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Introduction: Sinonasal papillomas are benign epithelial tumors in the underlying stroma of the nasal cavity and paranasal sinuses, locally aggressive and with potential malignant transformation. They are classified in three different subtypes: exophytic (squamous), inverted and oncocytic (cylindrical cells). The inverted papilloma (IP) is the most prevalent subtype. Objective: Report a case of sinonasal inverted papilloma, previously diagnosed as nasal polyposis. Resumed report: A 65 years old patient, female, complaining of obstruction in the left nasal cavity and chronic headache. Previous endoscopic sinus surgery 4 years ago, with the diagnosis of nasal polyposis. Computed tomography showing lesion in the left nasal cavity and sinusopathy in left maxillary, frontal sinuses and ethmoidal cells. Patient underwent endoscopic sinus surgery, with resection of polyploidy appearance lesions in the middle meatus and anterior ethmoidal cells. Material sent to histopathological examination, with result compatible with IP. Patient evolved with clinical and nasal functioning improvement after surgery. Conclusion: Pathogenesis of IP is not completely know, but some theories associate them with Human Papilloma Virus (HPV) infection. The malignancy transformation rate is of 1.9-15% and the risk should be consider when there is a rapid tumor growth, nasal bleeding or invasion of adjacent structures. Treatment consists on a complete tumor excision with removal of adjacent mucosa and mucoperiosteum at the site of tumor origin. Literature describes recurrence rate in up to 78%, with some risk factors such as tobaco exposure, size of tumor, hyperqueratosis, HPV positivity and others favoring this occurrence. [ABSTRACT FROM AUTHOR]

Introduction: Rhinosinusitis complications involve a set of inflammatory or infectious diseases that extend beyond the boundaries of the nose and paranasal sinuses. Among several complications, we can mention: periorbital cellulitis/edema, subperiosteal abscess and orbitary abscess. Objectives: Approach to the maxillary sinus by an unconventional route due to the lowering of the orbital floor. Resumed report: 45 year old female patient with Graves disease who underwent bilateral orbital decompression in 2019 with removal of the medial and inferior orbital bone wall. In January 2022 she started with blepharitis to the left, unresponsive to clinical treatment, evolving with acute rhinosinusitis, edema and bilateral ocular hyperemia, worse to the left. The patient came to our service and a CT scan was requested, which showed complete opacification of the maxillary antrums and a lowering of the bony floor of both orbits. During the surgery:the inferior turbinate was dislocated medially to access the inferior meatus. The mucosa was flapped and folded back to the floor of the nasal fossa. Inferior meatotomy was performed (just above the nasal floor, 1.5 posterior to the inferior turbinate head), procedure performed bilaterally. Presence of thick secretion in the right maxillary sinus and abundant purulent secretion on the left side. After surgery the patient was followed up and there was complete resolution of the case. Conclusion: Rhinosinusitis complications should be diagnosed and solved with the greatest possible urgency, avoiding major problems. The inferior meatotomy to access the maxillary sinus shows to be a safe and resolutive way to solve cases where the sinusotomy of the maxillary sinus by the conventional method becomes unfeasible. [ABSTRACT FROM AUTHOR]

Introduction: Paranasal sinus mucoceles are cystic lesions of epithelial lining with mucoid content, which present slow growth with expansile and resorptive features. Eventually he may compromise adjacent noble structures such as the orbit and intracranial cavity. It can cause facial pain, headache, nasal obstruction, diplopia, decreased visual acuity, displacement of the eyeball, facial edema or even meningitis. It most commonly affects the frontal and anterior ethmoid sinuses. Objectives: Case report of an external approach to the frontal sinus. Resumed report: 70 year old male patient with a history of automobile accident 3 years ago, suffered head trauma with loss of the anterior plate of the frontal bone on the left side. In February 2022 he came to our service with ocular proptosis to the left, pain in the left ocular region and occasional headache. A CT scan of the facial sinuses was requested, showing an expansile lesion with epicenter in the left frontal sinus, associated with signs of ipsilateral proptosis. During surgery, the medial wall of the orbit was identified with the presence of a large bulging in its posterior region and hardening of adjacent tissues, where it was not possible to access the frontal sinus endoscopically. A modified Lynch incision was then performed on the left side and the mucocele was identified. Drainage of dark, foulsmelling secretion. After surgery the patient is now without any complaints and resolution of the case. Conclusion: Although currently the paranasal endoscopic approach is the first choice, there are cases of difficult access to the frontal sinus, where we must have the study and practice of access by external routes for the resolution of the case. [ABSTRACT FROM AUTHOR]

