bluuebunny/crossref_metadata_2025 huggingface dataset:
Synovial Sarcoma of the Larynx Treated by Supraglottic Laryngectomy: Case Report and Literature Review
Authors: Luna-Ortiz Kuauhyama , Cano-Valdez Ana María , da Cunha Isabela Werneck , Mosqueda-Taylor Adalberto
Published: January 2019

We describe a case of synovial sarcoma of the larynx, and we discuss the use of fluorescence in situ hybridization (FISH) in confirming the diagnosis. The patient was a 21-year-old woman who presented with a recurrence of a previously resected supraglottic tumor of the aryepiglottic folds. A horizontal supraglottic laryngectomy was performed, and the 0.5-cm tumor was resected. Histopathologic study suggested that it was a biphasic malignant tumor compatible with a synovial sarcoma. The diagnosis of synovial sarcoma was confirmed by FISH immunohistochemistry with the use of an SYT break-apart probe. The patient recovered satisfactorily, but at follow-up 5 years and 4 months later, tumoral activity was evident in the left side of the neck. A biopsy found that 5 lymph nodes contained a metastasis of the synovial sarcoma. Again, a bilateral neck dissection was performed, and it revealed that 16 of 16 right-side nodes and 36 of 36 left-side nodes were negative. Two months later, the patient received 46 Gy of radiotherapy in 23 sessions. She remained free of disease during 2 more years of follow-up. Synovial sarcoma of the larynx is a rare entity. Organ preservation seems to be indicated in these cases. The histologic diagnosis may be difficult. In this case, the identification of a genetic mutation corroborated the diagnosis.
Laryngotracheal Rhinosporidiosis
Authors: Madana J. , Yolmo Deeke , Gopalakrishnan S. , Saxena Sunil K.
Published: January 2019

Rhinosporidiosis is a chronic granulomatous disease caused by Rhinosporidium seeberi. It usually affects mucous membranes of the nose, nasopharynx, and ocular conjunctiva. Cutaneous, laryngeal, tracheal, genital, and bony dissemination is rare. Laryngotracheal involvement poses many diagnostic and therapeutic challenges. A 45-year-old South Indian man presented with complaints of a mass in both nostrils for 2 years, associated with progressive hoarseness of voice and difficulty in breathing for 6 months. Rhinosporidial lesions were seen bilaterally in the nasal cavity. Telescopic and fiberoptic laryngoscopic examinations showed reddish, strawberry-like masses with whitish spots on their surface involving the larynx and trachea. Computed tomography of the head and neck revealed soft-tissue mass lesions involving the bilateral nasal cavities and nasopharynx, extending to the oropharynx and involving the larynx and trachea. A preliminary tracheostomy was performed, followed by direct laryngoscopic excision of the laryngeal lesions and rigid-bronchoscopy–guided excision of the tracheal lesions. The patient was prescribed dapsone and advised to take it for 2 years. At 2 years of follow-up, there was no recurrence.
Middle Ear Effusion in Adult ICU Patients: A Cohort Study
Authors: Kesser Bradley W. , Woodard Charles Ryan , Stowell Nicholas G. , Becker Samuel S.
Published: January 2019

We conducted a prospective study of 74 adults—34 men and 40 women, aged 18 to 90 (mean: 60.2)—to determine the prevalence of middle ear effusion (MEE) among patients in the setting of an intensive care unit (ICU) and to compare the findings with those of a control group of non-ICU hospitalized patients. Other goals were to identify risk factors associated with MEE in ICU patients and to evaluate any association with fever. Both groups included 37 patients. MEE was present in 19 patients (51.4%) in the ICU group, compared with only 2 patients (5.4%) in the control group ( p < 0.01; odds ratio: 18.5; 95% confidence interval: 3.9 to 88.3). In the ICU group, there were statistically significant associations between MEE and both the use of mechanical ventilation ( p = 0.03) and the use of sedation ( p = 0.02). No significant relationships were seen in terms of length of stay, body position, the use of an endotracheal tube, the length of ventilation, and the use of a feeding tube. Fever was present in 8 ICU patients (21.6%) and 3 controls (8.1%), but none of the fevers was associated with MEE. We conclude that adult ICU patients have a high prevalence of MEE (51.4% in our sample) that is perhaps unrecognized. We believe that MEE in these patients is most likely related to altered consciousness, sedation, and mechanical ventilation. MEE was an unlikely cause of fever.
Thiersch Skin Grafting in Otologic Surgery
Authors: Xu Helen , Pollak Natasha , Paparella Michael M.
Published: January 2019

Thiersch skin grafting is an old but highly effective surgical technique in otology. We frequently place a Thiersch graft after otologic procedures that either create a mastoid cavity or result in reduced skin coverage of a portion of the external auditory canal. The purpose of this article is to introduce this surgical technique to a new generation of otologists. We discuss its indications, the surgical technique, tips for a successful outcome, and postoperative care. A key to successful skin grafting is to perform the procedure about 10 days after the primary procedure to allow sufficient time for the formation of an adequate vascular bed at the recipient site. The goal in all cases is to achieve a safe, dry ear that is covered with keratinizing squamous epithelium. Thiersch grafting accomplishes this very well.
Transient Auditory Dysfunction: A Description and Study of Prevalence
Authors: Almond Laurence Maximilian , Patel Ketul , Rejali Darius
Published: January 2019

