bluuebunny/crossref_metadata_2025 huggingface dataset:
The Internist's Literature on Chronic Rhinosinusitis: An Evaluation of the Amount and Quality of Published Information
Authors: Chester Alexander C.
Published: January 2019

Most patients with chronicrhinosinusitis (CRS) are treated by internists, yet the information available to internists about CRS is rarely assessed. The author undertook a study to evaluate the amount and quality of information about CRS that is available to internists. Four information sources were analyzed: (1) five journals routinely read by internists, published over a 10-year period and searched on PubMed for the “exploded” terms chronic and sinusitis; (2) seven representative general and outpatient medicine texts, searched on MD Consult and STAT!Ref; (3) the 14th edition of the Medical Knowledge Self-Assessment Program (MKSAP 14), a review of internal medicine; and (4) four commonly used Internet databases. The five journals contained a total of 37,250 cited articles of various types over the study period; CRS was mentioned in only 19 of them. The standard medical texts offered little information about CRS, and MKSAP 14 did not mention CRS at all in the text, although it included some information in the questions and answers. Finally, among the online sources, UpToDate, a proprietary Internet database, offered an excellent discourse on CRS; in contrast, the Physicians’ Information and Education Resource, maintained by the American College of Physicians, contained no information about CRS in its 436 subject modules. The author concludes that, with few exceptions, the literature routinely available to internists offers little information about CRS.
Adult Nasal Dermoid Sinus Cyst
Authors: Chu Eugene A. , Ishii Lisa E.
Published: January 2019

Midline congenital nasal lesions are rarely encountered in adults. We present the case of a 31-year-old man with a nasal dermoid sinus cyst who presented with a nasal dorsal abscess. We review the embryology of nasal dermoid sinus cysts, and we discuss their presentation, evaluation, and management in adults.
A Case of Head and Neck Cancer Metastasizing to the Axillary Lymph Nodes
Authors: Wormald Rob , Sheahan Patrick , Timon Con
Published: January 2019

Metastases of head and neck cancers to the axillary lymph nodes are rare. Our review of the literature found only five such reports involving 10 patients. We describe a new case that occurred in a 69-year-old man who presented with a 6-week history of right neck swelling. Positron-emission tomography/computed tomography demonstrated high F18-fluorodeoxyglucose uptake in the neck and also in the right axilla. Fine-needle aspiration cytology revealed squamous cell carcinoma (SCC) at both sites. The patient underwent right-sided radical neck dissection with pecto-ralis major myocutaneous flap reconstruction and axillary node block dissection. The patient was subsequently treated with chemoradiotherapy, but 6 months later he developed an SCC in the lung. The lung lesion was also treated with chemotherapy, but the patient died 5 months later. Our case is unique among similar cases in that our patient had not undergone any previous treatment of the neck primary. We discuss the mechanism of this unusual presentation.
Pasteurella Multocida Epiglottitis: A Review and Report of a New Case with Associated Chronic Lymphocytic Leukemia
Authors: Harris Penelope J. , Osswald Michael B.
Published: January 2019

Pasteurella multocida is a gram-negative coccobacillus that primarily affects animals. P multocida infections in humans are usually associated with animal contact. To the best of our knowledge, only 7 cases of P multocida epiglottitis have been previously reported in the English-language literature; none of these cases occurred in a patient with chronic lymphocytic leukemia. We describe what we believe is the first reported case of P multocida epiglottitis in a patient with chronic lymphocytic leukemia, and we review the previous reports of this rare entity.
Steatocystoma Simplex of the Infratemporal Fossa: An Uncommon Location for a Rare Entity
Authors: Koshkareva Yekaterina A. , Weinstein Gregory S. , Feldman Michael , Moonis Gul
Published: January 2019

Steatocystoma simplex is a rare entity characterized by the presence of a solitary cutaneous cyst derived from a sebaceous duct or gland. Multiple locations of this lesion have been reported previously. The purpose of this article is to report the unusual presentation of steatocystoma simplex as an infratemporal fossa mass. To the best of our knowledge, no case of steatocystoma simplex at this site has been previously reported. We also describe the radiologic and pathologic features of this entity, which might aid in diagnosis and management, and we discuss its etiology and treatment options.
Primary Diffuse Large B-Cell Lymphoma of the Skull Mimicking Osteomyelitis
Authors: Senthilvel Egambaram , Subbiah Shanmugam , Jain Vikas , Seidman Michael
Published: January 2019

Primary lymphomas of the skull are extremely rare, as fewer than 20 cases have been reported in the literature. We describe the case of a 51-year-old woman with Huntington chorea who presented with forehead swelling. Imaging studies detected an enhancing mass in the skull with some destruction of the underlying bone. These features were suggestive of osteomyelitis. Surgical excision was performed, and the mass was found to be a primary diffuse large B-cell lymphoma. The patient was administered postoperative chemotherapy, and she was in complete remission at the 1-year follow-up.
Angiosarcoma of the Scalp with Complete Response to a Biweekly Gemcitabine and Docetaxel (GEMDOC) Chemotherapy Regimen
Authors: Shkoukani Mahdi A. , Carron Michael A. , Tulunay Ozlem , Kucuk Omer , Lin Ho-Sheng
Published: January 2019

