Ethmoid Research Articles

Cavernous sinus thrombosis due to mucor infection of ethmoid sinus

Cavernous sinus thrombosis due to mucor infection of ethmoid sinus

Sex-Based Differences in Frontal Sinus Anatomy: A Cross-Sectional Study

Within the frontal bone of the skull, directly above the eyebrows and behind the forehead, lies an air-filled chamber known as the frontal sinus. Objectives: To investigate sex-based differences in frontal sinus anatomy, including measurements such as height, width, and area. Method: This cross-sectional study was conducted at the Department of Anatomy, Women Medical and Dental College, Abbottabad from January 2023 to December 2023. A total of 300 participants were (N = 300). The participants were divided into two groups: 160 men and 140 women. The participants were physically examined using a radiological process. Results: The female and male mean age of 35.2 ± 18.5 years. The right and left side areas of the frontal sinus were significantly higher in males 77.7% and 82.8%, respectively; p = 0.0001) than in females. Males had a significantly greater height (73.3%) and 75.9 % (p = 0.0001) than females on both sides. It was shown that the right and left side widths in males 79.6% and 74.4% significantly higher, p = 0.0001 as compared to females. Males had more supra agger frontal cells and supraorbital ethmoid cells (78.1% and 81.2%, respectively; p < 0.0001). Conclusions: It was concluded that males have larger frontal sinuses in terms of height, width, area, and ethmoid air cell count than females. These results indicate that males have larger and more developed frontal sinuses than females.

The Morphometric Analysis of the Ethmoid Roof for Endoscopic Sinus Surgery With Multidetector Computed Tomography.

Most potential major complications in endoscopic sinus surgery are related to the ethmoid bone. To prevent complications, it is necessary to define the concept of a "dangerous ethmoid." The coronal multidetector computed tomography (MDCT) scans of a total of 271 patients, including 101 patients under 18 years old and 170 patients over 18 years old, were examined. For each patient, the depth of the olfactory fossa (DOF), the width of the olfactory fossa (WOF), the angle between the lateral lamella and the cribriform plate (LLCPA), the length of the lateral lamella (LLL), the distance between the nasal floor and the ethmoid roof (NFERL), and the width of the olfactory cleft (WOC) were recorded. The Keros and Gera types were determined. NFERL was found to be significantly higher in males across all age groups. WOC was significantly higher in males only under 18 years old. Only LLCPA was found to be significantly higher on the right side in both sexes. It was determined that NFERL increased with age, while WOC increased with age until 18. Keros type III and Gera type C, which are called dangerous types, were detected in 28 and 24 cases in total, respectively. The data obtained from significant anatomical landmarks in pediatric and adult cases provide useful information about the region in preoperative planning. The analysis results of the prevalence of Keros and Gera classifications allow the identification of high-risk anatomical conditions within the ethmoid.

Maxillary Antrostomy Versus Complete Sinus Surgery for Odontogenic Sinusitis With Frontal Sinus Extension.

Endoscopic sinus surgery (ESS) is often necessary when managing odontogenic sinusitis (ODS), but ESS extent for ODS with extramaxillary sinus involvement has been incompletely studied. This study compared outcomes after wide maxillary antrostomy (MA) alone versus complete ESS for ODS with frontal sinus involvement. A multicenter prospective cohort study was conducted on patients with uncomplicated ODS (no extrasinus spread) who underwent ESS when computed tomography demonstrated maxillary, anterior ethmoid (AE), and frontal sinus opacification. Multiple preoperative and postoperative variables were recorded, including 22-item sinonasal outcome tests (SNOT-22) and endoscopic findings. Ultimate SNOT-22 and endoscopic resolution, and time to SNOT-22 and endoscopic resolution were compared between patients who underwent MA alone versus "complete" ESS (maxillary, ethmoid, frontal; not sphenoid). Of 70 patients, mean age was 59.2 years, and 55.7% were male. Thirty-five underwent MA alone, and 35 had complete ESS. At first postoperative visits (mean 9.3 days), AE sinus purulence was more likely resolved after complete ESS compared with MA (97.1% vs. 71.4%, p = 0.006). However, time to resolution of AE purulence was comparable by 6 weeks postoperatively (p = 0.158). There were no significant differences in times to foul smell resolution and achieving ≥9 point SNOT-22 reduction (p > 0.05). For ODS with frontal sinus involvement, MA alone and complete ESS both resulted in rapid and long-term symptomatic resolution. While ultimate resolution of sinus purulence was equivalent between surgery groups, complete ESS did lead to faster resolution of frontoethmoidal purulence in a significant number of cases. 2 Laryngoscope, 2024.

