Frontal Sinus Drainage in Acute Pediatric Sinusitis With Intracranial Complications

2021 ◽  
pp. 194589242199131
Author(s):  
Stephen R. Chorney ◽  
Adva Buzi ◽  
Mark D. Rizzi
Keyword(s):  
Surgical Procedures ◽  
Frontal Sinus ◽  
Case Series ◽  
Primary Objective ◽  
Acute Sinusitis ◽  
Intracranial Abscess ◽  
Repeat Surgery ◽  
Initial Surgery ◽  
Intracranial Complications ◽  
Sinus Drainage

Background The indication for frontal sinus drainage is uncertain when managing pediatric acute sinusitis with intracranial complications. Objective The primary objective was to determine if addressing the frontal sinus reduced need for subsequent surgical procedures in children presenting with acute sinusitis complicated by intracranial abscess. Methods A case series with chart review was performed at a tertiary children’s hospital between 2007 and 2019. Children under 18 years of age requiring surgery for complicated acute sinusitis that included the frontal sinus with noncontiguous intracranial abscess were included. Outcomes were compared among children for whom the frontal sinus was drained endoscopically, opened intracranially, or left undrained. Results Thirty-five children with a mean age of 11.1 years (95% CI: 9.9-12.3) met inclusion. Most presented with epidural abscess (37%). Hospitalizations lasted 12.9 days (95% CI: 10.2-15.5), 46% required a second surgery, 11% required three or more surgeries, and 31% were readmitted within 60 days. Initial surgery for 29% included endoscopic frontal sinusotomy, 34% had a frontal sinus cranialization and 37% did not have any initial drainage of the frontal sinus. Groups were similar with respect to demographics, severity of infection, need for repeat surgery, length of stay, and readmissions (p > .05). Further, persistence of cranial neuropathies, seizures, or major neurological sequelae after discharge were no different among groups (p > .05). Conclusion Drainage of the frontal sinus, when technically feasible, was not associated with reduced surgical procedures or increased complications and there is unclear benefit on measured clinical outcomes.

Reducing Surgical Revisions in Intracranial Complications of Pediatric Acute Sinusitis

2018 ◽  
Vol 159 (2) ◽  
pp. 359-364 ◽  
Author(s):  
Sarah A. Gitomer ◽  
Wei Zhang ◽  
Lucila Marquez ◽  
Binoy M. Chandy
Keyword(s):  
Surgical Procedures ◽  
Revision Surgery ◽  
Frontal Sinus ◽  
Odds Ratio ◽  
Acute Sinusitis ◽  
Sinus Surgery ◽  
Frontal Sinus Surgery ◽  
Intracranial Complications ◽  
Subdural Abscess

Objective (1) To describe the demographics and clinical course of children with intracranial complications of sinusitis. (2) To elucidate factors that predict revision surgery in this population, such as type of initial surgery. Study Design Case series with chart review. Setting Tertiary care academic children’s hospital. Subjects and Methods A 15-year retrospective review identified 71 patients with intracranial complications of acute sinusitis. Primary outcome was need for revision surgery. Secondary outcomes were readmission, length of hospitalization, and long-term complications. Results This study is the largest to date examining this disease process. Overall, 69 (97%) patients had surgery; 33 (46%) required revision surgery. Half of the patients with frontal sinus opacification underwent frontal sinus surgery at presentation (endoscopic, trephination, or cranialization). There was no difference in revision surgery between patients who had frontal sinus surgery and those who did not. Patients with frontal sinus surgery did not have a higher rate of complications or chronic sinusitis ( P > .05). Subdural abscess was associated with multiple surgical procedures (odds ratio, 20.0; P < .01). Thirty-four patients (49%) required neurosurgery. These patients had a longer length of stay (odds ratio, 11.0; P < .01) and a higher readmission rate ( P = .02). During the mean 92-month follow-up, 22 patients (33%) had long-term complications, and there was 1 death (1.4%). Conclusion Almost half of this cohort required multiple surgical procedures. In particular, patients with subdural abscess had significantly higher rates of revision surgery. Type of frontal sinus surgery was not correlated with need for revision surgery and was not associated with an increased rate of complications.