Angiosarcoma is a rare, aggressive soft-tissue sarcoma with a high rate of recurrence and distant metastasis. Only a few cases of angiosarcoma involving the scalp have been reported in the literature. We describe a case involving a 75-year-old woman who presented to the emergency department at the Detroit Medical Center with multiple painful scalp lesions. She had had similar lesions intermittently for several years that apparently had responded to treatment with antifungal creams, but those occurring in the 6 months before her presentation had not responded to that therapy. The final diagnosis was a metastatic angiosarcoma. The patient achieved complete remission following treatment with a combination chemotherapy regimen consisting of gemcitabine (1,500 mg/m2) and docetaxel (50 mg/m2) administered biweekly. The patient was free of disease at the 15-month follow-up. This regimen is well tolerated and should be considered, especially in elderly patients and patients with comorbid conditions who may not tolerate other chemotherapeutic regimens.
Incomplete Horner Syndrome: Report of a Case and Description of the Sympathetic Nervous System Anatomy Involved in Horner Syndrome
Authors: Garbo Grant M. , Harmatz Alexander J. , Isaacson Glenn
Published: January 2019

Horner syndrome, in which ptosis, miosis, and anhidrosis occur concomitantly, can arise from injury to the sympathetic nerve pathways anywhere from the brain to the end organs. Incomplete Horner syndrome lacks the sign of anhidrosis. We present a case of incomplete Horner syndrome caused by internal carotid artery dissection and provide a road map of the cervical sympathetic nerves involved in Horner syndrome to explain its etiology. We also discuss the imaging of and therapy for internal carotid artery dissections.
Postaural Inflammatory Pseudotumor: An Extremely Unusual Complication of Trauma in a Child
Authors: Sethi Ashwani , Malhotra Vikas , Sethi Deepika , Nigam Sonu
Published: January 2019

We report the case of a 12-year-old boy who presented with a rapidly enlarging, painless mass behind the ear following trauma to the area. The mass was excised, and histopathologic and immunohistochemical evaluations revealed it to be an inflammatory pseudotumor. At 1 year postoperatively, the child exhibited no evidence of recurrence.
Nasal Septal Deviation in the Pediatric and Adult Populations
Authors: Reitzen Shari D. , Chung Wayne , Shah Anil R.
Published: January 2019

A significant proportion of the population has nasal septal deviation of varying degrees. Recent reports of such deviation occurring at younger ages suggest a congenital etiology. To the best of our knowledge, no previous clinical studies have compared the septal deviation of adult and pediatric populations with a uniform measure that focuses on the degree of deviation. We retrospectively analyzed computed tomography (CT) and magnetic resonance imaging (MRI) scans obtained from 81 patients who had undergone head and neck imaging for a variety of reasons. These subjects were divided into four age groups: younger than 4 months; 4 months to less than 5years; 5 to 15years; and more than 15 years. We used a measure of tortuosity to examine and compare nasal septal deviation among the different age groups. The tortuosity of the septum was measured at four precise points along the length of the septum on thin-section sinus CT and MRI. Tortuosity was defined as the ratio of the “actual” length of the septum to the “ideal” length of the septum, which was defined as the length of a straight line drawn from the superior to the inferior aspect of the septum. We found that subjects younger than 5 years of age exhibited significantly less tortuosity (p ≤ 0.017459) than did the older children and the adults. Therefore, we conclude that nasal septal deviation occurs at a higher frequency in older children and in adults when calculations of tortuosity are used as a measure. Our data may suggest that a noncongenital etiology is responsible for nasal septal deviation. However, given that the growth of the septum continues throughout childhood, our results do not preclude the possibility of a genetic predisposition to the later development of a deviated nasal septum.
Abrupt Tonsillar Hemorrhage from a Metastatic Hemangiosarcoma of the Breast: Case Report and Literature Review
Authors: Bar Ronen , Netzer Aviram , Ostrovsky Dmitry , Daitzchman Marcelo , Golz Avishay
Published: January 2019

We describe a case of primary breast hemangiosarcoma with tonsillar metastasis that manifested as a profuse oropharyngeal hemorrhage. The patient was a 54-year-old woman who presented to the emergency department with oral bleeding. A thorough examination revealed a distorted morphology of the left tonsil and a hemorrhage originating from it. Conservative methods to control the hemorrhage failed, and tonsillectomy was carried out. Histopathologic analysis revealed that the left tonsil contained hemangiosarcoma cells of the same kind that had been removed from the breast. Primary hemangiosarcomas of the breast are rare; when they do occur, they usually recur locally and spread hematogenously. To the best of our knowledge, this is the first case of a primary breast hemangiosarcoma with tonsillar metastasis to be reported in the literature. We present a detailed analysis of this case, and we review the relevant literature on metastatic tonsillar tumors, with attention to the role of therapeutic embolization.
Skull Base Osteomyelitis Originating in the Middle Ear or Mastoid: A Review of 3 Cases
Authors: Pang Aaron , Chong Kevin
Published: January 2019

Skull base osteomyelitis is a life-threatening condition that sometimes arises as a sequela of otitis media and mastoiditis. We present a retrospective analysis of the clinical course of 3 patients with skull base osteomyelitis that originated in the middle ear or mastoid. All 3 patients were elderly diabetic men who presented with headache. We review the clinical features, radiologic findings, and culture results in all 3 cases, and we describe the treatment regimens that led to a successful response in all 3 patients.
Cervical Esophageal Perforation and Cricopharyngeal Dysfunction
Authors: Helton W. Brian , Unnikrishnan Raman , Gal Thomas
Published: January 2019

