September 7, 2012 Robert S. Schmidt, MD; Evan R. Reiter, MD
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Abstract
A 64-year-old man undergoing major head and neck surgery received clindamycin for perioperative antimicrobial prophylaxis. On the third postoperative day, he became acutely neutropenic. The neutropenia resolved 3 days later, after the administration of filgrastim. After ruling out other causes of acute neutropenia, we determined that the neutropenia was secondary to clindamycin toxicity. While clindamycin-induced neutropenia has been reported elsewhere, to our knowledge this is the first report of its occurrence following head and neck surgery. Otolaryngologists should be aware of this potentially serious reaction.
September 7, 2012 Carlos M. Rivera-Serrano, MD; Brian J. Park, MD, MPH; Robert L. Ferris, MD
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Abstract
Thyroid hematoma secondary to blunt trauma is uncommon, and no consensus exists for its management. We describe the case of a 46-year-old man who presented with neck swelling after he had sustained a blunt-trauma injury to his neck while playing soccer. Imaging revealed a large mass consistent with a thyroid hematoma. The patient was admitted for observation and followed up with serial imaging. He was eventually discharged without surgical intervention. However, he later underwent a thyroid lobectomy to treat compressive symptoms and for cosmetic reasons. Pathology revealed that the patient had a papillary thyroid carcinoma, which might have predisposed him to the hemorrhage. Thyroid hematoma secondary to blunt trauma has been documented in normal thyroid glands and in glands with preexisting benign pathology, but to the best of our knowledge, no report associating this condition with a thyroid carcinoma has previously been reported in the literature. A neoplasm should be suspected in a case of thyroid hematoma that fails to resolve with conservative treatment. The management of this condition is surgeon- and case-specific, and the overall prognosis is good.
September 7, 2012 Eric J. Moore, MD; Steven S. Hamilton, MD
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We conducted a study to evaluate functional and cosmetic outcomes following reconstruction of the mandibular condyle with direct placement of a vascularized free fibula. We retrospectively reviewed the cases of all patients who had undergone hemimandibulectomy and condyle resection with immediate reconstruction at the Mayo Clinic in Rochester, Minn., between Nov. 1, 2005, and Jan. 31, 2007. We found 7 such cases, all of which occurred in men aged 32 to 61 years (mean: 50.7). Six of these patients had a malignancy and 1 had osteomyelitis. Postoperatively, 6 patients had no difficulty with occlusion, which was rated as “good” or “excellent” at their 6-month follow-up visit; the other patient had an open-bite deformity, but he was able to masticate solid food and maintain an oral diet. Cosmesis was generally satisfactory, and all patients maintained intelligible speech. We conclude that free fibula transfer with direct seating of the fibula into the condylar fossa followed by aggressive physiotherapy provides acceptable functional reconstruction of the mandibulectomy-condylectomy defect.
September 7, 2012 Melissa J. Maguire, MD; Uma Nath, MD; Guiseppe E. Bignardi, MD
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Abstract
We report a case of otogenic pneumocephalus in an 80-year-old woman with multiple myeloma. The pneumocephalus was associated with Haemophilus influenzae otitis media and reactive meningitis in the absence of an intracranial brain abscess. Myeloma causes thinning of bone trabeculae and destructive lytic bone lesions. This can predispose to a risk of pathologic fractures and, in patients with skull vault involvement, to the rare complication of pneumocephalus. Therefore, pneumocephalus should be considered in the differential diagnosis of acute headache in patients with multiple myeloma, especially those with skull vault involvement. Prompt computed tomography and liaison between the otolaryngology and neurology teams may assist in making an early diagnosis and preventing life-threatening intracranial complications.
September 7, 2012 Lester D.R. Thompson, MD
September 7, 2012 Daniel O. Rosenblatt, MD; Rosa B. Lipin, MD; Enrique Palacios, MD, FACR; Paul Friedlander, MD; Harold Neitzschman, MD, FACR
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Chondrosarcomas can be distinguished from osteosarcomas because they have the distinction of producing chondroid (cartilaginous matrix) but not osteoid. When they occur in the head and neck, they usually are found in the anterior maxilla and sinonasal structures
August 10, 2012 Jason Hamilton, MD, FACS; Reena Gupta, MD, FACS
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To avoid mistaking parotid masses and venous malformations for each other, based on imaging, requires a high level of clinical suspicioun, especially when operative findings and images are contradictory.