Automatic personal identification using a single CT image.

Computer vision (CV) mimics human vision, enabling computers to automatically compare radiological images from recent examinations with a large image database for unique identification, crucial in emergency scenarios involving unknown patients or deceased individuals. This study aims to extend a CV-based personal identification method from orthopantomograms (OPGs) to computed tomography (CT) examinations using single CT slices. The study analyzed 819 cranial computed tomography (CCT) examinations from 722 individuals, focusing on single CT slices from six anatomical regions to explore their potential for CV-based personal identification in 69 procedures. CV automatically identifies and describes interesting features in images, which can be recognized in a reference image and then designated as matching points. In this study, the number of matching points was used as an indicator for identification. Across six different regions, identification rates ranged from 41/69 (59%) to 69/69 (100%) across over 700 possible identities. Comparison of images from the same individual achieved higher matching points, averaging 6.32 ± 0.52% (100% represents the maximum possible matching points), while images of different individuals averaged 0.94 ± 0.15%. Reliable matching points are found in the teeth, maxilla, cervical spine, skull bones, and paranasal sinuses, with the maxillary sinuses and ethmoidal cells being particularly suitable for identification due to their abundant matching points. Unambiguous identification of individuals based on a single CT slice is achievable, with maxillary sinus CT slices showing the highest identification rates. However, metal artifacts, especially from dental prosthetics, and various head positions can hinder identification. Radiology possesses a multitude of reference images for a CV database, facilitating automated CV-based personal identification in emergency examinations or cases involving unknown deceased individuals. This enhances patient care and communication with relatives by granting access to medical history. Unknown individuals in radiology or forensics pose challenges, addressed through automatic CV-based identification methods. A single CT slice highlighting the maxillary sinuses is particularly effective for personal identification. Radiology plays a pivotal role in automated personal identification by leveraging its extensive image database.

Impaired Coordination of the Ciliary Movement in Patients with Chronic Rhinosinusitis with Nasal Polyps: The Role of Decreased Planar Cell Polarity Protein Expression

The planar cell polarity (PCP) of epithelial ciliated cells is essential for effective mucociliary clearance (MCC) in the sinonasal mucosa. We hypothesize that MCC coordination is impaired in nasal polyp (NP) mucosae due to the suppressed expression of a series of CPLANE (ciliogenesis and planar cell polarity effector) complex proteins in chronic rhinosinusitis (CRS) patients. To investigate this hypothesis, we subjected sinonasal mucosal samples to live video recording to measure mucociliary transport velocity (MCTV) and scanning electron microscopy to evaluate surface morphology. The expression and distribution of a panel of PCP proteins, e.g., WDPCP and FUZ, were investigated in relation to inflammatory cytokine levels and clinical features. The mean MCTV of NP mucosae was significantly lower than that of the inferior turbinate mucosae. The CRS group with NPs (CRSwNP group) (n = 28) showed increased expression of IL-13 and CCL26 mRNA compared to CRS patients without NPs (n = 25) and controls (n = 30). WDPCP and FUZ mRNA levels were significantly decreased in NP mucosae compared to ethmoid sinus mucosae in CRSwNP patients. WDPCP protein distribution was reduced in the cytoplasmic region of ciliated cells in CRSwNP patients. We conclude that suppression of WDPCP in ciliated cells is responsible for the impaired MCC of nasal polyps with type-2 inflammation. This mechanism might explain the decreased clearance and the potential for worsening symptoms of CRSwNP.

Retrospective Study on the Prevalence of Haller Cells Using Cone Beam Computed Tomography.

