How Often Does Isolated Sphenoid Sinus Disease Turn Out to be a Neoplasm?

Isolated sphenoid sinus disease (ISSD) describes a wide spectrum of pathologies including inflammatory, vascular, bony dysplastic, and neoplastic diseases. The aim of this study was to assess the frequency with which a neoplastic process was diagnosed in patients of ISSD and patient management strategies. A retrospective analysis was conducted for all ISSD patients who underwent surgery between January 2005 and January 2014 at a tertiary center. The clinical characteristics, radiologic studies, operative findings, endoscopic surgical techniques, pathology results, and treatment outcomes of the patients were analyzed. In all, 42 patients (31 women and 11 men) were included in the study. Histopathologic examinations revealed that 10 patients (23.4%) had neoplasms (8 benign and 2 malignant), 19 (45.2%) had mucocele, 7 (16.7%) had fungal disease, and 6 (14.3%) had meningoencephalocele and cerebrospinal fluid leakage. With the exception of 2 patients with plasmacytoma, complete removal of the lesions was achieved in all patients using transnasal or transethmoidal endoscopic approaches, and no local recurrences were observed during the mean follow-up period of 42 months. More than one fifth of the patients with ISSD were diagnosed with neoplasms. The results indicated that endonasal endoscopic approaches could effectively help manage patients with ISSD lesions, including those that were neoplastic. It is clear that precaution during preoperative planning is imperative to avoid unexpected situations and complications that may put surgeons in a difficult position during surgery.

Acantholytic squamous cell carcinoma of the maxilla: unusual location and aggressive behavior of a rare histologic variant.

Acantholytic squamous cell carcinoma (ASCC) of the mucosal membranes has been documented sporadically. The highly aggressive behavior of a mucosal ASCC arising in the oral cavity has been recently reported. To the best of our knowledge, only 1 autopsy case of maxillary ASCC previously has been reported in the literature. We present what we believe is only the second case of maxillary ASCC. Our goal is to emphasize the aggressive behavior of this tumor in order to add weight to the argument that the prognosis is poor.

Tooth in the nose: unusual presentation of a misdiagnosed maxillary ossifying fibroma.

Fibro-osseous lesions involving the paranasal sinuses are uncommon, and making a determination of their histologic type is challenging. Correlating clinical and surgical findings with radiologic and histologic characteristics is essential for making a definitive diagnosis. We describe a case of misdiagnosed maxillary ossifying fibroma presenting as a solitary mass that completely filled and enlarged the left maxillary sinus. Another interesting finding was the presence of a molar tooth embedded in the tumor. We briefly comment on the genesis, natural course, and differential diagnosis of this lesion.

Four hands technique in transoral endoscope-assisted fixation of condyle fractures.

OBJECTIVE: We present the short-term treatment results of a modified technique in transoral endoscopic condyle repair. DESIGN: A pilot prospective study from April 2006 to November 2007. SETTING: Ankara University Medical School Teaching Hospital. METHODS: Four patients with subcondylar fracture were treated with transoral endoscopic condyle repair. Preliminary restoration of the occlusion was provided with maxillomandibular fixation. Four hands endoscopic sinus surgery principles were adapted to transoral endoscopic condyle repair. MAIN OUTCOME MEASURES: Providing condylar stabilization with good occlusion and temporomandibular joint function was expected from treatment. RESULTS: Open reduction and internal fixation were achieved in all patients. Condylar stabilization was confirmed by intraoperative endoscopic findings and postoperative panoramic radiographs. Uneventful healing with good occlusion and temporomandibular joint function were noted in 3 to 14 months of follow-up. CONCLUSION: Endoscope-assisted minimal invasive procedures have been taking more part in head and neck soft tissue and trauma surgery. The cost of instruments and technical difficulties are the main constraints of endoscopic techniques. In this study, we present a practical way to perform transoral endoscopic condyle repair using the otolaryngologist's standard sinus surgery endovisual equipment and a titanium miniplate system. With the addition of a surgical hand, successful treatment results could be achieved with reduced cost.

Hidden unilateral agenesis of the frontal sinus: human cadaver study of a potential surgical pitfall.

PURPOSE: The aim of the study was to attract attention to the surgical significance of unilateral agenesis of the frontal sinus hidden by the overlapping expansion of the contralateral sinus toward the agenetic side. MATERIALS AND METHODS: Retrospective review of endoscopic transnasal sinus dissections of 55 human cadavers (42, formalin fixated; 13, fresh frozen) was done in a tertiary care academic medical center. Surgical and radiologic findings were noted. RESULTS: Absence of right frontal sinus ostium in the presence of a connection between the right and left frontal sinuses was demonstrated in 2 (3.6%) cadavers. An absent and an incomplete septum between the frontal sinuses were also noted in these cadavers. No accompanying abnormality of other sinuses was found, and no evidence of previous sinus surgery was noted in these 2 cadavers. CONCLUSIONS: If one of the frontal sinus ostia cannot be found during sinus surgery, although this sinus and its recess can be seen on the thick-sliced coronal computed tomographic (CT) scans, keep in mind that it may be (3.6%) an agenetic frontal sinus hidden by the extensive pneumatization of the contralateral sinus that is crossing the midline. It may not be possible to foresee this variant preoperatively by endoscopic examinations or thick-sliced CT scans. If there is suspicion, thin-sliced CT scans with reconstruction will be ideal to confirm the agenesis of the frontal sinus and to avoid complications. In the presence of such variant of frontal sinus, 1-sided successful frontal sinusotomy is adequate because this sinus or cell will already be drained through the treated frontal recess.

Demographic, epidemiologic, and surgical characteristics of maxillofacial fracture repair in a developing country.

