Head and Neck

Metastatic cervical carcinoma from an unknown primary: Literature review

May 7, 2014     Rodrigo Arrangoiz, MS, MD; Tom J. Galloway, MD; Pavlos Papavasiliou, MD; John A. Ridge, MD, PhD; Miriam N. Lango, MD
article

Abstract

Carcinoma of an unknown primary (CUP) encompasses a heterogeneous group of tumors for which no primary site can be detected following a thorough history, physical examination, and noninvasive and invasive testing. CUP presenting with metastasis to the neck (metastatic cervical carcinoma from an unknown primary [MCCUP]) has been an enigma since von Volkmann first described it in 1882 as a cancer arising in a branchial cleft cyst. Genetic studies have shed some light on this unusual entity. In most cases, clinical features, imaging studies, and a meticulous assessment of the upper aerodigestive tract should assist in identifying the source of disease. Molecular testing of cytologic specimens for Epstein-Barr virus and human papillomavirus (HPV) can facilitate identification of the primary site in the nasopharynx and oropharynx. At least 25% of MCCUPs are directly attributable to HPV-related malignancies, and this number can be expected to increase. Minimally invasive transoral mucosal sampling can identify an otherwise clinically and radiologically occult cancer. We performed a literature review with the objective of discussing the history, epidemiology, clinical presentation, diagnostic workup, and management of MCCUP.

Parathyroid adenoma in a woman with secondary hyperparathyroidism

May 7, 2014     Darrin V. Bann, PhD; Neerav Goyal, MD, MPH; David Goldenberg, MD, FACS
article

For surgical treatment of secondary hyperparathyroidism, a common approach is the removal of three and one-half glands (subtotal parathyroidectomy), leaving the remaining half gland in place with an intact vascular pedicle. Alternatively, a total parathyroidectomy may be performed, and one-half of one gland may be minced and reimplanted into shallow pockets created in the sternocleidomastoid or brachioradialis muscles.

Endoscopic transnasal transsphenoidal approach for craniopharyngioma: Report of 6 cases

May 7, 2014     Chan-Soon Park, MD; Byung-Guk Kim, MD; Ji-Hyeon Shin, MD; Jin-Hee Cho, MD
article

Abstract

We conducted a retrospective study to evaluate outcomes in patients with a craniopharyngioma who were managed via a transnasal transsphenoidal approach. Craniopharyngiomas exhibit histologically benign but “clinically malignant” features. Our study group was made up of 5 patients who underwent a total of 6 operations. The study population included 1 female and 5 males, aged 14 to 50 years (mean: 29.2). The overall rate of near-total tumor removal was 67%, but all patients eventually experienced a recurrence. Revision surgery to correct any severe postoperative complications was not required in any case. We found that the endoscopic transnasal transsphenoidal approach could be a safe and less invasive surgical option for the removal of craniopharyngiomas, although we were unable to remove all tumor or prevent recurrences.

Massive pleomorphic adenoma of the parotid gland: Surgical considerations

May 7, 2014     Alex Fernandez, MS; Ryan F. Osborne, MD, FACS; Jason S. Hamilton, MD, FACS
article

Preservation of the facial nerve and its branches requires special consideration when dealing with a large parotid mass. The traditional approach of anterograde dissection of the facial nerve proves ineffective in patients with large lesions that effectively obstruct the field of view and origin of the nerve trunk

Fungal necrotizing fasciitis of the head and neck in 3 patients with uncontrolled diabetes

March 18, 2014     Saravanam Prasanna Kumar, DNB; Arunachalam Ravikumar, MS; Lakshmanan Somu, MS
article

Abstract

Necrotizing fasciitis is an uncommon, rapidly progressive soft-tissue infection that is associated with a high incidence of morbidity and mortality. It is usually caused by bacteria and rarely caused by or complicated by a fungus. We report 3 cases of necrotizing fasciitis of the head and neck in patients with uncontrolled diabetes. Fungi were isolated in all 3 cases. In 1 fatal case, the invasive zygomycete Apophysomyces elegans was isolated. Keys to the management of this condition are (1) early isolation of the causative organism by fungal smear and culture, (2) adequate control of diabetes, (3) maintenance of electrolyte balance, and (4) controlled aggressive surgical debridement at an early stage. We emphasize the importance of fungal smears and cultures in the management of this rapidly spreading infection.

