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5. The rapid spread of SARS-COV-2 Omicron variant in Italy reflected early through wastewater surveillance

Author

La Rosa, G., Iaconelli, M., Veneri, C., Mancini, P., Bonanno Ferraro, G., Brandtner, D., Lucentini, L., Bonadonna, L., Rossi, M., Grigioni, M., Suffredini, E., Giuseppe, Bucciarelli, Paolo, Torlontano, Giuseppe, Michele La Bianca, Rosa Anna Cifarelli, Achille, Palma, Giovanna La Vecchia, Giuseppe, Lauria, Rosanna, Brienza, Patrizia, Montenegro, Angelo, D'Argenzio, Luigi, Cossentino, Renato, Olivares, Antonio, Pizzolante, Giovanna, Fusco, Alessandra, Tosco, Amalia, Porta, Francesca, Pennino, Triassi, Maria, Paola, Angelini, Laura De Lellis, Daniele, Nasci, Giovanni, Alborali, Nicoletta, Formenti, Flavia, Guarneri, Nadia, Fontani, Giulia, Nani, Franca, Palumbo, Gianluca, Borlone, Marco, Guercio, Lisa, Gentili, Marika, Mariuz, Gabriella, Trani, Anna, Pariani, Carla, Ancona, Doriana Antonella Giorgi, Irene, Ferrante, Monica, Monfrinotti, Silvia, Riosa, Valeria, Capparuccini, Maria Teresa Scicluna, Antonella, Mariaconcetta, Arizzi, Giancarlo, Cecchini, Claudio, Ottaviano, Elena, Nicosia, Elena, Grasselli, Giorgia, Allaria, Alberto, Izzotti, Stefano, Rosatto, Emanuela, Ammoni, Danilo, Cereda, Marina Nadia Losio, Barbara, Bertasi, Andrea, Aliscioni, Desdemona, Oliva, Sara, Castiglioni, Silvia, Schiarea, Ettore, Zuccato, Manuela, Antonelli, Arianna, Azzellino, Francesca, Malpei, Andrea, Turolla, Sandro, Binda, Pellegrinelli, Laura, Valeria, Primache, Clementina, Cocuzza, Andrea, Franzetti, Giorgio, Bertanza, Maria Luisa Callegari, Luigi, Bolognini, Fabio, Filippetti, Marta, Paniccia, Francesca, Ciuti, Sara, Briscolini, Silvia, Magi, Michele, Colitti, Carmen, Montanaro, Giuseppe, Aprea, Maria Grazia Cerroni, Bartolomeo, Griglio, Renza, Berruti, Mauro, Cravero, Angela, Costa, Manila, Bianchi, Lucia, Decastelli, Angelo, Romano, Fabio, Zuccon, Elisabetta, Carraro, Cristina, Pignata, Silvia, Bonetta, Giuseppe Di Vittorio, Onofrio, Mongelli, Osvalda De Giglio, Francesca, Apollonio, Francesco, Triggiano, Maria Teresa Montagna, Nicola, Ungaro, Mario, Palermo, Carmelo Massimo Maida, Walter, Mazzucco, Simona De Grazia, Giovanni, Giammanco, Giuseppa, Purpari, Margherita, Ferrante, Antonella, Agodi, Martina, Barchitta, Piergiuseppe, Cala’, Carducci, Annalaura, Verani, Marco, Federigi, Ileana, Giulia, Lauretani, Sara, Muzio, Matteo, Ramazzotti, Alberto, Antonelli, Enrica, Ricci, Giovanni, Santoro, Ermanno, Federici, Maya, Petricciuolo, Sofia, Barigelli, Mauro, Ruffier, Francesca, Borney, Eric, Grange, Florida, Damasco, Francesca, Russo, Gisella, Pitter, Vanessa, Groppi, Franco, Rigoli, Marco, Zampini, Tatjana, Baldovin, Irene, Amoruso, Elena, Mengon, Maria, Cadonna, Mattia, Postinghel, Francesco, Pizzo, Alessandra, Schiavuzzi, Francesca, Cutrupi, Paola, Foladori, Serena, Manara, Lorella, Zago, Alberta, Stenico, Anna-Maria, Prast., La Rosa, G, Iaconelli, M, Veneri, C, Mancini, P, Bonanno Ferraro, G, Brandtner, D, Lucentini, L, Bonadonna, L, Rossi, M, Grigioni, M, Suffredini, E, Bucciarelli, G, Torlontano, P, Aprea, G, La Bianca, M, Cifarelli, R, Palma, A, La Vecchia, G, Lauria, G, Brienza, R, Montenegro, P, D'Argenzio, A, Cossentino, L, Olivares, R, Pizzolante, A, Fusco, G, Tosco, A, Porta, A, Pennino, F, Maria, T, Angelini, P, De