Two Cases of Foreign Body Frontal Sinusitis due to Filling with Bone Wax after Craniotomy

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  • 開頭術後に発症した骨蝋による異物性前頭洞炎の2例

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Abstract

<p>Bone wax is a useful agent for treatment of intraoperative bleeding, but it is also known to induce chronic inflammation. We report two cases of refractory frontal sinusitis that were caused by a foreign body. Both patients underwent a craniotomy more than 10 years ago. CT scans showed a low density area in the frontal sinus, and the lesion produced a signal intensity void on MRI in both patients. In case 1, the main complaint was swelling of the right upper eyelid and pain for 5 months. Because the lesion showed bone destruction, endoscopic modified Lothrop procedure (EMLP) surgery was performed for diagnosis and treatment, and the foreign body was removed. A histological examination identified multinucleated giant cells in the mucosa, but the removed mass was dissolved in ethanol in paraffin embedding. These findings suggest that a foreign body had caused the inflammation. In case 2, recurrent subcutaneous epidural abscess was suspected to have spread from the frontal sinusitis. The foreign body was removed by the Draf 2b technique, and was proved to be bone wax based on the operative history. The postoperative course was good in both cases. These cases show that a history of craniotomy using bone wax should be considered when atypical imaging findings are found in a patient with refractory frontal sinusitis. Complete surgical removal of the foreign object is useful for treatment in such cases.</p>

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