Complications of Sinusitis: About 9 Cases in the Ear Nose &Throat (ENT) Department of the University Hospital Gabriel Touréin Bamako

Objective: This study aims to analyze clinical, paraclinical and therapeutic aspects of sinusitis complications in the Otorhinolaryngology department at the teaching hospital of Gabriel Toure in Bamako. Materials and methods: This descriptive and longitudinal study was conducted on 12 months from March 2012 to February 2013 in 9 cases of sinusitis complications in the department of Otorhinolaryngology at the University Hospital Gabriel Toure in Bamako. Results: The average age of patients was 22.7 years;a median of 19 years within 6 men and 3 women with almost 12.9 days of care seeking duration. The factors of risky were the use of nonsteroid anti-inflammatory drugs NSAID (4 cases), maxillofacial trauma (1 case) and HIV (1 case). Facial pain was the major symptom, such as frontal oedema, rhinorrhea with pus shedding and nasal obstruction. Computer tomography was used for complications specification. Frontal sinusitis was the most encountered with subperiosteal abscess (44.4%). Streptococcus pneumoniae was identified in 3 cases. Medical treatment associated to surgery was conducted on 7 patients. Two cases of death have been registered. Conclusion: The complicated sinusitis is an emergency and dangerous disease requiring specific care by a multidisciplinary staff. Much of complications are commonly encountered despite the antibiotic era.

Oculo Orbital Complications of Sinusitis

The ocular-orbital complications of sinusitis constitute a diagnostic and therapeutic urgency that requires a correct multidisciplinary assumption. Objectives: The description of clinical and therapeutic data of the orbital complications of acute sinusitis. Methods: Our work is based on a retrospective study of 86 cases of ocular-orbital complications of sinusitis hospitalized at the ENTdepartment of Hassan II Hospital in Fes (Morocco), between the years of 2006 and 2014. Results: It is about 56 men and 30 women. The average age was 24 years, with the extremes of 3 years and 65 years. The average time of consultation was 13 dates. The achievement was frontal-ethmoido in 26 cases, and it is about a pan sinusitis in 24 cases. About 13% and 7% of cases were classified respectively in the stage III and the stage IV of chandler. The surgery was done for 24 cases. Bacteriological sample was performed among 24 patients and allowed to isolate a streptococcus (3.5%), and a staphylococcus (5.8%), and a poly microbial flora for 15.1% of patients. A death in sepsis panel was noted for a patient who presented a thrombosis of cavernous sinus. And we have noted a persistent left exophthalmia without the diminution of visual acuity for another patient. Conclusion: The orbital complications of sinusitis require a multi-disciplinary medical approach associated to ear specialist, ophthalmologist, and neuro-radiology. A precocious diagnosis, an appropriate anti-biotic therapy, and sometimes an associated surgical treatment, can significantly diminish the mortality and the morbidity related to this pathology.

Epidemiological, Clinical and Therapeutic Profiles of Ophthalmological Complications of Rhino-Sinusitis in a Tertiary Facility in Black Africa

Introduction: Rhinosinusitis is one of the most common ENT diseases. Its main complications are of three types: cranial, endo-cranial and ophthalmological. The aim of this study was to contribute to the study of ophthalmological complications of rhino-sinusitis in our context. Material and Methods: This was a prospective study, of descriptive type, of six (6) months (July-December 2017), concerning the patients received and treated for ophthalmological complications of rhino-sinusitis at the National IgnaceDeen Hospital. Results: During our study period, we collected 32 ophthalmological complications of rhinosinusitis, i.e. 65.31% of cases. The average age of our patients was 34.25 ± 15.15 years with extremes of 8 and 76 years and a sex ratio of 0.45. A history of rhinitis and/or rhino-sinusitis was reported in all our patients. Housewives were the most affected socio-professional group, accounting for 34.37% of cases. The average consultation time was 20 ± 52 days. Tearing, palpebral oedema and purulent rhinorrhea were present in all our patients. Preseptal cellulitis and abscess were the most common complications, accounting for 56.25% and 28.12% of cases respectively. The treatment was medical-surgical. Drainage of a subperiosteal abscess of the ethmoid involved 53.12% of cases. Surgical treatment of the maxillary sinus and/or ethmoid by endoscopy was sometimes associated. The evolution was favourable in all cases. Conclusion: Ophthalmological complications of rhino-sinusitis are still frequent in our developing countries. Their management must be multidisciplinary.

