bluuebunny/crossref_metadata_2025 huggingface dataset:
Microbiology of the Ethmoid Sinus following Endoscopic Sinus Surgery
Authors: Bhattacharyya Neil , Gopal Harsha V.
Published: May 2019

We prospectively studied the native microbiology of the ethmoid sinus following endoscopic sinus surgery in 113 patients (mean age: 41.3 yr). After each patient had regained complete mucosalization (minimum follow-up: 6 wk), we obtained a bacterial swab of the ethmoid sinus and submitted it for culture and sensitivity analysis. We then compiled data on sensitivity patterns and the number and type of bacteria isolated. Of the 113 patients, 67 (59.3%) had positive cultures, 26 (23.0%) had sterile cultures, and 20 (17.7%) had normal flora. Multiple bacteria were isolated in 31 of the 113 patients (27.4%). The most common isolates were gram-positive cocci, and the most common bacteria were staphylococcal species. A significant degree (42.9%) of beta-lactamase resistance was exhibited. We conclude that the ethmoid sinus is not microbiologically sterile following endoscopic sinus surgery.
Experience with Stapedectomy in a Developing Country: A Review of 200 Cases
Authors: Salahuddin Iftikhar , Salahuddin Azhar
Published: May 2019

Since stapedectomy was first performed in 1956, many innovations have been described. We retrospectively analyzed 200 cases of stapedectomy that had been performed with standard otologic instruments. Of the 200 patients, 54 (27.0%) had significant sensory deafness associated with footplate fixation. In most cases, the footplate was partially removed (stapedotomy group); in the remainder, the footplate was removed in its entirety or subtotally (stapedectomy group). Of the 200 patients, 163 were available for short-term follow-up. The air-bone gap was closed to within 10 dB in roughly 83% of both groups. Although long-term follow-up was possible in only a limited number of cases, we believe that an experienced otologist working with standard equipment and a basic operating microscope can obtain satisfactory stapedectomy results with minimal complications.
Spontaneous Sublingual Hematoma as a Complication of Severe Hypertension: First Report of a Case
Authors: Prepageran Narayanan , Raman Rajagopalan , Ismail Siti Mazlipah , Rahman Zainal Ariff Abdul
Published: May 2019

We describe what we believe is the first reported case of a sublingual hematoma secondary to severe hypertension. The patient, a 77-year-old woman, experienced a spontaneous hematoma of the floor of the mouth, tongue, and sublingual space that eventually caused an airway obstruction. We performed an emergency tracheostomy under local anesthesia and then evacuated the hematoma through an incision along the floor of the mouth. The patient recovered uneventfully.
Extragonadal Germ-Cell Tumor: A Rare Differential Diagnosis of a Cervical Lump in a Young Man
Authors: Eickhoff Britta , Jaehne Michael , Langer Florian
Published: May 2019

In this case report, we discuss the potential diagnostic difficulty of identifying the cause or origin of a cervical swelling, a clinical situation often encountered in otolaryngology patients. A 30-year-old man came to us with a painless left cervical lump that he had noticed 8 weeks earlier. A series of examinations—including various biopsies, computed tomography, and extensive staging procedures—could not establish the diagnosis. We eventually identified the mass as an extragonadal germ-cell tumor. The diagnosis was established only after additional serologic testing and detection of tumor markers specific for extragonadal germ-cell tumor.
Incidence of Post-Tonsillectomy Hemorrhage in Children and Adults: A Study of 4,848 Patients
Authors: Windfuhr Jochen P. , Chen Yue-Shih
Published: May 2019

We conducted a retrospective study of 4,848 patients to evaluate the age-specific incidence of post-tonsillectomy hemorrhage that required surgical treatment. We reviewed the charts of 2,567 patients younger than 15 years (pediatric group) and 2,281 patients aged 15 years and older (adult group) who had undergone tonsillectomy with or without adenoidectomy. We found that post-tonsillectomy hemorrhage occurred significantly more often in the adult group (3.9 vs 1.6%; p< 0.001). Moreover, primary hemorrhage (<24 hr postoperatively) was also significantly more common in the adult group than in the pediatric group (82.9 vs 65.9%, p = 0.023). Analysis of other parameters revealed that post-tonsillectomy hemorrhage was significantly more common in males and in patients who had a history of chronic or recurrent throat infection. Awareness of these risk factors should help improve patient care and outcomes.
Unusual MRI Appearance of an Intracranial Cholesteatoma Extension: The ‘Billiard Pocket Sign’
Authors: Quaranta Nicola , Chang Phillip , Moffat David A.
Published: May 2019

We describe a unique case of an intracranial extension of acquired cholesteatoma. Previous reports have described cholesteatoma extension through the middle fossa plate and into the middle cranial fossa, but to our knowledge ours is the first report of a case in which the sac herniated into the temporal lobe and overlying dura from a site far lateral to the otic capsule. The findings on magnetic resonance imaging were most unusual, and we call the radiologic characteristics of the mass in this case the “billiard pocket sign.” We also discuss the possible mechanisms that produced such an image.
Tracheal Necrosis and Surgical Emphysema: A Rare Complication of Thyroidectomy
Authors: To Edward W.H. , Tsang W.M. , Williams Michael D. , Lai Eric C.H. , Chan Matthew
Published: May 2019

We describe the first reported case of tracheal necrosis following a thyroidectomy. This complication resulted in massive subcutaneous emphysema and pneumomediastinum. which required emergency exploration of the neck to decompress the trapped air. We also discuss the suggested etiology and management of this rare condition.
Rapid Growth of Acoustic Neuromas after Stereotactic Radiotherapy in type 2 Neurofibromatosis
Authors: Ho Steven Y. , Kveton John F.
Published: May 2019

