Case report: Supraglottic SCC with sphenoid and cavernous sinus metastases.

INTRODUCTION & IMPORTANCE: Primary Sino-nasal metastases are rare. The most common anatomical sites that metastasise to this region are the kidneys followed by the lungs, breast, thyroid and prostate. Metastases from laryngeal cancer are even rarer. We report a unique case of sphenoid and cavernous sinus metastases in a patient with glottic cancer. Herein we describe to the authors' knowledge the first reported case of supraglottic metastases to the sphenoid and cavernous sinus. This study will help further our understanding metastatic spread outside of those well described in literature. CASE PRESENTATION: A 75-year-old with a right neck swelling and hoarseness, treated for glottic SCC and represented with cranial nerve involvement suspicious for sinonasal metastases. CLINICAL DISCUSSION: Metastases to the sinonasal cavity are rare representing 3 % of head and neck malignancies. The most common primary sites include breast, colon, thyroid and prostate. Metastases from the larynx are exceedingly rare. CONCLUSION: This case report illustrates a rare case of Sino-nasal metastases from a patient with glottic SCC, it highlights an alternative metastatic pathway which often proves fatal.

Concurrent management of suppurative intracranial complications of sinusitis and acute otitis media in children.

OBJECTIVE: Intracranial complications of sinusitis and acute otitis media (AOM) are rare but life-threatening events. In children with suppurative intracranial complications, concurrent neurosurgical and otolaryngological (ORL) intervention has been recommended to optimize outcomes. The aim of this study was to investigate outcomes following concurrent neurosurgical and ORL intervention. METHODS: A retrospective cohort study of children undergoing neurosurgical intervention for intracranial complications of sinusitis or AOM in two neurosurgical centres in Ireland was conducted. RESULTS: 65 children were identified. Mean age was 11.9 years. The most prevalent symptoms were headache, pyrexia, altered level of consciousness, facial swelling, and vomiting. Subdural empyema (n = 24, 36.9%) and extradural abscess (n = 17, 26.2%) were the most common complications. 54 underwent same admission ORL intervention; 47 (87%) were performed concurrently or earlier. For rhinogenic infections, 35 (64.8%) underwent endoscopic sinus surgery (ESS), 13 (24.1%) underwent frontal sinus trephine, and 5 (9.3%) underwent maxillary sinus washout alone. For otogenic infections, 10 (90.9%) underwent mastoidectomy and 7 (63.6%) underwent tympanostomy tube placement. 19 (29.2%) had post-operative neurological deficits, of which 2 (3.1%) were permanent. Streptococcus intermedius was the most common pathogen (n = 30, 46.2%). Concurrent intervention reduced the prevalence of residual collection (p = 0.018) and the need for revision neurosurgical intervention (p = 0.039) for sinogenic complications. The same trends did not achieve statistical significance for the otogenic group. Mortality was 0%. CONCLUSION: Intracranial complications of sinusitis and AOM are best managed in a specialist centre with multidisciplinary input. Concurrent ORL and neurosurgical intervention reduces abscess recurrence and requirement for revision neurosurgery in sinogenic complications and should represent the standard of care. ESS is the ORL modality of choice in experienced hands.