The Role of Endoscopic Sinus Surgery in Children Undergoing External Drainage of Non-Medial Subperiosteal Orbital Abscess

2020 ◽  
pp. 194589242095379
Author(s):  
Stephen R. Chorney ◽  
Adva Buzi ◽  
Mark D. Rizzi
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Case Series ◽  
Primary Objective ◽  
Acute Sinusitis ◽  
Sinus Surgery ◽  
Symptom Duration ◽  
Retrospective Case ◽  
Orbital Abscess ◽  
Significant Difference ◽  
Subperiosteal Orbital Abscess

Background The extent of surgery required in the management of pediatric non-medial subperiosteal orbital abscess (SPOA) due to medically refractory complicated acute sinusitis is unknown. Objectives The primary objective is to compare operative outcomes of children treated with combined endoscopic sinus surgery (ESS) and external orbital drainage (EOD) versus those treated with EOD alone. Methods Retrospective case series from a tertiary children’s hospital analyzing outcomes in children requiring surgical management for acute sinusitis complicated by non-medial SPOA between November 2007 and September 2019. Results Sixteen children with a mean age of 9.4 years (95% CI: 7.3–11.4) met inclusion. Eleven (68.8%) underwent combined EOD and ESS, while five (31.2%) underwent EOD alone. Groups were similar in age, symptom duration, white blood cell count, C-reactive protein level, intraocular pressure, Lund-Mackay score, and abscess volume. There was no significant difference in median length of stay between patients treated with a combined approach versus those treated by EOD alone. Cultures identified non-beta-hemolytic Streptococcus species in 56.3% of patients, with Streptococcus intermedius representing the most common organism in 37.5%. In one case, ESS identified a pathogen not acquired via concomitant EOD, which did influence management. No child required a subsequent surgical procedure and there were no operative complications. Conclusions The addition of ESS in the management of pediatric non-medial SPOA was not associated with a statistically different duration of hospitalization. Cultures from concomitant ESS rarely aided in diagnosis or antibiotic therapy. Further study should delineate the indications for ESS in these cases.

scholarly journals Intracranial Complications of Acute Sinusitis on Brain CT

2017 ◽  
Vol 32 (1) ◽  
pp. 57-58
Author(s):  
Ian C. Bickle
Keyword(s):  
Paranasal Sinuses ◽  
Frontal Sinus ◽  
Subdural Empyema ◽  
Acute Sinusitis ◽  
Sinus Surgery ◽  
Common Disease ◽  
Bony Destruction ◽  
Intracranial Complications ◽  
Acute Bacterial Rhinosinusitis ◽  
Ct Brain

