The pediatric nasal cavity and paranasal sinuses, when compared to those in adults, differ not only in size but also in proportion. Knowledge of the unique anatomy and pneumatization of children's sinuses is an important prerequisite to understanding the pathogenesis of sinusitis and its complications. It is also important in evaluation of radiographs and in planning surgical interventions. In order to study the development of the paranasal sinuses in children and relate clinical anatomy to sinus surgery, the sinuses in 102 pediatric skulls and cadaver heads were measured. The results were classified by stage of development into 4 different age groups: newborn and 1 to 4, 4 to 8, and 8 to 12 years. The characteristics of each group and their clinical importance for paranasal sinus surgery are described.

The combination of two minimally invasive therapies, endoscopic sinus surgery and stereotactic radiosurgery, provide a reliable new approach to the treatment of a series of olfactory neuroblastomas that offers excellent quality of life, less injury to the patient, fewer side-effects, and fewer long-term effects than other treatment strategies.

Carcinomas of the oro/nasopharynx often present with regional lymph node (LN) metastases before the primary tumour is discovered. Some of the cervical LN metastases feature prominent cyst formation. Solitary cystic LN metastases have often been mistaken for primary squamous cell carcinomas (SCC) originating within a branchiogenic lateral neck cyst (LNC), resulting in the commonly used terms 'branchioma' and 'branchiogenic carcinoma ' (von Volkmann, 1882;Wolff et al, 1979;Khafif et al, 1989;Parks and Karmody, 1992;Carroll et al, 1993;Hall and Dexter, 1993;Flanagan et al, 1994;Knobber et al, 1995). For patients with an isolated finding of SCC in a neck LN, a search for a primary carcinoma in the upper aerodigestive tract is mandatory, including US, MRI and CT, as well as extensive biopsies of the base of tongue, nasopharynx and tonsillectomies in the case of clinically occult tumours (Spiro et al, 1983;Flanagan et al, 1994). This clinical practice has provided overwhelming evidence in recent years that isolated cystic SCC in neck LN are metastases from primary SCC of the palatine tonsils, the base of the tongue and the nasopharynx, tissues also collectively referred to as the Waldeyer's ring (Micheau et al, 1974(Micheau et al, , 1990Flanagan et al, 1994;Thompson and Heffner, 1998). Although this explanation has been slow to gain wide recognition and claims of the first true 'branchiogenic carcinoma' have been made rather recently (Micheau et al, 1974;Jones et al, 1993), cystic SCC in cervical LN is now regarded as a typical presentation of metastatic SCC arising in the oro/nasopharynx. At the same time, the idea of a primary branchiogenic carcinoma has become a vanishing concept (Thompson and Heffner, 1998). Despite the body of literature about this topic, there is little information regarding the frequency of cystic LN metastases from SCC of the Waldeyer's ring. Our goal was to establish the frequency of cystic LN metastases in our series of 123 patients with SCC of Waldeyer's ring origin who had been treated primarily surgically along with neck dissections. Furthermore, we discuss the morphological features and clues for establishing a diagnosis of cystic LN metastases rather than 'branchiogenic carcinoma'. 1984 and 1997, 108 patients with biopsy-proven SCC of Waldeyer's ring origin underwent neck dissections at the ORL Department of the University Hospital in Graz, Austria. Fifteen patients were treated at the Elisabethinen Hospital, Graz, Austria, between 1992 and 1997. Archival formalin-fixed, paraffinembedded haematoxylin and eosin (HE) stained sections of all primary SCC and their corresponding neck dissections were reviewed. SCC were separated into (1) tonsillar origin (palatine tonsil), (2) base of tongue origin and (3) nasopharyngeal origin. Extensive tumours involving the entire oropharynx, and multiple or synchronous intraoral carcinomas were not included in this study, because we were not able to determine the exact origin of the SCC in these cases. Initial diagnosis was established by biopsy and fol...

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The development of the paranasal or accessory sinuses begins very early in utero. In the newborn the ethmoidal sinus, which gives rise to all the other sinuses, as well as the maxillary sinus, can already be identified on x-rays. The frontal sinus appears as a triangle at the age of four and oversteps the supraorbital margin at the age of six. The sphenoidal sinus begins to excavate the concha sphenoidalis at the age of four and can be seen on x-rays at the age of eight, when it extends to the hypophyseal fossa. In the twelve-year-old child all sinuses almost reach their final sizes. However, the size and shape of all sinuses, particularly of the frontal and the sphenoidal sinuses are very different.

Although systemic absorption of locally injected vasoconstrictors occurs, adrenaline-related side effects during FESS are extremely rare when the patient is monitored exactly.

We present 14 patients with primary sinonasal melanomas (SM) identified from 1984–1997 in our archives (11/14 lateral nose, 1/14 nasal septum, 2/14 paranasal sinuses; 8M/6F, mean age 67.7 years, range 39–88 years). Survival was poor (median 9 months) with death related to extensive local disease and/or widespread hematogenous metastases. The following histological subtypes were identified in descending order: amelanotic small blue cell, pleomorphic, epithelioid, spindle cell and myxoid. High mitotic rate and vascular invasion, absence of tumor‐infiltrating lymphocytes and regression were features shared by all SM. Negative staining of B‐ and T‐cell markers, LCA, neuroendocrine markers such as NSE, chromogranin and synaptophysin, and CK‐negativity excluded olfactory neuroblastoma, small cell undifferentiated carcinoma, and lymphoma. S‐100 protein was expressed in all SM, but demonstrated variable staining intensity with areas of complete negativity. HMB45 was strongly and uniformly (>80%) expressed in all undifferentiated small blue cell SM. The pigmented SM were predominantly HMB45‐negative. The strong HMB45 staining in amelanotic small blue cell SM is explained by the reaction of HMB45 antibody with an oncofetal antigen found in immature melanosomes. In these poorly differentiated amelanotic malignant melanomas, antibody to HMB45 proved to be a superb diagnostic marker. We therefore strongly advocate the inclusion of HMB45 antibody in the panel of antibodies for initial work‐up of undifferentiated mucosal neoplasms, since a negative S‐100 stain in small biopsy material may result in incorrect classification of these neoplasms.

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