Surgical removal of an impacted third molar is one of the most common oral surgical procedures performed in dental offices. The postoperative phase is often associated with severe inflammation. Non-steroidal anti-inflammatory drugs (NSAIDs) are usually prescribed to manage postoperative discomfort. NSAIDs have been associated with gastrointestinal bleeding, renal function disturbances, and platelet count reductions. Thus, the present study demonstrates the utility of aescin in managing postoperative discomfort after the surgical removal of impacted mandibular third molars.This study aimed to correlate and compare the impact of aescin and diclofenac on salivary PGE2 levels and serum C-reactive protein levels after surgical extraction of the mandibular third molar. The study will also evaluate and compare the effectiveness of individual drug therapy in managing postoperative pain, swelling and mouth opening. The planned study is a single-center, double-blind, randomized, parallel, prospective clinical trial. Each patient will be prescribed either diclofenac sodium 150 mg/day or aescin (escin) 120 mg/day to be taken orally in divided doses for five days after surgically removing the impacted mandibular third molar.Pain will be assessed using a visual analog scale. Facial swelling and mouth opening will be recorded using a metric scale with standardized reference points. ELISA (enzyme-linked immunosorbent assay (ELISA) will be employed to measure salivary Prostaglandin E2 and serum C-reactive protein levels. All parameters will be recorded preoperatively (T0) on the second postoperative day (T1) and fifth postoperative day (T2). The proposed study is expected to show a clinically acceptable response to the administration of aescin for the management of postoperative discomfort compared to diclofenac sodium after third molar surgery.The proposed study is expected to positively manipulate the levels of salivary Prostaglandin E2 and serum C-reactive protein, which are reliable inflammatory markers.The outcome of this study may provide an efficacious and safe alternative to conventional nonsteroidal anti-inflammatory drugs for managing postoperative discomfort following third molar surgery.

This study aimed to assess the effectiveness of four-duct ligation following Botulinum toxin-A injections into the parotid and submandibular glands in pediatric patients with sialorrhea resistant to nonsurgical treatments. Prior research has individually explored either surgical or Botulinum toxin interventions; however, the safety and efficacy of the combined approach to these treatments have yet to be documented. Patients were assessed before surgery and 6, 12, and 24months post-operatively. Evaluations involved interviews with parents and caregivers, conducted face-to-face or by telephone, using the Drooling Severity and Frequency Scales. Additionally, metrics such as the daily count of bib changes and the hourly frequency of saliva wiping were recorded. Quality-of-life assessments were performed before and after the surgical procedures. All complications associated with the interventions were carefully recorded. The study group consisted of 25 participants, with a median age of 6years (range 2-17years). Each participant was diagnosed with a neurological, metabolic, or genetic disorder. Evaluations were conducted periodically, culminating in a final follow-up at 24months. The treatment demonstrated a 100% success rate at six months post-operation (25/25 patients), which slightly decreased to 96% at the 12-month mark (24/25 patients) and further to 84% by the 24-month follow-up (21/25 patients). Major complications were not observed. However, minor complications were reported in six patients (24%): three exhibited temporary facial swelling (12%), two encountered minor bleeding (8%), and one experienced excessive dryness (4%). The combination of Botulinum toxin-A injection 3 weeks prior to the four-duct ligation procedure demonstrated high success rates and substantially reduced the incidence of infectious and cosmetic complications. Consequently, this staggered approach to combination treatment is recommended for managing pediatric sialorrhea cases that are resistant to non-surgical interventions.

Rhino-orbital-cerebral mucormycosis (ROCM) infections are rare and usually occur in patients with diabetes, malignancy, or organ transplantation. The most common presenting symptoms include facial pain and swelling, fever, and rhinorrhea. Mortality rates reach nearly 50%. Those with previous organ transplants typically present with sinus symptoms a few weeks to months after transplantation. A 75-year-old man presented with headache. His history was significant for bilateral lung transplantation in 2017. On his fourth presentation, he was admitted to the hospital for work up. Imaging showed small fluid levels within the right maxillary and sphenoid sinuses. Infectious work-up revealed no meningitis. On day three, the patient complained of diplopia on the right. His examination was significant for right lateral rectus palsy. Repeat imaging was performed and showed increasing fluid levels of the right maxillary and sphenoid sinuses, and the otolaryngology consultation service was consulted. Nasal endoscopy was significant for pink, vascularised mucosa with no obvious regions of pallor or necrosis. Endoscopic sinus surgery was performed. There were no findings suggestive of fungus but purulence of the right sphenoid grew Rhizopus. The patient’s nerve palsy did not resolve and progressed to the contralateral orbit. Repeat nasal endoscopy continued to show healthy mucosa while MRI showed enhancement worrisome for meningitis. To our knowledge, this is the only reported case of fungal sphenoid sinusitis resulting in meningitis and death six years after transplant. Current literature documents fungal infection in post-transplant patients up to four years after surgery, with most occurring within the first year. Suspicion for fungal infection should remain high in this patient population. Keywords: mucormycosis, lung transplant, sinusitis, lateral rectus palsy

