Anomaly

Congenital os vomer agenesis: Case report and literature review

March 31, 2012     Ediz Yorgancilar, MD, Muzeyyen Yildirim, MD, Ramazan Gun, MD, Faruk Meric, MD, and Ismail Topcu, MD
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Abstract

Defects of the nasal septum occur as a result of a variety of causes, including tuberculosis, irritation, neoplasia, trauma, infection, and chronic inflammatory diseases. Congenital os vomer agenesis as a cause is very rare. We report the case of a 28-year-old man with a defect in the posteroinferior part of the nasal septum that was discovered incidentally during a routine endoscopic examination. The patient was diagnosed with congenital os vomer agenesis, and the diagnosis was confirmed by computed tomography. We discuss the features of this case and review the literature on this rare anomaly.

Two-flap palatoplasty: Description of the surgical technique and reporting of results at a single center

March 1, 2012     Emmanouel Koudoumnakis, MD, Ioannis M. Vlastos, MD, PhD, Kostas Parpounas, MD, PhD, and Michael Houlakis, MD, PhD
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Abstract

Two-flap palatoplasty is commonly used to treat cleft palate defects, but only a few reports on outcomes have been published in the literature. We conducted a retrospective analysis of 257 cases of cleft palate treated with two-flap palatoplasty at a single center in Greece over a 13-year period. Our outcomes data included surgical complication rates, the results of speech assessments, midface development, and other parameters. We found a low rate of short- and long-term complications that required revision surgery, such as symptomatic fistula (5.4%) and velopharyngeal insufficiency (5.3%). Speech outcomes in relation to intelligibility, hypernasality, and nasal emissions were satisfactory in 70 to 86% of patients. Dental arch relationships, as estimated by the 5-Year-Olds Index, were judged to be either good or excellent in 62% of those evaluated. A considerable proportion of patients (45%) who had otitis media with effusion experienced a spontaneous resolution without the use of tympanostomy tubes 2 to 8 months after their operation. We conclude that two-flap palatoplasty is an effective procedure that warrants further attention. We describe the surgical technique in detail. Our technique includes a modified intravelar veloplasty that incorporates near-total muscle retropositioning.

Frontal infundibular cells: Pathway to the frontal sinus

March 1, 2012     Ozum Tuncyurek, MD, Murat Songu, MD, Zehra Hilal Adibelli, MD, and Kazim Onal, MD
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Abstract

A frontal infundibular cell (FIC) is an uncommon anatomic variant of an anterior ethmoid pneumatization that originates from the frontal recess and typically extends into the lumen of the frontal sinus ostium. FICs may show several anatomic variants that impact the anatomy of the frontal recess. Familiarity with these variants is required for safe endoscopic sinus surgical procedures. We conducted a retrospective chart review, examining 1,040 frontal recesses in 520 adults with no frontal sinus disease, to explore the anatomy of the healthy frontal recess and to describe the prevalence of FICs in patients without a history of conditions that cause frontal pneumatization. Review of axial and coronal computed tomography data, which were reformatted for sagittal reconstruction, was performed at a computer workstation. Bent and Kuhn's classification was used to define types of FICs. We identified 167 patients (32.1%) as having unilateral or bilateral FICs. Type I infundibular cells were the most common type (found in 15.7% of the entire study population). Type II and type III FICs were found in 3.8% and 12.1%, respectively; type IV FICs were present in 0.4%. The FIC has not been emphasized as an important potential cause of frontal sinus obstruction in the radiology literature, but clinicians should specifically watch for it on all routine computed tomography of the frontal sinus. Fine-cut computed tomography scans aid in the identification of each individual cell and allow the surgeon to formulate a clear and precise surgical plan. A surgical plan with a thorough understanding of the anatomy enables confident dissection of this complex and difficult area.

Paradoxical giant inferior concha

July 13, 2011     Barış Naiboğlu, MD, Atılay Yaylacı, MD, and Çağatay Oysu, MD
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Abstract

Anatomic variations of the middle and superior conchae are common, but inferior concha anomalies are rare. These anomalies have included pneumatization, agenesis, and duplication. We describe what we believe is the first reported case of a paradoxical curvature of the bony part of the inferior concha. The patient was a 13-year-old girl. The development of a huge inferior concha blocked the left nasal cavity and deviated the nasal septum to the contralateral side, resulting in bilateral obstruction. The patient was successfully treated with surgery.

