bluuebunny/crossref_metadata_2025 huggingface dataset:
Sternocleidomastoid Muscle Flap Reconstruction during Parotidectomy to Prevent Frey's Syndrome and Facial Contour Deformity
Authors: Asal Korhan , Köybaşioğlu Ahmet , Inal Erdoğan , Ural Ahmet , Uslu S. Sabri , Ceylan Alper , Ileri Fikret
Published: May 2019

We studied the incidence of Frey's syndrome and facial contour deformity in two groups of patients who had undergone superficial parotidectomy. One group was made up of 12 patients who were randomized to undergo reconstruction of the surgical defect with a sternocleidomastoid muscle flap; the other 12 patients did not receive a flap. All 24 patients were evaluated via a short questionnaire, the starch-iodine test, and a visual examination. On the questionnaire, none of the 24 patients said they experienced abnormal facial sweating, flushing, or warmth while eating, although 6 of the 12 patients in the nonflap group had a mildly positive starch-iodine test. No patient in the flap group had a positive test. The difference between the two groups was statistically significant (p < 0.05). No statistically significant difference was seen between the two groups with respect to cosmetic results.
Mastoidectomy for Acute Otomastoiditis: Our Experience
Authors: Migirov Lela , Kronenberg Jona
Published: May 2019

We conducted a retrospective study of 53 mastoidectomies in 51 patients with acute otomastoiditis. In 26 cases (49.1%), surgery had been performed within 48 hours of the development of symptoms. The most common complication of acute otomastoiditis was subperiosteal abscess, which occurred in 37 cases (69.8%). Intracranial complications were seen in 6 cases (11.3%). The most common pathogens isolated from subperiosteal abscesses, the mastoid cavity, and intracranial collections were Streptococcus spp and Staphylococcus aureus. In 14 cases (26.4%), conservative treatment failed to cure acute otomastoiditis; such cases should raise a suspicion of a subperiosteal abscess, an underlying cholesteatoma, or an infection caused by gram-negative bacteria. Upon hospital admission, patients should receive antibiotics that are effective against both gram-positive and gram-negative organisms. Patients with intracranial complications or facial nerve paralysis may require a combination of two or more antibiotics. Long-term follow-up is highly recommended.
Auditory Steady-State Response Audiometry in Profound SNHL: The Impact of Abnormal Middle Ear Function
Authors: Tonini Ross , Ballay Charles , Manolidis Spiros
Published: May 2019

Auditory steady-state response (ASSR) audiometry is a commercially available tool that is used to predict behavioral auditory threshold levels. Its particular value stems from the technology's ability to measure frequency-specific responses in the background electroencephalogram to auditory stimuli presented across a broad range of frequencies and sound pressure levels. It is clearly of benefit when used to assess threshold levels in infants and children with severe-to-profound hearing impairment (i. e., cochlear implant candidates). Although numerous authors have provided evidence of the usefulness of ASSR testing, their reports have concerned patients whose middle ear impedance measures were normal. We report the cases of 2 patients who, following improvement of abnormal middle ear impedance values, experienced a marked improvement in measurable thresholds by ASSR testing.
Use of a Powered Shaver to Remove Multiple Oral Cavity Papillomas
Authors: Miller Robert Sean , Tami Thomas A.
Published: May 2019

We report a previously undescribed method of removing multiple oral papillomas, which we performed on 5 men with human immunodeficiency virus (HIV) infection. Patients were brought to the operating room and placed under general anesthesia. In addition, 1% lidocaine with 1:100,000 epinephrine was injected under and around the lesions. We then removed the lesions with a Tricut laryngeal blade attached to a handheld powered shaver. Postoperatively, patients were sent home on clindamycin, a pain medication, and Peridex. At the 1-week follow-up, patients reported only minimal pain, and their wounds were well healed. We observed no adverse events associated with the shaving procedure. Our method expedites the process of removing multiple oral cavity papillomas while reducing the morbidity generally associated with other procedures.
Biphasic Synovial Sarcoma of the Posterior Pharyngeal Wall: A Case Report
Authors: Agada Frank O. , Murphy Justin , Sharma Ravi , Karsai Laszlo , Stafford Nick D.
Published: May 2019

Synovial sarcoma is not common in the head and neck region. Because its histopathologic features are many and varied, it is often misdiagnosed. We report a case of biphasic synovial sarcoma of the posterior pharyngeal wall, and we discuss the clinical and pathologic features of this case.
Tympanostomy Tubes for Otitis Media: Quality-of-Life Improvement for Children and Parents
Authors: Mui Stanley , Rasgon Barry M. , Hilsinger Raymond L. , Lewis Brent , Lactao Gretchen
Published: May 2019

We measured quality of life issues for both children and their parents on the premise that parental quality of life should be an aspect of cost-effectiveness in otitis media treatment. The patients were less than 18 years of age and had had myringotomy with tube insertion at the head and neck surgery department of a large health maintenance organization. Quality of life for patients, parents, and caregivers was evaluated by telephone survey of parents or caregivers and by retrospective chart review of the number of pre- and postoperative healthcare visits and antibiotic usage. Chart review showed a significant postoperative reduction in the number of clinic visits and in use of antibiotic drugs after insertion of tympanostomy tubes. Improved postoperative hearing was noted, and tympanostomy tube insertion was shown to be safe. The chart-review cost analysis showed that tympanostomy tube insertion is a cost-effective treatment for otitis media in children, and the telephone survey results showed that it improves quality of life for children and their parents or other caregivers.
Advantages of Perforator Flaps in Reconstruction of Complex Defects of the Head and Neck
Authors: Guerra Aldo Benjamin , Lyons George Dewey , Dupin Charles Louis , Metzinger Stephen Eric
Published: May 2019

