bluuebunny/crossref_metadata_2025 huggingface dataset:
Paediatric neck masses – a diagnostic dilemma
Authors: Connolly A. A. P. , MacKenzie K.
Published: November 2007

Three hundred and sixty children who had a head and neck mass excised during 1987 to 1992 at the Royal Hospital for Sick Children, Glasgow were studied. There were 210 males and 150 females with a mean age of 60.7 months (0.5 to 198 months). Pilomatrixomata/sebaceous cysts (34 per cent), thyroglossal cysts (13 per cent), branchial remnants (nine per cent) and dermoids (nine per cent) accounted for almost twothirds of the 264 non-lymphadenomatous benign lesions excised. Ninety-three lymphadenopathy masses consisted of 60 with reactive hyperplasia, 21 withMycobacteriuminfection and 12 lymphomas. There were three solid malignant tumours, two were rhabdomyosarcomata and one disseminated round cell tumour. The correlation between clinical diagnosis and histopathology of benign non-lymph node masses and solid tumours was 90 per cent and 100 per cent respectively, in benign lymph nodes, 66 per cent, but was poor in differentiating lymph node content. The mean time from presentation of a swelling to its excision was almost a year and the mean in-patient stay for excision of a mass was almost five days. The role of fine needle aspiration cytology (FNAC) in arriving at a diagnosis and reducing patient morbidity is discussed.
Cavernous lymphangioma in the adulat parotid
Authors: Morgan M. , Bennett M. , Wilson J.A.
Published: November 2007

Cavernous lymphangioma is a benign congenital lesion that usually appears in childhood. It rarely presents in the adult but may be diagnosed at this late stage due to the slow growing nature of the tumour. It is rarely found i n the salivary glands and when it does occur, the gland is usually incorporated by lymphangioma of surrounding tissue.

We present and discuss the case of a cavernous lymphangioma in the parotid gland of an adult male.
A case of a large dentigerous cyst containing a canine tooth in the maxillary antrum leading to epiphora
Authors: Altas Enver , Karasen R. Murat , Yilmaz A. Berhan , Aktan Bulent , Kocer Ibrahim , Erman Zekai
Published: November 2007

A case of a large dentigerous cyst containing a canine tooth in the maxillary antrum is presented. This case is of interest due because of its extensiveness and thepresence of a canine tooth in the roof of the maxillary sinus. In addition, this caused aright-sided epiphora. Enucleation of the cyst containing the ectopic tooth was made.
Metastatic follicular thyroid carcinoma to the paranasal sinuses: a case report and review
Authors: Altman Ken W. , Mirza Natasha , Philippe Lucien
Published: November 2007

Thyroid carcinoma metastatic to the paranasal sinuses is extremely rare, with only 11 cases reported in the English and European literature. We report a case of metastatic follicular thyroid carcinoma to the clivus with extension into the sphenoid and posterior ethmoid sinuses. Pathological diagnosis was obtained using an intranasal endoscopic biopsy. As with our patient, metastatic thyroid carcinoma may present with symptoms related to distant metastases rather than the primary lesion. Distant metastases in differentiated thyroid carcinoma portends a poor prognosis. Our case of metastatic thyroid carcinoma to the paranasal sinuses is summarized in the context of the 11 additional cases, and treatment options are discussed.
Lateral neck abscess caused by Streptococcus bovis in a patient with undiagnosed colon cancer
Authors: Goumas P. D. , Naxakis S. S. , Rentzis G. A. , Tsiotos P. D. , Papadas T. A.
Published: November 2007

Bacteraemia or endocarditis caused by Streptococcus bovis, a non-enterococcal group D streptococcus, is a very common finding in patients suffering from intestinal tumours or other colon diseases. A case of a patient with a lateral neck abscess caused by S. bovis is reported. During the treatment the patient was found to have colonic malignant lesions. The problems in the appropriate diagnosis and the possible correlation between these two clinical entities are presented and discussed.
Large endolymphatic sac. A congenital deformity of the inner ear shown by magnetic resonance imaging
Authors: Phelps P. D. , Mahoney C. F. O. , Luxon L. M.
Published: November 2007

Fluctuant and progressive hearing impairment in a patient with a wide vestibular aqueduct has been called the ‘large vestibular aqueduct syndrome’. Recently reports of magnetic resonance imaging (MRI) studies describe enlargement of the endolymphatic sac and duct in patients shown to have large vestibular aqueducts by computed tomography (CT). A patient with progressive deafness was shown to have borderline or slightly enlarged vestibular aqueducts by re-formatted sagittal CT. However, MRI in axial and sagittal planes gave a more satisfactory demonstration of both aqueduct and endolymphatic sac enlargement.
Aberrant common carotid artery encountered during free jejunal graft repair of oesophageal stricture
Authors: Prior M. J. , Johnson I. J. M. , Jones K. , Sharp J. F.
Published: November 2007

The origin and course of the carotid arterial sysem in the superior mediastinum and neck are remarkably constant. Although variations are rare, they can have important implications in certain clinical problems. In this report, a patient underwent free jejunal graft repair of a cervical oesophageal stricture caused by radiotherapy for a post-cricoid carcinoma. The common carotid artery on the side of the surgical approach was found to cross the midline to the other side of the neck, and created difficulties both with the procedure and future management. This has not been previously reported.
An unusual foreign body in the post-nasal space: a case report
Authors: Al-Ayoubi A. , Ray J.
Published: November 2007

