Rhinology

Clinical management of a patient with advanced mucosal malignant melanoma in the sinonasal area

January 21, 2014     Marco Fusetti, MD; Alberto Eibenstein, MD; Ettore Lupi, MD; Enzo Iacomino, MD; Tiziana Pieramici, MD; Alessandra Fioretti, MD, PhD
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Abstract

We describe a case of mucosal malignant melanoma in the sinonasal area of a 65-year-old woman. She presented with a history of nasal obstruction and epistaxis with subsequent tenderness, facial anesthesia involving cranial nerve V2, red eye, proptosis, diplopia, and conjunctival chemosis. Computed tomography detected a nonspecific solid mass that had involved the left maxillary sinus and surrounding tissues, with extension into the nasal cavity and invasion of the orbital floor and eye muscles. Histopathologic examination of the neoplasm revealed that it was a malignant melanoma. We performed a radical hemimaxillectomy that extended to the orbit, which allowed for radical excision of the tumor. Postoperatively, the patient received adjuvant chemotherapy and radiotherapy. Mucosal melanoma in the head and neck is a rare and highly malignant neoplasm. We suggest that malignant melanoma be suspected when a small-round-cell tumor is found on light microscopy, and we confirm the usefulness of immunohistochemical investigations.

Recurrent chondro-osseous respiratory epithelial adenomatoid hamartoma of the nasal cavity in a child

January 21, 2014     Kazuhiro Nomura, MD, PhD; Takeshi Oshima, MD, PhD; Atsuko Maki, MD, PhD; Takahiro Suzuki, MD, PhD; Kenjiro Higashi, MD; Mika Watanabe, MD, PhD; Toshimitsu Kobayashi, MD, PhD
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Abstract

Chondro-osseous respiratory epithelial adenomatoid hamartoma (COREAH) is an extremely rare type of hamartoma. To the best of our knowledge, only 1 case has been previously reported. A 7-year-old girl presented with a case of COREAH of the bilateral nasal cavities. Polypous masses in both nasal cavities were resected endoscopically, and they were histologically diagnosed as COREAH. A large polypous mass recurred 1 year postsurgically on the right side only. A second endoscopic surgery was performed, and the lesion was confirmed to be recurrent COREAH. Hamartoma of the nasal cavity is rare and is generally considered to be self-limiting. This case suggests that nasal hamartomas may have neoplastic characteristics, and therefore require complete resection.

Bilateral dacryocystoceles as a rare cause of neonatal respiratory distress: Report of 2 cases

January 21, 2014     Mélanie Lecavalier, MD; Lily H.P. Nguyen, MD, MSc, FRCSC
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Abstract

Although obstruction of the nasolacrimal duct is a fairly common finding in newborns, development of a dacryocystocele (nasolacrimal duct cyst) is uncommon. Bilateral dacryocystoceles that expand intranasally and cause respiratory distress in the newborn are rarer still. We present 2 cases of bilateral dacryocystoceles that caused neonatal respiratory compromise. Our first patient, a newborn girl, was managed successfully with probing of the nasolacrimal ducts and endoscopic marsupialization of the cysts. Our second patient, a newborn boy, responded well to conservative treatment with a nasal decongestant, lacrimal sac massage, and warm compresses. While bilateral dacryocystoceles are rare, they should be considered in cases of neonatal respiratory distress and concomitant nasal obstruction.

Concha bullosa mucocele and mucopyocele: A series of 4 cases

January 21, 2014     Khalid H. Al-Sebeih, MD, FRCSC, FACS; Mohd H. Bu-Abbas, MD
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Abstract

Concha bullosa is an aerated turbinate in the nose. It is a common anatomic variant that can develop a mucocele if obstructed, which can further progress to become a mucopyocele if infected. A mucopyocele can expand and cause destruction of neighboring tissues. A review of the literature revealed only 10 cases previously reported. We describe 2 cases of mucocele and 2 cases of mucopyocele.

The endoscopic transnasal paraseptal approach to a sphenoid sinus osteoma: Case report and literature review

December 20, 2013     Frank Rikki Canevari, MD; Georgios Giourgos, MD; Andrea Pistochini, MD
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Abstract

Osteomas are the most common benign tumors of the nose and paranasal sinuses. Their symptoms, which are nonspecific, occur as the result of a blocked nasal airflow or, in some rare cases, the involvement of nearby structures. Isolated sphenoid sinus osteomas are very rare, as only 20 cases have been previously reported in the literature. Most authors advise surgical treatment for symptomatic lesions. Surgical access to the sphenoid sinus has traditionally been a challenge for surgeons. We describe an endoscopic transnasal paraseptal resection of a sphenoid osteoma in a 35-year-old man. We also discuss surgical access and review the evolution of the surgical approaches to the sphenoid sinus.

