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Recurrent ameloblastoma with skull base invasion is a rare clinical entity with poor prognosis. We report a case of a mandibular ameloblastoma recurrence involving the anterior skull base. The diagnostic and therapeutic processes are presented with emphasis on the radiologic features of ameloblastoma. Another aim of this case report is to underline the importance of close and long-term follow-up after resection. Ameloblastoma recurrences are frequent and mainly occur after incomplete surgical resection. These recurrences may be diagnosed late because of lack of symptoms in the mandibular area.

Introduction: The aim of our study was to analyze a series of patients from our institution who underwent surgery for head and neck cutaneous melanoma and who received sentinel lymph node biopsy (SLNB)., Material and Methods: A single-center observational cohort of 120 head and neck melanoma patients was investigated from 2002 to 2011., Results: Among the 107 patients (89.2%) with lymph node identified during lymphoscintigraphy, at least one node was collected and analyzed in 96 patients (90.6%). A positive sentinel lymph node was found in 9.4% of patients. Our data showed higher failure rate of lymphoscintigraphic identification (11.7%), lower rate of SLN positivity (9.4%), and higher false-negative rate of SLNB (24.1%) than the usualfigures established for malignant melanomas in other locations. After a mean follow-up of 38.1 months, the disease-free survival (DFS) rate in the positive SLN group was 53% vs 75% for the negative SLN after 2 years of follow-up and 53% vs 48% after 5 years (p = 0.44)., Conclusion: The complexity of lymphatic drainage and the anatomy of the cervical region probably accounts for a specificities which result in a lower predictive value of SLNB in head and neck melanoma than in MM in other locations.

Introduction: Merkel cell carcinoma (MCC) is a rare neuroendocrine skin tumor. The aim of our study was to analyze the prognosis of patients operated on for CCM and having no lymph node involvement after analysis of sentinel lymph node (SLN)., Material and Method: This was a retrospective study of 10 cases of CCM stage I or II who received the SLN technique in our institution between 2003 and 2010. RESULTS Among the 10 patients, 7 had an identification of at least one SLN, among which the node could be surgically removed in 6 cases. In cases of failure of SLN technique, a neck dissection +/- parotidectomy was performed. No lymph node metastasis was found in our series. Mean follow-up was 38 months. The overall survival rate was 100% at 2 years and 50% at 5 years. The Disease-free survival was 85% at 2 and 5 years., Conclusion: Our results show that the technique of sentinel lymph node is a reliable tool for evaluating nodal status of patients with CCM and that pN0 patients have a good prognosis.

Objectives: Unlike Aspergillus sinusitis, sinus infections by mucormycosis are often invasive and have a lethal potential. We report two cases of chronic sinusitis with unilateral uncomplicated diagnosis of mucormycosis confirmed by pathology or mycology and discuss the therapeutic strategy., Presentation: Case 1) An immunocompetent patient with a right chronically sphenoid sinusitis uncomplicated underwent endonasal surgery in our institution. Rhizopus Oryzae was found on the surgical mycological specimen. The patient received no adjuvant medical therapy after surgery, because there were no invasive clinical or radiological criteria and no histopathological confirmation. Clinical, radiological and mycological follow-up was done. Case 2) A patient with a chronic maxillary sinusitis underwent endonasal surgery in our institution. Histological analysis found filaments in favor of mucormycosis without vascular emboli. We decided in agreement with the national reference center for mycology not to treat medically., Conclusion: A follow up of more than 3 years for both cases tends to confirm this collective decision.

Introduction: Mucoepidermoid carcinoma (MEC) is considered as the most common malignant salivary gland tumor. Its prognosis is dominated by the presence of high-grade forms involving life-threatening. The aim of our study was to evaluate the usefulness of immunohistochemistry to identify the most aggressive forms and allow better discrimination between low grade, intermediate grade and high grade tumors., Materials and Methods: This was a retrospective study of 49 cases of mucoepidermoid carcinomas of salivary glands. Two immunohistochemical markers have mainly been studied: a marker of proliferation (Ki-67) and a growth factor receptor (EGFR). Additional analyzes were performed with other markers (p53, ACE, bcl2, CD 117 and her2). Statistical analysis investigated the existence of a correlation between the presence of these factors and the histopathological grade on one hand and survival of patients on the other hand., Results: Regarding the results of immunohistochemical Ki-67 and EGFR, it was observed a better survival rate when the immunostaining was less than 10%. The expression of Ki-67 and EGFR was correlated with the histological grade, but did not, in our study, allow discrimination between low-grade, intermediate grade and high grade. Our results are consistent with data of the literature, including Ki-67, which appears to be a useful but not powerful marker of prognosis of MEC. Other markers studied (p53, ACE, bcl2, CD 117 and her2) showed no contributory results., Conclusion: The prognosis of MEC is appreciated satisfactorily following histological criteria: histological grade, surgical margins, perineural invasion or vascular emboli. The integration of immunohistochemistry in a therapeutic algorithm could be particularly useful for the challenging assessment of prognosis of intermediate grades.

