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In this review we provide comprehensive analysis of the imaging features of diseases affecting the sphenoid sinus, including a large and heterogeneous spectrum of pathologies such as sinusitis, pseudotumours, bony pathologies, and tumours. Clinical symptomatology related to sphenoid pathologies is often non-specific and patient clinical examination and endoscopic investigations are not definitive; thus, radiological imaging is mandatory for diagnosis. Strengths and limitations of both morphological and functional imaging methods such as computed tomography (CT), magnetic resonance imaging (MRI), and combined positron-emission tomography/computed tomography (PET/CT) have been considered and integrated into a well-defined clinical context in order to recognise specific imaging features and to underline their clinical relevance for an early and accurate diagnosis. An overview of several sphenoid conditions is herein selected with a didactic objective including both common and less common diseases.

Aims:Prognosis of ethmoid sinus adenocarcinoma (ADK) is essentially determined by local tumor control. There is a high rate of recurrence of these tumors across the range of patient series. Development of an optimal follow-up protocol of such tumors is recommended.Patients and methods:A retrospective, monocentric study was carried out including all patients diagnosed with ADK who underwent surgery and were followed up at our center between 2012 and 2016 and who were monitored postoperatively using magnetic resonance imaging (MRI) and histopathological verification of suspicious areas identified via imaging. Time to postoperative MRI, time to recurrence and sites of recurrence were obtained for each patient.Objectives:Performance evaluation of MRI in early screening of recurrence or residualtumors postoperatively in the management of ADK and identification of the main sites prone to risk of recurrence in these tumors.Results:We included 24 cases of ADK, there were 33% cases of recurrence with a mean time to recurrence of 35 months postoperatively. Mean time to completion of the first MRI scan was 65 days postoperatively.Performance parameters of screening for recurrence or residual tumors on the first postoperative MRI were:Se 64%; Sp 78%; PPV 69%; NPV 74%.Conclusions: Efficacy of postoperative MRI screening appears to be limited and regular endoscopic monitoring associated with imaging is required. Sites prone to risk should be subject to particular consideration in primary surgical resection and management of recurrence.The benefit of imaging in the immediate postoperative period has yet to be assessed in terms of disease-free survival and disease control.

Resume Introduction Les tumeurs brunes sont des lesions osteolytiques rares dues a une activite osteoclastique accrue, liee a une hyperparathyroidie. Observation Une femme de 37 ans avait une hypercalcemie de decouverte fortuite due a une hyperparathyroidie primaire. Une tomographie par emission de positons au 18F-fluorodesoxyglucose (FDG) retrouvait plusieurs foyers d’hyperfixation du FDG au niveau de multiples lesions osteolytiques maxillaires et mandibulaires bilaterales evoquant des tumeurs brunes. Un orthopantomogramme et une IRM confirmaient radiologiquement cette hypothese diagnostique. Une echographie cervicale et une scintigraphie parathyroidienne etaient en faveur d’un adenome parathyroidien inferieur gauche, confirme apres exerese chirurgicale. Conclusion Les tumeurs brunes maxillaires peuvent etre confondues avec d’autres diagnostics. Notre observation souligne l’importance d’une approche multidisciplinaire clinicoradiologique pour optimiser l’interpretation de l’ensemble des examens d’imagerie disponibles.

Although obstruction of the lacrimonasal duct is a fairly common finding in newborns, development of a dacryocystocele (nasolacrimal duct cyst) is uncommon and is caused by stenosis in the proximal and distal area of the nasolacrimal duct leading to a cystic dilatation. Its diagnosis remains difficult for the pediatrician, the ENT specialist, the ophthalmologist, and the radiologist. The study of six cases of dacryocystocele and the review of the literature led the authors to describe the clinical and radiological features of this uncommon entity. The symptomatology includes nasal obstruction and, when bilateral, significant respiratory distress in the newborn (obligate nose-breather) and dilatation of the lacrimal duct with blue cystic swelling inferior to the medial canthus or with an inflammatory aspect of the lacrimal duct in case of infection. A careful endoscopic examination of the nasal cavities and CT or MRI imaging reveals a cystic tumor, which arises in the inferior meatus, inferolateral to the inferior turbinate, and can partly or completely obstruct the endonasal space, uni- or bilaterally. CT and MRI are equally sensitive in detecting dacryocystocele and are also useful for differential diagnosis for other cystic or tumoral nasal lesions such as meningoencephalocele, dermoid cyst, and glioma. To avoid the risk of potential complications (respiratory distress or even sudden infant death, infectious ophthalmologic complications), this radiological and clinical entity should not be forgotten. Endoscopic marsupialization leads to immediate and definitive healing recovery.

