Roy A. Holliday

Asymmetry of the Ethmoid Roof: Analysis Using Coronal Computed Tomography†

Objectives/Hypothesis To determine the incidence and degree of asymmetry in the height and contour of the ethmoid roof.

Role of the Agger Nasi Cell in Chronic Frontal Sinusitis

Agger nasi cells contribute to nasofrontal duct (NFD) obstruction and chronic frontal sinus disease. To investigate this relationship, we conducted a review of the surgical outcome and computed tomographic imaging in 26 patients with chronic frontal sinusitis. Coronal and sagittal images were used to delineate the anatomic variability and mucosal disease in the NFD and frontal sinus region. Data from coronal and sagittal images were compared. The results were also correlated with the outcome of frontal sinus surgery in patients with a clinical history of chronic frontal sinus disease. Our data suggest that agger nasi cell pneumatization with narrowing of the frontal sinus outflow tract is a significant cause of persistent frontoethmoid pain and chronic frontal sinusitis. Sagittal reformatted images are more capable than coronal images of demonstrating agger nasi cell encroachment on the NFD, as well as NFD mucosal disease. Endoscopic frontal sinusotomy is an effective treatment for chronic frontal sinus disease.

Preoperative sagittal CT evaluation of the frontal recess.

Endoscopic surgical approaches for chronic frontal sinusitis require the reestablishment of adequate frontal sinus ventilation and drainage for relief of symptoms. After the resection of anterior ethmoid mucosal disease and cellular structure, the anterior to posterior depth of the nasofrontal beak to the base of skull at the insertion of the ethmoidal bulla (frontal sinus ostium) often represents a critical margin for functional success. However, little information concerning this dimension is available. Depending on intraoperative surgical judgment of this distance, extended endoscopic surgical procedures involving additional bone resection may be indicated. These approaches may be hazardous due to the proximity of the cranial cavity and orbit. In addition, secondary stenosis can result from the subsequent inflammatory response. Improved CT imaging, high resolution sagittal reformatting, and computer workstations provide the ability to obtain direct preoperative measurements of the frontal recess. We used a paramedian sagittal section and recorded the maximal anterior to posterior depth from the nasofrontal beak to the base of skull at the insertion of the ethmoidal bulla in 20 patients, 31 sides, undergoing primary endoscopic frontoethmoidectomy. In addition, we found a positive correlation between this distance and agger nasi air cell size measured in the same 31 sides.

Petrous Jugular Malposition (Diverticulum)

Jugular bulb anatomy is variable. A “high-riding” bulb extending into the tympanic cavity is a well-described anomaly. Petrous jugular malposition (diverticulum) (PJMD), however, is rare. The relationship between PJMD and clinical symptoms is questionable because the differentiation between PJMD as an anatomic variant and pathologic process is unproved. A literature review reveals 14 previously documented cases. We report an additional four cases. Diagnostic and management dilemmas are discussed, with the importance of high-resolution CT Stressed.

Recurrent mucormycosis of the paranasal sinuses in an immunologically competent host.

Mucormycosis of the paranasal sinuses usually presents with a fulminant clinical picture, is rapidly progressive and often fatal. This disease process most commonly represents an opportunistic infection that occurs in patients with diabetic ketoacidosis, malignancy, immunosuppressive therapy, or any chronic debilitating disease. We present a case of recurrent paranasal sinus mucormycosis in an immunologically competent host.

Spontaneous Retropharyngeal Emphysema

Spontaneous retropharyngeal emphysema (SRE) is a rare clinical entity where free air is present within the retropharyngeal space with no apparent causes. It is crucial for otolaryngologists to be familiar with the clinical presentation and the differential diagnoses associated with SRE. Air in the retropharyngeal space may precede mediastinitis with disastrous consequences. Prompt investigation is essential in preventing such occurrences. SRE, however, is usually benign and self-limited. Patients typically recover with no sequelae after conservative treatment. A case of SRE is presented. The relevant anatomy, differential diagnoses, clinical presentation, and treatment are discussed herein.

