Head and Neck

Oncocytic mucoepidermoid carcinoma of the parotid gland: A case report and review of the literature

July 20, 2015     Deepali Jain, MD; Nabeen C. Nayak, MD
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Abstract

Oncocytic metaplasia rarely has been reported in mucoepidermoid carcinomas. Most salivary gland lesions with oncocytic change are benign; therefore, it is important to distinguish mucoepidermoid carcinoma from other entities that may show prominent oncocytic change. We report a rare case of oncocytic mucoepidermoid carcinoma in a 65-year-old woman.

Sweet syndrome: A case report and review of the literature

July 20, 2015     Robert B. Contrucci, DO; Donna Bilu Martin, MD
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Abstract

Sweet syndrome (acute febrile neutrophilic dermatosis) is a disorder of unknown etiology. It has been associated with autoimmune processes, malignancies, infections, drug reactions, and gastrointestinal disorders such as inflammatory bowel disease. We describe the case of a 51-year-old man who presented with severe pain in his tongue and throat and referred pain in his right ear, along with odynophagia, fever, and hoarseness of 48 hours'duration. An oral and oropharyngeal examination revealed the presence of aphthous ulcerations, as well as a 3 x 3-cm raised inflammatory lesion on the right anterior lateral tongue and a 5 x 5-mm bulla on the hard palate in the midline. In addition, erythematous papules and macules were noted on his face, neck, and extremities. Cultures, a biopsy, and laboratory tests yielded a diagnosis of Sweet syndrome. The patient was prescribed oral prednisone, and his signs and symptoms resolved within 2 months. Although Sweet syndrome is uncommon, even in dermatology practice, its head and neck and oral manifestations and its association with paraneoplastic disease warrant the need for otolaryngologists to be aware of the condition.

Cervical necrotizing fasciitis as a complication of acute epiglottitis managed with minimally aggressive surgical intervention: Case report

July 20, 2015     Rajesh Babu Gollapalli, MBBS, MS(ENT), DORL; Ana Nusa Naiman, FRACS; David Merry, FRACS
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Abstract

Cervical necrotizing fasciitis secondary to epiglottitis is rare. The standard treatment of this severe condition has long been early and aggressive surgical debridement and adequate antimicrobial therapy. We report the case of an immunocompetent 59-year-old man who developed cervical necrotizing fasciitis as a complication of acute epiglottitis. We were able to successfully manage this patient with conservative surgical treatment (incision and drainage, in addition to antibiotic therapy) that did not involve aggressive debridement.

Post-thyroidectomy hypocalcemia: Impact on length of stay

July 20, 2015     Joe Grainger, FRCS; Mohammed Ahmed, MRCP; Rousseau Gama, FRCPath; Leonard Liew, FRCS; Harit Buch, FRCP; Ronald J. Cullen, FRCS
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Abstract

Hypocalcemia is a recognized complication following thyroid surgery. Variability in the definition of hypocalcemia and different opinions on its management can lead to unnecessary patient morbidity and longer hospital stays as a result of inappropriate or untimely treatment. Therefore, we developed a management guideline for the recognition and treatment of post-thyroidectomy hypocalcemia, and we conducted a retrospective study to assess its impact on length of stay (LOS). Between April 1, 2007, and March 31, 2009, 29 adults had undergone a total or completion thyroidectomy at our large district general hospital. Of this group, postoperative hypocalcemia (defined as a serum calcium level of <2.00 mmol/L) developed in 13 patients (44.8%) during the first 3 postoperative days. Our guideline went into effect on July 1, 2009, and from that date through June 30, 2010, 18 more adults had undergone a total or completion thyroidectomy. Of that group, hypocalcemia developed in 7 patients (38.9%); the guideline was actually followed in 5 of these 7 cases (71.4%). In the preguideline group, the development of hypocalcemia increased the mean LOS from 2.0 days to 7.0 days (p < 0.001). The management of postoperative hypocalcemia in these cases was highly variable and was dictated by variations in practice rather than patient needs. In the postguideline group, postoperative hypocalcemia increased the mean LOS from 2.7 days to only 3.7 days (p = 0.07). While the difference between LOS in the two hypocalcemic groups did not reach statistical significance, we believe it merely reflects the relatively small number of patients rather than any lack of guideline efficacy. The implementation of a simple flowchart guideline for the management of postoperative hypocalcemia in our hospital has resulted in more uniform management and a reduced LOS.

Cervical lipoblastoma: An uncommon presentation

July 20, 2015     Rohaizam Jaafar, MD; Tang Ing Ping, MS(ORL-HNS); Doris Evelyn Jong Yah Hui, MS(ORL-HNS); Mohammad Zulkarnaen Ahmad Narihan, MPath
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Abstract

Lipoblastoma is extremely rare and mainly occurs in children younger than 3 years old. It is predominantly found in the extremities and trunk. Head and neck region occurrences are rare; only 4 such cases involving patients who presented with stridor have been previously reported. We report the fifth case of lipoblastoma of the neck with stridor in a 9-year-old girl, which had gradually worsened over the previous year. Imaging showed a retrotracheal mass extending superiorly to the thyroid level and inferiorly to below the carina of the trachea. Total resection of the tumor was performed, and the histopathologic findings were consistent with lipoblastoma. Postoperatively, the patient was well with no complications.

