Foreign bodies of the parapharyngeal space are rarely encountered in the otolaryngological fields, and may cause severe complications such as descending suppurative mediastinitis, jugular thrombophlebitis with septic pulmonary emboli, cavernous sinus thrombosis, and carotid erosion. Therefore, early diagnosis and surgical intervention are needed to reduce morbidity and motality. Recently, we experienced two cases penetrating injury of parapharyngeal foreign bodies (woodstick). The one was penetrated in right parapharyngeal space from left medial canthal area and the other in left parapharyngeal space from left infraorbital area. They were removed by skin incision and transantral approach with Caldwell-Luc operation, and we report these cases with a review of literature.
Cavernous Sinus Thrombosis ; Early Diagnosis ; Foreign Bodies* ; Mediastinitis ; Skin ; Thrombophlebitis

Pituitary abscess may be caused by direct extension of contiguous infections from purulent sphenoid sinusitis, meningitis or cavernous sinus thrombophlebitis. It also develop after craniotomy or transsphenoidal hypophysectomy. In some cases, it was associated with primary pituitary tumor or cyst which were vulnerable to infection because of impaired circulation, areas of necrosis or local immunological impairment. Primary pituitary abscess may also occur without any preceding infection. Since the clinical features, computed tomographic findings, and laboratory data of primary pituitary abscess were similar to pituitary tumor, preoperative diagnosis of pituitary abscess is difficult. Inhomogenous enhancement with central low density and focal bulge at the level of diaphragm was reported to be compatible with computed tomographic findings of pituitary abscess.
Abscess* ; Cavernous Sinus Thrombosis ; Craniotomy ; Diagnosis ; Diaphragm ; Hypophysectomy ; Meningitis ; Necrosis ; Pituitary Neoplasms ; Sphenoid Sinus ; Sphenoid Sinusitis

Although orbital abscess may originate from a number of sources, acute paranasal sinus disease is the most common source of infection. The clinical presentation is eyelid swelling, proptosis, conjunctival chemosis, diplopia, and decreased visual acuity. Diagnostic methods available for evaluating orbital abscess include sinus X-ray, ultrasound, computed tomography(CT), and bacterial culture of abscess content. Orbital abscess is treated with systemic antibiotics, or surgical draining followed by intravenous antibiotic therapy. Prompt diagnosis and treatment are necessary to prevent meningitis, subdural abscess, cavernous sinus thrombosis, frontal sinus thrombosis, visual loss from increased intraorbital pressure, even death. The authors exprienced a 2-month-old female neonate who presented with eyelid swelling, erythema, propotsis, eyeball deviation on right eye. Her orbital CT disclosed orbital abscess and only systemic intravenous antibiotics and topical antibiotic eyedrop instillation improved the symptoms.
Abscess* ; Anti-Bacterial Agents ; Cavernous Sinus Thrombosis ; Diagnosis ; Diplopia ; Erythema ; Exophthalmos ; Eyelids ; Female ; Frontal Sinus ; Humans ; Infant* ; Infant, Newborn* ; Meningitis ; Orbit* ; Paranasal Sinus Diseases ; Thrombosis ; Ultrasonography ; Visual Acuity

PURPOSE: To evaluate the MR findings of septic thrombosis of the cavernous sinus. MATERIALS AND METHODS: Eleven MR images of six patients with septic cavernous sinus thrombosis obtained over a five-year period and proven clinically or radiologically were retrospectively reviewed. The contour and enhancement pattern of the cavernous sinus, changes in the internal carotid artery, orbit, pituitary gland and sphenoid sinus, and intracranial abnormalities were analyzed and compared with the findings of follow-up studies. RESULTS: In all six patients, contrast study revealed asymmetrical enlargement of the ipsilateral cavernous sinus and multiple irregular filling defects within it. Narrowing of the cavernous portion of the ipsilateral internal carotid artery was noted in five patients, upward displacement of the ipsilateral internal carotid artery in four, ipsilateral proptosis with engorgement of the superior ophthalmic vein in two, pituitary enlargement in five, and inflammatory change in the sphenoid sinus in six. Associated intracranial abnormalities included edema and enhancement in the meninx, temporal lobe, or pons adjacent to the cavernous sinus in four patients, hydrocephalus in one, and cerebral infarction in one. Follow-up MR imaging indicated that the extent of asymmetrical enlargement of the cavernous sinus, filling defects within it, as seen on contrast study, and enlarged pituitary glands had all decreased, without significant interval change. CONCLUSION: MR imaging is useful in the diagnosis of septic cavernous sinus thrombosis. Asymmetrical enlargement of the cavernous sinus, multiple irregular filling defect within it, as seen on contrast study, and changes in the internal carotid artery are characteristic findings.
Carotid Artery, Internal ; Cavernous Sinus Thrombosis* ; Cavernous Sinus* ; Cerebral Infarction ; Diagnosis ; Edema ; Exophthalmos ; Follow-Up Studies ; Humans ; Hydrocephalus ; Magnetic Resonance Imaging ; Orbit ; Pituitary Gland ; Pons ; Retrospective Studies ; Sphenoid Sinus ; Temporal Lobe ; Thrombophlebitis ; Thrombosis ; Veins

