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Objectives: A diagnostic indicator for the differentiation of inverted papillomas (IPs) from inflammatory nasal polyps (NPs) has not been established. This study aimed to evaluate whether CT attenuation values relative to those of the brainstem (relative CT number) could be useful for differentiating IPs from NPs.Material and Methods: Consecutive patients who were pathologically diagnosed with IP or NP between 2005 and 2019 were retrospectively identified. Relative CT numbers were compared between the two patient groups. The factors with predictive power for differentiating IPs from NPs were identified by univariate and multivariate logistic regression analyses.Results: One hundred and twenty-two sinonasal masses were finally analysed (IP, 51 cases; NP, 71 cases). Relative CT numbers were significantly higher in IP than in NP (P < 0.001). Univariate logistic regression analysis showed relative CT number, bone erosion and bone thickening to have predictive value for differentiating IPs from NPs (relative CT number, P < 0.001; bone erosion, p = 0.04; bone thickening, P < 0.001). In the multivariate logistic regression analysis, relative CT number and bone thickening had predictive value for distinguishing IP from NP (relative CT number, p < 0.001; bone thickening, p = 0.02). The optimum cut off value calculation from the area under the receiver operating characteristics curve indicated that a relative CT number >1.3 was significantly associated with IP (sensitivity, 72.6%; specificity, 87.3%). Within cases not showing bone thickening, only the relative CT number was a predictive factor for differentiating IPs from NPs in the univariate analysis.Conclusions: High relative CT numbers could potentially indicate IP, and their measurement could provide a basis for differentiating IPs from NPs. [ABSTRACT FROM AUTHOR]

Cholesterol granulomas (CGs) are frequently found in the temporal bone, but their presence in the facial nerve has not been reported. We report a case of a 58-year-old woman who presented with left facial palsy caused by a CG that appeared to have originated in the facial nerve. Temporal bone computed tomography (CT) revealed soft tissue masses in the left middle ear spaces, and the facial canal was dilated from the genu to the vertical portion. Magnetic resonance imaging (MRI) revealed high signal intensity on T1-weighted images and partially high signal intensity on T2-weighted images, although no significant enhancement was observed on gadolinium-enhanced MRI. Surgical findings revealed CG in the middle ear spaces, but the facial canal remained intact and lacked continuity with the internal mass. Histopathological analysis verified the mass as a CG accompanied by cholesterol crystals. The mass was located within and continuous with the epineurium. These findings indicate that hemorrhage in the facial canal may have triggered the formation of the CG, causing left facial palsy due to increased pressure in the facial canal. [ABSTRACT FROM AUTHOR]

Hereditary gelsolin amyloidosis (HGA) is an autosomal dominant systemic amyloidosis, characterized by cranial and sensory peripheral neuropathy, corneal lattice dystrophy, and cutis laxa. We report a case of HGA presenting with bilateral facial palsy. A 70-year-old Japanese man presented with slowly progressive bilateral facial palsy and facial twitching, which had started in his 40s. His mother also had the same symptoms due to an unknown cause but rest of the family did not. He showed incomplete facial palsy with no frontal muscle movement and partial movement of the orbicularis oris and orbicularis oculi muscles. The patient showed no synkinesis. Electroneurography revealed symmetric low compound motor action potential amplitude of the orbicularis oris muscle, and a nerve excitability test showed a symmetric increase in the response threshold. Despite the partial voluntary movement of the orbicularis oculi muscle, bilateral blink reflexes were absent. He also showed facial spasms after contraction of the orbicularis oris muscle. Genetic testing revealed a heterozygous c.640G>A mutation (p. Asp214Asn); therefore, the patient was diagnosed with HGA. HGA related facial palsy showed moderate bilateral, upper blanch-dominant axonal degeneration of the facial nerve without reinnervation, and trigeminal nerve neuropathy. [ABSTRACT FROM AUTHOR]