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Granular cell (Abrikossoff) tumor in the head and neck: A series of 5 cases

January 22, 2016     Petros Koltsidopoulos, MD, PhD; Konstantinos Chaidas, MD; Paschalis Chlopsidis, MD; Charalambos Skoulakis, MD, PhD


We evaluated a series of 5 patients-3 men and 2 women, aged 39 to 70 years (mean: 54.4)-with a granular cell tumor (GCT) of the head and neck in an effort to better define the clinical presentation, imaging characteristics, and surgical management of this type of tumor. In all cases, the diagnosis was established by pathologic analysis. There were 2 cases of laryngeal GCT and 1 case each of GCT arising in the nostril, hypopharynx, and the tongue base. The clinical findings were variable, depending on the location and extent of each lesion. Four of these patients underwent endoscopic examination, and in 2 cases computed tomography was performed. Treatment included wide surgical excision of the lesion in all cases. Otolaryngologists should be familiar with this unusual tumor. Although an accurate preoperative diagnosis is extremely difficult to make, appropriate therapeutic intervention is associated with a cure rate that is quite high.

Intratonsillar metastasis of EBV-positive nasopharyngeal carcinoma

January 22, 2016     Matthew R. Naunheim, MD, MBA; Linda N. Lee, MD; Harrison W. Lin, MD; Peter M. Sadow, MD, PhD; Daniel G. Deschler, MD


We present the case of a 47-year-old man with a history of Epstein-Barr-virus-positive nasopharyngeal carcinoma who developed a metastasis to the palatine tonsil. To the best of our knowledge, this is the first reported case of an intratonsillar metastasis of a nasopharyngeal carcinoma. The aim of this report is to emphasize the importance of vigilant surveillance in patients with nasopharyngeal carcinoma. This case also demonstrates that an atypical metastatic pattern can raise suspicion of a local disease recurrence.

Laryngitis obscuring an anterior glottic mass

January 22, 2016     James D. Thompson, MD; Jaime Eaglin Moore, MD; Robert T. Sataloff, MD, DMA, FACS

Anterior masses, such as the one seen in this case, can cause glottic insufficiency and vocal strain.

Management of a cocaine-induced palatal perforation with a nasal septal button

January 22, 2016     Matteo Trimarchi, MD; Vittoria Sykopetrites, MD; Mario Bussi, MD


A cocaine-induced midline destructive lesion (CIMDL) is a rare consequence of cocaine insufflation that involves the nose, sinuses, and occasionally the palate. Palatal perforations compromise swallowing, mastication, and speech. An obturator prosthesis can be used to overcome these complications. In selected cases, a nasal septal button is a good alternative for the sealing of a palatal perforation, especially when surgery is not indicated, such as in cases of persistent cocaine abuse. Abstinence from cocaine is the most effective long-term management option for patients with a CIMDL, and surgical correction of the defect should be postponed until the patient stops sniffing cocaine and the lesion becomes stable. We describe the case of a 39-year-old cocaine abuser whose oronasal communication was plugged with a nasal septal button, which resulted in an immediate alleviation of his oronasal reflux.


January 22, 2016     Ashley E. Kita, MD; Jennifer L. Long, MD, PhD

Hemangiomas can occur anywhere blood vessels are present; they have been observed in deeper tissues such as the larynx, muscles, liver, and brain.

Clival lesion: Atypical osteomyelitis vs. a neoplastic process

January 22, 2016     Mike C. Butterfield, MD; Juan S. Gomez, MD; Ngoc Ly, MD; Enrique Palacios, MD, FACR

The differential diagnosis of a clival lesion includes malignancy, infection, meningioma, and chordoma. In this patient, a recurrent neoplasm was suspected because of his medical history and the imaging findings

Slag injury to the tympanic membrane

January 22, 2016     Emily Marchiano, BA; Robert W. Jyung, MD

The presence of slag can be confirmed on CT, which can be used to evaluate damage to the ossicles and the proximity of the foreign body to nearby structures such as the carotid canal.