The paranasal sinuses are cavities filled with air located within specific bones, namely the frontal, ethmoidal, maxillary, and sphenoidal sinuses. The ethmoidal sinus is composed of three groups: anterior, middle, and posterior, which are found on both sides. Haller cells (HC), also known as infraorbital ethmoid cells, are projections of the anterior ethmoid sinus that extend into the floor of the orbit and the upper part of the maxillary sinus. Infraorbital ethmoid cells have been associated with several disease conditions and symptoms, such as sinusitis, headaches, orofacial pain, and mucoceles. Consequently, determining the frequency and form of HC is crucial. The objective of the study was to determine the frequency, form, and clinical significance of Haller cells (HC) using cone beam computed tomography (CBCT). This retrospective study analyzed 100 cone beam computed tomographic (CBCT) images, with an equal distribution of 50 males and 50 femalesfrom the age range of 19 to 70 years. The images were randomly selected from the CBCT archives. The participants were chosen according to the specific criteria for inclusion and exclusion established for the study. The collected data were subjected to statistical analysis utilizing the Chi-square test, independent student t-test, one-way ANOVA test, Cohen's Kappa statistics, and intraclass correlation coefficients. The occurrence of Haller cells (HC) was found to be 73%, with 32 cases observed in males and 41 in females. Among the 73 patients with HC, 52 (71%) had unilateral HC, while 21 (28.76%) had bilateral HC. Regarding the shape of the HCs, 31 (42.46%) were teardrop-shaped, 26 (35.61%) were oval-shaped, and 16 (21.91%) were round-shaped. Additionally, out of the 73 cases of HC, 69 (94.52%) were unilocular, and four (5.47%) were multilocular. Furthermore, the average dimensions of HC were greater in males than in females, regardless of whether the cells were distributed unilaterally or bilaterally. The interobserver agreement between observers one and two showed complete consistency, and our study found that the assessment of the dimension of HC had outstanding interrater reliability. The findings of this study indicate that CBCT is highly effective in visualizing and accurately delineating Haller cells in a significant number of patients. It is essential for oral physicians and oral radiologists to be aware of these anatomical structures to accurately identify them. This awareness will enable them to provide a comprehensive differential diagnosis for individuals experiencing orofacial pain and discomfort that may be attributed to the presence of Haller cells.

Rostral cranial fossa and sinonasal neoplasms with cribriform plate involvement in 32 dogs and 17 cats.

The rostral cranial fossa (RCF) consists of the sphenoid and ethmoid bones, which accommodate the olfactory bulbs and nerves along the recesses of the cribriform plate. Neoplasms located in the vicinities of the RCF can compress and/or invade the cribriform plate. Here we describe the clinical and pathologic findings of neoplasms involving the cribriform plate in 32 dogs and 17 cats autopsied over a 13-y period. The average ages of affected dogs and cats were 9.2 y and 9.7 y, respectively. No sex or breed predisposition was evident in dogs, but 13 of 18 cats were spayed females and 14 of 18 were domestic shorthair cats. The main clinical signs were seizures (10 cases) and epistaxis (5 cases) in dogs, and red-to-brown nasal discharge (5 cases) and seizures (4 cases) in cats. In dogs, the 22 sinonasal neoplasms included adenocarcinoma (14 cases), transitional carcinoma (4), squamous cell carcinoma (2), lymphoma (1), and histiocytic sarcoma (1); the 10 intracranial neoplasms consisted of high-grade gliomas (3 cases), psammomatous meningiomas (2), histiocytic sarcomas (2), olfactory neuroblastomas (2), and a meningeal granular cell tumor (1). In cats, the 14 sinonasal neoplasms included lymphoma (8 cases), adenocarcinoma (4), adenosquamous carcinoma (1), and squamous cell carcinoma (1); the 3 intracranial neoplasms consisted of oligodendroglioma (1), transitional meningioma (1), and olfactory neuroblastoma (1).

