More radical resection that may include LTBR mitigates the poorer prognosis with advanced disease in our series. Treatment must be individualized in immunocompromised patients who have shortened overall survival.

In endoscopic sinus surgery, the anterior ethmoidal artery (AEA) is usually identified as it traverses obliquely across the fovea ethmoidalis, posterior to the bulla ethmoidalis and anterior to or within the ground lamella's attachment to the skull base. Injury to the AEA may result in hemorrhage, retraction of the AEA into the orbit, and a retrobulbar hematoma. The resulting increase in intraorbital pressure may threaten vision. Waardenburg's syndrome (WS) is a rare congenital, autosomal dominantly inherited disorder, distinguished by characteristic facial features, pigmentation abnormalities, and profound, congenital, sensorineural hearing loss. We present a case of AEAs located anterior to the bulla ethmoidalis in a 36-year-old male with WS and chronic rhinosinusitis. The anatomic abnormality was not obvious on a preoperative computed tomography scan and was discovered intraoperatively when the left AEA was injured, resulting in a retrobulbar hematoma. The hematoma was immediately identified and decompressed endoscopically without lasting complications. The AEA on the right was identified intraoperatively and preserved. The characteristic craniofacial features in WS were probably associated with the abnormal vascular anatomy. Endoscopic sinus surgeons should be aware of these potential anatomic anomalies in patients with abnormal craniofacial development.

Spontaneous retropharyngeal haematoma: report of a casea ns_5862 756..766 Spontaneous retropharyngeal haematoma (SRH) is rare. To our knowledge, only nine cases have been published in the English literature. 1-5 Herein, we report another case of SRH.A 53-year-old man presented to the Emergency Department with a 3-week history of coryza, sore throat and cough. Examinations were unremarkable apart from an erythematous throat. Blood tests showed haemoglobin of 94 g/L but no other abnormalities. Electrocardiogram and chest X-ray were normal. The patient was discharged with presumed upper respiratory tract infection.Overnight, he developed hoarseness and dysphagia, and he represented the next morning. Upon examination, he had obvious neck swelling and right anterior neck ecchymosis. Investigations showed further drop in haemoglobin to 88 g/L. Computed tomography (CT) and magnetic resonance imaging showed a retropharyngeal mass with features consistent with haemorrhage (see Fig. 1). CT aortogram located the source of bleeding from the right inferior thyroid artery and the patient underwent a successful embolization of the thyrocervical trunk. Repeat CT scan 2 months later showed complete resolution of the haematoma.SRH is rare, making diagnosis difficult for the unwary. The Capp's triad (superior mediastinal obstruction, anterior tracheal displacement and neck bruising) is a useful diagnostic criterion to screen for SRH. 1 On the second presentation, the patient demonstrated classic signs and symptoms of Capp's triad, including superior mediastinal obstruction (hoarseness, dysphagia and neck swelling), anterior tracheal displacement on radiological imaging and anterior neck ecchymosis.Management of SRH depends on its cause. In our case, the source of the haemorrhage was identified, leading to successful embolization of the right thyrocervical trunk.In summary, SRH is extremely rare. Capp's triad is a useful diagnostic criterion, and management depends on the cause. References1. Munoz A, Fischbein NJ, de Vergas J, Crespo J, Alvarez-Vincent J. Spontaneous retropharyngeal hematoma: diagnosis by MR imaging. AJNR Am. J. Neuroradiol. 2001; 22: 1209-11. 2. Singh A, Ofo E, Cumberworth V. Spontaneous retropharyngeal haematoma: a case report. J. Med. Case Reports 2008; 2: 8. 3. Taniguchi I, Maeda T, Morimoto K, Miyasaka S, Suda T, Yamaga T. Spontaneous retropharyngeal hematoma of a parathyroid cyst: report of a case. Surg. Today 2003; 33: 354-7. 4. Newton AI. Spontaneous retropharyngeal hematoma: an unusual presentation of thoracic aortic dissection.

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Extranodal natural killer (NK)/T-cell lymphomas are rare tumors that account for 1.5% of all non-Hodgkin-type lymphomas in the United States and almost 7-10% of all non-Hodgkin's lymphomas in Asia and South America. The nasal type commonly presents with facial cellulitis, nasal obstruction or proptosis. Occasionally, local extension from the nasal cavity causes destruction of the hard palate, previously known as "lethal midline granuloma." We present a case of a 37-year-old male who presented with recurrent right-sided facial swelling, periorbital cellulitis and sinusitis. There was some delay in confirming the diagnosis but he was eventually diagnosed with stage 1e NK/T-cell lymphoma (nasal type). Disease diagnosed at an early stage confers a very favorable curative remission rate. Therefore, clinicians should be aware of the possibility of an NK/T-cell lymphoma when facing a presentation of recurrent sinusitis associated with atypical presentation such as periorbital cellulitis.