Helio Andrade Lessa

Clinical and tomography evolution of frontal osteomyelitis: case report

Introduction:u2003The frontal osteomyelitis is a complication of rhinosinusitis which can evolve to acute or chronicle. There is inflammatory reaction by the increasing of intraosseous pressure, ischemia and local necrosis, leading to bone abscess formation. There is no drainage, it will occur detachment of the periosteum, soft tissue invasion and worsening of ischemia with subsequent bone sequestration. Method:u2003Case report of an inpatient in an emergency service of another institution by the complication of rhinosinusitis who was referred to the Otorhinolaryngology Service of University Hospital Professor Edgard Santos of Federal University of Bahia. Case Report:u2003Male patient, 16 years-old, presented himself to the ER of another institution with cephalea, vomits and fever which evolved to periorbital edema and frontal to the left, moving to palpebral fluctuation and frontal. Subjected to frontal and palpebral abscess drainage, with broad-spectrum antibiotic therapy with no improvement. He was referred to our service keeping edema and fluctuation in region frontal and light edema in left periorbital region. The nasal endoscopy showed edema in meatus to the left and the computerized tomography showed fronto-ethmoid sinusitis to the left and signs of frontal osteomyelitis with bone sequestration and epidural empyema. Subjected to sinasal endoscopy surgery, external Access or removal of the frontal one affected and epidural empyema drainage. Evolved to the remission of the disease. Final Considerations:u2003Failure in the diagnosis and rhinosinusitis complication treatment can lead to sequalae and fatal complications. The diagnosis of the frontal osteomyelitis is confirmed by the clinical suspicion and confirmed by radiological examination. The surgery is indicated when the evolution is insidious, there is bone sequestration and intracranial complications.INTRODUCTION: The frontal osteomyelitis is a complication of rhinosinusitis which can evolve to acute or chronicle. There is inflammatory reaction by the increasing of intraosseous pressure, ischemia and local necrosis, leading to bone abscess formation. There is no drainage, it will occur detachment of the periosteum, soft tissue invasion and worsening of ischemia with subsequent bone sequestration. METHOD: Case report of an inpatient in an emergency service of another institution by the complication of rhinosinusitis who was referred to the Otorhinolaryngology Service of University Hospital Professor Edgard Santos of Federal University of Bahia. CASE REPORT: Male patient, 16 years-old, presented himself to the ER of another institution with cephalea, vomits and fever which evolved to periorbital edema and frontal to the left, moving to palpebral fluctuation and frontal. Subjected to frontal and palpebral abscess drainage, with broad-spectrum antibiotic therapy with no improvement. He was referred to our service keeping edema and fluctuation in region frontal and light edema in left periorbital region. The nasal endoscopy showed edema in meatus to the left and the computerized tomography showed fronto-ethmoid sinusitis to the left and signs of frontal osteomyelitis with bone sequestration and epidural empyema. Subjected to sinasal endoscopy surgery, external Access or removal of the frontal one affected and epidural empyema drainage. Evolved to the remission of the disease. FINAL CONSIDERATIONS: Failure in the diagnosis and rhinosinusitis complication treatment can lead to sequalae and fatal complications. The diagnosis of the frontal osteomyelitis is confirmed by the clinical suspicion and confirmed by radiological examination. The surgery is indicated when the evolution is insidious, there is bone sequestration and intracranial complications.

