Survival characteristics of injected human cartilage slurry in a nude mouse model: A preliminary study

July 13, 2014     Bounmany Kyle Keojampa, MD; Jacob Pieter Noordzij, MD; Bohdana Burke, MD; Joseph Alroy, DVM; Vartan Mardirossian, MD; Alphi Elackttu, MD; Zhi Wang, MD


We conducted a study to examine the viability, host response, and volume retention characteristics of drilled human septal cartilage slurry when injected into an athymic nude mouse model. We injected 0.2 ml of the slurry into the hind limbs of 6 mice. The mice were sequentially sacrificed over a period of 180 days. Histologic reviews of the hind limbs were performed to determine the viability of injected chondrocytes, host response, and volume retention. Specimens were obtained and histomorphologic analysis was performed at 1, 30, 90, and 180 days after injection. We identified viable cartilage throughout the study. Cartilage injection was well tolerated, and minimal inflammatory reaction occurred without significant adverse effects. The injected bolus of cartilage was found to have progressively dispersed throughout the muscle over time. Our findings warrant further investigation with a larger cohort of nude mice or possibly human subjects.

Introduction Unilateral vocal fold paralysis is a significant cause of morbidity. Nerve injury can occur in a variety of ways: as an iatrogenic recurrent laryngeal nerve injury during surgery, as a complication of endotracheal intubation, and as the result of blunt chest/neck trauma, a viral infection, or a tumor of the skull, neck and chest;...

Angiolipoleiomyoma located in the earlobe

July 13, 2014     Sirin Yasar, MD; Zehra Asiran Serdar, MD; Fatih Goktay, MD; Burcu Barutcugil, MD; Selvinaz Ozkara, MD; Pelin Demirturk, MD


Angiolipoleiomyoma (ALLM) is a solid tumor that is mostly derived from muscle tissue. It is often located in the kidneys of patients with tuberous sclerosis; ALLMs located outside the kidneys are very rare. Among the rare presentations are cutaneous ALLMs, which manifest as 1- to 4-cm asymptomatic, acquired, solitary, subcutaneous nodules that have a strong predilection for males. To the best of our knowledge, only 22 cases of ALLM of the skin have been previously reported in the literature; in 5 of these cases, the tumor was located on the ear. Histologically, tumoral proliferation is observed with smooth muscle, fat tissue, and vascular channels surrounded by a fibrous capsule; cellular atypia is not observed. We report the case of a 67-year-old man who presented for evaluation of a purplish nodular lesion that had been present on his right earlobe for 10 years. Analysis of an excisional biopsy specimen revealed a nodular formation that consisted mostly of thick-walled veins within a fibromyxoid stroma; smooth-muscle tissue and fat globules were observed in places. The lesion was diagnosed as a cutaneous ALLM.

Otologic manifestation of Samter triad

July 13, 2014     Danielle M. Blake, BA; Alejandro Vazquez, MD; Senja Tomovic, MD; Robert W. Jyung, MD

It is important for otolaryngologists to be aware of the mucoid quality of these middle ear effusions, as they tend to be persistent and they do not respond well to myringotomy and tube placement, which usually results in tube obstruction.

Acute vocal fold hemorrhage after phonosurgery

July 13, 2014     Joel E. Portnoy, MD; Catherine Capo, BS; Robert T. Sataloff, MD, DMA, FACS

In this case, the KTP laser was used to vaporize the bilateral vocal fold varicosities.

A 48-year-old truck driver presented with hoarseness, vocal fatigue, volume disturbance, and a loss of range following an upper respiratory infection 6 months earlier. Five years previously, he had undergone removal of vocal fold “polyps” elsewhere; he had received no postoperative voice therapy.

Parathyroid adenoma

July 13, 2014     Lester D.R. Thompson, MD

Most of these lesions are identified in glands within their usual anatomic location instead of in an ectopic or supernumerary site.

A parathyroid adenoma is a benign neoplasm of parathyroid parenchymal cells. There is an association with the HRPT2 gene (1q25-q31), which is associated with hyperparathyroidism-jaw tumor syndrome (an autosomal dominant disorder). Parathyroid adenoma is the single most common cause of hyperparathyroidism. It is usually seen in patients in the...

Large osteoma of the maxillary sinus accompanied by an unerupted tooth

July 13, 2014     Jae-Hoon Lee, MD

CT of the maxillofacial region is required for patients with an osteoma to rule out Gardner syndrome, which should be considered when a patient has more than one osteoma.

A 17-year-old boy presented with a 1-year history of intermittent localized pain over his right cheek. He had no history of notable facial trauma or nasal surgery, and his medical conditions were noncontributory. He had no history of sinonasal symptoms.

