Cholesteatomas of the frontoethmoid region must always be considered in the differential diagnosis of a mass in the frontoethmoid region. A painless, slow-growing mass, often accompanied by proptosis and diplopia, but without history of trauma or infection, should make one suspect of this pathologic entity. Although histologically a benign lesion, the keratinizing squamous epithelial lining will continue to desquamate and expand, leading to erosion of surrounding structures which could be life-threatening. In order to prevent recurrence, complete removal of the cyst lining is mandatory. Cosmetic reconstruction, often requiring obliteration of the surgical cavity, should be delayed for one year to insure against recurrence of the covering of active squamous tissue adjacent to dura, cribriform plate or ocular structures.

Background The purpose of this study was to analyze long‐term follow‐up of a single institution's experience with a regimen of concomitant cisplatin/fluorouracil (5‐FU) infusion and radiation given every other week. This analysis was stimulated by results of a randomized trial showing superiority for this regimen over induction cisplatin/5‐FU chemotherapy followed by radiotherapy, especially in regional disease control. Methods All patients with stage III/IV disease who were referred by surgeons for nonoperative therapy and had a follow‐up of at least 2 years were included. Concomitant chemoradiotherapy was administered days 1–5 of a 2‐week treatment cycle, for a total of 7 cycles, with cisplatin 60 mg/m2 day 1, 5‐FU 800 mg/m2 given over 24 hours days 1–5, and radiation 2 Gy days 1–5. Results Seventy‐eight patients with stage III (n = 16) or IV (n = 62) were treated and followed for a median of 8 years. Six patients died during treatment, of aspiration pneumonia, sudden death, gastrointestinal bleeding, and stroke. When assessed 6 weeks after the end of treatment, 45 patients (63%) had no clinical evidence of disease, whereas 27 (37%) still had some persistent abnormality. However, 17 of these “partial responders” have not recurred. In all, 24 patients (31%) have recurred or progressed, 13 at the primary site, 5 after 3 years. None of 16 stage III and 24 (39%) of 62 stage IV patients ever progressed. Tongue and glottic larynx did best, with only 1 of 22 patients ever failing (none locally). Supraglottic and oral cavity cancers other than tongue had the worst failure rates. Nineteen patients (24%) died of other causes (DOC), tumor‐free. Patients who DOC correlated strongly with T stage (p < .002) but not with N stage or with AJC stage. The 5‐year progression‐free survival was 60% (confidence interval [CI] = 49% to 72%), and overall survival was 43% (CI = 33% to 56%). Conclusions Disease control for this advanced head and neck cancer population was excellent. This regimen was especially effective in advanced tongue and glottic cancers and all stage III disease sites. Advanced supraglottic and hypopharynx cancers are problematic. These, and especially T4 lesions, are associated with high DOC rates, possibly in part related to swallowing malfunction. Nevertheless, the long‐term survival without surgical intervention was high with this regimen. © 1997 John Wiley & Sons, Inc. Head Neck 19: 684–691, 1997.

Primary small cell carcinoma of the nose and paranasal sinuses is rare. This tumor appears to behave differently from the pulmonary small cell tumor, with propensity for local recurrence rather than early distant spread. Two new cases will be presented.SMALL cell carcinoma arising in the nasal cavity and paranasal sinuses is very rare. Although references to highly undifferentiated and anaplastic carcinoma have appeared in the literature, the designation of small cell carcinoma of the nasal tract did not appear until 1972. Several additional cases have since been reported. Although these tumors were histologically identical to the small cell carcinoma arising in the lung, review of the literature suggests a different clincial behavior for these tumors arising in the nose and sinuses, with a propensity for local recurrence rather than early metastatic spread. This necessitaties a different treatment approach, using surgical extirpation of the lesion in conjunction with chemotherapy and radiotherapy. We have treated two such patients. CASE REPORTSCase 1.-A 54-year-old man was evaluated for intermittent epistaxis. Results of the initial examination were normal. Shortly after that, nasal obstruction and proptosis developed. A granular area was noted on the left middle turbinate. Decreased sensation was noted along the first and second divisions of the fifth cranial nerve. Medial and lateral gaze was restricted. Pupillary responses were normal. Admission

Although nasal polyposis is a common entity, it is seldom considered a cause of bony destruction with consequent ophthalmologic and neurologic sequelae. Acute bilateral visual loss developed suddenly in a young, healthy woman with nasal polyps. Evaluation revealed erosion of the floor of the anterior cranial fossa, with compression of the optic nerves secondary to extensive paranasal and nasal polyposis. The clinical course, treatment, and histopathologic findings are discussed.