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An unusual case of pseudoaneurysm of the internal carotid artery secondary to tonsillectomy is reported. The management consisted of combined intraoperative transcatheter embolization with surgical ligation of the internal carotid artery. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the images obtained by CT in diagnosis and treatment plan of teeth in the maxillary sinus., Methods: Twelve patients with teeth in the maxillary sinus were studied by plain film radiography (PFR) and by CT with a dental software programme, which displays multiple panoramic and cross-sectional views of the mandible and maxilla. The three-dimensional morphology of the tooth, its inclination, proximity to the sinus wall, surgical planning and prediction of prognosis and complications were estimated on both PFR and on CT scans and scored., Results: The radiographical features interpreted from PFR were fair or poorly diagnosed whereas CT provided excellent features. The surgical approach of choice was based on CT interpretation., Conclusion: CT is useful for diagnosis and treatment planning of teeth in the maxillary antrum.

A case of intraoperative tracheostomy tube obstruction is reported. The clinical features and the chain of events leading to the diagnosis of cuff herniation are presented. The different mechanisms of herniation are discussed. In the present case we speculate that a manufacturing defect together with nitrous oxide diffusion into the cuff caused dilatation and herniation of the latter which led to obstruction of the distal tube lumen. We draw attention to this rare but life-threatening complication.

The term masked mastoiditis defines a subclinical infectious inflammatory process of the mucosal lining and bony structures of the mastoid air cells with an intact tympanic membrane. The disease follows an apparently well treated recent acute otitis media. Probably due to an anaerobic colonizing flora, the developing bone infection is of low grade without pus formation. The clinical features of the disease are not overt as those in coalescent mastoiditis. The intact ear drum does not reflect the severity of bone eroding disease which is characterized by non-exudative but proliferative changes. Hence there is no pus formation. The incidence of complications is high. Plain X-ray film and CT scan do not specifically define the disease process. Bone scan indicates the bone invading nature of the mastoid infection. The osteoblastic reaction secondary to osteitis is demonstrated by the high uptake of the isotope in the involved mastoid. Antibiotics may cure the disease process but in most of the cases surgery in unavoidable.

Review of 122 head and neck lymphomas diagnosed between 1976 and 1992 revealed 40 extranodal lymphomas. In 30 of them follow-up was available. We review the demographic, clinical, histological and immunohistochemical features of the 30 extranodal lymphomas according to site of origin. Comparison is made between these extranodal lymphomas and nodal non-Hodgkin's lymphomas and cases of Hodgkin's disease first diagnosed in the head and neck area.

Septic Internal Jugular Vein Thrombosis (SIJVT) is a rare but potentially life-threatening condition which necessitates early clinical recognition and rapid administration of appropriate therapy. Although termed by some authors a "forgotten disease" in the antibiotic era, this entity is still present but frequently overlooked. Deep neck infections, Lemierre syndrome, central venous catheterization and mastoiditis are the etiologies in this series. The diagnosis of SIJVT utilized CT and Doppler ultrasound imaging. The treatment included aggressive abscesses, necrotizing fasciitis, mastoiditis). Anti-coagulant agents were used in order to reduce the risks of pulmonary embolism.

Masked mastoiditis defines a subclinical infectious inflammatory process of the mucosal lining and the bony structure of the mastoid air cells, with intact tympanic membrane. It follows an apparently well-treated recent acute otitis media. Because of obstruction of the tympanic diaphragm by mucosal swelling, polypoid mucosa or granulation tissue, a complete separation of the tubo-tympanic cavity from the mastoid air cell system results. The latter remains unaereated and the local infectious mucosal disease progresses to osteitis. Probably due to colonizing flora in this unventilated media, the developing bone infection is low-grade, without pus formation. The clinical features of the disease are not overt as those in coalescent mastoiditis. The intact ear drum does not reflect the severity of bone-eroding disease within the mastoid. Since this disease is characterized not by exudative but by proliferative changes, there is no pus formation. The incidence of complications is high. Plain x-ray and CT scan do not specifically define the disease process, but bone scan indicates the bone-invading nature of the mastoid infection. The osteoblastic reaction secondary to osteitis is demonstrated by high uptake of the isotope in the involved mastoid. Antibiotics may cure the disease, but in most cases surgery is unavoidable.

