Sinus Fossa Research Articles

Minimally Invasive Management of Neonatal Piriform Fossa Sinus Tract: A Scoping Review.

In rare situations, neonates may present with respiratory distress and neck swelling from a piriform fossa sinus tract (PFST) lesion. Open surgical excision of PFST may be associated with higher complication rates, especially in neonates. Endoscopic treatment has been shown to have high success rates in older children, but neonatal outcomes appear to be less promising. The objective of this study was to review the existing literature on endoscopic treatment of PFST in neonates. PRISMA-ScR guidelines for scoping reviews were employed. Medline and Embase databases were searched in accordance with a detailed search strategy. Nine studies met criteria for inclusion. A total of 21 neonates with PFST treated endoscopically were reviewed. Mean age at onset of symptoms was 11.6 days. Neck swelling was the most common presenting symptom (20/21, 95%), followed by respiratory distress (6/9, 66.6%). Success rate after initial endoscopic treatment was 57% (12/21); among those, seven patients required additional concurrent treatments such as neck/pharyngeal swelling decompression or sclerotherapy. Nine patients underwent a second intervention (43%) and three patients (14%) required three interventions. Notably, 90% of patients (19/21) achieved success with only minimally invasive approaches. Two patients underwent open salvage surgical excision after recurrence following initial endoscopic treatment. Neonates with PFST and cystic neck masses are prone to recurrence after initial minimally invasive endoscopic treatment; however, high success rate may be achieved after repeat interventions. Adjunctive measures to optimize outcome may include swelling decompression w/wo sclerotherapy to cause fibrosis and postoperative nasogastric tube feeding. NA Laryngoscope, 134:2585-2591, 2024.

Treatment Outcomes of Maxillary Sinus Squamous Cell Carcinoma at a Dedicated Cancer Institute: A Retrospective Study.

IntroductionSquamous cell carcinoma arising at the maxillary sinus is a rare neoplasm, characterized by an aggressive growth pattern and glooming prognosis. The proximity of the maxillary sinus with complex anatomical structures such as the eye, skull base, infratemporal fossa, pterygomaxillary fossa, nasal cavities, and ethmoid sinuses makes the surgical treatment of tumors infiltrating into these structures very challenging. The study's objective was to investigate the prognostic factors of survival and maxillary sinus SCC treatment outcomes.MethodsWe did a retrospective analysis of patients treated for maxillary sinus SCC at our institution between 2004 -2018. The study included all the patients with histologically proven maxillary sinus SCC treated with curative intent. The medical record of 43 patients was reviewed and utilized for the analysis. The Kaplan-Meier curve calculated five-year overall survival.ResultsA total of 43 patients were analyzed. At the presentation time, the mean age was 54.56 years (SD ± 11.65). Smoking (n=13, 30.2%) was the common risk factor. 36 (83.7%) patients presented with stage IV disease. Surgery was performed in 16 (37.2%) patients, whereas 27 (62.8%) patients received radiation and chemotherapy. Treatment failure was seen in 35 (81.4%) patients with locoregional recurrence in 30 (85.7%) patients and distant metastases in 5 (14.3%) patients. The five years overall survival in our study was 22%. Loco-regional recurrence and distant metastasis were the significant factors impacting survival (p=0.01).ConclusionMaxillary sinus SCC is rare cancer that is more common in males and usually presents at an advanced stage with a poor outcome. These tumors have a higher rate of treatment failure with a poor prognosis. Locoregional recurrence and distant metastasis adversely impact the overall survival.

Piriform fossa sinus tract - a 15-year retrospective review with a focus on atypical neonatal presentations.