We report a case of a 13-year-old boy who inserted a 5 cm nail into his nose. X-ray showed it in the post-nasal space and it was removed through the mouth.
Tumours and pseudotumorous lesions of the temporomandibular joint: a diagnostic challenge
Authors: Allias-Montmayeur Fabienne , Durroux Régine , Dodart Laurent , Combelles Roger
Published: November 2007

Tumours and pseudotumorous lesions originating from the synovial membrane of the temporomandibular joint are rare. We report a series of six cases of such disorders. There were two cases of synovial chondromatosis, two of calcium pyrophosphate dihydrate crystal deposition disease, one nodular synovitis and one synovial sarcoma. Three patients were female and three were male. Their ages ranged from 36 to 70 years. All had atypical clinical and radiographical presentation. The prevalence, clinical and radiographical findings and pathological features of each disease entity are discussed and a review of the literature is made concerning all tumours and pseudotumours arising from the temporomandibular joint.
Prevalence of otitis media with effusion in multicultural schools in Hong Kong
Authors: Rushton H. C. , Yue V. , Wormald P. J. , van Hasselt C. A.
Published: November 2007

The prevalence of otitis media with effusion (OME) in Asia has only been studied in a limited fashion. This preliminary study forms part of a larger study aiming to establish the prevalence of OME in Hong Kong. One hundred and seventy-seven children (from multicultural schools) between the ages of five and 6.03 years were screened for OME using otoscopy and tympanometry. Nine positive screens (5.1 per cent) were obtained for OME. Within this mixed ethnic group, Chinese children had a significantly lower point prevalence (1.3 per cent) than Caucasian children (9.5 per cent) (p<0.05). Although the point prevalence from this mixed ethnic group of children was significantly higher (p<0.05) than that of local Chinese school children (1.95 per cent) by the same group of investigators, the point prevalence in the ethnic Chinese children was comparable. The reason for the lower prevalence of OME in the Chinese population needs further research.
A consideration of the effect of ear canal resonance and hearing loss upon white noise generators for tinnitus retraining therapy
Authors: Baguley David M. , Beynon Graham J. , Thornton Frances
Published: November 2007

Tinnitus retraining therapy has been heralded as a major advance in the alleviation of tinnitus perception. A cornerstone of this technique is to use white noise produced by a white noise generator (WNG) over a period of several months in order to assist the patient to habituate to their tinnitus. There are three factors which influence the frequency spectrum of the perceived noise such that the perception of white noise from a WNG is unlikely. These factors are the actual spectrum of the emitted noise, the ear canal resonance of the patient and the hearing sensitivity of the patient.

Advocates of tinnitus retraining therapy state that white noise is the optimal stimulation to assist habituation of tinnitus. This paper demonstrates that this optimal situation is unlikely to be achieved and that this may account for the long periods needed for patients to achieve benefit from the technique. The development of devices that allow for the above factors to be countered is suggested.
Teeth in the maxillary sinus – imaging and management
Authors: Bodner Lipa , Tovi Ferit , Bar-Ziv Jacob
Published: November 2007

Purpose

To evaluate the images obtained by CT in diagnosis and treatment plan of teeth in the maxillary sinus.

Methods

Twelve patients with teeth in the maxillary sinus were studied by plain film radiography(PFR) and by CT with a dental software programme, which displays multiple panoramic and cross-sectional views of the mandible and maxilla. The three-dimensional morphology of the tooth, its inclination, proximity to the sinus wall, surgical planning and prediction of prognosis and complications were estimated on both PFR and on CT scans and scored.

Results

The radiographical features interpreted from PFR were fair or poorly diagnosed whereas CT provided excellent features. The surgical approach of choice was based on CT interpretation.

Conclusion

CT is useful for diagnosis and treatment planning of teeth in the maxillary antrum.
Diagnostic importance of the nucleolar organizer regions in Wegener's granulomatosis
Authors: Yue Wen L. , Ma Zheng Z. , Sun Zhi H.
Published: November 2007

The number and distribution pattern of silver staining nucleolar organizer regions (AgNORs) were thought to reflect the cellular proliferative activity and the malignancy of tumours. Using a silver-staining method, the variations of AgNORs have been studied in patients with atypical inflammatory lesion (n = 5), malignant reticulosis (n = 5) and Wegener's granulomatosis (n = 6). Our results reveal that there was a statistically significant difference (p<0.01), highly suggestive of a difference in AgNOR counts between the atypical inflammatory lesion and Wegener's granulomatosis, with the Wegener's granulomatosis specimens having the higher irregular AgNORs, but the difference between Wegener's granulomatosis and malignant reticulosis is probably not clinically important. It is concluded that AgNORs may be useful in differentiating Wegener's granulomatosis from an atypical inflammatory lesion, and the simplified counting technique is adequate for the purpose.
Adult obstructive sleep apnoea syndrome and tonsillectomy
Authors: Houghton D. J. , Camilleri A. E. , Stone P.
Published: November 2007

