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Most inflammatory and neoplastic diseases of the ear, nose, nasopharynx, and paranasal sinuses have the capability of intracranial extension. CT is extremely important in defining such lesions, and surpasses complex motion tomography in delineating the extracranial soft tissue involvement and intracranial spread. Trauma can simultaneously affect both intracranial and extracranial compartments but because of its scope, is not dealt with in this submission.

Current generation CT with its high resolution technology, its capability for soft tissue and bone imaging through an expanded gray scale, its feature of thin section imaging (1.5 mm cuts), and its capacity for multiplanar imaging (axial, direct coronal, coronal, and sagittal reformations, etc.) bring a truly unique element to radiologic evaluation of the skull base and basilar foramina. CT modifications continue to develop, such as dynamic scanning. Thus CT provides the possibility of improved radiologic diagnosis in a clinically problematic area--the recognition of occult disease, invariably tumor, involving the skull base, the neurovascular foramina that penetrate it, and portions of the subjacent visceral cranium and the suprajacent brain. The purpose of this manuscript is to demonstrate and define a role for CT in the possible solution of this problem. Equally, a role for the selective and continued use of conventional radiology and other imaging modalities to both guide and complement CT is considered.

Several non-glomus middle ear masses may mimic glomus tumors. Clinical features alone may not be sufficient to differentiate these lesions. Radiography, particularly angiography is valuable in establishing the diagnosis in most cases. In some, however, diagnosis can only be made on tympanotomy. Four case reports are included in which the diagnosis turned out to be hemangioma, meningioma, high jugular bulb, and cholesterol granuloma. Careful assessment of the clinical, radiological, and operative findings is essential in order to avoid serious complications.

Paranasal sinus and related malignancies affect air-containing mucosal-lined bony structures which can only be studied by appropriate radiologic examination. Pre-treatment staging by radiologic study, primarily utilizing tomography with complex motion, is essential for election of proper treatment modalities. It is the purpose of this presentation to define the conventional tomographic and advanced radiologic modalities which can be used in paranasal sinus radiologic examinations. The indications for the studies as well as their limitations are demonstrated. Finally, the role of radiology in post-therapy evaluation is noted.

A rare lesion of the maxillary and ethmoid sinuses, an ossifying capillary hemangioma, is presented. The therapeutic options and our choice of embolization followed one day later by radical surgery under hypotensive, hypothermic anesthesia are discussed. The principles of therapy involved in this lesion apply to the management of any large vascular tumor of the head and neck.