Evolução clínica e tomográfica da osteomielite frontal: relato de caso

Introduction:u2003The frontal osteomyelitis is a complication of rhinosinusitis which can evolve to acute or chronicle. There is inflammatory reaction by the increasing of intraosseous pressure, ischemia and local necrosis, leading to bone abscess formation. There is no drainage, it will occur detachment of the periosteum, soft tissue invasion and worsening of ischemia with subsequent bone sequestration. Method:u2003Case report of an inpatient in an emergency service of another institution by the complication of rhinosinusitis who was referred to the Otorhinolaryngology Service of University Hospital Professor Edgard Santos of Federal University of Bahia. Case Report:u2003Male patient, 16 years-old, presented himself to the ER of another institution with cephalea, vomits and fever which evolved to periorbital edema and frontal to the left, moving to palpebral fluctuation and frontal. Subjected to frontal and palpebral abscess drainage, with broad-spectrum antibiotic therapy with no improvement. He was referred to our service keeping edema and fluctuation in region frontal and light edema in left periorbital region. The nasal endoscopy showed edema in meatus to the left and the computerized tomography showed fronto-ethmoid sinusitis to the left and signs of frontal osteomyelitis with bone sequestration and epidural empyema. Subjected to sinasal endoscopy surgery, external Access or removal of the frontal one affected and epidural empyema drainage. Evolved to the remission of the disease. Final Considerations:u2003Failure in the diagnosis and rhinosinusitis complication treatment can lead to sequalae and fatal complications. The diagnosis of the frontal osteomyelitis is confirmed by the clinical suspicion and confirmed by radiological examination. The surgery is indicated when the evolution is insidious, there is bone sequestration and intracranial complications.INTRODUCTION: The frontal osteomyelitis is a complication of rhinosinusitis which can evolve to acute or chronicle. There is inflammatory reaction by the increasing of intraosseous pressure, ischemia and local necrosis, leading to bone abscess formation. There is no drainage, it will occur detachment of the periosteum, soft tissue invasion and worsening of ischemia with subsequent bone sequestration. METHOD: Case report of an inpatient in an emergency service of another institution by the complication of rhinosinusitis who was referred to the Otorhinolaryngology Service of University Hospital Professor Edgard Santos of Federal University of Bahia. CASE REPORT: Male patient, 16 years-old, presented himself to the ER of another institution with cephalea, vomits and fever which evolved to periorbital edema and frontal to the left, moving to palpebral fluctuation and frontal. Subjected to frontal and palpebral abscess drainage, with broad-spectrum antibiotic therapy with no improvement. He was referred to our service keeping edema and fluctuation in region frontal and light edema in left periorbital region. The nasal endoscopy showed edema in meatus to the left and the computerized tomography showed fronto-ethmoid sinusitis to the left and signs of frontal osteomyelitis with bone sequestration and epidural empyema. Subjected to sinasal endoscopy surgery, external Access or removal of the frontal one affected and epidural empyema drainage. Evolved to the remission of the disease. FINAL CONSIDERATIONS: Failure in the diagnosis and rhinosinusitis complication treatment can lead to sequalae and fatal complications. The diagnosis of the frontal osteomyelitis is confirmed by the clinical suspicion and confirmed by radiological examination. The surgery is indicated when the evolution is insidious, there is bone sequestration and intracranial complications.

Acesso endoscópico para tratamento do papiloma nasossinusal: um estudo clínico retrospectivo

INTRODUCTION: Sinonasal Papilloma is a benign tumor originating from the epithelium schneiderian lateral nasal wall. Its incidence is rare and according to literature accounts for 0.5 to 4% of all nasal tumors. OBJECTIVE: To report our institutions experience in the treatment of sinonasal inverted papilloma using endoscopic approach and compare the results with the literature. METHODS: A retrospective study of all patients with sinonasal papillomas who underwent a purely endoscopic surgery in the Otorhinolaryngology, Hospital das Clinicas, Federal University of Bahia (UFBA), from January 2004 to May 2010. RESULTS: A total of 12 patients were included in this study. The median follow-up was 23 months. There was one case of recurrence. Malignant transformation has not occurred in these cases. CONCLUSION: The treatment of sinonasal papilloma has been largely benefited from the advances in endoscopic techniques, with recurrence rates equivalent to those reported for external access. Imaging exams are essential in preoperative planning and the decision of surgical technique. A regular follow-up and long term is essential for a good monitoring of the evolution of this pathology.