Lellis, L, Nasci, D, Alborali, G, Formenti, N, Guarneri, F, Fontani, N, Nani, G, Palumbo, F, Borlone, G, Guercio, M, Gentili, L, Mariuz, M, Trani, G, Pariani, A, Ancona, C, Giorgi, D, Ferrante, I, Monfrinotti, M, Riosa, S, Capparuccini, V, Scicluna, M, Cersini, A, Arizzi, M, Cecchini, G, Ottaviano, C, Nicosia, E, Grasselli, E, Allaria, G, Izzotti, A, Rosatto, S, Ammoni, E, Cereda, D, Losio, M, Bertasi, B, Aliscioni, A, Oliva, D, Castiglioni, S, Schiarea, S, Zuccato, E, Antonelli, M, Azzellino, A, Malpei, F, Turolla, A, Binda, S, Laura, P, Primache, V, Cocuzza, C, Franzetti, A, Bertanza, G, Callegari, M, Bolognini, L, Filippetti, F, Paniccia', M, Ciuti, F, Briscolini, S, Magi, S, Colitti, M, Montanaro, C, Cerroni, M, Griglio, B, Berruti, R, Cravero, M, Costa, A, Bianchi, M, Decastelli, L, Romano, A, Zuccon, F, Carraro, E, Pignata, C, Bonetta, S, Di Vittorio, G, Mongelli, O, De Giglio, O, Apollonio, F, Triggiano, F, Montagna, M, Ungaro, N, Palermo, M, Maida, C, Mazzucco, W, De Grazia, S, Giammanco, G, Purpari, G, Ferrante, M, Agodi, A, Barchitta, M, Cala', P, Carducci, A, Verani, M, Federigi, I, Lauretani, G, Muzio, S, Ramazzotti, M, Antonelli, A, Ricci, E, Santoro, G, Federici, E, Petricciuolo, M, Barigelli, S, Ruffier, M, Borney, F, Grange, E, Damasco, F, Russo, F, Pitter, G, Groppi, V, Rigoli, F, Zampini, M, Baldovin, T, Amoruso, I, Mengon, E, Cadonna, M, Postinghel, M, Pizzo, F, Schiavuzzi, A, Cutrupi, F, Foladori, P, Manara, S, Zago, L, Stenico, A, Prast, A, La Rosa G., Iaconelli M., Veneri C., Mancini P., Bonanno Ferraro G., Brandtner D., Lucentini L., Bonadonna L., Rossi M., Grigioni M., Bucciarelli G., Torlontano P., Aprea G., La Bianca M., Cifarelli R.A., Palma A., La Vecchia G., Lauria G., Brienza R., Montenegro P., D'Argenzio A., Cossentino L., Olivares R., Pizzolante A., Fusco G., Tosco A., Porta A., Pennino F., Maria T., Angelini P., De Lellis L., Nasci D., Alborali G., Formenti N., Guarneri F., Fontani N., Nani G., Palumbo F., Borlone G., Guercio M., Gentili L., Mariuz M., Trani G., Pariani A., Ancona C., Giorgi D.A., Ferrante I., Monfrinotti M., Riosa S., Capparuccini V., Scicluna M.T., Cersini A., Arizzi M., Cecchini G., Ottaviano C., Nicosia E., Grasselli E., Allaria G., Izzotti A., Rosatto S., Ammoni E., Cereda D., Losio M.N., Bertasi B., Aliscioni A., Oliva D., Castiglioni S., Schiarea S., Zuccato E., Antonelli M., Azzellino A., Malpei F., Turolla A., Binda S., Laura P., Primache V., Cocuzza C., Franzetti A., Bertanza G., Callegari M.L., Bolognini L., Filippetti F., Paniccia' M., Ciuti F., Briscolini S., Magi S., Colitti M., Montanaro C., Cerroni M.G., Griglio B., Berruti R., Cravero M., Costa A., Bianchi M., Decastelli L., Romano A., Zuccon F., Carraro E., Pignata C., Bonetta S., Di Vittorio G., Mongelli O., De Giglio O., Apollonio F., Triggiano F., Montagna M.T., Ungaro N., Palermo M., Maida C.M., Mazzucco W., De Grazia S., Giammanco G., Purpari G., Ferrante M., Agodi A., Barchitta M., Cala' P., Carducci A., Verani M., Federigi I., Lauretani G., Muzio S., Ramazzotti M., Antonelli A., Ricci E., Santoro G., Federici E., Petricciuolo M., Barigelli S., Ruffier M., Borney F., Grange E., Damasco F., Russo F., Pitter G., Groppi V., Rigoli F., Zampini M., Baldovin T., Amoruso I., Mengon E., Cadonna M., Postinghel M., Pizzo F., Schiavuzzi A., Cutrupi F., Foladori P., Manara S., Zago L., Stenico A., Prast A.-M., Suffredini E., and Triassi, M

