An otherwise healthy 13-month-old girl was noted by her pediatrician to have developed a left head turn. The patient was referred to a pediatric ophthalmologist, who noticed signs of incomplete third cranial nerve palsy. Magnetic resonance imaging revealed the presence of an abnormal lesion in the inferonasal orbit that was abutting the ethmoid sinus. After consultation with an ENT specialist, the decision was made to remove the lesion via functional endoscopic sinus surgery because this approach was deemed to provide adequate access while limiting morbidity. Histology of the excised lesion identified it as true ectopic lacrimal gland tissue with cysts. We recognize and comment on the fact that in many reported cases of ectopic lacrimal gland cyst, the tissue was not ectopic at all but instead represented an extension of normal lacrimal gland tissue.
Hearing loss commonly occurs after radiation therapy for an acoustic neuroma, and it is highly unusual for hearing to return after a prolonged period of time. We report the case of a 12-year-old boy with neurofibromatosis 2 who underwent fractionated stereotactic radiotherapy for the treatment of a left-sided vestibular schwannoma. Following treatment, he demonstrated an elevation of pure-tone audiometric thresholds and a sudden decrease in speech discrimination score (SDS) to 0%. However, 20 months postoperatively, his SDS suddenly and spontaneously rose to 92%, although there was no improvement in his speech reception threshold. We discuss the possible reasons for the unusual outcome in this patient.
Neurofibromatosis type 2 (NF-2) is a genetic disorder caused by a mutation in the merlin gene located on chromosome 22. Absence of the merlin tumor-suppressor gene results in the development of bilateral vestibular schwannomas and other intracranial and spinal tumors, including meningiomas and ependymomas. The management of...
The sphenoid sinus has been considered a more challenging sinus to view with the lighted guide wire; unlike the other three paranasal sinuses, the sphenoid sinus is “hidden” from view because of its more posterior location.
This 44-year-old patient presented with recurrent vertex headaches, nasal congestion, and “runny nose.” Her symptoms persisted despite multiple antibiotic treatments and a course of oral steroids. This nonsmoking patient had no history of diabetes or allergies, and she had not previously undergone sinus surgery. Preoperative sinus...
Eosinophilic otitis media is refractory to conventional therapy for otitis media and may lead to severe hearing impairment if not recognized promptly.
While malignancies of the accessory parotid gland are rare, when they do occur they jeopardize ductal integrity.
The patient is a 41-year-old woman who presented with a 1 year history of a painful left cheek mass. She denied weight loss, fevers, chills, or difficulty tolerating a normal diet. However, she presented for removal because of persistent pain. On exam, a 1.0 x 1.0-cm mass was palpated in the left cheek, overlying the masticator muscle.