Technical Quality of Contemporary Endoscopic Sinus Surgery: An Assessment by Study of Anatomical Features Needing Attention at Revision Surgery

Although technical causes of endoscopic sinus surgery (ESS) failure have long been reported, we were curious about the quality of contemporary sinus surgery. The electronic health database of Mayo Clinic, Arizona was scrutinized to identify adult patients with diffuse chronic rhinosinusitis (CRS) who underwent revision ESS between January 2019 and September 2023 with a history of bilateral full-house ESS. Anatomical features on preoperative radiology and intraoperative endoscopy were cataloged: residual uncinate tissue, maxillary antrostomy with a non-incorporated natural os, residual ethmoidal septations (three septations > 3 mm), and inadequate sphenoid osteotomy (os size < 6 mm). Sixty-nine subjects were identified. A deviated nasal septum was present in 53.6%. Residual uncinate tissue was noted in 50.7% of patients associated with missed natural maxillary os in 39.13% of antrostomies. An inadequate os diameter was noted in 63.8% of sphenoidotomies. Significant residual septations were seen in posterior ethmoidal cells in 66.7% and anterior ethmoidal cells in 62.3% of patients. Residual frontoethmoidal cells were noted in 72.4% of patients. Although the extent of ESS must be individualized, a high prevalence of features reflecting suboptimal surgery that could limit the success of ESS was identified. These findings merit further consideration for focused training during residency and continuous professional development activities.

A computerized tomography-based study of anatomical variations of the ethmoidal uncinate process

Background: The uncinate process is very relevant with respect to the ventilation and drainage of the frontal, maxillary and anterior ethmoid sinuses in the osteomeatal complex. Aims and Objectives: The study was conducted with the aim to examine and assess various patterns of upper attachment of the ethmoidal uncinate process. The secondary objective of the study was to study the incidence of pneumatization of the uncinate process. Materials and Methods: With the objective to study the various patterns of upper attachment of the uncinate process, the study was conducted at the Department of Ear, Nose, and Throat (ENT) Head and Neck Surgery, at Government Medical College, Doda, J and K, India. The period of study was from November 2020 up to November 2021. The study involved 100 patients who had presented to the ENT outpatient with nasal and or sinus-related complaints. Results: The study included 58 males and 42 females. Among the various patterns, it was the type-2 pattern of the uncinate attachment that was the most prevalent (42%). This was followed by a type-1 pattern (attached to the lamina papyracea) (16%) and then a type-6 pattern (14%). Type-3 in 4%, type-4 in 3%, and type-5 in 7%. In 14% of the cases, there was no upper attachment of the uncinate process. The pneumatization of the uncinate process was noted among 42 of the uncinate processes that we studied. The pneumatization was unilateral in 41% and bilateral in 59% of the uncinate process. The patients with a pneumatized uncinate process had more severe clinical presentation. Conclusions: A thorough computerized tomography scan assessment of the attachments of the uncinate process and its variations aids in minimizing damage to the related landmarks during the surgery and helps minimizing the chances of iatrogenic trauma to the nasolacrimal duct, medial orbital wall, and other surrounding structures. It can also assist in figuring out the likely cause of refractory sinusitis.

Centripetal endoscopic sinus surgery in rhinogenic headache

ObjectivesThe aim of this manuscript is to analyse a diagnostic protocol to select correctly patients with Rhinogenic Headache Contact Point (RH) and to investigate the effect of surgical treatment and medical therapy in pain relief. MethodsA prospective no-randomized study selected adult patients with headache and nasal alteration at CT exam or endoscopic vision with positive response to test with nasal spray with corticosteroids and antihistamine or/and local anesthesia test to the contact points. MIDAS score, intensity score, daily duration of symptoms, frequency of headache in the last month were collected in patients who performed surgery and in patients who performed medical therapy. ResultsFollowing the inclusion, 415 patients were selected for this study. 302 patients performed nasal surgery (septoplasty, turbinoplasty and/or endoscopic surgery with centripetal technique), 113 performed medical therapy. There was a statistically significant improvement in MIDAS score, intensity score, daily duration of symptoms, frequency of headache in the last month in patients who performed surgery and in patients who performed medical therapy. Regarding the comparison between patients who performed surgery (Group A) and patients who performed only medical therapy for RH (Group B), better outcomes were obtained by Group A. Considering the daily life handicap index, the lowest handicap was obtained in Group A. ConclusionThis study demonstrates that surgery, using in some cases centripetal technique, gives an improvement statistically significant than medical therapy in RH. The use of nasal spray with corticosteroids and with anti-histamine is a good method in the diagnosis of RH, especially in patients with anatomical variants such as concha bullosa, agger nasi cells and Haller cells.