Transient auditory dysfunction (TAD) is a previously undescribed symptom complex of unknown cause. It is characterized by short-lasting sensorineural hearing loss (unilateral or bilateral), it is associated with tinnitus, it resolves completely within minutes, and it is not accompanied by vestibular symptoms. We conducted a cross-sectional prospective study to define TAD, find its prevalence, and discuss its significance. Two hundred healthy subjects between the ages of 16 and 49 years were surveyed using a questionnaire. Of these subjects, 41 (20.5%) reported experiencing symptoms of TAD. The mean number of episodes was 5.9 times per month, the mean duration was 41 seconds, and 80% experienced concomitant tinnitus. We conclude that TAD is a common finding in a healthy population. This may have implications for the pathogenesis of sudden-onset sensorineural hearing loss. Further longitudinal studies and detailed audiologic evaluation of patients with TAD are required to ascertain the significance, etiology, and pathophysiology of this condition.
The Impact of Pulmonary Tuberculosis Treatment on the Prevalence of Allergic Rhinitis
Authors: Sui Lin Carren Teh , Krishnan Gopala , Manuel Anura Michelle
Published: January 2019

Atopy is a syndrome characterized by immediate hypersensitivity reactions to common environmental antigens. The “hygiene hypothesis” stipulates that childhood infections are associated with a lower risk of allergies. Not much has been published about the effects that the treatment of pulmonary tuberculosis (TB) has on allergies, specifically allergic rhinitis. We conducted a study to investigate the prevalence of allergic rhinitis in patients with pulmonary TB before and after treatment of their TB. Our initial study group was made up of 121 patients with confirmed pulmonary TB who were followed up by questionnaire. In addition to demographic data, they provided information about their personal and family history of atopy and their current status with regard to allergic rhinitis. After providing informed consent, all patients underwent skin-prick testing with Dermatophagoides pteronyssinus, Dermatophagoides farinae, and Blomia tropicalis allergens before and after TB treatment. Stool samples were obtained to identify patients with worm infestation, and they were excluded from the study. In all, 94 patients completed treatment and follow-up, and their data were included in the final analysis. Of this group, 31 patients (33.0%) exhibited symptoms of allergic rhinitis prior to TB treatment, and 26 (27.7%) had a positive skin-prick test. Following treatment, only 12 patients (12.8%) reported allergic rhinitis symptoms (p = 0.004), but there was no significant reduction in the number of patients with a positive skin-prick test (n = 20 [21.3%]; p = 0.555). We conclude that the treatment of pulmonary TB results in significant relief of atopy, particularly allergic rhinitis symptoms.
Human Papillomavirus and Tobacco Use in Tongue Base Cancers
Authors: Stoler Daniel L. , Smaldino Philip J. , Darbary Huferesh K. , Sullivan Maureen A. , Popat Saurin R. , Hicks Wesley L. , Merzianu Mihai , Gaile Daniel P. , Anderson Garth R. , Loree Tom R.
Published: January 2019

Human papillomavirus 16 (HPV-16) infection and tobacco use are associated with human oropharyngeal cancers. We conducted a study of the role of HPV and tobacco use in base of the tongue (BOT) cancers. DNA from 34 such cancers was subjected to HPV-16 and HPV-18-specific polymerase chain reaction analysis. Demographic and clinicopathologic data were obtained from each patient's medical record. HPV-16 was detected in 68% of tumors. Tobacco use was the only factor found to be significantly associated with HPV status. Tumors from 100% of patients who had never use d tobacco tested positive for HPV, compared with only 56% of those who had ever used tobacco (Fisher exact test, p = 0.024). All tumors were associated with either tobacco use or HPV infection. These findings are consistent with the hypothesis that either tobacco use or HPV infection is necessary to the etiology of BOT tumors, and they suggest that tongue base carcinoma may be prevented by combining HPV vaccination with tobacco avoidance.
Comparison of Complication Rates Associated with Stapling and Traditional Suture Closure after Total Laryngectomy for Advanced Cancer
Authors: Miles Brett A. , Larrison Deborah , Myers Larry L.
Published: January 2019

We conducted a retrospective, matched-cohort, case-control study to compare complication rates associated with two wound closure procedures—stapling vs. traditional hand suturing—following total laryngectomy. Our study population was made up of 42 consecutively presenting patients—39 men and 4 women, aged 34 to 92 years (mean: 60.3) whose pharyngotomies were amenable to primary closure. Of this group, 37 patients had active endolaryngeal squamous cell carcinoma (SCC), 2 patients had inactive endolaryngeal SCC, 2 patients had thyroid cancer, and 1 patient had been treated for chronic aspiration. A total of 26 patients (61.9%) had undergone traditional suture closure of the neopharynx (suture group) and 16 patients (38.1%) had undergone closure with a linear stapling device (staple group). Other than the fact that the patients in the staple group were significantly older than those in the suture group (median: 71.0 vs. 56.5 yr, p = 0.002), there were no significant differences between the two groups in terms of comorbidities or cricopharyngeal myotomy, tracheoesophageal puncture, or neck dissection. There was a total of 8 postoperative infections—5 in the staple group (31.3%) and 3 in the suture group (11.5%)—not a statistically significant difference. Fistulas occurred in 4 staple patients (25.0%) and 6 suture patients (23.1%)— again, not statistically significant. We conclude that in appropriately selected patients, primary closure of the neopharynx can be safely and effectively achieved with a linear stapling device.
Mummified Leiomyoma of the Midline Anterior Neck: Case Report and Literature Review
Authors: Minor Jacob , Rizeq Mona , Wine Todd
Published: January 2019

