Granuloma

Subacute airway obstruction caused by a suprastomal tracheal granuloma following tracheotomy in an adult

September 20, 2011     Elizabeth A. Kelly, MD, Arunkumar N. Badi, MD, PhD, Joel H. Blumin, MD, and David M. Poetker, MD
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Abstract

We report a case of a post-tracheotomy suprastomal granuloma in the early postoperative phase that caused subacute airway obstruction in a 28-year-old woman. The patient had undergone the tracheotomy during the surgical treatment of a submental abscess. During recovery, several capping trials had failed. Therefore, direct laryngoscopy was performed on postoperative day 11, and it revealed that the airway was being obstructed by a tracheal granuloma. The granuloma was managed with a partial resection and corticosteroids. The patient was successfully decannulated with no recurrence of the granuloma. To the best of our knowledge, airway obstruction secondary to a tracheal granuloma has not been previously reported as an early complication of a traditional surgical tracheotomy in an adult. In this report, we discuss the presenting features of this case and we propose several possible etiologies.

Approach to benign tumors of the palate: Analysis of 28 cases

August 15, 2011     Ahmet Ural, MD, Murat Livaoğlu, MD, Devrim Bektaş, MD, Osman Bahadır, MD, Atilla Hesapçıoğlu, MD, Mehmet İmamoğlu, MD, and Abdülcemal Ümit Işık, MD
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Abstract

We conducted a retrospective analysis of 28 patients-15 men and 13 women, aged 17 to 71 years (mean: 41.6)-who had undergone surgery for the treatment of a benign tumor of the hard or soft palate. The most common chief complaint was a palatal mass, which was reported by 14 patients (50.0%). Tumors were more common in the hard palate than in the soft palate by a margin of 23 to 5 (82.1 to 17.9%; p = 0.001). The most common histopathologic diagnosis was pleomorphic adenoma, which occurred in 9 cases (32.1%). Most patients were treated with local excision with clear margins, which was sufficient in almost all cases, as there were only 2 recurrences, both of which occurred in men with a hard-palate pleomorphic adenoma. For these 2 patients, a wider excision and repair with palatal islet flaps was performed, and no further recurrence or malignant transformation was observed during follow-up. Two patients with a soft-palate hemangioma were treated with an intralesional steroid injection and radiofrequency ablation, which reduced the size of their lesion considerably.

Laryngeal Teflon granuloma: Endoscopy, laryngeal videostroboscopy, and CT imaging

March 1, 2011     Carlos M. Rivera-Serrano, MD and Libby J. Smith, DO
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Malacoplakia of the vallecula masquerading as a malignancy

March 1, 2011     A.A.S. Rifat Mannan, MD, Mehar Chand Sharma, MD, and Sudhir Bahadur, MS, PhD
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Abstract

Malacoplakia is an unusual chronic granulomatous inflammation that commonly occurs in the urinary tract. It is rarely encountered in the head and neck region, and only a handful of such cases have been described. We report a case of malacoplakia in a 50-year-old woman who presented with a mass in the vallecula that was clinically suspected of being malignant. This case illustrates the importance of recognizing this unusual benign lesion, which closely mimics a malignancy on clinical examination.

Cholesterol granuloma of the external ear canal: A rare presentation

December 17, 2010     Kang-Chao Wu, MD, Min-Tsan Shu, MD, and Cheng-Chien Yang, MD
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Abstract

Almost all aural cholesterol granulomas develop in the mucosa of the middle ear. We describe the case of a 14-year-old girl who presented with an asymptomatic, nontender, dark-blue, cystic lesion in the posteroinferior portion of the left ear canal. The mass was excised via a postauricular approach. Postoperatively, the mass was identified as a cholesterol granuloma on pathologic examination. To the best of our knowledge, this is the first reported case of a human cholesterol granuloma limited to the external ear canal.

Cholesterol granuloma and recurrent cholesteatoma after canal-wall-down mastoidectomy

June 30, 2010     S. Todd Hamilton, MD, Swarupa A. Gadre, MD, and Arun K. Gadre, MD, FACS
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Inflammatory pseudotumor (plasma cell granuloma) of the temporal bone

June 30, 2010     Dare V. Ajibade, BA, Iwao K. Tanaka, MD, Kapila V. Paghdal, PharmD, MD, Neena Mirani, MD, Huey-Jen Lee, MD, and Robert W. Jyung, MD
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Abstract

We report the case of a 41-year-old man who presented with progressive right-sided ear pressure, otalgia, hearing loss, tinnitus, and intermittent otorrhea. Computed tomography and magnetic resonance imaging detected a soft-tissue mass in the right mastoid with intracranial invasion and erosion through the tegmen tympani and mastoid cortex. Histopathologic examination was consistent with an inflammatory pseudotumor (plasma cell granuloma). These lesions rarely occur in the temporal bone. When they do, they are locally destructive and can erode bone and soft tissues. Aggressive surgery is recommended as a first-line treatment, with adjunctive steroid or radiotherapy reserved for residual or refractory disease. Our patient subsequently experienced multiple recurrences, and his treatment required all of these modalities. At the most recent follow-up, he was disease-free and doing well.