Third and fourth branchial anomalies are rare, accounting for less than 10% of all branchial anomalies. The piriform fossa sinus tract (PFST) typically presents with left-side suppurative thyroiditis, although it can present earlier in neonates as a non-inflamed cystic neck mass. PFST poses a considerable diagnostic challenge with variable clinical and imaging features, leading to long delays to definitive diagnosis and appropriate management. To analyse the patterns of presentation and imaging findings in children with PFST, with a particular focus on neonatal presentation. This was a retrospective review of the clinical presentation, imaging findings and management in 16 cases of PFST presenting to our tertiary children's hospital between 2003 and 2018. Cases were identified by medical records and picture archiving and communication system (PACS) search using relevant International Classification of Diseases (ICD)-10 coding. Age at presentation ranged from prenatal to 16years, with a male-to-female ratio of 2:1. All patients presented with neck swelling. Thirteen patients (81%) had suppurative thyroiditis at initial presentation. Two patients had severe thyroiditis/mediastinitis that required intensive care unit admission. Three neonates presented with noninfected, asymptomatic large cystic neck masses; two of these were detected prenatally and misdiagnosed as lymphatic malformations with subsequent spontaneous clinical resolution that later represented with evidence of PFST. The PFST was on the left side in 15/16 (94%) patients. All patients had neck imaging before definitive diagnosis. Imaging studies included radiographs, ultrasound, computed tomography, magnetic resonance imaging and barium esophagram studies. No single modality was diagnostic of PFST in all patients. Seventy-five percent of patients had multimodal imaging before diagnosis. All PFSTs were confirmed by endoscopic visualisation. Management of PFST was by endoscopic cauterisation in 13 patients and open surgery in 2. One patient did not require surgical correction. Our study highlights the complex nature of PFST. The anomaly is uncommon, has variable clinical and imaging features and may have a lengthy, complicated course if not considered at initial presentation. An episode of suppurative thyroiditis in a child should prompt investigation for PFST. We describe atypical presentations with cystic masses in neonates that appear to resolve but represent later as typical clinical features of PFST.

Endoscopic cauterisation and injection of Voicegel for treatment of congenital pyriform fossa sinus tracts.

SUMMARYObjectiveTo demonstrate our experience in treating pyriform fossa sinus tracts (PFST) using a novel technique of endoscopic cauterisation of the pyriform fossa sinus opening combined with injection of sodium carboxymethylcellulose gel (VoiceGel) lateral to the tract to encourage tight closure.MethodsOver a 48-month period, we used this technique on 11 patients who were diagnosed with PFST at BC Children’s Hospital, a tertiary paediatric centre in Vancouver, BC, Canada.ResultsThe 11 patients included 8 males and 3 females, and mean age at presentation was 69 months (range 22-108 months). Mean time from beginning of symptoms till diagnosis was 15 months (range 12-22 months). Ten PFST were on the left side of the neck and one on the right. Nine patients presented with recurrent neck infections and two had suppurative thyroiditis. All patients had endoscopic cauterisation of their PFST opening combined with injection of carboxymethylcellulose lateral to the sinus tract to cause tract collapse. Mean follow up was 15.8 months (range 8-24). All patients are asymptomatic without recurrence at the last follow-up visit. No post-operative complications were reported.ConclusionsEndoscopic management of paediatric PFST combined with the injection of sodium carboxymethylcellulose gel lateral to the sinus tract appears to be a safe and effective treatment option for PFST.

Primary disease sites and patterns of spread in cases of neurolymphomatosis in the orbit associated with lymphoma

BackgroundNeurolymphomatosis involving the cranial nerves (CNs) is rare. We sought a better understanding of the primary disease sites and patterns of spread in neurolymphomatosis of the orbit and retro-orbital cranial nerves.MethodsPatients with lymphoma and MRI evidence of neurolymphomatosis of CN II, III, IV, V1, or V2 were retrospectively reviewed. Demographics and primary disease site and sites of neurolymphomatosis on MRI were recorded. Wilcoxon rank sum test was used to compare number of sites of neurolymphomatosis with lymphoma type and survival.ResultsThe study included 18 patients. The most frequent types of lymphoma were diffuse large B-cell (DLBCL) (n = 9) and marginal zone (n = 3). In 9 patients, lymphoma presented as a mass (n = 7) or infiltrative disease (n = 2) directly involving the orbit; in 6, a maxillofacial mass spread directly to CNs; and in 3, lymphoma at remote sites spread to orbital CNs. Overall, 81 sites of neurolymphomatosis were noted. The most common sites were the maxillary nerve (V2) including at the infraorbital fissure or foramen rotundum (17 patients; 19 nerves), pterygopalatine fossa (16 patients; 19 nerves), and cavernous sinus (9 patients; 12 nerves). Number of sites of neurolymphomatosis was significantly lower for DLBCL than for other lymphoma types (p = 0.007). Number of sites of neurolymphomatosis did not affect survival (p = 0.26). The mean interval between the pathologic diagnosis and MRI documentation of the full extent of neurolymphomatosis was 39 days after pathologic diagnosis.ConclusionsBased on our study results, neurolymphomatosis in the orbit appears to be frequently associated with an orbital and/or maxillofacial mass and commonly involves CN V2, the pterygopalatine fossa, and the cavernous sinus. DLBCL may be associated with fewer sites of neurolymphomatosis than other lymphomas. In patients with lymphoma, a systematic search for neurolymphomatosis is imperative for early detection.

