Head and Neck

Complete second branchial cleft anomaly presenting as a fistula and a tonsillar cyst: An interesting congenital anomaly

October 17, 2014     Prasad John Thottam, DO; Samba S. Bathula, MD; Janet M. Poulik, MD; David N. Madgy, DO
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Abstract

Branchial cleft anomalies make up 30% of all pediatric neck masses, but complete second branchial cleft anomalies are extremely rare. We report an unusual case of a complete second branchial cleft anomaly that presented as a draining neck fistula and a tonsillar cyst in an otherwise healthy 3-month-old girl. At the age of 7 months, the patient had been experiencing feeding difficulties, and there was increasing concern about the risk of persistent infections. At that point, the anomaly was excised in its entirety. Our suspicion that the patient had a complete second branchial cleft anomaly was confirmed by imaging, surgical excision, and histopathologic analysis.

Submental nodular fasciitis: Report of an unusual case

October 17, 2014     Jiun Fong Thong, MRCS(Eng); Tiong Yong Tan, FRCR(UK); Shi Wang, FRCPA(UK); Paul Mok, FRCS(Glasg); David Loke, FRCS(Edin)
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Abstract

A 30-year-old woman presented for evaluation of a hard, enlarging, submental mass that was fixed to the underlying mandible. Fine-needle aspiration cytology initially led to a diagnosis of pleomorphic adenoma, which was unusual given the superficial location of the lesion on computed tomography. The lesion was a well-defined rim-enhancing mass, and it had displaced adjacent structures medially. Intraoperatively, the mass was found to abut against and erode the mandibular cortex. A diagnosis of nodular fasciitis was established by histologic analysis. Such a location for this tumor is unusual. The prognosis for patients with this benign condition is excellent following complete surgical excision. We discuss the clinical presentation and the cytologic, histologic, and radiologic features of this uncommon entity.

Medullary thyroid carcinoma presenting as a supraglottic mass

October 17, 2014     Jeremy White, MD; Ahmed Mohyeldin, MD, PhD; Arnold Schwartz, MD, PhD; Steven Bielamowicz, MD
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Abstract

We report a rare case of medullary thyroid carcinoma that presented as a metastasis to the supraglottic larynx. A 92-year-old man with a 3-month history of voice change and airway obstruction was diagnosed with medullary thyroid carcinoma metastatic to the supraglottis. Excision of the mass, total thyroidectomy, and elective neck dissection were recommended, but the patient declined because of his advanced age. Medullary carcinoma of the thyroid gland is a rare neuroendocrine tumor with a poor prognosis when associated with a distant metastasis. To the best of our knowledge, this is the first case of a medullary carcinoma of the thyroid presenting as a supraglottic mass. Total thyroidectomy, neck dissection, and surgical excision of the entire tumor comprise the treatment of choice.

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 persistent left superior vena cava, with the accessory nerve passing through a duplicate segment of the left internal jugular vein: A unique presentation

October 17, 2014     Omar Ayoub, MSc, FRCSEd(ORL-HNS); Jamie Benton, MRCS; Shaun Jackson, FRCSEd
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Abstract

The internal jugular vein and the spinal accessory nerve are important landmarks during neck dissection; unexpected variations in their positions can result in inadvertent iatrogenic damage to adjacent structures. We report the case of a 79-year-old man who was found during neck dissection to have a duplicate segment of his left internal jugular vein (IJV), a persistent left superior vena cava, and an absent right superior vena cava. The spinal accessory nerve passed through the duplicate section of the IJV. A MEDLINE search found no previously reported case of these anomalies occurring together. We also review 10 previously reported cases of IJV duplication. Finally, we discuss the embryologic and anatomic background of these malformations so that otolaryngologists may be aware that identification of such anomalies may help to prevent postoperative morbidity.

Castleman disease of the parotid gland in a pediatric patient: A case report

October 17, 2014     Sudesh Kumar, MS, DNB; Rashid Al Abri, MD, FRCS; Nasreen Abdul Kadir, MD; Dilani Lokuhetty, MD
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Abstract

Castleman disease, also called angiofollicular lymph node hyperplasia, is a rare lymphoproliferative disorder characterized by enlarged hyperplastic lymph nodes. Affected patients usually present with mediastinal lymphadenopathy; sometimes other groups of lymph nodes are involved, with or without associated systemic manifestations. We report a case of Castleman disease involving the intraparotid lymph node in a 15-year-old boy who presented with a 3-month history of a painless swelling of the right parotid gland. Fine-needle aspiration cytology of the mass revealed only reactive hyperplasia. The diagnosis of Castleman disease was established on histopathologic examination of the resected mass. We discuss the clinical course, histopathologic features, radiologic characteristics, and management of Castleman disease of the parotid gland in a pediatric patient.

