Interesting case of intraorbital foreign body

Penetration of intraorbital foreign bodies into the nose and paranasal sinuses although reported in the past are uncommon. Here we present a case of a 26 years old male who came to us with a seemingly trivial injury of his right eye due to a foreign body. Which on further investigation revealed the major part of a large foreign body impacted into the nose and bilateral sinuses, removed successfully.     

Retained foreign body in sino-orbital region

It is rare to find foreign bodies in nose and paranasal sinuses. The further rarity is to encounter impacted foreign body in this region and route of entry being through the orbit. We are here by presenting a case, where a metallic foreign body was retained for duration of 4 months in sino — orbital region.     

Spontaneous intra-antral rhinolith. A case study

Rhinoliths of the paranasal sinuses have often been reported and are generally due to trauma and surgery of these cavities and to retained foreign bodies. In the present case, an unilateral chronic rhinosinusitis had been treated by antiinflammatory agents only, but never underwent surgery or trauma. Tomography revealed a high density concretion. A solid rhinolith was removed by a Caldwell-Luc procedure and was then submitted to spectrographic and electron microscopic investigations.     

Unilateral opacification of the paranasal sinuses in CT or MRI: an indication of an uncommon histological finding

BACKGROUND: Clinical and radiological differentiation between subacute or chronic sinusitis and differential pathologies such as malignoma, inverted papilloma or mycosis can be very difficult. In some cases the CT- or MRI-scan shows a unilateral opacification of the paranasal sinuses. Which histological results can be found in patients with persisting sinusitis related problems and a unilateral opacification of the paranasal sinuses in the CT- or MRI-scan? There are only a few publications on this topic. PATIENTS: In a prospective study between June 1998 and November 1999 all patients who underwent surgery in our Department for subacute or chronic sinusitis problems were included into our study group if they had a unilateral opacification of the paranasal sinuses. Thereafter, the same neuroradiologist verified the unilateral radiological findings on CT or MRI, unaware of the clinical and histological findings. Cases with a pre-existing histological examination, previous operation or injury to the paranasal system were excluded from this study. Data on clinical symptoms, radiological and histological findings were analysed. RESULTS: 43 cases with unilateral opacified paranasal sinuses were diagnosed by means of CT or MRI. These were comprised of 24 males and 19 females with an average age of 43.6 years (range 6 to 88 years). The major findings of our study were as follows: Firstly unilateral opacification of the paranasal sinuses is often (19/43 cases or 43%) associated with diseases othe than simple chronic sinusitis (8 inverted papilloma, 5 malignoma, 3 mycoses and one brown tumor, one osteoidosteoma and one haemangioma). Secondly the incidence of significant pathology other than simple chronic sinusitis rises strikingly with increasing age of the patient. For instance pathologies other than simple chronic sinusitis were found in 14% (1/7) of cases in the under 16 years group, 27% (6/22) of cases in the 16-60 years group and in 86% (10/12) of cases in the over 60 years group. Concerning clinical signs of our patients with unilateral sinus opacity 7 of 11 patients (63%) with epistaxis and 3/5 with diplopia had histological findings other than simple chronic sinusitis. In contrast unilateral rhinorrhea, unilateral nasal congestion and cephalgia were not of predictive value. CONCLUSION: Unilateral opacification of paranasal sinuses in the CT or MRI is--especially at a higher age--an indice for a neoplasm or mycotic sinusitis and therefore an early histological diagnosis or operative treatment is always suggested.     

Prostatic metastases in the nose and paranasal sinuses

Prostatic metastases in the nose and paranasal sinuses are rare. Seven cases have previously been reported in the world literature. We describe the clinical presentation of a patient with prostatic metastases and the use of prostate specific antigen in confirming the diagnosis. We also review the literature about metastases involving the nose and paranasal sinuses.     