A surgical cure for adult obstructive sleep apnoea syndrome (OSAS) is an attractive alternative to nasal continuous positive airway pressure, but current research suggests that uvulopalatopharyngoplasty is not effective in all patients. No subgroup of these patients, who might benefit from surgery to the oropharynx, has as yet been identified. In this study we examined the results of tonsillectomy either as an isolated procedure or as part of uvulopalatopharyngoplasty in seven patients, who had tonsillomegaly. In all seven there was a short-term improvement between the pre-operative and post-operative apnoea/hypoapnoea (A/H) index (100-65 per cent), which could not be accounted for by change in the body mass index (BMI). In one patient a diagnosis of Non-Hodgkin's lymphoma was made from histological examination of the tonsils. The results suggest that adult patients with tonsillomegaly may represent a subgroup of patients with OSAS, who would benefit from surgery aimed at the oropharynx.
Metastatic carcinoma of the temporal bone presenting as glomus jugulare and glomus tympanicum tumours: a description of two cases
Authors: Hellier W. P. L. , Crockard H. A. , Cheesman A. D.
Published: November 2007

Two cases of metastatic carcinoma of the temporal bone, that simulated glomus tumours on thorough preoperative evaluation are described. Although rare, metastatic spread to this area is recognized, but presentation in this way is unique.
Childhood obstructive sleep apnoea syndrome due to nasopharyngeal viral papillomatosis
Authors: Wheatley A. H. , Temple R. H. , Camilleri A. E.
Published: November 2007

We present a case of obstructive sleep apnoea in a child that is caused by papillomatosis of the post-nasal space.
Occult sphenoid sinusitis presenting clinically as parotid swelling: A case report
Authors: Balraj A. , Abramovich S. , Shorvon P.
Published: November 2007

A case of occult sphenoid sinusitis was diagnosed by an MRI scan in a patient who presented clinically with meningism and unilateral parotid swelling. Although the patient improved with a prolonged course of antibiotics complete resolution occurred only after surgical drainage of the affected sinus.
Cochlear implantation: a review of the literature and the Nijmegen results
Authors: Makhdoum Mohammad Jamal A. , Snik Ad F. M. , van den Broek Paul
Published: November 2007

The field of cochlear implantation is developing rapidly. In subjects with bilateral profound deafness who gain no benefit from conventional hearing aids the aim of cochlear implantation is to provide a means for them to receive auditory sensations. Throughout the world, most cochlear implant centres are still continuing their research efforts to improve the results with this technique. Although it is still difficult to predict how an individual will perform with a cochlear implant, the success of cochlear implantation can no longer be denied. In this paper, we review some recent papers and reports, and the results of the various Nijmegen cochlear implant studies. Data about subject selection, examinations, surgery and the outcome are discussed. Our results were in good agreement with those of other authors. It can be concluded once again that cochlear implantation is an effective treatment for postlingually deaf adults and children, and for prelingually (congenital or acquired) deaf children with profound bilateral sensorineural deafness.
Congenital and early-onset bilateral hearing impairment in children: the delay in detection
Authors: Vartiainen Eero , Karjalainen Seppo
Published: November 2007

A retrospective review of 168 consecutive children with congenital or early-onset bilateral hearing impairment (>25 dB, 0.5–4 kHz, in the better hearing ear) was conducted. Only 39 per cent of the hearingimpaired children were diagnosed within the first two years of life. The age at diagnosis was related to the severity of hearing loss with profound (>95 dB) hearing losses being detected earlier than the other degrees. However, 37 per cent of children with severe to profound (>70 dB) hearing loss were still not diagnosed until after two years of age. Children with severe to profound hearing loss and with known risk factors were diagnosed earlier than children with the same hearing status but with no known risk factors. It was concluded that the behavioural hearing screening tests used in our well-baby clinics are insufficient and, therefore, more reliable methods, preferably evoked otoacoustic emissions, should be used for universal hearing screening of infants and young children in spite of the great cost.
The techniques of nonmuscular closure of hypopharyngeal defect following total laryngectomy: the assessment of complication and pharyngoesophageal segment
Authors: Wang Ching-Ping , Tseng Tzu-Chan , Lee Rheun-Chuan , Chang Shyue-Yih
Published: November 2007

The usual method of reconstructing a hypopharyngeal defect during total laryngectomy includes pharyngeal muscle layer closure, which may result in high pharyngoesophageal pressure. We hypothesize that nonclosure of the pharyngeal muscle can reduce the pressure of the pharyngoesophageal segment which can reduce the chances of the formation of pharyngocutaneous fistulae. A technique of nonmuscular closure of a hypopharyngeal defect is presented. The differences in the rate of fistula formation and swallowing function between patients with usual and nonmuscular closure were also studied. Sixty consecutive laryngectomees were enrolled in this study. Thirty patients received usual closure after total laryngectomy, whereas the other 30 patients underwent non closure of their pharyngeal muscles. One patient (3.3 per cent) in the nonmuscular closure group and three patients (10 per cent) in the usual closure group developed a pharyngocutaneous fistula. The pharyngoesophageal pressures of the nonmuscular closure group were significantly lower than those of the usual closure group. We conclude that the technique of nonclosure of the pharyngeal constrictor muscle after total laryngectomy is relatively more simple and is not associated with a higher rate of fistula formation. Furthermore, nonclosure of the pharyngeal constrictor muscle is preferable to muscular closure because it reduces the spasm of the pharyngoesophageal segment which limits voice rehabilitation.
Susac's syndrome: a rare cause of fluctuating sensorineural hearing loss
Authors: Bateman Neil D. , Johnson Ian J. M. , Gibbin Kevin P.
Published: November 2007

