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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., (© 2022. The Author(s).)

Woakes' syndrome (WS) is a rare entity, defined as severe recalcitrant nasal polyposis with consecutive deformity of the nasal pyramid. WS occurs mainly in childhood and its aetiology remains unclear. We report a case of a 68-year old woman, with aspirin-exacerbated respiratory disease, who presented with recurrent nasal polyposis and progressive broadening of the nasal dorsum. CT scan revealed extensive bilateral nasal polyposis and diffuse osteitis, with anterior ethmoidal calcified lesions. The patient underwent revision endoscopic sinus surgery and nasal pyramid deformity was successfully managed without osteotomies., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

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.

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., (Copyright © 2019. Published by Elsevier B.V.)

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., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Objective: The anatomical and developmental particularities of sinus cavities in paediatric population lead acute ethmoiditis to be the earliest form of sinusitis in children. Orbital complications are frequent and could lead to visual and neurological impairment. This study investigated the clinical, biological and radiological features of orbital complications. We identified the predictive factors of severe ophthalmological lesions and/or associated cerebral complications of acute ethmoiditis., Design and Methods: This cross sectional study included all patients identified as having orbital extension of acute ethmoiditis in the database of a single academic paediatric care centre over a period of 14 years. All orbital and cerebral Scans of the included patients were reviewed and the cohort was classified using Chandler's classification as having less severe lesions (Chandler's 1 and 2) or more serious lesions (Chandler's 3, 4 and 5)., Results: In total, 16 patients (12 girls and 4 boys) were included among 39 consecutives cases of ethmoiditis recessed with a complication rate of 41%. Average consultation delay was 4.88 days. The mean age was 4.37 years. Fever was objectified in 13 cases (81%). Six patients (37.5%) had exophthalmos. Orbital extension spectrum was: stage I (n = 4, 25%), stage II (n = 4, 25%), stage III (n = 6, 37.5%), stage IV (n = 1, 6.5%), stage V (n = 1, 6.5%) and intra cranial extension was associated in two cases. Univariate analysis showed that fever, exophthalmos, ophthalmoplegia, positive CRP, age and white blood cells count were not associated with more severe lesions in the CT scan. Initially, all children received intravenous antibiotic treatment. Association of multiple antibiotics was prescribed in 75% of the cases. With 21.07 days ± 5.51 days as a total treatment duration. Only Four patients underwent surgical treatment., Conclusion: Orbital complications of ethmoiditis are frequent. No clinical or biological criteria seem to predict the severity of orbital lesions. Both orbital and brain CT scan could help detect eventual complications on time to adapt antibiotic treatment and eventually bring forward surgical intervention., (Copyright © 2019 Elsevier Inc. All rights reserved.)

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., Competing Interests: The authors report no conflicts of interest in this work., (Sociedad Argentina de Pediatría.)

