Head and Neck

The efficacy of photodynamic therapy in the treatment of oral squamous cell carcinoma: A meta-analysis

February 2, 2015     Eric W. Cerrati, MD; Shaun A. Nguyen, MD, MA, CPI; Joshua D. Farrar, MD; Eric J. Lentsch, MD
article

Abstract

We performed an extensive review of the literature to compare the efficacy of photodynamic therapy (PDT) to surgical resection, the current standard of care, in the treatment of adults with early-stage (T1-2N0M0) squamous cell carcinoma (SCC) of the oral cavity. Since patients who receive PDT are chosen with a high degree of selectivity, particular care was taken when extracting data for comparison. For outcomes measures, PDT was assessed in terms of a complete response to therapy, and surgery was evaluated in terms of locoregional control. Recurrences were also analyzed. We found 24 studies-12 for each treatment-to compare for this meta-analysis. In comparing a complete response to PDT and locoregional control with surgery, we found no statistically significant difference (mean difference [MD]: 1.166; 95% confidence interval [CI]: 0.479 to 2.839). With respect to recurrences, again no statistically significant difference was observed (MD: 0.552; 95% CI: 0.206 to 1.477). We conclude that PDT is as effective as primary surgical resection for the treatment of early-stage SCC of the oral cavity and that it is a valid function-preserving approach to treatment.

Giant palatal pyogenic granuloma

February 2, 2015     Yu-Hsuan Lin, MD; Yaoh-Shiang Lin, MD
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The differential diagnosis for a pyogenic granuloma should include hemangioma, bacillary angiomatosis, peripheral giant cell granuloma, peripheral ossifying fibroma, and some malignancies, such as Kaposi sarcoma, squamous cell carcinoma, and achromic melanoma.

IgG4-related disease of the thyroid: A consideration in the differential diagnosis of an expanding thyroid mass

January 19, 2015     Irina Chaikhoutdinov, MD; Eelam Adil, MD, MBA; Michael D.F. Goldenberg, BA, MA; Henry Crist, MD
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Riedel thyroiditis is a rare inflammatory process associated with IgG4; it involves the thyroid and surrounding cervical tissue, and it is associated with various forms of systemic fibrosis.

A case of myoepithelioma mimicking a parotid cyst

January 19, 2015     Haldun Onuralp Kamburoglu, MD, FEBOPRAS; Aycan U. Kayikcioglu, MD; Cigdem Himmetoglu, MD
article

Abstract

Myoepithelioma is an uncommon tumor of the myoepithelial cells that is considered to represent a distinct category of tumor by the World Health Organization. It accounts for less than 1% of all tumors that develop in the salivary glands. We describe the case of a 35-year-old woman who presented to us with a painless swelling on the right side of her face. She was diagnosed with a parotid gland cyst by ultrasonography and computed tomography. Following excision of the mass, however, the pathology report identified the tumor as a solid myoepithelioma. To the best of our knowledge, this is the first reported case of a myoepithelioma that exhibited cystic features on radiologic examination even though it had a solid architecture. We also discuss the preoperative diagnostic aspects of the myoepitheliomas.

Reconstructive and rehabilitation challenges following a cranio-orbital gunshot wound

January 19, 2015     Sachin S. Pawar, MD; John S. Rhee, MD, MPH; Timothy S. Wells, MD
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Abstract

We present a case of a 26-year-old man who sustained a close-range gunshot wound to the head. His injuries included significant left orbital injury resulting in a ruptured, blind eye and severely comminuted fractures of the left orbital roof, superior and inferior orbital rims, and orbital floor. Associated injuries included left frontal lobe injury, anterior and posterior table fractures of the left frontal sinus, and a comminuted left zygomaticomaxillary complex fracture. We employed an interdisciplinary surgical approach with collaboration among the Otolaryngology, Neurosurgery, and Oculoplastic Surgery services performed in two stages. Management of such extensive craniofacial injuries can be challenging and requires a coordinated, interdisciplinary approach.

Unusual presentation of a midline neck mass

January 19, 2015     Yann-Fuu Kou, MD; Gopi Shah, MD, MPH; Ronald Mitchell, MD; Larry L. Myers, MD
article

Venous malformations are usually visible at birth, although deeper lesions may have normal overlying skin or a bluish discoloration. They grow proportionately with the child and can expand in adulthood.

Group A beta streptococcal infections in children after oral or dental trauma: A case series of 5 patients

January 19, 2015     Brittany E. Goldberg, MD; Cecile G. Sulman, MD; Michael J. Chusid, MD
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Abstract

Group A streptococcus (GAS) produces a variety of disease processes in children. Severe invasive diseases such as necrotizing fasciitis can result. Traumatic dental injuries are common in the pediatric population, although the role of dental injuries in invasive GAS disease is not well characterized. In this article, we describe our retrospective series of 5 cases of GAS infection following oral or dental trauma in children.

