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A 72-year-old male patient was seen in ear, nose and throat (ENT) clinic with chronic rhinosinusitis and diplopia. He had previously undergone partial ethmoidectomy and maxillary antrostomies for sinus issues 6 years ago. One month prior to this visit, he had developed right nasal congestion

The concept of ethmoidal sinuses composed of ethmoidal air cells does not appear to fit with the embryological origin of the ethmoid. Post-natal formation of the paranasal sinuses, as visualized by MRI, appears to be fundamentally different from the embryological development of the ethmoid sinus. These two organs also appear to have very distinct functions: paranasal sinuses play a role in respiration and sanitization of the respiratory tract, while the ethmoid sinus plays a role in olfaction. However, human acquisition of bipedalism resulted in ethmoidal compartmentalization into olfactory clefts lined by olfactory mucosa and the ethmoidal labyrinth formed by a meshwork of ethmoturbinals that have lost their olfactory mucosa. Ethmoturbinals are septa that increase the surface area of olfactory mucosa in mammalian olfactory chambers. Embryological development of the human ethmoid sinus can be seen as the result of curved stacking of ethmoturbinal septa forming passages. Surgically, these passages can be accessed via the middle, superior and supreme meati. An ethmoidectomy technique following the ethmoturbinal passages can therefore be described. This structure of the ethmoidal labyrinth is both useful and necessary for the teaching of ethmoidal surgery.

The main objective of this study was to determine the rate of outpatient management in a population of patients undergoing bilateral ethmoidectomy. The secondary objectives were to evaluate the quality of outpatient management (rate of unscheduled overnight admission, readmission rate, complications) and to compare inpatient and outpatient groups to determine which elements of the phenotype and care pathway favored outpatient management.A single-center observational study included 204 patients operated on for bilateral ethmoidectomy. Study variables comprised: type of care pathway (outpatient/inpatient), outpatient quality indicators (unscheduled admission, readmission, complications), care pathway, and population characteristics.One hundred and twenty (58.8%) outpatients were operated on. No deaths occurred. The unscheduled admission rate was 7.5%, and the readmission rate 4.1%; at the P0.005 threshold, there were no significant differences between in- and out-patient groups. Outpatients had earlier surgery (P0.005), and nasal packing rates and pain on VAS were lower (P0.005).Ethmoidectomy could be carried out as an outpatient procedure in 58.8% of cases, with acceptable quality of care. Selection of patients and the organization of a dedicated care pathway seem to be elements favoring this management.

Background Nonsteroidal anti‐inflammatory drug (NSAID) exacerbated respiratory disease (N‐ERD) is a triad with asthma, chronic rhinosinusitis with nasal polyps, and NSAID intolerance. Uncontrolled N‐ERD forms a major public health problem due to frequent and difficult‐to‐treat exacerbations and/or requiring putatively frequent endoscopic sinus surgeries (ESS). Our aim was to study factors affecting control of N‐ERD. Methods Retrospective patient record data (patient characteristics, prior sinus surgeries, follow‐up data in 2020) from 167 N‐ERD patients undergoing consultation at three tertiary hospitals from 2001 to 2017 was used. Outcome measurements reflecting uncontrolled N‐ERD were revision ESS, corticosteroids/biological therapy, and antibiotic courses during 2016–2020. Associations were analyzed by using nonparametric tests, Cox's proportional hazard, and binary logistic regression models. Results Nasal polyp eosinophilia increased the risk of revision surgery during the follow‐up (adjusted hazard ratio [aHR] 3.21, confidence interval 1.23–8.38). Also baseline oral corticosteroids (OCS; HR, 1.73, 1.04–2.89) and baseline surgery without total ethmoidectomy increased the risk of revision ESS (HR, 2.17, 1.07–4.42) in unadjusted models. In addition, both baseline OCS (adjusted odds ratio [aOR] 2.78, 1.23–6.26) and a history of ≥4 previous ESS (aOR, 2.15, 0.98–4.70) were associated with the use of OCS/biological therapy during the follow‐up, but not with high number of antibiotics. Conclusions Nasal polyp eosinophilia, baseline OCS, and a history of recurrent ESS predict uncontrolled N‐ERD. These factors might be clinically useful in risk‐estimation of uncontrolled disease and for organizing follow‐ups. Prospective cohort studies with larger sample size are needed to further study the factors affecting the upper airway control of N‐ERD., The patient record data of 167 patients with NSAID‐exacerbated respiratory disease was analyzed to study factors affecting the disease control. Nasal polyp eosinophilia increased the risk of revision surgery, and baseline oral corticosteroids and a history of four or more endoscopic sinus surgeries were associated with poor disease control during the follow‐up.

