Secondary Sinusitis Research Articles

Polyodontia in donkeys

SummaryPolyodontia is defined as the presence of teeth in excess of the normal dental formula. In equids, supernumerary teeth are uncommon but, when present, are usually located mainly in the caudal aspects of the cheek teeth rows (distomolars), also being found adjacent to normal cheek teeth or even in an ectopic location. It is believed that this disorder is a result of an inappropriate differentiation of dental germinal tissue during gestational development, with external trauma also acting as an initiating factor, when teeth germs are affected. The presence of these abnormal teeth can lead to axial displacement, dental overgrowths, dental‐related soft tissue damage, diastemata formation, periodontal disease and development of secondary sinusitis. A large prospective, cross‐sectional study was performed in 800 donkeys, with the aim to investigate the prevalence and aetiopathogenesis of clinically diagnosed oral and dental disorders. Polyodontia was recorded in 2.25% of the donkeys, presenting 36 supernumerary teeth, with 2.80% being incisors and 97.20% cheek teeth, with prevalence increasing with age. The caudal aspects of the maxillary cheek teeth rows were the most common locations for supernumerary teeth development (distomolars). The mandible was far less commonly affected than the maxilla. Although polyodontia is uncommon in donkeys, it should be considered in the differential diagnosis of dental disease. A methodical oral examination and a complete radiographic survey of the entire dental arcades are crucial for a correct early diagnosis and treatment plan implementation. The increasing prevalence of fully erupted supernumerary teeth recorded in older groups suggested a late onset eruption process, and therefore, in donkeys undergoing regular dental prophylaxis, the presence of previously unnoticed supernumerary teeth should always be sought.

MAGNETIC RESONANCE IMAGING FEATURES OF SINONASAL DISORDERS IN HORSES

Diseases of paranasal sinuses and nasal passages in horses can be a diagnostic challenge because of the complex anatomy of the head and limitations of many diagnostic modalities. Our hypothesis was that magnetic resonance (MR) imaging would provide excellent anatomical detail and soft tissue resolution, and would be accurate in the diagnosis of diseases of the paranasal sinuses and nasal passages in horses. Fourteen horses were imaged. Inclusion criteria were lesions located to the sinuses or nasal passages that underwent MR imaging and subsequent surgical intervention and/or histopathologic examination. A low field, 0.3 tesla open magnet was used. Sequences in the standard protocol were fast spin echo T2 sagittal and transverse, spin echo T1 transverse, short-tau inversion recovery (STIR) dorsal, gradient echo 3D T1 MPR dorsal (plain and contrast enhanced), spin echo T1 fatsat (contrast enhanced). Mean scan time to complete the examination was 53 min (range 39-99 min). Lesions identified were primary or secondary sinusitis (six horses), paranasal sinus cyst (four horses), progressive ethmoid hematoma (two horses), and neoplasia (two horses). The most useful sequences were fast spin echo T2 transverse and sagittal, STIR dorsal and FE3D MPR (survey and contrast enhanced). Fluid accumulation, mucosal thickening, presence of encapsulated contents, bone deformation, and thickening were common findings observed in MR imaging. In selected horses, magnetic resonance imaging is a useful tool in diagnosing lesions of the paranasal sinuses and nasal passages.

A review of equine paranasal sinusitis. Aetiopathogenesis, clinical signs and ancillary diagnostic techniques

Summary The equine paranasal sinuses are air filled cavities of uncertain function that are susceptible to inflammation, usually associated with bacterial infection. A common feature of most types of sinusitis is the accumulation of exudate within the affected sinus and subsequent ipsilateral nasal discharge. Equine sinusitis can have a variety of causes, including primary sinusitis following upper respiratory tract infections, and secondary sinusitis caused by dental infections, intrasinus benign and malignant growths and head trauma.

