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Articles

Novel management of an isolated comminuted cricoid cartilage fracture

October 25, 2016     Aurora G. Standlee, MD, CPT, MC, USA; Derek J. Rogers, MD, MAJ, MC, USA

Abstract

Laryngeal trauma is a rare occurrence that can result in significant morbidity and mortality. Isolated cricoid cartilage fractures are exceedingly rare, and their treatment is highly variable. We describe a case of an isolated comminuted, uncalcified cricoid cartilage fracture in a 34-year-old man that responded well to novel management with suture and 2-octylcyanoacrylate tissue adhesive fixation intraoperatively and topical ciprofloxacin/dexamethasone applied to the airway postoperatively. We discuss the novel application of cyanoacrylate glue in laryngeal trauma and the potential benefits of topical ciprofloxacin/dexamethasone application to the airway.

Prognostic factors in metastatic cutaneous squamous cell carcinoma of the head and neck

October 25, 2016     Gideon Bachar, MD; Aviram Mizrachi, MD; Naomi Rabinovics, MD; Dan Guttman, MD; Thomas Shpitzer, MD; Dean Ad-El, MD; Tuvia Hadar, MD

Abstract

Metastatic cutaneous squamous cell carcinoma (SCC) of the head and neck poses a significant therapeutic challenge due to its aggressive biologic behavior. We conducted a retrospective study of 71 patients-58 men and 13 women, aged 28 to 88 years (mean: 71)-who had been treated at our university-affiliated tertiary care medical center for metastatic cutaneous SCC over a 15-year period. In addition to demographic data, we compiled and analyzed information on tumor characteristics, the site and extent of metastasis, treatment, follow-up, and outcome. Among the tumor factors, poorly differentiated carcinoma was an independent predictor of poorer disease-free survival, and older age was found to be an independent predictor of poorer overall survival. We found no significant difference in disease-free or disease-specific survival among patients with parotid involvement, neck involvement, or both. In our series, the site of nodal involvement appeared to have no prognostic significance in patients with metastatic cutaneous SCC of the head and neck.

More than 20 years of powered endoscopic ethmoidectomy

October 25, 2016     Dewey A. Christmas, MD; Joseph P. Mirante, MD, FACS; Eiji Yanagisawa, MD, FACS

Current operative techniques continue to build on the foundation of functional endoscopic sinus surgery from the work of Messerklinger.

Stapes-pyramidal fixation by a bony bar

October 25, 2016     Kai-Chieh Chan, MD

Stapes fixation caused by an ossified stapedius tendon with normal mobility of the footplate, although rare, should be included in the differential diagnosis of conductive hearing loss with a normal tympanic membrane.

Spontaneous laryngeal barotrauma depicted on CT

October 25, 2016     Daniel T. Ginat, MD

Laryngeal injuries may result from  external laryngeal trauma or, less often, internal processes such as iatrogenic causes and sneezing with a closed airway.

Clinical course of acute laryngeal hematoma associated with vocal fold fixation

October 25, 2016     Wan-Chun Tsai, MD; Jih-Chin Lee, MD; Chih-Hung Wang, MD, PhD; Hsin-Chien Chen, MD, PhD

Disruptions of the anterior commissure, multiple displaced cartilage fractures, and larger open lacerations require open laryngeal exploration.

Cervical metastasis in squamous cell carcinoma of the hard palate and maxillary alveolus

October 25, 2016     Yekaterina Koshkareva, MD; Jeffrey C. Liu, MD; Miriam Lango, MD; Thomas Galloway, MD; John P. Gaughan, PhD; John A. Ridge, MD, PhD