Susac's syndrome is extremely rare and is characterized by the clinical triad of encephalopathy, retinal artery occlusion and deafness. A case of this rare syndrome is presented and for the first time the fluctuating nature of the hearing loss is demonstrated. The site and nature of the hearing loss has been investigated. The value of neural hearing loss as a method of monitoring the clinical severity is discussed.
Actinomycosis of the posterior triangle: a case report and review of the literature
Authors: Burns B. V. , Al-Ayoubi A. , Ray J. , Schofield J. B. , Shotton J. C.
Published: November 2007

Actinomycosis presents acutely as an abscess, or as a chronic lesion mimicking malignancy, tuberculosis, or aspergillosis. Most disease involves the mouth and its immediate site of lymphatic drainage, the anterior triangle of the neck. We present a case of actinomycosis at th e apex of th e posterior triangle, suspected of being a malignancy, and discuss the importance of being aware of this as a cause of neck lumps. The diagnosis is usually made late because of the difficulties in culturing the organism, or in identifying characteristic ‘sulphur granules’ in pus or biopsy specimens. For these reasons, the disease is underdiagnosed. When acute or chronic neck lesions prove difficult to diagnose, microscopy and prolonged anaerobi c culture of pus and biopsy specimens should be performed in addition to Ziehl-Neelsen staining, tuberculosis and fungal cultures. The tests should be repeated if negative. Specific treatment requires prolonged courses of antibiotics, despite adequate surgical excision, to prevent relapse.
Sudden bilateral hearing loss due to gastric carcinoma and its histological evidence
Authors: Suzuki Yayoi , Kaga Kimitaka , Sugiuchi Yuriko , Ishii Tetsuo , Suzuki Jun-Ichi , Takiguchi Takashi
Published: November 2007

Six temporal bones and a brain tissue sample removed at autopsy from four patients with bilateral sudden hearing loss related to gastric adenocarcinoma were histologically studied. The pathological remains suggest that the sudden hearing loss of these patients may have occurred via one of two different mechanisms: (1) metastasis to the internal auditory meatus damaging the auditory nerve or (2) inner ear haemorrhage damaging Corti's organ. These two mechanisms may cause bilateral sudden deafness in patients with gastric adenocarcinoma.
Management of upper airway obstruction in Pierre Robin sequence
Authors: Bath A. P. , Bull P. D.
Published: November 2007

Pierre Robin sequence (PRS) presents in the neonatal period with upper airway obstruction and feeding difficulties. Infants with pronounced micrognathia may fail to thrive because of chronic airway obstruction, or experience severe respiratory distress. This is potentially fatal and surgical intervention in these cases is necessary. We present our series of cases with severe PRS requiring surgical relief of their airway obstruction, and the reasons for preferring tracheostomy over glossopexy.
Invasive aspergillosis of the paranasal sinuses: a medical emergency
Authors: Saleh Hesham A. , Beidger Michael W. M.
Published: November 2007

A rare case of invasive aspergillosis of the paranasal sinuses in a previously healthy individual is presented. The disease caused severe complications and proved fatal. Classification, aetiology and presentation of sinus aspergillosis are discussed. Early diagnosis and management is stressed to avoid the high incidence of morbidity and mortality.
Retropharyngeal abscess and acute torticollis
Authors: Harries Philip G.
Published: November 2007

Acute torticollis may result from an inflammatory process irritating the cervical muscles. In children there is often an association between acute torticollis and retropharyngeal cellulitis/abscess.

Over six weeks, two children with acute torticollis presented to our Department. Both children were found to have retropharyngeal cellulitis/abscess. The problem of differentiating between the non-suppurative and the suppurative phases of the disease process is discussed.
Invasive candidiasis of the tonsil
Authors: Kuo M. J. , Warfield A. T. , Nye K. J. , Crocker J.
Published: November 2007

A patient with unilateral tonsillar enlargement secondary to locally invasive candidal infection is presented. This was not associated with any history of immunosuppression or prolonged use of broad-spectrum antibiotics. Invasive candidal infection of the tonsil has not previously been reported.
Endoscopic management of paranasal sinus mucocoeles
Authors: Lund Valerie J.
Published: November 2007

Mucocoeles of the paranasal sinuses are relatively uncommon and in the past have been generally treated by an external surgical approach. Forty-eight mucocoeles in the frontal, fronto-ethmoidal and sphenoidal sinuses have been treated during the last five years, 20 by an entirely endonasal endoscopic approach and 28 by a combination of an external procedure and an endoscopic approach. There were no recurrences in the endoscopic group, with a mean follow-up of 34 months whilst three recurrences occurred in the combined external and endoscopic group which had a mean follow-up of 44 months. This may reflect the complexity and severity of concomitant disease. If a wide marsupialization can be achieved by an entirely endoscopic approach there are a number of advantages, notably a lack of facial scarring in children and young adults.
Claudication on mastication following bilateral external carotid artery ligation for posterior epistaxis
Authors: Motamed M. , Farrell R. , Philpott J. , Rea P.
Published: November 2007

This case highlights a potentially disabling complication of intermittent claudication inthe region of the masseter muscles on mastication, following bilateral external carotid artery ligation for epistaxis. Although there have been few reports of this complication this may be a reflection of the fact that the operation is rarely performed, and not because the complication is rare. Its potentially disabling nature, and its possible common occurrence after this procedure make awareness of it by surgeons who may carry out this procedure important.
Primary non-Hodgkin's lymphoma of the larynx in an AIDS patient
Authors: Simo Ricard , Hartley Christopher , Malik Tass , Wilson Godfrey E. , Taylor Peter H. , Mandal Bibhat K.
Published: November 2007