Inverted Papilloma — An Unusual Presentation (Foreign-Body like)

Inverted papilloma of the nose is an uncommon, but, well document ed lesion of the mucosal lining of the nose and paranasal sinuses. The manifestation of this disease are usually unilateral nasal obstruction, mucopurulent nasal discharge, anosinia and occasional headache. It is very rare to she this condition presenting with dyspnoea and dysphagia due to its extension in the laryngopharynx. In this paper, we report a patient who presented to us with dyspnoea and dysphagia due to a huge papillomatous mass extending from right nasal cabity to the maxillary antrum laterally, posteriorly into the nasopharynx, interiorly into the oropharynx and the laryngopharynx.     

Nasal chondromesynchymal hamartoma presenting in an adolescent

Nasal chondromesenchymal hamartoma (NCMH) is extremely uncommon primary benign cartilaginous growth of the nasal and paranasal sinuses. To date, it has been reported almost exclusively in infancy. We report a NCMH in a 16-year-old patient who presented with an asymptomatic, fixed swelling on the left side of the nose approximately 2x2 cm in size. Computed tomography (CT) and magnetic resonance imaging (MRI) of the nose, paranasal sinuses and neck confirmed a heterogeneous, calcified polypoidal mass protruding caudally into the left nasal cavity. After an initial inconclusive incisional biopsy, the patient underwent a complete radical resection, with staged reconstruction of the full nasal defect using septal mucosal flap, conchal cartilage graft and forehead skin flap. Histological examination of the resected specimen confirmed NCMH, which, we believe, had probably been present and undetected for many years. This report greatly extends the age at which NCMH may be entertained as part of the differential diagnosis of cartilaginous lesions of the nose and paranasal sinuses.     

Vascular malformation of the head and neck--diagnosis and treatment

Vascular malformations are the most common anomalies appearing from birth to any adulthood. They are not clinically and morphologically homogenous group. They may occur at different place but most often in the subcutaneous or submucous space in the oral cavity, pharynx, the paranasal sinuses and nose. The aim of this study was to present the difficulties in diagnosis and treatment of head and neck vascular malformations in patients hospitalized in ENT Department University of Lodz from 2001 to 2006. From 17 patients with vascular malformations we choose four to careful evaluation. Two patients had neck vascular malformation, two had the paranasal and nose sinuses tumors. Presented lesions were categorized as "low-flow" vascular malformation. In two cases there was vascular and lymphatic malformation, deeply located in the neck. In two cases arisen in the nose and the paranasal sinuses, there were capillary and cavernous types. We pointed out the clinical signs and diagnostic problems in deep vascular tumors and bleeding risk concerning treatment procedure. Even a needle biopsy and radiological imagining did not confirm the preoperative diagnosis. CT and MRI is recommended to delineate the extend the lesion, and evaluation of its special anatomical location, surrounding arteries, vessels and important neck structure prior to surgery. In the paranasal and nose tumor CT could show bone destructions as well. CONCLUSIONS: Surgical careful excision has been favorable in depth neck laying and extended paranasal and nose vascular malformation. Because of the risk of bleeding careful hemostasis are important challenges in the surgical removal, so embolization is preferred in some cases.     

Management of a maxillary sinus foreign body (dental bur)

Metal foreign bodies are occasionally found in the paranasal sinuses. Often they result from the escape of material through an oroantral fistula or from trauma. Rarely, they occur as a complication of a dental procedure. A literature review revealed only four other reports of iatrogenic dental bur lodgment in the maxillary sinus, all of which are in the dental literature. Otolaryngologists, who might be required to deal with this complication, must be knowledgeable about its management. In this article we describe a patient who was referred to our otolaryngology department for management of a retained dental bur in the maxillary sinus. We also review two treatment options--an endoscopic and an open surgical approach--for the removal of sinus foreign bodies.     

Aspergillus mycoses of the paranasal sinuses. Detection and analysis of roentgen opaque structures in fungal concretions

Out of 59 patients with aspergillosis of the paranasal sinuses 25 showed almost metal-dense X-ray-shadows in Highmore's sinus, resembling foreign bodies at first. It can be demonstrated, that these areas are equivalent to local enrichment of calcium phosphate mainly in the center of the fungal masses in the sinuses. Technique and methods of investigation and analysis are described. X-ray findings like these should be looked upon as a sign reading: "aspergillosis of the paranasal sinuses ahead."     

