Huge cholesteatoma presenting as a cerebral abscess

Otolaryngology Head and Neck Surgery Volume 115 Number 2

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Selective Rhinometry: A Method for the Functional Assessment of Stenosis in the Nasal Vestibule MICHAEL DAMM, MD, HANS EDMUND ECKEL, MD, ABDUL ALFAYEZ, MD, and DIRK SCHNEIDER, MD, Koeln, Germany

Scientific Posters

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necessitating m o d i f i c a t i o n of the Sistrunk procedure. Pathologic analysis c o n f i r m e d c o m p l e t e excision of a thyroglossal duct cyst. Postoperative three-dimensional CT reconstruction of the larynx revealed an osseous fusion of the thyrohyoid interval. In a review of the literature, this is the first reported case of a fused thyrohyoid interval. The functional and developmental implications of this unique anatomy will be discussed. The embryology of the thyroid gland and larynx along with the development of thyroglossal duct cysts will be reviewed, and our modification of the Sistrunk procedure will be described.

Objective: Active anterior rhinomanometry (AAR) is the standard procedure in determining nasal resistance. It is routinely used as a diagnostic tool in the preoperative checkup of nasally impaired patients. Conventional AAR allows no selective measurement of the resistance in the nasal vestibule and cavity. The aim of this study was to investigate the influence of a vestibule stent (VS) on the nasal airflow and to evaluate whether data obtained from the measurement with the VS can improve the diagnostic findings of AAR. Methods: To prove the influence of the VS on the nasal airflow, we performed AAR in 20 nasally healthy persons (group 1), in 30 nasally impaired subjects (group 2, suffering from hyperplastic turbinates and/or septum deviations), and 10 patients with stenosis of the nasal vestibule observed during rhinoscopy (group 3) with an without VS. A computer-aided rhinomanometer was used for the measurements. VSs were produced from silicon tubes and individually adapted to the patients' vestibule, ensuring a dilatation between the external ostium and the nasal isthmus. To prove a vestibule stenosis, we compared the airflow increase through the VS of each group at the pressure of 150 Pascal. Results: Patient's acceptance of insertion of VS was high and not linked with pain or bleeding due to the elasticity of the silicon material. The dilatation of the vestibule influenced several rhinomanometric parameters (i.e., the right/ left ratio and the decongestation test). In group 3 the airflow increased significantly higher (292 cm 3) through the VS compared with the remaining subjects (group 1 = 127 cm 3, group 3 = 167 cm3). Furthermore, a good outvote of the VS effect was observed in repeated application in AAR (mean variation, 3%). Conclusion: Stenosis in the nasal vestibule could be proved and measured in AAR by calculating the difference between the nasal flows with and without VS. Data obtained from selective rhinomanometry are helpful in functional assessment of nasally impaired patients, particularly to answer the question of whether the vestibule should be integrated in the operative course.

Congenital cholesteatomas are less common than acquired ones. Cholesteatomas are usually diagnosed in 5- to 10-yearold children and are normally located in the anterior middle ear. They have a strong male predominance, and the symptoms appear in a very early stage. Surgery is the treatment of choice, a c c o r d i n g l y to each case, g o i n g f r o m tympanoplasty to radical mastoidectomy. We present a case of a 29-year-old woman who came to our emergency department with a headache of 4 months' duration followed by a I-week history of retroauricular swelling and fever. She complained of progressive deafness and had no history of otorrhea or otologic infections. The eardrum was found to be normal and intact at the otoscopic examination. The retroauricular swelling was a mastoiditis, complicated with an abscess, which was drained, and a large amount of purulent secretion was found. A C T scan was made and showed a huge image in the middle and posterior fossae, resembling a cerebral abscess. The decision was to make a lateral craniotomy, and the finding was osteomyelitis and an infected giant cholesteatoma, measuring 8.0 • 7.0 x 3.0 cm 3. The inner and middle ear were completely destroyed, as was the mastoid bone. This is a rare case of a congenital cholesteatoma, asymptomatic for more than 20 years, presenting as a cerebral abscess. If not diagnosed in time, this benign lesion can lead to deafness and even more serious consequences, such as brain abscess and even death.

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Fusion of the Thyrohyold Interval in a Patient Wlth a Thyroglossal Duct Cyst: A Case Report SUSAN L. URBEN, MD, and ELIZABETHR. RANSOM, MD, Detroit, Mich.

Nodular Fasciitls Arlslng in the External Audltory Canal ANTON G. C, MILO, MD, DDS, KENNETH VITO, MD, SAM E. KINNEY, MD, and THOMAS W. BAUER, MD, PhD, Cleveland, Ohio

A healthy 35-year-old man presented to the outpatient clinic with a 2-month history of a midline, nontender, nonenlarging cervical mass. Clinical examination was consistent with a thyroglossal duct cyst. On surgical excision an anomalous fused thyrohyoid interval was encountered

Nodular fasciitis is a benign, pseudosarcomatous proliferative lesion of soft tissue most commonly seen in the upper extremities. Its etiology is unknown; however, an episode of trauma can be elicited in 5% to 10% of patients. Only 7% to 20% of these tumors are located in the head and

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Huge Cholesteatoma Presenting as a Cerebral Abscess PRISCILA BOGAR, RENATA CANTISANI DI FRANCESCO, OLAVO DE GODOY MION, and RICARDO FERREIRA BENTO, Aguiar, Spain