305 histochemical study of 62 cases, American Journal of clinical pathology 877: 425-433.

a clinico pathological study XII : schwan.Cell tumors : Cancer 50 : 2193-2202. 5.

6.

Vege D. S., Chinoy R. L., Ganesh B. et al (1987) : Malignant peripheral nerve seath tumors of head and neck : A clinico pathological study, Journal of surgical oncology 55 : 100-130. Wick M. R., Swason P. E., Scheithauer B. W, et al (1987) : M a l i g n a n t p e r i p h e r a l n e r v e seath tumor, an i m m u n o

Address for Correspondence: Dr. Utpal Jana 32, Gobra Road, Kolkata - 14, India

ANEURYSMAL BONE CYST OF PARANASAL SINUSES Sanjib Kumar Upadhyay ~, Ashok Kumar Jha 2, Satyendra Sharma 3, Satrughan Prasad Sah 4, Subhash Chandra Mishra s

Key words: Aneurysmal bone cyst, Paranasal sinuses.

INTRODUCTION The aneurysmal bone cyst is a non-neoplastic lesion of bone. The first case was reported by Jaffe and Liechtenstein in 1942 who proposed the term aneurysmal bone cyst. These cysts are frequently seen in long bones and vertebral column and rarely in craniofacial skeleton. The mandible is the most common site in head and neck region. Aneurysmal bone cyst may be found with other benign bone lesions such as non-ossifying fibroma, giant cell granuloma, fibrous dysplasia and fibromixoma. It destroys the architecture of the involved bone. Several theories have been postulated regarding its pathogenesis based upon its mixed histological pattern and is often said to be a hybrid lesion of the bone.

Sensation of touch was intact. The right nasal chamber was normal. Posterior rhinoscopy showed that left side of choana was narrowed. The vision of the left eye was 6/9 and there was obvious proptosis, the ocular movements were normal and pupillary reaction and corneal sensation were intact. Routine blood and urine analysis were normal. Skiagram of paranasal sinuses showed a lesion of mixed radiodensity in the area of ethmoid and left maxillary antrum. In the CT scan there was a radio-opaque mass on left side of ethmoid and maxillary antrum and there was medial shift of lateral nasal wall with proptosis of eye. (Fig. I and II).

A 18 years old boy came to the OPD with complaints of left sided nasal obstruction for 4 months, pain and bulging of left eye for 2 months. There was no history of trauma, nasal bleeding or any visual problem.

A biopsy was taken from left nasal cavity under local anesthesia, The mass which was in fact the bulge of lateral nasal wall had only a very thin sheet of bone which was broken with crackling sensation, There was profuse bleeding after biopsy which was managed by nasal packing.

The general and systemic examinations were normal. On anterior rhinoscopy a reddish fleshy mass was seen in the left nasal cavity completely filling it. The surface of the mass was smooth and it was firm but compressible.

Biopsy showed multiple dilated blood filled spaces separated by thick septa (Fig.Ill). The septa consisted of capillaries, ostoclastic giant cells, fibroablasts, chronic inflamatory cells and haemosiderin laden macrophages

CASE REPORT

~. Assistant Professor, 2.3Department of Otolaryngology and Head Neck Surgery, 4.SDepartment of Pathology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal

306

Aneu~smal Bone Cyst of Paranasal Sinuses - A Case Report and Review of literature

Fig. I : CT Scan PNS axial cut showing involvement of left maxilla, and orbit causing proptosis,

Fig. Ill : Photomicrograph showing multiple dilated spaces filled with blood and separated by septae (H & Stain, X 40).

Fig. II : Coronal section of CT Scan showing the mass in the nasal cavity extending to Maxilla, Ethmoid and pushing out and breaking lamina papyrechia and dislocating the eyeball.

Fig. IV : Higher magnification of septa showing Ostococlastic giant cells, chronic inflammatory cell3 and fibroblasts (H & E stain, X 400).

(Fig.IV). Fragments of trabecular bone included in biopsy were unremarkable. These features were those of aneurysmal bone cyst. In addition there were areas of reactive bone formation with fresh and old haemorrhage.

disease.