A case of lipoma arising in the eustachian tube

January 22, 2016     Jonathan Dabiri, MD; Georges Choufani, MD; Isabelle Delpierre, MD; Sergio Hassid, PhD


We report a case of a lipoma inside the eustachian tube, an extremely rare location for this lesion. To the best of our knowledge, this is only the second such case that has been described in the literature. The patient was a 47-year-old man, a fighter pilot, who was referred to our hospital with a 3-year history of (1) fullness in the right ear secondary to recurrent serous otitis media and (2) right ear pain, which was especially acute during flights. Nasopharyngeal endoscopy, computed tomography, and magnetic resonance imaging detected the presence of a well-encapsulated lesion inside the eustachian tube; macroscopic and radiologic findings identified the mass as a lipoma. The lesion was completely removed via transnasal endoscopy. Histopathologic evaluation confirmed the diagnosis of lipoma. The patient's postoperative course was favorable, and he was able to fly again without any ear complaints. Radiologic examination is useful for the diagnosis and preoperative evaluation of this benign tumor. Lesions located in the lower part of the eustachian tube can be easily removed via a transnasal endoscopic approach.

Urbach-Wiethe disease in a young woman: A case report

January 22, 2016     Stefanie Jansen, MD; Gero Quante, MD; Jan-Christoffer Luers, MD; Dirk Beutner, MD


Urbach-Wiethe disease (lipoid proteinosis) is an autosomal recessive disorder that is characterized by a general thickening of the skin and mucous membranes. We report the case of a 22-year-old woman with lipoid proteinosis who presented with hoarseness, poor dentition, and skin lesions, and we discuss the management of this rare disease.

A study of language development and affecting factors in children aged 5 to 27 months

January 22, 2016     Nuray Bayar Muluk, MD; Birgül Bayoğlu, MSci; Banu Anlar, MD


We conducted a study to assess the factors that affect language development in infants and toddlers using data obtained during developmental screening. Our study group consisted of 505 children-244 (48.3%) boys and 261 (51.7%) girls, aged 5 to 27 months. The children were divided into four age groups: group 1, which we designated as the “6 months” group (age range: 5 to 7 mo); group 2, designated as the “12 months” group (11 to 13 mo); group 3, designated as the “18 months” group (17 to 19 mo); and group 4, designated as the “24 months” group (23 to 27 mo). In addition to demographic data, we compiled data using the Denver II Developmental Screening Test, as well as neurologic examination findings and medical histories. At 6 months, the social item “Works for toy out of reach” was positively related to all language development items. Two gross motor development items-“Pull to sit, no head lag” and “Lifts chest with arm support”-were related to the “Turns to sound” and “Turns to voice” items, respectively. Overall, children whose mothers had higher education levels and who were living in higher socioeconomic areas showed significantly greater language development, as did boys, specifically. At 12 months, higher maternal ages, some gross motor development items, and some social items were related to better language development, and children living in higher socioeconomic areas had a significantly increased ability to pass the “4 words other than mama/dada” item. At 18 months, the ability of girls to pass the “4 words other than mama/dada” item increased, and children who passed the “4 words other than mama/dada” item did not pass the “Throws ball” gross motor item. At 24 months, children whose mothers were older had better “Combines 2 words” and “Speech half intelligible” items, girls had better “Comprehends prepositions (such as under/above)” skills, and boys had better “Shows 4 parts of doll” skills. We conclude that language items appear to change together with gross motor items and social development, and that they can be influenced by a family's socioeconomic level. However, as children get older, language development diverges from gross motor development.

Four cystic parathyroid adenomas in a 71-year-old man

January 22, 2016     Darrin V. Bann, MD, PhD; David Goldenberg, MD, FACS

Management of hyperparathyroidism-jaw tumor syndrome centers on parathyroidectomy to control the complications of hyperparathyroidism, but the extent of the parathyroidectomy that should be performed is controversial.