Mucoepidermoid carcinoma is a common malignant tumor of the major salivary glands but it rarely arises in the nasal cavity and paranasal sinuses. Like other paranasal sinus carcinomas, mucoepidermoid carcinoma of the ethmoid sinus may first be noticed by the extension of tumor mass to adjacent structures such as nasal cavity, orbit, other paranasal sinuses, and anterior skull base. We recently encountered a patient with complaints of right conjunctival edema and drowsy mentality who was initially treated under the impression of the maxillary, ethmoid and sphenoid sinusitis with cavernous sinus thrombosis. The patient underwent sinus surgery for control of ethmoid and sphenoid infection that was refractory to antibiotic treatment. During the operation, there was only inflammatory mucosal thickening without any specific mass lesion. But, the final diagnosis was mucoepidermoid carcinoma of intermediate grade.
Carcinoma, Mucoepidermoid* ; Cavernous Sinus Thrombosis ; Diagnosis ; Edema ; Ethmoid Sinus* ; Humans ; Nasal Cavity ; Orbit ; Paranasal Sinuses ; Salivary Glands ; Skull Base ; Sphenoid Sinus ; Sphenoid Sinusitis

PURPOSE: We report a case of a patient with ptosis, lid swelling, limitation of ocular movement, and visual disturbance after a trauma. The patient was diagnosed with unilateral orbital cellulitis, ophthalmic vein thrombosis and bilateral septic cavernous thrombosis and treated. CASE SUMMARY: After head and facial area trauma that occurred 1 month earlier, a 56-year-old man suffered from ongoing visual loss, limitation of ocular movement in all directions, proptosis in the left eye and abduction limitation of the right eye. A week before admission, mild fever and chills were also present. At admission, visual acuity of the left eye was no light perception and pupil reflex was lost. Brain MRA and MRI indicated dilation and thrombosis of the left superior ophthalmic vein, left orbital cellulitis and inflammation in bilateral cavernous sinuses. The patient was immediately treated with systemic antibiotics and steroid injection. Coagulase negative staphylococci were detected in blood culture. CONCLUSIONS: Infection caused by facial trauma spread through the facial area's venous plexus and caused orbital cellulitis. As a result, septic cavernous sinus thrombosis and ophthalmic vein thrombophlebitis occurred. Serious complications can occur after facial trauma, thus rapid differential diagnosis and appropriate treatment are important in determining prognosis.
Anti-Bacterial Agents ; Brain ; Cavernous Sinus ; Cavernous Sinus Thrombosis ; Caves ; Chills ; Coagulase ; Diagnosis, Differential ; Exophthalmos ; Eye ; Fever ; Head ; Humans ; Inflammation ; Light ; Orbital Cellulitis ; Prognosis ; Pupil ; Reflex ; Thrombophlebitis ; Thrombosis ; Veins ; Visual Acuity

A nasal septal abscess results from the collection of purulent fluid between the cartilage of bony septum and overlying mucoperichondrium or mucoperiosteum. Unless early diagnosis and surgical treatment are performed, serious complications such as cavernous sinus thrombophlebitis, sepsis, and saddle nose may occur. We report a case of septal abscess and sphenoid sinusitis that occurred after dental implant. A 74-year-old female with diabetes and liver cirrhosis was referred to the hospital for management of rapidly aggravated perinasal pain, nasal obstruction, and headache. The patient had undergone dental implant in the right upper incisor area 6 days ago. A CT revealed septal abscess and bilateral sphenoid sinusitis. The patient was operated upon to drain septal abscess, and both sphenoid sinuses were opened widely.
Abscess ; Aged ; Cartilage ; Cavernous Sinus Thrombosis ; Dental Implants ; Early Diagnosis ; Female ; Headache ; Humans ; Immunocompromised Host ; Incisor ; Liver Cirrhosis ; Nasal Obstruction ; Nasal Septum ; Nose ; Sepsis ; Sphenoid Sinus ; Sphenoid Sinusitis

