Salivary gland adenoid cystic carcinoma

July 20, 2015     Lester D.R. Thompson, MD

Tumors are poorly circumscribed with an infiltrative border, including extracapsular extension beyond the salivary gland.

A case of transient cortical blindness associated with hypercapnia as a result of extremely enlarged adenoid tissue

January 19, 2015     Baris Malbora, MD; Nihan Malbora, MD; Zekai Avci, MD; Asburce Olgac, MD; Alper Nabi Erkan, MD


Adenotonsillar hypertrophy is common among children, but it can lead to serious complications if left untreated. Among the well-known complications are obstructive sleep apnea syndrome, growth failure, cor pulmonale, and hypertension. One complication of adenotonsillar hypertrophy that has not been previously reported in the English-language literature is transient cortical blindness. We describe such a case, which occurred in a 6-year-old boy who presented with a sudden loss of vision and subsequent unconsciousness. He had experienced hypercapnia and was resuscitated via endotracheal tube ventilation. Laboratory and radiologic assessments found no pathology except for extremely enlarged adenoid tissue. Once the patient was stabilized, an urgent adenotonsillectomy was performed. The patient recovered well, and his vision and respiratory symptoms resolved. Severe hypertrophy of the adenoid tissue can cause hypercapnia and acidosis secondary to upper airway obstruction. The possibility of adenoid hypertrophy and hypercapnia should be kept in mind in cases of transient cortical blindness. Aggressive treatment, including early intubation and adenoidectomy, may lead to a rapid resolution of symptoms.

Rapidly developing iatrogenic hyponatremia in a child following tonsillectomy

October 31, 2012     Umit Taskin, MD; Omer Binay, MD; Cigdem Binay, MD; Ozgur Yigit, MD


Hyponatremia develops as a result of the inappropriate secretion of antidiuretic hormone. In rare cases, it develops as an iatrogenic complication. For example, acute iatrogenic post-tonsillectomy hyponatremia has been described in children following the infusion of hypo- or isotonic fluid. We report a case of rapidly developing post-tonsillectomy iatrogenic hyponatremia in a 5-year-old girl following an excessive infusion of hypotonic fluid. Her signs and symptoms began with nausea and vomiting and progressed to seizures and coma. We corrected the electrolyte disturbance by infusing a 3% sodium chloride solution until her neurologic manifestations disappeared, at which time her serum sodium concentration had risen back to 135 mEq/L. Otolaryngologists are not generally exposed to much information about hyponatremia, so we must be aware of its associated neurologic signs and symptoms.

Utility of preoperative hematologic screening for pediatric adenotonsillectomy

August 10, 2012     Yekaterina A. Koshkareva, MD; Michael Cohen, MD; John P. Gaughan, PhD; Vincent Callanan, MD; Wasyl Szeremeta, MD


We conducted a 3-year retrospective study to examine the results of preoperative 
hematologic screening, the incidence of postoperative bleeding, and the possible 
relationship between the two factors in patients who had undergone tonsillectomy 
with or without adenoidectomy. Our study population was made up of 875 patients—441 
boys and 434 girls, aged 2 to 18 years (mean: 7.52 ± 4.25)—who had been treated at 
our institution from January 2004 through December 2006. In addition to demographic 
data, we compiled information on each patient’s medical and surgical history, personal 
and family history of abnormal bleeding, indication for tonsillectomy, and preoperative 
hematologic screening results. The latter included determinations of the prothrombin 
time, activated partial thromboplastin time, international normalized ratio (INR), and 
platelet count. A total of 748 patients (85.5%) had normal findings on preoperative 
hematologic screening, and 127 (14.5%) had at least one abnormality. Postoperatively, 
hemorrhagic complications occurred in 31 children (3.5%)—in 22 of the 748 patients 
with normal screening results (2.9%) and in 9 of the 127 with a screening abnormality 
(7.1%); the difference between the two groups was statistically significant (p = 0.041). 
The abnormalities in the latter group consisted of an elevated INR but no otherwise 
identifiable coagulopathy. Another 14 patients with an abnormal screening result 
(11.0%) were found to have at least one coagulopathy that was newly diagnosed during 
our preoperative evaluation; they were treated perioperatively, and none bled 
postoperatively. Of 21 patients who had a personal or family history of abnormal 
bleeding, 5 (23.8%) were found to have a coagulopathy, but none bled following surgery. 
In conclusion, we found that preoperative hematologic screening identified patients 
with undiagnosed coagulopathies, and with appropriate treatment our surgeons were able 
to prevent some bleeding events in these patients. Our finding that patients with a 
mildly elevated INR had a higher incidence of postoperative hemorrhage warrants 
further study.

Adenoid cystic carcinoma of the nasal cavity: A case report

June 4, 2012     Angel J. Perez, MD, LT MC USN; Parul Goyal, MD


Adenoid cystic carcinoma (ACC) is the most common malignant tumor of the minor salivary glands. The sinonasal tract is a common site of ACC occurrence, second only to the oral cavity. Of all cases of sinonasal ACC, a minority (22 to 35%) arise in the nasal cavity. Three histologic patterns of ACC have been described: cribriform, tubular, and solid. Compared with the cribriform and tubular forms, predominantly solid-type ACCs have been associated with higher rates of perineural invasion, higher S-phase fractions, and a higher incidence of aneuploidy. The histologic differentiation of solid-pattern ACC from other sinonasal malignancies typically requires the identification of one or both of the other ACC patterns in the same specimen. We present the case of a 39-year-old man with solid-pattern ACC arising in the nasal cavity. The tumor was resected endoscopically. We also discuss the relevant literature regarding the histologic diagnosis, prognosis, and treatment options for solid-pattern ACC.