Cộng hưởng từ chẩn đoán ung thư vòm mũi họng di căn hạch hầu sau

Purpose: Survey the rate and distribution of retropharyngeal lymph node metastasis, the suitability between Magnetic Resonance and computed tomography in the evaluation of nasopharyngeal tumor and the ability to detect retropharyngeal lymph node. Methods and Materials: Cross-sectional descriptive study conducted on 35 patients with nasopharyngeal carcinoma diagnosed and treated at Hue Central Hospital from April 2018 to July 2019. The patient underwent Magnetic Resonance Imaging and Computed Tomography. Data processed with SPSS 20.0 for Windows. Investigate the level of correlation between the two techniques based on the Kappa coefficient. Results: 14 patients had retropharyngeal lymph node metastasis with a total of 25 lymph nodes, all of which in the lateral position, none in the middle. 76% the lymph nodes are at the level of C1 vertebra. 48% of lymph nodes have heterogeneous enhancement. There is a close match between Magnetic Resonance Imaging and Computed Tomography in assessing the invasion at anatomical positions: Rosenmuller fossa, Eustachian tubes, nasal cavity, pharynx, and paranasal sinuses; There is a moderate match between the two methods in assessing the invasion of the cranial base and the sphenomaxillary suture. In 14/35 cases where the retropharyngeal lymph node was detected on Magnetic Resonance Imaging (accounting for 40%), Computed Tomography identified only 6 cases (17.1%). Conclusions: There are differences on many levels between Magnetic Resonance Imaging and Computed Tomography in the diagnosis of tumor invasion and retropharyngeal lymph node metastasis in nasopharyngeal carcinoma. In particular, Magnetic Resonance Imaging is better in detecting retropharyngeal lymph node metastasis due to high structural contrast, these lymph nodes are often difficult to detect on Computed Tomography because it is difficult to distinguish from posterior pharyngeal structures or tumors.

Sphenoid sinus aspergilloma clinically mimicking as malignancy\u2014a case report

BackgroundFungal sphenoid sinusitis mimicking as malignant tumor and invading the pituitary fossa is an uncommon entity. This report aims to highlight radiological salient features to help differentiate fungal lesion from malignant tumor in sphenoidal sinus mass lesions.Case presentationWe intend to report a case of middle-aged female who presented with gradual progressive diminution of vision since 3 years complicated with acute attack of unilateral headache and numbness. Computed tomography (CT) showed hyperdense lesion involving the sphenoid sinus extending into pituitary fossa and bilateral cavernous sinuses with smooth bony remodeling. Lesion appeared hypointense on T2-weighted and hyperintense on T1-weighted images on magnetic resonance imaging (MRI). Surgical excision of the lesion was done and pathological examination showed fungal hyphae and aspergillus fumigatus species on culture after 2 weeks of incubation. Post-operative CT revealed empty sinuses with surrounding bone remodeling.ConclusionCombination of T1 hyperintensity, T2 hypointensity, and hyperdense sinus is a strong predictor of fungal mass lesion involving sphenoid sinus.

