scholarly journals Endoscopic approach to the frontal sinus with modified Lothrop technique. Outcomes in a large Argentinean center

2019 ◽  
Vol 11 (2) ◽  
pp. 140-143
Author(s):  
Carlos S Ruggeri ◽  
Sebastian Aragon ◽  
Ana Laura Cajelli ◽  
Lourdes Principe ◽  
Agustin Martinez Font ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Frontal Sinus ◽  
Malignant Tumors ◽  
Fungal Sinusitis ◽  
Modified Technique ◽  
Allergic Fungal Sinusitis ◽  
Transnasal Approach ◽  
History Of ◽  
Sinus Drainage ◽  
Unilateral Block

Objectives: To determine the permeability of the frontal drainage obtained by the modified Lothrop surgical technique. Study design: Descriptive and retrospective. Methods: Patients treated with modified Lothrop technique to widening the frontal recess drainage pathway which was obstructed by inflammatory or tumor diseases in the Rhinology section of the Hospital Italiano in Buenos Aires were included between April 2011 and December 2017. Patients with minor permeabilizations were excluded (Draf I-II). Results: 16 patients were treated, 7 women and 9 men, the youngest was 24 and the oldest 90. The average age was 56 years. The etiologies of diseases affecting the frontal sinus were allergic fungal sinusitis (2/16), recurred frontal mucocele with a history of Draf 2 (3/16), recurred frontal mucocele to external surgery with obliteration (1/16), frontal mucocele, nasal polyposis and cystic fibrosis (1/16), previous frontal sinusitis surgery (4/16), frontal mucopioceles (2/16) and malignant tumors originating in the ethmoid and frontal sinus (3/16). An unilateral block drainage of the frontal by mucosal hyperplasia was diagnosed in a patient, caused by her allergic fungal rhinosinusitis 5 years after Lothrop surgery. Moreover the patient was operated again by transnasal approach permeabilizing the frontal sinus. Another patient had a total obstruction of the frontal drainage and was successfully repeated with the same surgical technique. The other patients had permeable frontal drainage and were asymptomatic during the average follow-up of 3.5years. Conclusion: The obtained permeability of the frontal sinus drainage with Lothrop modified technique was 87.50% (14/16). With rescue endonasal assisted surgery, frontal sinus patency was 100%.

Diagnosis of Allergic Fungal Sinusitis

1994 ◽  
Vol 111 (5) ◽  
pp. 580-588 ◽  
Author(s):  
John P. Bent ◽  
Frederick A. Kuhn
Keyword(s):  
Nasal Polyposis ◽  
Bone Erosion ◽  
Skin Tests ◽  
Type I ◽  
Fungal Culture ◽  
Fungal Sinusitis ◽  
Allergic Fungal Sinusitis ◽  
High Attenuation ◽  
Fungal Invasion ◽  
History Of

Allergic fungal sinusitis is a noninvasive disease first recognized approximately one decade ago. It accounts for approximately 6% to 8% of all chronic sinusitis requiring surgical intervention and has become a subject of increasing interest to otolaryngologists and related specialists. Although certain signs and symptoms, as well as radiographic, intraoperative, and pathologic findings, may cause the physician to suspect allergic fungal sinusitis, no standards have been defined for establishing the diagnosis. It is extremely important to recognize allergic fungal sinusitis and differentiate it from chronic bacterial sinusitis and other forms of fungal sinusitis because the treatments and prognoses for these disorders vary significantly. To delineate a set of diagnostic criteria, we prospectively evaluated our most recent 15 patients with allergic fungal sinusitis. An allergy evaluation confirmed atopy through a strong history of inhalant mold allergies, an elevated total immunoglobulin E level, or a positive result of a skin test or radioallergosorbent test to fungal antigens in 100% of patients. All 15 patients had nasal polyposis, and 8 of 15 had asthma. There was a unilateral predominance in 13 of 15 cases. A characteristic computerized tomography finding of serpiginous areas of high attenuation in affected sinuses was seen in all patients, and 12 of 15 patients had some degree of radiographic bone erosion. Pathologic examination uniformly revealed eosinophilic mucus without fungal invasion into soft tissue; Charcot-Leyden crystals and peripheral eosinophilic were each observed in 6 of 15 patients. Every patient had fungus identified on fungal smear, although only 11 of 15 fungal cultures were positive. Therefore, for the diagnosis of allergic fungal sinusitis to be established, the following criteria should be met: (1) type I hypersensitivity confirmed by history, skin tests, or serology; (2) nasal polyposis; (3) characteristic computed tomography signs; (4) eosinophilic mucus without fungal invasion into sinus tissue; and (5) positive fungal stain of sinus contents removed during surgery. Radiographic bone erosion does not necessarily imply invasive disease, and a positive fungal culture, although desirable, is not necessary to confirm the diagnosis. Unilateral predominance of disease, a history of asthma, Charcot-Leyden crystals, and peripheral eosinophilla corroborate the diagnosis but are not always present. Perhaps because of the novelty of the disease, much misunderstanding surrounds allergic fungal sinusitis. Misdiagnosis is common, recurrence rates are high, and proper treatment remains elusive. Before proceeding with other advances, a common understanding of the diagnosis of allergic fungal sinusitis is mandatory.

