Glottic myxoma presenting as chronic dysphonia: A case report and review of the literature

January 19, 2015     Christopher G. Tang, MD; Daniel L. Monin, MD; Balaram Puligandla, MD; Raul M. Cruz, MD
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Abstract

Myxomas of the vocal fold are rare benign tumors often presenting with chronic dysphonia and less frequently with airway obstruction. The current consensus is that all laryngeal myxomas should be totally excised with clear margins to prevent recurrences. The recommendation for complete excision, however, has to be balanced with consideration of preserving vocal fold phonatory and sphincteric function. We report a case of vocal fold myxoma recurring twice after subtotal excision via two surgical approaches. This case illustrates a benign lesion with potential for recurrence and the need for a balanced treatment approach.

Osteoradionecrosis of the temporal bone

January 19, 2015     Edmund W. Lee, BA; Robert W. Jyung, MD
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The pathogenesis of osteoradionecrosis is not completely understood, but it has been thought that radiation causes tissues to become hypoxic, hypovascular, and hypocellular, leading to tissue breakdown and a nonhealing wound.

A 66-year-old man was referred to our clinic for evaluation of a sensation of excessive wax in his left ear that had worsened over the previous 3 years. He had a history of a left parotid malignancy 20 years earlier that required a parotidectomy and postoperative radiation therapy. Following the irradiation, he felt an altered pattern of wax...

Unusual presentation of a midline neck mass

January 19, 2015     Yann-Fuu Kou, MD; Gopi Shah, MD, MPH; Ronald Mitchell, MD; Larry L. Myers, MD
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Venous malformations are usually visible at birth, although deeper lesions may have normal overlying skin or a bluish discoloration. They grow proportionately with the child and can expand in adulthood.

A 13-year-old girl presented with a 2-week history of a low midline neck mass that had caused her intermittent pain and some difficulty breathing. It enlarged on straining. She denied dysphagia, odynophagia, voice changes, weight loss, fever, chills, and cough. She had no significant medical or surgical history.

Cherubism

January 19, 2015     Lester D.R. Thompson, MD
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When there is significant infraorbital maxillary involvement, the inferior rim of the sclera is more prominent, resulting in the classic “eyes to heaven” appearance.

Cherubism is an autosomal-dominant inherited disease with variable expression. It is characterized by a progressive, painless, and symmetric expansion of the jaws. The disease is caused by a point mutation in the SH3BP2 gene (chromosome 4p16.3), which leads to dysregulation of the Msx-1 gene; this gene is involved in regulating mesenchymal...

Arrested development: Lingual thyroid gland

January 19, 2015     Mark R. Williams, MRCS(ENT); Vivek Kaushik, FRCS(ORL-HNS)
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Most patients with lingual thyroid are asymptomatic and are diagnosed incidentally following a radiologic investigation for another condition of the head and neck.

Most patients with a lingual thyroid gland are asymptomatic, as it rarely manifests clinically with aerodigestive symptoms, malignancy, or endocrine dysfunction. It is therefore usually diagnosed as an incidental finding, more so now with the increased use of cross-sectional imaging in the head and neck region.

Endoscopic view of nasopharyngeal scarring

January 19, 2015     Joseph P. Mirante, MD, FACS; Dewey A. Christmas, MD; Eiji Yanagisawa, MD, FACS
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A finding of fibrous or scar tissue in the nasopharynx usually indicates previous trauma or surgery in the area. The most common iatrogenic cause is adenoidectomy.

Spontaneous bilateral dural arteriovenous fistulas with pulsatile tinnitus

January 19, 2015     Tzu-Chieh Lin, MD; Hsiung-Kwang Chung, MD; Jeng-Nan Hsu, MD
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Abstract

Pulsatile tinnitus with normal otoscopic findings often presents a diagnostic challenge to otolaryngologists and can be attributed to serious vascular malformations such as dural arteriovenous fistulas (DAVFs). Spontaneous DAVFs are relatively rare. A 65-year-old woman presented with sudden-onset subjective/objective pulsatile tinnitus on the right side that had persisted for 2 months. Angiography and magnetic resonance angiography revealed DAVF formation. Stereotactic radiosurgery was performed, and total remission of the DAVFs was achieved.

An uncommon cause of allergic fungal sinusitis: <i>Rhizopus oryzae</i>

January 19, 2015     Marie Devars du Mayne, MD; Maxime Gratacap, MD; David Malinvaud, MD, PhD; Frederic Grenouillet, PhD; Pierre Bonfils, MD, PhD
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Abstract

We report what we believe is the first case of allergic fungal rhinosinusitis (AFRS) caused by the fungus Rhizopus oryzae. Our patient was a 32-year-old woman who presented with unilateral nasal polyps and chronic nasal dysfunction. Computed tomography of the sinuses detected left-sided pansinusitis and bone erosion. T2-weighted magnetic resonance imaging demonstrated a signal void that suggested the presence of a fungal infection. The patient underwent unilateral ethmoidectomy. Histologic examination of the diseased tissue identified allergic mucin with 70% eosinophils and no fungal hyphae. Mycologic culture detected R oryzae. After a short period of improvement, the patient experienced a recurrence, which was confirmed by radiology. A second surgery was performed, and the same fungal hyphae were found in the mucus and on culture, which led us to suspect AFRS. Since no IgE test for R oryzae was available, we developed a specific immunologic assay that confirmed the presence of specific IgG, which identified a high degree of immunologic reaction against our homemade R oryzae antigens. With a long course of systemic antifungal treatment, the patient's symptoms resolved and no recurrence was noted at 5 years of follow-up.

Bronchoscopic extraction of a chicken bone 5 years after aspiration

January 19, 2015     Parth Shah, MD; Angela Han, BA; Rishin Patel, MD; Paul Howlett, MD; Scott Akers, MD; Mitchell Margolis, MD; Sunil Singhal, MD
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Abstract

A 58-year-old man with a remote history of choking on a chicken bone 5 years earlier presented with chronic cough but had no remarkable clinical examination findings. He was being followed for recurrent pneumonias complicated by a resistant empyema, for which he had undergone thoracotomy and decortication. Imaging studies initially missed a foreign body (the chicken bone), which was found on follow-up studies and was removed with a flexible bronchoscope despite the fact that 5 years had passed since the aspiration.

Introduction A review of the literature shows that occult foreign body aspiration poses difficulties in diagnosis and that a history of aspiration is often lacking. However, the recurrent nature and persistent localization of pneumonia to one area of the lung, as well as findings during bronchoscopy, should alert the physician to the possibility...

IgG4-related disease of the thyroid: A consideration in the differential diagnosis of an expanding thyroid mass

January 19, 2015     Irina Chaikhoutdinov, MD; Eelam Adil, MD, MBA; Michael D.F. Goldenberg, BA, MA; Henry Crist, MD
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Riedel thyroiditis is a rare inflammatory process associated with IgG4; it involves the thyroid and surrounding cervical tissue, and it is associated with various forms of systemic fibrosis.

A 70-year-old woman was transferred to our institution with progressive shortness of breath secondary to a compressive thyroid mass. Over the previous 2 months, she had noticed an enlargement of her thyroid mass and the onset of compressive symptoms, including difficulty breathing when lying supine or with neck flexion. On physical examination,...