Spontaneous perforation of the esophagus is an uncommon event; when it does occur, it usually affects the thoracic esophagus. We present a rare and fatal case of spontaneous perforation of the cervical esophagus in a 68-year-old woman. We believe this rupture was related to a proximal outlet obstruction secondary to cricopharyngeal muscle dysfunction.
Extraskeletal Giant Cell Tumor of the Larynx: Case Report and Review of the Literature
Authors: Rochanawutanon Mana , Praneetvatakul Phurich , Laothamatas Jiraporn , Sirikulchayanonta Vorachai
Published: January 2019

Giant cell tumors of the larynx typically arise within the laryngeal skeleton. We report a case of a laryngeal tumor in a 29-year-old man that clearly originated outside the laryngeal cartilage. It was identified as a soft-tissue giant cell tumor. To the best of our knowledge, an extraskeletal laryngeal giant cell tumor has not been previously reported.
Laryngeal Coccidioidomycosis with Vocal Fold Paralysis
Authors: Allen Jacqui E. , Belafsky Peter C.
Published: January 2019

We present the case of a 52-year-old woman with recurrent disseminated coccidioidomycosis involving the larynx that was associated with vocal fold paralysis. The diagnosis was confirmed by histologic biopsy, and the patient had an excellent response to systemic antifungal treatment. However, her vocal fold motion did not return. We also review the current world literature.
A Case of a Coexisting Aberrant Internal Carotid Artery and Persistent Stapedial Artery: The Role of MR Angiography in the Diagnosis
Authors: Hatipoglu Hatice Gul , Cetin Mehmet Ali , Yuksel Enis , Dere Huseyin
Published: January 2019

We describe the case of a 37-year-old woman who presented with a complaint of recurrent headaches since childhood. Clinical examination revealed the presence of a reddish-bluish mass in the inferior half of the tympanic membrane in her right ear. Source and three-dimensional time-of-flight magnetic resonance angiography (MRA) detected a protruded right internal carotid artery (ICA) in the hypotympanum. The vertical segment of the ICA was absent, and the artery was narrowed and lateralized and had a “reverse 7” shape. Meanwhile, a persistent stapedial artery (PSA) was seen originating in the petrous portion of the ICA to form a middle meningeal artery. The A1 segment of the right anterior cerebral artery was hypoplastic. Based on these findings and on follow-up findings on computed tomography, the patient was diagnosed with a concomitant aberrant ICA and PSA. No intervention was undertaken. We review the management of this rare finding, and we discuss the role of MRA in its diagnosis.
Schneiderian Carcinoma Developing in an Inverted Papilloma of the Palatine Tonsil: An Unusual Case
Authors: Vayisoglu Yusuf , Unal Murat , Apa Duygu Dusmez , Gucluturk Mehmet Taylan
Published: January 2019

Schneiderian papillomas are among the most common benign tumors of the nose and paranasal sinuses. These lesions frequently originate in the lateral nasal wall, and they have a tendency toward recurrence and malignant transformation. Carcinomas arise in association with schneiderian papillomas in approximately 10% of cases. Outside the sinonasal tract, the ectopic occurrence of a schneiderian papilloma is extremely rare. We describe the case of a 52-year-old man with an invasive schneiderian carcinoma that arose within an inverted papilloma in the palatine tonsil. To the best of our knowledge, no such case has been previously reported in the English-language literature.
Primary Intraosseous Carcinoma of the Anterior Maxilla: An Unusual Case and Review of the Literature
Authors: Mohyuddin Nadia , Yao Mike
Published: January 2019

Primary intraosseous carcinoma of the head and neck is rare, and lesions isolated to the anterior maxilla are obviously even more rare. The diagnosis of intraosseous carcinoma can be difficult, and it must be based on strict criteria. We report the case of a 40-year-old man who was referred for definitive treatment of a cancerous lesion of the anterior maxilla. The patient's mass had initially been thought to be a benign odontogenic cyst. The patient was treated with surgery and prosthetic rehabilitation. We describe the clinical presentation, pertinent workup including imaging, and the treatment of this case, and we review the literature.
Reconstruction of the Paralyzed Face
Authors: Robey Ashley B. , Snyder Mary C.
Published: January 2019

Facial nerve paralysis can be difficult to treat because it presents a variety of functional, aesthetic, and psychosocial challenges. The goals of treatment include facial symmetry at rest, corneal protection, oral competence, restoration of voluntary and spontaneous facial movements, and minimal synkinesis. A multitude of static and dynamic procedures have been used to achieve these goals. Facial nerve reapproximation or interpositional grafting is associated with the best end results. The results of dynamic procedures are generally better than those of static procedures. Optimal reconstruction of the paralyzed face usually requires multiple surgeries with both types of procedures. Patients must be extensively counseled regarding expected results before they embark on what is an oftentimes lengthy reconstructive process. In this article, we discuss the anatomy of the facial nerve, the etiologic factors associated with facial nerve paralysis, the evaluation of the patient with facial paralysis, and the various surgical options for static and dynamic reconstruction of the paralyzed face. We also review the literature.
Aids-Related Primary Kaposi Sarcoma of the Nasopharynx
Authors: Çelenk Fatih , Yilmaz Metin , Asal Korhan , Ekinci özgür , Tokgöz Nil
Published: January 2019

