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Hintergrund: Die frontoethmoidale Region ist geprägt durch eine komplexe Anatomie aufgrund zahlreicher anatomischer Varianten. Diese können die Drainage der Stirnhöhle beeinflussen und den operativen Zugang zum Sinus und Recessus frontalis erschweren. Durch die 2016 veröffentlichte International Frontal Sinus Anatomy Classification (IFAC) sollte eine einfache Benennung der verschiedenen frontoethmoidalen Zellen ermöglicht werden. Ziel dieser Studie war eine Analyse der Häufigkeiten frontoethmoidaler Zellen anhand der IFAC. Zusätzlich wurde ein Zusammenhang zwischen bestimmten anatomischen Varianten und einem gehäuften Auftreten entzündlicher Nasennebenhöhlenveränderungen untersucht. Methoden: Es erfolgte eine retrospektive Untersuchung von Computertomographien der Nasennebenhöhlen anhand koronarer, axialer und sagittaler Schichten. Neben den frontoethmoidalen Zellen wurden weitere anatomische Varianten untersucht: verschiedene Siebbeindachkonfigurationen, Ansatzmöglichkeiten und eine Pneumatisation des Processus uncinatus, eine Pneumatisation der Crista galli und eine Hypoplasie bzw. Aplasie des Sinus frontalis. Die Verschattungsgrade der Nasennebenhöhlen wurden anhand einer in der Literatur häufig verwendeten Stadieneinteilung bewertet. Ergebnisse: Es wurden 249 CT-Datensätze und somit 498 frontoethmoidale Komplexe untersucht. Agger nasi Zellen fanden sich als die häufigste anatomische Variante bei 89,2 % der frontoethmoidalen Komplexe, gefolgt von Supra Bulla Zellen (74,3 %), Supra Agger Zellen (31,7 %), Supra Bulla Frontalzellen (16,7 %), Septum interfrontale Zellen (15,5 %), Supra Agger Frontalzellen (14,5 %) und Supraorbitalen Ethmoidzellen (5,6 %). Ein statistisch signifikanter Zusammenhang zwischen Supra Agger Frontalzellen bzw. Supra Bulla Frontalzellen und einem gehäuften Auftreten von Nasennebenhöhlenverschattungen war nicht nachweisbar (p > 0.05). Schlussfolgerung: Die IFAC ist durch eine Orientierung anhand leicht erkennbarer anatomischer Bezugspunkte und die Vermeidung von Eigennamen im Vergleich zu früheren Klassifikationen vereinfacht. Ihr wissenschaftlicher Wert und die klinische Anwendbarkeit muss in weiteren Studien erprobt werden. Der Einfluss frontoethmoidaler Zellen auf die Entstehung entzündlicher Nasennebenhöhlenerkrankungen wird kontrovers diskutiert. Ein statistisch signifikanter Zusammenhang von Schleimhautpathologien im Bereich des Sinus frontalis bei Vorliegen von Supra Agger Frontalzellen bzw. Supra Bulla Frontalzellen ließ sich in dieser Studie nicht nachweisen.

We report a rare case of granulomatosis with polyangiitis (GPA) presenting with bilateral orbital apex syndrome (OAS). A 73-year-old woman with a history of endoscopic sinus surgery for ethmoidal sinusitis experienced a sudden decrease in visual acuity (VA) of both eyes. At the initial examination, her VA had decreased to 0.01 in the right eye and 0.03 in the left eye, and eye movement in both eyes was mildly limited in all directions. Visual field tests of both eyes showed a large central scotoma. Laboratory tests revealed an elevation of myeloperoxidase-anti-neutrophil cytoplasmic antibody. Facial computed tomography demonstrated a thickened mucosal membrane in the entire ethmoidal sinus, and the posterosuperior walls of Onodi cells filled with infiltrative lesions had thinned. Orbital magnetic resonance imaging showed severe inflammation in the orbital apex. From these clinical findings, the patient was diagnosed with GPA presenting with OAS associated with ethmoid sinusitis. Emergent endoscopic sinus surgery was performed for biopsy and debridement of the ethmoidal and sphenoid sinusitis to decompress the optic nerve. One day after endoscopic sinus surgery, the patient’s VA and visual field were improved, and steroid pulse therapy was commenced postoperatively. Four days later, VA had recovered to 1.0 in both eyes, and eye movement and visual field had were improved. Although OAS is a rare manifestation, early surgical treatment should be considered when the orbital lesion presents as risk of rapid deterioration of visual function in patients with GPA.

