1/21. nasolacrimal duct obstruction and orbital cellulitis associated with chronic intranasal cocaine abuse.OBJECTIVE: To report the association of acquired nasolacrimal duct obstruction and orbital cellulitis in patients with a history of chronic intranasal cocaine abuse. methods: Retrospective, consecutive case series. Results of imaging, histopathologic examinations, and clinical courses of these patients were studied. RESULTS: Five women and 2 men (mean age, 41 years) with a history of chronic intranasal cocaine abuse (mean, 11 years; range, 5-20 years) presented with epiphora and in some cases acute onset of periorbital pain, edema, and erythema associated with fever. The suspicion of intranasal cocaine abuse was made on anterior rhinoscopy with the detection of an absent nasal septum and inferior turbinate. Computed tomographic and magnetic resonance imaging findings in 4 patients included extensive bony destruction of the normal orbital wall architecture, opacification of the sinuses, and the presence of an intraorbital tissue mass. Histopathologic examination of the nasolacrimal duct in 2 patients and of the orbital mass in a third patient revealed marked chronic inflammation with fibrosis causing secondary nasolacrimal duct obstruction. Six patients were treated with systemic antibiotics followed by dacryocystorhinostomy in 3 patients, and a pericranial flap to insulate the exposed orbit in 1 patient. CONCLUSIONS: Chronic intranasal cocaine abuse can result in extensive bony destruction of the orbital walls with associated orbital cellulitis, and should be included in the differential diagnosis of acquired nasolacrimal duct obstruction. Anterior rhinoscopy is very helpful in establishing the correct diagnosis in these patients.- - - - - - - - - - ranking = 1keywords = sinus (Clic here for more details about this article) |
2/21. nasolacrimal duct obstruction secondary to ectopic teeth.OBJECTIVE: To describe two patients with nasolacrimal duct obstruction (NLDO) caused by ectopic eruption of teeth. The literature concerning nasal and other unusual ectopic sites of tooth eruption is reviewed. DESIGN: Two interventional case reports and literature review. PARTICIPANTS: A 3-year-old girl with epiphora and recurrent dacryocystitis of the right eye. Previous medical and surgical management was unsuccessful. A 32-year-old female with a long history of right eye discomfort and epiphora. Previous examinations and workup were negative. INTERVENTION: A computed tomographic (CT) scan of the orbits and sinuses was performed in both patients. The ectopic teeth were surgically removed. MAIN OUTCOME MEASURES: Nasolacrimal system function and response to treatment at the last follow-up were recorded. RESULTS: In the first patient, CT imaging disclosed two teeth within the right inferior meatus compressing the nasolacrimal duct. In the second patient, CT revealed a large dental structure in the maxillary sinus compressing the nasolacrimal duct. Endoscopic tooth extraction and nasolacrimal duct probing in the first patient and surgical removal of the dental structure in the second patient effected complete resolution of symptoms. Both patients were symptom free at last follow-up. CONCLUSIONS: These cases suggest that ectopic eruption of teeth should be added to the differential diagnosis of NLDO. Surgical removal of the ectopic teeth compressing the nasolacrimal duct results in resolution of the lacrimal drainage obstruction.- - - - - - - - - - ranking = 2keywords = sinus (Clic here for more details about this article) |
3/21. Epiphora following rhinoplasty and Caldwell-Luc procedures.Cosmetic rhinoplasty and maxillary sinus surgery are rare causes of lacrimal obstruction. The lacrimal sac is quite vulnerable to damage by the lateral osteotomy of the rhinoplasty. While obstruction from such damage usually resolves in three months, these three cases illustrate the risk of perisitent obstruction, particularly in complicated cases. The nasoantral window in the Caldwell-Luc may damage the distal lacrimal opening if it is placed too high, or made too large. Occasionally, the duct will extend more anterior and inferior and be quite vulnerable to damage by the nasal antrostomy.- - - - - - - - - - ranking = 1keywords = sinus (Clic here for more details about this article) |
4/21. dentigerous cyst in the maxillary sinus: a rare cause of nasolacrimal obstruction.The main types of maxillary cysts are antral mucoceles, retention cysts, pseudocysts, dentigerous cysts and keratocysts. Despite the theoretical possibility of maxillary sinus cysts leading to nasolacrimal duct obstruction, only two cases have been reported in the literature so far. The present authors report this rare presentation of a dentigerous cyst with a tooth in the roof of the maxillary sinus, which led to nasolacrimal duct obstruction.- - - - - - - - - - ranking = 6keywords = sinus (Clic here for more details about this article) |
