bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical Experiences with Acute Mastoiditis–1988 through 1998
Authors: Lee Eun-Soo , Chae Seong-Won , Lim Hyun-Ho , Hwang Soon-Jae , Suh Han-Kyu
Published: May 2019

The incidence of acute mastoiditis has declined dramatically during the postantibiotic era. Even so, antibiotic-resistant or unusual pathogens can still cause this disease entity. At our hospital, we documented an increase in antibiotic-resistant and atypical pathogens such as Actinomyces spp. and Mycobacterium tuberculosis. In this paper, we discuss the optimal diagnosis and treatment strategy for acute mastoiditis, and we describe our retrospective review of 13 patients with mastoiditis who were treated at our hospital from 1988 through 1998. Eight of these patients recovered following treatment with intravenous antibiotics, with or without myringotomy, and five who had complications of disease were managed surgically. Among these five, one developed chronic otitis media and one developed cholesteatoma 3 years later. For patients with acute mastoiditis, we emphasize the need to be aware of any unusual pathogens that do not respond to empiric antibiotic therapy.
Hydroxyapatite Cranioplasty in Fibrous Dysplasia of the Skull
Authors: Vories Andrew , Mansfield Eric
Published: May 2019

We describe the case of a woman who had complained of worsening headache during the previous year. Analysis of computed tomography imaging and biopsy led to a diagnosis of fibrous dysplasia of the skull. A symptomatic frontal bone lesion was removed, and the resulting defect was repaired with hydroxyapatite cement. Hydroxyapatite cement has several advantages over hydroxyapatite ceramic blocks and granules, and it is particularly well suited for calvarial reconstruction.
Bilateral Submandibular Gland Infection Presenting as Ludwig's Angina: First Report of a Case
Authors: Honrado Carlo P. , Lam Samuel M. , Karen Matthew
Published: May 2019

We diagnosed and treated a case of Ludwig's angina in a 45-year-old man who had edema of the floor of mouth and the tongue along with bilateral submandibular sialadenitis and sialolithiasis. We secured the patient's airway via nasal fiberoptic intubation in the surgical intensive care unit and administered intravenous antibiotics. The edema subsided, and the patient was extubated on the third postoperative day and discharged shortly thereafter. To our knowledge, this is the first reported case of a patient with bilateral submandibular sialadenitis and sialolithiasis presenting as Ludwig's angina. Despite the decreasing incidence of this disease, Ludwig's angina remains an important disease process because a failure to control the airway can have disastrous consequences. Proper diagnosis, airway control, antibiotic therapy, and occasionally surgical management are essential to ensure the safety of the patient.
Cortical Representation of the Vestibular System as Evidenced by Brain Electrical Activity Mapping of Vestibular Late Evoked Potentials
Authors: Schneider Dieter , Schneider Lucia , Claussen Claus-Frenz , Kolchev Christo
Published: May 2019

We examined the space and temporal distributions of the rotatory evoked brain electrical activity patterns (brain electrical activity mapping of vestibular evoked potentials [VestEP]) in humans. We performed a longitudinal scalp line analysis, transversal line analysis, and clockwise/counterclockwise rotation analysis of the VestEP principal components in 75 healthy persons aged 22 to 30 years (mean: 25.8). We found that the shortest VestEP latencies and the highest amplitudes were registered in a relatively distinct cortical area that is covered by the transversal electrode line T3-C3-Cz-C4-T4, in accordance with the 10/20 international electrode scheme. This area corresponds to the posterior part of the frontal lobe (Brodmann's area 4, the primary motor field of the isocortex) and the anterior parts of the cerebral parietal lobe (the gyrus postcentralis, which corresponds to the primary somatosensory fields, Brodmann's areas 1, 2, and 3). In this article, we discuss a method of investigation that exhibits the VestEPs, and we review one normal case and three typical cases of pathologic VestEPs.
Vestibular and Hearing Manifestations of Phenytoin Toxicity: A Retrospective Series
Authors: De Diego Juan I. , Prim Maria P. , Marcos Sol , De Sarria Maria J. , Arpa Javier , Gavilan Javier
Published: May 2019

We undertook a study to identify the vestibular and hearing abnormalities associated with phenytoin toxicity. Since October 1977, 23 patients with phenytoin toxicity have been referred to the Department of Otorhinolaryngology by the Department of Neurology for electro-oculographic (EOG) evaluation. (There have been no cases of serious phenytoin toxicity seen in our department since August 1989.) In addition to EOG, all patients had undergone otoscopic, audiometric, and neurologic examinations. We found that the most common pathologic findings detected by EOG were abnormalities in pursuit tracking. The most common signs found on clinical exploration were cerebellar dysfunction and facial palsy. EOG findings in patients with phenytoin toxicity are compatible with cerebellar disease.
Granular Cell Tumor of the Parotid: A Case Report and Literature Review
Authors: Smith Joseph L. , Feehery John M. , O'Hara Brian J. , Rao Vijay M. , Vernose Gerard V.
Published: May 2019

Granular cell tumors are relatively uncommon soft tissue lesions that originate in Schwann's cells. Although these tumors can occur at any site, their presence in the parotid gland is very unusual. This article describes one such case in a 48-year-old woman, followed by a brief review of the literature on this subject.
Chondrosarcoma of the Larynx: A Therapeutic Challenge
Authors: Shinhar Shai , Zik Daniel , Issakov Jelena , Rappaport Yoram
Published: May 2019

