December 31, 2012 Trupti Shreyans Patel, MD; Swapan L. Desai, MD; Priti P. Trivedi, MD; Manoj J. Shah, MD
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Abstract
Thyroid carcinoma metastatic to the maxillofacial area is extremely rare. Other carcinomas can metastasize to this area, but very few cases of follicular thyroid carcinoma metastasizing to the nasopharynx have been reported. Carcinoma from the kidney, liver, large bowel, prostate, and thyroid are known to have the potential for clear cell differentiation, and all of them can metastasize to the sinonasal area. Histochemical and immunohistochemical evaluations, along with clinical details, are useful in distinguishing metastases of these clear cell tumors from primary sinonasal tumors. In this article we describe a rare case of metastatic thyroid carcinoma with clear cell change mimicking metastatic renal cell carcinoma in the nasopharynx.
December 31, 2012 Matthew T. Gill, MD; Timothy S. Lian, MD; Joel D. Thibodeaux, MD; Cherie-Ann O. Nathan, MD, FACS
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Abstract
Cervical thoracic duct cysts occur infrequently but are an important consideration when evaluating cystic supraclavicular masses. Only 22 cases have been reported to date. We review the clinical presentation, evaluation, and treatment of 2 cases of large thoracic duct cysts treated with surgical resection. A high suspicion of thoracic duct cyst based on location, radiographic findings, and fine-needle aspiration results is sufficient evidence for recommendation of surgical excision. However, enlarged cysts, as noted in our cases, can obliterate or attenuate the thoracic duct, making it difficult to identify intraoperatively. A high suspicion of thoracic duct cyst is important for identifying and ligating the duct to prevent complications such as chyle leak or chylothorax.
October 31, 2012 Senol Civelek, MD; Ibrahim Sayin, MD; Ibrahim Ercan, MD; Burak Omur Cakir, MD; Suat Turgut, MD
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Abstract
We report our assessment of the effectiveness of bipolar radiofrequency-induced interstitial thermoablation (BRIT) for the treatment of certain oral cavity vascular malformations in 5 children. Two of these patients had lymphangiomatous macroglossia (LM), 1 had lymphangioma circumscriptum (LC), and 2 had a venous malformation (VM). Each patient underwent BRIT at least twice; treatment was delivered at 4- to 8-week intervals according to each patient's circumstances. The 2 patients with LM required three treatment sessions; although their tongue volume decreased after each session, both still required a partial glossectomy to achieve a satisfactory reduction in volume. The patient with LC underwent two BRIT treatments, which reduced the size of the lesion by half; the remainder was excised. The 2 patients with a VM (1 buccal and 1 lingual) responded well to BRIT, and their malformations almost completely disappeared. Our early results with BRIT suggest that it is an effective treatment for oral cavity vascular malformations-more so for patients with venous rather than lymphangiomatous lesions.
October 31, 2012 Ankur Gadodia, MD, DNB; Ashu Seith, MD; Raju Sharma, MD
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Abstract
Sjögren syndrome is a chronic autoimmune exocrinopathy that destroys salivary and lacrimal gland tissue. We report an unusual case of this disease in a 40-year-old woman who presented with bilateral parotid cystic masses. As this case illustrates, Sjögren syndrome should be included in the differential diagnosis of bilateral cystic parotid lesions.
October 31, 2012 J. Madana, MS, DNB; Deeke Yolmo, MS; S. Gopalakrishnan, MS; Sunil Kumar Saxena, MS
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Abstract
Angiokeratoma is a very rare vascular lesion of the papillary dermis. It is characterized by vascular ectasia with overlying epidermal hyperkeratosis. The systemic form of angiokeratoma is associated with Fabry disease and fucosidosis. There are several localized forms. Tongue involvement is uncommon. Hemangiomas are tumors made up of capillaries; they grow by active endothelial proliferation as opposed to expansion of vascular spaces in vascular malformations. Lingual hemangiomas are usually indolent, but they can cause cosmetic deformities, recurrent hemorrhage, and functional problems with speaking, mastication, and deglutition. We report a case of angiokeratoma of the tongue with an underlying hemangioma in a 30-year-old woman. Angiokeratomas have been reported to develop over arteriovenous malformations and in the area of lymphangioma circumscriptum following repeated local trauma. To the best of our knowledge, the development of a lingual hemangioma in a patient with long-standing angiokeratomatous lesions has not been previously reported in the literature.
October 31, 2012 Abu Bakar Zulkiflee, MS; Narayanan Prepageran, FRCS; Omar Rahmat, MS; Pailoor Jayalaskhmi, MPath, FRCPath; Tengku Sharizal, MS
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Abstract
We report a case of primary extracranial meningioma arising from the hypoglossal nerve in a 54-year-old man who presented with a 9-month history of hoarseness and progressive dysphagia. He had also noticed that his tongue was deviated to the left and, as a result, he was having difficulty pronouncing words. Examination revealed fasciculation and muscle wasting on the left side of the tongue. Other cranial nerve functions were normal. Contrast-enhanced computed tomography detected a heterogeneous mass that had arisen above the bifurcation of the left common carotid artery and had extended to near the skull base. Transcervical excision of the tumor was performed, and histopathology identified it as a meningioma of the hypoglossal nerve. The patient recovered uneventfully, and he was without recurrence at more than 2 years of follow-up. A primary extracranial meningioma is extremely rare, and its presentation may be subtle. A thorough investigation is necessary to avoid fatal compressive symptoms.
