Head and Neck

Maggot infestation of an ulcerated neck wound

June 4, 2015     Sidharth V. Puram, MD, PhD; Margaret S. Carter, MD; Daniel Deschler, MD, FACS
article

The presence of maggots was hardly deliberate in this case, but these larvae successfully debrided a locally recurrent necrotic lymph node.

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
article

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.

ACE-inhibitor-related angioedema

June 4, 2015     Norman J. Chan, MD; Ahmed M.S. Soliman, MD
article

There is debate regarding whether patients who experience ACE-inhibitor-related angioedema can be safely switched to angiotensin receptor blockers.

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.

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.

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
article

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.

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
article

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.

Duplication of the right internal jugular vein: A case report

June 4, 2015     Srinivasalu Bathala, FRCS(ORL-HNS); Zvoru G. Makura, FRCS(ORL-HNS)
article

Abstract

We present a case of duplication of the right internal jugular vein (IJV) in a patient who underwent neck dissection as part of the management of carcinoma of the larynx. The patient was a 63-year-old man who presented to the otolaryngology department with a 7-month history of hoarseness and a 3-week history of noisy breathing. Flexible endoscopy detected a transglottic tumor that had extended beyond the vocal folds. The patient underwent a total laryngectomy and bilateral selective neck dissection at levels II-VI. Intraoperatively, the right IJV was noted to be duplicated. The duplicate segment was approximately 10 cm in length, and it rejoined the normal vein before the normal vein joined the subclavian vein.

Giant Stensen duct calculus

April 27, 2015     Wen-Sen Lai, MD; Jih-Chin Lee, MD; Yueng-Hsiang Chu, PhD; Ying-Nan Chang, MD
article

A sialolith in the anterior third of a Stensen duct usually can be extracted in a minimally invasive manner via trans-oral sialolithotomy to avoid the morbidity associated with a sialadenectomy.

Massive myiasis in an advanced metastatic neck tumor

April 27, 2015     Tomasz Rowicki, MD, PhD; Mirosława Pietniczka-Załęska, MD, PhD
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Abstract

Only a small number of cases of myiasis have been previously reported in patients with a head and neck malignancy; most of these occurred in patients with primary or metastatic skin cancer. We report a case of massive Lucilia sericata myiasis in the neck of a 57-year-old man with primary squamous cell carcinoma of the larynx and hypopharynx that metastasized to the neck lymph nodes. The neck disease manifested as necrosis and skin involvement. Clinical examination revealed an extensive wound within the neck tumor at levels II and V on the right that was heavily infested with maggot larvae. Removal of larvae clusters was performed, and the isolated larvae were subsequently identified as L sericata. To the best of our knowledge, this is the first report of an infestation of L sericata myiasis in a metastasis to the neck lymph nodes.

Parathyroid localization using 4D-computed tomography

April 27, 2015     Darrin V. Bann, PhD; Thomas Zacharia, MD; David Goldenberg, MD, FACS; Neerav Goyal, MD, MPH
article

To decrease the risk of iatrogenic cancers associated with 4D-CT, several groups have used one- or two-phase imaging protocols to identify parathyroid adenomas.

Perineural spread of cutaneous squamous cell carcinoma along the great auricular nerve

April 27, 2015     Daniel Thomas Ginat, MD, MS; Diana Bolotin, MD, PhD; Alexander J. Langerman, MD
article

Although perineural tumor spread in the head and neck most commonly involves the cranial nerves, particularly the trigeminal and facial nerves, the spinal nerve branches can also be affected.

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