The diagnosis of laryngeal chondrosarcoma is likely to be missed because of its infrequent occurrence and its indolent pattern of growth. A 53-year-old woman came to our service with an 18-year history of hoarseness and increasing dyspnea. She had been previously documented as having left vocal fold paralysis and a bulging laryngeal mass. Computed tomography revealed the presence of a large calcified tumor that had caused a deformity of the larynx and an erosion of the arytenoid and cricoid cartilages. Direct laryngoscopy detected a large supraglottic mass with a normal-appearing mucosa. Total excision of the tumor was achieved through a lateral neck incision that spared the larynx. This case emphasizes the importance of a high index of suspicion for laryngeal chondrosarcoma in a patient who has unexplained vocal fold paralysis and a submucosal subglottic mass. Every effort should be made to take a conservative surgical approach that preserves laryngeal function when possible.
Autoimmune Inner Ear Disease: Steroid and Cytotoxic Drug Therapy
Authors: Lasak John M. , Sataloff Robert T. , Hawkshaw Mary , Carey Thomas E. , Lyons Karen M. , Spiegel Joseph R.
Published: May 2019

The goal of this study was to assess the effects of immunosuppressive therapy on hearing inpatients with presumed autoimmune sensorineural hearing loss (AISNHL) and a Western blot assay positive for a 68 kD inner ear antigen. To achieve this objective, we conducted a retrospective review of 39 such patients who were treated with either a steroid alone or with a steroid followed by a cytotoxic agent. Pure-tone average (PTA) at 500 Hz, 1 kHz, 2 kHz, and 3 kHz and speech discrimination scores (SDS) were used as objective measures of outcome. At the completion of treatment, 23 of the 39 patients (59.0%) exhibited a positive response to therapy. The steroid-only responders (n = 6) tended to demonstrate a greater improvement in PTA (14.8 vs 4.5 dB), while the cytotoxic-agent responders (n = 17) had a significantly greater improvement in SDS (26.2 vs 6.9%; p< 0.01). We conclude that most patients with AISNHL benefit from immunosuppressive therapy and that cytotoxic medications appear to improve SDS, even in some patients who have not responded to corticosteroid therapy.
A Case of Laryngeal Carcinoma Appearing as a Goiter
Authors: Donangelo Ines , Coelho Sabrina Mendes , Buescu Alexandru , Vaisman Mario
Published: May 2019

We describe the case of a 41-year-old man with hoarseness and a hard, fixed mass in the anterior cervical region. He was referred to our endocrinology service for evaluation of possible thyroid cancer. The results of laboratory tests of thyroid function were normal. Indirect laryngoscopy revealed paralysis of the left hemilarynx and the presence of a large vegetating lesion. Computed tomography of the neck disclosed the presence of a mass in the anterior region, along with invasion and destruction of the adjacent structures. The cytologic diagnosis was established by analysis of a fine-needle aspiration biopsy specimen, which revealed a squamous cell carcinoma. The final diagnosis was carcinoma of the larynx.
An Unusual Case of Actinomycosis
Authors: Baliga Shrikala , Shenoy Shalini , Wilson Godwin , Katara Vidyalakshmi
Published: May 2019

We describe an unusual case of actinomycosis that appeared as a nasal mass. The diagnosis was established when Actinomyces viscosus was isolated from pus obtained from the right maxillary antrum by intranasal antrostomy. The patient was treated with intravenous crystalline penicillin and made an uneventful recovery within 10 days.
Hepatocellular Cancer Metastatic to the Zygoma: Primary Resection and Immediate Reconstruction
Authors: Neff Brian A. , Pribitkin Edmund A. , Willcox Thomas O.
Published: May 2019

Hepatocellular carcinoma is common worldwide but relatively rare in the United States, where only 13,000 new cases are diagnosed each year. Metastasis to osseous structures in the head and neck are extremely rare; when they do occur, most appear as oral cavity masses secondary to mandibular and maxillary involvement. We report the case of an isolated zygomatic metastasis in a patient who had been previously treated for hepatocellular carcinoma with orthotopic liver transplantation. The patient underwent a complete excision of the mass followed by immediate reconstruction of the zygomaxillary buttress and the orbital rim and floor. To our knowledge, only one other case similar to ours has been previously reported; in that instance, the metastatic tumor was not resectable.
Aortobronchial Fistula: A Rare Etiology for Hemoptysis
Authors: Oppenheimer Randy , Brotherton Lawrence
Published: May 2019

Aortobronchial fistula is an extremely rare cause of hemoptysis. Aortobronchial fistula occurs in patients who have a history of thoracic vascular surgery. Because its symptoms are nonspecific, a high index of suspicion is critical if the physician is to detect it. The results of imaging studies (e.g., plain films, computed tomography, and angiography) and bronchoscopy are sometimes, but not always, diagnostic—another reason the diagnosis is difficult. Left untreated, mortality in patients with aortobronchial fistula is 100%. Patients can be salvaged by a variety of techniques, including the placement of an endovascular stent. We describe the case of a 52-year-old man who came to us with hoarseness and hemoptysis, which proved to be underlying symptoms of aortobronchial fistula. He was treated successfully.
Magnetic Resonance Imaging in the Diagnosis of Subglottic Cysts of Infancy: Case Report and Review
Authors: Mobley Steven Ross , Pacheco Esperanza , Josephson Gary D.
Published: May 2019

