Current management of isolated sphenoiditis.

Isolated sphenoiditis (IS) is a relatively rare clinical entity which might present with serious complications. The clinical records of ten patients with IS were reviewed. The presenting symptoms, the findings, and the treatments given were noted. Eight patients were female and two were male, and their age varied between 9 and 65 years (mean 31 years). The main presenting symptom was headache in five patients, diplopia in four patients, and postnasal drainage in one patient. The duration of the symptoms ranged between 48 h and 1 year. The diagnosis was accomplished by history, nasal endoscopy and radiological examination (computed tomography and/or magnetic resonance imaging). Two patients had fungus ball. One patient was a scuba diver as a possible predisposing factor. All of the patients underwent medical treatment consisting of intravenous antibiotics or oral antibiotics, and endoscopic sinusotomy was performed in nine patients additionally. Complete resolution was obtained for all patients except one who had diplopia for one year. IS may present with headache and orbital symptoms. Timely diagnosis and treatment are substantial in order to avoid serious complications, and to obtain a complete recovery. Medical treatment does not avoid surgery in majority of cases. Surgery is indicated from the very beginning specifically for the cases starting with diplopia which might be suggestive of a progression of the infection. Currently the most frequently used approach is endoscopic transnasal sphenoidotomy. This technique seems to be effective and less traumatic compared to other approaches.

Modified midfacial degloving approach for sinonasal tumors.

A perfect surgical approach to nasal cavity and paranasal sinus tumors should provide a broad exposition preserving the important structures with no cosmetic defect. Midfacial degloving (MD) technique provides good exposure without incisions and scars in the face. Classic MD technique includes rhinoplasty incisions. However, combination of the facial plastic skills of the rhinoplasty techniques with an oncologic approach limits its popularity. We modified the classic technique, which is performed without classic rhinoplasty incisions. The surgical approaches to 55 patients with benign and malignant sinonasal neoplasms are reviewed, and the modification of MD technique performed without rhinoplasty incisions is described. The study includes 41 male and 13 female patients with both benign and malignant sinonasal neoplasms. The ages of the patients were between 9 and 78 years with a mean age of 41.15 years. Follow-up of the patients ranged from 2 to 96 months with a mean of 31.7 months. Most of the cases were angiofibroma and inverted papilloma. Modified MD approach was used for all patients, and in 6 cases, the technique was combined with subcranial approach. We successfully resected the tumors in all of the patients. The most frequently encountered complaint in the postoperative period was temporary nasal crusting and epistaxis. An important complication was the rupture of subpetrous part of the internal carotid artery in one patient and also a temporary facial palsy in another one. Palatal dysfunction, oroantral fistula, or vestibular stenosis, which are significant complications of MD, were not observed in any of our cases. In this modified technique, rhinoplasty incisions are not used; therefore, the duration of operation is shortened, the technique becomes easier, and the incisions of the rhinoplasty procedure, which could cause circular stenosis, are avoided.

Intratracheal ectopic thyroid: case report and review.

Intratracheal ectopic thyroid tissue is a rare abnormality that can cause airway obstruction. The symptoms can easily be confused with those of bronchial asthma. We describe the case of a 40-year-old man with subglottic thyroid tissue and multinodular goiter who had been misdiagnosed earlier with bronchial asthma. After the correct diagnosis was established, the lesion was excised via an external approach. We also discuss the clinical features and management of intratracheal thyroid tissue.

Surgical approaches to juvenile nasopharyngeal angiofibroma.

INTRODUCTION: Juvenile nasopharyngeal angiofibromas are highly vascular, non-encapsulated tumours affecting predominantly young males. These lesions are benign histologically but they may become life-threatening with excessive bleeding or intracranial extension. MATERIAL AND METHODS: The surgical approaches to 22 male patients with nasopharyngeal angiofibromas are reviewed. A modification of midfacial degloving performed without rhinoplasty incisions and lateral osteotomies is described. RESULTS: The patients' ages ranged between 9 and 26 years (mean 14.9). Three stage I tumours, 8 stage II tumours, 6 stage III tumours and 5 stage IV tumours were included into this study. All stage I lesions and one stage II lesion were treated via transnasal endoscopic approach. A modified midfacial degloving approach was used for the removal of seven other stage II lesions, all six stage III lesions, and three stage IV lesions. A combined midfacial degloving-infratemporal fossa Fisch C-transcranial approach was the route chosen for the remaining two stage IV lesions. The complications encountered in the postoperative course include temporary facial palsy in one patient (following a Fisch C infratemporal resection), mild crusting in the nasal cavity in 8 patients, and facial paraesthesia in 6 patients whose tumours were resected via midfacial degloving, and rupture of the subpetrous part of the internal carotid artery in one patient. CONCLUSION: The suggested treatment of juvenile nasopharyngeal angiofibroma consists of an endoscopic transnasal approach for early stage lesions, and a modified midfacial degloving for almost all of the advanced lesions. The latter approach is very useful considering surgical exposure, duration of surgery, cosmetic outcome, and morbidity. It can be combined with an infratemporal approach or craniotomy if necessary.