Microsurgical transfer of vascularized tissue during the past three decades has allowed highly complicated postoncologic defects in the head and neck region to be reconstructed. Recently, perforator flaps have been used to reduce postoperative pain, shorten hospital stay, and lessen donor-site complications. These flaps are offsprings of previously known musculocutaneous and fasciocutaneous flaps and are harvested with preservation of the underlying muscular and fascial structures. The vascularized skin and soft-tissue envelope is supplied by perforating branches from the parent vessel. Less is known about the performance of these flaps in the head and neck region. During a 4-year period, 22 patients at our institution underwent reconstruction of the head and neck region with deep inferior epigastric perforator (DIEP) or thoracodorsal artery perforator (TDAP) flaps. All but one of the flaps survived. Advantages noted include: (1) longer vascular pedicles, (2) less postoperative pain, (3) less donor-site deformity, (4) improved aesthetic outcome, (5) potential for a neurosensory flap, (6) potential for an osteocutaneous flap, and (7) ease of postoperative radiologic follow-up. The DIEP flap can be harvested concurrent with oncologic resection, with the patient in the supine position. The TDAP flap is dissected with the patient in the decubitus position, creating an additional step to change operative position, and separates extirpative and reconstructive stages.
Cochlear Implantation in Severe Traumatic Brain Injury and Paranoid Schizophrenia: Two Case Studies
Authors: Siegal Jane T. , Robiner William , Smith Sharon , Levine Samuel C.
Published: May 2019

In view of the demanding instruction and training requirements associated with cochlear implantation, patients with cognitive impairments have typically been considered to be poor candidates for this procedure. This presumption persists in part because experience and research in this area are limited. We describe our experience with implanting cochlear devices in 2 patients who had significant psychological impairments; 1 patient had experienced a severe brain injury, and the other had paranoid schizophrenia. Nevertheless, both patients were able to follow the implant training program, and they experienced different degrees of improvement in their hearing. We discuss our preoperative evaluations of these patients and the key factors that led to our decision to proceed with surgery.
Primary Chordoma of the Lateral Nasal Wall: Case Report and Review
Authors: Lynn-Macrae Alastair , Haines G. Kenneth , Altman Kenneth W.
Published: May 2019

Chordomas are malignant, nonepithelial neoplasms derived from notochordal tissue. A primary chordoma of the nasal cavities and paranasal sinuses is extremely rare compared with clival chordomas, which often present as nasal masses after spreading anteriorly. Only a few cases of primary chordoma of the nasal cavities and paranasal sinuses have been reported in the literature. We report a case of a primary chordoma of the lateral nasal wall. Pathologic diagnosis was obtained using an intranasal endoscopic excision. As in our patient, a primary chordoma of the nasal cavity or paranasal sinuses may present with symptoms related to mechanical obstruction secondary to the tumor mass. We summarize our case in the context of the other reported cases, and we discuss treatment options, natural history, and prognosis.
Nasal Glioma (Neuroglial Heterotopia) Mimicking an Astrocytoma: Case Report
Authors: Amin Ali , Monabati Ahmad , Kumar Perikala V. , Hashemi Seyed Baseer
Published: May 2019

Nasal glioma is a rare benign tumor that usually occurs during infancy. We report a case of nasal glioma in a 6-month-old boy in which the histomorphologic features resembled those of an anaplastic astrocytoma.
Supernumerary Nostril with Congenital Cataract
Authors: Sinha Ramanuj , Das Saumik , Sikder Biswajit , Ray Sanjay , Bit Utpal Kumar
Published: May 2019

Supernumerary nostril is a very rare congenital anomaly. It can be unilateral or bilateral, and it sometimes occurs in the presence of other congenital deformities. Behind the external opening of a supernumerary nostril is a small accessory nasal cavity, which may or may not communicate with the normal nasal cavity on the same side. We describe a new case in which the supernumerary nostril with a small accessory nasal cavity, which did not communicate with the normal nasal cavity on the same side, appeared in a young girl who also had microcornea and congenital cataract. The accessory nasal cavity was successfully removed surgically We believe that this case may represent the first reported case of a supernumerary nostril with a congenital cataract on the same side. We also discuss the hypotheses that have been proposed to explain supernumerary nostrils.
Surgical Emphysema in the Neck as a Result of a Dental Procedure
Authors: Iqbal Moghira , Ikram Mubasher , Raza Farhan , Banday Ninette
Published: May 2019

We report the development of subcutaneous emphysema in a middle-aged woman that occurred several hours after she had undergone a dental restoration procedure. The patient presented to the emergency department, and she was admitted for observation and prophylactic antibiotic coverage. She recovered in 3 days without further intervention and was discharged.
Minimally Invasive Transoral Catheter-Assisted Drainage of a Danger-Space Infection
Authors: Adelson Robert T. , Murray Alan D.
Published: May 2019

We report the case of a 3-year-old boy who was brought to the emergency department for evaluation of a prolonged upper respiratory infection and diminished neck movement. Computed tomography identified a unilocular abscess extending from the level of C2 inferiorly to the diaphragm at the level of the T9 vertebral body. We successfully treated this transcervical, transthoracic infection surgically via a transoral approach to the retropharyngeal abscess combined with catheter drainage and irrigation of the abscess cavity at a depth of 13 cm. At 25 months of follow-up, the patient exhibited no evidence of recurrent disease or postsurgical complications. In this article, we describe our minimally invasive technique for managing unusual deep-space neck infections in children.
Schwannoma of the True Vocal Fold: A Rare Diagnosis
Authors: Taylor Jennifer , Stiefel Marc , Park Steven Y.
Published: May 2019

