Twenty-six patients diagnosed as having mucopyoceles or empyemas of the frontal sinus were submitted to endoscopy-aided endonasal surgery of the anterior ethmoid and the adjacent frontal sinus between April 1989 and July 1991. Eighteen patients followed-up for a period exceeding the 3 months normally required for wound healing are presented (follow-up 3-22 months, mean 11 months). The subjective assessment of the patient was good to excellent in 16 cases. Two of these patients refused endoscopic follow-up, since they felt so well that they saw no need for it. At endoscopy, the frontal sinus was highly accessible in 5 patients, while in another 8 patients with a smaller frontal ostium it was possible to explore it adequately. Two patients in whom symptoms persisted had to be submitted to transfacial revisional surgery. An increasing percentage of patients with inflammatory frontal sinus disease can be treated by endoscopic endonasal surgery followed by thorough endoscopic aftercare.

Angiotensin-converting enzyme (ACE) inhibitor-induced angioedema is supposed to be an uncommon cause for oropharyngeal edema. Between January 1, 1993 and February 1, 1997 we treated 20 patients with edema of the oropharyngeal region that was not caused by infection or irradiation. The most common reason was an ACE-inhibitor-induced angioedema and occurred in 9 cases, all of whom required inpatient treatment. The medical management consisted of the administration of intravenous (i.v.) glucocorticosteroids in all cases, H1-blockers in 6 cases, epinephrine by inhalation in one case and i.v. epinephrine in another case. Tracheostomy had to be performed in one patient. In our experience it is necessary to reconsider ACE inhibitor-induced angioedema in any case of an oropharyngeal edema. However, there is no reason for the routine application of epinephrine in these cases.

Severe maxillofacial trauma accompanied by a dislocated ethmoidal bone fracture was confirmed by CT imaging in 15 adult patients. Routine surgical management included reduction of fractures, miniplate fixation and/or intermaxillary fixation with interosseous wiring. The fractured ethmoidal cell system was left to heal spontaneously. A follow-up examination including endoscopy of the nasal cavity as well as active anterior rhinomanometry and computed tomography was carried out approximately 24 months after surgery. The fractured ethmoidal cell system showed a clear tendency to spontaneously reventilate and drain. However, in 8 of 30 sides a traumatic obstruction of the anterior ethmoid led to secondary frontal sinus mucositis. 12 out of 30 maxillary sinuses ranged from marked mucosal swelling to the development of a traumatic mucocele. Altogether, 9 of the 15 patients suffered from paranasal sinusitis. Routine debridement of every fractured ethmoidal cell system does not appear to be necessary. In case of fractures of the anterior ethmoid with probable obstruction of the nasofrontal duct and/or maxillary sinus ostium, endonasal endoscopic surgery is recommended for minimally invasive reconstruction of the ventilation and drainage of the frontal and maxillary sinus during primary surgical management. Furthermore, patients with severe naso-orbito-ethmoidal fractures should undergo rhinological follow-up examination including CT-imaging approximately 3 months after surgery.

Acute suppurative parotitis is a possible consequence of poisoning by organophosphates (E 605). The endogenous accumulation of acetylcholine results--as in the acute pancreatitis caused by poisoning with organophosphates--in massive hyperemia and an increased secretory activity with leakage of saliva into the tissue, in an activation of the kallikrein-kinin system, the phospholipase A2, and, ultimately, in toxic tissue lesions caused by lysolecithin and the superoxide-radical anion. In spite of antibiotic therapy this is followed by bacterial inflammation. Treatment consists in the administration of aprotinin (Trasylol) and corticosteroids. In the case of abscess formation surgical drainage is necessary.

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