October 31, 2012 Pradipta Kumar Parida, MS, DNB, MNAMS
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Abstract
The paranasal sinuses are a rare location for metastases. The most frequent infraclavicular primary tumor to metastasize to the nose and paranasal sinuses is renal cell carcinoma. Three cases of bilateral renal cell carcinoma with metastases to the paranasal sinuses and with destruction of the skull base are reported. These patients had a primary renal cell carcinoma on the left side for which they had undergone a left nephrectomy many years previously. Right-sided renal cell carcinoma was diagnosed only after the patients had developed symptoms secondary to their metastases. These patients presented with the unusual manifestations of frontal swelling, proptosis, and epistaxis. They were offered palliative treatment in the form of radiotherapy and interferon therapy.
October 8, 2012 Wan-Ling Ho, MD; Kai-Chieh Chan, MD
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The histopathologic hallmark of juvenile xanthogranuloma is the Touton giant cell, a multinucleated giant histiocyte whose rings of nuclei separate a central homogeneous core from a foamy periphery.
October 4, 2012 Pradipta K. Parida, MS, DNB; Ramandeep Singh Virk, MS;
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Abstract
Meningioma of the sinonasal tract is a rare entity. Meningioma of the nose and paranasal sinuses may occur in one of two ways: (1) by secondary extension of a primary tumor in the cranial cavity or orbit or (2) primarily in the nose and paranasal sinuses de novo from the ectopic meningocytes derived from pluripotent mesenchymal cells. Primary sinonasal meningiomas are often difficult to diagnose because of their infrequent occurrence. The final diagnosis rests on the histologic examination. We report what is to our knowledge the first case of primary meningioma of the middle turbinate.
October 4, 2012 David A. De Poortere, MD; Boris M. De Poortere, MD; Noam A. Cohen, MD, PhD
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Abstract
Angiolipoma is a rare, benign variant of lipoma; its distinctive feature is its prominent vascularity. It presents as a subcutaneous nodule of white adipose tissue; pain, which may be exacerbated by pressure, is the chief symptom. The anatomic distribution predominantly involves the trunk and extremities. Because of the rarity of this condition in otorhinolaryngology, our understanding of its diagnosis, treatment, and follow-up is limited. Microscopically, two different histopathologic forms of angiolipomas exist: circumscribed and infiltrating. The diagnosis of angiolipoma can be aided by ultrasound, computed tomography, or magnetic resonance imaging. Surgical excision remains the treatment of choice. Sites of previously reported otolaryngologic cases include the cheek, palate, mandible, nasal septum, and cervical area. We describe what we believe to be the second case of a nasal tip angiolipoma in a 78-year-old woman complaining of progressive aesthetic deformity.
October 4, 2012 Brandon Pierson, MD; Rosser Powitzky, MD; G. Paul Digoy, MD, FAAP
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Abstract
We present 2 cases of advanced juvenile nasopharyngeal angiofibroma (JNA) to illustrate the advantages of endoscopic Coblation-assisted resection of intranasal extensions of these masses. Both patients—an 11-year-old boy and a 14-year-old boy—presented with a large, extensive mass (Radkowski stage IIIb and Fisch stage IVb in both cases). After embolization was performed on each patient, his JNA was partially ablated via an endoscopic approach with the Coblator II Surgery System with an EVac Xtra Plasma Wand in conjunction with an image-guided navigation system. Both patients experienced resolution of their nasal obstruction with removal of the intranasal extension of the tumor. Coblation allowed for a controlled debulking of the tumors with less blood loss and without the need for multiple instruments. To the best of our knowledge, our report is one of the first to describe image-guided endoscopic Coblation of advanced JNA tumors. Future studies in adequately sized populations are needed to determine the safety and effectiveness of Coblation-assisted endoscopic removal of both advanced and lower-stage JNAs.
September 7, 2012 Dewey A. Christmas, MD; Joseph P. Mirante, MD, FACS; Eiji Yanagisawa, MD, FACS
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Powered instrumentation is a good choice for the removal of maxillary sinus lesions. It is efficient and safe and preserves normal sinus mucosa.
