Systemic sclerosis and reflux

April 17, 2013     John J. Petronovich, BS; Jonathan M. Bock, MD
article

MII-pH testing with impedance-based symptom association may improve diagnostic accuracy in patients with systemic sclerosis and reflux.

A 47-year-old woman with systemic sclerosis was seen for complaints of heartburn, regurgitation, and a paroxysmal, nonproductive cough that worsened at night. Her systemic sclerosis symptoms included calcinosis, Reynaud phenomenon with recurrent digital ulcers, and mild interstitial lung disease. She also had solid food dysphagia with food...

A false-positive FDG uptake in Teflon granuloma: A case report

April 17, 2013     Munir Demir Bajin, MD; Ali Sefik Hosal, MD
article

Abstract

Positron emmision tomography (PET) is successfully used to monitor malignancies. Unfortunately it is not tumor specific. We present a case with history of rectum cancer and lentigo maligna who underwent PET-CT which revealed an increased uptake in the larynx. What was first considered as a third pirmary turned out to be a Teflon granuloma.

Introduction Teflon injection had been widely used in the 1960s when it was first introduced to treat unilateral vocal fold paralysis. Unfortunately, long term granuloma formation and unpredictability of the material resulted in its being replaced with other injectables including hyaluronic acid, autologous fat and collagen injections and or with...

Prolonged ulcerative laryngitis in an 18-year-old voice major

April 17, 2013     Brent L. Toland, MD; Rima A. DeFatta, MD; Robert T. Sataloff, MD, DMA, FACS
article

Management of prolonged ulcerative laryngitis requires close observation with strobovideolaryngoscopy; therapy involves steroids, antibiotics, antifungal drugs, and antireflux treatment.

An 18-year-old female vocal performance major presented with complaints of worsening hoarseness for 4 months. Her dysphonia was accompanied by excessive throat clearing, vocal fatigue, and loss of high pitches. She reported several upper respiratory tract infections in the months preceding her voice symptoms. She was healthy otherwise and had...

Cavernous hemangioma of the external auditory canal

April 17, 2013     Min-Tsan Shu, MD; Kang-Chao Wu, MD; Yu-Chun Chen, MD
article

The differential diagnosisfor cavernous hemangioma of the external auditory canal includes attic cholesteatoma with aural polyp, glomus tumor, arteriovenous malformation, granulation tissue, and carcinoma of the EAC.

A 57-year-old woman visited our clinic with the complaint of right-sided ear pain for 10 days. Otoscopic examination revealed a purple mass at the roof of the medial part of the osseous external auditory canal (EAC), about 5 mm in diameter (figure). Temporal bone computed tomography (CT) scans showed that the tumor was limited to the EAC only....

Glomangioma of the nasal septum: A case report and review

April 17, 2013     Magdalena Chirila, MD, PhD; Liliana Rogojan, MD
article

Abstract

Glomangioma is a painful, blue-red tumor that appears as a solitary encapsulated nodular mass, almost always on the skin. The first case of nasal glomangioma was reported in 1965. Since then, only 31 other cases have been reported in the literature. We present a new case of glomangioma of the nasal septum in a 61-year-old woman. The tumor was removed via an intranasal endoscopic excision. No recurrence was found at 3 years of follow-up. Our challenge was to distinguish the glomangioma from a true hemangiopericytoma and a paraganglioma.

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Hemorrhagic vocal process granuloma

April 17, 2013     Farhad R. Chowdhury, DO; Kevin Hsu, DO; Robert T. Sataloff, MD, DMA, FACS
article

Most small vocal process granulomas will resolve spontaneously if the primary insult is removed, but these lesions have a very high tendency to recur.

Endoscopic view of the posterior septal branch of the sphenopalatine artery

April 17, 2013     Jae Hoon Lee, MD
article

Moderate posterior epistaxis can be avoided if the posterior septal branch of the sphenopalatine artery is accounted for when extending the natural ostium inferiorly to a distance greater than approximately 5 mm.

Giant osteoma of the middle turbinate: A case report

April 17, 2013     Samar Pal Singh Yadav, MS(ORL); Joginder Singh Gulia, MS(ORL); Anita Hooda, MDS(Prosthodontics); Ajoy Kumar Khaowas, MS
article

Abstract

Osteoma of the nose is a slowly developing benign tumor with a reported incidence of 0.6% of all the osteomas of the nose and paranasal sinuses. It is asymptomatic in initial stages and is usually diagnosed when it causes nasal obstruction. Osteoma arising from the middle turbinate is very rare and only two cases have been previously reported. We report a giant middle turbinate measuring 36 x 35 x 20 mm which, to the best of our knowledge, is the largest reported osteoma arising from the middle turbinate.

Management of pterygoid venous plexus hemorrhage during resection of a large juvenile nasopharyngeal angiofibroma: A review of 27 cases

April 17, 2013     Lin Chang, MD; Yi Zixiang, MD; Fang Zheming, MD; Lin Gongbiao, MD; Li Zhichun, MD; Zhang Rong, MD; Zhou Aidong, MD; Lan Shuzhan, MD
article

Abstract

We retrospectively reviewed the cases of 27 patients who experienced intraoperative bleeding during resection of a large (Fisch type III or IV) juvenile nasopharyngeal angiofibroma (JNA). Of this group, 16 patients had a type III JNA and 11 had a type IV tumor. The degree of hemorrhaging during excision of these JNAs varied greatly among individual patients. The amount of blood lost ranged from 200 to 5,000 ml (mean: 1,800) in the type III cases and from 700 to 8,000 ml (mean: 2,850) in the type IV cases. In 5 of these cases, both intraoperative observations and imaging data suggested that an important factor in the blood loss was damage to the pterygoid venous plexus (PVP). The PVP communicates with the cavernous sinus, ophthalmic vein, maxillary vein, and facial vein; no valve exists between these veins. In patients with a large JNA, the PVP is usually compressed by or adherent to the tumor. When a PVP is seriously damaged during removal of a JNA, hemorrhaging can be very profuse. Therefore, a suitable surgical approach and appropriate hemostatic procedures should be used to prevent or manage PVP hemorrhage as effectively as possible. We also describe in greater detail 5 typical cases of JNA excision that did (n = 3) and did not (n = 2) involve PVP damage.

Introduction In recent years, we began to study whether damage to the pterygoid venous plexus (PVP) during the resection of large juvenile nasopharyngeal angiofibroma (JNAs) in the infratemporal fossa is an important factor in blood loss. Our analyses were based on intraoperative observations and advanced imaging methods. The key to success in...

Endoscopic view of a septochoanal polyp

April 17, 2013     Jae Hoon Lee, MD
article

Most nasal cavity polyps develop from the mucosa of the anterior ethmoid sinus, the contact areas of the uncinate process, and the middle turbinates.

A 69-year-old woman with a 1-year history of slowly progressive left nasal obstruction was referred to our hospital. She had no other health problems. Nasal endoscopy showed a protruding polypoid nasal mass in the left sphenoethmoidal recess extending toward the choana (figure, A). Computed tomography (CT) of the nose and paranasal sinuses showed...
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