Leiomyomas are benign smooth-muscle tumors that have only rarely been reported in the head and neck. Extensive calcification (mummification) is occasionally seen in deep somatic soft-tissue leiomyomas, which represent a rare subtype. We describe a case of mummified leiomyoma of the soft tissues of the midline anterior neck in a 31-year-old man. His tumor was successfully managed with surgical excision. To the best of our knowledge, this case represents the only description of a mummified leiomyoma at this particular site and the first reported case of any leiomyoma at this site in more than 50 years. We also review the literature concerning leiomyomas of the head and neck, their subtypes, diagnostic and management considerations, and outcomes.
Migration of a Fish Bone from the Upper Aerodigestive Tract to the Skin of the Neck: A Case Report
Authors: Sinha Ramanuj , Sen Indranil , Saha Jayanta , Mukherjee Ankur , Guha Ruma
Published: January 2019

We describe an unusual case of a migratory foreign body (fish bone) in the neck of a 45-year-old woman. The 2.1-cm bone migrated from the esophagus and traversed through the entire soft tissue of the neck, and it almost extruded through the skin of the neck. With the patient under local anesthesia, the foreign body was easily extracted through an incision over the skin.
Laterality of Sudden Sensorineural Hearing Loss
Authors: Reiss Michael , Reiss Gilfe
Published: January 2019

It is known that sudden sensorineural hearing loss and other otoneurologic diseases, such as tinnitus or Meniere disease, occur more frequently in the left ear than in the right. We studied lateralization of sudden deafness in 489 patients treated at Radebeul Hospital from January 2004 to December 2009. The male-to-female ratio was 1:1.24; we found a predominance of the left side only in female patients. The cause for this predominance is unclear. The slight asymmetry might indicate a greater vulnerability of the left inner ear in women, suggesting hormonal factors in the genesis of sudden deafness.
Vertigo in Elderly Patients: A Review of 164 Cases in Brazil
Authors: Albernaz Pedro Luiz Mangabeira
Published: January 2019

The author conducted a study to identify and categorize those vestibular disorders that were the most common among elderly patients at his private clinic over a 20-year period. He reviewed the records of 735 patients aged 65 to 90 years. The most common diagnosis was vertigo and/or disequilibrium, which occurred in 164 patients (22.3%). Of this group, 121 patients (73.8%) had a peripheral vestibular disorder and 43 (26.2%) had a central vestibular disorder. The characteristics of these cases are discussed.
Postoperative Management in Laryngeal Cancer with Subglottic Extension and Histologically Negative Nodes: Which Patients Need Adjuvant Radiotherapy?
Authors: Ampil Federico , Cherie-Ann O. Nathan , Lian Timothy , Baluna Roxana , Milligan Edward , Caldito Gloria
Published: January 2019

We conducted a study of 19 patients who had laryngeal cancer with subglottic extension (LCSE) and pathologically negative lymph nodes (pN0) following total laryngectomy and neck dissection (TEND). These patients had undergone surgery during a 17-year period from 1986 through 2002. Of this group, 9 did not receive postoperative radiotherapy (non-RT group) and 10 did (RT group). Adjuvant irradiation had been administered to those with additional histopathologic risk factors for recurrence. We found that recurrence rates in the neck were 44% in the non-RT group and 11% in the RT group (1 of 9 evaluable patients), and the corresponding 5-year disease-free survival rates were 51 and 89%. While both of these differences were clinically significant, neither was statistically significant (p = 0.29 and p = 0.14, respectively). The presence of LOSE was not known prior to or during TLND in 4 non-RT patients and in 7 RT patients; their corresponding neck recurrence rates were 50 and 0%. Two of 8 patients (25%) whose ipsilateral lobe of the thyroid gland was not removed experienced a stomal recurrence. We conclude that three factors can be used to identify patients with pN0 LCSE who may be candidates for adjuvant postoperative radiotherapy: (1) a failure to remove the ipsilateral thyroid gland lobe during TLND, (2) a failure to examine the level VI lymph node for metastatic disease status, and (3) unfavorable histopathologic findings.
Saccular Cyst as a Complication of Medialization Laryngoplasty: A Case Report
Authors: Benscoter Brent J. , Akst Lee M.
Published: January 2019

We report the case of a 54-year-old woman who presented for evaluation of deterioration in her voice and swallowing function, which had begun after she had undergone a medialization laryngoplasty for unilateral vocal fold paralysis. Findings on examination and imaging revealed that a mass had developed adjacent to the Silastic implant that had been placed during the laryngoplasty. The superior extent of the implant reached above the laryngeal ventricle. Endolaryngeal surgical resection of the mass was accomplished without the need to remove the implant. Pathologic analysis identified the mass as a laryngeal saccular cyst. Although laryngeal saccular cysts are uncommon, medialization laryngoplasties are not. This case represents a rare complication of medialization laryngoplasty in which an implant compressed the laryngeal saccule and led to formation of the cyst.
Transoral Robotic Surgery and Oropharyngeal Cancer: A Literature Review
Authors: O'Leary Pádraig , Kjærgaard Thomas
Published: January 2019