Objective: To define indications and limitations of Functional Endoscopic Sinus Surgery (FESS) for mucoceles therapeutic management., Patients and Methods: 52 cases of mucoceles were treated in our institution during the 8-year period 1993-2001. All patients underwent follow-up for a minimal period of 4 years, with a clinical (endoscopy) and imaging assessments, in order to diagnose recurrences., Outcomes: Distribution of mucoceles location was: fronto-ethmoid sinus (25 cases), maxillary sinus (10 cases), anterior ethmoid sinus (3 cases), posterior ethmoid sinus (8 cases), sphenoid sinus (4 cases) and nasal cavity (2 cases). Thirty eight patients had undergone a nasal (1 septoplasty, 2 rhinoplasties) or sinusal surgery in their history. Recurrences were reported in 2 cases (3.8%). These 2 patients presented primarily with nasal polyps (nasal polyposis or cystic fibrosis) and both recurrences involved fronto-ethmoid sinuses., Discussion and Conclusion: Mucoceles involve quite commonly the maxillary sinus and the frontoethmoid sinus. Exclusive FESS with large opening of the mucocele (marsupialization) is an efficient therapeutic procedure. FESS procedure should be a procedure of first choice for mucocele management as it is highly efficient and has a low morbidity. Nevertheless, latero-frontal sinus mucoceles might be difficult to cure with FESS. Recurrences most likely occur in patients with associated ethmoidal inflammatory diseases.

Objective: To define clinical, histological and radiological features of sinonasal hemangiopericytoma (SNHPC) and to describe its therapeutic management., Patients and Methods: A case of SNHPC (47 year old man) of the left nasal cavity underwent endoscopic sinus surgery at our institution. This case is reported and discussed with a review of the literature., Discussion: SNHPC is a low grade malignant vascular tumour. The intra-nasal location is very rare. This unusual tumour of the nasal cavity has a specific clinical behaviour and prognosis. Diagnosis is confirmed by histological studies with immunohistochemical methods. Vimentin and SMA markers are reported positive in 98% and 92% of cases, respectively. Work up includes MRI and CT scan in order to assess the tumour extent. Angiography is useful to assess the vascularization and preoperative embolization reduces the intra-operative bleeding of large tumours. The gold standard treatment is surgery and the aim is to perform a wide excision with tumour free margins. Surgery can be performed by endoscopic techniques in patients without extra-nasal extension. Radiotherapy is advised for cases of suspect or positive margins. Post-treatment follow up focuses on lifelong endoscopic surveillance. Metastases are rare but recurrences can occur many years postoperatively. The treatment of recurrence is also surgical.

Purpose: Nasal polyposis is an invading disease whose evolution is dominated by functional symptoms. The aim of this study was to evaluate in cortico-resistant patients with nasal polyps the pre-operative functional symptoms in order to define factors that might increase them., Methods: 403 patients were included in this study. All of them met the inclusion criteria of follow-up and initial examination. Anosmia, pain, nasal obstruction, rhinorrhea and sneezing were evaluated by patients themselves. Radiological data, respiratory function test results and histological data were matched., Results: In our series, functional symptoms were dominated by anosmia, nasal obstruction and rhinorrhea. Pain and sneezing appeared to be less frequent. Analysis of co-variables allowed us to define factors which increased pre-operative functional symptoms. Some of them are well known (such as Fernand-Widal triad or stage 3 nasal polyposis), while others appear new or surprising. The same is true for frontal sinus involvement on CT-scan and glandular hyperplasia on histological study., Conclusion: Analysis of the complete clinical, radiological and histological picture has allowed us to emphasise the importance of certain factors on the functional symptoms of 403 patients with polyps of the nose and sinuses, resistant to steroid treatment. The same is true for Widal's disease, for a higher endoscopic grading, for frontal sinus involvement, and for histological evidence of glandular hyperplasia.