Sinonasal and temporal bone infections may extend to the skull, skull base, meninges, pericerebral spaces, brain parenchyma, dural sinuses, deep cerebral or cortical veins, intracranial arteries and cranial nerves either via contiguous or hematogeneous spread. The site of infection dictates the sites of potential complications: orbital with ethmoid sinusitis, cavernous sinus thrombophlebitis and oculomotor palsies with sphenoid sinusitis, transverse sinus thrombophlebitis with mastoiditis and superior sagittal sinus thrombophlebitis with frontal sinusitis. All may result in brain abscess. Congenital and acquired defects of the skull and meninges, with or without associated meningocele or meningoencephalocele, perilymphatic fistulas, and some anomalies of the inner ear may predispose to the intracranial extension of ENT infections.

Introduction Massage of the lateral pterygoid muscle according to Cyriax's principles is an unrecognized procedure. This procedure was tried on patients presenting with temporomandibular joint dysfunction syndrome. Material and methods Fifteen patients were treated. Pain, joint clicking, measurement of mouth opening, lateral excursion and propulsion were recorded. Assessment was made before and after the massage in the same consultation. Results Joint clicking was solved in 80% and pain in 50% of the cases. Mouth opening increased by 12.8%, propulsion by 11.6% and lateral excursion by 41.3%. Discussion Massage of the lateral pterygoid muscle according to Cyriax's principles is a simple and efficient method that can be recommended for patients presenting with temporomandibular joint dysfunction syndrome. We performed a brief anatomical and radiological MRI study supporting the feasibility of lateral pterygoid muscle palpation.

BACKGROUND AND PURPOSE: Hypoattenuated foci in the otic capsule are routinely identified on multidetector CT (MDCT), particularly in pediatric patients. We aimed to describe and characterize the hypoattenuated focus in the anterior otic capsule. MATERIALS AND METHODS: We first reviewed histologic sections of the temporal bone from 8-month-old fetuses to determine the nature of the hypoattenuated focus in the anterior otic capsule. A cadaver collection of skull bases from fetuses and neonates ( n = 19), infants ( n = 24), and young children ( n = 23) were then studied with MDCT to determine the developmental evolution of this hypoattenuated focus in relation to the petrous apex. We specifically looked for the hypoattenuated focus in the anterior otic capsule, the development of the petrous apex, and the presence of other hypoattenuated foci in the fissula ante fenestram and middle otic layer. RESULTS: The hypoattenuated focus in the anterior otic capsule corresponded histologically to a cancellous bone trabecula emanating from the middle otic layer and directed toward the petro-occipital fissure. At this level it was covered with a cartilaginous cap. The hypoattenuated focus was observed in all of the fetuses and in all of the postnatal subjects younger than 4 months of age and was always associated with hypoattenuated foci of the middle otic layer and the fissula ante fenestram. This hypoattenuated focus became less obvious as the petrous apex developed. CONCLUSION: The hypoattenuated focus in the anterior otic capsule should be recognized as a normal variant in pediatrics. It could represent a relic from the development of the petrous apex.

SUMMARY: A retrospective study was conducted on a cohort of 15 patients who underwent surgery because cholesteatoma or abscess was suspected. All patients had MR imaging prior to surgery with diffusion-weighted images (DWI) from which the apparent diffusion coefficient (ADC) value was calculated. Using this technique, we were able to determine 3 distinct ADC value ranges corresponding to the 3 groups of lesions found at surgery (pure cholesteatoma, cholesteatoma with infection, and abscess or infection). This needs to be confirmed by further studies with a wider range of patients.

High-resolution CT scans are able to determine with accuracy the location of the anterior ethmoidal artery in relation to the roof of the ethmoid. This investigation should greatly help functional endoscopic sinus surgery to avoid accidental injury of the artery and to coagulate the vessel in cases of severe epistaxis.This was a radio-anatomical study of the anterior ethmoid artery in order to assess the course of the artery prior to endoscopic cauterization.Eighteen ethmoid sinuses (nine heads) were dissected and high-resolution CT scans were performed in axial, coronal and sagittal planes.All anterior ethmoidal arteries were identifiable. The arteries were included in the roof of the ethmoid in eight cases. In three cases the arteries were prominent under the roof. In seven cases the dissection found the arteries distant from the roof. This anatomical feature was associated with pneumatization of the floor of the orbit. The correlation between CT scan and dissection was very satisfactory.

