Hugh D Curtin

Publications of Hugh D Curtin

• Cochlear Implantation in Children with Anomalous Cochleovestibular Anatomy: A Systematic Review.

  Authors: Michael N Pakdaman, Barbara S Herrmann, Hugh D Curtin, Jessica Van Beek-King, Daniel J Lee

  Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery. 12/2011;

  Objective. To determine the influence of inner ear dysplasia on both surgical and audiologic outcomes following pediatric cochlear implant (CI) surgery.Data Sources. MEDLINE (1982-2009) and data fromObjective. To determine the influence of inner ear dysplasia on both surgical and audiologic outcomes following pediatric cochlear implant (CI) surgery.Data Sources. MEDLINE (1982-2009) and data from Massachusetts Eye and Ear Infirmary.Review Methods. A systematic review of the literature was performed. Variables assessed included age at implantation, duration of CI use, radiologic and operative findings, and speech perception outcome data.Results. The initial search yielded 1326 articles. Including data from our own study, twenty-two fulfilled criteria for inclusion, representing 311 patients. Data for bilateral implants were recorded only for the first implant. Data on simultaneous bilateral implants were not recorded. The most common anomaly seen was large vestibular aqueduct (89/311 or 29%). When comparing patients with mild-moderate or severe dysplasia, rates of cerebrospinal fluid gusher were 31% versus 35% (odds ratio [OR] = 0.50), anomalous facial nerve anatomy was seen in 11% versus 51% (OR = 0.15), and postoperative speech perception abilities were found in 84% versus 54% (OR = 1.93), respectively. A large heterogeneity was found among studies regarding all outcome measures.Conclusion. Although we found that severe inner ear dysplasia was associated with increased surgical difficulty and lower speech perception, the lack of uniformity in published clinical data limited the strength of these results. Standardization of surgical and radiologic reporting as well as more consistent speech perception testing is needed to better determine the association between anomalous cochleovestibular anatomy and clinical outcomes.

• Cochlear Implantation in Children with Anomalous Cochleovestibular Anatomy.

  Authors: Michael N Pakdaman, Barbara S Herrmann, Hugh D Curtin, Jessica Van Beek-King, Daniel J Lee

  Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery. 11/2011;

  Our aim was to determine the influence of inner-ear anomalies on surgical difficulty and postoperative audiologic outcomes among pediatric cochlear implant (CI) recipients at our institution. WeOur aim was to determine the influence of inner-ear anomalies on surgical difficulty and postoperative audiologic outcomes among pediatric cochlear implant (CI) recipients at our institution. We reviewed medical and audiologic records from 78 consecutive pediatric CI cases between 1985 and June 2009. Thirty patients had high-resolution temporal bone computed tomography imaging available for retrospective interpretation. Seven of these 30 patients (23%) had cochleovestibular dysplasia. Fifty percent of patients with severe dysplasia had a cerebrospinal fluid gusher intraoperatively, compared with 13% of patients with no dysplasia. Of patients with available audiologic outcome data, 17 of 26 patients with normal/mild/moderate dysplasia were able to complete CNC testing, whereas neither of the 2 patients with severe dysplasia could complete the open set test. Our experience suggests that surgical difficulty and audiologic outcomes in pediatric CI recipients may be affected by the presence and severity of a cochleovestibular anomaly.

• Superior canal dehiscence syndrome associated with the superior petrosal sinus in pediatric and adult patients.

  Authors: Andrew A McCall, Michael J McKenna, Saumil N Merchant, Hugh D Curtin, Daniel J Lee

  Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology. 10/2011; 32(8):1312-9.

  To determine whether pediatric and adult patients with superior canal dehiscence (SCD) at the superior petrosal sinus (SPS) develop superior canal dehiscence syndrome (SCDS). RetrospectiveTo determine whether pediatric and adult patients with superior canal dehiscence (SCD) at the superior petrosal sinus (SPS) develop superior canal dehiscence syndrome (SCDS). Retrospective review. Tertiary care academic medical center. Pediatric and adult patients with SPS-associated SCD were identified from a database of 131 patients with SCD based on high-resolution temporal bone computed tomography. One pediatric patient experienced incapacitating exercise-induced vertigo, and this patient's superior semicircular canal defect was plugged via a transmastoid approach. The 11 remaining patients were managed by observation. Clinical symptoms and signs, audiologic testing, vestibular evoked myogenic potentials, and radiologic data. Twelve patients, aged 15 to 84 years, with SCD caused by the SPS contacting the superior semicircular canal were identified. The most characteristic clinical feature in this population (5/12) was dizziness related to exercise and exertion. Bilateral SCD was observed in 3 patients. Eleven patients did not have severe symptoms and were managed conservatively. One patient, aged 15, required surgical intervention for incapacitating vertigo and experienced relief of symptoms with reversal of diagnostic indicators postoperatively. This is the first reported surgical repair of SCDS in a pediatric patient. This is the first series of patients who have SCDS due to contact of the SPS with the superior semicircular canal. Exercise and exertion-related symptoms are common in patients who have SCD owing to this cause. Transmastoid superior canal plugging is feasible and successful in treating SCDS in the pediatric patient.

