his is an interesting group of case reports essentially documenting the presence and characteristics of retained surgical packing (non-resorbable) post sinus surgery.

Paranasal gossypiboma refers to surgical foreign objects such as sponge or patties that are left in the nose; this group included 21 patients over a 10-year period referred usually from smaller primary hospitals to their tertiary unit in Guangzhou, China. This entity is distinct from the more familiar rhinolith. The incidence of this condition was 0.36% of endoscopy surgery patients (5778 over 10 years) and average length of time until discovery was 200 days.

The predominant sites were the maxillary (48%) and ethmoid sinuses (29%). The commonest symptoms were mucopurulent discharge (91%) and epistaxis (81%), followed by headache (48%), nasal obstruction (48%) and post nasal drip (10%). Nasal endoscopy showed a red granular area, usually covered in pus. Five patients had a CT scan and in three the gossypiboma manifested as a cystic lesion with a thin calcified shell. It is proposed that there is a mixed fibrous and exudative inflammatory reaction where the material is entrapped by swollen mucosa in the sinuses and then gradually encapsulated by granular tissue, the sinus then becomes obstructed and infected. The packing can be confirmed histologically with H and E staining. The authors conclude by discussing possible aetiological factors and recommendations for increased counting of swabs and patties at the end of the procedure. 

Misdiagnosed paranasal gossypiboma: a 10-year experience with 21 cases at a tertiary center.
Wu P-Z, Sun W, Wen Y-H, Ma R-Q, Zhu X-L, Wen W-P.
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Suki Ahluwalia

Cairns Hospital / James Cook University, Queensland, Australia.

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