Introduction: Endoscopic endonasal surgery is currently a validated therapeutic modality in most nasal sinus disorders. In developed countries, this practice is common and sees the indications constantly reviewed; In sub-Saharan Africa, this surgical technique is popularized. The external pathways are morbid and not very functional. In our daily practice at the Yaounde General Hospital (YGH), this technique is still in its infancy. Gradually it’s entering our habits and sees its indications increases. Through this study, we are reporting readily available data from our experience. Objectives: The objective was to study the practice of endoscopic endonasal surgery in our setting. Patients and Method: This was a cross-sectional, descriptive, retrospective study. The site of study was the ear-nose and throat service of Yaounde General Hospital. The study was conducted from January 2013 to December 2020, for an 8 years basis. The sampling was consecutive. We included in this study all patients operated on for a nasal sinus disease by the endoscopic endonasal modality. We excluded patients with incomplete files, as well as those who had a complementary transfacial approach during the same operation. The data were collected on prepared questionnaire. Data analysis is done with ssps 23.0 software. Results: We recruited 30 cases, out of a total of 330 interventions carried out in our department. The prevalence of this surgery in our activity was 9%. Male and female had equal ratio of 50%. The most represented age group was 30 - 40 years (33.3%). All the patients had a facial sinus CT scan, we did not note any anatomical variant as risk. Two patients of our sample size had a history of sinus surgery, treated externally. Chronic maxillary sinusitis was the surgical indication in 36.7%, followed by Killian antro-choanal polyps in 13.3%, nasosinus polyposis in 13.3% and all performed under general anesthesia. The most performed procedure was unilateral mean meatotomy with 43.33% followed by bilateral mean meatotomy with 20%, ethmoidectomy 13.3%, bimeatotomy 10%. The admission lasted for 2 days. 100% of patients had a previous nasal tamponade at the end of the intervention. The tamponade was removed on the second postoperative day in 100% of patients. 16.7% of patients presented with complications of low abundance postoperative bleeding. All patients noted clinical improvement over the initial symptoms postoperatively. Conclusion: Endoscopic endonasal surgery is experiencing slow but certain progress in our daily practice. The operated patients are young, chronic maxillary sinusitis is the main indication, the most performed procedure is the unilateral mean meatotomy. The operation goes uneventful with satisfactory prognosis. A study with a larger sample is necessary in order to refine our results. The practice remains limited by the technical platform, which needs to be strengthened, in order to optimize the practice.

Treatment of sinonasal diseases is either conservative or surgical. The recent advances in surgical management is the use of endoscopic sinus surgery (ESS) as it causes less morbidity, complication, pain and above all, less recurrence rates. This study aimed to evaluate the effectiveness of ESS for the treatment of nasal & paranasal sinus diseases and to address the postoperative complications. A prospective study was done at the Department of Otolaryngology in Basrah Teaching Hospital in the period from January 2016 to August 2019. One hundred twenty six patients with sinonasal diseases were involved in this study, more than this number of patients was operated upon but they either refused participation in this study or dropped from follow-up. The main indications of surgery were; chronic rhinosinusitis without nasal polyp (33%), chronic rhinosinusitis with nasal polyp (28.6%), Allergic fungal sinusitis & mycetoma (17.4%), and acute recurrent sinusitis (16%). Main presenting symptoms were; nasal obstruction (85.7%), nasal discharge (69%), headache and facial pain (66.6%) and hyposmia and or anosmia (57.9%). The majority of operated upon patients were primary cases (98 patients, 77.7%), while (28 patients, 22.2%) were revision cases. The commonest causes of revision were; retained or incompletely removed uncinate process in 28.5% of cases, followed by incomplete removal or persistence of anterior ethmoid cells in 21.4% cases. In this series complications occurred in 15%, which were generally minor (9.5%), major complications occurred in 5.5% of operated upon patients. The commonest major complication is sever bleeding which was reported in 4.7% and anosmia which was reported in one patient. No CSF leak, retro orbital haemorrhage, or blindness was reported. Most of the patients in this series were improved (88.8%), complete symptom improvement occurred in (75 patients, 59.5%), partial improvement (37 patients, 29.3%), while (14 patients, 11%) were not improved. In conclusion, functional endoscopic sinus surgery is a safe surgery for sinonasal diseases, it carry good success rate with non-significant major complications. Key words: Nasal Sinus, Functional Surgery, Endoscopy