A case of primary non-Hodgkin's lymphoma of the larynx in an AIDS patient is presented with a review of the literature. Non-Hodgkin's lymphomas in AIDS patients are common but the primary laryngeal presentation is very rare. The symptoms usually include dysphonia and progressive airway obstruction requiring tracheostomy. As with laryngeal non-Hodgkin's laryngeal lymphomas in non-HIV positive patients the majority are of B cell lineage and respond well to radiotherapy. Our patient had a high grade lymphoma of B cell lineage which showed a good response to radiotherapy. The role of chemotherapy and surgery is not yet established. We suggest that the diagnosis of AIDS should not influence the management of these patients unless the individual is in the terminal disease stage.
Is primary radiotherapy an appropriate option for the treatment of verrucous carcinoma of the head and neck?
Authors: Ferlito Alfio , Rinaldo Alessandra , Mannarà Giacinto M.
Published: November 2007

The literature on verrucous carcinoma of the head and neck was reviewed to analyse the use of primary radiation therapy in the treatment of this lesion. The results emphasize an overall local control rate of 43.2 per cent, and 6.7 per cent of true anaplastic transformation following irradiation. Diagnosis remains the fundamental problem: without a correct diagnosis of verrucous carcinoma, no correct treatment can be applied.
Acute granulomatous myringitis
Authors: Hoshino Tomoyuki , Ueda Yoh , Mukohdaka Hiroyuki , Mizuta Kunihiro
Published: November 2007

This case report describes five cases of acute granulomatous myringitis treated during the nine-year period from 1987 to 1996. Otorrhoea and slight otalgia were the two major complaints. Findings included the appearance of a granulomatous bulge along the handle of the malleus or on the eardrum. No cases displayed eardrum perforation. No similarities were noted in patient age, sex or affected side. Treatment consisted of removal of the granuloma with a small cup forceps plus cauterization with 20 per cent trichloracetic acid. Two or three treatments resulted in complete healing, and average time to healing was 30 days, with no recurrences. Because it differs so distinctly from the more common chronic myringitis – characterized by mild symptoms, erosion and perforation of the eardrum with little granulomatous change, and a longer time to healing with frequent recurrence – the authors conclude that acute granulomatous myringitis should be regarded as a separate entity.
Tympanoscopy to increase the accuracy of diagnosis in conductive hearing loss
Authors: Karhuketo Tapio S. , Puhakka Heikki J. , Laippala Pekka J.
Published: November 2007

The diagnosis of conductive hearing loss is usually based on audiological methods and radiology. The aim of our study was to show that there is a useful additive method to clarify the findings of diseases with conductive hearing loss.

Patients (151 ears) with conductive hearing loss were examined using several methods: otomicroscopy, air- and bone-conduction threshold, pure tone average, speech threshold, speech discrimination, tympanometry and stapedial reflex and tympanoscopy.

The management of the patients changed in 17 per cent of cases due to tympanoscopy. In a group with normal tympanic membrane the movement of the stapes during endoscopy was compared to stapedial reflex. Stiff stapes were found more often than an abnormal stapedial reflex.

Middle ear endoscopy can increase the accuracy of diagnosis of conductive hearing loss thus enhancing decision making in the case of the patient.
Cochlear implantation of a Hungarian deaf and blind patient with discharging ears suffering from Behçet's disease
Authors: Szilvassy J. , Czigner J. , Jori J. , Toth F. , Szilvassy Z. , De Mora Mieszkowski J. , Kiss J. G.
Published: November 2007

A case is reported in which a Nucleus 22 channel intracochlear device was implanted a deaf/blind Hungarian adult with discharging ears suffering from Behçet's disease. Preconditioning surgery was employed three months prior to the implantation procedure to ensure a sterile, dry protected environment for the electrodes. One month after implantation, the patient exhibited excellent auditory discrimination capability at the time of the first switch on. We suggest that some deaf/blind individuals may serve as very good candidates for intracochlear implantation.
Extra-articular pigmented villonodular synovitis of the temporomandibular joint
Authors: Chow Louis T. C. , Kumta S. M. , King Walter W. K.
Published: November 2007

Pigmented villonodular synovitis, a benign but locally destructive fibrohistiocytic proliferative lesion involving tendon sheaths, bursae and diarthrodial joints, is distinctly rare in the temporomandibular joint. We report one such case occurring in a 42-year-old housewife who presented with a progressively enlarging right zygomatic mass for six months. On exploration, an orange-brown firm mass, 5 × 3 × 2 cm, was seen adherent to the lateral aspect of the capsule of the right temporomandibular joint, and eroding into the inferior aspect of the right temporal bone and part of the mandibular condyle. The mass was completely excised. Pathological examination showed features typical of those of pigmented villonodular synovitis and the lesion was entirely extra-articular in location. The patient remained well with no evidence of local recurrence two years after operation. Review of the literature and careful analysis of the clinicopathological features showed that the vast majority of the reported cases of pigmented villonodular synovitis of the temporomandibular joint belonged to the extraarticular variant, which is associated with a more aggressive local infiltrative behaviour and higher rate of local recurrence than the localized type. The recommended treatment for this condition is therefore wide local excision, aiming to remove the lesion as completely as possible without producing severe disability for the patient.
Failure to control the airway in a patient with Hunter's syndrome
Authors: Gaitini Luis , Fradis Milo , Vaida Sonia , Collins Geoffrey , Croitoru Millian , Somri Mustafa , Borochovltz Zvi , Golz Avishai
Published: November 2007