Maxillofacial trauma is becoming an increasing issue in Indian states, and fractures in the mandibular parasymphysis region are the most common. Standard treatment modality is open reduction and internal fixation but even that is not spared from complications. Corticosteroid administration locally has grown in favor; intramuscular injections of the drug close to the surgical site have been found to reduce postoperative edema. Despite being simple to apply, it may result in soft tissue dehiscence. In contrast, Vitamin C offers a promising substitute for improving the healing process when given submucosally. The purpose of this study was to evaluate and compare the postoperative wound healing, swelling, and pain in patients receiving local intramuscular injections of dexamethasone alone versus those receiving a combination of dexamethasone and Vitamin C. A total of 30 patients participated in study. Participants were divided into two groups by random allocation. Intraoperatively, injection dexamethasone was injected in one group into the mentalis muscle. In the second group, injection Vitamin C was injected submucosally near the suture line along with injection dexamethasone. Present study showed that there was a significant reduction in facial swelling in both groups along with reduction in postoperative pain. Intergroup comparison showed that soft tissue wound healing was better in patients who received Vitamin C injections. Vitamin C promotes the collagen synthesis which counteracts the degrading effect of dexamethasone on the soft tissues. Hence, the use of dexamethasone in combination with Vitamin C in management of mandibular parasymphysis fracture is recommended. The online version contains supplementary material available at 10.1007/s12663-024-02347-6.

BackgroundSubcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare form of non-Hodgkin lymphoma that primarily affects subcutaneous tissues. Its occurrence in the orofacial region is exceptionally uncommon, presenting diagnostic challenges due to symptom overlap with more prevalent orofacial condition.Case presentationThis report details the case of a 15-year-old male who presented with persistent left-sided facial swelling, initially misdiagnosed as facial cellulitis. Diagnostic complexity arose from the similarity of symptoms to common orofacial diseases. Comprehensive diagnostic approaches, including liquid-based thin-layer cytometry, immunohistochemistry, and advanced imaging, were pivotal in identifying SPTCL. The recurrence of symptoms following the cessation of dexamethasone treatment indicated hormone dependency. Surgical intervention and subsequent histopathological analysis confirmed SPTCL, with immunohistochemical profiling playing a critical role in the definitive diagnosis. The patient’s management involved a multidisciplinary approach, leading to a referral to a hematology specialist and subsequent favorable outcomes.ConclusionsThis case underscores the diagnostic challenges of orofacial lymphomas such as SPTCL and highlights the necessity for early, accurate pathological diagnosis. It emphasizes the role of advanced diagnostic techniques and the importance of a comprehensive, multidisciplinary approach in the management of such rare cases. This report contributes to the limited but growing body of literature on SPTCL in the orofacial region, providing insights for clinicians in similar future cases.

This study is aimed to see how gender and whether tooth is placed on the right or left affected the length of the operation, edema, trismus, and discomfort after surgical extraction of an impacted mandibular third molar. This prospective study was conducted in the Inonu University. The study included 104 mandibular wisdom tooth with bone retention. There were 55 females and 49 males among the 104 patients, with 53 left and 51 right impacted mandibular third molar. The operations were performed by the same surgeon in the same operating room. The time between the incision and the suture was determined and recorded as the operation time for each procedure. Before surgery, on the 2nd postoperative day, and on the 7th postoperative day, the patients were compared in terms of facial swelling impacted mandibular third molar, discomfort, and trismus. IBM SPSS V23 was used to evaluate the data. The left impacted mandibular third molar extraction takes longer than the right impacted mandibular third molar extraction. Tooth 38, which have a longer operation time, are more prone to swelling, discomfort, and trismus. When tooths are extracted, right-handed surgeons cause less postoperative morbidity 48. We recommend that both right-handed, left-handed surgeons operate in clinics that conduct impacted tooth extractions.