Endoscopic view of a middle meatal cyst

July 13, 2014     Dewey A. Christmas, MD; Joseph P. Mirante, MD, FACS; Eiji Yanagisawa, MD, FACS

Obstruction of the middle meatus and ethmoid infundibulum can occur as a result of swelling of the mucosal surfaces of the soft tissues, although most such obstructions are caused by polyps. Obstruction from a cystic mass is less common.

A 29-year-old man presented to us with a 2-year history of recurring right sinusitis. His most recent symptoms included right nasal congestion and persistent right facial discomfort. Endoscopic examination revealed the presence of a large polypoid cystic mass that had filled the right middle meatus (figure, A). Findings on examination of the left...

Leiomyosarcoma of the parapharyngeal space: A very rare entity

July 13, 2014     Haim Gavriel, MD; Eyal Yeheskeli, MD; Gratiana Hermann, MD; Ephraim Eviatar, MD


Leiomyosarcoma of the head and neck is very rare, as only about 100 cases have been reported; of these, only 3 cases have been previously reported in the parapharyngeal space. We report the fourth such case, and we review the features of this entity. The patient was an 84-year-old woman who presented to the emergency department for treatment of an 18-month history of right-sided headache, a 6-month history of right-sided hearing loss and nasal obstruction, and a 2-month history of dysphagia. Physical examination revealed a bulge in the right side of the soft palate and the right lateral nasopharyngeal wall and complete obstruction of the right eustachian tube. Indirect laryngoscopy detected a bulge in the right lateral hypopharyngeal wall. Otoscopy revealed otitis media with effusion in the right ear. Imaging demonstrated a space-occupying lesion in the right parapharyngeal space that extended from the base of the skull to the level of the hypopharynx. Biopsy and histology identified the mass as a leiomyosarcoma. Metastasis to the brain was discovered shortly thereafter, and the patient died 10 months later. The unusual presentation of head and neck leiomyosarcoma requires a high index of suspicion and appropriate diagnostic imaging. Surgical excision is the recommended treatment when feasible; chemoradiotherapy does not appear to affect disease progression.

Transoral removal of a large parapharyngeal space neurofibroma with the Harmonic Scalpel

July 13, 2014     Marcel Marjanovic Kavanagh, MD; Zlatko Sabol, MD, PhD, MSc; Sasa Janjanin, MD, PhD; Drago Prgomet, MD, PhD


We report the case of a 19-year-old man with neurofibromatosis type 1 who presented for evaluation of odynophagia, left-sided hemiparesis, multiple café au lait spots all over his body, and numerous subcutaneous and cutaneous neurofibromas. Imaging revealed the presence of two large neurofibromas-a 60 x 50 x 35-mm tumor in the left parapharyngeal space and an intradural tumor measuring 25 mm in diameter. We removed the larger tumor via a transoral route with the Harmonic Scalpel. The size of this tumor far exceeded the size of any other reported tumor removed in this manner. Various approaches to the parapharyngeal space have been described in the literature. To the best of our knowledge, this case represents the first report of a transoral removal of a huge parapharyngeal space neurofibroma with a Harmonic Scalpel.

Rhinosporidiosis: An unusual presentation

July 13, 2014     Borlingegowda Viswanatha, MS, DLO, PhD


Rhinosporidiosis is a chronic granulomatous disease that primarily affects the mucous membranes of the nose and nasopharynx. It is caused by Rhinosporidium seeberi. Clinically it presents as a reddish, bleeding, polypoid mass with a characteristic strawberry-like appearance on its surface, which is caused by the presence of mature sporangia. In the case described here, a 35-year-old man presented with a 6-month history of a slowly growing polypoid mass in his left nasal cavity. The surface of the mass was smooth, pale, and covered with nasal mucosa. It was attached to the nasal septum. Fine-needle aspiration cytology was suggestive of a parasitic cyst. The mass was excised with the use of local anesthesia. Histopathologic examination of the resected specimen revealed rhinosporidiosis. Prior to this diagnosis, the patient had not exhibited most of the typical clinical features that are suggestive of rhinosporidiosis. In the case of a nasal mass, a diagnosis of rhinosporidiosis is important to establish prior to any surgery because bleeding during and after surgery is usually profuse and can be life-threatening. The site of the excised mass should be cauterized to prevent recurrence.

Introduction Rhinosporidiosis is a chronic granulomatous lesion that is caused by Rhinosporidium seeberi, a fungus of the class Phycomycetes, family Coccoidiodaceae.1 This disease is endemic in India and Sri Lanka, but it is rarely found in other parts of world other than in individuals who have migrated from endemic areas.2