Cough in specific populations (paediatric patients, elderly patients and patients with underlying disease)

Cough in specific populations (paediatric patients, elderly patients and patients with underlying disease)

Use of Scintigraphy for Diagnosis of Equine Paranasal Sinus Disorders

To describe and analyze subjective and objective scintigraphic findings in horses with paranasal sinus disorders. Horses with suspected disorders of the paranasal sinuses or cheek teeth (n = 48) and control horses (n = 30). 99Technetium-methylenediphosphate (99Tc-MDP; 7500 MBq) was administered for scintigraphic examination of the skull. Abnormal patterns of increased radionuclide uptake (IRU) were identified and subjectively described. Scintigrams and radiographs were blindly assessed by 2 clinicians and the accuracy of the imaging modalities was compared. Objective analysis was performed by comparing regions of interest (ROI) drawn over areas of abnormal IRU to the equivalent area on the unaffected side using the Mann-Whitney test. An ROI ratio (affected:non-affected sides) was also calculated for each lesion. Twenty-eight horses were diagnosed with primary (15) or secondary (13) sinusitis. Nine primary sinusitis cases had focal area(s) of moderate or marked IRU in addition to a more diffuse uptake in the affected sinus(es). kappa was marginally higher for scintigraphic assessment of paranasal sinus disorders than for radiographic assessment. There were significant differences in mean counts/pixel in ROI drawn on the affected side compared with the non-affected side. There was considerable overlap between the magnitudes of ROI ratios found with many different disorders. Scintigraphy can be useful for differentiation of sinusitis of dental origin from other causes of sinusitis. Quantitative analysis of scintigrams is not reliable for identification of particular disorders. Focal areas of moderate or marked IRU may be observed with primary sinusitis. Careful 3-dimensional localization of the lesion, along with consideration of other clinical and diagnostic findings should be performed to prevent false-positive diagnoses of periapical infection in such instances.

Management of the middle turbinate during functional endoscopic sinus surgery

Controversy continues to surround the topic of middle turbinate resection (MTR) during endoscopic sinus surgery. Proponents of MTR cite lower incidences of synechiae formation and lateralization of the middle turbinate, as well as improved intraoperative and postoperative access to the middle meatus. Potential complications, such as alterations of nasal function, atrophic rhinitis, hyposmia, and secondary frontal sinusitis caused by MTR, have been addressed in the recent literature. Yet, despite the proven safety of this procedure, routine MTR is not advocated by most sinus surgeons. Our approach has been to perform partial MTR in cases of a diseased, destabilized, or obstructing middle turbinate. More recently, we have employed a technique for medialization of the middle turbinate or middle turbinate remnant using an absorbable transseptal suture. The stitch is placed through both middle turbinates and the nasal septum, holding the turbinates in a medial position. We have used this procedure in 75 patients undergoing endoscopic sinus surgery at New York University Medical Center between July 1998 and July 2000. There have been no complications associated with placement of the suture and no cases of middle turbinate lateralization or significant synechiae formation. This technique represents an alternative to MTR in the management of the middle turbinate during endoscopic sinus surgery and may also be used to prevent lateralization of a middle turbinate remnant in cases of partial MTR.

Complications of Dental Surgery

Both retrospective data and clinical experience indicate that complications of dental surgery are occasionally encountered and, to some extent, are inevitable. Many of the reported complications related to dental surgery such as incomplete removal of diseased teeth or removal of the wrong tooth can be avoided with sound preoperative planning and intraoperative technique. Diseased teeth should be properly identified prior to and during surgery. In addition, complete removal of the diseased tooth must be performed. Use of intraoperative radiographic examination to confirm the location of the diseased tooth and to document its removal cannot be overemphasized. Iatrogenic fracture of the maxillary or mandibular alveolar walls or palatine bone can be avoided by proper placement of the dental punch. The chances of developing incisional drainage or secondary sinusitis can be reduced by use of appropriate systemic antibiotics. These factors should guide the surgical approach to dental surgery to reduce the likelihood of developing common complications.

