Maxillary sinus

Large Haller cell mucocele leading to maxillary sinusitis

April 27, 2015     Jae-Hoon Lee, MD
article

Paranasal sinus mucoceles are epithelial-lined cystic lesions containing mucus or mucopurulent fluid. Symptoms vary depending on the location of the mucocele.

Prophylactic antibiotic therapy for fractures of the maxillary sinus

April 27, 2015     Robert S. Schmidt, MD; Kelley M. Dodson, MD; Richard A. Goldman, MD
article

Abstract

We conducted a study to examine the incidence of acute sinusitis following maxillary sinus fractures, as well as the impact of antibiotics in the postinjury period. Fifty patients who presented to our institution with a fracture of the maxillary sinus were prospectively randomized to receive either a nasal saline spray and a 3-day course of antibiotics (either amoxicillin/clavulanate or levofloxacin) or nasal saline alone; there were 25 patients in each group. After a minimum of 3 days, all patients were assessed for acute sinusitis. Follow-up data were available on 17 patients (a total of 21 fractured sinuses) in the antibiotic group (68%) and 14 patients (17 fractured sinuses) in the control group (56%). The groups were balanced in terms of demographics, location of fractures, mechanism of fracture, and time to follow-up. After 3 days, 95.23% of the fractured sinuses in the antibiotic group and 88.23% of the fractured sinuses in the control group exhibited signs or symptoms consistent with or suggestive of acute sinusitis. Very few sinuses in either group showed no evidence of sinusitis: only 1 in the antibiotic group (4.76%) and 2 in the control group (11.76%); this difference was not significant (p = 0.5768). We conclude that while the clinical rate of acute sinusitis after maxillary sinus fractures is high, a 3-day course of antibiotics is not effective in preventing its symptoms in the postinjury period.

Maxillary sinus cyst containing a bone chip

March 2, 2015     Jae-Hoon Lee, MD
article

If bone fragments in the sinus can be removed, the patient's prognosis is usually excellent.

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
article

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
article

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.

Mucormycosis (Mucor fungus ball) of the maxillary sinus

October 17, 2014     Hang Sun Cho, MD; Hoon Shik Yang, MD, PhD; Kyung Soo Kim, MD, PhD
article

Abstract

A fungus ball is an extramucosal fungal proliferation that completely fills one or more paranasal sinuses and usually occurs as a unilateral infection. It is mainly caused by Aspergillus spp in an immunocompetent host, but some cases of paranasal fungal balls reportedly have been caused by Mucor spp. A Mucor fungus ball is usually found in the maxillary sinus and/or the sphenoid sinus and may be black in color. Patients with mucormycosis, or a Mucor fungal ball infection, usually present with facial pain or headache. On computed tomography, there are no pathognomonic findings that are conclusive for a diagnosis of mucormycosis. In this article we report a case of mucormycosis in a 56-year-old woman and provide a comprehensive review of the literature on the “Mucor fungus ball.” To the best of our knowledge, 5 case reports (8 patients) have been published in which the fungus ball was thought to be caused by Mucor spp.

Large osteoma of the maxillary sinus accompanied by an unerupted tooth

July 13, 2014     Jae-Hoon Lee, MD
article

CT of the maxillofacial region is required for patients with an osteoma to rule out Gardner syndrome, which should be considered when a patient has more than one osteoma.

Endoscopic view of osteogenesis imperfecta of the maxilla

June 8, 2014     Dewey A. Christmas, MD; Joseph P. Mirante, MD, FACS; Eiji Yanagisawa, MD, FACS
article

Osseous lesions in the maxilla can represent ossifying fibroma, fibrous dysplasia, amelogenesis imperfecta, or osteogenesis imperfecta.