Hunter's syndrome is due to recessively inherited mucopolysaccharide storage diseases. The anaesthetic complications in this syndrome are related to the organs involved in the disease, but pertain especially to upper airway obstruction problems. We report a patient with Hunter's syndrome who, while under general anaesthesia for a simple procedure (the introduction of bilateral grommets), suffered a fatal outcome.
Level I dissection for laryngeal and hypopharyngeal cancer: is it indicated?
Authors: Ferlito Alfio , Rinaldo Alessandra
Published: November 2007

Squamous cell carcinoma of the larynx and hypopharynx tends to metastasize frequently to cervical lymph nodes, the location of which depends mainly on the site of the primary lesion. Five anatomical levels of cervical nodes have consequently been defined to standardize the terminology used to describe which lymph node groups are at risk for metastatic spread. Level I includes the submental and submandibular triangles. This review considers the role of these triangles in neck dissection and concludes that, unless there is clear evidence of spread, the inclusion of the level I triangles in the neck dissection is unwarranted since these nodes are not really at risk. There is therefore an important role for selective neck dissection in suitable cases of squamous cell carcinoma of the larynx and hypopharynx.
Pre-operative and per-operative factors conditioning long-term facial nerve function in vestibular schwannoma surgery through translabyrinthine approach
Authors: Deguine Olivier , Maillard André , Bonafe Alain , Adouli Hassan El , Tremoulet Michel , Fraysse Bernard
Published: November 2007

Facial nerve function was evaluated in 103 patients, after vestibular schwannoma removal through the translabyrinthine approach. The mean follow-up was 43 months (minimum six months). Grade I facial function was achieved in 100 per cent of stage I schwannomata compared with 36 per cent of stage IV schwannomata. Grade I or II facial function was found in 78 per cent of homogeneous schwannomata, compared with 48 per cent of heterogeneous schwannomata. Facial function was preserved in 89 per cent of cases, if the angle between the internal auditory canal and the schwannoma was >66°, compared with 54 per cent if the angle was <66°. There was 82 per cent of normal facial function when the nerve appeared normal after tumour removal, compared with 18 per cent when the nerve was traumatized. When the ratio (stimulation threshold at the internal auditory canal/stimulation threshold at brainstem) was <2, postoperative facial function was preserved in 87 per cent of cases, compared with 13 per cent when the ratio was >2.
Combined transfacial and neurosurgical approach to malignant tumours of the ethmoid sinus
Authors: Salvan D. , Julieron M. , Marandas P. , Janot F. , Leridant A. M. , Domenge C. , Mamelle G. , Schwaab G. , Luboinski B.
Published: November 2007

In order to understand the risks and benefits of a combined transfacial and neurosurgical procedure for neoplasms of the ethmoid sinus, we reviewed all patients who underwent this surgical approach in our department between 1986 and 1994.

The study included 41 patients. Pathological diagnoses included adenocarcinoma (31 patients), squamous cell carcinoma (three patients), aesthesioneuroblastoma (three patients), other (four patients). The overall morbidity rate was 39 per cent, and the post-operative mortality rate was 2.5 per cent. Complications were statistically more likely in patients with bone skull base reconstruction. The main carcinologic failures were local recurrences (24 per cent) and metastases (22 per cent). The one-year, three-year and five-year Kaplan Meir survival rates were respectively 84 per cent, 53 per cent and 36 per cent. In conclusion, the mortality and morbidity were acceptable, especially when no bone skull base reconstruction was performed. Better local control justifies a combined procedure with post-operative radiotherapy when tumours involve or reach the skull base.
Sudden onset aphonia caused by a Japanese-style bath
Authors: Tsunoda Koichi , Takanozawa Minako , Choh Kouhei
Published: November 2007

An 86-year-old man was referred by his family physicianto our clinic because of sudden onset aphonia immediately after a Japanese-style bath. On examination, the only abnormality was aphonia, with an otherwise normal physical examination. However, we found vocal fold oedema on laryngeal fibrescopy. For treatment, he was immediately given 30 mg prednisolone intravenously. Twelve hours after injection the oedema had completely disappeared and his aphonia had resolved. The patient was healthy for three months after returning home. However, at the beginning of a cold winter night he again complained of sudden onset hoarseness, after taking a Japanese-style bath.

Japanese-style baths are completely different from Western-style baths. There is a temperature difference of almost 30°C between the inside and outside of a bath; the transition may represent a type of physical exercise in elderly and exhausted individuals. This difference could cause a cold or heat-induced allergic reaction. We strongly recommend a laryngeal study in case of sudden onset aphonia.
Papillary endothelial hyperplasia (Masson's tumour) of the maxillary sinus
Authors: Lancaster J. L. , Alderson D. J. , Sherman I. W. , Clark A. H.
Published: November 2007

In 1923, Masson described a neoplastic process consisting of papillary hyperplasia of the endothelial cells, with a consequent obliteration of the vascular lumen, followed later by degenerative changes. Masson coined the term vegetant intravascular haemangioendothelioma, however, these days it is more commonly known as papillary endothelial hyperplasia (PEH), or by the pseudonym, Masson's tumour. Although relatively rare, there are numerous accounts of PEH in the literature, describing its predilection for the head and neck region. Our case report describes the finding of a PEH within the paranasal sinuses, a site not previously mentioned even in the largest of series found on literature search. We will then discuss the relevant histological features of the lesion, and its natural history.
Microsurgical technique in thyroid surgery – a 10-year experience
Authors: Nielsen Torfinnur Rubek , Andreassen Ulrik Koks , Brown Christopher Leigh , Balle Viggo Hulthin , Thomsen Jens
Published: November 2007

Objective

To report the results of thyroid surgery in a University department of ENT – head and neck surgery, and to evaluate the benefits of the use of the surgical microscope in thyroid surgery.

