Intraosseous hemangioma of the orbit: a case report involving pre-operative embolization with reconstruction using a custom porous polyethylene implant.

A 28-year-old female presented with a slowly enlarging, left cheek mass over two years. She underwent neuroimaging and was found to have a well-defined, low attenuating lesion with thickened vertical trabeculation of the left zygoma, consistent with intraosseous hemangioma. To minimize the risk of severe intraoperative hemorrhage, the patient underwent embolization of the mass by neuro-interventional radiology two days prior to resection. The patient subsequently underwent a left anterior orbitotomy and partial zygoma resection followed by reconstruction of the lateral orbit with a custom porous polyethylene zygomaxillary implant. The postoperative course was uneventful with a good cosmetic outcome.

Inhalation and deposition of spherical and pollen particles after middle turbinate resection in a human nasal cavity.

Middle turbinate resection significantly alters the anatomy and redistributes the inhaled air. The superior half of the main nasal cavity is opened up, increasing accessibility to the region. This is expected to increase inhalation dosimetry to the region during exposure to airborne particles. This study investigated the influence of middle turbinate resection on the deposition of inhaled pollutants that cover spherical and non-spherical particles (e.g. pollen). A computational model of the nasal cavity from CT scans, and its corresponding post-operative model with virtual surgery performed was created. Two constant flow rates of 5 L/min, and 15 L/min were simulated under a laminar flow field. Inhaled particles including pollen (non-spherical), and a spherical particle with reference density of 1000 kg/m3 were introduced in the surrounding atmosphere. The effect of surgery was most prominent in the less patent cavity side, since the change in anatomy was proportionally greater relative to the original airway space. The left cavity produced an increase in particle deposition at a flow rate of 15 L/min. The main particle deposition mechanisms were inertial impaction, and to a lesser degree gravitational sedimentation. The results are expected to provide insight into inhalation efficiency of different aerosol types, and the likelihood of deposition in different nasal cavity surfaces.

Cerebrospinal fluid leaks following septoplasty.

We conducted a retrospective review to identify the characteristics of cerebrospinal fluid (CSF) leak in patients who had undergone septoplasty and in selected patients who had experienced a spontaneous CSF leak. CSF leak is a known but infrequently reported complication of septoplasty; to the best of our knowledge, only 4 cases have been previously published in the literature. A review of our institution's database revealed 3 cases of postseptoplasty CSF leak. We reviewed all the available data to look for any commonalities among these 7 cases. In addition, we reviewed 6 cases of spontaneous CSF leak selected from our database for the same purpose. For all patients, we noted the side of the cribriform plate defect, its size and, for the postseptoplasty cases, the interval between the septoplasty and the leak repair. Overall, we found that leaks were much more common on the right side than on the left. The sizes of the leaks in the 2 postseptoplasty groups were comparable (mean: 14.0 × 6.4 mm). The interval between septoplasty and leak repair ranged from 2.5 to 20 years in our cases and from 3 days to 22 weeks in the previously published cases. All 3 of the postseptoplasty patients in our database presented with clear rhinorrhea. Two of the 3 patients had meningitis; 1 of these 2 also had pneumocephalus. Of the 6 cases of spontaneous CSF leaks, 4 occurred on the right and 2 on the left; the average size of the defect was 5.8 mm in the greatest dimension. The finding that cribriform plate defects after septoplasty were typically right-sided likely reflects the prevalence of left-sided surgical approaches. Also, the fact that the defects were larger in the postseptoplasty cases than in the spontaneous cases is likely attributable to the torque effect toward the thin skull base that occurs when the perpendicular plate is twisted during septoplasty.

Concurrent functional endoscopic sinus surgery and septorhinoplasty: using evidence to make clinical decisions.