Tonsillar metastasis of primary signet-ring cell carcinoma of the cecum.

Metastatic carcinoma of the palatine tonsil is unusual. The most common primary sites of the tonsillar metastasis are the kidney, cutaneous melanoma, lung and breast. Primary manifestation of these tumors as a tonsillar mass is extremely rare in the literature. We present a case with a tonsillar metastasis from unusually localized primary signet ring-cell carcinoma of the cecum.

Infantile supraglottic hemangioma: a case report.

Hemangiomas of the airway are benign vascular lesions that can involve any site from the nares to the tracheobronchial tree. Most of these lesions are seen in the subglottic area in infants. Supraglottic infantile hemangiomas are very rare. We report a case of supraglottic hemangioma in a 2-month-old boy who had been admitted to our hospital with inspiratory stridor and dyspnea. The hemangioma involved the left arytenoid and aryepiglottic fold. A tracheostomy was performed, and the patient was followed up endoscopically every 6 months thereafter The hemangioma disappeared when the child was 30 months old. Subsequently, a Montgomery T-tube was placed for 6 months to assist in maintaining normal breathing. The patient remains disease-free during ongoing follow-up. We also discuss the management strategies for infantile laryngeal hemangiomas.

Sudden hearing loss due to oxaliplatin use in a patient with colon cancer.

Oxaliplatin is used to treat advanced colorectal cancer. Platinum-containing chemotherapeutic agents are known to be ototoxic. However, ototoxicity is rare with newer generation platinum-derived agents, such as oxaliplatin. This case report presents a rare case of sudden unilateral sensorineural hearing loss following intravenous (IV) infusion of oxaliplatin in a 64-year-old woman with advanced colon cancer. The hearing loss was severe and did not respond to treatment. To the best of our knowledge, this is the fifth reported case of oxaliplatin ototoxicity. Although oxaliplatin ototoxicity is rare, physicians must be aware of this important adverse effect, and an audiometric evaluation must be performed when necessary. Patients treated with oxaliplatin should be followed closely for early signs and symptoms of hearing loss, and if hearing loss is detected, treatment should be stopped immediately.

Isolated sphenoid sinusitis presenting with unilateral VIth nerve palsy.

Isolated sphenoid sinusitis is a rare disorder. There are some difficulties in its diagnosis and the first presentation of this disorder might be with complications. These complications are essentially due to the anatomical location of the sinus and its proximity to the intra-cranial and orbital contents, to which infection may easily spread. In this paper, we report a case of isolated sphenoid sinusitis in a 12-year-old girl who was presented with unilateral VIth nerve palsy. She was initially treated with parenteral antibiotherapy, the abducens nerve palsy recovered but as sphenoiditis persisted she underwent an endoscopic sphenoidotomy. We discuss the clinical features, the diagnostic tools, and the treatment options for this entity.

Giant frontoethmoid mucocele with intracranial extension: case report.

We report the case of a 31-year-old woman who came to us with a giant frontoethmoid mass that had extended into the intracranial region and invaded the left orbit. We removed the lesion in its entirety via a combined intranasal and transcranial approach. We discuss the advantages and disadvantages of different surgical approaches, and we explain why we recommend a combined approach for the type of giant lesion that we encountered.

[Quality of life assessment with the use of the SF-36 in patients with nasal polyposis: correlations with clinical and laboratory findings]. / Nazal polipozisli hastalarda yasam kalitesinin SF-36 ile ölçülmesi, klinik ve laboratuvar verilerle degerlendirilmesi.