PURPOSE To evaluate periorbital volume changes, using quantitative photogrammetric stereoimaging, after bony orbital decompression for thyroid eye disease (TED) and compare this to changes in Hertel exophthalmometry. Tissue volumes of the upper and lower eyelids were also assessed independently. DESIGN Prospective, nonrandomized, nonconsecutive series of patients. SUBJECTS Adults with inactive TED who had elected to undergo bony orbital decompression at Moorfields Eye Hospital between 2015 and 2017. METHODS With their eyes gently closed, patients with inactive TED underwent imaging using the VECTRA M3 system (Canfields Imaging, Fairfield, NJ), both before and at least 3 months after orbital decompression. Proptosis was assessed by Hertel exophthalmometry. Using the manufacturer's software, changes in periorbital volumes between the preoperative and postoperative images were calculated for the upper and lower eyelids. The Pearson product-moment correlation coefficient was used to assess the linear relationship between changes in periorbital volume and exophthalmometry. MAIN OUTCOME MEASURES Change in stereoimaging volumes of the upper and lower eyelids, and clinical proptosis as measured with Hertel exophthalmometry. RESULTS Thirty-three patients (11 males; 33%) underwent lateral decompression (39 orbits in 26 patients), lateral decompression with complete ethmoidectomy (3 orbits in 3 patients), combined decompression of lateral wall, medial wall, and medial half of floor (10 orbits in 6 patients), or bilateral lateral, medial, and complete floor decompression (1 patient). The corresponding average volumetric changes were 1.74 ml (median 1.64; range 0.39-3.73 ml), 3.38 ml (median 3.38, range 1.89-4.88 ml), 4.05 ml (median 3.53, range 1.72-6.43 ml), and 4.52 ml (range 4.36-4.68 ml), respectively. Similarly, the average reduction in proptosis was 3.6 mm (median 3; range 1.5-7 mm), 5.3 mm (median 5; range 5-6 mm), 7.4 mm (7.5; range 6-9 mm), and 9 mm (range 8-10 mm). Periorbital volume changes were related to the reduction in exophthalmometry (r = 0.713, p < 0.0001), and reduction of lower eyelid volume did not increase further with more than two-wall decompression. CONCLUSION Graded orbital decompression reduces both proptosis and the upper and lower eyelid tissue volumes, the eyelid changes being likely to influence decisions about future restorative eyelid surgery. The significant changes in eyelid profiles underlines the established principle of thyroid periocular rehabilitation, namely decompression, then strabismus surgery, and finally eyelid surgery.

AIM OF STUDY: to improve the results of surgical treatment of patients with endocrine ophthalmopathy complicated by optical neuropathy. For this, medial orbitotomy and decompression of the optic nerve were performed for a patient with endocrine ophthalmopathy, CASRESULTS. The postoperative period was uneventful. In the early postoperative period, regression of exophthalmos was observed OD=18 mm, OS=20 mm, improvement in visual acuity OD=1.0 OS=0.5 . No complications were recorded. A satisfactory result was obtained.CONCLUSION. Transorbital endoscopic medial orbitotomy and optic decompression can be effectively used in the treatment of patients with endocrine ophthalmopathy complicated by optic neuropathy, refractory to conservative therapy. The technique is promising and requires further randomized studies.