Exploring the age and gender-based distribution of paranasal sinus osteomas using cone beam computed tomography: A retrospective cross-sectional study

ObjectiveThe objective of this study is to explore the prevalence, size, location and radiographic features of osteomas in the paranasal sinuses using cone beam computed tomography imaging. Study designThis study was planned as retrospective cross-sectional. 499 consecutive cone beam computed tomography scans obtained in a dentomaxillofacial radiology department for various dental indications. Statistical analysis of all data was done with SPSS version 22. Descriptive statistics and chi-square tests were used to determine the prevalence of categorical parameters. ResultsOsteoma was detected in 7 % (n = 35) of the 499 images analyzed. The age of the patients ranged from 6 to 96 years (mean 42.03 ± 18.70). No significant difference was found between the genders (p = 0.77). In terms of localization, it was significantly more common in the ethmoid sinuses (p < 0.01). Cortical type osteoma was observed the most frequently in the analyzed images (p < 0.01). The incidence of osteoma was not significant depending on age (p = 0.50). ConclusionOsteomas in the paranasal sinuses show a 7 % prevalence in CBCT images, with the ethmoid sinus being the most common site. The average size of osteomas was 3.43 ± 1.78 mm, predominantly cortical in type. These findings highlight the necessity for thorough examination of CBCT images by dentomaxillofacial radiologists to avoid overlooking osteomas.

Posterior Ethmoid Sinus Mucocele Complicated With Oculomotor Nerve Dysfunction.

Posterior Ethmoid Sinus Mucocele Complicated With Oculomotor Nerve Dysfunction.

Computed Tomography Signs of Sinonasal Inflammation in Patients with Acute Dacryocystitis.

Nasal and paranasal sinus abnormalities may be related to nasolacrimal duct obstructive disease but are strongly debated. Data of acute disease stage are lacking. The purpose of this study was to determine if there are correlations between radiologic signs of sinus inflammation and acute dacryocystitis (AD). This cross-sectional controlled study was conducted at Wenzhou, Zhejiang Province, China from February 2021 to November 2023. Forty-four consecutive patients with AD and 50 consecutive patients with orbital tumors (the control group), who completed preoperative computed tomography scans, were enrolled to evaluate the extent of their inflammatory sinonasal disease by the modified Lund-Mackay score system. The inflammation signs of the paranasal sinuses (total mean sinus scores, 95% CI [0.00, 2.00]; P < 0.001), namely the anterior ethmoid sinus(95% CI [0.00, 1.00]; P < 0.001), the posterior ethmoid sinus(95% CI [0.00, 0.00]; P = 0.003), the frontal sinus (95% CI [0.00, 0.00]; P = 0.02), and the ostiomeatal complex (P < 0.001) were more extensive in patients with AD when compared with the controls. The disease course was negatively correlated with the anterior ethmoid (P = 0.03) and frontal scores (P = 0.01). The symptom of eyelid swelling was positively correlated with the anterior ethmoid (P = 0.03), ostiomeatal complex (P = 0.004), and total sinus scores (P = 0.005). Inflammatory sinus disease was found to be more frequent in patients with AD, which was gradually alleviated with the prolongation of the disease course. The mutual spread of inflammation particularly in the acute course may play an important role in lacrimal duct obstructive disease.

Treatment of Sinonasal Teratocarcinosarcoma: A case report

AbstractSinonasal teratocarcinosarcoma (SNTCS) is a rare malignancy characterized by a highly aggressive nature. It mainly arises in the ethmoidal or maxillary sinus. SNTCS has a poor prognosis, with a mean survival rate of 55% at 2 years. Herein, we presented a case of advanced SNTCS successfully treated with surgery followed by chemoradiotherapy plus targeted therapy and reviewed the published literature on this rare entity.