Angioleiomyoma on the dorsum of the nose excised via an open rhinoplasty approach

December 20, 2013     Philip W. Stather, MBChB; Zuhair O. Kirresh, FRCS; Paul N. Jervis, FRCS
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Abstract

We describe what we believe is the first reported case of an angioleiomyoma on the dorsum of the nose. The patient was a 65-year-old woman who presented with a year-long history of an intermittently recurrent lump on the right side of the dorsum. The lesion was removed via an open rhinoplasty approach. Histologic examination identified it as an angioleiomyoma.

Sphenoid sinus mucocele as a cause of isolated pupil-sparing oculomotor nerve palsy mimicking diabetic ophthalmoplegia

December 20, 2013     Alireza Mohebbi, MD; Hesam Jahandideh, MD; Ali Amini Harandi, MD
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Abstract

A 37-year-old woman presented with isolated right-sided oculomotor nerve palsy. Neurologic examination revealed no other disorder. Computed tomography of the paranasal sinuses demonstrated complete opacification of the sphenoid sinus. Dense mucoid fluid was drained from the sphenoid sinus via an endoscopic transseptal sphenoidotomy. A biopsy confirmed the diagnosis of sphenoid sinus mucocele. At follow-up 4 weeks postoperatively, the patient's ocular symptoms were markedly alleviated. Considering rare causes of isolated oculomotor nerve palsy, such as sphenoid sinus mucocele, is important in the differential diagnosis, even in patients with well-known risk factors such as diabetes mellitus.

Recurrence of a nasopharyngeal carcinoma manifesting as a cerebellopontine angle mass

December 20, 2013     Min Han Kong, MS; Jahendran Jeevanan, MS; Thanabalan Jegan, MS
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Abstract

As many as 31% of patients with nasopharyngeal carcinoma present with intracranial extension. Despite this high percentage, extension to the cerebellopontine angle is rare. The mechanism of tumor spread to the cerebellopontine angle is not completely understood. The most likely mechanism is direct extension to the skull base with involvement of the petrous apex and further extension posteriorly via the medial tentorial edge. We report the case of a 46-year-old woman with nasopharyngeal carcinoma who had been treated initially with chemoradiation and subsequently with stereotactic radiosurgery for residual tumor. One year later, she presented with an intracranial recurrence of the nasopharyngeal carcinoma in the cerebellopontine angle; the recurrence mimicked a benign tumor on magnetic resonance imaging. The tumor was ultimately diagnosed as an undifferentiated carcinoma of nasopharyngeal origin. She was treated with palliative chemotherapy.

Extensive pneumatization of the ethmoid sinus in a case of velocardiofacial syndrome

December 20, 2013     Dewey A. Christmas, MD; Joseph P. Mirante, MD, FACS; Eiji Yanagisawa, MD, FACS
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A preliminary study of the use of ultrasound in defining nasal fractures: Criteria for a confident diagnosis

October 23, 2013     Farhad Ardeshirpour, MD; Keith M. Ladner, MD; Carol G. Shores, MD, PhD; William W. Shockley, MD
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Abstract

Nasal fractures are usually diagnosed by clinical examination, with or without the support of imaging studies. While plain-film radiography lacks sensitivity and specificity for diagnosing nasal fractures, and computed tomography (CT) is not always practical or cost-effective, ultrasonography (US) may be useful in this regard. The criteria by which adult nasal fractures are reliably identified on US must be clear. We conducted a preliminary prospective, controlled, observational study to define the appearance of nasal fractures on US. We used US to image 12 patients with a clinical or radiologic (CT or x-ray) diagnosis of nasal fracture. All patients presented within 2 weeks of their injury. For comparison purposes, we also obtained US images from 12 control subjects who had no history of nasal trauma or surgery. We found that we could confidently diagnose nasal fractures on lateral-view US on the basis of a disruption of bone continuity and/or displacement of fracture segments. However, our findings were not as consistent with dorsal-view US, and we do not believe it is adequate for diagnosis. We conclude that lateral US can be used to detect nasal fractures in adults, but further studies are needed to assess its sensitivity, specificity, cost-effectiveness, and practicality.

Glass in the frontal sinus: 28-year delayed presentation

October 23, 2013     Alice K. Guidera, MBChB, BSc; Peter M. Dixon, MBBS, FRCS; Hans R. Stegehuis, MBChB, FRACS
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Abstract

Reports of delayed presentation of foreign bodies in the frontal sinus are infrequent and likely to become rarer with the widespread availability of computed tomography in the last 2 decades. We present a case in which glass from a road traffic injury was found in the frontal sinus, causing symptoms of frontal sinusitis 28 years after the initial injury. We also present a review of the literature.

Endoscopic view of the sphenoid sinus seen through the posterior ethmoid sinus

October 23, 2013     Joseph P. Mirante, MD, FACS; Dewey A. Christmas, MD; Eiji Yanagisawa, MD, FACS
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Care must be taken when entering the sphenoid sinus, to dissect inferiorly and medially to avoid injury to the vital structures of the lateral wall of the sphenoid sinus.

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