Solitary giant skull base schwannomas--report of four cases

BACKGROUND: Solitary intracranial schwannomas not related to major nerves or neurofibromatosis as well as paranasal schwannomas are rare. Schwannomas simultaneously involving the paranasal sinuses and intracranial cavity are even rarer. METHODS: We report four cases of schwannomas simultaneously involving the intracranial cavity and paranasal sinuses. They were successfully managed by surgery. The literature on such tumors is reviewed. RESULTS: All patients were young adults; the male to female ratio was 1:3. In two patients, the tumor was predominantly intracranial with extension into the sphenoid and ethmoid sinuses, whereas in the other patients, the tumor was located predominantly in the paranasal sinuses and nasopharynx with intracranial extension. Radiologically, bone destruction was seen in three cases. The tumors were totally removed piecemeal with repair of the basal dura. Histopathologic examination confirmed the diagnosis of schwannoma in all four cases. Three patients are alive and well; one of them was reoperated for a recurrence. CONCLUSIONS: These tumors should be excised completely if possible. Radiologically, bone erosion or destruction are suggestive of malignancy but histopathology clinches the diagnosis. Therefore, drastic surgery should be avoided in these cases. Surgery is generally curative in these massive schwannomas.     

Coronal CT of the paranasal sinuses before and after functional endoscopic sinus surgery

Coronal CT of the paranasal sinuses and the ostiomeatal complex (OMC) was performed before and 12 months after bilateral functional endoscopic sinus surgery (FESS) in 30 patients with sinusitis and 12 patients with nasal polyposis. The extent of sinus mucosal thickening was graded, and the patency of the OMC was evaluated. After FESS, the percentage of open OMCs had increased from 42% to 83% in the sinusitis group, and from 8% to 45% in the polyposis group. There was only a small improvement in mucosal score in sinuses with opened OMC, so that the overall extent of sinus opacification before and after FESS was almost the same. Despite this, 91% of the patients reported clinical relief of symptoms. Preoperative coronal CT of the paranasal sinuses serves as an anatomical map for the surgeon, but there is no benefit of routine postoperative CT.     

Prevalence, follow-up and clinical significance of the anticardiolipin antibodies in normal subjects

We evaluated the occurrence of abnormalities in paranasal sinus radiographs in acute asthma by taking a radiograph of the sinuses of 110 consecutive patients admitted to a medical ward a total of 149 times for asthma. Maxillary sinus infection was assessed by taking aspirate from radiologically abnormal maxillary sinuses. An abnormal finding in any paranasal sinus was detected on 87% (130 of 149) of admissions and the yield of maxillary aspirate was macroscopically mucous, purulent or mucopurulent in 60% (42 of 70) of aspirates. A positive bacteriological culture was obtained from 23 aspirates and a virus was detected in 15, there being 7 aspirates in which both a bacterium and a virus could be detected. Although the correlation between radiographic findings and the aspirates was not very close we conclude that radiographic abnormalities of the paranasal sinuses are common in acute asthma as are infections of maxillary sinuses with an abnormal radiographic finding. There is an obvious need to look for sinusitis when a patient with an exacerbation of asthma is being evaluated.     

Atypical localization of a small cell carcinoma in the paranasal sinus area--case report

BACKGROUND: Malignant neoplasms of the paranasal sinuses are estimated at 3 to 5% of all head and neck malignant neoplasms. More than 50% of the cases are classified as squamous cell or anaplastic undifferentiated carcinomas. Extremely rare are small cell carcinomas localized in the paranasal sinuses. METHOD AND PATIENT: A 60-year-old male patient was seen in February 1996 in our ENT Department with unspecific pain on the left maxillary sinus and alveolar ridge. Anterior rhinoscopy revealed an extended tumor on the left nasal fossa; histopathological examination showed a small cell carcinoma. No other primary tumors or metastases were detected in extended staging. Due to the extended paranasal tumor as well as the histopathological findings, the patient was given induction chemotherapy followed by radiation therapy. RESULTS: To date (4/97), we achieved partial remission without any clinical complaints. CONCLUSIONS: The therapeutical result is comparable to other therapeutical regimens.     

