Sphenoid sinus mucoceles are rare lesions that account for less than 2% of all sinonasal mucoceles. In revision cases, surgery is more challenging because prior operations alter the normal anatomy and remove important surgical landmarks. A 79-year-old male presented with a headache 10 years after prior sphenoid surgery for fungal disease. Preoperative MRI showed a multiloculated, expansile sphenoid mucocele. Bony erosion involved the sellar floor and the right internal carotid artery (ICA) canal, with additional erosion of the mid-clivus. Endoscopic transnasal marsupialization was performed using the posterior choana and nasal septum as fixed landmarks to localize the sphenoid face. After entering the sphenoid sinus, the optic nerve prominence, ICA prominence, opticocarotid recess, and sella were identified on the posterior wall. A stepwise compartment-by-compartment approach was used to drain the mucocele and remove all septations under continuous visualization of these landmarks. The anterior sphenoid wall was completely removed to establish wide and durable drainage. All mucocele compartments were successfully drained. All posterior sphenoid landmarks were clearly identified. Bony dehiscence was noted at the sellar floor, mid-clivus, and right ICA canal. The dura was intact at all sites. No complications occurred. The headache improved after surgery. Follow-up confirmed a patent sphenoidotomy with no recurrence. This technique provides a safe and systematic approach to revision sphenoid mucocele surgery. It may be applied to other complex sphenoid lesions in which altered anatomy and skull-base dehiscence require careful landmark-based dissection.

Gastrointestinal cancers encompass a range of malignancies, including esophageal, gastric, esophagogastric, hepatocellular, pancreatic, and intestinal cancers. Considering the prevalence of these cancers, alongside their fatal nature, and the nonspecific symptoms that often arise in the advanced stages, developing a non-invasive screening/diagnostic method capable of detecting cancer early is in high demand. Exhaled breath serves as an accessible source of biomarkers, including volatile organic compounds (VOCs), a promising type of diagnostic marker. This method requires a sample as small as five breaths. Exhaled breath analysis is conducted using different mass spectrometry methods coupled with nano sensors or neural networks. Furthermore, innovative devices like electronic noses have also shown great promise in diagnosing different types of cancers. These biomarkers show potential in reliably differentiating between healthy individuals and cancer patients. Additionally, these compounds can be utilized for cancer staging and monitoring treatment response. However, certain fallbacks persist in differentiating malignant from pre-malignant conditions. Despite the promise of this diagnostic approach, certain limitations, such as variations in VOC profiles across different populations, lack of standardized collection protocols, and absence of established universal reference standards, underscore the need for proper standardization and large-scale, multi-center validation studies.

We describe a case of sinonasal glomangiopericytoma (GPC), a rare perivascular tumour accounting for less than 0.5% of sinonasal neoplasms, presenting with refractory unilateral epistaxis. An anticoagulated male in his 60s required admission, nasal packing and unilateral left internal maxillary artery embolisation to achieve haemostasis.Following stabilisation, nasoendoscopy identified a vascular polypoid lesion arising high in the left nasal cavity near the olfactory cleft. MRI demonstrated a contrast-enhancing mass abutting the cribriform plate without orbital or skull-base invasion, which had not been recognised on prior imaging. Endoscopic biopsy confirmed GPC, followed by endoscopic resection at a tertiary skull-base centre.Postoperative recovery was uncomplicated, with early resolution of epistaxis and safe recommencement of anticoagulation. However, the tumour was transected at the surgical margin, indicating incomplete or margin-uncertain excision and requiring close surveillance for residual or recurrent disease. This case highlights a rare cause of refractory unilateral epistaxis and illustrates the importance of diagnostic vigilance, multidisciplinary management and the potential role of embolisation in selected high-risk patients.