5/21. vasculitis of the lacrimal sac wall in wegener granulomatosis.A 35-year-old woman with a 4-year history of generalized wegener granulomatosis (WG) had clinically controlled disease. She was evaluated for a 6-month history of right lacrimal sac mass. On examination, a right chronic dacryocystitis and mucocele were observed. A right external dacryocystorhinostomy was performed. The surgical biopsy specimen from the lacrimal sac showed leukocytoclastic vasculitis with more aggressive damage to the small vessels in the deeper mucosa and focal microhemorrhages. The patient was free of symptoms 1 year after surgery. We believe this is the first report of generalized WG presenting features of an active vasculitis of the lacrimal sac wall on surgical biopsy specimen. We conclude that the lacrimal drainage system can be affected directly by focal WG vasculitis, suggesting that nasolacrimal duct obstruction is not always due to contiguous paranasal disease.- - - - - - - - - - ranking = 25.730404568927keywords = paranasal (Clic here for more details about this article) |
6/21. The pitfall of dacryostenosis.We examined a 65-year-old woman with complaints of epiphora, which was diagnosed as due to dacryostenosis. After she had undergone dacryocystorhinostomy for this presumed condition, we discovered a large mass protruding through the incision. A biopsy showed anaplastic carcinoma, and a CT scan revealed that the right-side sinuses were filled with tumor. We conclude that the possibility of paranasal sinus tumors should at least be considered before initiating treatment for complaints of epiphora in elderly patients.- - - - - - - - - - ranking = 89.578051366232keywords = paranasal sinus, paranasal, sinus (Clic here for more details about this article) |
7/21. Massive enlargement of the nasolacrimal canal causing epiphora and chronic maxillary sinusitis.OBJECTIVES: Enlargement of the nasolacrimal canal (NLC) is a rare anatomic variant. We present the first report of a massively dilated NLC causing epiphora and chronic sinusitis. methods: The authors conducted a literature review and case report. RESULTS: A 65-year-old man with refractory sinonasal symptoms and a remote history of a dacryocystorhinostomy was found to have a massively dilated, air-filled NLC. Using a combined endoscopic transnasal and endoscope-assisted Caldwell-Luc approach, the posterolateral wall of the NLC was removed. The patient's symptoms were improved 10 months postoperatively. CONCLUSIONS: Symptoms suggestive of nasolacrimal dysfunction should prompt a search for potential sinonasal pathology.- - - - - - - - - - ranking = 5keywords = sinus (Clic here for more details about this article) |
8/21. Lacrimal obstruction after medial maxillectomy.Medial maxillectomy can result in lacrimal obstruction and the need for subsequent dacryocystorhinostomy. Computed tomographic dacryocystography is a technique in which radiopaque dye is instilled in the lacrimal sac and computed tomography is subsequently performed. Computed tomographic dacryocystography facilitated the management of a patient with lacrimal obstruction after medial maxillectomy by helping to exclude recurrent tumor and sinusitis, and by providing a surgical "roadmap" in the presence of altered anatomy.- - - - - - - - - - ranking = 1keywords = sinus (Clic here for more details about this article) |
9/21. Combined computed tomography and dacryocystography for complex lacrimal problems.Two imaging modalities, computed tomography (CT) and dacryocystography (DCG), were combined to demonstrate the relationships between the lacrimal system and the surrounding soft-tissue structures. In selected cases, such as those involving severe facial trauma, midfacial tumours, significant sinus disease, or previous lacrimal, nasal or sinus surgery, this imaging technique may be useful in better evaluating the anatomy of the lacrimal system and planning a surgical approach.- - - - - - - - - - ranking = 2keywords = sinus (Clic here for more details about this article) |
10/21. Orbital complications of paranasal sinus surgery.Despite the low complication rate from surgery of the paranasal sinuses, orbital injury may be seen in up to 3% of all procedures. These complications include orbital edema, orbital hemorrhage, enophthalmos, extraocular muscle injury, and nasolacrimal duct obstruction. The most devastating complication is blindness, usually resulting from optic nerve compression with central retinal artery occlusion, or direct injury to the nerve itself. Early recognition of orbital injury during sinus surgery and appropriate intervention may prevent later, more serious ophthalmic complications.- - - - - - - - - - ranking = 443.89025683116keywords = paranasal sinus, paranasal, sinus (Clic here for more details about this article) |
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