Abstract

We conducted a retrospective study to determine the incidence and treatment outcomes of neck metastases in patients with squamous cell carcinoma (SCC) of the hard palate and/or maxillary alveolus after surgical excision of the primary tumor. We also sought to identify any risk factors for recurrence. Our study population was made up of 20 patients-9 men and 11 women, aged 46 to 88 years (mean: 72.6)-who had undergone excision of an SCC of the hard palate and/or maxillary alveolus at a tertiary care cancer center over a 7-year period. Half of all patients were former tobacco users. Of the 20 tumors, 10 involved the maxillary alveolus, 4 involved the hard palate, and 6 involved both sites. Three patients were clinically categorized as T1, 9 as T2, 6 as T3, and 2 as T4; pathologically, 8 tumors were categorized as T4a. In addition to maxillectomy, a neck dissection was performed in 7 patients-4 therapeutically and 3 electively. Eight of 20 patients experienced a recurrence: 4 local, 6 regional, and 2 distant (several patients had a recurrence at more than one site). Univariate analysis identified perineural invasion (p = 0.04) as a statistically significant risk factor for recurrence. Of 14 patients with a clinicopathologically negative neck, 5 (36%) developed a cervical recurrence, and 4 of them died of their disease. An advanced stage (T4 vs. <T4) was not significantly correlated with the risk of regional metastasis (p = 0.58). The rate of occult nodal metastasis in clinically and radiologically N0 necks was high. Clinical and radiologic understaging was common, and regional recurrences frequently resulted in death. We conclude that elective nodal evaluation and treatment of the neck warrants strong consideration for most patients with cancer of the hard palate and/or maxillary alveolus.

Posterior epistaxis: Common bleeding sites and prophylactic electrocoagulation

October 25, 2016     Juan Liu, MD; Xicai Sun, MD; Limin Guo, MD; Dehui Wang, MD

Abstract

Posterior epistaxis is a frequent emergency, and the key to efficient management is identification of the bleeding point. We performed a retrospective study of 318 patients with posterior epistaxis treated with endoscopic bipolar electrocautery during a 4-year period. Distribution of the bleeding sites was recorded. Patients with no definite bleeding sites in the first operation were assigned to Group A (n = 39) and Group B (n = 34). Patients in Group A were only observed in the ward. Patients in Group B were given prophylactic electrocoagulation at the common bleeding points. Of the 318 patients, bleeding sites were successfully identified and coagulated in 263 patients. All of them were located posteriorly, with 166 on the lateral nasal wall, 86 on the septum, and 11 on the anterior face of the sphenoid sinus. The rebleeding rate of Group B (8.8%) was lower than that of Group A (38.5%) (p < 0.01).

Chronic otitis media with effusion following radiation therapy

October 25, 2016     Anya Miller, MD; Francis Hall, MBChB, FRACS; Syed Ahsan, MD, FACS

Abstract

The incidence of chronic otitis media with effusion (COME) after radiotherapy for nasopharyngeal or sinonasal tumors is relatively high. It is often a difficult-to-treat problem in these patients. In this retrospective study, we sought to describe the clinical course of COME in 51 patients-33 men and 18 women, aged 39 to 90 years (mean: 58.9 ± 15)-who had been referred to the Henry Ford Health System in Detroit between 2001 and 2011 for management of a tumor that had involved either the nasopharyngeal area or the sinonasal area. The median length of follow-up from the time of cancer diagnosis was 32 months. Of the 51 patients, 23 (45.1%) developed COME before, during, or after radiation therapy. Of these 23 patients, 13 (56.5%) did not experience any improvement after treatment with various combinations of therapies, including myringotomy, tympanostomy tube placement, otic drops, oral antibiotics, and corticosteroid nasal sprays. No patient- or tumor-specific factors were found to be significantly associated with the incidence of COME after irradiation to the sinonasal area. Older age and squamous cell tumor pathology were found to be significant factors for the resolution of COME after it had developed, whereas treatments with tympanostomy tubes and ear drops were not. Because of the high incidence of COME after radiotherapy and the high rate of COME's failure to resolve after tympanostomy tube insertion, we suggest that these patients require an alternative treatment.

Cutaneous angiosarcoma of the scalp mimicking facial cellulitis

October 25, 2016     Sheng-Chiao Lin, MD; Ting-Shou Chang, MD

On first appearance, angiosarcomas can be mistaken for benign lesions, such as cellulitis, hemangioma, rosacea, and rhinophyma.