Guzy nowotworowe u chorych z jednostronnymi zmianami zapalnymi zakwalifikowanymi do operacji endoskopowych

Introduction

The aim of this work was to analyze the occurrence and type of neoplasm in unilateral pathological lesions within the nose and paranasal sinuses in patients who underwent endoscopic surgery, in own material.

Material and methods

Between 2006 and 2012 2295 patients, including 1006 women aged 15–84 and 1289 men aged 17–87, were operated on due to diseases of paranasal sinuses in the Department of Otolaryngology and Laryngological Oncology. The patients underwent surgery after a medical interview, physical examination, 3D CT of paranasal sinuses and laboratory tests. The removed lesions were histopathologically investigated. The studied group included the patients with only unilateral lesions and histopathologically recognized neoplastic lesion.

Results

In the studied material, neoplastic lesions occurred in 9.8% cases, out of which 5.4% were inverted papillomas, 3.1% osteomas, and 1.5% malignant tumors. However, in the patients who were operated due to hypertrophic changes within paranasal sinuses, neoplasm was found in 1.3% cases, while inverted papilloma in 0.7%, osteoma in 0.4% and malignant tumors in 0.1%, which altogether amounts to 8 times higher occurrence of neoplastic lesions in unilateral changes.

Results

Unilateral changes within paranasal sinuses require highly inquisitive pre-operative diagnostics, peri-operative analysis and histopathological evaluation.     

Possibilities of treating nasal turbinates in the framework of endonasal microsurgery

Pathologic alterations of the turbinates are common in infectious diseases of the nose and paranasal sinuses. Over 300 patients were treated for paranasal sinuses disease from 1986 to 1989 by endonasal microsurgery. One-third of the patients were found intraoperatively to have alterations of the middle and inferior turbinate causing obstruction and functional disorders of the nose and sinuses. Our concept comprises a step-by-step microsurgical approach to the turbinates. The technique and the results are presented.     

Fremdkörperendoskopie im Kopf-Halsbereich

Summary The importance and necessity of an endoscopic examination in case of suspected foreign body is demonstrated by endoscopic findings in the ear, nose and paranasal sinuses, the pharynx and esophagus as well as in the larynx, trachea and bronchial system.The principles, advantages and limitations of endoscopic foreign body removal are shown.     

Unilateral pathological lesions of paranasal sinuses removed by endoscopic surgery

Introduction

The aim of this study was to analyze the incidence and nature of unilateral pathological lesions of paranasal sinuses in patients who had endoscopic sinus surgery performed in ENT. Materials and methods: In the years 2006–2011 endoscopic sinus surgery for unilateral pathological lesions of paranasal sinuses was performed in 1847 patients (838 women and 1009 men). The enrollment of patients was based on the findings of otolaryngological clinical and subjective examinations, assessment of the paranasal sinuses on three-dimensional CT scans, and laboratory examinations. Based on the analysis of medical history data, including gender, age, the type of surgical procedure performed, and histopathological findings the cases were finally analyzed.

Results

Pathological lesions of the paranasal sinuses were localized on the left side in 132 (57%) patients, and on the right side in 100 (43%) patients. Of the 232 patients with unilateral pathological changes, 41.8% subjects underwent endoscopic sinus surgery for polypotic changes in the ethmoid and maxillary sinuses; 28.4% for the maxillary sinus; 10.8% for the ethmoid, maxillary and frontal sinuses; and 8.6% patients for all paranasal sinuses on one side. The number of operations of only one sinus was considerably lower: sphenoid sinus, 4.7%; ethmoid sinus, 2.2%; and frontal sinus, 1.7% patients. The histopathological analysis of unilateral pathological lesions removed by endoscopic surgery showed chronic paranasal sinusitis with polyps in 56.5% patients; chronic paranasal sinusitis in 22.8% patients; and maxillary sinus cyst was confirmed in 11.6% patients. In 5.1% patients inverted papilloma was diagnosed and in 2.2% patients the presence of osteoma was found.