We describe a rare complication of stereotactic radiotherapy for large acoustic neuromas in a patient with type 2 neurofibromatosis. We retrospectively reviewed the case of a 14-year-old girl who had been referred to our tertiary care center. Prior to referral, the patient had been evaluated for hoarseness. During the work-up, magnetic resonance imaging (MRI) detected two large bilateral acoustic neuromas and two bilateral jugular foramen tumors. The patient was diagnosed with type 2 neurofibromatosis, and she underwent stereotactic radiotherapy for treatment of the two acoustic neuromas; the jugular foramen tumors were not irradiated. The patient's post-treatment course was complicated by hydrocephalus and symptoms of brainstem compression, which required urgent surgical intervention. Follow-up MRI 7 months following radiotherapy demonstrated a rapid growth of the acoustic neuromas, but no appreciable change in the size of the jugular foramen neuromas. These findings suggest that the radiotherapy might have been the cause of the rapid growth of the acoustic neuromas. To our knowledge, no such report has been published in the literature, and this phenomenon might be unique. Our findings suggest that radiotherapy might not be the optimal first-line treatment for acoustic neuromas in patients with type 2 neurofibromatosis.
Study of Surgeons’ Agreement on the Presence of Bony Anomalies on Coronal CT of Paranasal Sinuses
Authors: El-Hakim Hamdy , Oluwole Matthew , MacKerrow William S. , McClymont Leo G. , White Paul S.
Published: May 2019

We conducted a study to determine the level of agreement among five surgeons who assessed the surgical risk to key neighboring structures prior to endoscopic sinus surgery as depicted on coronal computed tomography (CT). The five observers studied preoperative CT scans that had been performed on 29 patients. Two scoring systems were used to rate each scan: the Lund-Mackay system and our own risk-assessment system. Kappa analysis was used to measure interobserver agreement. We found that the overall level of agreement among the five surgeons according to the Lund-Mackay criteria was moderate, while agreement according to our risk-assessment system was only slight. We conclude that surgeons agreement on the bony detail of risk structures is not as strong as our agreement on other factors, such as staging disease.
Facial Paralysis caused by Malignant Skull Base Neoplasms
Authors: Marzo Sam J. , Leonetti John P. , Petruzzelli Guy
Published: May 2019

This article has been published previously in Neurosurgical Focus: Marzo SJ, Leonetti JP, Petruzzelli G. Facial paralysis caused by malignant skull base neoplasms. Neurosurgical Focus 2002, Article 2;12(5) ( http://www.neurosurgery.org/focus/may02/12-5-nsf-toc . html).

Object

Bell palsy remains the most common cause of facial paralysis. Unfortunately, this term is often erroneously applied to all cases of facial paralysis.

Methods

The authors performed a retrospective review of data obtained in 11 patients who were treated at a university-based referral practice between July 1988 and September 2001 and who presented with acute facial nerve paralysis mimicking Bell palsy. All patients were subsequently found to harbor an occult skull base neoplasm. A delay in diagnosis was demonstrated in all cases. Seven patients died of their disease, and four patients are currently free of disease.

Conclusions

Although Bell palsy remains the most common cause of peripheral facial nerve paralysis, patients in whom neoplasms invade the facial nerve may present with acute paralysis mimicking Bell palsy that fails to resolve. Delays in diagnosis and treatment in such cases may result in increased rates of mortality and morbidity.
Visual-Field Loss Caused by Sinusitis: A Case Report
Authors: Gouws Pieter
Published: May 2019

The author reports a case of visual-field loss that was not characterized by any direct compression or external signs of sinus disease. The patient's hemianopia was found to be associated with severe sinusitis, which had not been clinically apparent and which had not extended beyond the bony walls of the sinuses. Following surgical drainage of the affected sinuses, the hemianopia resolved immediately and completely.
Hysterical Stridor: A Report of Two Cases
Authors: Nayar Ravi C. , Zanak Sanjay R. , Ahmed Sahar M.
Published: May 2019

Stridor as an initial symptom of a conversion reaction (hysteria) is rare. We report cases of hysterical stridor in two older women, unrelated and unacquainted, from the same rural community in Oman. Once the diagnosis was made, both patients were successfully treated with a single dose of an anxiolytic. We also review the literature on hysterical stridor and discuss the diagnostic dilemmas and therapeutic options.
Adult Supraglottitis Subsequent to Smoking Crack Cocaine
Authors: Osborne Ryan , Avitia Sofia , Zandifar Hootan , Brown Jimmy
Published: May 2019

Supraglottitis is one possible complication of smoking crack cocaine. From 1992 through 2001, our institution treated nine patients for thermal supraglottitis secondary to crack cocaine inhalation. In this article, we describe two of these cases, and we briefly review what is known about this entity and the mechanism of injury. We also provide our recommendations for management.
Infiltrating, Moderately Differentiated Neuroendocrine Tumor of the Larynx: A Brief Report
Authors: Shemen Larry , Petratos Peter , Patel Suketu , Horowitz Laurie
Published: May 2019

We report a rare case of moderately differentiated neuroendocrine carcinoma of the larynx. We describe the clinical and pathologic findings relevant to this case, and we review the literature on the pathologic features of this malignancy. We also discuss treatment options.
Massive Nasal Polyposis in Pediatric Cystic Fibrosis: Report of an Unusually Severe Case
Authors: Senocak Dogan , Oran Yalcin
Published: May 2019