Type 1 first branchial cleft anomaly: Duplication of the external auditory canal

July 13, 2011     Matthew L. Carlson, MD, David J. Archibald, MD, and Shelagh A. Cofer, MD
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Stahl ear deformity associated with Finlay-Marks syndrome

May 31, 2010     Young S. Paik, MD and C.W. David Chang, MD
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Adult presentation of a fourth branchial pouch sinus

September 30, 2009     Jon Robitschek, MD, Nici Bothwell, MD, Guy Takahashi, MD, Daniel Hall, MD, FACS, and Joseph Sniezek, MD, FACS
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Abstract

A fourth branchial pouch sinus is a rare clinical entity. The handful of previously reported cases have all involved children. We report a rare case of an intrathyroidal fourth branchial pouch sinus in an adult. A 36-year-old man presented with a recurrent left-sided deep neck abscess. A diagnostic evaluation by barium pharyngoesophagography in conjunction with computed tomography revealed the presence of a sinus tract that extended inferiorly from the left piriform sinus to the left thyroid lobe. The synchronous use of both of these imaging modalities with shared contrast enabled us both to establish the diagnosis and formulate a successful surgical approach. The patient underwent elective neck exploration with resection of the left thyroid lobe and superior sinus tract. Postoperative pathology confirmed the presence of an epithelium-lined sinus within the left lobe of the thyroid consistent with a branchial pouch derivative. Follow-up barium pharyngoesophagography demonstrated successful closure of the sinus tract. This unique case represents a delayed clinical presentation, and it broadens the differential diagnosis of recurrent deep neck abscess and thyroid cyst in the adult.

Fistulography: A useful imaging modality for identifying the exact location and extent of complete branchial fistulas

August 31, 2009     Sampan Singh Bist, MS, Saurabh Varshney, MS, Rakesh Kumar, MS, and Nitin Gupta, MS
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Ectopic molar in the maxillary sinus precipitating a mucocele: A case report and literature review

July 31, 2009     Jarom F. Lamb, MD, Omar F. Husein, MD, and Adam C. Spiess, MD
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Abstract

Ectopic teeth are rarely found in the maxillary sinus. When they are, they represent an anomaly of odontogenic development that is generally associated with odontogenic cysts, trauma, or idiopathic etiology. Although affected patients are often asymptomatic, documented morbidities include sinus disease that is often refractory to treatment. The diagnosis is usually made by plain-film radiography. Computed tomography is indicated when an ectopic tooth is associated with an antral mass and prior to surgery. Treatment of symptomatic patients and those with an antral mass is surgical, with either a Caldwell-Luc operation or an endoscopic procedure. We describe what we believe is the first reported case of a third molar in the roof of the maxillary sinus associated with a mucocele, and we review the literature.

Lingual thyroid

May 31, 2009     Manish Gupta, MS and Gul Motwani, MS
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Abstract

Lingual thyroid gland is a rare clinical entity caused by failure of the gland's anlage to descend early in the course of embryogenesis. It may present with symptoms of dysphagia, upper airway obstruction, or even hemorrhage anytime from infancy through adulthood. Treatment of this disorder includes the use of exogenous thyroid hormone to correct the hypothyroidism and to induce shrinkage of the gland. When symptoms of obstruction or bleeding appear, ablative therapy by means of surgery or radioiodine is warranted. We report our experience with lingual thyroid gland and discuss elements of the diagnostic and therapeutic evaluation, with emphasis on the clinical findings, laboratory tests, and radiographic imaging studies.

The value of CT venography in the diagnosis of jugular bulb diverticulum: A series of 3 cases

March 31, 2009     Matthew L. Bush, MD, Raleigh O. Jones, MD, and Curtis Given, MD
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Abstract

Jugular bulb diverticulum is a rare diagnosis, as fewer than 50 cases have been reported in the literature. It has been reported that unilateral auditory symptoms may accompany this entity, although some patients are asymptomatic. We present a case series of 3 patients who were referred to our tertiary care neurotology center with a unilateral jugular bulb diverticulum along with unilateral sensorineural hearing loss and tinnitus. These patients were evaluated clinically and radiographically. This case series (1) adds further documentation of the presence of unilateral auditory symptoms in patients with a jugular bulb diverticulum and (2) demonstrates the value of computed tomographic venography in the diagnosis of jugular bulb diverticulum.

Bilateral transversely clefted middle turbinates

March 31, 2009     Laura M. Dooley, MD and C.W. David Chang, MD
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