Chiara Rustichelli

Background and Clinical Significance: Frontal sinus disease remains one of the most challenging conditions in rhinology due to its complex and variable anatomy and high tendency toward postoperative stenosis. Paranasal sinus mucoceles are uncommon, delayed complications following functional endoscopic sinus surgery (FESS), most often involving the frontal or anterior ethmoidal sinuses. They may arise from obstruction or scarring of natural drainage pathways, producing recurrent sinusitis or headache; Case Presentation: A 21-year-old male presented with persistent left-sided frontal headache and nasal obstruction after two previous FESS procedures. Radiologically, CT and MRI demonstrated chronic left-sided sinonasal inflammatory disease and two frontal-ethmoidal mucoceles. Revision endoscopic sinus surgery was performed with an image-guided (neuronavigation-assisted) technique, including Draf IIb frontal sinusotomy, mucocele marsupialization, and corrective septoplasty. The postoperative course was uneventful with rapid clinical improvement; Conclusions: Double postoperative mucoceles following ESS are rare. Neuronavigation-assisted revision surgery can be used for effective management in scarred, anatomically distorted sinus regions. However, this single case cannot establish superiority over conventional endoscopic guidance or demonstrate an effect on safety, efficacy, or recurrence.

Type 2 inflammation is a central immunopathogenic driver of chronic immune-mediated disease, characterized by IgE polarization, eosinophilia, epithelial barrier disruption, and tissue remodeling. In veterinary medicine, especially in canine atopic and allergic disorders, the absence of validated functional endpoints hampers disease monitoring and therapeutic assessment. In humans, this endotype underlies a spectrum of linked conditions, including asthma, allergic rhinitis, atopic dermatitis, and chronic rhinosinusitis with nasal polyps (CRSwNP), where olfactory dysfunction is common, quantifiable, and clinically meaningful. In this narrative review, we examine the relationship between type 2 inflammation and olfactory outcomes in human disease and consider its translational relevance in dogs within a reverse translational One Health framework. Evidence from human studies, particularly in CRSwNP, shows a strong association between type 2 inflammatory burden and olfactory loss, while biologics targeting these pathways yield clinically meaningful gains in smell function. Comparable clinical evidence is still lacking in dogs. Olfactory function should therefore be regarded as a promising, yet unvalidated, translational endpoint in canine type 2 disease and a priority for prospective clinical investigation and methodological validation.

We report the case of a 16-year-old girl presenting with a painless, clinically stable subcutaneous swelling of the nasal dorsum with a three-year history. Despite an extensive multidisciplinary diagnostic work-up—including dermatological, otorhinolaryngological, and radiological evaluations (ultrasound, CT, and MRI)—the nature of the lesion remained indeterminate. In order to achieve a definitive diagnosis while preserving the nasal profile aesthetics, the mass was entirely excised via an endoscope-assisted closed rhinoseptoplasty approach. Histopathological analysis revealed a spindle cell lipoma characterized by CD34 positivity and a Ki-67 proliferation index of less than 1%. This finding is extremely rare in terms of both anatomical location and patient age. The present case highlights the crucial role of histopathological examination in establishing the correct diagnosis, supported by a multidisciplinary assessment.

Background: Sphenoiditis poses diagnostic and treatment challenges due to its complex anatomy and potential for serious complications. Anatomic variations, such as Onodi cells, could play a role in the onset and spreading of inflammation. The diagnosis and treatment of sphenoiditis can be more difficult if Onodi cells are present, especially due to their proximity to delicate vital tissues. Objectives: The purpose of this study was to look at the frequency, features, and relationship between Onodi cells and sphenoiditis. Methods: This multicentric study comprised 550 people who received sinonasal CT imaging. The Thimmaiah classification was used to assess the presence and features of Onodi cells, and radiographic results were used to diagnose sphenoiditis. We conducted univariate and multivariate logistic regression to evaluate the relationships between sphenoiditis and Onodi cells. Results: The prevalence of Onodi cells was 32.40%, with a higher prevalence on the right side (18.40%) compared to the left side (8.40%). The multivariable analysis revealed a significant correlation between right-side Type II Onodi cells and a higher incidence of sphenoiditis (OR = 6.81, 95% CI: 1.14–38.97, p = 0.029). In the univariable analysis (OR = 3.00, 95% CI: 1.15–6.96, p = 0.015), but not in the multivariable analysis, the presence of Type I Onodi cells on the left side was significantly associated with sphenoiditis. Conclusions: There may be a link between a higher incidence of sphenoiditis and the presence of Type II Onodi cells on the right side. In order to validate these findings and clarify the underlying processes of this connection, more prospective research is required.

Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) and asthma are mutually correlated with Type-2 inflammation. Dupilumab is effective in uncontrolled and relapsing CRSwNP. However, the precise characterization of Type-2 inflammation and the impact of previous surgery on clinical outcomes need clarification. Methods: We present a prospective observational study on a 38 CRSwNP-patient cohort, whose Type-2 endotype was confirmed after a multidisciplinary approach shared among ENTs, pneumologists and allergologists. Patients were treated with dupilumab and evaluated at 15 days and 1-3-6-12-18-24-30 months, focusing on clinical (VAS, nasal polyp score—NPS), radiological (Lund-Mackay) and quality of life (SNOT-22) parameters, as well olfactory function, asthma control, variation of Type-2 markers and number and extent (ACCESS score) of previous surgeries. Results: We confirmed the efficacy of dupilumab in total and sub-items VAS, NPS, SNOT-22 and sniffing score, as well as Lund–Mackay score improvements, observable and significant after 2 weeks of treatment (p < 0.0001) and long-lasting over 30 months. Good to excellent response criteria to biologic treatment at 6 months was observed in 30/32 patients. Comorbid asthma reached rapid control (p < 0.0001) and exhaled nitric oxide normalization was achieved. One single “not adequate” surgery showed a trend to milder improvement, as well as a higher ACCESS score to better olfactory outcome. Conclusions: The accurate selection of uncontrolled relapsing CRSwNP in terms of Type-2 endotyping by multidisciplinary approach can maximize dupilumab efficacy. The number and extent of previous surgeries may differentiate the response, although this effect is difficult to catch in real life. “Adequate” ESS surgery before dupilumab may drive mostly effective disease control.