August 10, 2012 Benjamin D. Liess, MD; Alan A.Z. Alexander, MD; Matthew E. Dahl, MD; Robert P. Zitsch III, MD; Jason Scott Lawrence Holly, MD
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Abstract
Castleman disease is a relatively uncommon lymphoproliferative disorder. A presentation as an isolated lesion in the neck is extremely rare. We report the case of a 26-year-old man who presented with a 4-month history of an enlarging right neck mass that was identified as Castleman disease on excisional biopsy. The biopsy was curative. In localized forms of Castleman disease, excisional biopsy is both diagnostic and curative. However, in multicentric forms, additional treatment is required.
August 10, 2012 Ümit Tunçel, MD; Hasan Mete İnançlı, MD; Şefik Sinan Kürkçüoğlu, MD; Murat Enoz, MD
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We conducted a retrospective study of 35 adults who had undergone tongue base suspension in addition to other surgery for the treatment of obstructive sleep apnea syndrome (OSAS). Our goal was to determine the most effective surgical approach by comparing these patients’ preoperative apnea-hypopnea index (AHI) with their postoperative scores at 6 months. The 35 patients were divided into three groups based on a preoperative assessment of their level of airway obstruction; the assessment included a determination of AHI and endoscopic findings during the Müller maneuver. Patients in group 1 (n = 9) exhibited unilevel obstruction, and they were treated with lateral pharyngoplasty; patients in group 2 (n = 13) also had unilevel obstruction, and they underwent Z-palatoplasty; patients in group 3 (n = 13) had multilevel obstruction, and they underwent combined surgery. Postoperatively, all three groups exhibited statistically significant improvements in AHI, but we determined that of the three approaches, multilevel surgery was significantly more effective (p < 0.001).
August 10, 2012 Domenico Destito, MD; Sebastiano Bucolo, MD; Alessandra Florio, MD; Carmelo Quattrocchi, MD
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We conducted a retrospective study of the long-term functional results of surgery for head and neck paragangliomas. Our study population was made up of 9 patients—4 men and 5 women, aged 22 to 59 years (mean: 46.6; median: 51)—who had undergone surgical excision of a head and neck paraganglioma from January 2002 through December 2006 in the ENT Department at Pugliese-Ciaccio Hospital in Catanzaro, Italy. Of the 9 paragangliomas, 4 were carotid body tumors, 2 were glomus tympanicum tumors, and 3 were glomus vagale tumors. None of the cases was bilateral or hereditary. Complete tumor resection was achieved in 8 patients; in the remaining patient, a small amount of intradural residual vagus nerve paraganglioma had to be left in situ. The internal carotid artery was preserved in all 4 resections of carotid body tumors. There was only 1 case of postoperative lower cranial nerve deficits, which occurred in a patient with a carotid body tumor. Follow-up ranged from 12 to 53 months (mean: 37.2; median: 36), and no recurrences were documented. Our small sample showed that surgical treatment of head and neck paragangliomas provided excellent tumor control with low postoperative morbidity, even in patients with large tumors. A wait-and-scan policy may be more appropriate for patients at an advanced age or who are otherwise at high surgical risk, as well as for those whose tumors have recurred following radiotherapy.
July 5, 2012 James K. Fortson, MD, MPH; Michael Rosenthal, DMD; Vijaykumar Patel, MBBS, FRCS; Gillian E. Lawrence, MD; Jennifer S. Lin, MD
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Abstract
Radiation therapy to the head and neck for the treatment of benign diseases carries the potential for the late development of carcinoma. Low-dose radiation has been used as an adjunctive treatment for recurrent keloids, especially massive keloids, but the carcinogenic potential of ionizing radiation in this setting remains controversial. We report the case of a 37-year-old black woman with a history of severe earlobe keloids who had been first treated with resection and postoperative radiation at the age of 9 years. When she had reached the age of 36 years, she required reoperation for massive keloid scarring, after which she underwent a second course of postoperative radiation to the right side of her face and neck. Some 20 months after the second administration of radiation therapy, she developed a mucoepidermoid carcinoma in the right parotid gland. The tumor was successfully treated with surgery.
July 5, 2012 Kiran M. Bhojwani, MS; Mahesh Chandra Hegde, MS; Arathi Alva, MS; K.V. Vishwas, MBBS, MS
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A lingual thyroid is a mass of ectopic thyroid tissue located in the midline of the base of the tongue. Its estimated prevalence ranges from 1 in 3,000 to 1 in 10,000 population. We report the interesting case of a 28-year-old woman who presented with a primary papillary carcinoma in a lingual thyroid and a histologically normal thyroid gland. To the best of our knowledge, this case probably represents only the second reported case of a follicular variant of a papillary carcinoma arising in a lingual thyroid.