The incidence of head and neck squamous cell carcinoma has risen steadily over the past decade due to the increase in cancers associated with the human papillomavirus (HPV). The prognosis for the treatment of this type of cancer with radiotherapy and chemoradiotherapy is good. However, because these treatments can have detrimental effects on organ function and quality of life, researchers are looking into transoral robotic surgery (TORS) as a possible alternate therapy. TORS might have a positive effect on postoperative function and quality of life for cancer survivors. The aim of this review is to report on the current situation regarding the treatment of oropharyngeal cancer with TORS, with a focus on the long-term oncologic and functional outcomes of this strategy. The articles cited in this review were selected from the Pub Med and MEDLINE database. They contain study results pertaining to TORS implementation, complications, oncologic and functional outcomes, and the implications of HPV-associated cancer. We found that while TORS has some clear advantages and strengths and almost certainly a permanent place in future treatment, further research is necessary to correctly evaluate the role it will play in the complete management of oropharyngeal cancer.
Transnasal Endoscopic Resection of a Calcifying Cystic Odontogenic Tumor
Authors: Schuster Daniel , Cure Joel , Woodworth Bradford A.
Published: January 2019

Calcifying cystic odontogenic tumor (CCOT) is a rare histologic subtype of odontogenic tumor. Treatment requires complete enucleation. We report what we believe is the first case of CCOT to be removed via a transnasal endoscopic approach. A16-year-old boy was referred to our department by his dentist for evaluation of an expansile mass of the left maxillary sinus. The dentist had noted an area of hyperlucency of the left palate during a routine examination. Computed tomography confirmed the presence of a large tumor. Complete resection of the tumor was achieved via a transnasal endoscopic surgical approach. Resection of odontogenic tumors is necessary because of their tendency to expand and produce a mass effect on surrounding structures. We believe resection via an entirely transnasal endoscopic approach is a valuable and important technique in the treatment of odontogenic tumors that leaves the patient with a more cosmetically acceptable postoperative appearance.
Waldeyer Ring Lymphoma: A Case Series
Authors: Teh Carren S.L. , Jayalakshmi Pailoor , Chong Sheldon Y.C.
Published: January 2019

We encountered a patient with a tongue base lymphoma that we initially diagnosed as a lingual tonsil in view of its benign appearance. We established the correct diagnosis of Waldeyer ring lymphoma by histology. This case led us to conduct a study of all cases of Waldeyer ring lymphoma that had been treated at our center during a 10-year period. We retrospectively examined our case records and found 35 such cases. From this group, we excluded 5 cases because of incomplete data. Thus our final study group was made up of 30 patients—14 males and 16 females, aged 14 to 76 years (mean: 51.6; median 54). The primary presenting signs and symptoms were dysphagia (n =17 [57%]), a neck mass (n = 7 [23%]), nasal symptoms (n = 5 [17%]), and pain (n = 1 [3%]). Only 4 patients (13%) had B symptoms. A total of 20 patients (67%) presented with tonsillar involvement, 8 (27%) with nasopharyngeal involvement, 1 (3%) with tongue base lymphoma, and 1 with anterior tongue involvement. Most patients (77%) presented at an early stage. Histologically, 25 patients (83%) had high-grade diffuse large B-cell lymphoma, 4 (13%) had T-cell lymphoblastic lymphoma, and 1 (3%) had follicular lymphoma. Twenty-one patients (70%) were treated with chemotherapy, 4 (13%) received adjuvant chemotherapy with either radiotherapy or surgery, 3 (10%) resorted to other forms of treatment (primarily traditional remedies), and 2 (7%) declined treatment altogether. There were 14 patients (47%) alive at the end of the study period.
A Rare Case of Ameloblastic Carcinoma
Authors: Yunaev Michael , Abdul-Razak Muzib , Coleman Hedley , Mayorchak Yaroslav , Kalnins Ian
Published: January 2019

Ameloblastic carcinoma is a rare type of ameloblastoma that has received little mention in the literature. While a number of cases have been published over many years, no institution has been able to produce a substantial case series. Ameloblastic carcinoma originates in the embryonic tooth components. It is believed to be an aggressive tumor that can metastasize; once metastasis occurs, the prognosis tends to be poor. Ameloblastic carcinoma is primarily a surgical condition that is best treated with resection; there has been little indication that other modalities are helpful. We present the case of a 40-year-old woman who was found to have a mandibular lesion by a dentist. After surgical resection, the tumor was found to be an ameloblastic carcinoma. The patient recovered without complication, and she was recurrence-free 18 months postoperatively. We also briefly review the available literature on the natural history of and management options for this rare tumor.
Superior Omohyoid Muscle Flap Repair of Cervical Esophageal Perforation Induced by Spinal Hardware
Authors: Surek Christopher Chase , Girod Douglas A.
Published: January 2019

Cervical esophageal perforation is a rare and life-threatening condition. Its prompt diagnosis and treatment require a high index of suspicion. Cervical spine hardware is an uncommon cause of posterior esophageal perforation. Management has included a variety of musculofascial flaps for surgical repair. We present 2 cases of cervical esophageal perforation induced by spinal hardware that were repaired with a superior omohyoid muscle (SOM) flap for closure and/or primary closure reinforcement. Advantages and techniques of the SOM flap are discussed.
Reconstructive and Rehabilitation Challenges following a Cranio-Orbital Gunshot Wound
Authors: Pawar Sachin S. , Rhee John S. , Wells Timothy S.
Published: January 2019