Design

A retrospective evaluation of the records of all patients who underwent thyroid surgery in the 10-year period 1987–1996.

Methods

In addition to standard surgical principles the Zeiss multi-discipline universal surgical microscope with a 250 mm ocular lens was used in all cases. Total thyroidectomy was performed in all malignant cases, while unilateral lobectomy plus isthmus resection was the standard procedure in benign cases.

Patients

There were 573 patients, aged 11–87 years, 444 females and 129 males. Four hundred and fifty-one had benign lesions, 122 malignant. Four hundred and eighty-nine had primary surgery, 84 underwent completion surgery or surgery for recurrent disease.

Results

Primary thyroid gland surgery in benign/malignant disease resulted in permanent recurrent laryngeal nerve palsy in 0.6 per cent/3.5 per cent of the patients respectively, when calculated as nerves at risk (NAR). In benign recurrent or malignant completion surgery this complication rate was 4.5 per cent/2.9 per cent respectively.

Conclusion

Thyroid surgery in our University ENT – Head and Neck Department with the use of the surgical microscope provides pleasing results, especially considering the diversity of surgeons, due to the departments' teaching responsibilities.
Frontal sinolith
Authors: Grant D. G. , Hussain A. , Burgel R.
Published: November 2007

We report on a case of an endogenous frontal sinolith and a literature review of classification and use of the terms rhinolith, and sinolith.
Rheumatoid nodules of the larynx
Authors: Sørensen Waldemar Trolle , Møller-Andersen Kim , Behrendt Nille
Published: November 2007

A 67-year-old woman with rheumatoid arthritis was hospitalized because of dysphagia and severe nodulosis. Over a two-year period the patient had been treated with methotrexate. A computed tomography (CT) scan of the neck showed a 2 × 2 cm large tumour behind the top left lateral thyroid cartilage. A biopsy taken during direct laryngoscopy showed it was a rheumatic nodule. Treatment with colchicine reduced the patient's dysphagia. As methotrexate is used increasingly in the treatment of rheumatoid arthritis and as this particular drug causes rheumatic nodules in five to 10 per cent of the patients, it must be foreseen that the incidence of nodules in the upper airways will increase.
Invasive laryngeal candidiasis: a cause of stridor in the previously irradiated patient
Authors: Ganesan S. , Harar R.P.S. , Dawkins R. S. , Prior A. J.
Published: November 2007

Upper airway obstruction is always a serious condition. In patients who have previously been irradiated for a laryngeal malignancy, it normally implies either residual or recurrent disease. We report a case of stridor due to invasive laryngeal candidiasis in a patient who had undergone radiotherapy for a T1aN0squamous cell carcinoma of the glottis eight months earlier. Extensive investigation failed to identify recurrence of disease and the patient responded to prolonged topical antifungal therapy. Infection withCandidaspecies is most frequently found in debilitated or immunocompromised patients. Although cases of upper airway obstruction in children secondary to idiopathic laryngeal candidiasis have been reported, to our knowledge no such presentation has been described in adults. This report highlights the difficulty of diagnosis and treatment. Familiarity with candidal infection is important for early diagnosis and appropriate treatment.
Recurrent unilateral tonsillitis secondary to a penetrating foreign body in the tonsil
Authors: Sekhar P. , El-Jassar P. , Ell S. R.
Published: November 2007

We report a case of an impacted foreign body in the tonsil presenting as recurrent unilateral tonsillitis. A completely embedded foreign body should be considered in cases of recurrent unilateral tonsillitis.
Tuberculosis of the mandible in a child
Authors: Kothari Prasad , Bartella Lia , Carter John , Chan Otto , Piper Kim
Published: November 2007

The incidence of notification of tuberculosis is increasing in the developed world. The disease has a variable mode of presentation and therefore diagnosis is not easy. We present an unusual case of tuberculosis involving the ramus of the mandible in a six-year-old boy and outline its management.
Tuberculosis of the parotid gland
Authors: Süoǧlu Yusufhan , Erdamar Burak , Çölhan İsmail , Katircioǧlu O. Sami , Çevikbas Uǧur
Published: November 2007

The presentation of tuberculosis as an isolated parotid lump is rare. In this paper, six cases with tuberculous parotitis are reported which were evaluated as a benign parotid neoplasm in 216 specimens pre-operatively. All but one of them had no previous history of tuberculosis and all had a parotid lump as a sole symptom for at least one year. The diagnosis of tuberculosis was made, after superficial parotidectomy, by histopathology. Parenchymal involvement and intraparotid lymph node involvement with tuberculosis were seen in five and three patients, respectively. Two of the patients had lymph node involvement outside the parotid area. One of six patients had a coincidental Warthin tumour. A surgical approach is not only therapeutic but also diagnostic when other diagnostic tools fail.
Study of common aerobic flora of human cerumen
Authors: Campos A. , Arias A. , Betancor L. , Rodríguez C. , Hernández A. M. , Aguado D. López , Sierra A.
Published: November 2007

Cerumen is the product of the secretion of the sebaceous, ceruminous or apocrine glands together with cells exfoliated from the cornified stratum of the epithelium of the external auditory canal (EAC).