鼻アレルギー患者の上顎洞粘膜における浸潤細胞の定量的検討

The cloudiness of the maxillary sinus in Waters-view is 37% in patients with nasal allergy. The pathogenesis of this cloudiness has not fully understood yet; is it due to the type- I allergic reaction, or secondary maxillary sinusitis? To clarify the pathology, we studied the infiltrated cells in 37 mucosae of the maxillary sinus in which X-ray revealed an abnormal shadow. Samples were also taken from 9 antrums with chronic sinusitis, and 18 and 4 nasal mucosae form the inferior turbinate with nasal allergy and sinusitis, respectively. Each specimen were fixed with Carnoy solution and formalin, and were stained with Hematoxylin & Eosin, and with Alcian blue & Safranin. Numbers of formalin sensitive and resistant mast cells and eosinophils were determined in the epithelium, and superficial and deep layers of the lamina propria, respectively. The population of both mast cells in each compartment was not different between nasal allergy and maxillary sinusitis both in the nasal and maxillary mucosae. The number of eosinophils in the maxillary and nasal epithelial significantly increased in nasal allergy compared with sinusitis. These results suggested that type-I allergic reaction might occur in the maxillary mucosa as well as nasal mucosa in patients with nasal allergy.

Radiographic examination of the facial, nasal and paranasal sinus regions of the horse. II. Radiological findings.

The radiographic findings in 167 horses subjected to radiography of the facial area, nasal cavity and paranasal sinuses are recorded. Cases were grouped according to clinical diagnosis and the common and disparate radiographic features between and within groups are discussed. Dental disease occurred most frequently and accounted for about 30 per cent of cases, most of which had periapical infection. This disorder presented as two distinct clinical entities in almost equal numbers affected teeth with roots rostral to the maxillary sinus usually produced facial swelling, whereas those with roots within the sinus were generally associated with nasal discharge as a result of secondary sinusitis. In the former group periapical changes could readily be identified on radiographs, but in the latter group affected teeth could be recognised with confidence in only about half the cases. Primary sinusitis was the commonest specific condition recorded and accounted for 32 cases, three of which were mycotic. Using lateral erect projections, comparison of the radiographic features of primary sinusitis and sinusitis secondary to dental disease showed some useful differentiating signs. In four ponies, rhinitis associated with sinusitis led to disruption of the intra-nasal structures but mycotic rhinitis, nasal ulceration and an intra-nasal foreign body produced no radiographic abnormalities. Sixteen cases of suture periostitis were recorded, with varying degrees of new bone formation, and of 13 animals presented for evaluation of trauma, pre-diagnosed fractures were demonstrated in 10 and complications due to sinusitis in three.(ABSTRACT TRUNCATED AT 250 WORDS)

Toxic Shock Syndrome, Staphylococcus aureus, and Influenza

<h3>To the Editor.—</h3> The recent reports of toxic shock syndrome (TSS) during influenza outbreaks^1,2may not imply a unique association with the influenza virus, but are more probably due to secondary focal staphylococcal infections including sinusitis—a frequent complication of influenza. The patient reported by Sperber and Francis¹had clear-cut pneumonia, as did two of the nine patients reported by MacDonald et al²; the remainder could have had occult sinus infection. In either situation, it would not be unusual to culture<i>Staphylococcus aureus</i>from respiratory secretions. Such focal infections appear to be linked both epidemiologically and microbiologically to the pathogenesis of TSS.³During the last two influenza outbreaks in Denver, we have noted a large number of patients with secondary sinusitis. Growth of a toxin producing<i>S aureus</i>in a sinus (or in a lung) may provide conditions for toxin production that may not ordinarily be present

COLLAPSE OF THE NARES

Little attention has been directed to the action of the nares as a possible cause for the altered physiology of the nose and as a factor in producing secondary sinusitis, with its aftermath. Physiologists have placed little stress on the importance of the nares as an obstruction in the deviation of air currents. This has been brought to light by Proetz in his experimental work on animals. The results of Proetz'1experiments with smoke demonstrated that the direction of air currents is determined by the shape and position of the nostril and the angle at which the inspired air impinges on the slope of the bridge of the nose. It also appeared that employing a head with thin and shrunken middle turbinates or one with an amputated middle turbinate did not materially alter either the inspiratory or the expiratory air currents. Introducing obstacles of any description on either the septal