Transnasal endoscopic management of frontal sinus mucopyocele with orbital and frontal lobe displacement as minimally invasive surgery.

AIM: An obstructive condition of paranasal sinus secondary to surgery, trauma, flogosis or neoplasms could become a predisposing state to the occurrence of mucocele. Frontal sinus mucoceles, which can turn into mucopyoceles due to bacterial super-infections, may invade the orbit, erode the skull base and displace respectively the ocular bulb and the frontal lobe. The surgical treatment of this disease ranges from mini-invasive approaches, such as the transnasal endoscopic marsupialization, to a more aggressive surgery such as osteoplasty through coronal flap and frontal sinus exclusion by fat tissue. METHODS: From 2005 to 2007, we treated with transnasal endoscopic surgery 10 patients, affected by frontal sinus mucopyoceles displacing both the ocular bulb and the frontal lobe. RESULTS AND DISCUSSION: In the present study, we report the clinical and diagnostic features of this series, the treatment modalities and the achieved results and confirm the effectiveness of the mini-invasive transnasal endoscopic technique in the treatment of the frontal sinus mucopyocele.

Neurotrophic spread of both neuroblastoma and adenoid cystic carcinoma in the maxillofacial district: common aspects of pre- and postsurgical adjuvant treatment. Multidisciplinary study.

We have studied a common aspect of both adenoid cystic carcinoma (ACC) and neuroblastoma (NB) with the purpose of finding the optimal medical and surgical treatment. This article is based on a case study involving 22 cases of ACC and NB performed at the University of Rome La Sapienza from 1993 to 2001. Of the 22 cases, 17 were diagnosed with ACC and 5 with NB. ACC largely involved the maxillae, having been detected in this location in eight cases. Two of these patients, one affected by ACC and the other affected by NB, received neoadjuvant treatment, whereas 14 were affected by ACC, and 3 with NB received adjuvant treatment. Despite the fact that the two neoplasms have different embryogenic structures, they share common aspects. Both spread invasively through the perineural sheets, and both are responsive to radiotherapy or chemotherapy. The common biologic behavior and the similar response that both show to neoadjuvant radiotherapy or chemotherapy may suggest a way to develop a more effective treatment protocol. The aim of this article is to suggest a line of research along that path.