Head and Neck

Black thyroid

October 17, 2014     Darrin V. Bann, PhD; Neerav Goyal, MPH, MD; Henry Crist, MD; David Goldenberg, MD, FACS
article

Despite the benign impact of minocycline on thyroid function, several studies have reported an association between black thyroid and thyroid cancer.

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.

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
article

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.

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.

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.

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)
article

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.

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
article

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.

Keratocystic odontogenic tumor

September 17, 2014     Lester D.R. Thompson, MD
article

Bite-wing or orthopantomograph images reveal a well-defined, unilocular radiolucency with a smooth border, showing minimal bone expansion and even cortication.

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
article

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
article

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.

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)
article

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.

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