An intrathyroidal thyroglossal duct cyst

October 30, 2015     Robert Saadi, BS; David Goldenberg, MD, FACS

Thyroglossal duct cysts  are classically midline, associated with the hyoid bone, move with swallowing or tongue protrusion, and often initially present with some degree of inflammation.

Soft palate mass

October 30, 2015     Evan Longfield, MD; Matthew W. Stark, MD; Anita Jeyakumar, MD, FACS

Although pleomorphic adenomas are mostly benign, they have the potential to grow very large yet remain asymptomatic.

Effects of different combinations of growth factors on the differentiation of neural stem cells into hair-like cells

October 30, 2015     Ying Wang, MD; Ming-min Dong, MD


The differentiation of neural stem cells (NSCs) is influenced by a variety of factors. Therefore, it is important to explore the best external conditions that will induce NSCs to differentiate into hair cells. In this study, we investigated the best in vitro conditions for differentiation of NSCs derived from the hippocampus of newborn guinea pigs into hair-like cells. NSCs were separated and induced in different combinations of growth factors-in a control group and 7 combinations. Myosin VIIa-positive cells were detected to compare the effects of various combinations of growth factors on the differentiation of NSCs into hair-like cells. NSCs were differentiated into hair-like cells in all groups, but cell growth was best in the basic fibroblast growth factor (bFGF) + epidermal growth factor (EGF) group and the bFGF + EGF + brain-derived neurotrophic factor (BDNF) group. The rates of myosin VIIa-positive cells in the 8 groups studied ranged from 13.53 to 22.71%, but the results in the bFGF+EGF and bFGF+EGF+BDNF groups had statistical significance compared with other groups (p < 0.05). While bFGF, EGF, and BDNF all can induce the differentiation of NSCs into hair-like cells, the synergies of bFGF+EGF and bFGF+EGF+BDNF are the best.

Chondroid chordoma of the sella turcica mimicking a pituitary adenoma

October 30, 2015     Arthur W. Wu, MD; Sunita Bhuta, MD; Noriko Salamon, MD; Neil Martin, MD; Marilene B. Wang, MD


We report an unusual case of a chondroid chordoma of the sella turcica that mimicked the clinical and radiologic presentation of the more common pituitary adenoma. A 50-year-old man presented with bitemporal visual field deficits. Magnetic resonance imaging (MRI) detected a sellar mass that was suggestive of a pituitary adenoma. However, the intraoperative appearance of the mass was not consistent with an adenoma, and frozen-section pathology was obtained. Pathology identified the mass as a malignant lesion. Based on this finding, the mass was treated more aggressively. Chondroid chordomas are rare and slowly growing but locally aggressive tumors. The prognosis depends on the ability to totally resect the mass, so differentiating this tumor from a benign lesion is critical. An intrasellar chordoma can be confused clinically and radiologically with a pituitary adenoma. These two lesions are nearly identical on MRI, although T2-weighted imaging sometimes demonstrates higher intensity with a chondroid chordoma. Computed tomography may be helpful in demonstrating bony destruction by these lesions, as can the presence of intralesional calcifications. Intraoperative findings of bony invasion or a purple-red color may also lead the surgeon to suspect a diagnosis other than pituitary adenoma.

