A 31-year-old man diagnosed with type 2 chronic rhinosinusitis with nasal polyps, initially presenting with a 1-year history of nasal blockage and anosmia, was refractory to medical therapy and had been advised to undergo endoscopic sinus surgery (ESS). Bilateral frontal sinusotomy and complete ethmoidectomy were needed to ensure adequate delivery of post-operative topical steroids. During this portion of ESS, the anterior skull base would be vulnerable to iatrogenic injury. How could the surgeon prepare pre-operatively to avoid such a complication?

Despite advances in imaging technology, instrumentation and surgical techniques for ESS, complications may still happen. Iatrogenic injury to the anterior skull base causing a cerebrospinal fluid (CSF) leak is one of the dreaded complications of ESS. The anterior skull base is composed of the cribriform plate and the fovea ethmoidalis or ethmoid roof. These bony structures are connected by the lateral lamella of the cribriform plate (LLCP) which delineates the lateral border of the olfactory fossa. The LLCP is known as the most vulnerable structure of the anterior skull base during ESS especially during ethmoidectomy and frontal sinusotomy.

Human ; Male ; Adult: 25-44 Yrs Old ; Paranasal Sinuses ; Cerebrospinal Fluid Leak

OBJECTIVES: To provide an initial overview of the outcomes of different treatment modalities used for hemangiomas.
METHODS:
Design: Case Series
Setting: Tertiary National University Hospital
Participants: Records of 21 patients diagnosed with head and neck hemangiomas in the Philippine General Hospital Department of Otorhinolaryngology from 2009 to 2014 were reviewed.
RESULTS: Majority of the patients were female (61.9%) and in the pediatric age group (57.1%). Of the 21 patients, 6 underwent medical management, 13 had surgical management, 1 had both medical and surgical management and 1 opted to observe the lesion. All patients treated with propranolol observed a decrease in the size of the lesion. Seven out of the 13 patients had radiofrequency ablation; all had gross residual lesion. Six of the 13 underwent excision with complete excision being achieved in 5 of 6 cases.
CONCLUSION: Treatment response of patients in this series with hemangiomas of the head and neck to propranolol at a dose of 1 to 2 mg/kg/day may reflect international data. Outcomes analysis for radiofrequency ablation and surgical excision requires a longer duration of follow-up.

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Young Adult ; Adolescent ; Child ; Child Preschool ; Infant ; Propranolol ; Hospitals, University ; Philippines ; Hemangioma ; Neck ; Head ; Hospital Departments ; Otolaryngology