Use of balloon catheter dilation vs. traditional endoscopic sinus surgery in management of light and severe chronic rhinosinusitis of the frontal sinus: a multicenter prospective randomized study

OBJECTIVE: Chronic rhinosinusitis (CRS) of the frontal sinus is a complex pathological condition and many surgical techniques were described to treat this area endoscopically, like traditional endoscopic sinus surgery (ESS) and balloon catheter dilation (BCD). PATIENTS AND METHODS: We designed a multicenter prospective randomized study to assess the validity and safety of BCD vs. ESS in symptomatological chronic rhinosinusitis of the frontal sinus enrolling a population of 102 adult patients (64 men and 38 women; overall 148 frontal sinuses studied) with non-polypoid CRS. For a better evaluation of the disease, in our study we decided to analyze both radiological (Lund-McKay CT scoring modified by Zinreich) and symptomatological results (SNOT-20 questionnaire). We divided the population affected in two groups, one with light/mild frontal CRS and the other with moderate/severe frontal CRS, basing on radiological findings at Lund-MacKay modified by Zinreich score. Every group was divided in two subgroups, in one we used BCD and in the other we used traditional ESS. RESULTS: The current literature does not support the suggestion that indications for BCD and ESS are identical, and additional research is needed to determine the role for BCD in specific patient populations. The results showed a not statistically significative difference between BCD and conventional ESS of the frontal sinus in patients with light/mild CRS and in patients with moderate/severe CRS at Lund-Mackay modified by Zinreich score. The same not statistically significative difference was observed comparing the results of SNOT-20 questionnaire in the group of light/mild frontal chronic rhinosinusitis. However, we noticed a statistically significant better outcome of SNOT-20 score in patients with moderate/severe chronic rhinosinusitis that underwent BCD of frontal sinus compared to ESS. CONCLUSIONS: BCD and ESS are two alternative weapons in the baggage of every endoscopic surgeon, even because they present similar outcomes, safeness and effectiveness both in light/mild and moderate/severe chronic rhinosinusitis of the frontal sinus. An interesting result of our study was the statistically significant better outcome of SNOT-20 score in patients that underwent BCD of frontal sinus for a moderate/severe CRS, compared to those that underwent a traditional ESS

Use of balloon catheter dilation and steroid-eluting stent in light and severe rhinosinusitis of frontal sinus: a multicenter retrospective randomized study

OBJECTIVE: Frontal sinus surgery has an increased rate of re-stenosis, if compared to other sinuses, that mainly depends on recurrent inflammation and abnormal scarring at the frontal recess; its reduction represents one of the keys of therapeutic success. Balloon catheter dilation (BCD) and implantable sinus stents/spacers represent strategies to improve sinus ventilation respecting the integrity of mucosa and reducing abnormal post-surgical scarring. The purpose of this study is to evaluate the effectiveness, safety and correct indication for the use of BCD and a non-absorbable stent (Relieva Stratus™ MicroFlow spacer) in the management of chronic rhinosinusitis (CRS) of the frontal sinus. PATIENTS AND METHODS: In this multicentric retrospective study we included a population of 76 frontal sinuses with non-polypoid CRS. Forty-one frontal sinuses were treated with BCD alone and 35 with BCD + Spacer. We analysed both radiological (Lund-McKay CT scoring modified by Zienrich) and symptomatologic results (SNOT-20 questionnaire) before surgery and after 12 months, dividing patients in two main groups: group “L” (light/mild frontal CRS) and group “S” (moderate/severe frontal CRS). RESULTS: Our results confirm a good safety and effectiveness of BCD in management of frontal CRS and show a good safety, although without significant effectiveness, of Relieva Stratus™ MicroFlow spacer when added to BCD in the management of light and severe frontal CRS. CONCLUSIONS: BCD is an option in management of frontal CRS; the use of stents/spacers could become a new and effective tool in management of CSR, both in addition to standard therapies and in patients where the use of systemic drugs is contraindicated

Pyocele of the middle turbinate

Pneumatization of the middle turbinate bone is a result of migration of ethmoid air cells. The accumulation of mucus when the ostium is blocked results in the formation of -a mucocele or, if superadded infection is present, a pyocele (empyema)

Complicated Onodi cell mucocele presenting with orbital apex syndrome; a case report and literature review

Mucocele is defined as the accumulation of mucus within a cystic structure lined by mucoperiosteum causing bone remodeling and erosion. The sphenoidal sinus mucoceles, due to its proximity to the optic nerve, can cause ocular complications. A50-year-old woman with a history of previous endoscopic nasal surgery (30 months ago), blurred vision, severe right-sided orbital pain since three weeks ago and severe unilateral headache was admitted. Mucocele related orbital apex syndrome due to the sphenoid sinus mucocele was diagnosed. The optic nerve was fully dehiscent and under compression. Paranasal sinus pathologies must be taken into consideration when a patient with the diagnosis of optic neuropathy and involvement of the superior orbital fissure is approached.

Flying through congested airspaces: imaging of chronic rhinosinusitis

The complex regional anatomy of the nose and paranasal sinuses makes the interpretation of imaging studies of these structures intimidating to many radiologists. This paper aims to provide a key to interpretation by presenting a simplified approach to the functional anatomy of the paranasal sinuses and their most common (and most relevant) variants. This knowledge is basic for the full understanding of chronic rhinosinusitis and its computed tomography (CT) patterns. As fungal infections may be observed in the setting of chronic rhinosinusitis, these are also discussed. Chronic sinus inflammation produces bone changes, clearly depicted on CT images. Finally, clues to suspecting neoplastic lesions underlying inflammatory sinus conditions are provided

Mucocele com reabsorção da parede do seio maxilar: relato de caso

Mucoceles are locally-expansive, slow-growing benign lesions that are generated from obstructed seromucous glands in the sinonasal mucosa. It has a cystic aspect and leads to sinus opacification. Patients usually present non-specific opacification and, in rare cases, enlarged mucoceles can lead to bone destruction through the compression of sinus surrounding bone walls. This report shows the case of a female patient without any clinical complaints who presented an evident opacification in her left maxillary sinus eroding the sinus wall, which was noticeable by means of panoramic radiograph, aside from maxillary sinus wall thinning and destruction, demonstrated through cone beam computed tomography examinations. The main diagnosis hypothesis was mucocele, as confirmed by the patient’s otolaryngologist. As the presence of any inflammatory disease in the maxillary sinus contraindicates sinus augmentation, the patient was referred to otorhinolaryngy treatment before implant rehabilitation.As mucoceles são lesões benignas localmente expansivas, de crescimento lento, que se desenvolvem a partir de glândulas seromucosas obstruídas na mucosa nasossinusal. Os pacientes geralmente apresentam radiograficamente opacificação inespecífica de aspecto cístico e, em casos raros, mucoceles de grandes proporções podem levar à destruição óssea, por meio da compressão do seio ao redor das paredes ósseas. Neste relato, é demonstrado um caso de uma paciente do gênero feminino, sem queixas clínicas, que apresentava evidente opacificação em seu seio maxilar esquerdo, erodindo a parede sinusal, observada inicialmente em radiografia panorâmica. Por meio da tomografia computadorizada de feixe cônico, notou-se afinamento e erosão da parede do seio maxilar. A principal hipótese diagnóstica foi mucocele, confirmada posteriormente pelo otorrinolaringologista da paciente. Como a presença de qualquer doença inflamatória no seio maxilar é uma contraindicação a cirurgias em soalho de seio maxilar, a paciente foi encaminhada para tratamento otorrinolaringológico antes da reabilitação com implantes