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Endoscopic management of solid sphenoid sinus lesions
Otolaryngology– Head and Neck Surgery Volume 129 Number 2
P133 Endoscopic Management of Solid Sphenoid Sinus Lesions Andrew David Sheppert MD (presenter); Rick A Fornelli MD Morgantown WV; Erie PA
Objectives: Although sphenoid sinus opacification due to routine sinusitis is common, sphenoid opacification with radiological solid tissue characteristics is uncommon and presents a unique diagnostic and clinical challenge. Although headache and eye pain are sometimes described with acute infection, diplopia has not been previously described due to a sphenoid mass. Three cases of a solid sphenoid mass treated with endoscopic resection are presented, each resulting in unusual pathology. Methods: Three case reports. A 49-year-old male, a 38year-old female, and a 67-year-old male each presented with a unilateral sphenoid mass. Each underwent endoscopy and imaging with CT scans (provided). The decision to proceed with endoscopic surgery for definitive diagnosis and treatment was made. Pathology slides are reviewed (provided). Results: For the three cases, pathologic evaluation revealed inverted papilloma, nasal schwannoma, and mycetoma of the sphenoid sinus, respectively. Each case was treated by endoscopic transnasal resection. Conclusion: Inverted papilloma, schwannoma, and myce-
P255
toma are rare lesions of the sphenoid sinus. However, each has characteristic preoperative findings with imaging studies (CT/MRI) and endoscopy that should alert the clinician to include these lesions in a differential diagnosis. One patient had ophthalmologically documented diplopia which resolved soon after surgery, a symptom not previously reported in the literature due to isolated sphenoid disease. The symptomatic presentation, clinical workup (including endoscopy and imaging), pathology (micro-photographs and special stains), and treatment are presented for each case. An algorithm and differential for approaching the solid, unilateral sphenoid mass are presented. P134 Subdural Empyema as a Complication of Sinusitis in a Pediatric Population Huma A Quraishi MD (presenter) Newark NJ
Objectives: Subdural empyema comprises 33% to 50% of all intracranial complications of sinusitis and still results in significant morbidity and mortality. In spite of the liberal use of antibiotics by primary care physicians, the significance of persistent headache and fever in the adolescent male population is often overlooked. We present our case series of intracranial complications of sinusitis in a pediatric inner city population. Methods: Retrospective chart review with review of literature. Pediatric patients admitted to University Hospital in Newark from 1996-2001 with intracranial complications of sinusitis comprised the study population. Results: Five patients presented with subdural empyema and one with cavernous sinus thrombosis. The mean age was 13.6 years. Five patients were male. Only 2 patients presented with nasal symptoms. All patients presented with fever and headache. Three patients had headache and non-specific complaints for 1 month with acute exacerbation of headache and onset of focal neurological signs within 3 days of admission. Four patients had received prior antibiotics. Two patients were unresponsive on presentation. One expired shortly after arrival to the hospital and was diagnosed with subdural empyema on autopsy. Conclusion: Intracranial complications of sinusitis carry a significant mortality, 17% in our series, and have a male predominance. Symptoms can be present from days to months. The most common presenting symptoms are fever and headache. Adolescent males with these symptoms warrant aggressive management and close follow-up. P135 Lipoid Proteinosis (Urbach-Wiethe’s Disease): Otorhinolaryngologic Manifestations Jose Antonio Pinto MD (presenter) Sao Paulo Brazil
POSTERS
Objectives: Rhabdomyosarcoma is most commonly a malignancy of childhood. Cases of adult rhabdomyosarcoma have been reported, yet no conclusive treatment protocol exists with regard to treatment in adults. The purpose of this paper is to review the literature on adult head and neck rhabdomyosarcomas along with a case presentation to formulate trends in diagnosis and management of adult rhabdomyosarcoma. Methods: A Medline review of literature was performed to find all reported head and neck cases of adult rhabdomyosarcomas. The authors’ own case was also incorporated to review tumor characteristics, treatments, and follow-up data. Results: 32 cases of adult rhabdomyosarcomas were found in the literature review and authors’ population with ages ranging from 18 to 72 years. These cases were organized according to subsite of involvement, management modalities, and patient follow-up. Meta-analysis revealed some trends in treatment. Surgery, radiation therapy, and chemotherapy were all employed in patient treatments with limited follow-up data. Conclusion: Rhabdomyosarcoma of the head and neck is a rare malignancy in adults. Due to the aggressive nature of the disease and relatively poor outcomes, no definitive treatment has been formulated. While the treatment options for patients need to be chosen on an individual basis, the use of radiation therapy and surgery when able to be employed should dictate management.
