Rhinophyma: Our experience based on a series of 12 cases

INTRODUCTION

Rhinophyma is a rare, benign and unsightly disease of the skin of the nose that was first described a very long time ago, as illustrated by portrait of an old man with a bulbous nose holding his grandson, by Ghirlandaio in 1490. It was described for the first time by Ferdinando Hebra Von (1816-1880), as the third stage of rosacea. The objective of this study is to report the author's experience and propose a new treatment option in the management of rhinophyma.

MATERIAL AND METHODS

We describe our experience of rhinophyma based on a retrospective case study.

RESULTS

We identified 12 cases over a 12-year period, with a marked male predominance. The therapeutic approach was the same in all patients, consisting of a combination of dermabrasion, decortication and application of fibrin glue, with a favourable outcome in every case with complete epithelialisation.

CONCLUSION

Rhinophyma is a rare condition of uncertain pathophysiology. Management is surgical and, in view of the many techniques and procedures proposed, we advocate the slogan "to each his own technique", until a consensus has been reached. Our technique combining dermabrasion, decortication and application of fibrin glue has given very good results.

Intraorbital foreign body: A rifle bullet removed 20 years after the accident

INTRODUCTION

Trauma of the orbit and eyeball is common, but intraorbital bullet is a relatively rare event.

CLINICAL CASES

The authors report the management of a patient with chorioretinitis sclopetaria secondary to a gunshot wound twenty years previously.

DISCUSSION

The clinical, diagnostic and therapeutic aspects of this unusual case of intraorbital foreign body are discussed.

Post-traumatic Pott's puffy tumour: A case report

INTRODUCTION

Osteomyelitis of the frontal sinus is a rare clinical entity and generally occurs as a complication of trauma to the forehead or frontal sinusitis. It can be responsible for life-threatening complications, as the first symptoms may appear to be minor. Early diagnosis and appropriate management to prevent central nervous system complications significantly reduce the morbidity and mortality.

CASE REPORT

The authors report the case of a 34-year-old man with Pott's puffy tumour following trauma to the frontal sinus.

DISCUSSION

The diagnosis was suggested clinically and confirmed radiologically. Treatment was surgical with craniotomy and external drainage.

[The silent sinus syndrome: A reconstruction of the orbital floor with Medpor implant]

INTRODUCTION

The silent sinus syndrome (SSS) is a rare clinical entity in both ENT and ophthalmology. It is characterized by enophthalmos and ptosis associated with a reduction in pressure in the maxillary sinus caused by chronic hypoventilation. The objective of this study was to demonstrate the importance of maxillary hypoplasia whether congenital or acquired in this disease, and the use of Medpor implant for reconstruction of the orbital floor.

MATERIAL AND METHODS

We report 3 cases of silent sinus syndrome proved clinically and radiologically. The first is a 45 year old male patient complaining of enophthalmos which occurred gradually, without any medical history; the second case is that of a woman of 39 years with a gradual onset enophthalmos, with a history of sinusitis; the third case, a man of 25 years who had a history of nasal trauma and consults for enophthalmos and diplopia.

RESULTS

Endoscopic surgery is performed quickly allowing a disappearance of enophthalmos and diplopia. All patients underwent a reconstruction of the orbital floor with a Medpor implant fixed by miniplates without complications.

[Post operative Caldwell-Luc procedure maxillary cyst: Report of a case]

Rare complication of radical surgery (Caldwell Luc procedure) of the maxillary sinus, maxillary cyst can occurred several years after. We describe the case of a patient 56 years old, who came to our consultationfor repeated pain in the right maxillary region with moderate facial asymmetry. In her history we noted a previous sinus surgery (Caldwell Luc) more than 10 years before. The imaging showed an expansive process filled with proteinic tissue of the posterior wall of the maxillary. With the history of the former surgery, we suspected the existence of a mucocele. She underwent an endonasal surgery and the pathological examination of the specimen revealed an intra osseous cyst lined with ciliated respiratory type mucosa post surgery of the maxillary sinus. The diagnosis of a maxillary cyst complicating a Caldwell Luc was established based on the results obtained with the clinico-radiological and pathological results.