Conclusions

Unilateral paranasal pathological lesions, leaving aside rather typical maxillary sinus cysts, require a particularly thorough pre-operative diagnosis and a precise histopathological assessment.     

The paranasal sinuses as reservoirs for nitric oxide

OBJECTIVE: Nitric oxide (NO) is an important mediator and inflammatory marker in human upper airways. Enzymes responsible for NO production have been demonstrated both in the nose and in the paranasal sinuses, but NO levels in the sinuses are reported to be several times higher than those in the nose. It has been postulated that the paranasal sinuses may be the primary sites for NO production in the upper respiratory tract. The present study was designed to compare the NO levels sampled from the nose with those found in the paranasal sinuses. MATERIAL AND METHODS: NO levels in the maxillary sinus and nose were determined using a continuous chemiluminescence measuring technique in seven healthy volunteers. RESULTS: When NO was sampled, via a drainage tube inserted into the maxillary sinus, a transient peak in NO level was recorded. The maximal NO level (5,761 +/- 1,513 ppb; n = 7) was reached within 10 s and was followed by the establishment of a lower steady-state level (304 +/- 51 ppb). When NO was continuously sampled from the nose a steady-state level, similar to that found in the sinus, was immediately established (313 +/- 52 ppb). CONCLUSION: The data presented confirm previous findings of extremely high NO levels in the paranasal sinuses and suggest that these cavities may also function as reservoirs for NO.     

A case of solitary fibrous tumour of the nose and paranasal sinuses

Solitary fibrous tumours (SFT), formerly known as benign fibrous mesothelioma, are rare mesenchymal spindle cell neoplasms, originally described in the pleura, but now found to arise in many other locations such as mediastinum, urogenital tract, face, nose, paranasal sinuses, orbit, meninges, ear, buccal mucosa, tongue, salivary gland etc. It was first described as a distinct neoplasm in 1931 by Klemperer and Rabin. On reviewing the literature, so far, 21 cases have been reported involving the nose and paranasal sinuses. A case of solitary fibrous tumour of the nose and paranasal sinuses is presented     

Malignant tumors of the nose and paranasal sinuses: a retrospective review of 291 cases

Malignant neoplasms of the nose and paranasal sinuses are not common among the general population. We present a retrospective study of 291 cases of malignant tumors of the nose and paranasal sinuses that were diagnosed in a northern Romanian population over a period of 35 years. We review the etiology, diagnosis, prognosis, and treatment of these tumors.     

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

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.     

Destructive aspergillosis

The incidence of mycotic infections of paranasal sinuses is on the rise. Aspergillosis is the commonest fungal infection involving the nose and paranasal sinuses. This disease has a varied presentation ranging from the allergic form to the more deadly invasive or destructive form. Destructive fungal disease is almost regarded as synonymous with mucormycosis. The destructive potential of aspergillosis has not been highlighted in the medical literature. We here report a case of aspergillosis, which caused massive destruction of maxilla in an apparently healthy patient.     

Endoscopic surgery for selected tumors of the nose and paranasal sinuses--practical sense of the four hands technique

Endoscopic sinus surgery is a gold standard in chronic sinusitis since middle '80. More and more attention is put on endosnasal tumor removal with the endoscopic technique. Two major pathologies are present in the literature, the inverted papilloma and the angiofibroma. Other tumors are rare. In the ENT Department of Poznań Medical University, endoscopic removal of tumors of the nose and paranasal sinuses is done with the four hands technique. Since November 2006 to July 2007 12 cases were operated in our institution. Fully endoscopic removal was performed in 7 cases. In 2 cases an endoscopic assisted surgery was performed. In 3 cases a convertion to open surgery was necessary. Endoscopic approach to nonmalignant tumor of the nose and parana sal sinuses is an alternative to open surgery of tumor of the nose and paranasal sinuses. The four hands technique is very helpful and leads to extend limits of this surgery. Performing an endoscopic surgery of tumor one has to be prepared to make an intraoperative convertion to open surgery.