Nasal polyposis is common among children with cystic fibrosis. We report the case of a 14-year-old girl with cystic fibrosis who experienced severe facial disfigurement as a result of massive polyposis. Her polyps were removed surgically, and she was referred for cosmetic surgery.
Management of Acoustic Neuromas in the Elderly: Retrospective Study
Authors: Piazza Fabio , Frisina Antonio , Gandolfi Angelo , Quaranta Nicola , Zini Carlo
Published: May 2019

The wide availability of gadolinium-enhanced magnetic resonance imaging (MRI-Gd) has led to the discovery of an increasing number of small and less symptomatic acoustic neuromas in elderly patients. We conducted a retrospective study in order to obtain data on outcomes and complications associated with different management strategies that would be useful in establishing a management guideline. We identified 44 patients aged 65 to 77 years with acoustic neuromas who had been managed with either surgery or simple observation with MRI-Gd imaging. Of the entire group, 36 patients had tumors larger than 1 cm, and they underwent surgery (most via the translabyrinthine approach). Complete removal of the tumor was achieved in 34 of these patients (94.4%). At the 1-year follow-up, grade VI facial nerve paralysis was evident in only two of 35 evaluable patients (5.7%). Postsurgical complications occurred in five patients (13.9%), including one death. The remaining eight patients had tumors 1 cm or smaller, and they were managed with periodic MRI-Gd scanning. At the 5-year follow-up, no tumor growth was seen in six of these patients. The other two patients exhibited a tumor growth rate of less than 2 mm per year. No patient in the observation group required surgical intervention.
Nasopharyngeal Carcinoma and Nasal Allergy: Any Correlation?
Authors: Prepageran Narayanan , Lingham Omkara Rubini , Krishnan Gopala , Jalaludin Mohammad Amin , Raman Rajagopalan
Published: May 2019

Although it has been observed that nasal allergy is rarely seen in patients who have nasopharyngeal carcinoma, to our knowledge, no actual study of such a lack of association has been previously reported. To fill this void, we conducted a pilot study to investigate any such inverse relationship. We conducted skin-prick allergen tests on 22 patients with newly diagnosed but not-yet-treated nasopharyngeal carcinoma. Combining these test results with findings on the history and clinical examination, we concluded that only one of the 22 cancer patients (4.5%) had allergic rhinitis. Our study also confirmed the validity of using findings on the history, clinical examination, and skin-prick testing as a reliable means of diagnosing allergic rhinitis.
Endotracheal Tube Obstruction: A Rare Complication in Laser Ablation of Recurrent Laryngeal Papillomas
Authors: Skoulas Ioannis G. , Kountakis Stilianos E.
Published: May 2019

During the past 25 years, use of the carbon dioxide (CO2 ) laser has been accepted as the most appropriate surgical method for the treatment of recurrent laryngeal papillomatosis. Although CO2 laser technology and surgical techniques continue to improve, laser-related complications still occur. We describe a case of a very rare complication—to our knowledge, only the second such case reported in the literature—in which an endotracheal tube was almost completely obstructed by a piece of papillomatous tissue during CO2 laser microlaryngoscopy for the treatment of recurrent laryngeal papillomatosis.
Intratracheal Ectopic Thyroid Tissue: A Case Report and Literature Review
Authors: Byrd Michael C. , Thompson Lester D.R. , Wieneke Jacqueline A.
Published: May 2019

We discuss a case of intratracheal ectopic thyroid tissue (ETT) that was retrieved from the files of the Otorhino-laryngic–Head and Neck Pathology Registry at the Armed Forces Institute of Pathology. The patient was a 54-year-old man who had a history of papillary thyroid carcinoma, which had been treated with a subtotal thyroidectomy. During routine follow-up 4 years later, the patient's primary care physician detected an elevated thyroglobu-lin level. Further referrals and evaluations revealed that the patient had intratracheal ETT. The patient refused to undergo surgical excision and remains without evidence of recurrent carcinoma. In a MEDLINE literature review, we found only 13 other well-documented cases of intratracheal ETT since 1966; in all but two cases, patients had benign disease. Once the possibility of thyroid carcinoma has been eliminated by histologic examination, intratracheal ETT can be managed by complete surgical excision with the prospect of an excellent long-term clinical outcome.
The Effect of Topical Fluticasone on Nasal Nitric Oxide Levels in a Patient with Allergic Rhinitis
Authors: Vural Cetin , Gungor Anil
Published: May 2019

Nitric oxide (NO) in exhaled breath is produced primarily by the upper respiratory airway mucosa. The nasal output of this gas is increased in patients with allergic rhinitis. We performed a study on a 41 -year-old nonsmoking male volunteer with allergic rhinitis to investigate the effect of fluticasone nasal spray on nasal NO output (VNO). A total of 28 nasal NO measurements from both nostrils were taken during the 2-month period of June and July 2002. During the second half of the study period (treatment phase), the patient took fluticasone in doses of 100 μg per nostril once a day. During the treatment phase, nasal NO measurements were taken 10 days after the initiation of treatment. In addition, we also recorded the patient's nasal symptom scores and the grass pollen counts in the greater Pittsburgh area. The patient's mean VNO was 989.9 nl/min prior to treatment and 787.7 nl/min following treatment—a statistically significant 20.4% decrease (p<0.01) The findings of our study support the observation that topical nasal steroid treatment decreases NO production in sinonasal mucosa.
Sternoclavicular Joint Septic Arthritis Manifesting as a Neck Abscess: A Case Report
Authors: Mohyuddin Atta
Published: May 2019