Endoscopic diathermy cauterization of piriform fossa sinus tract (PFST)

Introduction A congenital piriform fossa sinus tract is thought to be caused by a developmental abnormality of the third or fourth pharyngeal arches. This condition is traditionally managed by an open approach, external excision of sinus tract with hemi-thyroidectomy. However, endoscopic cauterization of PFST is now recognized as a minimally invasive definitive first line therapeutic option. Objective To evaluate the success of endoscopic cauterization of the PFST as a definitive first line therapeutic option. Method Retrospective analysis was done on medical records of ten patients (aged 1-12y), who were diagnosed with PFST and underwent endoscopic diathermy cauterization of PFST during one-year period (2015/2016) at LRH. Data including demography, presentation, management and response to treatment were analyzed. Results Median age of our case series was 8.23 years and eight out of ten patients (80%) were males. The most common presentation was recurrent thyroid abscess 60% (6/10) and the side of the disease was left in 90% (9/10). Eight out of ten (80%) patients had complete closure of the PFST after one session of endoscopic diathermy cauterization. Two out of ten (20%) patients had to undergo two sessions. Average follow up period was 17 months. Conclusion We propose the endoscopic diathermy cauterization as a safe and definitive first line therapeutic option in the management of the PFST.

Removal of a maxillary tumor with simultaneous placement of intraosseous zygomatic implants

The study objective is to report a case of successful placement of intraosseous zygomatic implants for functional and aesthetic rehabilitation of a patient with a maxillary defect resulted from maxillary resection for right-sided stage IIB maxillary sarcoma (сT2N0M0, G3). Materials and methods . A 34-year-old male patient visited a doctor in P.A. Herzen Moscow Oncology Research Institute with complaints of maxillary tumor. During the examination of the oral cavity, we found a dense endophytic tumor in the area of two missing teeth (17 and 18) involving the alveolar process and palatine process of the maxilla. Computed tomography revealed destruction of the alveolar process, lateral, medial, and posterior walls of the maxillary sinus on the right, and tumor invasion into the right iliac fossa, pterygopalatine fossa, and right maxillary sinus. We also observed tumor destruction of the right palatine process of the maxilla. The patient was diagnosed with osteogenic sarcoma. Results. The patient received 4 courses of polychemotherapy with cisplatin and doxorubicin, which resulted in disease stabilization. Then the patient underwent en-block resection of the fragment of the right maxilla with alveolar and palatine processes, fragments of the zygomatic bone, wings of the sphenoid bone on the right side, and adjacent soft tissues. Simultaneously, we placed two zygomatic implants to provide supportfor the maxillary plate denture. To create an additional supporting point, we extracted tooth 11 and installed an implant with external hexagonal connection. Later, we produced and installed a specially designed palatal obturator. Conclusion. Installation of removable dentures supported by implants ensures complete and rapid rehabilitation, allowing a patient to chew, swallow, and speak normally. A palatal obturator on implants supports the soft tissues of the medial face, thus ensuring complete aesthetic rehabilitation.

Yaquinacetus meadi, a new latest Oligocene–early Miocene dolphin (Cetacea, Odontoceti, Squaloziphiidae, fam. nov.) from the Nye Mudstone (Oregon, U.S.A.)

ABSTRACTRepresented by a nearly complete cranium with associated mandible, teeth, and vertebrae, Yaquinacetus meadi is a new genus and species of archaic homodont odontocete from the latest Oligocene–early Miocene (24–19.2 Ma) of Oregon, U.S.A. The new species is characterized by a moderately elongated rostrum bearing approximately 51 alveoli per tooth row and a knob-like, rectangular vertex. Together with Squaloziphius emlongi from the early Miocene of Washington State, Y. meadi constitutes a new odontocete family, Squaloziphiidae, fam. nov., diagnosed by a unique combination of characters, including transversely wide dorsal opening of the mesorostral groove at base of rostrum, followed posteriorly by an abrupt narrowing; thickened lateral margin of the maxilla in the antorbital region making a long and laterally concave crest; and massive, anteroposteriorly and ventrally long postglenoid process of the squamosal. Although sharing with Ziphiidae the presence of transverse premaxillary crests on the vertex, Squaloziphiidae differs in the pterygoid sinus fossa being shorter anteriorly and ventrally; the tubercule of the malleus being less reduced; and lacking a pair of enlarged alveoli for mandibular tusks. Our phylogenetic analysis confirms the sister-group relationship between S. emlongi and Y. meadi, either as late diverging stem odontocetes or as early crown odontocetes, but distant from Ziphiidae. These results confirm the northeastern Pacific as a center of diversification for several groups of archaic homodont odontocetes during the late Oligocene–early Miocene.

