Leiomyoma of the nasal septum.

Leiomyoma is a benign myogenic tumor that may develop wherever smooth muscle is present. It occurs commonly in the uterus, skin, and gastrointestinal tract and is rare within the nasal cavity. Only three of twenty-four reported cases of sinonasal leiomyoma have been found to originate from the nasal septum. Treatment of choice for these neoplasms is surgical excision. We present two cases of nasal septal leiomyoma. Unique features discussed include recurrence of one neoplasm and the technique used to endoscopically repair a cerebrospinal fluid leak resulting from resection of the neoplasm.

Lymphoma of the tympanic membrane in acquired immunodeficiency syndrome.

Lymphoproliferative disease is more common in the immunocompromised host and can occur at unusual sites. Lymphomas of the temporal bone are rare. We present the first case of a large B-cell Lymphoma of the tympanic membrane in a patient with acquired immunodeficiency syndrome. The tympanic membrane is a site rich with antigen-presenting dendritic cells that may play an etiologic role in neoplastic transformation at this site. The staging, treatment and prognosis of an immunocompromised host afflicted with lymphoma is discussed. Future directions in improving survival include better therapy for the primary viral infection and less toxic therapy for the lymphoma.

Petrous apex arachnoid cyst: radiographic confusion with primary cholesteatoma.

The advent of combined computed tomography (CT) and magnetic resonance imaging (MRI) for the evaluation of petrous apex lesions has improved the otologist's ability to differentiate among many disease processes. Temporal bone CT details osseous anatomy, whereas MRI delineates soft tissue signal characteristics. The employment of these two imaging modalities is often successful in differentiating between cholesterol common entities encountered in the petrous apex. The finding of a smoothly marginated, expansile, bone eroding lesion on CT, coupled with hypointensity on T1-weighted and hyperintensity on T2-weighted images on MRI, is highly suggestive of cholesteatoma. The authors recently encountered two cases of arachnoid cyst involving the petrous apex that shared the same imaging features seen with the more common cholesteatoma. One patient presented with tic douloureux, whereas the other had a spontaneous transotic cerebrospinal fluid leak. The contemporary skull base surgeon should include arachnoid cyst as a rare possibility in the evaluation and treatment of petrous apex lesions.

Frontoethmoidectomy with Sewall-Boyden reconstruction: alive and well, a 25-year experience.

Recent controversies in the rhinologic literature regarding surgical management of the frontal sinus center around relatively new techniques using endoscopic intranasal approaches. Few authors have addressed the concept of frontal "duct" reconstitution, relying instead upon variations of the stenting concept, which fail at least 30% of the time. Some oral presentations and discussions in the past have gone so far as to say that external frontoethmoidectomy is an antiquated operation with few indications. One reason for its recent disfavor concerns the reported high rate of postoperative naso-frontal drainage track stenosis leading to recurrent disease. The senior author has a 25-year experience with a frontal recess reconstruction technique known as the Sewall-Boyden flap. This technique, coupled with the frontoethmoidectomy approach, has been effective with a low failure rate in 41 cases. This article serves to remind sinus surgeons of a safe, effective technique for establishing a drainage track from the frontal sinus: external fronto-ethmoidectomy with Sewall-Boyden flap reconstruction.