ABSTRACT
Inflammatory sinus disease most commonly results from or is exacerbated by areas of obstruction within the sinuses. Recent revision of our understanding of mucociliary clearance has placed a renewed emphasis on sinus anatomy, particularly in identifying natural sinus ostia. A discussion of paranasal sinus anatomy is presented in this article along with special reference to these areas as well as contiguous sites that may be involved as a complication of inflammatory disease.
Subject(s)
Paranasal Sinuses/anatomy & histology , Female , Humans , Male , Paranasal Sinuses/growth & development , Terminology as TopicABSTRACT
The otolaryngologist who is called on to uncover the cause of a child's airway obstruction is a treasured consultant. Continuing technologic advances in office-based equipment have made it easier to discover pathology with a minimum of complications. However, the physician who does not do a thorough history and physical examination or is unable to develop a bond of trust with the patient and family will be without the essential tools of the profession and will be unable to make an accurate diagnosis and implement a treatment plan.
Subject(s)
Airway Obstruction/diagnosis , Airway Obstruction/diagnostic imaging , Ambulatory Care , Child , Endoscopy , Humans , Manometry , Physical Examination , RadiographyABSTRACT
Adenotonsillar hypertrophy has been documented to cause chronic upper airway obstruction resulting in cardiopulmonary sequelae in children. It has been less recognized that long-term adenotonsillar hypertrophy may additionally cause acute, life-threatening airway obstruction. A review of 5000 adenotonsillectomies performed at 3 New York Medical College affiliated hospitals from 1982 to 1989 showed 6 pediatric patients with progressive upper airway obstruction severe enough to necessitate intubation in the emergency room or operating room, and subsequent urgent adenotonsillectomy after cardiorespiratory stabilization. Patients were monitored in the ICU with pre- and postoperative blood gases. Observations of cyanosis, cor pulmonale, and use of accessory respiratory muscles were carefully recorded. This study illustrates that life-threatening upper airway obstruction may be due to chronic adenotonsillar enlargement and require treatment by urgent adenotonsillectomy.
Subject(s)
Adenoidectomy , Adenoids/surgery , Lung Diseases, Obstructive/surgery , Palatine Tonsil/surgery , Tonsillectomy , Adenoids/pathology , Child , Child, Preschool , Emergencies , Female , Humans , Hypertrophy , Lung Diseases, Obstructive/etiology , Male , Palatine Tonsil/pathologyABSTRACT
A marked increase has recently been noted in the incidence of lymphoma in patients with AIDS. These lymphomas are generally high-grade, of B-cell origin, and often involve extranodal sites. Reported here are twenty patients with AIDS in whom symptoms and physical findings developed related to the head and neck region as a result of lymphoma. The tumor was observed in a variety of sites, including the nasopharynx, orbit, submandibular triangle, anterior and posterior cervical triangles, supraclavicular fossa, and the hypopharynx. Sixteen tumors were large cell nonHodgkin's B-cell lymphomas, three were small cell nonHodgkin's B-cell lymphomas, and one was Hodgkin's disease, mixed cellularity. All were treated with combination chemotherapy. A high degree of suspicion for lymphoma is required in treating any patient with AIDS who has a rapidly enlarging mass in the head and neck. If needle aspiration is nondiagnostic, excisional biopsy should be performed after a complete head and neck evaluation. Although the development of lymphoma associated with AIDS portends a grave prognosis, prompt diagnosis will allow an improved chance of remission of the lymphoma.
Subject(s)
Acquired Immunodeficiency Syndrome/complications , Head and Neck Neoplasms/pathology , Lymphoma, B-Cell/pathology , Adult , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Biopsy, Needle , Head and Neck Neoplasms/drug therapy , Humans , Lymphoma, B-Cell/drug therapy , Lymphoma, Non-Hodgkin/drug therapy , Lymphoma, Non-Hodgkin/pathology , Male , PrognosisABSTRACT
Primary synovial sarcoma is an unusual tumor of the head and neck. Fewer than 75 cases have been reported in the literature. We have treated 7 additional cases; 3 in the hypopharynx, 2 in the parapharyngeal space, 1 in the oral pharynx and 1 in the posterior triangle of the neck. An enlarging cervical mass, voice change, and dysphagia were among the presenting complaints. CT revealed solitary nonhomogenous tumors from 3 to 7 cm in diameter. Microscopically, all cases showed a biphasic cellular pattern verified by immunohistochemical staining. Multimodality treatment consisted of surgery and postoperative radiation therapy with 3 patients receiving chemotherapy. Although the original pathology report was incorrect in 3 cases, clinical suspicion for synovial sarcoma ensured proper diagnosis.
Subject(s)
Head and Neck Neoplasms/pathology , Sarcoma, Synovial/pathology , Adolescent , Adult , Child , Combined Modality Therapy , Female , Follow-Up Studies , Head and Neck Neoplasms/therapy , Humans , Male , Sarcoma, Synovial/therapyABSTRACT
Classifying soft tissue tumors of the head and neck is often difficult for both surgeon and pathologist because of the potential similarities in appearance of metastatic lesions, epithelial tumors, lymphomas, and inflammatory processes. This paper discusses four unusual soft tissue tumors of the head and neck: osteosarcoma of the mandible, biphasic synovial cell sarcoma of the hypopharynx, soft part sarcoma of the maxillary sinus/alveolus, and adult rhabdomyoma of the larynx. Precise diagnosis of these lesions requires adequate tissue sampling, immunocytochemical staining, and electron microscopy. The clinical and pathological features of these tumors, as well as a practical approach to the diagnosis, is presented.