Endoscopic Cauterization with Pneumatic Distension for Piriform Fossa Sinus Tracts.

Piriform fossa sinus tracts (PFSTs) are a cause of recurrent neck infections in the pediatric population. Conventional management required open resection, but over the last years minimally invasive approaches have been reported in an attempt to endoscopically obliterate the PFST, using different methods such as electrocautery, laser, trichloroacetic acid, or silver nitrate. We undertook a retrospective review of the medical records of 12 children (aged 4 months to 14 years) with PFSTs treated with endoscopic sclerosis with diathermy (ESD) between 2010 and 2016 at a tertiary care children's hospital. We also present a technical modification of ESD, using continuous infusion of airflow through the gastroscopy, to distend the piriform sinus and facilitate its recognition. PFST obliteration was performed using diathermy through a guide wire. Clinical presentation of the 12 affected children included neck tumor (7 [58%]), neck abscesses (4 [33%]), and thyroiditis (5 [41%]). All lesions occurred on the left side. All patients underwent both ultrasonography and barium esophagography (the latter being positive only in 50%). Two patients were treated with ESD after the open approach had failed. There was no procedure-related morbidity. One patient had a recurrence (positive barium swallow without symptoms). The success rate of this procedure in our series was 91% with one attempt and 100% with two attempts. In our experience, treatment of PFST with ESD is a reproducible, noninvasive, and an effective option. ESD could be considered a primary approach and also for revision after open surgery has failed in these patients.

Giant trigeminal schwannomas-case report and a short literature review

Abstract Trigeminal schwannomas (TS) are rare tumors that are located in the posterior and middle cranial fossae in about a quarter of the cases. The presentation pattern is different according to the involved compartment and the goal of surgery is complete removal. We present the case of a 35-year old woman who presented a left sided TS extending from the posterior to the middle fossa and cavernous sinus. We review the relevant literature regarding diagnosis and surgical treatment of these tumors.

Mucoepidermoid Carcinoma with Distant Metastases to the Kidney, Adrenal Gland, Skull and Gluteus Maximus Muscle: a Case Report

Introduction: Distant metastases of mucoepidermoid carcinoma (MEC) are reported with the most common sites being the soft tissue of skin, lung, liver, and bone. We report here a very rare case of MEC with multiple metastases to the kidney, adrenal gland, skull and gluteus maximus muscle. Case report: A 63-year-old male patient presented with left-sided headache. Radiologic evaluations including CT and MRI showed ill-defined soft tissue lesion involving the left infratemporal fossa and left sphenoid sinus, and multiple enlarged lymph nodes in neck and mediastinum. PET-CT demonstrated multiple hypermetabolic lesions in and around the left kidney, left adrenal gland, right ischium, right gluteus maximus and skull base. These lesions were confirmed as MEC with multiple metastases through biopsy. Discussion: Only one case of metastasis to the skull has been previously reported, and moreover, there has not been a case of metastatic MEC to the kidney, adrenal gland and gluteus maximus muscle so far in the medical literature. It is important to acknowledge the possibility of every unusual MEC metastases, since the presence of metastasis has statistically significant influence on the survival of MEC.

Systematic Review of Endoscopic Obliteration Techniques for Managing Congenital Piriform Fossa Sinus Tracts in Children.

Piriform fossa sinus tracts (PFSTs) are a recognized cause of recurrent deep neck infections in the pediatric population. Conventional management has historically required open resection, but over recent years minimally invasive endoscopic approaches to obliterate the pharyngeal opening of the sinus have been performed in many centers. However, there is a lack of clear evidence regarding the success rate and safety of these approaches. To determine the success rate of endoscopic management of PFST through a systematic review of the existing literature. MEDLINE (1964-2014) and bibliographies of identified papers. Two authors independently reviewed 170 abstracts and identified relevant studies for full-text review. Data were independently extracted from those studies, and the Oxford Centre for Evidence-Based Medicine guidelines were used to classify the level of evidence. Thirteen studies met the inclusion criteria, comprising a total of 84 patients. All included studies were evidence level 4 (case series). Various methods of obliterating the PFST were described: electrocautery (n = 39), laser (n = 19), trichloroacetic acid (n = 19), silver nitrate (n = 4), combination of silver nitrate and laser (n = 2), and fibrin glue (n = 1). The success rate for endoscopic management of PFST was 89.3% overall (90.5% in primary cases and 85.7% in revision cases). The only adverse event reported was temporary vocal cord immobility in 2.4% (n = 2) of cases. Endoscopic management of pediatric PFST appears to be safe and effective, as a primary option and for revision after open surgery.

