ABSTRACfSchwannomas are benign neoplasms arising from the peripheral nerve sheath. The sinonasal tract is an unusuallocation for these neoplasms. Because of their rarity, few series have been reported. Five previously unreported cases of schwannomas of the nose and paranasal sinuses are presented that illustrate the spectrum of disease. The clinical presentation, diagnostic work-up, clinical course, and diverse therapeutic approaches will be discussed. A management philosophy based on the diversity of these tumors and their clinical behavior, and incorporating the new diagnostic and therapeutic tools available to the clinician wi(f be presented. The implications of newer diagnostic techniques including sinonasal endoscopy, magnetic resonance imaging, and immunochemistry in the diagnosis and treatment of these tumors will be discussed. (Am J Rhinology 7: [59][60][61][62][63][64][65] 1993) S Chwannomas are benign neoplasms of peripheral nerve sheath origin. Although several other terms have been applied to these lesions, schwannoma seems to be the most appropriate name because the cell of origin is the Schwann cell. 1 The sinonasal tract is an unusual location for these An Official Abstract form is included in the this issue of The American Journal of Rhinolol!.Y Am J Rhinology 65
Suppurative mediastinitis following neck infection is an uncommon entity that carries a 40% mortality. It is most commonly associated with esophageal perforation or odontogenic abscess. The rapidity of spread has been attributed to dependent drainage from the neck into the mediastinum, negative intrathoracic pressure, and synergistic necrotizing bacterial growth. Cultures obtained usually grow streptococci and/or Bacteroides. We report the case of a 34-year-old woman with an upper respiratory infection who subsequently was found to have a para-/retropharyngeal and mediastinal abscess. Septic shock, respiratory failure, and death ensued, despite aggressive treatment with broad-spectrum antibiotics (for both aerobes and anaerobes), surgical drainage of the neck and mediastinum, and cardiorespiratory support. The danger of a rapid downhill clinical course with mortality due to suppurative mediastinitis makes early diagnosis of critical importance. All clinicians evaluating a “sore throat” should consider neck edema or gas on neck radiograms as evidence of cervical abscess, and subsequent widening of the mediastinum on chest x-ray as an ominous sign suggesting mediastinal abscess.
ABSTRACfUsing conventional radiography, maxillary sinus hypoplasia (MSH) may be misdiagnosed as chronic infective sinusitis in patients with chronic nasal symptoms. Commonly associated anatomical abnormalities of the lateral nasal wall and orbit may also be missed. Failure to recognize these abnormalities is fraught with hazards should sinus surgery be contemplated on such patients. With the use ofhigh resolution computed tomography scans and rigid nasal endoscopy, MSH and associated subtle anatomic abnormalities of related structures are diagnosed with higher precision and surgical complications minimized. The incidence, pathogenesis, and classification of MSH is reviewed. The clinical and surgical implications of associated anomalies of the lateral nasal wall are discussed. Two illustrative cases are presented. (Am J Rhinology 7: [105][106][107][108][109][110] 1993) H ypoplasia of the maxillary sinus has been described as early as 1912. 1 Early descriptions were confined to the maxillary antrum with little attention given Am J Rhinology to adjacent anatomic structures, namely the lateral nasal wall and the orbit. This was, at least partly, due to the suboptimal visualization of these structures using traditional methods of clinical examination and plain roentgenography.Since the embryology and development of the nose, sinuses, and orbit are closely related, anomalies of the maxillary antrum are often associated with abnormal anatomy of the lateral nasal and orbital walls.2,3Using conventional roentgenography, maxillary sinus hypoplasia (MSH) could be misdiagnosed as an opacified maxillary sinus suggesting chronic infective sinusitis in patients with chronic nasal symptoms. More importantly, associated anatomical abnormalities of the lateral nasal wall and orbit may be missed. Failure to recognize these abnormalities is fraught with hazards should sinus surgery be contemplated on such patients.The use of computed tomography (CT) scans and the advent of nasal endoscopy have revolutionized the diagnosis and management of nasal-sinus disorders. With the improved visualization offered, subtle anatomic abnormalities are diagnosed with greater accuracy and surgical hazards are minimized.This present report describes MSH in two patients and emphasizes the advantages of using high resolution coronal CT scans and nasal endoscopy in evaluating such patients. A literature review describing the incidence, pathogenesis, classification, as well as the clinical and surgical implication of MSH is presented. CASE REPORTS Case 1A 7-y.ear-old male presented to his family physician WIth a 4-month history of intermittent bilateral 105
Laryngeal stenosis can present with recurrent lower respiratory tract infections, hoarseness, stridor or decreased exercise tolerance. Asphyxia and death may follow. One accepted method of treatment is to perform a tracheostomy, dilate the stricture and insert an obturator for 6 to 9 mo. Ten children with a subglottic stenosis were treated by this technique and 7 completed the treatment. Results in 5 of these children were good, 1 was improved and 1 restenosed. These results compare favorably with those reported by others. This form of treatment is indicated for unyielding but dilatable strictures which have failed to respond to other approaches. The choice, therefore, lies between resection and plastic repair or prolonged dilatation. Results are generally quite good for strictures near the vocal cords, but are variable for those well below the cords. The manufacture and insertion of a prosthesis used in the above cases are described.
Recurrent epistaxis can be a rare presentation of ruptured internal carotid artery aneurysm. Although primarily a neurosurgical problem, these cases may be seen initially by the otolaryngologist, as the aneurysm erodes through the thin adjacent sphenoid sinus wall and ruptures, producing epistaxis. In most cases these aneurysms are traumatic in origin. We present the first cited case of a nontraumatic internal carotid aneurysm, arising from the origin of the ophthalmic artery, which presented as intermittent epistaxis from the sphenoid sinus. We suggest that aneurysmal rupture be considered in the differential diagnosis of all cases of epistaxis from the sphenoid sinus. Nasal endoscopy and CT scan of the paranasal sinuses in nonemergent cases is valuable in localizing the source of the bleed. Furthermore, preoperative angiography is essential in making the diagnosis of aneurysm and avoiding fatal torrential hemorrhage caused by nasal surgery. Once the diagnosis is made, the definitive treatment is surgical or intravascular trapping of the aneurysm. (American Journal of Rhinology 9:9-13, 1995)
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