Basal cell adenocarcinoma is a rare and relatively recently characterised malignant salivary gland tumour. It accounts for 5 per cent of parotid gland tumours and 1 per cent of salivary gland malignancies. It is very rarely documented in anatomical sites other than the major salivary glands. Basal cell adenocarcinoma has only been described once before in the ethmoid sinus.

We report a case of basal cell adenocarcinoma in the ethmoid sinus, extending into the right orbit and anterior cranial fossa. We describe the clinical aspects of the patient's management and detail the histopathological features of this very rare diagnosis.

The development of infra-clavicular lymph node metastasis from head and neck squamous cell carcinoma is an uncommon event. We present a rare case of bilateral axillary nodal metastasis that developed in a patient previously treated for a primary ethmoidal squamous cell carcinoma. To our knowledge, there have only been five case reports in the English literature, accounting for a total of 10 patients, which documented a clinically apparent metastasis to axillary lymph nodes from various head and neck malignancies. Significantly however, the simultaneous ipsilateral and contralateral lymphatic spread of disease from a tumour in the para-nasal sinus, so as to involve bi-axillary nodes, has not been previously reported. We discuss the possible pathogenesis and the prognostic significance of this manifestation.

We report a case of sinolith in the left ethmoid sinus of a 61-year-old man. The patient complained of nasal obstruction. Computed tomography revealed a small, calcified mass associated with a nasal polyp in the left ethmoid sinus. The antrolith and polyp were removed via endoscopic sinus surgery. Histopathological analysis of the antrolith revealed it to be bone-like in formation. The antrolith was about 1 cm in diameter. Infrared spectroscopy revealed that the antrolith contained protein (45 per cent), calcium phosphate (43 per cent) and calcium carbonate (12 per cent).

The purpose of this retrospective study is to determine the pattern of cerebrospinal fluid (CSF) rhinorrhoea presenting to our tertiary referral centre in Kuala Lumpur and to assess the clinical outcomes of endonasal endoscopic surgery for repair of anterior skull base fistulas. Sixteen patients were treated between 1998 and 2004. The aetiology of the condition was spontaneous in seven and acquired in nine patients. In the acquired category, three patients had accidental trauma and this was iatrogenic in six patients (five post pituitary surgery), with one post endoscopic sinus surgery (ESS). Imaging included computed tomography (CT) scan and magnetic resonance imaging (MRI). Endoscopic repair is less suited for defects in the frontal sinuses with prominent lateral extension and defects greater than 1.5 cm in diameter involving the skull base. Fascia lata, middle turbinate mucosa, nasal perichondrium and ear fat (’bath plug’) were the preferred repair materials in the anterior skull base, whereas fascia lata, cartilage and abdominal fat obliteration was preferentially used in the sphenoid leak repair. Intrathecal sodium flourescein helped to confirm the site of CSF fistula in 81.3 per cent of the patients. Ninety per cent of the patients who underwent ’bath plug’ repair were successful. The overall success rate for a primary endoscopic procedure was 87.5 per cent, although in two cases a second endoscopic procedure was required for closure. In the majority of cases endoscopic repair was successful, and this avoids many of the complications associated with craniotomy, particularly in a young population. Therefore it is our preferred option, but an alternative procedure should be utilized should this prove necessary.

The authors present a case report of a retired furniture worker who initially presented with a mucin-secreting adenocarinoma of the right ethmoid sinus. He underwent surgical resection, leaving the nasal septum intact, and topical treatment with 5-fluorouracil. He remained disease free. Three years after his initial presentation he was found to have a left nasal polyp on routine examination. This subsequently proved to be a second primary adenocarcinoma. A review of the literature has not shown any other cases of a second primary adenocarcinoma of the ethmoid sinuses.

In this study we report on the correlation between the bacteriology of the middle meatusand ethmoid sinus in chronic sinusitis. When patients with chronic sinusitis underwent functional endoscopicsinus surgery (FESS), swab specimens were taken from the middle meati before surgery. After removing the ethmoid bullae, swab specimens were taken from the ethmoid sinuses. Between November 1998 and February 2001, 186 pairs of middle meatal and ethmoid sinus specimens were collected from 186 patients. No bacteria were cultured from either specimen in 32 patients. The same bacteria were cultured from both specimens in another 60 patients. The culture results differed between the middle meatal and ethmoid sinus specimens in the remaining 94 patients. There was a significant difference between culture rates of 63.4 per cent for middle meatal specimens and 76.3 per cent for the ethmoid sinus specimens. In analysing bacterial species, significantly more aerobic Gram negative bacteria were cultured from the ethmoid sinus specimens than from the middle meatalspecimens. This study shows that the bacteriology of the middle meatus was different from that of the ethmoid sinus. Therefore, the bacteriological findings in the middle meati may not reflect the real bacteriology in chronic sinusitis.

