Hypocalcemia after minimally invasive thyroidectomy

September 17, 2014     Doug Massick, MD; Matthew R. Garrett, MD
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Abstract

We conducted a retrospective study to determine the incidence of postoperative hypocalcemia following minimally invasive thyroidectomy. During the 2-year study period, 74 patients-16 men and 58 women (mean age: 43.7)-underwent either total or hemithyroidectomy through a 3-cm incision. Postoperative hypocalcemia occurred in 14 of these patients (18.9%)-4 men and 10 women-all of whom underwent total rather than hemithyroidectomy. All these patients received supplementation with calcium and vitamin D for 2 weeks postoperatively in order to regain a normal calcium status, and all demonstrated normal serum calcium levels at 3 weeks. Despite their low calcium levels, none of the 14 patients exhibited any overt symptoms of hypocalcemia. We conclude that minimally invasive thyroidectomy is associated with a low rate of postoperative hypocalcemia that is comparable to the rates previously reported for standard thyroidectomy.

Mesenchymal chondrosarcoma of the mandible: A rare malignant tumor

September 17, 2014     Rakesh Kumar Singh, MS; Saurabh Varshney, MS; Sampan Singh Bist, MS; Meena Harsh, MD; Nitin Gupta, MD
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Abstract

Mesenchymal chondrosarcoma (MCHS) is a highly aggressive, malignant, cartilaginous tumor that represents about 1% of all chondrosarcomas. Only about 50 cases of MCHS of the jaw have been reported in the English-language literature; maxillary tumors are much more common than mandibular tumors. We present a new case of MCHS of the mandible that arose in a 22-year-old woman whose initial two biopsies did not reveal the features of the tumor. The diagnosis was made only after an incisional biopsy.

Ear mold impression material as an aural foreign body

September 17, 2014     Yu-Hsuan Lin, MD; Ming-Yee Lin, MD, PhD
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Physicians should not rush indiscriminately into action without a careful otoscopic examination and a detailed history, to discern whether a patient has abnormal anatomy and is at risk for complications.

Although most patients who are fitted for a hearing aid experience no adverse outcomes, ear mold impression material does occasionally impact the ear. Most of the patients in whom this occurs have preexisting anatomic aural abnormalities. Hence, careful history taking and an otoscopic examination should be undertaken by persons entrusted with...

Chronic rhinosinusitis in patients requiring surgical repair of a midface fracture

September 17, 2014     Joshua C. Yelverton, MD; Peter Jackson, MD; Robert S. Schmidt, MD
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Abstract

Midface fractures commonly occur following trauma to the face and may cause changes in the normal sinus outflow system. To the best of our knowledge, no study has examined the incidence of rhinosinusitis following midface fractures. We report the incidence of chronic rhinosinusitis in patients who underwent surgical repair of a midface fracture. Our evaluation tool was the 20-item Sino-Nasal Outcome Test quality-of-life survey (SNOT-20). We mailed a demographic survey and the SNOT-20 questionnaire to 486 eligible patients who had undergone surgical repair of either a midface (n = 234) or mandible (n = 252) fracture; we had intended to use the latter cohort as a control group. Of the 234 midface patients, 34 (14.5%) returned a usable survey, but only 7 of the 252 mandibular patients (2.8%) did so, which was not a sufficient number for analysis; therefore we used normative data obtained from another study for comparison purposes. The mean SNOT-20 score in our cohort was 24.15, which was similar to the 28.7 mean score in the control cohort of patients with rhinosinusitis. The highest mean scores for the individual components of the SNOT-20 were for “Wake up at night,” “Lack of a good night's sleep,” “Wake up tired,” and “Frustrated/restless/irritable.” The components that the most patients found bothersome were “Facial pain/pressure,” “Need to blow nose,” “Runny nose,” and “Lack of a good night's sleep.” We conclude that patients who experience a midface fracture have a much higher risk of developing chronic rhinosinusitis that negatively affects their long-term quality of life. These patients should be monitored with long-term follow-up and treated appropriately.

Introduction The midface skeleton extends from the superior orbital rims to the upper alveolus. It contains the paranasal sinuses, which function to protect critical structures, including the globes, the carotid arteries, the internal jugular veins, and the brain.1 The walls of the paranasal sinuses are quite thin and easily fractured in facial...

Keratocystic odontogenic tumor

September 17, 2014     Lester D.R. Thompson, MD
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Bite-wing or orthopantomograph images reveal a well-defined, unilocular radiolucency with a smooth border, showing minimal bone expansion and even cortication.

Keratocystic odontogenic tumor (KCOT; formerly known as odontogenic keratocyst) is a distinct developmental odontogenic cyst that may be locally aggressive and may be part of the nevoid basal cell carcinoma syndrome (NBCCS, or Gorlin syndrome). Inherited as an autosomal dominant trait, there is high penetrance, although with variable expression,...

