Meningoencephalocele is a rare defect of the skull base in which brain tissue and meninges herniate through a bony defect. Skull base meningoencephaloceles are rare, particularly those not associated with the sphenoid sinus or other aerated anatomical structures. Due to their nonspecific clinical presentation, recognition is often delayed. The aim of this paper is to present a rare case of a meningoencephalocele of the middle cranial base with an atypical localization and clinical presentation. We present a 66‐year‐old patient who was treated at a tertiary otorhinolaryngology center for a meningoencephalocele of the left middle cranial base in the region of the pterygoid process of the sphenoid bone. The disease manifested solely as a chronic, nonproductive cough resistant to pharmacological treatment, which for several years had been attributed to asthma. The patient had no history of craniofacial trauma, prior skull base surgery, or risk factors for elevated intracranial pressure. Clinical ENT and neurological examinations revealed no abnormalities. MRI and CT of the head, performed for other indications, later confirmed the presence of a meningoencephalocele. The patient was successfully treated with a transnasal endoscopic surgical approach with skull base reconstruction, after which the cough resolved immediately. The presented case of a pterygoid meningoencephalocele of the middle cranial base at an atypical location within the sphenoid bone demonstrates that meningoencephaloceles may present without involvement of aerated anatomical structures and without typical signs of cerebrospinal fluid (CSF) leakage. In our patient, CSF leakage manifested exclusively as chronic cough, leading to a delayed diagnosis. Given the absence of risk factors for intracranial hypertension, this case raises consideration of dysembryogenesis of the sphenoid bone as a possible cause of meningoencephalocele formation. This report highlights the importance of considering rare causes of persistent, unexplained symptoms and confirms the transnasal endoscopic surgical approach as an effective treatment method.
Acute otitis media (AOM) is a common pediatric condition, with facial nerve paralysis (FNP) as a rare complication. It occurs in approximately 0.004%–0.005% of cases. This report presents a unique case of a female infant with recurrent FNP related to AOM who experienced four episodes within the first 3 months of life. The patient was referred to our department at the 34th day of life with facial paralysis linked to left AOM. Treatment with intravenous antibiotics and systemic steroids initially improved FNP. Tympanotomy was performed during the second episode, and a tympanostomy tube was inserted during the third episode. However, left facial paralysis persisted after the fourth episode. Imaging studies showed effusion in the middle ear bilaterally, and a horizontal bone defect and peripheral stenosis of the left facial nerve canal. FNP management in AOM remains a subject of debate, with differing recommendations, especially regarding systemic steroid administration. This case highlights the criticality of considering anatomical factors in pediatric patients presenting with FNP and AOM, underscoring the requirement for further research on effective treatment strategies and understanding the pathophysiology of this rare condition.
Objectives Primary basal cell carcinoma (BCC) of the external auditory canal (EAC) is an uncommon malignancy for which evidence‐based treatment recommendations remain limited. This study reports two institutional cases treated with sleeve resection and provides a structured review of the published literature, with particular emphasis on patient selection, surgical technique and the limitations of the currently available evidence. Methods A retrospective review was performed of patients with primary BCC of the EAC treated at the Otolaryngology and Otoneurosurgery Department, Parma University Hospital (Italy). In addition, a structured review of the literature based on a systematic search of PubMed and Google Scholar was conducted. Only histologically confirmed primary BCCs arising from the EAC were included. Institutional and published cases were summarised descriptively with regard to tumour stage, treatment modality, recurrence, postoperative complications, adjuvant therapy and follow‐up. Results Two patients with early‐stage primary BCC of the EAC underwent sleeve resection with intraoperative frozen‐section margin assessment and remained disease‐free after 24 and 36 months of follow‐up, respectively. One patient developed partial postoperative EAC stenosis. The literature search identified 11 additional patients from five published studies, resulting in a descriptive cohort of 13 cases. Conservative surgical approaches, including local canal resection and sleeve resection, were the most frequently reported treatments. Only one recurrence was identified across the available reports. However, treatment strategies and follow‐up duration were highly heterogeneous, precluding meaningful comparisons between conservative and more extensive surgical approaches. Conclusion Sleeve resection appears to be a feasible hearing‐preserving option for carefully selected patients with early‐stage primary BCC confined to the EAC and without radiological or intraoperative evidence of bony invasion. However, the currently available evidence is limited to isolated case reports and small retrospective series. Consequently, no conclusions regarding oncological equivalence with more extensive surgery can be drawn. Careful preoperative staging, intraoperative margin assessment and long‐term clinical surveillance extending beyond 5 years remain essential.