Clinical and tomography evolution of frontal osteomyelitis: Case report

Introduction:u2003The frontal osteomyelitis is a complication of rhinosinusitis which can evolve to acute or chronicle. There is inflammatory reaction by the increasing of intraosseous pressure, ischemia and local necrosis, leading to bone abscess formation. There is no drainage, it will occur detachment of the periosteum, soft tissue invasion and worsening of ischemia with subsequent bone sequestration. Method:u2003Case report of an inpatient in an emergency service of another institution by the complication of rhinosinusitis who was referred to the Otorhinolaryngology Service of University Hospital Professor Edgard Santos of Federal University of Bahia. Case Report:u2003Male patient, 16 years-old, presented himself to the ER of another institution with cephalea, vomits and fever which evolved to periorbital edema and frontal to the left, moving to palpebral fluctuation and frontal. Subjected to frontal and palpebral abscess drainage, with broad-spectrum antibiotic therapy with no improvement. He was referred to our service keeping edema and fluctuation in region frontal and light edema in left periorbital region. The nasal endoscopy showed edema in meatus to the left and the computerized tomography showed fronto-ethmoid sinusitis to the left and signs of frontal osteomyelitis with bone sequestration and epidural empyema. Subjected to sinasal endoscopy surgery, external Access or removal of the frontal one affected and epidural empyema drainage. Evolved to the remission of the disease. Final Considerations:u2003Failure in the diagnosis and rhinosinusitis complication treatment can lead to sequalae and fatal complications. The diagnosis of the frontal osteomyelitis is confirmed by the clinical suspicion and confirmed by radiological examination. The surgery is indicated when the evolution is insidious, there is bone sequestration and intracranial complications.INTRODUCTION: The frontal osteomyelitis is a complication of rhinosinusitis which can evolve to acute or chronicle. There is inflammatory reaction by the increasing of intraosseous pressure, ischemia and local necrosis, leading to bone abscess formation. There is no drainage, it will occur detachment of the periosteum, soft tissue invasion and worsening of ischemia with subsequent bone sequestration. METHOD: Case report of an inpatient in an emergency service of another institution by the complication of rhinosinusitis who was referred to the Otorhinolaryngology Service of University Hospital Professor Edgard Santos of Federal University of Bahia. CASE REPORT: Male patient, 16 years-old, presented himself to the ER of another institution with cephalea, vomits and fever which evolved to periorbital edema and frontal to the left, moving to palpebral fluctuation and frontal. Subjected to frontal and palpebral abscess drainage, with broad-spectrum antibiotic therapy with no improvement. He was referred to our service keeping edema and fluctuation in region frontal and light edema in left periorbital region. The nasal endoscopy showed edema in meatus to the left and the computerized tomography showed fronto-ethmoid sinusitis to the left and signs of frontal osteomyelitis with bone sequestration and epidural empyema. Subjected to sinasal endoscopy surgery, external Access or removal of the frontal one affected and epidural empyema drainage. Evolved to the remission of the disease. FINAL CONSIDERATIONS: Failure in the diagnosis and rhinosinusitis complication treatment can lead to sequalae and fatal complications. The diagnosis of the frontal osteomyelitis is confirmed by the clinical suspicion and confirmed by radiological examination. The surgery is indicated when the evolution is insidious, there is bone sequestration and intracranial complications.

Complicação orbital e intracraniana devido à rinossinusite aguda: relato de caso

INTRODUCTION: Among the rhynosinusitiscomplications, the orbitals are the most frequent and these occur in most of the cases between the youngs and children. Simultaneous complications envolving the orbit and the intracranial space are extremely rare, but they must be treated aggressively because present a morbidity and mortality high rate. CASE REPORT: In this work, the authors report a case of a patient which presented with cellulitis pre-septal and epidural abscess, as simultaneous complications of an acute rhynosinusitis. In the patient of this case, they chose for a clinic treatmentassociated to a nasosinusal endoscopic cirugy and neurocirurgic drainage of the intracranial abscess. The CT was sufficient in the presented case for the diagnostic realization. COMMENTS FIANIS: However it is recommended that in the cases where the patients with rhynosinusitis complications the intracranial extension investigation has to be deepened even when this is not so evident in the beginning. As the polymicrobial nature of these infections, an aggressive antibiotictherapy guided for culture and accompaniment with a multidisciplinary staff, increase considerably the chances of success.ano.*** Medica Otorrinolaringologista.**** Doutor, Medico Otorrinolaringologista. Pesquisador associado do servico de Otorrinolaringologia e Imunologia do Hospital U niversitario Professor Edgard Santos- UFBA.***** Doutor, Medico Otorrinolaringologista. Professor e Chefe do Departamento de Otorrinolaringologia do Hospital Universitari o Professor Edgard Santos.Instituicao: Departamento de Otorrinolaringologia - Hospital Universitario Edgard Santos - Universidade Federal da Bahia (UFBA).Salvador / BA – Brasil.Endereco para correspondencia: Luana Alves de Souza - Rua Clemente Ferreira, 139 - Apto 201 – Canela – Salvador / BA – Brasil - CEP: 40110-200 – Celular:(+55 71) 9606-2333 – E-mail: lua_goias@hotmail.comArtigo recebido em 6 de Agosto de 2009. Artigo aprovado em 14 de Dezembro de 2009.

