Sphenoid sinus mucocele is a rare condition. In this study, radiation to the head and neck appeared to be a predisposing factor, and eye symptoms were the commonest presentation. Endoscopic sinus surgery is a safe and effective treatment modality.

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Objectives: Prevention of “a problem cavity” following modified radical mastoidectomies (MRM) and canalplasties requires careful preoperative consideration and an adept surgical technique. We aim to describe our technique of a superiorly-based middle temporal artery flap, with an inferiorly-based musculoperiosteal flap, in combination with a Corner-Tag-meatoplasty, and to evaluate the surgical outcomes on a semi-quantitative scale. Methods: Retrospective consecutive case review from 2010-2013. Primary end-point measure of creating a low maintenance dry mastoid cavity was graded using Merchant’s grading system. Results: Twenty-four patients (13 males and 11 females) with a mean age of 42.6 years (range, 17-76 years) were included. All except 3 cases were primary ear cases. None had previous reduction procedures done. Nineteen cases were MRMs, 3 were revision mastoidectomies, and 2 were canalplasties. A well-epithelized, dry mastoid cavity was achieved in 12 patients by 1-month post surgery, with another 9 achieving this by 3-months. Twenty-three cases (96%) resulted in cavities with adequate control of infection based on Merchant’s summary grade. The cavities took an average of 1.75 months to epithelize. Three patients had recurrent tympanic membrane perforation with one requiring revision surgery. None had disease recurrence at mean 15.8 months follow-up (range, 6-25 months). Our technique of meatoplasty allowed excellent visualization of the mastoid bowl affording bimanual instrumentation in the clinic setting. Conclusion: The middle temporal artery and inferior musculoperiosteal flap in combination with the Corner-Tag meatoplasty is an effective technique in reducing the mastoid cavity, aiding epithelization, has low complication rates, and allows good surveillance postoperatively.

Objective: We aim to measure the intra-system reliability and the inter-system agreement between the Facial Nerve Grading 2.0 and Sunnybrook Facial Grading system (SFGS). Method: Video clips of 12 patients with facial nerve dysfunction performing a protocol of facial expressions were recorded. Thirteen physicians were asked to evaluate the videos independently using the 2 scales. Results: The ICC score for FNG 2.0 and SFGS was 0.820 (95% CI=0.677-0.931) and 0.831 (95% CI=0.696-0.936), respectively. The FNG 2.0 and SFGS inter-system agreement ICC score was 0.959 (95% CI=0.944-0.970). Conclusion: Studies have established high intra-system reliability for the SFGS, and our results corroborate these. FNG 2.0 similarly shows high intra-system reliability. As the inter-system agreement was found to be near perfect in our study, the new FNG 2.0 should be considered as an alternative grading scale for facial nerve palsy.

Describe a case report of an apocrine hydrocistoma of unusual presentation site (nasal) and a literature review. Its pathogeny seems to be a result of the sudoriferous conduct obstruction just above the glandular wound, due to trauma or an inflammatory process. Method: Female, 43 years-old, complaining of a swelling over the right side of the nose, associated to pain and nasal obstruction over 1 year. The examination showed facial asymmetry with an elevated right nasal wing and bulging of nasal floor. We performed cyst resection. Results: This case shows a nasal apocrine hydrocistoma that differs from its usual eyelid location. The patient's clinical and physical history, as well CT scan images, guided us to cyst resection with an intraoral access. The anatomopathology study proved to be an apocrine hydrocistoma. The literature review points this case report as a differential diagnosis for diseases in this area, such as inflammatory periapical lesions, nasal boils, nasopalatine duct cysts, dermoid cysts, and nasolabial cysts. Conclusion: Apocrine hydrocistomas are sudoriferous gland benign tumors in the face. Most people present themselves with a well-delimitated swelling, local pain, and partial or complete nasal obstruction. CT is the ideal examination for its evaluation, with anatomopathology to confirm the diagnosis. Cyst resection is a choice treatment.