Background: Recurrent periorbital cellulitis (RPOC) associated with rhinosinusitis is rarely noted and scarcely discussed in the literature. The aim of our study was to analyze the characteristics and disease course of a group of pediatric patients with RPOC., Methods: The medical records of all pediatric patients with a diagnosis of RPOC treated in a tertiary children's hospital were retrieved. Included were patients with a history of two or more episode of RPOC., Results: A total of 14 children were included. Mean follow up was 3 years (SD ± 2.5). Median age of first POC episode was 12 months (range 5 months-12 years). Overall, 75 events of RPOCs were documented. A median of 3 events per patient was noted (range 2-16). Preseptal cellulitis was diagnosed in all but five patients, in whom orbital cellulitis or subperiosteal abscess were identified, one following failure of conservative treatment, and the remaining at first presentation or recurrence. Rhinorrhea was present in only five patients (35%). The majority of patients were treated with intra-venous antibiotics. Imaging studies were performed in all patients revealing ethmoidal sinusitis in all patients, with lamina papyracea dehiscence in two patients. Immune deficiency was diagnosed in one patient. Endoscopic sinus surgery was performed in seven patients, in four as preventive procedure and in three during an acute phase. Post-operative recurrent disease was noted in two patients that were operated during the acute phase., Conclusions: RPOC is a rare entity. Rhinosinusitis should be suspected in events of recurrent preseptal cellulitis even in the absence of nasal symptoms. CT scan is diagnostic for sinus origin of disease and possible anatomical abnormalities. In the majority of patients no evident etiology was identified. Elective Surgery or prophylactic antibiotic treatment should be strongly considered in this subgroup of patients as it seems beneficial., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Objective: The objective of this study was to investigate the microbiological cultures and the management of acute ethmoiditis complicated by subperiosteal orbital abscess (SPOA) in a pediatric population., Methods: The medical records of children under 18 years old was performed in a tertiary referral pediatric center from January 2009 to April 2017. Clinical examination, computed tomography scans, medical and surgical treatments were reviewed and compared to other studies in literature., Results: One hundred and twenty-nine children were hospitalized for acute ethmoiditis. Among them, forty eight were complicated by SPOA. The mean age of these children were 7 years (range 10 months-16 years). Thirtyfour underwent surgical drainage; for the others the medical treatment was sufficient. Microbiological samples were obtained during the surgical intervention and were contributive in 91% of cases. Streptococcus spp was the most frequently encountered bacteria (60% of cases). We also found anaerobic bacteria (12%), and Staphylococcus aureus (12%). 94% of children received two intravenous antibiotics (a third-generation cephalosporin and metronidazole) for a mean duration of four days. Then the oral treatment was based on amoxicillin-clavulanate during about 8.5 days. All children were cured without sequelae., Conclusions: For five years Streptococcus milleri, Staphylococcus spp and anaerobic bacteria are on the rise in acute ethmoiditis complicated by SPOA. That is why antibiotics must be adapted to these bacteria even in children under ten years old., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Objectives: The aim of the present prospective, randomized, double-blind, and placebo-controlled investigation (approved by the Ethical Committee of Padova University Hospital [Italy]) was to assess the effect of a nasal gel containing a combination of silver sucrose octasulfate and potassium sucrose octasulfate (Silsos gel® [SG]) in wound healing after endoscopic sinus surgery (ESS) for chronic rhinosinusitis in terms of: nasal symptoms (SNOT22), endoscopic appearance of the sinonasal mucosa (Lund-Kennedy score), nasal air flow (anterior active rhinomanometry), evidence of mucosal inflammatory processes (nasal cytology and histology), and microbiological growth., Methods: Thirty-four patients with chronic rhinosinusitis were randomized on a 1:1 ratio to receive after ESS either SG or placebo (contained only the excipients [carbopol and propylene glycol] in the same concentrations as in SG)., Results/conclusions: Judging from the present prospective investigation on patients who underwent ESS for chronic rhinosinusitis, treatment with SG seems to enable a significantly faster improvement in specific symptoms (assessed on the validated SNOT22 scale) than placebo. Patients treated with SG also had a quicker improvement in the endoscopic appearance of their nasal mucosa after ESS than patients treated with placebo. These endoscopic improvements in the SG group were also confirmed at the long-term follow-up, while the same did not apply to the placebo-treated group., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Background: Sub-periosteal orbital abscess (SPOA) typically presents as a collection of pus in the space between the periorbita and the lamina papyracea, adjacent to acute suppurative ethmoiditis. Osteitis of the lamina papyracea may lead to sequestrum formation, with progression of the infectious process to cause suppuration beneath the orbital periosteum., Materials and Methods: A case series of children with rhinosinusitis and SPOA admitted to our institute, from January 2005 to December 2011, was carried out. Included were children operated upon, in whom the lamina papyracea was submitted for histological examination, and in which bacteriologic studies were obtained., Results: Nine children with SPOA with a mean age of 5.03 years (range 1-12 years) were included in the present study. In five of them (55.5%), features of osteitis were noted histologically. No pathogens were observed histologically in the sections. Bacteriologic studies revealed Streptococcus viridans in four patients, and coagulase negative Staphylococcus in one., Conclusion: SPOA in rhinosinusitis children was associated in our small cohort with high rate of lamina papyracea osteitis. The direct spread through the involved bone was raised as a possible pathophysiology of SPOA formation., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

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.