Use of the laryngeal microdebrider blade in treating Teflon-induced vocal fold granuloma: A case report

December 1, 2009     Heitham Gheriani, FRCSI, FRCSC, Mohammad Habibulla Khan, MRCSI, and John D. Russell, MCh, FRCSI
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Abstract

Vocal fold granuloma induced by polytef (Teflon) injection is rare. This condition requires surgical intervention in order to restore the voice. In this report, we discuss the use of an endoscopic laryngeal microdebrider blade in successfully treating this condition. To the best of our knowledge, this procedure has not been previously described in the literature.

Pyogenic granuloma of the hard palate: A case report and review of the literature

August 31, 2009     Jaimanti Bakshi, MS, DNB, Ramandeep Singh Virk, MS, FIMSA, and Mayuresh Verma, MS
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Abstract

We describe the case of a 35-year-old man who presented with a 4 x 4-cm ulcerated swelling over the hard palate that had progressed over 6 months. The lesion was associated with recurrent bleeding and occasional pain. Based on the lesion's clinical appearance and other characteristics (i.e., the slow progression, ulceration, and lack of regional lymphadenopathy), a provisional diagnosis of pyogenic granuloma was made, even though pyogenic granulomas of such size are rare. The mass was excised via a transoral route with a 0.5-cm margin of healthy mucosa, and the base was curetted. Histopathologic examination of the excised specimen confirmed the diagnosis. We discuss the etiopathogenesis of this entity and the various treatment options, and we review the relevant literature.

Surgical treatment is warranted in aggressive central giant cell granuloma: A report of 2 cases

March 1, 2009     Jason Roberts, MD, Carol Shores, MD, and Austin S. Rose, MD
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Abstract

Central giant cell granuloma (CGCG) is a benign but locally destructive lesion of the mandible or maxilla that presents most often in the second and third decades of life. Reports of treatment include curettage or complete en bloc resection and nonsurgical approaches such as intralesional steroid injections, interferon alfa-2a, and calcitonin. We describe the cases of 2 young adults with CGCG of the maxilla involving the palate. The first patient, an 18-year-old man, was initially treated with a partial maxillectomy via a facial degloving approach and a postoperative series of transoral intralesional steroid injections to the site of the residual hard palate disease. The partial maxillectomy achieved a near-total debulking of the mass and immediate cosmetic improvement, and the steroid injections resulted in initial regression of the residual disease. However, the patient experienced a recurrence 8 months postoperatively, so a bilateral total inferior maxillectomy via a facial degloving approach was performed with subsequent placement of an obturator. No recurrence was seen 15 months following revision surgery. In view of the incomplete resolution of disease with the use of steroid injections in the first patient, we treated the second patient, a 22-year-old woman, with a subtotal maxillectomy without steroid injection. No recurrence of disease was noted 12 months postoperatively. We conclude that a combination of partial surgical resection and intralesional steroid injection may not be sufficient for the treatment of large CGCGs of the maxilla. Complete surgical resection should be considered for the initial treatment of CGCG, particularly in aggressive cases.

An unusual presentation of Teflon granuloma: Case report and discussion

January 1, 2009     Nitin A. Pagedar, MD, Catherine M. Listinsky, MD, and Harvey M. Tucker, MD, FACS
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Abstract

For more than 25 years, Teflon was the most commonly used material for injection laryngoplasty. However, the incidence of Teflon granuloma and the consequent deterioration of glottic function ultimately led to the development of other injectable materials, and as a result, Teflon granulomas are no longer frequently encountered. We present a case of Teflon granuloma that was unusual in that (1) a long period of time had elapsed between the injection and the granuloma formation and (2) there was no change in the patient's glottic function.

Laryngeal sarcoidosis

April 30, 2008     Enrique Palacios, MD, FACR, Andrew Smith, MD, and Neel Gupta, MD
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