Changes in antibiotic resistance in recurrent Pseudomonas aeruginosa infections of chronic suppurative otitis media

October 25, 2016     Jae-Jun Song, MD; Byung Don Lee, MD; Koen Hyeong Lee, MD; Jong Dae Lee, MD; Young Joo Park, MD; Moo Kyun Park, MD, PhD

Abstract

This study investigated the changes in antibiotic resistance in recurrent Pseudomonas aeruginosa infections in chronic suppurative otitis media (CSOM). Its aim was to provide a treatment strategy for P aeruginosa infections in CSOM for the prevention of multidrug resistance. A case-control study was conducted in tertiary teaching hospitals in Korea. The experimental group included patients with recurrent P aeruginosa infection who had relapsed within 2 months after the successful control of a previous P aeruginosa infection. The control group consisted of patients with a P aeruginosa infection who had no history of such an infection. An antibiotic sensitivity test was performed for each culture. The proportion of recurrent P aeruginosa infection was 22.69% (98 of 432 cases). Drug resistance to amikacin, tobramycin, netilmicin, ciprofloxacin, and levofloxacin was significantly changed after recurrent infection. The fluoroquinolone strains seen in recurrent P aeruginosa showed high cross-resistance to other drugs. Antibiotic resistance of P aeruginosa in CSOM changed with recurrent infection.

Evaluation of transiently evoked otoacoustic emissions and auditory brainstem responses in patients with multiple sclerosis

October 25, 2016     Emre Kaytanc&inodot;, MD; O. Ilkay Ozdamar, MD; Gul Ozbilen Acar, MD; Muhammet Tekin, MD

Abstract

Multiple sclerosis (MS) is an inflammatory and demyelinating disease of the central nervous system. This prospective study was planned to evaluate these changes through brainstem evoked response audiometry (BERA) latency abnormalities and otoacoustic emissions (OAE). This study was performed between September 2009 and May 2010. A total of 160 recordings of BERA and OAE were examined, which were obtained from 80 ears of 40 participants. Twenty of these were MS patients and 20 were healthy volunteers in the control group. Mean ages of the MS group and the control group were 31.3 ± 4.73 and 30.95 ± 4.83 years, respectively. In patients' right ears in the MS group, the wave I, III, and V peak latencies and the I-V interpeak latencies were significantly prolonged compared to those in the control group. In patients' left ears in the MS group, the wave I, III, and V peak latencies and the I-III and I-V interpeak latencies also were significantly prolonged compared to those in the control group. There were no significant differences between the right and left ears for each group regarding wave latencies and intervals. In the MS group, the average of the interaural difference for I-V interpeak latency was significantly prolonged compared to that in the control group. The most reliable diagnostic method in MS is magnetic resonance imaging (MRI). However, sometimes plaques in the central nervous system may not be displayed. The pathologic process may exist and continue before these plaques become detectable on MRI, but electrophysiologic testing such as BERA can demonstrate these changes.

Features of oral, pharyngeal, and laryngeal lesions in bullous pemphigoid

October 25, 2016     Masafumi Ohki, MD; Shigeru Kikuchi, MD, PhD; Atsushi Ohata, MD, PhD; Yuka Baba, MD; Junichi Ishikawa, MD; Hirohito Sugimoto, MD

Abstract

Bullous pemphigoid is an autoimmune bullous disease characterized by skin lesions, with or without oral lesions. The occurrence of pharyngolaryngeal lesions is very rare in affected patients. We conducted a study to investigate the characteristics of oral and pharyngolaryngeal lesions in bullous pemphigoid. Our study population was made up of 6 consecutively presenting outpatients-2 men and 4 women, aged 40 to 83 years (mean: 68.2)-who had been referred to our department over an 11-year period. Presenting symptoms included sore throat in all 6 patients and oral pain in 3. The sites of mucosal lesions included the soft palate, epiglottis, gingiva, hypopharynx, tongue, nasal cavity, and buccal mucosa. These lesions appeared as erosions, erosions with white coating, erythematous patches, and/or blisters. Mucosal lesions preceded skin lesions in 2 patients, appeared after skin lesions in 1 patient, and appeared simultaneously with skin lesions in 3 patients. We conclude that bullous pemphigoid sometimes involves the mucosa, such as that of the laryngopharynx and the oral cavity, and it can manifest as skin lesions. In the differential diagnosis of refractory pharyngolaryngeal lesions, bullous pemphigoid should be considered.

