November 2007 Newsletter

Case of the Month
Submitted by Umang Khetarpal, MD
Southwest Facial Plastic Surgery Institute, Brownsville, TX

36 yr old female presented with many year history of moderate to severe nasal congestion, facial and cheek pressure and congestion, hyposmia, cough with some sneezing and watery eyes. Visual analog scale scores were generally in the 6-8 range for these symptoms.

Co-morbid conditions included Sjogren's syndrome and rheumatoid arthritis with history of pericarditis. Two trial of augmentin unsuccessful previously. Exam revealed dry nasal mucosa with septal deviation and thick greenish crusty discharge from both middle and superior meatuses. Endoscopically guided swab yielded MRSA susceptible to Levaquin. She failed treatment with bactroban ointment, salagen and Levaquin for six weeks. Pre-op CT sinus showed diffuse bilateral pansinusitis with septal deviation (Figures 1,2). 

She underwent bilateral sphenoethmoidectomy with maxillary antrostomies and frontal sinusotomies with septoplasty. Intra-op frontal sinus pus was negative on culture. Two months post-op, her scores on visual analog scale were 0 for all pre-op symptoms except for body pain secondary to rheumatoid arthritis. Pre-op CT (Figure 1,2) and post-op CT (Figure 3-6) images shown for comparison. Residual asymptomatic left maxillary sinusitis noted which on endoscopy shows thick mucus.
 
Umang Khetarpal, MD

Preop Scan (Figure 1)	Preop Scan (Figure 2)
Postop Scan (Figure 3)	Postop Scan (Figure 4)
Postop Scan (Figure 5)	Postop Scan (Figure 6)