Primary sclerosing fibroinflammatory pseudotumor of the maxillary sinus

December 15, 2011     Richard J. Vivero, MD, Pooja H. Doshi, MD, Jean Anderson Eloy, MD, Carmen Gomez-Fernandez, MD, and Roy R. Casiano, MD


Inflammatory pseudotumor is a well known but poorly understood pathologic entity. It is associated with an unusual growth of fibrotic tissue admixed with varying amounts of inflammation that displaces and compresses normal anatomic structures, resulting in dysfunction. Pseudotumors have been found in multiple locations-the orbit in particular-but to the best of our knowledge, none has previously been reported as an isolated sinus lesion. We describe a case of primary sclerosing fibroinflammatory pseudotumor of the maxillary sinus that manifested as recurrent unilateral maxillary sinusitis in a 47-year-old woman. The patient was managed with surgery and oral steroids with full resolution of her symptoms. We also review the presentation, diagnosis, and treatment of fibroinflammatory pseudotumors within the context of the current literature.

Changes in intramaxillary sinus pressure following antrostomy, draining tubes, and YAMIK procedures in 25 patients treated for chronic paranasal sinusitis

August 15, 2011     Masato Miwa, MD, PhD, Mayumi Miwa, MD, PhD, and Kensuke Watanabe, MD, PhD


When conservative therapies are not effective in treating sinus infections, alternate steps can be taken to improve paranasal cavity ventilation. These measures may include surgical procedures such as intranasal endoscopic or maxillary sinus fenestration, and other procedures such as placement of a maxillary sinus tube or a YAMIK sinus catheter. We conducted a prospective study of 25 patients to investigate the effects on the nasal mucosa of improved ventilation between the nasal and paranasal cavities. We accomplished this by comparing (1) the results of simultaneously measured nasal cavity and intramaxillary sinus pressures before and after widening of ventilation openings, (2) changes in mucociliary transport function as measured by the saccharin test, and (3) changes in nasal airway resistance. Just as multiple transit routes between the nasal cavity and maxillary sinus give rise to greater fluctuations in intramaxillary sinus pressure, and just as rapid breathing gives rise to even greater pressure fluctuations than does quiet breathing, we believe that both intranasal cavity airflow velocity and the number of ventilation openings present have an effect on the state of ventilation between the nasal cavity and maxillary sinus. We also suggest that the establishment of maxillary sinus ventilation openings improves mucociliary clearance.

Bilateral sphenoid fungal sinusitis

July 13, 2011     Jae Hoon Lee, MD

Nasal septal abscess

March 31, 2011     Jordan Cain, MD and Soham Roy, MD, FACS, FAAP

Allergic fungal sinusitis

March 1, 2011     Lester D.R. Thompson, MD

Endoscopic views of bilateral dacryocystorhinostomies

February 1, 2010     Joseph P. Mirante, MD, FACS, Dewey A. Christmas, MD, and Eiji Yanagisawa, MD, FACS

Isolated sphenoid sinusitis presenting as blindness

January 1, 2010     Simon Wright, MBChB and Naeem Khan, MBChB, MRCS

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


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

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

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

March 31, 2009     Christopher M. Garvey, MD


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.

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


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.

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