Head and Neck

Merkel cell carcinoma

March 18, 2014     Jeffrey D. Shiffer, MD; Lester D.R. Thompson, MD
article

The expected 5-year survival rate for patients with Merkel cell carcinoma is more than 80% if the tumor is less than 2 cm and has not metastasized. Once a tumor has metastasized regionally, the 5-year survival rate drops to about 50%.

Cervical sympathetic chain paraganglioma: A report of 2 cases and a literature review

March 18, 2014     Rahul Seth, MD; Manzoor Ahmed, MD; Aaron P. Hoschar, MD; Benjamin G. Wood, MD; Joseph Scharpf, MD
article

Abstract

We review 2 cases of surgically and pathologically confirmed paraganglioma of the cervical sympathetic chain. Both patients-a 46-year-old man and a 33-year-old woman-were treated surgically. Intraoperatively, both tumors were found to be hypervascular and arising from the cervical sympathetic chain. Histopathologic analysis confirmed both as paragangliomas. Paragangliomas arising from the cervical sympathetic chain are exceptionally rare, but they must be considered in the differential diagnosis of parapharyngeal masses. They often present with ipsilateral Horner syndrome and oropharyngeal fullness, and they may be associated with a higher rate of catecholamine secretion. Typical imaging characteristics include anterolateral or lateral displacement of both the carotid and jugular vessels.

Madelung disease: Multiple symmetric lipomatosis

March 18, 2014     Enrique Palacios, MD, FACR; Harold R. Neitzschman, MD, FACR; Jeremy Nguyen, MD
article

Patients with multiple symmetric lipomatosis commonly also suffer from various neuropathies, especially paresthesias and autonomic neuropathy.

Fungal necrotizing fasciitis of the head and neck in 3 patients with uncontrolled diabetes

March 18, 2014     Saravanam Prasanna Kumar, DNB; Arunachalam Ravikumar, MS; Lakshmanan Somu, MS
article

Abstract

Necrotizing fasciitis is an uncommon, rapidly progressive soft-tissue infection that is associated with a high incidence of morbidity and mortality. It is usually caused by bacteria and rarely caused by or complicated by a fungus. We report 3 cases of necrotizing fasciitis of the head and neck in patients with uncontrolled diabetes. Fungi were isolated in all 3 cases. In 1 fatal case, the invasive zygomycete Apophysomyces elegans was isolated. Keys to the management of this condition are (1) early isolation of the causative organism by fungal smear and culture, (2) adequate control of diabetes, (3) maintenance of electrolyte balance, and (4) controlled aggressive surgical debridement at an early stage. We emphasize the importance of fungal smears and cultures in the management of this rapidly spreading infection.

Facial nerve palsy associated with a cystic lesion of the temporal bone

March 18, 2014     Na Hyun Kim, MD; Seung-Ho Shin, MD
article

Abstract

Facial nerve palsy results in the loss of facial expression and is most commonly caused by a benign, self-limiting inflammatory condition known as Bell palsy. However, there are other conditions that may cause facial paralysis, such as neoplastic conditions of the facial nerve, traumatic nerve injury, and temporal bone leions. We present a case of facial nerve palsy concurrent with a benign cystic lesion of the temporal bone, adjacent to the tympanic segment of the facial nerve. The patient's symptoms subsided after facial nerve decompression via a transmastoid approach.

Iatrogenic subcutaneous emphysema after dental treatment

February 12, 2014     Young S. Paik, MD; Kevin W. Lollar, MD; and C.W. David Chang, MD
article

Abstract

Subcutaneous emphysema as a complication of a dental procedure is uncommon. When it does occur, it can result in significant and sometimes alarming cervicofacial swelling. Management in most cases involves close observation while awaiting spontaneous resolution. However, in some cases the swelling can progress to cause serious complications and even death. Even though such complications are more commonly seen by our dental and oromaxillofacial surgery colleagues, otolaryngologists should be aware of this condition since we are often asked to consult in these cases. We describe the case of a 13-year-old girl who presented to the emergency department of our institution with an unusually dramatic acute-onset cervicofacial swelling after she had undergone a dental procedure earlier in the day. Computed tomography revealed subcutaneous emphysema. The patient was admitted to the hospital for close observation, and within 24 hours her condition had improved significantly. Shortly after discharge, she experienced a complete recovery. We review the clinical presentation, physical examination findings, diagnostic workup, and management of this complication.

