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A 52-year-old man was referred to the ENT department with a 10-week history of facial pain. He described the worst pain he had ever experienced and had been unable to work during the preceding fortnight.He had noted increasing swelling around his left eye and forehead and green discharge from his left nostril, with occasional blood-staining. He had received three courses of antibiotics with little effect.The patient described a long history of sinus problems, previously requiring hospital admission for intravenous antibiotics. He had undergone functional endoscopic sinus surgery (FESS) on three occasions electively for nasal polyposis and had undergone emergency surgery to the maxillary sinuses for an episode of orbital cellulitis. He is an asthmatic and had previously had an attack triggered by aspirin.On examination, marked tenderness was noted bilaterally over the orbital and maxillary regions and there was a fluctuant swelling in the region of the left forehead. Eye movements and vision were normal. Polyps and pus were visible on anterior rhinoscopy. Full blood count, renal function and electrolytes were normal.Swabs from both nostrils were sent for culture and sensitivity and an urgent CT scan was requested (Figures 1 and 2) showing soft tissue swelling with abscess formation overlying the left frontal sinus, bony erosion of the anterior wall of the sinus and inflammation of most paranasal sinuses. Figure 1. Axial CT showing bony defect of the anterior wall of the frontal sinus with overlying soft tissue swelling Figure 2. Coronal CT showing extensive shadowing of the paranasal sinuses suggestive of mucosal thickening and retained secretions What do these findings indicate and why would this patient be prone to develop this condition? Answer and Discussion

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Ellen Welch, GP Specialist Trainee; Foon Ng Kee Kwong, Foundation Year 1 Doctor; Hiba Mohammed, Foundation Year 2 Doctor; Russell Cathcart, Consultant Otolaryngologist; Department of Otolaryngology, North Cumbria University Hospitals NHS Trust, Carlisle, England

Acknowledgements

Correspondence

Mr Russell Cathcart, Consultant Otolaryngologist, Department of Otolaryngology, North Cumbria University Hospitals NHS Trust, Cumberland Infirmary, Newtown Road, Carlisle, Cumbria CA2 7HY, United Kingdom. Fax: +44 (0)122 8814276

Correspondence Email

russell.cathcart@ncuh.nhs.uk

Competing Interests

Fokkens W, Lund V, Mullol J. European position paper on rhinosinusitis and nasal polyps. Complications of rhinosinusitis and nasal polyps. Rhinology 2007;45(suppl. 20):80-83.Tattersall R, Tattersall R. Potts puffy tumour. The Lancet 2002;359:1060-63.Pott P. Injuries of the head from external violence. 1st edn. London: C Hitch and L Hawes, 1760:47-48.Verbon A, Husni RN, Gordon SM, et al. Potts puffy tumour due to Haemophilus influenzae: Case report and review. Clinical Infectious Diseases 1996;23:1305-1307.Goldberg AN, Oroszglan G, Anderson TD. Complications of frontal sinusitis and their management. Otolaryngologic Clinics of North America 2001;34:211-225.Samter M, Beers RF. Intolerance to aspirin, Clinical studies and consideration of its pathogenesis. Annals of Internal Medicine 1968;68:975-983.Kim JE, Kountakis SE. The prevalence of Samters triad in patients undergoing functional endoscopic sinus surgery. Ear, Nose and Throat Journal 2007;86:396-399.Kowalski ML. Rhinosinusitis and nasal polyposis in aspirin sensitive and aspirin tolerant patients: are they different? Thorax 2000;55:S84-86.McFadden EA, Kany RJ, Fink JN, Toohill RJ. Surgery for sinusitis and aspirin triad. Laryngoscope 1990;100:1043-1046.Collet S, Grulois V, Eloy P, et al. A Potts puffy tumour as a late complication of a frontal sinus reconstruction: case report and literature review. Rhinology 2009;47:470-475.

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A 52-year-old man was referred to the ENT department with a 10-week history of facial pain. He described the worst pain he had ever experienced and had been unable to work during the preceding fortnight.He had noted increasing swelling around his left eye and forehead and green discharge from his left nostril, with occasional blood-staining. He had received three courses of antibiotics with little effect.The patient described a long history of sinus problems, previously requiring hospital admission for intravenous antibiotics. He had undergone functional endoscopic sinus surgery (FESS) on three occasions electively for nasal polyposis and had undergone emergency surgery to the maxillary sinuses for an episode of orbital cellulitis. He is an asthmatic and had previously had an attack triggered by aspirin.On examination, marked tenderness was noted bilaterally over the orbital and maxillary regions and there was a fluctuant swelling in the region of the left forehead. Eye movements and vision were normal. Polyps and pus were visible on anterior rhinoscopy. Full blood count, renal function and electrolytes were normal.Swabs from both nostrils were sent for culture and sensitivity and an urgent CT scan was requested (Figures 1 and 2) showing soft tissue swelling with abscess formation overlying the left frontal sinus, bony erosion of the anterior wall of the sinus and inflammation of most paranasal sinuses. Figure 1. Axial CT showing bony defect of the anterior wall of the frontal sinus with overlying soft tissue swelling Figure 2. Coronal CT showing extensive shadowing of the paranasal sinuses suggestive of mucosal thickening and retained secretions What do these findings indicate and why would this patient be prone to develop this condition? Answer and Discussion

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Ellen Welch, GP Specialist Trainee; Foon Ng Kee Kwong, Foundation Year 1 Doctor; Hiba Mohammed, Foundation Year 2 Doctor; Russell Cathcart, Consultant Otolaryngologist; Department of Otolaryngology, North Cumbria University Hospitals NHS Trust, Carlisle, England

