An algorithm to improve lateralization accuracy of inferior petrosal sinus sampling: procedural nuances for complex patterns of venous drainage. Patient series

BACKGROUND Inferior petrosal sinus sampling (IPSS) is a useful technique in the diagnosis of Cushing’s disease (CD) when the imaging finding is negative or equivocal. Different authors have reported considerable variability in the ability to determine tumor laterality with IPSS. Here the authors present a retrospective case series of 7 patients who underwent IPSS using a systematic algorithm to improve lateralization accuracy by identifying optimal sampling sites on the basis of individual cavernous sinus drainage patterns in each patient. OBSERVATIONS Of the 7 patients identified, 6 were determined to have CD and subsequently underwent surgery. IPSS was accurate in all patients from whom laterality was predicted. Arterial and venous angiography were used to define cavernous sinus drainage patterns and determine optimal sampling sites. All patients who underwent surgery achieved hormonal cure. LESSONS All IPSS predictions of lateralization were correct when available, and all patients who underwent surgery achieved hormonal cure. Advances in angiographic techniques for identification of the site of primary drainage from the cavernous sinus and subsequent optimization of microcatheter placement may improve the ability to predict tumor laterality.

Variação da técnica de drenagem do seio maxilar após remoção de corpo estranho pela abordagem descrita por Caldwel-Luc

In this paper, an improvement of the maxillary sinus drainage after the remotion of foreign bodies by Caldwell-Luc surgery is developed. Three patients with tooth or radicular apex introduced into the maxillary antrum during dental extraction were submitted to the surgery. In contrast to the opening to the nasal cavity, two probes were installed to perform the irrigation and aspiration of the antrum after the surgery. The conclusions are that the use of the probes is an advance in the Caldwell-Luc surgery. With the irrigation and aspiration, the opening to the nasal cavity is not necessary and the result is a comfortable recovery to the patient. The Caldwell-Luc surgery is a safe and simple procedure to remove foreign bodies from the maxillary sinus.

Cervicofacial Actinomycosis in the Pediatric Population: Presentation and Management

Background: Infection caused by Actinomyces species is a rare cause of head and neck infection in children. This chronic cervicofacial infection can present with localized swelling, abscess formation, sinus drainage and can be complicated by osteomyelitis. Methods: Presented are 2 pediatric cases of secondary actinomycosis in the context of congenital lesions: 1 patient with a previously excised preauricular sinus and another with a persistent sublingual mass. A comprehensive literature search was conducted for reported cases of pediatric actinomycosis in the cervicofacial region. Results: Both cases presented were successfully treated with a combination of complete surgical excision of the lesions and prolonged antibiotic therapy. Thirty-four pediatric cases of cervicofacial actinomycosis are reviewed, 2 presented herein, and 32 from the published literature. There was equal gender distribution and the median age was 7.5 years. The most common site for infection was the submandibular area. Four (12%) of cases arose in pre-existing congenital lesions. Most patients were treated with penicillin-based antibiotics for a median duration of 6 months following surgical excision or debridement. Conclusions: Actinomycosis is a rare infection of the cervicofacial region; secondary infections arising from congenital lesions of the head and neck are even more rare. A previously excised pre-auricular sinus and a sublingual dermoid cyst are not previously reported sites of infection. Actinomycosis should be suspected in chronically draining sinuses of the head and neck region and confirmed through anaerobic culture. Osteomyelitis is a potential complication and magnetic resonance (MR) imaging is warranted. Long-term antibiotic therapy with a penicillin-based antibiotic and surgical excision should be considered.

Frontal Mucocele With Proptosis: DrafIIa Approach

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

Frontal Sinus Drainage in Acute Pediatric Sinusitis With Intracranial Complications

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.

Neurilemmoma of fronto-ethmoid paranasal sinuses: aggressive anterior skull base destructing tumor—a case report

Neurilemmomas (Schwannomas) of sinonasal tract are very unusual. They are benign, slow-growing, usually solitary encapsulated perineural tumors. They arise from Schwann cells of the neural sheath of the peripheral nervous system including motor, sensory and autonomic nerves. They can occur throughout the body, but the head and neck region demonstrate a higher incidence of occurrence (25–45%). The sinonasal region, however, has the lowest incidence rate with only 3–4%. We report here a rare case of fronto-ethmoid sinus neurilemmoma that is locally destructing the anterior skull base and the lateral orbital wall. A left eye proptosis, diplopia and chemosis were the presenting complaints. Images and histopathology examinations confirmed the diagnosis. The patient underwent tumor resection through Endoscopic Endonasal approach, followed by a functional sinus drainage of the retained secretions. The patient made a good postoperative recovery and remained disease free at a 1-year follow up period.