Schwannomas of the larynx are rare, benign, slowly growing tumors. When they do occur, they are most often isolated in the aryepiglottic folds or false vocal folds. When a tumor originates in the larynx, it typically causes hoarseness and a globus sensation. As the tumor expands, it may cause dyspnea, stridor, and possibly asphyxiation as a result of the mass effect. In this article, we report an unusual case of a schwannoma of the true vocal fold in a young woman.
Atypical Presentation of Cutaneous Tuberculosis and a Retropharyngeal Neck Abscess
Authors: Agada Frank O. , Sharma Ravi , Makura Zvoru G.G.
Published: May 2019

A 70-year-old Asian man with noninsulin-dependent diabetes presented with a 4-month history of left-sided otitis externa and right-sided facial palsy. Physical examination of the left ear revealed a punched-out ulcerative lesion on the tragus, an edematous and inflamed external auditory canal, and a purulent nonmucoid discharge. Computed tomography of the brain and neck demonstrated a large retropharyngeal abscess, an abscess in the left parapharyngeal space, and a small collection adjacent to the right carotid sheath at the level of C4; the cervical vertebrae and lungs were normal. Microscopy of drained pus and histology of left ear and neck node biopsies identified tuberculosis. The patient was started on antituberculosis drug therapy, but he died within 2 weeks of treatment. We discuss the characteristics of this unusual presentation of tuberculosis infection.
Mandibular Distraction Osteogenesis with a Small Semiburied Device in Neonates: Report of 2 Cases
Authors: Brevi Bruno , Laganà Francesco , Piazza Fabio , Sesenna Enrico
Published: May 2019

Distraction osteogenesis has recently assumed an important role in the correction of craniofacial anomalies, particularly for the treatment of potentially life-threatening, deformity-associated upper airway obstruction and respiratory dysfunction in neonates. Such deformities include Treacher Collins syndrome, Goldenhar's syndrome, Nager's syndrome, temporomandibular joint ankylosis, and Pierre Robin sequence. These conditions frequently require a tracheostomy to maintain airway patency. We report our experience with using mandibular distraction as a valid alternative to tracheostomy. Minimally invasive surgery is possible with small semiburied devices.
Kimura's Disease of the Parapharyngeal Space
Authors: Keng Christopher Goh Hood , Pang Kenny Peter , Teng Poh Wee
Published: May 2019

Kimura's disease is a fairly uncommon inflammatory condition of unknown etiology. It classically presents in young Asian males as tumorlike subcutaneous nodules in the head and neck with associated lymphadenopathy, peripheral eosinophilia, and an elevated serum IgE level. Kimura's disease affects the subcutaneous tissues, salivary glands, and lymph nodes; less common sites in the head and neck include the eyelid and tympanic membrane. We report a case of Kimura's disease of the parapharyngeal space in a 42-year-old Chinese woman. To the best of our knowledge, this is the first report of Kimura's disease at this site.
Congenital Midline Cervical Cleft: A Report of 3 Cases
Authors: Smith Ronald M. , Barth Patrick C. , Castillo Jasper , Millman Brad , Wood W. Edward
Published: May 2019

Congenital midline cervical cleft is a rare anomaly of the anterior neck. The diagnosis is typically made on the basis of the lesion's characteristic clinical presentation at birth. It appears to occur as a result of a failure of fusion of the paired second branchial arches in the midline during embryogenesis. Surgical intervention is necessary to avoid potential long-term complications, such as contractures and limitation of neck mobility. We present 3 cases of congenital midline cervical cleft, arid we discuss the embryology, presentation, and surgical management of this unusual condition.
Postauricular Abscess Leading to Internal Jugular Vein Thrombosis: A Case Report
Authors: Miller Robert Sean , Steward David L.
Published: May 2019

Thrombosis of the internal jugular vein (IJV) is uncommon. It usually responds to conservative medical treatment. We describe a case of IJV thrombosis in a 31-year-old man. The patient was successfully treated with IJV ligation after conservative therapy had failed.
Malignant Melanoma of the Mucous Membranes of the Head and Neck: Three Case Reports
Authors: Dass Arjun , Virk Ramandeep S. , Hundal Harbir , Mohan Harsh
Published: May 2019

Primary malignant melanoma of the oronasal region is rare. When it does occur, it is difficult to manage, and the prognosis is not good. Early diagnosis and radical surgical management appear to offer the best hope of curing the disease. We report 3 new cases of malignant melanoma of the mucous membranes of the head and neck. Despite the generally poor outlook, 2 of these patients underwent excision of the tumor and remained disease-free 2 years later; the other patient refused surgery and was lost to follow-up.
Primary Malignant Melanoma of the Epiglottis: A Rare Presentation
Authors: Durai Rajaraman , Hashmi Syed
Published: May 2019

