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Malignant transformation of a high-grade osteoblastoma of the petrous apex with subcutaneous metastasis

June 14, 2016  |  Casey T. Kraft, BS; Robert J. Morrison, MD; H. Alexander Arts, MD, FACS


We describe the clinical presentation, management, and pathologic findings in a case of osteosarcoma of the petrous apex with an atypical metastasis to the lower abdominal wall. We retrospectively reviewed the record of a 49-year-old man who was diagnosed with a right petrous apex lesion, which biopsy identified as a high-grade osteoblastoma. After two attempts at en bloc resection were not curative, radiation and chemotherapy were recommended. The patient subsequently developed a cutaneous lower abdominal mass that was diagnosed as an osteosarcoma. Meanwhile, the petrous apex tumor continued to grow despite treatment until the patient died from the burden of disease. Temporal bone osteoblastomas and osteosarcomas are both extremely rare, and they can be difficult to differentiate histologically. Our case illustrates this difficulty and demonstrates the possibility of a high-grade osteoblastoma's malignant conversion to an osteosarcoma.

Aberrant position of nonrecurrent inferior laryngeal nerve: Report of 3 cases and a review of the literature

June 14, 2016  |  Thomas J. Willson, MD; Jayne Stevens, MD; Nathan Salinas, MD; Joseph A. Brennan, MD


The presence of a nonrecurrent inferior laryngeal nerve (NRILN) is a significant risk factor for nerve injury during thyroid, parathyroid, and vascular surgeries involving the paratracheal area of the head and neck. The objective of this report is to review the association between an aberrant right subclavian artery (SCA) identified on preoperative imaging and an NRILN identified intraoperatively during thyroid and parathyroid surgery. We reviewed 3 selected cases in which we preoperatively identified an aberrant right SCA and determined the intraoperative position of the inferior laryngeal nerve on the right. It is important to note that 1 of these cases demonstrated that the inferior laryngeal nerve may be found in its normal anatomic position, coursing inferiorly through the tracheoesophageal groove. This anatomic finding is unexpected in a patient with a preoperatively identified aberrant right SCA. We also performed a literature review of more than 250 cases to investigate the association between an intraoperative finding of NRILN and vascular anomalies on imaging. We found 5 reported cases that involved an aberrant right SCA, predictive of NRILN, with the nerve identified in the tracheoesophageal groove.

Twenty-four years of powered endoscopic nasal polypectomy

June 14, 2016  |  Dewey A. Christmas, MD; Joseph P. Mirante, MD, FACS; Eiji Yanagisawa, MD, FACS

Powered endoscopic nasal polypectomy with a microdebrider can be performed with either local or general anesthesia.

Investigation of diagnosis and surgical treatment of mucosal contact point headache

June 14, 2016  |  Jia Wang, MD; Jin-Shu Yin, MD; Hong Peng, MD


We aimed to investigate the differences in incidence of nasal anatomic abnormalities between patients with and without headache and the outcome of surgical treatment for the headache patients with mucosal contact points. We conducted the observational study and recruited 107 subjects without headache (nonheadache group) and 78 patients with recurrent headache for more than 2 years (headache group). Study participants underwent high-resolution sinus computed tomography scans, and the incidence of nasal anatomic abnormalities was calculated in both groups. An additional 25 patients with recurrent headache underwent endoscopic surgical treatment. Mucosal contact points were observed in 85.9% of patients with recurrent headache and also in 80.4% of participants without headache. The most common mucosal contact point was between a deviated nasal septum and lateral nasal wall (41.1%). The incidence of deviated nasal septum contacting with lateral nasal wall was significantly different between the headache group (55.1%) and the nonheadache group (40.2%) (p < 0.05). The postoperative pain scores of the additional 25 headache patients with recurrent headache and mucosal contact point who were treated with endoscopic surgery decreased significantly compared with their preoperative measurements (p < 0.001), but only 44% of patients had recovered from headache 7 days postoperatively. We conclude that some patients with recurrent headache may not have a mucosal contact point, and some patients with mucosal contact points may not meet the diagnostic criteria of mucosal contact point headache since pain was not resolved within 7 days after surgical treatment. The diagnostic criteria of mucosal contact point headache before surgery should be reevaluated.

Unconventional fix for an orocutaneous fistula

June 14, 2016  |  Laura Garcia-Rodriguez, MD; Rahil Dharia, BS; Cameron Heilbronn, MD; Tamer Ghanem, MD, PhD

Local risk factors for OCF and PCF secondary to total laryngectomy include infections, exposure of salivary fluids, and radiation.

Asymptomatic medial vocal fold hemorrhagic polyp

June 14, 2016  |  Ozlem E. Kantarcioglu, MD; Amy L. Rutt, DO; Robert T. Sataloff, MD, DMA, FACS

This patient did not realize that her voice was pathologic until after she had been treated.