Acquired cholesteatoma presenting as a pars squamosa temporal bone mass

February 12, 2014     Christopher Vanison, MD; Eric M. Jaryszak, MD, PhD; Amanda L. Yaun, MD; and Diego A. Preciado, MD, PhD
article

Abstract

Acquired cholesteatomas typically arise in the middle ear and mastoid cavities; they rarely present elsewhere. We describe a case of acquired cholesteatoma that presented as a large mass of the pars squamosa of the temporal bone in a 16-year-old girl. The mass was surgically removed without complication. To the best of our knowledge, this is only the second reported case of an acquired cholesteatoma in the lateral temporal bone.

Accessory parotid malignancy requiring ductal transection

February 12, 2014     Avery Kaplan; Alex Fernandez, MS; and Ryan Osborne, MD, FACS
article

While malignancies of the accessory parotid gland are rare, when they do occur they jeopardize ductal integrity.

When is a neck lump not a neck lump? Initial presentation of a solitary sternocleidomastoid muscle in an adult

January 21, 2014     Sonia Kumar, MRCS; Suzie Jervis, MRCS; Harpreet Uppal, FRCS(ORL-HNS)
article

Abstract

A 70-year-old woman was referred to us for evaluation of a presumed left-sided neck mass. The referral was based on the visual appearance of subtle neck asymmetry. The patient reported no ENT symptoms. Clinical examination and ultrasonography identified no pathology, but computed tomography revealed that the asymmetry was present because the patient's right sternocleidomastoid muscle (SCM) was absent. The SCM on the left side was normal. Congenital absence of an SCM is uncommon, and to the best of our knowledge, an initial presentation in an adult has not been previously reported in the literature.

A case of bilateral internal auditory canal osteomas

January 21, 2014     Maria K. Brake, MD; David P. Morris, MD, FRCS(C); Jonathan Trites, MD, FRCS(C); S. Mark Taylor, MD, FRCS(C); Rene G. Van Wijhe, PhD; Robert D. Hart, MD, FRCS(C)
article

Abstract

Osteomas of the skull base are rare, benign, slowly progressing growths of dense cortical bone. Osteomas occurring in the internal auditory canal are extremely rare. These lesions have sometimes been linked with dizziness, sensorineural hearing loss, and/or tinnitus. Although there have been documented cases in which surgical excision has improved these symptoms, symptomatic relief is not always achieved with surgical management. Here we pre-sent, to the best of our knowledge, only the third reported case of bilateral osteomas of the internal auditory canal. An 82-year-old woman presented with an acute onset of vertigo without a history of trauma or ear infection. She reported two similar episodes occurring a few years earlier, with symptoms persisting for only a few days. Audiometry showed presbycusis. Computed tomography and magnetic resonance imaging identified bilateral internal auditory canal osteomas. The patient was treated conservatively, monitored, and had complete resolution of her symptoms.

Polymorphous low-grade adenocarcinoma

January 21, 2014     Lester D.R. Thompson, MD
article

PLGA affects the palate (60% of cases) most commonly, especially at the mucosal junction of the hard and soft palates; the next most common sites are the cheek and the lip, often the upper lip.

Unusual rhabdomyolysis of the masticator space

January 21, 2014     Jason Rodulfa, BS; Enrique Palacios, MD, FACR; Jeremy Nguyen, MD; Harold Neitzschman, MD, FACR
article

Head and neck rhabdomyolysis can mimic other head and neck conditions such as an inflammatory process, blunt trauma, a neoplasm, and autoimmunity disorders, among others.

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