Cavernous sinus thrombosis: Successful treatment using functional endonasal sinus surgery

Ramzi T Younis, R. H. Lazar

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Objective: Infections of the paranasal sinuses can be complicated by septic thrombosis of the cavernous venous sinuses. After standard antibiotic treatment, fewer than 50% of the patients recover completely, and the mortality rate is approximately 30%. We chose to treat this potentially catastrophic complication with functional endonasal sinus surgery in addition to standard antibiotic therapy. Design: Case study. Patient: A 15-year-old boy presented to the emergency room of LeBonheur Children's Medical Center, Memphis, Tenn, with right proptosis, chemosis, ptosis, ophthalmoplegia, cranial nerve palsies, and paresthesia. The physical examination and computed tomographic scans of the sinuses and orbits revealed edema of the right orbit and pansinusitis, with secondary right cavernous sinus thrombosis and right superior ophthalmic vein thrombosis. Intervention: The patient was started on a regimen of cefuroxime and nafcillin sodium and was scheduled for emergency functional endonasal sinus surgery to drain the primary sites of infection. After surgery, the patient was placed on a 3-week regimen of cefotaxime sodium, metronidazole hydrochloride, vancomycin hydrochloride, and heparin sodium. Results: During surgery, the frontal recess and ethmoid, sphenoid, and maxillary sinuses were found to be filled with polypoid tissue and purulent material. Functional endonasal sinus surgery restored the sinuses to their normal physiologic state. The sinuses demonstrated the progress observed clinically. Conclusions: The improvement in outcome effected by standard antibiotic therapy can be significantly augmented by using functional endonasal sinus surgery in the treatment of cavernous sinus thrombosis.

Original languageEnglish
Pages (from-to)1368-1372
Number of pages5
JournalArchives of Otolaryngology - Head and Neck Surgery
Volume119
Issue number12
StatePublished - Dec 21 1993
Externally publishedYes

Fingerprint

Cavernous Sinus Thrombosis
Orbit
Anti-Bacterial Agents
Therapeutics
Nafcillin
Ethmoid Sinus
Sphenoid Sinus
Cranial Nerve Diseases
Ophthalmoplegia
Cefuroxime
Exophthalmos
Cefotaxime
Maxillary Sinus
Paresthesia
Paranasal Sinuses
Metronidazole
Vancomycin
Infection
Physical Examination
Heparin

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

Cavernous sinus thrombosis : Successful treatment using functional endonasal sinus surgery. / Younis, Ramzi T; Lazar, R. H.

In: Archives of Otolaryngology - Head and Neck Surgery, Vol. 119, No. 12, 21.12.1993, p. 1368-1372.

Research output: Contribution to journalArticle

@article{987649be21104e598d5f385981118ae5,
title = "Cavernous sinus thrombosis: Successful treatment using functional endonasal sinus surgery",
abstract = "Objective: Infections of the paranasal sinuses can be complicated by septic thrombosis of the cavernous venous sinuses. After standard antibiotic treatment, fewer than 50{\%} of the patients recover completely, and the mortality rate is approximately 30{\%}. We chose to treat this potentially catastrophic complication with functional endonasal sinus surgery in addition to standard antibiotic therapy. Design: Case study. Patient: A 15-year-old boy presented to the emergency room of LeBonheur Children's Medical Center, Memphis, Tenn, with right proptosis, chemosis, ptosis, ophthalmoplegia, cranial nerve palsies, and paresthesia. The physical examination and computed tomographic scans of the sinuses and orbits revealed edema of the right orbit and pansinusitis, with secondary right cavernous sinus thrombosis and right superior ophthalmic vein thrombosis. Intervention: The patient was started on a regimen of cefuroxime and nafcillin sodium and was scheduled for emergency functional endonasal sinus surgery to drain the primary sites of infection. After surgery, the patient was placed on a 3-week regimen of cefotaxime sodium, metronidazole hydrochloride, vancomycin hydrochloride, and heparin sodium. Results: During surgery, the frontal recess and ethmoid, sphenoid, and maxillary sinuses were found to be filled with polypoid tissue and purulent material. Functional endonasal sinus surgery restored the sinuses to their normal physiologic state. The sinuses demonstrated the progress observed clinically. Conclusions: The improvement in outcome effected by standard antibiotic therapy can be significantly augmented by using functional endonasal sinus surgery in the treatment of cavernous sinus thrombosis.",
author = "Younis, {Ramzi T} and Lazar, {R. H.}",
year = "1993",
month = "12",
day = "21",
language = "English",
volume = "119",
pages = "1368--1372",
journal = "JAMA Otolaryngology - Head and Neck Surgery",
issn = "2168-6181",
publisher = "American Medical Association",
number = "12",