Scientific Posters
P133 Endoscopic Management of Solid Sphenoid Sinus Lesions Andrew David Sheppert MD (presenter); Rick A Fornelli MD Morgantown WV; Erie PA
Objectives: Although sphenoid sinus opacification due to routine sinusitis is common, sphenoid opacification with radiological solid tissue characteristics is uncommon and presents a unique diagnostic and clinical challenge. Although headache and eye pain are sometimes described with acute infection, diplopia has not been previously described due to a sphenoid mass. Three cases of a solid sphenoid mass treated with endoscopic resection are presented, each resulting in unusual pathology. Methods: Three case reports. A 49-year-old male, a 38year-old female, and a 67-year-old male each presented with a unilateral sphenoid mass. Each underwent endoscopy and imaging with CT scans (provided). The decision to proceed with endoscopic surgery for definitive diagnosis and treatment was made. Pathology slides are reviewed (provided). Results: For the three cases, pathologic evaluation revealed inverted papilloma, nasal schwannoma, and mycetoma of the sphenoid sinus, respectively. Each case was treated by endoscopic transnasal resection. Conclusion: Inverted papilloma, schwannoma, and myce-
P255
toma are rare lesions of the sphenoid sinus. However, each has characteristic preoperative findings with imaging studies (CT/MRI) and endoscopy that should alert the clinician to include these lesions in a differential diagnosis. One patient had ophthalmologically documented diplopia which resolved soon after surgery, a symptom not previously reported in the literature due to isolated sphenoid disease. The symptomatic presentation, clinical workup (including endoscopy and imaging), pathology (micro-photographs and special stains), and treatment are presented for each case. An algorithm and differential for approaching the solid, unilateral sphenoid mass are presented. P134 Subdural Empyema as a Complication of Sinusitis in a Pediatric Population Huma A Quraishi MD (presenter) Newark NJ
Objectives: Subdural empyema comprises 33% to 50% of all intracranial complications of sinusitis and still results in significant morbidity and mortality. In spite of the liberal use of antibiotics by primary care physicians, the significance of persistent headache and fever in the adolescent male population is often overlooked. We present our case series of intracranial complications of sinusitis in a pediatric inner city population. Methods: Retrospective chart review with review of literature. Pediatric patients admitted to University Hospital in Newark from 1996-2001 with intracranial complications of sinusitis comprised the study population. Results: Five patients presented with subdural empyema and one with cavernous sinus thrombosis. The mean age was 13.6 years. Five patients were male. Only 2 patients presented with nasal symptoms. All patients presented with fever and headache. Three patients had headache and non-specific complaints for 1 month with acute exacerbation of headache and onset of focal neurological signs within 3 days of admission. Four patients had received prior antibiotics. Two patients were unresponsive on presentation. One expired shortly after arrival to the hospital and was diagnosed with subdural empyema on autopsy. Conclusion: Intracranial complications of sinusitis carry a significant mortality, 17% in our series, and have a male predominance. Symptoms can be present from days to months. The most common presenting symptoms are fever and headache. Adolescent males with these symptoms warrant aggressive management and close follow-up. P135 Lipoid Proteinosis (Urbach-Wiethe’s Disease): Otorhinolaryngologic Manifestations Jose Antonio Pinto MD (presenter) Sao Paulo Brazil
POSTERS
Objectives: Rhabdomyosarcoma is most commonly a malignancy of childhood. Cases of adult rhabdomyosarcoma have been reported, yet no conclusive treatment protocol exists with regard to treatment in adults. The purpose of this paper is to review the literature on adult head and neck rhabdomyosarcomas along with a case presentation to formulate trends in diagnosis and management of adult rhabdomyosarcoma. Methods: A Medline review of literature was performed to find all reported head and neck cases of adult rhabdomyosarcomas. The authors’ own case was also incorporated to review tumor characteristics, treatments, and follow-up data. Results: 32 cases of adult rhabdomyosarcomas were found in the literature review and authors’ population with ages ranging from 18 to 72 years. These cases were organized according to subsite of involvement, management modalities, and patient follow-up. Meta-analysis revealed some trends in treatment. Surgery, radiation therapy, and chemotherapy were all employed in patient treatments with limited follow-up data. Conclusion: Rhabdomyosarcoma of the head and neck is a rare malignancy in adults. Due to the aggressive nature of the disease and relatively poor outcomes, no definitive treatment has been formulated. While the treatment options for patients need to be chosen on an individual basis, the use of radiation therapy and surgery when able to be employed should dictate management.
Scientific Posters