Rhinogenic complications. Description of an interdisciplinary clinical case – V.E. Arevina, E.O. Andriadze, G.A. Golubovsky, A.R. Guseynov

Background. Acute sinusitis is an inflammation of the mucous membrane of the nasal cavity and paranasal sinuses (PNS) lasting <12 weeks, which can have an infectious etiology (viral, bacterial, fungal) or be caused by non-infectious factors: allergens, environmental irritants, etc. As a rule, orbital diseases represent a complication of inflammation in the PNSs, the cause of which are: suppurative lesions of the PNSs, mucocele and retention cysts of the frontal sinus, nasopharyngeal tumors. Phlegmon is an unbounded purulent inflammatory lesion that has spread to several adjacent cellular spaces. Phlegmons of the buccal, infratemporal, temporal spaces constitute 20% of cases of purulent inflammatory diseases of the maxillofacial region. Most often, these phlegmons have odontogenic etiology, but there are cases of rhinogenic infection, in which the inflammatory process spreads to the adipose tissue from the PNS in purulent sinusitis. Case description. Male patient Ch., 20 years old, was admitted to the ENT department of the Moscow Regional Research and Clinical Institute on February 17, 2023, with complaints of pain and swelling in the forehead, left cheek and left eyelid, body temperature increase up to 37-38 oC, inability to open the left eye. History taking was complicated due to language barrier. A contrast-enhanced CT scan, which was performed the same evening, revealed phlegmon of the soft tissues of the upper eyelid, temporal and infratemporal fossae muscles on the left side with fluid-containing (pus-containing) cavities; purulent pansinusitis. An interdisciplinary medical team consisting of: an otorhinolaryngologist, an ophthalmologist, a maxillofacial surgeon, performed emergency opening and drainage of phlegmon of the left eyelid (about 30 ml of purulent hemorrhagic discharge was obtained), opening and drainage of an inflammatory lesion of the soft tissues of the face (about 15 ml of purulent discharge was obtained), sinusotomy using videoendoscopy (purulent discharge was obtained from the frontal sinus, maxillary sinuses, and air cells of the ethmoidal labyrinth on both sides). Conclusion. A 20-year-old patient successfully underwent successful multidisciplinary surgical treatment of acute purulent polysinusitis complicated by phlegmon of the upper eyelid and phlegmon of the temporal, infratemporal, and buccal spaces on the left. There were no complications in the postoperative period. Keywords: sinusitis, phlegmon, rhinogenic complications, pansinusitis, facial soft tissues, upper eyelid, temporal space, infratemporal space, buccal space Conflicts of interest. The authors have no conflicts of interest to declare. Funding. There was no funding for this study