Bilateral orbital preseptal cellulitis after combined adenotonsillectomy and strabismus surgery--case report and pathogenetic hypothesis

The first case of bilateral orbital preseptal cellulitis complicating combined adenotonsillectomy and strabismus surgery is reported. The issues of antimicrobial prophylaxis are discussed. The authors speculate about the possible routes of surgical site infection. Transient bacteraemia secondary to adenotonsillectomy may be theoretically a source of distant surgical site infection to the orbit, raising the issue of distant surgical site contamination during multidisciplinary surgery. Combined adenotonsillectomy and eye surgery might benefit from prophylactic systemic antibiotic administration.

Individual differences in prefrontal cortex activity during perception of bitter taste using fNIRS methodology

Although bitter taste has a crucial role in nutrition by preventing the ingestion of toxic foods, there are few studies on bitter taste neuroimaging. To identify cortical areas involved in bitter taste perception and to determine if individual differences in taste sensitivity to 6-n-propylthiouracil (PROP) are represented in the brain by different cortical activation patterns, we examined 48 healthy volunteers using functional near-infrared spectroscopy. Participants rated the perceived intensity of filter paper disks impregnated with PROP and NaCl during the imaging procedure and were then classified as PROP tasters and nontasters. We monitored cortical activity in both the anterior and posterior regions of the dorsolateral prefrontal cortex (DLPFC) and in the ventrolateral prefrontal cortex (VLPFC). No activity was detected in the anterior DLPFC in any of the participants. However, during the administration of PROP, significant cortical activation was detected in the more posterior regions of the left DLPFC and in the left and right VLPFC but only in PROP tasters. PROP nontasters showed no cortical activity in these areas. These data suggest that the prefrontal cortex is involved in the conscious perception of the bitter taste of PROP and that the pattern of activity is consistent with individual differences in the ability to taste this compound. Thus, the PROP phenotype is associated with fundamental differences in cortical taste processing.

Role of the "rooming-in" on efficacy of universal neonatal hearing screening programmes

Sensorineural hearing loss is one of the most common congenital abnormalities in infants and it affects approximately one to two neonates in every 1000 births. Early identification of hearing loss in the newborn is the first step for a successful rehabilitation programme. The introduction of Otoacoustic Emission responses as a useful tool in hearing screening programmes, allowed the identification of hearing loss in the well-baby nursery and in targeted populations of the neonatal intensive care unit. Recently, a new concept of breastfeeding during hospitalization after birth has been developed. Indeed, the so-called "rooming-in" allows a mother to stay with her child in the same room, located in the nursery. This new trend has been developed to avoid any psychological adverse consequences of birth on the child-mother relationship. To enhance how "rooming-in" could affect the Universal Neonatal Hearing Screening (UNHS) programmes, an analysis has been made of the data coming from two maternity wards using different breastfeeding protocols. Data obtained demonstrate a worse performance on obtaining essential benchmark in the UNHS in the maternity ward where rooming-in is adopted (60% of newborns tested). UNHS programme efficacy could be affected by the wider adoption of the "rooming-in" regimen in the maternity wards and early detection of hearing loss revealed by UNHS could be vanished by dispersion of patients. In fact, more data are necessary to evaluate the impact of rooming, even though our data show a worsening in the UNHS results.

Lateral sinus thrombosis as a complication of acute mastoiditis

Lateral sinus thrombosis is a rare complication of middle ear diseases: in children, it is usually related to acute otitis media, but it is also found in adults with chronic otitis. It was more frequent in the pre-antibiotic era and mortality was high. The Authors present a paediatric case of lateral sinus thrombosis in which they describe the clinical approach and related literature.

Lymphangiomas of the head and neck in children

Lymphangiomas are rare benign congenital tumours, involving both the head and the neck and causing obstructing symptoms in the upper airways as well as aesthetic anomalies. In recent years, sclerosing therapy with OK-432 has become the treatment of choice in the management of these lymphatic malformations. Nonetheless, surgery still seems to be the therapy advocated for resolution of symptoms. Herein, three cases of lymphangiomas involving the head and the neck are described and a review of the English scientific literature is outlined.

Pneumocephalus and meningitis as a complication of acute otitis media: case report

Otogenic pneumocephalus is a rare condition. The case is described of pneumocephalus and meningitis secondary to acute otitis media. Although the rate of intracranial complications related to middle ear disease is only 0.5 to 4%, mortality still ranges between 5 and 15%.

Mucoceles of the frontal sinus. Clinical and therapeutical considerations

BACKGROUND

Mucocele is an epithelial lined mucus-containing sac completely filling a paranasal sinus and capable of expansion by virtue of a dynamic process of bone resorption and new bone formation. It is the most common lesion causing expansion of the paranasal sinuses. Even though mucoceles of paranasal sinuses are increasingly treated by endoscopic surgery, the external approach with or without the obliteration of the sinus still remains a useful and sometimes the only tool in the treatment of this disease.

METHODS

The results obtained in seven patients observed at the ENT Department of the University of Ferrara (Italy) in the period ranging from 1989 to 1999 are presented; they were affected by massive fronto-ethmoidal mucoceles and treated with the external approach alone or combined with an endonasal approach and osteoplastic flap. They were five males and two females, with a mean age of 56.5 years. Locations were bilateral in one mucocele, while in six patients only one side was involved, with a prevalence of the left frontal sinus (4:2).

RESULTS

No patient showed any local or general complication in the postoperative period. The follow-up showed no recurrence of the disease.

CONCLUSIONS

Since the osteoplastic flap was introduced one hundred years ago, it still remains the optimal surgical treatment for fronto-ethmoidal mucoceles. Even though, today, endoscopic surgery represents the new horizon in the management of the sinonasal disease, mucoceles need a surgical treatment which allows the total vision of the cavity to obtain radical treatment and any recurrence of disease.

Malignant myoepithelioma of the tongue base: case report and literature review

Malignant myoepithelioma is a rare tumor of salivary origin, preferentially located in the parotid and submandibular glands and in the palate. We report the first case involving the tongue base in a 30-year-old man. The histopathological and clinical features and therapeutic options are discussed.

Schwannoma of the parapharyngeal space

A schwannoma (or neurilemmoma) of the parapharyngeal space is a rare tumor in the head and neck region arising from the sheath of cranial nerves and/or the sympathetic chain. In the early stages of growth, there is usually a lack of symptoms because of the anatomical localization and slow growth of the tumor. The large dimension of the mass at presentation makes it difficult to perform a functional surgery, and in many cases the operation worsens the nerve status. The choice of surgical approach is of paramount importance in both preserving nerve function and achieving vascular control. The authors report a case and discuss the English literature.

Normal and altered cytoarchitecture of the inner ear

Scanning electron microscope gave new insights into real morphology of the inner ear and has enhanced basic research. In fact, during the last twenty years, the cellular system that composes the organ of Corti and the vestibular apparatus has been clearly described by many authors. We now have a better understanding of each cell type and that they have a physiological functioning as ear and vestibular system. In addition, new insights into the damage caused by many drugs, such as aminoglucosides, can be investigated by studying the morphological changes and the reparative process following the injury. Animals such as guinea pigs can be used as ideal models to investigate the alterations in the sensory epithelium of the cochlear and vestibular receptors following ototoxic poisoning.