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 11,717 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

An osteoplastic modification of the Caldwell-Luc operation is described. Starting from two small drill holes a quadrangular lid is cut out of the anterior wall of the maxillary sinus using the reciprocating micro-saw after Feldmann. This allows adequate access to the cavity as in the classic procedure. If required the window can be extended in the superior medial angle with rongeurs. After completing the operation within the cavity the osseous lid is reimplanted and fixed with 3 sutures of chromic catgut, which are threaded through small drill holes. By this prodecure prolapse of fat into the sinus is prevented, postoperative closure of the antral nasal window is less likely to occur, the bony structure of the maxilla is restored. Keeping of the reimplant presents no problem. Sequestration or other complications have not been encountered either in suppurative or in polypous sinusitis.
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PMID:[Osteoplastic operation of maxillary sinus (author's transl)]. 34 87

An 8-year-old boy suffered severe craniocerebral trauma with left-sided fronto-orbitobasal fracture. The CT scan showed minor subdural air inclusions. The child recovered well and had no clinical signs of aftereffects. Eight years after the accident, symptoms of intracranial pressure developed progressively with nuchal rigidity and elevated temperature. The CT showed an extensive left fronto-orbitobasal abscess. The intraoperative finding was a brain prolapse both into the frontal sinus and into the ethmoidal cavity with a large dura-bone defect at the site of the former fracture line, which was closed with refobacin-bone-meal fibrin sealant plasty and glued periostal patch. The postoperative course was unremarkable. Evidently, the accident had caused a brain prolapse into the bone defect, which prevented liquorrhea. Due to the lack of bone and dura barrier, a late brain abscess developed in the course of sinusitis. In such cases, primary surgical revision seems to be indicated.
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PMID:Late brain abscess years after severe cerebrocranial trauma with fronto-orbitobasal fracture. 273 50

Thirteen patients complained of recent fluctuating aching of one orbit, punctuated by stabbing pains. All had exquisite point tenderness over the trochlea and in half of the patients the pain was aggravated by eye movement. Standardized A-scan echography demonstrated swelling of the peritrochlear tissue and thickening of the superior oblique muscle with low internal acoustic reflectivity, typical of myositis. CT scan showed a soft tissue density in the region of the trochlea. Biopsy, performed on two patients, revealed peri-trochlear inflammation. In all patients the symptoms resolved within a period of weeks or months: indomethacin or naproxen were not effective, but oral or locally injected corticosteroids shortened the course compared to no treatment. None of the patients had ptosis, proptosis, Brown's syndrome, or a click, nor did they have echographic or radiographic signs of sinusitis or inflammation away from the trochlea. This probably represents a highly localized subtype of idiopathic orbital inflammation ("pseudotumor").
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PMID:Trochleitis with superior oblique myositis. 638 70

Thirty-one patients with sphenoid sinusitis were treated from 1978-1982. Twenty patients had infections contiguous with other paranasal sinus disease. Five of these patients had fungal sinusitis. Eleven patients were seen with isolated sphenoid sinusitis; 3 were secondary to trauma and 8 were due to nontraumatic causes. Possible etiologies include upper respiratory infections, developmental abnormalities, and water forced into the nasal cavity during swimming. The immunocompromised patient is more likely to present with minimal symptoms with a fungal infection, and aggressive diagnostic and therapeutic measures should be undertaken. Because the symptoms of headache, nasal stuffiness, proptosis, ptosis and decreased visual acuity may be interpreted as an intracranial, neurological, or vascular problem, a misdiagnosis may be made. A high index of suspicion for sphenoiditis should be maintained. Therapy involves a combination of medical (antimicrobial agent) and surgical (sinus drainage and marsupialization) management.
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PMID:Infectious diseases of the sphenoid sinus. 670 Mar 47

The Goodale-Montgomery osteoplastic obliterative frontal sinusotomy has been the ultimate resource in America for the most difficult and intractable cases of frontal sinusitis. This operation respects the integrity of the frontal floor and is based upon a concept with which the author disagrees: that the frontal sinus may be treated as an entity quite separate form the ethmoid. Macbeth, who does not obliterate, avails himself of the excellent transfrontal approach to the ethmosphenoids, but breaches the frontal floor in so doing. American surgeons have not followed his lead. The pros and cons of obliteration are discussed, reviewing relevant clinical and experimental data. The author believes that Macbeth's operation is more rational and effective than Goodale's. In an effort to utilize it and have the benefits of an obliterative technique, he employs a composite fat-fascia lata graft which prevents prolapse of fat down into nose and ethmoid. Three cases are briefly reported.
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PMID:Indications and methods for performance of osteoplastic-obliterative frontal sinusotomy with a description of a new method and some remarks upon the present state of the are of external frontal sinus surgery. 724 88

