Repair of traumatic inferior orbital wall defects with nasoseptal cartilage.

PURPOSE: This study evaluated the effectiveness of nasoseptal cartilage for repairing traumatic orbital floor defects. PATIENTS AND METHODS: Autogenous septal cartilage was used in 20 patients. They were evaluated for the presence or absence of diplopia, enophthalmus, infraorbital nerve paresthesia, and ocular motility disorders. Surgical indications for orbital exploration included entrapment of orbital tissues, large orbital defect (greater than 50% of the orbital floor or more than 8 mm), or orbital floor defects with involvement of other zygomaticofrontal complex fractures. RESULTS: All patients were successfully treated by restoration of the orbital wall continuity. Follow-up at 1 week to 6 months showed 1 patient with postoperative enophthalmos and 1 patient with lower lid edema. There were no donor site and graft infections or graft extrusion. CONCLUSIONS: Nasal septal cartilage is a readily accessible autogenous tissue that should be considered when an autogenous graft is needed for orbital floor defect reconstruction.

The subcranial approach for the treatment of cerebrospinal fluid rhinorrhea: a report of 10 cases.

PURPOSE: Because of the likelihood of meningitis and other intracranial complications, optimal treatment for a cerebrospinal fluid (CSF) fistula is to close the leak. The neurosurgical approach to the management of CSF rhinorrhea has been by intracranial access. Extracranial approaches are now gaining acceptance as the preferred method for initial treatment of CSF leakage, because the success rates are reasonable, and the morbidity is lower. This report describes the results of using such an approach. PATIENTS AND METHODS: The extended subcranial approach was used in 10 patients with CSF rhinorrhea. Selection criteria included defects of the anterior skull base greater than 15 mm in diameter, defects not accessible by endoscopes, fistula sites that could not be localized preoperatively, and multiple and transverse fractures of the cribriform region. Follow-up ranged from 8 to 23 months, with a mean of 17 months. RESULTS: Resolution of rhinorrhea was achieved in 9 (90%) of the patients. Anosmia was the only postoperative complication, occurring in 8 patients. CONCLUSION: The authors conclude that the extended subcranial approach to the anterior skull base is a safe, versatile, and effective procedure for the surgical treatment of CSF rhinorrhea involving the anterior skull base.

Detection of sinus-induced orbital mycosis with standardized orbital ultrasonography: a case report.

Fungal involvement of the paranasal sinuses is frequently observed in the immunocompromised host, and it can become life-threatening if it is not diagnosed. Although the definitive diagnosis is made by tissue biopsy and culture, imaging is of vital importance in the clinical workup and in planning treatment. We present a case of fulminant ethmoidal sinusitis caused by Aspergillus flavus with orbital involvement in an immunocompromised patient. Standard computed tomography of the paranasal sinuses was complemented by the use of standardized orbital ultrasonography, which was able to identify the intraorbital extension. We discuss the role of standardized orbital ultrasonography as a complementary imaging modality in the diagnosis of fungal sinusitis and in the assessment of local extension. To the best of our knowledge, the role of SOU in diagnosing an orbital extension of a fungal infection of the paranasal sinuses has not been previously discussed in the literature.

Identification and typing of human papillomavirus (HPV) in squamous cell carcinoma of the oral cavity and oropharynx.

Recent epidemiological research has raised the possibility of a connection between viral infection by the human papilloma virus (HPV) and the existence of squamous cell carcinoma of the oral cavity and oroharynx (SCCa). Some 60 subtypes have been identified to date, and specific subtypes are associated with lesions or infections at specific tissue sites. Twenty-three patients with SCCa of the oral cavity were studied for the presence of HPV in their tumours. HPV DNA (all type 16) was isolated from four specimens (17.3 per cent) using the Polymerase Chain Reaction (PCR) method. The four patients were all over age 50, and had advanced tumours (two T3 and two T4) that originated in the oropharynx. Our data supports other reports in the literature, demonstrating the presence of HPV DNA type 16 within cells from oropharyngeal SCCa. We conclude that the PCR method is a useful and reliable method for the detection of HPV DNA within tumour cells.

