Articles

Endoscopic view of a medial ethmoid drainage pathway into the middle meatus

February 2, 2015     Dewey A. Christmas, MD; Joseph P. Mirante, MD, FACS; Eiji Yanagisawa, MD, FACS

The ostium of the ethmoid bulla is often found in the hiatus semilunaris superior, but that it can also be found in the anterior or lateral wall of the bulla, the ethmoid infundibulum, the hiatus semilunaris inferior, or the retrobullar recess.

Giant palatal pyogenic granuloma

February 2, 2015     Yu-Hsuan Lin, MD; Yaoh-Shiang Lin, MD

The differential diagnosis for a pyogenic granuloma should include hemangioma, bacillary angiomatosis, peripheral giant cell granuloma, peripheral ossifying fibroma, and some malignancies, such as Kaposi sarcoma, squamous cell carcinoma, and achromic melanoma.

Mixed verrucous and squamous cell carcinoma of the larynx

February 2, 2015     Giuseppe V. Staltari, BS; John W. Ingle, MD; Clark A. Rosen, MD

The lesion was removed en bloc, including the involved thyroarytenoid muscle.

Primary thyroid-like papillary adenocarcinoma of the nasal septum: A case report

February 2, 2015     Kerem Ozturk, MD; Rasit Midilli, MD; Ali Veral, MD; Yesim Ertan, MD; Bulent Karci, MD

Abstract

Primary thyroid-like papillary adenocarcinomas are extremely rare neoplasms that generally originate in the nasopharynx. We report the case of a 24-year-old woman who was diagnosed with a thyroid-like papillary adenocarcinoma that originated in the nasal septum. The tumor was surgically removed, and the patient showed no evidence of local recurrence during 4 years of follow-up.

Palliative endoscopic surgery for sinonasal metastases: A case report and literature review

February 2, 2015     Jason M. Roberts, MD; Christopher Brook, MD; Steven Parnes, MD

Abstract

Cancer metastatic to the paranasal sinuses often presents with ophthalmologic and facial deformities, as well as sinonasal complaints. These diminutive tumors are difficult to effectively treat, often leading to poor quality of life. Although breast cancer is a common cancer affecting more than 150,000 women each year,1 rarely is metastatic breast cancer found within the sinuses. We report our palliative treatment approach and outcomes of a 40-year-old patient with breast cancer metastatic to the paranasal sinuses. While providing a better understanding of this tumor's metastasis through a review of the literature, our report describes the role of palliative surgery for metastases to the paranasal sinuses.

Absence of the long process of the incus

February 2, 2015     Christina H. Fang, BS; Robert W. Jyung, MD

A definitive diagnosis of an ossicular defect, such as absence of the incus long process, requires an exploratory tympanotomy.

Bilateral Eagle syndrome causing dysphagia

February 2, 2015     Lyndsay L. Madden, DO; Roxann Diez Gross, PhD; Libby J. Smith, DO

Patients with Eagle syndrome often report symptoms that include dysphagia, otalgia, throat pain, globus sensation, facial pain, headache, taste disturbances, and dental pain that worsen with chewing, head and tongue movements, and swallowing.

Vestibular dehiscence syndrome caused by a labyrinthine congenital cholesteatoma

February 2, 2015     Francesco Fiorino, MD; Francesca B. Pizzini, MD, PhD; Barbara Mattellini, MD; Franco Barbieri, MD

Abstract

A 40-year-old man presented with conductive hearing loss and pressure- and sound-related vestibular symptoms. Computed tomography and diffusion-weighted magnetic resonance imaging revealed the presence of a cholesteatoma involving the vestibular labyrinth. The patient underwent a canal-wall-up tympanoplasty, which revealed evidence of a disruption of the vestibular labyrinth and a wide dehiscence of the vestibule, which was immediately resurfaced. At the 2-month follow-up, the patient's pressure- and sound-related vestibular symptoms had disappeared. Pure-tone audiometry showed a reduction in the air-bone gap with a slight deterioration of bone conduction and an improvement in the air-conduction threshold. Fistulization of the otic capsule produces a “third window,” which can lead to a dehiscence syndrome. One possible cause is a cholesteatoma of the middle ear or petrous bone. When the vestibule is invaded by a cholesteatoma, hearing is almost invariably lost, either pre- or postoperatively. However, in our case, wide opening of the vestibule resulted in hearing preservation.

Bilateral keratin horns arising from the tympanic membranes: A case report

February 2, 2015     Chu Qin Phua, MRCS, DOHNS; Vikas Malik, FRCS(ORL-HNS); Patrick Zaid Sheehan, FRCS(ORL)

Abstract

A keratin horn is a horn-like projection composed of dense keratotic material. It usually arises in sun-exposed areas of the body. It can be derived from a variety of underlying benign, premalignant, or malignant epidermal lesions. Risk factors associated with malignant change within a keratin horn include a wide base, male sex, and increasing age, in addition to an origin in a sun-exposed area. The mainstay of management is to obtain a biopsy from the base of the horn and subsequent excision if the histopathologic analysis suggests a malignancy. We report an extremely rare case of bilateral keratin horns arising from the tympanic membranes in a 64-year-old woman. To the best of our knowledge, this is the first report of its kind to be published in the English-language literature.

