Mass

Large osteoma of the external auditory canal

July 21, 2013     Takashi Iizuka, MD; Takuo Haruyama, MD; Keiko Nagaya, MD
article

Primary laryngeal actinomycosis in an immunosuppressed woman: A case report

July 21, 2013     Tarik Abed, MBBS; Jay Ahmed, MBBS; Niamh O'Shea, MBBS; Simon Payne, FRCPath; Gavin W. Watters, FRCS
article

Abstract

We report a rare case of primary laryngeal actinomycosis, which occurred in a 35-year-old woman with end-stage renal failure secondary to systemic lupus erythematosus with membranous glomerulonephritis. The patient, who had been on long-term immunosuppression therapy, presented with hoarseness. Flexible laryngoscopy detected the presence of a granular glottic mass at the anterior commissure of the larynx. Histology revealed actinomycotic organisms associated with an abscess. The patient was treated with a prolonged course of oral penicillin V and speech therapy, and her dysphonia resolved almost completely. Although actinomycotic infection of the larynx is rare, it should be considered in the differential diagnosis of hoarseness in an immunocompromised patient.

Pigmented villonodular synovitis of the temporomandibular joint

July 21, 2013     Helen Giannakopoulos, DDS, MD; Joli C. Chou, DMD, MD; Peter D. Quinn, DMD, MD
article

Abstract

Pigmented villonodular synovitis (PVNS) is a proliferative disorder that affects synovium-lined joints, bursae, and tendon sheaths. It appears in both diffuse and localized forms, depending on the extent of synovial involvement. PVNS rarely involves the temporomandibular joint (TMJ); when it does, it manifests clinically as a slowly growing and painless preauricular mass that resembles a parotid tumor. TMJ dysfunction, paresthesia, and/or hearing loss can result. We present a case of a large extra-articular PVNS of the TMJ, and we review the literature.

Infected sublingual hematoma: A rare complication of frenulectomy

July 21, 2013     Amal Isaiah, MD, DPhil; Kevin D. Pereira, MD, MS
article

Given the spectrum of potential poor outcomes, some consensus has emerged in favor of early surgical management of significant ankyloglossia.

Nasal actinomycosis mimicking a foreign body

July 21, 2013     Dimitrios Batzakakis, MD; Petros D. Karkos, AFRCS, MPhil, PhD; Sotirios Papouliakos, MD; Samuel C. Leong, MRCS, DO-HNS; Ioannis Bardanis, MD
article

Abstract

Nasal actinomycosis is a rare disease. We present a case of nasal actinomycosis causing symptoms similar to those of a nasal foreign body. A 34-year-old woman presented with a long history of halitosis and unilateral offensive, purulent rhinorrhea. Rigid nasendoscopy showed a hard, dark gray mass between the middle and inferior turbinates. Computed tomography findings were typical of a nasal foreign body. Endoscopic removal of the mass was performed, and histopathology established a diagnosis of actinomycosis. We suggest that every clinician confronted with unilateral nasal symptoms and/or signs should have this clinical entity in mind, since it has justifiably been characterized as the head and neck “mimic.”

Hypopharyngeal lipoma causing obstructive sleep apnea: Discovery on dental cone-beam CT

March 24, 2013     Ashok Balasundaram, BDS, DDS, MDS, MS, Diplomate ABOMR
article

Abstract

Cone-beam computed tomography (CBCT) is primarily used for a variety of dental purposes, but it may also yield nondental findings that can have significant implications for patient health. For example, physicians should be aware that CBCT can identify some of the etiopathogenic causes of obstructive sleep apnea, as occurred in the case described in this report. The patient was a 76-year-old man who presented to a dentist for implant therapy. A CBCT that had been performed in preparation for dental implant placement revealed the presence of a large hypopharyngeal lesion that was obstructing the airway. An otolaryngologist excised the lesion, which on biopsy proved to be a lipoma. Following removal of the lesion, the patient's episodic sleep apnea and snoring resolved. Medical physicians should be aware of maxillofacial CBCT technology and its ability to identify lesions that could cause potential life-threatening situations.

Mucocele: Retention and extravasation types

March 24, 2013     Lester D.R. Thompson, MD
article

The extravasation type is the most common mucocele, more common in children and young adults, with a peak in the second decade of life.

Ectopic thymus presenting as a retropharyngeal mass: Surgical approach

January 24, 2013     Abby R. Nolder, MD; Amit Agarwal, MD; Emily Howard, MD, PhD; Gresham T. Richter, MD
article

Abstract

Cervical ectopic thymus is a rare cause of solid neck masses in children. Most children are asymptomatic, but some may present with a palpable neck mass, with or without compressive symptoms. Cervical ectopic thymus is often discovered incidentally and mistaken for an infection or neoplasm. We present the case of an infant with retropharyngeal ectopic thymus and describe our intraoral surgical approach.

External auditory canal exostosis

January 24, 2013     Joseph A. Ursick, MD; Jose N. Fayad, MD
article

Exostoses, composed of immature layers of lamellar bone that cause a progressive stenosis of the external ear canal, are typically bilateral, occur at suture lines, and are associated with repeated exposure to cold water.

Pilomatricoma of the pinna

January 24, 2013     Aroor Rajeshwary, MS (ENT); Gangadhara Somayaji, MS (ENT); Sai Manohar, MS (ENT)
article

Abstract

A 4-year-old boy presented with a painless swelling over the right pinna of 4 months' duration. Histopathologic examination of the excised mass revealed features of pilomatricoma-a rare, benign skin neoplasm arising from hair follicle matrix cells. The unusual location of the lesion over the pinna, despite its frequent occurrence in the head and neck, prompted this article. We discuss the etiology, clinical presentation, and management of pilomatricoma of the auricular region

Castleman disease of the neck: An uncommon location

January 24, 2013     Lorena Garza Garcia, MD; Enrique Palacios, MD, FACR; Alexander Quiroz-Casian, MD; Harold Neitzschman, MD, FACR
article

Patients with the hyaline vascular variant of Castleman disease tend to be asymptomatic, although some have complained of symptoms caused by compression of adjacent structures, and others have reported a palpable mass.

Intraparotid arterial aneurysm treated with embolization followed by surgical resection

December 31, 2012     Daniel T. Ganc, MD; Charles Prestigiacomo, MD; Soly Baredes, MD
article

Abstract

We describe the case of a 41-year-old woman who presented to a local facial plastic surgeon for evaluation of a cosmetic defect of the cheek of 1 month's duration. When imaging revealed the presence of a vascular mass, the patient was referred to us. Further imaging identified the mass as an intraparotid external carotid artery aneurysm. The decision was then made to treat the patient with embolization of the lesion followed by surgical resection the next day. During the resection, the lateral-most aspect of the aneurysm was found to be adherent to and splaying the facial nerve. The embolized mass and the surrounding fascial layer were removed, and the branches of the facial nerve were retracted superiorly and inferiorly. Dissection proceeded around the aneurysm in this plane. Blood loss during the procedure was minimal. On postoperative day 1, the patient exhibited minimal lower facial asymmetry. In this case, performing embolization prior to surgical resection appeared to be a prudent and efficacious strategy. The preoperative embolization greatly reduced the risk of damage to the facial nerve.

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