3D CT stereoscopic imaging: an improved anatomical understanding of the anterior ethmoid sinus and frontal sinus drainage pathway

OBJECTIVE: The objective of this presentation is to display a series of new anatomical concepts and terms regarding the frontal si- nus, its drainage pathway and cells vs. spaces of the anterior ethmoid, based on Three-Dimensional Computer X-ray Tomography Stereoscopic Imaging (3DCTSI) and contrast these concepts to those reported in the current literature. METHODS: Given the new anatomic observations provided by 3DCTSI, and the widespread anatomic variations a small sample was initially selected to describe our observations. Six exemplary cases according to the “Classification of Fronto-Ethmoidal cells” by Kuhn, Bent et al., Lee et al., expanded by Wormald et al., and adopted by Ramakrishnan et al., Huang et al., and Void et al. (1-7) were chosen to illustrate our detailed anatomic observations. Additional observations and data of prevalence identified in a larger series will follow. RESULTS and CONCLUSION: Conceptually, the anterior ethmoid “cells” are in essence “spaces” with openings that communicate with the middle meatus and/or the ethmoidal infundibulum. The frontal sinus and frontal recess are a united and continuous three-dimensional, irregularly shaped space, the Frontal Sinus/Recess Space (FSRS). The uncinate process has two segments: the Ethmoidal Uncinate Process (EUP), which encompasses the Infundibular Space of the EUP (IS-EUP), currently known as the Agger Nasi cell; and the Turbinal Uncinate Process (TUP), which borders the Turbinal Infundibulum (TI) medially. The superior attach- ment of the EUP will be detailed in each of the six cases (Table 2). The middle meatus and infundibular passages are the drainage pathways from the frontal sinus and maxillary sinus to the nasal cavity.

CRI over MRI: A Cranial Approach to Dizziness

Dizziness is a nonspecific term that describes symptoms such as feeling “faint, woozy, weak or unsteady.”1 Dizziness can have various etiologies, but the diagnosis remains unclear in about 10% of presenting cases.2 Our hypothesis is that osteopathic evaluation and treatment can aid in the management of undiagnosed cases of dizziness. A 46-year old female presented with a 5-year history of dizziness after recovering from a traumatic brain injury (TBI) secondary to a syncopal episode with fall onto a cement floor. Prior to her osteopathic examination and treatment, she had attempted medical intervention for vertigo and underwent imaging and hematological studies to no avail. After 4 applications of osteopathic cranial manipulative medicine (OCMM), including the v-spread, cranial bone lifts, venous sinus drainage, and other osteopathic manipulative treatment (OMT) techniques, the patient had zero dizzy episodes and has been able to return to daily activities with complete resolution of symptoms.

Anticongestion therapy of sinusitis in children

Sinusitis is one of the most common respiratory diseases in children. Swelling of the nasal mucosa and paranasal sinuses accompanies sinusitis; but this is not only a symptom, edema leads to blockage of the normal sinus drainage pathway, which is key in the pathogenesis of sinusitis. Decongestants are considered a key treatment for sinusitis because they improve the function of the sinuses. According to EPOS-2012, treatment of acute sinusitis in children up to 5 days includes nasal lavage, decongestants, and in the absence of effect within 10 days, endonasal corticosteroids are added to the treatment. Decongestants are prescribed from the onset of sinusitis in children. They not only alleviate the annoying manifestations of nasal congestion, but also keep unlocked paranasal sinuses, prevent the progression of sinusitis to bacterial and prevent complications. In the treatment of sinusitis, we successfully combine the benefit of decongestants (rapid, relatively shortterm anti congestion) with the effect of endonasal corticosteroids (slow, relatively long-acting anti congestion). The article shows our algorithm of topical sinusitis treatment.