Vocal fold immobility after finger sweep self-extrusion of impacted food in a choking victim with resolution following laryngeal mask ventilation

January 22, 2016     Shaum Sridharan, MD; Milan R. Amin, MD; Ryan C. Branski, PhD


We report a case of unilateral vocal fold immobility in a 57-year-old woman that occurred subsequent to a choking episode, which she resolved by removing impacted food with a finger sweep. Other than the unilateral immobility, no abnormality of the laryngeal mucosa or framework was detected on physical examination, laryngoscopy, and computed tomography. Weeks later, the patient underwent an unrelated surgical procedure necessitating laryngeal mask airway ventilation. When she emerged from the procedure, she noted full resolution of her voice symptoms. Office laryngoscopy confirmed the full return of vocal fold function. We discuss possible explanations for the return of function in the context of this unusual onset and resolution. We also review the literature regarding unilateral vocal fold immobility, including its etiology, presentation, workup, and treatment.

Huge lipoma of the right parotid gland: Case report and review of 42 cases

January 22, 2016     Timuçin Baykul, DDS, PhD; M. Asım Aydın, DDS, DMD, PhD; Yavuz Fındık, DDS, PhD; Derya Yıldırım, DDS, PhD


Lipomas are rarely found in the parotid gland region. Because of their rarity at this site, they are not often considered in the differential diagnosis of parotid tumors. The parotid lipoma is a slowly growing, asymptomatic, freely movable, soft mass. Preoperative diagnosis is generally difficult. We present a case of a slowly enlarging mass of the parotid region in a 44-year-old man that proved to be a lipomatous tumor of the parotid gland. We also review 42 other cases from the literature. Our patient's huge tumor was located in the superficial lobe of the gland, and a parotidectomy with preservation of the facial nerve was performed. There was no complication or recurrence of the tumor after a follow-up of 1 year.

Retained crossbow bolt after penetrating facial trauma

January 22, 2016     Manan U. Shah, MD; Shankar K. Sridhara, MD; Jeffrey S. Wolf, MD; Bryan T. Ambro, MD, MS


We present an unusual case of a retained crossbow bolt in the maxillofacial area of a 31-year-old man. While crossbow injuries are rare, this case is of interest because otolaryngologists are often faced with treating retained foreign objects after penetrating facial trauma. These cases are difficult to manage because of the complexity and variety of injuries that can occur during both the initial trauma and the removal. We focus on the management of the bolt's removal and provide a brief discussion of the relevant literature on crossbow injuries to the head and neck.

Physician liability issues and telemedicine: Part 3 of 3

January 22, 2016     Steven T. Kmucha, MD, JD, FACS

While many states (and many specialties) are gradually moving toward a more national concept of standard of care, some regions and states still use a “local” standard of care. These differences may be significant.

A useful technique for adjusting nasal tip projection in Asian rhinoplasty: Trapezoidal caudal extension cartilage grafting

January 22, 2016     Shao-Cheng Liu, MD; Deng-Shan Lin, MD; Hsing-Won Wang, MD; Chuan-Hsiang Kao, MD


The purpose of this article is to present our experience with Asian patients in (1) using a trapezoidal caudal extension cartilage graft to adjust the tip projection in tip refinement for augmentation rhinoplasty, especially for the correction of short nose, and (2) avoiding complications of augmentation rhinoplasty with alloplastic implants. We conducted a retrospective chart review of 358 rhinoplasties that were performed by the corresponding author from January 2004 through July 2009. Patients were included in this study if they had undergone open rhinoplasty with a trapezoidal caudal extension cartilage graft as the only tip-modifying procedure. Patients in whom any additional grafting was performed that might have altered the nasal tip position were excluded. The surgical results were analyzed in terms of the degree of satisfaction judged separately by investigators and by patients. A total of 84 patients-46 males and 38 females, all Asians, aged 13 to 61 years (mean: 29.3)-met our eligibility criteria. Postoperative follow-up for 24 months was achieved in 62 patients. At the 24-month follow-up, the surgeons judged the results to be good or very good in 57 of the 62 patients (91.9%); at the same time, 56 patients (90.3%) said they were satisfied or very satisfied with their aesthetic outcome. Good nasal tip projection, a natural columellar appearance, and improvement in the nasolabial angle were achieved for most patients. Two patients required revision rhinoplasty to correct an insufficient augmentation and migration of the onlay graft. No severe complications were observed during the 2-year follow-up. We have found that trapezoidal caudal extension cartilage grafting in nasal tip refinement is an easy technique to learn and execute, its results are predictable, and it has been associated with no major complications. We recommend trapezoidal caudal extension cartilage grafting for Asian patients as a good and reliable alternative for managing tip projection and support.