Cavernous venous malformations (CVMs) of the paranasal sinuses are rare benign vascular lesions that can mimic aggressive neoplasms. Here, we report a 24-year-old male presenting with progressive nasal obstruction, rhinorrhea, and visual impairment. Preoperative CT demonstrated an expansile, soft-tissue mass within the left frontal sinus, characterized by a delicate osseous shell, internal radial bony ridges, and a pedunculated attachment to the anterior sinus wall. Dynamic contrast-enhanced MRI revealed progressive centripetal enhancement with a characteristic "slow-filling" pattern. The lesion was successfully excised via an endoscopic approach. Histopathological analysis confirmed the diagnosis of CVM, demonstrating multiple irregular vascular spaces lined by flattened endothelial cells within the mucosal stroma. Postoperative outcomes were favorable without recurrence. CVM should be included in the differential diagnosis of unilateral frontal sinus masses when bony remodeling, internal radial ridges, and progressive centripetal enhancement are present. Combining CT and MRI findings is indispensable for distinguishing CVM from other sinonasal lesions and guiding minimally invasive endoscopic resection.

Nasolabial cysts are rare, benign, nonodontogenic, extraosseous maxillofacial lesions, with bilateral involvement being uncommon. A 40-year-old woman presented with long-standing bilateral nasal vestibular swelling. Magnetic resonance imaging (MRI) demonstrated well-defined bilateral cystic lesions along the nasal floor with characteristic signal intensities and smooth anterior maxillary bone scalloping, consistent with bilateral nasolabial cysts containing internal debris. This case highlights the characteristic MRI appearance of bilateral nasolabial cysts and emphasizes the role of MRI in accurate diagnosis and surgical planning.

IntroductionAchieving an optimal therapeutic ratio in head and neck cancer (HNC) radiotherapy requires balancing dose conformity with organ-at-risk (OAR) sparing. Traditional auxiliary devices often lack the customized geometry needed for modern techniques. This study developed and evaluated a 3D-printed integrated tissue compensator that serves as both a positioning stent for OAR displacement and a conformal bolus for dose build-up.MethodsIn this case series, five HNC patients (including floor of mouth, tongue, and nasal cavity and sinus cancers) were prospectively and consecutively enrolled, and their computed tomography (CT) data were used to fabricate the compensators. Dosimetric comparisons were conducted between the 3D-printed compensator, a simulated air cavity, and a conventional bite block.ResultsThe integrated device demonstrated adequate geometric fidelity, maintaining random translational setup errors (σ) at ≤ 1.34 mm, comparable to traditional immobilization. Compared to the conventional group, the device demonstrated a numerical reduction in the maximum dose to the hard palate and the mean dose to the external surface, while ensuring effective dose build-up in the target region. Compared with the air cavity group, the observed numerical reductions in dose for key OARs (oral cavity, mandible, and parotid gland) approached but did not reach conventional statistical significance (p = 0.063). Furthermore, the device maintained comparable conformity (CI) and homogeneity (HI) indices, showing an observed numerical improvement in homogeneity for high-dose targets.ConclusionThis feasibility study demonstrates that a 3D-printed integrated tissue compensator offers potential dosimetric advantages over conventional approaches. By maintaining setup reproducibility and OAR sparing, this device represents a practical exploratory tool for HNC radiotherapy.

Spindle cell lipoma (SCL) is a rare benign lipomatous tumor that typically arises in the posterior neck, upper back, and shoulders. SCL of the retropharyngeal space is exceptionally rare, with only a few cases reported in the literature. We present a case of a 32-year-old man with a 3-year history of progressive neck swelling, dysphagia, and dysphonia. The patient initially attributed the neck swelling to his heavier body habitus. After weight loss failed to resolve the mass, worsening voice quality and cosmetic concerns prompted him to seek medical attention. Computed tomography revealed a large heterogeneous mass measuring 21 cm, extending from the oropharynx to the superior mediastinum and occupying the entire retropharyngeal space. Physical examination demonstrated a diffuse, bilateral neck mass that was soft, elastic, and non-tender, with intact cranial nerve function. Transcervical en bloc excision with finger dissection was performed in collaboration with a thoracic surgeon (total operative time: 276 minutes). Histopathological examination confirmed spindle cell lipoma, characterized by bland spindle cells, mature adipocytes, and ropey collagen fibers. Immunohistochemical staining showed positivity for CD34 and S100 and negativity for desmin and MDM2, confirming the benign diagnosis. The patient became symptom-free immediately after surgery, with the most notable improvement being resolution of breathing difficulty. At 22 months of follow-up, there was no evidence of recurrence on clinical examination and contrast-enhanced computed tomography. This is the fifth reported case of retropharyngeal SCL in the English literature and the largest by size. Despite the extensive dimensions and proximity to critical neurovascular structures, simple transcervical excision with finger dissection proved fully effective. Clinicians should be aware of this rare entity and its distinction from malignant lesions such as liposarcoma to avoid overtreatment.

