Listening to tailor-made notched music reduces tinnitus loudness and tinnitus-related auditory cortex activity.

Maladaptive auditory cortex reorganization may contribute to the generation and maintenance of tinnitus. Because cortical organization can be modified by behavioral training, we attempted to reduce tinnitus loudness by exposing chronic tinnitus patients to self-chosen, enjoyable music, which was modified ("notched") to contain no energy in the frequency range surrounding the individual tinnitus frequency. After 12 months of regular listening, the target patient group (n = 8) showed significantly reduced subjective tinnitus loudness and concomitantly exhibited reduced evoked activity in auditory cortex areas corresponding to the tinnitus frequency compared to patients who had received an analogous placebo notched music treatment (n = 8). These findings indicate that tinnitus loudness can be significantly diminished by an enjoyable, low-cost, custom-tailored notched music treatment, potentially via reversing maladaptive auditory cortex reorganization.

Modeling the vestibular evoked myogenic potential.

Measuring the vestibular evoked myogenic potential (VEMP) promises to become a routine method for assessing vestibular function, although the technique is not yet standardized. To overcome the problem that the VEMP amplitude depends not only on the inhibition triggered by the acoustic stimulation of the vestibular end organs in the inner ear, but also on the tone of the muscle from which the potential is recorded, the VEMP is often normalized by dividing through a measure of the electromyogram (EMG) activity. The underlying idea is that VEMP amplitude and EMG activity are proportional. But this would imply that the muscle tone is irrelevant for a successful VEMP recording, contradicting experimental evidence. Here, an analytical model is presented that allows to resolve the contradiction. The EMG is modeled as the sum of motor unit action potentials (MUAPs). A brief inhibition can be characterized by its equivalent rectangular duration (ERD), irrespective of the actual time course of the inhibition. The VEMP resembles a polarity-inverted MUAP under such circumstances. Its amplitude is proportional to both the ERD and the MUAP rate. The EMG activity, by contrast, is proportional to the square root of the MUAP rate. Thus, the normalized VEMP still depends on the muscle tone. To avoid confounding effects of the muscle tone, the standard deviation of the EMG could be considered. But the inhibition effect on the standard deviation is small so that the measuring time would have to be much longer than usual today.

Vascular risk factors in sudden hearing loss.

Low density lipoprotein (LDL) and fibrinogen apheresis was recently reported to be an effective therapy in sudden hearing loss (SHL). In this study, we investigated whether lipoprotein and/or fibrinogen plasma concentrations, related gene polymorphisms and other cardiovascular risk factors are also risk factors for SHL. Total cholesterol, HDL and LDL cholesterol plasma concentrations, fibrinogen levels, and two functionally relevant fibrinogen polymorphisms were determined in 142 consecutive patients and in 84 age- and sex-matched control subjects of the same ethnic background, using routine laboratory methods and PCR analysis. In addition, we determined the platelet glycoprotein Ia (GPIa) C807T polymorphism, which was recently proposed to be a genetic risk factor for SHL, and we compared the patients' and controls' clinical characteristics. Total and LDL cholesterol concentrations were not different between patients and controls. Fibrinogen plasma levels were significantly increased in SHL patients (260+/-57 vs. 239+/-110 mg/dl, p=0.002). However, fibrinogen was not related to SHL in multivariate analysis, and none of the investigated fibrinogen polymorphisms was associated with SHL. By contrast, T allele carriers of the GPIa 807 polymorphic site had an increased risk to develop SHL (OR 1.81) and were more likely not to recover from SHL, compared to C allele carriers (OR 3.0). Moreover, significantly more SHL patients were current smokers (56.3% vs. 19.3% in the control group, p<0.0001). In conclusion, there is a partial overlap between classical coronary risk factors and risk factors for SHL. Hypercholesterolemia and hypoalphalipoproteinemia (low HDL cholesterol levels) are apparently no major risk factors for SHL, whereas the GPIa C807T polymorphism, elevated fibrinogen levels, and smoking are associated with an increased risk for SHL. Altogether these findings suggest a vascular involvement in the pathogenesis of SHL and may have important implications for the development of therapeutic and preventive strategies.

Aesthetic outcome of transfacial sinus surgery: the patient's view.

