CT remains the standard modality for diagnosing sinusitis, but MRI frequently is necessary, especially for patients with intracranial complications. Both diagnostic methods have improved the management and outcomes of patients who have sinusitis with complications.

The general practice guidelines mandate obtaining histopathologic diagnoses on most of the tissues received. Based on our review, histopathology of tonsillectomy and/or adenoidectomy may not be necessary, especially in children. In this era of cutting excess costs of health care dollars, waving histopathology in these cases may have major implications without compromising delivery of quality care.

A modification of the preauricular skull-base approach is described. After sectioning and downward displacement of the zygomatic arch, the coronoid process of the mandible is dissected and sectioned at its base. The temporal muscle, with its coronoid insertion, is then retracted upward. This approach provides direct and unobstructed access to the temporal and infratemporal fossae. Adequate vascularity of the temporal muscle is maintained. The exposure encompasses the internal carotid artery in the neck for vascular control. Extensive reconstruction is eliminated. The described technique was used in seven patients with lesions of the skull base. There was no operative mortality, and morbidity consisted of temporary restriction of mandibular opening in two patients.

From 1969 to 1990, 43 patients with tracheal stenosis were treated at the University of Mississippi Medical Center. Seventy-four percent of these patients (n = 32) had intrinsic tracheal stenosis, most frequently as a complication of prolonged endotracheal trauma. A total of 41 distinctly separate stenotic segments were identified in the 32 patients. The stenoses were considered moderate or severe in 33 (80%) of the 41 cases and the length of the stenotic segment was greater than 1 cm in 23 (56%) of the cases. An overall 70% success rate was achieved following 93 surgical procedures in this group. The concurrent presence of glottic/subglottic stenosis, multiple segments of stenosis, bilateral vocal cord paralysis, tracheoesophageal fistula, and a tendency to marked hypertrophic scar formation were found to be significant factors in the surgical management of this patient group.

Despite improvements in antibiotic therapies and surgical techniques, sinusitis still carries a risk ofserious and pote ntially fa tal complications. We exa mined the charts of 82 patients who had been admitted to the University ofMississippi Medical Center betw een Jan. I , 1985, and Dec. 31, 1999,/01' treatm ent of complications of sinu sitis. Ofthese 82patients, 43 had orbital complications and 39 had intracranial complications. In this article, we describe ourfi ndings in those patients who had intracranial complications (our fi ndings in patients with orbital compli cations will be reported in a f uture article). The most common intracranial complication was meningitis; others were epidural abscess, subdural abscess, intra cerebral abscess, Pott's puffy tumor, and supe rior sag ittal sinus thrombosis. Most patients with meningiti s were treated with drug therapy only; patients with abscesses were generally treated with intravenous antibiotics and drainage ofthe affected sinus and the abscess. Advancements in antibiotic therapy, endosco p ic surgery, imagin g studies, and computer-assisted surge ry have helped impr ove outcomes. Management ofthese patients should be undertaken immedia tely and is best achieved via a multidisciplinary approach, involving the otolaryngo logist, neurosurgeon, radiologist, anesthesiologist, inf ection disease spec ialist, pediatrician, internist, and others.