Head and Neck

Intracranial and internal jugular vein thrombosis secondary to ENT infections: A report of 3 cases

October 23, 2013     Faruque Riffat, BSc(Med), MBBS (Hons); Martin Forer, FRACS; Andrew Wignall, FRACS; David Veivers, FRACS; Nirmal Patel, MS, FRACS
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Abstract

We report 3 cases of rare, life-threatening intracranial and internal jugular vein (IJV) thrombosis that were caused by common ENT infections. These infections included otitis media in a 6-year-old girl, tonsillitis in a 21-year-old woman, and odontogenic sepsis in a 56-year-old woman. All 3 patients were treated with culture-directed systemic antibiotics; 2 of them also required surgical drainage (the child and the older adult). The 2 adults also received therapeutic anticoagulation, which was continued until venous recanalization was documented; the duration of combined antibiotic and anticoagulation treatment was 6 weeks. All 3 patients made uneventful recoveries. Significant morbidities associated with intracranial and IJV thrombosis were avoided as a result of prompt diagnosis and judicious treatment.

Endoscopic appearance of a healed skull base resection reconstructed with a pedicled nasoseptal flap

October 23, 2013     Hadia M. Leon, MD; Mark H. Tabor, MD
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Expanded endonasal approaches to the skull base are becoming more common, and closure of CSF leaks with reliable separation of the sinonasal tract from the cranial cavity is critical to a successful outcome.

Amyloidosis: A rare case with nodular lesions on the tongue and buccal mucosa

October 23, 2013     Evren Erkul, MD; Hakan Cincik, MD
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The pathogenesis of amyloidosis appears to be multifactorial, but the common final pathway is identical in all forms of the disease; i.e., the production of amyloid fibrils in the extracellular matrix.

Lymphoepithelial carcinoma of the parotid gland, a very unusual tumor: Case report and review

September 18, 2013     Natarajan Anantharajan, MRCS, MCh; Nagamuttu Ravindranathan, FRCS, FDRCS; Pathmanathan Rajadurai, MBBS, FRCPA
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Abstract

Lymphoepithelial carcinoma (LEC) of the parotid gland is rare. When it does occur, it is usually seen in Asians and Greenland Eskimos. An association with Epstein-Barr virus (EBV) infection has been documented. We report a case of EBV-associated LEC of the parotid gland in a 30-year-old Chinese woman. The patient underwent a total parotidectomy with preservation of the facial nerve, followed by postoperative radiotherapy. She recovered well without complications or recurrence. We present this case in view of the rarity of LEC, which has prevented extensive study of its clinical course, optimal treatment options, and overall prognosis.

Thyroglossal duct cyst carcinoma: Case report and review of the literature

September 18, 2013     David W. Jang, MD; Andrew G. Sikora, MD, PhD; Anatoly Leytin, MD
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Abstract

Well-differentiated thyroid carcinoma of a thyroglossal duct cyst (TGDC) is a rare entity, found in about 1% of all TGDCs. Diagnosis is usually made incidentally after a Sistrunk procedure. Options for further therapy include total thyroidectomy, T4 suppression therapy, and radioactive iodine ablation. In a patient with a normal-appearing thyroid gland and no evidence of metastatic disease, the treatment course is controversial. The recent literature emphasizes the identification of risk factors that may prompt the clinician to pursue more aggressive treatment. We present the case of a 35-year-old woman who was found to have a 1-cm midline neck mass that showed atypical cells on fine-needle aspiration. Histologic analysis after a Sistrunk procedure revealed a small focus of papillary carcinoma within the TGDC. The patient subsequently underwent total thyroidectomy with no evidence of carcinoma on histologic examination.

Acantholytic squamous cell carcinoma of the maxilla: Unusual location and aggressive behavior of a rare histologic variant

September 18, 2013     Ozan Bagis Ozgursoy, MD; Ozden Tulunay, MD; Sami Engin Muz, MD; Gaffar Aslan, MD; Babur Kucuk, MD
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Abstract

Acantholytic squamous cell carcinoma (ASCC) of the mucosal membranes has been documented sporadically. The highly aggressive behavior of a mucosal ASCC arising in the oral cavity has been recently reported. To the best of our knowledge, only 1 autopsy case of maxillary ASCC previously has been reported in the literature. We pre-sent what we believe is only the second case of maxillary ASCC. Our goal is to emphasize the aggressive behavior of this tumor in order to add weight to the argument that the prognosis is poor.

Practical applications of in-office fiberoptic transnasal esophagoscopy in the initial evaluation of patients with squamous cell cancer of the head and neck

September 18, 2013     Robert W. Dolan, MD; Timothy D. Anderson, MD
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Abstract