[Setting up a "Bonebridge"]

Hearing rehabilitation after bilateral radical mastoidectomy has different options. The Bonebridge is a new type of middle ear implant bone conduction. It leaves the external ear canal opened and offers acoustic and aesthetic advantages that make it a new alternative of choice. We report our first case of Bonebridge implanted on a 17 years old patient. He had bilateral conductive hearing loss secondary to a bilateral radical mastoidectomy with open technique and meatoplasty for a bilateral cholesteatoma. The surgical technique is described. After 8 months of use the hearing gain is stable without cutaneous adverse effect.

[Cochlear implant in a patient with dilatation of the endolymphatic sac and vestibular aqueduct]

We present an 8 years patient old with a giant dilatation of the vestibular aqueduct associated with profound and progressive bilateral sensorineural hearing loss. The patient received a cochlear implant and during the surgery a pulsatile clear fluid via the cochleostomy was observed, without gusher. We present all the problems, and offer some advices for this kind of surgery.

Hipoacusia neurosensorial por hiperbilirrubinemia neonatal

In this article, the sensorineural hearing loss is presented as a possible sequelae of neonatal hyperbilirubinemia. In our program of early hipoacusia detection, 241 babies were examined from January 1996 until November 1999; 7 cases had a history of hyperbilirubinemia in the neonatal period and 2 of them were diagnosed of sensorineural hearing loss. We discuss how the bilirubin or any other associated factor might have been the cause and this could explain the selective affectation of some children.

[Jugular dehiscence in the hypotympanum: report of 9 cases]

We report on nine cases with jugular dehiscence in middle ear diagnosticated and followed up in our clinic from 1987 to 2000. Diagnosis was made, in some cases, when carrying out an otoscopy and others by clinical symtomatology, otomicroscopically imaging, audiometry, CT-scan and MRI. All patients were affected of hearing loss. Some of them also suffered pulsatile tinnitus and even vertigo. The follow up of all patients has been stable and devoid of bleeding complications.

[Obstructive sleep apnea in children. Our experience]

We expose our experience in obstructive sleep apnea syndrome (OSAS) in the pediatric population and review the literature. Forty-six nocturnal respiratory polygraphies were performed using a portable device (Eden Trace II Plus) that measures heart rate, chest wall impedance, nasal/oral airflow and oxygen saturation. Seven children have been studied before and six weeks after Adenotonsillectomy. All this children experienced an immediate and important improvement of their obstructive symptoms. After Adenotonsillectomy the number of obstructive sleep apneas disminished up to 87.25% and the number of hypoapneas disminished up to 73.3. The arterial oxygen saturation during the night normalized in the seven patients. The initial treatment of OSAS in children should be the Adenotonsillectomy, although the diagnostic criteria of OSAS in children have to be defined more precisely in the future.

[Pansinusitis secondary to inflammatory myofibroblastic tumor]

Inflammatory myofibroblastic tumors are aetiologically enigmatic and biologically unpredictable lesions. The lungs are the organs of apparent predilection. These tumors have also been documented in a number of extrapulmonary sites including head and neck. Paranasal location is rare. We report a case of a maxillary location in a 10 years and 10 months old girl initiated as an acute pansinusitis.

[Pleomorphic adenoma in ectopic salivary tissue in a child]]

Benign tumors appearing in cervical ectopic salivary tissue are rare. Most of these tumors are pleomorphic adenomas and many occur in adults. We report two cases of pleomorphic adenoma developing in cervical ectopic salivary tissue in children and review the pathogenesis of salivary heterotopia and these benign tumors.

[Determination of plasma ciprofloxacin levels in children treated with 0.2% topical ciprofloxacin for tympanic perforation]

Topical drug use can produce locally adverse effects by direct action or systemic effects as a result of drug absorption. Local tolerance of topically-administered ciprofloxacin (ear drops) and serum antibiotic levels after 7-10 days of treatment were evaluated in 30 children with tympanic membrane perforation and suppuration. There were no signs of local intolerance or ototoxicity and significant serum ciprofloxacin levels were not detected. We conclude that ciprofloxacin ear drops can be safely used in children with suppurative otitis media and tympanic perforation.

[Labyrinth involvement in Langerhan's cell histiocytosis]

Langerhans' cell histiocytosis is a rare pathology that implies an abnormal proliferation of these kind of cells associated with granular infiltration that affects different structures of the human body, including the temporal bone. The middle ear and the mastoid are mostly involved (61%). The inner ear is more resistant to the destruction caused by the granulation tissue, but when occurs, an irreversible neurosensorial hearing loss appears. The early diagnose and the choice of the therapeutical sequences are essential to avoid these lesions.