This 35-year-old woman presented to a peripheral hospital Accident and Emergency department in a moribund state.  She was intubated, stabilized and transferred urgently to a tertiary centre. She had attended the hospital in the prior week with a diagnosis of sinusitis. An urgent CT brain was requested by the attending A and E officer which was undertaken on the basis of her low Glasgow coma scale (GCS).   The paranasal sinuses were partially visualised on this investigation. Acute bacterial rhinosinusitis is a common disease presenting to both general practitioners and ENT surgeons.  It is on the most part short-lived in duration responding to antibiotics and symptomatic medications.  Rarely it may be associated with severe life threatening complications, in the form of intra-orbital extension or even less so intracranial complications. These typically occur in the pediatric and young adult population.1 Cross-sectional imaging plays an essential role in the assessment of this small sub-set of patients and is largely and almost always in the first instance with CT.2 Computed Tomography is broadly available, even out of standard working hours, and facilitates the review of potential intracranial complications and thereby guide neurosurgical management. Given that a proportion of the paranasal sinuses are always visualised on a CT brain it is an important review area, especially in patients with sepsis. There are a number of well recognized intracranial complications of acute rhinosinusitis which include; meningitis, cerebral abscess, subdural empyema, cavernous sinus and dural venous thrombosis.3    Additional sequelae from the intracranial infection may result, such as arterial territory cerebral infarction, ventriculitis and hydrocephalus.   Those patients in whom intracranial extension occurs often demonstrate bony destruction of the sinuses on imaging. Disease involving the frontal sinus is typically associated with intracranial complications, through foci of bony dehiscence or osteomyelitis involving the floor of the anterior cranial fossa.3  In this case the patient presented in a moribund state due to severe intracranial complications following failed treatment in the community.  The initial CT imaging identified subdural collections (Figure 1a and 1b) as well as pan-sinusitis (Figure 2) and the suggestion of an arterial territory infarct (Figure 1a).  The frontal sinus however was not involved in this instance. A complete CT study of the paranasal sinuses (with a dedicated paranasal sinuses protocol) is merited including isotropic reconstructions to review the bony integrity and aid the planning of ENT surgical intervention.  An MRI brain if available would eloquently confirm the CT findings including confirmation of the acute parietal lobe infarct.4 Neurosurgical drainage of the subdural empyemas was undertaken. Furthermore, functional endoscopic sinus surgery (FESS) was also performed with drainage of a large volume of pus from the sphenoid, ethmoidal and right maxillary sinuses.4 This case demonstrates intracranial complications are not an entity unique to the paediatric population.  When caring for patients with acute sinusitis always have a high index of suspicion for these potential complications and have a low threshold for engagement with radiology colleagues for imaging if concerned.     REFERENCES Sultész M, Csákányi Z, Majoros  T, Farkas  Z, Katona G. Acute bacterial rhinosinusitis and its complications in our pediatric otolaryngological department between 1997 and 2006. Int J Pediatr Otorhinolaryngol. 2009 Nov;73(11):1507-12. DOI: 10.1016/j.ijporl.2009.04.027 PMID: 19500861 Dankbaar JW, van Bemmel AJM, Pameijer FA. Imaging findings of the orbital and intracranial complications of acute bacterial rhinosinusitis. Insights Imaging. 2015 Oct; 6(5): 509–518. doi:  10.1007/s13244-015-0424-y  PMCID: PMC4569601 Osborn MK, Steinberg JP. Subdural empyema and other suppurative complications of paranasal sinusitis. Lancet Infect Dis. 2007 Jan;7(1):62-7. DOI: 10.1016/S1473-3099(06)70688-0 PMID: 17182345 Bickle IC. Intracranial complications of acute sinusitis. Case rID: 45559. Created 30 May 2016 in Radiopaedia.org ©2005-2017. [Cited 2017 June 13] Available from: https://radiopaedia.org/cases/intracranial-complications-of-acute-sinusitis.

Pituitary gigantism: a retrospective case series

2016 ◽  
Vol 29 (5) ◽  
Author(s):  
Ana L. Creo ◽  
Aida N. Lteif
Keyword(s):  
Transsphenoidal Surgery ◽  
Case Series ◽  
Small Sample ◽  
Long Term Outcomes ◽  
Retrospective Case ◽  
Repeat Surgery ◽  
Gh Secretion ◽  
Initial Surgery ◽  
And Gender

AbstractPituitary gigantism (PG) is a rare pediatric disease with poorly defined long-term outcomes. Our aim is to describe the longitudinal clinical course in PG patients using a single-center, retrospective cohort study.Patients younger than 19 years diagnosed with PG were identified. Thirteen cases were confirmed based on histopathology of a GH secreting adenoma or hyperplasia and a height >2 SD for age and gender. Laboratory studies, initial pathology, and imaging were abstracted.Average age at diagnosis was 13 years with an average initial tumor size of 7.4×3.8 mm. Initial transsphenoidal surgery was curative in 3/12 patients. Four of the nine patients who failed the initial surgery required a repeat procedure. Octreotide successfully normalized GH levels in 1/6 patients with disease refractory to surgery (1/6). Two out of five patients received pegvisomant after failing octreotide but only one patient responded to treatment. Five patients were ultimately treated with radiosurgery or radiation patients were followed for an average of 10 years.PG is difficult to treat. In most patients, the initial transsphenoidal surgery failed to normalize GH levels. If the initial surgery was unsuccessful, repeat surgery was unlikely to control GH secretion. Treatment with octreotide or pegvisomant was successful in less than half the patients failing surgery. Radiosurgery was curative, but is not an optimal treatment for pediatric patients. Despite the small sample, our study suggests that the treatment outcome of pediatric PG may be different than adults.

