Orbital complication due to a paranasal sinus cyst is classified as visual disturbance, external ophthalmoplegia, or disturbance of ocular motility caused by nerve palsy. Isolated abducens nerve palsy due to a paranasal sinus cyst is rare. Here, we report a case of isolated abducens nerve palsy and double vision with a postoperative posterior ethmoid cyst. A 75-year-old man was referred to our clinic because of pain around the left orbit and double vision. Computed tomography and magnetic resonance imaging revealed a lt. posterior ethmoid cyst of 30 mm in diameter that had destroyed the superior and lateral walls of the sphenoid bone, and was close to the left cavernous sinus. Ophthalmological examination showed left isolated abducens nerve palsy on a Hess screen test, but unassisted vision did not worsen. The patient had a surgical history of a left Caldwell-Luc operation and had been diagnosed with isolated abducens nerve palsy due to a postoperative posterior ethmoid cyst. About 3 weeks after onset, he underwent endoscopic sinus surgery under general anesthesia. Viscous fluid was observed in the cyst, but no signs of infection were detected. Left abducens nerve palsy was not improved at admission, but did improve by about 2 months after surgery. In this case, we consider that isolated abducens nerve palsy occurred because the paranasal sinus cyst had enlarged inferiorly and inside the cavernous sinus, but without impairment of oculomotor and trochlear nerve functions.

A postoperative paranasal sinus cyst may occur at various sites and can be difficult to treat surgically due to difficulty obtaining a good field of view, despite use of a 30° endoscope. The utility of endoscopic modified medial maxillectomy (EMMM) for these cases has recently been reported. Here, we report an operation performed with EMMM for a case of postoperative maxillary cyst located outside of the ductus nasolacrimalis. The patient was a 64-year-old woman with a chief complaint of right cheek pain. Her history included bilateral Caldwell-Luc surgery at age 20 years old. Computed tomography identified two cystic lesions of the pars maxillaries: a lesion of 20mm in diameter in contact with the inferior meatus, and a lesion of 10mm diameter outside the ductus nasolacrimalis and in contact with the inside of the infraobital nerve and inferior wall of the orbit. We initially performed fenestration of the large cyst close to the inferior meatus under local anesthesia. However, relapse of right cheek pain occurred eight months later. Therefore, we performed fenestration of the osseous cystic wall in the meatus nasi medius with a drill using a navigation system. A mucoperiostium flap was inserted into the cyst to prevent restenosis. However, cheek pain recurred one month later, and complete resection of the cystic wall was subsequently performed using EMMM with a navigation system. At 19 months after surgery, the cyst has not occluded again. We review the utility of the EMMM with a navigation system for treatment of a nasolacrimal lateral small osseous cyst.

Approximately 0.5–2.0% of new outpatients in the Department of Otorhinolaryngology have foreign bodies, among which approximately 10–20% are in the nasal cavity and some are in the paranasal sinus. Here, we report a case of chopsticks as foreign bodies found in the frontal sinus, with a few in the paranasal sinus. The patient was a 27-year-old male. He got dead drunk and was struck in the face and injured. He visited the emergency room of our hospital due to ongoing pain and intermittent nasal bleeding; subsequently, with no indication of a foreign substance, we instructed him to visit an otolaryngologist at a later date and sent him home. However, he visited a local otolaryngologist five days after the injury due to continuation of the nasal occlusion, at which point a foreign substance inside his nose was indicated, prompting him to visit our department. Upon discovering a stick as the foreign substance inserted from the inside of his nose into the frontal sinus, we immediately attempted to extract the foreign substance under a nasal endoscope. The foreign substance was part of a plastic chopstick. A literature review indicated that all previous cases of this condition involve direct invagination of foreign bodies. This is believed to be the first reported case in this country of foreign bodies in the frontal sinus that were invaginated via the nasal cavity. The intracranial injury was avoided as part of the chopstick was inserted inside the frontal sinus without damaging the base of the skull, which could have resulted due to factors such as the region/angle of insertion, material, and shape of the foreign substance. Moreover, although we could not find the foreign substance while in the emergency room for our experienced case, it has been pointed out as easy to overlook because most past reported cases of foreign substances in the frontal sinus involved foreign substances with corrosion resistance and radiolucency such as glass, etc. We acknowledged the fact that it is necessary to consider the possibility of a foreign substance particularly for patients with nasal bleeding and injuries and pay attention to reliable diagnoses using CT, etc, when a foreign substance is suspected from the medical records and symptoms.

A novel postoperative endoscopic scoring system (E score) after endoscopic sinus surgery (ESS) in patients with chronic rhinosinusitis (CRS) was proposed and the usuefulness of the scoring for the postoperative evaluation was discussed. The E score represents physical findings of each operated sinuses and olfactory clefts (OC) scored on the endoscope. The condition of each sinus and OC were endoscopically scored as zero points when normal, one point when partially diseased by thicken mucosae and/or discharge, and two points when completely closed by lesions. The E score is expressed as a percentage of the maximum possible score. Unoperated sinuses are excluded for the E score. A method for E score had high level of interclass reliability, based on intraclass correlation coefficient. The E scores showed strong significant positive correlations with endoscopic scoring system for nasal cavity by Lund and Kennedy and CT scores by Lund and Mackay, based on Spearman’s rank-correlation coefficient. On the other hand, when deeper operated sinuses cannot be endoscopically observed due to reccurrent nasal polyps located in the anterior part, the E score showed higher difference from the CT score. The E score for operated sinuses and OC after ESS could be done easily and quickly and be a useful scoring system together with the other endoscopic and radiologic scoring sytems.