Objectives Olfactory neuroblastoma (ONB) is a rare malignant tumor of the sinonasal tract with heterogeneous clinical behavior and recurrence potential. Due to its low incidence, prognostic factors and optimal treatment strategies remain incompletely defined. The objective of this study was to describe the clinicopathological characteristics, treatment approaches, and recurrence patterns of ONB over a 15‐year period at a tertiary referral center. Methods A retrospective case series and literature review were performed. Medical records of nine patients with histologically confirmed ONB treated between 2007 and 2022 were reviewed. Demographic characteristics, presenting symptoms, imaging findings, Hyams histologic grade, treatment modalities, and follow‐up outcomes were analyzed. Diagnosis in every case rested on characteristic morphology together with a full neuroendocrine immunohistochemical panel, and Hyams grade was assigned on the definitive resection specimen. Variables that were not uniformly documented across the 15‐year archive—clinical stage, surgical margin status and the anatomical compartment of recurrence—were deliberately not imputed and are reported as unavailable. Results Patients ranged in age from 18 to 61 years (mean 41.3 ± 12.4 years; median 42 years), with a male predominance (6/9, 66.7%). The most common presenting symptoms were nasal congestion, headache, and nasal mass. All patients underwent surgical resection with curative intent, predominantly through endoscopic endonasal approaches, followed by adjuvant chemoradiotherapy. Within a uniform, protocol‐defined posttreatment observation window of 3 years (median follow‐up 36 months), tumor recurrence occurred in 4 of 9 patients (44.4%), and 5 of 9 patients (55.6%) remained free of documented recurrence. Recurrence was observed across different Hyams grades, including grade I tumors, without a statistically significant association between histologic grade, age, or gender and recurrence. Conclusions ONB demonstrates variable clinical presentation and recurrence patterns, even following multimodal treatment. Histologic grade alone may not reliably predict recurrence in small cohorts. Recurrence despite low‐grade histology and uniformly administered chemoradiotherapy supports grade‐, stage‐, and margin‐adapted rather than uniform adjuvant strategies, and structured surveillance continued well beyond 5 years.
Background Pleomorphic adenoma (PA), the most prevalent benign neoplasm of the parotid gland, typically manifests as a slow‐growing, painless mass. In cases where treatment is substantially delayed, the tumor may undergo progressive enlargement, potentially resulting in significant facial deformity. This, in turn, can complicate surgical management. Case Presentation A 60‐year‐old female patient exhibited a long‐standing right parotid mass that had been gradually increasing in size since 2007, with a notable escalation in dimensions during the year prior to the preliminary assessment. Magnetic resonance imaging in 2021 revealed a well‐defined, multilobulated right parotid lesion measuring over 9 cm, and fine‐needle aspiration cytology was consistent with PA. Despite the recommendation of surgical excision, the patient initially declined treatment and was subsequently lost to follow‐up. In 2025, the patient returned with a parotid mass measuring over 15 cm, accompanied by pronounced facial asymmetry and significant skin stretching. The patient underwent a superficial parotidectomy with complete excision of the lesion, meticulous monitoring of the facial nerve, and preservation of its function. Concurrently, surgical interventions were performed to modify the patient’s skin. A subsequent histopathological examination confirmed the presence of PA, devoid of any substantial nuclear atypia or augmented mitotic activity. On Postoperative Day 3, a hematoma developed at the surgical site, necessitating surgical evacuation and hemostatic revision. The ensuing recovery was uneventful, and follow‐up at 14 months postoperatively confirmed no recurrence and complete facial nerve function. Conclusions This case exemplifies the ramifications of protracted untreated growth of a PA, culminating in substantial tumor enlargement and pronounced facial deformity. Notwithstanding the advanced size of the lesion, complete excision was achieved while preserving the function of the facial nerve. In the management of giant parotid tumors, meticulous surgical planning and close postoperative monitoring are paramount.