• Radiologic and audiologic evidence of the location of an intracochlear mass.

  Authors: Mary Elizabeth Cunnane, Leena Hamberg, Hugh D Curtin, Allan J Goldstein, Saumil N Merchant, Chris F Halpin

  Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology. 11/2010; 32(5):e34-5.

• Ocular adnexal lymphoma: diffusion-weighted mr imaging for differential diagnosis and therapeutic monitoring.

  Authors: Letterio S Politi, Reza Forghani, Claudia Godi, Antonio G Resti, Maurilio Ponzoni, Stefania Bianchi, Antonella Iadanza, Alessandro Ambrosi, Andrea Falini, Andrés J M Ferreri, Hugh D Curtin, Giuseppe Scotti

  Radiology. 08/2010; 256(2):565-74.

  To describe the magnetic resonance (MR) imaging and diffusion-weighted (DW) imaging features of ocular adnexal lymphomas (OALs), to determine the diagnostic accuracy of apparent diffusion coefficientTo describe the magnetic resonance (MR) imaging and diffusion-weighted (DW) imaging features of ocular adnexal lymphomas (OALs), to determine the diagnostic accuracy of apparent diffusion coefficient (ADC) for discriminating OALs from other orbital mass lesions, and to assess whether variations in ADC constitute a reliable biomarker of OAL response to therapy. Institutional ethical committee approval and informed consent were obtained. In this prospective study, 114 white subjects (65 females and 49 males) were enrolled. Thirty-eight patients with histopathologically proved OAL underwent serial MR and DW imaging examination of the orbits. ADCs of OALs were compared with those of normal orbital structures, obtained in 18 healthy volunteers, and other orbital mass lesions, prospectively acquired in 58 patients (20 primary non-OAL neoplasms, 15 vascular benign lesions, 12 inflammatory lesions, 11 metastases). Interval change in ADC of OALs before and after treatment was analyzed in 29 patients. Analysis of covariance and a paired t test were used for statistical analysis. Baseline ADCs in OALs were lower than those in normal structures and other orbital diseases (P < .001). An ADC threshold of 775 x 10(-6) mm(2)/sec resulted in 96% sensitivity, 93% specificity, 88% positive predictive value, 98.2% negative predictive value, and 94.4% accuracy in OAL diagnosis. Following appropriate treatment, 10 (34%) of 29 patients showed OAL volumetric reduction, accompanied (n = 7) or preceded (n = 3) by an increase in ADC (P = .005). Conversely, a further reduction of ADC was observed in the seven patients who experienced disease progression (P < .05). ADC permits accurate diagnosis of OALs. Interval change in ADC after therapy represents a helpful tool for predicting therapeutic response.

• Imaging of the mylohyoid muscle: separation of submandibular and sublingual spaces.

  Authors: Mika Otonari-Yamamoto, Koh Nakajima, Yuriko Tsuji, Takamichi Otonari, Hugh D Curtin, Tomohiro Okano, Tsukasa Sano

  AJR. American journal of roentgenology. 05/2010; 194(5):W431-8.

  OBJECTIVE: This article focuses on the anatomy of the mylohyoid muscle, a crucial landmark in imaging of the oral cavity and upper neck, showing dissected specimens and CT and MR images. CONCLUSION:OBJECTIVE: This article focuses on the anatomy of the mylohyoid muscle, a crucial landmark in imaging of the oral cavity and upper neck, showing dissected specimens and CT and MR images. CONCLUSION: Identification of the relationship of a lesion in the sublingual space to the mylohyoid muscle using MDCT and high-resolution MRI is a key part of the imaging assessment of the oral cavity and upper neck.

• Craniofacial and temporal bone CT findings in cleidocranial dysplasia.

  Authors: Guido E Gonzalez, Paul A Caruso, Juan E Small, Robert W Jyung, Maria J Troulis, Hugh D Curtin

  Pediatric radiology. 09/2008; 38(8):892-7.