In 70 patients with initial otorhinological infections there were 87 different central nervous system (CNS) complications. 40 (57%) were children (from 1 month to 15 years). 15 (21%) had more than 1 complication. Mortality was 14% (10/70). Leptomeningitis was the most common CNS complication (43%) and it occurred mainly in the pediatric age group. Lateral sinus thrombosis (LST) was accompanied by other intracranial infections in 80% of the patients. The highest mortality was found in patients with brain abscess (38%) as the initial or concomitant complication. Despite liberal use of antibiotics, CNS complications of otorhinologic infections are still encountered with considerable mortality rates. Modern imaging techniques are of great value in localizing the intracranial disease, but a complete initial otorhinologic examination is needed to rule out an extracranial focus of infection, sometimes with an insidious course.

Temporomandibular joint arthritis is a rare manifestation of familial Mediterranean fever and should be considered in patients of Mediterranean origin. Recently we treated four patients suffering from this condition, and intra-articular corticosteroid injection resulted in rapid resolution of the pain and disability in two. Computed tomography confirmed the usefulness of this therapeutic modality.

Fifty-eight central nervous system complications were noted in 39 pediatric patients with a primary oto-rhinological infection. The ages ranged from 1 to 15 years. Eleven patients (25%) had more than one complication. 12.8% of the cases died. Leptomeningitis was the most common intracranial complication (54%) Lateral sinus thrombosis (LST) occurring in 10 patients (26%) was accompanied with other intracranial abnormalities in 80% of cases. Brain abscess as an initial or concomitant complication was associated with the highest mortality rates (40%). In two of these fatal cases multiple brain abscesses were detected. The low incidence of intracranial infections secondary to oto-rhinologic infections and the masking effect of antibiotics present difficulties in the early recognition of the CNS complication. Despite the value of the modern imaging techniques in the investigation of the CNS complication, the clinical oto-rhinologic examination is of paramount importance in detecting the original infection in the pneumatic spaces of the upper respiratory tract. Additionally, bone scans were found of value in demonstrating the osteitic process of these cases.

Osteoblastic osteitis is a rare kind of bone infection typified by a proliferative reaction of the periosteum and by exuberant bone formation. In the maxillary sinus, it occurs as a consequence of chronic or recurrent sinusitis. It usually manifests with a vague facial discomfort, followed by complications in the deep facial spaces or fossae. The diagnosis is a radiological one. Eradication of this bone infection necessitates removal of the precipitating condition as well as the long-term administration of appropriate anti-biotics. In the case of a deep facial fossae abscess, drainage is mandatory.

In 9 of 118 patients with differentiated thyroid carcinomas, a solitary cystic lateral cervical mass simulating a branchial cleft anomaly was the sole presenting sign of the disease. These masses were nodal metastases of occult papillary adenocarcinoma of the thyroid that underwent liquefaction necrosis. Sonographically, the masses presented a complex pattern. Accordingly, it is suggested that, in patients presenting with an asymptomatic solitary lateral cystic cervical mass, the possibility of metastasis from an occult thyroid malignancy should be considered, and consent for definitive surgery should be obtained. The ultrasonic pattern of the cystic mass is of importance in the differentiation of a cavitated lymph node from a branchial cleft cyst.

Septic thrombophlebitis of the internal jugular vein is a rare condition with diverse etiologies. The significance of the systemic effects of this condition far exceeds its local implications. Complications occur frequently and may be life threatening. The pathogenesis, histologic features, clinical and imaging aspects of this entity, based on a series of 13 patients, are discussed.

Orbital abscess of rhinosinogenic origin may develop, either by contiguous spread of the infection or by a thrombophlebitic process. While destruction of the bony walls of the paranasal sinus occurs in propagation of the infection by tissue continuity, haematogenous spread may take place through intact bone. Computed tomography demonstrates the status of the bony partitions shared by the orbit and paranasal sinuses, and the source of the orbital sepsis, thereby influencing the therapeutic approach.

