Aneurysmal bone cyst of the ethmoid.

Although nearly 500 cases of aneurysmal bone cyst have been recorded in the English literature, involvement of the facial bone is uncommon. To our knowledge, this is the first case of extragnathic, facial aneurysmal bone cyst to be reported in the English literature. A left ethmoid aneurysmal bone cyst was found in a 20-year-old pregnant woman who had a 5-month history of progressive left periorbital swelling, left cystic nasal mass, progressive nasal obstruction, blurred vision, and occasional diplopia. The diagnostic evaluation included a sinus series, facial lamiograms, and an EMI scan. Needle aspirates taken frequently from the intranasal cyst consisted of a dark bloody fluid. The surgical procedure, using external rhinotomy approaches, pathologic findings, and a literature review are presented.

Goals and mechanisms for training otolaryngologists in the area of geriatric medicine.

Population dynamics indicate that the need for services by otolaryngologist-head and neck surgeons will increase. These requirements will also be more complex because of the prevalence of other diseases in the elderly and their varied social and psychological demands. To meet that need, additional research in head and neck disorders and physiology will be necessary. Current and newly developed information relating to geriatrics in otolaryngology must be incorporated into present training and continuing education programs to provide members of our specialty with enough background to adequately diagnose and treat head and neck disorders in the elderly. Otolaryngologist - head and neck surgeons and their elderly patients will benefit from the creation of centers and fellowships that study pathologic processes and normal physiologic change, and that train a new generation of physician-scientists committed to the care of elderly head and neck patients.

Acquired stenosis of the upper airway in neonates. An increasing problem.

Thirty neonates with acquired airway stenosis were treated between 1975 and 1979 at the C. S. Mott Children's Hospital of the University of Michigan. Neonates surviving a period of ventilation are at risk of developing subglottic stenosis (8.3%). The stenosis is often severe. Children with respiratory distress syndrome and/or neurologic disorders were particularly prone to developing a stenosis (37%). Following treatment, 43% were successfully decannulated and decannulation occurred in a biphasic pattern. Thirty-seven percent were still tracheostomy-dependent but had a voice and were developing normal speech patterns. The mean decannulation time was 92.5 weeks, confirming that acquired subglottic stenosis in the neonate is a serious problem with long-term disability.

Developmental effects of impaired breathing in the face of the growing child.

Craniofacial morphology and occlusal pattern are evaluated in 71 subjects having impaired breathing as diagnosed by an otolaryngologist, and in an equal number of controls. The impaired group demonstrate characteristic combinations of craniofacial deformities and malocclusions, with the younger individuals demonstrating a lesser expression of malocclusion progression and morphologic deformities. This suggests that early recognition of such facial patterns may be utilized to identify those breathing compromised individuals who have a likely tendency to develop certain types of malocclusion.

The role of nasal obstruction in obstructive sleep apnea syndrome.

In summary, there is much evidence in the literature that nasal obstruction causes obstructive sleep apnea, usually of mild to moderate degree, in many individuals. In addition, it is a contributory factor in individuals with severe obstructive sleep apnea. This appears to occur because of its contribution to upper airway resistance which directly or indirectly results in a reduction in intraluminal pressure during inspiration and collapse. Nasal obstruction via its influence on the so-called nasal-pulmonary reflex, may also result in alveolar hypoventilation. In patients who have symptoms consistent with obstructive sleep apnea syndrome and/or other disorders of excessive somnolence, a careful history eliciting findings of possible nasal obstruction as well as a thorough nasal examination is appropriate. If nasal obstruction is present, intervention should be considered as part of the routine therapy for obstructive sleep apnea syndrome.