OBJECTIVE: To investigate the patient's view of the cosmetic outcome of transfacial sinus surgery. DESIGN: Prospective survey of patients after transfacial sinus surgery in a tertiary referral academic otolaryngology department. SETTING: Academic outpatient clinic of otorhinolaryngology. Patients Seventy patients (52 men, 18 women; mean +/- SD age, 56.2 +/- 14.9 years) who had undergone transfacial sinus surgery more than 4 months prior to study entry. INTERVENTIONS: Standardized patient self-assessment for postoperative alteration of facial appearance and emotional impairment and standardized observer assessment by surgeons and laypersons by means of visual analogue scales. RESULTS: Seventy-nine percent of the patients rated their appearance unaltered or minimally altered after transfacial surgery, and 91% reported no or minimal cosmetic morbidity. Postoperative cosmetic morbidity was significantly more common in women, in patients with chronic disease, and in those operated on for trauma. The surgeons' assessment was significantly correlated with the patients' self-assessment of altered appearance, but not with the patients' emotional impairment. CONCLUSION: Consideration of these risk factors may help to further improve patient selection for, and patients' satisfaction with, transfacial sinus surgery.

Preseptal transconjunctival approach for orbital floor fracture repair: ophthalmologic results in 209 patients.

CONCLUSIONS: The transconjunctival approach to orbital floor fractures permits excellent exposure of the inferior orbit and provides a good surgical outcome, especially with regard to ocular motility. OBJECTIVE: Surgical access to orbital floor fractures can be accomplished via the transconjunctival approach. The majority of studies on this subject deal with surgical aspects and complications. The purpose of this study was to report the ophthalmologic outcome after transconjunctival orbital floor fracture repositioning in a significant number of patients. MATERIAL AND METHODS: In a retrospective study, the data of 209 patients with orbital floor fractures treated via the transconjunctival approach with (n=181) and without (n=28) lateral canthotomy were analyzed. RESULTS: The commonest cause of injury was forms of violence (32%). An isolated fracture of the orbital floor had occurred in 62 cases, while concomitant facial fractures were present in the remaining 147. A total of 24 patients (11%) had an exophthalmos and 13 (9%) an enophthalmos. Most patients (69%) complained of infraorbital dysesthesia. When elevating the eyeball, the majority of patients showed a marked or severe disturbance of ocular motility (53% in abduction; 51% in adduction) and diplopia (37% in abduction; 36% in adduction). Thirteen patients required repeat surgery. After a follow-up period of 2 years, infraorbital dysesthesia was observed in only three patients, one of whom presented with a considerable persistent enophthalmos of 4 mm, and only four patients had persistent reduced motility and diplopia.

Interference between muscle relaxation and facial nerve monitoring during parotidectomy.

CONCLUSION: There is a worst case scenario involving a small risk of facial nerve injury and dysfunction of facial nerve monitoring. With regard to patient safety the use of a short-acting muscle relaxant and the analysis of neuromuscular blockade are necessary because these permit documentation of the temporal course of relaxation and the progress of surgery. OBJECTIVES: The use of muscle relaxant may disturb facial nerve monitoring during parotidectomy. The aim of the study was to analyze the duration of muscle relaxation in relation to the progress of surgery. STUDY DESIGN/METHODS: Twenty-one patients who underwent parotidectomy were enrolled in this prospective study, where the short-acting muscle relaxant mivacurium (0.2 mg/kg) was used. The neuromuscular blockade was monitored on the basis of train-of-four (TOF) peripheral stimulation. The time of intubation, skin incision, facial nerve identification and the end of surgery were documented. RESULTS: The mean times of the TOF ratios (2/4; 3/4; 4/4), skin incision, and facial nerve identification differed significantly (chi(2)=0.05; df=1; p>0.05). For the earliest skin incision (21 min), 14.3% of patients have a TOF ratio smaller than 2/4 at which a neuromuscular block of the facial nerve is possible.

Comparison of ultrasonography and conventional radiography in the diagnosis of nasal fractures.