Stylohyoid syndrome, also known as Eagle syndrome: An uncommon cause of facial pain

September 17, 2014     Erin L. Werhun, MD; Mandy C. Weidenhaft, MD; Enrique Palacios, MD, FACR; Harold Neitzschman, MD, FACR
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Eagle syndrome is often a diagnosis of exclusion after other etiologies of pain are thoroughly investigated, and it can be determined via a physical examination and characteristic radiographic findings.

Eagle syndrome, also known as stylohyoid syndrome, was first described by Dr. W. Watt Eagle in 1937 as an uncommon cause of facial pain.1 It is characterized by an elongated styloid process, a calcified stylohyoid ligament, or a combination of the two.2,3 The exact pathophysiology of Eagle syndrome is unclear, although many theories exist.4

Pedunculated cavernous hemangioma originating in the olfactory cleft

September 17, 2014     Kaiming Su, MD, PhD; Weitian Zhang, MD, PhD; Haibo Shi, MD, PhD; Shankai Yin, MD, PhD
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Abstract

Sinonasal cavernous hemangioma is a rare condition that usually affects the lateral wall of the nasal cavity. We report the case of a 77-year-old man who presented with severe epistaxis, nasal congestion, and olfactory dysfunction. Endoscopic examination of the nasal cavity revealed the presence of a red-blue tumor that had almost completely filled the nasopharynx. Preoperatively, it was difficult to distinguish this lesion from a juvenile nasopharyngeal angiofibroma. During endoscopic surgery, the tumor was found to originate in the left olfactory cleft, and it had a long peduncle that contained blood vessels. Postoperative histopathologic examination indicated that the mass was a cavernous hemangioma. To the best of our knowledge, this is the first case of an olfactory cleft cavernous hemangioma and the first case of olfactory cleft disease associated with a cavernous hemangioma to be reported in the English-language literature.

Introduction Hemangiomas are common lesions of the head and neck. They are classified histologically as capillary, cavernous, or mixed.1 Although the cause is unknown, microtrauma and hormonal factors have been implicated in their etiology.2 Funding/support: This work was supported by grant 20124450 from the Shanghai Municipal Health Bureau....

Report of a rare case of carcinoma arising in a branchial cyst

September 17, 2014     Natarajan Anantharajan, MBBS, MS, MRCS; Nagamuttu Ravindranathan, BDS, MBBS, FRCS(Edin)
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Abstract

Primary branchiogenic carcinoma is a rare condition. In fact, most of the cases that were previously reported as such were actually cystic metastases of oropharyngeal carcinomas. We report a true case of primary branchial cleft cyst carcinoma. Our patient was a 42-year-old woman who presented with a painless fluctuant swelling in the right side of her neck. The lesion was completely excised, and pathology identified it as a squamous cell carcinoma in a branchial cleft cyst. Patients with this condition require a careful evaluation of the entire head and neck region, especially the oropharynx, to look for any cystic metastasis of the primary tumor.

Introduction Von Volkmann first described branchiogenic carcinoma in 1882.1 However, in 1950, Martin et al questioned the existence of this entity.2 Martin et al proposed four criteria for the diagnosis of branchiogenic carcinoma2: The tumor must lie along a line anterior to the sternocleidomastoid muscle between the tragus and the clavicle....

Cochlear fistula in a noncholesteatomatous ear

September 17, 2014     Yoav Hahn, MD; Dennis I. Bojrab, MD
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Abstract

Bony destruction of the labyrinth is usually associated with long-standing cholesteatomatous otitis media. The promontory is not a common site for bone resorption because (1) it is not an area that is involved in accumulation of cholesteatoma perimatrix substances, (2) it is the densest bone of the human body, and (3) pressure necrosis from overlying tissue is uncommon. We report a case of cochlear erosion associated with noncholesteatomatous middle ear disease. As far as we know, this is only the second such case reported in the literature. We also review decision-making factors and techniques for the safe management of this condition.

Introduction Labyrinthine fistula may be a complication of otitis media with cholesteatoma.1 Labyrinthine fistula most commonly affects the horizontal semicircular canal. A fistula of the cochlea is a rare finding; when it does occur, it is usually associated with extensive middle ear disease and cholesteatoma.

Plummer-Vinson syndrome following gastric bypass surgery

September 17, 2014     Andrew Sapthavee, MD; Matthew L. Kircher, MD; Lee M. Akst, MD
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Abstract

Plummer-Vinson syndrome (PVS) is the combination of dysphagia, angular cheilitis, atrophic glossitis, and esophageal webbing in the setting of iron deficiency anemia. Although it is relatively uncommon, this condition is important to recognize because it is a source of dysphagia and it confers an increased risk for hypopharyngeal cancer. Cases of PVS associated with gastrointestinal conditions such as celiac disease and gastric cancer have been previously reported in the literature, but as far as we know, no case of PVS associated with bariatric surgery has been previously reported. We describe the case of a 39-year-old woman who developed PVS following gastric bypass surgery, and we briefly discuss the current knowledge of this syndrome.