Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts - P301

Poster Presentations

Rapidly Progressive Orbital Apex Syndrome
due to Scedosporium apiospermum Following
Functional Endoscopic Sinus Surgery
Steven R. Engebretsen (Presenter); Luxman Srikantha;
Samba Siva; Reddy Bathula, MD
Objectives: Scedosporium apiospermum is a ubiquitous,
highly resistant opportunistic fungus that can be mistaken for
Aspergillus and is found in the paranasal sinuses. There has
never been a reported case of Scedosporium-induced orbital
apex syndrome (OAS) following routine sinus surgery.
Methods: Case report.
Results: An 80-year-old man with diabetes mellitus underwent functional endoscopic sinus surgery for chronic sinusitis
with polyposis. Immediate pathologic examination reports
indicated noninvasive Aspergillus. On postoperative day 4,
the patient presented with examination and imaging findings
suggestive of right OAS from postsurgical inflammation. He
was given high-dose steroids because there were no clinical
signs of invasive fungal disease. Within 72 hours, the patient
developed vision loss of the left eye. He underwent emergent
surgical decompression of the optic nerve, sphenoidotomy,
and posterior septectomy with mucosal stripping. A dehiscence in the right lamina papyracea and posterior ethmoid lateral wall adjacent to the right orbital apex were found. The
day following the emergent intervention, cultures from the
original sinus surgery were revised to identify Scedosporium
apiospermum. The patient was given high-dose voriconazole.
Unfortunately, vision loss persisted, and the patient subsequently had other medical complications that led the patient to
pass away 47 days after the initial routine sinus surgery.
Conclusions: Trauma to the delicate bony walls of the orbit
during sinus surgery in an immunocompromised patient who
is unknowingly colonized with Scedosporium apiospermum
can lead to rapid spread of this highly neurotoxic organism.
Care and a high index of suspicion should be had for the rapid
identification and treatment of this devastating infection.

A Rare Case of Angiofibroma With Primary
Vascular Supply Arising From the Anterior
Ethmoid Artery
Michael W. Randall, MD (Presenter); Nicholas W.
Pritchard, MD; Arjun Parasher, MD
Objectives: Angiofibromas are benign, vascular masses, most
commonly found in the nasopharynx. The most common primary arterial supply is the internal maxillary artery, a branch of
the external carotid artery. The second most common arterial
supply is from the ascending pharyngeal branch of the external
carotid artery, with additional accessory arteries including the
middle meningeal, accessory meningeal, and facial artery
branches. There are some reports describing the recruitment of
internal carotid artery branches, most commonly the vidian
artery and to a slightly lesser degree the ophthalmic artery.
Methods: We present a case of a 64-year-old man with a right
anterior skull base tumor extending from the right ethmoid skull
base. The patient had persistent epistaxis, and he was found to
have a vascular right skull-base mass pedicled primarily from
the right anterior ethmoid artery on angiogram.
Results: The tumor was resected completely after embolization, and the patient did well postoperatively without complications. The pathology was confirmed to be an angiofibroma
with extensive myxoid change.
Conclusions: Angiofibromas are benign, highly vascular
lesions that comprise approximately 0.05% to 0.5% of all
head and neck masses. They most commonly arise from the
internal maxillary or ascending pharyngeal arteries. This is
likely the first described case of an angiofibroma with a primary arterial blood supply from the anterior ethmoid artery.
A Rare Case of Soft Tissue Giant Cell Tumor
From the Maxillary Sinus: A Case Report
and Review
Soh Leonard (Presenter); Koh Leslie
Objectives: Head and neck giant cell tumors of the soft tissue (GCT-ST) are a rare entity, with only a handful of reported
cases in the literature. Here we present the first known case of
GCT-ST arising from the maxillary sinus cavity and seek to
shed further light on this uncommon entity.
Methods: A case report of a 49-year-old Chinese woman
who presented with repeated episodes of left epistaxis.
Results: Examination showed an everted left uncinate process suggestive of an underlying maxillary sinus space-
occupying lesion. Computed tomography imaging revealed a
solid well-circumscribed enhancing mass, measuring 2.6 × 2.0 ×
2.6 cm, seen extending through the left maxillary ostium with
widening of the infundibulum. Surgical excision via an endoscopic approach with stripping of surrounding sinus wall mucosa
for margin clearance was performed. Histology revealed a soft
tissue giant cell tumor with immunostaining (CD68+, S100-)
highlighting multinucleated giant cells and loose histiocytes.

Rhinology/Allergy

After covering the exposed bone surface with an axillary flap,
calcium alginate was inserted into the frontal sinus. Calcium
alginate was cleaned about 1 week after surgery. Thereafter, selfnasal washes using physiological saline were performed. The
degree of opening of the frontal sinus ostium 1 year after surgery
was divided into 3 groups: patent, stenosis, and closure.
Results: The frontal sinus ostium was patent in 10 of 14 cases
(71.4%) and narrowed in 2 of 14 cases (14.2%). In all cases of
patency and stenosis, there was no recurrence of the original disease. Frontal sinus ostium closure occurred in 2 cases (14.2%).
Both were caused by postoperative bone regeneration.
Conclusions: EMLP is useful as a surgical procedure for
recurrent refractory frontal sinus lesions. In this study, axillary
flap and calcium alginate were used to prevent postoperative
restenosis of frontal sinus ostium. However, there are cases in
which reocclusion may occur even if this method is used.

P301

Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts

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