Cervical sympathetic chain paraganglioma: A report of 2 cases and a literature review

March 18, 2014     Rahul Seth, MD; Manzoor Ahmed, MD; Aaron P. Hoschar, MD; Benjamin G. Wood, MD; Joseph Scharpf, MD
article

Abstract

We review 2 cases of surgically and pathologically confirmed paraganglioma of the cervical sympathetic chain. Both patients-a 46-year-old man and a 33-year-old woman-were treated surgically. Intraoperatively, both tumors were found to be hypervascular and arising from the cervical sympathetic chain. Histopathologic analysis confirmed both as paragangliomas. Paragangliomas arising from the cervical sympathetic chain are exceptionally rare, but they must be considered in the differential diagnosis of parapharyngeal masses. They often present with ipsilateral Horner syndrome and oropharyngeal fullness, and they may be associated with a higher rate of catecholamine secretion. Typical imaging characteristics include anterolateral or lateral displacement of both the carotid and jugular vessels.

Madelung disease: Multiple symmetric lipomatosis

March 18, 2014     Enrique Palacios, MD, FACR; Harold R. Neitzschman, MD, FACR; Jeremy Nguyen, MD
article

Patients with multiple symmetric lipomatosis commonly also suffer from various neuropathies, especially paresthesias and autonomic neuropathy.

Merkel cell carcinoma

March 18, 2014     Jeffrey D. Shiffer, MD; Lester D.R. Thompson, MD
article

The expected 5-year survival rate for patients with Merkel cell carcinoma is more than 80% if the tumor is less than 2 cm and has not metastasized. Once a tumor has metastasized regionally, the 5-year survival rate drops to about 50%.

Facial nerve palsy associated with a cystic lesion of the temporal bone

March 18, 2014     Na Hyun Kim, MD; Seung-Ho Shin, MD
article

Abstract

Facial nerve palsy results in the loss of facial expression and is most commonly caused by a benign, self-limiting inflammatory condition known as Bell palsy. However, there are other conditions that may cause facial paralysis, such as neoplastic conditions of the facial nerve, traumatic nerve injury, and temporal bone leions. We present a case of facial nerve palsy concurrent with a benign cystic lesion of the temporal bone, adjacent to the tympanic segment of the facial nerve. The patient's symptoms subsided after facial nerve decompression via a transmastoid approach.

Accessory parotid malignancy requiring ductal transection

February 12, 2014     Avery Kaplan; Alex Fernandez, MS; and Ryan Osborne, MD, FACS
article

While malignancies of the accessory parotid gland are rare, when they do occur they jeopardize ductal integrity.

Acquired cholesteatoma presenting as a pars squamosa temporal bone mass

February 12, 2014     Christopher Vanison, MD; Eric M. Jaryszak, MD, PhD; Amanda L. Yaun, MD; and Diego A. Preciado, MD, PhD
article

Abstract

Acquired cholesteatomas typically arise in the middle ear and mastoid cavities; they rarely present elsewhere. We describe a case of acquired cholesteatoma that presented as a large mass of the pars squamosa of the temporal bone in a 16-year-old girl. The mass was surgically removed without complication. To the best of our knowledge, this is only the second reported case of an acquired cholesteatoma in the lateral temporal bone.

Iatrogenic subcutaneous emphysema after dental treatment

February 12, 2014     Young S. Paik, MD; Kevin W. Lollar, MD; and C.W. David Chang, MD
article

Abstract

Subcutaneous emphysema as a complication of a dental procedure is uncommon. When it does occur, it can result in significant and sometimes alarming cervicofacial swelling. Management in most cases involves close observation while awaiting spontaneous resolution. However, in some cases the swelling can progress to cause serious complications and even death. Even though such complications are more commonly seen by our dental and oromaxillofacial surgery colleagues, otolaryngologists should be aware of this condition since we are often asked to consult in these cases. We describe the case of a 13-year-old girl who presented to the emergency department of our institution with an unusually dramatic acute-onset cervicofacial swelling after she had undergone a dental procedure earlier in the day. Computed tomography revealed subcutaneous emphysema. The patient was admitted to the hospital for close observation, and within 24 hours her condition had improved significantly. Shortly after discharge, she experienced a complete recovery. We review the clinical presentation, physical examination findings, diagnostic workup, and management of this complication.

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