Chronic nasal crusting is a commonly encountered entity in an otolaryngology office. Progressive, extensive nasal crusting with erosion is relatively unusual, however. We present the case a 58-year-old renal transplant patient with a history of vasculitis and immunosuppression who presents with subjective headache and facial pain, nasal crusting, and isolated left ethmoid sinusitis. She developed extensive intranasal necrosis and underwent multiple endoscopic sinus surgeries with intraoperative biopsies, which played a critical role in her workup and eventual diagnosis of Acanthamoeba rhinosinusitis. Although she endured a difficult course, proper diagnosis and treatment allowed for her recovery over time. The differential diagnosis for intranasal necrosis is often broad. This case highlights the wide range of etiologies to be considered in a patient with extensive nasal crusting and erosion/necrosis, and the importance of thorough diagnostic evaluation in these patients, especially those in an immunocompromised state.

OBJECTIVE This study aims to investigate nasal morphologies associated with nasal airway obstruction in unilateral alveolar cleft patients. METHODS A total of 234 unilateral alveolar cleft cases were performed cone beam computed tomography scans. The digital imaging and communication in medicine data were imported into Simplant Pro software. The radiographic features including nasal septum deviation and inferior turbinate hypertrophy as well as nasal airway volume and sinusitis were analyzed. RESULTS A new radiographic classification of relationship between nasal septum and inferior turbinate (NS-IT) on the cleft side was proposed and three types of NS-IT relationship (type I, II and III) were identified in 234 cases. The statistical analysis revealed that the nasal airway volume on non-cleft side was significantly higher than that on cleft side in each of three types (P

Introduction The role of the accessory maxillary ostium, a common anatomical variant, in the development of chronic sinusitis remains unclear. This study aimed to examine the association between chronic sinusitis and presence of an accessory maxillary ostium using computed tomography (CT) of the paranasal sinuses. Methods We conducted a retrospective study of 1188 paranasal sinus CT scans performed in a major tertiary medical center between January 1, 2016 and December 31, 2016. Axial and coronal and views were reviewed to evaluate the presence of accessory maxillary ostia and maxillary and ethmoid sinusitis. Results Nine hundred twenty-eight patients were included for analysis. A 52.8% were male. Mean patient age was 33.8 years. A right accessory maxillary ostium was detected in 274 patients (29.5%), which was the same number of patients with a left accessory maxillary ostium. Bilateral accessory maxillary ostia were found in 172. The presence of right maxillary sinusitis was significantly associated with male gender and the presence of a right accessory maxillary ostium. Male gender was the only factor significantly associated with the presence of left sinusitis. Left or right ethmoidal sinusitis was significantly associated with male gender and the presence of left or right maxillary sinusitis, respectively. Conclusion The presence of an accessory maxillary ostium may contribute to the development of maxillary and ethmoidal sinusitis. Further studies are needed to elucidate this association and determine indications for incorporating the natural and accessory ostia when performing middle meatus antrostomy during endoscopic sinus surgery.