Primary malignant melanoma of the epiglottis is extremely rare. Until now, only 4 cases have been reported in the world literature. We describe a new case of epiglottic primary malignant melanoma in a 74-year-old man who presented with hoarseness and a foreign-body sensation. Clinical examination revealed the presence of a small, whitish, polypoid tumor on the laryngeal surface of the epiglottis; no other primary melanoma was detected. Wide excision of the lesion was performed, and microscopy revealed that it contained melanin-pigmented tumor cells in both the mucosa and submucosa. Immunostaining was positive for S-100 protein. The patient was treated with radiotherapy, and he remained well 1 year after the diagnosis with no evidence of recurrence.
Factors that Predict the Need for Intubation in Patients with Smoke Inhalation Injury
Authors: Madnani Dilip D. , Steele Natalie P. , de Vries Egbert
Published: May 2019

Early identification of smoke inhalation patients who will require intubation is crucial. We conducted a retrospective chart review to identify predictors of respiratory distress in patients who present with smoke inhalation injury. Our study involved 41 patients who had been treated in the emergency room at a regional burn center. Eight of these patients required intubation. Intubation was positively correlated with physical examination findings of soot in the oral cavity (p < 0.001), facial burns (p = 0.025), and body burns (p = 0.025). The need for intubation was also predicted by fiberoptic laryngoscopic findings of edema of either the true vocal folds (p < 0.001) or the false vocal folds (p < 0.01). No statistically significant correlation was found between intubation and any of the classic symptoms of smoke inhalation: stridor, hoarseness, drooling, and dysphagia (all p = 1.0). Also, multivariate analysis revealed that facial burns correlated significantly with edema of the true vocal folds (p = 0.01) and body burns correlated significantly with edema of both the true (p = 0.047) and false (p = 0.003) vocal folds. We conclude that patients with soot in the oral cavity, facial burns, and/or body burns should be monitored closely because these findings indicate a higher likelihood of laryngeal edema and the need for intubation.
Computer-Assisted Surgery and Computer-Assisted Telesurgery in Otorhinolaryngology
Authors: Klapan Ivica , Vranješ Željko , Rišavi Ranko , Šimičić Ljubimko , Prgomet Drago , Glušac Branko
Published: May 2019

Surgical preparation is enhanced by the availability of computer-generated three-dimensional models that allow surgeons to explore the surgical field in various projections prior to an actual operation. In fact, with adequate computed tomography images, an entire operation can be simulated beforehand so that surgeons can plan the safest and most effective approach and be prepared to avoid or overcome obstacles during the actual procedure. Also, computer technology allows surgeons to conduct remote consultations and to even perform telesurgery—that is, to operate on a patient from a great distance. In this article, we describe our experience with computer-assisted local and remote endoscopic sinus surgery in Croatia.
Laryngomalacia: A Classification System and Surgical Treatment Strategy
Authors: Kay David J. , Goldsmith Ari J.
Published: May 2019

Laryngomalacia, the most common congenital laryngeal anomaly, is not a single disease entity but rather a variety of entities along a spectrum of underlying pathophysiologies. Based on our study of 10 children who were surgically treated for laryngomalacia in an urban tertiary care center, we have developed a system of classifying laryngomalacia on the basis of its different underlying pathophysiologic processes. Type 1 laryngomalacia is characterized by a foreshortened or tight aryepiglottic fold. Type 2 disease is defined by the presence of redundant soft tissue in the supraglottis. The type 3 designation applies to cases caused by other etiologies, such as underlying neuromuscular disorders. While the three types are not mutually exclusive, each should be considered as a separate disease entity with a final common clinical presentation. Each type requires a specific approach to surgical repair.
Coexistent Cervical Tuberculosis and Metastatic Squamous Cell Carcinoma in a Single Lymph Node Group: A Diagnostic Dilemma
Authors: Gheriani Heitham , Hafidh Maky , Smyth David , O'Dwyer Tigh
Published: May 2019

Primary cervical tuberculosis is uncommon, although its incidence has risen somewhat over the past few years. In this article, we describe a rare case in which the patient developed a dual pathology—cervical tuberculosis and a malignant squamous cell carcinoma—in a group of lymph nodes on one side of the neck. Initially, tuberculosis was diagnosed on the basis of histology and culture. However, when the patient did not respond to antituberculous drug therapy, a repeat biopsy detected the second pathology: squamous cell carcinoma. To the best of our knowledge, no such presentation has been previously reported in the world literature. We conclude that repeat biopsy might be required in cases of tuberculous cervical lymphadenopathy that do not respond to conventional antituberculous therapy.
Solitary Fibrous Tumor of the Floor of the Mouth: Case Report and Review of the Literature
Authors: Shine Neville , nor nurul Khasri Mohd , Fitzgibbon Jim , O'Leary Gerard
Published: May 2019

Solitary fibrous tumor is an uncommon spindle cell neoplasm that is believed to be of mesenchymal origin. Rarely does it originate in the oral cavity, and only 1 case of this lesion in the floor of the mouth has been previously reported. We describe a new case of solitary fibrous tumor arising from the soft tissues of the floor of the mouth.
Thyroglossal Duct Cyst: An Unusual Presentation
Authors: Prasad Kishore Chandra , Dannana Naveen Kumar , Prasad Sampath Chandra
Published: May 2019

Most thyroglossal duct cysts are located at or very close to the midline. They generally manifest as painless neck swellings, and they move on protrusion of the tongue and during deglutition. We describe a case of thyroglossal duct cyst that was unusual in that the cyst was located far from the midline, it did not move on protrusion of the tongue, and it was associated with symptoms of dysphagia and extensive neck swelling that mimicked a colloid goiter.
Associations between Fatigue and Medication Use in Chronic Rhinosinusitis
Authors: Bhattacharyya Neil , Kepnes Lynn J.
Published: May 2019