Purpose The aim of this work is to demonstrate the outcomes of endonasal dacryocystorhinostomy (En-DCR) with anterior ethmoid sinus mucosal and posterior lacrimal sac flap anastomosing in patients with previous failed DCR. Methods The clinical data of patients who suffered from recurrent epiphora after failed DCR between September 2014 and March 2018 were reviewed retrospectively. Among them, those who received the second En-DCR procedure were enrolled in this study. During the surgery, anterior ethmoidectomy was performed. Posterior lacrimal sac flap was apposed closely to the mucosal of anterior ethmoid sinus instead of nasal flap at end of the surgery. Patients were followed up more than 12 months were included, the success rate and complications were recorded. Results Sixty-one eyes of 61 patients were enrolled in the study. The success rate of our modified En-DCR was 83.6% (51/61). Among 10 eyes with postoperative obstruction, 4 eyes caused by granuloma, 2 eyes caused by scar synechia, 2 eyes caused by membranous obstruction, and 2 eyes caused by common canalicular stenosis. No serious complications such as orbital fat prolapse, cerebrospinal fluid leak, sinusitis, or visual impairment were occurred in this study. Conclusion Endoscopic approach with anterior ethmoid sinus mucosal and posterior lacrimal sac flap anastomosing is a good choice for patients with recurrent epiphora after previous failed DCR.

Functional endoscopic sinus surgery (FESS) has become one of the most common surgical techniques performed by otolaryngologists with significant data demonstrating its efficacy in managing patients with chronic rhinosinusitis (CRS). However, despite this initial success, patients may continue to present with recurrent symptoms and approximately 10-15% of them will require revision surgery. Failure of FESS may have many different causes which include inappropriate patient selection and preparation, comorbidities like cystic fibrosis and Samter's triad, insufficient surgical skills or anatomical variations that have not been addressed adequately. Two inverse European techniques were introduced in the 1980s. The one promoted by Messer-klinger, who practiced the anterior-to-posterior approach, another one, developed by Wigand who performed posterior-to-anterior dissection, opens the sphenoid ostium or removes the anterior wall of the sphenoid sinus and ends with a total ethmoidectomy. Hereby in RESS we start dissection in posterior-to-anterior fashion by following a structured approach in the identification of the fixed landmarks to allow quick and easy orientation to the skull base and medial orbital wall to avoid the complications.

Pneumosinus dilatans (PD) is a rare disorder of unknown etiology which consists of an abnormal dilatation of one or more paranasal air sinuses without radiological evidence of localized mucous membrane alterations, hyperostosis, or bony erosion. Sinus walls are therefore of normal thickness. The enlargement of the bone may be generalized or focal, and apart from the aesthetic problem it carries, it is important to bear in mind the possible functional consequences it may imply. Although PD is usually a benign asymptomatic condition, some patients may develop progressive neurological signs and symptoms caused by the expanded sinuses. We herein present the case of a 12-year-old boy who had been referred to the Ophthalmology Department, complaining of a progressive and painless exophthalmos of his left eye, developed during 1 year. The cause was unknown and there were no functional problems. Computed tomography and magnetic resonance showed a large pneumatized ethmoidal sinus and confirmed the resulting proptosis. We asked the Ear Nose and Throat (ENT) department for a further examination, and finally, the patient was taken to the operating room, where the left ethmoidal sinus was exposed to an endoscopic endonasal technique; in particular, a maxillary and frontal endoscopic antrostomy ethmoidectomy was performed. Excellent results were obtained and the patient had no complaints. Currently, he remains well after a 16-month postoperative period.

Introduction: The aim of our study is to describe the prevalence of the accessory ethmoidal artery in endonasal endoscopic cadaver dissections and to identify its intraorbital origin. Material and Methods: From 2018 to 2020, thirty-four nasal dissections were performed in seventeen adult cadaveric heads. We performed a complete ethmoidectomy to identify the ethmoidal canals. Then, we removed the bony canal and the lamina papiracea to verify the injected vessel and to confirm the vascular structure inside the canal. Results: We found the anterior ethmoidal canal (AEC) and the posterior ethmoidal canal (PEC) in 100% of nasal cavities (34/34). We identified 4 accessory ethmoidal canals (AcEC) in the 34 nasal fossae dissected (12%). All AEC contained an arterial vessel. The AcEC contained an arterial vascular structure in 2 cases, a neural structure in other specimen, and in the fourth case no structure could be verified. In 32 of 34 nasal cavities, the PEC contained an artery and only in 2 cases the PEC did not contain any vascular structure. In these specimens, we observed that the AcEC with an arterial vessel inside (6%) was closer to the posterior canal than the anterior canal. Conclusion: According to our findings, we can suggest that the presence of a canal does not necessarily imply the presence of an arterial vessel, and that presence of the accessory ethmoidal artery could be associated with the absence of posterior ethmoidal artery.