Primary nasopharyngeal Kaposi sarcoma is extremely rare, as only 1 case has been previously reported in the literature. We report a new case, which occurred in a 37-year-old man with a known history of acquired immune deficiency syndrome (AIDS). The patient presented with complaints of recurrent epistaxis and postnasal hemorrhage. Endoscopic examination detected a bluish, smooth, firm, nonpulsatile mass in the nasopharyngeal wall. Histopathologic findings on biopsy were consistent with Kaposi sarcoma. The tumor was successfully treated with radiotherapy. Kaposi sarcoma should be considered in the differential diagnosis of any AIDS patient who presents with recurrent unilateral nasal bleeding.
Osteomyelitis of the Temporal Bone in Identical Twin Infants
Authors: Prasad Sampath C. , Prasad Kishore Chandra , Bhandary Rukma , Abhijith Kumar , Sampath Pallavi
Published: January 2019

Osteomyelitis of the skull base almost always occurs in elderly patients with diabetes; however, it may occur in patients with compromised immune function regardless of their age. We present the cases of a pair of immunocompetent, 2-year-old identical twins who experienced osteomyelitis of the temporal bone almost exactly 1 year apart. An incident such as this, in this age group, has never been reported in the literature.
An Unusual Cause of Foreign-Body Sensation in the Throat: A Displaced Superior Cornu of the Thyroid Cartilage
Authors: Karaman Emin , Saritzali Gkioukxel , Albayram Sait , Kara Batuhan
Published: January 2019

Foreign-body sensation is a nonspecific symptom of aerodigestive tract diseases. We describe the case of a 42-year-old man who presented with a foreign-body sensation in the throat that was found to be caused by a displaced superior cornu of the thyroid cartilage. Such a displacement is not well known, but we believe that it may not be rare. These cases can be overlooked and misdiagnosed as chronic nonspecific pharyngitis or laryngopharyngeal reflux. However, a careful laryngoscopic examination by an otolaryngologist who considers the possibility of such a pathology may result in an accurate diagnosis, which might spare an affected patient from a lifelong pharmacotherapeutic regimen.
Myofibroma of the Zygomatic Bone in an Older Child: A Case Report
Authors: Acioğlu Engin , Acar Gül Özbilen , Alimoğlu Yalçin , Cansiz Harun , Dervişoğlu Sergülen
Published: January 2019

Myofibroma/myofibromatosis is a rare mesenchymal disorder that is part of a heterogeneous group of approximately 20 disorders that are classified primarily according to the proliferation of benign fibrous elements. These lesions can arise during a wide range of ages, with many occurring in the first decade of life, and they are slightly more common in males than females. The etiology of this disease is not well understood. Clinically, patients with myofibroma/myofibromatosis present with various signs, ranging from superficial, cutaneous, purplish macules to freely movable subcutaneous masses to deep-seated fixed lesions. The definitive diagnosis is made on histopathologic grounds. The destructive clinical behavior of myofibroma/myofibromatosis in the setting of insufficient pre- or perioperative diagnostic evaluations (e.g., a failure to perform fine-needle aspiration or frozen-section biopsy) may guide the clinician toward a radical surgical procedure rather than a simple excision.
Primary Nasal Tuberculosis—A Rare Clinical Entity
Authors: Lerra Sandeep , Nazir Tanvir , Qadri Sajjad Mir , Kirmani Masod
Published: January 2019

Primary tuberculosis of the nose is very rare. We report a case of a 35-year-old woman who presented with bilateral nasal obstruction and epistaxis of 3 months’ duration but who was otherwise healthy. She was diagnosed with primary nasal septal tuberculosis and was treated with antituberculosis DOTS (directly observed treatment, short course) therapy for 6 months with complete recovery. Given the resurgence of tuberculosis in recent times, it is important that clinicians remain aware of this rare and treatable clinical entity.
Paradoxical Giant Inferior Concha
Authors: Naiboğlu Bariş , Yaylaci Atilay , Oysu Çağatay
Published: January 2019

Anatomic variations of the middle and superior conchae are common, but inferior concha anomalies are rare. These anomalies have included pneumatization, agenesis, and duplication. We describe what we believe is the first reported case of a paradoxical curvature of the bony part of the inferior concha. The patient was a 13-year-old girl. The development of a huge inferior concha blocked the left nasal cavity and deviated the nasal septum to the contralateral side, resulting in bilateral obstruction. The patient was successfully treated with surgery.
Ballpoint Pen Ingestion in a 2-Year-Old Child
Authors: Rameau Anaïs , Anand Sumeet M. , Nguyen Lily H.P.
Published: January 2019

A 2-year-old girl ingested a ballpoint pen, which was found on chest x-ray to have lodged in the lower esophagus and stomach. The pen, which measured nearly 15 cm in length, was removed via rigid esophagoscopy without complication. To the best of our knowledge, this is the longest nonflexible foreign body ingested by a young child ever reported in the English-language literature. We describe the presentation of this case and the current guidelines for safety as enumerated in the Small Parts Regulations established by the U.S. Consumer Product Safety Commission.
Malignant proliferating Trichilemmal Tumor Involving the Sinuses
Authors: Harris Tashneem , Meyer Estie , Lubbe Darlene E. , Smit Werner , Walker Chris
Published: January 2019