We present a case of a 26-year-old man who sustained a close-range gunshot wound to the head. His injuries included significant left orbital injury resulting in a ruptured, blind eye and severely comminuted fractures of the left orbital roof, superior and inferior orbital rims, and orbital floor. Associated injuries included left frontal lobe injury, anterior and posterior table fractures of the left frontal sinus, and a comminuted left zygomaticomaxillary complex fracture. We employed an interdisciplinary surgical approach with collaboration among the Otolaryngology, Neurosurgery, and Oculoplastic Surgery services performed in two stages. Management of such extensive craniofacial injuries can be challenging and requires a coordinated, interdisciplinary approach.
Metastatic Breast Carcinoma Presenting as Unilateral Pulsatile Tinnitus: A Case Report
Authors: Moore Andrew , Cunnane Max , Fleming Jason C.
Published: January 2019

Pulsatile tinnitus is a rare symptom, yet it may herald life-threatening pathology in the absence of other symptoms or signs. Pulsatile tinnitus tends to imply a vascular cause, but metastatic disease also can present in this way. Clinicians should therefore adopt a specific diagnostic algorithm for pulsatile tinnitus and always consider the possibility of metastatic disease. A history of malignant disease and new cranial nerve palsies should raise clinical suspicion for skull base metastases. We describe the case of a 63-year-old woman presenting with unilateral subjective pulsatile tinnitus and a middle ear mass visible on otoscopy. Her background included the diagnosis of idiopathic unilateral vagal and hypoglossal nerve palsies 4 years previously, with normal magnetic resonance imaging (MRI). Repeat MRI and computed tomography imaging were consistent with metastatic breast carcinoma. This case raises important questions about imaging protocols and the role of serial scanning in patients at high risk of metastatic disease.
Effects of Nasal Saline Lavage on Pediatric Sinusitis Symptoms and Disease-Specific Quality of Life: A Case Series of 10 Patients
Authors: Lin Sandra Y. , Baugher Katherine M. , Brown David J. , Ishman Stacey L.
Published: January 2019

We conducted a prospective study to assess (1) the effects of daily nasal irrigation in children with chronic sinonasal symptoms and (2) the impact that treatment had on disease-specific quality of life as assessed by a validated instrument, the five-item Sinus and Nasal Quality of Life Survey (SN-5), and by an overall nasal quality-of-life (NQL) score based on a 10-point faces scale. Our patient population was made up of 10 children—7 girls and 3 boys, aged 3 to 9 years (mean: 6.1)—who had presented with symptoms of chronic rhinosinusitis for more than 3 months and who had not responded to previous medical management. Patients were administered nasal saline lavage daily for 1 month. These patients and/or their caregivers completed an SN-5 questionnaire upon entry into the study and at the completion of treatment. At study's end, a comparison of pre- and post-treatment scores with paired Student t tests showed that the mean total SN-5 score improved significantly over baseline, falling 45% from 21.4 to 11.7 (p = 0.0002). Moreover, significant overall improvement was seen in each of the five subcategories of the SN-5 survey (p = 0.0009 to 0.038). The NQL scores also improved significantly from 4.7 to 7.7 (p = 0.0034). Compliance with nasal lavage was generally good among the 10 patients, as 8 of them used at least 75% of the recommended quantity of saline at least once a day. During a follow-up period that ranged from 2 to 23 months (mean: 10.4), only 1 patient required an adenoidectomy for symptom control. The results of this pilot study suggest that nasal saline lavage may significantly alleviate chronic sinonasal symptoms and improve disease-specific quality of life in children with symptoms of chronic rhinosinusitis.
Septic Arthritis: A Unique Complication of Nasal Septal Abscess
Authors: Olsen Steven M. , Koch Cody A. , Ekbom Dale C.
Published: January 2019

Nasal septal abscesses (NSAs) occur between the mucoperichondrium and the nasal septum. They most often arise when an untreated septal hematoma becomes infected. The most commonly reported sequela is a loss of septal cartilage support, which can result in a nasal deformity. Other sequelae include potentially life-threatening conditions such as meningitis, cavernous sinus thrombosis, brain abscess, and subarachnoid empyema. We report the case of a 17-year-old boy who developed an NSA after he had been struck in the face with a basketball. He presented to his primary care physician 5 days after the injury and again the next day, but his condition was not correctly diagnosed. Finally, 7 days after his injury, he presented to an emergency department with more serious symptoms, and he was correctly diagnosed with NSA. He was admitted to the intensive care unit, and he remained hospitalized for 6 days. Among the abscess sequelae he experienced was septic arthritis, which has heretofore not been reported as a complication of NSA. He responded well to appropriate treatment, although he lost a considerable amount of septal cartilage. He was discharged home on intravenous antibiotic therapy, and his condition improved. Reconstruction of the nasal septum will likely need to be pursued in the future.
Duplication of the Right Internal Jugular Vein: A Case Report
Authors: Bathala Srinivasalu , Makura Zvoru G.
Published: January 2019

We present a case of duplication of the right internal jugular vein (IJV) in a patient who underwent neck dissection as part of the management of carcinoma of the larynx. The patient was a 63-year-old man who presented to the otolaryngology department with a 7-month history of hoarseness and a 3-week history of noisy breathing. Flexible endoscopy detected a transglottic tumor that had extended beyond the vocal folds. The patient underwent a total laryngectomy and bilateral selective neck dissection at levels II–VI. Intraoperatively, the right IJV was noted to be duplicated. The duplicate segment was approximately 10 cm in length, and it rejoined the normal vein before the normal vein joined the subclavian vein.
Juvenile Nasopharyngeal Angiofibroma Staging: An Overview
Authors: Alshaikh Nada Ali , Eleftheriadou Anna
Published: January 2019