Subjects
Omicron, RT-qPCR, SARS-CoV-2, Sewage, Variant, Wastewater-based epidemiology, Wastewater-Based Epidemiological Monitoring, Environmental Engineering, COVID-19, Wastewater, Pollution, Humans, RNA, Viral, Waste Water, SARS-Cov2, Environmental Chemistry, RNA, Viral, wastewater based epidemiology, Waste Management and Disposal, Human, Omicron, RT-qPCR, SARS-CoV-2, Sewage, Variant, Wastewater-based epidemiology
Abstract

The SARS-CoV-2 Omicron variant emerged in South Africa in November 2021, and has later been identified worldwide, raising serious concerns. A real-time RT-PCR assay was designed for the rapid screening of the Omicron variant, targeting characteristic mutations of the spike gene. The assay was used to test 737 sewage samples collected throughout Italy (19/21 Regions) between 11 November and 25 December 2021, with the aim of assessing the spread of the Omicron variant in the country. Positive samples were also tested with a real-time RT-PCR developed by the European Commission, Joint Research Centre (JRC), and through nested RT-PCR followed by Sanger sequencing. Overall, 115 samples tested positive for Omicron SARS-CoV-2 variant. The first occurrence was detected on 7 December, in Veneto, North Italy. Later on, the variant spread extremely fast in three weeks, with prevalence of positive wastewater samples rising from 1.0% (1/104 samples) in the week 5-11 December, to 17.5% (25/143 samples) in the week 12-18, to 65.9% (89/135 samples) in the week 19-25, in line with the increase in cases of infection with the Omicron variant observed during December in Italy. Similarly, the number of Regions/Autonomous Provinces in which the variant was detected increased from one in the first week, to 11 in the second, and to 17 in the last one. The presence of the Omicron variant was confirmed by the JRC real-time RT-PCR in 79.1% (91/115) of the positive samples, and by Sanger sequencing in 66% (64/97) of PCR amplicons. In conclusion, we designed an RT-qPCR assay capable to detect the Omicron variant, which can be successfully used for the purpose of wastewater-based epidemiology. We also described the history of the introduction and diffusion of the Omicron variant in the Italian population and territory, confirming the effectiveness of sewage monitoring as a powerful surveillance tool.

Published
2022

6. The PROCLIPI international registry of early-stage mycosis fungoides identifies substantial diagnostic delay in most patients