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.

Anatomic Variants of Sphenoid Sinuses and Adjacent Structures: A Study of 225 Skull CT Scans at CNHU-HKM in Benin, West Africa

Objective: This study aimed to describe anatomic variants of sphenoidal sinuses and adjacent structures. Methods: A retrospective and descriptive study was carried out at The National and University Teaching Hospital Hubert Koutoukou Maga (CNHU-HKM), of Cotonou in Benin from November 1st to December 31st. A review of CT scans skull was done for the subjects aged at least 16 years old. Anatomic variants of the sphenoid sinuses and adjacent structures have been investigated. Results: 225 CT scans of skull were analyzed. The sellar type was the most common type of pneumatization of sphenoid sinuses (74.7%). Pneumatization of anterior clinoid processes of greater and lesser wings of the sphenoid and of pterygoid processes was observed in 7.1%;4.6%;3.3% and 7.3%;respectively. Protrusion of carotid canals and optic canals, maxillary and vidian nerves were observed in 48.3%;13.1%;18% and 9.5%;respectively. Conclusion: Risky anatomic variants of the sphenoid sinuses and adjacent structures are also described by CT-scan among Beninese. Before any surgery and to avoid bad outcome, a precise approach of these risky anatomic variants must be carried out by using CT-scan.

Treatment of Organized Hematoma of the Sphenoid Sinus with Pre-Operative Embolization and Endoscopic Resection

The differential diagnosis for expansile masses of the sphenoid sinuses includes both benign and malignant lesions. We herein present a case of a 79-year-old female who presented with chronic epistaxis and an expansile soft tissue mass centered in the sphenoid sinus with erosion of the skull base. Endoscopic resection of the lesion was performed, with histopathological examination revealing organized hematoma. To our knowl- edge, this is the first reported case of sphenoid sinus organizing hematoma treated with pre-operative embolization followed by endoscopic excision.

A Study of Cardiac Profile in Patients with Snake Envenomation and Its Complications

Background: Snake bite is a common and frequently devastating environmental and occupational disease, especially in rural areas of tropical developing countries. The present study was undertaken to evaluate the effect on cardiac profile in patients with snake envenomation and its complications. Methods: A total of 200 patients with snake envenomation were enrolled in this study excluding patients having history of any cardiovascular disease, renal disease, coagulopathy, liver disease, neuromuscular disease and those cases who bitten by non-poisonous snakes. All patients underwent physical examination, laboratory, Electrocardiogram (ECG), X-ray of chest and echocardiogram investigations. Results: A total of 200 cases had envenomation having 116 (58%) of male subjects. Most common local signs were edema 187 (93.5%), tenderness 141 (70.5%), skin necrosis 81 (40.5%) and blistering 12 (6%). Severity of local envenomation was graded into mild 66 (33%), moderate 120 (60%) and severe 14 (7%) cases. Systemic manifestations were present in 83 patients of venomous bites. It includes that majorly 53 (26.5%) cases had vomiting, 44 (22%) cases had abdominal pain and 9 (4.5%) cases of hypotension. ECG manifestation showed 27 (13.5%), 6 (3%) and 1 (0.5%) patients had sinus tachycardia, sinus bradycardia and ventricular tachycardia respectively. While, 9 (4.5%) cases had T inversion alone in precordial leads. Mortality (3%) was observed in intracranial bleed, neurotoxicity and capillary leak syndrome. However, cardiovascular involvement was not responsible for mortality in any cases. Conclusion: In conclusion, ventricular tachycardia is one of the manifestations of snake envenomation. Moreover, sinus tachycardia is common cardiovascular sign which may not be due to cardiac causes. Mortality results conclude that, cardiovascular involvement could not be responsible for mortality in snake envenomation.

