Rhinology
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The diagnosis of chronic rhinosinusitis (CRS) is clinical as it is based on patient symptoms. Sinus CT has been used as an objective measure of CRS with varying degrees of success and correlation to patient symptoms. ⋯ Patients were followed up for a mean of 2 years. Overall, there was a good or improved outcome in 81% of patients. Those with a positive CT did significantly well with surgical treatment.
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Review Case Reports
A Pott's puffy tumour as a late complication of a frontal sinus reconstruction: case report and literature review.
A Pott's Puffy Tumour (PPT) is a rare clinical entity, which, traditionally has been described as an acute abscess with periosteitis secondary to osteomyelitis of the external table of the frontal bone of the skull, complicating an acute frontal sinusitis. The aim of this article is to present a case of progressively evolving PPT, which emerged during the course of a common rhinitis, in a patient who, thirty years previously, had undergone a reconstruction of the frontal sinus involving osteosynthesis. ⋯ Frontal sinus obliteration was undertaken using methyl methacrylate, preferable in this case to hydroxyapatite, due to the direct communication with the neighbouring sinus cavities and the presence of defective bone in the superior orbit. A review of literature available on Medline up to January 2008 reveals that this is the third published case of PPT complicating a frontal reconstruction.
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Cerebrospinal fluid (CSF) leaks and meningoencephaloceles of the lateral recess of sphenoid sinuses are rare findings. A congenital bony defect in the lateral wall of sphenoid sinus called Sternberg's canal could be the origin of these lesions. Their endoscopic transnasal management is challenging though less traumatic than transcranial approaches. The aim of this study was to define Sternberg's canal as a potential source for these rare lesions and to describe their endoscopic endonasal management. ⋯ Persisting Sternberg's canal can be the source of spontaneous CSF-leaks and meningoencephaloceles in the lateral recess of sphenoid sinus especially when associated with extensive pneumatisation. Endoscopic management is technically challenging, nevertheless its advantages are a good view of the surgical field while being less traumatic than transcranial approaches.
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Case Reports
Intracranial abscess after anterior skull base defect: does pneumocephalus play a role?
Intracranial complications of skull base defects are uncommon; however, they can be devastating when they do occur. Often these complications arise suddenly and without warning. Identifying patients at risk for intracranial abscesses may help with early diagnosis and allow for early interventions. ⋯ Intracranial abscess formation, traumatic skull base defects, and massive pneumocephalus are uncommon entities, which may be associated. It may be prudent to have heightened suspicion for the presence of intracranial abscess formation in patients with massive pneumocephalus secondary to anterior skull base trauma.
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Arterial ligation remains a key option in the treatment of persistent epistaxis and clarification of the arterial configuration of the distal maxillary/sphenopalatine artery is important for understanding the rationale behind current surgical treatments. Greater understanding of the arterial anatomy will reduce the risk of technical failures and improve the reliability of surgical interventions for persistent epistaxis and will also be useful for surgeries involving the pterygopalatine fossa. ⋯ The arterial configuration of the maxillary artery in the pterygopalatine fossa can be complex but may be classified into one of three forms. Some configurations may be more liable to lead to difficulties with branch identification during surgical treatment of epistaxis particularly in combination with an inadequate osteotomy. Clinicians should expect to find more than one vessel exiting the sphenopalatine foramen and actively search for these during surgery. Asymmetry in the maxillary/sphenopalatine arteries is not common and contralateral ligations are not indicated.