Pott Puffy Tumor Caused by Dental Infection: A Case Report and Literature Review.

ABSTRACT: Pott puffy tumor (PPT), first described by Sir Percivall Pott in 1760, is a rare clinical entity characterized by a subperiosteal abscess associated with osteomyelitis of the frontal bone caused by direct or hematogenous spread. Although rare in this modern age of antibiotics, this tumor usually occurs as a complication of sinusitis. Moreover, intracranial complications such as subdural abscess, meningitis, sinus thrombosis, or brain abscess can occur concomitantly with the underlying sinusitis, despite the administration of antibiotics. Herein, we present the case of a 48-year-old man who was diagnosed with PPT using computed tomography and treated medically and surgically. The infection remained uncontrollable after surgery and drain removal, owing to the persistence of the original dental focus of the infection. This case highlights the importance of treating the source of the infection in addition to the local area of inflammation, to facilitate complete infection control in PPT.

Sixth Cranial Nerve Palsy and Vertigo Caused by Vertebrobasilar Insufficiency.

A 38-year-old woman presented with a week's history of binocular horizontal double vision and acute vertigo with gaze-induced nystagmus. We considered a diagnosis of one of the six syndromes of the sixth cranial nerve and evaluated several causes. She had history of severe anemia, vitamin B12 deficiency, and hypertension. Magnetic resonance imaging with angiography showed stenosis of the right vertebral artery and hyperintensity on both basal ganglia. As we describe here, we should consider vertebrobasilar insufficiency as a cause for sixth cranial nerve palsy if a patient has high risk for microvascular ischemia, even in the absence of acute brain hemorrhage or infarction.

Epithelial-myoepithelial carcinoma originating from a minor salivary gland in the nasal septum: A case report and literature review.

RATIONALE: Epithelial-myoepithelial carcinoma is an extremely rare, malignant neoplasm that occurs most frequently in the major salivary glands and accounts for approximately 1% of all salivary gland neoplasms. Few reports have described the presence of epithelial-myoepithelial carcinoma in the sinonasal region; hence, the treatment guideline and prognosis remain unclear. PATIENT CONCERNS: We reported a case of a 75-year-old woman with complaint of nasal obstruction and frequent epistaxis for 3 years. During the nasal endoscopic examination, a mass in the left nasal cavity originating from the left nasal septum that caused bleeding on touch was observed. DIAGNOSES: A diagnosis of epithelial-myoepithelial carcinoma was made based on the features of histopathology and immunohistochemistry of the surgical specimens. The patient was treated by surgical removal of the septal mass using the endonasal endoscopic approach. OUTCOMES: In the serial follow-up paranasal sinus imaging and endoscopic inspection, evidence of recurrence was absent for 18 months after surgery. LESSONS: This report highlights a case of epithelial-myoepithelial carcinoma originating from a minor salivary gland in the nasal septum, one of the most unusual locations. Diagnosis of epithelial-myoepithelial carcinoma should be made based on the findings of immunohistochemistry of the operative specimen. Clinicians should consider complete surgical resection as the effective treatment of choice.

Measurement of Skull Size on Computed Tomography Images for Developing a Bone Conduction Headset Suitable for the Korean Standard Head Size.

BACKGROUND AND OBJECTIVES: We aimed to measure the head dimensions on computed tomography (CT) images, to compare them to directly measured head dimensions, and to predict a new parameter of bone thickness for aiding bone conduction implant (BCI) placement. SUBJECTS AND METHODS: We reviewed the facial and mandibular bone CT images of 406 patients. Their head sizes were analyzed using five parameters included in the 6th Size Korea project, and they were divided into age groups (ranging from the 10s to the 80s). We compared the head length, head width, sagittal arc, bitragion arc, and head circumference in the CT and Size Korea groups. We also added the parameter bone thickness for aiding BCI placement. RESULTS: All the head size parameters measured using CT were significantly smaller than those measured directly, with head length showing the smallest difference at 7.85 mm. The differences in the other four parameters between the two groups according to patient age were not statistically significantly different. Bone thickness had the highest value of 4.89±0.93 mm in the 70s and the lowest value of 4.10±0.99 mm in the 10s. Bone thickness also significantly correlated with head width (p=0.038). CONCLUSIONS: Our findings suggested that the CT and direct measurements yielded consistent data. Moreover, CT enabled the measurement of bone sizes, including bone thickness, that are impossible to measure directly. CT measurements may complement direct measurements in the Size Korea data when used for developing bone conduction hearing devices (BCIs and headsets) for the Korean population.

Therapeutic efficacy and safety of percutaneous radiofrequency ablation of hepatocellular carcinoma abutting the gastrointestinal tract.

OBJECTIVE: The purpose of this study was to evaluate the therapeutic efficacy and safety of percutaneous radiofrequency ablation in the treatment of hepatocellular carcinomas abutting the gastrointestinal tract. MATERIALS AND METHODS: Forty-one patients with hepatocellular carcinomas abutting the gastrointestinal tract underwent sonographically guided percutaneous radiofrequency ablation. Forty-one tumors (1.2-4.3 cm in maximum diameter) had parts 5 mm or greater (or at least one quarter of their circumferences) abutting the stomach in 23 patients and the colon in 18 patients. Thirty tumors were ablated with internally cooled electrodes and 11 with multitined expandable electrodes. All patients were followed up for at least 1 year after ablation. Therapeutic efficacy and safety were evaluated with follow-up sonography and multiphase helical CT. RESULTS: At 1-month follow-up CT, three (7%) of the 41 tumors showed residual unablated tumor in the ablation zone. Of the remaining 38 hepatocellular carcinomas (93%) with no evidence of residual unablated tumor, four (11%) showed local tumor progression in the ablation zones on subsequent follow-up CT. We observed one major complication-a small perihepatic abscess-that needed specific treatment. CONCLUSION: Percutaneous radiofrequency ablation is an effective and safe technique for treating hepatocellular carcinomas abutting the gastrointestinal tract.