Staging of tumors is very important in treatment and surgical decision making, as well as in predicting disease recurrence and prognosis. This review focuses on the different available classifications of juvenile nasopharyngeal angiofibroma (JNA) and their impact on the evaluation, management, and prognosis of JNA. The literature was reviewed, and publications on JNA staging were examined. Our MEDLINE search of the entire English-language literature found no review article on the current available staging systems for JNA. In this article, we review the common JNA classification systems that have been published, and we discuss some of their advantages and disadvantages. The most commonly used staging systems for JNA are the Radkowski and the Andrews-Fisch staging systems. However, some newer staging systems that are based on advances in technology and surgical approaches— the Onerci, INCan, and UPMC systems—have shown promising utility, and they will probably gain popularity in the future.
Nonossifying Fibroma (Metaphyseal Fibrous Defect) of the Mandible in a 15-Year-Old Boy
Authors: Mannan Abul Ala Syed Rifat , Singh N. Gopendro , Al-Waheeb Salah , Taher Taher N.M. , Mohammed Emad El Din A.M.
Published: January 2019

We describe a rare case of nonossifying fibroma of the mandible in a 15-year-old boy who presented with a left mandibular swelling. Conventional imaging showed an expansile radiolucent lesion involving the angle and the body of the left mandible. The lesion was curetted, and a miniplate was implanted at the excision site. Microscopic examination of the removed specimen revealed a cellular lesion characterized by a proliferation of uniform spindle-shaped cells in a vague but prominent storiform pattern, which represented the classic appearance of nonossifying fibroma. Three months later, radiography detected a fracture of the implantation plate. The area was re-explored with curettage of the soft tissue, which on microscopy demonstrated findings similar to the initial curettage findings. Follow-up radiology revealed satisfactory healing of the jaw, and no further recurrence was seen 2 years after the initial surgery. We present this case to highlight the importance of recognizing nonossifying fibroma in the mandible, which can be easily confused with more common mandibular lesions.
Post-Thyroidectomy Hypocalcemia: Impact on Length of Stay
Authors: Grainger Joe , Ahmed Mohammed , Gama Rousseau , Liew Leonard , Buch Harit , Cullen Ronald J.
Published: January 2019

Hypocalcemia is a recognized complication following thyroid surgery. Variability in the definition of hypocalcemia and different opinions on its management can lead to unnecessary patient morbidity and longer hospital stays as a result of inappropriate or untimely treatment. Therefore, we developed a management guideline for the recognition and treatment of post-thyroidectomy hypocalcemia, and we conducted a retrospective study to assess its impact on length of stay (LOS). Between April 1, 2007, and March 31, 2009, 29 adults had undergone a total or completion thyroidectomy at our large district general hospital. Of this group, postoperative hypocalcemia (defined as a serum calcium level of <2.00 mmol/L) developed in 13 patients (44.8%) during the first 3 postoperative days. Our guideline went into effect on July 1, 2009, and from that date through June 30, 2010, 18 more adults had undergone a total or completion thyroidectomy. Of that group, hypocalcemia developed in 7 patients (38.9%); the guideline was actually followed in 5 of these 7 cases (71.4%). In the preguideline group, the development of hypocalcemia increased the mean LOS from 2.0 days to 7.0 days (p < 0.001). The management of postoperative hypocalcemia in these cases was highly variable and was dictated by variations in practice rather than patient needs. In the postguideline group, postoperative hypocalcemia increased the mean LOS from 2.7 days to only 3.7 days (p = 0.07). While the difference between LOS in the two hypocalcemic groups did not reach statistical significance, we believe it merely reflects the relatively small number of patients rather than any lack of guideline efficacy. The implementation of a simple flowchart guideline for the management of postoperative hypocalcemia in our hospital has resulted in more uniform management and a reduced LOS.
Chronic Invasive Fungal Sinusitis Causing a Pathologic Le Fort I Fracture in an Immunocompetent Patient
Authors: Richter Amy L. , Gallagher K. Kelly
Published: January 2019

We describe the case of a 77-year-old immunocompetent woman with a history of chronic rhinosinusitis who presented with a pathologic Le Fort I fracture after a forceful sneeze. Imaging revealed diffuse sinus opacification and a Le Fort type I complex fracture involving the maxilla, pterygoid plates, clivus, and right nasal bridge. The patient underwent endoscopic debridement of her sinuses, which revealed mucosal dehiscence and otherwise normal healthy bleeding tissue. Anatomic pathology identified necrotic bone with invasive fungal hyphae. Cultures demonstrated Burkholderia cepacia, diphtheroid organisms, and Enterococcus and Serratia spp. The patient was administered an intravenous antibiotic and antifungal for several months, but interval imaging found no significant improvement in bone healing although the stability of her palate had improved on clinical examination. Chronic rhinosinusitis has been found to be a complication of soft-tissue, orbital, and intracranial infections but, to the best of our knowledge, a pathologic facial fracture secondary to chronic invasive fungal and bacterial rhinosinusitis has not been previously reported in the literature.
Primary Salivary Duct Carcinoma Arising from the Stensen Duct
Authors: Noda Kenji , Hirano Takashi , Okamoto Tomoyo , Suzuki Masashi
Published: January 2019

