Senja Tomovic

High-resolution computed tomography analysis of the prevalence of onodi cells†‡

Onodi cells are the posterior‐most ethmoid air cells that lie superior to the sphenoid sinus. Identification of these cells is essential prior to endoscopic sinus and skull base surgery due to their intricate relationship with the optic nerves and carotid arteries, which may lead to deleterious complications. In this study, high‐resolution computed tomography (HRCT) scans from 170 adult‐patients were analyzed by two independent observers for the presence of Onodi cells.

Management of hyoid bone fractures: a systematic review.

Objective Fractures of the hyoid bone are rare occurrences. They are mainly caused by strangulation/asphyxiation injuries, trauma to the neck, and motor vehicle accidents (MVAs). As a result of their rarity, proper treatment guidelines are not in place for dealing with these injuries. In this study, a systematic literature review was conducted with the goal of identifying optimal management for patients with fracture of the hyoid bone. Data Sources MEDLINE and PubMed databases. Review Methods The MEDLINE and PubMed databases were searched for patients diagnosed with hyoid bone fracture. Further cases were obtained from the bibliographies of relevant articles. Full-text articles were obtained. Patient presentation, method of diagnosis, treatment regimen, and outcomes are discussed. Results Forty-six cases were collected from 36 articles. No randomized controlled trials regarding treatment of hyoid fractures were found. The most common etiologies were MVA, assault, and neck trauma during athletic activities. Most common presenting symptoms included dysphagia, odynophagia, and pain upon neck rotation. Most frequent presenting signs included anterior neck tenderness and swelling. Five cases out of 46 had surgical repair of the fractured hyoid bone. In the remaining 41 cases, 26 were treated with conservative management, which included rest/observation, diet changes, and analgesia, while the other 15 cases required tracheotomy or surgical treatment for related injuries. All patients survived and had excellent outcomes with resolution of symptoms. Conclusion This review shows that direct surgical treatment of hyoid fractures was performed in only 10.9% of cases. Both conservative and surgical management yielded positive outcomes.

Cochlear-facial dehiscence--a newly described entity.

Dehiscence of the cochlear otic capsule has recently been described as a pathologic entity. We describe two cases of cochlear‐facial dehiscence, which are the first reported: a 69‐year‐old male who complained of hearing loss, autophony, and pulsatile tinnitus and a 41‐year‐old female who complained of left‐sided hearing loss, pulsatile tinnitus, and vertigo. In both, computed tomography (CT) showed bony dehiscence between the facial nerve and cochlea. Cochlear‐facial dehiscence is another example of otic capsule dehiscence that produces symptoms of third‐window lesions. When patients present with symptoms of third‐window lesions and CT does not show superior canal dehiscence, cochlear‐facial dehiscence should be considered. Laryngoscope, 124:283–289, 2014

Sinonasal and ventral skull base inflammatory pseudotumor: a systematic review.

Inflammatory pseudotumor is a benign idiopathic inflammatory process often misdiagnosed as an infection or neoplasm. This review analyzes all reported cases of sinonasal and ventral skull base inflammatory pseudotumor to date, and provides a framework for evaluation and management of this uncommon condition.

The central Onodi cell: A previously unreported anatomic variation.

Preoperative recognition of the Onodi cell is necessary to avoid injury to closely associated structures, including the internal carotid artery and the optic nerve. This article describes the central Onodi cell, a variation in which a posterior ethmoid cell lies superior to the sphenoid sinus in a midline position with at least one optic canal bulge. To our knowledge, this anatomic variation has not been previously reported in the literature. Radiographic and endoscopic imaging of this unique variation is provided.

Angiosarcoma arising from the frontal sinus

Primary sinonasal angiosarcomas are very rare tumors. They typically occur in the nasal cavity of middle-aged patients. They are classically highly aggressive. Primary treatment is surgical excision when feasible. We describe a unique case of angiosarcoma in a young woman arising from the frontal sinus with distant metastasis. This case represents the first report of angiosarcoma arising from the frontal sinus in the English literature. The traditional treatment options for the advanced nature of her disease and overall poor prognosis are discussed. We further review the literature and discuss alternative treatments options. Newer chemotherapeutic regiments on the horizon show promise in helping to control this disease.

MRSA Central Skull Base Osteomyelitis and Occipital Condylar CSF Leak

Objective: Community acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) is emerging as an important pathogen in paranasal sinus disease. However, CA-MRSA has been a rarely reported source of central skull base osteomyelitis or a subsequent occipital condylar cerebrospinal fluid leak in an otherwise immunocompetent patient. Method: Case report and current literature review. Results: We report on an unusual case of a previously healthy and immunocompetent adult who developed meningitis, central skull base osteomyelitis, and occipital condylar cerebrospinal fluid rhinorrhea from CA-MRSA sphenoid sinusitis requiring endoscopic surgical repair. Conclusion: The increasing prevalence of CA-MRSA, in conjunction with its potential for intracranial complications, challenges the otolaryngologist to remain vigilant about detecting its possible manifestations. This case clearly demonstrates the expanding spectrum of severe infections caused by CA-MRSA, which requires prompt diagnosis and appropriate medical and/or surgical management.