Orbital and intracranial complication due to rhynosinusitis case's report

INTRODUCTION: Among the rhynosinusitiscomplications, the orbitals are the most frequent and these occur in most of the cases between the youngs and children. Simultaneous complications envolving the orbit and the intracranial space are extremely rare, but they must be treated aggressively because present a morbidity and mortality high rate. CASE REPORT: In this work, the authors report a case of a patient which presented with cellulitis pre-septal and epidural abscess, as simultaneous complications of an acute rhynosinusitis. In the patient of this case, they chose for a clinic treatmentassociated to a nasosinusal endoscopic cirugy and neurocirurgic drainage of the intracranial abscess. The CT was sufficient in the presented case for the diagnostic realization. COMMENTS FIANIS: However it is recommended that in the cases where the patients with rhynosinusitis complications the intracranial extension investigation has to be deepened even when this is not so evident in the beginning. As the polymicrobial nature of these infections, an aggressive antibiotictherapy guided for culture and accompaniment with a multidisciplinary staff, increase considerably the chances of success.ano.*** Medica Otorrinolaringologista.**** Doutor, Medico Otorrinolaringologista. Pesquisador associado do servico de Otorrinolaringologia e Imunologia do Hospital U niversitario Professor Edgard Santos- UFBA.***** Doutor, Medico Otorrinolaringologista. Professor e Chefe do Departamento de Otorrinolaringologia do Hospital Universitari o Professor Edgard Santos.Instituicao: Departamento de Otorrinolaringologia - Hospital Universitario Edgard Santos - Universidade Federal da Bahia (UFBA).Salvador / BA – Brasil.Endereco para correspondencia: Luana Alves de Souza - Rua Clemente Ferreira, 139 - Apto 201 – Canela – Salvador / BA – Brasil - CEP: 40110-200 – Celular:(+55 71) 9606-2333 – E-mail: lua_goias@hotmail.comArtigo recebido em 6 de Agosto de 2009. Artigo aprovado em 14 de Dezembro de 2009.

Orbital and Intracranial Complication Resulting from Acute Rhinosinusitis: Case Report

INTRODUCTION: Among the rhynosinusitiscomplications, the orbitals are the most frequent and these occur in most of the cases between the youngs and children. Simultaneous complications envolving the orbit and the intracranial space are extremely rare, but they must be treated aggressively because present a morbidity and mortality high rate. CASE REPORT: In this work, the authors report a case of a patient which presented with cellulitis pre-septal and epidural abscess, as simultaneous complications of an acute rhynosinusitis. In the patient of this case, they chose for a clinic treatmentassociated to a nasosinusal endoscopic cirugy and neurocirurgic drainage of the intracranial abscess. The CT was sufficient in the presented case for the diagnostic realization. COMMENTS FIANIS: However it is recommended that in the cases where the patients with rhynosinusitis complications the intracranial extension investigation has to be deepened even when this is not so evident in the beginning. As the polymicrobial nature of these infections, an aggressive antibiotictherapy guided for culture and accompaniment with a multidisciplinary staff, increase considerably the chances of success.ano.*** Medica Otorrinolaringologista.**** Doutor, Medico Otorrinolaringologista. Pesquisador associado do servico de Otorrinolaringologia e Imunologia do Hospital U niversitario Professor Edgard Santos- UFBA.***** Doutor, Medico Otorrinolaringologista. Professor e Chefe do Departamento de Otorrinolaringologia do Hospital Universitari o Professor Edgard Santos.Instituicao: Departamento de Otorrinolaringologia - Hospital Universitario Edgard Santos - Universidade Federal da Bahia (UFBA).Salvador / BA – Brasil.Endereco para correspondencia: Luana Alves de Souza - Rua Clemente Ferreira, 139 - Apto 201 – Canela – Salvador / BA – Brasil - CEP: 40110-200 – Celular:(+55 71) 9606-2333 – E-mail: lua_goias@hotmail.comArtigo recebido em 6 de Agosto de 2009. Artigo aprovado em 14 de Dezembro de 2009.