Head and Neck

Primary Burkitt lymphoma of the thyroid

December 20, 2013     Samuel Albert, MD
article

Abstract

Primary Burkitt lymphoma of the thyroid is extremely rare. The author describes a new case in a 15-year-old boy who presented with a rapidly enlarging thyroid mass and dyspnea.

Chronic facial pain and Meckel cave masses as the initial presentation of neurosarcoidosis: A case report

December 20, 2013     Graham M. Strub, PhD; Jaime E. Moore, MD; Andrew T. Huang, MD; Aaron W. Stevenson, MD; Evan R. Reiter, MD, FACS
article

Abstract

Sarcoidosis is a systemic inflammatory disease that can affect virtually every organ system, leading to a wide variety of clinical manifestations. Central nervous system involvement producing neurologic symptoms can occur in patients with sarcoidosis, yet rarely are these symptoms the initial manifestations of the disease. Here we present the case of a 38-year-old man who presented with a history of chronic facial pain, blurred vision, increased lacrimation, and periodontal abscesses. Physical examination revealed no evidence of infection or neoplasm. Magnetic resonance imaging revealed space-occupying lesions in Meckel cave bilaterally, with soft-tissue density extending into the left sphenoid and posterior ethmoid sinuses. Endoscopic biopsy of sinus mucosa demonstrated the presence of noncaseating granulomas and the absence of organisms, findings suggestive of neurosarcoidosis. The diagnosis was further supported by chest radiography, which demonstrated bilateral hilar adenopathy. The patient was treated with corticosteroids, and his facial pain improved markedly. In this article we discuss neurosarcoidosis and its manifestations, diagnosis, and clinical course.

Submandibular gland megalith eroding the floor of the mouth: A case report

December 20, 2013     Sourav Singh, MDS; Smita Singh, MDS
article

Abstract

Sialolithiasis is the most common pathologic condition affecting the salivary glands. However, large sialoliths (megaliths) are considered rare. The submandibular glands are more susceptible to stone formation than are the other salivary glands. We describe the case of a 55-year-old man with an unusually large sialolith that had eroded the floor of the mouth.

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
article

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.

Diffuse sphenoid bone cavernous hemangioma presenting during pregnancy

October 23, 2013     Hugh Robertson, MD, FACR; Enrique Palacios, MD, FACR; Sheryl Rincon, MD; Kamal R. Shah, MD
article

Abstract

We present a case of diffuse sphenoid bone cavernous hemangioma in a 22-year-old primigravid woman. Her disease first manifested clinically as progressively decreasing vision in her left eye during her third trimester of pregnancy. We also discuss the known causes and some theoretical causes of cavernous hemangioma enlargement during pregnancy.

Undifferentiated thyroid carcinoma

October 23, 2013     Lester D.R. Thompson, MD
article

Histologically, undifferentiated thyroid carcinomas show a variety of patterns, from sheet-like, storiform, fascicular, angiomatoid, and meningothelial to solid, exhibiting extensive lymph-vascular invasion.

A case of chronic subdural hematoma following lumbar drainage for the management of iatrogenic cerebrospinal fluid rhinorrhea: Pitfalls and lessons

October 23, 2013     Vincent Eng-Soon Tan, MD, MRCS, MS(ORL-HNS); Donald Liew, FRACS
article

Abstract

Chronic subdural hematoma as a complication of lumbar drain placement for the management of iatrogenic cerebrospinal fluid (CSF) leak has not been previously documented in the literature. We describe such a case in a 69-year-old man who presented with right nasal obstruction secondary to an inverted papilloma involving the paranasal sinuses. The patient underwent endoscopic sinus surgery, which included a medial maxillectomy. Surgery was complicated by a small CSF leak, which was repaired intraoperatively. Five days later, the patient experienced CSF rhinorrhea, and a lumbar drain was inserted. He developed overdrainage symptoms but was well when he was discharged. However, 22 days later he returned with right hemiparesis. Computed tomography of the brain showed a left frontoparietal subdural hematoma with a mass effect. The neurosurgical team performed an emergency drainage procedure, and the patient experienced a complete neurologic recovery. We discuss the pitfalls of lumbar drainage, the possible pathophysiology of overdrainage, and the lessons learned from this case.

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
article

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.

Transdermal scopolamine in the management of postparotidectomy salivary fistula

October 23, 2013     Andrea Gallo, MD, PhD; Valentina Manciocco, MD, PhD; Giulio Pagliuca, MD, PhD; Salvatore Martellucci, MD; Marco de Vincentiis, MD
article

Abstract

Parotid fistula represents an uncommon complication in parotid surgery. Its early recognition contributes to successful management. The condition is distressing for both the patient and the surgeon, since conservative and operative treatment frequently fail. There is no consensus on the optimal management of parotid gland fistula. The aim of this study is to describe a new, simple procedure in the treatment of this condition using transdermal scopolamine. We report 3 cases of salivary fistulae occurring after parotidectomy. The patients were admitted to our department with swelling in the parotid region and an output of clear drainage from the drain site during oral intake. The patients were treated with a scopolamine transdermal release system applied to hairless skin overlying the parotid region. A prompt and remarkable decrease in daily salivary output was observed. Fistulae healed completely within 3 days. No collateral effects were observed. Parotid fistulae do not generally occur as a complication of parotidectomies. Their management can be difficult, and several methods of treatment have been attempted. We believe that the use of transdermal scopolamine is a valid option in the treatment of parotid fistulae without causing collateral effects.

Synchronous verrucous carcinoma and inverted papilloma of the lacrimal sac: Case report and clinical update

October 23, 2013     Cheryl Gustafson, MD; Eugene Einhorn, MD; Mary H. Scanlon, MD; Kenneth E. Morgenstern, MD; Paul J. Howlett, MD; Noam A. Cohen, MD, PhD
article

Abstract

Inverted papilloma is a benign epithelial tumor of the nasal cavity. It is known to coexist with malignancy in 5 to 13% of cases, with squamous cell carcinoma being the most common malignancy. Another associated malignancy, one that is extremely rare, is verrucous carcinoma. To the best of our knowledge, no case of verrucous carcinoma occurring alone or in association with another neoplasm has been described in the nasolacrimal system. We report a case of synchronous verrucous carcinoma and inverted papilloma of the lacrimal sac in a 47-year-old man. The patient presented with epiphora, nasal obstruction, swelling of the left medial canthus, and drainage of a foul-smelling fluid from the left nostril. Computed tomography and magnetic resonance imaging detected the presence of a large mass occupying the left nasal cavity and sinuses with extension into the nasopharynx. In addition, bony invasion of the anteroinferomedial wall of the left orbit was noted with extension of the tumor into the orbit itself, which resulted in lateral displacement of the left medial rectus muscle. The patient underwent endoscopic debulking of the left sinonasal lesion. Of note, the surgery had to be completed in stages because of excessive blood loss. Histopathologic examination of the intranasal component of the tumor identified it as an inverted papilloma. One month after the intranasal resection, a left dacryocystectomy was performed; histopathologic examination revealed that an invasive verrucous squamous cell carcinoma had arisen within the inverted papilloma.

Langerhans cell histiocytosis: Temporal bone invasion in an adult

October 23, 2013     Richard L. Alexander, MD, PhD, MBA; Mary L. Worthen, BS; Changlee S. Pang, MD; John S. May, MD
article

Despite the characteristic of extensive destruction of the temporal bone in this disease, the facial nerve is surprisingly resistant to destruction, and facial nerve palsy is rare.

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

October 23, 2013     Evren Erkul, MD; Hakan Cincik, MD
article

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.

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