OBJECTIVE: To compare the diagnostic findings of ultrasonography and radiography in nasal fractures. DESIGN AND MAIN OUTCOME MEASURES: In this prospective study, 63 patients (23 female and 40 male; mean age, 26.8 years) with clinical signs of a nasal bone fracture were investigated. All patients underwent radiography (lateral view of the nose plus occipitomental view) and ultrasonography (10-MHz ultrasound scanner) of the nasal dorsum and the lateral nasal walls and a clinical examination by 2 consultants. Thirty-six patients underwent nasal fracture reduction. Two radiographs and 3 ultrasound images of each patient were analyzed by 2 experienced readers at different times. After assessing the nasal dorsum and lateral nasal walls in radiographs and ultrasound images, they decided whether the nose was fractured or not or whether the results were uncertain. The results were analyzed by various statistical testing methods (for sensitivity, specificity, positive and negative predictive value, and accuracy). RESULTS: Assessment of the lateral nasal walls revealed that ultrasonography was statistically superior (P = .04) to radiography. In contrast, assessment of the nasal dorsum showed radiography to be statistically superior (P = .01) to ultrasonography. Assessment of the nasal pyramid revealed no statistical difference between radiography and ultrasonography (P = .91). CONCLUSION: In assessment of the nasal pyramid, ultrasonography can be considered an alternative to radiography, with equivalent diagnostic performance.

Effect of angular acceleration on the localization performance of a remembered target.

Both the influence of a remembered "earth-fixed" target (RT) on the vestibulo-ocular reflex and the effect of "unilateral cold caloric vestibular stimulation" on the localization of a RT have previously been proved. As "unilateral caloric stimulation" is not a physiological stimulus, the aim of the present study was to analyze whether even physiological "bilateral vestibular stimulation" (rotation) is able to affect the RT position. The pointing error (PE) towards an RT both without and following angular acceleration was investigated in 24 healthy volunteers. Postrotatory nystagmus response was recorded by electronystagmography. Evaluation parameters were "nystagmus frequency", "total amplitude" and "velocity of the slow phase"; the horizontal and vertical PE. The fixation of an RT led to a significant reduction of about 28% in nystagmus amplitude compared to the test condition in darkness. "After rotatory stimulation" a systematic horizontal PE in the direction of the fast phase of the postrotatory nystagmus (direction of "illusory self-rotation") occurred and the magnitude of this PE increased significantly compared to the test situation "without vestibular stimulation", but showed only a non-uniform negative correlation with two of the nystagmus parameters. It has to be concluded that "after rotatory stimulation", in contrast to "unilateral cold caloric vestibular stimulation", the subjective sense of "illusory self-motion" leads to a horizontal PE in the direction of the nystagmus fast phases.

The minimal ice water caloric test compared with established vestibular caloric test procedures.

Caloric testing of the vestibular labyrinth is usually performed by classical caloric test procedures (CCTP) using water warmed to 30 degrees C and 44 degrees C. Ice water irrigation (4 degrees C) is usually not performed, although it might be useful as a bedside test. To verify the validity of the Minimal Ice Water Caloric Test (MIWCT), comparative video-oculographic investigations were performed in 22 healthy subjects using ice water (0.5 ml, 1.0 ml, 2 ml), CCTP, and cold air (27 degrees C). Frequency, amplitude, slow phase velocity (SPV), the onset, and the duration of nystagmus were documented. After addition of three ice cubes, the temperature of conventional tap water (16 degrees C) fell within 13 min to 4 degrees C. In pessimum position the subjects demonstrated no nystagmus response. Compared to CCTP, MIWCT was associated with a significantly later onset of nystagmus and a significant prolongation of the nystagmus reaction. In contrast to air stimulation (27 degrees C), a significant Spearman's correlation was noted between MIWCT (1 and 2 ml) and established CCTP in respect of essential nystagmus parameters (frequency, amplitude and SPV). Furthermore, MIWCT (0.5 and 1 ml) showed a higher sensitivity and specificity with regard to the detection of canal paresis based on Jongkees' formula compared to stimulation with air 27 degrees C. Thus, MIWCT appears to be a suitable procedure for bedside investigation of vestibular function outside the vestibular laboratory, e.g. in a hospital ward, where bedridden patients with vertigo occasionally require vestibular testing.

The effect of endogenous nitric oxide on cholinergic ciliary stimulation of human nasal mucosa.

