Laryngology

Plexiform schwannoma of the posterior pharyngeal wall in a patient with neurofibromatosis 2

March 2, 2015     Luca Raimondo, MD; Massimiliano Garzaro, MD; Jasenka Mazibrada, MD, PhD; Giancarlo Pecorari, MD; Carlo Giordano, MD
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Abstract

We report a case of plexiform schwannoma of the posterior pharyngeal wall that occurred in a 37-year-old man who had been previously diagnosed with neurofibromatosis type 2 (NF2). Plexiform schwannoma has been rarely reported in association with NF2. Moreover, as far as we know, only 6 cases of posterior pharyngeal wall schwannoma have been previously reported in the literature, none of which was associated with NF2 and none of which was histopathologically differentiated in schwannoma or plexiform schwannoma. The patient was treated with laser excision of the tumor via a transoral route, and at 6 and 12 months of follow-up, he exhibited no signs of recurrence. To the best of our knowledge, our patient represents the first reported case of a posterior pharyngeal wall schwannoma that occurred in association with NF2 and the first case in which the schwannoma was removed via transoral laser excision. This case illustrates that plexiform schwannoma is a possible finding in NF2 and that transoral laser excision is a safe surgical procedure in such a case.

A case of solitary fibrous tumor arising from the palatine tonsil

March 2, 2015     Takeharu Kanazawa, MD, PhD; Kozue Kodama, MD; Mitsuhiro Nokubi, MD, PhD; Kazuo Gotsu, MD; Akihiro Shinnabe, MD; Masayo Hasegawa, MD; Gen Kusaka, MD, PhD; Yukiko Iino, MD, PhD
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Abstract

Solitary fibrous tumor (SFT) is a distinctive, relatively uncommon soft-tissue neoplasm that usually arises from the pleura. It occurs at various sites; head and neck lesions are very rare. While most of these tumors have a benign course, a small number have malignant potential. We describe a rare case of SFT arising from the left palatine tonsil in a 66-year-old Japanese woman. The mass was completely resected. Immunohistochemical studies were strongly positive for CD34 and bcl-2, mildly positive for phosphorylated protein kinase B and phosphorylated extracellular signal-regulated kinase 1/2, and negative for platelet-derived growth factor receptor alpha and p53. These findings suggested that this tumor was benign. The patient showed no evidence of recurrence during 2 years of follow-up. We believe that the candidate prognostic marker should be checked to distinguish malignant from benign SFTs.

Minimally invasive drainage of a posterior mediastinal abscess through the retropharyngeal space: A report of 2 cases

March 2, 2015     Dan Lu, MD; Yu Zhao, MD, PhD
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Abstract

Foreign-body ingestion is a common cause of esophageal perforation, which can lead to a fatal posterior mediastinal abscess. Routine treatments include the drainage of pus through the esophageal perforation, thoracotomy, and videothoracoscopic drainage. We present 2 cases of posterior mediastinal abscess caused by esophageal perforation. Both patients-a 44-year-old woman and an 80-year-old man-were successfully treated with a novel, minimally invasive approach that involved draining pus through the retropharyngeal space; drainage was supplemented by the administration of broad-spectrum antibiotics and nasal feeding.

The harm of ham hocks: Foreign body impaction in long-standing multiple sclerosis

March 2, 2015     Anish Patel, MD; Jacqueline Weinstein, MD; Mandy Weidenhaft, MD; Enrique Palacios, MD, FACR
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The incidence of foreign body impaction in neurologic dysfunctional swallowing, such as in multiple sclerosis (MS), has been not widely reported.

World Voice Day 2015

March 2, 2015     Robert T. Sataloff, MD, DMA, FACS, Editor-in-chief
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The 2015 theme is “Voice: The original social media.”

Lipoid proteinosis of the larynx

March 2, 2015     Jagdeep Singh Virk, MA(Cantab), MRCS, DOHNS; Sonal Tripathi, BSc, MBChB; Ann Sandison, FRCPath; Guri Sandhu, MD, FRCS, FRCS(ORL-HNS)
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here is no accepted gold standard of management, but surgery should be used judiciously in selected patients to improve voice function and maintain the airway. Long-term follow-up and repeat procedures are usually required for disease control, and genetic counseling may be needed.

Mixed verrucous and squamous cell carcinoma of the larynx

February 2, 2015     Giuseppe V. Staltari, BS; John W. Ingle, MD; Clark A. Rosen, MD
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The lesion was removed en bloc, including the involved thyroarytenoid muscle.