Subglottic cysts can cause stridor and respiratory distress in the infant. The diagnosis of subglottic cysts is often confirmed during direct laryngoscopy and bronchoscopy. We describe the case of a 6-month-old boy with bilateral subglottic cysts that were preoperatively diagnosed by magnetic resonance imaging (MRI). We also review the current literature on the diagnosis and treatment of subglottic cysts. Up until now, 63 cases of subglottic cysts were reported in the literature since 1966, and most were diagnosed by direct endoscopy. In this article, we describe a new case and we provide the first published report of the novel use of MRI in diagnosing this lesion.
G-induced Vestibular Dysfunction (‘the wobblies’) among Aerobatic Pilots: A Case Report and Review
Authors: Muller Thomas Upson
Published: May 2019

G-induced vestibular dysfunction (GIVD) is a condition well known to aircraft pilots who experience high positive and negative G loads during unlimited-aerobatic competitions and air-show demonstrations. After landing and walking from their aircraft, pilots with GIVD manifest an extremely unstable gait, which they call the wobblies. This article includes a report of one such case of GIVD, which to the author's knowledge is the first published case report of this condition in the medical literature. The author also discusses what is known and theorized about the pathogenesis of GIVD, and he reviews its diagnosis, treatment, and prevention.
Cellular Schwannoma of the Paranasal Sinuses: Initial Report of a Case
Authors: Al-Otieschan Abdullah T. , Manohar Manirajulu Babu , Gangopadhyay Kunal , Tulbah Asma
Published: May 2019

Cellular schwannomas are a benign variant of classic schwannomas. Their histologic appearance closely mimics that of malignant peripheral nerve-sheath tumors, which are high-grade sarcomas. In this article, we describe what to our knowledge is the first reported case of a cellular schwannoma of the paranasal sinuses and only the 33rd reported case of any schwannoma at this site. We also discuss the histology and management of cellular schwannomas and review the pertinent literature.
A Method for off-line Nasal Nitric Oxide Measurement
Authors: Gungor Anil , Vural Cetin
Published: May 2019

We conducted a study to test the accuracy of an immediate and delayed off-line technique for measuring nasal nitric oxide (NO) by comparing it with on-line measurements. With the assistance of one volunteer, we obtained these measurements during 30 sessions over a period of 2 months. Off-line measurements were made immediately following the acquisition of NO samples and 1, 2, and 4 hours later. NO samples were obtained from nasal air collected in syringes. We found that the correlation between on-line measurements and the immediate and delayed off-line measurements ranged from 95 to 98%, according to a Bland-Altman analysis. We conclude that off-line nasal NO measurements can be reliably used in clinical practice and research projects, thus obviating the need for patients/subjects to be in close proximity to the analyzer. Off-line nasal NO measurements can effectively substitute for on-line measurements when the latter technique is not practical.
Adenoid Cystic Carcinoma of the Paranasal Sinuses or Nasal Cavity: A 40-Year Review of 35 Cases
Authors: Wiseman Sam M. , Popat Saurin R. , Rigual Nestor R. , Hicks Wesley L. , Orner James B. , Wein Richard O. , McGary Carl T. , Loree Thom R.
Published: May 2019

We retrospectively reviewed 35 cases of adenoid cystic carcinoma that had originated in the minor salivary glands of the paranasal sinuses or nasal cavity. All patients had been seen at two tertiary-care referral centers in western New York State between 1960 and 2000. Twenty patients had been treated with surgery and adjuvant radiotherapy, 10 patients with surgery alone, three with radiotherapy alone, and two with concurrent radiotherapy and chemotherapy. During the study, 22 patients developed recurrent disease—11 locally; three distantly; seven locally and distantly; and one locally, regionally, and distantly. At the conclusion of the study, 14 patients were alive and disease-free, and eight were alive with disease; 10 patients had died with disease, and three had died of other causes with no evidence of disease. Adenoid cystic carcinoma of the paranasal sinuses or nasal cavity is an aggressive neoplasm that results in a high incidence of both local recurrence and distant metastasis, regardless of treatment modality. Most cases are ultimately fatal, although long disease-free intervals have been observed. A combination of surgery and radiotherapy offers these patients the best chance for disease control.
Nebulized Antibiotics for the Treatment of Acute Exacerbations of Chronic Rhinosinusitis
Authors: Scheinberg Philip A. , Otsuji Alan
Published: May 2019

We studied the effectiveness of aerosol delivery of antibiotics to the sinuses via a nebulizer in 41 patients who had chronic, recurrent sinusitis that had persisted despite endoscopic sinus surgery and that had not responded to multiple courses of oral antibiotics. We compared pre- and post-treatment symptom scores in five categories: nasal obstruction, facial pain, pressure, mucopurulent rhinorrhea, and malaise. Following 3 to 6 weeks of treatment, 34 patients (82.9%) experienced either an excellent or good response to treatment. Side effects were infrequent, mild, and transient. We conclude that nebulized antibiotics should be considered for all patients with chronic sinusitis who have undergone functional endoscopic sinus surgery and who have failed to respond to oral antibiotics or who do not tolerate them.
Penetrating Trauma to the Head and Neck from a Nail Gun: A Unique Mechanism of Injury
Authors: Buchalter Gregory M. , Johnson Leland P. , Reichman Mark V. , Jacobs John
Published: May 2019

Published reports of nail gun injuries to the head and neck are rare. We describe the cases of three patients who sustained nail gun injuries to the head and who were managed at our institution. All patients were treated successfully and all recovered with minimal morbidity. Any physician who is called on to manage a nail gun injury to the head or neck should understand that most likely the patient will have sustained a surprisingly limited amount of tissue injury, owing to the relatively low velocity of the projectile compared with that delivered by firearms. Computed tomography and selective angiography can play a vital role in assessing the integrity of relevant vascular structures. Moreover, catheter angiography with embolization can be a most useful nonsurgical adjunct to control the extent of vascular injury.
Bilateral Vocal Process Papillomas: Report of a Case
Authors: Sidle Douglas M. , Haines G. Kenneth , Altman Ken W.
Published: May 2019

