Head and Neck

Melioidosis of salivary glands with coexisting diabetes: Management of a difficult case

January 21, 2014     M. Panduranga Kamath, MS, DLO; Kiran Bhojwani, MS; Mahabala Chakrapani, MD; Katara P. Vidyalakshmi, MD; K.P. Vishnuprasad, MBBS
article

Abstract

Melioidosis is an infectious disease caused by the gram-negative bacillus Burkholderia pseudomallei. Melioidosis is endemic in Southeast Asia and northern Australia. An important risk factor for the development of melioidosis is the presence of diabetes mellitus, which may increase the relative risk of infection by as much as 100-fold. We report a rare case of melioidosis of the parotid and submandibular gland with coexisting diabetes. This was successfully managed conservatively with intravenous ceftazidime followed by trimethoprim/sulfamethoxazole and doxycycline.

How to approach a bilobed petrous apex granuloma: A case report

January 21, 2014     Aaron G. Benson, MD
article

Abstract

Cholesterol granulomas are the most common lesions involving the petrous apex. However, they are still an uncommon finding overall, and they often remain undiagnosed until they have become extremely large and symptomatic. Many surgical approaches to the petrous apex exist. Factors that often influence the surgical approach include the surgeon's experience, the patient's anatomy, and the patient's hearing status. The purpose of this case report-which involved a 66-year-old woman who was referred to our clinic for evaluation of severe headaches, dizziness, and left-sided pulsatile tinnitus-is to demonstrate the definitive need for an extended middle fossa approach when a bilobed petrous apex mass is encountered.

Severe symptomatic hypocalcemia following total thyroidectomy in a patient with a history of Roux-en-Y gastric bypass surgery

January 21, 2014     Justin A. Gross, MD; Steven M. Olsen, MD; Cody A. Koch, MD, PhD; Eric J. Moore, MD
article

Abstract

Patients who undergo a Roux-en-Y gastric bypass (RYGB) procedure are at moderate risk for calcium and vitamin D deficiency. Those who subsequently undergo thyroid or parathyroid surgery are at high risk for developing severe symptomatic hypocalcemia if they are not monitored and adequately treated prophylactically. We describe the case of a morbidly obese 40-year-old man who had undergone RYGB surgery 6 months prior to the discovery of metastatic papillary thyroid carcinoma. He subsequently underwent total thyroidectomy with central and bilateral neck dissection. Following surgery, he developed severe symptomatic hypocalcemia, as his calcium level fell to a nadir of 6.0 mg/dl. He required aggressive oral and intravenous repletion therapy with calcium, vitamin D, and magnesium for 10 days before hospital discharge. Providers should institute careful preoperative screening, patient counseling, and prophylactic calcium and vitamin D therapy for all thyroid surgery patients who have previously undergone RYGB surgery to prevent the development of severe and life-threatening hypocalcemia. Only a few reports of patients have been published on the dangers of thyroid and parathyroid surgery in patients who have undergone bariatric surgery. We report a new case to add to the body of literature on this patient population. We also review calcium homeostasis and supplementation as they relate to this situation.

Submandibular gland megalith eroding the floor of the mouth: A case report

December 20, 2013     Sourav Singh, MDS; Smita Singh, MDS
article

Abstract

Sialolithiasis is the most common pathologic condition affecting the salivary glands. However, large sialoliths (megaliths) are considered rare. The submandibular glands are more susceptible to stone formation than are the other salivary glands. We describe the case of a 55-year-old man with an unusually large sialolith that had eroded the floor of the mouth.

Primary Burkitt lymphoma of the thyroid

December 20, 2013     Samuel Albert, MD
article

Abstract

Primary Burkitt lymphoma of the thyroid is extremely rare. The author describes a new case in a 15-year-old boy who presented with a rapidly enlarging thyroid mass and dyspnea.

Chronic facial pain and Meckel cave masses as the initial presentation of neurosarcoidosis: A case report

December 20, 2013     Graham M. Strub, PhD; Jaime E. Moore, MD; Andrew T. Huang, MD; Aaron W. Stevenson, MD; Evan R. Reiter, MD, FACS
article

Abstract

Sarcoidosis is a systemic inflammatory disease that can affect virtually every organ system, leading to a wide variety of clinical manifestations. Central nervous system involvement producing neurologic symptoms can occur in patients with sarcoidosis, yet rarely are these symptoms the initial manifestations of the disease. Here we present the case of a 38-year-old man who presented with a history of chronic facial pain, blurred vision, increased lacrimation, and periodontal abscesses. Physical examination revealed no evidence of infection or neoplasm. Magnetic resonance imaging revealed space-occupying lesions in Meckel cave bilaterally, with soft-tissue density extending into the left sphenoid and posterior ethmoid sinuses. Endoscopic biopsy of sinus mucosa demonstrated the presence of noncaseating granulomas and the absence of organisms, findings suggestive of neurosarcoidosis. The diagnosis was further supported by chest radiography, which demonstrated bilateral hilar adenopathy. The patient was treated with corticosteroids, and his facial pain improved markedly. In this article we discuss neurosarcoidosis and its manifestations, diagnosis, and clinical course.

