Laryngology

Hypopharyngeal hemangioma in an adult: A case report

October 17, 2014     Lindsay Reder, MD; Sunil Verma, MD; Niels Kokot, MD
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Abstract

Hemangiomas of the postcricoid region have been reported almost exclusively in infants and young children. Our adult patient with symptoms of dysphagia and weight loss underwent transoral CO2 laser microsurgery of a postcricoid mass, and final pathologic examination confirmed the presence of a hemangioma. She is doing well after surgery, with an excellent voice, resolution of dysphagia, and no evidence of recurrence. There have been few cases of hypopharyngeal hemangioma in the adult population; to our knowledge, there have been no reports in the English-language literature of adult patients diagnosed specifically with a postcricoid hemangioma. Otolaryngologists should be familiar with the presentation and treatment of this unusual entity.

Rapid growth of a laryngeal oncocytic cyst after surgical irritation

October 17, 2014     John T. Sinacori, MD; Robert A. Jack II, MD; Jonathan R. Workman, MD
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The origin of oncocytic lesions remains controversial. They occur more frequently with increasing age, and patients commonly present with a prolonged duration of hoarseness

Management of soft palate agenesis in Nager syndrome with an elongated, superiorly based pharyngeal flap

October 17, 2014     Oneida A. Arosarena, MD; Troy Hemme, DO
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Abstract

Nager syndrome, or preaxial acrofacial dysostosis, is associated with aberrant development of the first and second branchial arch structures, as well as abnormal development of the limb buds. It is a rare disorder, and its clinical manifestations have not been completely defined. Absence of the soft palate has been reported in patients with Nager syndrome. In this report we describe the use of an elongated, superiorly based pharyngeal flap for the treatment of severe velopharyngeal insufficiency in a patient with Nager syndrome and absence of the soft palate. We also describe the dysmorphisms associated with Nager syndrome and present a differential diagnosis for the condition.

Fish bone impaction in the supraglottis

October 17, 2014     Willis S.S. Tsang, FRCSEd(ORL); John K.S. Woo, FRCS(ORL); C. Andrew van Hasselt, M Med (Otol)
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The most common sites of fish bone impaction are the tonsils, tonsillar pillars, tongue base, valleculae, and piriform fossa. Impaction in the supraglottic area is extremely uncommon.

A transoral surgical approach to a parapharyngeal-space pleomorphic adenoma

October 17, 2014     Christopher Schutt, MD; Joehassin Cordero, MD, FACS
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Abstract

It is relatively difficult to gain surgical access to pleomorphic adenomas of the parapharyngeal space. Since the lateral border is the mandible, gaining access to them can put several important neurovascular structures at risk. A number of surgical approaches have been developed to overcome this difficulty, and each has its advantages and disadvantages. We report the case of a 59-year-old woman with a parapharyngeal-space pleomorphic adenoma that was accessed via a transoral approach. Transoral approaches are controversial and rarely used. However, we feel that for a selected group of tumors, this approach provides clear benefits by decreasing cosmetic and functional disability while providing good surgical access to the tumor.

Synchronous double cancers of the hypopharynx: Malignant fibrous histiocytoma and squamous cell carcinoma

October 17, 2014     Shao-Cheng Liu, MD; Wan-Fu Su, MD
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Abstract

We report a unique case of synchronous double hypopharyngeal tumors in a 39-year-old man. The patient presented with a 1-year history of a muffled voice and mild odynophagia. Laryngoscopy detected two grossly different tumors in the hypopharynx: a malignant fibrous histiocytoma (MFH) in the postcricoid area and a squamous cell carcinoma (SCC) in the posterior pharyngeal wall. Chemoradiotherapy was administered, and the patient was free of disease at 23 months of follow-up. Synchronous double cancers of the hypopharynx that feature different oncotypes are very rare, especially those that include an MFH. In fact, to the best of our knowledge, no case of synchronous MFH and SCC of the hypopharynx has been previously reported in the literature. Because the number of reported cases of MFH in the hypopharynx is so small, no consensus exists with respect to the preferred option among the various treatment choices.