We conducted a prospective study of 586 adults to determine if associations exist between fatigue symptom scores and three classes of medications prescribed for the treatment of chronic rhinosinusitis (CRS): prescription nonsedating antihistamines, topical nasal steroids, and antibiotics. Patients were assessed with the assistance of the Rhinosinusitis Symptom Inventory and Likert-scale fatigue symptom scores. On multivariate analysis and correcting for disease severity, we found that significantly higher fatigue symptom scores were associated with the use of nonsedating antihistamines (mean Likert score: 2.75 vs. 2.27 for patients not taking a nonsedating antihistamine; p = 0.029). Higher fatigue scores were also associated with a greater number of antibiotic courses and more total weeks of antibiotic use (p < 0.001 in both cases). No association was seen between fatigue scores and the use of topical nasal steroids (mean Likert score: 2.65 vs. 2.24; p = 0.658). We recommend that long-term use of a nonsedating antihistamine be scrutinized in CRS patients who report symptoms of fatigue.
Spinal Accessory Nerve Monitoring with Clinical Outcome Measures
Authors: Witt Robert L. , Gillis Theresa , Pratt Robert
Published: May 2019

We conducted a prospective study of 11 patients to (1) determine the feasibility of electrophysiologic monitoring of the spinal accessory nerve (SAN) during modified radical neck dissection, (2) determine whether a threshold increase in current is required to stimulate the SAN by comparing the amount of current on initial identification of the SAN and the amount of current after completion of the dissection prior to closure, and (3) determine whether clinical outcome measures of shoulder syndrome at 72 hours and 45 days postoperatively are affected by a threshold increase. We found that 3 of 11 patients (27.3%) experienced significant threshold increases (>0.4 mA) on completion of the dissection. Of 8 patients who completed a shoulder syndrome evaluation, 3 (37.5%) had scapular winging, mild to moderate pain, and less than 90% of shoulder abduction. Two of 3 patients with shoulder syndrome had a threshold increase on electrophysiologic monitoring. We conclude that electrophysiologic monitoring of the SAN is feasible. It did not identify a threshold increase in more than 70% of patients. Electrophysiologic integrity of the SAN did not completely correlate with clinical outcome measures for shoulder syndrome.
Malignancy in Asymmetrical but Otherwise Normal Palatine Tonsils
Authors: Oluwasanmi Adenike F. , Wood Stephen J. , Baldwin David L. , Sipaul Fabian
Published: May 2019

An abnormally large tonsil may be a sign of malignancy. We retrospectively analyzed the case files of 87 patients who had asymmetrically sized but otherwise normal tonsils and no risk factors for cancer to determine if asymmetry is associated with a higher incidence of malignancy. We found 2 cases (2.3%) of malignancy among these patients. One patient had high-grade non-Hodgkin's lymphoma in the larger tonsil, and the other had lymphocyte-rich Hodgkin's lymphoma. Both patients were older than 50 years, and neither had a history of recurrent tonsillitis. We believe that although the incidence of cancer in our series was small, it is significant. Therefore, we recommend routine excision of abnormally large tonsils. Moreover, when making such a recommendation to a patient, it is essential that the patient have a clear understanding of the risk and benefit of having a tonsil removed solely because of asymmetry.
Sarcoidosis Presenting as a Solitary Parotid Mass
Authors: McCormick James T. , Newton E. Douglas , Geyer Stanley , Caushaj Philip F.
Published: May 2019

We describe an unusual case of sarcoidosis in which the patient presented with a discrete solitary parotid mass and no other manifestation of the disease. The diagnosis was based on the unexpected pathologic findings during examination of a superficial parotidectomy specimen. To the best of our knowledge, no such presentation has been previously reported in the English-language literature.
Blood–but not Bleeding–at a Tracheotomy Site: A Case of Munchausen's Syndrome
Authors: Patenaude Bart , Zitsch Robert , Hirschi Scot D.
Published: May 2019

Munchausen's syndrome is a factitious illness in which patients fabricate medical problems in order to receive medical attention. Their “symptoms” are typical of actual medical conditions and their history is dramatic yet plausible, but no pathology can be found on imaging and other investigations. We report the case of a young woman whose Munchausen's syndrome manifested as purported bleeding from a tracheotomy site. In actuality, she had drawn the blood from an arm vein and spattered it on her neck.
Spontaneous Facial Subcutaneous Emphysema
Authors: Ramchandar Kevin , Carr Michele M.
Published: May 2019

Patients with spontaneous pneumomediastinum present with various manifestations, but it is extremely rare for head and neck signs to be the sole presenting feature. In fact, our search of the literature found only 1 previously documented case of spontaneous facial subcutaneous emphysema of the head and neck. In this article, we report what to the best of our knowledge is the second such case—and the first in which pneumomediastinum manifested as an isolated cheek swelling.
Endoscopic Removal of a Dentigerous Cyst Producing Unilateral Maxillary Sinus Opacification on Computed Tomography
Authors: Di Pasquale Paul , Shermetaro Carl
Published: May 2019

We report the case of a 14-year-old girl who was referred to us with a 2-year history of abnormal panoramic dental x-rays. Computed tomography of the paranasal sinuses demonstrated a left unilateral maxillary sinus opacification that had been produced by an ectopic molar. The tooth was removed via an endoscopic approach rather than with a traditional Caldwell-Luc procedure. A nasal endoscope was used to create a middle meatal antrostomy and deliver the tooth and its cystic contents. The patient recovered without complications, and she exhibited no signs of recurrence at the 2-year follow-up.
Submental Midline Dermoid Cyst in a 25-Year-Old Man
Authors: Burger Mark F. , Holland Paul , Napier Bradford
Published: May 2019