The patient was operated upon under general anesthesia through lateral rhinotomy approach and entire mass which was cystlike in appearance was enucleated and remnant of bony wall was gently curreted. Bleeding was managed by blood transfusion, filling of resultant bony cavity with gelfoam and medicated ribbon gauge packing. The whole specimen removed was sent for detailed histopathological examination. The pack and stiches were removed on 3rd and 5th post-operative days respectively and patient discharged on 7th post operative day. The histological picture of this mass of 8x5x3cms was same as seen in previous biopsy. The patient is being regularly followed up for last one year and has no sign of recurrence of

DISCUSSION The aneurysmal bone cysts are a cystic vascular lesion of bone which destroy and expand the bone, common in long bones and only 2% are reported in head and neck (Matt, 1993). Kaffe et al (1999) reported no difference in sex distribution, ratio of involvement of maxilla and mandible is 1:2.4, and 92% of lesions were in posterior part of jaw. The lesions were radiolucent in 87%, radioopaque in 2% and of mixed opacity in 11%. Hady et al (1990) reported a case of aneurysmal bone cyst and claimed it to be the first reported case of aneurysmal bone cyst of maxilla. Kimmelman et al (1982) reported a case of aneurysmal bone cyst of sphenoid in a child resulting in loss of vision due to compression on optic chiasma.

Indian Journal of Otolaryngology and Head and Neck Surgery Vol. 54 No. 4, October - December 2002

307 On the basis of clinicopathological review of aneurysmal bone cyst of maxilla Bataineh (1997) reported that trauma has no role in pathogenesis of aneurysmal bone cyst. Swelling was the main complaint of aneurysmal bone cyst of maxilla in his study and pain and proptosis were infrequent findings whereas in the case under report pain and proptosis were associated with nasal obstruction. Kershisnik and Batsakis(1994) reported that aneurysmal bone cyst of jaws are histologically the same as those found in long bones. They may be primary or secondary associated with another definable osseous lesion. Mandible has a 2:1 or 3:1 predilection over the maxilla. According to them curettage is associated with high recurrence rates while surgical excision with negative margins of primary lesion markedly reduces this incidence. This case has been treated by enucleation and curettage as radical excision would have produced an ugly deformity. The patient is being regularly followed-up and so far has had no recurrence. REFERENCES 1.

Bataineh AB (1997) : Aneurysmal bone cyst of maxilla: a clinicopathological review. Journal of oral and Maxillofacial

surgury ; 55:1212-6. 2.

Hady MR, Ghanaam B, Hady MZ (1990): Aneurysmal bone cyst of maxillary sinus. Journal of Laryngology and otology; 104:501-3.

3.

Kaffe I, Naor H, Calderons S, Buchner A (1999): Radiological and clinical features of aneurysmal bone cyst of the jaws Dentomaxillofacial Radiology;28: 167-72.

4.

Kershisnic M, Batsakis JG (1994): Aneurysmal bone cysts of the jaws. Annals of Otology, Rhinology and Laryngology; 103:164-5.

5.

Kimmelman CE Potsic WP, Schut L (1982): Aneurysmal bone cyst of the sphenoid in a child. Ann Otology Rhinology Laryngology; 91(3 pt).

6.

Matt. B.H (1993): Aneurysmal bone cyst of the maxilla: Case report and review of the literature. International Journal of Pediatric Otorhinolaryngology; 25:217-26.

7.

Saito K. Fukuta K, Takahashi M, Seki V, Yoshida J (1998): Benign fibrosseous lesions involving the skull base, paranasal sinuses and nasal cavity. Journal of Neuro-surgery. 88:1116-9.

Address for correspondence Dr. Sanjib Kumar Upadhyay Assistant Professor Department of Otolaryngology and Head Neck Surgery B.P. Koirala Institute of Health Sciences Dharan, Nepal

INTERESTING CASE OF FRONTAL SINUS INJURY V. I. Sajithkumar l, P. K. Rathore", S. Mandal 3 INTRODUCTION Foreign bodies causing frontal sinus injury is reported in literature and is commonly secondary to mid-facial trauma. The problems associated include concomitant injury to adjoining structures with intracranial bleeding. We are reporting an unusual case of a traumatic injury and foreign body [bent iron rod] penetrating the frontal sinus which is a rare mode of injury. CASE REPORT This 20 years old labourer was standing on a stool and trying to catch a hen on the roof of a house which was under construction. His stool slipped & his head struck against the bent sharp iron rod coming out from the edge of the construction. The rod penetrated the left frontal sinus from the floor. He lost conciousness and was seen

hanging from rod by his family members after half an hour. The iron rod was cut from the roof and the patient was brought in unconscious state with an attendent holding iron rod. On admission to the hospital, he was unconscious but pulse and blood pressure were more or less normal. On local examination, his left frontal region was cut by rod without injuring the eyeball. Other physical and neurological examination showed no abnormality except for one lacerated wound on the floor of the left frontal sinus (2 cm) and pointing at the anterior frontal wall (5 mm). The rod was fixed and could not move in any direction. Skull X-ray revealed a single long radiopaque foreign body penetrating the floor of frontal sinus & lying in the sinus lumen. There was no evidence of injury to

~Senior Resident, 2Assistant Professor, 3Assistant Professor, Dept. of ENT, JIPMER, Pondicherry