Head and Neck

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.

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.

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.

Keratocystic odontogenic tumor

September 17, 2014     Lester D.R. Thompson, MD
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Bite-wing or orthopantomograph images reveal a well-defined, unilocular radiolucency with a smooth border, showing minimal bone expansion and even cortication.

Mirror book therapy for the treatment of idiopathic facial palsy

September 17, 2014     Jodi Maron Barth, PT; Gincy L. Stezar, PTA; Gabriela C. Acierno, SPT; Thomas J. Kim, MD; Michael J. Reilly, MD
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Abstract

We conducted a retrospective chart review to determine the effectiveness of treating idiopathic facial palsy with mirror book therapy in conjunction with facial physical rehabilitation. We compared outcomes in 15 patients who underwent mirror book therapy in addition to standard therapy with those of 10 patients who underwent standard rehabilitation therapy without the mirror book. Before and after treatment, patients in both groups were rated according to the Facial Grading System (FGS), the Facial Disability Index-Physical (FDIP), and the Facial Disability Index-Social (FDIS). Patients in the mirror therapy group had a mean increase of 24.9 in FGS score, 22.0 in FDIP score, and 25.0 in FDIS score, all of which represented statistically significant improvements over their pretreatment scores. Those who did not receive mirror book therapy had mean increases of 20.8, 19.0, 14.6, respectively; these, too, represented significant improvements over baseline, and thus there was no statistically significant difference in improvement between the two groups. Nevertheless, our results show that patients who used mirror book therapy in addition to standard facial rehabilitation therapy experienced significant improvements in the treatment of idiopathic facial palsy. While further studies are necessary to determine if it has a definitive, statistically significant advantage over standard therapy, we recommend adding this therapy to the rehabilitation program in view of its ease of use, low cost, and lack of side effects.

A rare case of ameloblastic carcinoma

September 17, 2014     Michael Yunaev, MBBS; Muzib Abdul-Razak, FRCS(Edin); Hedley Coleman, FFOP(RCPA); Yaroslav Mayorchak, MBBS; Ian Kalnins, FRACS
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Abstract

Ameloblastic carcinoma is a rare type of ameloblastoma that has received little mention in the literature. While a number of cases have been published over many years, no institution has been able to produce a substantial case series. Ameloblastic carcinoma originates in the embryonic tooth components. It is believed to be an aggressive tumor that can metastasize; once metastasis occurs, the prognosis tends to be poor. Ameloblastic carcinoma is primarily a surgical condition that is best treated with resection; there has been little indication that other modalities are helpful. We present the case of a 40-year-old woman who was found to have a mandibular lesion by a dentist. After surgical resection, the tumor was found to be an ameloblastic carcinoma. The patient recovered without complication, and she was recurrence-free 18 months postoperatively. We also briefly review the available literature on the natural history of and management options for this rare tumor.

Waldeyer ring lymphoma: A case series

September 17, 2014     Carren S.L. Teh, MBBS, MS(ORL-HNS); Pailoor Jayalakshmi, FRCPath; Sheldon Y.C. Chong, MBBS, MS(ORL-HNS)
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Abstract

We encountered a patient with a tongue base lymphoma that we initially diagnosed as a lingual tonsil in view of its benign appearance. We established the correct diagnosis of Waldeyer ring lymphoma by histology. This case led us to conduct a study of all cases of Waldeyer ring lymphoma that had been treated at our center during a 10-year period. We retrospectively examined our case records and found 35 such cases. From this group, we excluded 5 cases because of incomplete data. Thus our final study group was made up of 30 patients-14 males and 16 females, aged 14 to 76 years (mean: 51.6; median 54). The primary presenting signs and symptoms were dysphagia (n = 17 [57%]), a neck mass (n = 7 [23%]), nasal symptoms (n = 5 [17%]), and pain (n = 1 [3%]). Only 4 patients (13%) had B symptoms. A total of 20 patients (67%) presented with tonsillar involvement, 8 (27%) with nasopharyngeal involvement, 1 (3%) with tongue base lymphoma, and 1 with anterior tongue involvement. Most patients (77%) presented at an early stage. Histologically, 25 patients (83%) had high-grade diffuse large B-cell lymphoma, 4 (13%) had T-cell lymphoblastic lymphoma, and 1 (3%) had follicular lymphoma. Twenty-one patients (70%) were treated with chemotherapy, 4 (13%) received adjuvant chemotherapy with either radiotherapy or surgery, 3 (10%) resorted to other forms of treatment (primarily traditional remedies), and 2 (7%) declined treatment altogether. There were 14 patients (47%) alive at the end of the study period.

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.

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.

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.

Transnasal endoscopic resection of a calcifying cystic odontogenic tumor

August 27, 2014     Daniel Schuster, MD; Joel Cure, MD; Bradford A. Woodworth, MD
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Abstract

Calcifying cystic odontogenic tumor (CCOT) is a rare histologic subtype of odontogenic tumor. Treatment requires complete enucleation. We report what we believe is the first case of CCOT to be removed via a transnasal endoscopic approach. A 16-year-old boy was referred to our department by his dentist for evaluation of an expansile mass of the left maxillary sinus. The dentist had noted an area of hyperlucency of the left palate during a routine examination. Computed tomography confirmed the presence of a large tumor. Complete resection of the tumor was achieved via a transnasal endoscopic surgical approach. Resection of odontogenic tumors is necessary because of their tendency to expand and produce a mass effect on surrounding structures. We believe resection via an entirely transnasal endoscopic approach is a valuable and important technique in the treatment of odontogenic tumors that leaves the patient with a more cosmetically acceptable postoperative appearance.

Paragangliomas of the head and neck: Imaging assessment

August 27, 2014     Alejandro Zuluaga, MD; Daniel Ocazionez, MD; Roy Riascos, MD; Enrique Palacios, MD; Carlos S. Restrepo, MD
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Abstract

Paragangliomas are uncommon tumors that arise from the parasympathetic neuroectodermal ganglionic cells and have been described in numerous anatomic locations, most commonly in the abdomen. Head and neck paragangliomas are classified into carotid body (most common), vagal, and jugulotympanic types. Computed tomography is the initial imaging modality of choice for the preoperative assessment of the extent of paragangliomas. Magnetic resonance imaging and selective angiography provide more detail of the surrounding tissues and vasculature. Surgical resection is the treatment of choice.

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