Ophthalmic vein thrombosis (OVT) is a rare condition occurring secondary to varied etiologies that commonly presents with proptosis, globe dystopia, ophthalmoplegia, periorbital edema, and occasionally diminished visual acuity. It may be related to inflammation of the orbit or paranasal sinuses. We herein report imaging findings of thrombosed superior and inferior ophthalmic veins in bilateral involvement in a 20-year-old male patient without cavernous sinus thrombosis. He presented with pain, swelling, and blurred vision in both eyes. Magnetic resonance (MR) imaging, cerebral MR angiography, and susceptibility weighted imaging were performed. Bilateral superior and inferior OVT due to a complication of ethmoidal sinusitis was diagnosed in the patient. Anticoagulant and systemic broad-spectrum antibiotic therapy was started. His symptoms were recorded at the end of 14 days of the treatment.

We report a case of a middle aged, hypertensive man who presented with nasal obstruction, sneezing spells, headache and nasal discharge of long duration. On evaluation, he was diagnosed to have a deviated nasal septum with allergic rhinosinusitis with sinonasal polyposis. CT of the paranasal sinuses revealed a hyperdense, oval structure suggestive of a sinolith in the right anterior ethmoid sinus. The patient underwent septoplasty with right Draf 2B procedure and extraction of the sinolith from the ethmoid sinus.

Lactococcus lactis cremoris (L. lactis cremoris) infections are very rare in humans. Only three case reports of brain abscess have been reported and the infectious routes and pathological features are still unknown. We experienced a subdural empyema due to L. lactis cremoris in an immunocompetent adult. A 33-year-old man was admitted with fever, right facial pain, left hemiparesis, and left hemianopsia. Computed tomography demonstrated low density fluid collection in the right falcotentorial subdural space. Magnetic resonance (MR) images revealed a high signal lesion on a diffusion-weighted image (DWI) and fluid attenuated inversion recovery (FLAIR) images in the right paratentorial and parafalcine subdural space, right maxillary sinus, and bilateral ethmoidal sinus. He underwent two sequential open surgeries for removal and drainage of empyema and was treated with antibiotics including meropenem and ampicillin. To our knowledge, this is the first report of subdural empyema caused by L. lactis cremoris infection. We report the case and discuss the pathological features with the previous literature.

Acute ethmoiditis is a rare infection of ethmoidal cells. The pathognomonic sign is an edema of the internal corner of the eye. Imaging may be necessary to verify the absence of orbital or endocranial complications. Thrombophlebitis of the cavernous sinus is a serious complication of this infectious process. We report the case of an 11-year-old boy who presented with ethmoiditis complicated with thrombophlebitis of the cavernous sinus, with right hemiplegia and left Bell palsy sequelae. Early diagnosis of this disorder and urgent therapy are essential. Treatment is based on the antibiotic therapy., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Orbital complications secondary to acute rhinosinusitis can result in permanent blindness or death if not treated promptly and appropriately. Many authors have reported that almost all such patients had abscesses adjacent to the infected sinuses. However, the authors experienced an orbital abscess secondary to contralateral sinusitis. Here, the authors report an 8-year-old patient who had a left superior orbital abscess secondary to a right ethmoidomaxillary sinusitis.