Black thyroid

October 17, 2014     Darrin V. Bann, PhD; Neerav Goyal, MPH, MD; Henry Crist, MD; David Goldenberg, MD, FACS
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Despite the benign impact of minocycline on thyroid function, several studies have reported an association between black thyroid and thyroid cancer.

Stylohyoid syndrome, also known as Eagle syndrome: An uncommon cause of facial pain

September 17, 2014     Erin L. Werhun, MD; Mandy C. Weidenhaft, MD; Enrique Palacios, MD, FACR; Harold Neitzschman, MD, FACR
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Eagle syndrome is often a diagnosis of exclusion after other etiologies of pain are thoroughly investigated, and it can be determined via a physical examination and characteristic radiographic findings.

Mesenchymal chondrosarcoma of the mandible: A rare malignant tumor

September 17, 2014     Rakesh Kumar Singh, MS; Saurabh Varshney, MS; Sampan Singh Bist, MS; Meena Harsh, MD; Nitin Gupta, MD
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Abstract

Mesenchymal chondrosarcoma (MCHS) is a highly aggressive, malignant, cartilaginous tumor that represents about 1% of all chondrosarcomas. Only about 50 cases of MCHS of the jaw have been reported in the English-language literature; maxillary tumors are much more common than mandibular tumors. We present a new case of MCHS of the mandible that arose in a 22-year-old woman whose initial two biopsies did not reveal the features of the tumor. The diagnosis was made only after an incisional biopsy.

Hypocalcemia after minimally invasive thyroidectomy

September 17, 2014     Doug Massick, MD; Matthew R. Garrett, MD
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Abstract

We conducted a retrospective study to determine the incidence of postoperative hypocalcemia following minimally invasive thyroidectomy. During the 2-year study period, 74 patients-16 men and 58 women (mean age: 43.7)-underwent either total or hemithyroidectomy through a 3-cm incision. Postoperative hypocalcemia occurred in 14 of these patients (18.9%)-4 men and 10 women-all of whom underwent total rather than hemithyroidectomy. All these patients received supplementation with calcium and vitamin D for 2 weeks postoperatively in order to regain a normal calcium status, and all demonstrated normal serum calcium levels at 3 weeks. Despite their low calcium levels, none of the 14 patients exhibited any overt symptoms of hypocalcemia. We conclude that minimally invasive thyroidectomy is associated with a low rate of postoperative hypocalcemia that is comparable to the rates previously reported for standard thyroidectomy.

Report of a rare case of carcinoma arising in a branchial cyst

September 17, 2014     Natarajan Anantharajan, MBBS, MS, MRCS; Nagamuttu Ravindranathan, BDS, MBBS, FRCS(Edin)
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Abstract

Primary branchiogenic carcinoma is a rare condition. In fact, most of the cases that were previously reported as such were actually cystic metastases of oropharyngeal carcinomas. We report a true case of primary branchial cleft cyst carcinoma. Our patient was a 42-year-old woman who presented with a painless fluctuant swelling in the right side of her neck. The lesion was completely excised, and pathology identified it as a squamous cell carcinoma in a branchial cleft cyst. Patients with this condition require a careful evaluation of the entire head and neck region, especially the oropharynx, to look for any cystic metastasis of the primary tumor.

Second branchial cleft anomaly with an ectopic tooth: A case report

September 17, 2014     Jennifer C. Alyono, MD; Paul Hong, MD; Nathan C. Page, MD; Denise Malicki, MD, PhD; Marcella R. Bothwell, MD
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Abstract

Branchial cleft cysts, sinuses, and fistulas are the most common congenital lateral neck lesions in children. They arise as a result of an abnormal development of the branchial arches and their corresponding ectoderm-lined branchial clefts. Of these diverse anomalies, second branchial cleft lesions are the most common, accounting for approximately 95% of all branchial arch pathologies. We describe what is to the best of our knowledge the first reported case of an ectopic tooth in a branchial cleft anomaly. The patient was a young girl who had other congenital abnormalities and syndromic features and who was eventually diagnosed with Townes-Brocks syndrome. We describe the clinical presentation, management, pathologic analysis, and postoperative outcomes of this case, and we present a brief review of Townes-Brocks syndrome.

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