The social and health characteristics of California cities

The ethmoid sinuses play a key role in the health or disease of the entire paranasal sinus complex. Multiple underlying inflammatory processes may easily obstruct the narrow ostia of each ethmoid air cell, leading to infection. By virtue of its unique anatomic position and relationship to the ostiomeatal complex, the ethmoid labyrinth becomes the key to treatment of acute and chronic sinusitis. Surgical intervention for sinus disorders in children has grown in popularity. This article reviews the anatomy and pathophysiology of ethmoid sinusitis and discusses the role of surgery for these disorders.     

Bacteriology of vulvo-vaginitis in pediatrics]

The first naso-sinus laboratory has been set up in Siriraj Hospital for better training of rhinosurgeons. The specimens used for practice operation are the entire nasal cavities with all paranasal sinuses, taken from cadavers and preserved in 95% ethanol. The "Siriraj" sinus holder is specially designed and constructed to hold various sizes of specimens. It is made of plastic board and stainless steel screws; it is an inexpensive and simple device which can be afforded by every centre. With this naso-sinus laboratory, ENT residents and rhinosurgeons can achieve their skills in performing nasal endoscopy, endoscopic or microscopical sinus surgery and all kinds of sinus operations at their convenience.     

Neoplasms of the nasal passages and paranasal sinuses in domesticated animals as reported by 13 veterinary colleges

Three hundred cases of primary neoplasms involving the nasal cavity or paranasal sinuses were found among the reports of 12,300 microscopically confirmed neoplasms. The multispecies data were compiled from abstracts of medical records by 13 colleges of veterinary medicine in the United States and Canada from 1964 to 1973. Significant numbers of neoplasms were observed in dogs, horses, and cats. Intranasal neoplasms were more frequent than those of the paranasal sinuses in dogs and cats. Only cats had a sex difference in the occurrence of nasal neoplasms, with a male predilection. The frequency of neoplasms of the nasal cavity and paranasal sinuses increased with age in all species examined. A clear relationship could not be established between nose length and of intranasal neoplasms. Of the tumors, 80% were malignant in dogs, 68% in horses, and 91% in cats. Detailed review of medical records in a subset of 49 dogs with neoplasms of the nasal passage and paranasal sinuses revealed major clinical signs of nasal and ocular discharge, facial deformity, and stertorous breathing. Median duration of signs prior to diagnosis was 3 months and 95% of the dogs had been given treatment prior to definitive diagnosis. All 49 tumors were malignant; 27 were classified histologically as carcinomas and 22 were sarcomas. Nineteen dogs were treated, using surgery alone or in combination with radiation therapy. Median survival duration was 5 months (mean 6.7 mo).     

Value of B-image ultrasound in diagnosis of paranasal sinus diseases in comparison with computerized tomography

BACKGROUND: In diagnostic imaging of the paranasal sinuses, the A-mode technique is increasingly being substituted by B-mode ultrasonography. To assess the value of B-mode sonography we compared in a double-blind study computed tomography with our ultrasound findings. PATIENTS AND METHODS: Seventy-eight patients were examined by CT and subsequently by ultrasound, two-thirds before endonasal surgery and one-third for diagnosis of serious facial pain and swelling. RESULTS: Among 114 pathological maxillary sinus tomograms, 83 findings could also be diagnosed by ultrasound (sensitivity 72.8%). In the frontal sinuses only 12 of 52 of pathological findings could be detected (23.1%) and only 9 of 80 in the frontal ethmoid (11.3%). Except for circumscribed polyps and moderate general swelling of the mucosa, the detection rate by sonography was 97.4% for the maxillary sinuses, 31.5% for the frontal and 18% for the ethmoid sinuses. CONCLUSIONS: Ultrasound usually only demonstrates the presence of absence or unspecific findings. Differential diagnosis between tumors and sinusitis is generally difficult. The healthy individual is correctly assessed as healthy due to the total reflection of the air-filled healthy sinus. According to our findings ultrasound has a certain value in the diagnosis of maxillary sinuses. It can be used to obtain a preliminary diagnosis and as a screening method although a negative result never excludes a disease of the sinuses. As it does not involve radiation exposure, ultrasonography can be recommended as first step in diagnosis for children, pregnant women, and young women especially in acute sinusitis, because in acute sinusitis the maxillary sinuses are generally affected.     

