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Background: Leiomyosarcomas (LMSs) is a type of sarcoma that arises from smooth muscle and generally presents in the abdomen. Although intracranial LMS has been identified before, most reported presentations have been in immunocompromised patients. Here, we present an intracranial LMS in an immunocompetent patient. Case Description: A 22-year-old male with a history of an atypical pineal parenchymal tumor of intermediate differentiation resected by suboccipital craniotomy at the age of 12 followed by adjuvant radiation therapy, presented with 3 weeks of decreased appetite, weight loss, and lethargy. He subsequently underwent transbasal approach skull base tumor resection. Histologic examination of the mass along with the patient's history of radiation was supportive of a low-grade, radiation-induced LMS arising from the anterior fossa of the skull or meninges and extends to the frontal sinus and ethmoid air cells. Conclusion: Primary intracranial LMS is an extremely rare diagnosis and presenting symptoms vary with the location and size of the tumor. Due to the poor specificity of clinical symptoms, diagnosis is often based on histology. The most common treatment is surgical resection. Adjuvant chemotherapy with various agents has been found to be somewhat effective outside the central nervous system. When LMS does occur, a history of immunocompromised state or previous radiation exposure is often present. Pathological confirmation is required for an appropriate diagnosis.

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The maxillary bone's frontal process, lacrimal bone, and ethmoidal labyrinth's uncinate process can each harbor pneumatizations, referred to as agger nasi cells (ANCs), lacrimal cells (LCs), and uncinate bullae (UBs), respectively. Different studies have failed to differentiate ANCs from LCs. We aimed at studying these 3 anatomic sites to establish the anatomical patterns that could be encountered. We performed a retrospective study on cone-beam computed tomography scans of 36 patients (72 sides); the anatomic identification was supported by bidimensional multiplanar reconstructions (MPRs) in all 3 planes and 3-dimensional volume renderings. We established 6 patterns of pneumatization as follows: (1) type I: single LCs (47%), (2) type II: distinctive adjacent LCs and ANCs (8%), (3) type III: LCs expanded as UBs (6%), (4) type IV: ANCs adjacent to LCs expanded with UBs (1%), (5) type V: ANCs expanded as LCs (27%), and (6) type VI: ANCs expanded as LCs and further expanded as UBs (11%). In a type I pattern case, we found a cell-in-cell aspect on sagittal MPRs, which was further demonstrated as being an anterolateral recess of the middle nasal meatus projected in front of an LC. Such an "agger nasi recess" of the middle meatus was not previously described. For an accurate anatomical diagnosis, computed tomography studies should use complementary MPRs in all anatomical planes, as well as 3-dimensional models, to avoid confusing ANCs with LCs and better document the drainage pathways.

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BACKGROUND: Although several studies have commented on causes of dacryocystorhinostomy (DCR) failure, detailed description of anatomical findings in such cases remains insufficient. OBJECTIVE: Our objective was primarily to analyze radiologic, endoscopic, and intraoperative findings in patients presenting with failed DCR and secondarily to assess the outcome of revision endoscopic DCR (endo-DCR) carried out at our institution. METHODS: Twenty-four failed DCRs presenting to our tertiary care center were retrospectively analyzed. Data collection included patients' history, diagnostic, and management data, as well as thorough analysis of sinonasal CT scans, along with endoscopic and intraoperative findings. Outcome was also assessed in 21 cases with revision endo-DCR performed. RESULTS: The anterior part of uncinate process was not previously removed in 15 sides (62.5%), with unopened agger nasi in 13 sides (54.2%). The lacrimal bone was detected covering the posterior sac despite removal of the anterior ascending process of maxilla in 9 sides (37.5%). Rhinostoma was anterior to lacrimal sac in 2 sides (8.3%) and was below the sac in 7 sides (29.2%). Fibrous membrane covered the rhinostoma despite removal of all sac-overlying bones in 6 sides (25%). Other findings included intranasal adhesions, septal deviation, lateralized middle turbinate, granulation tissue, foreign body reaction, and chronic sinusitis. Nineteen of the 21 revision endo-DCRs were successful (90.5%). CONCLUSION: This study provides a precise anatomical description of findings in cases of failed DCR. Such information is paramount in helping surgeons enhance their learning curve, refine the surgical technique, and improve patients' outcome.