Proliferating trichilemmal tumor (PTT) is a rare adnexal neoplasm that arises from the outer sheath of the hair follicle. It is believed that PTTs originate in trichilemmal cysts. These tumors have the potential for malignant transformation; when this occurs, the tumor is known as a malignant PTT (MPTT). Recurrence after simple local excision is common, and it can cause considerable morbidity. We report a case of MPTT that was initially diagnosed as a benign PTT. The primary tumor had arisen from the skin over the glabella. It was excised, but it recurred 3 years postoperatively. The recurrent tumor involved the eyelid, nasal cavity, and frontal and ethmoid sinuses, and it extended into the orbit. The recurrent tumor was excised via combined endoscopic and open surgery. As far as we know, this is the first documented case of an MPTT that involved the sinuses.
Congenital Fixation of the Head of the Stapes in Three Family Members
Authors: Wetmore Stephen J. , Gross Andrew F.L.
Published: January 2019

We conducted a retrospective chart review at a university hospital on a family that exhibited a rare cause of conductive hearing loss. Four male patients of this family had congenital conductive hearing loss. Three of these family members underwent bilateral ossiculoplasty, a father and two of his three sons. All three were found to have mild or moderate conductive hearing loss due to fixation of the head of the stapes by a bony bar that extended from the head of the stapes to the posterior ear canal wall. Surgical removal of the bony bar improved hearing in all cases. This family exhibits autosomal-dominant inheritance of this abnormality. Fixation of the head of the stapes by a bony bar that extends to the posterior ear canal wall is a rare cause of congenital, autosomal-dominant, mild or moderate conductive hearing loss that can be surgically corrected.
Approach to Benign Tumors of the Palate: Analysis of 28 Cases
Authors: Ural Ahmet , Livaoğlu Murat , Bektaş Devrim , Bahadir Osman , Hesapçioğlu Atilla , İmamoğlu Mehmet , Işik Abdülcemal Ümit
Published: January 2019

We conducted a retrospective analysis of 28 patients—15 men and 13 women, aged 17 to 71 years (mean: 41.6)—who had undergone surgery for the treatment of a benign tumor of the hard or soft palate. The most common chief complaint was a palatal mass, which was reported by 14 patients (50.0%). Tumors were more common in the hard palate than in the soft palate by a margin of 23 to 5 (82.1 to 17.9%; p = 0.001). The most common histopathologic diagnosis was pleomorphic adenoma, which occurred in 9 cases (32.1%). Most patients were treated with local excision with clear margins, which was sufficient in almost all cases, as there were only 2 recurrences, both of which occurred in men with a hard-palate pleomorphic adenoma. For these 2 patients, a wider excision and repair with palatal islet flaps was performed, and no further recurrence or malignant transformation was observed during follow-up. Two patients with a soft-palate hemangioma were treated with an intralesional steroid injection and radiofrequency ablation, which reduced the size of their lesion considerably.
Utility of Panendoscopy for the Detection of Unknown Primary Head and Neck Cancer in Patients with a Negative PET/CT Scan
Authors: Pattani Kavita M. , Goodier Michael , Lilien David , Kupferman Todd , Caldito Gloria , Cherie-Ann O. Nathan
Published: January 2019

We conducted a retrospective review of the records of 23 patients who had been diagnosed with regionally metastatic head and neck squamous cell carcinoma from an unknown primary tumor. Our goal was to assess the utility of panendoscopy in locating the primary tumor in those patients whose positron-emission tomography/computed tomography (PET/CT)findings were negative. Overall, we found that PET/CT had correctly identified the unknown primary in 12 of the 23 patients (52%); panendoscopy confirmed this finding in all 12. Of the remaining 11 patients, however, panendoscopy located the primary tumor in only 1 (9%). In this era of cost containment and ongoing advances in imaging and transnasal esophagoscopy, it is important to revisit the workup of an unknown primary inpatients with a negative PET/CT scan. There are various advantages and disadvantages to performing panendoscopy with biopsy inpatients with an unknown primary and a negative PET/CT scan, but our results and the findings of others indicate that it will detect the primary in only about 10% of these cases. We recommend careful selection of patients who are to undergo panendoscopy for the routine workup of an unknown primary.
Idiopathic Acquired Supraglottic Web: A Case Report
Authors: Pegg David , Kanatas Anastasios , Makura Zvoru
Published: January 2019

We report a case of an idiopathic acquired supraglottic web in an 83-year-old man. The web was managed with a combination of dilation and unilateral CO2 laser excision. Subsequent to removal, the web recurred three times; it was removed in the same fashion twice and left alone once. To the best of our knowledge, this is the first reported case of a truly idiopathic acquired laryngeal web.
Calcifying (Juvenile) Aponeurotic Fibroma of the Scalp
Authors: Thakur Jagdeep S. , Diwana Vijay K. , Sharma Sudarshan , Thakur Anamika
Published: January 2019

Calcifying aponeurotic fibroma is a benign tumor with a predilection for distal parts of the extremities; it is very rare in the head and neck region. It commonly affects young patients—hence the term juvenile in the name. It is fibroblastic in origin and considered a cartilage analogue of fibromatosis, but its exact etiology remains unknown. Clinically, this tumor needs to be differentiated from fibromatosis, nodular fasciitis, chondroma, schwannoma, and rheumatoid nodule. A 24-year-old woman presented with swelling in the forehead for the previous 6 months. Wide surgical excision of the lesion was performed, and histopathologic examination revealed a calcifying aponeurotic fibroma. We reviewed the literature on this rare clinical entity and present our hypothesis on its etiology.
Primary Adenocarcinoma of the Frontal Sinus
Authors: Wadhera Raman , Gulati S.P. , Garg Ajay , Ghai Anju , Kumar Sanjay
Published: January 2019

