We report a case of chondrosarcoma in the ethmoid extending to the anterior skull base. A 71-year-old woman complained of a right-sided nasal obstruction for one month prior to visiting a regional hospital. Under a tentative diagnosis of an ethmoidal tumor, an endonasal endoscopic biopsy was performed. The histopathological diagnosis was grade-II chondrosarcoma, and the patient was referred to our department. Computed tomography and magnetic resonance imaging revealed a tumor arising in the right ethmoid with extension to the orbit, nasal septum, sphenoid and cribriform plate. Ophthalmological findings were normal. She underwent tumor resection via a lateral rhinotomy combined with an anterior craniotomy followed by an immediate reconstruction of the skull base using a galeopericranial flap. Because the posterior surgical margin was microscopically tumor cell-positive, she was given postoperative radiotherapy (cyber knife). The patient is currently free from disease 6 months after surgery. The epidemiology, pathology, clinical characteristics and treatment of chondrosarcoma of the head and neck are reviewed.

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Rhinolith caused by actinomycosis is rare; to the best of our knowledge, only two cases have been reported in Japanese and English medical literature. A 19-year-old woman had been suffering from a left nasal obstruction for several years. A large brown mass was found in the left nasal cavity. Actinomycosis was suspected based on a histopathological examination of a biopsy specimen. Computed tomography showed a calcified lesion in the left nasal cavity and mucosal hypertrophy in the left maxillary sinus. Based on these findings, the mass lesion was diagnosed as a rhinolith associated with actinomycosis that had caused left maxillary sinusitis by obstructing the ostium. The lesion, which weighed 3.8 grams, was removed via an endscopic endonasal approach. Histopathological examination revealed an actinomycotic body. Chemical analysis revealed a composition of phosphates, protein, and carbonate. Postoperatively, the patient was treated with clarithromycin for 3 months, and the left maxillary sinusitis improved.

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We analyzed the clinical features of 54 patients (33 males, 21 females, mean age 62 years) with carcinoma of the nasal cavity who underwent radical treatment at Kurume University Hospital between 1980 and 2003.
The T classification was Ti in 15 cases, T2 in 10 cases, T3 in 20 cases, and T4 in 9 cases. The N classification was NO in 52 cases and N2 in 2 cases. There were 15 stage I cases, 10 stage II cases, 19 stage III cases, and 10 stage IV cases. There were six histopathological types of tumor, and squamous cell carcinoma was the most common.
Surgery was performed in all 54 cases. In 18 patients, the primary disease was treated by surgery alone. In 27 cases treatment was by surgery and supportive radiotherapy. One case was treated by surgery and supportive chemotherapy. Eight cases were treated by a combination of surgery, radiotherapy, and chemotherapy.
The disease-specific 5-year and 10-year survival rate was 74% (T1: 77%, T2: 90%, T3: 77%, T4: 40%; Stage I: 77%, Stage II: 89%, Stage III: 83%, Stage IV: 43%). The 5-year local control rate was 76%. The disease-specific 5-year survival rate according to histopathological type was squamous cell carcinoma 65%, adenoid cystic carcinoma 83%, adenocarcinoma 100%. Local recurrence was detected in 16 cases (mean interval: 28 months). According to histopathological type, recurrence was detected in 8 cases of squamous cell carcinoma, 5 cases of adenoid cystic carcinoma, 2 cases of undifferentiated carcinoma, and 1 case of adenocarcinoma. Thirteen patients died of their primary disease (7 deaths from locoregional disease, 5 from distant metastasis, and 1 from complications).
The results of this retrospective review indicate the need for postoperative adjuvant radiotherapy for carcinoma of the nasal cavity and emphasize the need for both radiotherapy and chemotherapy after surgery for histopathologically high-grade malignancies.

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In recent years, gamma knife surgery (GKS) has become an effective treatment for patients with intracranial metastases. We treated 8 patients with metastatic and invasive intracranial tumors from malignant nasal and paranasal sinus tumors using GKS. Three of the patients had squamous cell carcinomas, two had adenoid cystic carcinomas, and the others had malignant melanomas. The primary cancers were located in the maxillary sinus in 5 cases, and in the frontal sinus, ethomoid sinus and nasal cavity in one case each. Six patients had uncontrolled primary cancers or some metastatic tumors in addition to their brain tumors at the time of GKS. The mean GKS dose delivered to the tumor margin in the 50% isodose was 20Gy (range 15-30Gy). We treated all the lesions detected by gadolinium-enhanced MRI simultaneously, if the whole brain radiation dose was under the level that causes acute brain swelling. Follow-up MRI examinations were performed every 1 to 3 months after the initial treatment. New distant lesions in the brain detected by gadolinium-enhanced MRI were treated with repeat GKS, if the patient's condition allowed. Regardless of the histological type of the primary cancer, all tumors less than 2cm in diameter disappeared and did not recur. The maximum survival period was 1390 days, and the mean survival period was 140 days after the initial GKS. One patient survived for 2 years after the GKS without developing any neurological symptoms. Although three patients' deaths were caused by intracranial diseases, GKS seemed to be effective for preventing neurological death. In conclusion, GKS for metastatic and invasive intracranial tumors from the nasal and paranasal cavity is effective in terms of improving quality of life and preventing neurological death.

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Ventilation of the paranasal sinuses is critical in curing rhinosinusitis, because blockage of the natural ostium leads to retention of nasal discharge or pus. In a previous study, we studied the effect of widening the middle nasal meatus in patients with rhinosinusitis. Patients were assigned to two groupes. X-ray densities were significantly better in the meatus-treated group than those in the non treated group.
In this study, we focused on efficacy in the same patient. Cotton wool soaked with epinephrine was applied to widen the middle nasal meatus for 10 minutes after cleaning it (widening treatment) . Widening treatment was used on one side, but not on the other. Other conditions such as nebulizer and taking macrolides were the same. We quantified improvement in paranasal sinuses by densitometric X-ray analysis. The improvement ratio was significantly better on the treated than on the non treated side (p<0.05). We verified the efficacy of widening by both interindividual reseach in the past and intraindividual treatment in this study.

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