Cobalt 60 radiotherapy for treatment of squamous cell carcinoma of the nasal cavity and paranasal sinuses in three horses

Three adult horses underwent aggressive treatment of squamous cell carcinoma of the nasal cavity and paranasal sinuses, using course-fractionated cobalt 60 radiotherapy. Squamous cell carcinoma of the nasal cavity and paranasal sinuses is not commonly diagnosed in horses. Historically, horses with this type of neoplasm have not been treated or have undergone some form of surgery. The prognosis for long-term survival or cure has been poor. Long-term results of cobalt 60 radiotherapy were good to excellent and exceeded those usually reported for horses treated surgically. On the basis of these results, use of radiotherapy for these neoplasms is recommended.     

Chronic mycoses of the paranasal sinuses--value of endonasal paranasal sinus surgery

BACKGROUND: Many host factors even in immunocompetent patients may have an influence on development of a fungal diseases within the paranasal sinuses. Fungal sinusitis can occur in an acute form or more often to a chronic type of the disease. These mainly relatively asymptomatic chronic forms and further divided into a chronic noninvasive, chronic allergic, and chronic invasive disease. Endonasal microsurgery has significantly changed the management of chronic fungal sinusitis and allows adequate removal of pathologic tissue even in advanced situations. The aim of this study was to analyze the efficacy of endonasal surgery in chronic fungal sinusitis. MATERIAL AND METHODS: In a retrospective study we assessed a group of 40 patients who had endonasal surgery for chronic fungal sinusitis. Patient records, CT and MRI scans, microbiology and histology as well as the postoperative clinical follow-up including endoscopic photo documentation were evaluated over a period of 5 years. All patients underwent endonasal surgery using endoscopic techniques. The microscopic was of additional help in a few cases with extended disease and multiple dehiscences of the skull base. RESULTS: Twenty-four patients had a chronic noninvasive of fungal sinusitis and 16 patients had a chronic invasive form. All these patients underwent endonasal surgery without external incision. The fungal disease was erradicated in 39 cases, and revision surgery was required in only one case in which involvement of the contralateral side was not initially detected. in two cases scar tissue in the middle meatus was later excised but without evidence of residual fungal disease. Only in 6 cases was antifungal chemotherapy required, where the disease had spread into surrounding tissue or the patient had severe symptoms. CONCLUSIONS: Endonasal microsurgical techniques are today the appropriate approach for managing chronic fungal sinus disease even in severe cases with radiologic evidence of expansion or invasion of surrounding tissue. Additional antifungal chemotherapy is only rarely indicated, specifically when the fungal disease invades surrounding tissue.     

Azoxymethane-induced colon tumors and aberrant crypt foci in mice of different genetic susceptibility