Acknowledgements

Correspondence

Mr Russell Cathcart, Consultant Otolaryngologist, Department of Otolaryngology, North Cumbria University Hospitals NHS Trust, Cumberland Infirmary, Newtown Road, Carlisle, Cumbria CA2 7HY, United Kingdom. Fax: +44 (0)122 8814276

Correspondence Email

russell.cathcart@ncuh.nhs.uk

Competing Interests

Fokkens W, Lund V, Mullol J. European position paper on rhinosinusitis and nasal polyps. Complications of rhinosinusitis and nasal polyps. Rhinology 2007;45(suppl. 20):80-83.Tattersall R, Tattersall R. Potts puffy tumour. The Lancet 2002;359:1060-63.Pott P. Injuries of the head from external violence. 1st edn. London: C Hitch and L Hawes, 1760:47-48.Verbon A, Husni RN, Gordon SM, et al. Potts puffy tumour due to Haemophilus influenzae: Case report and review. Clinical Infectious Diseases 1996;23:1305-1307.Goldberg AN, Oroszglan G, Anderson TD. Complications of frontal sinusitis and their management. Otolaryngologic Clinics of North America 2001;34:211-225.Samter M, Beers RF. Intolerance to aspirin, Clinical studies and consideration of its pathogenesis. Annals of Internal Medicine 1968;68:975-983.Kim JE, Kountakis SE. The prevalence of Samters triad in patients undergoing functional endoscopic sinus surgery. Ear, Nose and Throat Journal 2007;86:396-399.Kowalski ML. Rhinosinusitis and nasal polyposis in aspirin sensitive and aspirin tolerant patients: are they different? Thorax 2000;55:S84-86.McFadden EA, Kany RJ, Fink JN, Toohill RJ. Surgery for sinusitis and aspirin triad. Laryngoscope 1990;100:1043-1046.Collet S, Grulois V, Eloy P, et al. A Potts puffy tumour as a late complication of a frontal sinus reconstruction: case report and literature review. Rhinology 2009;47:470-475.

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

A 52-year-old man was referred to the ENT department with a 10-week history of facial pain. He described the worst pain he had ever experienced and had been unable to work during the preceding fortnight.He had noted increasing swelling around his left eye and forehead and green discharge from his left nostril, with occasional blood-staining. He had received three courses of antibiotics with little effect.The patient described a long history of sinus problems, previously requiring hospital admission for intravenous antibiotics. He had undergone functional endoscopic sinus surgery (FESS) on three occasions electively for nasal polyposis and had undergone emergency surgery to the maxillary sinuses for an episode of orbital cellulitis. He is an asthmatic and had previously had an attack triggered by aspirin.On examination, marked tenderness was noted bilaterally over the orbital and maxillary regions and there was a fluctuant swelling in the region of the left forehead. Eye movements and vision were normal. Polyps and pus were visible on anterior rhinoscopy. Full blood count, renal function and electrolytes were normal.Swabs from both nostrils were sent for culture and sensitivity and an urgent CT scan was requested (Figures 1 and 2) showing soft tissue swelling with abscess formation overlying the left frontal sinus, bony erosion of the anterior wall of the sinus and inflammation of most paranasal sinuses. Figure 1. Axial CT showing bony defect of the anterior wall of the frontal sinus with overlying soft tissue swelling Figure 2. Coronal CT showing extensive shadowing of the paranasal sinuses suggestive of mucosal thickening and retained secretions What do these findings indicate and why would this patient be prone to develop this condition? Answer and Discussion

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Ellen Welch, GP Specialist Trainee; Foon Ng Kee Kwong, Foundation Year 1 Doctor; Hiba Mohammed, Foundation Year 2 Doctor; Russell Cathcart, Consultant Otolaryngologist; Department of Otolaryngology, North Cumbria University Hospitals NHS Trust, Carlisle, England

Acknowledgements

Correspondence

Mr Russell Cathcart, Consultant Otolaryngologist, Department of Otolaryngology, North Cumbria University Hospitals NHS Trust, Cumberland Infirmary, Newtown Road, Carlisle, Cumbria CA2 7HY, United Kingdom. Fax: +44 (0)122 8814276

Correspondence Email

russell.cathcart@ncuh.nhs.uk

Competing Interests

Fokkens W, Lund V, Mullol J. European position paper on rhinosinusitis and nasal polyps. Complications of rhinosinusitis and nasal polyps. Rhinology 2007;45(suppl. 20):80-83.Tattersall R, Tattersall R. Potts puffy tumour. The Lancet 2002;359:1060-63.Pott P. Injuries of the head from external violence. 1st edn. London: C Hitch and L Hawes, 1760:47-48.Verbon A, Husni RN, Gordon SM, et al. Potts puffy tumour due to Haemophilus influenzae: Case report and review. Clinical Infectious Diseases 1996;23:1305-1307.Goldberg AN, Oroszglan G, Anderson TD. Complications of frontal sinusitis and their management. Otolaryngologic Clinics of North America 2001;34:211-225.Samter M, Beers RF. Intolerance to aspirin, Clinical studies and consideration of its pathogenesis. Annals of Internal Medicine 1968;68:975-983.Kim JE, Kountakis SE. The prevalence of Samters triad in patients undergoing functional endoscopic sinus surgery. Ear, Nose and Throat Journal 2007;86:396-399.Kowalski ML. Rhinosinusitis and nasal polyposis in aspirin sensitive and aspirin tolerant patients: are they different? Thorax 2000;55:S84-86.McFadden EA, Kany RJ, Fink JN, Toohill RJ. Surgery for sinusitis and aspirin triad. Laryngoscope 1990;100:1043-1046.Collet S, Grulois V, Eloy P, et al. A Potts puffy tumour as a late complication of a frontal sinus reconstruction: case report and literature review. Rhinology 2009;47:470-475.

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