  Cleidocranial dysplasia (CCD) is a multistructural polyostotic genetic disorder that results from mutation of the CBFA1 gene. Hearing loss is a frequent finding in CCD. We describe the CTCleidocranial dysplasia (CCD) is a multistructural polyostotic genetic disorder that results from mutation of the CBFA1 gene. Hearing loss is a frequent finding in CCD. We describe the CT craniofacial findings in CCD and provide a comprehensive discussion of the CT temporal bone findings in these patients.

• Imaging of acoustic neuromas.

  Authors: Hugh D Curtin, William L Hirsch

  Neurosurgery clinics of North America. 05/2008; 19(2):175-205, v.

  Diagnosis of acoustic neuromas has been simplified considerably by computed tomography (CT) and magnetic resonance imaging (MRI). Either enhanced method will visualize almost every acoustic neuroma.Diagnosis of acoustic neuromas has been simplified considerably by computed tomography (CT) and magnetic resonance imaging (MRI). Either enhanced method will visualize almost every acoustic neuroma. MRI is more sensitive inside the internal auditory canal. Currently, a gadolinium-enhanced MRI scan is considered an accurate indicator of whether or not an individual has an acoustic neuroma, although there have been false-positive enhanced MRI scans recently reported.

• Odontogenic orbital inflammation: clinical and CT findings--initial observations.

  Authors: Paul A Caruso, Lynnette M Watkins, Pantip Suwansaard, Mika Yamamoto, Marlene L Durand, Laura Vitale Romo, Sandra P Rincon, Hugh D Curtin

  Radiology. 05/2006; 239(1):187-94.

  PURPOSE: To retrospectively review computed tomographic (CT) and clinical findings in patients with odontogenic orbital infection. MATERIALS AND METHODS: Approval from the institutional review boardPURPOSE: To retrospectively review computed tomographic (CT) and clinical findings in patients with odontogenic orbital infection. MATERIALS AND METHODS: Approval from the institutional review board was obtained for chart and scan review, and informed consent was waived for this HIPAA-compliant study. Five patients, two male and three female (median age, 37 years; age range, 13-55 years), who had odontogenic orbital cellulitis underwent clinical evaluation, CT scanning, and treatment. CT findings, including periapical lucency suggesting abscess, sinus opacification, and the route of spread of infection, were analyzed in each patient. Imaging, clinical, and surgical findings, including the initial clinical diagnosis and the presence of a periapical abscess at surgery and at pathologic examination, were compared. RESULTS: Periapical lucency and sinus opacification were seen in all patients. The route of infection spread was through either the premalar soft tissues or the maxillary sinuses. The odontogenic origin of the orbital infection was not clinically suspected in any patients. Correct diagnosis was later made at CT in all patients. Four patients had periapical abscesses at pathologic analysis, and the fifth patient had apical periodontitis at clinical analysis and granuloma at pathologic analysis. Dental surgery was required in each of the five patients for resolution of infection; four patients underwent extraction of the infected tooth, and one patient underwent incision and drainage of a periapical abscess. CONCLUSION: Abnormal periapical lucency, widening of the periodontal ligament space, and the presence of a subperiosteal abscess suggested an odontogenic origin of orbital infection.

• A modeling investigation of articulatory variability and acoustic stability during American English /r/ production.

  Authors: Alfonso Nieto-Castanon, Frank H Guenther, Joseph S Perkell, Hugh D Curtin

  The Journal of the Acoustical Society of America. 06/2005; 117(5):3196-212.

  This paper investigates the functional relationship between articulatory variability and stability of acoustic cues during American English /r/ production. The analysis of articulatory movement dataThis paper investigates the functional relationship between articulatory variability and stability of acoustic cues during American English /r/ production. The analysis of articulatory movement data on seven subjects shows that the extent of intrasubject articulatory variability along any given articulatory direction is strongly and inversely related to a measure of acoustic stability (the extent of acoustic variation that displacing the articulators in this direction would produce). The presence and direction of this relationship is consistent with a speech motor control mechanism that uses a third formant frequency (F3) target; i.e., the final articulatory variability is lower for those articulatory directions most relevant to determining the F3 value. In contrast, no consistent relationship across speakers and phonetic contexts was found between hypothesized vocal-tract target variables and articulatory variability. Furthermore, simulations of two speakers' productions using the DIVA model of speech production, in conjunction with a novel speaker-specific vocal-tract model derived from magnetic resonance imaging data, mimic the observed range of articulatory gestures for each subject, while exhibiting the same articulatory/acoustic relations as those observed experimentally. Overall these results provide evidence for a common control scheme that utilizes an acoustic, rather than articulatory, target specification for American English /r/.