Introduction: Pleomorphic adenoma is a common and benign tumour, originating from sero-mucous glands. Location in the nasal cavity and particularly on the medial wall of the maxillary sinus is very rare., Patients and Methods: One patient with a pleomorphic adenoma of the nasal cavity and a review of literature are reported in order to describe the diagnostic and therapeutic management of this tumour., Results: A 63-year-old woman was referred to our institution for evaluation of an unilateral nasal tumour. Clinical and radiological studies revealed an intra-nasal tumour, slightly lytic in nature, arising from the mucosa of the medial wall of the maxillary sinus. More than 2 years after complete excision of the tumour using an endoscopic procedure, the nasal cavity was free of tumour., Discussion: Pleomorphic adenoma of the nasal cavity is a rare and benign tumour, usually presenting as a unilateral nasal tumour. Prognosis of this tumour is mainly linked to recurrences in cases of incomplete resection and to possible metastasis, such as an eventual malignant evolution. The gold standard treatment is complete surgical resection. After a complete imaging study for patient selection (CT scan and MRI), endonasal endoscopic surgery seems to be a reliable therapeutic treatment., Conclusion: Intra-nasal pleomorphic adenoma originates from nasal seromucous glands. Radiological study reveals a slightly lytic tumour developed from the septum of the medial wall of the maxillary sinus. Resecton can be performed with endoscopic endonasal surgery as long as the orbital bony framework and the ethmoidal roof are free of tumour. Whatever technique is employed, long term follow-up has to be used to detect any recurrence.

Though a rare lesion, non-functioning parathyroid cyst is of clinical significance because it usually mimics a thyroid nodule. The cyst can be ectopic in location and therefore constitutes a differential diagnosis to a bronchial or thymic cyst. Two recent cases of non-functioning parathyroid assay are reported. Needle puncture with estimation of the level of parathyroid hormone in the aspirate allows the diagnosis to be made before surgery.

Purpose of Study: To establish a diagnosis and therapeutic management in patients with extramedullar plasmocytomas., Method: There is no consensus concerning extramedullar plasmocytoma treatment. One patient with a nasal cavity tumor location and a review of literature are reported., Results: Extramedullar plasmocytoma is a rare tumor that occurs most frequently in the upper respiratory tract. The most common location is the nasal cavity. Diagnosis can only be made after histological and immunohistochemical examinations. Localized tumors are treated by radiation therapy, combined or not with surgery. Disseminated diseases are treated by chemotherapy., Conclusion: Diagnosis can only be confirmed after the exclusion of a systemic disease (multiple myeloma).

CT scanning has become the major investigation for sinusitis which is not acute, but chronic. It is a good diagnostic tool, but also allows follow-up assessment of progress, and preoperative evaluation of particular problems related to abnormalities or anatomical variations. MRI scanning has a lesser place, and is most useful in evaluating certain types of pseudo-tumorous sinus conditions, or excluding local complications (in the anterior cranial fossa or orbit).

Inferior turbinate surgery has been proposed as a treatment modality in severe childhood hypertrophic rhinitis refractory to medical treatment. The authors present a series of 38 children treated in the otorhinolaryngology department of the Timone University Hospital, Marseille, and the Rangueil University Hospital, Toulouse. Thirty eight children between 9 and 16 years of age (27 males and 11 females) underwent a bilateral inferior turbinectomy, and followed-up for a period of 6 months to 4 years. Allergy was fund in 19 patients, asthma in 11 patients, and an underlying sinus pathology associated in 9 patients. Turbinate surgery was isolated in 16 cases, and in 22 cases, it was associated with an adenoidectomy, a septoplasty, and/or an ethmoidectomy. The authors discuss the operative indications, and describe the turbinectomy technique in children. Post-operative complications are rare (no crusting rhinitis, one non symptomatic synechia). One case of nasal bleeding was noted after nasal packing removal. Functional obstructive symptoms were improved in near 90% of cases. Asthma was improved or disappeared in 27.3% of cases, and no cases of worsening asthma was noted. The authors conclude that this type of turbinectomy is efficient and non-iatrogenic when a precise indication and a rigorous technique are applied.

The authors report on 11 cases of congenital cholesteatomas, treated between 1979 and 1988. In all cases, there was a long-standing history of deafness. The diagnosis revealed 6 cophoses, 5 cases of mixed deafness, 9 cases of impairment of the facial nerve (7 cases of paralysis including 4 with sudden onset and 2 hemispasms), 2 facial neuralgias with facial hypesthesia, one Gradenigo-Lannois syndrome, 2 leaks of the C.S.F. (1 nasal, 1 very abundant auricular leak). In 6 cases, the surgical approach route was trans-cochlear, and in 5 cases surpa-petrosal, two of which were extended to a petrectomy. Of the 5 cases of partial deafness, only one was preserved. In 5 cases, the facial nerve was destroyed at the level of the ganglion of the facial nerve, a region where a frankly epidermal tissue is always found. In 4 cases the facial nerve was repaired (three hypo-glosso-facial anastomoses and one end-to-end suture, after re-routing). The authors share the opinion of Fisch that the origin of the intra-petrosal congenital cholesteatoma always occurs at the level of the ganglion of the facial nerve.