In the present study we identified and quantified common flora of human cerumen. The mean count obtained was 106microorganisms per ml of cerumen suspension.

In 24 pools of cerumen (33.3 per cent) the isolates were monomicrobial,Staphylococcus epidermidis(12),Corynebacteriumspp (10),Staphylococcus aureus(1) andStreptococcus saprophyticum(1). In 48 pools (66.6 per cent) we found polymicrobial isolates.

The most commonly isolated bacteria in these polymicrobial isolates wereS. epidermidis(35) andCorynebacteriumspp. (43). It is noteworthy that there were isolates ofCandida albicansin three cases; in one case ofPseudomonas stutzeri, in one case ofPseudomonas aeruginosa, and, on seven occasions, ofS. aureus.

The organisms isolated as common bacterial components of human cerumen in our experience were similar to those found by other authors. However, the mean count was much higher. This could be related t o climatic conditions and to the length of time the cerumen had remained in the external auditory canal.
Isolated sphenoethmoid recess poiyps
Authors: Sethi Dharambir S. , Lau David P. C. , Chee Lincoln W. J. , Chong Vincent
Published: November 2007

Isolated sphenoethmoid recess (SER) polyps are rare. They usually arise from the sphenoid sinus. We report six patients with SER polyps as the only abnormal clinical finding at initial presentation. All cases were investigated with outpatient biopsy and computed tomography (CT) or magnetic resonance (MR) imaging. Pre-operative histology revealed three cases of inflammatory disease, two cases with inverted papilloma, and one case of an ectopic pituitary adenoma arising from the sphenoid sinus. One of the inflammatory polyps arose directly from the mucosa around the sphenoid ostium. The other five cases involved the sphenoid sinus. Except for the ectopic pituitary adenoma all the polyps were managed by transnasal endoscopic surgery. We emphasize that isolated SER polyps may signify existing sphenoid pathology and a pre-operative biopsy is valuable for planning surgery.
Grommet insertion in children: a survey of parental perceptions
Authors: Karkanevatos A. , Lesser T. H. J.
Published: November 2007

Grommet insertion is a widely accepted method of treatment of glue ear in children. There have been questions raised over the last few years about the indications for grommets and whether assessing the hearing alone is an efficient outcome measure. Parental pressure accounts for one of the factors that is taken into consideration when the decision to insert grommets for glue ear is made. In this paper, a prospective questionnaire is used to investigate the parental perceptions of the effectiveness of grommet insertion in children, focusing on alternative outcome measures such as general health, language, and social skills. The results of this survey suggest that grommet insertion causes improvement in many factors other than hearing and this seems to account for the parental pressure for siblings to have grommet insertion.
Expression of transforming growth factor-α (TGF-α) in cholesteatoma
Authors: Shiwa Masanori , Kojima Hiromi , Moriyama Hiroshi
Published: November 2007

This study aims at elucidating the role of cytokines in the mechanism of proliferation of cholesteatoma epithelium by investigating the mode of expression of epidermal growth factors, such as TGF-α. The subjects of this study were patients who had undergone operation for middle ear cholesteatoma. Skins of the bone region of the externalear canal (normal skin) of the same patients were used as the negative control. The mode of expression of TGF-α was studied by immunohistochemistry andin situhybridization. In the immunohistochemical study, there were no conspicuous differences observed between cholesteatoma tissues and normal skin. Afterin situhybridization, expression of TGF-α mRNA was mainly observed in the epidermal basal cell layer in the normal skin, while in the cholesteatoma epidermis with severe inflammatory cell infiltration, expression of TFG-α mRNA was observed up to layers superior to the basal cell layer. The expression of TGF-α mRNA is greatly affected by subepithelial connective tissue, strongly suggesting involvement of paracrine regulation in proliferation of cholesteatomaepithelium.
Management of subglottic haemangioma
Authors: Martin Bailey C. , Froehlich Patrick , Hoeve Hans L. J.
Published: November 2007

Two contrasting methods of treatment for paediatric subglottic haemangioma are presented. Dr. Hoeve describes his results using intralesional steroids and short-term intubation, and Dr. Froehlich discusses his outcomes with open surgical excision. Mr. Bailey then reviews the currently available therapeutic options with special reference to each of the above techniques, and suggests an optimum plan of management given our current state of knowledge.

The conclusion is that very small haemangiomas may not require treatment, or may be amenable to CO2 laser vaporization. Medium-sized lesions seem suitable for intra-lesional steroids and intubation, but large ones are probably best managed by primary submucous resection. Very large haemangiomas, and especially those which are circumferential or in which magnetic resonance imaging (MRI) shows extension down into the trachea and/or through the tracheal wall into the surrounding tissues, may be more safely dealt with by performing a tracheostomy and awaiting spontaneous involution.
An unusual presentation of a nasal septal abscess
Authors: Cuddihy P. J. , Srinivasan V.
Published: November 2007

Nasal septal abscess is a rare complication of septal haematoma. Nasal obstruction and, less frequently, pain are the usual presenting features. We report a case of a nasal septal abscess in a 21-year-old female patient who developed a naso-oral fistula. To our knowledge this is the first report of such an unusual presentation of a septal abscess. The aetiology, pathogenesis and management of septal abscesses are discussed.