Study of the relationship between sphenoid sinus volume and protrusions in the sphenoid sinus

The relationship between the volume of sphenoid sinus (SS) and the prevalence of internal carotid artery (ICA) and optic nerve (ON) protrusions in the SS was studied by using high-resolution CT imaging. The ICA and ON protrusions in SS were observed in randomly selected normal head CT scanning images from 350 adult subjects. Ac-cording to the incidence of ICA protrusion, three groups were divided into no ICA protrusion (70.75%), unilateral protrusion (8.68%) and bi-lateral protrusions (20.57%). The ON protrusion accounted for 16% in 350 subjects and accom-panied absolutely with ICA protrusion, but ICA protrusion appeared without accompanying with ON protrusion. The SS volume depended upon the protrusions in it and showed statistical dif-ferences, without ICA protrusion, the smallest size (11.16 ± 1.60) cm3;the unilateral protrusion, medium size (14.20 ± 1.80) cm3 and the bilateral protrusion, the largest size (25.03 ± 2.21) cm3. By observing 3D reconstructed models of ON and SS, we found ON was adjacent to SS (46%) and to posterior ethmoid sinuses (44%). The current study indicates that SS volume is varied with numbers of the protrusions and that ON location varies with the pneumatization of SS. Our results provide an anatomical basis to the surgeries for SS and its surrounding structures.

Application and Care of Two Kinds of Sphenoid Sinus Packing Materials after Pituitary Tumor Resection with the Transnasal Endoscopic Approach

Background: Neuroendoscopic transsphenoidal approach for resection of pituitary adenomas has the advantages of less damage, fewer complications, and a faster recovery than the traditional approach and has beening favored by neurosurgeons. However, there has no standard method of selecting suitable packing materials after the operation to relieve pain in patients and achieve the ideal hemostatic effect. We compared the postoperative complications and treatment effects of two different packing materials in patients with pituitary adenomas. Objective: To investigate the advantages and disadvantages of using a catheter balloon and iodoform gauze for hemostasis in patients undergoing pituitary tumor resection by neuroendoscopic transsphenoidal approach. Materials and Methods: We retrospectively analyzed these data of 48 cases treated with pituitary adenoma resection by the single nasal approach from January 2018 to October 2019 in Sun Yat-sen University Cancer Center. According to the type of sphenoid sinus packing material used, these patients were divided into balloon tamponade oppression group (24 cases) and tela iodoformum oppression group (24 cases), respectively. The balloon tamponade oppression group received catheter balloon tamponade oppression hemostasis, and the tela iodoformum oppression group underwent tela iodoformum oppression hemostasis. The outcomes and complications were compared between the two groups in which two kinds of sphenoid sinus packing materials were used for hemostasis after tumor resection by transnasal endoscopic approach. For the catheter balloon compression hemostasis method, on account of the plasticity of the balloon, the volume of water in the balloon can be adjusted according to the size of the patient’s own sphenoid cavity. The amount of bleeding and several complications in terms of discomfort during placement and removal of the packing material, rebleeding after removal of the packing, cerebrospinal fluid rhinorrhea and electrolyte disturbance are compared between the two groups. Results: 48 patients were enrolled. The two groups’ data of patients were similar in age structure, sex ratio, tumor size at baseline and so on. No complications, such as abscess formation, were found in both groups. The success rate in the compression with catheter balloon group was 100% (24 of 24 patients);and in the iodoform gauze group 83.33% (20 of 24 patients). A catheter balloon was more successful in stopping bleeding at early stage than iodoform gauze. There were no statistically significant differences in the hospitalization stay time, operating day to discharge day and tampon indwelling time (P > 0.05). There were also no significant differences in pairwise comparison between the catheter balloon group and iodoform gauze groups in the incidence of cerebrospinal fluid rhinorrhea or electrolyte disturbance between the two groups (P > 0.05). The incidence of headache in the catheter balloon group was statistically significantly lower than that in the iodoform gauze group (P < 0.05). Conclusion: In patients undergoing endoscopic pituitary tumor resection, compression and hemostasis by means of catheterization expansion lead to lower rates of injury and complications and have a good effect, so this method is worthy of being recommended for clinical practice.