A 25-year-old man presented with a painless, nontender, nonerythematous sublingual mass that had gradually increased in size over the preceding 2 years. Fine-needle aspiration biopsy was nondiagnostic. During the week following our evaluation, the mass became increasingly painful and swollen, and it severely impaired his speech and swallowing. Magnetic resonance imaging demonstrated a sharply demarcated, fluid-filled, sublingual cyst that measured approximately 7.1 x 4.5 x 2.9 cm. During surgical excision, the mass was found to contain a large amount of sebaceous material, which was removed along with the entire capsule of the cyst. Histologic examination of the cystic contents identified epidermis, sebaceous glands, and hair follicles along with copious sebaceous material. These findings are consistent with a dermoid cyst.
Sudden Sensorineural Hearing Loss and Hemodialysis
Authors: Lasisi Olawale A. , Salako Babatunde L. , Kadiri Solomon , Arije Ayo , Oko-Jaja Richard , Ipadeola Arinola , Olatoke Fatai
Published: May 2019

The etiology of sensorineural hearing loss (SNHL) associated with renal failure and hemodialysis is controversial. Possible mechanisms include a shared antigenicity between the kidney and the labyrinths, osmotic alteration caused by hemodialysis, and the ototoxic effect of diuretics. We present 2 cases of SNHL associated with renal failure and its treatment. One patient was a 35-year-old man who developed profound SNHL after 5 sessions of hemodialysis, and the other was a 36-year-old woman who developed severe to profound SNHL after 7 sessions. It is our impression that both hearing losses might have been attributable to osmotic disequilibrium in the labyrinth or to an acute labyrinthine injury caused by contamination of the blood by the degraded product of an old cellulose acetate hemodialyzer membrane; the hemodialyzer had been in use for 15 years.
Two Cases of Incidental Epidermoid Cysts: Sphenoid Sinus and Temporal Bone
Authors: Hewitt Derek K. , Kinney William C.
Published: May 2019

Epidermoid cysts or tumors are uncommon. When they do occur, they are usually large at presentation, and the initial symptoms usually involve the cranial nerves. Congenital epidermoids are believed to arise as a result of cellular dysfunction during embryogenesis, which leads to an abnormal migration of ectodermal cells. We present 2 cases of epidermoids that were identified incidentally at our institution during radiologic evaluations of head trauma; one was found in the sphenoid sinus and the other in the temporal bone. Both patients were treated surgically. We review the pathogenesis, diagnosis, and imaging characteristics of these epidermoids.
Neurofibroma of the Pinna
Authors: Shaida Azhar M. , Yung Matthew W.
Published: May 2019

Neurofibromas are relatively common lesions of the nervous system, but only a few cases involving the pinna have been reported. The emphasis in most of these reports was on the cosmetic deformity; functional impairment in the form of hearing loss has been mentioned in only a few reports. We report a case of pinnal neurofibroma in which the primary complaint was otitis externa; hearing loss and cosmetic deformity were also present. Surgical excision resulted in an excellent functional and cosmetic outcome. This case demonstrates that neurofibroma of the pinna in the area of the external meatus can produce functional as well as cosmetic impairment, and surgery can produce a very satisfactory result.
The Prevalence of Colonization with Drug-Resistant Pneumococci among Adult Workers in Children's Daycare
Authors: Rosen Frederick S. , Ryan Matthew W.
Published: May 2019

We conducted a study to determine if employment at a children's daycare facility increases an adult's risk of carrying Streptococcus pneumoniae in general and antibiotic-resistant S pneumoniae in particular. From January through March 2003, we obtained nasopharyngeal and oropharyngeal specimens from 63 adult workers at 6 daycare facilities and 65 similarly aged controls; all but 2 controls were nonclinical employees at our tertiary care center. Culture and sensitivity data were obtained from all specimens, and written questionnaires were used to gather information on each daycare worker, control, and daycare center. The vaccination records of children at 5 of the 6 daycare centers were reviewed. Odds ratios with 95% confidence intervals were calculated to compare the rates of colonization with S pneumoniae in the daycare workers and controls. Multinomial logistic regression analysis was used to compare different daycare centers and to identify risk factors for S pneumoniae carriage. Analysis of the results revealed that the prevalence of S pneumoniae colonization among daycare workers (3/63 [4.76%]) and controls (3/65 [4.62%]) was nearly identical. Whereas no S pneumoniae isolate from a daycare worker displayed multiple drug resistance, all 3 isolates from the controls did; however, this difference was not statistically significant. We conclude that employment at a children's daycare facility in our community did not increase an adult's risk of carrying S pneumoniae. In fact, daycare workers may be even less likely to carry antibiotic-resistant S pneumoniae because of the widespread and successful use of the heptavalent pneumococcal vaccine in young children.
Bilateral Peritonsillar Abscesses: A Challenging Diagnosis
Authors: Edinger James T. , Hilal Elias Y. , Dastur Khurshed J.
Published: May 2019

Peritonsillar abscess is the most common complication of acute tonsillitis. Bilateral peritonsillar abscesses are much less common, and they may be more difficult to detect on physical examination because the oropharynx often appears to be symmetrical rather than asymmetrical, as is the case in unilateral abscess. Previous steroid treatment may also complicate the diagnosis by masking the signs and symptoms of abscess. We describe the case of a young woman who presented to the emergency department with relatively mild symptoms despite having large bilateral peritonsillar abscesses. We believe that her symptoms had been masked by previous steroid therapy. We also review the treatment and microbiology of peritonsillar abscess.
Irreversible Hydrocolloid: An Unusual Presentation of Esophageal Obstruction
Authors: Kim Sihun Alex , Meleca Robert J.
Published: May 2019