Septic arthritis of the sternoclavicular joint is an uncommon condition, and the diagnosis can be missed until a complication occurs. The sternoclavicular joint is more often involved in ankylosing spondylitis, degenerative arthritic conditions (i.e., rheumatoid arthritis and osteoarthritis), and primary and secondary metastatic conditions. The patient described in this case report came to the otolaryngology department on two occasions for treatment of a unilateral cutaneous neck abscess. The correct diagnosis was not made until the second visit. The author reviews the clinical course, diagnosis, and treatment of this uncommon disease.
Tracheostomy in Patients with Cervical Rib: A Note of Caution
Authors: Prepageran Narayanan , Raman Rajagopalan
Published: May 2019

Cervical rib is a congenital phenomenon that usually occurs in association with upper-limb neurovascular symptoms. The presence of a cervical rib displaces the great vessels that cross the thoracic outlet superiorly and proceed into the neck. We report an unusual case of iatrogenic hemorrhage during a tracheostomy in a patient whose right subclavian artery had been displaced by a cervical rib. Our aim is to alert surgeons to the hidden risks of this phenomenon.
Respiratory Complications following Tonsillectomy/UPPP: Is Step-Down Monitoring Necessary?
Authors: Gessler Eric M. , Bondy Peter C.
Published: May 2019

We conducted a study to determine if the risk of airway compromise following tonsillectomy with uvulopalatopharyngoplasty justifies the added cost and inconvenience of step-down monitoring in an intensive care unit. We performed a retrospective chart review of 130 patients with obstructive sleep apnea who had undergone isolated tonsillectomy with uvulopalatopharyngoplasty at our tertiary care center. The average length of stay in the step-down unit was 18 hours. We found that only eight of these patients (6.2%) had a postoperative desaturation level of less than 90%, including three of 12 patients (25%) who had comorbid conditions. No patient had an adverse respiratory event. We conclude that step-down monitoring in an intensive care unit is not necessary, although caution should be exercised in monitoring patients with comorbidities because they appear to be more prone to desaturation. A complete lack of adverse respiratory events has not been reported in previous studies.
Phylogeny and Embryology of the Facial Nerve and Related Structures. Part I: Phylogeny
Authors: Sataloff Robert Thayer , Selber Jesse C.
Published: May 2019

The study of evolution provides invaluable insights into human structure and function. Much of evolution is recapitulated during human gestation. Understanding the evolutionary process helps clarify seemingly complex embryology and anatomy, such as that of the facial nerve and related ear structures, as well as the anomalies that occur when human development is interrupted.
Juvenile Xanthogranuloma: A Rare Cause of Subglottic Cyst and Stenosis
Authors: Sahhar Hanna S. , Marra Silvio , Shahid Ramzan , Akhter Javeed
Published: May 2019

Only two cases of juvenile xanthogranuloma of the larynx have been previously reported in the literature. We report a new case, which occurred in an 18-month-old girl. The patient was brought to us for treatment of stridor and respiratory distress. During examination, she was found to have a subglottic mass. The lesion was treated with laser microlaryngoscopy, which relieved the patient's respiratory distress and obviated the need for tracheotomy. Pathologic examination of the mass revealed that it was consistent with a juvenile xanthogranuloma. Juvenile xanthogranuloma is generally a benign and self-limiting disease, but complications can occur when the space that the tumor occupies causes functional impairment.
Phylogeny and Embryology of the Facial Nerve and Related Structures. Part II: Embryology
Authors: Sataloff Robert Thayer , Selber Jesse C.
Published: May 2019

A precise description of the developmental anatomy of the facial nerve and associated ear structures, augmented by an appreciation of phylogenic history, has proven extremely helpful intraoperatively. Predictions of facial nerve position can be made with reasonable accuracy when they are based on a proper analysis of developmental anomalies of other ear structures. In cases in which the facial nerve canal has not developed, it may be impossible to obtain accurate localization of the facial nerve radio-graphically prior to surgery. In such cases, judgment based on an understanding of embryology may be the surgeon's only guide to the position of the facial nerve. Although these principles have proven valid and reliable so far, it is not prudent for the surgeon to consider them gospel, of course. Extreme caution must always be exercised when operating on an ear with congenitally abnormal anatomy. Nevertheless, it is not necessary for the surgeon to approach a congenitally malformed ear with the fear that “You never know where the facial nerve is going to be. Understanding embryology allows otologic surgery to be planned with reasonable accuracy and carried out safely and expeditiously.
Hyperhomocysteinemia and Left Internal Jugular Vein Thrombosis with Ménière's Symptom Complex
Authors: Scaramella John G.
Published: May 2019

The author describes the case of a 68-year-old woman who experienced severe symptoms of Ménière's syndrome. Ultrasonography of the neck detected a clot in the left internal jugular vein. The patient was hospitalized and anticoagulated, and her symptoms soon resolved. The author speculates that the clot-induced hemodynamic changes led to venous insufficiency in the vein of the paravestibular canaliculus and ultimately caused the patient's symptoms. The blood work-up revealed that the patient had an elevated fasting homocysteine level, which is a known risk factor for thrombus formation.
Malacoplakia Manifesting as a Chronic Inflammatory Mass at the Site of a Nonhealing Surgical Wound
Authors: Pang Leou-Chuan
Published: May 2019