Solitary Fungus Ball of the Sphenoid Sinus

A 50-year-old woman with long standing nonspecific disturbing headaches of the mid-face and rear of the head plus retro-orbital pain for about one year duration was proved to suffer from the fungus ball involvement of the left sphenoid sinus after operation. The diagnosis was established by histopathologic examination of the specimen removed at the time of operation.

Computed tomography scans of paranasal sinuses before functional endoscopic sinus surgery

This review aims to familiarize the radiologist with the common types of sinus surgery including their indications and techniques.We also illustrate how surgeons interpret 3D sinus anatomy when evaluating computed tomography(CT)studies.Preoperative evaluation by CT is mandatory for all patients undergoing functional endoscopic sinus surgery(FESS).In the past decade in particular,CT of the paranasal sinuses has become a roadmap for FESS.The radiologist's goal is to report on five key points:the extent of sinus opacification,opacification of sinus drainage pathways,anatomical variants,critical variants,and condition of surrounding soft tissues of the neck,brain and orbits.We present a systematic approach to the use of coronal,axial,and sagittal images in CT evaluation before FESS.

Evaluation of anatomical considerations in the posterior maxillae for sinus augmentation

The edentulous posterior maxilla is considered a clinical challenge during dental implant treatment for many dental practitioners. This is because its insufficient bone quality, deficient alveolar ridge, spiny ridges, undercuts, and sinus pneumatization are often encountered after tooth loss. To overcome these problems, several approaches have been developed and are currently used, including sinus augmentation and bone augmentation. Today, two main procedures of sinus floor elevation for dental implant placement are in use: a two-stage technique using the lateral window approach, and a onestage technique using a lateral or a crestal approach. In this study, we deal with the anatomic relations ofthe structures of the maxillary sinus during sinus augmentation. These anatomical findings can help in complications and potential injuries of the maxillary sinus procedures. It can be suggested that pre-operative evaluation is helpful for diagnosis and treatment planning and minimizing complication during the surgery.

Anatomical relevance of ablation to the pulmonary artery root:clinical implications for characterizing the pulmonary sinus of Valsalva and coronary artery

Background and Objective Ablation within the pulmonary sinus of Valsalva (PSV) becomes increasingly common in certain ventricular outflow arrhythmia. Understanding the regional anatomy is intensively concerned to avoid procedure complications. The purpose of this study is to describe the anatomic relationships of PSV to its adjacent structures using computed tomographic coronary angiograms (CTCA).

Orbital Injury in Endoscopic Sinus Surgery for Sinonasal Inflammatory Disorders: Juntendo’s Ten-Year Experience

Orbital injury and complications are commonly encountered in endoscopic sinus surgery (ESS) despite advances in techniques and instrumentation. For the recent 10 years, we summarized the experience of the rhinology unit of our department regarding orbital injury and complications of ESS for sinonasal inflammatory disorders. One thousand seventy-three patients (1869 sides) from January 1, 2003 to December 31, 2012 undergoing ESS for sinonasal inflammatory diseases were enrolled in the present study. The age of the patients ranged from 8 to 81 years, mean age 49 years. Orbital injury and complications were observed in 13 patients (13 sides), which corresponded to 0.7% of the operated sides and 1.2% of the patients. Eight patients showed herniation of orbital fat alone through the injury of the lamina papyracea. The protruding orbital fat was snipped and cut using forceps in 2 patients. Removal of exposed orbital fat using powered instruments was performed in 3 patients, two of whom transiently showed periorbital edema postoperatively. No permanent complications were observed. Meticulous preoperative and perioperative planning is critical to prevent orbital complications. Especially, exposure of the periorbit and herniation of orbital fat after lamina injury with powered instrumentation dramatically increases the potential for more severe complications.