Otogenic Intracranial Complications - A Case Series

2017 ◽  
Vol 3 (2) ◽  
Author(s):  
Mohd Ashraf ◽  
Abhishek Gupta ◽  
Ibrahim Al Jabr
Keyword(s):  
Case Series ◽  
Intracranial Complications

Tracheocutaneous Fistula After Pediatric Open Airway Reconstruction

2021 ◽  
pp. 000348942098742
Author(s):  
Stephen R. Chorney ◽  
Joanne Stow ◽  
Luv R. Javia ◽  
Karen B. Zur ◽  
Ian N. Jacobs ◽  
...  
Keyword(s):  
Costal Cartilage ◽  
Case Series ◽  
Primary Objective ◽  
Multivariable Logistic Regression Analysis ◽  
Pediatric Airway ◽  
Surgical Closure ◽  
Laryngotracheal Reconstruction ◽  
Airway Reconstruction ◽  
Tracheocutaneous Fistula

Objectives: Tracheocutaneous fistula (TCF) is a common occurrence after pediatric tracheostomy decannulation. However, the persistence of TCF after staged reconstruction of the pediatric airway is not well-described. The primary objective was to determine the rate of persistent TCF after successful decannulation in children with staged open airway reconstruction. Methods: A case series with chart review of children who underwent decannulation after double-stage laryngotracheal reconstruction between 2017 and 2019. Results: A total of 26 children were included. The most common open airway procedure was anterior and posterior costal cartilage grafting (84.6%, 22/26). Median age at decannulation was 3.4 years (IQR: 2.8-4.3) and occurred 7.0 months (IQR: 4.3-10.4) after airway reconstruction. TCF persisted in 84.6% (22/26) of children while 15.4% (4/26) of stomas closed spontaneously. All closures were identified by the one-month follow-up visit. There was no difference in age at tracheostomy ( P = .86), age at decannulation ( P = .97), duration of tracheostomy ( P = .43), or gestational age ( P = .23) between stomas that persisted or closed. Median diameter of stent used at reconstruction was larger in TCFs that persisted (7.0 mm vs 6.5 mm, P = .03). Tracheostomy tube diameter ( P = .02) and stent size ( P < .01) correlated with persistence of TCF on multivariable logistic regression analysis. There were 16 surgical closure procedures, which occurred at a median of 14.4 months (IQR: 11.4-15.4) after decannulation. Techniques included 56.3% (9/16) by primary closure, 18.8% (3/16) by secondary intention and 25% (4/16) by cartilage tracheoplasty. The overall success of closure was 93.8% (15/16) at latest follow-up. Conclusions: Persistent TCF occurs in 85% of children who are successfully decannulated after staged open airway reconstruction. Spontaneous closure could be identified by 1 month after decannulation and was more likely when smaller stents and tracheostomy tubes were utilized. Surgeons should counsel families on the frequency of TCF and the potential for additional procedures needed for closure.