Adenoid cystic carcinoma of the trachea metastatic to the nasal cavity: A case report

December 1, 2009     Azita S. Khorsandi, MD, James E. Silberzweig, MD, Bruce M. Wenig, MD, Mark L. Urken, MD, and Roy A. Holliday, MD


Cases of carcinoma metastatic to the nasal cavity are rare. We report the case of a 63-year-old woman with a metastasis to the nasal cavity from a primary tracheal adenoid cystic carcinoma (ACC). The nasal tumor was treated with surgical resection. No evidence of any local recurrence was observed at 4 years of follow-up. To the best of our knowledge, no case of a tracheal ACC metastatic to the nasal cavity has been previously reported in the literature. Although rare, metastatic disease to the nasal cavity should be considered in patients who have a known primary carcinoma elsewhere and who present with nasal symptoms.

Should we treat lung metastases from adenoid cystic carcinoma of the head and neck in asymptomatic patients?

May 31, 2009     Irfan M. Syed, BSc, MRCS, DO-HNS and David J. Howard, FRCS, FRCS (Edin)


Adenoid cystic carcinoma is a rare malignant tumor that is well known for its deceptively encouraging 5-year survival rate and its dismal survival rate at longer intervals. Controversy exists as to the benefit of regularly following asymptomatic patients to look for distant metastases because even if one is found, the options for further management are limited. When a metastasis is limited to the lung in an asymptomatic patient with no locoregional recurrence, metastasectomy might provide some long-term benefit, although we cannot know for certain. We encountered such a case, and we opted for surgical resection rather than a conservative approach. There is a need for multicenter trials so that the management of such patients, be it active or conservative, can be evidence-based.

Safety and efficacy of pressure-assisted tissue-welding tonsillectomy: A preliminary evaluation

February 1, 2008     Randall G. Michel, MD, FACS, Bernard I. Weinstock, MD, and Kang Tsau, MD


We conducted a retrospective study of the safety and efficacy of a new pressure-assisted tissue-welding technology (ENTceps; Starion Instruments Corp.; Sunnyvale, Calif.) for total tonsillectomy, either alone or with adenoidectomy. The use of this instrument was compared in two groups of patients categorized by age. The younger group was made up of 50 patients aged 2 to 12 years who had undergone total tonsillectomy and adenoidectomy (T&A), and the older group was made up of 50 patients aged 13 to 47 years who had undergone either T&A or isolated total tonsillectomy. The primary safety endpoint was the presence or absence of intra- or postoperative complications—particularly the amount of intraoperative blood loss and the incidence of delayed postoperative bleeding. In each group, the mean amount of intraoperative blood loss was no more than 30 ml, and only 2 of the 100 patients experienced postoperative hemorrhage. Among the efficacy parameters were the amount of operating and recovery time and the postoperative appearance of the tonsillar fossae. The mean operating time was 13.0 minutes in the younger group and 19.5 minutes in the older group, and the mean total recovery times were 120.0 and 130.4 minutes, respectively; all tonsillar fossae were well epithelialized by 2 weeks after surgery. Finally, surgical morbidity was determined on the basis of the amount of perioperative pain medication administered, the number of unscheduled patient telephone contacts and clinic visits, and the amount of time needed to return to a normal diet and activities. Nine patients in the younger group and 6 in the older group required no pain medications during recovery; overall, pain was not a significant issue for most patients. Sixteen patients made a total of 20 telephone calls and 8 clinic visits prior to their scheduled postoperative appointment; almost all of these encounters dealt with postoperative pain. Only 1 patient, who had previously undiagnosed von Willebrand disease, had not returned to a normal diet and activities by the end of 1 week. Based on our preliminary findings—and a comparison of our results with those of other studies published in the literature relative to the amount of intraoperative bleeding, the incidence of postoperative bleeding, and operating times—we conclude that pressure-assisted tissue-welding technology is safe and compares favorably with other tonsillectomy techniques. This method of electrocautery is straightforward and relatively easy to learn.

Bifid epiglottis

October 31, 2007     Stefanie K. Horne, MD, Peter G. Michaelson, MD, and Erik Weitzel, MD

Use of the laryngeal mask airway in preventing airway fires during adenoidectomies in children: A study of 25 patients

September 30, 2007    

Charles J. Militana, MD;
Michael K. Ditkoff, MD, FACS;
Kenneth F. Mattucci, MD, FACS


We report the results of our study of 25 children who underwent adenoidectomy under general anesthesia with a laryngeal mask airway to determine their risk of fire in the oropharynx. We explain the distinct advantage that such an anesthetic technique has with respect to minimizing the conditions that may contribute to an airway fire. We also discuss additional advantages of using a laryngeal mask airway during adenoidectomies.

Management of paratracheal adenoid cystic carcinoma

March 1, 2007     Sofia Avitia, MD; Jason S. Hamilton, MD; Ryan F. Osborne, MD, FACS