Odontogenic rhinosinusitis and sinonasal complications of dental disease or treatment: prospective validation of a classification and treatment protocol

PURPOSE: Odontogenic sinusitis and sinonasal complications of dental disease or treatment (SCDDT) represent a heterogeneous group of conditions that often require multidisciplinary care. The present study aims to prospectively validate a classification and treatment protocol for SCDDT patients. METHODS: One hundred twenty-eight consecutive patients (73 females and 45 males, mean age 52.4 years) affected by SCDDT not responding to dental and medical therapy were classified and surgically treated according to the proposed protocol. The protocol classified patients into three aetiology-based groups (preimplantologic, implantologic, and related to traditional dental diseases and procedures, respectively). The groups were further divided into classes according to the presence of oro-antral communications and/or dislocated dental hardware. Each condition was treated according to the class-related, protocol-defined treatment, by either a transnasal or combined transnasal/transoral approach. All patients were successfully classified according to our protocol. None of the proposed classes were redundant, and no condition fell outside the definitions. RESULTS: The surgical treatment protocol proved to be adequate and effective, in that 125 of the 128 patients completely recovered after surgical treatment. CONCLUSIONS: The term SCDDT and the consequent classification proposed by the authors appear, therefore, to be nosologically correct. Furthermore, the protocol-related proposed treatment appears to be clinically sound, with a success rate nearing 98%

Retinal detachment after trans-scleral local resection of choroidal melanoma

Rhegmatogenous retinal detachment is one of the main complications of trans-scleral local resection of choroidal melanoma. Purpose. To determine the incidence and outcome of rhegmatogenous retinal detachment after trans-scleral local resection for choroidal melanoma. Methods. 67 patients with choroidal melanoma treated consecutively by choroidectomy (50) or cyclochoroidectomy (17) between 1993 and 1995 by a single surgeon (B.D.) were analysed prospectively. Results. Mean patient age was 48.5 yrs, tumour diameter was 13.1mm; tumour thickness was 8.4mm. 36% of tumours extended less than two disc diameters from disc or fovea and 52% extended anterior to ora serrata. Nine patients developed retinal detachment by the close of the study, with Kaplan Meier estimation showing a 14% actuarial rate at 93 days. Although Cox multivariate analysis did not identify any risk factors, the clinical impression is that the resections were technically difficult, because of optic disc involvement (1), extraocular extension (1), longstanding total exudative retinal detachment (1) and pathological tumour diameter more than 16mm (4). Vitreo-retinal surgery achieved anatomical success in 6/9 cases and by the close of the study the eye was retained in 7/9 cases. Conclusion. With appropriate surgical expertise, rhegmatogenous retinal detachment is an uncommon complication after trans-scleral local resection of choroidal melanoma, and can usually be treated successfully.link_to_subscribed_fulltex