Malacoplakia in the head and neck is uncommon, and malacoplakic lesions involving the thyroid are extremely rare. The author describes the case of a 64-year-old woman who developed malacoplakia at the site of a previous total thyroidectomy. The disease manifested as a chronic inflammatory mass beneath a persistently discharging surgical wound site, and it prevented the incision from healing. Diagnosis was based on a thorough histopathologic analysis.
Improved Immunotherapy with a Rapid Allergen Vaccination Schedule: A Study of 137 Patients
Authors: Smits William , Inglefield Joseph T. , Letz Kevin , Lee Robert , Craig Timothy J.
Published: May 2019

Rapid allergen vaccination (RA V) is the updated term for what was previously called rush immunotherapy and rapid desensitization. RAV offers several advantages over traditional immunotherapy—that is, conventional allergen vaccination (CAV)—in terms of faster efficacy, better compliance, and cost-effectiveness. We used a 3-hour RAV protocol to treat 137 allergy patients. All patients were premedicated with either prednisone or prednisolone and an H1 antihistamine. Following the RAV procedure, all patients resumed a CAV schedule. Only six patients (4.4%) experienced a mild systemic reaction to RAV, and five (3.6%) experienced a mild systemic reaction to CAV 14 to 77 days later. All six patients who reacted to RAV quickly responded to treatment—in most cases, subcutaneous epinephrine and/or nebulized albuterol—and were sent home after a short period of observation. Compliance rates at 3, 6, and 12 months were 96.4, 94.2, and 75.9%, respectively, which is an improvement over rates previously reported for patients undergoing CAV therapy. We conclude that the 3-hour RAV protocol can be safely and successfully administered. Patients who undergo RAV are more compliant with their subsequent CAV regimen than are patients who do not undergo RAV because signs of clinical efficacy manifest almost immediately and because RAV is associated with substantially lower rates of systemic reactions. Moreover, RAV is associated with less morbidity and less expense. Our findings should encourage physicians who treat allergy patients to give further consideration to using RAV.
Mandibular Ameloblastoma and Maxillary Adenoid Cystic Carcinoma: Case Report
Authors: Tamme Tiia , Leibur Edvitar , Kulla Andres
Published: May 2019

We report the case of a 74-year-old woman who developed a follicular ameloblastoma of the right mandible and 22 months later developed a cribriform adenoid cystic carcinoma of the soft palate on the right maxilla. The ameloblastoma was treated by hemimandibulectomy, and the adenoid cystic carcinoma was managed by resection of the soft palate and the surrounding tissue and bone followed by a 6-week course of radiotherapy. Our review of the literature indicates that only one similar case has been previously reported where an odontogenic tumor and a salivary gland tumor involved two different anatomic locations in the same patient at nearly the same time.
Hydrodissection for Complete Removal of a Ranula
Authors: Choi Tae-Wook , Oh Cha-Kun
Published: May 2019

Hydrodissection has been used in various surgical fields to facilitate excision in both routine and difficult cases. This procedure involves the injection under pressure of saline and lidocaine with 1:100,000 epinephrine into the dissection plane. Removing a ranula without rupturing it can be a tedious and time-consuming process. Therefore, we used hydrodissection to assist us in performing these procedures. To review our experience with the treatment of ranulas, we performed a retrospective study of 38 patients who had undergone hydrodissection for ranula removal between January 1996 and December 2002 at our academic tertiary care hospital. Compared with other removal techniques, we found that hydrodissection was associated with less bleeding, fewer incidents of neural and soft-tissue damage, and a lower recurrence rate. In addition to reporting our study results, we also describe our hydrodissection technique, which is relatively simple, effective, and convenient for otolaryngologists.
Unidentified Coagulation Disorders in Post-Tonsillectomy Hemorrhage
Authors: Windfuhr Jochen P. , Chen Yue-Shih , Remmert Stephan
Published: May 2019

We conducted a retrospective study of 6,966 patients who had undergone tonsillectomy or adenotonsillectomy to evaluate the incidence and clinical features of previously unidentified coagulation disorders in patients who experienced postoperative hemorrhage (n = 201). We found that post-tonsillectomy hemorrhage secondary to unidentified coagulation disorders is extremely rare. However, normal coagulation values and an insignificant history do not rule out coagulation disorders. If diffuse, persistent, and bilateral bleeding is not related to arterial hypertension, dissection technique, or local infection, a rapid and detailed analysis of coagulation factors should be considered.
Leiomyosarcoma of the Maxillary Sinuses: Report of Two Cases
Authors: Prasad Kishore Chandra , Alva Thokur Bhasker , Khadilkar Urmila , Madhu Damodara
Published: May 2019

Leiomyosarcoma is a malignant smooth-muscle tumor that has a predilection for the gastrointestinal tract and the female genital tract. It is locally fast-spreading and highly aggressive, and the prognosis is poor. We report two cases of leiomyosarcoma of the maxilla in patients who sought treatment for maxillary swelling, nasal obstruction, and epistaxis; one patient also had orbital involvement and cervical lymph node metastasis. Both patients underwent radical surgery followed by chemo-and/or radiotherapy. The patient with orbital involvement died shortly thereafter, but the other was disease-free at 18 months.
A Case of Simultaneous Retroauricular Traumatic Neuroma and Arteriovenous Aneurysm
Authors: Gaio Elena , Marioni Gino , Poletti Sandro , de Filippis Cosimo , Staffieri Alberto
Published: May 2019

