Sinusitis

Allergic fungal sinusitis

March 1, 2011     Lester D.R. Thompson, MD
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Endoscopic views of bilateral dacryocystorhinostomies

February 1, 2010     Joseph P. Mirante, MD, FACS, Dewey A. Christmas, MD, and Eiji Yanagisawa, MD, FACS
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Isolated sphenoid sinusitis presenting as blindness

January 1, 2010     Simon Wright, MBChB and Naeem Khan, MBChB, MRCS
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An acute ischemic stroke secondary to sphenoid sinusitis

October 31, 2009     Christian Adrien Righini, MD, PhD, Fabrice Bing, MD, Pierre Bessou, MD, Kamel Boubagra, MD, and Emile Reyt, MD
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Abstract

Acute isolated sphenoid sinusitis is a relatively uncommon entity. Because its symptoms and clinical findings are nonspecific, it can be easily misdiagnosed. Left unrecognized and untreated, it can lead to several well-known and severe complications, including meningitis, cerebral abscess, cavernous sinus thrombosis, and epidural or subdural empyema. We report the case of a 28-year-old woman with acute sphenoid sinusitis complicated by ischemic stroke in the left caudate nucleus, lentiform nucleus, and posterior part of the internal capsule. The stroke was diagnosed on magnetic resonance imaging. Also, magnetic resonance angiography showed a narrowing of the internal carotid artery and a narrowing of the first part of the left anterior and middle cerebral arteries (A1 and M1 segments). The patient was treated with medical therapy, including antibiotics, and surgical drainage of the sphenoid sinus via an endoscopic approach. Her outcome was good, and she experienced minimal neurologic sequelae. We discuss the possible explanations for this rare complication.

Endoscopic view of secretion transport from a maxillary antrostomy to the nasopharynx

September 30, 2009     Dewey A. Christmas, MD, Joseph P. Mirante, MD, FACS, and Eiji Yanagisawa, MD, FACS
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Endoscopic view of the carotid artery appearing as a sphenoid sinus mass

July 31, 2009     Dewey A. Christmas, MD, Joseph P. Mirante, MD, FACS, and Eiji Yanagisawa, MD, FACS
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Periorbital emphysema as a complication of functional endoscopic sinus surgery

March 31, 2009     Michael J. Rodriguez, MD, Sandeep P. Dave, MD, and Frank C. Astor, MD
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Abstract

Clinically significant periorbital emphysema is an unusual complication of functional endoscopic sinus surgery (FESS). In most instances, it resolves spontaneously without any serious sequelae. Rarely, it can progress rapidly and become severe enough to cause irreversible blindness. We present and discuss the management of 2 cases of periorbital emphysema after FESS.

Management of allergic fungal sinusitis with postoperative oral and nasal steroids: A controlled study

March 31, 2009     Mubasher Ikram, FCPS, Akbar Abbas, FCPS, Anwar Suhail, FRCS, Maisam Abbas Onali, MBBS, Shabbir Akhtar, FCPS, and Moghira Iqbal, FCPS
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Abstract

In patients with allergic fungal sinusitis, the mainstay of treatment remains surgical removal of allergic mucin and fungal debris. But as a single modality, surgery is associated with high rates of recurrence, so a number of adjunctive medical modalities have been tried, including postoperative corticosteroid therapy. We conducted a study of 63 patients with allergic fungal sinusitis who underwent endoscopic sinus surgery with or without postoperative steroid therapy. A group of 30 patients who had been treated prior to January 2000 had undergone surgery only; their cases were reviewed retrospectively, and they served as historical controls. Another 33 patients who were treated after June 2000 underwent surgery plus oral and nasal steroid therapy. All patients were followed for a minimum of 2 years. Recurrences were seen in 50.0% (15/30) of the no-steroid group and 15.2% (5/33) of the steroid group-a statistically significant difference (p = 0.008). The results of our study strongly support the use of steroids to control allergic fungal sinusitis and prevent its recurrence, and we recommend further study to identify the optimal dosage and duration of therapy.

Sinus balloon dilators: One surgeon's experience and proposed indications for their use

March 31, 2009     Christopher M. Garvey, MD
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Abstract

From October 2006 through September 2007, balloon sinusotomies were attempted on 89 sinuses in 45 patients with chronic sinus disease. Ninety-eight percent of sinuses were successfully dilated, 3.4% required revision surgery, and one complication (unlikely related to use of the balloon) occurred. Forty-four percent had previous conventional endoscopic sinus surgery (ESS), 87% were hybrid cases (combination of balloon and conventional ESS instruments used), 33% had nasal polyposis, and 1.98 sinuses per patient were dilated. Preoperative Lund-Mackay radiographic sinus-staging scores averaged 12.62. Sinus balloon dilators (SBDs) were used on the frontal sinuses 81% of the time, sphenoids 13%, and maxillary sinuses 6%. SBDs were found to be efficacious and safe. The devices were useful in identifying and dilating the frontal recess, especially in cases with altered anatomy or limited visibility. When compared to conventional ESS instrumentation, however, SBDs were found to offer little advantage in opening the maxillary or sphenoid sinuses. In frontal sinus hybrid cases, using the author's proposed surgical algorithm reduces operative time, costs and, in some cases, the need for balloon dilatation. SBDs have limited indications in a select group of patients.

Bilateral transversely clefted middle turbinates

March 31, 2009     Laura M. Dooley, MD and C.W. David Chang, MD
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Endoscopic view of purulent sphenoid sinusitis

February 1, 2009     Dewey A. Christmas, MD, Joseph P. Mirante, MD, FACS, and Eiji Yanagisawa, MD, FACS
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Sinonasal mycetoma

October 31, 2008     Enrique Palacios, MD, FACR, Wesley Jones, MD, and Jorge Alvernia, MD
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