Six patients were treated for gradual onset of enophthalmos, a deep superior sulcus and globe ptosis. There was no history of orbital trauma or sinusitis. CT scan showed an opacified shrunken maxillary sinus with dehiscence and depression of the orbital floor and downward displacement of the orbital contents. Pathological review of the surgical specimens showed a respiratory mucosal lining with thick mucoid secretions, new bone formation, but no purulence. The etiology is thought to be maxillary sinus mucocele. Surgical treatment with an otolaryngologist consisted of a Caldwell-Luc procedure to evacuate the maxillary sinus with nasal antrostomy and an orbital floor exploration with insertion of a methylmethacrylate implant molded at the time of surgery to reform the orbital floor and reposition the globe. Follow-up of 2 1/2-4 years shows excellent functional and cosmetic results.
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PMID:Globe ptosis secondary to maxillary sinus mucocele. 874 16

A 15-year-old man was admitted because of diplopia and bilateral ptosis which occurred a few days after initial clinical signs, such as fever up, nausea, vomiting and headache. His pupils were anisocoric (Rt. phi 3.5 mm < Lt. phi 6.0 mm). In his left eye, light reflex was absent and its movements were limited in all directions. Brain MRI revealed the findings of paranasal sinusitis in bilateral ethmoidal and sphenoidal sinuses and swelling of bilateral cavernous sinus. Combination of intravenous antibiotic therapy and drainage improved his clinical symptoms and MRI findings. It was diagnosed as the inflammation originated in the sphenoid and ethmoid sinuses, which extended to the cavernous sinus and then involved III, IV, and VI cranial nerves. In conclusion, MRI was very useful to detect the cavernous sinusitis secondary to sphenoidal sinusitis.
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PMID:[A case of paranasal sinusitis-cavernous sinusitis with ophthalmoplegia externa]. 899 45

A 24-year-old woman presented with left-sided ptosis, diplopia, sensory impairment on the left side of her face and diminished hearing in her left ear. The neurological findings were hypo-anesthesia in all three divisions of the trigeminal nerve, left-sided facial paralysis of the oculomotor and abducens nerves. Initially the condition was misdiagnosed as maxillary sinusitis and was treated with antibiotics. It seems that this presentation has not been previously described in commonly read English-language journals. In our case, the tumour was removed totally and the neuropathological diagnosis was schwannoma. The case report describes the presentation, investigations, management and outcome in this patient.
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PMID:Giant schwannoma of the trigeminal nerve misdiagnosed as maxillary sinusitis. A case report. 942 30

Intracranial complications from isolated sphenoid sinusitis are rare but nevertheless demonstrate both a high morbidity and mortality. We herein report a case of a pituitary abscess secondary to sphenoid sinusitis in a 12-year-old boy. This patient presented with an acute onset of moderate fever and headache, followed by progressive right ptosis. An emergency endoscopic endonasal sphenoidotomy with sinus drainage and postoperative antibiotic therapy resulted in a satisfactory recovery.
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PMID:Pituitary abscess secondary to isolated sphenoid sinusitis. 1066 27

A 34-year-old man developed fever, headache, nausea, double vision, exophthalmus, ptosis, disturbance of vision and oculomotor nerve palsy. Magnetic resonance imaging and cerebral angiography led to the clinical diagnoses of cavernous sinus thrombophlebitis and suspicion of bacterial aneurysm of the left internal carotid artery, respectively. Peptostreptococcus was detected in blood culture analysis. He died 15 days after admission. Systemic organs showed several septic changes. In particular, the bilateral cavernous sinuses were enlarged and showed severe neutrophilic leukocyte infiltration of the walls and organization, recanalization and abscesses in thrombi. In anterior to the middle cranial fossa, abscess-forming, necrotic, hemorrhagic meningitis, purulent sphenoid sinusitis, pyogenic osteomyelitis of the sphenoid bone, suppurative encephalitis, and inflammatory necrosis of the hypophysis were seen. Based on these findings, we diagnosed the patient with cavernous sinus thrombophlebitis caused by sphenoid sinusitis.
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PMID:Cavernous sinus thrombophlebitis caused by sphenoid sinusitis--report of autopsy case. 1143 Apr 92


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