Extramedullary plasmacytoma associated with an ectopic tooth in the nasal cavity

October 30, 2015     Yi Zhang, MD; Yong Xu, MD; Yu Xu, MD; Zezhang Tao, MD


Extramedullary plasmacytoma and tooth eruption into the nasal cavity are both rare events. We report a case of plasmacytoma associated with an ectopic tooth. To the best of our knowledge, such a case has not been previously reported in the literature. A 63-year-old woman presented for evaluation of an 8-month history of a bloody nasal discharge from the posterior naris. Nasal endoscopy detected a slight eminence approximately 0.5 cm in diameter in the right nasal floor. Computed tomography demonstrated a tooth-like, high-attenuation shadow. A biopsy identified chronic inflammation of the mucosa and tissue. A diagnosis of an ectopic tooth in the right nasal cavity was initially considered. The mass and the tooth-like neoplasm were removed via nasal endoscopy. Immunohistochemistry of the excised mucosa showed strong positivity for kappa light chains, positivity for leukocyte common antigen and CD138, and negativity for lambda light chains, epithelial membrane antigen, CD1, and HMB-45. The final diagnosis was an extramedullary plasmacytoma in the right nasal cavity associated with an ectopic tooth. No bone metastasis was observed. Definitive radiotherapy was performed after the operation. During 40 months of follow-up, the patient exhibited no evidence of local recurrence or metastasis. The diagnosis in this case was made difficult by the nonspecific clinical manifestations, the presence of the ectopic tooth, and incorrect interpretation of preoperative histopathology. Physicians should maintain a clinical suspicion for the possibility that an ectopic tooth might be associated with a tumor.

"Cannonball" delayed pulmonary metastases in parotid adenoid cystic carcinoma

October 30, 2015     David X. Liu, BS; Juan S. Gomez, MD; Enrique Palacios, MD, FACR; Jeremy Nguyen, MD

Optimal imaging studies for perineural invasion can be obtained with magnetic resonance imaging, which demonstrates abnormal enhancement of the cranial nerves involved.

Severe necrosis of the palate and nasal septum resulting from intranasal abuse of acetaminophen

October 30, 2015     Scott A. Hardison, MD; Kristin K. Marcum, MD; Catherine Rees Lintzenich, MD


Intranasal drug abuse frequently leads to sinonasal complications, particularly sinus, nasal, and palatal necrosis. Classically, this type of necrosis has been linked to cocaine use, but the intranasal abuse of prescription narcotics and other pain medications can also lead to severe damage to the sinonasal tract. We describe a case of palatal and nasal septal necrosis resulting from intranasal acetaminophen abuse. The patient was a 34-year-old man with a remote history of polysubstance abuse who presented to the emergency department with worsening dysphagia and a recent history of exclusive intranasal acetaminophen abuse. He had an existing palatal fistula that was found to have dramatically increased in size. Examination revealed complete destruction of the soft palate and nasal septum and partial destruction of the hard palate. The areas of necrosis were surgically debrided. We describe the general clinical presentation and surgical outcome of this case.

Silastic injection for vocal fold medialization resulting in a false-positive finding on F18 FDG-PET/CT

September 20, 2015     Ayman Mahfouz, MBBS; Meeran Naji, MSc, MRCS, FRCR; Wing Yan Mok, BSc, MBBS, FRCR; Ali S. Taghi, MBBS, MD, FRCS(ORL-HNS); Zarni Win, MRCP, FRCR


A false-positive uptake of F18-fluorodeoxyglucose (FDG) on positron-emission tomography/computed tomography (PET/CT) can result in confusion and misinterpretation of scans. Such uptakes have been previously described after injection of polytetrafluoroethylene (Teflon) into the vocal folds. Similarly, vocal fold injection of silicone elastomer (Silastic) can result not only in a false-positive FDG uptake on PET/CT, but also in chronic inflammation. We report a case of increased FDG uptake in a vocal fold after Silastic injection that was misinterpreted as a malignancy in a 70-year-old woman who had metastatic carcinoma of the stomach.

Endoscopic resection of a mucocele of the crista galli

September 20, 2015     Mani Shidanshid, BSc, MBBS; Ali S. Taghi, MBBS, MD, FRCS(ORL-HNS); Romana Kuchai, FRCS; Hesham A. Saleh, FRCS


Mucoceles expand by the process of bone resorption and new bone formation, which leads to local destruction and displacement of adjacent structures. We present the case of a 47-year-old woman who presented with recurrent headaches, nausea, and vomiting, all of which were believed to have occurred secondary to a mucocele of the crista galli. To the best of our knowledge, only 1 similar case has been previously reported in the world literature; in that case, the crista galli was drained externally. In our patient, resolution of symptoms was achieved by endoscopic dacryocystorhinostomy, endoscopic frontal sinusotomy, and drainage of the mucocele under image guidance. We recommend that an endoscopic surgical approach be considered for the management of mucoceles of the crista galli.