Traumatic neuroma is a well-defined clinicopathologic entity that is seldom associated with vascular neoformations. We describe the case of a patient with a postsurgical retroauricular neuroma that was associated with a coexisting arteriovenous aneurysm. We also performed an extensive immunohistologic characterization of the traumatic neuroma.
Aggressive Fibromatosis of the Parapharyngeal Space: Two Cases and Treatment Recommendations
Authors: Sanders Kenneth W. , Fowler Marjorie R. , Milner Joseph , Stucker Fred J. , Nathan Cherie-Ann O.
Published: May 2019

Aggressive fibromatosis is an uncommon tumor that is locally aggressive but not malignant. Therefore, its classification falls between the benign and malignant neoplasms of soft-tissue origin. In the past, these lesions were misdiagnosed as low-grade fibrosarcomas. Otolaryngologists should be familiar with these lesions because as many as 15% of them occur in the head and neck. The treatment of choice is wide surgical excision, which is often difficult. Postexcision recurrence rates are high. Nonsurgical treatment includes radiation and chemotherapy, both of which are usually reserved for recurrences. We describe two cases of aggressive fibromatosis of the parapharyngeal space, and we review the available treatment options.
Langerhans’ Cell Histiocytosis: Current Trends and the Role of the Head and Neck Surgeon
Authors: Davis Steven E. , Rice Dale H.
Published: May 2019

Langerhans’ cell histiocytosis (LCH)—once called histiocytosis X— is a complex reticuloendothelial disease that often involves the head and neck. We discuss the current nomenclature of this disease and review its pathologic and clinical characteristics, with particular emphasis on the role of the head and neck surgeon. LCH can be challenging to diagnose, and the otolaryngologist must be familiar with its varied presentations. Because LCH usually responds well to medical therapy and extensive resection can easily cause more morbidity than the disease itself, a minimalist approach to treatment usually provides the best outcome. We also discuss the case of a 9-month-old girl with LCH who presented with aggressive head and neck disease.
Laryngotracheal Reconstruction with a Muscle-Pedicle Hyoid Bone Flap: A Series of 23 Patients
Authors: Cansiz Harun , Yener H. Murat , Sekercioglu Nihat , Günes Muammer
Published: May 2019

We conducted a study to evaluate the effectiveness of muscle-pedicle hyoid bone flaps in the repair and reconstruction of the larynx and trachea in 23 patients who had undergone extended partial laryngectomy. Of this group, 17 patients had undergone surgery to correct laryngotracheal stenosis and 6 to remove laryngeal carcinoma. Intervention resulted in successful decannulation in 20 of the 23 patients (87.0%). Of the 3 patients who did not experience a successful outcome initially, 2 were successfully decannulated following a second intervention; the other patient required a total laryngectomy because of cancer recurrence. In light of our follow-up results, we conclude that hyoid bone appears to be an effective autograft in such cases.
Brown Recluse Spider Bites to the Head: Three Cases and a Review
Authors: Leach Joseph , Bassichis Benjamin , Itani Kamel
Published: May 2019

Consequences of envenomation from the bite of a brown recluse spider (Toxosceles reclusa) range from mild itching to death. The bite of this spider causes the most severe form of arthropod-induced tissue necrosis. These bites pose several challenges to the clinician in that diagnosis can be difficult, systemic manifestations can occur, and healing can be resistant to conventional measures. Bites to the head and neck—particularly the face—are uncommon, and they have not been widely reported in the otolaryngology literature. As experts in facial soft tissue, otolaryngologists and facial plastic surgeons should be able to recognize and treat these lesions. Because no laboratory test is available to identify the cause of symptoms in these cases, the diagnosis is made clinically. Early intervention can make a significant difference in cosmetic outcome, so a high index of suspicion is warranted. Local wound care includes rest, ice, compression, and elevation of the affected part of the body. Drug therapy with dapsone may limit the severity of the bite and prevent complications. Because some bites cause systemic loxoscelism, clinicians should be familiar with its manifestations. When necrosis occurs despite adequate medical treatment, reconstructive procedures should be delayed until healing is complete. We report 3 cases of brown recluse spider bites to the head. These cases illustrate the broad spectrum of the disease course, and they highlight the therapeutic challenges that these lesions pose.
Parathyroid Carcinoma: A Multicenter Review of Clinicopathologic Features and Treatment Outcomes
Authors: Wiseman Sam M. , Rigual Nestor R. , Hicks Wesley L. , Popat Saurin R. , Lore John M. , Douglas Wade G. , Jacobson Michael J. , Tan Dongfeng , Loree Thorn R.
Published: May 2019

We conducted a retrospective study of 13 patients with parathyroid carcinoma to assess their clinical characteristics and surgical outcomes. Study parameters included patient demographics, survival, treatment response, and recurrence. We found that all patients who had undergone local tumor excision developed a recurrence, compared with only 33% of those available for follow-up after en bloc tumor resection. Based on these findings, we recommend en bloc tumor resection as the initial treatment of choice for patients diagnosed with parathyroid carcinoma.
Intracranial Neuromuscular Choristoma: A Case Report and Literature Review
Authors: Owor Geraldine , Qian Jiang , Payner Troy , Martin Anita , Shan Yuan
Published: May 2019

Neuromuscular choristoma (NMC) is an uncommon tumor that usually involves a large nerve trunk. Only 28 cases of NMC have been previously reported in the English-language literature, 17 of which involved cranial nerves. We report a new case of intracranial NMC that arose from a facial nerve at the cerebellopontine angle in a 44-year-old man. The patient was taken to surgery, where the lesion was found to involve the right facial nerve. The tumor was partially removed, and at the 2-year follow-up, the patient showed no sign of recurrence.
Craniocervical Necrotizing Fasciitis of Odontogenic Origin with Mediastinal Extension
Authors: Edwards John D. , Sadeghi Nader , Najam Farzad , Margolis Mark
Published: May 2019