Mucormycosis, a rare fungal infection, mainly affects individuals with diabetes mellitus and those who were immunocompromised and has a high mortality rate. Its most common presentation is similar to that of acute bacterial sinusitis with symptoms of nasal congestion, headache, and fever. The involvement of multiple cranial nerves in mucormycosis was rarely reported in the literature and indicates severe disease. Herein, we report the case of a 56-year-old man who was referred to the ophthalmology outpatient clinic for facial nerve palsy. He was treated with systemic steroids for 10 days with no improvement. On examination, he had a loss of vision and a frozen orbit due to involvement of cranial nerves II, III, IV, V, VI, and VII. An extensive workup revealed a hemoglobin A1C of 10%. However, he was never diagnosed with diabetes mellitus previously and denied any of the classical symptoms of diabetes mellitus. He underwent ethmoidectomy, maxillectomy, and drainage of an intraorbital abscess after appropriate imaging studies. Histopathology confirmed the diagnosis of mucormycosis, and the patient was started on systemic amphotericin B. This case emphasizes the importance of screening for diabetes mellitus. Early recognition of underlying diabetes mellitus in this patient may have prevented the development of mucormycosis along with its devastating complications.

Objective: To investigate computerized tomography (CT) data of patients who needed revision surgery for chronic rhinosinusitis.Material and Methods: 83 patients who underwent revision endoscopic sinus surgery by the senior author due to recurrent and/or persistent chronic rhinosinusitis were included in this study. The following data were obtained from preoperative CT scans and recorded for each side of every patient: recurrent polyposis, incomplete uncinectomy, retained agger nasi cell, lateralization of middle turbinate, recirculation phenomenon, maxillary antrostomy stenosis, incomplete anterior and posterior ethmoidectomy, scarring at the frontal recess, sphenoid ostium stenosis, or novel onset sphenoid disease. Results: Based on our findings, septal deviation caused inadequate posterior ethmoidectomy, while incomplete uncinectomy increased the risk of frontal sinus disease. Conclusions: We suggest that septum deviation may cause insufficient visualization, while incomplete uncinectomy may prevent adequate intervention to the frontal sinus and these subsequently play a role in ESS failure.

A 65-year-old man with a history of sensorineural hearing loss and recurrent otitis externa presented with complaints of otorrhea, nasal congestion, and facial pressure. He was previously treated with two courses of antibiotics for his otitis. In addition, he was administering saline rinses, cetirizine, and fluticasone nasal spray; however, it is unclear if these therapies were targeted to sinonasal complaints as he had no documented history of allergic or rhinologic complaints beyond “mucinous nasal discharge.” Computed tomography (CT) imaging of his sinuses demonstrated mucosal thickening in the maxillary sinuses and opacification of the ethmoid and sphenoid sinuses. A recommendation was made for the patient to proceed with office-based endoscopic sinus surgery (ESS). The patient underwent bilateral ethmoidectomy, frontal sinusotomy, sphenoidotomy, and maxillary antrostomy in the office setting under local anesthesia; image guidance was not used. The ethmoidectomy was completed with Blakesly forceps and a microdebrider, while the maxillary, sphenoid, and frontal sinuses were addressed via balloon sinuplasty; placement of the balloon in the frontal sinus was reportedly confirmed by transillumination. The middle turbinates were avulsed with grasping forceps. No complications were noted intraoperatively and the patient was discharged to home from clinic.