Two cases of thyroid rupture after blunt cervical trauma

July 20, 2015     Ji Hoon Shin, MD; Yong Bae Ji, MD; Jin Hyeok Jeong, MD; Seung Hwan Lee, MD; Kyung Tae, MD
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Abstract

The consequences of thyroid gland rupture following blunt cervical trauma can be quite grave. Almost all of these cases are associated with preexisting thyroid lesions; the traumatic rupture of a previously normal thyroid gland is very rare. Both surgical and nonsurgical management techniques have been advocated for thyroid injuries, but there is still no consensus on treatment. We report cases of thyroid gland rupture following blunt cervical trauma in 2 patients: a 24-year-old man with a previously normal thyroid and an 8-year-old boy with a preexisting thyroid nodule. The man was treated surgically and the boy was treated conservatively. Based on our experience with these cases and our review of the literature, we propose treatment guidelines for thyroid injuries.

Use of fluoroscopic guidance to remove a migrating esophageal foreign body

June 4, 2015     Ramanuj Sinha, MS; Utpal Jana, MS; Soumya Ghatak, MS; Gautam Biswas, MS; Jayanta Saha, MS; Indranil Sen, MS
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Abstract

Ingested foreign bodies that migrate extraluminally are rare. In such cases, exploration of the neck via an external approach is the recommended procedure to remove the object. However, locating such a foreign body can be a difficult task. We report what we believe is the first adult case of fluoroscopically guided localization of an accidentally ingested foreign body that had migrated into the soft tissues of the neck. We also review the other methods used to locate a migrating foreign body.

Nonossifying fibroma (metaphyseal fibrous defect) of the mandible in a 15-year-old boy

June 4, 2015     Abul Ala Syed Rifat Mannan, MD; N. Gopendro Singh, MD; Salah Al-Waheeb, MBBCh, FRCPC, FRCPath; Taher N.M. Taher, MBBCh, BDS, MOMS; Emad El Din A.M. Mohammed, BDS, MSc, PhD
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Abstract

We describe a rare case of nonossifying fibroma of the mandible in a 15-year-old boy who presented with a left mandibular swelling. Conventional imaging showed an expansile radiolucent lesion involving the angle and the body of the left mandible. The lesion was curetted, and a miniplate was implanted at the excision site. Microscopic examination of the removed specimen revealed a cellular lesion characterized by a proliferation of uniform spindle-shaped cells in a vague but prominent storiform pattern, which represented the classic appearance of nonossifying fibroma. Three months later, radiography detected a fracture of the implantation plate. The area was re-explored with curettage of the soft tissue, which on microscopy demonstrated findings similar to the initial curettage findings. Follow-up radiology revealed satisfactory healing of the jaw, and no further recurrence was seen 2 years after the initial surgery. We present this case to highlight the importance of recognizing nonossifying fibroma in the mandible, which can be easily confused with more common mandibular lesions.

Intraductal infusion of steroids in patients with Sjogren syndrome to treat painful salivary swelling: Report of 2 cases

June 4, 2015     Henry R. Diggelmann, MD; Henry T. Hoffman, MD, MS, FACS
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Abstract

Painful salivary swelling in patients with Sjögren syndrome presents the clinician with a difficult-to-manage condition, and treatment options are limited. We report 2 cases that demonstrate the utility of a clinic-based intraductal corticosteroid infusion for the treatment of painful salivary swelling associated with Sjögren syndrome. Steroid infusion is a cost-effective, simple-to-perform, well-tolerated gland-sparing procedure that may yield good clinical results in selected patients.

Maxillary myxoma: A case report and review

June 4, 2015     Matthew P. Connor, MD, Capt.; Michael Neilson, DMD, Maj.; Cecelia E. Schmalbach, MD
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Abstract

An odontogenic myxoma is a rare, benign tumor that is found almost exclusively in the facial bones, usually the mandible. The diagnosis poses a challenge because its features overlap with those of other benign and malignant neoplasms. We present an unusual case of odontogenic myxoma that involved the maxilla, and we review the clinical, radiographic, and histologic characteristics of this case. Even though it is benign, odontogenic myxoma can be locally invasive and cause significant morbidity. Complete surgical excision is the treatment of choice, but it can be challenging because of the tumor's indistinct margins.

Anaplastic large-cell lymphoma presenting as a nasopharyngeal mass and cervical lymphadenopathy

June 4, 2015     Gregory R. Dion, MD, MS, Capt.; Col. Mark D. Packer, MD
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Abstract

Cervical lymphadenopathy in adults has a broad differential diagnosis, including bacterial and viral infections, Kikuchi-Fujimoto disease, systemic lupus erythematosus, and various neoplasms. Many of its etiologies share similar symptomatology and presentations, which complicates the diagnosis. A thorough history and a comprehensive physical examination, to include nasopharyngoscopy and imaging as indicated by the specific case, are key to determining the origin of the lymphadenopathy and to avoid a missed or delayed diagnosis. Based on our review of the literature, we present the second reported case of anaplastic lymphoma kinase-positive anaplastic large-cell lymphoma presenting in an adult with an obstructing adenoid/nasopharyngeal mass and lymphadenopathy. The mass, which occurred in a 19-year-old woman of Asian descent, caused nasal airway obstruction in the setting of cervical lymphadenopathy that was initially ascribed to mononucleosis.

ACE-inhibitor-related angioedema

June 4, 2015     Norman J. Chan, MD; Ahmed M.S. Soliman, MD
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There is debate regarding whether patients who experience ACE-inhibitor-related angioedema can be safely switched to angiotensin receptor blockers.

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