经鼻内镜手术治疗以眼部症状为首发的真菌性蝶窦炎

目的探讨以眼部症状为首发的真菌性蝶窦炎的早期诊断及导航辅助下真菌病变清除术。方法对2007年1月-2022年12月广州市中山大学附属第一医院耳鼻咽喉科收治的17例以眼部症状为首发的真菌性蝶窦炎患者的临床表现、影像学检查、手术方法及术后转归等方面进行回顾性分析,总结临床经验。结果17例患者影像学均符合真菌性鼻窦炎,且术后病理确诊为真菌感染。11例患者术后眼部症状得到不同程度改善,包括视力下降、眼球运动障碍、眼睑下垂等,6例患者术后症状无明显改善。结论临床上病因不明的渐进性视力下降及迁延不愈的头痛,应考虑真菌性蝶窦炎可能,及时完善头颅CT、MRI等检查,一经确诊首选鼻内镜下手术治疗。术中导航技术可辅助准确定位病变并判断病变范围,保障手术安全并提高手术效率。侵袭性真菌性鼻窦炎需要联合系统性抗真菌治疗。

儿童鼻窦炎影像学研究进展

儿童鼻窦炎是常见的耳鼻咽喉科炎性疾病,发病率逐年上升。儿童鼻窦炎具有独特性,儿童鼻窦在出生后继续发育,并在不同年龄和阶段完成成熟和气化,这使得儿童鼻窦炎的感染与患者的年龄有关。儿童慢性鼻窦炎是比较常见的疾病,有时症状不明显,故诊断需要借助影像学检查。儿童发生鼻窦炎如果得不到及时的诊治,可能会引起眼眶及颅内严重的并发症,给患者带来不可逆转的失明、复视等严重后果。如果疾病得到及早发现和诊治,一般预后良好。儿童鼻窦炎并发症的诊断,除了临床症状及实验检查外,常结合影像学的检查加以明确,主要是CT和MRI检查;CT能提供较高的骨骼分辨率,是确诊眼眶并发症时的首选技术;MRI具有更好的软组织分辨率,对于精细部位成像效果好。影像学检查对于诊断儿童鼻窦炎,特别是并发症具有重要的临床意义。因此,本文重点对常见类型儿童鼻窦炎及其并发症的CT和MRI等影像学方面的研究展开综述。

真菌球型蝶窦炎和真菌球型上颌窦炎的临床症状及影像学特征比较

目的分析真菌球型蝶窦炎和真菌球型上颌窦炎的临床症状及影像学特征。方法收集2015年1月至2020年6月就诊于我院的30例真菌球型蝶窦炎患者以及同期收治的126例真菌球型上颌窦炎患者的病历及影像学资料,对比分析两者的临床症状及影像学特征。结果真菌球型蝶窦炎和真菌球型上颌窦炎均好发于40~60岁的女性,病程均以半年内最常见,CT特征性表现均为钙化灶及骨质增生。与真菌球型上颌窦炎相比,真菌球型蝶窦炎的头痛、眼胀、溢泪更多见(P<0.05);与真菌球型蝶窦炎相比,真菌球型上颌窦炎的面部不适更多见(P<0.05)。结论真菌球型蝶窦炎和真菌球型上颌窦炎的CT特征均为钙化灶、骨质增生。头痛是真菌球型蝶窦炎常见且相对特征性的临床症状。眼胀和溢泪是真菌球型蝶窦炎相对特征性的临床症状,面部不适是真菌球型上颌窦炎相对特征性的临床症状。