This report describes a salivary duct carcinoma (SDC) arising from the extraglandular portion of the Stensen duct. The patient was a 56-year-old man who presented with a palpable, elastic, hard mass without tenderness in the right cheek. Computed tomography revealed a tumor of the extraglandular portion of the Stensen duct. Supraomohyoid right neck dissection and total right parotidectomy were performed, and the histologic diagnosis was SDC of the Stensen duct. Postoperatively, the patient received no additional treatment. Neither recurrence nor metastasis was observed during 4 years of follow-up examination. SDC of the Stensen duct is extremely rare. To our knowledge, there is no report that describes primary SDC arising from that location. We also believe this is the first report that describes the clinical course of primary SDC arising from a Stensen duct.
Speech Perception and Auditory Performance following Cochlear Implantation in Elderly Koreans
Authors: Lee Sungsu , Park Hyong-Joo , Cho Hyong-Ho , Cho Yong-Beom
Published: January 2019

The benefits of cochlear implantation (CI) in the elderly remain debatable in terms of sound and speech perception. Moreover, the results of CI may be affected by the intensity and pitch of spoken language. We conducted a retrospective study to evaluate surgical and hospitalization times, postoperative complications, and hearing outcomes after CI in elderly Koreans. Our study population was made up of 55 postlingually deafened adults who underwent unilateral CI. They were divided into two groups based on age; an older group consisted of 21 patients aged 65 years or older (mean 71.8) at the time of CI, and a comparison group was made up of 34 patients aged 18 to 64 years (mean: 47.5). The mean surgical and hospitalization times and the mean number of postoperative complications in the two groups were comparable. Auditory outcomes were quantified by the speech reception threshold (SRT), the speech discrimination test (SDT), scores on the Korean version of the Glendonald Auditory Screening Procedure (GASP-K), and categories of auditory performance (CAP) scores. The SDT and GASP-K values were significantly lower in the older group at 3 months, 1 year, and 2 years; there were no significant differences in mean SRT and CAP values. We conclude that elderly patients may obtain appreciable benefits from CI without experiencing serious surgical complications. Nevertheless, difficulties in speech perception should be taken into consideration in older patients.
Evaluating the Quality and Readability of Internet Information Sources regarding the Treatment of Swallowing Disorders
Authors: Ferster Ashley P. O'Connell , Hu Amanda
Published: January 2019

The Internet has become a popular resource for patient education. The information it provides, however, is rarely peer-reviewed, and its quality may be a concern. Since the average American reads at an 8th grade level, the American Medical Association and the National Institutes of Health have recommended that health information be written at a 4th to 6th grade level. We performed a study to assess the quality and readability of online information regarding the treatment of swallowing disorders. A Google search for “swallowing treatment” was conducted. We studied the first 50 websites that appeared on the search engines results with the use of the DISCERN quality index tool, the Flesch Ease of Reading Score (FRES), and the Flesch-Kincaid Grade Level (FKGL) readability test. DISCERN is a validated 16-item questionnaire used to assess the quality of written health information; FRES and FKGL are used to assess readability. We classified the websites as either patient-targeted or professional-targeted sites, as well as either major or minor. The overall DISCERN score was 1.61 ± 0.61 (range: 1 to 5), the overall FRES was 39.1 ± 19.0 (range: 1 to 100), and the overall FKGL was 11.8 ± 3.4 (range: 3 to 12). As would be expected, patient-targeted websites had significantly higher FRES and significantly lower FKGL scores than did the professional-targeted websites (p = 0.01 and p = 0.04, respectively); there was no significant difference between the two in DISCERN scores. The major websites had significantly higher DISCERN scores than did the minor sites (p = 0.002); there were no significant differences in FRES and FKGL scores. We conclude that online information sources regarding the treatment of swallowing disorders were of sub optimal quality in that information was written at a level too difficult for the average American to easily understand. Also, the patient-targeted websites were written at a lower reading level, and the major websites contained a higher quality of information.
Laryngoceles: Concepts of Diagnosis and Management
Authors: Mobashir Mohammad Kamal , Basha Waleed M. , Mohamed Abd ElRaof Said , Hassaan Mostafa , Anany Ahmed M.
Published: January 2019

A laryngocele is an abnormal dilatation of the laryngeal saccule. It is a rare benign lesion of the larynx. Various modalities of treatment have been advocated for its management. We present our treatment results and outcomes of a series of cases of laryngoceles and discuss the concepts of their management. This study included patients with different laryngocele types. Patients with an internal laryngocele underwent endoscopic CO2 laser resection, while those with a combined laryngocele underwent resection via a V-shaped lateral thyrotomy approach. Seven patients had an internal laryngocele, and 4 patients had a combined laryngocele. Hoarseness and neck swelling were the most common symptoms. The mean follow-up period was 8.5 months. None of the patients needed a tracheostomy either preoperatively or postoperatively, or had recurrence of laryngocele. We advocate the lateral thyrotomy approach for combined laryngoceles as it provides safe, precise, and complete resection under direct visualization via a single approach, while we favor the endoscopic laser approach for the internal ones as it allows resection of the entire lesion with minimal laryngeal trauma, less operative time, and a shorter hospital stay.
Metastatic Chordoma of the Tongue: Case Report
Authors: Bişkin Sultan , Erdemir Rabiye Uslu , Eliçora Sultan Şevik , Aydinli Sevim , Özdamar Şükrü Oğuz
Published: January 2019