OBJECTIVES: We evaluated the quality of life of patients with nasal polyposis and sought correlations between clinical and laboratory parameters and quality of life. PATIENTS AND METHODS: Thirty-two patients (8 females, 24 males; mean age 43 years; range 15 to 68 years) with nasal polyposis were evaluated by history, physical examination, endoscopy, computed tomography (CT), nasal smear, and skin prick tests. Quality of life was assessed using the Medical Outcomes Study Short Form 36 (SF-36). RESULTS: The mean CT score showed a weak correlation with symptom and endoscopic scores (p<0.05), whereas the latter two scores were not correlated. All the SF-36 scales were adversely influenced, particularly including the scores for role limitation caused by emotional problems, general perception of health, vitality, and role limitation caused by physical problems. An inverse correlation was found between increasing age and complaints of pain (p<0.05). Symptom scores were correlated only with role limitation caused by emotional problems (p<0.05). Duration of nasal symptoms was correlated with increased scores for role limitation caused by physical problems, mental health, social functioning, and pain (p<0.05). Computed tomography stage was correlated with role limitation caused by emotional problems, pain, and social functioning, whereas CT scores showed correlation only with pain (p<0.05). The presence of asthma adversely influenced general perception of health scores (p<0.05). CONCLUSION: Nasal polyposis adversely affects the quality of life of patients, the extent of deterioration being more prominent in certain subscales.

Intravascular papillary endothelial hyperplasia (Masson lesion) of the hypopharynx and larynx.

Masson lesion is characterized by a benign intravascular papillary hyperplasia and subsequent thrombosis. Clinically, this lesion can be misdiagnosed as mucocele, hemangioma, Kaposi sarcoma, angiosarcoma, pyogenic granuloma, and several other lesions. In this article, we report a case of intravascular papillary endothelial hyperplasia of the hypopharynx and larynx, which caused dysphagia in an 18-year-old female patient. The lesion was excised entirely via a lateral pharyngotomy approach. We discuss the clinical and histopathologic features, differential diagnosis, and treatment of this uncommon entity.

Synovial chondromatosis of the temporomandibular joint with skull base extension.

Synovial chondromatosis is a benign pathologic lesion that is considered to be a metaplastic process. This disease is rarely encountered in the temporomandibular joint (TMJ). In this article, a 72-year-old patient with synovial chondromatosis of the TMJ extending to the infratemporal fossa is presented and the literature is reviewed.

Urinary N-acetyl-beta-D-glucosaminidase levels in patients with laryngeal squamous cell carcinoma.

OBJECTIVE: Tumour markers play an important role in the diagnosis of cancer and the early detection of recurrences during follow-up. This study aimed to assess the clinical value of measuring urinary N-acetyl-beta-d-glucosaminidase (U-NAG) levels in patients with laryngeal squamous cell carcinoma. DESIGN: Prospective, controlled study. SETTING: Tertiary university hospital. PATIENTS AND METHODS: Our study included 21 patients with primary laryngeal squamous cell carcinoma and 17 cases with recurrent laryngeal squamous cell carcinoma. U-NAG levels of patients with tumours at different stages were compared with a control group of 19 healthy individuals with no known cancer. MAIN OUTCOME MEASURES: Patients' age, TNM stage, blood urea, glucose, alanine aminotransferase (ALT), and U-NAG. RESULTS: A statistically significant difference was found between U-NAG levels of patients with a primary tumour (preoperative period) and the control group (one-way analysis of variance, p = .00; Dunnett's t-test, p = .00). In the postoperative period, the observed trend was that of a significant decrease among primary cases (paired t-test, p = .00). U-NAG levels of patients with a recurrent tumour and patients with a primary tumour (preoperative period) were not significantly different (Tukey honest significant difference test, p = .841). There was no statistically significant difference for blood urea (t = -1.95, p = .064), glucose (t = -1.84, p = .074), or ALT (t = -1.79, p = .080). No significant relationship was found between the TNM stage and preoperative U-NAG levels (p > .05). CONCLUSIONS: These results suggest that U-NAG might be used in the diagnosis of laryngeal carcinoma and the early detection of recurrences during follow-up. Further investigations are warranted to clarify the prognostic significance of U-NAG levels.

Unusual extension of the first branchial cleft anomaly.

First branchial cleft is the only branchial structure that persists as the external ear canal, while all other clefts are resorbed. Incomplete obliteration and the degree of closure cause the varied types of first branchial cleft anomalies. They were classified based on the anatomical and histological features. We present an unusual type of first branchial cleft anomaly involving the external auditory canal, the middle ear and the nasopharynx through the eustachian tube.

Asymptomatic retropharyngeal abscess related to cervical Pott's disease.

Pott's disease is an uncommon manifestation of tuberculosis, which usually involves thoracic or lumbar vertebrae. The body of the vertebrae is most severely affected and a compression fracture is an almost inevitable consequence of the disease. A paravertabral abscess generally accompanies vertebral involvement. Tenderness over the involved vertebrae, weakness of the related muscles, and paraesthesia are the usual symptoms. In this article, we report a case of cervical Pott's disease presenting mainly with neurologic symptoms such as weakness, pain, numbness of both arms and hands, and an asymptomatic retropharyngeal abscess.