Facial nerve paralysis after pre-operative embolization of a paraganglioma

Vascular tumors pose a challenging problem in treatment, as surgical planning can be extensive. Often times, pre-operative embolization is required to minimize blood loss during surgery. With the advent of new biochemical compounds, embolization modalities have evolved over the past decade. Although rare, side effects and complications of embolic materials have been cited sporadically in the literature. We present an interesting case of a patient afflicted with facial paralysis and other cranial neuropathies following embolization of a paraganglioma, along with the appropriate imaging that confirms the etiology of her paralysis.

Emergencies in AIDS patients: the otolaryngologic perspective.

Otolaryngologists today must be prepared to diagnose and treat the secondary manifestations of AIDS in both routine and emergent settings. The immune deficiency brought on by the AIDS virus may directly or indirectly result in an unexpected course of illness, despite a benign initial presentation. Every organ system can be affected by AIDS and dysfunctions may include blood dyscrasias, respiratory abnormalities, and neoplasia. The otolaryngologic manifestations of these abnormalities require a special concern for the unexpected and unusual directions that these illnesses may take.

Pre-operative chemoradiation for sinonasal undifferentiated carcinoma of the anterior nasal cavity resected through a lateral nasal flap approach ☆

INTRODUCTION Sinonasal undifferentiated carcinoma (SNUC) is an exceedingly rare and aggressive tumor that carries a poor prognosis due to its non-specific presentation and advanced stage at time of diagnosis. Early detection and treatment are vital, with chemotherapy, radiation, and surgery all being viable options. The literature is sparse and there is no consensus for optimal treatment. In surgical candidates, the otolaryngologist must have a vast skill set in order to resect the tumor with wide margins and reconstruct the defect in hopes of returning the patient to their pre-morbid state. METHODS A 74-year-old female presented with a growing left nasal mass which was biopsied and found to be a sinonasal undifferentiated carcinoma originating from the anterior nasal cavity between the septum and upper lateral cartilage. The patient was treated with neo-adjuvant carboplatin with concurrent radiation, followed by resection through a lateral nasal flap. The defect was reconstructed with a contralateral septal hinge flap and septal cartilage graft with primary closure of the lateral nasal flap. RESULTS Intraoperatively, no skin or cartilage invasion was noted and as such, nasal skin was spared and utilized for primary closure. At a follow-up of 3 months, the patient had no evidence of recurrence and had a well healing repair site with satisfactory cosmesis. CONCLUSIONS Despite the aggressive nature of SNUC tumors, neo-adjuvant chemo-radiation and surgical intervention with functionally and aesthetically minded reconstruction can provide patients with improved outcomes and decreased morbidity.

Variable Esophagram Post-Endoscopic Cricopharyngeal Myotomy

OBJECTIVE: 1) To validate the Spanish translation of the disorder-specific health status instrument (Singing Voice Handicap Index, SVHI) for use in patients with singing problems. 2) To determine the SVHI threshold of a healthy population of professional classical singers. METHOD: S-VHI was translated into Spanish from validated version in English. The questionnaire was completed by 29 dysphonic singers and 81 healthy singers between January and December 2009. Test-retest reliability, internal consistency, and construct validity were assessed. RESULTS: Results showed high test-retest reliability (r 0.63, P .000), and high item-total correlation for the Spanish version of the SVHI. Internal consistency demonstrated a Cronbach’s alpha of 0.96, and the correlation between the SVHI and self-rated singing voice impairment was 0.52 (p .000). Dysphonic singers had worse SVHI scores than normal singers (ANOVA, F 10.9, P 002). CONCLUSION: The Spanish version of the questionnaire translated into S-VHI is a validated tool with proper internal consistency and reliability. The average score of the S-VHI singers in healthy singers is 20% of the maximum possible score of the questionnaire, well above the average score in a healthy population for the spoken voice with HIV-specific-30 (6.7%).