We describe a case of bilateral vocal process lesions in a 65-year-old man. His history was strongly suggestive of vocal process granulomas: previous gastroesophageal reflux, intubation, smoking, and oral squamous cell carcinoma. Medical management with a proton-pump inhibitor, reflux precautions, voice therapy, and adequate hydration yielded no results. Subsequent surgical intervention revealed that he had squamous papillomas. We also provide a brief review of vocal process granulomas and squamous papillomas.
Blastomycosis of the Vocal folds with Life-Threatening upper Airway Obstruction: A Case Report
Authors: Ebeo Celso T. , Olive Kenneth , Byrd Ryland P. , Mirle Girish , Roy Thomas M. , Mehta Jay B.
Published: May 2019

Blastomycosis is a chronic fungal disease that primarily affects the lower respiratory tract. The acute inflammatory phase of the primary pulmonary infection is characterized by a lymphohematogenous spread to extrapulmonary sites, especially the skin. The presence of disseminated infection with Blastomyces dermatitidis in the larynx is unusual. In areas of the United States where this fungus is endemic, failure to consider laryngeal involvement might lead to inappropriate therapy and thus worsening inflammation and airway compromise.
Prognostic Factors in Mortality and Morbidity in Patients with differentiated Thyroid Cancer
Authors: Witt Robert L. , McNamara Ann Marie
Published: May 2019

We attempted to determine if women younger than 45 years of age who have isolated papillary thyroid cancer and whose tumors are smaller than 4 cm (T2N0M0) are at low risk for mortality and morbidity following thyroid lobectomy. To this end, we analyzed information on both women and men obtained from our review of the literature, and we integrated it with data compiled in the Delaware Cancer Registry. We performed a secondary analysis to determine if the risk of death and recurrence can be predicted on the basis of age, tumor size, sex, histology, and the type of operation. We found that among patients who had undergone either thyroid lobectomy or total thyroidectomy, mortality rates were 1.3% for those younger than 45 years of age and 15.6% for those 45 years and older (p< 0.0001). With respect to tumor size, patients whose masses were smaller than 4 cm had significantly lower mortality (3.0%) and recurrence (11.1%) rates than did those whose tumors were 4 cm or larger (16.8 and 33.3%, respectively; p< 0.0001). Other significant risk factors for death were male sex and the presence of follicular thyroid cancer (as opposed to papillary thyroid cancer). The risk of permanent hypocalcemia was significant among patients who had undergone total thyroidectomy, but not among those who had been treated with lobectomy. The subgroup of patients who had the lowest risk of mortality and morbidity was made up of women younger than 45 years who had a papillary thyroid tumor smaller than 4 cm that was limited to one lobe and who had undergone lobectomy. On the other hand, we found that lobectomy might carry a higher risk of recurrence (from a micrometastasis in the cervical lymph node) than does total thyroidectomy. Experienced surgeons whose rates of hypocalcemia and recurrent laryngeal nerve paralysis following total thyroidectomy are low offer their patients the unambiguous advantage of superior follow-up with thyroglobulin and radioactive iodine.
Is Same-Day Discharge Suitable following Rigid Esophagoscopy? Findings in a Series of 655 Cases
Authors: Kubba Haytham , Spinou Ekaterini , Brown Denise
Published: May 2019

It has been suggested that more otolaryngologic procedures should be performed on an outpatient basis, and that rigid upper aerodigestive tract endoscopy might be a particularly suitable procedure in this regard. To determine if this is indeed the case, we retrospectively reviewed the records of 563 patients who had undergone 655 rigid esophagoscopies in our unit between Jan 1, 1991, and July 31, 1998. We ascertained the rate of complications (primarily esophageal perforation) following such procedures and, when they did occur, we determined the length of time between surgery and the onset of the complications’ signs and symptoms. Our aims were to establish the minimum duration of postoperative observation that is required following esophagoscopy and to propose criteria for safe same-day discharge. We found that perforation rates were 4.5% following therapeutic procedures (dilation, biopsy, and foreign-body removal) and 1.2% following diagnostic procedures. In 40% of the patients who experienced perforations, no such signs or symptoms were noted within the first 8 hours following surgery. This finding has important implications for surgeons who wish to perform rigid esophagoscopy on an outpatient basis.
A Proposed Protocol for Monitoring Ototoxicity in Patients who Take Cochleo- or Vestibulotoxic Drugs
Authors: Vasquez Rachel , Mattucci Kenneth F.
Published: May 2019

No widely accepted protocol or guideline exists for monitoring ototoxicity in patients who take powerful and potentially cochleotoxic and/or vestibulotoxic agents. Many physicians in other specialties who prescribe these drugs do not understand the important role of otolaryngologists and audiologists in pretreatment counseling and evaluation and the need for follow-up assessments of their patients’ auditory function. Based on our combined experience of more than 50 years, we have developed a uniform yet flexible approach to monitoring cochlear and vestibular function in these patients. We discuss the mechanisms of ototoxic agents, risk factors for ototoxicity, the need for ongoing communication among the various disciplines, and the methods and timing of monitoring.
Tularemia of the Head and Neck: A Possible Sign of Bioterrorism
Authors: Stupak Howard D. , Scheuller Michael C. , Schindler David N. , Ellison David E.
Published: May 2019