• Imaging-guided biopsy.

  Authors: Hugh D Curtin, Nina Brogle, Paul Caruso

  Atlas of the oral and maxillofacial surgery clinics of North America. 04/2005; 13(1):51-62.

• Experimental flat-panel high-spatial-resolution volume CT of the temporal bone.

  Authors: Rajiv Gupta, Soenke H Bartling, Samit K Basu, William R Ross, Hartmut Becker, Armin Pfoh, Thomas Brady, Hugh D Curtin

  AJNR. American journal of neuroradiology. 09/2004; 25(8):1417-24.

  BACKGROUND AND PURPOSE: A CT scanner employing a digital flat-panel detector is capable of very high spatial resolution as compared with a multi-section CT (MSCT) scanner. Our purpose was toBACKGROUND AND PURPOSE: A CT scanner employing a digital flat-panel detector is capable of very high spatial resolution as compared with a multi-section CT (MSCT) scanner. Our purpose was to determine how well a prototypical volume CT (VCT) scanner with a flat-panel detector system defines fine structures in temporal bone. METHODS: Four partially manipulated temporal-bone specimens were imaged by use of a prototypical cone-beam VCT scanner with a flat-panel detector system at an isometric resolution of 150 microm at the isocenter. These specimens were also depicted by state-of-the-art multisection CT (MSCT). Forty-two structures imaged by both scanners were qualitatively assessed and rated, and scores assigned to VCT findings were compared with those of MSCT. RESULTS: Qualitative assessment of anatomic structures, lesions, cochlear implants, and middle-ear hearing aids indicated that image quality was significantly better with VCT (P < .001). Structures near the spatial-resolution limit of MSCT (e.g., bony covering of the tympanic segment of the facial canal, the incudo-stapedial joint, the proximal vestibular aqueduct, the interscalar septum, and the modiolus) had higher contrast and less partial-volume effect with VCT. CONCLUSION: The flat-panel prototype provides better definition of fine osseous structures of temporal bone than that of currently available MSCT scanners. This study provides impetus for further research in increasing spatial resolution beyond that offered by the current state-of-the-art scanners.

• Virtual cisternoscopy: 3D MRI models of the cerebellopontine angle for lesions related to the cranial nerves.

  Authors: James D Rabinov, Frederick G Barker, Michael J McKenna, Hugh D Curtin

  Skull base : official journal of North American Skull Base Society ... [et al.]. 06/2004; 14(2):93-9; discussion 99.

  This study was conducted to show that high-resolution magnetic resonance imaging (MRI) can aid in the neurosurgical approach to lesions affecting the cranial nerves (CNs) in the cerebellopontineThis study was conducted to show that high-resolution magnetic resonance imaging (MRI) can aid in the neurosurgical approach to lesions affecting the cranial nerves (CNs) in the cerebellopontine angle (CPA). Three patients with symptomatology related to CNs VII and VIII underwent MRI examinations performed on a 1.5-Tesla Siemens MR scanner. As part of these routine examinations, the imaging technique of constructive interference in the steady state (CISS) was used to collect a volume of data through the brainstem and internal auditory canals. This high-resolution technique acquires a three-dimensional (3D) volume of data at 0.7-mm intervals. Parameters included TR 12.3/TE 5.9, number of acquisitions of 2, a matrix of 230 x 512, bandwidth of 130 Hz per pixel, and time of 8:40. Data were transferred to a commercially available GE workstation and reconstructed into a 3D surface-rendered model. This interactive method allows the model to be visualized from any angle, including that of a standard skull base approach of suboccipital craniotomy for access to the CPA cistern. The images shown include the CPA cistern as seen from the suboccipital surgical approach. CNs V, VII, and VIII can easily be seen in relation to the pons and petrous face. The relationship between the CNs and acoustic neuromas and skull base tumors can be evaluated. Vascular structures, which are often seen in relation to CNs VII and VIII, can be viewed in a 3D format to determine the need for microvascular decompression. Direct intraoperative photographs taken through the operating microscope confirmed the anatomic accuracy of the 3D models. Imaging used for interactive neurosurgical planning must demonstrate a high degree of anatomic detail. Virtual cisternoscopy using CISS MRI technique can achieve the required resolution. Reconstruction algorithms to create surface rendering can generate images with similar 3D anatomic detail to that seen during neurosurgical approaches to the CPA cistern.