Although isolated cranial nerve palsies are common in diabetic patients, multiple, simultaneous cranial neuropathies are rare. We describe the second case of a complete superior orbital fissure syndrome including the optic nerve in a middle-aged Papuan man with newly diagnosed diabetes mellitus. The differential diagnosis included septic cavernous sinus thrombosis and Tolosa Hunt syndrome, and management was initially directed at excluding these serious, treatable conditions.
Cavernous Sinus Thrombosis - diagnosis ; Diabetes Mellitus, Type 2 - complications ; Diabetes Mellitus, Type 2 - diagnosis ; New Guinea ; Oculomotor Nerve Diseases - diagnosis ; Oculomotor Nerve Diseases - etiology ; Tolosa-Hunt Syndrome - diagnosis

PURPOSE: We report a case of bilateral cavernous sinus thrombosis and unilateral intraorbital abscess in a patient suffering proptosis, a limitation of ocular movement, and visual disturbance. METHODS: After several days of febrile and chilling sensation, a 49-year-old man suffered from vision loss, a limitation of ocular movement in all directions, proptosis in the right eye and mild abduction limitation in the left eye. Brain MRI, indicated inflammation in the bilateral cavernous sinuses and intraorbital abscess in the right eye, leading to a diagnosis of cavernous sinus thrombosis. Systemically, the patient was treated with antibiotics and steroid injection. For intraorbital abscess, aspiration and antibiotics injection were administered locally. The patient improved overall and the abscess size decreased. Blood culture showed alpha-hemolytic Streptococcus. The Gram stain of the specimen from the intraorbital abscess revealed Gram-positive cocci but no specific strain was cultured. RESULTS: We believe that proptosis in the right eye, intraorbital abscess, limitation of ocular movement, retinal hemorrhage, and optic atrophy were due to alpha-hemolytic Streptococcus, which had spread to the cavernous sinus and right orbit through the vascular system. CONCLUSIONS: We report a case of bilateral cavernous sinus thrombosis and intraorbital abscess in the right eye in a patient who suffered from sepsis caused by alpha-hemolytic Streptococcus.
Abscess* ; Anti-Bacterial Agents ; Brain ; Cavernous Sinus Thrombosis* ; Cavernous Sinus* ; Diagnosis ; Exophthalmos ; Gram-Positive Cocci ; Humans ; Inflammation ; Magnetic Resonance Imaging ; Middle Aged ; Optic Atrophy ; Orbit ; Retinal Hemorrhage ; Sensation ; Sepsis ; Streptococcus

Cavernous sinus thrombophlebitis is characterized by edema of the eyelids and the conjunctivae, and paralysis of the cranial nerves. It is rare, often misdiagnosed or underestimated by neurosurgeons, and is generally related with high rates of mortality and morbidity. High rate of suspicion is required for early diagnosis, and aggressive managements can lead to better outcomes. With recent advancements in antibiotic therapies, the mortality rate has been decreased to less than 30%. However, the morbidity remains high and complete recovery is rare. A 69-year-old woman presented with headache and right ocular pain with sixth cranial nerve palsy for one week. Under the suspicion of Tolosa-Hunt syndrome, steroid treatment was done. On discharge, there was improvement in right ocular pain, but the cranial nerve palsy remained. Subsequently, the patient returned with left ocular pain, lid swelling, redness, ecchymosis of conjunctiva, and ptosis. Enhanced brain magnetic resonance imaging revealed an asymmetrically enlarged left cavernous sinus with heterogeneously enhancing contour. Intravenous antibiotics and oral steroids along with anticoagulant medications were administered.
Abducens Nerve Diseases ; Aged ; Anti-Bacterial Agents ; Brain ; Cavernous Sinus ; Cavernous Sinus Thrombosis ; Caves ; Conjunctiva ; Cranial Nerve Diseases ; Cranial Nerves ; Early Diagnosis ; Ecchymosis ; Edema ; Exophthalmos ; Eyelids ; Female ; Headache ; Humans ; Magnetic Resonance Imaging ; Paralysis ; Steroids ; Tolosa-Hunt Syndrome