A case of giant lateral cervical cystic metastasis from occult thyroid carcinoma mimicking branchial cleft cyst is reported. Lateral cervical cystic metastases arising from occult thyroid carcinoma and their ultrasonic differentiation from true cysts are discussed.

While infections of the infratemporal fossa are occasionally documented in the otolaryngologic literature, a recent computer literature search failed to identify any significant series of cases describing this potentially fatal infection. This presentation focuses attention on the joint clinical/imaging experience of 11 cases of infratemporal fossa infection, as seen at the Soroka Medical Center of the Ben Gurion University of the Negev, in Beer-Sheva, Israel, and the Mount Sinai Hospital, of the University of Toronto, in Toronto, Canada. This manuscript reviews our experience, with particular emphasis on the effective role and accuracy of CT scanning in identifying the correct anatomic and pathologic diagnosis, as well as in the planning of treatment.

Sixty-four diverse central nervous system (CNS) complications were noted in a series of 50 patients initially suffering from an otorhinological infection. Thirty-five patients (70%) were in pediatric age groups (1-15 years). Twelve patients (24%) had more than one complication. Mortality rates were 16% in patients with one CNS complication and 25% in patients with multiple complications. Overall mortality rate was 18%. Leptomeningitis was the most common intracranial complication (42%) occurring, mainly in pediatric patients. Lateral sinus thrombosis (LST) was accompanied with other intracranial abnormalities in 72% of the cases. Brain abscess as an initial or concomitant complication was associated with the highest mortality rates (44%). Three of these fatal cases had multiple brain abscess. The rarity of intracranial suppurations secondary to ear and nose infections and the masking effect of the antibiotics bring difficulties in the early detection of CNS complications. Although the modern imaging techniques contribute to the recognition and localization of the intracranial pathology, the clinical investigation is still of paramount importance in detection of the original infection in the pneumatic spaces of the upper respiratory tract.

Laryngotracheal stenosis is a recognized complication of local injuries, such as prolonged intubation. Surgical reconstruction with the use of a tracheal T-tube is widely recommended. We report a serious complication consisting of the sudden obstruction of the T-tube by viscous secretions. In order to prevent this undesirable consequence, a simple modification of the T-tube technique is proposed.

A cystic dilatation of a paranasal sinus by an entrapped air mass has been termed pneumosinus dilatans or a pneumocoele. The occurrence of this condition in the maxillary sinus is quite rare. In the present case, a mid-face mass mimicking an osteoma was the presenting sign of the disease. The pathogenesis, clinical features and radiological aspects of this entity are reviewed. In order to avoid confusion with other conditions of different aetiopathogenesis, we propose to label the lesion as 'air cyst' of the paranasal sinus, a term that best describes the nature of the lesion.

The clinicopathological aspects of 15 patients with necrotizing soft-tissue infections in the head and neck are reviewed. Our relatively large series suggests that the disease occurs more frequently than described in the literature. Histological studies showed that tissue superficial and deep to the fascia is frequently involved with the infectious inflammatory process, even in early stages of the disease. These pathologic changes were also found in healthy-appearing tissues at the periphery of the lesions. The early recognition of the disease and the prompt and aggressive surgical and medical therapeutic approach have resulted in far lower mortality rates (7%) than those reported in the literature. Frozen-section examination contributed to the maximal eradication of the pathologic process. This successful outcome was achieved in spite of the adverse associated clinical conditions, such as old age, debilitating disease, or complications, observed in half of the patients.

Hypoglossal nerve palsy occurred in 2 patients with infected second branchial arch cleft cyst. This very unusual complication of the congenital anomaly has been related to the mechanical compression of the mass. Histologic features of the perineural coat were also suggestive for this etio-pathogenesis.

Fifteen pediatric patients with orbital floor fractures were successfully treated early, following injury by a transantrally introduced catheter-balloon technique. The latter stabilizes and supports the torn, but still vascularized periosteum at the edges of the fracture and also serves as a guide for its further proliferation and new bone formation. Apart from a transient anesthesia in the dermatome of the infraorbital nerve in certain patients no complication or sequela was noted in this series. Accordingly early repair with the use of catheter-balloon appears to be a viable alternative in the repair of orbital floor fracture in children.