Foreign Bodies in Sinonasal Tissues: A Potential Pitfall yet a Hint to Oroantral Fistulas.

Foreign bodies in the maxillary sinus are infrequent findings with various organic and inorganic materials have been reported. Most are iatrogenic due to abnormal communications between the oral cavity and the sinus cavity, predominantly secondary to dental and oral procedures. Oroantral fistulas might be asymptomatic incidental findings or may present with sinusitis-related symptoms. Even though oroantral fistulas are frequently encountered iatrogenic complications, most studies focused on radiologic findings and surgical closure procedures. A few cases reported the histopathologic findings of foreign body-related antral sinusitis. Our aim is to report three cases of chronic maxillary sinusitis induced by various foreign bodies of oral and dental origin associated with oroantral fistulas. Our focus is to highlight the different histopathologic patterns, potential pitfalls and helpful clues of foreign body-induced maxillary sinusitis. Altered foreign bodies in procured sinus specimens might be missed, misinterpreted or ignored by pathologists. Obvious vegetable food remnants were detected, but subtle vegetable residuals showed pulse granuloma, rings and sheet-like patterns embedded in the granulation tissue and fibrous stroma. Some materials mimicked fungal hyphae while others were ignored as nonspecific debris. Periodic acid Schiff stain and polarizing light helped delineate their nature. Other helpful hints included the presence of oral-type squamous epithelium, crystals, hemosiderin pigments, dental materials such as alvogyl, and microorganisms of oral origin for example Actinomyces. Our series emphasizes the importance of correct recognition of foreign bodies of oral and dental origin in paranasal specimens to guide clinicians to the possibility of oroantral fistula-associated odontogenic sinusitis versus conventional rhinosinusitis.

Benign mesenchymal tumors of the external ear: A series of 14 cases.

Primary soft tissue tumors of the head and neck region are relatively uncommon. Most are not distinctive to this region. Benign mesenchymal tumors of the external ear are rare. Some are common tumors but unusual in this location. All of the reported cases were single case reports or small series. Our aim was to study the prevalence and spectrum of different types of benign mesenchymal tumors that involve the external ear in our institution, to find out whether any lesion is distinctive to this site, their potential clinical associations and to highlight their potential diagnostic challenges. We performed a retrospective review study over 13 years. We retrieved 14 cases of external ear tumors. They included two cases of leiomyomas, two hemangiomas, three neurofibromas, two xanthogranulomas, three osteomas, a lipoma and a sclerotic fibroma. The age range was between 8 and 61 years with an average age of 34.2 years. The male to female ratio was 1.3 to 1. The average size was 8 mm. They were miscellaneous uncommon lesions and most were not unique to the external ear. Meatal osteomas and auricular angioleiomyomas are not infrequent with some predilection to the ear. With the exception of neurofibromatosis type-1, they were solitary nonsyndromic lesions. Multiplicity can be a hint to a syndrome. Clinically, benign external ear mesenchymal tumors can be confused with neoplastic and nonneoplastic lesions. Histopathologic examination is needed for proper classification. Benign soft tissue tumors of the external ear are generally easy histologic diagnosis. Immunohistochemistry is needed to confirm the diagnosis in certain tumors showing overlapping features.