The high reliability of the fat graft and the technical simplicity of this procedure in anterior perforations, especially with the use of intraoperative endoscopy, make it an attractive technique.

No abstract

Silent sinus syndrome is a rare clinical entity typically characterized by spontaneous and progressive enophthalmos and hypoglobus caused by an alteration of the normal orbital architecture and function from maxillary collapse in the setting of the chronic maxillary sinus hypoventilation. The authors report an unusual case revealed by mild dental pain, present the imaging (before, during and after the development of the disease), discuss the different theories related to pathogenesis and comment the treatment.

Paragangliomas of the neck region arise most commonly in the carotid and vagal bodies. The goal of this retrospective study is to evaluate intraoperative vascular and neurological morbidity and to define the therapeutic strategy. During the period 1990-2004, 32 patients with 42 neck paragangliomas were referred to our institution (Head and Neck Service, Otolaryngology Federation, CHU La Timone, Marseilles, France). There were 29 carotid body tumors and 11 vagal body tumors. There were 14 men and 18 women. Forty paragangliomas were surgically excised. Mean age of patients with family history of paragangliomas was 34 years and that of patients without any familial history was 47 years. Only one patient had a malignant paraganglioma. A vascular repair procedure was performed in 10% and always occurred in carotid body tumors including the malignant one. Postoperative hypoglossal nerve deficit was reported in five cases (12.5%). Paralysis of vagus nerve was reported in 11 cases (27.5%), nine of whom were patients with vagal body tumors. Knowledge of number of paragangliomas and their location is of main importance and influences the therapeutic strategy. The goal of this strategy is to avoid major neurovascular morbidity and to optimize treatment of multiple or bilateral tumors. Early management of patients prevents progressive neurological deficit due to an enlarging tumor mass and minimizes neurovascular complications.

The aim of this retrospective study was to assess and compare the diagnostic value of fine-needle cytology and MRI for the prediction of malignancy in parotid tumors. During an 11-year period, 148 patients underwent preoperative fine-needle aspiration cytology in our institution. Eighty-seven patients underwent a preoperative MRI study, and 54 had both MRI and cytology. The study compares results of cytology and MRI with histological reports. The sensitivity, specificity and accuracy for detecting malignant lesions were 87, 94 and 93% respectively for MRI, 81, 95 and 92% respectively for cytology and 100, 88 and 91% respectively for both studies combined. Fine-needle cytology provided better information than MRI concerning precise histological diagnoses. Conversely, the proportion of non-diagnostic smears reached 10%. Fine-needle cytology and MRI are simple, well-tolerated diagnostic means with an impact on the management of salivary gland tumors. The associated anatomic information obtained by MRI imaging makes it the test of first choice in an optimal medical environment.