Mucormycosis is an invasive fungal infection associated with high mortality. Orbital involvement was usually reported but was rarely isolated. We report the case of a 57-year-old patient who presented a proptosis associated to an ethmoid sinusitis. Inflammatory symptoms were late which was responsible for delayed diagnosis. Our patient died because of multi-organ failure., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

The authors report a case of Aspergillus ethmoiditis associated with an orbital abscess, diagnosed in an immunocompetent 6-year-old child, this is a rare infection and diagnosis is difficult, cause of a delayed treatment and frightening prognosis. Mycoses have emerged as important infections in clinical practice; this phenomenon is explained by the ever-growing number of immunocompromised patients and the increasing number of people traveling in areas where fungal diseases are endemic. Surgery with mycological and anatomopathologic examination can suggest a fungal infection confirmed by culture and contribute to institute adequate treatment., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Objective: The aim of the present study was to compare the external (EA), transnasal endoscopic (TEA), and combined (CA) external and transnasal approaches to drain orbital subperiosteal abscesses complicating pediatric ethmoiditis., Methods: This retrospective study included 38 children consecutively operated in our center for an orbital subperiosteal abscess complicating an acute ethmoiditis. The distribution of surgical approaches used for our patients was the following: 12 TEA (32%), 21 EA (55%) and 5 CA (13%). All data were retrieved from patients' clinical charts., Results: No surgical complication was observed in the present study regardless of the approach. The percentage of surgical failures requiring additional drainage was almost twice as high after TEA (failure rate: 25%) than after EA (failure rate 14.3%), but this difference was not significant. Parameters which significantly influenced the risk of failure of TEA were the length and width of the abscess. The duration of postoperative hospitalization was significantly lower in the TEA group (3.1 days) than in the EA one (5.4 days). There were no failures in the CA group., Conclusions: Failures of surgical drainage of orbital subperiosteal abscess complicating pediatric ethmoiditis are not rare and did not differ between external and transnasal endoscopic approaches in our study. The transnasal route is associated with a shorter postoperative duration of postoperative hospitalization. CA seems to be a viable surgical option combining the advantages of both endoscopic and external approaches., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Localized sphenoethmoid sinusitis in children is a rare occurrence. It is usually overlooked because of the misconception that the sinuses are not developed. We describe a case of localized acute sphenoid and right posterior ethmoid sinusitis that presented as right frontobasal subdural empyema and multiple deep cerebral abscesses. Morbidity from subdural empyema in children is high. Early diagnosis and treatment based on recognition that the etiology might involve the paranasal sinuses affects the overall prognosis.

Objective: Endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) may be compromised by postoperative inflammation, polyposis, and adhesions, often requiring subsequent intervention. To address this issue, the authors investigated the safety and effectiveness of controlled delivery of mometasone furoate to the sinus mucosa via bioabsorbable implants deployed at the time of ESS., Study Design: Prospective, multicenter, randomized, controlled, double-blind trial using an intrapatient control design., Setting: Otolaryngology-head and neck surgery centers; both academic and private practices., Subjects and Methods: The study enrolled 105 patients with CRS undergoing bilateral ethmoidectomy to compare the effect of drug-releasing to non-drug-releasing implants using an intrapatient control design. Postoperative interventions, polyposis, and adhesions were assessed postoperatively. Efficacy was determined through independent analysis of randomized video-endoscopies by 3 blinded sinus surgeons. Safety assessments included ocular examinations., Results: Implants were successfully deployed in all 210 ethmoid sinuses. Compared with control sinuses with non-drug-releasing implants, the drug-releasing implant provided a 29.0% relative reduction in postoperative interventions (P = .028) and a 52% (P = .005) decrease in lysis of adhesions. The relative reduction in frank polyposis was 44.9% (P = .002). Similar reductions were observed in real-time grading performed by the clinical investigators. No clinically significant changes from baseline in intraocular pressure or cataracts were observed., Conclusion: This study provides a high level of evidence that use of steroid-releasing implants that apply a sustained release of corticosteroid improves surgical outcomes by reducing synechiae formation, polyposis, and the need for postoperative interventions, with no observable ocular safety risk.