International audience; Importance: Non-steroidal anti-inflammatory drugs (NSAIDs) are known to inhibit chemotaxis, oxidative burst and phagocytosis, bacterial killing in granulocytes as well as inhibiting neutrophil aggregation or degranulation, thereby interfering with the function of lymphocytes. On the other hand, ibuprofen is widely prescribed in pediatrics for its powerful analgesic and antipyretic effects. To our knowledge, no previous publication outlines the relationship between Ibuprofen therapy and an increased risk of intracranial and/or orbital complications of acute fronto-ethmoidal sinusitis in childhood. Objective: To look for a relationship between ibuprofen and occurrence of intra-cranial and/or orbital complications of acute fronto-ethmoidal sinusitis in pediatrics. Setting and methods: The medical charts of patients younger than 18 years admitted into the E.N.T. departments of 4 academic care centers during 2 consecutive years for fronto ethmoidal sinusitis were reviewed retrospectively. The history of ibuprofen intake, the occurrence of complication (orbital or intracranial) as well as the usual demographic data were noted. A statistical analysis was performed in order to ascertain whether a relationship between taking NSAIDs and the onset of an intracranial and/or orbital complication exists. Results: Intake of ibuprofen appeared to be a risk-factor of intracranial complications or associated orbital and intracranial complications of acute fronto-ethmoidal sinusitis in children. Neither gender nor age nor initial pain intensity were statistically related to the onset of complications. Conclusion and relevance: This retrospective multicenter cohort study appears to suggest that ibuprofen increases the risk of orbital and/or intracranial complications of acute fronto-ethmoidal sinusitis in childhood. Therefore, we recommend not prescribing ibuprofen if one suspects an acute sinusitis in a child or adolescent.

Background and aim of the work: Fungal rhinosinusitis (FRS) is a clinical entity characterized by the presence of fungi within sino-nasal cavities that may occur in patients with normal or defective immunity. Allergic fungal rhinosinusitis (AFRS) is a form of non-invasive FRS that affects patients with an abnormal immuno-mediated response to fungal antigens. This article describes a case of isolated fronto-ethmoidal AFRS. Methods: A 20-year old male patient presented with a history of a left nasal respiratory obstruction and allergic oculorhinitis. CT scans showed a polypoid mass in the left nasal cavity and opacification of the left ethmoid sinus, frontal recess and frontal sinus with hyperdense component. The patient underwent functional endonasal sinus surgery (FESS) with removal of nasal polyps from the left nasal cavity and of cheesy-like material and dense mucus from the left ethmoid and frontal sinus. Histological examination showed presence of fungal hyphae within the allergic mucus; a diagnosis of AFRS was made. Results: Follow up at 14 months showed no signs of recurrence. Conclusions: The AFRS case reported herein is characterized by isolated unilateral fronto-ethmoid involvement, a rare presentation. Endoscopic nasal treatment was effective with complete patient recovery. (www.actabiomedica.it)

Introduction Ostiomeatal complex variations may be affected by maxillary and ethmoid sinus pathologies. Objectives: To evaluate the presence of accessory maxillary ostium (AMO), Haller cell (HC), maxillary sinus patho­logies, and ethmoid sinusitis, using cone-beam computed tomography (CBCT). Material and methods CBCT images of 628 patients (339 males and 289 females) between 19 and 91 years (mean age, 47.5 ± 15.3 years) were retrospectively evaluated. Presence of AMO, HC, maxillary sinus pathologies, and ethmoid sinusitis was investigated. Maxillary sinus pathologies were classified. Associations of parameters with each other, and with maxillary sinus pathologies and ethmoid sinusitis were observed. Chi-square test was applied to analyze the relationships between variables and distribution of parameters. Results AMO was detected in 27%, HC in 15.3%, ethmoid sinusitis in 61.5%, and maxillary sinus pathology in 47.9% of the images. The most common maxillary sinus pathology was localized mucosal thickening, with 28.8% on the right and 25.2% on the left. Statistically significant differences were determined between AMO and maxil­lary sinus pathologies with ethmoid sinusitis (p < 0.001), and HC with maxillary sinus pathologies (p < 0.05). Maxillary sinus pathology and presence of ethmoid sinusitis were more common in males (p < 0.001). Conclusions There was a significant association among maxillary sinus pathology, AMO, HC, and ethmoid sinusitis. Significant relationship was observed between ethmoid sinusitis and all parameters, except for HC. The presence of these variations may increase the possibility of maxillary and ethmoid sinus pathologies. CBCT is a very successful imaging method in examining the anatomy of the paranasal sinus region.