October 8, 2012 Jagdeep S. Thakur, MBBS, MS; Dev R. Sharma, MBBS, MS; Narinder K. Mohindroo, MBBS, MS, DORL
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Even the most experienced head and neck surgeons can encounter problems during neck dissections in patients with rare anatomic variations in their major vessels, such as the internal jugular vein.
October 8, 2012 Juan F. Yepes, DDS, MD, DrPH; Mohd Khalaf, DDS; Larry Cunningham, DDS, MD, FACS; John Lindroth, DDS
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Abstract
Temporomandibular joint (TMJ) disorders are common in the general population, with a particularly high prevalence among girls and women aged 15 to 25 years. The presence of chronic focal Langerhans cell histiocytosis in the mandibular condyle is rare, as only a few cases have been reported in the literature. We present the case of a 23-year-old woman who was referred to the Orofacial Pain Center at the University of Kentucky College of Dentistry with a chief complaint of limited jaw opening of 7 months’ duration. She had previously received a preliminary diagnosis of a TMJ disorder and had been treated conservatively, but she did not improve. An initial panoramic film revealed a suspicious radiolucent area at the head of the left mandibular condyle. She was eventually diagnosed on histopathology with chronic focal Langerhans cell histiocytosis. She was treated with condylectomy and surgical curettage of the lesion.
October 8, 2012 Juliette Thariat, MD, PhD; Pierre-Yves Marcy, MD; Isabelle Peyrottes, MD; Alexandre Bozec, MD, PhD; Nicolas Venissac, MD, PhD
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Abstract
The prevalence of malignant peripheral nerve sheath tumor (MPNST) among the general population is only 0.001%. Most cases originate in peripheral nerve root trunks in the extremities; MPNST rarely occurs in the head and neck. We describe the case of a 61-year-old man who presented with Horner syndrome, dysphonia, and enlarged neck nodes. Imaging detected a paraspinal mass of the deep superior cervical chain next to the internal carotid artery. The patient underwent an upfront modified radical neck dissection of the right-sided lymph nodes from levels II through V. Postoperative irradiation was performed. Two years after the initial diagnosis, the patient was found to have a pulmonary metastasis of the MPNST. A wedge resection was performed, and at 6 months of follow-up, the patient was alive without disease. However, he subsequently developed soft-tissue metastases in his buttocks, and he died 2 years later of brain metastases. In our case, the clinical symptoms suggested the anatomic location of the primary tumor, and imaging findings suggested the diagnosis, which was confirmed on histopathology. As far as we know, no case of MPNST of the superior ganglia of the sympathetic chain has been previously described in the literature.
October 4, 2012 J. Madana, MS, DNB; Deeke Yolmo, MS; Sunil Kumar Saxena, MS; S. Gopalakrishnan, MS
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Abstract
Branchial cleft fistulae are rare congenital anomalies that arise from the abnormal persistence of branchial remnants. Branchial arch anomalies are rare. They usually present as a lateral neck mass or abscess in the form of acute suppurative thyroiditis. A complete fistula of the third arch is extremely rare. We describe such a case in a 13-year-old girl who presented with a small opening in the left lower neck, from which a mucoid discharge had been present since birth. The fistula was accompanied by recurrent neck swelling. Computed tomography with contrast injection into the external skin opening revealed a continuous tract that extended to the base of the piriform sinus. Total excision of the tract up to the piriform sinus with a left hemithyroidectomy was performed. At follow-up 28 months postoperatively, the patient exhibited no evidence of recurrence.
October 4, 2012 John M. Carter, MD; April Landry, MD; Michael Hinni, MD, FACS
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Abstract
Parathyroid lipohyperplasia is an extremely rare cause of hyperparathyroidism. According to a MEDLINE search, there have been only 9 previously reported cases of parathyroid lipohyperplasia in the English-language literature. We report a new case of parathyroid lipohyperplasia, with a brief discussion of this rare disease process.
September 7, 2012 Nezahat Erdogan, MD; Erdogan Bulbul, MD; Murat Songu, MD; Engin Uluc, MD; Kazim Onal, MD; Melda Apaydin, MD; Huseyin Katilmis, MD
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Abstract
We conducted a prospective study to compare the effectiveness of conventional computed tomography (CT) and puffed-cheek CT in detecting the presence and extension of oral cavity malignant tumors. We enrolled 11 patients—5 men and 6 women, aged 32 to 85 years—who had a primary squamous cell carcinoma of the oral cavity. These tumors were located in the floor of the mouth in 4 patients, in the buccal mucosa in 4, in both the buccal mucosa and retromolar trigone in 2, and in the retromolar trigone only in 1. First, conventional contrast-enhanced axial CT was obtained through the oral cavity and neck in each patient. Next, axial imaging was obtained through the oral cavity while patients inflated their cheeks, pursed their lips, and held their breath. We found that the puffed-cheek CTs provided more information regarding the size and extent of the squamous cell carcinomas than did the conventional CTs. For example, in 8 patients, conventional CT could not differentiate the tumor from the normal mucosal surface, but puffed-cheek images clearly showed the surface of the tumor as distinct from the normal mucosa. More disconcerting was the fact that in the other 3 patients, conventional CTs were evaluated as normal, even though puffed-cheek imaging clearly showed the mass in each case. We conclude that puffed-cheek CT is superior to conventional CT for evaluating the mucosal surfaces of the oral cavity. It provides a clearer and more detailed picture with no downside.
