Wilson, Carl

ABSTRACT Objectives Odontogenic sinusitis (ODS) refers to purulent sinusitis caused by infectious maxillary dental pathologies, with > 90% occurring unilaterally. While various clinical features suggest ODS, diagnosing some ODS patients can be challenging. This study aimed to determine the value of maxillary sinus papillary edema (MSPE) in predicting ODS. Methods A retrospective cohort study was conducted on patients who underwent at least maxillary antrostomy for unilateral sinus disease (USD). Adequately powered samples of three USD cohorts were generated: ODS, infectious maxillary CRS without nasal polyps (CRSsNP), and noninfectious CRSwNP. Multiple variables were collected, but the primary outcome was MSPE presence via double‐blinded endoscopic image review by three rhinologists. Inter‐rater agreement was calculated, and a predictive model for MSPE was generated. Results Of 41 ODS, 22 infectious CRSsNP, and 13 noninfectious CRSwNP patients, mean age was 57.0 years and 55.3% were female. There was almost perfect agreement between rhinologists when assessing for MSPE on endoscopic images ( κ = 0.927). MSPE was seen in 100% of ODS, 22.7% infectious CRSsNP, and 0% CRSwNP. MSPE was significantly more likely in ODS compared to non‐odontogenic CRS ( p < 0.0001), demonstrating 100% sensitivity and 89.1% specificity for ODS, with 85.7% positive and 100% negative predictive values. Conclusions MSPE is a distinct finding that is reliably identifiable and is significantly more likely in ODS compared to infectious CRSsNP and noninfectious CRSwNP. With 100% sensitivity and NPV, MSPE absence makes ODS very unlikely. With 86% PPV, MSPE is not pathognomonic for ODS, but should arouse suspicion for a possible odontogenic source. Level of Evidence 3.

ABSTRACTObjectiveIntrathecal fluorescein (IF) is effective for localizing nasal cerebrospinal fluid (CSF) leaks along the skull base during endoscopic exploration, with largest studies reporting sensitivities ranging from 66%–93%. Due to reports of intraoperative and postoperative neurologic complications such as seizures and paralysis, surgeons often dilute the fluorescein and inject it intrathecally slowly over a variable amount of time. However, no study has assessed whether rapid IF administration causes the aforementioned risks or whether it affects its accuracy in identifying CSF leaks intraoperatively.MethodsA prospective study was conducted from 2015 to 2024, where all patients undergoing endoscopic exploration and/or repair of CSF rhinorrhea had 0.1 mL of 10% fluorescein (10 mg) mixed with 3–5 mL of patients' CSF injected rapidly via the lumbar drain over a few seconds.ResultsOf the 82 included patients, the mean age was 53.8 ± 15.2 years, and 84% were female. Sixty‐nine patients underwent successful endoscopic CSF leak repairs, and 13 had negative endoscopic explorations. Rapid IF injection was 80% sensitive (20% false negative rate) and 100% specific for identifying CSF leaks, and it caused no seizures, paralysis, or other neurologic complications.ConclusionCompared to prior reports of slow low‐dose IF injection for CSF leak localization, rapid IF injection yielded similar efficacy (80% sensitivity) with no IF‐related complications. Rapid IF injection was safe and effective but should be corroborated by future studies.Level of Evidence4.