Primary sinonasal tuberculosis is a rare form of TB even in developing countries where TB is prevalent and invasive mycotic infection is more common in immunocompromised patients. It is unusual to have a dual infection with tuberculosis and mycosis in the maxillary region mimicking a neoplastic process and causing bone erosion. A 49-year old male presented with 2-year history of left-sided facial swelling. On microscopic examination, epithelioid cell granulomas, chronic inflammatory infiltrate, macrophages, giant cells, and focal necrosis were seen. Ziehl Neelsen staining for acid-fast bacilli with 20% H2SO4 was positive. Fungal hyphae were also seen in the sections examined. Special stains (Periodic acid-Schiff and Grocott’s methenamine silver stain) for fungal hyphae were positive. Mycosis and tuberculosis should always be considered in the differential diagnosis of maxillary lesions or sinusitis.

Maxillary sinusitis of odontogenic origin (MSOO) presents a diagnostic challenge due to its overlapping symptoms with other forms of sinusitis. We present a case of a 17-year-old male with MSOO, emphasizing varied treatment modalities. Clinical assessment revealed facial swelling and pain, prompting a differential diagnosis. Orthopantomogram and Cone Beam Computed Tomography (CBCT) confirmed odontogenic involvement. Surgical intervention included extraction, sinus lavage, and closure of oroantral communication. Postoperative recovery was successful. Discussion highlights the prevalence, diagnosis, and management of MSOO. Contemporary reports suggest odontogenic sources contribute to over half of maxillary sinusitis cases. Radiographs and CBCT aid diagnosis, delineating odontogenic involvement. Effective management includes dental evaluation and endoscopic sinus surgery, and early diagnosis is crucial to prevent complications. However, consensus on antimicrobial therapy and drainage routes is lacking. This case underscores the importance of interdisciplinary collaboration and tailored management strategies for MSOO.

Accidental inoculation of dirofilarial worm by mosquitos into humans cause a zoonotic disease called dirofilariasis. Common sites of involvement are lungs, eyes and rarely subcutaneous areas. This is a case report of a 60-year-old woman presented with facial swelling for the past 6 months. Ultra sonogram revealed a cyst with worm like structures inside, which was excised surgically and histopathology confirmed with diagnosis with demonstration of Dirofilaria worm. This case report aims at reminding clinicians not to overlook or misdiagnose rare diagnoses like dirofilariasis during evaluation of subcutaneous swellings.

Background Renal disease is increasing being recognized as a significant cause of morbidity and mortality in HIV positive patients. Human Immunodeficiency virus associated nephropathy (HIVAN) is the most common type of HIV related renal disease and rapidly progress to end stage renal disease(ESRD). There is paucity of report on true prevalence of HIVAN in African. This study was aimed at determining the prevalence of HIVAN, clinical features, treatment and outcome, in Calabar Nigeria. Methods/Subject This was a retrospective review of all renal patients managed by Pediatric nephrology unit of University of Calabar Teaching Hospital from January 2016 to December 2022 enrolled in the Renal register. During the period of study 215 patients had renal diseases out of which 15 had HIVAN. The following information were extracted from the HIVAN patients; Demographics and clinical data as well as mode of transmission, laboratory investigations, renal Ultrasound scan, treatment and Outcome were obtained and analyzed using SPSS version 20. Results There were 215 cases of renal diseases seen during the study period of which 15 had HIVAN giving a prevalence of 6.9% There were 5 males and 10 females giving a ratio of 1:2, age range 69-192months. with a mean age of 127±43.7months All received HAART and had acquired HIV infection through vertical transmission. 8 (53%) of patient were asymptomatic with 6 (40%) presenting with both legs and facial swelling. Nephrotic range proteinuria was a common presentation seen in 40% of the patients and 5(33.3%) had hypertension. Only 4 (33%) had eGFR<60 ml/min/1.73m2 and 2(16%) had ESRD. Two were lost to follow-up and 4 (26%) died with two requiring dialysis. Conclusion HIVAN is common in patients with renal diseases and there is need to monitor patient at initiation of HAART and at risk patients with low CD4+ count and exposure to nephrotoxic HAART.

