Complex Anterior Skullbase Fracture Caused by a Bottle Cap: A Case Report and Review of the Literature

We report a case of foreign body presence in the ethmoid sinus cavity with anterior skull base fracture and visual loss. A 42-year-old male had an uncertain history of trauma and a penetrating wound near the left medial canthus. Computed tomography imaging showed a 3.0-cm bottle cap penetrating into the anterior skull base. He underwent foreign body removal, canalicular repair, ethmoidectomy, and cerebrospinal fluid leakage repair using packing material. Six months after the initial surgery, a second-stage operation for blow-out fracture repair was performed. At the 18-month postoperative follow-up from the initial surgery, the patient had no complaints except anosmia. This is a very rare case of a large, blunt, foreign body penetrating into the anterior skull base without long-term complications after successful removal and skull base repair. Simultaneous repair of cerebrospinal fluid leakage, management of canaliculi injury, and traumatic optic nerve neuropathy should be considered in such cases.

An Evaluation Protocol of the Upper Airway for Pediatric Patients with Stridor or Extubation Failure / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Adequate evaluation of the upper airway is critical in the management of pediatric patients with stridor or extubation failure. For this purpose, we designed an evaluation protocol of the upper airway for these patients, in collaboration with Dept. of Pediatrics, Intensive care team and Anesthesiology. Here we present the clinical results of our evaluation protocol and provide information about the etiology and management of the upper airway problems. SUBJECTS AND METHOD: Clinical data of 380 pediatric patients (M:F=231:149) having airway evaluation for their problems (stridor or extubation failure) were retrospectively analyzed. Among them, patients of age less than 3 months ranked first (30.0%). Comorbidities of pulmonary diseases (30.8%) and cardiovascular diseases (29.5%) were found. The pre and post-evaluation diagnosis, management and prognosis were evaluated and the usefulness of an airway evaluation protocol was discussed. RESULTS: Frequent pre-evaluation diagnoses were subglottic stenosis (55.2%), laryngomalacia (12.6%) and tracheal stenosis (9.2%) and these were changed to subglottic stenosis (44.5%), laryngomalacia (9.7%), tracheal stenosis (6.6%) and no abnormality (14.5%). Particularly, 50% of pre-diagnosis laryngomalacia, 25% of subglottic stenosis and 37% of tracheal stenosis were corrected to other causes by airway evaluation. The procedures were exam only (41.6%), endoscopic dilatation (20.8%) and tracheostomy (17.9%). In 190 out of 380 (50.0%), extubation was successful, but 151 patients (39.7%) had tracheostomy tube. CONCLUSION: Adequate evaluation of the upper airway in pediatric patients with stridor or extubation failure can facilitate the diagnosis and management of their problems.

A Case of Cranial Fasciitis in Midface / 대한이비인후과학회지

Cranial fasciitis is an uncommon subset of nodular fasciitis composed of spindle cells and myxoid stroma. This is not considered as a true neoplasm, as it occurs mostly in the scalp as a rapidly growing mass accompanied by adjacent bony structure destruction. There are few cases of cranial fasciitis reported in the literature; however, we experienced a case of a 2-year-old girl with swelling of midface. Subtotal resection was performed and the final pathological result confirmed cranial fasciitis. We report this rare case with a review of the literature.