When tumor involvement of the frontal sinus occurs, it is usually the result of the direct spread of the mass from the nasal cavity or anterior ethmoid sinuses. Primary frontal sinus tumors are extremely rare. We describe a case of primary adenocarcinoma of the frontal sinus in a 53-year-old man. The patient refused surgery, so he was treated with chemotherapy followed by radiotherapy. At the 1-year follow-up, only a slight reduction of the swelling was noted. Thereafter, he was lost to follow-up. This case represents a typical example of a paranasal cancer extending beyond the bony margins, with a silent onset that simulated benign disease. The best hope for an early diagnosis of such a tumor lies in the greater use of computed tomography to assess chronic rhinosinusitis.
Is There An Ototoxicity Risk from Cortisporin and Comparable Otic Suspensions? Distortion-Product Otoacoustic Emission Findings
Authors: Berenholz Leonard P. , Rossi Dyana L. , Lippy William H. , Burkey John M. , Berenholz Leonard
Published: January 2019

The purpose of this investigation was to use distortion-product otoacoustic emission (DPOAE) testing to address the issue of possible ototoxicity from the use of neomycin/polymyxin B/hydrocortisone otic suspension following tympanostomy tube placement. We retrospectively reviewed our clinical records and identified 36 children (52 ears) who had met our three study criteria: (1) unilateral or bilateral placement of transtympanic ventilation tubes, (2) treatment for 3 to 5 days with neomycin/polymyxin B/hydrocortisone drops, and (3) postoperative evaluation by DPOAE testing. We identified another set of 36 children (52 ears) who had not received these drops and who had not undergone tube placement but who had been evaluated by DPOAE testing to serve as a control group. We found no significant differences in DPOAE amplitudes between the treatment and control groups. These findings are consistent with decades of clinical experience indicating that neomycin/polymyxin B/hydrocortisone otic suspension is safe when used responsibly.
Otomycosis in Immunocompetent and Immunocompromised Patients: Comparative Study and Literature Review
Authors: Viswanatha Borlingegowda , Sumatha Dadarao , Vijayashree Maliyappanahalli Siddappa
Published: January 2019

A comparative clinical study was carried out that included 50 cases of otomycosis in immunocompetent patients and 50 cases of otomycosis in immunocompromised patients. Clinical presentation, predisposing factors, mycologic profile, and treatment outcomes were compared. Aspergillus spp were the most commonly isolated fungi in the immunocompetent group, and Candida albicans in the immunocompromised group. Bilateral involvement was more common in the immunocompromised group. All the patients were treated with topical clotrimazole ear drops. Four patients in the immunocompromised group did not respond to treatment with clotrimazole but were treated successfully with fluconazole ear drops. Three patients had a small tympanic membrane perforation due to otomycosis.
Outcomes of Intubation in Difficult Airways Due to Head and Neck Pathology
Authors: Iseli Tim A. , Iseli Claire E. , Golden J. Blake , Jones Virginia L. , Boudreaux Arthur M. , Boyce James R. , Weeks David M. , Carroll William R.
Published: January 2019

The purpose of this study was to examine the impact of surgical pathology, anesthesiologist experience, and airway technique on surgically relevant outcomes in patients identified by preoperative laryngoscopy to have a difficult airway due to head and neck pathology. We prospectively recorded a series of 152 difficult airway cases due to head and neck pathology out of 2,145 direct laryngoscopies undertaken between November 2005 and June 2008. One of two senior anesthesiologists specializing in head and neck procedures intubated 101 (66.4%) of the 152 patients and did so 3.3 minutes faster (p = 0.51), with better oxygenation (87.3 vs. 81.8%; p = 0.02) and fewer airway plan changes (p = 0.001) than did other, nonspecialist anesthesiologists. Predictors of failure of the first intubation plan included: cancer diagnosis (p = 0.02), previous radiotherapy (p = 0.03), and supraglottic lesions (p = 0.03). Glottic/subglottic lesions required the most intubation attempts (p = 0.02). Awake fiberoptic Intubation was the most common method used (44.7%) but resulted in a change in the airway plan in 6 cases (8.8%). Gas induction maintained the best oxygenation (p = 0.01). Awake tracheostomy was infrequent (1.3%) and took the longest (p = 0.006). We concluded that difficult airways due to head and neck pathology require teamwork and a backup plan. An anesthesiologist specializing in head and neck procedures may help to avoid adverse outcomes associated with cancer, especially previously irradiated supraglottic/glottic lesions, leading to a less frequent need for awake tracheostomy.
Rhinoplasty and Septorhinoplasty Outcome Evaluation
Authors: Chisholm Edward , Jallali Navid
Published: January 2019

Outcome measures are a crucial tool in the analysis and comparison of medical interventions. We review the subjective and objective methods of assessing outcomes of rhinoplasty and septorhinoplasty. Both form and function of the nose are considered.
Bilateral Congenital Lacrimal Fistulae: A Case Report
Authors: Zhuang Lei , Sylvester Christin L. , Simons Jeffrey P.
Published: January 2019

A congenital lacrimal fistula is a rare developmental anomaly, usually unilateral. While it is often asymptomatic, some patients present with epiphora or discharge. We report the case of a 4-year-old boy with bilateral lacrimal fistulae. No other systemic, nasal, or ocular anomalies were found. In the absence of significant symptoms, we decided on a course of observation. In this article, we discuss the embryologic basis of congenital lacrimal fistulae, as well as the typical presentation and possible treatment modalities. The presence of a lacrimal fistula is an indication to search for a variety of underlying systemic and ocular anomalies.
Aneurysmal Bone Cyst at the base of the Skull
Authors: Goyal Arun , Rastogi Shalabh , Singh P.P. , Sharma Sonal
Published: January 2019