Case of a tick as an unusual animate aural foreign body

June 14, 2016  |  Chao-Hsun Huang, MD; Min-Tsan Shu, MD

The risk of acquiring a tick foreign body in the external auditory canal is generally related to geographic and climatic factors, such as warmer months and areas with forests, high grass, and leaf litter.

Coexistent chronic myelogenous leukemia with squamous cell carcinoma of the larynx associated with NOD2/CARD15 mutation in a young adult

June 14, 2016  |  Marcin Fraczek, MD; Agnieszka Stembalska, MD; Pawel Karpinski, MD; Tomasz Krecicki, MD


We report the case of a 37-year-old man with human papillomavirus-positive squamous cell carcinoma of the larynx coexisting with chronic myelogenous leukemia. The patient had no history of smoking or alcohol consumption. Within a few months, his rapidly growing tumor was classified as T4aN2cM0. It could be assumed that the rapid increase in the tumor mass, which did not respond positively to treatment, might have been associated with the coexistence of the chronic myelogenous leukemia, which had been found incidentally. Genetic testing revealed the presence of insertion mutation 3020insC within the NOD2 gene, which might be an important genetic predisposing factor, not only for a single tumor such as laryngeal cancer, but also for multiple primary neoplasms. The presence of an NOD2 mutation could significantly worsen the course of the cancer. Therefore, given the relatively high frequency of 3020insC mutations in the general population, it might be reasonable to perform genetic testing on a wider scale for patients with head or neck cancer, particularly in cases that follow an atypical course. It is also worth emphasizing the importance of thorough and periodically repeated laryngeal examinations in patients with chronic leukemia.

Diagnosis and management of a tympanic membrane hemangioma

June 14, 2016  |  Glen Watson, MBBS, FRCS; Amanda McSorley, MBChB, BSc, MRCS; Vivek Kaushik, MBBS, FRCS, DLO


Vascular tumors arising in the temporal bone represent 0.7% of all lesions in this area. Hemangiomas confined to the tympanic membrane are exceptionally rare. We report a new case of tympanic membrane hemangioma that arose in 59-year-old man who presented with a 2-month history of constant right-sided pulsatile tinnitus and associated neck discomfort. The lesion and a cuff of healthy tympanic membrane were excised, and the resulting defect was repaired with a temporalis fascia graft. At 3 months, the neotympanum was well healed and the patient's symptoms had resolved. We also review the limited number of previously published cases of tympanic membrane hemangioma, and we discuss the presentation and management of these lesions. Some tympanic hemangiomas are asymptomatic and others present as hearing loss, tinnitus, otalgia, and/or otorrhea. Pure-tone audiometry and high-resolution computed tomography of the temporal bones are essential to determine the extent of the lesion. An excisional biopsy is recommended because it is curative and it provides histologic confirmation of the diagnosis. Excision requires elevation of a tympanomeatal flap, en bloc resection, and reconstruction of the tympanic membrane defect. Small lesions can be excised via a permeatal or endaural approach, while larger lesions require a postauricular approach.

Antibacterial effects of the povidone-iodine vacuum impregnation technique in expanded polytetrafluoroethylene augmentation rhinoplasty

June 14, 2016  |  Jung Min Lee; Joong Seob Lee, MD; Dong-Kyu Kim, MD, PhD; Jun Ho Lee, MD, PhD; Hae Sang Park, MD, PhD; Ho Jun Lee, MD; Sung Hee Bae, MD; Ji Su Jang, MD; Jae Jun Lee, MD; Chan Hum Park, MD, PhD


Expanded polytetrafluoroethylene (e-PTFE) is a popular graft material for augmentation rhinoplasty. Gore-Tex and Surgiform are two types of e-PTFE; Surgiform has thicker fibrils and is more compact than Gore-Tex. We conducted an ex vivo study to evaluate the ability of povidone-iodine (PVP-I) vacuum pretreatment to prevent infection with these two types of e-PTFE. Gore-Tex and Surgiform specimens were cut into 2-mm3 pieces, which were separated into two groups. One group for each e-PTFE was disinfected with vacuum PVP-I impregnation and the other group was not disinfected. Using the pieces of implant material, swabs were obtained from the nasal cavities of 20 healthy adults, and the specimens were incubated on agar plates and viewed by scanning electron microscopy (SEM). We found that PVP-I treatment significantly reduced the bacterial colony counts in both the Gore-Tex and Surgiform groups. In the SEM images, bacterial colonies were observed both inside and outside the untreated Gore-Tex; on the untreated Surgiform, they were found primarily on the surface. Few bacteria were detected in the PVP-I-treated Gore-Tex and Surgiform groups. Our findings suggest that PVP-I pretreatment can reduce the risk of infection associated with e-PTFE.