Head and Neck

Late-onset complications after chemoradiation for head and neck carcinomas

August 21, 2013     Marc I. Surkin, MD, FACS; Sandra A. Schwartz, MS, CCC-SLP; and Deborah A. Markiewicz, MD
article

Abstract

Acute complications from chemoradiation for head and neck cancers are relatively common. These can be minor or severe and can have a significant impact on the patient's quality of life. The incidence of late-onset (>5 years after cancer cure) complications is unknown, but the effect on quality of life is just as severe as with acute problems. What makes matters worse is that many of these patients lived years without dysphagia or other issues and were able to resume a normal lifestyle before developing complications. We present 4 cases involving patients with late-onset complications and discuss the need to remain vigilant in follow-up and caring for patients with head and neck cancer.

Extensive dentigerous cyst associated with a mesiodens: CT findings

August 21, 2013     Kyung Soo Kim, MD, PhD and Seog-Kyun Mun, MD, PhD
article

Abstract

The most common of the supernumerary teeth in humans are mesiodentes, which arise in the midline of the maxilla between the central incisors. The most common pathologic findings associated with a mesiodens are retention of the adjacent incisors, malposition, and diastema. The development of a dentigerous cyst in association with an impacted mesiodens is relatively uncommon. We report the case of a 35-year-old man with an extensive dentigerous cyst associated with a mesiodens who presented with a painful swelling in the left nasolabial area. We discuss the imaging findings in this case, particularly the contribution of computed tomography, and we review the literature on this interesting condition.

Peripheral osteoma of the hard palate

August 21, 2013     Borlingegowda Viswanatha, MS, DLO, PhD
article

Abstract

Peripheral osteomas of the hard palate are relatively rare. Two cases of osteoma of the hard palate are reported, along with a review of the literature.

Analysis of the vertebrobasilar system in patients with obstructive sleep apnea

August 21, 2013     Umit Taskin, MD; Ozgur Yigit, MD; Ayse S. Sisman, MD; Sahin Ogreden, MD; Elad Azizli, MD; Fatih Kantarci, MD; and Ismail Mihmanli, MD
article

Abstract

We conducted a prospective study to evaluate the vertebrobasilar system in adults with and without obstructive sleep apnea (OSA). Our study population was made up of 48 patients with OSA and 21 healthy volunteers who served as controls; the OSA patients were subdivided into one group with mild or moderate OSA (n = 22) and another with severe OSA (n = 26). Each participant underwent Doppler ultrasonography three times to measure the diameter of the vertebral artery, the peak systolic velocity (PSV), the resistive index (RI), and the vertebral artery flow volume; the mean of the three measurements was calculated for each patient, for the OSA and control groups, and for various subgroups. No significant differences in vessel diameter, PSV, or RI were seen among any of the subgroups. Overall, the vertebral artery flow volume was slightly, but not significantly, higher in all patients with OSA (206 ml/min) than in the control group (177 ml/min); this difference might reflect the body's daytime response to the chronic apneic events experienced during sleep. The only statistically significant difference we found was in vertebral artery flow volume between the controls and the subgroup with mild or moderate OSA (p = 0.026); no difference was seen between the controls and the patients with severe OSA (p = 0.318). Likewise, no significant difference in any of the four parameters was seen when patients were subclassified by body mass index and arterial oxygen saturation level.

Migration of a fish bone from the upper aerodigestive tract to the skin of the neck: A case report

August 21, 2013     Ramanuj Sinha, MS, DNB; Indranil Sen, MS; Jayanta Saha, MS; Ankur Mukherjee, MS; and Ruma Guha, MS
article

Abstract

We describe an unusual case of a migratory foreign body (fish bone) in the neck of a 45-year-old woman. The 2.1-cm bone migrated from the esophagus and traversed through the entire soft tissue of the neck, and it almost extruded through the skin of the neck. With the patient under local anesthesia, the foreign body was easily extracted through an incision over the skin.

