Cavernous hemangioma of the middle turbinate: a case report.

Most cavernous hemangiomas present at birth or soon after. Cavernous hemangiomas of the nasal cavity, which are rare, usually do not present until adulthood; their incidence peaks in the fourth decade of life. Most affected patients experience epistaxis or hemoptysis and an enlarging lesion in the nose. Histologically, cavernous hemangiomas appear as closely packed, dilated vascular channels lined with a layer of flattened endothelial cells. We describe the case of a 32-year-old man who was admitted to our clinic with the complaint of a nasal obstruction. On anterior rhinoscopy, he was found to have a hypervascularized and hypertrophied left middle turbinate and septal deviation. Computed tomography and magnetic resonance imaging of the paranasal sinuses demonstrated a well-defined cystic lesion that had arisen within the bony left middle turbinate and caused deviation of the septum to the right. The lesion was excised via endoscopic surgery with general anesthesia. No complications occurred during the postoperative period. Histologic examination identified the tumor as a cavernous hemangioma. To the best of our knowledge, this is the first case reported in the English-language literature of a cavernous hemangioma appearing as a cystic mass in the middle turbinate.

Endoscopic sinus surgery for maxillary sinus mucoceles.

BACKGROUND: Maxillary sinus mucoceles are relatively rare among all paranasal sinus mucoceles. With the introduction of endoscopic sinus surgical techniques, rhinologic surgeons prefer transnasal endoscopic management of sinus mucoceles. The aim of this study is to describe the clinical presentation of maxillary sinus mucoceles and to establish the efficacy of endoscopic management of sinus mucoceles. METHODS: Between 2003 and 2005, 14 patients underwent endoscopic sinus surgery for maxillary sinus mucocele. The presenting sign and symptoms, radiological findings, surgical management and need for revision surgery were reviewed. RESULTS: There were eight males and six females with an age range of 14 to 65. Ten patients complained of nasal obstruction, five of nasal drainage, five of cheek pressure or pain and one of proptosis of the eye and cheek swelling. The maxillary sinus and ipsilateral ethmoid sinus involvement on computed tomographic studies was seen in 4 patients. Four patients had history of endoscopic ethmoidectomy surgery for ethmoid sinusitis and one had Caldwell-Luc operation in the past. Ethmoidectomy with middle meatal antrostomy and marsupialization of the mucocele was performed in all patients. Postoperative follow-up ranged between 8 to 48 months. All patients had a patent middle meatal antrostomy and healthy maxillary sinus mucosa. No patients need revision surgery. CONCLUSION: The most common causes of mucoceles are chronic infection, allergic sinonasal disease, trauma and previous surgery. In 64% of the patients of our study cause remains uncertain. Endoscopic sinus surgery is an effective treatment for maxillary sinus mucoceles with a favorable long-term outcome.

Hyperaeration of the frontal sinus.

The nasal cavity and paranasal sinuses constitute an anatomical and functional unit. Paranasal sinuses communicate with the nasal cavities, which are covered by the same mucosa, via small openings and narrow ducts that allow both aeration and sinus drainage. Anatomical variations of the paranasal sinuses and nasal cavity are important in sinus diseases. Computerized tomography (CT) plays a critical role in evaluation of the patients with paranasal sinus pathology and variations. A 38-year-old man admitted to our clinic with headache and postnasal dripping for 1 year. His paranasal CT scanning revealed that there is hyperaeration of the frontal sinus which is in continuity with the sphenoid sinus. Hyperaeration of the sinuses may be kept in mind in a patient complaining of headache.

[Endoscopic removal of sinonasal tumors]. / Endoskopik sinonazal tümör rezeksiyonu.

OBJECTIVES: To evaluate the efficacy of endoscopic surgery for sinonasal tumors. PATIENTS AND METHODS: Clinical records of 20 patients (10 males, 10 females; mean age 34; range 12 to 63 years) who underwent endoscopic tumor resection with diagnosis of sinonasal tumor between January 1998 and August 2004 were retrospectively reviewed. Patients who were operated by transnasal endoscopic surgery or by combined (endoscopic or external) surgical methods were included in the study. Patients were reviewed for age, sex, pathologic diagnosis and tumor location, surgical techniques, need for additional surgery, complications, recurrence, and follow-up period. RESULTS: There were five osteomas, one fibrous dysplasia, one ossifying fibroma, seven inverted papillomas, one oncocytic papilloma, three angiofibromas, one schwannoma, and one esthesioneuroblastoma. The patients follow-up period ranged between 6 months and 6 years (mean 26 months). The fibrous dysplasia involving the posterior ethmoid sinuses was subtotally resected due to its close proximity to the optic nerve. One inverted papilloma of the maxillary sinus was resected by a combined endoscopic and Caldwell-Luc approach. A combined endoscopic intranasal and external frontoethmoidectomy approach was performed for the removal of frontal sinus schwannoma. Recurrence was observed in one of the inverted papilloma cases. Total removal of the tumors was achieved in all other cases without any complications or recurrences. CONCLUSION: Low recurrence rates in our series showed that endoscopic resection of nasal-paranasal sinus tumors in selected cases, may be an appropriate method as solely or in combined with other surgical techniques for experienced surgeons.