Arrested development: Lingual thyroid gland

January 19, 2015     Mark R. Williams, MRCS(ENT); Vivek Kaushik, FRCS(ORL-HNS)
article

Most patients with lingual thyroid are asymptomatic and are diagnosed incidentally following a radiologic investigation for another condition of the head and neck.

Acute exacerbation of Hashimoto thyroiditis mimicking anaplastic carcinoma of the thyroid: A complicated case

December 19, 2014     Hiroaki Kanaya, MD; Wataru Konno, MD; Satoru Fukami, MD; Hideki Hirabayashi, MD; Shin-ichi Haruna, MD
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The fibrous variant of Hashimoto thyroiditis is uncommon, accounting for approximately 10% of all cases of Hashimoto thyroiditis. We report a case of this variant that behaved like a malignant neoplasm. The patient was a 69-year-old man who presented with a right-sided anterior neck mass that had been rapidly growing for 2 weeks. Fine-needle aspiration cytology revealed clusters of large multinucleated cells suggestive of an anaplastic carcinoma. A week after presentation, we ruled out that possibility when the mass had shrunk slightly. Instead, we diagnosed the patient with an acute exacerbation of Hashimoto thyroiditis on the basis of laboratory findings. We performed a right thyroid lobectomy, including removal of the isthmus, to clarify the pathology and alleviate pressure symptoms. The final diagnosis was the fibrous variant of Hashimoto thyroiditis, with no evidence of malignant changes. Physicians should keep in mind that on rare occasions, Hashimoto thyroiditis mimics a malignant neoplasm.

Solitary peritoneal lymph node metastasis of head and neck cancer diagnosed with FDG-PET/CT imaging

December 19, 2014     Yong-Wan Kim, MD; Byung-Joo Lee, MD; Jin-Choon Lee, MD; Tae-Yong Jeon, MD; Hak-Jin Kim, MD
article

Distant metastasis of head and neck squamous cell carcinoma (SCC) to the infraclavicular lymph nodes-with the exception of the upper mediastinal lymph nodes-is rare. We report the case of a 44-year-old man who was treated with surgery and radiotherapy for SCC of the floor of the mouth. During regular follow-up 6 months after the cessation of radiotherapy, F18-fluorodeoxyglucose positron-emission tomography/computed tomography (FDG-PET/CT) detected a hypermetabolic lesion in the left lobe of the liver that was diagnosed as a metastasis of the head and neck SCC; no locoregional recurrence was found. The metastasis was surgically removed and more radiotherapy was administered, but the SCC recurred at the same site and the patient died of disseminated disease 12 months after the appearance of the first metastasis. To the best of our knowledge, this is the first reported case of a solitary peritoneal lymph node metastasis from an SCC of the floor of the mouth. We believe that regular FDG-PET/CT follow-up scans are useful for the detection of unusual distant metastases of head and neck cancers.

Calcific tendinitis of the longus colli muscle

December 19, 2014     Sam S. Torbati, MD, FAAEM; Elaine M. Vos, BA; Daniel Bral, BA; Joel M. Geiderman, MD, FACEP; Benjamin Broukhim, MD, FAAOS
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Presenting signs and symptoms of acute calcific tendinitis of the longus colli musclegenerally include severe, often debilitating, neck pain and odynophagia without any recent associated trauma.

Simultaneous non-Hodgkin lymphoma of the external auditory canal and thyroid gland: A case report

December 19, 2014     BeeLian Khaw, MD; Shailendra Sivalingam, MS-ORL; Sitra Siri Pathamanathan, MBBS; Teck S. Tan, MBChB, MRCS; Manimalar Naicker, MPath
article

Approximately 25% of all cases of extranodal non-Hodgkin lymphoma (NHL) occur in the head and neck region; NHL of the external auditory canal (EAC) and thyroid gland are rare. Specific immunohistochemical staining of the excised tissue is required to confirm the final pathologic diagnosis. We report the case of a 53-year-old woman with underlying systemic lupus erythematosus and autoimmune hemolytic anemia that were in remission. She presented with chronic left ear pain, a mass in the left EAC, and rapid growth of an anterior neck swelling that had led to left vocal fold palsy. High-resolution computed tomography (CT) of the temporal bone and CT of the neck detected a mass lateral to the left tympanic membrane and another mass in the anterior neck that had infiltrated the thyroid gland. The patient was diagnosed with simultaneous B-cell lymphoma of the left EAC and thyroid gland. She was treated with chemotherapy. She responded well to treatment and was lost to follow-up after 1 year. To the best of our knowledge, the simultaneous occurrence of a lymphoma in the EAC and the thyroid has not been previously described in the literature.

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