Recent bioterror attacks and other world events have focused the medical community's attention on agents that might be used in biological warfare. One of these potential biological weapons is Francisella tularensis, a gram-negative coccobacillus that is one of the most infectious bacteria known. F tularensis can cause severe, even fatal, systemic tularemia. Under normal circumstances, F tularensis is transmitted by infected ticks, insects, and other animals. As a weapon of terrorism, the bacterium would likely be disseminated as an aerosol and contracted by inhalation. Because many cases of tularemia are characterized by head and neck symptoms, otolaryngologists should be familiar with the diagnosis and management of this disease. In this article, we describe a case of zoonotic tularemia that manifested as a neck mass, and we review the pathophysiology, diagnosis, and treatment of tularemia. We also summarize what is known about its potential as a biological weapon.
The Effects of a Preoperative Steroid/Anesthetic Injection on Post-Tonsillectomy Pain
Authors: Cupero Timothy M. , Kim Sam Y. , Silva Andrew B.
Published: May 2019

We conducted a placebo-controlled, single-blind study to determine the efficacy of a local preoperative injection of a steroid/anesthetic combination in preventing post-tonsillectomy pain. We randomized 21 adults to receive either triamcinolone/bupivacaine on the left side and saline on the right or vice versa. Injections were administered in the area of the tonsillar pillars following intubation and prior to tonsillectomy. Based on the “generalized estimating equations” model of statistical analysis, we found no significant difference in the degree of postoperative pain between the active-treatment and control sides.
Extra-Abdominal Fibromatosis: A Case Report
Authors: Stephens Nathan , Ahsan Farhan , Murray Daran P. , Hussain Akhtar , Chapman Andrea D.
Published: May 2019

Head and neck fibromatosis is a rare disease with a variable clinical picture. We report the case of a 40-year-old woman who had a 1-week history of a painless mass overlying her right neck. Histology confirmed a diagnosis of extra-abdominal fibromatosis. Two unusual features of this case were the site of the lesion and its rapid growth. In this article, we discuss the clinical picture of head and neck fibromatosis, its etiology and pathology, and current opinion regarding its treatment.
Subjective Assessment of Visual Verticality in follow-up of Patients with Acute Vestibular Disease
Authors: García Angélica Gómez , Jáuregui-Renaud Kathrine
Published: May 2019

We conducted a study of 10 patients with acute unilateral peripheral vestibular failure in order to assess their ability to perceive visual verticality during the acute stage of their disease and during recovery. We also evaluated 31 healthy volunteers to test the reproducibility of our assessment methods. The 10 patients were first evaluated within 4 days of the onset of their vestibular failure, and follow-up tests were conducted 2 and 4 weeks later. The healthy subjects were similarly tested at 2 and 4 weeks following their baseline evaluation. All patients and subjects were tested 10 times during each evaluation session, and results from each as well as from the groups as a whole were calculated as a mean of all responses. The mean visual vertical tilt (the amount of deviation from true verticality) among the 10 patients declinedfrom 8.4° (± 2.4°) at the first examination to 3.2° (± 1.6°) at week 2 and to 1.4° (± 0.7°) at week 4. These decreases coincided with the pace of the resolution of their vestibular symptoms. The rates of reproducibility among the 31 healthy volunteers at 2 and 4 weeks following their initial assessment were 95 and 97%, respectively. We conclude that repeated measurements of the static visual vertical can be useful as a follow-up tool for patients with vestibular neuritis.
Follicular Dendritic Cell Sarcoma of the Tonsil: Report of a Rare Case
Authors: Tisch Matthias , Hengstermann Frank , Kraft Klaus , von Hinüber Gerd , Maier Heinz
Published: May 2019

Follicular dendritic cell tumors are extremely rare. Only 17 cases have been previously described in the literature, and only three of them involved primary tumors of the oral cavity. We describe a new case of the latter, which occurred in a 51-year-old man who sought evaluation for a painless enlargement of his left palatine tonsil. The tonsil was excised, and histologic examination revealed that the tumor was a primary sarcoma that had arisen from the dendritic reticulum cells of the palatine tonsil. Postoperatively, the tumor site was treated with percutaneous irradiation (total dose: 70 Gy). After more than 5 years of follow-up, the patient showed no evidence of recurrence. We also discuss the salient features of the immunohistochemical examination.
Inflammatory Pseudotumor of the Trachea
Authors: Restrepo Santiago , Mastrogiovanni Luciano P. , Palacios Enrique
Published: May 2019

“Inflammatory pseudotumor” is a broad descriptive term used to describe a localized collection of inflammatory and fibroblastic cells. It is an uncommon lesion that can mimic a tumor when it is located intraluminally in the trachea or bronchi. Because an inflammatory pseudotumor has an abundance of polyclonal plasma cells, its etiology (postinflammatory vs immunologic) is still being debated. We report a new case of inflammatory pseudotumor that arose in the trachea of a 20-year-old man. We also review the histologic and clinical characteristics of this lesion.
Pigmented Villonodular Synovitis of the Temporomandibular Joint: A Report of Two Cases
Authors: Church Christopher A. , Rowe Mark , Llaurado Raymund , Liwnicz Boleslaw H. , Martin Paul A.
Published: May 2019