INTRODUCTION: Virtual endoscopy is a new 3D technique which permits to depict the inner surface of anatomic cavities. We report our experience in the study of the nasal cavity and paranasal sinuses. MATERIAL AND METHODS: CT examinations of the maxillofacial region were obtained using 1.5 or 3.0 mm slices, 1.5 or 3.0 mm table feed, 120 kV, 140 mA, 2 s scan time, standard and high resolution algorithms for bony structures and a field of view of 14-16 cm. The images were transferred on a workstation and processed with the Navigator virtual endoscopy software (General Electric). A threshold value ranging -300 to -550 UH was applied. RESULTS: We report a series of virtual images of the nasal cavity which includes rhinopharynx vault, torius tubarius, choanae, turbinates, tubal orifice and osteomeatal complex. Moreover, images of frontal sinus and tear duct, of polyps and fracture of maxillary sinus are also presented. 3D virtual endoscopy provides a clear visualization of the anatomic structures of the nasal cavity and sinuses. The images are similar to those of conventional endoscopy. Moreover virtual endoscopy visualizes the paranasal sinuses, which are not accessible at conventional endoscopy. The main limitations of this new technique are the arbitrary choice of the threshold value and the homogenization of different tissue densities, which reduces the contrast resolution. CONCLUSIONS: Virtual endoscopy can presently be considered a complementary technique of the standard axial and coronal CT examination. It provides an effective demonstration of the anatomy of these structures and shows areas which are difficult to visualize with conventional endoscopy. This technique could be of help in didactical activity; its clinical application has to be verified.     

Retinoid X receptor expression in the normal pituitary and clinically ''non-functioning'' pituitary tumours

Nasal chondromesenchymal hamartoma is the suggested appellation for a tumefactive process of the nasal passages and contiguous paranasal sinuses in seven children with a detectable mass in the nose. With the exception of one patient who was 7 years of age at diagnosis, the others were 3 months of age or less upon recognition of the mass. Two children were diagnosed in the first 2 weeks of life. Imaging studies showed a complex solid and cystic mass or masses filling the nasal cavity and extending into the ethmoid sinuses in most cases. Erosion of the surrounding bone, including the cribriform plate, resulted in an intracranial component in the four cases. Surgical resection was the treatment of choice despite its technical difficulties that often necessitated a combined intranasal and intracranial approach. Residual disease with continued growth in one case was the clinical outcome in two children, and the remaining five patients have not experienced any further difficulties. The piecemeal fragments of tissue disclosed a collage of histologic features, but the basic morphologic elements were well-demarcated nodules of cartilage with some variation in the cellular density and maturation of the chondrocytes, a myxoid to spindle cell stroma, focal osteoclastlike giant cells in the stroma, and erythrocyte-filled spaces resembling those of the aneurysmal bone cyst. Two of the tumors were less polymorphous or complex in their spectrum of histologic features. These nasal masses have similarities to the so-called chest wall hamartoma or mesenchymal hamartoma of the chest wall in terms of the clinical presentation in infancy and the basic cartilaginous character of both entities. There is a degree of presumption in the designation of these nasal and chest wall tumors as hamartomas because the pathogenesis has not been established for either entity.     

Follicular adenocarcinoma of the thyroid in the maxillary sinus

No reports of metastatic thyroid carcinoma in the maxillary, ethmoid, or sphenoid sinuses can be found in the literature. A woman with severe posterior epistaxis was examined recently. She had undergone a partial lobectomy for a thyroid tumor 16 years previously. Hemorrhagic thyroid tissue was in the maxillary sinus. The results of subsequent examinations indicated thyroid deposits in the lung and spine. The patient received radioactive iodine, 100 MCi. Her lung and spine deposits lysed, and she experienced no further epistaxis. Thyroid carcinoma's ability to metastasize to a paranasal sinus is documented here. Epistaxis after a thyroidectomy for cancer now must be considered an unusual clinical manifestation of metastatic spread, unless otherwise proved. The differential diagnosis of epistaxis must now include thyroid carcinoma metastatic to the sinonasal tract.     

Cavernous sinus syndrome caused by a primary paranasal sinus non-Hodgkin's lymphoma

Although uncommon, non-Hodgkin's lymphomas occasionally arise from the nose and paranasal sinuses. Rarely, they may invade into the cavernous sinus and produce signs and symptoms that characteristically include unilateral ophthalmoplegia, sensation loss in the distribution of the ophthalmic and other divisions of the trigeminal nerve, sympathetic nerve paralysis and proptosis. In this report, we present a case of cavernous sinus syndrome (CSS) caused by infiltration of non-Hodgkin's lymphoma from the adjacent paranasal sinuses and address issues regarding its diagnosis and treatment.     