• Superior semicircular canal dehiscence presenting as conductive hearing loss without vertigo.

  Authors: Anthony A Mikulec, Michael J McKenna, Mitchell J Ramsey, John J Rosowski, Barbara S Herrmann, Steven D Rauch, Hugh D Curtin, Saumil N Merchant

  Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology. 04/2004; 25(2):121-9.

  OBJECTIVE: The objective of this study was to describe superior semicircular canal dehiscence (SSCD) presenting as otherwise unexplained conductive hearing loss without vestibular symptoms. STUDYOBJECTIVE: The objective of this study was to describe superior semicircular canal dehiscence (SSCD) presenting as otherwise unexplained conductive hearing loss without vestibular symptoms. STUDY DESIGN: Retrospective. SETTING: Tertiary referral center. PATIENTS: The study comprised 8 patients (10 ears), 5 males and 5 females aged 27 to 59 years. All 10 ears had SSCD on high-resolution computed tomography scan of the temporal bone. DIAGNOSTIC TESTS AND RESULTS: All 10 ears had significant conductive hearing loss. The air-bone gaps were largest in the lower frequencies at 250, 500, and 1000 Hz; the mean gaps for these 3 frequencies for the 10 ears were 49, 37, and 35 dB, respectively. Bone-conduction thresholds below 2000 Hz were negative (-5 dB to -15 dB) at one or more frequencies in 8 of the 10 ears. There were no middle ear abnormalities to explain the air-bone gaps in these 10 ears. Computed tomography scan and laboratory testing indicated lack of middle ear pathology; acoustic reflexes were present, vestibular evoked myogenic potentials (VEMPs) were present with abnormally low thresholds, and umbo velocity measured by laser Doppler vibrometry was above mean normal. Middle ear exploration was negative in six ears; of these six, stapedectomy had been performed in three ears and ossiculoplasty in two ears, but the air-bone gap was unchanged postoperatively. The data are consistent with the hypothesis that the SSCD introduced a third mobile window into the inner ear, which in turn produced the conductive hearing loss by 1) shunting air-conducted sound away from the cochlea, thus elevating air-conduction thresholds; and 2) increasing the difference in impedance between the oval and round windows, thus improving thresholds for bone-conducted sound. CONCLUSION: SSCD can present with a conductive hearing loss that mimics otosclerosis and could explain some cases of persistent conductive hearing loss after uneventful stapedectomy. Audiometric testing with attention to absolute bone-conduction thresholds, acoustic reflex testing, VEMP testing, laser vibrometry of the umbo, and computed tomograph scanning can help to identify patients with SSCD presenting with conductive hearing loss without vertigo.

• Identification of juxtaforaminal fat pads of the second division of the trigeminal pathway on MRI and CT.

  Authors: Mika Yamamoto, Hugh D Curtin, Pantip Suwansa-ard, Osamu Sakai, Tsukasa Sano, Tomohiro Okano

  AJR. American journal of roentgenology. 03/2004; 182(2):385-92.

• CT characteristics of intraocular perfluoro-N-octane.

  Authors: John B Christoforidis, Paul A Caruso, Hugh D Curtin, Tito Fiore, Donald J D'Amico

  AJNR. American journal of neuroradiology. 11/2003; 24(9):1769-71.

  Perfluoro-N-octane (PFO) is a heavy liquid that is used as an aid for complicated retinal surgical procedures. Although PFO is usually removed intraoperatively, the radiographic appearance ofPerfluoro-N-octane (PFO) is a heavy liquid that is used as an aid for complicated retinal surgical procedures. Although PFO is usually removed intraoperatively, the radiographic appearance of retained PFO may mimic an intraocular foreign body or vitreous hemorrhage. As the use of PFO in retinal procedures has become more widespread, recognition of its imaging appearance has become important in the differential diagnosis of intraocular foreign body and ocular trauma.

• Helical computed tomographic dacryocystography with three-dimensional reconstruction: a new view of the lacrimal drainage system.

  Authors: Suzanne K Freitag, John J Woog, Philip D Kousoubris, Hugh D Curtin

  Ophthalmic plastic and reconstructive surgery. 04/2002; 18(2):121-32.

