Pharynx

Potentially lethal pharyngolaryngeal edema with dyspnea in adult patients with mumps: A series of 5 cases

April 27, 2015     Masafumi Ohki, MD; Yuka Baba, MD; Shigeru Kikuchi, PhD; Atsushi Ohata, PhD; Takeshi Tsutsumi, PhD; Sunao Tanaka, MD; Atsushi Tahara, MD; Shinji Urata, MD; Junichi Ishikawa, MD
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Abstract

In this article we describe 5 rare cases of mumps-associated pharyngolaryngeal edema. To the best of our knowledge, this report includes the first case of mumps-associated pharyngolaryngeal edema in a patient who had previously received mumps vaccination, and these cases represent the sixth report of mumps-associated pharyngolaryngeal edema in the English literature. All 5 of our patients with mumps infection were adults and manifested airway stenosis due to pharyngolaryngeal edema. This edema responded favorably to steroid treatment without tracheotomy. We conclude that a pharyngolaryngeal examination is recommended for patients with mumps infection. Steroid treatment is usually effective against pharyngolaryngeal edema; however, in certain cases tracheotomy may be inevitable.

Acinic cell carcinoma of the posterior wall of the pharynx

April 27, 2015     Gökhan Erpek, MD; Ceren Günel, MD; Ibrahim Meteoğlu, MD
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Abstract

Acinic cell carcinoma accounts for approximately 2 to 6% of all salivary gland tumors. It usually originates in the parotid gland; the minor salivary glands and the upper respiratory tract are involved only infrequently. We describe a case of acinic cell carcinoma of the posterior wall of the pharynx in a 21-year-old woman. To the best of our knowledge, this is the first case of this type of carcinoma at this location to be published in the literature. The mass was excised, and the patient was referred for postoperative radiation therapy to reduce the risk of local recurrence, but she did not keep her appointment and was lost to follow-up.

Plexiform schwannoma of the posterior pharyngeal wall in a patient with neurofibromatosis 2

March 2, 2015     Luca Raimondo, MD; Massimiliano Garzaro, MD; Jasenka Mazibrada, MD, PhD; Giancarlo Pecorari, MD; Carlo Giordano, MD
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Abstract

We report a case of plexiform schwannoma of the posterior pharyngeal wall that occurred in a 37-year-old man who had been previously diagnosed with neurofibromatosis type 2 (NF2). Plexiform schwannoma has been rarely reported in association with NF2. Moreover, as far as we know, only 6 cases of posterior pharyngeal wall schwannoma have been previously reported in the literature, none of which was associated with NF2 and none of which was histopathologically differentiated in schwannoma or plexiform schwannoma. The patient was treated with laser excision of the tumor via a transoral route, and at 6 and 12 months of follow-up, he exhibited no signs of recurrence. To the best of our knowledge, our patient represents the first reported case of a posterior pharyngeal wall schwannoma that occurred in association with NF2 and the first case in which the schwannoma was removed via transoral laser excision. This case illustrates that plexiform schwannoma is a possible finding in NF2 and that transoral laser excision is a safe surgical procedure in such a case.

The harm of ham hocks: Foreign body impaction in long-standing multiple sclerosis

March 2, 2015     Anish Patel, MD; Jacqueline Weinstein, MD; Mandy Weidenhaft, MD; Enrique Palacios, MD, FACR
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The incidence of foreign body impaction in neurologic dysfunctional swallowing, such as in multiple sclerosis (MS), has been not widely reported.

Bilateral Eagle syndrome causing dysphagia

February 2, 2015     Lyndsay L. Madden, DO; Roxann Diez Gross, PhD; Libby J. Smith, DO
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Patients with Eagle syndrome often report symptoms that include dysphagia, otalgia, throat pain, globus sensation, facial pain, headache, taste disturbances, and dental pain that worsen with chewing, head and tongue movements, and swallowing.

Fusobacterium necrophorum in a pediatric retropharyngeal abscess: A case report and review of the literature

December 19, 2014     Jeffrey Cheng, MD; Andrew J. Kleinberger, MD; Andrew Sikora, MD, PhD
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We present the case of a 17-year-old boy who developed a deep space neck infection following cervical trauma. He was initially managed conservatively with broad-spectrum antibiotics, but when he failed to improve clinically, he required surgical drainage. Wound cultures grew Fusobacterium necrophorum, an uncommon pathogen that can cause pediatric deep neck space infections, especially when it is not associated with Lemierre syndrome. The prognosis for this infection is favorable when it is identified early. Treatment with culture-directed antibiotics and surgical drainage as indicated is appropriate. When treating a pediatric deep neck space infection empirically, physicians should avoid treatment with a macrolide antibiotic, since Fusobacterium spp may be involved and they are often resistant to this class of drugs.