Paranasal sinuses: only one of nature's games?

BACKGROUND: Many theories exist concerning the function of paranasal sinuses, but it is rather difficult to definitively name the right one. Despite the fact that many of them have been proved to be wrong, they are still used. THEORIES: Galen postulated 2000 years ago that they were "porous bones", which helped with weight reduction. Like Galen's theory, most of the others have been refuted as well. A list of these refuted theories covers a range of postulated functions including a relative warming or moistening of the breath, protection against high pressure in the nasal region when sneezing, paranasal sinuses as a place of efficient mucus production, or an aid for smelling, similar to the ethmoidal cells of the porcupine. Others include an isolated function for protection against cold climates and an aid for formulating sound by acting as a resonance chambers. CONCLUSIONS: Two theories still remain. One says that the paranasal sinuses are only the result of the evolutionary processes that have taken place in the skull during human development. The other theory explain that the form of the paranasal sinuses exists through the influence of the forces created during the act of chewing. Small cavities appear as a result of the minimal energy created, and these cavities can be found in the form of paranasal sinuses.     

Evaluation of fetal condition in pregnancy complicated by hypertension--biochemical assessment of amniotic fluid. I. Protein and lipid components and kidney maturation

Leiomyoma is a benign tumor that originates from the smooth muscle. If often develops in the uterus and in organs rich of smooth muscle like bowel and subcutaneous tissue. It is infrequently observed in the oral nasal cavities or in paranasal sinuses. The authors, after an accurate revision of the literature, present their first case of zygomatic leiomyoma. They underline the diagnostic aspects in relationship to histologic and immunohistochemical examinations, for surgical therapy.     

Invasive aspergillosis of the paranasal sinuses: a medical emergency

A rare case of invasive aspergillosis of the paranasal sinuses in a previously healthy individual is presented. The disease caused severe complications and proved fatal. Classification, aetiology and presentation of sinus aspergillosis are discussed. Early diagnosis and management is stressed to avoid the high incidence of morbidity and mortality.     

Sinus aspergillosis after an endodontic treatment. Presentation of a clinical case

Aspergillosis is an opportunistic deep mycosis that occurs in immunocompromised patients, often in the paranasal sinuses. However, it sometimes occurs in healthy subjects, producing symptoms similar to those of a chronic sinusitis that is unresponsive to conventional treatment. A possible entry point for Aspergillus is the oroantral communication originated by perforation of the dental root cavity during root canal of a molar with penetration of material. We report the clinical case of a patient with symptoms of chronic sinusitis who was diagnosed as sinus aspergillosis after radiological and histological study. The origin may have been a third upper molar in which a root canal was performed.     

Characteristics of lesions of paranasal sinuses in patients with optic chiasm arachnoiditis

The paper provides data on a comprehensive rhinological and x-ray examination of 201 patients suffering from optochiasmal arachnoiditis (OCA). Paranasal affection (as a rule polysinusitis) was disclosed in 75.6% of the examinees. The lesion occurred primarily in the sphenoidal sinuses and frequently combined with ethmoidal labyrinth and maxillary sinus involvement. Rhinological and x-ray symptoms in OCA are rarely prominent giving grounds to physicians for defining it as the syndrome of minor clinical signs. The latter hold importance for diagnosis which enables early cleansing of the paranasal sinuses in combined treatment of OCA.     

Bone marrow transplantation in children. Imaging assessment of complications

As the use of BMT increases for the treatment of a variety of malignant and nonmalignant diseases in children, awareness of the complications that can occur in these children is important. The imaging appearance of the complications that may occur in the central nervous system, paranasal sinus, lungs, abdomen, and pelvis in children following BMT have been reviewed. CT and MR imaging examination with the use of contrast material as indicated is important for defining pathology in the brain. Plain films should be supplemented with CT examination as needed to identify and characterize disease in the paranasal sinuses and lungs. Finally, the use of ultrasound and CT is crucial for defining complications that may occur in the abdomen and pelvis.