Background We report a rare case of orbital subperiosteal hematoma associated with frontal and ethmoidal sinusitis. Common concerns involving the orbital subperiosteal space include abscess, hematoma and tumor. Case presentation A patient presented to our clinic with periorbital swelling and limited extraocular muscle movement in her left eye. Computed tomography revealed a superior subperiosteal mass with frontal and ethmoidal sinusitis. We diagnosed the patient with subperiosteal hematoma and surgical evacuation was performed via superior orbitotomy. Brown serous discharge was drained and biopsy demonstrated fibrin clots. The final diagnosis was orbital subperiosteal hematoma and the patient was discharged with symptoms resolved. Conclusion Orbital subperiosteal hematoma is difficult to distinguish from abscess owing to its rarity and similar presentation. Computed tomography is helpful in diagnosis, and surgical evacuation during the early stages is essential to achieving a good outcome.

Ocular tuberculosis (OTB) is a rare form of extrapulmonary Tuberculosis (EPTB) and a rare presenting feature of tuberculosis (TB) in children. We report such a case in a 3-year-old boy who presented with a painless swelling over left upper eyelid. Mycobacterium tuberculosis bacilli were isolated from the swelling by a Fine Needle Aspiration Cytology (FNAC) which confirmed the diagnosis. Investigating him for the extent of disease, we found him to have intracranial extension to involve the ethmoid sinus on contrast enhance Computed Tomography and Pott's disease causing a compression fracture of L3 with bilateral paravertebral collection, epidural extension and a left psoas abscess on Magnetic Resonance Imaging. After starting antitubercular therapy, the child is doing well and on regular follow up. We are presenting this case to highlight the fact that extensive spinal tuberculosis can present without any neurological deficit and may even present only as a benign looking orbital swelling.

Background: Subperiosteal abscesses (SPOA) are a complication of acute purulent sinusitis, and their optimal treatment regime is a controversial topic. Some otolaryngologists consider surgery to be mandatory in the treatment of subperiosteal abscesses others advocate that especially paediatric patients can be treated medically in some cases. The purpose of this study was to evaluate our current treatment guidelines for subperiosteal abscesses. Methodology: A retrospective study was undertaken from 2010 to 2016, including patients registered with the diagnosis of subperiosteal abscesses derived from acute sinusitis based on clinical diagnoses, and CTs or MRIs. All patients received treatment with IV-antibiotics and were booked for prompt surgery. The main outcome measures were CT-measurements and intraoperatively identified pus. Treatment included antibiotic choice, microbiology, and outcomes. Results: Thirty-one patients were included in the study having the diagnosis of sinusitis and SPOA. Per operatively, we found pus in the subperiosteal space in 21/31 patients and 17 of the patients with available contrast-enhanced CT scans. When patients were grouped based on radiographically confirmed abscesses or not per the preoperative MRI or CT, we found that the presumed abscess volume was 0.83 mL greater in the patients, who had an abscess confirmed during surgery. Two patients needed endoscopic re-operation. In addition, three patients had sequela at the last follow-up, two with minor subjective sequelae due to oedema most likely resolving themselves over time and one with memory and concentration difficulties due to intracranial empyema. Conclusion: Endoscopic drainage of SPOA combined with an intravenous antibiotic is a safe and effective treatment strategy when executed in trained surgical hands, which is substantiated by low recurrence and morbidity rates. Because of the relatively high incidence of contrast-enhanced CT-confirmed subperiosteal abscesses that cannot be identified intraoperatively, we suggest considering other parameters such as volume of the abscess to determine whether surgical intervention is needed.