Aneurysmal bone cysts have been described as pseudocysts in view of their lack of an epithelial lining. These cysts are uncommon, but when they do occur they typically involve the long bones of the extremities, the membranous bones of the thorax and pelvis, and the vertebrae. Skull involvement is uncommon. We present the case of a 14-year-old girl who presented with nasal obstruction and a swelling of the right cheek. Contrast-enhanced computed tomography detected a heterogeneous cystic mass involving the sphenoid and ethmoid bones. The mass was excised via a lateral rhinotomy approach, and it was identified as an aneurysmal bone cyst on histologic examination. The patient experienced a recurrence in the right sphenoid sinus within 3 months, and the lesion was removed via transnasal endoscopy.
Nontuberculous Mycobacterial Otomastoiditis: A Case Report
Authors: Tsai Li-Tai , Wang Ching-Yuan , Lin Chia-Der , Tsai Ming-Hsui
Published: January 2019

Nontuberculous mycobacterial otomastoiditis is rare and can be easily confused with various different forms of otitis media. We describe the case of a 50-year-old woman who presented with left-sided chronic otitis media that had persisted for more than 1 year. It was not eradicated by standard antimicrobial therapy and surgical debridement. After appropriate antibiotic therapy for nontuberculous mycobacteria was added to the therapeutic regimen, the patient improved significantly and the lesion had healed by 6 months. Based on our experience with this case, we conclude that early bacterial culture and staining for acid-fast bacilli in ear drainage material or granulation tissue should be performed when standard antimicrobial therapy fails to eradicate chronic otitis media of an un-determined origin that is accompanied by granulation tissue over the external auditory canal or middle ear. Polymerase chain reaction testing is also effective for rapid diagnosis. Surgical debridement and removal of the foreign body can successfully treat nontuberculous mycobacterial otomastoiditis only when effective antimicrobial therapy is also administered.
Primary Mucosal Melanoma Arising from the Eustachian Tube with CTLA-4, IL-17A, IL-17C, and IL-17E Upregulation
Authors: Wei Calvin , Sirikanjanapong Sasis , Lieberman Seth , Delacure Mark , Martiniuk Frank , Levis William , Wang Beverly Y.
Published: January 2019

Primary malignant melanoma arising from the eustachian tube is extremely rare. We report the case of a 63-year-old white man who presented with a 1-month history of left-sided hearing loss and aural fullness. Flexible fiberoptic laryngoscopy detected a blue-purple mass that appeared to arise from the left lateral nasopharynx. Computed tomography demonstrated an enhancing mass arising from an orifice of the left eustachian tube. The tumor was debulked endoscopically and was confirmed to have originated in the left eustachian tube. Histologically, the tumor was made up of heavily pigmented pleomorphic spindle cells with frequent mitoses. The tumor cells were immunohistochemically positive for S-100 protein, HMB-45, Melan-A, and PNL-2. The final diagnosis was a mucosal malignant melanoma. We also performed a nested polymerase chain reaction assay for several genes of interest, including CTLA-4, IL-17A, IL-17B, IL-17C, IL-17D, IL-17E, IL-17F, PLZF, Foxp3, RORγt, CD27, and CD70. These genes have been studied mainly in cutaneous melanomas, especially for the development of immunotherapy, but only very limited studies have been done on mucosal melanomas. Our investigation found upregulation of CTLA-4, IL-17A, IL-17C, and IL-17E. Based on our finding of CTLA-4 upregulation, it may be suggested that our patient might have had low antitumor immunity and that he might have benefited from CTLA-4 blockade. On the other hand, upregulation of IL-17A and IL-17E might reflect increased antitumor immunity, which could suggest that patients with a mucosal melanoma might benefit from immunomodulators associated with the effect of T17. These genes also have great potential to help melanoma patients obtain tailored treatment, and they can be used as biomarkers for predicting prognosis.
Massive Calcification in a Pleomorphic Adenoma: Report of an Unusual Presentation
Authors: Coelho Luiz O.M. , Ono Sergio E. , de Carvalho Neto Arnolfo , Kawasaki Christiane S. , Sabóia Luciano V. , Soares Maria F.
Published: January 2019

We report a case of histology-proven pleomorphic adenoma of the parapharyngeal space in a 20-year-old man. This case was unusual in that a massive amount of dystrophic calcification was scattered throughout the tumor. The patient underwent successful surgical resection, and he exhibited no signs of recurrence during follow-up. Literature about such an unusual presentation is scarce.
Reinnervation of Facial Muscles with Only a Cross-Facial Nerve Graft in a 25-Year-Old Patient with Congenital Facial Palsy
Authors: Seyed-Forootan Kamal , Karimi Hamid , Hasani Esmaiil
Published: January 2019

The standard method for managing chronic facial palsy is the two-stage free-muscle flap. We report a case involving a 25-year-old patient who had facial palsy from her birth. Twelve months after the first stage of a cross-facial nerve graft, we found that the voluntary movements of her facial muscles had returned. Within the following 12 months, she gained complete recovery of her movements on the affected side, as confirmed by electromyography studies. This case demonstrates that neurotization of facial muscles in chronic facial palsy is possible. However, further studies are needed to define the trophic effects or trophic mediators that can restore function to atrophied facial muscles and to determine which patients might benefit from the cross-facial nerve graft procedure without the free-muscle graft procedure.
Repair of a Posterior Perforation of the Trachea following Thyroidectomy with a Muscle Transposition Flap
Authors: Escott Alistair B.J. , Pochin Rosalynd S.B.
Published: January 2019

