Michelle M. Smith

An Evolution in the Management of Sinonasal Inverting Papilloma

Objective We reviewed the 15‐year experience of our institution (Medical College of Wisconsin, Milwaukee, WI) in managing sinonasal inverting papilloma, examining trends in diagnosis and treatment.

Management of substernal goiter.

Objective: To analyze the presentation, evaluation and treatment of patients with large substernal goiters, with emphasis on the radiographic evaluation and the results of treatment. Study Design: A retrospective chart review of 150 patients undergoing thyroidectomy at the Vanderbilt University Department of Otolaryngology—Head and Neck Surgery. Methods: Charts of patients undergoing thyroidectomy were reviewed. Those with substernal goiter, defined as a major portion of the goiter within the mediastinum, were included in the study. When available, the radiographic studies were reviewed by a staff neuroradiologist. Results: Twenty‐three patients (15.3%) presented with substernal extension of the goiter. Characteristics of these patients included mean age of 59 years, 78% female, symptoms of compression such as dyspnea, choking, and dysphagia (65%), hoarseness (43%), and previous thyroid surgery (30%). Seventeen percent were asymptomatic. Preoperative radiographs demonstrated tracheal compression (73%), tracheal deviation (77%), esophageal compression (27%), and major vessel displacement (50%). Histology revealed multinodular goiter (16/23, 70%), thyroiditis (3/23, 13%), and malignancy (4/23, 17%). The average size of the resected specimen in greatest dimension was 8.0 cm (range, 3.0–14.0 cm) and weighed 148 g (range, 39–426 g). All were successfully approached through a transcervical incision without the need for sternotomy, and total thyroidectomy was performed in 83% of the cases. No major complications have been documented, and no evidence of tracheomalacia was encountered. Conclusion: Despite the large size of these goiters and the significant involvement of the major mediastinal structures, all were approached through the transcervical incision. Further, despite significant tracheal involvement, there were no cases of tracheomalacia or major complications. For intraoperative planning, the authors advocate the routine use of preoperative computed tomography scanning. Laryngoscope, 108:1611–1617, 1998

Coronal computed tomography analysis of frontal cells

Background Described by Schaefer in 1916, frontal cells have been implicated as a cause of frontal recess obstruction. In this cross-sectional study, we determine the prevalence of frontal cells and other anatomic variants and examine their relationships. Methods Coronal computed tomography scans of the sinuses performed from January 2000 to June 2001 were evaluated for frontal cells, other anatomic variants, and sinus disease. Of 1009 scans evaluated, 768 scans were included for data collection. Frontal cells were classified. Results In this population, 20.4% of individuals had frontal cells (14.9% had type I, 3.1% had type II, 1.7% had type III, and 2.1% had type IV). The presence of frontal cells was positively associated with hyperpneumatization of the frontal sinus (p = 0.01) and negatively associated with hypopneumatization of the frontal sinus (p < 0.01). Individuals with frontal cells had an increased prevalence of concha bullosa compared with individuals without frontal cells (41.4% versus 24.1%, p < 0.01). The prevalence of frontal mucosal thickening was increased in individuals with type III and type IV cells compared with individuals without frontal cells (38.5 and 69.0% versus 17.1%, p = 0.04 and p < 0.01). Conclusion The prevalence of frontal cells among a population undergoing sinus computed tomography is 20.4%. Frontal cells are associated with other variants of sinonasal pneumatization and should be suspected when these variants are noted. The presence of frontal cells does not invariably lead to frontal sinusitis but may contribute to the mechanical obstruction of the frontal recess and should be appropriately addressed during the surgical management of frontal sinusitis.

MRI nerve root enhancement in Krabbe disease

Krabbe disease is characterized by abnormal breakdown and turnover of myelin, leading to extensive demyelination in both the peripheral and central nervous systems. A 7-month-old infant with early-onset Krabbe disease had deceptively normal head images, but spinal MRI demonstrated abnormal gadolinium enhancement of the lumbosacral sacral nerve roots and cauda equina such as that seen in Guillain-Barré syndrome. Abnormal enhancement in spinal MRI has not been previously described in patients with leukodystrophies.

