Meningiomas presenting in the paranasal sinuses and temporal bone.

Head and neck meningiomas are primarily intracranial neoplasms; they rarely present in extracranial locations. Two cases of meningiomas in the paranasal sinuses and seven cases in the temporal bone are described. The pathology, pathogenesis, clinical evaluation, and therapy are discussed. It is stressed that intracranial components of such meningiomas be sought and, as appropriate, treated.

Necrotizing sialometaplasia in the setting of acute and chronic sinusitis.

Necrotizing sialometaplasia is a benign lesion that may be mistaken for mucoepidermoid or squamous cell carcinoma. A case report is presented in which necrotizing sialometaplasia was noted as an incidental finding in the setting of acute and chronic sinusitis. It is critical to recognize the lesion as benign so as to avoid overdiagnosis and overtreatment.

The otolaryngologic presentation of botulism.

Botulism, although an uncommon disease, may nonetheless present to the otolaryngologist. The clinical signs of a severely erythematous, parched tongue, oropharynx, hypopharynx and larynx, especially when associated with bilateral cranial nerve deficits, should arouse suspicion of this disorder. Once the presumptive diagnosis of botulism is made, the otolaryngologist should expeditiously act to ensure appropriate airway control, as respiratory collapse may be imminent.

Surgical anatomy of the temporal bone in the chinchilla.

The chinchilla is of value in otological research for many reasons, including the surgical accessibility of the majority of structures within its temporal bone. This paper describes the anatomy of the chinchilla's temporal bone, and four surgical approaches to the labyrinth and ossicular chain, three through the bulla and the other via the external canal. No one approach reveals all the temporal bone structures, and each route is therefore more suited to some surgical procedures than others. The cochlea is particularly accessible for microsurgical procedures because it projects into the labyrinthine part of the bulla and because its bony capsule is thin. Surgery in the posterior cranial fossae is both hazardous and difficult; the hazard is bleeding from the venous sinuses which run within the occipital and temporal bones, and the difficulty is the limited access due to the intervening cerebellum and the closeness of the brain stem.

Fetal rhabdomyoma of the larynx.

A patient had fetal cellular rhabdomyoma of the larynx confirmed histologically and by electron microscopy. The literature on laryngeal rhabdomyomas is reviewed. Adult and fetal rhabdomyomas demonstrate no clinical differences in the larynx, unlike rhabdomyomas described elsewhere in the body. Most patients are middle-aged men with less than three years' history of hoarseness. The diagnosis is established pathologically by using routine histologic criteria, special stains, and electron microscopy. Treatment consists of local surgical excision. The tumors rarely recur.

Spontaneous retropharyngeal and cervical subcutaneous emphysema in adults.

The presence of air in the retropharyngeal and cervical subcutaneous spaces of the neck in association with the acute onset of severe odynophagia and dysphagia is an uncommonly recognized initial feature of pneumomediastinum. Free air in the mediastinum extends into the neck via fascial planes. Spontaneous pneumomediastinum is a self-limited disorder that can be confused with Boerhaave's syndrome (spontaneous esophageal perforation), which is potentially fatal. The diagnosis is established radiologically.