Frontoethmoidal osteoma - comments on a clinical case

ORL ro ◽  
2016 ◽  
Vol 3 (1) ◽  
pp. 12-14
Author(s):  
Andreea Nicoleta Costache ◽  
I. Bulescu ◽  
Alexandra Guligă ◽  
A. Panfiloiu ◽  
Mihai Tușaliu ◽  
...  
Keyword(s):  
Growth Rate ◽  
Surgical Approach ◽  
Frontal Sinus ◽  
Clinical Case ◽  
Benign Tumor ◽  
Slow Growth ◽  
Computer Tomographic ◽  
Slow Growth Rate ◽  
History Of ◽  
Sinus Drainage

The paranasal sinus osteoma is a benign tumor characterized by a slow growth rate. Initially, the symptoms are uncharacteristic in most of the cases, afterwards they can cause headaches, nasal obstruction, epiphora etc. The authors present the case of a 45-year-old patient from IFACF - ENT “Prof. Dr. D. Hociota” with a history of frontal headache and retrobulbar pain, which started about 6 months ago. The endoscopic and computer tomographic exam mark the presence of a left frontoethmoidal tumor with bone consistency. The surgical approach was combined, with the complete macroscopic removal of the tumor and ensuring the physiological frontal sinus drainage.

Minitrephination as an Adjunctive Measure in the Endoscopic Management of Complex Frontal Sinus Disease

2007 ◽  
Vol 21 (5) ◽  
pp. 629-636 ◽  
Author(s):  
Alen N. Cohen ◽  
Marilene B. Wang
Keyword(s):  
Los Angeles ◽  
Frontal Sinus ◽  
Medical Center ◽  
Retrospective Chart Review ◽  
Sinus Surgery ◽  
Endoscopic Management ◽  
Fungal Sinusitis ◽  
Allergic Fungal Sinusitis ◽  
Sinus Disease

Background Frontal sinus disease and its surgical management continues to remain an area of controversy among rhinologists. This is evidenced by the multitude of surgical procedures, both external and endoscopic, that have been developed in its management. This study was performed to evaluate the safety and efficacy of frontal sinus minitrephination in combination with endoscopic frontal sinus exploration for the management of complex frontal sinus disease. Methods A retrospective chart review identified 13 patients treated with minitrephination, in conjunction with endoscopic frontal sinus exploration, at the University of California at Los Angeles Medical Center or West Los Angeles VA Medical Center from July 2004 to October 2005. Results Thirteen patients with diagnoses of chronic sinusitis (n = 10), nasal polyposis (n = 7), frontal mucocele (n = 4), allergic fungal sinusitis (n = 3), and inverting papilloma (n = 1) underwent either unilateral (n = 9) or bilateral (n = 4) minitrephination during primary or revision functional endoscopic sinus surgery. Median follow-up was 14.2 months. There were no complications attributed to the procedure, and all patients had improvement of their sinus symptoms and displayed no evidence of recurrence of their frontal sinus disease at last follow-up. Conclusion Minitrephination is a safe and effective adjunct in the management of complex frontal sinus disease, as it allows identification of the frontal recess and vigorous irrigation of the sinus contents.

Allergic Mucin Sinusitis without Fungus

1997 ◽  
Vol 11 (2) ◽  
pp. 145-148 ◽  
Author(s):  
Hassan H. Ramadan ◽  
Huma A. Quraishi
Keyword(s):  
Clinical Picture ◽  
Nasal Polyposis ◽  
Clinical Presentation ◽  
Fungal Sinusitis ◽  
Asthma Treatment ◽  
Allergic Fungal Sinusitis ◽  
Fungal Hyphae ◽  
History Of ◽  
Allergic Mucin

Allergic fungal sinusitis (AFS) is a distinct clinical pathologic entity that has been recognized for over a decade. The hallmark of this process is eosinophilic allergic mucin with fungal hyphae on histopathology. We have identified a subset of patients who present with a clinical picture similar to that of AFS patients in which fungus could not be demonstrated pathologically or on culture. We present four cases of allergic mucin sinusitis without fungus. A comparison of the clinical presentation of this group of patients with those with AFS will be discussed. Both groups had nasal polyposis and a history of multiple sinonasal procedures. By contrast, the patients with allergic mucin sinusitis were older than the AFS group. All of the patients with allergic mucin sinusitis also had asthma. Treatment was the same for both groups of patients.

