Tumors of the lacrimal sac are rare, and are discussed primarily in the ophthalmological literature. The otolaryngologist, however, often performs the definitive surgery and must, therefore, be familiar with this disease. The lacrimal apparatus secretes and then drains lubricating fluid from the eye. This report focuses on the drainage mechanism which is anatomically and functionally a single structure composed of the canaliculi, the lacrimal sac, and the nasolacrimal duct. By 1963, 184 lacrimal sac tumors had been reported in the world literature. We have collected an additional 21 patients from the literature. This brings the total malignant tumors to 125, of which 74 were of epithelial origin. One sarcoma and four poorly differentiated epidermoid tumors treated in our department are presented in detail. The diagnosis is often evasive though the history of mass and epiphora is typical. Conservative treatment for dacryocystitis only temporizes. Work-up should include external and slitlamp examination, complete rhinological evaluation, sinus x-rays, tomograms of the bony lacrimal sac area, and dacryocystograms. Biopsy gives pathological confirmation. The largest group is epidermoid carcinoma, mostly of the poorly differentiated nonkeratinizing type. The treatment for benign lesions is local excision. Preoperative irradiation is indicated for epidermoid carcinoma, followed by wide local excision. Radical maxillectomy may be reserved for recurrences, and neck dissection for palpable nodes may be helpful. Mesenchymal tumors respond best to radiotherapy. Death in lacrimal sac cancer results from metastases, most often to the neck and lung. Five year survival rates appear to be slightly greater than 50%.

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Twenty‐eight patients, who underwent ossicular reconstruction one or more years after the incident trauma, were studied. The overall short‐term (one year or less) improvements were as follows: 1. 66 percent were within 10 db of closure of the air bone gap, and 82 percent were within 20 db; 2. 85 percent had a 10 db improvement in the SRT; and 3. 60 percent had a 10 percent improvement in the discrimination scores. On long‐term (two years or more) follow‐up, the results demonstrated that: 1. 43 percent maintained a 20 db air bone gap; 2. 50 percent had a 10 db improvement in the SRT; and 3. 35 percent had a 10 percent improvement in the discrimination score. These patients are subdivided into four classes of injuries: 1. incudostapedial complex; 2. incus dislocation or trauma; 3. epitympanic trauma; and 4. middle ear fibrosis. Patients who sustained isolated incudal injuries or incudo‐stapedial injuries had the best prognosis for maintaining the hearing after reconstruction, while in the latter two classes, this was not the case. Lysis of adhesions, incus interposition and reposition methods gave un‐predictable postoperative hearing improvement. Incus replacement prosthesis and conversion to Type III tympanoplasty gave more stable audiologic results. Selected case histories are presented to demonstrate the variability of the results in each of the four classes of injury. Two concepts are stressed: 1. ossicles which have been severely traumatized, interposed, repositioned or transposed behave as autogenous grafts, and 2. the post traumatic ear is not in a static state and that surgery alters the ongoing process of healing only to a certain extent.

The surgical complications associated with a cholesteatoma are predictable preoperatively depending upon the location of a cholesteatoma. If the patient has as attic cholesteatoma the surgeon can anticipate postoperatively a dry ear, minimal chance of persistent or recurrent cholesteatoma, satisfactory hearing restoration, and, although a mastoidectomy is usually necessary, the size of the mastoid cavity in an adult can be extremely small. If a patient has a middle ear cholesteatoma the surgeon can anticipate postoperatively a relatively high incidence of moist ears, persistent or recurrent cholesteatoma, and an unsatisfactory hearing result. However, seldom will the creation of a mastoid cavity be necessary as rarely will mastoidectomy be required. Although most of the children before puberty in the study had middle ear cholesteatomas, all children--regardless of the location of cholesteatoma--had a higher incidence of surgical failure than did the adults.