Erosion of the incus by the chorda tympani nerve from a complex retraction pocket

September 20, 2015     Ramanan Daniel, MBBS; Fiona Hill, MBBS; Timothy Price, FRCS(OHNS)

Chronic eustachian tube dysfunction can lead to retraction of the tympanic membrane and bone erosion.

Endoscopy-assisted resection of a submandibular gland mass via a thyroidectomy incision

September 20, 2015     Jin Pyeong Kim, MD; Jung Je Park, MD; Hyun Woo Park, MD; Seung Hoon Woo, MD


Submandibular gland excision is traditionally performed via the transcervical approach. In an effort to avoid or reduce visible scarring and nerve injury, diverse innovative surgical trials have been conducted. We report the case of a submandibular gland mass that was endoscopically resected through a thyroidectomy incision. The patient was a 56-year-old woman with a long-standing right-sided submandibular gland mass and a smaller thyroid gland mass that was recently discovered on a routine checkup. The thyroid mass was managed with a total thyroidectomy. The submandibular mass was resected with endoscopic assistance through the thyroidectomy incision with an ultrasonic scalpel. The resection was successful, and the patient experienced no acute complications such as neural injury, hematoma, or seroma formation. Upon healing of the thyroidectomy scar, the cosmetic result was excellent. We conclude that endoscopic resection of a submandibular gland mass through a thyroidectomy incision is a feasible option that results in excellent surgical and cosmetic outcomes.

Facial nerve paralysis: Smile reconstruction using the masseteric nerve

September 20, 2015     Moustafa Mourad, MD; Christopher Linstrom, MD; Grigoriy Mashkevich, MD

Reanimation methods range from static slings and nerve transfers to dynamic muscle techniques, such as regional temporalis and free gracilis transfer.

A radiologic view of migration of a foreign body in the maxillary sinus by mucociliary movement

September 20, 2015     Jae Hoon Lee, MD

Displaced foreign objects should be removed from the antrum to prevent the development of maxillary sinusitis.

Posthemorrhagic polyp: Risk of misdiagnosis of the cause of glottic insufficiency

September 20, 2015     Massi Romanelli-Gobbi, MD; Julia Ellerston, MA; Rima A. DeFatta, MD; Joel Portnoy, MD; Robert T. Sataloff, MD, DMA, FACS

Patients with vocal fold hemorrhage often present with sudden dysphonia and may not be able to recall an inciting event.

Primary sinonasal meningioma in a child

September 20, 2015     Dodul Mondal, MBBS; Manisha Jana, MD; Prabir Kumar Sur, MD; Ebnam Murshed Khan, MD


Meningiomas are common intracranial extra-axial masses. They are rarely encountered in extracranial locations; when they are, the most common head and neck locations are the paranasal sinuses and the temporal bone. Meningiomas in children are very rare, especially in the neonatal period. The clinical presentation and clinical findings are often nonspecific. The diagnosis can be established by imaging and histopathologic examination with immunohistochemistry. We describe a case of primary sinonasal meningioma in a 2-year-old boy whose onset of symptoms had begun during the neonatal period. We discuss the clinical features, imaging results, and histopathologic and immunohistochemical findings in this case.

Spontaneous true aneurysm of the superficial temporal artery presenting as an asymptomatic forehead mass

September 20, 2015     Nenad Zivkovic, MD, PhD; Milan B. Jovanovic, MD, PhD; Marko Markovic, MD, PhD; Sanja Milenkovic, MD, PhD


Superficial temporal artery aneurysms are rare; when they do occur, they are usually associated with head trauma. Spontaneous true aneurysms of the superficial temporal artery are extremely rare. They are classified as true aneurysms when all three layers of the vessel are found to be involved on histologic examination. Therapeutic options include conservative management, image-guided embolization, and surgical excision. We report a case of an extracranial spontaneous aneurysm of the frontal branch of the superficial temporal artery. A 20-year-old man presented with an asymptomatic, pulsatile, 1-cm forehead mass that had gradually increased in size. The aneurysm was evaluated by clinical examination and three-dimensional computed tomographic angiography. Complete resection was performed with local anesthesia. Histologic examination revealed that the aneurysm involved all three layers of the blood vessel: the tunica intima, tunica media, and tunica adventitia. No atherosclerotic changes or inflammatory cells were found. To the best of our knowledge, this is only the third reported case of a histologically verified spontaneous aneurysm of the frontal branch of the superficial temporal artery. Awareness of this rare pathology in the differential diagnosis of a forehead mass may facilitate diagnosis and prevent complications.

