V.E. Parfyenov, A.N. Savchuk, G.I. Prokhvatilov
(Chair of Neurosurgery, Chair of Maxillofacial Surgery Medicomilitary Academy, Saint Petersburg)
Patient Kh., aged 61, complained of a mass in the right frontoorbital area. Long before admission he had been operated for purulent frontal sinusitis (1966) and sustained four episodes of purulent meningitis (1966-1967). Since 1996 there had been a soft mass in the right supraciliary area. The patient was admitted to our Clinic of Neurosurgery; he complained of a cosmetic defect.
Neurologic examination revealed ptosis and exophthalmos on the right side. Local findings were as follows: a soft cyanotic mass, consisting of two nodes (10´15 cm and 7´10 cm) in the right frontoorbital area. CT examination demonstrated a pathologic mass (193´123´11 mm) in the right frontal sinus and cells of the ethmoidal labyrinth. It spread into subcutaneous areas of the face upper half and had two chambers, communicating with each other. There were no density changes in enhancement.
Spontaneous emptying of one of the pathologic cysts took place on December 24, 2001. Thick discharge with fetid smell was of a mucous-purulent character. An urgent operation, consisting in opening and drainage of abscess of the frontoorbital area, was made (Prof. Parfyenov V.E.). The wound healed by the first intention. Control CT examination of the brain failed to reveal any change of densitometric indices of the gray and white substance; there was no dislocation of median structures.
This patient is worth mentioning, as he suffered from a delayed pyo-septic complication after reconstruction of the skull fornix and base during 5 years and it took place against a background of minimum clinical and laboratory manifestations.