Schneiderian inverted papilloma is a benign, locally aggressive tumor that typically arises in the respiratory mucosa of the nasal cavity and paranasal sinuses. These tumors are often asymptomatic but can cause unilateral nasal obstruction, discharge, hyposmia and epistaxis. They warrant attention particularly due to the potential for malignant transformation. They are treated most often with surgical excision. This case report describes a patient with Schneiderian inverted papilloma arising outside its usual location and managed with definitive radiation therapy instead of surgical excision due to concerns for functional impairment. Remission was obtained with radiation therapy, although the patient experienced treatment-related side effects.

Pituitary neuroendocrine tumours (PitNETs) commonly present with symptoms related to mass effect or hormonal dysfunction, including headache, visual disturbances, and endocrine abnormalities. However, atypical presentations without neurological or hormonal "red flag" symptoms may delay diagnosis, particularly in primary care settings where benign upper respiratory conditions are more frequently encountered. We report the case of a 56-year-old postmenopausal woman who presented with a five-month history of persistent postnasal drip, chronic non-productive cough and a sensation of nasal congestion characterised by fullness in the nasal and retro-orbital region. Despite conservative medical management, persistent symptoms prompted a computed tomography (CT) of the brain and paranasal sinuses, which unexpectedly revealed a sellar mass extending into the left sphenoid sinus. Subsequent magnetic resonance imaging (MRI) confirmed a 3.4cm pituitary macroadenoma with left cavernous and sphenoid sinus invasion, left internal carotid artery encasement, optic nerve involvement, and imaging features of pituitary apoplexy. Hormonal evaluation showed hyperprolactinaemia, and histopathology following endoscopic endonasal resection confirmed a lactotroph PitNET. This case highlights the importance of diagnostic reassessment in patients with persistent symptoms and demonstrates that clinically significant PitNETs can masquerade behind common benign upper respiratory conditions.

PurposeMajor maxillary and facial tumor resections are often associated with substantial intraoperative blood loss due to rich vascular supply from branches of the external carotid artery (ECA). We present a case series of three selected patients undergoing extensive maxillofacial tumor resection in whom temporary proximal ECA restriction using a Rummel tourniquet was applied.ResultsEstimated blood loss ranged from 550 to 1500 mL. No postoperative neurological deficits or delayed arterial hemorrhage were observed. Temporary proximal ECA restriction was technically feasible through cervical exposure and provided reversible arterial inflow modulation.ConclusionsAlthough limited by the small sample size and lack of comparative analysis, this case series suggests that temporary proximal ECA restriction using a Rummel tourniquet may serve as a practical adjunct in selected patients undergoing extensive maxillofacial tumor resection. Further studies are warranted to better define its clinical value.

Central giant cell granuloma (CGCG) is a rare benign and locally aggressive osteolytic lesion that predominantly affects the mandible and maxilla in the head and neck region. Involvement of the nasal cavity is extremely uncommon in children, with only a few cases reported, and is typically managed via external or transoral surgical approaches. We report CGCG in a healthy 13-year-old girl presenting as an expansile lesion of the right nasal cavity with adjacent bony remodeling. Diagnosis was established through radiological and histopathologic evaluation. The tumor was resected entirely using an endoscopic endonasal technique without an external approach. The patient remained disease-free and asymptomatic at 36 months. This report is complemented by a concise literature review that addresses the pathogenesis, diagnostic considerations, and management strategies for CGCG. The case highlights the feasibility of a minimally invasive approach without external access for managing pediatric nasal CGCG. This technique achieved complete excision with excellent cosmetic and functional outcomes and is considered a safe alternative to more extensive surgical procedures.