[Technical aspects in endoscopic surgery of frontal mucopyocele]

The term mucocele is applied to define a chronic, expanding, mucosa-lined lesion of the paranasal sinus characterized by mucous retention that can be infected becoming a mucopyocele. Until recently the majority of patients with frontoethmoidal mucoceles were treated through an external approach, however, selected cases of mucoceles can be approached endoscopically, decreasing the morbidity associated to external approaches. We report the case of a frontal mucopyocele with rapid expansion and erosion of the anterior wall. Surgical aspects and postoperative follow-up are described.

Solitary fibrous tumour of the nasal cavity and paranasal sinuses

OBJECTIVE

Solitary fibrous tumour (SFT) is an uncommon unilateral benign lesion that usually arises from the pleura. Recently, SFT has been described in many other locations, such as the mediastinum, head and neck, orbit and urogenital system. To date, only 21 cases of SFT arising from the nasal cavity and paranasal sinuses have been reported in the literature.

MATERIAL AND METHODS

We describe a case of SFT localized in the right nasal cavity with extension to the right ethmoid and sphenoid sinuses in a 43-year-old man who presented with a 6-month history of unilateral right-sided nasal obstruction, rhinorrhoea and recurrent epistaxis.

RESULTS

CT showed a large mass arising from the right anterior ethmoid and sphenoid sinuses. Histopathologically, the lesion consisted of a non-encapsulated mass with spindle-shaped cells within a collagenous stroma. Definitive diagnosis was obtained by means of immunohistochemical analysis, which showed vimentin and CD34 cells.

CONCLUSION

The tumour was removed by endoscopic sinus surgery, and the patient remained free of tumour after 12 months of follow-up.

Cavernous haemangioma of the internal auditory canal

Cavernous haemangioma is a rare neoplasm that can be easily misdiagnosed as acoustic neuroma when it occurs in the internal auditory canal (IAC) or cerebello-pontine angle. A right cavernous haemangioma is reported in a 61-year-old male. The lesion was associated with non-pulsative tinnitus, deteriorating hearing loss and facial nerve dysfunction (House and Brackmann grade IV). A T1-weighted Gd-diethylenetriaminepentaacetic acid-enhanced MRI scan demonstrated a small hyperintense lesion confined to the right IAC. The tumor was completely resected via a retrosigmoidal approach. Histologic examination demonstrated a vascular tumor composed of an irregular, dilated vascular space with collagenous walls lined by a vascular endothelium. Facial nerve function remained unchanged and the patient remained well with no evidence of recurrence 2 years after surgery. We conclude that progressive hearing loss associated with facial nerve dysfunction, particularly when the lesion in the IAC is small, should raise the possibility of cavernous haemangioma.

[Sino-nasal endoscopic surgery in fungal sinusitis. Our experience]

Fungal sinusitis is a rare entity which has increased amongst immunocompromised individuals. Records of thirteen patients treated of fungal sinus disease between 1995 and 2001 were reviewed. Histopathological studies demonstrated infection due to Aspergillus in eight patients and due to Mucormycosis in five patients. The surgical debridement via endoscopic sinus surgery was the essential part of the management. The follow-up is 12-72 months (mean 29.08). The main clinical findings and a review of the literature are presented. We conclude that endoscopic sinus surgery is the treatment of choice for fungal sinusitis except in advanced cases of mucormycosis in which a combined approach is still necessary together with intravenous antifungal drugs (amphotericin B).

Percutaneous endoscopic gastrostomy in head and neck cancer patients

OBJECTIVE

To present our experience with the indications and complications of percutaneous endoscopic gastrostomy (PEG) in head and neck cancer patients.

MATERIALS AND METHODS

In a retrospective study of the patients treated, we reviewed the records of 43 patients diagnosed with head and neck cancer at the Otorhinolaryngology Department, in which a PEG was performed by the Unit of Digestive Endoscopy.

RESULTS

All cases had squamous cell carcinoma. Larynx was the most frequent primary site, with 21 cases (49%), followed by hypopharynx, 12 patients (28%). Indications for PEG were: dysphagia (53.5%) and pharyngocutaneous fistula (43.5%). The most frequent complication was a local infection.

CONCLUSION

PEG is a good choice for long-term enteral feeding in head and neck cancer patients due to its low complication rate and easy handling.

Treatment of rhinocerebral mucormycosis by combination of endoscopic sinus debridement and amphotericin B

Rhinocerebral mucormycosis (RCM) is an aggressive fungal infection with a high mortality rate. It frequently develops in patients with uncontrolled diabetes mellitus or immunocompromised patients. RCM typically presents in a rapidly fulminant manner with headache, fever, mucosal necrosis, and ophthalmic symptoms. Although the definitive diagnosis is achieved by histopathological examination, computed tomography (CT) scanning and magnetic resonance (MR) are the best imaging procedures in early diagnosis to assess the extent of the disease.

[Jugular vein thrombosis: report of six cases]

Venous thrombosis in superior extremities and neck represent less than 5% of the total of venous thrombosis. Internal jugular vein thrombosis is associated with intravenous drug abuse, long term venous catheterization, local infection or spontaneous occlusion. The clinical findings are cervical swelling, progressive inflammatory signs overlying sternomastoid muscle, and an important functional limitation. Diagnosis is confirmed by cervical ultrasounds and contrast-enhanced computer tomography. Usual treatment involves anticoagulation and antibiotics, surgery is not frequently needed. We described the management and outcome of six cases of internal jugular vein thrombosis.