Management of a maxillary sinus foreign body (dental bur).

Metal foreign bodies are occasionally found in the paranasal sinuses. Often they result from the escape of material through an oroantral fistula or from trauma. Rarely, they occur as a complication of a dental procedure. A literature review revealed only four other reports of iatrogenic dental bur lodgment in the maxillary sinus, all of which are in the dental literature. Otolaryngologists, who might be required to deal with this complication, must be knowledgeable about its management. In this article we describe a patient who was referred to our otolaryngology department for management of a retained dental bur in the maxillary sinus. We also review two treatment options--an endoscopic and an open surgical approach--for the removal of sinus foreign bodies.

Effectiveness of gabapentin for treatment of burning mouth syndrome.

Burning mouth syndrome is a debilitating disorder involving oral pain that may have at least 4 underlying causes. Although several treatments have been proposed, none seems to be universally effective. We report the case of a 67-year-old woman with unremitting oral burning that is increased with the application of anesthetic agents. Initial treatments with nortriptyline hydrochloride and sertraline hydrochloride were contraindicated because of adverse effects, but the administration of gabapentin significantly reduced oral burning. The present case illustrates the effectiveness of gabapentin as a treatment of burning mouth syndrome.

Bilateral vocal cord paralysis secondary to esophageal compression.

Bilateral vocal cord paralysis is most commonly caused by trauma, malignancy, and neurologic disorders. Cases secondary to esophageal compression of the recurrent laryngeal nerves are rare. We report a patient admitted with an exacerbation of achalasia who developed acute respiratory distress from bilateral immobile vocal cords. Imaging studies revealed impressive dilation of the cervical esophagus causing compression of both recurrent laryngeal nerves. After securing the airway and decompression of the esophagus, mobility of the vocal cords returned within 1 week. This case shows the importance of a careful airway workup in patients with esophageal distention. Early decompression may prevent permanent recurrent laryngeal nerve injury and airway obstruction.