Author

J.J. Scarisbrick, P. Quaglino, H.M. Prince, E. Papadavid, E. Hodak, M. Bagot, O. Servitje, E. Berti, P. Ortiz‐Romero, R. Stadler, A. Patsatsi, R. Knobler, E. Guenova, F. Child, S. Whittaker, V. Nikolaou, C. Tomasini, I. Amitay, H. Prag Naveh, C. Ram‐Wolff, M Battistella, S. Alberti‐Violetti, R. Stranzenbach, V. Gargallo, C. Muniesa, T. Koletsa, C. Jonak, S. Porkert, C. Mitteldorf, T. Estrach, A. Combalia, M. Marschalko, J. Csomor, A. Szepesi, A. Cozzio, R. Dummer, N. Pimpinelli, V. Grandi, M. Beylot‐Barry, A. Pham‐Ledard, M. Wobser, E. Geissinger, U. Wehkamp, M. Weichenthal, R. Cowan, E. Parry, J. Harris, R. Wachsmuth, D. Turner, A. Bates, E. Healy, F. Trautinger, J. Latzka, J. Yoo, B. Vydianath, R. Amel‐Kashipaz, L. Marinos, A. Oikonomidi, A. Stratigos, M.‐D. Vignon‐Pennamen, M. Battistella, F. Climent, E. Gonzalez‐Barca, E. Georgiou, R. Senetta, P. Zinzani, L. Vakeva, A. Ranki, A.‐M. Busschots, E. Hauben, A. Bervoets, F.J.S.H. Woei‐A‐Jin, R. Matin, G. Collins, S. Weatherhead, J. Frew, M. Bayne, G. Dunnill, P. McKay, A. Arumainathan, R. Azurdia, K. Benstead, R. Twigger, K. Rieger, R. Brown, J.A. Sanches, D. Miyashiro, O. Akilov, S. McCann, H. Sahi, F.M. Damasco, C. Querfeld, A. Folkes, C. Bur, C.‐D. Klemke, P. Enz, R. Pujol, K. Quint, L. Geskin, E. Hong, F. Evison, M. Vermeer, L. Cerroni, W. Kempf, Y. Kim, R. Willemze, Scarisbrick, J J, Quaglino, P, Prince, H M, Papadavid, E, Hodak, E, Bagot, M, Servitje, O, Berti, E, Ortiz-Romero, P, Stadler, R, Patsatsi, A, Knobler, R, Guenova, E, Child, F, Whittaker, S, Nikolaou, V, Tomasini, C, Amitay, I, Prag Naveh, H, Ram-Wolff, C, Battistella, M, Alberti-Violetti, S, Stranzenbach, R, Gargallo, V, Muniesa, C, Koletsa, T, Jonak, C, Porkert, S, Mitteldorf, C, Estrach, T, Combalia, A, Marschalko, M, Csomor, J, Szepesi, A, Cozzio, A, Dummer, R, Pimpinelli, N, Grandi, V, Beylot-Barry, M, Pham-Ledard, A, Wobser, M, Geissinger, E, Wehkamp, U, Weichenthal, M, Cowan, R, Parry, E, Harris, J, Wachsmuth, R, Turner, D, Bates, A, Healy, E, Trautinger, F, Latzka, J, Yoo, J, Vydianath, B, Amel-Kashipaz, R, Marinos, L, Oikonomidi, A, Stratigos, A, Vignon-Pennamen, M-D, Climent, F, Gonzalez-Barca, E, Georgiou, E, Senetta, R, Zinzani, P, Vakeva, L, Ranki, A, Busschots, A-M, Hauben, E, Bervoets, A, Woei-A-Jin, F J S H, Matin, R, Collins, G, Weatherhead, S, Frew, J, Bayne, M, Dunnill, G, McKay, P, Arumainathan, A, Azurdia, R, Benstead, K, Twigger, R, Rieger, K, Brown, R, Sanches, J A, Miyashiro, D, Akilov, O, McCann, S, Sahi, H, Damasco, F M, Querfeld, C, Folkes, A, Bur, C, Klemke, C-D, Enz, P, Pujol, R, Quint, K, Geskin, L, Hong, E, Evison, F, Vermeer, M, Cerroni, L, Kempf, W, Kim, Y, Willemze, R, and University of Zurich

Subjects
Adult, Male, medicine.medical_specialty, Delayed Diagnosis, Skin Neoplasms, International Cooperation, education, Datasets as Topic, 610 Medicine & health, Dermatology, Cutaneous lymphoma, 2708 Dermatology, 030207 dermatology & venereal diseases, 03 medical and health sciences, 0302 clinical medicine, International Prognostic Index, Mycosis Fungoides, Quality of life, Interquartile range, Risk Factors, Internal medicine, Medicine, Humans, Prospective Studies, Registries, Stage (cooking), Prospective cohort study, Aged, Neoplasm Staging, Skin, Mycosis fungoides, business.industry, Age Factors, 10177 Dermatology Clinic, Middle Aged, mycosis fungoides, PROCLIPI, Cutaneous Lymphoma, medicine.disease, Prognosis, Cohort, Disease Progression, Female, Human medicine, business, Follow-Up Studies
Abstract

