Metastatic tumors to the head and neck are uncommon. We report a case of renal cell carcinoma that presented as an epidermal inclusion cyst on the forehead. The forehead is an exceedingly uncommon site for renal cell metastases. We review the biology of tumor metastases and explore the pathways by which infraclavicular tumors spread to the head and neck. We then discuss the clinical appearance and management of metastatic renal cell carcinoma.

Fibroblast growth factors (FGFs) induce the proliferation and differentiation of cells of mesodermal and neuroectodermal origin. Using in situ hybridization, messenger ribonucleic acid encoding acidic FGF, basic FGF and FGF receptor 1 (FGFR1) were localized in the middle ear mucosa of experimental animals with acute and chronic immune-mediated otitis media with effusion (OME). Basic FGF-labeled cells were seen in the subepithelial connective tissue layer (SE) preferentially near the epithelial basement membrane. Acidic FGF-labeled cells were seen in the SE, preferentially near blood vessels and occasionally in the cellular middle ear effusion (CE). FGFR1-labeled cells were seen in the SE and in the CE. The distribution of labeled cells in the middle ear suggests that basic FGF is produced by fibroblasts, acidic FGF is produced by leukocytes, and FGFR1 is produced by both fibroblasts and leukocytes. A role is proposed for these peptides in the proliferation and maintenance of the middle ear submucosa during otitis media.

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A eutectic mixture of local anesthetics (EMLA), prepared as a cream, is an oil-in-water emulsion of 2 anesthetic agents lidocaine and prilocaine. Several clinical applications of EMLA cream, its effectiveness as a topical anesthetic, and its safety profile have been previously reported. We report our experience with EMLA cream in 17 adult and 24 pediatric patients. We find EMLA to be the preferred anesthetic for performing minor outpatient otologic procedures in adults. We also find EMLA to be a safe, well-tolerated alternative to general anesthesia in some pediatric patients. Potential cost savings of EMLA cream during pediatric myringotomies in the clinic are also discussed.

Based on changes in hearing thresholds and tinnitus that are co-related with the menstrual cycle, it has been suggested that the cochlea may respond directly to estrogen. For this to occur, the cochlea should express estrogen receptors. In situ mRNA hybridization was performed on normal female rat cochleas, using radiolabeled RNA probes complementary to mRNA encoding estrogen receptor, to determine whether estrogen receptors are present in the cochlea. Strong hybridization of the riboprobes to sections of uterus and hypothalamus indicated that the technique detected estrogen receptor mRNA. No hybridization to any cochlear tissues was observed. The results indicate that estrogen receptors are not expressed on cochlear cells, at least in rats. This in turn suggests that variation in cochlear responses during the estrus cycle are not the result of the direct effect of estrogen on the cochlea. Such variation may, however, be caused by systemic changes in fluid regulation induced by estrogen receptors at a distant site, or by other hormone receptors.