BACKGROUND: Concurrent septorhinoplasty (SRP) and functional endoscopic sinus surgery (FESS) has been a controversial topic in the literature over the last decade. Warnings and admonitions about the risks of performing these procedures together in a single surgery are both published and voiced at national meetings. Although pros and cons have been discussed in the literature, there have been no guidelines published based solely on a review of the level of evidence. METHODS: A systematic review of the literature was performed and the Clinical Practice Guideline Manual, Conference on Guideline Standardization (COGS), and the Appraisal of Guidelines and Research Evaluation (AGREE) instrument recommendations were followed. Study inclusion criteria were an adult population >18 years old, description or implication of study design available, concurrent FESS and SRP performed without additional procedures, and report of complications included in the study. RESULTS: We identified and evaluated the literature meeting those criteria: 11 retrospective studies. The literature was reviewed for both quality of research design as well as benefit and harm of the proposed interventions. CONCLUSION: If a patient is in need of FESS and SRP, either for functional or cosmetic reasons, and is found on the risk matrix to either have low or moderate risk, that patient is a good candidate for a concurrent procedure. If the patient is found to have higher risk, it is not an absolute contraindication, but the surgeon must use best clinical judgment when deciding to move forward and must counsel the patient preoperatively about possible increased risks.

Stylohyoid complex syndrome: a new diagnostic classification.

OBJECTIVE: To describe stylohyoid complex syndrome (SHCS) as a new diagnostic classification of all lateral neck and/or facial pain conditions resulting from an elongated styloid process, ossified stylohyoid ligament, or elongated hyoid bone. All of these pathologic conditions result in tension and reduced distensibility of the stylohyoid complex (SHC), with resultant irritation of the surrounding cervical structures with movement of the complex. DESIGN: A retrospective medical chart review was performed to identify a cohort of patients who underwent surgical intervention for lateral neck and/or facial pain due to pathologic SHCS. Follow-up time of greater than 1 year is reported in 5 of 7 patients. SETTING: Tertiary, academic referral center. PATIENTS: Patients included were those given a diagnosis of SHCS who underwent surgical intervention from June 2006 through September 2009. There were 7 patients, 5 of whom were female. The age range was 38 to 53 years at time of presentation (mean age, 45.3 years). Common presenting complaints were lateral neck and oropharyngeal pain exacerbated by tongue and head movements. INTERVENTION: The pathologic areas were surgically addressed through transoral or cervical approaches. MAIN OUTCOME MEASURE: Symptoms following surgical intervention. RESULTS: Seven patients (8 sides) were identified as having SHCS. Computed tomographic findings included elongated styloid processes (3 sides), ossified stylohyoid ligaments (2 sides), and elongated hyoid bones (3 sides). Computed tomographic scan, frequently with volume-rendered 3-dimensional reconstructions, identified the pathologic condition. All patients experienced clinically significant relief of presenting symptoms following surgical intervention. CONCLUSIONS: Stylohyoid complex syndrome includes all lateral neck and/or facial pain conditions resulting from an elongated styloid process, ossified stylohyoid ligament, or elongated hyoid bone. Surgical intervention directed at any pathologic point to disrupt this complex relieves tension and offers patients relief of symptoms.

Diagnosis and treatment of supraglottic laryngeal paraganglioma: report of a case.

BACKGROUND: Paragangliomas of the larynx are unusual tumors that are seen as a vascular submucosal mass. These usually are seen in the supraglottic larynx but have also been found in the subglottis. This is the only laryngeal neuroendocrine tumor with a female predilection. It is important that paragangliomas be differentiated from other neuroendocrine tumors of the larynx, including atypical carcinoid, because of differing treatment modalities. METHODS: We present the clinical, radiologic, and pathologic findings of a supraglottic laryngeal paraganglioma seen in a 50-year-old woman with a 6-month history of slowly progressive hoarseness. RESULTS: The tumor was successfully approached by means of a midline laryngofissure with mucosal preservation. The patient remains disease free 24 months after surgery. CONCLUSIONS: Preoperative CT and angiography are useful in making the diagnosis of paraganglioma before surgical intervention. Complete excision through an external mucosa-sparing approach is the treatment of choice. Distinguishing laryngeal paraganglioma from other neuroendocrine tumors can be difficult. Immunohistochemistry is an important tool for the correct pathologic diagnosis.