Ethmoid Sinus

Spectrum of paranasal sinus mycoses in coastal India

June 4, 2012     Jyoti R. Kini, MD; Spoorthy S. Shetty, MBBS; Hema Kini, MD
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Abstract

Fungal infections of the nose and paranasal sinuses are uncommon, and the disease they cause can be identified from their histopathologic appearance. The aim of this study was to assess the incidence of fungal infection and histopathologic changes in specimens sent for evaluation of chronic sinusitis and correlate with culture findings wherever possible. The records of 200 consecutive cases coded as paranasal sinuses over a period of 3 years were retrieved from the Department of Pathology, Kasturba Medical College, Mangalore, India. Twenty nine out of a total of 200 specimens (14.5%) were positive for fungal elements on histopathologic examination. The most common etiologic agents in our study were Aspergillus spp (37.9%); only 1 culture (3.4%) was positive for a Candida species. Eight of 29 patients with fungal sinusitis (27.6%) had diabetes, and 1 patient was being treated for rheumatoid arthritis. Eight of the 29 patients had allergic fungal sinusitis, 8 had chronic granulomatous sinusitis, and 1 had acute fulminant invasive sinusitis. Fungi have been increasingly recognized as an important pathogen in chronic sinusitis. It is imperative for patient management not only that paranasal sinus mycoses be diagnosed but also that the specific histologic category be identified.

Osteoid osteoma of the ethmoid sinus: A rare diagnosis

April 30, 2012     E. Bradley Strong, MD; James R. Tate, MD; Dariusz Borys, MD
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Abstract

Osteoid osteomas are benign osseous lesions. They have seldom been described in the otolaryngology literature, and they are extremely rare in the ethmoid sinuses. We report a new case of osteoid osteoma of the ethmoid sinus in a 15-year-old girl. The workup consisted of computed tomography. Treatment involved local excision via an external ethmoidectomy approach. The diagnosis was based on histopathologic examination.

Endoscopic view of an asymmetric roof of the ethmoid sinus

April 30, 2012     Dewey A. Christmas, MD; Joseph P. Mirante, MD, FACS; Eiji Yanagisawa, MD, FACS
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It is important to study the anatomy of the roof of the ethmoid sinus both preoperatively and intraopereatively, especially to determine whether there are differences in the height and thickness of the left and right sides.

Inflammatory myofibroblastic tumor of the nose and paranasal sinuses masquerading as a malignancy

April 30, 2012     Mohamed Amin, MD, FRCSI; Rohana Ali, AFRCS; Susan Kennedy, MD; Conrad Timon, MD, FRCSI
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Abstract

Inflammatory myofibroblastic tumor (IMT) of the nose and paranasal sinuses is a rare entity that exhibits a diverse histologic pattern that can mimic malignant tumors clinically and radiologically. We present a case of IMT in an 88-year-old man who presented with an aggressive tumor-like lesion in the nose and paranasal sinuses that had a malignant appearance on radiology. We discuss this tumor's clinicoradiologic resemblance to a malignancy, and we review the treatment options following careful histologic and immunohistochemical analysis.

Endoscopic view of the ostium of the posterior ethmoid sinus

March 31, 2012     Eiji Yanagisawa, MD, FACS, Dewey A. Christmas, MD, and Joseph P. Mirante, MD, FACS
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The anterior cells of the ehtmoid sinus, located anterior to the basal lamella, vary in number and size and always drain into the middle meatus. The posterior ethmoid cells, located posterior to the basal lamella, drain into the superior meatus.The drainage pathway of the posterior ethmoid cells is usually not easily visualized from within the ethmoid sinus as an ostium leading into the nasal cavity.

A case of extranasopharyngeal angiofibroma of the ethmoid sinus: A distinct clinical entity at an unusual site

February 18, 2012     Sandeep Lerra, MS(ENT), Tanvir Nazir, MS(ENT), Nazir Khan, MS(ENT), Mir Sajjad Qadri, MS(ENT), and Nisar H. Dar, MS(ENT)
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Abstract

Angiofibromas of the head and neck usually arise from the nasopharynx in adolescent boys. The term extranasopharyngeal angiofibroma (ENA) has been applied to vascular fibrous nodules that arise outside the nasopharynx. Because the clinical characteristics of ENA are not consistent with those of juvenile nasopharyngeal angiofibroma (JNA), diagnosis of the former can be challenging. Biopsy is ill advised in a patient with an ENA because it might result in brisk bleeding. A high index of suspicion and a methodical evaluation are essential in establishing the proper diagnosis and treatment. We report the rare case of a 16-year-old girl who presented with a pinkish lobulated mass in her left nostril that had arisen from the anterior ethmoid sinus. The mass was removed via a lateral rhinotomy approach. Postoperative histopathologic analysis identified it as an angiofibroma. To best of our knowledge, only 9 cases of ENA arising from the ethmoid sinus have been previously reported in the English-language literature.