}

TY - JOUR

T1 - Cavernous sinus thrombosis

T2 - Successful treatment using functional endonasal sinus surgery

AU - Younis, Ramzi T

AU - Lazar, R. H.

PY - 1993/12/21

Y1 - 1993/12/21

N2 - Objective: Infections of the paranasal sinuses can be complicated by septic thrombosis of the cavernous venous sinuses. After standard antibiotic treatment, fewer than 50% of the patients recover completely, and the mortality rate is approximately 30%. We chose to treat this potentially catastrophic complication with functional endonasal sinus surgery in addition to standard antibiotic therapy. Design: Case study. Patient: A 15-year-old boy presented to the emergency room of LeBonheur Children's Medical Center, Memphis, Tenn, with right proptosis, chemosis, ptosis, ophthalmoplegia, cranial nerve palsies, and paresthesia. The physical examination and computed tomographic scans of the sinuses and orbits revealed edema of the right orbit and pansinusitis, with secondary right cavernous sinus thrombosis and right superior ophthalmic vein thrombosis. Intervention: The patient was started on a regimen of cefuroxime and nafcillin sodium and was scheduled for emergency functional endonasal sinus surgery to drain the primary sites of infection. After surgery, the patient was placed on a 3-week regimen of cefotaxime sodium, metronidazole hydrochloride, vancomycin hydrochloride, and heparin sodium. Results: During surgery, the frontal recess and ethmoid, sphenoid, and maxillary sinuses were found to be filled with polypoid tissue and purulent material. Functional endonasal sinus surgery restored the sinuses to their normal physiologic state. The sinuses demonstrated the progress observed clinically. Conclusions: The improvement in outcome effected by standard antibiotic therapy can be significantly augmented by using functional endonasal sinus surgery in the treatment of cavernous sinus thrombosis.

AB - Objective: Infections of the paranasal sinuses can be complicated by septic thrombosis of the cavernous venous sinuses. After standard antibiotic treatment, fewer than 50% of the patients recover completely, and the mortality rate is approximately 30%. We chose to treat this potentially catastrophic complication with functional endonasal sinus surgery in addition to standard antibiotic therapy. Design: Case study. Patient: A 15-year-old boy presented to the emergency room of LeBonheur Children's Medical Center, Memphis, Tenn, with right proptosis, chemosis, ptosis, ophthalmoplegia, cranial nerve palsies, and paresthesia. The physical examination and computed tomographic scans of the sinuses and orbits revealed edema of the right orbit and pansinusitis, with secondary right cavernous sinus thrombosis and right superior ophthalmic vein thrombosis. Intervention: The patient was started on a regimen of cefuroxime and nafcillin sodium and was scheduled for emergency functional endonasal sinus surgery to drain the primary sites of infection. After surgery, the patient was placed on a 3-week regimen of cefotaxime sodium, metronidazole hydrochloride, vancomycin hydrochloride, and heparin sodium. Results: During surgery, the frontal recess and ethmoid, sphenoid, and maxillary sinuses were found to be filled with polypoid tissue and purulent material. Functional endonasal sinus surgery restored the sinuses to their normal physiologic state. The sinuses demonstrated the progress observed clinically. Conclusions: The improvement in outcome effected by standard antibiotic therapy can be significantly augmented by using functional endonasal sinus surgery in the treatment of cavernous sinus thrombosis.

UR - http://www.scopus.com/inward/record.url?scp=0027135952&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0027135952&partnerID=8YFLogxK

M3 - Article

C2 - 17431992

AN - SCOPUS:0027135952

VL - 119

SP - 1368

EP - 1372

JO - JAMA Otolaryngology - Head and Neck Surgery

JF - JAMA Otolaryngology - Head and Neck Surgery

SN - 2168-6181

IS - 12

ER -