Abstract Disclosure: A. Tiwari: None. S. Mantravadi: None. N. Doshi: None. A. Dabaja: None. C. Saad: None. Introduction: Autoimmune thyroiditis is the predominant cause of primary hypothyroidism, with an incidence of estimated 0.3-1.5 cases per 1000 people, with female to male predominance of 7-10[1]. Hypothyroid myopathy affects 79 % of the affected population. Its common presentation is fatigue and cramp but in rare instances rhabdomyolysis can occur with trivial triggers like alcohol, exercise2, Case Presentation: A 32-year-old male with no significant medical history, presented with generalized weakness, myalgia, and facial puffiness for last three months. The patient engaged in regular-intensity workouts and reported consuming 12 beers several times a week for past 5 years. Physical examination revealed facial puffiness and proximal muscle weakness. Initial Laboratory findings showed elevated creatinine (1.68 mg/dL, baseline 1.0 mg/dL in April 2020), CK (8113 U/L), AST (260 U/L), ALT (129 U/L). Urinalysis revealed hematuria and mild proteinuria. Serum electrolytes were unremarkable. Abdominal ultrasound showed diffuse hepatic steatosis with normal kidney appearance. This could not explain the reason for the Acute Kidney Injury and further workup showed TSH (>150 mIU/L) and TPO antibodies (197.9 U/mL). Autoimmune panel was unremarkable. Thyroid ultrasound done subsequently revealed a markedly heterogeneous gland. Treatment included parenteral crystalloids, low-dose prednisone which was empirically added for suspected autoimmune myositis and was later discontinued once the autoimmune panel was negative, and Levothyroxine at the recommended dose. At the time of discharge, his creatinine was reduced to 1.33 mg/dL and CK to 2,298 U/L. Discussion: Severe rhabdomyolysis is a rare but significant complication of autoimmune thyroiditis, potentially leading to acute kidney injury (AKI) if not promptly diagnosed and treated. Resident physicians often attribute symptoms like myalgia and generalized weakness in males to clear evident rhabdomyolysis if they find a cause like alcohol consumption and exercise, potentially overlooking the actual etiology. We recommend thyroid workup in such patients to promptly detect and manage underlying etiology predisposing to muscle damage and subsequent kidney injury. Our patient never had any Physician encounter as his prior medical history was unremarkable, however we suggest thorough family history and thyroid profile should be a part of outpatient workup as well for patients who show other risk factors for rhabdomyolysis like daily alcohol consumption, vigorous workout, consume medications like HMG CoA inhibitors, antipsychotics etc. Presentation: 6/3/2024

Abstract Disclosure: S. Khalid: None. H. Whitlatch: None. Introduction: Central giant cell granulomas (CGCG) are rare, expansile non-neoplastic bone lesions involving the mandible or maxilla. These lesions consist of a mix of mononuclear and multinucleated giant cells in a mesenchymal stromal background. CGCG typically occurs before the age of 20 years and is more common in females. Conventionally, surgery has been the mainstay of treatment, ranging from curettage to aggressive resection. Unfortunately, curettage is associated with a recurrence rate of up to 49%. While surgical resection lowers recurrence rate to 6%, it can be associated with substantial morbidity, especially with larger lesions. This has led to the investigational use of medical adjunctive therapy, including intralesional corticosteroids, bisphosphonates, and calcitonin. Recently, there have been case reports involving the successful use of denosumab, a monoclonal antibody to receptor activator of nuclear factor-ΚB ligand (RANK-L). Here, we describe an unusual case of adult-onset CGCG treated with surgery and denosumab. CASE: A 24-year-old female presented to the oral maxillofacial surgery clinic with progressive left-sided mandibular swelling of 2 years duration. On examination, she was noted to have left lower third facial swelling and asymmetry. Intraoral exam showed buccal and labial expansion extending from tooth 19 to 27. CT scan revealed a large, multiloculated, expansile lytic lesion of the left mandible measuring up to 4.2 cm. Biopsy of the lesion was rich in giant cells, and the appearance favored giant cell granuloma. Biochemical evaluation included PTH 29 mg/dL (normal 15 mg/dL - 65 mg/dL), calcium 9.2 mg/dL (8.7 mg/dL -10.2 mg/dL), phosphorus 4.7 mg/dL (3 mg/dL -4.4 mg/dL) and alkaline phosphatase 94 mg/dL (44 mg/dL -121 mg/dL). She underwent enucleation and curettage of the lesion. 3 months after the surgery, she started her course of denosumab 120 mg weekly for 4 weeks, followed by monthly dosing with planned 1 year course. She noted improvement in pain after 2 doses of denosumab, and x-ray imaging at 1 month showed improved bone fill. Conclusion: Denosumab exerts its therapeutic effect in giant cell lesions by inhibiting osteoclast maturation, thereby suppressing osteolysis and giant cell formation. Our case suggests it could be considered first line adjuvant treatment for patients with large CGCG lesions. Presentation: 6/2/2024