Upper digestive tract obstruction can occur after ingestion of various types of foreign bodies. However, to the best of our knowledge, no case of a near-total obstruction caused by an irreversible hydrocolloid has heretofore been reported in the literature. We present just such a case, and we discuss our preferred method of removing foreign bodies from the cervical esophagus.
A New Method for Closure of Small to Medium-Size Nasoseptal Perforations
Authors: De Witt Ward S.
Published: May 2019

This article describes a new method of repairing nasoseptal perforations. The surgical procedure involves rotating a composite transposition flap of mucosa and cartilage anchored at the posterior margin of the perforation. The focus of the repair is to preserve vascularity to the flap and thereby enhance the survival of the cartilage and mucosa. This method appears to be most suitable for repairing small to medium-size perforations. Early success has been promising and warrants a trial by others.
Vocal Fold Deposits in Macrophagic Myofasciitis
Authors: Glynn Fergal , O'Sullivan Peter
Published: May 2019

Macrophagic myofasciitis was first reported in 1998. This disease manifests as diffuse myalgia and chronic fatigue. Its pathophysiology has been traced to the presence of an aluminum adjuvant used in vaccines against hepatitis A and B virus and tetanus toxoid; the adjuvant aggregates at the site of injection. One-third of patients with macrophagic myofasciitis develop autoimmune disease. Vocal fold deposits have been described in autoimmune diseases such as sarcoidosis, systemic lupus erythematosus, multiple sclerosis, rheumatoid arthritis, Sjögren's syndrome, and Hashimoto's thyroiditis. We report what to the best of our knowledge is the first published case of vocal fold deposits in macrophagic myofasciitis.
Tracheobronchial Stenting in an Infant with an Anomalous Right Main Bronchus
Authors: DePasquale Kalpana S. , Tucker John A. , Wolfson Barbara , Varlotta Laurie
Published: May 2019

Congenital anomalies of the right main bronchi have not been fully described. Bronchial anomalies are usually asymptomatic unless they coexist with other abnormalities. We describe a rare bronchial anomaly in a 2-month-old girl in which the right upper lobe, middle lobe, and lower lobe bronchi all originated at the same point as a result of a developmental teratogenic long right main bronchus and an absent bronchus intermedius. Furthermore, the left main bronchus contained a proximal segment of stenosis. This combination of anomalies, along with right upper lobe atelectasis and left-sided hyperinflation, resulted in a severe right mediastinal shift and respiratory distress. The mediastinum was returned to midline with endoscopic placement of an in-dwelling tracheobronchial stent into the left main bronchus. To the best of our knowledge, the specific developmental anomaly in our patient has not been previously described.
Bilateral Cerebellopontine Angle Metastatic Melanoma: A Case Report
Authors: Jacob Abraham , Brightman Rebecca P. , Welling D. Bradley
Published: May 2019

Although melanoma accounts for approximately 1% of all malignancies, melanoma metastases to the cerebellopontine angles (CPAs) are exceedingly rare. Here we describe a patient with melanoma metastases to the internal auditory canals and CPAs who presented with a remote history of cutaneous melanoma. This patient had a rapidly progressive hearing loss, vestibulopathy, and facial nerve dysfunction. Magnetic resonance imaging demonstrated bilateral, enhancing CPA lesions but was otherwise nonspecific. The diagnosis required a careful history, unilateral surgical resection for tissue acquisition, and histopathologic confirmation. A search for primary cutaneous melanoma at the time of presentation was negative. However, the history of cutaneous melanoma 8 years earlier distinguishes this patient's metastatic disease from solitary primary intracranial melanoma, an equally rare disease. Treatment consists of surgical excision, radiation, chemotherapy, and immunotherapy. The prognosis for patients with melanoma metastases is generally poor, but isolated reports of long-term survival have been described. Metastatic disease to the CPAs must be included in the differential diagnosis for any patient presenting with rapid-onset VIIth or VIIIth cranial nerve symptoms.
Kikuchi-Fujimoto Disease: A Report of 3 Cases
Authors: Phelan Eimear , Lang Emer , Gormley Peter , Lang John
Published: May 2019

Cervical lymphadenopathy has many underlying etiologies. One of its rare causes is Kikuchi-Fujimoto disease (Kikuchi's disease, histiocytic necrotizing lymphadenitis). We discovered such a cause in a 37-year-old woman who had presented with malaise, night sweats, and weight loss in addition to cervical lymphadenopathy. We based our diagnosis on excisional lymph node biopsy. We also review 2 other cases of Kikuchi's disease that were diagnosed by others at our institution. Clinically and histologically, Kikuchi's disease is very similar to lymphoma, and distinguishing the two is difficult. However, despite the fact that Kikuchi's disease is benign, an accurate diagnosis is important because misdiagnosis might lead to unnecessary surgery and/or chemotherapy.
A Study of Middle Cranial Fossa Anatomy and Anatomic Variations
Authors: Djalilian Hamid R. , Thakkar Kunal H. , Hamidi Sanaz , Benson Aaron G. , Mafee Mahmood F.
Published: May 2019