Effects of nasal saline lavage on pediatric sinusitis symptoms and disease-specific quality of life: A case series of 10 patients

February 2, 2015     Sandra Y. Lin, MD; Katherine M. Baugher, DO; David J. Brown, MD; Stacey L. Ishman, MD

Abstract

We conducted a prospective study to assess (1) the effects of daily nasal irrigation in children with chronic sinonasal symptoms and (2) the impact that treatment had on disease-specific quality of life as assessed by a validated instrument, the five-item Sinus and Nasal Quality of Life Survey (SN-5), and by an overall nasal quality-of-life (NQL) score based on a 10-point faces scale. Our patient population was made up of 10 children-7 girls and 3 boys, aged 3 to 9 years (mean: 6.1)-who had presented with symptoms of chronic rhinosinusitis for more than 3 months and who had not responded to previous medical management. Patients were administered nasal saline lavage daily for 1 month. These patients and/or their caregivers completed an SN-5 questionnaire upon entry into the study and at the completion of treatment. At study's end, a comparison of pre- and post-treatment scores with paired Student t tests showed that the mean total SN-5 score improved significantly over baseline, falling 45% from 21.4 to 11.7 (p = 0.0002). Moreover, significant overall improvement was seen in each of the five subcategories of the SN-5 survey (p = 0.0009 to 0.038). The NQL scores also improved significantly from 4.7 to 7.7 (p = 0.0034). Compliance with nasal lavage was generally good among the 10 patients, as 8 of them used at least 75% of the recommended quantity of saline at least once a day. During a follow-up period that ranged from 2 to 23 months (mean: 10.4), only 1 patient required an adenoidectomy for symptom control. The results of this pilot study suggest that nasal saline lavage may significantly alleviate chronic sinonasal symptoms and improve disease-specific quality of life in children with symptoms of chronic rhinosinusitis.

Head and neck cancer: A humanitarian effort in your own backyard

February 2, 2015     Judith Fornadley, MS, CF-SLP; Wendy Stern, MD; Cherie-Ann O. Nathan, MD, FACS

April 12-18 is Oral, Head and Neck Cancer Awareness Week (OHANCAW).

Basaloid squamous cell carcinoma of the sinonasal tract with metastasis to the liver: A case report and literature review

February 2, 2015     Boon Ping Toe, FRCR(Lond); Norlisah Ramli, FRCR(Lond); Sze Yin Lam, MRad(Mal); Kum Thong Wong, FRCPath(Lond); Narayanan Prepageran, FRCS(Edin)

Abstract

Basaloid squamous cell carcinoma (BSCC) is a rare subtype of squamous cell carcinoma. To date, only 95 cases of sinonasal BSCC have been reported in the English-language literature, and they account for 5% of all cases of head and neck BSCC. We describe what we believe is only the second reported case of a sinonasal tract BSCC that metastasized to the liver. The patient was a 36-year-old woman who presented with right-sided nasal obstruction and a foul-smelling discharge. Clinical examination and imaging identified a large lobulated enhancing mass in the right nasal cavity. Following excision of the mass, the patient was scheduled for radiotherapy. However, before it could be administered, follow-up imaging detected a metastasis to the liver and lung, and the patient was switched to chemotherapy. Initially, she responded well clinically, but at 5 months postoperatively, a follow-up CT showed an increasing metastatic presence in the liver and bone. The patient died of her disease 1 year after surgery.

Salivary gland choristoma of the middle ear

February 2, 2015     Shubin Chen, MD; Yongxin Li, MD

Abstract

Salivary gland choristoma of the middle ear is a rare entity. It is believed to be a developmental abnormality that may be associated with anomalies of adjacent structures. We describe the case of a 6-year-old girl who had a salivary gland choristoma in the middle ear that was associated with an ossicular chain anomaly and a facial nerve anomaly. We discuss the clinical features and management of this condition, and we review the literature.

The efficacy of photodynamic therapy in the treatment of oral squamous cell carcinoma: A meta-analysis

February 2, 2015     Eric W. Cerrati, MD; Shaun A. Nguyen, MD, MA, CPI; Joshua D. Farrar, MD; Eric J. Lentsch, MD

Abstract

We performed an extensive review of the literature to compare the efficacy of photodynamic therapy (PDT) to surgical resection, the current standard of care, in the treatment of adults with early-stage (T1-2N0M0) squamous cell carcinoma (SCC) of the oral cavity. Since patients who receive PDT are chosen with a high degree of selectivity, particular care was taken when extracting data for comparison. For outcomes measures, PDT was assessed in terms of a complete response to therapy, and surgery was evaluated in terms of locoregional control. Recurrences were also analyzed. We found 24 studies-12 for each treatment-to compare for this meta-analysis. In comparing a complete response to PDT and locoregional control with surgery, we found no statistically significant difference (mean difference [MD]: 1.166; 95% confidence interval [CI]: 0.479 to 2.839). With respect to recurrences, again no statistically significant difference was observed (MD: 0.552; 95% CI: 0.206 to 1.477). We conclude that PDT is as effective as primary surgical resection for the treatment of early-stage SCC of the oral cavity and that it is a valid function-preserving approach to treatment.

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

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

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.

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

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.

Cherubism

January 19, 2015     Lester D.R. Thompson, MD

When there is significant infraorbital maxillary involvement, the inferior rim of the sclera is more prominent, resulting in the classic “eyes to heaven” appearance.

Arrested development: Lingual thyroid gland

January 19, 2015     Mark R. Williams, MRCS(ENT); Vivek Kaushik, FRCS(ORL-HNS)

Most patients with lingual thyroid are asymptomatic and are diagnosed incidentally following a radiologic investigation for another condition of the head and neck.

Endoscopic view of nasopharyngeal scarring

January 19, 2015     Joseph P. Mirante, MD, FACS; Dewey A. Christmas, MD; Eiji Yanagisawa, MD, FACS

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.

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