Angiomatous ethmoidochoanal polyp in an infant: Case report

November 22, 2011     Nuno Oliveira, MD, Nuno Trigueiros, MD, Delfim Duarte, MD, and Manuel Rodrigues eRodrigues, MD
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Abstract

Nasal polyps are rare in children younger than 10 years. We describe the case of an infant girl who had undergone a traumatic intubation at birth that had resulted in nasal bleeding. At the age of 5 months, she was brought to us with an obstructive left nasal mass. Imaging revealed the presence of an ethmoidochoanal polyp, as well as a fracture of the posterior cribriform plate and a small associated meningocele. Four months later, the polyp was excised, and the meningocele was corrected with endoscopic nasal surgery. Pathologic evaluation identified the lesion as an angiomatous polyp, which was probably related to the previous traumatic episode. We discuss the clinical aspects of a pathologic entity that has not been previously reported in an infant.

Endoscopic views of ostia of the anterior wall of the ethmoid bulla

October 26, 2011     Eiji Yanagisawa, MD, FACS, Dewey A. Christmas, MD, and Joseph P. Mirante, MD, FACS
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Cholesteatoma of the nose and maxillary and ethmoid sinuses: A rare complication of palatal surgery

September 20, 2011     Borlingegowda Viswanatha, MS, DLO
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Abstract

A 10-year-old boy presented with a complaint of a left-sided nasal obstruction with an associated foul-smelling discharge. Physical examination and anterior rhinoscopy revealed that a whitish, friable mass had completely filled the left nasal cavity. On computed tomography, a soft-tissue mass was seen filling the cavity and extending to the paranasal sinuses with bone erosion. A biopsy of the mass suggested that it represented a cholesteatoma. The lesion was removed via nasal endoscopy, and histopathology confirmed the diagnosis of a cholesteatoma. No recurrence was noted during 6 months of follow-up. Cholesteatoma of the paranasal sinuses is a rare entity, as only a few dozen cases have been reported in the literature.

Malignant proliferating trichilemmal tumor involving the sinuses

July 13, 2011     Tashneem Harris, MBChB, FC ORL(SA), Estie Meyer, MBChB, FC ORL(SA), Darlene E. Lubbe, MBChB, FC ORL(SA), Werner Smit, MBChB, FC Plast Surg(SA), and Chris Walker, MBChB, FC Path(SA) Anat
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Abstract

Proliferating trichilemmal tumor (PTT) is a rare adnexal neoplasm that arises from the outer sheath of the hair follicle. It is believed that PTTs originate in trichilemmal cysts. These tumors have the potential for malignant transformation; when this occurs, the tumor is known as a malignant PTT (MPTT). Recurrence after simple local excision is common, and it can cause considerable morbidity. We report a case of MPTT that was initially diagnosed as a benign PTT. The primary tumor had arisen from the skin over the glabella. It was excised, but it recurred 3 years postoperatively. The recurrent tumor involved the eyelid, nasal cavity, and frontal and ethmoid sinuses, and it extended into the orbit. The recurrent tumor was excised via combined endoscopic and open surgery. As far as we know, this is the first documented case of an MPTT that involved the sinuses.

Endoscopic view of bilateral Haller cell ostia

June 13, 2011     Dewey A. Christmas, MD, Joseph P. Mirante, MD, FACS, and Eiji Yanagisawa, MD, FACS
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Fibromyxomatous spindle-cell neoplasm of the ethmoid sinus with extension into the orbit

March 1, 2011     Joshua M. Levy, MD, Christian P. Hasney, MD, Paul L. Friedlander, MD, Enrique Palacios, MD, Michael S. Ellis, MD, and Mary A. Fazekas-May, MD
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