Subcutaneous nasal angioleiomyoma: Case of a rare tumor and review of the literature

October 25, 2016     Robert Saadi, MD; Benjamin S. Oberman, MD; Henry Crist, MD; Jessyka Lighthall, MD

Abstract

We describe the case of a 46-year-old woman with a rare presentation of angioleiomyoma of the subcutaneous nasal tissue. The patient presented with pain and severe nasal obstruction. Her nasal deformity was sufficient to indicate an external rhinoplasty for both extirpation of the tumor and reconstruction of the defect with cartilage grafts. The procedure resulted in successful removal of the tumor and a satisfactory cosmetic outcome.

A novel approach to excision of distal tracheal granulation tissue in tracheostomy patients with difficult anatomy

October 25, 2016     Allison Rasband-Lindquist, MD; Keith Sale, MD

Abstract

Tracheostomy predisposes patients to various complications. The most common late complication is granuloma formation; others include tracheal stenosis, bleeding, infection, and fistula development. Small granulomas may not require treatment, but large ones necessitate removal to prevent bleeding, obstruction, respiratory distress and, in rare cases, death. Various treatment options have been described, but no single modality has proved to be superior. We describe a novel approach to treating substomal tracheal granulation by using trans-stomal Coblation for patients whose granulation is difficult to visualize. This procedure offers several advantages over other means, including better hemostasis, less risk of distal tissue loss, ease of use, and potentially less operative time.

Unusual case of dyspnea in a child

October 25, 2016     Stephanie Warrington, MD; Anita Jeyakumar, MD, FACS

Is the location of a septal deviation associated with the degree of postoperative pain after septoplasty?

October 25, 2016     G&uuml;l Soylu &Ouml;zler, MD

Abstract

The author conducted a prospective study of patients who underwent septoplasty for nasal obstruction secondary to a septal deviation to determine if the location of the deviation had any association with the degree of postoperative pain. Patients with an anteroposterior deviation were not included in this study, nor were patients with vasomotor rhinitis, allergic rhinitis, nasal polyposis, turbinate pathologies, or a systemic disease; also excluded were patients who were taking any medication and those who had undergone any previous nasal surgery. The final study population included 140 patients, who were divided into two groups on the basis of the location of their deviation. A total of 64 patients (35 men and 29 women; mean age: 29.8 yr) had an anterior deviation, and 76 patients (35 men and 41 women; mean age: 30.3 yr) had a posterior deviation; there were no statistically significant differences between the two groups in terms of sex (p = 0.309) or age (p = 0.848). During the postoperative period, pain intensity in both groups was self-evaluated on a visual analog scale on days 1, 3, and 7 and again at 3 and 6 months. The mean postoperative pain scores on days 1, 3, and 7 were significantly higher in the posterior deviation group than in the anterior group; scores in the two groups were similar at 3 and 6 months.

Breast cancer metastasis to the thyroid gland

October 25, 2016     Michael Goldenberg, MA; Joshua Warrick, MD; Mariano Russo, BS; Darrin V. Bann, MD, PhD

It is important to distinguish between metastatic disease and a second primary thyroid malignancy, which is more common than thyroid gland metastasis.

Myeloid sarcomas of the head and neck in pediatric patients with myeloid leukemia

September 19, 2016     David W. Cuthbertson, MD; Jyotinder Nain Punia, MD; Vicki L. Owczarzak, MD

Abstract

Myeloid sarcoma is a rare extramedullary tumor composed of malignant myeloid cells that occur in the presence of myeloid leukemia. We report a case series of pediatric head and neck myeloid sarcomas representative of the epidemiology, symptomatology, laboratorial correlations, prognoses, and treatment of extramedullary leukemia. Presented are 3 cases involving patients ranging from 17 months to 11 years of age. Two patients were successfully treated with chemotherapy, and in the third patient, a large lytic lesion was treated palliatively with proton beam therapy. Knowledge and recognition of myeloid sarcomas is important as they can be locally invasive, and they may also be used as a diagnostic tool or a prognostic indicator for leukemia.

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