Ethmoid Sinus

Endoscopic view of a medial ethmoid drainage pathway into the middle meatus

February 2, 2015     Dewey A. Christmas, MD; Joseph P. Mirante, MD, FACS; Eiji Yanagisawa, MD, FACS
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The ostium of the ethmoid bulla is often found in the hiatus semilunaris superior, but that it can also be found in the anterior or lateral wall of the bulla, the ethmoid infundibulum, the hiatus semilunaris inferior, or the retrobullar recess.

An uncommon cause of allergic fungal sinusitis: Rhizopus oryzae

January 19, 2015     Marie Devars du Mayne, MD; Maxime Gratacap, MD; David Malinvaud, MD, PhD; Frederic Grenouillet, PhD; Pierre Bonfils, MD, PhD
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Abstract

We report what we believe is the first case of allergic fungal rhinosinusitis (AFRS) caused by the fungus Rhizopus oryzae. Our patient was a 32-year-old woman who presented with unilateral nasal polyps and chronic nasal dysfunction. Computed tomography of the sinuses detected left-sided pansinusitis and bone erosion. T2-weighted magnetic resonance imaging demonstrated a signal void that suggested the presence of a fungal infection. The patient underwent unilateral ethmoidectomy. Histologic examination of the diseased tissue identified allergic mucin with 70% eosinophils and no fungal hyphae. Mycologic culture detected R oryzae. After a short period of improvement, the patient experienced a recurrence, which was confirmed by radiology. A second surgery was performed, and the same fungal hyphae were found in the mucus and on culture, which led us to suspect AFRS. Since no IgE test for R oryzae was available, we developed a specific immunologic assay that confirmed the presence of specific IgG, which identified a high degree of immunologic reaction against our homemade R oryzae antigens. With a long course of systemic antifungal treatment, the patient's symptoms resolved and no recurrence was noted at 5 years of follow-up.

An unusual case of acute periorbital swelling

October 17, 2014     Sara Torretta, MD; Alessandra Brevi, MD; Davide Pagani, MD; Lorenzo Pignataro, MD
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Abstract

Periorbital swelling is frequently encountered in ear, nose, and throat practices and, as it may be secondary to acute sinusitis, delayed diagnosis may lead to significant morbidity. We describe the case of a 24-year-old man with acute ethmoid-maxillary sinusitis and ipsilateral facial swelling particularly involving the periorbital area. We also discuss the workup that led to the formulation of an unusual diagnosis.

Focal hyperostosis of an intranasal inverted papilloma observed on computed tomography

September 17, 2014     Jae-Hoon Lee, MD; Ha-Min Jeong, MD
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Precise preoperative identification of the tumor origin is as important as detecting the extent of tumor invasion.

Primary diffuse large B-cell lymphoma of the ethmoid sinus: A case report

August 27, 2014     Jing-pu Yang, MD; Lian-ji Wen, MD; Chun-shun Jin, MD; Yan Liu, MD
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Abstract

B-cell lymphoma of the paranasal sinuses is rare. We present the case of a 42-year-old woman who presented with proptosis, diplopia, and vision disturbances in the right eye. She was diagnosed with diffuse large B-cell lymphoma of the ethmoid sinus. We describe the general clinical presentation, diagnosis, and differential diagnosis of this entity, and we review the pathology of diffuse large B-cell lymphoma.

Anatomic measurements of the anterior and posterior ethmoid arteries in cadaveric heads using endoscopic sinus instrumentation

May 7, 2014     Zeeshan S. Aziz, MD; Ninef E. Zaya, MD; Richard M. Bass, MD
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Abstract

The challenges of endoscopic sinus surgery lie in the complexity of the anatomy of the nasal vault and side walls and the proximity to critical structures. Additionally, operating in a three-dimensional space while relying on a two-dimensional image for surgical navigation can be a disorienting task. Successful sinus surgery relies on the surgeon having a clear understanding of the anatomy and relationships within the operative field. We performed a study of 8 adult cadaveric heads to better elucidate the location of the ethmoid arteries in relation to an accessible external landmark, the nasal sill. Sinus endoscopy was performed on the heads to identify and measure the distance from the nasal sill to the anterior and posterior ethmoid arteries. We found that the distance from the nasal sill to the anterior ethmoid artery was approximately 6.0 cm, and the distance to the posterior ethmoid artery was approximately 6.7 cm. The interarterial distance was approximately 1.2 cm. With a better understanding of these vessels, surgeons will be better able to avoid them during surgery and thereby minimize the risk of excessive intraoperative bleeding and perioperative orbital hematoma.

Pseudo third cranial nerve palsy secondary to orbital ectopic lacrimal gland cyst: Management with functional endoscopic sinus surgery

February 12, 2014     Puneet S. Braich, BSc; Jonathan E. Silbert, MD; Andrew J. Levada, MD; and Neil R. Schiff, MD
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Abstract

An otherwise healthy 13-month-old girl was noted by her pediatrician to have developed a left head turn. The patient was referred to a pediatric ophthalmologist, who noticed signs of incomplete third cranial nerve palsy. Magnetic resonance imaging revealed the presence of an abnormal lesion in the inferonasal orbit that was abutting the ethmoid sinus. After consultation with an ENT specialist, the decision was made to remove the lesion via functional endoscopic sinus surgery because this approach was deemed to provide adequate access while limiting morbidity. Histology of the excised lesion identified it as true ectopic lacrimal gland tissue with cysts. We recognize and comment on the fact that in many reported cases of ectopic lacrimal gland cyst, the tissue was not ectopic at all but instead represented an extension of normal lacrimal gland tissue.