Endoscopic Cauterization of Congenital Pyriform Fossa Sinus Tracts

Congenital pyriform fossa sinus tracts predispose to neck masses and neck abscesses in pediatric and occasionally adult patients. Traditional management involves open excision with substantial potential morbidity. Endoscopic management allows an alternative, less morbid treatment approach. To evaluate the long-term effectiveness of endoscopic cauterization as definitive treatment for pyriform fossa sinus tracts. Retrospective review of the medical records of 23 children (aged 7 months to 14 years) with pyriform fossa sinus tracts treated with endoscopic cauterization between 1995 and 2013 at a tertiary care children's hospital. Endoscopic electrocauterization of pyriform fossa sinus tract opening. Recurrence of symptoms after endoscopic treatment. Twenty-one of 23 patients experienced no recurrence after their first endoscopic electrocauterization of the sinus tract. The 2 patients with recurrence experienced symptoms within 1 month of cauterization and were treated with either open excision or recauterization. Endoscopic cauterization was able to definitively treat 9 patients whose treatments with incision and drainage or open excision had failed. Mean (range) follow-up for the 15 patients with follow-up was 7.4 (0.10-14.2) years. No procedure-related morbidity was reported. Endoscopic cauterization seems to be an effective and potentially permanent treatment for congenital pyriform fossa sinus tracts.

Management of third branchial pouch anomalies – An evolution of a minimally invasive technique

ObjectivesThe management of third branchial pouch anomalies has evolved in recent times with the popularisation of the endoscopic diathermy technique to sclerose the pyriform fossa sinus opening. We present our experience in managing 3 children with third branchial pouch anomalies and propose a minimally invasive management algorithm avoiding open neck surgery. MethodsRetrospective case review of 3 patients including demographics, mode of presentation, investigations, management and complications. ResultsThree children, two male and one female of mean age 9.6 years presented with painful left anterior neck swelling. Axial neck imaging showed a superficial abscess with air locules and a sinus tract leading towards the left pharynx. Diagnosis was confirmed by endoscopic examination of the pyriform fossa revealing a sinus opening. Two patients underwent open excision; one combined with diathermy to the sinus opening. The last patient was diagnosed at his initial presentation and managed with endoscopic diathermy of the sinus opening combined with percutaneous needle aspiration of the neck abscess at the same sitting. One patient had two recurrences, the first after initial open surgery and the second after the first cautery. Two patients developed temporary hoarseness after the procedure, which resolved within two weeks. All patients were free from recurrences at follow-up. ConclusionsIntroduction of the technique of endoscopic diathermy to the pyriform fossa sinus opening in children with third branchial pouch anomalies has revolutionised their management avoiding open and potentially morbid surgery. Our algorithm takes this further by advocating percutaneous needle aspiration of the infective component and performing diathermy to the sinus opening at the first presentation.

Image features of aspergillosis arising from the pterygopalatine fossa: a case report and literature review

Aspergillosis of the skull base is an unusual disease entity, mainly found in immunocompromised patients. Aspergillosis originating in the pterygopalatine fossa (PPF) without contiguous spread from the sinuses is extremely rare. A 79-year-old woman complained of having suffered pain in her left cheek and headaches for 4 months. Computed tomography (CT) scans revealed soft tissue filling the left PPF with sclerotic change and erosion of the adjacent bone. A follow-up CT scan 1 month later after supportive care showed an increase in the extent of the soft tissue lesion in the left PPF with progressive erosion of the posterior wall of the left maxillary sinus. Magnetic resonance imaging revealed a low-signal-intensity mass in the PPF on T2-weighted images; the mass displayed strong enhancement on contrast-enhanced T1-weighted images and extended into the left maxillary sinus, infratemporal fossa, and cavernous sinus. The patient underwent a Caldwell-Luc operation with debridement of the PPF; the histopathological diagnosis was aspergillosis. The patient eventually died from cerebral ischemic change and brain edema during the postoperative period.