It seems apparently that the 2 separate anatomical areas (nasal cavity and paranasal sinus mucosa) are indeed one single unit with an identical behavior during inflammatory process. Similar histopathologic evidence in long-term condition could emphasize on the concept of rhinosinusitis in patients with inflammatory paranasal sinus disease. Prospective study was performed on 50 consecutive patients with polyposis in 2 different groups, one with and the other without asthma. Inferior turbine and polyp with ethmoid sinus origin were selected to compare the histopathologic findings of the surgical specimens from the 2 sites (affected sinus vs apparently unaffected nose). The general degree of inflammation, epithelial thickening, and inflammatory cell count were measured. The degree of inferior turbinate inflammation correlated with that of the ipsilateral polyp of ethmoid sinus in both groups. In addition, the total inflammatory cell count was comparable. There was no statistically significant difference in total polymorphonuclear, lymphocyte, and eosinophil count between the 2 sites in each group (P > .05). The ethmoid sinus inflammation in polypoid chronic sinusitis is accompanied by a proportionate inferior turbinate inflammation, not only in the patients with asthma but also in those with isolated sinonasal polyposis., (Copyright © 2011 Elsevier Inc. All rights reserved.)

A 23-year-old woman presented with clinical symptoms suggestive of acute dacryocystitis. She had no history of epiphora, and her lacrimal drainage system was patent on irrigation. CT findings were consistent with anterior ethmoiditis and maxillary sinusitis. Although the symptoms responded to antibiotic treatment, they recurred 2 times within the following 5 months. During the last episode, a complete obstruction of the nasolacrimal duct developed. The condition did not recur after external dacryocystorhinostomy and anterior ethmoidectomy during a follow-up of 21 months. Ethmoiditis may rarely cause a localized infection in the lacrimal sac region mimicking dacryocystitis. Recurrent infections may progress to complete obstruction of the nasolacrimal duct.

Orbital complications of ethmoiditis are well-described. This case presents a healthy ten-year-old boy who was admitted under the diagnosis of acute ethmoiditis. A computed tomography (CT) showed orbital cellulitis, but no definite abscess. The patient improved during intravenous antibiotic treatment, but suddenly complained about loss of vision. The clinical signs were central scotoma and visual impairment to 0.05. Both repeat CT, magnetic resonance imaging and ethmoidectomy were performed without signs of abscess. Blindness due to ethmoiditis without abscess in orbita is rare and probably results from neuritis in the nervus opticus.

Acute sinusitis in children is a controversial issue in terms of its diagnostic criteria, classification and therapeutic management. A therapeutic delay can lead to complications if the cause is bacterial. Guidelines have been set, but they are not consensual in pediatrics. Complications of acute bacterial sinusitis are uncommon in children, but they can be extremely severe and cause high morbidity and mortality. Because of their rarity, they often are not identified early, exposing the patient to an unfavorable outcome. We report on a case of acute bacterial pan-sinusitis complicated with thrombophlebitis of the cavernous sinuses and meningitis in a 9-year-old child, in spite of early and adapted antibiotic therapy. The bacterial agent was Staphylococcus aureus, which had no resistance or toxin profile. The progression was favorable under intravenous antibiotic therapy and after bilateral sphenoidectomy. This case raises the question of the best therapy for acute bacterial sinusitis in pediatrics and the management of complications., (Copyright 2010. Published by Elsevier SAS.)

Primary ciliary dyskinesia (PCD) is a rare congenital autosomal recessive disease that produces impairment of mucosal ciliary movement. Children with this disorder usually manifest recurrent and chronic infections of the upper and lower airways. We describe the history of a 12-month-old boy in whom the correct diagnosis of PCD was achieved after the occurrence of ethmoid mucocele associated with omolateral proptosis. A careful description of this new feature of PCD and its dangerous complications are also presented., ((c)2009 Wiley-Liss, Inc.)

