Hydroxyapatite cements are safe in craniofacial reconstruction. The highest risk of implant infection comes from reconstruction in the area of the frontal sinus, immediately beneath coronal incisions, and in patients who receive postoperative radiation treatment. Based on our results, there does appear to be a statistically significant difference in rates of infection and foreign body reaction between the different types of hydroxyapatite cement. We would not recommend implantation of this material in contact with the frontal sinus. Caution should be exercised when it is placed directly beneath an incision or in patients receiving postoperative radiation, particularly if a boost dose is given.

To evaluate the effectiveness of endoscopic cauterization as definitive treatment for fourth branchial cleft sinuses. Design: Retrospective chart review with follow-up questionnaire. Setting: Tertiary care children's hospital. Patients: Ten children (age range, 10 months to 10 years) with fourth branchial cleft sinuses treated with endoscopic cauterization between 1995 and 2002. Main Outcome Measure: Recurrence of neck infections after endoscopic cauterization of fourth brachial cleft sinus tracts. Results: Seven of the 10 patients treated with endoscopic cauterization of the fourth branchial cleft sinuses showed no recurrence with an average follow-up of 3 years. Three of the patients were unavailable for followup, but medical records of the hospital showed no additional admissions for those patients for neck masses. No morbidity of the procedure was identified. All patients were discharged the day of surgery. Conclusions: Endoscopic cauterization of fourth branchial cleft sinuses appears to be an effective alternative to open excision.

We report the identification of a kaposiform hemangioendothelioma (KH) in the oropharynx of a 3-year-old boy. This is a rare endothelial-derived spindle cell neoplasm affecting children and early adolescents with features common to capillary hemangioma and Kaposi sarcoma. Nine cases of head and neck KH have been reported, this being the first in the otolaryngology literature. Our patient underwent wide local excision and has remained tumor free for over 1 year. KH should be considered in the differential diagnosis of a vascular lesion demonstrating unexpected behavior from that of a hemangioma.

The described technique of endoscopic repair of orbital floor fractures represents a precise method of fracture repair that results in excellent outcomes with minimal morbidity in the majority of patients. It allows for immediate fracture repair without the need to wait for periorbital edema to settle. It also allows for clear visualization of the entire fracture for precise graft placement.

No abstract

C-4.

The use of corticosteroid nasal sprays for the treatment of allergic rhinitis is widely accepted. Popularity of this class of medications is based on a well-established combination of efficacy, tolerability, and safety. Although current literature suggests that the use of intranasal steroids is indeed safe, increasing indications for prolonged administration continue to fuel debate regarding the long-term effect on local nasal structure and function. The purpose of this article is to review current literature addressing the effects of the components of local intranasal steroid sprays on the structure and function of the nasal mucosa.

Background. Nodular hidradenocarcinoma (NHAC), an eccrine carcinoma, has been reported in the dermatology and pathology literature, but few references have been made in the otolaryngology literature even though the head and neck is a common site of occurrence.Methods. A case report of a 37-year-old Hispanic man with a right-sided neck mass diagnosed preoperatively as a parotid mass by imaging and fine-needle aspiration is presented. After presentation at our multidisciplinary tumor board, excision of the mass was undertaken.Results. Final pathology reveled a NHAC, which is presented in our report.Conclusion. NHAC is an aggressive malignant tumor that is often misdiagnosed preoperatively and that must be treated with aggressive multimodality therapy for increased survival. Head Neck 29: 193-197, 2007 Keywords: nodular hidradenocarcinoma; eccrine tumor; malignant skin tumor; skin cancer Nodular hidradenocarcinoma (NHAC) is a malignant cell eccrine tumor, often with clear cell morphology, which has been reported less than 60 times in the literature. It has been rarely reported in the otolaryngology literature, though the head and neck is a common site of occurrence. The tumor has been identified in the literature under many names including clear-cell hidradenocarcinoma, malignant clear-cell hidradenoma, solidcystic adenocarcinoma, malignant acrospiroma, malignant clear-cell myoepithelioma, and clearcell eccrine carcinoma. 1 NHAC tumors usually develop as malignant tumors, though there have been reports of malignant degeneration of the benign counterpart, hidradenomas. 2 We present the case of a patient with what was believed to be a parotid neoplasm by preoperative clinical examination that turned out to be a hidradenocarcinoma. CASE REPORTA 37-year-old otherwise healthy Hispanic man presented to our tertiary care hospital complaining of a painless right neck mass that the patient said had been present for approximately 3 months. On physical examination the patient had a 4 cm 3 2 cm right parotid mass that appeared to be connected to the skin though there were no skin changes. Facial nerve function was House Brackmann I/VI bilaterally. The patient was sent for fine-needle aspiration of the neck mass, which showed cellular clusters and sheets of monomorphous epithelial cells with low nuclear:cytoplasm