Background: The clinical presentation of sphenoid sinus meningoencephaloceles (MEC) may have insidious onset and evolution. Contemporary treatment incorporates endoscopic resection via the endonasal route.Case description: We present a case of 3 year old girl who had been complaining of permanent nasal discharge, impeded nasal breathing and difficulty with feeding since she was 5 months old. There was no history of rhinoliquorrhea. Pre-operative magnetic resonance imaging demonstrated MEC that extended from the sellar region through the non-pneumatized sphenoid sinus to the nasopharynx. The lesion was resected via endoscopic endonasal approach. Follow-up rhinoscopy confirmed the absence of post-operative cerebrospinal fluid leak.Conclusion: Endoscopic endonasal approach can be an effective and a safe treatment option for resection of congenital transsphenoidal MEC in early childhood.Keywords: Sphenoid sinus; endoscopic endonasal approach; meningoencephalocele; CSF leak; congenital.
Introduction: Odontogenic maxillary sinusitis is associated with diseases of the maxillary teeth. The close anatomical relationship of these teeth with the floor of the maxillary sinus leads to violation of the integrity of its mucosa and creates prerequisites for the infection to pass into the sinus cavity. Odontogenic maxillary sinusitis is characterized by dental complaints and the typical symptoms of all rhinosinusitis. There is lack of consensus in the literature on the algorithm of behaviour in these cases. Aim: To recommend a contemporary algorythm of management in patients with odontogenic maxillary sinuitis, which is consistent with both the established rules for the treatment of rhinosinusitis and the individual characteristics of each clinical case. Materials and methods: For the period 2001-2021, 157 patients were treated at St. George University Hospital, after extraction of an upper tooth (4-6) or with symptoms of nasal breathing difficulties and unilateral whitish secretion with an unpleasant odour. All of them had a history of dental intervention and CT data for changes in the osteomeatal complex or "foreign bodies" in the maxillary sinus. Results: All patients were discharged on the third day after admission in improved general condition without complaints. No late postoperative complications were observed. In 8 of the patients with sinuscopy, after the control CT examination, performed a month later, a second intervention was necessary for the extraction of residual fungal material. Conclusion:The treatment of odontogenic maxillary sinusitis involves interdisciplinary approach of otorhinolaryngologists and dental specialists. However, modern understanding of the functioning of the nasal cavities and the development of pathological processes in them help us to build and present an adequate concept for diagnosis and therapeutic behavior.
Introduction: Eagle syndrome is a rare condition caused by elongation of the styloid process or ossification of the stylohyoid ligament. It's named after Watt W. Eagle an otolaryngologist at Duke university, who described the first case in 1937. In the clinical presentation, we found different signs of syndrome -dysphagia, odynophagia, otalgia, foreign body sensation, facial pain, trismus, headache, increased salivation, and/or voice changes. The diagnosis of Eagle's syndrome is based on an optimal medical history and physical examination. The most accurate imaging technique is the CT-scan. 3-D CT reconstruction of the neck specify the size of length of the styloid process (> 3 mm) and the ossified stylohyoid ligament. The treatment includes conservative and surgical approach. Material and methods: We present a 65-years old female, in a good health condition, with the following complains: difficulty swallowing, foreign body sensation in the throat. The patient states that she had palpated cartilage in the right side in the area of the tonsillar fossa. The physical examination revealed no abnormal findings, but palpable right styloid process. We performed CT and 3-D CT reconstruction, which showed an elongation of styloid process on right side. Results: The patient refused the surgical treatment. The conservative therapy includes the nonsteroidal anti-inflammatory medications. Conclusion: Eagle's syndrome is a rare condition with vast differential diagnosis, vague symptomatology and ambiguous incidence and etiology. When we suggest the syndrome, the CT scan is the imaging method of choice for diagnosis. It shows the measurement of styloid process, the position in the neurovascular complex and the prepositions of damages. The treatment can be surgical or non-surgical depend on the size, position and surgical risk of the approach.
РезюмеВъведение: Риноликвореята е изтичане на цереброспинална течност (ликвор) от субарахноидалното пространство в около� носните синуси и впоследствие в носната кухина. Определянето на точната локализация на дефекта на ринобазата представлява винаги сериозен проблем и правилният избор на метод на диаг� ностика стои в основата на успешното хирургично лечение. Цел: Въз основа на собствения опит и на базата на литературни данни представяме обзор на диагностичните методи при рино� ликворея и тяхното практично значение. Материал и методи: За периода от 2000-2015 г. в Клиниката по УНГ-болести към УМБАЛ "Св. Георги" ЕАД -Пловдив са диагностицирани общо 18 случая на риноликворея. Преоблада� ващи са спонтанни такива и вследствие на неопластичен процес. Съотношението мъже жени е 5:13. При всички пациенти като методи на диагностика са използвани глюкозо-оксидазен тест на носен секрет, компютърна томография с висока разделителна способност, като при един е приложен флуоресцеин интрате� кално с последваща ендоскопска ендоназална верификация. От 18-те случая на риноликворея 4-ри дебютират с риногенен менингит. При всички е осъществено ендоназално хирургично лечение -пластика на дура матер. Резултати: При 14-те от случаите пластиката на дура матер е успешна след първата операция. Не се установява изтичане на ликвор. Ендоскопският оглед показва сигурно затваряне на дефекта. При останалите 3 случая риноликвореята персистира� ше, а при един случай рецидивира след едногодишен период. След повторна ендоскопска интервенция последва дефинитивно спиране на изтичането на ликвор. Изводи: Съвременните диагностични тестове и ендоскопски ендоназални методи на пластика с алогенен материал позволяват относително сигурно доказване и локализиране на дефектите на ринобазата и дефинитивното им лечение при нисък морбидитет и ниво на компликации.
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