Bilateral Eagle syndrome causing dysphagia

February 2, 2015     Lyndsay L. Madden, DO; Roxann Diez Gross, PhD; Libby J. Smith, DO
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Patients with Eagle syndrome often report symptoms that include dysphagia, otalgia, throat pain, globus sensation, facial pain, headache, taste disturbances, and dental pain that worsen with chewing, head and tongue movements, and swallowing.

Bronchoscopic extraction of a chicken bone 5 years after aspiration

January 19, 2015     Parth Shah, MD; Angela Han, BA; Rishin Patel, MD; Paul Howlett, MD; Scott Akers, MD; Mitchell Margolis, MD; Sunil Singhal, MD
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Abstract

A 58-year-old man with a remote history of choking on a chicken bone 5 years earlier presented with chronic cough but had no remarkable clinical examination findings. He was being followed for recurrent pneumonias complicated by a resistant empyema, for which he had undergone thoracotomy and decortication. Imaging studies initially missed a foreign body (the chicken bone), which was found on follow-up studies and was removed with a flexible bronchoscope despite the fact that 5 years had passed since the aspiration.

A case of transient cortical blindness associated with hypercapnia as a result of extremely enlarged adenoid tissue

January 19, 2015     Baris Malbora, MD; Nihan Malbora, MD; Zekai Avci, MD; Asburce Olgac, MD; Alper Nabi Erkan, MD
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Abstract

Adenotonsillar hypertrophy is common among children, but it can lead to serious complications if left untreated. Among the well-known complications are obstructive sleep apnea syndrome, growth failure, cor pulmonale, and hypertension. One complication of adenotonsillar hypertrophy that has not been previously reported in the English-language literature is transient cortical blindness. We describe such a case, which occurred in a 6-year-old boy who presented with a sudden loss of vision and subsequent unconsciousness. He had experienced hypercapnia and was resuscitated via endotracheal tube ventilation. Laboratory and radiologic assessments found no pathology except for extremely enlarged adenoid tissue. Once the patient was stabilized, an urgent adenotonsillectomy was performed. The patient recovered well, and his vision and respiratory symptoms resolved. Severe hypertrophy of the adenoid tissue can cause hypercapnia and acidosis secondary to upper airway obstruction. The possibility of adenoid hypertrophy and hypercapnia should be kept in mind in cases of transient cortical blindness. Aggressive treatment, including early intubation and adenoidectomy, may lead to a rapid resolution of symptoms.

Glottic myxoma presenting as chronic dysphonia: A case report and review of the literature

January 19, 2015     Christopher G. Tang, MD; Daniel L. Monin, MD; Balaram Puligandla, MD; Raul M. Cruz, MD
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Abstract

Myxomas of the vocal fold are rare benign tumors often presenting with chronic dysphonia and less frequently with airway obstruction. The current consensus is that all laryngeal myxomas should be totally excised with clear margins to prevent recurrences. The recommendation for complete excision, however, has to be balanced with consideration of preserving vocal fold phonatory and sphincteric function. We report a case of vocal fold myxoma recurring twice after subtotal excision via two surgical approaches. This case illustrates a benign lesion with potential for recurrence and the need for a balanced treatment approach.

Metastatic squamous cell carcinoma of the tonsil presenting as otorrhea: A case report

January 19, 2015     Eelam Adil, MD; Dhave Setabutr, MD; Soha N. Ghossaini, MD; David Goldenberg, MD, FACS
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Abstract

We describe the case of a 52-year-old man with a history of squamous cell carcinoma (SCC) of the tonsil who presented with right subacute otalgia and otorrhea. Dedicated computed tomography of the temporal bones showed opacification within the mastoid process with destruction of bony mastoid septations consistent with coalescent mastoiditis. Preoperative imaging showed no destruction or expansion of the bony eustachian tube that would indicate that a direct spread had occurred. An urgent cortical mastoidectomy was performed. Intraoperatively, a friable white mass surrounded with purulence and granulation tissue was biopsied and returned as SCC. The discrete metastasis was removed without complication. Postoperatively, the patient was prescribed palliative chemotherapy. This case shows that a metastatic SCC can be masked by an overlying mastoiditis, and thus it should be considered in the differential diagnosis of a patient with a history of oropharyngeal cancer.

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