Introduction: Primary tooth eruption occurs at approximately six months of age. Neonatal teeth, defined as teeth that erupt within 30 days after birth, are uncommon, estimated to occur in 1:1,000 to 1:30,000 live births. Orbital infections in neonates are exceedingly rare. The small number of cases reported in the literature attribute ethmoid sinusitis as the underlying etiology of most neonatal orbital infections. This report describes orbital cellulitis and subperiosteal orbital abscess resulting from an infected neonatal tooth. Case Description: A 25-day-old, former full term, male presented with one day of fever and right eye swelling. Exam …

Neonatal orbital infections are quite rare, and are most often attributed to ethmoid sinusitis. This report describes a case of subperiosteal orbital abscess in a neonate secondary to an infected neonatal tooth. Although there have been two cases reported in the literature describing odontogenic infection resulting in orbital abscess in neonates, these cases were due to infected tooth buds rather than an infected neonatal tooth. We discuss workup and surgical management of this patient, including tooth extraction and intraoral approach to the orbit for abscess drainage.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a newly identified strain of coronavirus in the human body and was reported in Wuhan at the end of 2019. So far, the epidemic is continuing and very serious, with the number of infections and deaths increasing. Despite active investigations around the world to better understand the dynamics of transmission and the scope of clinical disease, COVID-19 continues to spread rapidly from person to person. The common signs and symptoms of SARS-CoV-2 infection include fever, fatigue, dry cough, and dyspnea; in severe cases, patients may have acute respiratory distress syndrome, septic shock, metabolic acidosis difficult to treat and coagulation disorder. However, some patients who test positive for SARS-CoV-2 in their respiratory tract may not have such clinical signs and symptoms. This report presents a case study analysis of a patient admitted in the Fourth Taiyuan People's Hospital, who had suffered traumatic injuries from a car accident and survived COVID-19, with pleural effusion as the initial symptom. We report a case of 2019-NCOV with pleural effusion as the first symptom. Describe in detail the differential diagnosis, diagnosis, clinical management, and cure of this case. In order to combat the novel CoronaviruscoVID-19 in the process to provide lessons and help.

Pfeiffer syndrome is one of six craniosynostosis syndromes and presents with craniosynostosis (the premature fusion of one or more calvarial sutures) and skeletal abnormalities. The aetiology of Pfeiffer syndrome is thought to be caused by mutations in the fibroblast growth factor genes FGFR1 and FGFR2. The anatomical complexity of craniosynostosis syndromes means that the long-term management of patients requires a multidisciplinary team approach. Patients with craniosynostosis syndromes are predisposed to sinus infections, including sinusitis, due to structural abnormalities and iatrogenic alterations in sinus anatomy following reconstruction. In this case report, we report a 14-year-old boy with Pfeiffer syndrome who presented with periorbital cellulitis secondary to recurrent ethmoid sinusitis. To the best of our knowledge, this is the first case of ethmoid sinusitis in a patient with Pfeiffer syndrome reported in the literature.

Mycoplasma pneumoniae induced rash and mucositis (MIRM) is a recently identified clinical entity, which describes a subset of extrapulmonary manifestations resulting from Mycoplasma pneumonia infection. Patients present with a wide variety of symptoms including cough, dyspnea, mucositis, conjunctivitis, with or without a variable cutaneous rash. A 24-year-old male presented to the emergency department with worsening dyspnea and new-onset oral, ocular, and genital mucosal lesions. The patient was also found to have bilateral otitis media with tympanic membrane rupture and ethmoid sinusitis upon further evaluation. The patient was originally diagnosed with atypical pneumonia leading to acute hypoxic respiratory failure and was admitted to inpatient care. Work-up revealed positive Mycoplasma pneumoniae immunoglobulin M, and the patient was subsequently diagnosed with MIRM. The patient was provided with supportive care as well as systemic antibiotics, and he fully recovered by day 12 without complication. No standardized treatment guidelines exist for MIRM, and it is universally accepted that supportive management is the mainstay of treatment, consisting of pain management, intravenous hydration, and mucosal care. Although the majority of MIRM patients are generally known to have a full recovery (81%), a variety of ocular, oral, and genital complications have been noted in the literature. Here we present a unique case of MIRM in a 24-year-old male who also had ethmoid sinusitis and bilateral otitis media with unilateral tympanic membrane perforation - two head and neck symptoms not described in previous literature.