Case series: Endoscopic management of fourth branchial arch anomalies

IntroductionFourth branchial arch anomalies represent <1% of all branchial anomalies and present as recurrent neck infections or suppurative thyroiditis. Traditionally, management has consisted of treatment of the acute infection followed by hemithyroidectomy, surgical excision of the tract and obliteration of the opening in the pyriform fossa. Recently, it has been suggested that endoscopic obliteration of the sinus tract alone using laser, chemo or electrocautery is a viable alternative to open surgery. ObjectivesTo determine the results of endoscopic obliteration of fourth branchial arch fistulae in children in our institute. MethodsRetrospective case note review of all children undergoing endoscopic treatment of fourth branchial arch anomalies in the last 7 years at the Royal Manchester Children's Hospital. Patient demographics, presenting symptoms, investigations and surgical technique were analysed. The primary and secondary outcome measures were resolution of recurrent infections and incidence of surgical complications, respectively. ResultsIn total 5 cases were identified (4 females and 1 male) aged between 3 and 12 years. All presented with recurrent left sided neck abscesses. All children underwent a diagnostic laryngo-tracheo-bronchoscopy which identified a sinus in the apex of the left pyriform fossa. This was obliterated using electrocautery in 1 patient, CO2 laser/Silver Nitrate chemocautery in 2 patients and Silver Nitrate chemocautery in a further 2 patients. There were no complications and no recurrences over a mean follow-up period of 25 months (range 11–41 months). ConclusionEndoscopic obliteration of pyriform fossa sinus is a safe method for treating fourth branchial arch anomalies with no recurrence.

Intraoral Approach for Surgical Removal of a Nail in Penetrating Maxillofacial Injury

An unusual case of penetrating maxillofacial injury caused by a nail gun is presented. In this case, the foreign body was shot into the left infratemporal fossa and maxillary sinus through the left cheek. We used an intraoral approach that allowed precise localization of the point of the infratemporal surface of the maxilla through which the nail penetrated the maxillary sinus. The nail was successfully removed and the patient was discharged with complete recovery. The details of the surgical approach as well as localization techniques are described. Different approaches to remove the nail as well as the advantages and disadvantages of each approach are discussed.

Two new extinct basal phocoenids (Cetacea, Odontoceti, Delphinoidea), from the upper Miocene Koetoi Formation of Japan and their phylogenetic significance

ABSTRACT Two new extinct porpoises—Archaeophocaena teshioensis, gen. et sp. nov., and Miophocaena nishinoi, gen. et sp. nov.—are described from the upper Miocene Koetoi Formation (5.5–6.4 Ma) of Hokkaido, Northern Japan. The holotype of the former is composed of a partial skull, whereas the holotype of the latter is composed of a partial skull, right periotic, right stylohyoid, and pelvis. Both species are assigned to Phocoenidae on the basis of a unique combination of phocoenid characters: presences of frontal bosses, nasal protuberances, premaxillary eminences, and fossae for the inferior vestibule. However, they do not have dorsally developed preorbital sinus fossae or high premaxillary eminences, unlike derived phocoenids. Furthermore, their premaxillae contact the nasals (or the right premaxilla alone contacts the right nasal), unlike all other known phocoenids except Pterophocaena. A comprehensive morphological cladistic analysis indicates that the two new extinct species are the second-most basal phocoenids next to Pterophocaena and that Phocoenidae is the sister group of Delphinidae. The cranial morphology of the two new extinct species is intermediate in form between that of phocoenids and delphinids, supporting the hypothesis of a sister relationship for the two groups. Thus, these new species fill not only the morphological gap between Phocoenidae and other families of Delphinoidea but also a temporal gap in the fossil record of phocoenids in the western North Pacific.