External auditory canal eccrine spiradenocarcinoma: a case report and review of literature.

Eccrine spiradenocarcinoma is a rare dermal appendage carcinoma believed to arise from transformation of a long‐standing benign spiradenoma. This tumor demonstrates highly malignant biologic behavior with a high recurrence rate, frequent lymph node metastases, and overall poor survival.

Imaging of the optic nerve and visual pathways

The visual pathway extends from the globes anteriorly to the occipital cortex posteriorly. A wide variety of disease processes may produce visual dysfunction. Because the optic nerve is a fiber tract of the brain covered by meninges, it can be affected by many of the same pathologic processes that occur in the brain and meninges. Physical examination and diagnostic tests of visual function performed by the clinician can frequently identify the anatomic location of the causative lesion in the patient with vision loss. This enables the radiologist to optimize the imaging evaluation of the patient. This article reviews the normal anatomy of the optic nerve and visual pathways, presents computed tomography (CT) and magnetic resonance (MR) imaging techniques for evaluation of these structures, and discusses the pathologic processes intrinsic to the optic nerve and visual pathways.

Bone involvement in chronic rhinosinusitis

The pathogenesis of chronic rhinosinusitis remains poorly understood. The mucosal changes associated with this inflammatory disease have been well studied and described but the underlying bony involvement remains poorly defined. Osteitis and osteomyelitis are terms describing the clinical, pathologic, and radiographic appearance of bone involvement, but no consensus exists regarding the most appropriate terminology. It is still unclear whether bone around the sinuses acts as an innocent bystander becoming secondarily involved in the inflammatory process or whether bone plays a more active role in propagating inflammation.

The role of CT imaging in rhinosinusitis and the need for a standardized CT reading system

Chronic rhinosinusitis is a prevalent disease and a significant cause of morbidity to the patients it affects. The diagnosis of chronic rhinosinusitis is based on the patient’s clinical history, findings on physical examination, and findings on nasal endoscopy. CT scanning of the sinuses has become the standard diagnostic imaging modality for evaluation of chronic rhinosinusitis. CT scanning is an objective means of evaluating the sinonasal cavities for the presence and extent of disease and is helpful in defining the bony anatomy of the sinuses and their drainage pathways. Recent advances in CT technology, including the introduction of helical (spiral) CT and CT computer-assisted techniques for endoscopic surgery, have further aided in the diagnosis and treatment of these patients. The relationship between symptom severity and CT scan findings, however, remains poorly defined. Confusion and frustration among clinicians occur from radiologists’ lack of use of standardized terminology in CT reports and the lack of a standardized method of CT interpretation. This paper reviews the recent literature focused on the role of CT imaging in the diagnosis and follow-up of patients with rhinosinusitis. In addition, suggestions for systematic, quantitative, and consistent CT interpretation are described.

Enlarged vomeronasal organ in a child: imaging findings.

The vomeronasal organ is a special sensory organ that exists in both animals and humans. It is located on the sides of nasal septum and although it involutes with age, occasionally it may be seen in humans. We present the imaging findings in a child with an enlarged nasal septum whose features we believe are compatible with a vomeronasal organ.

Meningitis due to Enterobacter aerogenes subsequent to resection of acoustic neuroma and percutaneous endoscopic gastrostomy tube placement: a rare nosocomial event.

We present a case of meningitis after percutaneous endoscopic gastrostomy (PEG) tube placement subsequent to acoustic neuroma resection and cranioplasty. Four days following PEG tube placement, the patient developed Enterobacter aerogenes meningitis, requiring explantation of infected cranioplasty material. His condition subsequently improved. Etiology and future intervention strategies are discussed.