Resident on call CMH cases

Collected by: Lisa H. Lowe, MD

Hx: Newborn with difficulty breathing relieved by crying

Findings:

•Narrow anterior choana/nares with abnormal “waist” like shape of the maxillary spines and medial angulation of the nasal walls

•Central mega incisor

Hx: Pyriform aperture stenosis

Normal nasal cavity for comparison (walls of max sinuses and septum are parallel, not funnel shaped)

•Other midline anomalies are common such as holoprosencephaly and central megaincisor

Hx: 5 year old with bulging forehead

Findings:

•Defect in between nasal bone and frontal bone

•Brain bulges through the defect

Dx: Nasofrontal encephalocele

•Congenital extension of brain through skull at the Glabella (should never biopsy this mass)

•Treated surgically

Hx: 1 mo male old w/ swollen eye

Findings:

•Well defined area left medial canthus with minimal peripheral enhancement of the wall

•Lt mass in nose

•Lt soft tissue swelling preseptal

Dx: Dacrocystitis

•Needs prophylactic antibiotics and definitive therapy somewhat urgently to prevent infection and nasolacrimal duct damage

Hx: Right eye swelling 12 week old

Findings:•Well defined area right medial canthus with minimal peripheral enhancement of the wall and fluid level

•Rt mass in nose

•Rt soft tissue swelling preseptal

Dx: Dacrocystocele•Well defined area right medial canthus with minimal peripheral enhancement of the wall and fluid level

•Rt mass in nose

•Rt soft tissue swelling preseptal

Hx: 4y male fvr, recent dental procedure

Findings

•Sublingual fluid with cellulitis/inflammation

Dx: Sublingual abscess due to tooth abscess

Hx: Lt facial swelling & redness 2ym

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Findings

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•Enhancing left parotid with tiny foci of low density; rt is normal; no calcifications

Dx: Parotitis

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•Unilateral usually bacterial or due to stone. Mumps is bilateral. Can be viral also