ABSTRACT
INTRODUCTION: Paraffinomas (also known as 'sclerosing lipogranulomas' or 'myospherulosis') are a widely acknowledged complication of cosmetic paraffin injections but they are rare following functional endoscopic sinus surgery. CASE PRESENTATIONS: Our first case features a 45-year-old woman presenting with a peri-ocular swelling two weeks after functional endoscopic sinus surgery. The procedure was complicated by a fractured lamina papyracea. A nasal packing with antibiotic ointment was left in situ. Initially, the inflammation was controlled successfully with corticosteroids but the swelling persists to this day. Our second case is a 45-year-old man who suffered from a recurrent swelling of the right eyelid after endoscopic sinus surgery. Multiple treatments with oral antibiotics and corticosteroids brought about no improvement. Debulking surgery was performed and a PDS film was placed between the peri-orbita and the bony orbital floor but the swelling recurred. The patient finally consulted a plastic surgeon as a last resort, but the reconstructive procedure only exacerbated the clinical picture. In both cases a biopsy was performed which established the foreign body reaction typical of a paraffinoma. At present, both patients still suffer from this condition. CONCLUSION: The complete resection of a paraffinoma is seldom possible because of diffuse infiltration and recurrence is very likely. We therefore conclude that paraffin-based ointments should not be used with nasal packing after sinus surgery, especially when there has been a lesion involving the orbital wall.
Subject(s)
Endoscopy/methods , Granuloma, Foreign-Body/surgery , Paranasal Sinuses/surgery , Diagnosis, Differential , Female , Granuloma, Foreign-Body/diagnosis , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Ointments/adverse effectsABSTRACT
This paper summarizes the value of diffusion-weighted magnetic resonance imaging in the evaluation of temporal bone pathology. It highlights the use of different types of diffusion-weighted magnetic resonance imaging in the different types of cholesteatoma, prior to first stage surgery and prior to second look surgery. The value of diffusion-weighted magnetic resonance imaging in the evaluation of pathology of the apex of the petrous bone and the cerebellopontine angle is also discussed.
Subject(s)
Cholesteatoma/pathology , Diffusion Magnetic Resonance Imaging/methods , Image Enhancement/methods , Skull Neoplasms/pathology , Temporal Bone/pathology , Adult , Female , Humans , Male , Middle Aged , Young AdultABSTRACT
OBJECTIVE: The canal wall up bony obliteration technique lowers the incidence of recurrent cholesteatoma, but carries the potential risk of obliterating residual cholesteatoma. The objective of this study was to report long-term follow-up radiological findings after performing a canal wall up bony obliteration technique procedure, in order to detect residual and/or recurrent cholesteatoma. PATIENTS: Fifty-one patients presenting with a cholesteatoma or a troublesome cavity were operated upon using the canal wall up bony obliteration technique, and were evaluated by follow-up imaging a mean of 76.4 months post-operatively (range, 53.8-113.6 months). INTERVENTION: All patients were evaluated with high resolution computed tomography and magnetic resonance imaging (including delayed contrast, T1-weighted imaging and non-echo-planar, diffusion-weighted imaging). RESULTS: Imaging revealed the presence of one residual, one recurrent and one congenital petrosal apex cholesteatoma. On high resolution computed tomography, completely obliterated mastoid filled with bone was observed in 74.5 per cent (38/51) of patients, and an aerated middle-ear cavity in 64.7 per cent (33/51). High resolution computed tomography clearly detected any associated soft tissue present in the middle-ear cavity (18/51) and in the obliterated mastoids (13/51), but could not characterise this tissue. Non-echo-planar, diffusion-weighted magnetic resonance imaging clearly identified all three cholesteatomas, and differentiated them from other associated soft tissues. No cholesteatoma was found within the obliterated mastoids. CONCLUSION: Long-term follow up indicated that the canal wall up bony obliteration technique is a safe method with which to treat primary and recurrent cholesteatoma and to reconstruct unstable cavities. Soft tissue was found quite often in the middle ear and obliterated mastoids. High resolution computed tomography identified its presence but could not further characterise it. However, non-echo-planar, diffusion-weighted magnetic resonance imaging succeeded in differentiating soft tissues, enabling detection of residual or recurrent cholesteatoma after a canal wall up bony obliteration technique procedure.
Subject(s)
Cholesteatoma, Middle Ear , Mastoid , Otologic Surgical Procedures/methods , Adolescent , Adult , Aged , Child , Cholesteatoma, Middle Ear/diagnostic imaging , Cholesteatoma, Middle Ear/prevention & control , Cholesteatoma, Middle Ear/surgery , Female , Follow-Up Studies , Humans , Magnetic Resonance Imaging , Male , Mastoid/diagnostic imaging , Mastoid/surgery , Middle Aged , Neoplasm, Residual , Secondary Prevention , Tomography, X-Ray Computed , Young AdultABSTRACT
Middle ear opacification on imaging studies performed in a non-traumatic setting mostly reflects chronic inflammatory/infectious disease. In some of these patients an underlying cholesteatoma will be found. High-resolution computed tomography examinations and magnetic resonance imaging are often used in the work-out of the disease. High-resolution computed tomography of the opacified middle ear serves to describe the status of the ossicular chain, and its suspensory apparatus, as well as the status of the tympanic and mastoid wall. When ossicular erosions are visualized, the probability of a present cholesteatoma is about 90%. Whereas high-resolution computed tomography is not able to differentiate cholesteatoma from other types of opacification, magnetic resonance imaging is. The combined use of delayed post-Gd T1-weighted images and non-EPI based DWI seems to be the actual best option on this matter.