Primary Frontal Sinus Carcinoma: A Case Report

Primary frontal sinus carcinoma is rare, with an incidence of 0.3-1% of all paranasal sinus carcinomas. We present an 84-year-old woman who, about a month ago, developed erythema and edema of the skin of the upper eyelids and glabella, accompanied by eye discharge and slight tenderness to touch. We performed an X-ray and CT examination of paranasal cavities that found no pathological changes. The patient underwent several consultations and treatments from different specialists without any effect. Due to the growth of edema and the formation of a dense lesion at the base of the nose and frontal sinus, a repeat CT examination of the paranasal cavities was performed, which established the presence of a soft tissue oval lesion frontally in the area of the glabella with dimensions of 38/36/40 mm, which infiltrates and lyses the upper part of the right nasal bone, anterior ethmoid cells, medial wall of the right orbit, and anterior wall of the frontal sinus. The patient was referred to an otorhinolaryngology clinic, where a diagnosis of low-differentiated squamous cell carcinoma was made with the help of a biopsy and immunohistochemical examination. Due to the judgment of inoperability, definitive large-fractionated percutaneous radiotherapy was performed. The presented case illustrates the need for broad differential-diagnostic thinking in cases with edema in the head region.

Blood eosinophilia and a higher ethmoid sinus/maxillary sinus score ratio predict new-onset asthma in patients with chronic rhinosinusitis with nasal polyps

Backgroud Presently, the impact of Chronic rhinosinusitis with nasal polyps (CRSwNP) on asthma onset is unknown. Aims To evaluate the role of CRSwNP in asthma onset. Materials and Methods A total of 3107 CRSwNP patients were retrospectively screened from 1 January 2018, to 31 May 2021; 624 patients were enrolled. Clinical data regarding nasal symptoms, Lund-Mackay scores, blood eosinophil percentage, and onset of asthma were analyzed. Patients were divided into different groups according to past history of nasal polyps, Lund-Mackay score, and the extent of blood eosinophilia. Asthma-free rates between these subgroups were analyzed by Kaplan–Meier curves and Cox regression models. Results The prevalence of asthma was 10.90% in patients with CRSwNP, and new-onset asthma occurred in 3.14% of these patients. Higher Lund-Mackay scores for ethmoid sinus and maxillary sinus (E/M) and blood eosinophil percentages were two independent risk factors for new-onset asthma, with hazard ratios of 1.267 (95%CI, 1.155–1.390) and 1.224 (95%CI, 1.054–1.422), respectively. CRSwNP patients with an E/M ratio > 2.33 or a blood Eos percentage > 5.5% were at risk for asthma onset. Conclusions and significance Blood eosinophilia and a higher E/M score ratio were associated with new-onset asthma in patients with CRSwNP.

ОСОБЕННОСТИ СТРОЕНИЯ СКЕЛЕТА ГОЛОВЫ АЗИАТСКОГО (БЕЛОХВОСТОГО) ДИКОБРАЗА (HYSTRICIDAE LEVICURA)

The purpose of research is to study the structural features of the head skeleton of the Asian (white-tailed) porcupine. The object of the study is the skeleton of the head of an Asian (white-tailed) porcupine at the age of 12 years. To make the porcupine skeleton, a biological method of processing the material was used. The study of the bones was accompanied by measuring their length and width using an electronic caliper with an accuracy of 0.1 mm, describing and photographing. The head skeleton of the Asian (white-tailed) porcupine is divided into cerebral and facial sections, the size of which is related to the size of the brain and the development of the masticatory apparatus. The brain region is represented by unpaired (occipital, sphenoid, interparietal, ethmoid) and paired (temporal, frontal, parietal, alar) bones. The facial region is represented by the maxillary, incisive, palatine, zygomatic, lacrimal and nasal bones. The rostral edge of the orbit serves as the boundary between the facial and brain regions. The facial section reaches the greatest development, occupying 59.8 % of the length of the brain. The configuration of the skull and the presence of a large number of processes make it possible to attach well-developed masticatory muscles to it. The caudal part of the skull is represented by the occipital bone, and the cranial part by the ethmoid bones. The body of the occipital bone is connected to the sphenoid bone, which participates in the formation of the foramen lacerum. The body of the sphenoid bone is trapezoidal in shape, from which the orbital and temporal wings branch. There are six foramina on the orbital wing: optic, orbital fissure, round, caudal alar, oval and carotid. The temporal wing is involved in the formation of the foramen lacerum with the oval, spinous and carotid notches. On the facial surface of the maxillary bone there is a facial ridge; between its facial and nasal surfaces there is an extensive maxillary sinus. The mandibular bone is paired, represented by two bones connected to each other by a ligament. The massive, triangular-shaped lower jaw has two processes: the condylar and the coronoid. The condylar process is convex, oval-elongated. The coronoid process is low with a bifurcated apex. The pterygoid and chewing fossae are deep and triangular in shape.