Pigmented villonodular synovitis is a benign but locally destructive disease that originates in the synovial membranes of the joints. It is a proliferative disorder of unknown etiology, and it is usually monarthric. Approximately 80% of cases involve the knee; the hip, ankle, foot, hand, elbow, and shoulder account for most other cases. Pigmented villonodular synovitis in the temporomandibular joint is rare. When it does occur, its features include preauricular swelling, trismus, and symptoms of temporomandibular joint dysfunction. It can be diagnosed by a combination of the history, clinical examination, characteristic radiologic findings, and fine-needle aspiration or biopsy results. Wide local excision, including the involved bone, and a total synovectomy are advocated because the lesion can recur if it is not adequately excised. We report two new cases of pigmented villonodular synovitis of the temporomandibular joint, and we review the literature on this subject.
Pneumococcal Bacteremia with Retropharyngeal Soft-Tissue Inflammation and Acute Epiglottitis
Authors: Jayaraman Gnananandh , Ramshesh Priya , Padmanabhan Krishnan , Zaman Muhammad M.
Published: May 2019

Pneumococcal bacteremia secondary to acute epiglottitis is relatively rare, and all previously reported cases occurred in immunocompromised patients. We report a case of pneumococcal bacteremia associated with acute epiglottitis and retropharyngeal soft-tissue inflammation with upper airway narrowing that occurred in an otherwise healthy patient. In light of our unique finding, we recommend that pneumococcal bacteremia be suspected in an otherwise healthy patient who has systemic manifestations associated with acute epiglottitis.
Traumatic Ulceration Mimicking Oral Squamous Cell Carcinoma Recurrence in an Insensate Flap
Authors: Hitchings Anne , Murray Andrew
Published: May 2019

We report our experience with a patient who developed an ulcer within a free flap 2 months following resection of an oral squamous cell carcinoma. We discuss this clinical problem and the issues it raised, with particular attention to early tumor recurrence and the restoration of sensation in free-flap reconstructions.
Extramedullary Hematopoiesis Occurring as a Nasal Polyp in a Man with a Myeloproliferative Disorder
Authors: Brennan Lawrence V. , Mayer Thomas , Devitt James
Published: May 2019

We describe the case of a patient with a known myeloproliferative disorder who presented with epistaxis and what clinically appeared to be a nasal polyp. The mass was resected and proved to represent a focus of extramedullary hematopoiesis. The patient subsequently developed extramedullary hematopoiesis of the skin and the stomach wall. Following nasal polypectomy, he did well for a time, but he eventually died as a result of other complications of his disease. This unique case serves as a reminder that common rhinologic complaints can be a sign of significant and life-threatening pathology.
Treatment of Radiation-Induced Fibrosis of the Face with Manual Compression Therapy
Authors: Oppenheimer Randy , Finkel Rima , Brennan Andrea
Published: May 2019

Radiation-induced fibrosis (RIF) is an uncommon complication of radiation therapy. RIF most often occurs in the extremities; it is rare in the head and neck. Only a few medical treatments for RIF are available, and they have been mediocre at best. We describe a case of RIF of the face that was treated successfully with a nonmedical modality: manual compression therapy.
Infantile Fibromatosis of the Nose and Paranasal Sinuses: Report of a Rare Case and Brief Review of the Literature
Authors: Mannan Abul Ala Syed Rifat , Ray Ruma , Sharma Suresh C. , Hatimota Pradeep
Published: May 2019

Infantile fibromatosis is an uncommon, usually cutaneous, nonmetastasizing but locally aggressive fibroblastic proliferation. Involvement of the sinonasal area is extremely uncommon, and only 5 cases have been previously reported. We report a new case, which occurred in a 2-year-old boy. The mass involved the nasal cavity and the paranasal sinuses and extended into the cranial cavity. We also discuss the clinicopathologic features of this lesion, including its ultrastructural characteristics, and we review the literature.
A Case of Recurrent Subcutaneous Emphysema as a Complication of Endotracheal Intubation
Authors: Cavuslu Saban , Oncul Oral , Gungor Atilla , Kizilkaya Esref , Candan Hasan
Published: May 2019

We describe a case of subcutaneous cervicofacial emphysema in a 21-year-old man who had undergone endotracheal intubation while under general anesthesia 2 months earlier. The emphysema had arisen on the right side of the face and neck and extended to the right shoulder and the cubital fossa. The patient was hospitalized and treated with parenteral antibiotics and hyperbaric oxygen. On hospital day 10, he had improved sufficiently to warrant discharge on the next day. Two months later, the patient presented at a follow-up visit with a recurrence, and he was readmitted. By hospital day 28, his condition had improved and he was scheduled for discharge. However, he experienced another recurrence just before he was to leave the hospital. The circumstances of this second recurrence led us to suspect that the patient was able to produce these signs and symptoms on his own. He was referred for psychiatric evaluation, and findings were negative. He was then sent to the Ear, Nose, and Throat Service, where we confirmed that his subcutaneous emphysema could be brought on by Valsalva's maneuver. We performed suspension laryngoscopy and detected two orifices of fistular tracts next to the right vallecula and three at the root of the epiglottis. We repaired the injured mucosa and the orifices of the fistulae with absorbable sutures and cauterized the area. The swelling resolved completely within 4 days, and findings on a radiographic examination of the chest and neck 1 week later were normal. The patient was then lost to follow-up. The presence of air in the retropharyngeal and cervical subcutaneous spaces of the neck and shoulder without pneumomediastinum is an uncommon complication of endotracheal intubation. We discuss the clinical and radiographic findings associated with this complication, and we review diagnostic considerations and management.
Fluconazole Nasal Spray in the Treatment of Allergic Fungal Sinusitis: A Pilot Study
Authors: Jen Albert , Kacker Ashutosh , Huang Clark , Anand Vijay
Published: May 2019

