Rhinology

Primary amelanotic melanoma of the nasal cavity: A case report

January 21, 2014     Seema Gupta, MD; Mohan Chand Pant, MD; Nuzhat Husain, MD; Sham Sundar, MD; Huma Khan, PhD
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Abstract

Primary mucosal malignant melanomas of the nose are rare, accounting for only 0.3 to 2% of all cases of malignant melanoma and about 4% of all head and neck melanomas. The amelanotic variant of mucosal malignant melanoma is even more rare, and the prognosis is poor. This variant usually arises in locations in which it is not noticeable, and therefore it is usually diagnosed at an advanced clinical stage when symptoms eventually manifest. We report a case of locally advanced amelanotic melanoma of the nasal cavity in a 55-year-old woman who presented with complaints of nasal obstruction and intermittent bleeding on the right side of the nose for 3 months and a gradually progressive diffuse swelling over the right periorbital and maxillary areas for 2 months with associated pain for 15 days. She was diagnosed with amelanotic melanoma on the basis of clinical, radiologic, and pathologic findings. In view of her advanced disease, she declined surgery and was treated with chemoradiotherapy, and she experienced a significant alleviation of her symptoms.

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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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.

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.

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.

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.

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.

A case and a series of published cases of esthesioneuroblastoma (ENB) in which long-standing paraneoplastic SIADH had preceded ENB diagnosis

October 23, 2013     Uri Gabbay, MD, MPH; Leonor Leider-Trejo, MD; Gideon Marshak, MD; Merav Gabbay, MD; and Dan M. Fliss, MD
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Abstract

Esthesioneuroblastoma (ENB) is a rare tumor of the olfactory mucosa. We treated a 50-year-old man with an ENB in the right ethmoid sinus who had been diagnosed 16 years earlier with syndrome of inappropriate antidiuretic hormone secretion (SIADH) of unknown cause. When the ENB was surgically removed, the patient's osmoregulation returned to normal-that is, his SIADH resolved completely, which suggested that the SIADH was paraneoplastic in nature. These events prompted us to review the literature to determine if there is an association between our patient's ENB and his SIADH in general and between long-standing SIADH that precedes ENB in particular. Based on our review and an extrapolation of data, we have estimated that 1,300 cases of ENB have occurred since it was first described in 1924. Of these cases, SIADH was reported in 26 cases, including ours, which represents an estimated prevalence of 2% (although we believe this is actually an underestimation of the true prevalence). Of the 26 cases, SIADH had already been present in 14 patients (54%) prior to their diagnosis of EBN for a median duration of 3.5 years. We recommend that patients with newly diagnosed EBN be evaluated for SIADH. In those who are SIADH-positive, a resolution of SIADH should be expected once the ENB has been removed. If this does not occur, one should suspect that the ENB was not completely removed. If SIADH resolves but later recurs during follow-up, then a relapse should be suspected. In long-standing SIADH of unknown etiology, nasal sinus imaging should be considered.

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 closure of a frontocutaneous fistula

October 23, 2013     Alexandros Tsikoudas, DLO, FRCS(Otol), FRCS(ORL-HNS); Christos Georgalas, PhD, MRCS, FRCS(ORL-HNS)
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Abstract

A frontocutaneous fistula is a rare sequela of frontal sinus pathology. Management via an endoscopic approach is not frequently reported in the literature. We describe such an approach with the aid of still photography and imaging plus videoendoscopy, and we discuss the current literature.

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.

Progressive blindness caused by an unusual sphenoid sinus dehiscence

September 18, 2013     Mariana Marquez, MD; Enrique Palacios, MD, FACR; Jeremy Nguyen, MD; Harold R. Neitzschman, MD, FACR, FACNM, FAAP
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The optic nerve and other important structures in the anterior skull base can be involved in chronic sphenoidal sinus disease.

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