scholarly journals A rare presentation of orbital complication of invasive fungal sinusitis in an immunocompetent young boy-a rare case

2012 ◽  
Vol 8 (1) ◽  
pp. 48-51
Author(s):  
S Gaur ◽  
A Lavania ◽  
R Saxena
Keyword(s):  
Eye Movements ◽  
Maxillary Sinus ◽  
Young Male ◽  
Medial Wall ◽  
Fungal Sinusitis ◽  
Rare Presentation ◽  
Allergic Fungal Sinusitis ◽  
Surgery Patient ◽  
History Of ◽  
Ethmoid Sinuses

We present a case of allergic fungal sinusitis (AFS) in a 24 -year old man with history of left sided nasal obstruction and discharge since few years. Since few months he developed epiphora in the left eye associated with discomfort on eye movements. Patient was examined and CT with contrast was done. CT contrast showed an enhancing lesion in Left maxillary and ethmoid sinuses and erosion of the inferior bony wall of the orbit and medial wall of maxillary sinus. Though most patients of fungal sinusitis are immunocompromised but this patient was young male immunocompetent and made an unusual presentation with visual epiphora and painful eye movements. CT showed bony erosion of the Left inferior Bony wall of the Orbit and medial wall of Maxillary Sinus. After through examination and specific investigations, the patient was posted for surgery. We planed for Cald well –Luc’s Surgery and Endoscopic excision of the mass .Histological examination was reported as non malignant and microscopy showed Fungal Hyphae. After the surgery patient was discharged satisfactorily within couple of days and followed up regularly. Journal of College of Medical Sciences-Nepal,2012,Vol-8,No-1, 48-51 DOI: http://dx.doi.org/10.3126/jcmsn.v8i1.6826

scholarly journals The Frontal Sinus and Frontal Recess: Anatomical, Radiological and Surgical Concepts

2020 ◽  
Vol 24 (03) ◽  
pp. e364-e375
Author(s):  
Camila S. Dassi ◽  
Flávia R. Demarco ◽  
João Mangussi-Gomes ◽  
Raimar Weber ◽  
Leonardo Balsalobre ◽  
...  
Keyword(s):  
Frontal Sinus ◽  
Malignant Tumors ◽  
Surgical Techniques ◽  
Anatomical Variations ◽  
Point Of View ◽  
Therapeutic Success ◽  
Frontal Recess ◽  
Clinical Presentations ◽  
Individualized Approach ◽  
Sinus Drainage

Abstract Introduction The frontal sinus (FS) is the most complex of the paranasal sinuses due to its location, anatomical variations and multiple clinical presentations. The surgical management of the FS and of the frontal recess (FR) is technically challenging, and a complete understanding of its anatomy, radiology, main diseases and surgical techniques is crucial to achieve therapeutic success. Objectives To review the FS and FR anatomy, radiology, and surgical techniques. Data Synthesis The FS features a variety of anatomical, volumetric and dimensional characteristics. From the endoscopic point of view, the FR is the point of greatest narrowing and, to have access to this region, one must know the anatomical limits and the ethmoid cells that are located around the FR and very often block the sinus drainage. Benign diseases such as chronic rhinosinusitis (CRS), mucocele and osteomas are the main pathologies found in the FS; however, there is a wide variety of malignant tumors that can also affect this region and represent a major technical challenge to the surgeon. With the advances in the endoscopic technique, the vast majority of diseases that affect the FS can be treated according to Wolfgang Draf, who systemized the approaches into four types (I, IIa, IIb, III). Conclusion Both benign and malignant diseases that affect the FS and FR can be successfully managed if one has a thorough understanding of the FS and FR anatomy, an individualized approach of the best surgical technique in each case, and the appropriate tools to operate in this region.

scholarly journals Frontal Mucocele With Proptosis: DrafIIa Approach

2021 ◽  
Vol 5 (3) ◽  
pp. 366
Author(s):  
Siti Nazira Abdullah ◽  
Mohamad Azizul Fitri Khalid ◽  
Ramiza Ramza Ramli
Keyword(s):  
Frontal Sinus ◽  
Mass Effect ◽  
Health Sciences ◽  
Facial Trauma ◽  
Nasal Allergy ◽  
Endonasal Surgery ◽  
Gradual Onset ◽  
History Of ◽  
Sinus Drainage ◽  
Sinus Obliteration