Background Survival in mycosis fungoides (MF) is varied and may be poor. The PROCLIPI (PROspective Cutaneous Lymphoma International Prognostic Index) study is a web‐based data collection system for early‐stage MF with legal data‐sharing agreements permitting international collaboration in a rare cancer with complex pathology. Clinicopathological data must be 100% complete and in‐built intelligence in the database system ensures accurate staging. Objectives To develop a prognostic index for MF. Methods Predefined datasets for clinical, haematological, radiological, immunohistochemical, genotypic, treatment and quality of life are collected at first diagnosis of MF and annually to test against survival. Biobanked tissue samples are recorded within a Federated Biobank for translational studies. Results In total, 430 patients were enrolled from 29 centres in 15 countries spanning five continents. Altogether, 348 were confirmed as having early‐stage MF at central review. The majority had classical MF (81·6%) with a CD4 phenotype (88·2%). Folliculotropic MF was diagnosed in 17·8%. Most presented with stage I (IA: 49·4%; IB: 42·8%), but 7·8% presented with enlarged lymph nodes (stage IIA). A diagnostic delay between first symptom development and initial diagnosis was frequent [85·6%; median delay 36 months (interquartile range 1290)]. This highlights the difficulties in accurate diagnosis, which includes lack of a singular diagnostic test for MF. Conclusions This confirmed early‐stage MF cohort is being followed‐up to identify prognostic factors, which may allow better management and improve survival by identifying patients at risk of disease progression. This study design is a useful model for collaboration in other rare diseases, especially where pathological diagnosis can be complex.

Published
2019

7. The PROCLIPI international registry of early-stage mycosis fungoides identifies substantial diagnostic delay in most patients.

Author

Scarisbrick JJ, Quaglino P, Prince HM, Papadavid E, Hodak E, Bagot M, Servitje O, Berti E, Ortiz-Romero P, Stadler R, Patsatsi A, Knobler R, Guenova E, Child F, Whittaker S, Nikolaou V, Tomasini C, Amitay I, Prag Naveh H, Ram-Wolff C, Battistella M, Alberti-Violetti S, Stranzenbach R, Gargallo V, Muniesa C, Koletsa T, Jonak C, Porkert S, Mitteldorf C, Estrach T, Combalia A, Marschalko M, Csomor J, Szepesi A, Cozzio A, Dummer R, Pimpinelli N, Grandi V, Beylot-Barry M, Pham-Ledard A, Wobser M, Geissinger E, Wehkamp U, Weichenthal M, Cowan R, Parry E, Harris J, Wachsmuth R, Turner D, Bates A, Healy E, Trautinger F, Latzka J, Yoo J, Vydianath B, Amel-Kashipaz R, Marinos L, Oikonomidi A, Stratigos A, Vignon-Pennamen MD, Battistella M, Climent F, Gonzalez-Barca E, Georgiou E, Senetta R, Zinzani P, Vakeva L, Ranki A, Busschots AM, Hauben E, Bervoets A, Woei-A-Jin FJSH, Matin R, Collins G, Weatherhead S, Frew J, Bayne M, Dunnill G, McKay P, Arumainathan A, Azurdia R, Benstead K, Twigger R, Rieger K, Brown R, Sanches JA, Miyashiro D, Akilov O, McCann S, Sahi H, Damasco FM, Querfeld C, Folkes A, Bur C, Klemke CD, Enz P, Pujol R, Quint K, Geskin L, Hong E, Evison F, Vermeer M, Cerroni L, Kempf W, Kim Y, and Willemze R

Subjects
Adult, Age Factors, Aged, Datasets as Topic, Disease Progression, Female, Follow-Up Studies, Humans, International Cooperation, Male, Middle Aged, Mycosis Fungoides mortality, Mycosis Fungoides pathology, Neoplasm Staging, Prognosis, Prospective Studies, Risk Factors, Skin pathology, Skin Neoplasms mortality, Skin Neoplasms pathology, Delayed Diagnosis statistics & numerical data, Mycosis Fungoides diagnosis, Registries statistics & numerical data, Skin Neoplasms diagnosis
Abstract

