Iranian Journal of Otorhinolaryngology

Iranian Journal of Otorhinolaryngology

Burkholderia Cepacia Causes Frontal Mucopyocele with Anterior Cranial Fossa Extension: A Novel Case Report

Document Type : Case Report

Authors
Athanasios Saratziotis 1
Claudia Zanotti 2
Maria Baldovin 2
Vlatko Prosenikliev 3
Enzo Emanuelli 2
1 Department of Otolaryngology, General University Hospital of Larisa, Greece.
2 Department of Neurosciences, Otolaryngology Section, University of Padua, Italy.
3 Department of Otolaryngology, General Hospital San Dona di Piave, Venice, Italy.
10.22038/ijorl.2021.51654.2753
Abstract
Introduction:
Burkholderia cepacia complex (Bcc) is a group of gram-negative bacilli that have rarely been isolated in the ear, nose and throat region in immunocompetent patients. Bcc show resistance to most available antibacterial drugs.
 
Case Report:
We present the case of an immunocompetent 31-year-old male reporting a pulsating headache with right supraorbital swelling associated with exophthalmos. A brain CT scan showed an expansive giant cystic lesion occupying the right frontal sinus, extending to the anterior cranial fossa. Management and outcome: drainage with the resecting of the floor of the frontal sinus from the orbital plate of the ethmoid bone to the nasal septum (Draf IIb) was performed with wide marsupialization of the mucopyocele. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis was used to identify the isolate. MRI 1 and 12 months after surgery showed complete lesion removal. The patient was followed for 12 months with complete recovery of symptoms.
 
Conclusion:
Paranasal sinuses disease with cranial expansion and orbital complications constitutes an emergency. For the first time in the literature, Bcc was isolated in the frontal sinus, extending into the anterior cranial fossa, in an immunocompetent patient. An endoscopic surgical approach with microbiological identification and management by appropriate antibacterial drug treatment seems to be the key to success.
Keywords
Burkholderia cepacia complex
Mucocele
Frontal Sinus
Surgical Endoscopy
Culture Media
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Iranian Journal of Otorhinolaryngology
Volume 33, Issue 5
September and October 2021
Pages 327-332