Osteoid osteoma of the ethmoid sinus: A rare diagnosis

April 30, 2012     E. Bradley Strong, MD; James R. Tate, MD; Dariusz Borys, MD
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Abstract

Osteoid osteomas are benign osseous lesions. They have seldom been described in the otolaryngology literature, and they are extremely rare in the ethmoid sinuses. We report a new case of osteoid osteoma of the ethmoid sinus in a 15-year-old girl. The workup consisted of computed tomography. Treatment involved local excision via an external ethmoidectomy approach. The diagnosis was based on histopathologic examination.

Introduction Osteoid osteomas are benign osseous lesions that are extremely rare in the ethmoid sinuses. Osteoid osteomas can be easily identified radiologically by the presence of a central nidus surrounded by dense sclerotic bone on computed tomography (CT). In this article, we report a new case of osteoid osteoma that originated in the ethmoid...

Endoscopic view of an asymmetric roof of the ethmoid sinus

April 30, 2012     Dewey A. Christmas, MD; Joseph P. Mirante, MD, FACS; Eiji Yanagisawa, MD, FACS
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It is important to study the anatomy of the roof of the ethmoid sinus both preoperatively and intraopereatively, especially to determine whether there are differences in the height and thickness of the left and right sides.

This patient who had sinus surgery 15 years previously presented with recurrent bilateral sinusitis involving the ethmoid and maxillary sinuses as shown by computed tomography (CT). Of note was the CT finding of marked differences in the ethmoid roof on the right and left sides. There was a significant difference in the height of the ethmoid roof...

Mycobacterial tuberculosis superimposed on a Warthin tumor

April 30, 2012     Kang-Chao Wu, MD; Bo-Nien Chen, MD
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Abstract

The concomitant occurrence of tuberculosis infection within a Warthin tumor is extremely rare, as only 6 cases have been previously reported in the English-language literature. We report a new case in a 92-year-old man, who presented with a 20-year history of a painless swelling in the right infra-auricular area that had recently become painful and larger. The patient had no history of tuberculosis, weight loss, or chronic cough. The fluctuant mass was aspirated, but histopathology and routine culture were negative. Computed tomography identified a 5-cm, heterogeneous, enhancing mass with multiple, variably sized, low-density areas without surrounding edema in the area of the right parotid gland. Complete excision was performed to relieve the patient's symptoms. Histopathology diagnosed an acid-fast bacillus infection within a Warthin tumor. On polymerase chain reaction testing, formalin-fixed, paraffin-embedded tissue was negative for tuberculosis, but subsequent culture identified Mycobacterium tuberculosis. Initially, the patient refused antituberculosis therapy, but he relented when miliary pulmonary tuberculosis was diagnosed 11 weeks postoperatively.

Introduction Warthin tumor is the second most common tumor of the parotid gland.1 It has both epithelial and lymphoid components.1 Parotid tuberculosis (TB) is an uncommon clinical entity, accounting for only 2.8% of all parotid diseases.2 To the best of our knowledge, only 6 cases of TB infection within a Warthin tumor have been reported in the...

Bilateral congenital lacrimal fistulae: A case report

April 30, 2012     Lei Zhuang, MD; Christin L. Sylvester, DO; Jeffrey P. Simons, MD
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Abstract

A congenital lacrimal fistula is a rare developmental anomaly, usually unilateral. While it is often asymptomatic, some patients present with epiphora or discharge. We report the case of a 4-year-old boy with bilateral lacrimal fistulae. No other systemic, nasal, or ocular anomalies were found. In the absence of significant symptoms, we decided on a course of observation. In this article, we discuss the embryologic basis of congenital lacrimal fistulae, as well as the typical presentation and possible treatment modalities. The presence of a lacrimal fistula is an indication to search for a variety of underlying systemic and ocular anomalies.

Introduction A congenital lacrimal fistula is a rare developmental anomaly that is caused by an interruption in the embryogenesis of the nasolacrimal system. While it is often asymptomatic, some patients present with epiphora or discharge that requires surgical intervention. Rasor described the first reported case of congenital lacrimal fistula in...

Killian-Jamieson diverticulum

April 30, 2012     Ashli K. O'Rourke, MD; Paul M. Weinberger, MD; Gregory N. Postma, MD
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Killian-Jamieson diverticulum is generally smaller than Zenker diverticulum and is associated with less dysphagia, regurgitation, and gastroesophageal reflux.