Non-traumatic nasal septal abscesses (NSAs) are rare and those associated with acute sinusitis are even rarer. We report a case of a 12-year-old female child with NSA and complicating acute spheno-ethmoiditis that was diagnosed by physical examination and computed tomography (CT) scan. The NSA was treated by surgical incision and drainage of the abscess, endoscopic aspiration of pus from the spheno-ethmoidal recess, systemic antibiotic therapy, and nasal cleansing.

Objective: To evaluate the therapeutic effect of endoscopic ethmoid and maxillary surgery on chronic hypertrophic rhinitis., Method: A total of 54 cases of chronic hypertrophic rhinitis were treated by endoscopic ethmoid and maxillary surgery between 2003 and 2004, undergoing postoperative follow-up of more than one year. Age of patients ranged from 17 to 60 years, with a mean of 35 years. All of them were identified with nasal endoscopy and CT before surgery., Result: Fifty (92.59%) of 54 cases showed their nasal obstruction symptoms were relieved completely or improved significantly, with nearly normal infraturbinal appearance., Conclusion: Endoscopic ethmoid and maxillary surgery is an effective approach for the treatment of chronic hypertrophic rhinitis, with good preservations of infraturbinal structure and function.

Sinusitis has rarely been associated with short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) syndrome. We describe a case of symptomatic SUNCT syndrome caused by sinusitis, which showed typical features of SUNCT syndrome. The patient's symptoms completely resolved without recurrence after endoscopic sinus surgery followed by antibiotic treatment. We suggest that ipsilateral paranasal sinusitis accompanied by the spreading of inflammation through a dehiscence in the lamina papyracea could lead to the development of SUNCT syndrome.

Acute sinusitis is a common childhood illness most often involving the ethmoid and maxillary sinuses. Diagnosis is usually based on a history of an upper respiratory tract infection lasting longer than 7 days with a prominent nasal component. Treatment involves 10-14 days of antibiotics. Intracranial complications of pediatric sinusitis are rare, but potentially life-threatening. These include cavernous sinus thrombosis, orbital and intracranial extension, and meningitis. Children with these complications may experience significant morbidity from their infection. In such cases, delay in diagnosis and treatment may lead to irreparable brain damage or death. We report a case of sinusitis causing a subdural empyema in an otherwise healthy immunocompetent adolescent boy.

Non-traumatic nasal septal abscess is rare, commonly seen in patients with poor immunity, and presents as isolated nasal septal abscess. Further, nasal septal abscess complicated with acute sinusitis is rather rare. Very little literature has been generated for non-traumatic nasal septal abscess complicated with acute sinusitis in healthy patients. Prompt diagnosis and adequate treatment will help to prevent the complications associated with nasal septal abscess such as saddle nose and intracranial involvement. Herein, to our knowledge, we present the first case involving an otherwise healthy little girl with nasal septal abscess complicated with acute sinusitis and facial cellulitis.

Nasal polyposis is a very common and multifactorial disease. Whereas eosinophil-dominated polyps often are sensitive to anti-inflammatory treatment like corticosteroids, the therapy of polyps without eosinophils is more difficult and disappointing. We report the clinical course of a 29-year-old albino patient suffering from a extreme manifestation of Woakes' syndrome, which is characterized by severe recurrent nasal polyps, often without eosinophils on histological examination and with broadening of the nose. In this case, the recurrent fibrotic polyps without eosinophils were resistant to conventional medical and surgical treatment and required further treatment with radiotherapy with awareness of all possible future sequelae. The pathoetiology and treatment of Woakes' syndrome as well as of albinism were discussed.

Crohn's disease is a chronic idiopathic slowly developing transmural inflammation of the digestive system. It usually involves the small intestine and/or the area around the anus but can also affect the entire gastrointestinal tract anywhere from the mouth to the anus. Extra intestinal manifestations occur frequently and multiple organ systems may be affected: the skin, joints, spine, eyes, liver and bile ducts. In contrast, nasal manifestations are extremely rare and only a few cases have been reported up to date in the worldwide literature. The authors report two cases with nasal manifestations concomitant to intestinal Crohn's disease and go over the relevant literature on such an association.