Teresa Matos

Chronic Rhinosinusitis and Lacrimal Obstructive Disease

Objective: To investigate if chronic inflammatory sinus disease has a pathogenic role in the obstructive pathology of the neighboring lacrimal system, including obstruction alone and chronic or recurring dacryocystitis. Method: One hundred patients were selected for endoscopic DCR because of persistent epiphora and/or chronic or recurrent dacryocystitis. Their sinus CT scans were evaluated using the Lund-Mackay score.The nonoperated side and a further group of 30 head trauma patients were the control groups. Results: No statistically significant differences were found in either presence or absence, or even disease extension or location, of image defined inflammation of the sinuses and obstructive pathology of the lacrimal system, including chronic or recurring dacryocystitis. DCR sides and patients do not have higher scores of sinonasal disease than nonsurgical sides or normal subjects. Conclusion: These results lead to the conclusion that chronic inflammatory sinus disease is a comorbidity that very likely does not play a pathogenic role in any form of obstructive disease of the lacrimal system.

Adenocarcinoma in facial nerve.

Facial nerve malignancies are rare, destructive, and an uncommon cause of facial paralysis, accounting for less than 5% of all cases (1). The neoplastic involvement can be intrinsic or extrinsic and occur along the entire course of the nerve: extracranial, intratemporal, or intracranial. Extratemporal malignancies, such as parotid tumors, can present as perineural invasion, providing a route of spread and being a major risk factor for recurrence and regional dissemination (1). Parotid adenocarcinoma is considered a high-grade malignancy according to the World Health Organization’s classification of salivary gland tumors and has a higher risk of local recurrence or metastases compared to nonYhigh-grade malignancies (2). Adenocarcinomas of the parotid have a propensity to invade and infiltrate facial nerve fibers, and the disease course can be characterized by an acute facial paralysis that can appear many years after the primary surgery. Although rare, facial nerve carcinoma must be considered in the differential diagnosis of a facial nerve paralysis in the presence of a previous history of a parotid adenocarcinoma, and Bell’s palsy must be used cautiously as a diagnosis of exclusion.

Endonasal Endoscopic Repair of Orbital Floor Defects

Objective: We have previously published an endonasal endoscopic technique of inferior orbital floor reconstruction, for the surgical management of the “silent sinus syndrome” and “blow-out” orbital fractures. Based on the same principles, we present an alternative version of the technique with the advantage of an “overlay” approach to the bone defect. Method: After creating a large middle meatal antrostomy, an autologous septal bone graft is placed over the orbit floor defect, in the subperiostal plane between orbital contents and bony floor, through an incision on the lamina papyracea. Results: At long-term follow-up we achieve, in most, if not all, cases, resolution of enophthalmos and ipsilateral chronic maxillary sinus atelectasis, with minimal morbidity. Conclusion: This technique provides excellent functional and aesthetic results in the surgical reconstruction of the orbit floor.