Paradoxical giant inferior concha

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


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

Stahl ear deformity associated with Finlay-Marks syndrome

May 31, 2010     Young S. Paik, MD and C.W. David Chang, MD

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


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

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


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


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


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

Unilateral submandibular gland aplasia: A rare phenomenon

March 1, 2009     Neel Gupta, MD, Enrique Palacios, MD, FACR, and Shannon Barry, MS

The thyroid foramen: A case report and literature review of a largely unrecognized laryngeal anomaly

March 1, 2009     Christine Gilliam, MD and Gregory Renner, MD


A thyroid foramen is a congenital linear opening located in the lamina of the posterosuperior portion of the thyroid cartilage. Although its overall incidence is reported to be as high as 39%, few practitioners are aware of its existence. We report the case of a 19-year-old man who was involved in a motor vehicle accident. He experienced transient left true vocal fold paresis and what were initially thought to be “bilateral thyroid cartilage fractures” based on computed tomography of the neck performed as part of his trauma evaluation. On further scrutiny, however, the “fractures” were determined to be bilateral thyroid foramina. The presence of the paresis in the setting of these thyroid foramina prompted us to review the literature to examine the significance of thyroid foramina and the vessels and nerves that course through them. The average diameter of a thyroid foramen is approximately 2.5 mm. These openings appear in an oblique orientation, and they occur both unilaterally and bilaterally. In 70% of cases, an anastomotic branch connects the external and internal branches of the superior laryngeal nerve. Embryologically, thyroid foramina are believed to arise from a combined branchial and neurovascular origin. A detailed understanding of laryngeal anatomy, including its variations and their physiologic implications, is important to head and neck surgeons.

Report of a scalp arteriovenous malformation spontaneously hemorrhaging into a preauricular sinus

February 1, 2009     Andrew A. Winkler, MD, M.J.B. Stallmeyer, MD, and Thomas T. Le, MD


Arteriovenous malformations (AVMs) of the scalp are rare congenital lesions that can be extremely disfiguring and even life-threatening. Another congenital lesion is the preauricular sinus, which forms when the auricular hillocks fail to fuse. We present a case of an AVM of the scalp that ruptured into a preauricular sinus. The occurrence of these two lesions on the same side of a patient is a notable and previously unreported event. The patient was successfully treated with intravascular embolization and surgical ligation.

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