Transdermal scopolamine in the management of postparotidectomy salivary fistula

October 23, 2013     Andrea Gallo, MD, PhD; Valentina Manciocco, MD, PhD; Giulio Pagliuca, MD, PhD; Salvatore Martellucci, MD; Marco de Vincentiis, MD
article

Abstract

Parotid fistula represents an uncommon complication in parotid surgery. Its early recognition contributes to successful management. The condition is distressing for both the patient and the surgeon, since conservative and operative treatment frequently fail. There is no consensus on the optimal management of parotid gland fistula. The aim of this study is to describe a new, simple procedure in the treatment of this condition using transdermal scopolamine. We report 3 cases of salivary fistulae occurring after parotidectomy. The patients were admitted to our department with swelling in the parotid region and an output of clear drainage from the drain site during oral intake. The patients were treated with a scopolamine transdermal release system applied to hairless skin overlying the parotid region. A prompt and remarkable decrease in daily salivary output was observed. Fistulae healed completely within 3 days. No collateral effects were observed. Parotid fistulae do not generally occur as a complication of parotidectomies. Their management can be difficult, and several methods of treatment have been attempted. We believe that the use of transdermal scopolamine is a valid option in the treatment of parotid fistulae without causing collateral effects.

Synchronous verrucous carcinoma and inverted papilloma of the lacrimal sac: Case report and clinical update

October 23, 2013     Cheryl Gustafson, MD; Eugene Einhorn, MD; Mary H. Scanlon, MD; Kenneth E. Morgenstern, MD; Paul J. Howlett, MD; Noam A. Cohen, MD, PhD
article

Abstract

Inverted papilloma is a benign epithelial tumor of the nasal cavity. It is known to coexist with malignancy in 5 to 13% of cases, with squamous cell carcinoma being the most common malignancy. Another associated malignancy, one that is extremely rare, is verrucous carcinoma. To the best of our knowledge, no case of verrucous carcinoma occurring alone or in association with another neoplasm has been described in the nasolacrimal system. We report a case of synchronous verrucous carcinoma and inverted papilloma of the lacrimal sac in a 47-year-old man. The patient presented with epiphora, nasal obstruction, swelling of the left medial canthus, and drainage of a foul-smelling fluid from the left nostril. Computed tomography and magnetic resonance imaging detected the presence of a large mass occupying the left nasal cavity and sinuses with extension into the nasopharynx. In addition, bony invasion of the anteroinferomedial wall of the left orbit was noted with extension of the tumor into the orbit itself, which resulted in lateral displacement of the left medial rectus muscle. The patient underwent endoscopic debulking of the left sinonasal lesion. Of note, the surgery had to be completed in stages because of excessive blood loss. Histopathologic examination of the intranasal component of the tumor identified it as an inverted papilloma. One month after the intranasal resection, a left dacryocystectomy was performed; histopathologic examination revealed that an invasive verrucous squamous cell carcinoma had arisen within the inverted papilloma.

Langerhans cell histiocytosis: Temporal bone invasion in an adult

October 23, 2013     Richard L. Alexander, MD, PhD, MBA; Mary L. Worthen, BS; Changlee S. Pang, MD; John S. May, MD
article

Despite the characteristic of extensive destruction of the temporal bone in this disease, the facial nerve is surprisingly resistant to destruction, and facial nerve palsy is rare.

A case of chronic subdural hematoma following lumbar drainage for the management of iatrogenic cerebrospinal fluid rhinorrhea: Pitfalls and lessons

October 23, 2013     Vincent Eng-Soon Tan, MD, MRCS, MS(ORL-HNS); Donald Liew, FRACS
article

Abstract

Chronic subdural hematoma as a complication of lumbar drain placement for the management of iatrogenic cerebrospinal fluid (CSF) leak has not been previously documented in the literature. We describe such a case in a 69-year-old man who presented with right nasal obstruction secondary to an inverted papilloma involving the paranasal sinuses. The patient underwent endoscopic sinus surgery, which included a medial maxillectomy. Surgery was complicated by a small CSF leak, which was repaired intraoperatively. Five days later, the patient experienced CSF rhinorrhea, and a lumbar drain was inserted. He developed overdrainage symptoms but was well when he was discharged. However, 22 days later he returned with right hemiparesis. Computed tomography of the brain showed a left frontoparietal subdural hematoma with a mass effect. The neurosurgical team performed an emergency drainage procedure, and the patient experienced a complete neurologic recovery. We discuss the pitfalls of lumbar drainage, the possible pathophysiology of overdrainage, and the lessons learned from this case.

Undifferentiated thyroid carcinoma

October 23, 2013     Lester D.R. Thompson, MD
article

Histologically, undifferentiated thyroid carcinomas show a variety of patterns, from sheet-like, storiform, fascicular, angiomatoid, and meningothelial to solid, exhibiting extensive lymph-vascular invasion.

Diffuse sphenoid bone cavernous hemangioma presenting during pregnancy

October 23, 2013     Hugh Robertson, MD, FACR; Enrique Palacios, MD, FACR; Sheryl Rincon, MD; Kamal R. Shah, MD
article

Abstract

We present a case of diffuse sphenoid bone cavernous hemangioma in a 22-year-old primigravid woman. Her disease first manifested clinically as progressively decreasing vision in her left eye during her third trimester of pregnancy. We also discuss the known causes and some theoretical causes of cavernous hemangioma enlargement during pregnancy.

PreviousPage
of 47Next