A sizeable aneurysmal bone cyst of the mandibular ramus on 15-year-old patient. Intraoral approach.

Aneurysmal bone cysts (ABCs) are benign, non-neoplastic bone lesions, which contain blood and demonstrate a destructive pattern. They rarely occur in the head and neck region, with the mandible being the most common site of craniofacial origin. They develop in the second decade of life and their etiology is obscure. ABCs can sometimes demonstrate distinct radiological features and imaging is also necessary for preoperative planning. Surgery is the mainstay of treatment. The ABC should be excised in toto and usually osteotomies and primary reconstruction are necessary. We present a case of sizeable ABC of the mandibular ramus that was excised intraorally, without the need of combined approaches or reconstruction.

Retropharyngeal Space Lipomas. A Systematic Review of the Reported Cases in the Literature.

Retropharyngeal space lipomas (RSLs) comprise a group of very uncommon head and neck benign, soft tissue tumors that originally grow in the retropharyngeal space. They can develop as individual tumors or in the context of syndromic lipomatosis. Symptoms usually arise as expanding RSLs exert pressure on adjacent structures, and clinical manifestations are often atypical and overlapping. Given the rarity of this diagnosis, current evidence is scarce, providing a rather fragmented picture. A literature search was conducted in all major medical databases, without time limitations. Tumors were considered RSLs if a benign lipomatous tumor appeared to develop originally in the retropharyngeal space. Cases with syndromic lipomatosis that demonstrated at least one such tumor involving the retropharyngeal space were included. A total of 52 publications concerning 79 eligible cases were found. Two of these cases concerned patients with Multiple Symmetrical Lipomatosis. A male predominance was found (61.5%, n = 48). Dysphagia (65.2%, n = 43) was by far the most common symptom, followed by snoring (37.9%, n = 25), dyspnoea (34.8%, n = 23) and dysphonia (30.3%, n = 20). The most used imaging modality was Computed Tomography (CT) (64.1%, n = 41). Surgery was the treatment in 73 cases (93.6%). The transcervical was the most selected approach (50.7%, n = 37), followed by the transoral approach (38.4%, n = 28). Complete recovery was reported, following treatment, in 60 cases (75.9%). Retropharyngeal space lipomas are benign tumors with a higher prevalence in male patients. Dysphagia is the most common symptom. Imaging is necessary for diagnosis, with CT scanning being usually sufficient as a single modality test. More than half of the patients in the literature are treated via an external approach. Diminishing of symptoms and full postoperative recovery is the most common outcome. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-021-02962-6.

Idiopathic posterior laryngeal web on an adult patient.

Posterior laryngeal webs are uncommon pathologies that are usually acquired at some point in adult life. Prior and prolonged intubation is the leading cause for developing such lesions. In certain rare cases of posterior laryngeal webs, no identifiable cause can be associated with the development of this pathology. We present a case with such an idiopathic lesion. Surgery is the treatment of choice. Several techniques and modifications can be used, to achieve maximum airway release and, at the same time, ensure that restenosis will be avoided. Our patient recurred following initial treatment and a more complex revision surgery was necessary. Special attention should be given in differentiating these lesions from abductor vocal cord paralysis. Furthermore, careful investigation of the cause and individualisation of patient treatment are crucial.

Frontal sinus pneumocele caused by a maxillary sinus mucocele.

A sinus pneumocele is a rare entity caused by obstruction of a paranasal sinus ostium. It is characterised by dilation and expansion of the sinus, with subsequent bony erosion. The most probable mechanism is air trapping in the paranasal sinus, via a one-way valve mechanism. The case presented concerns a 68-year-old Caucasian man, with recurrent episodes of acute rhinosinusitis. Clinical examination and subsequent imaging of the face, revealed a large pneumocele of the right frontal sinus that significantly eroded the posterior sinus wall. A large mucocele of the right maxillary sinus was also noted, extending to the middle meatus, causing full obstruction of the ostiomeatal complex. Endoscopic sinus surgery was performed, the mucocele was removed and the pneumatisation pathway of the frontal sinus was restored. The patient reports full resolution of symptoms and shows no evidence of recurrence, 6 months postoperatively.

Superiorly based subperiosteal orbital abscess: an uncommon presentation.

A 32-year-old female patient presented with severe facial pain, right eye proptosis and diplopia. Endoscopy revealed ipsilateral crusting, purulent discharge and bilateral nasal polyps. Imaging demonstrated a subperiosteal abscess on the roof of the right orbit. Due to patient's significant ocular manifestations, surgical management was decided. The abscess was drained using combined endoscopic and external approach, via a Lynch-Howarth incision. Following rapid postoperative improvement, patient's regular follow-up remains uneventful. A subperiosteal orbital abscess is a severe complication of rhinosinusitis that can ultimately endanger a patient's vision. It is most commonly located on the medial orbital wall, resulting from direct spread of infection from the ethmoid cells. The rather uncommon superiorly based subperiosteal abscess occurs superiorly to the frontoethmoidal suture line, with frontal sinusitis being its main cause. Treating it solely endoscopically is more challenging than in medial wall abscesses, and a combined approach is often necessary.