Introduction: Immune thrombocytopenic purpura (itp) is defined as an autoimmune disease characterized by increased destruction of platelets due to the action of antiplatetal auto antibodies. Clinically, it is characterized by the sudden beginning of echmosis, petechia and mucosal bleeding, with a frequent report of viral infection preceding the initial presentation. Objective: Show the importance of the extension of the otorhinolaryngologic exam. Resume report: 62 years old female patient, hypertensive, arrives in an immediate consultation of a private otolaryngology clinic with complaints of asthenia, rhinorhea, cough and blood expectoration. On examination, hyaline secretion and coat in the right anterior inferior region of the nasal septum, in addition to oroscopy with several coagules in the mucosa. Denied a history of previous coagulopathies. Fibronasus request that identified friable areas and vascular ectasies in the entire nasal mucosa and one in the laryneal face of the epiglotis, in addition to purulent secretion in the left middle meaus. Coagulogram revealed 30,000 platelets, being referred to a hospital service where research was extended, receiving diagnosis of itp. Conclusion: Upper airway infections are possible triggering factors for other clinical pathologies, therefore being necessary the extension and correlation of the otorhinolaryngological examination. [ABSTRACT FROM AUTHOR]

Introduction: Thyroglossal duct cyst is a rare congenital condition. It is located in the cervical midline, making a differential diagnosis of cervical masses in adults and children. Objectives: Knowing about the pathology, how to suspect it and have an early diagnosis is very important since the treatment is eminently surgical. The longer the time for diagnosis, the larger the lesion, which can invade, compress neighboring structures, get infected or spread to the base of the skull. Resume report: Patient H.P.B. 65 years old, reports the appearance of anterior cervical nodulation for more than a decade with insidious growth, which he has recently associated with halitosis and referred pain in the hypopharynx. HP: Social Ethylist. Denies smoking, weight loss or comorbidities. On otorhinolaryngological examination: voluminous anterior cervical bulge. Left septal deviation. Magnetic resonance imaging of the neck was requested, which was suggestive of a thyroglossal duct cyst. Performed the surgery to remove the lesion, placed a penrose drain and then removed after 10 days, with 14 days of antibiotic coverage. Reassessed with a good looking operative wound. Conclusion: The thyroglossal duct cyst comes from an embryonic malformation. The imaging exam is mandatory to exclude other embryonic alterations as well as to differentiate them. Appropriate surgical treatment resolves the condition and prevents recurrences. [ABSTRACT FROM AUTHOR]

Introduction: Lymphomas are non-epithelial malignant neoplasms and are subdivided into Hodgkin's Lymphoma (HL) and Non-Hodgkin's Lymphoma (NHL). Some NHLs have extranodal involvement, which can affect the nasopharynx. As nasal polyps, the main symptom is nasal obstruction. Other symptoms that may occur include epistaxis, otalgia and purulent nasal discharge, which are part of the different diagnosis of nasal polyposis. Objectives: To report the case of a patient nasal obstruction secondary to lymphoma. Resume Report: Male, 80 years old, presenting bilateral nasal obstruction and persistent purulent nasal discharge for the last two months without improvement with the use of amoxicillin clavulanate and levofloxacin was referred for functional endoscopic sinus surgery. Rhinoscopy revealed thick purulent rhinorrhea in the left nasal cavity. Oropharynx examination revealed bulging of the soft palate, otoscopy was normal. CT scan showed opacification on the left of the maxilla, ethmoid and sphenoid. Tissue biopsy was performed during nasal endoscopy, the anatomohistopathological and immunohistochemical study of the lesion was suggestive of small cell B-cell (CD20+) non-Hodgkin's lymphoma. Markers related to follicular (CD10, blc-6) or mantle (cyclin D1) lymphoma were negative. He was referred to the oncology team. The patient had history of treated neck lymphoma prior to 4 years. Conclusion: CRSwNP and lymphomas, like other neoplasms, have similar symptomatology but may have different disclosure depending on the delay of diagnosis and treatment. This case shows the importance of adequate anamnesis, physical examination and proper evaluation of complementary exams. Clinicians should always be aware of differential diagnosis on their regular practice. [ABSTRACT FROM AUTHOR]

Introduction: The Respiratory Epitelial Adenomatoid Hamartoma (REAH) is a benign intranasal glandular proliferation covered by multilayer ciliated respiratory epithelium and may be presented alone in the nasal cavity or associated with nasal polyps (NP). REAH are usually found in the olfactory cleft (OC) and frequently lead to hyposmia or anosmia. Objective: Report a case of REAH in the OC and NP, whose resection led to a complete recovery of patient's sense of smell. Resumed report: A 35 years old patient, male, reporting past of NP in addition to anosmia for about 2 years. Facial sinus tomography showing polypoid sinusopathy, enlargement and opacification of the OC. Preoperative Connecticut Olfactory Test (CCCRC) with anosmia. A complete endoscopic resection of NP and pedicle lesion in OC, whose histhopatological examination confirmed REAH, was performed. Thirty days after surgery, patient presented a normal CCCRC test. Conclusion: REAH is a benign lesion and the treatment is surgical complete resection of the lesion, with no reports of malignant transformation. Olfactory complaints are common and, although previously described in the literature as a rare entity, recent researches has shown a high prevalence of REAH associated with nasal polyps. The correct diagnosis is achieved when the lesion is collected from the OC region and the sample sent for histopathological examination in an individual bottle. Nasal surgeons should actively look for this diagnosis in all patients with nasal polyps. Olfactory status should be assessed after surgery using a validated test. [ABSTRACT FROM AUTHOR]