Extensive pneumatization of the ethmoid sinus in a case of velocardiofacial syndrome

December 20, 2013     Dewey A. Christmas, MD; Joseph P. Mirante, MD, FACS; Eiji Yanagisawa, MD, FACS
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A case and a series of published cases of esthesioneuroblastoma (ENB) in which long-standing paraneoplastic SIADH had preceded ENB diagnosis

October 23, 2013     Uri Gabbay, MD, MPH; Leonor Leider-Trejo, MD; Gideon Marshak, MD; Merav Gabbay, MD; and Dan M. Fliss, MD
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Abstract

Esthesioneuroblastoma (ENB) is a rare tumor of the olfactory mucosa. We treated a 50-year-old man with an ENB in the right ethmoid sinus who had been diagnosed 16 years earlier with syndrome of inappropriate antidiuretic hormone secretion (SIADH) of unknown cause. When the ENB was surgically removed, the patient's osmoregulation returned to normal-that is, his SIADH resolved completely, which suggested that the SIADH was paraneoplastic in nature. These events prompted us to review the literature to determine if there is an association between our patient's ENB and his SIADH in general and between long-standing SIADH that precedes ENB in particular. Based on our review and an extrapolation of data, we have estimated that 1,300 cases of ENB have occurred since it was first described in 1924. Of these cases, SIADH was reported in 26 cases, including ours, which represents an estimated prevalence of 2% (although we believe this is actually an underestimation of the true prevalence). Of the 26 cases, SIADH had already been present in 14 patients (54%) prior to their diagnosis of EBN for a median duration of 3.5 years. We recommend that patients with newly diagnosed EBN be evaluated for SIADH. In those who are SIADH-positive, a resolution of SIADH should be expected once the ENB has been removed. If this does not occur, one should suspect that the ENB was not completely removed. If SIADH resolves but later recurs during follow-up, then a relapse should be suspected. In long-standing SIADH of unknown etiology, nasal sinus imaging should be considered.

Central giant cell reparative granuloma of the ethmoids with bilateral proptosis and intracranial extension

February 25, 2013     Subhash C. Gupta, MS; Sachin Jain, MS; Ravi Mehrotra, MD; Himanshu P. Singh, MBBS
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Abstract

Central giant cell reparative granuloma is an infrequent, benign, proliferating lesion affecting the maxilla, mandible and, rarely, cranial bones. A 16-year-old girl presented with a 6-month history of recurrent nasal bleeding, a mass in the nose, difficulty in nasal breathing, a change in voice, and bilateral proptosis. Radiologically, an extensive ethmoidal mass was seen. Histologic examination revealed a central giant cell reparative granuloma. After endoscopic removal, the patient was symptom-free at the 12-month follow-up. The clinical picture of central giant cell reparative granuloma of the ethmoids is discussed, along with the differential diagnosis, histologic evaluation, appearance on computed tomography, and endoscopic management of this lesion.

Sinonasal teratocarcinosarcoma with intracranial extension: Case report and literature review

December 31, 2012     Shafik N. Wassef, MD; Payal Kapur, MBBS, MD; Samuel L. Barnett, MD; Larry L. Myers, MD, FACS
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Abstract

Sinonasal teratocarcinosarcoma (SNTCS) is an extremely rare malignancy of the paranasal sinuses that possesses the histopathologic features of both teratomas and carcinosarcomas. We report the case of a 58-year-old white man who presented with a 1-year history of a gradually enlarging left-sided nasal mass. The patient had previously undergone endoscopic sinus surgery at another facility, and the final pathologic specimen was reported as an SNTCS with positive margins. He was then referred to our institution, where he underwent a craniofacial resection combined with endoscopic intranasal resection. Postoperatively, he received combined chemotherapy and irradiation. At 48 months of follow-up, he was alive without evidence of disease.

Renal cell carcinoma metastatic to the sinonasal region: Three case reports with a review of the literature

October 31, 2012     Pradipta Kumar Parida, MS, DNB, MNAMS
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Abstract

The paranasal sinuses are a rare location for metastases. The most frequent infraclavicular primary tumor to metastasize to the nose and paranasal sinuses is renal cell carcinoma. Three cases of bilateral renal cell carcinoma with metastases to the paranasal sinuses and with destruction of the skull base are reported. These patients had a primary renal cell carcinoma on the left side for which they had undergone a left nephrectomy many years previously. Right-sided renal cell carcinoma was diagnosed only after the patients had developed symptoms secondary to their metastases. These patients presented with the unusual manifestations of frontal swelling, proptosis, and epistaxis. They were offered palliative treatment in the form of radiotherapy and interferon therapy.

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