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Rhinophyma – Case Report of a 67-Year-Old Male with Extensive Nodular Changes of the External Nose in the Course of Rosacea

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Zblewski J., Kozakiewicz B., Kowalska A., Dalke K.

Polski Przegląd Otorynolaryngologiczny

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2024

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vol. 13

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issue 3

32-36

EN

Introduction: Rhinophyma is a particularly advanced form of rosacea. It typically affects middle-aged and elderly men. It develops due to significant hypertrophy of the sebaceous glands, blood vessels, and connective tissue of the nasal skin. The external nose becomes enlarged, with the skin becoming thickened, fibrous, and oily. When pressure is applied, a mixture of sebum and blood may be expelled. Facial deformity often leads to social withdrawal in affected individuals. In extreme cases, it can lead to nasal passage obstruction. Case report: This paper discusses the case of a 67-year-old male patient with a long history of rosacea. A diagnosis of rhinophyma was established, and surgical treatment was employed, yielding satisfactory results. Various methods of treating rhinophyma are described. Discussion: The diagnosis of rosacea is based on medical history and characteristic skin changes on the face, with histopathological examination being decisive in doubtful cases. The etiopathogenesis of the condition is not well understood. Risk factors may include a positive family history of rosacea, improper treatment of rosacea, smoking, and excessive alcohol consumption. Conclusions: The treatment of choice for rhinophyma is surgical intervention. Patients should be informed about the possibilities that modern medicine offers in the treatment of rhinophyma. This can improve both nasal patency and external appearance, significantly enhancing the patient’s psychological comfort.

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Lemierre’s Syndrome – Case Report of a 20-Year-Old Male with Post-Anginal Sepsis

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Zblewski J., Kowalska A., Dalke K., Kożuchowski M.

Polski Przegląd Otorynolaryngologiczny

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2024

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vol. 13

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issue 3

37-41

EN

Introduction: Lemierre’s syndrome, first described by André Lemierre in 1936, is a rare but life-threatening condition. It is characterized by a triad of symptoms: pharyngeal infection, internal jugular vein thrombosis, and sepsis with distant abscesses, usually in the lungs. The primary pathogen is the anaerobic Gram-negative bacterium Fusobacterium necrophorum (F. necrophorum). In recent years, there has been an increase in the incidence of Lemierre’s syndrome. Case report: A 20-year-old male was admitted to the Emergency Department (ED) with jaundice, dyspnea, sore throat, fever up to 39°C, neck pain, and left lower limb weakness. Examination revealed enlarged palatine tonsils with purulent exudates and a right-sided peritonsillar abscess. Laboratory tests showed elevated inflammatory markers, thrombocytopenia, and leukocytosis. Computed topography (CT) confirmed internal jugular vein thrombosis, abscesses in the right sternocleidomastoid muscle, and bilateral pleural effusions. The patient received oxygen therapy, antibiotics, anticoagulation, and pleural drainage. After 26 days of hospitalization, he was discharged with a recommendation to continue antibiotic therapy and low-molecular-weight heparin, as well as planned removal of the palatine tonsils (tonsillectomy). Discussion: Lemierre’s syndrome is a severe complication of upper respiratory tract infections, mainly affecting young individuals. Symptoms include pharyngeal infection, sepsis, and internal jugular vein thrombosis. Early diagnosis and appropriate treatment, including prolonged antibiotics and sometimes anticoagulation, are crucial. The rise in incidence may be linked to the irrational use of antibiotics. Educating clinicians is vital to improve outcomes and reduce complications. Conclusions: Initial symptoms of Lemierre’s syndrome are nonspecific, complicating early diagnosis. Neck imaging and/or positive blood cultures are key for diagnosis. The incidence is 1–2.5 cases per million annually, making it rare but potentially fatal. Mortality before antibiotics was around 90%; currently, it is 5–18%, but higher without proper diagnosis. Early imaging significantly improves prognosis.

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Extensive resection of a giant sinus osteoma in a 73-year-old patient with exophthalmos

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Zblewski J., Kowalska A., Dalke K.

Polski Przegląd Otorynolaryngologiczny

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2024

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vol. 13

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issue 3

26-31

EN

Introduction: Osteomas are among the most common non-epithelial benign tumours of the facial skeleton, most often of the paranasal sinuses. They are usually asymptomatic and detected accidentally during head imaging tests. Sometimes, however, they cause severe conditions such as headaches, vision deficiencies, or facial deformation. Case report: This study presents the case of a 73-year-old patient who consulted a doctor due to increasing exophthalmos of the right eye, nasal congestion, and recurrent headaches. A computed tomography (CT) scan of the paranasal sinuses revealed an extensive, calcified, irregularly shaped pathological mass filling these structures. The lesion was completely excised using an external approach. Histopathological examination confirmed the clinical diagnosis of osteoma. Discussion: The case report reviews the literature, describes the most common locations of osteomas in the paranasal sinuses, includes possible etiopathogenesis, and compares surgical methods. Conclusions: Symptoms associated with osteomas in the craniofacial region depend on their size and location. The method of choice in symptomatic cases is surgical removal. Medical imaging can help decide on the surgical procedure. Endoscopic excision is less traumatic for patients and facilitates tissue healing. Due to the large extent of the tumour, its specific location, and the patient’s health condition, an external surgical approach may be necessary.

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3 Polski Przegląd Otorynolaryngologiczny

3 2024

3 Dalke K.

3 Kowalska A.

3 Zblewski J.

1 Kozakiewicz B.

1 Kożuchowski M.

Rhinophyma – Case Report of a 67-Year-Old Male with Extensive Nodular Changes of the External Nose in the Course of Rosacea

Lemierre’s Syndrome – Case Report of a 20-Year-Old Male with Post-Anginal Sepsis

Extensive resection of a giant sinus osteoma in a 73-year-old patient with exophthalmos