Ethmoidal air cell schwannoma presented as a fronto-ethmoidal mucocele.

AIM: To report a rare case of a fronto-ethmoidal mucocele secondary to an ethmoidal schwannoma. To our knowledge this is the first reported case of an ethmoidal schwannoma, a tumour of the peripheral nerve sheath originating from an area not believed to contain peripheral nerves that has presented as a fronto-ethmoidal mucocele. CASE REPORT: Our patient is a 23-year-old male presented with a one-year history of progressive proptosis and vertical diplopia with restriction of upgaze. Orbital imaging demonstrated a mass in the right medial ethmoidal air cells extending to the frontal sinus and orbit, consistent with a mucocele. Patient underwent endonasal decompression of the right fronto-ethmoidal mucocele. Histology confirmed a schwannoma and repeat imaging post-operatively revealed residual mass originating from the ethmoidal air cells. A right upper eyelid skin crease approach anterior orbitotomy was performed to successfully excise the mass via the lamina papyracea. Post-operatively the patient's proptosis and diplopia resolved, with a full range of ocular movements. Post-operative imagining at 3 months did not show any residual tumour. COMMENT: Mucocele formation may be secondary to an underlying schwannoma obstructing the fronto-ethmoidal foramen. In such cases we recommend an open-sky technique for full visualisation and improved chance of total removal.

Are trainees being adequately taught myringoplasty? A prospective study of Eastern Deanery otolaryngology trainees' surgical experience.

Reviewing surgical training is an important function of a modern ENT unit, even more so following recent reform of postgraduate medical training in the UK. We have developed a tool to review otology training of Eastern Deanery trainees by constructing a middle ear surgery data base and use a commonly performed procedure, myringoplasty, to illustrate its function. Three hundred and ninety-three myringoplasty operations were identified between March 2002 and March 2006, of which 307 were included in this study as having had a myringoplasty alone uncomplicated by another middle ear procedure. Perforation closure was successful in 83% of these cases with 90% of patients experiencing a beneficial outcome regardless of supervision level. Trainees at all stages of training are being exposed to myringoplasty with an adequate de-escalation of supervision. Myringoplasty outcomes are independent of seniority, if appropriately supervised, implying that otology training in the Eastern Deanery is appropriate.