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Rhinosinusitis
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
Anatomical variation may predispose a patient to isolated inflammation in only one of the sinuses as a post-obstructive phenomenon. CT scanning may identify anatomic variants such as an infra-orbital ethmoid cell, concha bullosa and narrow nasal cavity secondary to deviated nasal septum. Microbiology sampling of mucopus should be performed in conjunction with surgical drainage and aeration as medical therapy typically fails but these patients tend not to need any sustained post-operative medical treatment. In approximately 10% of these cases the cause will be odontogenic, and in unilateral cases an oral examination and a careful review of the maxillary sinus floor should be undertaken to look for signs of an oro-antral fistula. Involvement of oral maxillofacial surgery colleagues will be beneficial at an early stage where odontogenic aetiology is suspected to enable optimisation of management. In CRSwNP, ostiomeatal complex (OMC) obstruction may be a ‘barometer’ of overall disease burden, in that increasing Lund-Mackay scoring is associated with OMC involvement overall.
Reconstruction of skull base defects
Published in Jyotirmay S. Hegde, Hemanth Vamanshankar, CSF Rhinorrhea, 2020
Hemanth Vamanshankar, Jyotirmay S Hegde
Based on the greater palatine artery, this mucoperiosteal flap is harvested from the hard palate, and tunnelled through the greater palatine foramen into the nasal cavity. The possibility of an oroantral fistula formation as a complication should be taken into consideration.46,47
Rhinosinusitis: Definitions, Classification and Diagnosis
Published in John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie, Basic Sciences Endocrine Surgery Rhinology, 2018
Preceding events may include an allergic or viral exacerbation, leading to obstruction of the sinus ostia, with secondary bacterial infection. Depending on the attachment of the uncinate process, some cases may also involve the frontal and anterior ethmoid sinuses on that same side and endoscopy typically reveals a bulging uncinate process where the infection appears to be ‘walled-off’ in the anterior sinuses. Microbiology sampling of mucopus should be performed in conjunction with surgical drainage and aeration as medical therapy typically fails but these patients tend not to need any sustained post-operative medical treatment. In approximately 10% of these cases the cause will be odontogenic.66 Therefore, all unilateral cases should include an oral examination and a careful review of the maxillary sinus floor on the CT scan to look for signs of an oro-antral fistula.67 Involvement of oral maxillofacial colleagues will be beneficial at an early stage where odontogenic aetiology is suspected to enable optimization of management.68
Pediatric spontaneous tension pneumothorax in Langerhans cell histiocytosis
Published in Baylor University Medical Center Proceedings, 2021
Andrew L. Juergens, Archana K. Reddy, Matthew W. Fannell, Guy H. Grayson
Upon admission, the working differential diagnoses included cystic fibrosis vs LCH. Cystic fibrosis was deemed unlikely due to a normal newborn screen, the age of onset of pulmonary findings, and the severity of the pulmonary findings. An osseous survey was negative. Computed tomography of the mandible revealed periodontal osseous erosions of the mandibular molars and the base of tooth A, representing an oroantral fistula. Oral biopsies confirmed a diagnosis of LCH. The patient also had a bone marrow biopsy, extraction of nonviable teeth, and a port placed for chemotherapy. The oroantral fistula was closed with a tissue flap. Tissue and bone samples from the mandible and maxilla confirmed the diagnosis of LCH with positive S100 and CD1a immunostains.1 Bone marrow biopsies and magnetic resonance imaging of the brain showed no indication of disease. The patient began chemotherapy with vinblastine and prednisone. A chest x-ray on hospital day 9 revealed a resolved tension pneumothorax and the chest tube was pulled. He was discharged in stable condition.
Repair of oroantral fistula via modified endoscopic medial maxillectomy with free nasal mucoperichondrial-osteal graft
Published in Acta Oto-Laryngologica, 2019
Jiao Xia, Youxiang Ma, Hao Tian, Ruxiang Zhang
An oroantral fistula (OAF) is the chronic pathologic result of oroantral communication (OAC), characterised by epithelialisation between the oral cavity and the maxillary sinus [1,2]. OAF incidence varies, according to different studies, from 0.3 to 5% and increases after the age of 30 years [2]. The most frequent causes of OAF are procedures performed on the upper teeth, in particular, complicated teeth extractions [2,3]. Other causes include odontogenic sinusitis, maxillary dental cysts, tumours, radiotherapy sequela, and trauma [1–4]. Because OAFs are closely related with sinusitis, the cases are encountered in otorhinolaryngology departments.