Solitary Fibrous Tumour: A Rare Differential Diagnosis of Unilateral Nasal Mass.

Solitary fibrous tumors of the nasal cavity and paranasal sinuses are rarely encountered in clinical practice. These are unusual mesenchymal tumours initially described as primary spindle-cell neoplasms. Such tumours may manifest in pleural and extrapleural sites such as the liver, parapharyngeal space, sublingual and parotid glands, and thyroid but are seldom described in the nose and paranasal sinus region. Erosion of adjacent structures may occur, but the tumour itself does not metastasise. A young patient presented with a progressive unilateral nasal mass. The initial nasal biopsy reported it as a benign inflammatory nasal polyp. Imaging revealed a large, locally expansile mass within the right nasal cavity displacing the nasal septum. The patient underwent excision of the tumour and the diagnosis of solitary fibrous tumour was confirmed by immunohistochemistry staining. This case is intended to highlight the diagnosis and management of this rare tumour.

Facial Nerve Palsy Secondary to Parotid Abscess: Report of a Rare Case and Review of the Literature.

A parotid lesion with facial nerve involvement almost always indicates malignancy. Facial nerve palsy as a complication of parotid abscess is extremely rare. The postulated mechanisms include ischaemic neuropathy secondary to the compression of the facial nerve by the parotid swelling, local toxic effect and perineuritis from the inflammatory process. Here, we present our experience in managing a case of facial nerve palsy due to a parotid abscess in an otherwise healthy 44-year-old female. The abscess was drained surgically and the facial nerve function returned to normal at two months. Histopathological examination of the parotid tissue showed no features of malignancy. The severity of facial nerve impairment varied from grade II to total palsy. The mainstay of treatment of a parotid abscess is surgical drainage along with medical therapy including broad-spectrum antibiotics, adequate hydration and sialogogues.

Anatomical variations of anterior ethmoidal artery at the ethmoidal roof and anterior skull base in Asians.

PURPOSE: The variations of the anterior ethmoidal artery (AEA) in different populations should be recognized by surgeons to prevent unwarranted complications during surgery. The aim of this study was to assess the anatomical variations of AEA in Asian population. METHODS: A cross-sectional study of 252 AEA identified by computed tomography (CT) of the paranasal sinuses. The multiplanar CT images were acquired from SOMATOM® Definition AS+ and reconstructed to axial, coronal and sagittal view at 1 mm slice thickness. RESULTS: 42.5% of AEA was within skull base (grade I), 20.2% at skull base (grade II) and 37.3% coursed freely below skull base (grade III). The prevalence of supraorbital ethmoid cell (SOEC) and suprabullar cell (SBC) was 29.8% and 48.0%. The position of AEA at skull base has significant association with SOEC (p < 0.001), but not with SBC (p = 0.268). Type I Keros was 42.1% and Type 11 Keros was 57.9%. When lateral lamella's height is longer, the probability increases for AEA to course freely within the ethmoid sinus (p = 0.016). The mean distance of AEA from skull base was 1.93 ± 2.03 mm, orbital floor 21.91 ± 2.47 mm and nasal floor 49.01 ± 3.53 mm. CONCLUSIONS: The position of AEA at skull base depends on the presence of SOEC and length of lateral lamella, but not with SBC. When compared to European population, the mean distance between AEA and nasal floor is shorter in Asians.

Anatomical variations of anterior ethmoidal artery and their significance in endoscopic sinus surgery: a systematic review.

PURPOSE: Anterior ethmoidal artery (AEA) is at risk of injury in endoscopic sinus surgery due to its location. The aim of this review was to assess the anatomical variations of AEA and their significance. METHODS: A literature search was performed on PUBMED, SCOPUS AND EMBASE. The following keywords were used: ethmoidal artery; anterior ethmoidal artery; anterior ethmoidal canal; ethmoid sinus; ethmoid roof; skull base. The search was conducted over a period of 6 months between October 2016 and April 2017. RESULTS: 105 articles were retrieved. 76 articles which were either case reports or unrelated topics were excluded. Out of the 29 full text articles retrieved, 16 articles were selected; 3 were cadaveric dissection, 5 combined cadaveric dissection and computed tomography (CT) and the rest were of CT studies. All studies were of level III evidence and a total of 1985 arteries were studied. Its position at the skull base was influenced by the presence of supraorbital ethmoid cell (SOEC) and length of the lateral lamella of cribriform plate (LLCP). Inter population morphological variations contribute to the anatomical variations. CONCLUSIONS: The average diameter of AEA was 0.80 mm and the intranasal length was 5.82 mm. 79.2% was found between the second and third lamellae, 12.0% in the third lamella, 6% posterior to third lamella and 1.2% in the second lamella. Extra precaution should be taken in the presence of a well-pneumatized SOEC and a long LLCP as AEA tends to run freely below skull base.