OBJECTIVES: 1. Be able to discuss mechanism of the loss of smell due to the use of intranasal zinc gluconate gel. 2. Un- derstand that zinc gluconate, applied to the human nose in available doses, produces permanent loss of smell in some patients by the same mechanism as that of zinc sulfate (histor- ical control). METHODS: It has been shown that zinc gluconate gel squirted into the human nose reaches the olfactory cleft. Clin- ical endoscopic observations have evaluated the patency of the pathway from the external nasal opening to the olfactory cleft. Cadaver studies show that the gel reaches the olfactory cleft. Protein precipitate studies (albumin) presented here test the hypothesis that zinc ions from the gluconate salt produced pharmacodynamic changes in the same manner that other zinc salts do. RESULTS: These protein (albumin) studies show precipita- tion of the protein (albumin) in the same manner produced by zinc sulfate and other zinc salts, with a clear dose-response relationship, a precipitation that does not occur with similar salts with similar anions, lacking the zinc cation. A comparison of amounts of zinc ion per cm2 verified the olfactotoxic ED50 of the zinc gluconate, as compared to historical controls. CONCLUSIONS: Zinc gluconate gel, applied to the human nose in available doses, produces permanent loss of smell in some patients by the same mechanism as that of zinc sulfate. P187 Managing Benign Osseous Neoplasms of the Sinonasal Cavity Mark Checcone, MD (presenter); Ramzi Tamer Younis, MD Miami FL OBJECTIVES: A spectrum of rare osseous neoplasms origi- nating from the bony framework of the head and neck in children including osteomas, ossifying fibromas, and fibrous dysplasia are reviewed. Special attention is given to radio- graphic evaluation, clinical presentation, histological appear- ance, and surgical management. This study reviews the out- comes and complications of various surgical approaches. Indications for an endoscopic sinus surgery approach and the benefits of computer image guidance are highlighted. METHODS: The rare presentation of these bony lesions makes prospective studies very difficult. This study compares experience at a tertiary referral children’s hospital with those presented in the literature. Clinical presentations, indications for treatment, surgical options, and relevance of computer image guidance are reviewed. RESULTS: Osteoma is the most common benign neo- plasm of the sinonasal cavity. Surgical excision is the procedure of choice, which may vary from external ap- proaches to endoscopic sinus surgery. Surgical indica- tions include pain, obstructive symptoms, cosmesis, and intracranial complications. There exists a trend toward endoscopic approaches due to advances in instrumenta- tion. The presenters’ experience and a large body of case studies in the literature confirm the safety of endoscopic sinus surgery with and without image guidance in the excision of certain paranasal sinus osseous neoplasms. CONCLUSIONS: The recent popularity of computer image guidance has enhanced the utility of endoscopic sinus surgery for operative excision of these bony lesions, and endoscopic sinus surgery with or without image guidance proves to be a safe approach to complete tumor resection with the benefit of reducing surgical complications. P188 Nasopharyngeal Inflammatory Pseudotumor Arthur Chen, MD (presenter); David Rosen, MD; William M Keane, MD; Marc R Rosen, MD Philadelphia PA OBJECTIVES: Learn about an inflammatory pseudotumor, which is a heterogenous lesion of unknown etiology that may mimic a malignancy with local destruction of tissue, recur- rence following excision, and the development of multiple foci. Although not uncommonly reported, this lesion remains controversial and enigmatic. Recent investigations into the molecular origin of these pseudotumors reveals that some lesions may possess a chromosomal translocation notable in some lymphomas, indicating a resemblance to a malignant process; however, other pseudotumors appear to originate from an infectious etiology. METHODS: Two cases are presented involving unusually aggressive, benign nasopharyngeal lesions that were notable for invasion of the parapharyngeal and masticator space, as well as involvement of the clivus and temporal bone with extension through the skull base. RESULTS: Exhaustive pathologic examination of these ero- sive lesions did not reveal a malignant process. Immunohisto- chemical and molecular diagnostic testing ruled out any he- matologic or clonal lymphoid processes. In one case, biopsies noted a mixed population of bacteria in a setting of inflamma- tion. Long-term intravenous antibiotics were prescribed. This pseudotumor remains persistent, though the clinical course has been stable. In the second case, the nasopharyngeal pseudotu- mor was treated with radiation therapy resulting in a complete remission. CONCLUSIONS: The inflammatory pseudotumor remains a diagnostic dilemma. The question remains whether these pseudotumors represent a true neoplastic process or may en- compass a diverse spectrum of multiple lesions that mimic a malignancy. Surgery, radiation, and treatment with steroids and antibiotics has each yielded some success though results are discordant. P189 Use of the Titanium Plate in Septal Reconstruction Jose M Godoy, MD (presenter); Luis E Cabezas, MD; Andres Godoy; Jose M Godoy, MD Santiago Chile P274 Otolaryngology-Head and Neck Surgery, Vol 135, No 2S, August 2006