The Endoscopic Management of Different Pediatric Frontal Sinus Pathologies

Abstract

Background.The paranasal sinuses in pediatrics can harbor a wide variety of pathologies. With the present literature being composed of case studies only, this entity is quite understudied. Objectives. This article aims to study the clinical presentation, diagnosis, and endoscopic management of six different rare frontal sinus pathologies in pediatrics, which include extensive allergic fungal sinusitis, mucoceles, osteoma, superior sagittal sinus thrombosis, CSF leak, and subdural empyema. Methods. We retrospectively studied all pediatric patients with frontal sinus pathologies presenting to our center, King Fahad Specialist Hospital, Dammam, Saudi Arabia, from the period of 2006 to 2020. Results. A total of 8 patients presented to our hospital with different frontal sinus pathologies. 5 of them were males, and 3 were females with an age of presentation ranging from 7 to 17 years. The diagnosis and localization were performed through computerized tomography without contrast and magnetic resonance imaging, when indicated. All cases were primarily managed with endonasal endoscopic approaches successfully without complications and with no recurrence evident upon follow-up. Conclusion. In this case series, six different frontal sinus pathologies were managed by an endoscopic approach, with excellent recovery and no recurrence upon follow-up demonstrated. This approach enabled excellent visualization of the pathologies, accurate localization, adequate drainage, and repair or grafting when needed.

Paranasal mucoceles in children without cystic fibrosis: A case report

“…Local, orbital, and even intra-cranial complications are commonly seen in patients with mucoceles and may be caused by the lesion itself, compression of adjacent organs, or inflammation. [ 2 ] The case reported in this study presented mainly with orbital symptoms with no detectable etiology. Several risk factors are implicated in the etiology of the mucocele and include chronic sinusitis, facial trauma, surgery, neoplasia, cranio-facial malformations, allergy, and systemic diseases such as cystic fibrosis.…”

“…For its minimal invasion and low incidence of complication and morbidity and the absence of facial scarring, the endoscopic approach is now the gold standard in childhood endonasal surgery. [ 2 6 ] Besides eradication of the mucocele, surgical treatment also prevents recurrence. There is growing evidence that the recurrence of a sinus mucocele is extremely rare after endoscopic management, with recurrence rates approaching 0%.…”

“…The clinical picture of mucoceles depends on their extent of expansion and location. [ 2 ] Even though the exact etiology of a mucocele is not fully understood, several contributing factors have been found in the literature. A pediatric mucocele is very rare and may go under-recognized.…”

Isolated extra-sinus subcutaneous mucocele: A case report

“…Erosion of the lamina papyracea extending into the orbit and connection to the sinus were observed [ 10 ]. In another study evaluating the possible etiologies of pediatric mucoceles, one patient had an unremarkable medical and surgical history [ 11 ]. Similarly, our patient had an unremarkable history, and no possible risk factor for mucocele could be determined.…”

Endoscopic Endonasal Anterior Skull Base Meningoencephalocele and Cerebrospinal Fluid Leak Repair: Our Intraoperative and Postoperative Protocol and Long-term Outcomes

“…and MR cisternograms and radionuclide studies can also help localize CSF leakage 14,15 , they are associated with significant disadvantages; additionally, multiple sites of CSF leak or intermittent leaks can be especially challenging to identify with these studies 16 Historically, CSF Leaks were repaired by a craniotomy; however, these approaches were associated with significant morbidities. 2,17,18 Complications included disruption of cranial nerves and critical vessels, visual deficits, iatrogenic bran injury from retraction, loss of smell, large scars, new CSF leakage, and meningitis 17 .…”