45 years old male presented with a complaint of bilateral nasal obstruction for the past 3 years which was progressive and was planned for functional endoscopic sinus surgery. Polypoidal tissue was found to be coming from nasal septum intraoperatively. Histopathological examination confirmed the presence of REAH. This case demonstrates the rare presentation of REAH, clinically presented as sino nasal polyposis and confirmed as REAH by histopathological examination.</p>

Pediatric Endoscopic Nasal and Sinus Surgery

1995 ◽  
Vol 113 (3) ◽  
pp. 204-210 ◽  
Author(s):  
James A. Stankiewicz
Keyword(s):  
Patient Selection ◽  
Endoscopic Sinus Surgery ◽  
Nasal Polyposis ◽  
Chronic Sinusitis ◽  
Subjective Evaluation ◽  
Choanal Atresia ◽  
Sinus Surgery ◽  
Term Objective

A total of 83 children and teenagers underwent endoscopic nasal and sinus surgery. Six patients had surgery for choanal atresia (4) and adenoid hypertrophy (2) and will only be briefly mentioned. Seventy-seven children and teenagers underwent endoscopic sinus surgery for acute and chronic sinusitis, choanal polyposis, and nasal polyposis with a minimum 2-year follow-up. One hundred thirty-three ethmoidectomies, 37 sphenoidotomies, and 119 maxillary antrostomies were performed. Subjective evaluation of the sinus surgery patients indicated that 38% of patients were cured and 55% improved during an average of 3.5 years of follow-up. The number cured and number improved are lower and higher, respectively, than in other reports of results because of the longer follow-up and patient selection. In addition, objective data were obtained on 34 patients with a second- or third-look procedure 2 weeks to 2 months after surgery. These examinations found significant granulation tissue, and almost 50% of patients had at least one maxillary ostia closed. Long-term objective results, however, are not available to determine whether the ostia remained closed. Problems with healing in children's endoscopic sinus surgery are unpredictable compared those in adult surgery because postoperative debridement and examination are often difficult to perform, thus allowing tissue to heal without control. In this series, other factors such as the increased risks of cystic fibrosis, allergy, and immunodeficiency were also more prevalent and compromised healing. The best way to achieve good results in pediatric endoscopic sinus surgery requires appropriate patient selection, careful techniques, spacers or stents that don't cover the antrostomy, appropriate second- or third-look procedures for debridement and examination, and judicious postoperative medical therapy.

scholarly journals Twelve-year follow-up study after endoscopic sinus surgery in patients with chronic rhinosinusitis with nasal polyposis

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Lien Calus ◽  
Nicholas Van Bruaene ◽  
Cedric Bosteels ◽  
Sarah Dejonckheere ◽  
Thibaut Van Zele ◽  
...  
Keyword(s):  
Chronic Rhinosinusitis ◽  
Endoscopic Sinus Surgery ◽  
Nasal Polyposis ◽  
Sinus Surgery ◽  
Follow Up Study

scholarly journals Mucocele Development after Endoscopic Sinus Surgery for Nasal Polyposis: A Long-Term Analysis

2018 ◽  
Vol 97 (9) ◽  
pp. 284-294 ◽  
Author(s):  
Hakim Benkhatar ◽  
Idir Khettab ◽  
Philippe Sultanik ◽  
Ollivier Laccourreye ◽  
Pierre Bonfils
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Nasal Polyposis ◽  
Sinus Surgery ◽  
Multivariate Statistical ◽  
Radiologic Evaluation ◽  
Mean Delay ◽  
Aspirin Intolerance ◽  
The Mean

The aim of the present study was to determine the prevalence of long-term mucocele development after functional endoscopic sinus surgery (FESS) for nasal polyposis, to search for a statistical relationship with preoperative variables and to analyze the management of this complication. A retrospective analysis of 153 patients who underwent FESS for nasal polyposis, with a minimum of 7 years of follow-up, was performed. Mucocele diagnosis was based on regular clinical and radiologic evaluation. Univariate and multivariate statistical analysis was performed. The postoperative mucocele rate was 13.1% (20 patients). The mean delay between surgery and mucocele diagnosis was 6.25 years. A high preoperative Lund-Mackay score (>19) was a risk factor for postoperative mucocele (p = 0.04). Asthma and aspirin intolerance did not increase the risk of this complication. Endoscopic marsupialization of mucoceles was successful in 19 patients, with only one recurrent frontal mucocele. One patient required external approaches for two frontal mucoceles. In conclusion, mucocele risk after FESS for nasal polyposis is significant, especially in case of a high preoperative Lund-Mackay score (>19). Long-term clinical follow-up is recommended, imaging being prescribed based on symptoms or abnormal findings on clinical examination. Endoscopic marsupialization is very effective, but frontal mucoceles are more likely to recur.

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