OBJECTIVES To assess the feasibility of bilateral radical ethmoidectomy in ambulatory surgery by risk analysis, and to calculate possible medico-economic savings. METHODS This study was performed retrospectively over a 2-year period and prospectively for 1 year. It included all patients undergoing bilateral ethmoidectomy, associated to sphenoidotomy and/or septoplasty or not, in a university hospital department. Data were collected on demographics, disease etiology, previous surgery, operative details, postoperative course, complications and satisfaction assessed by questionnaire at days 1 and 30. Ambulatory surgery eligibility criteria were applied to this population, and an economic analysis compared savings between inpatient and outpatient management. RESULTS Hundred and sixty-five patients were included. Surgical indications comprised nasal polyposis (87%), chronic sinusitis without nasal polyps (6%) or cystic fibrosis (7%). Seventy-five septoplasties were associated (45.5%). Operating time depended on associated septoplasty (P=0.005), surgeon experience (P

Introduction. Rhinosinusitis polyposa consists in a chronic inflammation of the mucous membrane of the nose and paranasal sinuses, followed by recurrent growth of polyps and characterised by a high prevalence. Nasal polyps may be associated with the presence of viscous mucin; their characteristic CT signs are hyperostosis of the walls of the affected sinuses and thinning cavity walls until the bone is destroyed, this being a sign of aseptic osteomyelitis. The same sign is typical for inverted papilloma, the most common benign tumour of the nose and sinuses.Materials and methods. The present article presents a clinical observation. What makes it interesting is that a benign tumour was diagnosed against the background of bilateral rhinosinusitis polyposa. The clinical picture did not have nasal bleeding, which is typical for inverted papilloma; this was most likely due to the initial growth of the tumour. Thickening bone structures (hyperostosis) was balanced due to the pathogenetic peculiarities of the rhinosinusitis polyposa development with viscous mucin. Inverted papilloma was suspected during rhinoscopy, which revealed asymmetric growth of polyps. Final verification of the clinical diagnosis was carried out following computerised tomography of the nose and paranasal sinuses and histological examination of biopsy material.Results and discussion. This clinical case is of interest due to rhinocytogram data suggesting a viral and inflammatory etiology of the development of inverted papilloma. Therefore, the observed nucleoli of the nuclei of the columnar epithelium are characteristic of intracellular infection — in particular, viral. Remodelling of cells of the cylindrical epithelium is a sign of chronic inflammatory process.Conclusion. Thus, accurate performance of the diagnostic algorithm with histological verification of all removed material allows the identification of a neoplasm of the nasal cavity even in difficult cases, along with other diseases of the nasal cavity. Rhinocytogram data can help suggest the etiology of the intracellular type of infection in the epithelial cell and pathogenesis of inverted papilloma in a particular case.

Septic cavernous sinus thrombosis (SCST) is an uncommon consequence of head and face infection, but a rare complication after craniofacial fracture. In this case, SCST developed in a 13-year-old girl following a minor fall during volleyball, with impact and resulting abrasive contusion of the left forehead. She developed watery rhinorrhea, progressive headache, fever, nausea, vomiting, and left proptosis with blurred vision, and was admitted to hospital 3 days after injury. Drowsiness, high-grade fever, severe headache, left ocular pain with marked periorbital swelling, and paralysis of extraocular eye movements developed. Computed tomography scan identified left sphenoid and ethmoid sinusitis, a posterior clinoid fracture, and septic cavernous sinus thrombosis. She died after 10 days of in-hospital antibiotic therapy. Death was due to Staphylococcus aureus sepsis with septic pulmonary thromboemboli due to suppurative meningitis and cerebral infarction, due to SCST following apparently minor blunt head injury from an accidental fall.