We conducted a study to establish standardized measurements of the common anatomic landmarks used during surgery via the middle cranial fossa approach. Results were based on high-resolution computed tomography (CT) images of 98 temporal bones in 54 consecutively presenting patients. Measurements were obtained with the assistance of the standard PACS (picture archiving and communication system) software. We found that the superior semicircular canal (SSC) dome was not the highest point on the temporal bone (i.e., the arcuate eminence) in 78 of the temporal bone images (79.6%). Pneumatization above the SSC and above the internal auditory canal (IAC) was found in 27 (27.6%) and 39 (39.8%) temporal bone images, respectively. The anterior wall of the external auditory canal was always anterior to the anterior wall of the IAC. The mean angles between the SSC and the posterior and anterior walls of the IAC were 42.3° and 60.8°, respectively. We also measured other distances, and we compared our findings with those published by others. We hope that the results of our study will help surgeons safely and rapidly locate anatomic landmarks when performing surgery via the middle cranial fossa approach.
Solitary Fibrous Tumor of the Parapharyngeal Space
Authors: Vo Quang T. , Wolf Joseph A. , Turner James W. , Murkis Marina , Saw Daisy , Shemen Larry J.
Published: May 2019

Solitary fibrous tumors are benign neoplasms of mesenchymal origin. They usually arise from the visceral or parietal pleura and peritoneum, although they have been found in many areas throughout the body. We report a case of solitary fibrous tumor of the parapharyngeal space. Microscopically, the tumor contained spindle cells with areas of marked hypercellularity without a definite pattern. Consistent with a benign lesion, there were few mitoses and no necrosis. The tumor cells stained strongly positive for CD34 and vimentin. At the 2-year follow-up, the patient was well and free of local and/or distant disease.
Use of AlloDerm Implant to Improve Cosmesis after Parotidectomy
Authors: Sachsman Suzanne M. , Rice Dale H.
Published: May 2019

We evaluated the effectiveness and practicality of using AlloDerm, an acellular human dermal matrix graft, as an interpositional barrier in an attempt to improve the appearance of the surgical defect created by parotidectomy. We performed AlloDerm reconstruction in a series of 10 patients, and we found that normal contour was satisfactorily restored in all 10. We conclude that the use of an AlloDerm implant is a low-risk, practical option for repairing the surgical defect in postparotidectomy patients.
Recurrence of Isolated Multiple Myeloma in the Skull Base: A Case Report and Review of the Literature
Authors: Husein Omar F. , Jacob Abraham , Massick Douglas D. , Welling D. Bradley
Published: May 2019

Extramedullary plasmacytoma involving the skull base is rare. We describe what we believe is the first reported case of recurrent multiple myeloma presenting as an isolated lesion in the central skull base in a patient with no evidence of systemic involvement. We discuss the patient's presentation, clinical course, and treatment, and we review the relevant scientific literature.
Extramedullar Plasmacytomas of the Larynx and Parapharyngeal Space: Imaging and Pathologic Features
Authors: Lewis Khari , Thomas Rose , Grace Richard , Moffat Christopher , Manjaly George , Howlett David C.
Published: May 2019

Extramedullary plasmacytoma is a rare plasma cell neoplasm that can occur in the head and neck. In this article we describe a case of multiple synchronous extramedullary plasmacytomas involving the upper airway, pharynx, and larynx. The clinical, imaging, and pathologic features of this neoplasm are discussed, together with potential treatment options.
Migration of Cochlear Implant Magnets after Head trauma in an Adult and a Child
Authors: Stokroos Robert J. , van Dijk Pirn
Published: May 2019

Cochlear implantation is considered to be a safe and effective treatment for severe to profound sensorineural hearing loss. Device failures are rare. We report the cases of 2 patients—a 44-year-old woman and a 3-year-old boy—with cochlear implants who were referred to our tertiary cochlear implant center for treatment of magnet migration secondary to mild head trauma. The migration had led to device failure in both cases. Surgical re-exploration was performed with nonmagnetic instruments, and both magnets were easily returned to their proper place. Postoperatively, implant function was restored to previous levels, and wound healing was uncomplicated. The incidence of magnet migration in cochlear implant patients is unknown. A few cases have been reported in children, but to the best of our knowledge, ours is the first report of magnet migration in an adult.
Correction of Caudal Deflections of the Nasal Septum with a Modified Goldman Septoplasty Technique: How we do it
Authors: Lawson William , Westreich Richard
Published: May 2019

Correcting deviations of the caudal septum can be challenging because of cartilage memory, the need to provide adequate nasal tip and dorsal septal support, and the long-term effects of healing. The authors describe a minimally invasive, endonasal approach to the correction of caudal septal deviations. The procedure involves a hemitransfixion incision, unilateral flap elevation, and cartilage repositioning by limited dissection and excision.
Rosai-Dorfman Disease Presenting as an Isolated Extranodal Mass of the Carotid Sheath: A Case Report
Authors: Lee Lisa , Glastonbury Christine M. , Lin Doris
Published: May 2019

Rosai-Dorfman disease is a rare, benign granulomatous disease that typically presents with massive cervical lymphadenopathy. In less than 50% of cases, other soft-tissue manifestations may also be found in the head and neck. Rosai-Dorfman disease can be difficult to diagnose because of its rarity and its ability to mimic, both clinically and radiologically, more common diseases such as lymphoma. The histopathologic diagnosis can also be difficult to make, particularly when the disease exhibits extranodal manifestations. We present a case of isolated extranodal Rosai-Dorfman disease involving the carotid sheath, without the typical massive adenopathy.