Abstract Disclosure: M. Aguilera: None. A. Vu: None. J. Shakil: None. R. Al-Ward: None. Introduction: Cushing’s syndrome (CS) is a rare condition with an annual incidence of 2-8 per million. Endogenous CS is mainly due to corticotroph adenoma of the pituitary followed by excessive glucocorticoid production from adrenal and ectopic sources. CS has significant morbidity and mortality hence the need for timely diagnosis. The varied presentations often pose great challenges in identifying the source of hypercortisolism. We present two unusual cases of CS with distinct clinical presentations and atypical laboratory profiles. Case 1: 25-year-old male with no medical history presented with 9 months of facial puffiness, weight gain, fluid retention, hypertension and blurred vision. Physical examination revealed round facies, bilateral supraclavicular fat pads and wide abdominal striae. Laboratory workup showed markedly elevated ACTH 537 pg/mL [7.2-63 pg/mL], serum cortisol 8.5 ug/dL [6.2-19.4 ug/dl], 24-hour urine free cortisol (UFC) 30 [5-62 ug/24H] and normal late-night salivary cortisol (LNSC). Repeat workup a month later showed serum cortisol of 56ug/dL, ACTH 874 pg/dL, 24-hour UFC of 11880ug/24H and elevated LNSC. Pituitary MRI showed a large heterogenous 3.1 cm partially cystic sellar mass with suprasellar extension. Due to significantly elevated ACTH and short duration of symptoms, we suspected an ectopic source. Due to initial negative testing, except for high ACTH level, a silent corticotroph adenoma was also considered. The patient underwent transsphenoidal resection resulting in significant decrease of cortisol and ACTH postoperatively. Pathology showed a corticotroph adenoma with Ki-67 index of <1%. Case 2: 47-year-old woman with medical history of obesity, polycystic ovary syndrome and a stable 1 cm lung nodule since 2020, presented with fluid retention, worsening acne and resistant hypertension over a 1-year period. She required hospitalization for hypertensive emergency and hypokalemia. Laboratory data showed morning serum cortisol 28 ug/dL, ACTH of 90.1 pg/mL, 24-hour UFC 346 ug/24H, elevated LNSC on two occasions and cortisol 24.3 ug/dl after a 1mg dexamethasone suppression. MRI did not show a pituitary mass. PET dotatate scan revealed a tracer avid 1 cm right upper lobe pulmonary nodule. She underwent a right upper lobe lobectomy, resulting in a significant decrease in cortisol and ACTH levels on postoperative day 1. Pathology confirmed a typical carcinoid tumor. Discussion: High ACTH levels and a short symptom duration often point to ectopic production, paraneoplastic syndromes or corticotroph carcinomas. Cushing's disease typically exhibits mildly elevated ACTH levels, but our cases deviate from this norm, complicating source identification. This atypical presentation highlights the complexity of Cushing's syndrome, challenging conventional diagnostic paradigms. Presentation: 6/1/2024