A 65-year-old male with history of prior sinus surgery presented with persistent symptoms of sinus pressure and drainage. Following appropriate medical therapy, a preoperative CT scan showed an intact skull base. A planned left anterior ethmoidectomy, maxillary sinusotomy, and balloon frontal sinusotomy was performed. Confirmation of the wire entry into the frontal sinus was performed through forehead transillumination. The balloon was inflated to 12 cm H2O and immediately following deflation, clear fluid was seen in the anterior ethmoid. The lateral lamellar defect was then repaired using an overlay graft and the patient was admitted for conservative management of CSF leak. Postoperative CT scan demonstrated the location of the defect in the left cribriform (Fig. 21.1) [1].

A 56-year-old female presented to the Otolaryngology clinic with symptoms of chronic sinusitis. She was found to have nasal polyposis and purulent secretions draining from the middle meatus. After a course of medical therapy, she elected to proceed with surgical treatment of her disease. Computed tomography (CT) prior to surgery showed a thin lamina papyracea, but no obvious dehiscence on the left side. The patient underwent bilateral maxillary antrostomy, total ethmoidectomy, sphenoidotomy, and frontal sinusotomy. At the end of the procedure, all of the sinuses were irrigated. The frontal sinuses were irrigated with normal saline using a 60 cc syringe connected to a malleable, curved suction. Immediately following irrigation of the left frontal sinus, the patient was noted to have left-sided chemosis (Fig. 7.1). Manual massage of the orbit ensued and saline slowly emitted back into the superior ethmoid cavity through a small break in the lamina papyracea. Postoperatively, the patient denied vision changes or orbital pain. She was admitted for overnight observation. Her chemosis completely resolved 3 h postoperatively. She was discharged home the day after surgery and had no long-term sequelae of this complication.

A 41-year-old female with a history of allergic fungal rhinosinusitis underwent endoscopic sinus surgery (ESS) 2 years prior. A bilateral total ethmoidectomy, sphenoid, maxillary, and Draf IIb frontal sinusotomies were performed. Over the course of 2 years, the patient experienced progressive symptoms of frontal pressure and discolored thick secretions. On nasal endoscopy there was significant crusting and allergic mucin bilaterally requiring repeated debridements. The mucin was predominantly observed from the anterior ethmoid cavity and frontal recess area. There were also moderate polypoid changes throughout her sinus cavities. A non-contrast CT scan was performed revealing moderate mucoperiosteal thickening of her frontal and ethmoid sinuses with osteoneogenesis (Fig. 8.1). After failing multiple attempts at maximum medical therapy including high-volume irrigations, oral and topical corticosteroids (including budesonide), and culture-directed topical and oral antibiotics, revision surgery was advised. An extended sphenoidotomy, mega-maxillary antrostomies, and extended frontal sinusotomy (Draf III or modified Lothrop procedure) were performed to facilitate long-term debridements as well as the use of topical anti-inflammatory and antimicrobial management of the respective sinus cavities. During the surgery, dense allergic mucin, osteoneogenesis, and polypoid mucosa were present in all the sinuses. During the modified Lothrop portion of the surgery, the left anterosuperior orbital periosteum, in the area of the trochlea, was thinned with a cutting burr resulting in an inadvertent perirobita laceration. Mild bleeding in the tiny rent of torn periorbita was controlled with suction cautery followed by a topical 1:1000 adrenaline-soaked neurosurgical cottonoid.

Intranasal foreign bodies (FB) are a rare cause of chronic rhinosinusitis in adults. This report describes a unique case of bullet fragments embedded in the sphenoid bone and clivus for 34 years after a gunshot wound (GSW) to the face, leading to chronic rhinosinusitis. Recurrent acute infections were managed with antibiotics; however long-term cure required surgical intervention and removal of the largest bullet fragment. Surgery had been avoided on the patient for decades because of the proximity to critical neurovascular structures in the paracentral skull base, more specifically the sphenoid bone and clivus. Conservative endoscopic sinus surgery with left partial posterior ethmoidectomy and left maxillary antrostomy, followed by drilling of the sphenoid bone and clivus was performed to remove the FB. Bacterial cultures of surgical specimens revealed the presence of Proteus Mirabilis. The patient reported complete resolution of symptoms following surgery, which was maintained at six months follow-up. This case presents a patient with a metallic foreign body in the skull base for greater than 30 years. Removal of the retained metallic fragment addressed the patient's symptoms effectively. Despite the risks of the procedure related to the location of the foreign body, this case highlights the importance of addressing foreign bodies as underlying cause of chronic rhinosinusitis-like symptoms. Endonasal sinus surgery primarily for removal of a foreign body, also allows opening sinus outflow tracts and removing chronically infected bone and soft tissue.

