Jane L. Weissman

Head and Neck Space Infections in Infants and Children

A retrospective study was performed in 117 children with head and neck space infections treated at the Childrens Hospital of Pittsburgh from January 1986 through June 1992. Peritonsillar space infections were the most common (49%), followed by retropharyngeal (22%), submandibular (14%), buccal (11%), parapharyngeal (2%), and canine (2%) space infections. The most common pathogens isolated (N = 78) were the aerobes beta-hemolytic streptococcus (18%) and Staphylococcus aureus (18%), the anaerobes Bacteroides melaninogenicus (17%) and Veillonella (14%), and the gram-negative organism Haemophilus parainfluenzae (14%). beta-Lactamase production by aerobic pathogens was detected in 22% of cultures. Computed tomography scans (N = 16) were reviewed in blinded fashion and compared with operative findings. The sensitivity of computed tomography scan in detecting the presence of an abscess vs. cellulitis was high (91%), whereas the specificity was rather low (60%). Treatment of head and neck space infections in children should consist of accurate physical diagnosis aided by imaging studies, empiric antibiotic therapy that covers gram-negative and beta-lactamase--producing organisms as well as gram-positive organisms and anaerobes, and timely surgical intervention, when indicated.

Imaging Findings in Bisphosphonate-Related Osteonecrosis of Jaws

PURPOSE Bisphosphonate-related osteonecrosis of the jaws (BRONJ) is a well-described clinical condition with consistent radiographic findings. The purpose of this report was to review these findings in an attempt to offer important diagnostic, prognostic, and therapeutic information associated with BRONJ. MATERIALS AND METHODS The findings of studies assessing the radiographic landmarks on plain films, intraoral films, orthopantograph, computed tomography, magnetic resonance imaging, and nuclear bone scans in patients with BRONJ were analyzed. RESULTS The radiographic findings in patients with BRONJ include osteosclerosis, osteolysis, dense woven bone, a thickened lamina dura, subperiosteal bone deposition, and failure of postsurgical remodeling. CONCLUSIONS Consistent imaging findings are noted in the BRONJ patient. Imaging is an essential part of the clinical assessment of the BRONJ patient and might be an additional tool for tracking the progression of the disease.

Imaging of the salivary glands

CT and MRI have greatly facilitated evaluation of pathology of the three pairs of major salivary glands and the hundreds of minor salivary glands. Imaging can frequently offer a specific histological diagnosis for benign and malignant neoplasms of the parotid, submandibular, and sublingual glands. Obstruction, infection, autoimmune processes, and congenital anomalies also are readily diagnosed. CT and MRI studies assess the anatomic extent of minor salivary gland neoplasms. Sialography continues to provide useful information about intrinsic abnormalities of the parotid and submandibular ducts.

MRI detection of cervical metastasis from differentiated thyroid carcinoma

Background With the advent of the use of serum thyroglobulin as a marker for the recurrence of well‐differentiated thyroid cancer (WDTC) after total thyroidectomy, clinicians are increasingly faced with the diagnostic dilemma of detecting the site of recurrence in thyroglobulin‐positive patients with normal clinical examinations. The high protein content of this thyroglobulin may make it specifically detectable by magnetic resonance (MR) imaging.

Computer-assisted intraoperative navigation during skull base surgery

PURPOSE In patients with diseases of the cranial base, anatomical landmarks are often obliterated by tumor inflammatory diseases or previous surgery. The surgeon may fail to recognize important anatomical structures or tumor margins, increasing the morbidity of the surgery and downgrading the oncological outcome. MATERIALS AND METHODS The ISG Viewing Wand is an intraoperative navigational device that uses a position-sensing articulated arm linked to a computer that allows the surgeon to correlate the anatomy of the patient with the computerized display of the reformatted images of preoperative computerized tomography or magnetic resonance. We used the ISG system in 20 patients undergoing skull base surgery for the treatment of tumor inflammatory diseases and trauma. RESULTS The use of the ISG wand translated into a decreased need for the resection of vital structures and provided reliable mapping of the boundaries of the paranasal sinuses and tumor margins. CONCLUSION Intraoperative navigation is a promising technology that complements the surgeons interpretation of the surgical field. Further refinements of this technology will ease the incorporation of these intraoperative navigation systems into other surgical procedures.

Hydroxyapatite: An alternative method of frontal sinus obliteration

Obliteration of the frontal sinus may be necessary for the treatment of chronic sinusitis, infectious complications, trauma, and benign and malignant neoplasms. Hydroxyapatite cement (HAC) is a relatively new material that is approved for the repair of cranial defects. HAC has been successfully used to obliterate the frontal sinus in 19 patients with few minor complications and the avoidance of donor site morbidity. Compared with other alloplastic materials, HAC has the advantages of easy use, biocompatibility, and osseointegration.

The radiologic evaluation of tinnitus.

Tinnitus (“ringing in the ears”) is a prevalent symptom in the general population, and often brings patients to medical attention. Many causes of tinnitus are evident radiographically. The most frequently-encountered causes of tinnitus are discussed, and imaging recommendations are provided.

Intranasal endoscopic excision of a juvenile angiofibroma

Intranasal endoscopic excision of a juvenile nasopharyngeal angiofibroma (JNA) was performed in a 13 year old white male. The patient remains disease-free 24 months after the operation. Although endoscopic surgical techniques have been applied to the therapy of some benign nasal tumors, such as inverting papilloma, endoscopic resection of a documented JNA has not been previously reported. This technique is reserved for tumors which are limited to the nasal cavity and paranasal sinuses with minimal extension into the pterygopalatine fossa.

Chondrosarcoma of the nasal septum: Skull base imaging and clinicopathologic correlation

Chondrosarcoma arising in the head and neck and craniofacial region is an uncommon lesion. The nasal septum is a particularly rare site of origin, with approximately 30 cases previously reported in the English literature. We present six new cases of chondrosarcoma arising in the nasal septum. Each of these tumors required cranial base surgical approaches for removal. Current imaging techniques allow a very accurate diagnosis to be made before biopsy. The characteristic ring-forming calcifications seen on computed tomography scans can be correlated with the histologic pattern of calcification. Magnetic resonance imaging techniques allow precise definition of tumor extent, which is particularly important because the disease is best treated with primary surgery. Advances in imaging and surgical techniques allow a much more complete tumor removal. It is hoped that this will increase the likelihood of cure in these patients. Surgical management and indications for adjuvant therapy are discussed.

The Diagnostic Utility of Computed Tomography for Preoperative Localization in Surgery for Hyperparathyroidism

Objectives/Hypothesis: Successful unilateral or minimal‐access parathyroid exploration and reoperative surgery of the parathyroid glands requires accurate preoperative localization of parathyroid disease. Although ultrasound and nuclear imaging techniques have an established role in this regard, the use of computed tomography (CT) for parathyroid exploration is not well understood. The purpose of the present study was to better define the diagnostic utility of CT in preoperative localization of the abnormal gland in surgery for hyperparathyroidism.