We review an interesting case of craniocervical necrotizing fasciitis with thoracic extension in an immunocompetent 44-year-old man. The patient underwent aggressive medical and surgical management during a long hospitalization. Multiple surgical debridements, including transcervical mediastinal debridement, and eventually a thoracotomy for mediastinal abscess were required. The patient eventually recovered, and 3 months later he showed no sign of complications or recurrence. Craniocervical necrotizing fasciitis is a fulminant soft-tissue infection, usually of odontogenic origin, that requires prompt identification and treatment to ensure survival. Broad-spectrum intravenous antibiotics, aggressive surgical debridement and wound care, hyperbaric oxygen, and good intensive care are the mainstays of treatment.
Second Branchial Cleft Anomaly Presenting as a Rudimentary Pinna in the Nasopharynx of a Newborn
Authors: Ahmed Khwaja Asif , Poole Michael D.
Published: May 2019

We describe the case of a 4-day-old girl who presented with an epiglottic cyst that was later identified as a rudimentary pinna attached to the soft palate.
What's in a Fungus Ball? Report of a Case with Submucosal Invasion and Tissue Eosinophilia
Authors: Senocak Dogan , Kaur Ahmet
Published: May 2019

Fungus balls are tangled mats of hyphae that are often found in the maxillary sinus. In approximately half of affected patients, radiologic evaluation will reveal areas of hyperdensity within soft-tissue masses. Histopathologic examination will reveal no invasion of the mucosa and no granulomatous reactions. Surgical removal is sufficient because fungus balls are not known to recur. We describe an interesting case of a sinonasal fungus ball that resembled dental filling material on radiologic imaging because of its extraordinary radiopacity. Histopathologic examination detected eosinophilic infiltration, hyphae in the submucosal tissues, and tissue necrosis.
Treatment of nasal valve collapse with transcutaneous and intranasal electric stimulation
Authors: Vaiman Michael , Shlamkovich Nathan , Eviatar Ephraim , Segal Samuel
Published: May 2019

We conducted a prospective, randomized, double-blind pilot study of patients presenting with symptoms of obstructed nasal breathing to determine whether electrotherapy could provide nonsurgical symptom relief. Forty patients were divided into an electrotherapy group (n = 20) and a placebo group (n = 20). All selected patients demonstrated nasal valve stenosis with a positive Cottle maneuver and clinically evident nasal valve collapse. Treatment consisted of high-frequency transcutaneous and intranasal electric stimulation of nasal muscles for 15 minutes, 3 times a week for 10 weeks. Treated patients were followed for 10 to 12 months. Twelve patients in the electrotherapy group (60%) exhibited subjective improvement; in 8 cases (40%), the improvement was proved objectively. In the placebo group, 7 patients (35%) indicated subjective improvement; and in one case (5%), the improvement was proved objectively. Follow-up visits showed a rapid decline of positive results when treatment was discontinued. Therefore, we concluded that sure relief of nasal valve stenosis and collapse cannot be achieved with treatment by electric stimulation alone, and this method appears to have limited application. However, further studies are needed to determine whether electrotherapy used in combination with other treatments (e.g., biofeedback training or nasal springs) may provide more lasting relief for patients who want to avoid endonasal surgical intervention.
Surgical Implications of an Unusual Anomaly of the Infraorbital Nerve
Authors: Chandra Rakesh K. , Kennedy David W.
Published: May 2019

The infraorbital nerve is a direct extension of the maxillary division of the Vth cranial nerve. It typically courses anteriorly through a canal within the bone of the orbital floor. We describe an unusual anatomic variation of this canal that to our knowledge has not been previously described in the literature. This anomaly may have significant implications during surgery on the paranasal sinuses and maxillofacial skeleton. Careful preoperative assessment of the course of the infraorbital nerve is necessary to prevent iatrogenic hypoesthesia, paresthesia, or neuralgia.
Modified submandibular sialoadenectomy
Authors: Hussain Akhtar , Murray Daran P.
Published: May 2019

Submandibular sialoadenectomy is a common head and neck procedure. Indications include the presence of benign and malignant tumors and inflammatory disease with or without intraglandular sialolithiasis. The standard technique involves a variably sized incision. The facial artery and vein are usually ligated and transected during the procedure, and either suction or nonsuction wound drainage is generally instituted. We describe a modified sialoadenectomy technique that involves a minimal incision, preserves the facial artery and vein, and does not require wound drainage because the surgical site is closed in three layers. We performed this procedure on 19 patients and observed only 1 postoperative complication—mild paresis of the right marginal mandibular branch of the facial nerve following the excision of a Warthin's tumor. This patient recovered fully 3 months postoperatively.
Migraine and Benign Paroxysmal Positional Vertigo: An Outcome Study of 476 Patients
Authors: Uneri Alev
Published: May 2019