Tracheal perforation is a rare postoperative complication of total thyroidectomy. While previously documented cases have been reported in the anterior aspect of the trachea after a total thyroidectomy, we report what we believe is the first documented case of a perforation in the posterior aspect of the trachea. Our patient was a 29-year-old woman who presented with symptoms of tracheal impingement in the context of a right-sided goiter that subsequent investigation found to be three benign colloid nodules. Four teen days after her total thyroidectomy, she presented with surgical emphysema surrounding the wound. Computed tomography identified a 2.5-mm defect in the right posterior lateral trachea, posterior to the cartilaginous ring. The defect failed to seal spontaneously, and after 48 hours, the patient remained symptomatic. During reexploration, the defect was successfully repaired with a myovascular transposition flap in conjunction with Tisseel tissue-bonding agent. This technique has the potential to be applied in future intraoperative and postoperative cases of tracheal perforation.
Helicobacter pylori in lacrimal secretions
Authors: Batioglu-Karaaltin Aysegul , Saatci Ozlem , Akpinar Meltem , Celik Melih Ozgür , Develioglu Omer , Yigit Ozgur , Külekçi Mehmet , Akarsubaşı Alper Tunga
Published: January 2019

The aim of this study was to investigate the presence of Helicobacter pylori in human lacrimal and nasal secretions. Eighty patients with complaints of dyspepsia who had undergone endoscopies and gastric antrum biopsies were included in the study. A total of five specimens, including 2 lacrimal secretion samples, 2 nasal mucosal swab samples, and 1 gastric antrum biopsy, were collected from each patient and investigated with polymerase chain reaction (PCR) methods consisting of the urease enzyme coding gene GlmM (UreC) and the H pylori -specific 16S rRNA coding gene. The Reflux Symptom Index and ophthalmologic complaints of the patients were recorded. The detected positivity rates of the H pylori 16S rRNA coding gene in gastric biopsies and nasal mucous and lacrimal secretions were 55, 11.2, and 20%, respectively. The patients were grouped as gastric-antrum-biopsy–negative (Group I [n = 36]) and –positive (Group II [n = 44). In Group II, H pylori positivity in the lacrimal and nasal mucous secretions was 36.3 and 18%, respectively. A comparison between the groups in terms of H pylori presence in nasal mucous and lacrimal secretions yielded statistically significant differences (p = 0.0001, p = 0.003). The simultaneous presence of H pylori in nasal mucous and lacrimal secretions was 13.6% in Group II. H pylori positivity in nasal mucous and lacrimal secretions had a positive moderate correlation (r = 0.40; p = 0.0003). The present study is the first report on the presence of H pylori in lacrimal secretions through nested PCR, which suggested the presence of a number of mechanisms for H pylori transmission to lacrimal secretions.
Myxoinflammatory Fibroblastic Sarcoma of the Nose: First Reported Case at an Unusual Location (Nasal Dorsum), with a Review of the Literature
Authors: Numminen Jura , Bizaki Argyro , Kujansivu Jarno , Huovinen Sanna , Rautiainen Markus
Published: January 2019

Myxoinflammatory fibroblastic sarcoma (MIFS) is a rare, low-grade, malignant, soft-tissue tumor that typically affects the distal extremities of middle-aged patients. In most cases, it presents as a painless, slowly growing mass within the subcutaneous tissue. It is associated with a low rate of metastasis but a high rate of local recurrence. In addition to the distal extremities, MIFS has been reported in the thigh, arm, forearm, groin, upper back, neck, and temporal area. As far as we know, no case has been previously reported in the nasal area. We report for the first time a case of MIFS presenting on the dorsum of the nose. The painless, 3.0-cm tumor was initially mistaken for reticular erythematous mucinosis, a benign skin condition that occurs when fibroblasts produce abnormally large amounts of mucopolysaccharides. The tumor was surgically removed in its entirety with surgical margins of 3 to 5 mm. During 4 years of follow-up, no clinical or radiologic evidence of a recurrence or metastasis was seen. We discuss the imaging and histologic features of MIFS, as well as its clinical management and follow-up, and we review related reports in the literature.
Long-term Effects of Intracochlear Electrical Stimulation with Looped Patterns on Tinnitus: A Case Study
Authors: Arts Remo A.G.J. , George Erwin L.J. , Griessner Andreas , Zierhofer Clemens , Stokroos Robert J.
Published: January 2019

Electrical stimulation by cochlear implant (CI) has been proven to be a viable treatment option for tinnitus in many recent studies. In addition, intracochlear electrical stimulation independent of an acoustic input appears to suppress tinnitus, at least in the short term. We conducted a case study to investigate the long-term effects of both standard CI and intracochlear electrical stimulation independent of an acoustic input on tinnitus in a patient with single-sided deafness and tinnitus. We found no negative effects of intracochlear electrical stimulation independent of an acoustic input on speech perception in noise. Furthermore, the additional use of a standard CI was advantageous for speech discrimination in our patient. We conclude that long-term tinnitus suppression can be achieved via intracochlear electrical stimulation with looped patterns. Our findings in terms of speech discrimination in our patient were consistent with those reported in previous studies.