Primary chordoma of the paranasal sinuses are extremely rare tumours, with only a small number of cases verified and published in the literature. It appears that only five of these cases involved the ethmoid sinuses either as a primary or by local invasion, and of these documented cases only one other has been found to solely involve the ethmoid sinus. We present a case of primary ethmoid sinus chordoma treated by wide local surgical excision and present a review of the literature with regard to prevalence and treatment rationale.

A mucocele is an epithelial lined mucus-containing sac completely filling a paranasal sinus and capable of expansion. They are relatively unusual, occurring most frequently in the fronto-ethmoidal region. The imaging features on plain X-ray, computerized tomography and magnetic resonance imaging are relatively characteristic allowing distinction of the lesion from other pathologies in this area although the mucoceles may occur in association with other pathologies such as nasal polyposis and neoplasia.

In order to understand the risks and benefits of a combined transfacial and neurosurgical procedure for neoplasms of the ethmoid sinus, we reviewed all patients who underwent this surgical approach in our department between 1986 and 1994.

The study included 41 patients. Pathological diagnoses included adenocarcinoma (31 patients), squamous cell carcinoma (three patients), aesthesioneuroblastoma (three patients), other (four patients). The overall morbidity rate was 39 per cent, and the post-operative mortality rate was 2.5 per cent. Complications were statistically more likely in patients with bone skull base reconstruction. The main carcinologic failures were local recurrences (24 per cent) and metastases (22 per cent). The one-year, three-year and five-year Kaplan Meir survival rates were respectively 84 per cent, 53 per cent and 36 per cent. In conclusion, the mortality and morbidity were acceptable, especially when no bone skull base reconstruction was performed. Better local control justifies a combined procedure with post-operative radiotherapy when tumours involve or reach the skull base.

A seven-year-old boy complained of intermittent epistaxis for several months. Computerized tomography (CT) scans showed increased soft tissue density over the left ethmoid sinus. Endoscopic sinus surgery was used to remove the mass completely. The pathological report was craniopharyngioma. No other focus of lesion was found, and he continues to do well.

The presence of a benign osteoblastoma in the ethmoid sinus is rare and only a few cases have been reported. This is a case of a benign osteoblastoma arising from the perpendicular plate of the ethmoid bone with extension to the nasal cavity. The diagnosis and management of this unusual lesion, as well as the histopathology and the imaging characteristics are reviewed. We also review the previously reported cases of benign osteoblastomas of different origin, with nasal cavity involvement.

Metastatic carcinoma of the ethmoids is very rare. Of the few cases reported in the literature, the majority are renal in origin. Although metastases from the gastrointestinal tract have been reported. there are no known cases of metastases from the stomach.

We present a rare case of metastatic adenocarcinoma of the ethmoids in a patient previously treated for adenocarcinoma of the stomach and describe the possible mechanisms of spread. The patient had a craniofacial resection of the tumour but unfortunately died four weeks post-operatively from acute liver failure probably caused by a liver metastasis.

Sarcoidosis is a multisystem granulomatous disease of unknown aetiology. Nasal sarcoidosis commonly affects the mucosa of the septum and the inferior turbinates. These patients may present with nasal discharge, crusting, obstruction, epistaxis or anosmia. We present an unusual case of nasal sarcoidosis involving the ethmoid sinus causing recurrent eyelid swelling and discuss its management.

Orbital complications of ethmoiditis are not uncommon in children. They are, however, much rarer in the very young. A case is presented in which a neonate of gestational age 39 weeks developed a periorbital abscess. The relevant literature is reviewed with respect to embryology, aetiology and treatment.

Twenty patients with medically treated rhinoscleroma and residual ethmoidal manifestations were examined using CT scanning. Cases with positive radiological data of the ethmoids underwent diagnostic and therapeutic nasal endoscopy.

It has been found that ethmoidal scleroma is not as rare a condition as was previously thought. The diagnostic and therapeutic value of nasal endoscopy in ethmoidal scleroma is discussed.