Background: Survival in mycosis fungoides (MF) is varied and may be poor. The PROCLIPI (PROspective Cutaneous Lymphoma International Prognostic Index) study is a web-based data collection system for early-stage MF with legal data-sharing agreements permitting international collaboration in a rare cancer with complex pathology. Clinicopathological data must be 100% complete and in-built intelligence in the database system ensures accurate staging., Objectives: To develop a prognostic index for MF., Methods: Predefined datasets for clinical, haematological, radiological, immunohistochemical, genotypic, treatment and quality of life are collected at first diagnosis of MF and annually to test against survival. Biobanked tissue samples are recorded within a Federated Biobank for translational studies., Results: In total, 430 patients were enrolled from 29 centres in 15 countries spanning five continents. Altogether, 348 were confirmed as having early-stage MF at central review. The majority had classical MF (81·6%) with a CD4 phenotype (88·2%). Folliculotropic MF was diagnosed in 17·8%. Most presented with stage I (IA: 49·4%; IB: 42·8%), but 7·8% presented with enlarged lymph nodes (stage IIA). A diagnostic delay between first symptom development and initial diagnosis was frequent [85·6%; median delay 36 months (interquartile range 12-90)]. This highlights the difficulties in accurate diagnosis, which includes lack of a singular diagnostic test for MF., Conclusions: This confirmed early-stage MF cohort is being followed-up to identify prognostic factors, which may allow better management and improve survival by identifying patients at risk of disease progression. This study design is a useful model for collaboration in other rare diseases, especially where pathological diagnosis can be complex., (© 2018 British Association of Dermatologists.)

Published
2019
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8. Rare Cutaneous T-Cell Lymphomas.

Author

Damasco F and Akilov OE

Subjects
Biomarkers, Disease Management, Humans, Immunophenotyping, Lymphoma, T-Cell, Cutaneous diagnosis, Lymphoma, T-Cell, Cutaneous therapy, Prognosis, Receptors, Antigen, T-Cell, gamma-delta genetics, Receptors, Antigen, T-Cell, gamma-delta metabolism, Skin pathology, T-Lymphocyte Subsets pathology, Disease Susceptibility, Lymphoma, T-Cell, Cutaneous etiology, Lymphoma, T-Cell, Cutaneous metabolism, T-Lymphocyte Subsets immunology, T-Lymphocyte Subsets metabolism
Abstract

Rare lymphoma includes the entities that occur in less than 1% of cases of all lymphomas. Although the percentage is low, there are more than eight lymphomas classified as rare lymphomas. This article describes clinical presentation, diagnosis, prognosis, and management of the most common rare lymphomas, including primary cutaneous γδ T-cell lymphoma, primary cutaneous CD4 + small/medium T-cell lymphoproliferative disorder, primary cutaneous acral CD8 + T-cell lymphoma, primary cutaneous CD8 + aggressive epidermotropic cytotoxic T-cell lymphoma, extranodal NK-/T-cell lymphoma, nasal type, and subcutaneous panniculitis-like T-cell lymphoma., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Published
2019
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9. Stage II Chronic Maxillary Atelectasis Associated with Subclinical Visual Field Defect.

Author

Mangussi-Gomes J, Nakanishi M, Chalita MR, Damasco F, and De Oliveira CA

Abstract

Introduction Chronic maxillary atelectasis (CMA) is characterized by a persistent decrease in the maxillary sinus volume due to inward bowing of its walls. According to its severity, it may be classified into three clinical-radiological stages. Objective To report a case of stage II CMA associated with subclinical visual field defect. Case Report A 34-year-old woman presented with a 15-year history of recurrent episodes of sinusitis and intermittent right facial discomfort for the past 5 years. She denied visual complaints, and no facial deformities were observed on physical examination. Paranasal sinus computed tomography (CT) demonstrated a completely opacified right maxillary sinus with inward bowing of its walls, suggesting the diagnosis of stage II CMA. A computerized campimetry (CC) disclosed a scotoma adjacent to the blind spot of the right eye, indicating a possible damage to the optic nerve. The patient was submitted to functional endoscopic sinus surgery, with drainage of a thick mucous fluid from the sinus. She did well after surgery and has been asymptomatic since then. Postoperative CT was satisfactory and CC was normal. Discussion CMA occurs because of a persistent ostiomeatal obstruction, which creates negative pressure inside the sinus. It is associated with nasosinusal symptoms but had never been described in association with any visual field defect. It can be divided into stage I (membranous deformity), stage II (bony deformity), and stage III (clinical deformity). The silent sinus syndrome is a special form of CMA. This term should only be used to describe those cases with spontaneous enophthalmos, hypoglobus, and/or midfacial deformity in the absence of nasosinusal symptoms.

Published
2013
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