Spatial disorientation in airplane pilots is a leading factor in many fatal flying accidents. Spatial orientation is the product of integrative inputs from the proprioceptive, vestibular, and visual systems. One condition that can lead to sudden pilot incapacitation in flight is vestibular neuritis. Vestibular neuritis is commonly diagnosed by a finding of unilateral vestibular failure, such as a loss of caloric response. However, because caloric response testing reflects the function of only the superior part of the vestibular nerve, it cannot detect cases of neuritis in only the inferior part of the nerve. We describe the case of a Chinese naval command fighter pilot who exhibited symptoms suggestive of vestibular neuritis but whose caloric response test results were normal. Further testing showed a unilateral loss of vestibular evoked myogenic potentials (VEMPs). We believe that this pilot had pure inferior nerve vestibular neuritis. VEMP testing plays a major role in the diagnosis of inferior nerve vestibular neuritis in pilots. We also discuss this issue in terms of aeromedical concerns.
Spatial disorientation in airplane pilots is a leading contributor to many fatal flying accidents. According to a report from the U.S. Air Force, 356 major Air Force aircraft accidents attributable to pilot error occurred from January 1980 through December 1989; of these, spatial disorientation accounted for 81 incidents (22.8%).1
We report what is to the best of our knowledge the first case of malignant transformation of a giant cell tumor of the larynx. The patient, a 34-year-old man, presented to our tertiary care university teaching hospital where he underwent hemilaryngopharyngectomy with radial forearm free flap reconstruction and 11 of 15 cycles of chemotherapy. He remained disease-free at approximately 6 years and 4 months of follow-up. The patient is decannulated and continues to have a good voice with excellent quality of life to this day. We discuss the patient's clinical course and subsequent treatment within the context of a review of the current literature regarding this disease entity. Our experience demonstrates that giant cell tumor of the larynx may present as a malignant neoplasm without adversely affecting the patient's prognosis when treated aggressively with surgical resection and adjunct chemotherapy.
Previous presentation: The information in this article has been updated from its original presentation as a poster at The Triologic Society's Combined Southern and Middle Sections Meeting; January 8-11, 2009; Bonita Springs, Fla.
Neoplasms arising from the supporting laryngeal cartilages are uncommon.1-3 These tumors represent less than 2% of all primary laryngeal neoplasms, and they include chondromas, chondroblastomas, osteoblastomas, giant cell reparative granulomas, brown tumors of hyperparathyroidism, aneurysmal bone cysts, osteosarcomas, chondrosarcomas...
Ostial polys in the maxillary sinus can cause recurring maxillary sinus disease by obstructing the ethmoid infundibulum and natural ostium of the maxillary sinus.
A 38-year-old man presented with a 2-year history of recurrent left sinusitis. Computed tomography (CT) of the sinuses revealed minimal findings, with only a slight clouding in the left ethmoid infundibulum (figure, A). Nasal endoscopy identified polypoid tissue in the left middle meatus that had arisen from somewhere behind the left uncinate...
The rectus abdominis flap offers a number of advantages over other flaps used in head and neck reconstruction. The flap can be harvested by a separate team and can be tailored to include skin, muscle, and fat. In addition, the available vascular pedicle is long and its large caliber provides an appropriate size match with recipient neck vessels. Central to reconstructive success is defining an arterial and venous pedicle that provides balanced perfusion to all components of the flap. Anomalous vascular anatomy presents principal challenges in reestablishing free flap perfusion. We present a case of double, right deep inferior epigastric arteries encountered during vertical rectus abdominis myocutaneous flap reconstruction of the tongue and floor of the mouth and discuss the clinical outcomes of this reconstruction.
Often asymptomatic initially, neurofibromas may cause pain, weakness, and numbness as they grow as a result of compression of the underlying nerve fascicles.
Neurofibroma of the parotid gland is extremely rare. When it does occur, it usually does so in patients with neurofibromatosis type 1 (NF-1). We describe a case of intraparotid neurofibromatosis that was even more unusual because it occurred in the absence of a definitive diagnosis of NF-1 and because the patient had multiple nodules.