Radiological differentiation between bacterial orbital cellulitis and invasive fungal sino-orbital infections

PurposeInvasive fungal orbital infections (IFOI) may be difficult to differentiate from sinogenic bacterial orbital cellulitis (OC). This study investigates the features differentiating OC from IFOI on magnetic resonance imaging (MRI).MethodsRetrospective study of adult patients with sinogenic OC and IFOI with pre-intervention MRI. Patients without post-septal involvement, non-sinogenic OC (e.g.: secondary to trauma) and poor-quality scans were excluded. Independent Sample’s t test and Fisher’s exact test were conducted with p < 0.05 deemed statistically significant.ResultsEleven cases each of OC (Mean age: 41.6 ± 18.4 years-old, Male: 10) and IFOI (Mean age: 65.0 ± 16.6 years-old, Male: 9) between 2006 and 2023. IFOI patients were older, more likely immunocompromised and had a lower mean white-cell count (p value = 0.005, 0.035 and 0.017, respectively). The ethmoid and maxillary sinuses were most commonly involved in both entities. Pre-septal and lacrimal gland involvement were more common in OC (p = 0.001 and 0.008, respectively). Infiltrative OC orbital lesions were poorly demarcated, whilst those in IFOI were expansile/mass-like invading the orbit from the adjacent paranasal sinuses. Specific IFOI features included loss-of-contrast-enhancement (LoCE) of paranasal sinus tissues with orbital extension. Extra-orbital and -sinonasal extension indicative of IFOI included contiguous skull base or pterygopalatine fossa involvement, retro-antral and masticator space stranding and vasculitis.ConclusionThis study describes the key MRI features of IFOI including differentiating markers from OC. These specific features, such as LoCE of the paranasal and orbital soft tissues, the location and pattern of contiguous soft-tissue involvement, provide expedient identification of IFOI which necessitate early surgical intervention for microbiological confirmation of an invasive fungal pathology.

Clinical analysis of cases of otogenic sigmoid sinus thrombosis in children

Objective:To analyze the clinical characteristics of middle ear mastoiditis combined with sigmoid sinus thrombophlebitis in children. Methods:Author retrospectively analyzed the clinical data of 6 children with middle ear mastoiditis combined with sigmoid sinus thrombophlebitis who were hospitalized in the Department of Infectious Diseases and Department of Neurology with first diagnosis of fever/headache, and subsequently underwent middle ear mastoidectomy in our department. All patients underwent comprehensive otoscopic, audiologic, imaging, and pathogenetic examinations. Clinical manifestations, pathogenetic features, treatment methods and prognosis were summarized, and the follow-up period was 3-6 months. Results:All 6 cases were first diagnosed with intracranial complications such as fever and headache in the internal medicine department. Within one month, all patients developed ear symptoms including pain, discharge, and hearing loss. Audiologic examination revealed conductive hearing loss in five cases and total deafness in one case. MRI, MRV and MRA examinations suggested that there were 6 cases of middle ear infection combined with thrombophlebitis of the ethmoid sinus, of which 3 cases had thrombus in the ethmoid sinus. 6 cases received surgical treatments: 2 cases of radical mastoidectomy+grommet Insertion, and 4 cases of radical mastoidectomy. Pathogenetic examination identified Streptococcus pneumoniae in three cases, Pseudomonas aeruginosa in one case, Enterobacter cloacae complex in one case, and no pathogens were detected in one case. Postoperative pathology was inflammatory granulation in all 6 cases. Follow-up was 3-6 months with no recurrence of intracranial and middle ear lesions on regular review. Conclusion:Children with recurrent fever, headache, and a recent history of acute and chronic otitis media should be evaluated for the possibility of sigmoid sinus thrombophlebitis, and imaging tests should be performed in a timely manner to clarify the diagnosis. Once diagnosed, surgery to remove the lesions around the ethmoid sinus, smooth drainage combined with antibiotic therapy is the most direct and effective treatment, and anticoagulation therapy is given when necessary. Timely diagnosis, multidisciplinary collaboration, and accurate timing of the management of primary foci and comorbidities are crucial to the treatment of the disease.