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AIMS: Haller Cells refer to the ethmoidal pneumatization and are the extensions of anterior ethmoid sinus into the floor of the orbit and superior aspect of the maxillary sinus, basically an anatomic variation. They may be associated with orofacial pain, sinusitis, nasal obstruction, impaired nasal breathing, headache, chronic cough, and mucocele. The aim of the present study was to identify, determine the prevalence and characteristics of Haller's cells on Digital orthopantomographs in patient's reporting to a dental institution in Chennai. SETTINGS AND DESIGN:: This was a retrospective, cross-sectional study. SUBJECTS AND METHODS: The study group comprised 600 radiographs inclusive of both genders (379 females and 221 males) with an age range of 20-80 years. Retrospectively panoramic radiograph for each of the patients was viewed and interpreted for the presence of Haller's cells. The data collected was subjected to statistical analysis: frequencies/percentages, descriptive statistics to obtain the results. STATISTICAL ANALYSIS USED: Frequencies/percentages, descriptive statistics using SPSS for Windows Version 20 (SPSS Inc., Chicago, IL, USA), to obtain the results. RESULTS: Haller's cells were noted in patients, accounting for a prevalence of 23.61%. The majority of the cells were circular, ovoid, and irregular in shape. CONCLUSIONS: This study has attempted to explore the characteristics of Haller's cells on panoramic radiographs. A description of Haller's cells on these radiographs may prove vital in enumerating the differential diagnosis for patients afflicted with intractable orofacial pain and reduce the risk of untoward intraoperative complications during endonasal procedures.

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Bulges of the most posterior ethmoid air cells into the maxillary sinus were termed maxillary bullæ by Onodi. With few exceptions, they have since been ignored by anatomists through time. Likewise, Sieur cells-the spheno-ethmoido-maxillary air cells-are uncommonly found in anatomical texts. We therefore aimed to perform a retrospective cone beam computed tomography study on 50 patients to document the possibilities of anatomic variation in the situs of the orbital process of palatine bone-a variation related anatomically with the pterygopalatine fossa (PPF) and the respective angle of the maxillary sinus. Commonly occurring pneumatizations in this situs were the Sieur cell (58 %/64 % right/left side), and the maxillary recess of the sphenoidal sinus (20 %/22 % right/left side). Alone or in combination, these determined, but not exclusively, the maxillary bullæ. Uncommon pneumatizations in the anterior wall of the PPF were also found, such as a sphenoidal recess of the maxillary sinus, and lateral (maxillary, or pterygopalatine) recesses of the middle and superior, respectively, nasal meatuses. In two different cases, non-Haller, and non-Sieur posterior ethmoid air cells were found extruded posterior to the maxillary sinus. Significant statistical association indicated bilateral symmetry of Sieur's cell and of the maxillary recess of the sphenoidal sinus. It is important to identify such variant pneumatizations on a case-by-case basis in different surgical procedures and endoscopic corridors.

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BACKGROUND: Infraorbital ethmoid cells, also known as Haller's cells can be seen on panoramic radiographs. These help in identification of various pathologies and patient symptoms. OBJECTIVE: To determine the prevelance and characteristic of Haller's cells on panoramic radiographs. Infraorbital ethmoid cells are extensions of ethmoid air cells into areas of orbit and maxillary sinus. MATERIALS AND METHODS: This study comprised of 1000 panoramic radiographs of healthy adults of the age 18-80 years. Each radiograph was interpreted for the presence of haller's cells. The data collected were then tabulated and subjected to descriptive statistics and chi-square test. RESULTS: Haller's cells were observed in 19.2% patients. Majority of cells were present unilaterally (176 cells) while only 15 were seen bilaterally. Maximum cells were oval in shape, unilocular and single in number. CONCLUSION: Presence of haller's cells helps in enumerating the differential diagnosis for orofacial pain and in avoiding surgical complications in endonasal procedures.