[The subcranial approach to the anterior skull base. Retrospective study of 75 cases]. / La voie d'abord sous-crâniale de l'étage antérieur de la base du crâne. Etude rétrospective de 75 patients.

We reviewed the cases of 75 patients who underwent an extended subcranial approach to the anterior skull base for treatment of various tumors (35 patients), repair of craniofacial trauma injury (33 patients), or cerebrospinal fluid leakage (10 patients). Preoperative evaluation and surgical procedures were reassessed. Significant complications in the oncology group consisted of one hematoma requiring aspiration, 2 cases of transient pneumocephalus, 2 osteocutaneous fistulae and 2 epiphoras. In the trauma group, one patient died from intracerebral damage, 2 presented with transient pneumocephalus, 5 with telecanthus and 5 with enophthalmy. The most frequent late complication in all three groups was anosmia. Based on this review, we feel that this technique is a safe and effective procedure for the surgical treatment of various pathological conditions involving the anterior skull base.

Harvesting large fascia lata sheaths: a rational approach.

This article describes an "S"-shaped incision for the open approach of harvesting wide sheets of fascia lata with reference to the important anatomical landmarks. Forty-three patients required dural replacement in cases of tumors, trauma, or cerebrospinal fluid leak involving the anterior skull base. The extended anterior suberanial approach to the skull base was used for all patients. Early functional status of the operated limb in seven of the patients treated first was assessed by physical examination and then by means of the computerized Kinetic Communicator (Kin-Com; Medex Diagnostics, Canada) dynamometer. None of these patients suffered any significant immediate complications and had good results at the preliminary functional assessment. All other patients were evaluated clinically for functional deficits of the operated lower limb to further assess its morbidity. The technique described herein was shown to enhance the case and control of fascia lata harvesting. It affords low complication rate and donor limb morbidity. Donor limb morbidity did not have any deleterious effect on the patients' normal daily activities and only became apparent during strenuous physical activity.

Desmoid tumor (aggressive fibromatosis) of the neck.

Desmoid tumors are histologically benign fibrous neoplasms arising from the musculoaponeurotic structures throughout the body. There is similar biological behaviour between benign fibrous proliferations and fibrosarcoma. These neoplasms have the tendency to locally invade and erode adjacent muscular tissue and bone. Within the head and neck area they also tend to encase vital structures. We present a case of a 28-year-old white female with a five-month history of a painful mass in her left posterior cervical triangle who was treated by excisional biopsy of the lesion with preservation of the accessory nerve and post-operative radiation. The histopathologic characteristics of desmoid tumors and treatment of these lesions are also reviewed.

The use of standardized orbital ultrasound in the diagnosis of sinus induced infections of the orbit in children: a preliminary report.

Infections of the orbit in children usually present as a complication of sinusitis and may result in blindness or even death. Orbital cellulitis (OC) and subperiosteal abscess (SPA) represent different pathologies within the spectrum of orbital infections. The differentiation between OC and SPA is important, since it implies two different therapeutic modalities. While SPA is usually treated by incision and drainage and parenteral antibiotics, OC may be treated with antibiotics alone. Contrast enhanced CT scan is commonly used in the diagnosis of orbital infections, but does not always prove accurate in differentiating between these two conditions. MRI is superior to CT in the resolution of soft tissue pathology and may be more precise in such situations, but is less available imaging tool outside North America and Europe. There have been a few reports in the early 1980's on the use of standardized orbital ultrasound (SOU) in these two conditions. We have used SOU in seven children with sinus induced orbital infections--four with SPA and three with OC. We reviewed our experience in these patients and compared the imaging characteristics of OC and SPA on SOU with those of conventional imaging modalities, used in orbital infections. In four of the cases, CT scan was inconclusive, while SUO was diagnostic. In this preliminary report, we conclude that SOU may be useful in the diagnosis of orbital infections.

Early outcome and complications of the extended subcranial approach to the anterior skull base.

