Inferior vestibular neuritis in a fighter pilot: A case report

June 11, 2013     Xie Su Jiang, MD, PhD; Jia Hong Bo, PhD; Xu Po, MS; and Zheng Ying Juan, BSC
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Abstract

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.

Introduction 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

Giant cell tumor of the larynx: A case of malignant sarcomatous transformation

June 11, 2013     Richard J. Vivero, MD; Sandeep P. Dave, MD; Carmen R. Gomez, MD; and Donald T. Weed, MD
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Abstract

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.

Introduction 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...

Endoscopic view of ostial polyps of the maxillary sinus

June 11, 2013     Dewey A. Christmas, MD; Joseph P. Mirante, MD, FACS; and Eiji Yanagisawa, MD, FACS
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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...

Double deep inferior epigastric arteries encountered during vertical rectus abdominis flap harvest: A case report and literature review

June 11, 2013     Thomas K. Chung, MA; Keith Wilson, MD; and Yash J. Patil, MD
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Abstract

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.

Intraparotid neurofibromatosis presenting with multiple nodules

June 11, 2013     Ryan F. Osborne, MD, FACS; Jason S. Hamilton, MD, FACS; and Reena Gupta, MD, FACS
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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.

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Supraglottoplasty for airway obstruction

June 11, 2013     Nausheen Jamal, MD; Farhad Chowdhury, DO; Reena Gupta, MD; and Robert T. Sataloff, MD, DMA, FACS
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Supraglottoplasty may be helpful in a patient with tracheotomy-dependent  adult obstructive sleep apnea/hypopnea syndrome that is causally related to or aggravated by supraglottic obstruction.

Spindle cell lipoma of the larynx

June 11, 2013     Antonio D'Antonio, MD, PhD; Giampiero Mottola, MD; Alessia Caleo, MD; Maria Addesso, MD; and Amedeo Boscaino, MD
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Abstract

Among the primary mesenchymal tumors of the hypopharynx and larynx, lipomas are rare. Macroscopically, they often resemble a retention cyst or laryngeal nodule. Spindle cell lipomas (SCLs) are an uncommon variant of lipoma. SCLs are extremely rare in the larynx; as far as we know, only 4 cases have been previously described in the literature. We present a new case of laryngeal SCL in a 65-year-old man who presented with a 1-year history of hoarseness, choking spells, stridor, and dyspnea. Examination revealed the presence of a large polyp on the left true vocal fold that had caused stenosis of the posterior glottis. The polyp was removed endoscopically, and the patient's stridor and dyspnea resolved. Histologically, the tumor was composed of bland, CD34-positive spindle cells with an abundant fibrous and myxoid stroma interspersed with mature fatty tissue. The patient was free of local recurrence at 2 years of follow-up.

Introduction Spindle cell lipomas (SCLs) represent a rare variant of lipoma. Microscopically, these tumors are composed of mature fat cells mixed with bland spindle cells, hyperchromatic round cells, and multinucleated giant cells.1 Most SCLs originate in the subcutaneous tissue of the posterior neck and upper back.1 In rare cases, these benign...

Kasabach-Merritt syndrome in a child with upper airway compromise and spontaneous periorbital bruising

June 11, 2013     Jay Goswamy, MRCS, DOHNS; Rohini Aggarwal, FRCS(ORL-HNS); Iain A. Bruce, MD, FRCS(ORL-HNS); and Michael P. Rothera, FRCS
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Abstract

A hemangioma that rapidly increases in size has the potential to trap platelets and cause a consumptive coagulopathy. We describe the case of an 18-week-old boy who was brought to a local emergency department with ecchymosis on his nasal bridge and medial epicanthi, as well as a subconjunctival hemorrhage. He was noted to be anemic and thrombocytopenic. Packed red blood cells and platelets were transfused. However, despite hematologic correction, the ecchymosis and petechiae worsened, and a mass became evident in the right posterior triangle of the patient's neck. Computed tomography demonstrated a lobular soft-tissue-density mass in the right posterior triangle that extended to the level of the skull base. Histologic analysis of a biopsy specimen revealed that the lesion was a giant kaposiform hemangioma. The patient was diagnosed with Kasabach-Merritt syndrome, and prednisolone was commenced as a first-line treatment. However, the mass continued to grow, resulting in inspiratory stridor. Magnetic resonance imaging revealed encroachment into the thecal sac and compression of the spinal cord. The lesion was embolized, and vincristine therapy was commenced. Following a second embolization, the size of the lesion decreased and no further blood products were required. The hemangioma was deemed to be unresectable. The successful treatment in this case was dependent on the maintenance of hemostasis, the initial medical treatment with a corticosteroid, repeat embolization, and longer-term control with vincristine.

Letters to the Editor

June 11, 2013    
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MRSA parotitis Dear Editor: Our otolaryngology practice in Erie, Pennsylvania, has noted an increasing number of hospitalized patients with methicillin-resistant Staphylococcus aureus (MRSA) parotitis. Over a 2-month span, we have identified 4 patients seen in hospital consultation by our otolaryngology service with MRSA parotitis.

Cicatricial external auditory canal stenosis caused by ectodermal dysplasia: Rapp-Hodgkin syndrome

June 11, 2013     Amanda B. Sosulski, MD and James D. Hayes, MD
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Abstract

We present a case of recurrent cicatricial stenosis of the external ear canals caused by ectodermal dysplasia, specifically Rapp-Hodgkin syndrome, in a 45-year-old woman. No form of medical or surgical management has produced durable patency of the patient's ear canals, and her hearing loss is being managed with hearing aids. Topical management of the recurring external otitis slows the process but has been unsuccessful in preventing restenosis of both external auditory canals.

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