OBJECTIVES/HYPOTHESIS: Endogenous nitric oxide (NO) production by inducible nitric oxide synthase is enhanced in the nasal ciliated respiratory tract epithelium of patients with allergic rhinitis. Recent experimental data have suggested endogenous NO to be strongly involved in the complex regulation of ciliary activity, the driving force of the mucociliary transport system. The authors investigated the effect of endogenous NO on acetylcholine-stimulated ciliary activity of human nasal mucosa. STUDY DESIGN: In vitro study. METHODS: Cultures of human nasal mucosa explants were incubated with tumor necrosis factor-alpha and bacterial lipopolysaccharides to enhance endogenous NO production. Expression of inducible NO synthase was morphologically demonstrated by immunohistochemistry. Ciliary beat frequency was determined by phase-contrast microscopy of ciliated epithelium, using a computerized photoelectric technique. Stimulation experiments were performed in vitro with acetylcholine and N(G)-nitro-l-arginine methyl ester (L-NAME), a NO synthase inhibitor. RESULTS: Upregulation of inducible NO synthase in the respiratory tract epithelium after stimulation with tumor necrosis factor-alpha and lipopolysaccharide was visualized by immunohistochemical analysis. Experimental inhibition of enhanced endogenous NO production by 10 mol/L L-NAME significantly reduced baseline ciliary beat frequency from 8.6 +/- 0.2 to 7.8 +/- 0.2 Hz (P < .05). Cholinergic ciliary stimulation above baseline by 10 mol/L acetylcholine was not significantly different before (11.5%) or after (10.8%) blocking of endogenous NO production. CONCLUSION: Taken together, the study results suggest that baseline ciliary activity depends on endogenous NO production but that the extent of cholinergic ciliary stimulation is independent of endogenous NO production. The combination of the two effects may improve nasal mucociliary clearance of inhaled allergens in patients with allergic rhinitis.

Bacteria and granulation tissue associated with Montgomery T-tubes.

OBJECTIVES: Although complications (infection, development of granulation tissue) of silicone Montgomery T-tubes have been reported, the microbiological consequences and the origin of granulation tissue have not yet been evaluated. STUDY DESIGN: A prospective trial. METHODS: Twenty-three Montgomery T-tubes from 10 patients were analyzed with regard to the development of granulation tissue, bacterial growth (including genotyping with polymerase chain reaction), and results of sensitivity testing. Furthermore, stent sterilization (n = 6) was investigated. RESULTS: Granulation tissue occurred with 74% of the stents, and all specimens showed signs of infection but no foreign body reaction. The predominant organisms were Staphylococcus aureus (35%) and Pseudomonas aeruginosa (17%). The differences between groups with and without granulation tissue were significant for P aeruginosa. Polymerase chain reaction fingerprinting of the S aureus obtained from 15 stents (n = 3 patients) revealed a total of seven different genotypes. Whereas two of these patients harbored six different genotypes of S aureus, the third patient was persistently colonized by S aureus over a 15-month period with the identical genotype. Susceptibility testing showed most commonly (65%) sensitivity to a combination of amoxicillin-clavulanate and ofloxacin. After sterilization, 92% of analyzed stent segments showed no bacterial growth. CONCLUSIONS: Granulation tissue commonly occurred next to the silicone (subglottic area, stoma) where S aureus and P aeruginosa were commonly isolated. A combination of mechanical irritation and bacterial infection seems to account for the development of granulation tissue. Polymerase chain reaction fingerprinting showed both prolonged persistence and a change of colonizing strains after multiple stent replacements. A combination of amoxicillin-clavulanate and ofloxacin is the most effective antibiotic therapy. Sterilization of the cost-intensive silicone stents is feasible, and reuse in the same patient is justifiable from economic aspects.

Clinical and experimental investigations of spontaneous impedance changes of the middle ear.

The major symptoms of glomus tympanicum tumors are pulsatile tinnitus and spontaneous impedance changes (SICs) of the middle ear. On the other hand, SICs often occur even in the absence of pathological findings. The aim of this study was to analyze the occurrence of SICs in patients and healthy volunteers. We retrospectively evaluated 184 patients with SICs and/or complaints of periodic tinnitus. Most of them (n = 134) showed pulse-synchronous SICs. Pathological findings were recorded in only 66 patients. Binaural SICs were registered significantly (p = .03) more frequently in patients with arterial hypertension (63% versus 18%). Because of the positive correlation between arterial hypertension and the occurrence of SICs, the influence of increasing blood pressure (systolic blood pressure > 160 mm Hg after physical activity) on the occurrence of SICs was investigated in a prospective trial in healthy test subjects (n = 42). In 17 of them, pulse-synchronous SICs occurred for the first time or were registered at a lower sensitivity level after an increase in blood pressure. In summary, only half of the patients with pulse-synchronous SICs showed pathological findings. A significant correlation between high blood pressure and binaural pulse-synchronous SICs was demonstrated in patients with arterial hypertension and healthy volunteers after physical activity.