Pneumatization of all three nasal turbinates

January 22, 2016     Jae Hoon Lee, MD

Clinically, it is difficult to distinguish pneumatization of the inferior turbinate from hypertrophy of the inferior turbinate without a CT scan.

Management of sinonasal undifferentiated carcinoma with intracerebral invasion: Clinical experience at a single institution and review of the literature

January 22, 2016     Valerie Zielinski, MD; Simon Laban, MD; Silke Tribius, MD; Phillipe Schafhausen, MD; Simon Veldhoen, MD; Rainald Knecht, PhD; Till Clauditz, MD; Adrian Muenscher, MD


Sinonasal undifferentiated carcinoma (SNUC) represents less than 1% of all malignancies. Most of the tumors are diagnosed at an advanced stage, when they have already invaded neighboring tissue structures. We describe the cases of 2 patients with a substantial intracerebral extension of SNUC who were treated at our institution. One was treated with surgery followed by chemoradiotherapy. The other was primarily treated with induction chemotherapy with a combination of docetaxel, cisplatin, and 5-fluorouracil followed by concurrent chemo- and radiotherapy. In view of the rarity of SNUC, no prospective clinical trials have been performed and a gold standard for treatment has not yet been established. Therefore, treatment recommendations are based on level IV evidence. These recommendations are diverse and controversial. In our 2 cases, the patient who was treated with induction chemotherapy had a better outcome. In cases of intracerebral extension, radical surgery is necessary and induction chemotherapy should be considered.

Case series: Internal jugular vein ectasia in pediatric patients

January 22, 2016     Neha A. Patel, MD; Shai Shinhar, MD


Jugular vein ectasia is a dilation of the vein without tortuosity. This finding can easily be misdiagnosed or overlooked. Because of its rarity, many pediatricians, otolaryngologists, and pediatric surgeons are unfamiliar with this diagnosis and how to manage it. We report a series of 2 cases of internal jugular vein ectasia in pediatric patients and discuss its clinical findings, simple and noninvasive method of diagnosis, and treatment.

Laryngotracheal mucormycosis: Report of a case

January 22, 2016     Jillian Mattioni, DO; Joel E. Portnoy, MD; Jaime Eaglin Moore, MD; David Carlson, DO; Robert T. Sataloff, MD, DMA, FACS


Airway mucormycosis is a deadly opportunistic infection that affects immunocompromised persons, particularly diabetics and those undergoing chemotherapy. Although it is typically a pulmonary or sinonasal infection, mucormycosis can affect the larynx and trachea, with devastating results. We report the case of a 46-year-old man with human immunodeficiency virus infection, hepatitis C infection, neurosyphilis, and recently diagnosed Burkitt lymphoma who presented with dysphonia and stridor after receiving one dose of intrathecal chemotherapy. Flexible laryngoscopy detected the presence of fibrinous material that was obstructing nearly the entire glottis. Surgical debridement revealed a firm mucosal attachment; there was little bleeding when it was removed. After debridement, the patient's dyspnea improved only to recur 2 days later. After an awake tracheotomy, laryngoscopy and bronchoscopy identified necrosis extending from the supraglottic area to the carina tracheae. Biopsies demonstrated hyphal architecture consistent with mucormycosis. Despite continued debridements, the fibrinous material reaccumulated. The patient was placed in hospice care; his airway remained patent, but he died from other causes several weeks after presentation. The management of airway mucormycosis is challenging and complex. Fungal airway infections should be considered in the differential diagnosis of an immunosuppressed patient who presents with dyspnea, dysphonia, and vocal fold immobility. Timely diagnosis and management are critical for a successful outcome, although the prognosis is poor if the infection is widespread, even with the best of efforts.