Patient: Male, 49-year-old Final Diagnosis: Rhinosinusitis Symptoms: Cough • fatigue • headache • seizure Medication: — Clinical Procedure: — Specialty: Infectious Diseases Objective: Rare coexistence of disease or pathology Background: We present a case of invasive sinusitis with rhinocerebral infection in a patient who had mild symptoms of COVID-19 infection and did not receive any immunosuppressive therapies. Case Report: A 49-year-old man with a history of uncontrolled diabetes presented to the hospital with multiple generalized tonic clonic seizures. He had recently been diagnosed with mild COVID-19 and was treated at home with supportive care only. He was found to have cerebritis in the right frontal lobe along with right fronto-ethmoid sinusitis. He underwent extensive testing with nasal endoscopy with gram stain and culture, cryptococcal studies, 1–3-Beta-D glucan, blood cultures, fungal CSF studies, Lyme disease, HIV, Fungitell assay, and galactomannan studies, which were all negative. He was started on i.v. antibacterial therapy with cefepime, vancomycin, and metronidazole along with amphotericin B. After 2 weeks, his repeat imaging revealed progression of cerebritis along with new early abscess. Given these findings, his antibiotics were changed to meropenem and the amphotericin B dose was increased. He was recommended debridement and sinus surgery but refused. During the course of treatment, he developed acute kidney injury and was switched to Posaconazole. Unfortunately, the patient decided to leave against medical advice 6 weeks into admission. He was advised to continue Posaconazole and levofloxacin but he could only afford levofloxacin. He was then recommended long-term levofloxacin. He has since recovered, with resolution of cerebritis noted in follow-up imaging 1 year later. Conclusions: Our patient had mild COVID-19 infection and presented with secondary infective complications, which are usually associated with an immunocompromised state, despite receiving no immunosuppressives. It is imperative that all clinicians treating COVID-19 be watchful for fungal or bacterial co-infections in patients with active SARS-CoV-2 infection, even if the presenting symptoms are mild, particularly if other risk factors are present.

Mucormycosis is a life-threatening infection affecting patients with diabetes. It is an angioinvasive disease often resistant to treatment with a debilitating course and high mortality. Here, we report a case of a 45 year old woman with type 2 diabetes mellitus who presented to us with history of right-sided ptosis and facial palsy, and subsequently developed loss of vision and palatal palsy. She was in diabetic ketoacidosis. Nervous system examination revealed involvement of right second, third, fourth, sixth, seventh, ninth, and tenth cranial nerves, suggestive of Garcin syndrome. The hard palate had been eroded with formation of black eschar. Computed tomography of paranasal sinuses revealed right maxillary and ethmoid sinusitis, with spread of inflammation to infratemporal fossa and parapharynygeal neck spaces. Debridement of sinus mucosa was done, and culture of the same yielded growth of rhizopus species. Histopathological examination of the tissue showed angioinvasion and fungal hyphae suggestive of mucormycosis. She was treated with amphotericin B, posaconazole, and periodic nasal sinus debridement, but her general condition worsened after 8 weeks due to secondary sepsis and she succumbed to death.