Chordomas are rare bone tumors that arise from notochord remnants. They most commonly occur in the sacrum, but they also can be seen in the skull base, cervical spine, and thoracolumbar vertebrae. Chordomas account for 1 to 4% of all primary skeletal tumors. They are usually indolent, locally growing tumors. Distant metastasis has been reported in 3 to 48% of cases. When metastasis occurs, it is usually observed in the lung, bone, and liver. To the best of our knowledge, no case of a chordoma metastasis to the tongue has been previously reported in the literature. We report such a case in a 61-year-old man.
Outsiders on the Inside: Italian Jewish Ghettos and Cholera in the 1830s
Authors: Martin Myrna Gene
Published: January 2019

This article analyses the initial encounter with epidemic cholera in the Italian cities of Florence, Ferrara and Modena. The large body of scholarship that explores themes related to medical theory, urban infrastructure, and political and social change across the nineteenth century demonstrates the importance of the historical evaluation of cholera epidemics. There is, however, minimal scholarship exploring the relationship between dominant social structures and minority groups. This article illuminates previously unexplored connections between Jews and Christians in relation to urban disease management efforts. Scapegoating Jewish population groups during times of crisis has a long tradition in Europe. A traditional ‘outsider’ subjected to highly institutionalized segregation, the Jews of Italy were readily identifiable. As such, societal anxiety surrounding the horrors of cholera could have easily found release in violence against the Jews. Yet this did not happen during the 1830s. This article seeks to determine why this was the case. Bureaucratic records contained in the municipal archives of these cities shed light on the dynamics of both urban disease management in the early nineteenth century and the interactions between Jews and Christians during this relatively understudied period of Italian history. Analysing the traditional understanding of both disease origin and transmission, in conjunction with the realities of the urban environment, this article concludes that both of these factors mitigated the potential for scapegoating Italian Jews. Jews had been resident ‘outsiders’ in these cities for centuries. However, the quotidian realities of urban life created strong administrative connections between the Jews and the Christian authorities that ultimately overruled the confessional divisions expressed in the walls and gates of the ghettos.
Assessing sizes of breast cancers that show non-mass enhancement on MRI based on inter-observer variability and comparison with pathology size
Authors: Koh Jieun , Park Ah Young , Ko Kyung Hee , Kim Sewha , Jung Hae Kyoung
Published: January 2019

Background

Magnetic resonance imaging (MRI) is largely used for preoperative evaluation of breast cancer.

Purpose

The aim of this study is to evaluate inter-observer variability for measuring the sizes of non-mass enhancement (NME) breast cancers on various sequences of MRI and to compare with pathology size.

Material and Methods

From January 2013 to April 2017, 70 breast cancers in 70 women showed NME on preoperative MRI. Three observers retrospectively measured the cancers with the longest diameters on subtracted early dynamic contrast-enhanced (DCE) T1 (early T1), delayed DCE T1 (delayed T1), and maximum intensity projection (MIP) images; the measurements between observers were analyzed using the intraclass correlation coefficient (ICC). Pathology sizes were compared using ICCs and Bland–Altman plots, and concordance rates were calculated with MRI and pathology size differences of ≤0.5 cm.

Results

The ICC for the three observers’ breast cancer size measurements was excellent (0.945) and that between MRI and pathology size was good to excellent in all observers (0.742–0.850). Compared with pathology size, the Bland–Altman plots revealed a positive trend of differences in all MRI measurements. Three observers overestimated nearly half of the measured breast cancers on all three MRI sequences; the overestimation rates were the highest on MIP for observers 1 and 3 (68.6% and 55.7%) and on delayed T1 for observer 2 (57.1%).

Conclusion

The size assessments of NME breast cancer on MRI showed high correlation between observers and with pathology size. However, MRI measurements need a cautious approach because of their high overestimation rates. Measurements from early T1 images showed the highest concordance rate with pathology size.
Truck Body-Type Classification using Single-Beam Lidar Sensors
Authors: Asborno Magdalena I. , Burris Collin G. , Hernandez Sarah
Published: January 2019

Understanding commodity flow through a region is key for estimating the demand for freight transportation facilities and services, forecasting energy consumption, analyzing safety risks, and addressing environmental concerns. Transportation planners and decision makers use commodity flow data to develop and implement long-term freight plans and manage infrastructure. State-of-the-practice commodity flow estimations based on regional socioeconomic data and periodic surveys have limited spatial and temporal coverage. Moreover, no existing methods tie vehicles to commodity movements at the link level. Although intrusive inductive loop detectors can identify the industry served (or commodity carried) by trucks based on the truck’s body type, intrusive sensor performance is limited by pavement quality. Unfortunately, poor pavement conditions are common in locations with high truck volumes. This paper investigates the use of a non-intrusive traffic sensor, Lidar, for high-resolution truck body-type classification. This paper develops a proof-of-concept Lidar sensor and a truck body-type classification model capable of classifying five-axle tractor-trailers into distinct body types: van and container, platform, low-profile trailer, tank, and hopper and end dump. These body-class groups link to commodity movements and provide insight into link-level commodity flows. Data for model development and validation were collected along a major interstate corridor and a low-speed local road. The classification model achieves an 81% true positive rate (TPR) with class-specific TPR as high as 94% and average volume accuracy of 87% for the primary test location. Overall, the proposed sensor represents an adequate proof of concept to evaluate the industry served by trucks on a network link.