The implications of orbital invasion in sinonasal tract malignancies.

In recent decades, the management of sinonasal tumors abutting the orbit has been widely discussed. A real guideline has yet to be proposed, as prospective randomized studies on this topic are very difficult to organize, given the relative rarity of this pathology, the wide spectrum of histologic patterns, and the different clinical behavior of tumors. Nevertheless, in recent years, a better assessment of tumor extension has been obtained thanks to the refinement of preoperative imaging tools and, therefore, more conservative approaches could be adopted, with no worsening of the oncological outcomes and, at the same time, with more attention given to the post-surgical quality of life. Currently, tumors that extend to the bony orbital walls with or without focal infiltration of the periorbit are amenable to orbital preservation. On the other hand, infiltration of extraocular muscles and neurovascular structures are an indication to orbital exenteration. The ideal surgical treatment in cases of limited involvement of orbital fat still remains a matter of debate. We report and discuss the recent English literature on this interesting topic.

Endoscopic endonasal craniotomy in the management of selected ethmoidal malignancies: the University of Pisa experience.

The authors reviewed the medical records of patients who had undergone endoscopic endonasal craniotomy in our department between 2005 and 2009. Thirteen patients were included in this study: 12 males and 1 female. Patients were affected by ethmoidal malignancies abutting or involving the anterior skull base. In all the patients the anterior skull base was drilled down. Nine patients underwent dural resection. The procedure always included a skull base reconstruction. Postoperative complications included CSF leak, subdural haematoma and pneumocephalus. Our results show that endoscopic endonasal surgery can be a viable alternative to anterior craniofacial resection in the management of selected ethmoidal malignancies. The limited morbidity and high success rate fit well with the data in the literature and make this treatment option advisable.

Clear cell adenocarcinoma of the base of the tongue: a case report and review of the literature.

Clear cell adenocarcinoma is an extremely rare tumor of the head and neck region. We report a case of a 75-year-old Caucasian woman with a 10-day history of hemoptysis but with no pain or other significant symptoms. A head and neck computed tomography scan with contrast medium showed an irregular, soft-tissue-like, irregularly enhanced lesion of the base of the tongue extending to its posterolateral portion. The tumor reached the lateral wall of the oropharynx, which showed a nonhomogeneous aspect. The patient underwent resection of the tumor via a conservative transmandibular approach. A clear cell adenocarcinoma of the base of the tongue is rarely a primary malignant lesion; it is more frequently a secondary lesion from a metastatic renal tumor. Because of this neoplasm's relatively slow growth rate and low incidence of metastasis or local recurrence, the gold standard of treatment is complete excision of the tumor with a sufficient tumor-free margin.

Intratympanic methylprednisolone in refractory sudden hearing loss: a 27-patient case series with univariate and multivariate analysis.

BACKGROUND: Treatment of sudden hearing loss is a significant matter of discussion. Lack of knowledge of the natural history of the disease and the use of different success criteria are 2 of the main reasons why it is difficult to critically evaluate the data available in the literature. To date, no therapy has proved effective according to the evidence criteria. However, there has been a trend toward the use of steroids in recent years. The management of patients who fail to respond to standard therapy is even more complex; in these cases, intratympanic steroids have been proposed as a valuable solution. METHODS: Twenty-seven patients unresponsive to traditional systemic therapy were treated with intratympanic steroids. RESULTS: The mean pure-tone average before intratympanic treatment was 79.9 +/- 21.4 SD dB; at Day 30, after local steroid administration, the mean pure-tone average was 60.6 +/- 24.9 SD dB. According to our criteria, 15 (55%) of 27 patients presented a "useful" improvement in the hearing status. No serious complications have been observed. CONCLUSION: Local application is confirmed as easy to perform and is associated with negligible complications. Our experience, although retrospective, seems to confirm the usefulness (at least in 50% of patients) of local steroids administration in cases of refractory sudden sensorineural hearing loss. Our encouraging data strongly call for further and serious evaluation through randomized studies.

Endoscopic transnasal management of cerebrospinal fluid leaks of the sphenoid sinus.

The authors reviewed the medical records of patients who had undergone endoscopic management of sphenoid sinus (SS) cerebrospinal fluid (CSF) leaks in our department between 2005 and 2007. Eight patients were included in this study: 4 males and 4 females. CSF fistulae were due to trauma, surgery, and some were idiopathic. In all the patients, a multilayer skull base closure was performed. No SS obliteration was carried out. One patient required revision surgery for persistent CSF leak. Multilayer skull base closure is confirmed as the preferred option in sphenoid CSF leaks. The limited morbidity and high success rate fit well with the data in the literature and make this treatment option advisable.

Extensive solitary fibrous tumor of the retropharyngeal space.

BACKGROUND: Solitary fibrous tumor (SFT) is a rare neoplasm whose histologic diagnosis poses significant problems in differential diagnosis. Although most of these neoplasms arise at the level of the pleura, there have also been reports of extrapleural origins. The most frequent localization in the head and neck region is in the nasal cavity. METHODS: We describe the case of an 81-year-old patient with an SFT that arose in the retropharyngeal space. Symptoms were solid food dysphagia associated with modest dyspnea. RESULTS: Physical examination revealed the presence on the posterior pharyngeal wall of an apparently circumscribed, multilobed mass, which was compact in consistency and partially obstructed the upper aerodigestive tract. After radiologic assessment to carefully evaluate its size and relationship to surrounding structures, the tumor was surgically removed. CONCLUSIONS: The importance of immunohistochemical findings in the histologic differential diagnosis are discussed. Follow-up plays a crucial role in evaluating the possible recurrence of such tumors, because parameters for determining their aggressiveness are still controversial.