Major congenital anomalies of the internal carotid artery: agenesis, aplasia and hypoplasia

Agenesis, aplasia and hypoplasia of the internal carotid arteries (ICA) are rare congenital disorders with few descriptions in the otorhinolaryngological literature. We present two cases of major abnormalities of the ICA, one with isolated hypoplasia and another with agenesis associated with ear malformation and facial palsy. We briefly review the normal anatomy and discuss the main aspects of these malformations.

[Thrombophlebitis of the lateral sinus. A more frequent complication than expected]

At present, the frequency of intracranial complications of middle ear infections has decreased sharply as a result of the use of more effective antibiotics. We report two cases of lateral sinus thrombosis, in a 2-year-old male and a 14-year-old male respectively, after middle ear infection that progressed to mastoiditis with osteitis. The severity of these complications underlines the importance of clinical awareness and early diagnosis by angiographic magnetic resonance imaging so that suitable treatment can be begun.

Nasal gliomas: main features, management and report of five cases

Nasal gliomas are neurologic malformations that should be considered in the presence of a congenital nasal mass. Appropriate pre-operative examination must be performed to identify a possible connection with CNS, which is present in 15-20% of the cases. This examination should determine whether initial craniotomy is necessary. Here, we report five cases and review the main characteristics and management of this pathology.

[Use of expanded polytetrafluoroethylene in nasal augmentation]

PTFE-e patches were used in nasal augmentation in 14 patients with a four-year follow-up. This material was chosen because it is inert and biologically compatible with human tissue. None of the patients in which this material was used had intolerance reaction, skin changes, material extrusion, or signs of infection. A review of the world literature showed no cases of poor results with PTFE-e. It is concluded that the best material for nasal augmentation is autologous material, but if not available or difficult to obtain, PTFE-e is the most acceptable synthetic material and produces good results.

[Cochlear assessment before cochlear implantation by computer tomography with a modified Stenvers projection]

In the study protocol of candidates for cochlear implantation, the patency of the cochlea should be assessed. Therefore we systematically add the Stenvers modified projection to the routine coronal and axial sections which permits the visualization in a single sation of practically all the coils of the cochlea. This projection also is useful in postoperative controls, to confirm the correct intracochlear position of the electrode.

Middle-ear adenoma (MEA): a report of two cases, one with predominant "plasmacytoid' features

Middle-ear adenomas (MEAs) are rare neoplasms which can display several histological patterns and represent a diagnostic challenge. We present two cases of MEA which share some histopathological features such as medium to small cells forming solid infiltrating tumour nests as well as scattered glandular structures with Alcian blue and PAS positive material within. The second case also displayed a distinct and predominant "plasmacytoid' appearance which, in a small biopsy, might have been misleading. Both cases expressed an admixture of epithelial and neuroendocrine immunohistochemical markers, whereas ultrastructural study demonstrated electron dense granules. Taken together, these observations support a mixed epithelial and neuroendocrine nature for these neoplasms, the differential diagnosis of which includes paragangliomas and other tumours or tumour-like lesions involving less frequently the middle ear, such as meningiomas, plasmacytomas and inflammatory polyps. The existence of MEAs with plasmacytoid features should be remembered to avoid confusion with plasmacytomas, plasmacytoid myoepithelioma and plasma cell inflammatory infiltrates.

Primary localized nasopharyngeal amyloidosis. A case report

Primary localized amyloidosis of the nasopharynx is a rare disease. We present the case of a 13-year-old girl, to our knowledge only the second pediatric case reported in the literature. Symptoms were nasal obstruction and bleeding from the oral cavity. Physical examination revealed a mass in the nasopharynx and left side of the soft palate. The diagnosis was made by biopsy and histopathologic study of the surgical specimen. Immunohistochemical study revealed amyloid light chains (AL). The main treatment was surgical. At follow-up 9 months later, no recurrence had developed. While rare, localized amyloidosis should be considered in the differential diagnosis of nasal obstruction, epistaxis and glue ear, and must be recognized and understood by the otolaryngologist to allow appropriate diagnostic and therapeutic planning.

[Genetic counseling in profound deafness]

One of the responsibilities of cochlear implant centers is to counsel deaf patients regarding the potential for transmitting deafness of their children. Diagnostic studies should be made to determine if deafness is an isolated event or part of a syndrome. We report the criteria used in our center for genetic counseling of the deaf.