OBJECTIVES: To present the technique of the extended subcranial approach to the anterior skull base and to review the results in 55 patients who underwent the procedure. STUDY DESIGN: Retrospective review of the records of 55 patients who underwent the extended subcranial approach to the anterior skull base between 1994 and 1998 for the treatment of various neoplasms originating in the nasal cavity, nasopharynx, paranasal sinuses, orbit, or meninges, as well as for the repair of complex craniofacial trauma and/or cerebrospinal fluid (CSF) leak. Preoperative patient evaluation and the surgical technique are also reviewed. METHODS: Patient records were retrospectively reviewed and tabulated for age, sex, and indications for procedure, with special focus on early outcome and complications. RESULTS: Twenty-six patients underwent oncologic resections, 22 patients had reduction of complex fronto-naso-orbital and skull base fractures, and seven patients had repair of CSF leak. Significant complications in the oncologic group consisted of one hematoma requiring needle aspiration and two cases of temporary nontension pneumocephalus. In the fracture group, one patient died because of extensive intracerebral damage and multiorgan failure, and one patient had nontension pneumocephalus coupled with CSF leakage and one patient had temporary nontension pneumocephalus. The most common late complication in all three groups was anosmia. CONCLUSIONS: Based on their review, the authors conclude that the extended subcranial approach to the anterior skull base is a safe, versatile, and effective procedure for the surgical treatment of various pathological conditions involving the anterior skull base.

Growth potential of peripheral giant cell granuloma.

PURPOSE: The purpose of this study was to investigate the association of selected demographic, systemic health, and oral health characteristics of patients with large (> 2 cm) peripheral giant cell granuloma and to assess its growth potential and the possible underlying causes. METHODS: A series of 79 cases including 15 subjects with lesions 2 to 5 cm in the largest diameter is presented. Age, sex, site, size, systemic health, oral hygiene, and report of oral dryness of subjects with large lesions were compared with those of subjects with small lesions (< 2 cm). RESULTS: No differences were found in mean age between the small lesion group (mean age = 31 +/- 6 years) and the large lesion group (mean age 53 +/- 24.2 years). Female predilection (male/female ratio 1:1.5, 1:2.75.) was more significant in patients with large lesions. No statistically significant differences were found in systemic health score (mean American Society of Anesthesiology score 1.39, 1.53). Oral hygiene score (percent calculus 78% +/- 3.1%, 95% +/- 2.7%, percent gingival bleeding 58% +/- 3.6%, 73% +/- 5.4%, percent deep pocket 30% +/- 2.8%, 42% +/- 3.1) was better among the patients with small lesions. The percentage of patients with a report of oral dryness was significantly higher (3.1%, 27%) among patients with large lesions. CONCLUSIONS: Findings from this study suggest that patients with large (> 2 cm) peripheral giant cell granuloma lesions are more likely to be women with lower oral hygiene scores and xerostomia. Further studies are required to measure the relative risk of these factors.

Computerized tomographic and ultrasonographic features of Kimura's disease.

Kimura's disease (KD) is an uncommon condition once thought to affect only Orientals. The patients present with swelling of the major salivary glands associated with cervical lymphadenopathy. The clinical, histopathological and radiological findings of a young Caucasian female with KD will be presented and discussed.

CT and US features of cervical lymphadenopathy due to kikuchi's disease.

Kikuchi's disease or histiocytic necrotising lymphadenitis is a distinct benign clinicopathologic entity which is to be distinguished from malignant conditions, especially lymphoma.We report a young woman with Kikuchi's disease presenting with cervical lymphadenopathy and mild hepatomegaly. CT and US findings are presented as well as a review of the pertinent literature.

Technical note: oroantral fistula: improved imaging with a dental computed tomography software program.

Oroantral fistula (OAF) is an uncommon complication in oral surgery. About 5% of all extractions of maxillary premolars or molars may result in communication to the antrum. Small fistulae, 1-5 mm in diameter may close spontaneously, but larger fistulae usually require surgical closure. Pre-operative determination of the size of the fistula is often unreliable leading to difficulties in planning subsequent clinical management. We report a method for the precise determination of the size of the OAF using a dental computed tomography (CT) software program.

Palatal pleomorphic adenoma in a child.

Benign salivary gland tumours in childhood are rare. We present a case of a pleomorphic adenoma arising in a minor salivary gland within the hard palate, review the literature and discuss the diagnostic and therapeutic features of the condition.