The vertical linear vestibulo-ocular reflex in patients with a hyperactive response during horizontal angular acceleration.

OBJECTIVE: In clinical routine, some patients show a bilateral hyperactive response of the angular vestibulo-ocular reflex (AVOR). The aim of this prospective study was to determine whether these patients also show hyperactivity of the linear VOR (LVOR). MATERIAL AND METHODS: In 10 patients with a hyperactive AVOR (total amplitude of post-rotatory nystagmus > 400 degrees per 30 s) and 10 healthy subjects the AVOR (stopped after 180 s of rotation at 90 degrees/s) and vertical LVOR (amplitude 5 cm, frequency 1.2 Hz) were tested with eyes open in the dark. During vertical linear acceleration, each subject was instructed to look at an earth-fixed target and they performed vertical smooth pursuit as stationary observers. RESULTS: The mean eye velocity of the AVOR was significantly higher in the patients than the healthy subjects (19 vs 5 degrees/s; p = 0.00016). During vertical linear acceleration in darkness (49 vs 23 degrees/s; p = 0.004) and combined maculo-visual stimulation (88 vs 52 degrees/s; p = 0.007) the patients showed a significantly higher mean vertical eye velocity. When vertical smooth pursuit was performed, no significant differences were registered. All 20 subjects showed a significant (p = 0.01) positive Spearmnan correlation (rs = 0.79) between the eye velocities of AVOR and LVOR. CONCLUSION: Patients with a hyperactive AVOR also showed hyperactivity of the LVOR. Because two different sensory end organs and neuronal pathways are involved in these responses, a central rather than a peripheral vestibular lesion must be held responsible.

The effect of optical devices and repeated trials on the velocity of saccadic eye movements.

OBJECTIVE: The purpose of this prospective study was to analyze the effect of glasses and contact lenses on the latency and velocity of visually evoked saccadic eye movements. MATERIAL AND METHODS: A saccadic test was performed 10 times on 20 emmetropic controls (Group A) and 20 ametropic test subjects with myopia (Group B) who were using glasses (Subgroup Bg) or contact lenses (Subgroup Bc). RESULTS: No training or fatigue effect on either latency or eye velocity was registered. Regardless of visual acuity (Group A or B) or of the optical device used (Subgroup Bg or Bc), no significant intergroup difference in latency could ultimately be established. Subgroup Bc showed a significantly slower eye velocity than Group A. Regardless of the optical device used, subjects with a higher degree of myopia (> 6 D) showed a lower eye velocity than the Group A controls. Additionally, saccadic velocity was lower in this subgroup ( > 6 D) in subjects using contact lenses than in those using glasses. CONCLUSION: These results demonstrate that optical devices have an influence on the electronystagmographical analyses of the vestibulo-ocular reflex that must be taken into consideration, particularly in scientific investigations.

Extracellular matrix components in nasal polyposis.

OBJECTIVE: Macroscopically, tissue hydration in nasal polyps seems to be a phenomenon of unknown etiology. As the macromolecular composition of extracellular matrix (ECM) determines to a large extent tissue hydration, which in turn determines tissue volume, we investigated ECM components in nasal polyps (NP) in comparison to nasal mucosa of the inferior turbinate (TM) and sinus mucosa from patients with chronic sinusitis without polyps (CS). MATERIAL AND METHODS: The following parameters were determined: (i) the dry weight of freeze-dried NP, TM and CS; (ii) the total protein content (Bio-Rad Protein Assay) of the tissue; (iii) the quality of proteins, using sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE); (iv) the amount of albumin, using nephelometry; and (v) the amount of hyaluronic acid, using a chemical method: deaminative hydrolysis with carbazole. RESULTS: In 20 NP we found a significantly elevated total protein content compared to TM (n = 20) and CS (n = 15), referred to 0.1 g dry of tissue. In SDS-PAGE of NP (n = 20) a protein band at approximately 70 kDa, representing albumin, dominated, in comparison to TM. The amount of albumin was significantly increased in NP compared to CS and TM. In contrast, the amount of the glycosaminoglycan, hyaluronic acid, was not elevated in NP or CS. CONCLUSION: Albumin was significantly increased in NP and CS, possibly as a result of inflammatory plasma exudation mechanisms. Hyaluronic acid seems to play no role in the tissue hydration of NP.