Endoscopic transnasal transsphenoidal transtuberculum sellae extradural approach to suprasellar pituitary lesions: A case report

September 20, 2015     Tapan Nagpal, MS


Pituitary adenomas are benign tumors that arise within the anterior lobe (the adenohypophysis) of the pituitary gland in the sella turcica. As they grow, they can extend through the pituitary stalk and into the suprasellar compartment. The surgical management of these adenomas via a conventional intradural approach is fraught with a high risk of causing a large cerebrospinal fluid leak. We report a case of pituitary adenoma in a 60-year-old woman whose surgery was performed via a minimally invasive endoscopic transnasal transsphenoidal transtuberculum sellae extradural approach.

Pleomorphic sarcoma of the neck

September 20, 2015     Lester D. Thompson, MD

Pleomorphic sarcoma is an uncommon neoplasm in the head and neck now that refinements in diagnostic techniques have more accurately classified tumors that used to be placed in this category.

Protection from blood aerosol contamination when managing epistaxis: A study of the effectiveness of a patient mouth mask

September 20, 2015     Salman Baig, FRCSI; Tahir Rashid, FCPS, FEB(ORL-HNS); Muhammad Saleem, FRCS


The danger to healthcare personnel of acquiring a blood-borne infection accidentally transmitted by a patient is well known. Such an infection can have serious and career-altering implications. Epistaxis, which is the most common emergency seen in ENT practice, poses a great risk of contaminated blood being spattered on the face of the attending medical provider. Areas of possible contamination include the mucosa of the nasal passages, oral cavity, and conjunctiva. Various strategies to prevent contamination have been described in the literature, most of which involve the wearing of protective equipment by the healthcare provider. We conducted a prospective, randomized study of 60 epistaxis patients to determine if a simple surgical mask warn by the patient over his or her mouth would protect the treating physician from aerosolized blood contamination. We found evidence of significant blood splashes on the physician in 8 of the 30 cases (26.7%) in which the patient did not wear a mask, compared with only 4 cases (13.3%) when the mouth mask was worn. We therefore conclude that a patient mouth mask is a simple, inexpensive, and effective way to minimize the risk of aerosolized blood contamination during the treatment of epistaxis.

Schwannoma of the cervical esophagus: Report of 2 cases and a review of the literature

September 20, 2015     Yu-Long Wang, MD; Jian-Guang Sun, MD; Jian Wang, MD; Wen-Jun Wei, MD; Yong-Xue Zhu, MD; Yu Wang, MD; Guo-Hua Sun, MD; Kuan Xu, MD; Hui Li, MD; Ling Zhang, MD; Qing-Hai Ji, MD


Schwannomas of the cervical esophagus are extremely rare, as fewer than a dozen reports have been published in the literature. Therefore, their clinical characteristics and management have not been definitively elucidated. We report 2 cases of cervical esophageal schwannoma (CES) in which the patients-a 52-year-old woman and a 53-year-old woman-were initially misdiagnosed clinically. The correct diagnosis was later established on the basis of contrast-enhanced computed tomography (CT) and intraoperative frozen-section analysis. In both cases, the tumor was enucleated, and the esophagus was closed by primary intention. Both patients resumed an oral diet 2 weeks postoperatively. Follow-up detected no evidence of recurrence. Our review of the literature revealed that CES is a benign mesenchymal tumor that can be misdiagnosed both clinically and pathologically. Preoperative contrast-enhanced CT and intraoperative frozen-section analysis help in the planning for conservative enucleation, which precludes the need for esophageal resection and its associated morbidity.

of 15Next