To investigate whether migraine is more common in patients with benign paroxysmal positional vertigo (BPPV) than in the general population, the author conducted a retrospective study of 476 patients with BPPV seen over 12 years at a tertiary referral center. Records of patients with a confirmed diagnosis of BPPV followed for 1 to 7 years were reviewed. The typical history of BPPV and the characteristic torsional positional nystagmus were identified in all patients. A modified Epley maneuver was performed for all patients with posterior semicircular canal BPPV, with a 98% success rate. The survey consisted of detailed patient questionnaires and vestibular tests. Migraine and motion sickness were three times more common in patients with BPPV than in the general population. A family history of migraine (58.4%) and vertigo (44.9%) was also more common in patients than in a control group.
Spontaneous Bilateral Intrasphenoidal Lateral Encephaloceles: CT and MRI Findings
Authors: Firat Ahmet Kemal , Firat Yezdan
Published: May 2019

Lateral intrasphenoidal encephaloceles are rare anomalies. We describe a unique case in which spontaneous bilateral intrasphenoidal lateral encephaloceles were discovered in a 53-year-old man during a work-up for cerebrospinal fluid leak. We discuss our clinical findings and the results of preoperative computed tomography and magnetic resonance imaging.
Rosai-Dorfman Disease with Extranodal Manifestation in the Head
Authors: Sennes Luiz , Koishi Henry , Cahali Rafael , Sperandio Fabiana , Butugan Ossamu
Published: May 2019

The term sinus histiocytosis with massive lymphadenopathy (SHML) was introduced by Rosai and Dorfman in 1969. Although SHML was initially described as low-pain cervical lymphadenopathy accompanied by fever, leukocytosis, an increased erythrocyte sedimentation rate, and hypergammaglobulinemia, extranodal involvement is observed in 25 to 40% of cases. This pathology is very rare and involvement of the nasal fossae and paranasal sinuses is exceptional. We present two atypical cases of extranodal involvement exclusively confined to the head and review the literature. The first case showed a dramatic involvement of facial skin and muscles, orbit, and paranasal sinuses. In the second case, the disease was limited to the nasal fossae. Both cases showed exclusive extranodal involvement limited to the head region. In the absence of lymphadenopathy, diagnosing Rosai-Dorfman disease is difficult because of the lack of the most typical manifestation of the disease.
Follicular Dendritic Cell Sarcoma of a Cervical Lymph Node: Case Report and Review of the Literature
Authors: Sahadevan Kanagasabai , Banerjee Anirvan , Wight Richard
Published: May 2019

Follicular dendritic cell sarcoma is a rare tumor that occurs mainly in lymph nodes. We report a case of follicular dendritic cell sarcoma in a cervical lymph node that was initially diagnosed as a B-cell lymphoma by Tru-Cut biopsy. The correct diagnosis was established by excision biopsy and immunohistochemistry. This tumor is of interest to head and neck surgeons because its recurrence rate is significant and its metastatic potential has been underestimated because of its rarity and the difficulty in making the diagnosis. We discuss the salient clinical and pathologic features of this tumor, as well as its management protocol, and we review the literature.
Efficacy of the Epley Maneuver for Posterior Canal BPPV: A Long-Term, Controlled Study of 81 Patients
Authors: Richard Wietske , Bruintjes Tjasse D. , Oostenbrink Peter , van Leeuwen Roeland B.
Published: May 2019

We assessed the efficacy of the Epley maneuver (canalith repositioning) in a study of 81 patients with posterior semicircular canal benign paroxysmal positional vertigo (BPPV). A group of 61 patients underwent the maneuver, while a control group of 20 patients received no therapy. All patients were evaluated at 1 and 6 months. The percentage of patients who experienced subjective improvement was significantly higher in the treatment group at both 1 month (89% vs. 10%) and 6 months (92% vs. 50%). Three patients in the treatment group who did not improve after treatment underwent a second maneuver, and all achieved a positive result. In addition, 4 successfully treated patients experienced a recurrence between 1 and 6 months following treatment; 3 were retreated, and 2 of them responded well. We conclude that the Epley maneuver provides effective and long-term control of symptoms in patients with BPPV.
The use of Hydroxyapatite Cement and a Pericranial/Deep Temporal Fascia Graft for Cranioplastic Reconstruction of Translabyrinthine Craniectomy Defects
Authors: Hussain Akhtar , Ahsan Farhan
Published: May 2019

Most translabyrinthine temporal bone defects are reconstructed with free abdominal fat grafts, with or without the use of hydroxyapatite cement. However, these procedures are associated with considerable morbidity at the graft donor site, with a 6 to 15% incidence of cerebrospinal fluid (CSF) leaks, and with postoperative headaches. We have developed a new technique for reconstructive cranioplasty that involves the use of hydroxyapatite cement and a pericranial/deep temporal fascia graft. This technique obviates the need for an abdominal fat graft and therefore circumvents the morbidity associated with it; it may also significantly reduce the incidence of CSF leaks and postoperative headaches. We describe the results of our use of this technique in a series of 10 patients. Based on our early findings, we believe that this technique holds great promise for reconstructive cranioplasty following translabyrinthine craniectomy.
Preoperative Computerized Dynamic Posturography as a Prognostic Indicator of Balance Function in Patients with Acoustic Neuroma
Authors: Bergson Eric , Sataloff Robert T.
Published: May 2019

We conducted a study to determine the prognostic reliability of preoperative computerized dynamic posturography (CDP) in patients undergoing surgical excision of an acoustic neuroma. Our goal was to determine the correlation between objective preoperative assessments of balance function and subjective postoperative patient self-assessments. To that end, we retrospectively reviewed the records of 21 adults who had undergone preoperative CDP, and we subsequently obtained their subjective assessments of balance function by follow-up telephone surveys at least 1 year postoperatively. We conclude that although CDP has proven to be useful in many aspects of balance evaluation, it did not appear to be a valuable predictor of subjective postoperative balance function in these patients.