High CT Attenuation Values Relative to the Brainstem Predict Fungal Hyphae Within the Sinus.

Objectives: There is currently no established objective diagnostic indicator for the differentiation of sinus fungal ball (SFB) from unilateral nonfungal chronic sinusitis (UCRS). This study evaluated whether computed tomography (CT) attenuation values relative to those of the brainstem (relative CT number) are useful for differentiating SFB from UCRS. Materials and Methods: Consecutive patients who were pathologically diagnosed with SFB or UCRS between 2013 and 2021 were retrospectively identified. The relative CT numbers of region of interest (ROIs) within the sinuses were compared between the two patient groups. Factors with predictive power for differentiating SFBs from UCRSs were identified by uni/multivariable logistic regression analyses. Results: One hundred and eighty-three patients with unilateral chronic sinusitis were finally analyzed (SFB, 86 cases; UCRS, 97 cases). Regardless of the presence or absence of calcified lesions, the relative CT numbers in SFB were significantly higher than those in UCRS. ROIs showing high relative CT numbers were those where fungal hyphae were present. In the uni/multivariable logistic regression analysis, age (p < 0.001), relative CT number (p < 0.001), and calcification (p = 0.002) had predictive value for distinguishing SFB from UCRS. Within those cases not showing calcification, age (p = 0.004) and relative CT number (p < 0.001) were predictive factors for differentiating SFB from UCRS. A relative CT number >1.5 was significantly associated with SFB (sensitivity, 70%; specificity, 91%), with a significantly larger area under the receiver operating characteristics curve than age. Conclusions: High relative CT numbers within the sinus are strongly associated with the presence of fungal hyphae, and measurement of relative CT number is a powerful adjunctive diagnostic method for distinguishing between SFB and UCRS.

Recurrent facial palsy: The prognostic value of electrophysiological tests according to recurrence interval.

OBJECTIVE: The prognostic value of nerve excitability tests (NET) and electroneurography (ENoG) for recurrent peripheral facial palsy is poorly understood. This study aimed to evaluate the association between NET/ENoG results for the current palsy and recovery. METHODS: We extracted data on patients who were referred to our hospital (2005-2017). Adult patients with recurrent peripheral facial palsy who underwent NET and ENoG within 3 weeks of onset were retrospectively analyzed (n = 26). Favorable recovery was defined as the achievement of either House-Brackmann grade I/II or the same level of facial movement as before the current palsy. We evaluated the predictive NET/ENoG results by making comparison between the favorable recovery group and the unfavorable recovery group, which were subdivided based on the length of time after the previous palsy. RESULTS: In terms of patients with a >4-year recurrent interval, 8 out of 12 patients achieved favorable recovery. Compared to the favorable recovery group, the unfavorable recovery group had significantly higher NET results (9.03 mA vs. -1.08 mA, p = 0.017). Also, the unfavorable recovery group had significantly higher NET results in patients with a >2-year recurrent interval (9.03 mA vs. 1.06 mA, p = 0.036). However, other test results (NET in ≤4-year recurrent interval/all 26 patients, and ENoG in >4-year recurrent interval/≤4-year recurrent interval/all 26 patients) did not differ significantly between patients with favorable and unfavorable recovery. CONCLUSION: NET might be a useful prediction method in patients with at least a few years interval between the previous and the current palsy.

Endoscopic transoral and transmaxillary excision of the infratemporal fossa hemangioma.

Hemangiomas in the infratemporal fossa (ITF) are extremely rare benign vascular tumors. For many tumors of the ITF, with the exception of some small hemangiomas, a lateral facial approach has often been required. Recently, however, there have been some reports that minimally invasive endoscopic surgery can be used in the ITF; this would reduce the risk of surgical complications. To date, there has been no report of a hemangioma of the ITF exceeding 6 cm being resected by the endoscopic approach without facial incisions. Here, however, we report two cases of ITF hemangiomas that were completely extracted endoscopically, using a transmaxillary and transoral approach, without facial incisions or surgical complications.

Diffuse large B-cell lymphoma in the sphenoid sinus mimicking fibrous dysplasia in CT and MRI.

We present a 70-year-old man with lymphoma who presented with a right eye movement disorder. CT examinations showed 'ground-glass' appearance extending around the right sphenoid sinus which suggested fibrous dysplasia. However, biopsy from the mass histologically proved it to be diffusing large B-cell lymphoma and positron emission tomography examinations revealed increased fluorodeoxyglucose (FDG) uptake around the right sphenoid bone and multiple spinal bones. After chemotherapy for lymphoma, abnormal FDG uptake disappeared from the body.

T-cell lymphoblastic lymphoma in a child presenting as rapid thyroid enlargement.

The majority of lymphomas of the head and neck in children present as an enlarged cervical lymph node; however, malignant lymphoma arising from the thyroid gland is extremely rare. We report a case of a 12-year-old child who was admitted to our hospital because of a history of rapidly progressive anterior neck swelling. Histopathological studies revealed this case to be T-cell lymphoblastic lymphoma. We performed chemotherapy and the patient has kept recurrence-free survival for 18 months after the beginning of the treatment. This is the 2nd case of T-cell lymphoblastic lymphoma in the thyroid gland in a child.