Letters to the Editor
Not Enough Information
The article contains insufficient or even incorrect information (1).
The title implies isolated involvement of the orbital floor, but the authors reported extensive spread inside the patient’s nose/nasal cavity. The orbital floor is not represented in the axial plane view. The anatomical terms are incorrect (2). A “basal and medial orbital cavity” does not exist (anatomy). Instead, the lamina papyracea was marked. The described destruction of the nasal septum is not relatable. A bony destruction of all turbinates is not visible in the CT scan as only the middle turbinate could be visualized in the selected image plane. The description is therefore unsatisfactory.
Granulomatosis with polyangiitis mostly presents with oto-rhino-laryngeal symptoms. The case presented here had not been subject to an interdisciplinary work-up, as recommended in the guideline (3). In particular, neither an endo-nasal finding was obtained nor was the diagnosis (necrotizing vasculitis) confirmed by histology.
In this setting, a destruction of the nasal septum—that is, perforation of the nasal septum—would have been identified correctly.
Instead of using the term “bloody rhinitis,” the term “bloody rhinorrhea” would have been more appropriate.
DOI: 10.3238/arztebl.m2024.0198
Prof. Dr. med. Stephan Knipping
Städtisches Klinikum Dessau
stephan.knipping@klinikum-dessau.de
Conflict of interest statement
The author declares that no conflict of interest exists.
| 1. | Schulz N, Böttger P, Klemm P: Orbital floor involvement in granulomatosis with polyangiitis. Dtsch Arztebl Int 2024; 121: 533 VOLLTEXT |
| 2. | Sobotta: Atlas der Anatomie des Menschen. Kopf, Hals und Neuroanatomie.München: Urban und Fischer 2010. |
| 3. | AWMF: S3-Leitlinie Diagnostik-Therapie-ANCA-assoziierten_Vaskulitiden. https://register.awmf.org/assets/guidelines/060-012l_S3_Diagnostik-Therapie-ANCA-assoziierten_Vaskulitiden_2024-08_2.pdf (last accessed on 21 August 2024). |