  PURPOSE: To evaluate the utility of a new diagnostic radiologic technique for anatomic evaluation of the lacrimal outflow system in patients with epiphora and to delineate anatomic variations in thePURPOSE: To evaluate the utility of a new diagnostic radiologic technique for anatomic evaluation of the lacrimal outflow system in patients with epiphora and to delineate anatomic variations in the lacrimal systems of patients with both patent and obstructed systems. METHODS: This study retrospectively reviewed clinical and radiologic data in a series of 30 patients with epiphora who underwent our radiologic protocol. Imaging included fluoroscopic dacryocystography followed by helical CT dacryocystography after injection of lacrimal system contrast. Axial CT data was three-dimensionally reconstructed and rotated for viewing of images in multiple projections. Mean axial cross-sectional areas of the lacrimal sac and duct were determined. RESULTS: Sixty lacrimal systems in 30 patients were clinically and radiologically evaluated. The average mean cross-sectional area of the lacrimal sac and duct in the setting of complete obstruction was 0.153 cm2 and was statistically significantly larger (p=0.0286) when compared with average mean cross-sectional areas in unobstructed (0.045 cm2) and partially obstructed (0.052 cm2) lacrimal systems and were associated with lacrimal system dilation proximal to the level of obstruction. The difference in average mean cross-sectional area between patients with unobstructed and partially obstructed systems was not statistically significant. A number of lacrimal system abnormalities were noted in our series, including obstructions at various levels of the lacrimal outflow system, lacrimal sac masses, sinusitis, sarcoidosis, sinus carcinoma, and failed dacryocystorhinostomy. Twenty-three lacrimal systems were believed to be radiographically normal. Radiologic findings altered surgical treatment in 10 of 30 patients in this series. CONCLUSIONS: This relatively safe and well-tolerated radiologic technique provides detailed imaging of the lacrimal outflow system and surrounding structures. The information obtained from this technique may be helpful in clinical and surgical decision making.

• LYMPH NODE PATHOLOGY: BENIGN PROLIFERATIVE, LYMPHOMA, AND METASTATIC DISEASE

  Authors: Osamu Sakai, Hugh D. Curtin, Laura Vitale Romo, Peter M. Som

  Radiologic Clinics of North America.

  The evaluation of cervical lymph nodes is one of the main indications for performing CT and MR imaging of the neck. Imaging may be done for evaluation of an unknown neck mass, but more commonly theThe evaluation of cervical lymph nodes is one of the main indications for performing CT and MR imaging of the neck. Imaging may be done for evaluation of an unknown neck mass, but more commonly the neck is imaged to evaluate potential metastasis from a known mucosal malignancy. In these patients, the radiologist is asked to assess the presence of nodal metastasis, determine if extracapsular tumor spread is present, and if present, the relationship of this disease to adjacent critical structures, such as the carotid arteries and the skull base. [41] and [43] Because of the dominance of interest in staging of metastatic carcinoma the initial discussion focuses on this disease. CT and MR imaging characteristics of both malignant and nonmalignant nodal diseases are reviewed and the differential diagnosis of nodal pathologies for specific imaging findings are discussed. A recently proposed imaging-based nodal classification for metastatic nodal diseases from head and neck cancer is also described.47

• Medialization of the lamina papyracea after endoscopic ethmoidectomy: comparison of preprocedure and postprocedure computed tomographic scans.

  Authors: Mary Elizabeth Cunnane, Michael Platt, Paul A Caruso, Ralph Metson, Hugh D Curtin

  Journal of computer assisted tomography. 33(1):79-81.

  OBJECTIVE:: The purpose of this article is to report computed tomography demonstration of medial bowing of the lamina papyracea in 5 patients after internal ethmoidectomy. METHODS:: We identified 5OBJECTIVE:: The purpose of this article is to report computed tomography demonstration of medial bowing of the lamina papyracea in 5 patients after internal ethmoidectomy. METHODS:: We identified 5 patients who had apparent medial bowing of the lamina papyracea after functional endoscopic sinus surgery (FESS) and who had preoperative scans available. Preoperative and postoperative scans were reviewed using a 3-dimensional workstation to ensure similar angulation of the slices before measurement. Measurements of the interorbital distance and also the position of the posterior margin of the globe relative to a line connecting the lateral orbital walls were performed. RESULTS:: Each of the patients demonstrated a decrease in the interorbital distance on the postoperative scan. Measurement of globe position showed that 9 of the 10 globes lay in a more posterior position within the orbit on postoperative examination. CONCLUSIONS:: Medial bowing of the lamina papyracea may occur as a result of FESS and may lead to relative enophthalmos in comparison. The incidence of this phenomenon is unknown because most patients are not reimaged after FESS.