Primary meningioma of the fallopian canal.

Meningiomas are slow-growing lesions that represent approximately 20% of all intracranial tumors and are the second most common tumor of the cerebellopontine angle. In contrast, primary extracranial meningiomas are found relatively infrequently, and most cases have inadequate radiologic studies to determine if they were actually an extension from a primary intracranial source. Meningiomas of the intratemporal segment of the facial nerve have also been reported, but they are exceedingly rare and their pathophysiology remains unclear. We report a case of a meningioma of the facial nerve in the fallopian canal of a 7-year-old girl and review pertinent literature.

Bilateral cleft lip and palate and limb deformities: a presentation of amniotic band sequence?

We report a case of a child born with bilateral complete cleft lip and palate, absence of the left lower leg, complete absence of the right arm, and absence of the second and third distal phalanges of the right foot. The child had no other associated abnormalities. Prenatal ultrasonography recognized the cleft lip and palate but failed to appreciate the limb deformities. Although this specific constellation of abnormalities has not been previously reported in the English literature, it may represent an amniotic band sequence or two unrelated anomalies. However, unlike the vast majority of patients with amniotic band sequence described, there were no associated bizarre facial clefts or cranial defects. The case history and a review of the literature will be presented, with emphasis placed on categorization of these specific anomalies.

Scopulariopsis: an invasive nasal infection.

Scopulariopsis, a soil saprophyte, rarely produces disease and has not been reported to cause invasive nasal destruction in a nonimmunocompromised host. We report the first case of Scopulariopsis in the otolaryngology literature. Prompt surgical debridement is required and usually adequate. Disagreement exists on the use of antifungals as an effective treatment. A case of invasive Scopulariopsis involving the nasal septum of a 72-year-old man is detailed, and successful treatment consisted of local debridement without antifungal drugs. His diagnosis, clinical course, and outcome illustrates the expanding differential diagnosis faced by the otolaryngologist in patients with nasal disease.

Cerumen impaction.

Cerumen impaction represents the most common otologic problem encountered by physicians. It can affect up to 6% of the general population and a much higher percentage in the mentally retarded population. Cerumen is a mixture of secretory products of two glands in the external auditory canal where it serves a protective function. The external auditory canal possesses a unique anatomy and physiology that permits an efficient self-cleaning system. In most cases, a breakdown in the epithelial migration of the external auditory canal is thought to cause cerumen impaction. The management of cerumen impaction include direct removal, irrigation, and the use of cerumenolytics.

Orbital complications of sinusitis.

The ethmoid and maxillary sinuses are the sinuses most frequently involved with orbital infections. Routes of spread are by direct extension through bone and indirectly through the valveless venous plexuses of the orbit, nose, and sinus. Classification of orbital infections can be thought of as either preseptal or postseptal and then further subdivided from there. The diagnosis has been greatly improved by the use of CT scans; however this should never be the only entity used for diagnosis. The determination of visual acuity (VA) is the single most important finding and will ultimately determine treatment modality. Orbital infections show different and more virulent bacteria than does non-complicated sinusitis and this should be reflected in the choice of medical and surgical therapy. Medical management is well accepted for infections without abscesses, and surgery is generally needed for infections with an abscess.

Management of Bell's palsy.

Bell's palsy or idiopathic palsy is the most common disorder affecting the facial nerve. Diagnosis is primarily one of exclusion. There is typically an acute unilateral facial paresis that evolves in 24 to 48 hours. Etiology and pathophysiology are heavily disputed, and as of yet unknown. The natural history of Bell's palsy is favorable. Eight-four percent show satisfactory recovery without any treatment, however 16% suffer moderate to severe sequelae. Prognosis is influenced by degree of paresis, age of patient, and time until first signs of recovery. Prognostic testing currently involves various electrophysiological tests. More than 90% degeneration of the facial nerve carries a poor prognosis for recovery; these are the patients who may benefit from facial nerve decompression surgery. If surgery is performed it should be done early (< 21 days from onset of palsy) and should include a middle cranial fossa decompression. Steroids are generally agreed to be beneficial. Acyclovir would seem to be a promising drug; however studies have not adequately assessed its use.