The authors describe a prospective pilot study designed to investigate the use of topical nasal antifungal spray in addition to systemic steroids and itraconazole in the treatment of allergic fungal sinusitis. Sixteen patients with a history of allergic fungal sinusitis were given fluconazole nasal spray and followed for 3 months. Stabilization or improvement of disease without significant side effects was observed in 12 of the 16 patients who were treated with this protocol. These results indicate that topical fluconazole application may help patients with allergic fungal sinusitis; however, a larger multicenter study with longer patient follow-up is required to validate these initial findings.
Malignant Peripheral Nerve Sheath Tumor of the Paranasal Sinuses
Authors: Ahsan Farhan , Lee Maggie K. , Ah-See Kim W. , Chapman Andrea D.
Published: May 2019

Malignant peripheral nerve sheath tumors of the nose and paranasal sinuses are extremely uncommon. We report the case of a 65-year-old woman who presented with a rapid emergence of “nasal polyps” that completely obstructed her nasal passages. Six years earlier, she had been assessed elsewhere for nasal polyps. At presentation, the patient exhibited gross polyposis, with lesions protruding from both nostrils. Histology confirmed a diagnosis of a malignant peripheral nerve sheath tumor. This case demonstrates that symptoms of nasal obstruction are not always secondary to simple causes. We discuss the clinical picture of nasal and paranasal malignant peripheral nerve sheath tumor, its pathology, and its treatment.
Obstructing Lesions of the Endolymphatic Sac and Duct Mimicking Ménière's Disease
Authors: Cmejrek Ryan C. , Megerian Cliff A.
Published: May 2019

In this retrospective case series and literature review, we demonstrate that temporal bone lesions that obstruct the endolymphatic sac or duct can cause symptoms of Ménière's disease. This finding is likely attributable to endolymphatic hydrops; initially, such cases typically masquerade as Ménière's disease. Between July 1995 and April 2002, a total of 379 patients were treated for an initial diagnosis of Ménière's disease at our institution. Among this group, 3 patients were found to have an obstructing lesion of the endolymphatic sac or duct that we felt was causally related to their Ménière's-like symptomatology. We reviewed these cases and noted the similarities in each patient's presentation, including a common pathophysiology. On imaging studies, each patient had a different pathologic lesion that involved the endolymphatic sac or duct: patient 1 had a jugular megabulb, and she was ultimately treated with vestibular nerve section; patient 2 had a cholesterol granuloma, which was treated with surgical excision; patient 3 had an endolymphatic sac tumor that was treated with surgical excision. As has been suggested in previous reports, not all cases of Ménière's disease are idiopathic. We conclude that obstruction of the endolymphatic sac or vestibular aqueduct by a mass lesion or vascular anomaly can lead to vestibulocochlear pathology that mimics Ménière's disease.
Neck Abscess Secondary to Cat-Scratch Disease
Authors: Dean Robert L. , Eisenbeis John F.
Published: May 2019

A 7-year-old boy was referred to us for evaluation of an enlarging neck mass. The results of his primary care physician's initial clinical examination suggested lymph-adenopathy secondary to lymphadenitis, and the patient was treated over a 4-week period with two rounds of antibiotics. However, the mass did not resolve, and it subsequently became fluctuant. The patient was referred to our institution, where we diagnosed cat-scratch disease.
The Role of the Middle Fossa approach in the Management of Traumatic Facial Paralysis
Authors: Bento Ricardo Ferreira , Pirana Sulene , Sweet Robert , Castillo Arthur , Neto Rubens Vuono Brito
Published: May 2019

There are several controversial aspects to the management of traumatic facial paralysis. One of these involves the precise nature of surgical intervention once the decision to operate has been made. Between June 1, 1984, and June 30, 1993, we surgically treated 220 cases of traumatic facial paralysis with good cochlear reserve by decompressing the tympanic and mastoid segments via a transmastoid approach followed by decompression of the geniculate ganglion and the distal half of the labyrinthine segment via a middle fossa approach. We discuss the results of surgery via the middle fossa approach, and we review the literature.
Childhood Primary Parotid Non-Hodgkin's Lymphoma with direct Intracranial Extension: A Case Report
Authors: Hafner Jonathan W. , Costello Thomas H. , Stocks Rose Mary S. , Ibrahim Fadi , Thompson Jerome W.
Published: May 2019

Childhood primary parotid non-Hodgkin s lymphoma (NHL) is a rare but well-recognized entity in the literature. Perineural extension of masses between the head and neck and cranium, although rare, has also been well documented. We report the first documented case, to our knowledge, of a left-sided primary parotid NHL in a child with direct intracranial extension through the foramen rotundum. The mass arose in a 1½-month period. Following evaluation by computed tomography and magnetic resonance imaging, diagnostic procedures (first, fine-needle aspiration and, subsequently, an open biopsy) were undertaken. We discuss the case report and briefly review childhood NHL and perineural metastasis.
Primary Care Approach to Hearing Loss: The Hidden Disability
Authors: Cohen Seth M. , Labadie Robert F. , Haynes David S.
Published: May 2019