Introduction and importance: Mucoceles are expansive pseudocystic formations, developed from the sinuses of the face, affecting mainly adults. Evolving at low noise, they are most often revealed by neurological or ophthalmological complications. We report a rare case of a bilateral frontal mucocele with orbito-cerebral extension following nasal sinus polyposis. Case presentation This was a 35-year-old patient with a history of Widal syndrome, who presented frontal headaches and left proptosis evolving for 4 months, in whom clinical examination revealed a left superomedial eyelid swelling, left proptosis and stage 2 nasosinus polyposis. Computed tomography and craniofacial magnetic resonance imaging were in favor of a bilateral frontal mucocele with left orbital and bilateral cerebral extensions. The patient was bilaterally operated by a combined approach including external Jacques eyebrow and endonasal Draf IIa procedure in addition to a radical total ethmoidectomy. The outcomes were favorable with regression of headaches and resolution of exophthalmos. Clinical discussion The frontal mucocele, although benign, has an aggressive potential in the absence of treatment either towards the endocranium or the orbit behind the orbital septum causing intra-orbital extension, or in front of it; causing the dominant upper palpebral form as in the case of our patient. The treatment is still based on surgical excision of the cyst with drainage of the causal sinus, which was carried out for our patient. Conclusion Despite its benign behavior, frontal mucocele may become serious by compression of neighboring organs which require an early and appropriate surgical management., Highlights • Mucoceles are rare benign sinus tumors of the frontoethmoid complex. • They rarely extend to the endocranial anatomical structures. • Imaging is of capital importance for its multidisciplinary management. • Surgery is the standard treatment of mucocele based on external and endonasal routes.

Anticipating the possibility of olfactory recovery after functional endoscopic surgery (FES) in nasal polyposis (NP) is difficult. The main objective of this study was to assess the predictive factors of recovering the sense of smell after radical bilateral ethmoidectomy. Secondary objectives were to identify other predictors of olfactory recovery. Open prospective study was conducted at the Nantes University Hospital including all patients with NP operated on in the Ear, Nose, and Throat Department between January 2011 and September 2017. These patients underwent functional endoscopic surgery (radical ethmoidectomy) after medical treatment failure. Olfaction was quantified prospectively and systematically during the preoperative consultation using a visual analog scale. Multivariate analysis evaluated the presence of predictive factors of postoperative olfactory recovery. One hundred nineteen patients were included in the study. Overall, olfaction was partially improved after surgery. For patients who presented greater than 50% recovery of olfaction after systemic corticosteroid therapy before surgery, we observed a predictive better rate of olfactory recovery after surgery (p

Background The impact of Staphylococcus aureus on onset of nasal polyposis has been the focus of numerous studies, but there have been few studies of other germs found in the ethmoid of operated patients or of their impact on post-operative results. Material and methods All patients undergoing endoscopic radical ethmoidectomy for nasal polyposis in the teaching hospital of Nantes (France) between 2006 and 2016 had intraoperative ethmoid cavity bacterial sampling. Phenotypic characteristics, pre- and post-operative symptoms and endoscopic findings were analyzed. Mann–Whitney tests and Kruskal–Wallis correlation analysis were used to assess clinical/bacteriological correlations. Objectives The main objective was to describe bacterial colonization of patients undergoing surgery for nasal polyposis, and to assess correlations with phenotypic features, functional results and postoperative clinical course. Results One hundred and seven patients were included. A total of 26% were not infected, 55% mono-infected and 19% multi-infected. In 27.3%, staphylococci were isolated; in 30.5%, isolates were gram-negative bacilli. There were no significant correlations between presence or type of pathogen and symptom profile. Conclusion This study confirmed the high rate of pathogenic bacteria in nasal cavities in case of polyposis, with high frequencies of S. aureus but also of gram-negative bacilli, raising the question of their involvement in the inflammatory reactions underlying the nasal polyposis.