Background: Ameloblastoma is a rare, aggressive, benign odontogenic tumor that most commonly occurs in the jaw. Maxillary occurrences are rarely reported. Case Presentation: We report the case of a 61-year-old male presenting with right-sided unilateral nasal obstruction, characterized by a mass occupying the entire right nasal fossa upon anterior rhinoscopy. A computed tomography (CT) scan, combined with magnetic resonance imaging (MRI), revealed a locally advanced mass centered on the right maxillary sinus. The patient underwent wide excision of the mass, and histopathological analysis confirmed the diagnosis of ameloblastoma. Discussion: Naso-sinus ameloblastomas are rare, benign, and slow-growing tumors, accounting for approximately 0.11% of nasal and sinus tumors. More common in men, they typically present between the ages of 20 and 30. Symptoms include nasal obstruction and epistaxis, with occasional facial swelling or headaches. These tumors often originate in the posterior maxillary region and extend into the maxillary sinuses and nasal cavity. Diagnosis is facilitated by imaging, where the tumors appear as solid, radio-opaque masses. Radical surgical resection is the preferred treatment, as it is essential for preventing recurrence. The prognosis is generally favorable, with no documented cases of malignant transformation or metastasis, and recurrences are rare when appropriate surgical management is performed. Conclusion: Medical imaging plays a crucial role in diagnosis and allows for the evaluation of tumor dissemination and anatomical involvement. The treatment of maxillary ameloblastoma typically involves surgical excision, with the complexity of management often linked to the extent of tumor spread.

We studied the clinical presentation, risk factors, complications, and in-hospital outcomes of patients with coronavirus disease 2019 (COVID-19)-associated mucormycosis (CAM). A retrospective study was done on 69 COVID-19 patients with microbiologically proven mucormycosis admitted over a period of seven months from March 2021 to September 2021. All 69 mucormycosis patients (46 males, 23 females) had reverse transcriptase-polymerase chain reaction (RT-PCR)-confirmed COVID-19 infection. Their mean age was 52.8 years, with mucormycosis developing in 51 patients (73.9%) within 30 days of COVID-19 infection; 7 (10.1%) were positive on admission. Rhino-orbital-cerebral mucormycosis (ROCM) was the most common (40.3%), followed by rhino-orbital (37.3%) and sinonasal (22.4%). Diabetes mellitus was present in 98.6% of patients. Common symptoms of mucormycosis were facial pain, headache, facial swelling, and vision loss. During COVID-19, 88.4 and 52.5% received immunosuppressive treatment and zinc sulfate, respectively; 34.7% needed intensive care unit (ICU) admission. The mortality rate was 26.1%. On multivariate logistic regression analysis, the presence of chronic kidney disease, leukocytosis, ophthalmoplegia, oral/palate ulceration, current need for invasive ventilation, and past duration of oxygen therapy and zinc supplementation were significantly associated with mortality. Patients with current COVID-19 infection had severe disease with increased need for intensive care (57.1 vs 14.5%) and higher mortality (57.1 vs 22.6%) compared to mucormycosis patients with previous COVID-19 infection. Rhino-orbital-cerebral, rhino-orbital, and sinonasal were the most common presentations in cases of mucormycosis, with a mortality rate of 26.1%. COVID-19 coinfection predisposes patients with mucormycosis to severe disease with higher mortality.