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Giant tracheocele with multiple congenital anomalies

April 30, 2012     J. Madana, MS, DNB; Deeke Yolmo, MS; Sunil Kumar Saxena, MS; S. Gopalakrishnan, MS
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Abstract

Tracheocele-an outpouching of tracheal mucous membrane-is an uncommon entity. It can occur as a congenital or acquired form. The congenital entity remains mostly dormant until adulthood, and then it typically presents as a herniation with multiple air-filled sacs. The acquired form develops as the result of blunt trauma, recurrent pulmonary infection, intubation, instrumentation, or surgery, and it typically presents as a single paratracheal cavity. We present an extremely rare case of a tracheocele associated with multiple congenital anomalies involving the face, limbs, and heart.

Introduction Tracheocele is an uncommon abnormality that occurs as the result of the protrusion of mucosa through a defect in the tracheal wall. The protrusion leads to the formation of a large, single, air-filled cavity in the neck. Its pathophysiology differs from that of a tracheal diverticulum, in which multiple sacs develop.1,2

Primary acquired cholesteatoma

April 30, 2012     Joseph A. Ursick, MD; Jose N. Fayad, MD
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Cholesteatomas are believed to form as the result of poor eustachian tube function with resultant tympanic membrane retraction and a lack of normal epithelial migration.

A 40-year-old woman with a history of multiple ear infections as a child presented with right-sided hearing loss and aural pressure. Otoscopy revealed a pars flaccida retraction that contained crusted debris, as well as a white mass in the posterior mesotympanum (figure). The patient's audiogram showed a 25-dB right conductive hearing loss....

Diffuse large B-cell lymphoma of the nasopharynx

April 30, 2012     Lester D.R. Thompson, MD
article

Diffuse large B-cell lymphoma accounts for more than 50% of all Waldeyer ring lymphomas, which in turn account for about 15% of all head and neck lymphomas and about 50% of all extranodal head and neck lymphomas.

Figure 1. A: Photograph shows a gross illustration of the “fish flesh” appearance of a cut lymphoid tumor. B: A vague nodularity is seen in this otherwise effaced nasopharyngeal tissue.

Laryngeal schwannoma excised under direct laryngoscopy: Case report

April 30, 2012     Iosif Vital, MD; Dan M. Fliss, MD; Jacob T. Cohen, MD
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Abstract

Laryngeal schwannomas (neurilemmomas) are extremely rare, and they present the otorhinolaryngologist with diagnostic and management challenges. These lesions usually present as a submucosal mass, and they are always a potential threat to the airway. We describe the case of a 75-year-old woman with a laryngeal schwannoma that arose from the left postcricoid area and covered the piriform sinus and arytenoid cartilage on that side. The tumor was completely excised under direct laryngoscopy with the use of a CO2 laser, and preservation of the mucosal lining of the larynx was achieved.

Introduction Schwannomas (neurilemmomas) are benign encapsulated tumors that originate in the Schwann cells that sheathe the fibers of the peripheral, cranial, and autonomic nerves outside the central nervous system.1, 2 Malignant transformation is rare. The head and neck region is frequently involved (25 to 45% of cases), but schwannomas of the...

Primary intraosseous cavernous hemangioma of the zygoma: A case report and literature review

April 30, 2012     Anna M. Marcinow, MD; Matthew J. Provenzano, MD; Richard K. Gurgel, MD; Kristi E. Chang, MD
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Abstract

Intraosseous hemangiomas are rare. We report the case of a 47-year-old man who presented with a gradually enlarging left zygomatic mass that had caused pain, deformity, and superficial soft-tissue swelling. Computed tomography revealed a well-circumscribed 2.0 x 2.5-cm mass with a ground-glass matrix in the left zygoma. Following surgical excision, the patient's symptoms resolved. Findings on pathologic examination of the excised tissue were consistent with an intraosseous cavernous hemangioma. We describe the features of this rare case, we discuss the pertinent radiologic features and pathophysiology of intraosseous hemangiomas, and we review the available literature.

Introduction Intraosseous hemangiomas account for less than 1% of all tumors.1 Their most common sites are the calvaria and the vertebral column.1 Their presence in the midface, including the zygoma, has been described only in a few isolated case reports.2
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