Nasal surgery in patients with systemic disorders.

Multisystemic disorders represent a heterogenous group of diseases which can primarily manifest at the nose and paranasal sinuses as limited disease or secondarily as part of systemic involvement. Rhinologists therefore play an important role in the diagnostic but also therapeutic process. Although therapy of multisystemic disorders is primary systemic, additional rhinosurgery may become necessary. The spectrum of procedures consists of sinus surgery, surgery of the orbit and lacrimal duct, septorhinoplasty and closure of nasal septal perforation. Since the prevalence of most systemic diseases is very rare, recommendations are based on the analysis of single case reports and case series with a limited number of patients only. Although data is still limited, experiences published so far have shown that autologous cartilage or bone grafts can be used in nasal reconstruction of deformities caused by tuberculosis, leprosy, Wegener's granulomatosis, sarcoidosis and relapsing polychondritis. Experiences gained from these diseases support the concept that well-established techniques of septorhinoplasty can be used in systemic diseases as well. However, a state of remission is an essential condition before considering any rhinosurgery in these patients. Even under these circumstances revision surgery has to be expected more frequently compared to the typical collective of patients undergoing septorhinoplasty. In addition, experiences gained from saddle nose reconstruction may in part be of value for the treatment of nasal septal perforations since implantation of cartilage grafts often represents an essential step in multilayer techniques of closure of nasal septal perforations. Aside from the treatment of orbital complications sinus surgery has been proven beneficial in reducing nasal symptoms and increasing quality of life in patients refractory to systemic treatment.

Evaluation of treatment results with regard to initial anterior commissure involvement in early glottic carcinoma treated by external partial surgery or transoral laser microresection.

BACKGROUND: Modalities of surgical treatment of early glottic carcinoma include transoral laser microresection and external partial surgery. METHODS: This is a retrospective analysis of 119 glottic carcinomas treated by external partial surgery (57 pT1a, 1 pT1b, 10 pT2) or transoral laser microresection (46 pT1a, 4 pT1b, 1 pT2) with special regard to initial anterior commissure involvement. RESULTS: Local recurrence in external partial surgery was 12%. Three- and 5-year local control was 86%. Local recurrence in transoral laser microresection was 16%. Three- and 5-year local control was 88% and 70%, respectively. No significant correlation was found between local control and surgical approach. An analysis of all 119 tumor revealed that anterior commissure involvement significantly decreased local control. CONCLUSION: Initial anterior commissure involvement was associated with a higher risk of local recurrence. Overall, treatment of glottic carcinoma involving the anterior commissure requires much experience and advanced surgical skills regardless which technique is preferred.

Neither MRI, CT nor US is superior to diagnose tumors in the salivary glands--an extended case study.

OBJECTIVES: Ultrasonography (US), computed tomography (CT) and magnetic resonance imaging (MRI) are the most common radiological procedures for the diagnosis of tumor-like lesions of the salivary glands. The aim of the present study was to determine whether MRI or CT provide additional information besides that delivered by US. STUDY DESIGN/METHODS: 109 patients with a tumor-like lesion of the salivary glands underwent surgery. MRI and CT were arranged in 73 and in 40 patients respectively, whereas all 109 patients were prospectively diagnosed by US. The results of CT, MRI and US were compared with the histological outcome. Furthermore, the recent rise in the number of CT and MRI studies was investigated. RESULTS: On CT and MRI, there was no rise in the percentage of malignant tumors or advanced surgical procedures. In respect of the radiological assessment of the lesion (benign/malignant) and the correct diagnosis, CT, MRI and US were comparable in terms of sensitivity, specificity and accuracy. No significant difference was found in the Chi-square test (p > 0.05). CONCLUSION: The evaluation of the preoperative results of CT, MRI and US revealed no advantage for CT or MRI; these procedures are only required in specific cases. An update or revision of the current preoperative diagnostic management is deemed necessary.

Myxoid chondrosarcoma of the maxilla in a pediatric patient.

Myxoid chondrosarcomas of the head and neck region are rare. We report the case of an 8-year-old boy with progressive unilateral nasal obstruction resulting from a highly differentiated myxoid chondrosarcoma of the maxilla extending to the nasal cavity and the ethmoid. Clinical presentation, histological findings and therapy are presented with a brief review of the literature. This case reaffirms the importance of considering sarcomas or other neoplastic lesions in the differential diagnosis of progressive nasal obstruction in children.