We conducted a retrospective epidemiologic study to assess demographic data and characteristics of the etiology and management of maxillofacial fractures treated by surgery in Ankara, Turkey, over a 6-year period. We studied 293 maxillofacial fractures in 167 adults-122 men and 45 women (ratio: 2.7:1), aged 17 to 76 years (mean: 33.8). In addition to demographic and etiologic data, study parameters included the time of day, day of the week, and month of the year that the injury had been sustained; the site of the fracture; the length of time between the accident and surgery; and the specific treatment modality. Of the 293 fractures, 177 were midface fractures (60%), 102 were mandibular fractures (35%), and 14 were frontal fractures (5%). The most common causes were motor vehicle accidents (67%), fights/assaults (20%), and falls (9%). Half of all patients were injured on a weekend (including Friday night), and more than half of all patients had been injured from September through December. The most common midface fractures were maxillary fractures (37%), and the most common mandibular fractures were fractures in the symphysis/parasymphysis area (36%). Surgery was performed an average of 6 days following the injury. Open reduction with internal rigid fixation was the choice of treatment for most (82%) fractures. We believe that studies of the demographic and epidemiologic characteristics of maxillofacial fractures in different countries may help guide surgeons in the management of these injuries.

Giant concha bullosa containing another concha bullosa inside: unique anatomic variation of the middle turbinate.

Detailed knowledge of the anatomical variations of the lateral nasal wall is crucial for both the surgeon who is performing endoscopic sinus surgery and the radiologist who is involved in the preoperative work-up. Preoperative recognition of these variations will avoid possible complications during the surgery. In this report, we present a unique anatomical variant of the middle turbinate, a large concha bullosa inside a giant concha bullosa, which has never been reported before. Furthermore, we comment on the differential diagnosis of the variations of the middle turbinate and on the embryology of the nasal turbinates. This report also supplies additional aspects to rhinologists in the scope of middle turbinate pneumatization.

Unique variation of digastric muscle: a confusing landmark for head and neck surgeons.

An anatomical variation of the left digastric muscle was found during the functional neck dissection of a patient with laryngeal carcinoma. This variant of the digastric muscle had three bellies including an accessory posterior belly. The anterior and posterior bellies had normal origin and course and were linked to each other by an intermediate tendon, whereas the accessory posterior belly took its origin from the mastoid notch of the temporal bone, together with the original posterior belly, sloped inferiorly and anteriorly, and inserted to the lateral border of the strap muscles by an evident tendon. This unique variation has not been reported in the literature. Presentation of this variation will guide surgical procedures, as well as anatomical dissections and medical imaging of the neck.

Gastroesophageal reflux disease: symptoms versus pH monitoring results.

OBJECTIVES: The reason why some patients with gastroesophageal reflux disease (GERD) have symptoms of upper aerodigestive system irritation, while others mainly have gastroenterologic symptoms, is not well established. This retrospective case series study was designed to examine the existence of a correlation between symptoms and reflux characteristics, based on data obtained from esophageal pH monitoring. METHODS: The study population consisted of 139 patients; 97 patients presented with laryngopharyngeal symptoms of GERD, including unexplained hoarseness, throat clearing, chronic cough, laryngospasm, globus, throat pain, and 42 patients presented with gastroenterologic symptoms, including heartburn and regurgitation. The results of 24-hour, double-channel ambulatory esophageal pH monitoring were analyzed comparing 2 symptom groups. The incidence of abnormal acid reflux at the upper and lower esophageal segments and the effects of upright and supine positions on reflux parameters were evaluated. RESULTS: The incidence of laryngopharyngeal reflux was significantly higher in the laryngopharyngeal symptom group than in the other (52% versus 38%). The patients with laryngopharyngeal reflux from both groups showed no significant differences in terms of number of acid reflux episodes, percentage of times pH was 4, and esophageal acid clearance. Upright and supine parameters did not show significant differences between the patient groups. Upright acid reflux episodes were, however, common in both groups at the lower esophageal and laryngopharyngeal segments. CONCLUSION: Recent studies suggesting that otolaryngologic patients commonly show upright, daytime reflux with normal esophageal clearance and that typical GERD patients commonly have supine, nocturnal reflux with prolonged esophageal clearance are not supported by this study. This study indicates that acid reflux parameters and positional changes are not sufficient to explain why patients with GERD experience different symptoms. The regional symptoms of GERD may be attributed to the impairment of epithelial resistance, motor activity, and buffering systems for the esophageal antireflux barrier.

Basaloid squamous cell carcinoma of the maxilla: a case report and immunohistochemical analysis.

Basaloid squamous cell carcinoma (BSCC) is a recently recognized high-grade tumor with a propensity for nodal as well as systemic metastasis and can arise from different anatomic locations. The differential diagnosis includes adenoid cystic carcinoma, small cell neuroendocrine carcinoma and squamous cell carcinoma. Monoclonal antibodies reactive with cytokeratin (34betaE12, AE3, pancytokeratin), as well as other cellular antigens (vimentin [VIM]; synaptophysin [SYNF]; chromogranin A [ChA]; neuron-specific enolase [NSE]; S-100, desmin, smooth-muscle actin [SMA]), were used in an immunoperoxidase method with paraffin-embedded tissue to phenotypically characterize a case with features of BSCC arising in the maxillary sinus. Neoplastic cells reacted with the high-molecular-weight cytokeratin antibody 34betaE12, as well as with other antikeratin antibodies, but failed to react with the antibodies VIM, desmin and SMA and showed variable immunoreactivity for NSE, SYNF and S-100. The staining pattern for NSE was diffuse and intense and reactivity for ChA was inconsistent.