Mummified leiomyoma of the midline anterior neck: Case report and literature review

August 21, 2013     Jacob Minor, MD; Mona Rizeq, MD; and Todd Wine, MD
article

Abstract

Leiomyomas are benign smooth-muscle tumors that have only rarely been reported in the head and neck. Extensive calcification (mummification) is occasionally seen in deep somatic soft-tissue leiomyomas, which represent a rare subtype. We describe a case of mummified leiomyoma of the soft tissues of the midline anterior neck in a 31-year-old man. His tumor was successfully managed with surgical excision. To the best of our knowledge, this case represents the only description of a mummified leiomyoma at this particular site and the first reported case of any leiomyoma at this site in more than 50 years. We also review the literature concerning leiomyomas of the head and neck, their subtypes, diagnostic and management considerations, and outcomes.

Pigmented villonodular synovitis of the temporomandibular joint

July 21, 2013     Helen Giannakopoulos, DDS, MD; Joli C. Chou, DMD, MD; Peter D. Quinn, DMD, MD
article

Abstract

Pigmented villonodular synovitis (PVNS) is a proliferative disorder that affects synovium-lined joints, bursae, and tendon sheaths. It appears in both diffuse and localized forms, depending on the extent of synovial involvement. PVNS rarely involves the temporomandibular joint (TMJ); when it does, it manifests clinically as a slowly growing and painless preauricular mass that resembles a parotid tumor. TMJ dysfunction, paresthesia, and/or hearing loss can result. We present a case of a large extra-articular PVNS of the TMJ, and we review the literature.

Coexisting first and bilateral second branchial fistulas in a child with nonfamilial branchio-otic syndrome

July 21, 2013     Jose Florencio F. Lapena Jr., MA, MD; Genilou Liv M. Jimena, MD
article

Abstract

We describe what we believe is only the third reported case of coexisting first and bilateral second branchial fistulas associated with nonfamilial branchio-otic syndrome. The patient was a 6-year-old girl who presented with bilaterally draining anterior neck puncta, a preauricular sinus, and moderately severe bilateral hearing loss. She had no family history of branchial anomalies. Compared with branchial cysts and sinuses, branchial fistulas are rare. Even more rare are bilateral second branchial fistulas coexisting with first branchial anomalies, as only 10 cases have been previously reported in the English-language literature. Of these 10 cases, 5 were associated with either branchio-otic syndrome or branchio-oto-renal syndrome; 2 patients had familial branchio-otic syndrome, 2 had nonfamilial branchio-otic syndrome, and 1 had nonfamilial branchio-oto-renal syndrome.

Case report: Inadvertent carotid artery injury during myringotomy as a result of carotid artery dehiscence

July 21, 2013     Christopher Schutt, MD; Sharmila Dissanaike, MD; John Marchbanks, MD
article

Abstract

We report the case of a 3-year-old girl whose internal carotid artery was pierced during a myringotomy. Postoperative computed tomography demonstrated that the complication was caused by a dehiscent carotid canal wall; contralateral dehiscence was also present. The patient had previously received two sets of middle ear ventilation tubes with no complications. This article addresses the epidemiology and anatomy of carotid dehiscence, and discusses methods to potentially prevent this complication, including screening and imaging modalities.

Infected sublingual hematoma: A rare complication of frenulectomy

July 21, 2013     Amal Isaiah, MD, DPhil; Kevin D. Pereira, MD, MS
article

Given the spectrum of potential poor outcomes, some consensus has emerged in favor of early surgical management of significant ankyloglossia.

Dengue fever: A primer for the otolaryngologist

July 21, 2013     Demetri Arnaoutakis, MD; Tapan A. Padhya, MD
article

Abstract

It has been estimated that more than 50 million cases of dengue occur worldwide each year, mostly in the tropics. In light of recent cases appearing in central and southern Florida, dengue has reemerged as a public health issue in the United States with respect to infection control and prevention. We review the course of dengue infection and its clinical presentation from the perspective of the practicing otolaryngologist, and we outline tactics for prevention and management.

Osteosarcoma

July 21, 2013     Lester D.R. Thompson, MD
article

Osteosarcoma affects the mandible and the maxilla differently, with mandibular tumors tending to arise from the body of the mandible while maxillary tumors arise from the alveolar ridge and sinus.

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