Imaging of the temporal bone must be integrated into the clinical context because the information provided by otologists is of great interest. The temporal bone contains three cavities: two are filled with air (external ear and middle ear) and one contains fluid (inner ear, or labyrinth, connected to the brain by the eighth cranial nerve). The aims of imaging are, in all pathologies, to avoid surprises during surgery of the middle ear and to provide information about the morphology of the cavities, in particular the inner ear and internal auditory meatus. The procedures for analyzing the different structures of the temporal bone on diagnostic images are the same, and regard both the content and the walls of the cavities.

The aim of this study was to compare the clinical usefulness of ultrasmall superparamagnetic iron oxide (USPIO) MR contrast media (Sinerem, Guerbet Laboratories, Aulnay-sous-Bois, France) with precontrast MRI in the diagnosis of metastatic lymph nodes in patients with head and neck squamous cell carcinoma, using histology as gold standard. Eighty-one previously untreated patients were enrolled in a multicenter phase-III clinical trial. All patients had a noncontrast MR, a Sinerem MR, and surgery within a period of 15 days. The MR exams were analyzed both on site and by two independent radiologists (centralized readers). Correlation between histology and imaging was done per lymph node groups, and per individual lymph nodes when the short axis wasor = 10 mm. For individual lymph nodes, Sinerem MR showed a high sensitivity (or = 88%) and specificity (or = 77%). For lymph node groups, the sensitivity wasor = 59% and specificityor = 81%. False-positive results were partially due to inflammatory nodes; false-negative results from the presence of undetected micrometastases. Errors of interpretation were also related to motion and/or susceptibility artifacts and problems of zone assignment. Sinerem MR had a negative predictive value (NPV)or = 90% and a positive predictive value (PPV)or = 51%. The specificity and PPV of Sinerem MR were better than those of precontrast MR. Precontrast MR showed an unexpectedly high sensitivity and NPV which were not increased with Sinerem MR. The potential contribution of Sinerem MR still remains limited by technical problems regarding motion and susceptibility artifacts and spatial resolution. It is also noteworthy that logistical problems, which could reduce the practical value of Sinerem MR, will be minimized in the future since Sinerem MR alone performed as good as the combination of precontrast and Sinerem MR.

Genitale HPV-Infektionen besitzen einen zunehmenden Stellenwert in der gynakologischen Diagnostik. Ihre onkogene Bedeutung konnte mit Hilfe molekularbiologischer Verfahren nachgewiesen werden. Mit der in-situ-Hybridisierung (ISH) kann im Abstrichmaterial bei erhaltener Morphologie der Zelle mittels DNA-Sonde eine HPV-Typisierung durchgefuhrt werden (3). Seit langerer Zeit sind zytologische Hinweiszeichen auf eine HPV-Infektion bekannt (2). Ziel der Untersuchung war es, neben dem Vergleich der beiden diagnostischen Methoden die Pravalenz der genitalen HPV-Infektionen in den einzelnen Untersuchungsgruppen zu erfassen. Schlieslich uberpruften wir die Moglichkeit, ob die aufwendigere ISH durch die konventionelle Zytologie zu ersetzen ist.

ARTERIAL reconstruction is essential in liver transplantation (LT). Usually, the donor’s artery is anastomosed to the recipient’s hepatic artery. However, in some patients, usual reconstruction may be impossible because of arcuate ligament, post chemotherapy stenosis of the recipient’s hepatic artery, intimal dissection, or accidental lesion during harvesting. In these cases, we used arterial conduits derived from donor iliac arteries (IA). We compared the results of LT using IA as interposed vessels with those who had direct arterial anastomosis.

Untersuchungen uber den Rezeptorgehalt des Endometriums unter physiologischen Bedingungen sind selten. Im deutschen Sprachraum hat sich vor allem Pollow mit der Problematik beschaftigt [2]. Hiernach weist das Endometrium in der ersen Zyklushalfte eine relativ hohe Konzentration sowohl des ER als auch des PR auf, welche dann in der Lutealphase deutlich abfallt.