Subject(s)
Cholesteatoma, Middle Ear/diagnosis , Ear, Middle/pathology , Contrast Media , Humans , Magnetic Resonance Imaging/methods , Mastoid/pathology , Otitis Media/diagnosis , Temporal Bone/pathology , Tomography, X-Ray Computed/methodsABSTRACT
Performing stapes surgery for otosclerosis is known to be potentially irreversibly harmful to the inner ear function in about 1% of the cases. An early postoperative transient depression of the bone conduction thresholds is frequently detected after stapes surgery. The purpose of this study was to compare the evolution of bone conduction thresholds after primary stapedotomy with two different techniques: skeeter versus CO(2) laser stapedotomy. Audiological data of 336 otosclerosis operations performed by 2 surgeons between 1997 and 2003 were subjected to analysis. The calibrated hole in the footplate was performed randomly either with the skeeter drill or with the CO(2) laser. Preoperative bone conduction thresholds were compared with the postoperative levels (day 2-3, week 2, week 6 and month 6) in all patients. Evolution of the bone conduction was compared for the two studied subgroups (laser versus skeeter).
Subject(s)
Auditory Threshold , Bone Conduction , Laser Therapy/instrumentation , Otosclerosis/etiology , Postoperative Complications/etiology , Stapes Surgery/instrumentation , Surgical Instruments , Audiometry, Pure-Tone , Follow-Up Studies , Humans , Sound SpectrographyABSTRACT
Diagnosis of acquired middle ear cholesteatoma on MR imaging is mostly done on late postgadolinium T1-weighted MR images and/or echo-planar (EPI) diffusion-weighted (DWI) MR images. We describe the appearance of a case of a complicated attical middle ear cholesteatoma on single-shot (SS) turbo spin-echo (TSE) DWI compared with EPI-DWI. This case suggests a higher reliability of SS TSE-DWI in the diagnosis of acquired middle ear cholesteatoma.
Subject(s)
Cholesteatoma, Middle Ear/diagnosis , Diffusion Magnetic Resonance Imaging/methods , Echo-Planar Imaging/methods , Magnetic Resonance Imaging/methods , Aged , Contrast Media , Gadolinium , Humans , Image Enhancement/methods , Incus/pathology , Male , Semicircular Canals/pathology , Temporal Bone/pathologyABSTRACT
Chondrosarcomas of the nasal septum are extremely rare tumours. The clinical presentation, imaging features, histopathological characteristics, and therapeutical options for this uncommon lesion are discussed. In this report, two cases are presented, and the literature regarding this rare pathology is reviewed.
Subject(s)
Chondrosarcoma/diagnosis , Nasal Septum/pathology , Nasal Septum/surgery , Nose Neoplasms/diagnosis , Adult , Chondrosarcoma/pathology , Chondrosarcoma/surgery , Female , Humans , Magnetic Resonance Imaging , Male , Nose Neoplasms/pathology , Nose Neoplasms/surgery , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
A case of a large epidermoid tumor in a middle-aged woman with limited symptomatology is reported. Intracranial epidermoid tumors are slow growing and benign lesions. Although the treatment of choice consists in complete resection, partial removal may be preferred in some very extended cases presenting with minimal symptomatology because of the lower morbidity involved. This case illustrates a key-hole approach via a retrolabyrinthine route with preservation of all labyrinthine structures, including the endolymphatic sac and duct. The epidermoid was partially removed by extensive intracapsular debulking under endoscopic control with the aim of decreasing cerebral compression. All cranial nerve functions were preserved and the 6 month postoperative imaging has remained unchanged over a 2-year long follow-up period. The literature regarding this rare pathology is also reviewed.
Subject(s)
Carcinoma, Squamous Cell/diagnosis , Cerebellar Neoplasms/diagnosis , Cerebellopontine Angle , Adult , Carcinoma, Squamous Cell/complications , Carcinoma, Squamous Cell/surgery , Cerebellar Neoplasms/complications , Cerebellar Neoplasms/surgery , Female , Headache/etiology , Hearing Disorders/etiology , Humans , Hydrocephalus/etiology , Magnetic Resonance Imaging , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Long-term radiologic follow-up, from the age of 1 year to 27 and 28 years respectively, was performed for two patients with the XXXXY chromosome anomaly. The patients remained sexually immature; the major abnormality observed radiologically was delayed maturation of the skeleton, the growth plates persisting into adulthood. Early degeneration of the articular cartilage, particularly at the elbows, was observed, along with hypertrophy of the epiphyses and radiohumeral dislocation. One of the patients had intra-articular osteochondroma of the left elbow of unknown cause. Cerebral computed tomography showed enlargement of the lateral ventricles in both patients and the formation of pneumatic cavities in the parietal bones in one.