The case for skin camouflage in the management of upper limb scarring – A case series

Hand Therapy ◽  
2021 ◽  
pp. 175899832110078
Author(s):  
Laura Adamson ◽  
Anna Selby
Keyword(s):  
Upper Limb ◽  
Case Series ◽  
Primary Objective ◽  
Self Confidence ◽  
Published Evidence ◽  
Case Series Study ◽  
Visual Impact ◽  
Series Study ◽  
Increasing Function

Introduction For some people the appearance of their hands is as important as function. Upper limb scarring can cause some patients distress. Skin camouflage is an intervention that can be used to reduce the visual impact of a scar but there is limited published evidence for its use for hand scarring. Methods This is a case series study with a primary objective to determine whether skin camouflage reduces distress in patients with an upper limb scar and to evaluate this new service. Patients experiencing distress from an upper limb scar were recruited from a hand therapy outpatient clinic. The intervention delivered was a one hour skin camouflage session. Photographs of the upper limb pre and post skin camouflage intervention were taken. The patient-rated Michigan Hand Questionnaire (MHQ) and Derriford Appearance Scale (DAS24) were completed before treatment, at 1 week and 1 month after treatment. Results Six participants reporting distress from an upper limb scar received skin camouflage intervention. Only three out of six participants completed all follow-up. All three showed improvement in at least two domains of the MHQ (function and aesthetics) at one month post treatment. Increased confidence during functional and work-based activities was also reported on the DAS24. Participants reported increased engagement in daily activities as a result of being able to camouflage their scars. Conclusions This small case series shows that skin camouflage intervention may be beneficial for some patients who are experiencing distress related to an upper limb scar by increasing function and self-confidence.

scholarly journals Injuries, treatment, and impairment caused by different types of fireworks; results of a 10 year multicenter retrospective cohort study

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Daan T. Van Yperen ◽  
Esther M. M. Van Lieshout ◽  
J. Niels Dijkshoorn ◽  
Cornelis H. Van der Vlies ◽  
Michael H. J. Verhofstad
Keyword(s):  
Surgical Procedures ◽  
Hospital Admissions ◽  
Case Series ◽  
Secondary Outcome ◽  
Number Of Patients ◽  
Whole Person ◽  
Type Of Injury ◽  
Clear Increase ◽  
Level 1 Trauma Center ◽  
Head Neck

Abstract Objectives The primary aim of this study was to evaluate the number of patients reported to a hospital with injuries from consumer fireworks in the months December–January in the past 10 years, and to describe the association between the type of fireworks, injury pattern, treatment, and permanent impairment. Methods A multicenter, retrospective, observational case series. Patients were selected from two hospitals in the Southwest Netherlands: a level 1 trauma center and a specialized burn center. All patients with any fireworks-related injuries treated between December 1 and January 31, during 2007 (December) to 2017 (January), were eligible for participation. The primary outcome was the number of patients with any type of injury caused by fireworks. The secondary outcome measures were patient and injury characteristics, treatment details, and whole person impairment (WPI). The percentage WPI expresses a patient’s degree of permanent impairments as a result of fireworks-related injuries. Results Of the 297 eligible patients, 272 patients were included. From 2007 to 2017, between 21 and 40 patients were treated, and no clear increase or decrease was observed in the number of patients and in the number of patients per type of fireworks. Explosive fireworks mainly caused upper extremity (N = 65; 68%) injuries, while rockets (N = 24; 41%) and aerials (N = 7; 41%) mainly affected the head/neck. Decorative fireworks predominantly resulted in burns (N = 82; 68%), and explosive fireworks in soft tissue lacerations (N = 24; 25%), fractures (N = 16; 17%), and amputations (N = 14; 15%). Patients injured by explosive and homemade fireworks were most often admitted to a hospital (respectively N = 24; 36% and N = 12; 80%), and resulted in the highest proportion undergoing surgical procedures (respectively N = 22; 33% and N = 7; 47%). WPI found in this study was between 0 to 95%, with a median of 0%. In 34 (14%) patients, the injuries resulted in a WPI of ≥1%, mostly as a result of explosive fireworks (N = 18; 53%). Conclusion This study found no increase or decrease in the number of patients treated in two specialized hospitals. Explosive and homemade fireworks could be considered as most dangerous, as they result into the most hospital admissions, surgical procedures, and into the most injuries with permanent impairment as a result.

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