Retropharyngeal masses in neurofibromatosis type 1: Imaging findings in 2 cases

December 19, 2014     Roy Riascos, MD; Jennifer Dodds, MD; Nirav Patel, MD
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Neurofibromatosis type 1 (NF-1) affects mesenchymal development via multisystemic manifestations. We present 2 cases of NF-1 that manifested as a retropharyngeal mass-1 as a lateral cervical meningocele in a 60-year-old man and the other as a focal neurofibroma in a 37-year-old man. Contrast-enhanced magnetic resonance imaging (MRI) was invaluable in identifying the exact nature of the 2 lesions; no contrast enhancement was seen in the case of the meningocele, and enhancement was seen in the case of the neurofibroma. These 2 cases illustrate the importance of the history and contrast-enhanced MRI in managing NF-1 patients with a retropharyngeal mass.

Synchronous double cancers of the hypopharynx: Malignant fibrous histiocytoma and squamous cell carcinoma

October 17, 2014     Shao-Cheng Liu, MD; Wan-Fu Su, MD
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Abstract

We report a unique case of synchronous double hypopharyngeal tumors in a 39-year-old man. The patient presented with a 1-year history of a muffled voice and mild odynophagia. Laryngoscopy detected two grossly different tumors in the hypopharynx: a malignant fibrous histiocytoma (MFH) in the postcricoid area and a squamous cell carcinoma (SCC) in the posterior pharyngeal wall. Chemoradiotherapy was administered, and the patient was free of disease at 23 months of follow-up. Synchronous double cancers of the hypopharynx that feature different oncotypes are very rare, especially those that include an MFH. In fact, to the best of our knowledge, no case of synchronous MFH and SCC of the hypopharynx has been previously reported in the literature. Because the number of reported cases of MFH in the hypopharynx is so small, no consensus exists with respect to the preferred option among the various treatment choices.

Transoral approach to a deep-lobe parotid tumor

October 17, 2014     Lyndon Gonzalez, BS; Alex Fernandez, MS; Belinda Mantle, MD
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Because of their location in this potential space, parapharyngeal tumors tend to be asymptomatic and remain undetected for a long time.

A transoral surgical approach to a parapharyngeal-space pleomorphic adenoma

October 17, 2014     Christopher Schutt, MD; Joehassin Cordero, MD, FACS
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Abstract

It is relatively difficult to gain surgical access to pleomorphic adenomas of the parapharyngeal space. Since the lateral border is the mandible, gaining access to them can put several important neurovascular structures at risk. A number of surgical approaches have been developed to overcome this difficulty, and each has its advantages and disadvantages. We report the case of a 59-year-old woman with a parapharyngeal-space pleomorphic adenoma that was accessed via a transoral approach. Transoral approaches are controversial and rarely used. However, we feel that for a selected group of tumors, this approach provides clear benefits by decreasing cosmetic and functional disability while providing good surgical access to the tumor.

Hypopharyngeal hemangioma in an adult: A case report

October 17, 2014     Lindsay Reder, MD; Sunil Verma, MD; Niels Kokot, MD
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Abstract

Hemangiomas of the postcricoid region have been reported almost exclusively in infants and young children. Our adult patient with symptoms of dysphagia and weight loss underwent transoral CO2 laser microsurgery of a postcricoid mass, and final pathologic examination confirmed the presence of a hemangioma. She is doing well after surgery, with an excellent voice, resolution of dysphagia, and no evidence of recurrence. There have been few cases of hypopharyngeal hemangioma in the adult population; to our knowledge, there have been no reports in the English-language literature of adult patients diagnosed specifically with a postcricoid hemangioma. Otolaryngologists should be familiar with the presentation and treatment of this unusual entity.

Actinomycosis of the pharynx

September 17, 2014     Anna M. Lipowska, MD; Michael M. Johns III, MD
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Abstract

Few cases of pharyngeal actinomycosis have been documented in the literature. We describe the case of a 67-year-old white man who presented with symptoms of dysphagia. Laryngoscopy revealed a pedunculated mass in the left posterior pharyngeal wall; an excisional biopsy confirmed the diagnosis. Postoperatively, the patient underwent 10 weeks of intravenous penicillin therapy followed by 4 months of oral antibiotics, and his condition resolved. We discuss the diagnosis, management, and complications of this rare infection.

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