Recurrent epistaxis can be a rare presentation of ruptured internal carotid artery aneurysm. Although primarily a neurosurgical problem, these cases may be seen initially by the otolaryngologist, as the aneurysm erodes through the thin adjacent sphenoid sinus wall and ruptures, producing epistaxis. In most cases these aneurysms are traumatic in origin. We present the first cited case of a nontraumatic internal carotid aneurysm, arising from the origin of the ophthalmic artery, which presented as intermittent epistaxis from the sphenoid sinus. We suggest that aneurysmal rupture be considered in the differential diagnosis of all cases of epistaxis from the sphenoid sinus. Nasal endoscopy and CT scan of the paranasal sinuses in non-emergent cases is valuable in localizing the source of the bleed. Furthermore, preoperative angiography is essential in making the diagnosis of aneurysm and avoiding fatal torrential hemorrhage caused by nasal surgery. Once the diagnosis is made, the definitive treatment is surgical or intravascular trapping of the aneurysm.

Using conventional radiography, maxillary sinus hypoplasia (MSH) may be misdiagnosed as chronic infective sinusitis in patients with chronic nasal symptoms. Commonly associated anatomical abnormalities of the lateral nasal wall and orbit may also be missed. Failure to recognize these abnormalities is fraught with hazards should sinus surgery be contemplated on such patients. With the use of high resolution computed tomography scans and rigid nasal endoscopy, MSH and associated subtle anatomic abnormalities of related structures are diagnosed with higher precision and surgical complications minimized. The incidence, pathogenesis, and classification of MSH is reviewed. The clinical and surgical implications of associated anomalies of the lateral nasal wall are discussed. Two illustrative cases are presented.

Schwannomas are benign neoplasms arising from the peripheral nerve sheath. The sinonasal tract is an unusual location for these neoplasms. Because of their rarity, few series have been reported. Five previously unreported cases of schwannomas of the nose and paranasal sinuses are presented that illustrate the spectrum of disease. The clinical presentation, diagnostic work-up, clinical course, and diverse therapeutic approaches will be discussed. A management philosophy based on the diversity of these tumors and their clinical behavior, and incorporating the new diagnostic and therapeutic tools available to the clinician will be presented. The implications of newer diagnostic techniques including sinonasal endoscopy, magnetic resonance imaging, and immuno-chemistry in the diagnosis and treatment of these tumors will be discussed.

Laryngeal stenosis can present with recurrent lower respiratory tract infections, hoarseness, stridor or decreased exercise tolerance. Asphyxia and death may follow. One accepted method of treatment is to perform a tracheostomy, dilate the stricture and insert an obturator for 6 to 9 mo. Ten children with a subglottic stenosis were treated by this technique and 7 completed the treatment. Results in 5 of these children were good, 1 was improved and 1 restenosed. These results compare favorably with those reported by others. This form of treatment is indicated for unyielding but dilatable strictures which have failed to respond to other approaches. The choice, therefore, lies between resection and plastic repair or prolonged dilatation. Results are generally quite good for strictures near the vocal cords, but are variable for those well below the cords. The manufacture and insertion of a prosthesis used in the above cases are described.

A Silastic prosthesis anchored to a tracheostomy tube was used in the treatment of 5 children with subglottic stenosis. It did not cause any significant tissue reaction and obviated the problems of transfixion sutures. We treated 3 children successfully. Another died from complications owing to the tracheostomy. In the fifth patient the prosthesis was replaced by a Silastic T-tube. The use of the Silastic prosthesis is advocated for tough, dilatable laryngeal strictures, for which a T-tube is unsuitable. The advantages, disadvantages, method of manufacture and technique of insertion are discussed.