Nasal congestion caused by long-term retention of a nasal foreign body near the orbit:A case report

BACKGROUND Nasal trauma presents a risk of foreign body invasion into the nasal cavity.However,in the early treatment stage of nasal trauma,patients and doctors are not always aware of possible foreign body invasion,resulting in delayed detection.We describe the case of an adult patient admitted to the hospital due to left nasal congestion accompanied by yellow,purulent,and bloody discharge.CASE SUMMARY Consultation with the patient revealed a history of nasal trauma 30 years prior that did not receive thorough examinations and imaging during treatment,resulting in a glass fragment retained in the nasal cavity adjacent to the orbit.After admission,computerized tomography(CT)confirmed the presence of the foreign body in the patient’s left nasal–maxillary sinus.The nasal foreign body led to symptoms such as chronic sinusitis,nasal polyps,fungal infection,and deviated nasal septum.The foreign body was successfully removed by nasal endoscopy,polypectomy,sinus fungal removal,left middle turbinate conchoplasty,fenestration via the right inferior meatus,nasal endoscopic maxillary sinus cystectomy,and septolplasty.The operation was successful and without any complications.CONCLUSION CT scans should be performed in addition to necessary debridement sutures to avoid possible foreign body invasion during nasal trauma.Surgical planning should be tailored to the patient’s specific situation.The surgical method should be carefully selected,and sufficient preparation should be undertaken before the surgery to avoid possible displacement of the nasal foreign body.

Management of Sphenoidal Sinus Lesions by Septal-assisted Approach: Surgical Skills and Advantages

Summary： The aim of this study was to develop a less invasive trans-septal approach for the endo- scopic management of sphenoid sinus lesions. We performed a septal-assisted surgical procedure for endoscopic sphenoidectomy in 38 patients with isolated or combined sphenoidal sinus lesions, including fungal balls, mucoceles, purulent cystic sphenoidal sinusitis, etc. The posterior portion of the nasal sep- turn became flexible after removal of the vomer and the sphenoidal rostrum. The superior portion of the common meatus was expanded to accommodate the endoscope after the septum was repositioned con- tra-laterally. The lesions were individually managed through the enlarged ostiums while damage to the mucosa of the front sphenoidal wall was avoided. All the procedures were completed successfully without intraoperative complications, and the bony ostiums were identified easily and enlarged accu- rately. During the follow-up period of 16 weeks to 2 years, no re-atresia or restenosis was observed. The recurrence rate was 0. No postoperative complications were recorded. All the responses from the pa- tients were satisfactory. It was concluded that endoscopic sphenoidectomy assisted by trans-septal ap- proach is a feasible, safe, effective and minimally invasive approach for selected cases with unilateral or bilateral lesions in the sphenoid sinuses.

Intranasal endoscopic prelacrimal recess approach to maxillary sinus

Background The inferior turbinate （IT） and nasolacrimal duct （NLD） are often sacrificed while managing the diffuse lesion of maxillary sinus （MS）. We report a new approach to MS without ablation of NLD and IT. Methods This retrospective study enrolled 19 hospitalized patients （aged from 42 to 68 years） who underwent endoscopic sinus surgery between 2003 and 2008. Twelve patients had inverted papilloma （IP）, two had nasal polyps, two had Kubo＇s postoperative cyst of MS, one had recurrent bone cyst of maxilla, one had dentigerous cyst and one had bleeding of internal maxillary artery secondary to CaldwelI-Luc operation respectively. Two IP patients were excluded from this group since the follow-up time was less than 12 months. The NLD was dissected after removing the anterior bony portion of nasal lateral wall. The prelacrimal recess approach （PLRA） to MS was established when IT-NLD flap was raised medially. The flap was repositioned when MS lesion was removed. Results All the 17 patients had unilateral lesions. Ten MS IP patients were at the T3 Krouse stage. The follow-up ranged from 7 to 60 months. No recurrence was seen in 16 patients. Only one IP patient had a local recurrence in MS. All of them had no any complications. Conclusion The diffuse or severe diseases of MS may be the potential indications for PLRA.

Root canal therapy combined with endoscopic sinus surgery for odontogenic sinusitis:Efficacy comparison in a cohort study

BACKGROUND Odontogenic maxillary sinusitis,often triggered by dental issues like periapical periodontitis,significantly contributes to chronic sinusitis,mainly affecting adults around 50 years old,emphasizing the need for a multidisciplinary diagnostic and treatment approach.AIM To investigate the therapeutic effect and clinical value of root canal therapy combined with nasal endoscopic surgery compared with simple root canal the-rapy in the treatment of severe odontogenic maxillary sinusitis caused by peria-pical periodontitis.METHODS The clinical data,diagnosis,and treatment of 200 patients with severe odonto-genic maxillary sinusitis caused by periapical periodontitis from October 2020 to October 2021 were analyzed retrospectively.Among them,63 patients were treated with simple root canal therapy as the control group,and 137 patients were treated with root canal therapy combined with nasal endoscopic surgery as the observation group.The therapeutic effect,Lund-Kennedy endoscopic score,paranasal sinus Lund-Mackay score,complication rate,recurrence rate,and patient satisfaction were compared between the two groups.RESULTS First,we compared the effective rates:23 cases were cured,22 were improved,and 8 were ineffective in the control group,yielding a total effective rate of 84.90%.Meanwhile,97 cases were cured,34 improved,and 6 were ineffective in the observation group,resulting in a total effective rate of 95.62%.The observation group had a higher total effective rate compared with the control group(P<0.05).Second,we compared the Lund–Kennedy endoscopic score.Before treatment,no significant difference(P>0.05)was observed in this score between the two groups.After treatment,the Lund–Kennedy endoscopic score decreased in both groups.The Lund–Kennedy endoscopic score of the observation group at 3 and 6 mo after treatment was lower compared to that of the control group(P<0.05).Third,we compared the Lund–Mackay score of paranasal sinuses.Before treatment,there was no significant difference in this score between the two groups(P>0.05).After treatment,the Lund–Mackay scores of paranasal sinuses decreased in both groups.The Lund–Mackay scores of paranasal sinuses in the observation group at 3 and 6 mo after treatment were lower compared to those of the control group(P<0.05).Fourth,we compared the incidence and recurrence rate of complications.Three months after treatment,no significant difference was found in the incidence and recurrence rate of complications between the observation group(6.56%)and the control group(9.52%)(P>0.05).However,6 mo after treatment,the incidence and recurrence rate of complications in the observation group(2.91%)was significantly higher compared to that of the control group(12.69%)(P<0.05).Fifth,we compared patient satisfaction.Six months after treatment,the patient satisfaction of the observation group(93.43%)was significantly better than that of the control group(84.12%)(P<0.05).CONCLUSION Root canal therapy combined with nasal endoscopic surgery has a good therapeutic effect on severe odontogenic maxillary sinusitis caused by periapical periodontitis,and it can reduce the injury of maxillary sinus mucosa and bone,and significantly reduce the incidence of complications and recurrence rate.Meanwhile,it has high patient satisfaction and remarkable therapeutic effect,which is suggested to be popularized and applied in clinic.