Aggressive inflammatory pseudotumor of the maxillary sinus and orbit

March 18, 2014     Sheldon Chong, MBBS, MS(ORL-HNS); Carren S.L. Teh, MBBS, MS(ORL-HNS); Shashinder Singh, MBBS, FRACS; Mun Kein Seong, MBBS, MPath; Subrayan Viswaraja, MBBS, FRCS(Edin), FRCOphth(UK)
article

Abstract

Inflammatory pseudotumor (IPT) is a rare, locally aggressive, benign neoplasm of unknown etiology. It is uncommon in the head and neck region, particularly in the paranasal sinuses. We present an unusual case of IPT of the maxillary sinus and orbit in a 27-year-old woman who presented with cheek swelling, right orbital swelling, double vision, and associated fever and trismus. Computed tomography identified a mass with radiologic features suggestive of a malignancy of the maxillary sinus and orbit; the mass extended into the infratemporal fossa, parapharyngeal space, anterior antral wall, and surrounding soft tissue. A diagnosis of IPT was established on the basis of histologic and immunohistochemical analysis, which identified a proliferation of bland spindle cells and a mixed inflammatory cell infiltrate. Despite its aggressive appearance, IPT is associated with a good prognosis. Our patient was treated successfully with a combination of surgery, steroid therapy, and methotrexate. Chemotherapeutic agents are generally reserved for recalcitrant cases.

Organized hematoma of the maxillary sinus: A clinicopathologic study of 5 cases

February 12, 2014     Hidenori Yokoi, MD, PhD; Atsushi Arakawa, MD, PhD; Fumihiko Matsumoto, MD, PhD; Naoko Yokoi, MD, PhD; Katsuhisa Ikeda, MD, PhD; and Naoyuki Kohno, MD, PhD
article

Abstract

Organized hematoma of the maxillary sinus is rare. Its pathogenesis is still not clear, and it appears to have multiple causes. We report the clinical, clinicopathologic, and immunohistochemical findings in 5 patients-3 men and 2 women, aged 19 to 68 years (mean: 40.2)-with pathologically proven organized hematoma of the maxillary sinus. In all 5 cases, we were able to successfully perform curative treatment via endoscopic sinus surgery. Our findings suggest that most organized hematomas are angiomatous. Immunohistochemical analysis identified the presence of proliferative activity.

Unusual presentations of choanal polyps: Report of 3 cases

February 12, 2014     Ali Ozdek, MD; Halil Erdem Ozel, MD
article

Abstract

Most choanal polyps arise from the maxillary sinus, and they are called antrochoanal polyps. Their typical endoscopic and radiologic appearance makes them easy to diagnose. However, some choanal polyps originate in unusual sites in the paranasal sinuses and nose, such as the sphenoid sinus and the lateral wall of the nose. These polyps usually present unilaterally, although bilateral presentations are possible. We describe 3 cases of atypical choanal polyps: a sphenochoanal polyp, bilateral antrochoanal polyps, and a giant antrochoanal polyp. In each case, nasal endoscopy and computed tomography clinched the diagnosis, and endoscopic surgery was performed to successfully remove the polyp. We discuss the clinical characteristics of these 3 cases.

Clinical management of a patient with advanced mucosal malignant melanoma in the sinonasal area

January 21, 2014     Marco Fusetti, MD; Alberto Eibenstein, MD; Ettore Lupi, MD; Enzo Iacomino, MD; Tiziana Pieramici, MD; Alessandra Fioretti, MD, PhD
article

Abstract

We describe a case of mucosal malignant melanoma in the sinonasal area of a 65-year-old woman. She presented with a history of nasal obstruction and epistaxis with subsequent tenderness, facial anesthesia involving cranial nerve V2, red eye, proptosis, diplopia, and conjunctival chemosis. Computed tomography detected a nonspecific solid mass that had involved the left maxillary sinus and surrounding tissues, with extension into the nasal cavity and invasion of the orbital floor and eye muscles. Histopathologic examination of the neoplasm revealed that it was a malignant melanoma. We performed a radical hemimaxillectomy that extended to the orbit, which allowed for radical excision of the tumor. Postoperatively, the patient received adjuvant chemotherapy and radiotherapy. Mucosal melanoma in the head and neck is a rare and highly malignant neoplasm. We suggest that malignant melanoma be suspected when a small-round-cell tumor is found on light microscopy, and we confirm the usefulness of immunohistochemical investigations.

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