Mass

Pilomatricoma of the pinna

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

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
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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.

Sinonasal teratocarcinosarcoma with intracranial extension: Case report and literature review

December 31, 2012     Shafik N. Wassef, MD; Payal Kapur, MBBS, MD; Samuel L. Barnett, MD; Larry L. Myers, MD, FACS
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Abstract

Sinonasal teratocarcinosarcoma (SNTCS) is an extremely rare malignancy of the paranasal sinuses that possesses the histopathologic features of both teratomas and carcinosarcomas. We report the case of a 58-year-old white man who presented with a 1-year history of a gradually enlarging left-sided nasal mass. The patient had previously undergone endoscopic sinus surgery at another facility, and the final pathologic specimen was reported as an SNTCS with positive margins. He was then referred to our institution, where he underwent a craniofacial resection combined with endoscopic intranasal resection. Postoperatively, he received combined chemotherapy and irradiation. At 48 months of follow-up, he was alive without evidence of disease.

Intraoperative view of a glomus tympanicum

December 31, 2012     Waitsz T. Chang, MRCS; Willis S.S. Tsang, FRCSEd(ORL)
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For the treatment of a small glomus tympanicum, surgical excision via an anterior tympanotomy approach is possible.

Cervical thoracic duct cyst: Importance of preoperative suspicion for appropriate management of left-sided neck mass

December 31, 2012     Matthew T. Gill, MD; Timothy S. Lian, MD; Joel D. Thibodeaux, MD; Cherie-Ann O. Nathan, MD, FACS
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Abstract

Cervical thoracic duct cysts occur infrequently but are an important consideration when evaluating cystic supraclavicular masses. Only 22 cases have been reported to date. We review the clinical presentation, evaluation, and treatment of 2 cases of large thoracic duct cysts treated with surgical resection. A high suspicion of thoracic duct cyst based on location, radiographic findings, and fine-needle aspiration results is sufficient evidence for recommendation of surgical excision. However, enlarged cysts, as noted in our cases, can obliterate or attenuate the thoracic duct, making it difficult to identify intraoperatively. A high suspicion of thoracic duct cyst is important for identifying and ligating the duct to prevent complications such as chyle leak or chylothorax.

Intraparotid arterial aneurysm treated with embolization followed by surgical resection

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

Obstructive sleep apnea syndrome induced by laryngeal lesions: Two cases

October 31, 2012     Taha Tahir Bekci, MD; Mesut Tezer, MD; Nurdogan Ata, MD; Levent Emre, MD
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Abstract

We describe 2 cases of obstructive sleep apnea syndrome (OSAS) that were found to be caused by the presence of laryngeal masses. Both patients presented with a long-standing history of snoring, gasping for air while sleeping, excessive daytime sleepiness, and morning headaches. In both patients, the lesions were discovered by fiberoptic nasopharyngoscopy. Patient 1, a 46-year-old man, declined surgery, and his lesions (and OSAS) resolved spontaneously in 4 months. Patient 2, a 39-year-old man, did undergo excision of his mass, and he also experienced an alleviation of OSAS.

Nasal tip angiolipoma: The “Pinocchio” nasal deformity

October 4, 2012     David A. De Poortere, MD; Boris M. De Poortere, MD; Noam A. Cohen, MD, PhD
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Abstract

Angiolipoma is a rare, benign variant of lipoma; its distinctive feature is its prominent vascularity. It presents as a subcutaneous nodule of white adipose tissue; pain, which may be exacerbated by pressure, is the chief symptom. The anatomic distribution predominantly involves the trunk and extremities. Because of the rarity of this condition in otorhinolaryngology, our understanding of its diagnosis, treatment, and follow-up is limited. Microscopically, two different histopathologic forms of angiolipomas exist: circumscribed and infiltrating. The diagnosis of angiolipoma can be aided by ultrasound, computed tomography, or magnetic resonance imaging. Surgical excision remains the treatment of choice. Sites of previously reported otolaryngologic cases include the cheek, palate, mandible, nasal septum, and cervical area. We describe what we believe to be the second case of a nasal tip angiolipoma in a 78-year-old woman complaining of progressive aesthetic deformity.

Rosai-Dorfman disease with isolated laryngeal involvement

October 4, 2012     Elisa A. Illing, MD; Stacey L. Halum, MD
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Abstract

Rosai-Dorfman disease is a rare histiocyte disorder that is typically characterized by massive cervical lymphadenopathy. Isolated extranodal involvement is uncommon, and isolated laryngeal involvement is extremely rare. We report an unusual case of Rosai-Dorfman disease with isolated laryngeal involvement that led to recurrent dysphonia and airway obstruction. We discuss the challenges we faced in reaching a correct pathologic diagnosis and in deciding on an appropriate treatment regimen. Based on our experience, we believe that Rosai-Dorfman disease should be considered as a differential diagnosis in patients who present with a recurrent inflammatory (histiocytic) mass lesion of the larynx.

Intradermal melanocytic nevus of the external auditory canal

August 10, 2012     Kai-Chieh Chan, MD; Chi-Ju Yeh, MD; Wan-Ling Ho, MD
article

Intradermal melanocytic nevi are usually asymptomatic, but a patient with such a lesion in the external auditory canal can present with aural obstruction and conductive deafness.

Avoiding misdiagnosis in venous malformation of the parotid

August 10, 2012     Jason Hamilton, MD, FACS; Reena Gupta, MD, FACS
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To avoid mistaking parotid masses and venous malformations for each other, based on imaging, requires a high level of clinical suspicioun, especially when operative findings and images are contradictory.

Sulcus vocalis

August 10, 2012     Johnathan B. Sataloff; Rima A. DeFatta, MD; Mary J. Hawkshaw, BSN, RN, CORLN; Robert T. Sataloff, MD, DMA, FACS
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Sulcus vocalis causes stiffness of the vibratory margin of the vocal folds, and often in adynamic segments. Patients can experience hoarseness, breathiness, increased phonation threshold pressures, decreased vocal efficiency and, commonly, voice fatigue.

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