Abstract Background The nasal septum is essential for nasal stability because it supports the nasal tip, dorsum, and middle nasal third. When the nose is significantly deformed or deviated, it can cause nasal obstruction, a proclivity for chronic or recurring sinusitis, and, less commonly, contact point headaches. Aim of the Work The aim of this study was to compare between endoscopic and conventional septoplasty through a meta-analysis study. Patients and Methods In this meta-analysis we enrolled 22 articles fulfilled inclusion criteria as having symptomatic deviated nasal septum (headache, nasal obstruction, hyposmia and epistaxis) and refractory to medical treatment that diagnosed clinically, radiological and endoscopically having deviated nasal septum or spur. Results Our main finding was that the endoscopic septoplasty technique seemed to offer certain advantages, with fewer overall complications compared with the traditional open technique; According to the study population patients reported better improvement after endoscopic septoplasty over conventional septoplasty regarding: headache (RR = 0.12, 95% CI = 0.05 to 0.18, I2 =0. 01%, P value = 0. 948), nasal obstruction (RR = 0.14, 95% CI = -0.08 to 0.20, I2 = 43.14%, P value = 0. 003),and posterior nasal drip (RR = 0.22, 95% CI = 0.05 to 0.39, I2 = 0%, P value = 0. 921). Endoscopic septoplasty performed much better according to many objective parameters; reduction of turbinates hypertrophy (RR = -0.95, 95% CI = -1.87 to -0.04, I2 = 9.28%, P value = 0. 340), persistent posterior deviation (RR = -1.18, 95% CI = -1.72 to -0.63, I2 = 0%, P value = 0. 920), residual septal deviation (RR =-0.89, 95% CI = -1.31 to -0.48, I2 = 0%, P value = 0. 995), and residual spur (RR = -1.58, 95% CI = -2.39 to -0.76, I2 = 0%, P value = 0. 967). Endoscopic septoplasty was safer than conventional approach in the occurrence of facial swelling (RR = -1.20, 95% CI = -2.00 to -0.40, I2 = 0%, P value = 0. 985), postoperative hemorrhage (RR = -1.18, 95% CI = -1.69 to -0.66, I2 = 0%, P value = 0. 960), mucosal tear (RR = -0.73, 95% CI = -1.08 to -0.37, I2 = 0%, P value = 0. 692), length of postoperative stay (RR = -1.50, 95% CI = -2.07 to -0.93, I2 = 0%, P value = 0. 956), septal hematoma (RR = -1.45, 95% CI = -2.82 to -0.09, I2 = 0%, P value = 1.000), septal perforation (RR = -1.46, 95% CI = -2.61 to -0.31, I2 = 0%, P value = 1.000), nasal pain (RR = -1.02, 95% CI = -1.99 to -0.05, I2 = 0%, P value = 0.984), and synechiae (RR = -1.25, 95% CI = -1.67 to -0.83, I2 = 0%, P value = 0. 761). Conclusion Patients treated with endoscopic septoplasty had better outcome regarding nasal blockage, postnasal drip, headache and septal deviation. Furthermore, Endoscopic septoplasty reported safer result than conventional approach as it reduces residual pain, facial swelling, postoperative hemorrhage, mucosal tear, and length of postoperative stay, septal hematoma, septal perforation, nasal pain, and synechiae.

S2987 Perforated Sigmoid Diverticulitis Presenting With Facial and Neck Swelling

Dermatomyositis, weakness, rash, rheumatology, dermatology.

Infectious Coryza (IC) was a contagious respiratory bacterial infection in peacocks. The current study evaluated the outcomes of treating infectious coryza in a peacock. The adult peacock at the age of 2 years was presented with a history of anorexia, difficulty breathing, sticky eyes, nasal and ocular discharge, and semi-solid swelling under the eyes. Clinical examination confirmed respiratory depression, a swollen head and face, gasping, occluded eyelids, sticky purulent discharge from the eyes and nostrils, moist rales, depression, and recumbency. Treatment included the use of injection of gentamicin, meloxicam, and multivitamins therapy, along with surgical debridement of facial edematous swelling. The peacock successfully recovered after 5 days of treatment. It was concluded that infectious coryza was a treatable disease, and an antibiotic sensitivity test was highly recommended for selecting a suitable antibiotic against bacterial infections.

Hypothyroidism is a frequent condition in medical practice and clinical forms with ascites are exceptionally rare. After a review of the literature we found that the exudative nature of the fluid is the main feature associated with hypothyroidism, however no case of hypothyroidism associated with transudative ascites has been reported. We report a case of transudative ascites associated with hypothyroidism in a post thyroidectomy setting. This 72-year-old patient underwent total thyroidectomy 3 years ago, without supplementation with synthetic thyroid hormone. He had been treated in cardiology for compensated ischaemic heart disease for 4 months. He presented with apathy, significant physical asthenia and a hoarse voice. His general condition was altered, with a rounded, puffy face and infiltrated eyelids. The feet were oedematous. Haemodynamic constants revealed arterial hypotension. Ascites aspiration yielded a sterile, pauci-cellular, citrine-yellow, transudative fluid. After ruling out renal, glomerular and hepatic causes, the ascites persisted despite optimised treatment of his heart disease, making cardiac ascites unlikely. Signs of hypometabolism and myxedema, together with a very high TSH (TSHus = 54.26 microgr/L) and disappearance of ascites after thyroid hormone supplementation, supported the hypothesis of transudative ascites associated with hypothyroidism. Ascites associated with hypothyroidism is rare and the transudative nature of the fluid is exceptional; it is generally included in myxedema. Hypothyroidism is rarely manifested by ascites but can be considered after ruling out common causes. Hormonal treatment allows complete regression of ascites within a few weeks and constitutes a therapeutic test.