Intramuscular hemangioma of the masseter muscle.

Intramuscular hemangiomas (IMH) are uncommon tumors of the head and neck, but often occur in the trunk and extremities. When present in the head, the masseter muscle is the most frequently involved site, although constituting only 0.8% of all hemangiomas. Accurate preoperative diagnosis is uncommon without cytology or biopsy. A case of IMH of the masseter muscle in a 24-year-old Turkish woman is presented. Clinical, radiologic and histologic findings and treatment modalities are reviewed.

Middle ear pathology in day-care centre children.

BACKGROUND: Middle ear pathology, either otitis media with effusion or tubal dysfunction, is frequently seen in day-care centre children. Recognition and early treatment of this condition is crucial to the prevention of chronic otitis media, which is a major cause of hearing loss in later life. OBJECTIVES: We aimed to reveal the incidence of silent otitis media in day-care centre children and to determine the predisposing factors, risk factors and the awareness of the parents of the middle ear disease of their children. METHOD: Two hundred and thirteen children, aged 3-6 years, were screened in four daycare centres. A questionnaire was prepared that would reveal the predisposing factors. Information was gathered from both the parents and teachers. Children were examined by otoscopy, pneumotoscopy, tympanometry and X-rays for sinus pathology. RESULTS: Forty-three of 213 children had middle ear pathology; 39 of them were confirmed by tympanometry; 56.1 % of children had some degree of sinus pathology. We revealed that, although most of the children do not have the risk factors, they develop middle ear pathology. Among the parents, 81.4% of them were unaware of the condition. CONCLUSION: Early diagnosis of middle ear pathologies is necessary for prevention of future complications. In early stages the condition is silent. We emphasize the importance of the primary care physician's role in diagnosing the early stages of middle ear pathologies and recommend that teaching of otoscopic and pneumotoscopic skills should be part of the training for family physicians.

Sensorineural hearing loss associated with otitis media with effusion in children.

Sensorineural hearing loss (SNHL) is known to occur in various types of otitis media. Although the mechanism by which SNHL develops in association with otitis media with effusion (OME) is unknown, several hypotheses have been advocated up to now. We reviewed the clinical records of children with otitis media with effusion (OME) to reveal the association with sensorineural hearing loss. The material consisted of 71 children (119 ears) who were diagnosed as having OME and gave reliable audiograms in our clinic during an 11 month period from February 1997 through January 1998. From these cases those which showed bone conduction loss of 25 dB or higher at any one of the frequencies of 250 through 4 kHz were selected and considered to be cases of SNHL. Eight cases (9%) which had temporary threshold shift (TTS) or permanent threshold shift (PTS) were considered to be etiologically related to OME. The clinical course in each of these cases with SNHL was reviewed and evaluated in detail. We noted that all children with TTS improved completely. The result of this study indicates that we have to be aware of a possible development of SNHL during the course of OME.

Evaluation of some important anatomical variations and dangerous areas of the paranasal sinuses by CT for safer endonasal surgery.

The purpose of this study is to determine some important variations and dangerous areas carrying risks for major complications, in the routine CT examination. We also made specific measurements to evaluate the individual differences. This prospective study consisted of 111 patients (222 sides). Eighty patients underwent coronal, and the rest coronal and axial CT. The depth of lamina cribrosa, its distance to the inferior turbinate, and the distance of anterior ethmoidal artery (AEA) either to the orbital roof or inferior turbinate were measured. Variations of the upper attachment of uncinate process were encountered in 23%. AEA coursed freely within ethmoidal cells in 43%. Anterior clinoid aeration was seen in 14%, optic canal bulging into the sphenoid sinus in 13% and an extreme medial course of the carotid canal in 12% of the patients. The mean depth of lamina cribrosa was 5.9 mm, and its mean distance to the inferior turbinate was 25.7 mm. The mean distance of AEA to the orbital roof was 13.7 mm, and to the inferior turbinate 30.05 mm. Anterior clinoid aeration correlated well with the variations of carotid and optic canals, statistically (p < 0.01). A detailed CT study will provide important information on the areas carrying risks of complications and the size of the area to be worked on.

Cholesterol granuloma in the maxillary sinus.

A 35-year-old male complained of recurring headache and nasal obstruction over a 4-year period. A Caldwell-Luc operation was subsequently performed on the left maxillary sinus and a greenish appearing material was removed. Microscopic examination of the tissue specimen showed a granulomatous tissue with typical cholesterol clefts and inflammatory changes consistent with chronic sinusitis. This entity is presented and reviewed.