We conducted a study to analyze the effectiveness of transnasal esophagoscopy (TNE) as an alternative to operative endoscopy (OE) for the evaluation of primary head and neck cancers and for the surveillance of synchronous esophageal cancers. Our study population was made up of 96 consecutively presenting patients-75 men and 21 women, aged 45 to 88 years (mean: 64)-who were treated at our institution for squamous cell cancer of the head and neck. Of this group, 42 patients had been evaluated with TNE and 54 with OE. More OEs were performed in patients with an unknown primary (26 vs. 3). Incidental findings on TNE included 3 cases of gastritis, 2 cases each of hiatal hernia and esophagitis, 1 case of Barrett esophagus, and 1 inlet patch. No incidental findings were reported during OE. Primary cancers were biopsied by TNE through a port on the endoscope in 4 patients; 2 of these cancers were in the tongue base, 1 in the hypopharynx, and 1 in the aryepiglottic fold. After the initial visit, patients in the TNE group waited significantly fewer days for their endoscopy than did those in the OE group (median: 6.5 vs. 16; p < 0.05). Conversely, patients in the OE group waited significantly fewer days for treatment following endoscopy (median: 12 vs. 20; p < 0.05). However, there was no significant difference between the TNE patients and the OE patients in the total number of days comprising their entire course of management, from the initial visit to definite treatment (median: 27.5 and 33 days, respectively; p = 0.7). We conclude that TNE is a reasonable alternative to OE for the initial screening for synchronous esophageal cancers in patients with squamous cancers of the head and neck. OE is preferred for the initial workup of unknown primary cancers and for large tongue base cancers. The rate of detection of clinically relevant incidental findings is higher with TNE. Biopsy is possible during TNE for all subsites within the upper aerodigestive tract.

Features of sequential CT and US-guided biopsy in recurrent Kikuchi disease of the neck: A case report

September 18, 2013     Sang Kwon Lee, MD; Young Eun Bahn, MD; Dong Eun Kim, MD
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Abstract

A 26-year-old woman presented with recurrent Kikuchi disease 7 years after her initial episode. Computed tomography (CT) and ultrasonography demonstrated enlarged lymph nodes with extensive necrosis at the same site as the initial episode. Cytologic and histologic examinations were not conclusive. CT performed 1 month later demonstrated a complete resolution of the lymphadenopathy, which confirmed the diagnosis of recurrent Kikuchi disease. Care must be taken to avoid misdiagnosis of recurrent Kikuchi disease as tuberculous lymphadenitis.

Endometrial carcinoma metastatic to the retromolar pad

September 18, 2013     Hisham Hatoum, DDS; Bruno C. Jham, DDS, MS, PhD; Karen Garber, DMD; Jaime S. Brahim, DDS, MS; Mark A. Scheper, DDS, PhD
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Abstract

Metastatic carcinoma from the female genitalia to the oral mucosa is exceptionally rare, with only 11 such cases having been previously reported in the English-language literature. We describe a new case in a 65-year-old woman with a history of endometrial carcinoma who presented with swelling of the retromolar pad. Radiographic examination showed slight opacities and irregular trabecular bone in the left posterior mandible. Following an incisional biopsy, histologic examination and immunohistochemical studies revealed glandular adenocarcinoma with positivity for progesterone receptor, estrogen receptor, and cytokeratin 7. The patient was referred to her primary care physician for comprehensive treatment. This case illustrates the value of considering cancer metastasis in the differential diagnosis of an oral swelling, particularly in a patient with a history of cancer.

Calcific tendinitis of the prevertebral space: A case report

September 18, 2013     Roy Riascos, MD; Jillian Lazor, AB; Lisa Vu, MD; Rudiger Von Rischtl, MD; Roberto Zamudio, MD
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Abstract

Calcific prevertebral tendinitis is a self-limiting inflammatory condition of the prevertebral space that involves the insertion of the longus colli tendon. Understanding this condition and its characteristic imaging findings is essential for early diagnosis and differentiation of the disorder from other acute conditions. We describe a case of a 40-year-old patient who presented to the emergency department with severe odynophagia and exhibited the computed tomography findings necessary to confirm this disease.

Post-thyroidectomy early serum ionic calcium level: Predictor of prolonged hypocalcemia

August 21, 2013     Sanjana V. Nemade, MS, FCPS(ENT) and Atul P. Chirmade, MS
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Abstract

One of the more common complications of thyroid surgery is postoperative hypocalcemia, which is potentially serious. Its clinical manifestations range from minimal twitching to life-threatening tetany. Affected patients might require a prolonged hospital stay and supplementation with calcium and vitamin D. In cases of post-thyroidectomy hypocalcemia, it is not always easy to predict which patients will require close monitoring of serum calcium levels. We conducted a study to determine whether early (<24 hr) measurement of serum ionic calcium (SiCa) levels can predict the development of post-thyroidectomy hypocalcemia. We retrospectively analyzed the charts of 150 adults (144 women and 6 men) who had undergone total or partial thyroidectomy, and we identified 42 patients (all women) who had either transient (<1 mo; n = 27) or prolonged (1 to 6 mo; n = 15) temporary hypocalcemia. We found that the patients who turned out to have prolonged hypocalcemia had significantly lower early levels of SiCa than did the patients who later developed only transient hypocalcemia (p = 0.000002). Also, patients with prolonged hypocalcemia had a significantly higher incidence of serious sequelae, including carpopedal spasms and signs of tetany. We conclude that early measurement of SiCa is a reliable predictor of prolonged temporary hypocalcemia following total or partial thyroidectomy.

Nasopharyngeal yolk sac tumors: A rare pediatric occurrence

August 21, 2013     Belinda Mantle, MD and Ryan F. Osborne, MD, FACS
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Symptoms of yolk sac tumors depend on the site affected. The characteristic finding is rapid growth over a few weeks.

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