Objectives/Hypothesis Current rhinologic practice is devoid of minimally invasive procedures dedicated to the treatment of ethmoid sinusitis to improve ventilation and topical drug delivery. We have recently described a handheld spiral punch to create minimally invasive ethmoid punch sinusotomy (EPS) sites into the ethmoid bulla and basal lamella, which significantly increased irrigant access to the ethmoid sinuses in cadaver models. Here, we conducted a clinical feasibility study to determine the initial safety evaluation of EPS in chronic rhinosinusitis without polyposis (CRSsNP) patients with active ethmoid disease. Study Design Single-arm, institutional review board–approved observational study. Methods This study was performed in CRSsNP patients who failed medical management; were candidates for standard, traditional functional endoscopic sinus surgery; and were offered the option of EPS. EPS characteristics (patency, remucosalization) and complications (closure, mucus recirculation) were collected. Alterations in radiographic disease and symptoms after EPS were determined by Lund Mackay (LM) scoring and 22-item Sinonasal Outcome Test (SNOT-22) scoring, which was collected up to 6 months post-procedure. Results Thirty-two of 40 possible ethmoid compartments (17 of 20 anterior, 15 of 20 posterior) underwent EPS. Twenty-nine of 32 EPS sites remained patent (n = 29, 90.6%), with a minority displaying evidence of restenosis (n = 9, 28.1%) or closure (n = 3, 9.3%). All patent EPS sites had complete remucosalization (n = 29, 100%) with no evidence of mucus recirculation (n = 0, 0%) or other complications secondary to healing or device use. Ethmoid sinus cavities with a pre-EPS LM score of 1 or 2 universally improved to an LM score of 0 following EPS (n = 30 of 30, 100%). SNOT-22 scores significantly improved, with a mean reduction of 33.1 (49.6 ± 7.5 pre-EPS vs 16.5 ± 7.7 post-EPS, p < .0001). Conclusions This feasibility study demonstrates that EPS appears to be a safe, minimally invasive procedure to treat ethmoid sinusitis in CRSsNP patients unresponsive to medical therapy that establishes ethmoid ventilation, and likely improves effective sinus irrigation. Conducting a clinical trial would be appropriate in assessing a potential role for EPS in the management of this condition. Level of Evidence 4. Laryngoscope, 127:1268–1275, 2017

We report the case of a patient with pneumonia caused by the new coronavirus (COVID-19 pneumonia), who contracted the novel coronavirus (SARS-CoV-2) infection on a large cruise ship, and was hospitalized due to fever and cough The fever resolved immediately after admission, however, a mild cough persisted Chest CT showed multiple ground-glass opacities in the upper and lower lobes of both lungs However, we judged that the patient was at a low risk of exacerbation of the disease as he was young, and did not administer any antiviral drugs Since the subjective symptoms improved, we repeated the SARS-CoV-2 PCR test on day 9 after the onset of the illness, but the result was still positive As the patient was observed to have sinus stenosis in the left nasal cavity at the time of collection of the nasopharyngeal swab for testing, sinus CT was performed The findings were suggestive of inflammation of the left nasal mucosa, ethmoid sinusitis, and maxillary sinusitis It took a long 41 days before we could finally confirm two consecutive negative results of the nasopharyngeal swab PCR test for the novel virus It has not yet been clarified whether the SARS-CoV2-19 virus can cause rhinitis and/or sinusitis, but from our experience of this case, we believe that SARS-CoV2-19 can colonize already infected nasal mucosa and sinuses for a prolonged period of time It is necessary to pay attention to this aspect, as it may prolong the disease duration and/or increase the risk of relapse

Orbital infection is the most frequent complication of ethmoiditis. Recurrent periorbital cellulitis is a very rare complication of rhinosinusitis with only three reports in the literature describing this pathological process. This complication can be favored by an anatomical abnormality of the uncinate process or mucocele obstructing the normal drainage pathway, in addition to ethmoidal sinusitis. Computed tomography and magnetic resonance guide the diagnosis. The treatment is based on antibiotics, corticosteroids and local decongestants. Surgical treatment is indicated in the absence of response to treatment established after 48 hours or decrease in visual acuity or recurrent orbital complications without underlying tumor pathology. In this report, we present a case of orbital complication of rhinosinusitis in a 4 year-old-child with six episodes of unilateral periorbital cellulitis and one episode of subperiosteal orbital abscess since the age of 3 months. There was a complete resolution with no recurrence after the surgical intervention.