加速康复外科护理联合健康宣教对慢性鼻窦炎患者术后并发症发生率及效果的影响

目的探究慢性鼻窦炎采取加速康复外科护理结合健康宣教的实践效果及对并发症改善的影响。方法随机选取2022年9月-2023年3月福建医科大学附属第一医院滨海院区收治的70例慢性鼻窦炎患者作为研究对象,按照随机数表法分为两组,各35例。对照组采取常规化护理,观察组基于此采取加速康复外科结合健康宣教护理,比较两组患者术后局部症状疼痛水平、健康知识掌握评分、生活质量以及并发症发生率。结果观察组术后局部症状疼痛评分低于对照组,差异有统计学意义(P<0.05);观察组健康知识掌握评分高于对照组,差异有统计学意义(P<0.05);观察组生活质量评分优于对照组,差异有统计学意义(P<0.05);观察组并发症总发生率(2.86%)低于对照组(22.86%),差异有统计学意义(χ^(2)=4.590,P<0.05)。结论慢性鼻窦炎采取加速康复外科护理结合健康宣教效果显著,可提高患者认知水平,减轻其术后不适感,降低并发症发生率,改善患者生活质量。

鼻内镜手术联合全降解鼻窦药物支架植入治疗慢性鼻窦炎伴鼻息肉的效果

目的:观察鼻内镜手术联合全降解鼻窦药物支架植入治疗慢性鼻窦炎(CRS)伴鼻息肉的效果。方法:选取2022年2月—2023年2月东莞东华医院收治的70例CRS伴鼻息肉患者。根据随机数表法将其分为对照组和观察组,各35例。对照组给予鼻内镜手术联合布地奈德治疗,观察组给予鼻内镜手术联合全降解鼻窦药物支架植入治疗。比较两组时间指标,治疗前和术后1个月鼻窦炎症情况、鼻腔情况及并发症。结果:观察组鼻腔恢复通气时间、鼻黏膜恢复时间及住院时间均短于对照组,差异有统计学意义(P<0.05)。术后1个月,两组鼻窦CT Lund-Mackay评分及息肉、水肿、鼻腔分泌物等鼻内镜Lund-Kennedy评分均降低,观察组鼻窦CT Lund-Mackay评分及息肉、水肿、鼻腔分泌物、瘢痕/结痂等鼻内镜Lund-Kennedy评分均低于对照组,差异有统计学意义(P<0.05)。观察组术后并发症发生率低于对照组,差异有统计学意义(P<0.05)。观察组总有效率高于对照组,复发率低于对照组,差异有统计学意义(P<0.05)。结论:鼻内镜手术联合全降解鼻窦药物支架植入治疗CRS伴鼻息肉患者的效果显著,可明显改善鼻部相关症状及鼻窦CT、鼻内镜评分,加快术后恢复,减少术后并发症发生及远期复发。

经鼻内镜下耳鼻咽喉动力系统手术对慢性鼻窦炎患者的临床效果

目的探究慢性鼻窦炎治疗中应用经鼻内镜下耳鼻咽喉动力系统手术的临床效果。方法方便选取福建省宁化县总医院于2021年1月—2023年12月收治的129例鼻窦炎患者作为研究对象,用随机数表法分为对照组64例和研究组65例。比较两组患者临床效果、并发症发生率、手术指标、鼻窦结果、疼痛程度。结果研究组手术临床效果高于对照组,术后并发症发生率低于对照组,术中出血量少于对照组,鼻腔通气时间、黏膜恢复时间短于对照组,差异有统计学意义(P均<0.05);治疗后,研究组鼻塞、流涕、嗅觉障碍得分高于对照组,视觉模拟评分(Visual Analogu Scale,VAS)低于对照组,差异有统计学意义(P均<0.05)。结论慢性鼻窦炎治疗采用经鼻内镜下耳鼻咽喉动力系统手术有很好的临床效果,并发症少,康复快,有助于鼻窦功能恢复。