We report the results of a survey designed to investigate audiologic referral patterns of primary care physicians and, more specifically, their referral of patients for hearing aids and cochlear implants. Three hundred internal medicine and family medicine physicians were identified from a referral basin of a tertiary care center and chosen randomly to be faxed questionnaires concerning their views about patients with hearing loss, hearing loss screening and referral practices, and availability of local resources. Of the 260 physicians who received a questionnaire, 85 (32.7%) responded. Of their communities (60% of which had populations of fewer than 50,000), 82.4% had an otolaryngologist and 40% had access to an academic center. Although 97.6% of the responding physicians indicated that hearing loss affected patients’ quality of life, only 60% assessed patients for hearing loss. “Lack of time” and “more pressing issues” were the most common reasons given for not evaluating patients for hearing loss. Although 76 physicians (89.4%) said they were aware of cochlear implants, only 22 (25.9%) had referred patients for implant evaluation. Lack of referral most commonly resulted from uncertainties about “where to refer” and “which patients were potential candidates.” The results of this survey suggest that a large percentage of primary care physicians do not routinely test for hearing impairment in adults.
Spindle-cell Hemangioendothelioma of the Posterior Pharyngeal Wall
Authors: Lade Himani , Gupta Neelima , Singh P.P. , Dev Geeta
Published: May 2019

Spindle-cell hemangioendothelioma is an uncommon vascular lesion that exhibits a predilection for the extremities. Very few reports have been published describing this lesion in the head and neck, and to the best of our knowledge, its occurrence in the oropharynx has not been previously reported. In addition to reporting an unusual site of this lesion, our rationale for publishing this case is to comment on the diagnostic dilemma that arose in view of an unclear clinicohistopathologic pattern and to discuss this lesion's similarity to other aggressive tumors.
Brown Tumor of the Facial Bones: Case Report and Literature Review
Authors: Lessa Marcus M. , Sakae Flavio A. , Tsuji Robinson K. , Filho Bernardo C. Araújo , Voegels Richard L. , Butugan Ossamu
Published: May 2019

Brown tumor, an uncommon focal giant-cell lesion, arises as a direct result of the effect of parathyroid hormone on bone tissue in patients with hyperparathyroidism. The initial treatment involves the correction of hyperparathyroidism, which usually leads to tumor regression. We report a case of brown tumor of the right nasal fossa in a 71-year-old woman. The tumor had caused nasal obstruction and epistaxis. Laboratory evaluation revealed that the patient had primary hyperparathyroidism. Anatomicopathologic investigation revealed the presence of a giant-cell tumor. We performed a partial parathyroidectomy, but the tumor in the right nasal fossa failed to regress. One year later, we performed surgical resection of the lesion. The patient recovered uneventfully, and she remained asymptomatic and recurrence-free at the 1-year follow-up. Facial lesions with histologic features of a giant-cell tumor should be evaluated from a systemic standpoint. Hyperparathyroidism should always be investigated by laboratory tests because most affected patients are asymptomatic. Surgical resection of a brown tumor should be considered if the mass does not regress after correction of the inciting hyperparathyroidism or if the patient is highly symptomatic.
Preservation of the Superficial Lobe for Deep-Lobe Parotid Tumors: A Better Aesthetic Outcome
Authors: Hussain Akhtar , Murray Daran P.
Published: May 2019

Deep-lobe parotid tumors are relatively uncommon. Most of these tumors present as external masses. They can also present in the oral cavity or oropharynx. Magnetic resonance imaging and ultrasound-guided fine-needle aspiration for biopsy and cytology have made it possible to establish a definitive diagnosis and identify the exact location of the tumor in almost all cases before surgery. Traditionally, deep-lobe tumors have been managed by a formal superficial parotidectomy and identification and preservation of the facial nerve, followed by removal of the deep lobe that contains the tumor. Superficial parotidectomy is associated in most cases with periauricular depression secondary to a loss of volume, leading to variable aesthetic deformities. A complete parotidectomy is more likely to be associated with a larger aesthetic deficit secondary to a greater loss of tissue volume. The incidence of gustatory sweating is high after superficial parotidectomy, particularly in the early postoperative period. We hypothesize that if the superficial lobe is preserved, there is less likelihood of gustatory sweating because of the interposition of tissue between the skin and the cut ends of the secretomotor fibers. Approximately 80% of parotid tissue volume is made up of the superficial lobe, and therefore preservation of the superficial lobe should be associated with less postparotidectomy depression. Therefore, we decided to preserve the superficial lobe of the gland for deep-lobe tumors. Nine patients underwent deep-lobe parotidectomy with preservation of the superficial lobe over a 6-year period. Patients were studied prospectively with regard to technical difficulty, complications, and cosmetic outcome. Follow-up ranged from 12 months to 6 years. We did not experience any undue technical difficulty, and there were no cases of facial weakness. One patient developed gustatory sweating, which almost completely resolved over a 2-year period. There were no cases of postparotidectomy depression, and both patients and surgeons were satisfied with the cosmetic appearance. We present our technique and experience.
Primary Carcinosarcoma of the Helix of the Ear
Authors: Vincek Vladimir , Mirzabeigi Marjan , Jewett Brian S. , Goodwin W. Jarrard
Published: May 2019

We report our histologic and immunohistochemical findings in a rare case of cutaneous carcinosarcoma involving the helix of the ear. The tumor exhibited cellular features of both basal cell and squamous cell carcinoma and a malignant mesenchymal component that was consistent with malignant fibrous histiocytoma. The epithelial component exhibited a positive immunohistochemical reaction to cytokeratin and a negative reaction to vimentin, whereas the mesenchymal component showed a positive immunohistochemical reaction to vimentin and a negative reaction to cytokeratin. To the best of our knowledge, this is only the third reported case of a carcinosarcoma of the ear and the second case in which it developed on the helix.