Paranasal sinus mucocele commonly involved fronto-ethmoidal region rather than other due to its narrow anatomical drainage outflow, which put them at a higher tendency to get obstructed. Usually, it arises from an identifiable cause such as a history of endonasal surgery, facial trauma or background of nasal allergy or rhinosinusitis. Rarely patient presented with primary frontal mucocele, and its presentation depending on the mucocele location and extension with surrounding mass effect. Treatment is based on restoration of frontal sinus drainage and ventilation or towards a more radical and definitive approach which is sinus obliteration. Risk and benefits between these two need to be taken into consideration. We present a case of primary frontal mucocele with gradual onset of unilateral eye proptosis which first presented solely with ophthalmic symptoms.International Journal of Human and Health Sciences Vol. 05 No. 03 July’21 Page: 366-371

Allergic Fungal Sinusitis Imitating an Aggressive Skull Base Lesion in the Setting of Pembrolizumab Immunotherapy

2020 ◽  
Vol 130 (1) ◽  
pp. 108-111
Author(s):  
Natalie A. Krane ◽  
Daniel M. Beswick ◽  
David Sauer ◽  
Kara Detwiller ◽  
Maisie Shindo
Keyword(s):  
Skull Base ◽  
Nerve Palsy ◽  
Abducens Nerve ◽  
Abducens Nerve Palsy ◽  
Fungal Sinusitis ◽  
Allergic Fungal Sinusitis ◽  
Non Invasive ◽  
T Cell Infiltration ◽  
History Of ◽  
Base Lesion

Objectives: We report a case of acutely worsening allergic fungal sinusitis in a patient receiving immunotherapy with pembrolizumab, a programmed cell death protein 1 (PD-1) inhibitor. Methods: A 53-year-old man with a history of metastatic melanoma and recent initiation of pembrolizumab therapy presented with acutely worsening headaches, left abducens nerve palsy, and neuroimaging demonstrating an erosive skull base lesion with bilateral cavernous sinus involvement. Results: Intraoperative findings were consistent with non-invasive allergic fungal sinus disease. Microbiology and histopathologic data ruled out malignancy and demonstrated Aspergillus fumigatus without concern for angioinvasion. After treatment with antifungal therapy, the patient’s symptoms and abducens nerve palsy resolved. Symptoms were well-controlled 7 months after his initial presentation. Conclusions: Inflammatory sinusitis in patients receiving anti-PD-1 therapy may be secondary to T-cell infiltration, a similar pathophysiology as immune-related adverse events, and warrants appreciation by otolaryngologists given our increasing exposure to immunotherapy and its head and neck manifestations.

Allergic fungal sinusitis with extensive bone erosion of the clivus presenting with diplopia

2008 ◽  
Vol 123 (7) ◽  
pp. 817-819 ◽  
Author(s):  
S D Reitzen ◽  
R A Lebowitz ◽  
J B Jacobs
Keyword(s):  
Sphenoid Sinus ◽  
Bone Erosion ◽  
Nasal Congestion ◽  
Clinical Findings ◽  
Fungal Sinusitis ◽  
Allergic Fungal Sinusitis ◽  
Anatomical Structures ◽  
History Of ◽  
Cranial Fossa ◽  
Bony Erosion

AbstractObjective:We report a case of allergic fungal sinusitis causing bone erosion and diplopia.Case report:A 43-year-old man presented with a four-month history of increased nasal congestion and progressive diplopia. Clinical examination revealed bilateral nasal polyposis and a right lateral gaze deficit, consistent with a VIth cranial nerve palsy. Computed tomography of the paranasal sinuses demonstrated a large sellar mass with extensive bony erosion and both supra- and infra-sellar extension. An endoscopic approach to the sphenoid sinus, clivus and posterior cranial fossa with image guidance was performed, enabling surgical treatment involving nasal polypectomy, wide marsupialisation of the sphenoid sinus and removal of the extensive allergic fungal mucin. The patient awoke from anaesthesia with complete resolution of his diplopia.Conclusion:Otolaryngologists should be aware that approximately 20 per cent of patients with allergic fungal sinusitis demonstrate paranasal sinus expansion and bone erosion involving surrounding anatomical structures. Such patients may have clinical findings involving the orbit and cranial vault.

History of thyroid surgery

2020 ◽  
Vol 99 (11) ◽  
Keyword(s):  
Surgical Technique ◽  
20Th Century ◽  
Thyroid Surgery ◽  
History Of ◽  
Ancient Times

The authors present an outline of the development of thyroid surgery from the ancient times to the beginning of the 20th century, when the definitive surgical technique have been developed and the physiologic and pathopfysiologic consequences of thyroid resections have been described. The key representatives, as well as the contribution of the most influential czech surgeons are mentioned.

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