[Intralesional treatment of cutaneous leishmaniasis: a report of two cases]

Two clinical cases of cutaneous leishmaniasis of the outer ear in children are reported. The patients were treated successfully with a single intralesional injection of N-methylglucamine antimonate (Glucantime). Aetiopathogenesis, epidemiology, clinical manifestations, diagnosis, and treatment of cutaneous leishmaniasis are discussed.

[Parotid schwannoma]

We present the case of a 13-year-old boy with intra-parotid schwannoma of the facial nerve. We discuss the histopathology, preoperative diagnosis by fine needle aspiration cytology, and surgical strategy.

[The use of extraoral osteointegrated implants in otolaryngology and maxillofacial surgery in children]

We present our clinical experience with extraoral osteointegrated implants in children. We treated a total of a twenty cases. Seventeen were cases of auricular ephitesis, and in six of them we also inserted a bone conduction auditory prosthesis. In three cases we inserted an orbital ephitesis. Two operations are necessary to place the osteointegrated implants in the temporal and orbital regions respectively. We made a follow-up study of these patients for approximately two years, and we present the resulting statistics, and complications that we encountered. We conclude that osteointegrated implants in carefully pre-selected children, offer excellent ephitesis setting and a reliable method of installing bone conduction hearing aids.

[Frey syndrome in childhood]

Frey's syndrome is distinguished by the appearing of erythema, sensation of hotness, sometimes pain, and transpiration discharge in the preauricular and temporal area when ingestion stars. We present an eleven month old child with this pathology and we review the etiology and clinic manifestations of this syndrome.

Association of spontaneous anterior fossa CSF rhinorrhea and congenital perilymphatic fistula in a patient with recurrent meningitis

A case of recurrent meningitis associated with spontaneous cerebrospinal fluid (CSF) rhinorrhea and left sensorineural hearing loss in a 4-year-old boy was found to be due to simultaneous congenital defects. High resolution CT examination clearly showed an anterior fossa defect and an inner ear malformation, including demineralization in the region of the footplate of the stapes, and thus provided clear guidance for the surgeon.

[Melanotic progonoma of the maxillary: presentation of a case]

Male patient, two months of age, is affected by a tumour on the left side of the mandible, which has quickly grown over the last month. There are no other clinical pathological signs. A thorough exploration, the radiographic, tomographic and tomodensitometrical tests show the presence of a tumour on the maxilla. It was of low density, encapsulated and shifting the germinal teeth. Surgical removal reveals a melanotic neuroectodermal tumour typical of childhood. The tumour recurred in the same location and was actually larger, less than a month after the operation. A new screening is done for vanilmandelic acid and radiographies of the skull base and skeletal series were negatives. The patient is operated on again, with the same histological diagnosis. The diagnosis and treatment are discussed.

[Apropos of a case of recurrent meningitis]

The recurrent meningitis associated with spontaneous CSF rhinorrhea in a 4-year-old boy was found to be due to simultaneous congenital defects. There was a dehiscence of the anterior fossa associated with congenital changes in the temporal bone, the petrous bone and the stapes. All these defects were visible including demineralization of the footplate stapes region. The high-resolution X-ray CT served as a clear guide to the surgeon.

Melanotic neuroectodermal tumor of infancy: a case report

A male patients, two months of age, was affected by a rapidly growing tumor on the left side of the mandible. There were no other clinical or pathological signs. A thorough examination, as well as radiographic, tomographic and tomodensitometric tests showed the presence of a tumor on the maxilla. It was of low density, encapsulated and shifting the germinal teeth. Surgical removal revealed a melanotic neuroectodermal tumor typical of that in children. The tumor recurred in the same location and was actually larger, less than a month after the operation. A new screening was done for vanilmandelic acid and radiographies of the skull base and skeletal series were negative. The patient was operated on again, with the same histological diagnosis. The diagnosis and treatment are discussed.

Recombinant interferon-alpha-2C in laryngeal papillomatosis: preliminary results of a prospective multicentre trial

A preparation of interferon-alpha 2C of high purity formed by recombinant DNA technology was used as adjuvant therapy following removal of laryngeal papillomas by cauterization or laser vaporization. Preliminary data on 20 patients are reported and include 11 complete and 7 partial responses. Side-effects included initial temperature elevation, but this subsided and other side-effects were uncommon. No antibodies to the interferon preparation were found in any of the patients.