September 7, 2012 Aayesha M. Khan, MD; Paula J. Chor, MD; John F. Eisenbeis, MD
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Abstract
Adult extracardiac rhabdomyoma (ER) is a rare, slowly growing, benign tumor of skeletal-muscle origin that has a strong predilection for the head and neck. Complete surgical resection has been proposed as the treatment of choice. We describe a case of adult ER that manifested as a nasopharyngeal mass. The diagnosis was made by transnasal endoscopic biopsy, and the patient was managed conservatively. We discuss the current knowledge regarding the clinical presentation, diagnosis, and treatment of adult ER of the parapharyngeal space, and we propose a new concept for treating this tumor nonsurgically in appropriately selected patients.
September 7, 2012 Hasan Mercan, MD; Deniz Tuna Edizer, MD; Erkan Kilic, MD; Tugce Esen, MD; Rana Ramazanoglu, MD; Harun Cansiz, MD
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Abstract
Metaplasia is the conversion of one adult tissue or cell type into another tissue or cell type. Although osseous metaplasia has been described in many parts of the body, it is rarely encountered in the head and neck region, especially in nasal polyps. This article reports a case of unilateral sinonasal polyp containing areas of osseous metaplasia in a 44-year-old woman presenting with nasal obstruction. Also included are a brief discussion of osseous metaplasia in the head and neck region and a literature review.
August 10, 2012 Dewey A. Christmas, MD; Joseph P. Mirante, MD, FACS; Eiji Yanagisawa, MD, FACS
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It is important to remove any obstruction of the natural ostium of the maxillary sinus or the ethmoid infundibulum because maxillary sinus secretions will be transported toward the natural ostium even when a previously placed large and patent inferior meatal antrostomy is present.
August 10, 2012 Charles G. Hurbis, MD, FACS
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Abstract
A 3-year, single-center, prospective study was undertaken to measure the effect and long-term results of using the Monarch Nasal Implant to surgically correct nasal valve dysfunction. Thirty-nine patients were implanted, with follow-up lasting 36 months for 9 of the patients. Implant effectiveness and maintenance of effectiveness were determined through acoustic rhinomanometry and a subjective patient questionnaire. Rhinomanometry studies and patient questionnaires revealed a significant initial improvement in internal nasal valve areas and patient symptoms; the improvements were maintained or had even increased at 36 months. The cosmetic changes were acceptable to the patients. The Monarch Nasal Implant provides a consistent and lasting correction of nasal valve dysfunction with minimal drawbacks when properly used.
August 10, 2012 Nishant Kumar, MD; Raj Sindwani, MD, FACS
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Abstract
Bleeding during endoscopic sinus surgery (ESS) can interrupt the flow of the procedure and increase the risk of complications. Advances in microdebrider design now allow for bleeding to be controlled by bipolar energy during the suctioning and shaving of polyps. We conducted a retrospective study to examine the effects of this technology on blood loss and operating times during ESS for chronic rhinosinusitis with nasal polyps (CRS+P). Our patient population was made up of 80 patients who had undergone ESS for CRS+P by the same surgeon from January 2007 through May 2008. All surgeries were performed with either the PK diego bipolar microdebrider (Gyrus ACMI, ENT Division; Bartlett, Tenn.) or a standard microdebrider. There were 40 patients in each group. The PK group was made up of 23 males and 17 females, aged 14 to 66 years (mean: 43.1), and the control group included 21 males and 19 females, aged 17 to 71 years (mean: 43.1); there were no statistically significant differences between the two groups in terms of sex and age. In addition to demographic data, the charts were reviewed for comorbidities and operative variables; the latter included blood loss, operating room (OR) time, and complications. The preoperative treatment and anesthesia protocols were similar for all patients, and all patients demonstrated a similar disease burden on imaging (mean Harvard CT stage: 3.12 for the PK group and 3.15 for the controls; p > 0.05). We found that during ESS, the PK group experienced significantly less intraoperative blood loss than did the controls (means: 86.0 and 123.0 ml, respectively; p = 0.015). In addition, the PK device was associated with significantly shorter OR times (means: 88.9 and 101.4 min, respectively; p = 0.026). There were no complications in either group. We conclude that using a microdebrider with bipolar capabilities during ESS may offer the advantages of less blood loss and shorter operating times in patients with nasal polyps.
July 5, 2012 Lester D.R. Thompson, MD
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Radiographic findings are essential to the diagnosis of paranasal sinus mucocele. Usually opacification of the sinus with thinning, erosion, or destruction of the sinus wall are seen.
