A 54-year-old male patient, smoker and moderate drinker, allergic to penicillins, with a history of maxillary sinusitis and pansinusitis.
Anterior sinus seizure of the left frontal sinus was diagnosed after a biopsy by puncture in another hospital, where surgical excision was performed through an incision in the left eyebrow and a wall osteotomy.
A fragment of the sinus cavity was obtained for anatomopathological analysis, confirming the presence of congenital hypothyroidism.
Histopathological analysis of the excised sinus mucosa was also performed, which was reported as a possible mucocele accurate (mucopiocele).
Subsequently, he was referred to the Hematology Department of our Hospital for treatment.
Bone scintigraphy showed pathological tracer deposition in the maxillary sinus, nasal bones and frontal sinuses, suggesting the presence of myeloma.
Three cycles of chemotherapy were administered, separated by one month between them, consisting ofcryostin, adriomycin and dexamethasone+dialysis (1st cycle); etopoxide, dexamethasone + cyclophosphamide + vindiamycin (3rd cycle);
Two days after the end of the third cycle of chemotherapy, an increase in frontal tumor was observed, with signs of local inflammation lasting 24 hours.
Examination revealed a soft frontal tumor draining abundant purulent material through two holes in the eyebrow, with headache and fever of 38oC.
Samples were taken for culture and antibiogram (no microorganisms were isolated).
Cranial X-ray showed a radiolucent area at the level of the frontal bone.
CT and MRI confirmed the presence of a thickening of the frontal bone and occupation of its cavities with a lytic area on the left side suggesting osteomyelitis with frontal sequestration areas.
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He was referred to our Maxillofacial Surgery Service and after evaluation of the patient, it was decided to perform surgical treatment.
A butterfly wing incision was made in the glabellar region, including the fistulous tract.
After removing the flap, the frontal sinus that had lost the external table was visualized, cleaning and curettage were performed, and the sinus walls were milled with rotating material.
A graft of 50 cc of corticospongy bone of the right proximal tibia was taken by means of a previously placed graft mixed with a rich fraction concentrate of PRP growth factors prepared.
250 cc of venous blood were extracted to prepare the PRP, which were centrifuged using a two-phase technique (Platelet Concentrate Collection System PCCS; 3i/Imachplant Innovations®, Garm
Before application, PRP clot was activated by calcium chloride.
A mixture of 40 cc of material was obtained, with which both sinus cavities were completely filled.
The surgical wound was sutured, placing poor plasma growth factors on the scar.
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The curettage material of both sinus cavities was sent for pathological analysis.
The result reported the presence of mixed inflammatory tissue with bone and soft tissue involvement, with the diagnosis of chronic osteomyelitis of the frontal sinus being ruled out.
The patient was discharged after five days of hospitalization without symptoms or postoperative complications.
No complications occurred at the donor site, and the patient was discharged without discomfort.
CT scans were performed six and twelve months after the intervention in which a complete filling of the sinus cavity was observed, with no signs of disease.
The patient has not had swelling or suppuration back in the forehead, headaches or fever.
The aesthetic appearance of the surgical wound is very satisfactory.
