Mucosal cavernous hemangioma of the maxillary sinus: a series of 3 cases.

Mucosal cavernous hemangioma of the maxillary sinus: a series of 3 cases. INTRODUCTION: Sott-tissue hemangiomas are benign vascular tumors that are common in the head and neck region and rare in the sinonasal tract. Those originating in the sinus mucosa are extremely rare. We report three cases of non-osseous (mucosal) cavernous hemangioma (CH) originating in the maxillary sinus and successfully managed endonasally and endoscopically. PATIENTS AND METHODS: All patients were referred to the ENT outpatient department for a persistent unilateral pansinusitis that was resistant to broad-spectrum antibiotics for one year. All patients complained of unilateral persistent nasal obstruction, and one presented with nosebleeds. The sinus CT scan revealed complete opacification of the maxillary sinus extending into the ethmoid sinus. MR images depicted a heterogeneous signal on both TI- and T2-weighted sequences. In one case, the tumor was highly vascularized and required a preoperative selective arterial embolization. Complete resection via an endonasal endoscopic medial maxillectomy was performed successfully in all cases without severe intraoperative bleeding. The pathologist confirmed the diagnosis of CH. CONCLUSION: CH is rare in the sinonasal tract but must be considered in the differential diagnosis of benign and malignant sinonasal tumors in adults. An endonasal endoscopic medial maxillectomy enabled complete tumor removal with optimal control of its extensions and vascular supply. This approach is associated with less morbidity than an open approach. When nosebleeds are present, injection of a contrast agent and a preoperative arterial embolization are recommended.

An innovative approach to tracheotomy in patients with major obstruction of the upper airway.

BACKGROUND: Patients with severe dyspnea consecutive to locally advanced obstructive head and neck squamous cell carcinoma (HNSCC) or subglottic stenosis requiring definitive or temporary tracheotomy are frequently difficult to ventilate and intubate. MATERIALS AND METHODS: We describe a new procedure to perform tracheotomy easily and safely in patients with major obstruction of the upper airway. A catheter, specifically designed for cricothyroidotomy, was inserted into the trachea under local anesthesia. Then, general anesthesia was induced and the catheter was used as a guide for dilatation tracheotomy. From November 2009 to March 2013, the procedure was successfully used in 13 consecutive patients. Twelve out of 13 patients presented severe inspiratory dyspnea and stridor. RESULTS: During and after the procedure, no complications were reported. CONCLUSIONS: The reported technique is quickly performed and is a safe way to ensure short and long time ventilation of patients with major obstruction of the upper airway.