Solitary myofibroma of the oropharynx causing airway obstruction in an adult

September 17, 2014     Harrison W. Lin, MD; David Jung, MD, PhD; Linda N. Lee, MD; Peter M. Sadow, MD, PhD; James W. Rocco, MD, PhD
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Abstract

Myofibromas are benign neoplasms believed to be the most common fibrous proliferation of childhood. We present an unusual case of a 44-year-old woman who developed acute airway obstruction from a myofibroma in the oropharynx and accordingly required emergent tracheotomy tube placement. Serial laser excisions to adequately remove the entire lesion while maintaining pharyngeal structure and function were performed, and the patient was successfully decannulated. To date she has remained free of signs and symptoms of recurrence. Although rare in adults, solitary myofibromas should be considered in the differential diagnosis of any subcutaneous or submucosal head and neck lesion. Moreover, clinicians treating adult and pediatric patients with known solitary or multicentric forms of myofibroma should be aware of its potential for airway obstruction. Patients found to have a pharyngeal myofibroma should be managed with airway stabilization, surgical excision with preservation of speech and swallow function, and close postoperative monitoring for recurrence.

Vocal fold tear in an operatic tenor

September 17, 2014     Joel E. Portnoy, MD; Robert T. Sataloff, MD, DMA, FACS
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The patient complained of increased throat clearing and coughing. He had experienced similar symptoms 3 months previously, which had resolved with voice rest.

Plummer-Vinson syndrome following gastric bypass surgery

September 17, 2014     Andrew Sapthavee, MD; Matthew L. Kircher, MD; Lee M. Akst, MD
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Abstract

Plummer-Vinson syndrome (PVS) is the combination of dysphagia, angular cheilitis, atrophic glossitis, and esophageal webbing in the setting of iron deficiency anemia. Although it is relatively uncommon, this condition is important to recognize because it is a source of dysphagia and it confers an increased risk for hypopharyngeal cancer. Cases of PVS associated with gastrointestinal conditions such as celiac disease and gastric cancer have been previously reported in the literature, but as far as we know, no case of PVS associated with bariatric surgery has been previously reported. We describe the case of a 39-year-old woman who developed PVS following gastric bypass surgery, and we briefly discuss the current knowledge of this syndrome.

Actinomycosis of the pharynx

September 17, 2014     Anna M. Lipowska, MD; Michael M. Johns III, MD
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Abstract

Few cases of pharyngeal actinomycosis have been documented in the literature. We describe the case of a 67-year-old white man who presented with symptoms of dysphagia. Laryngoscopy revealed a pedunculated mass in the left posterior pharyngeal wall; an excisional biopsy confirmed the diagnosis. Postoperatively, the patient underwent 10 weeks of intravenous penicillin therapy followed by 4 months of oral antibiotics, and his condition resolved. We discuss the diagnosis, management, and complications of this rare infection.

Lingual tonsil abscess with parapharyngeal extension: A case report

September 17, 2014     Andrew M. Coughlin, MD; Reginald F. Baugh, MD; Harold S. Pine, MD
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Abstract

Lingual tonsil abscess is a rare disorder previously reported only once in the English literature. Because of their similar structure to that of the palatine tonsils, the lingual tonsils have the propensity to develop infection in the same way. The progression of infection, however, is different in that the lingual tonsils lack a capsule, thus preventing the formation of a peritonsillar abscess. Therefore, the only place for infection to spread is either into the tongue or into the parapharyngeal space. Here we present our experience with the latter, and we provide radiographic evidence of the disease. Lingual tonsil abscess, although rare, is an important potential cause of airway obstruction and must be considered in the case of a sore throat with a normal oropharyngeal exam.

Postoperative management in laryngeal cancer with subglottic extension and histologically negative nodes: Which patients need adjuvant radiotherapy?

August 27, 2014     Federico Ampil, MD; Cherie-Ann O. Nathan, MD; Timothy Lian, MD; Roxana Baluna, MD, PhD; Edward Milligan, MD; Gloria Caldito, PhD
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Abstract

We conducted a study of 19 patients who had laryngeal cancer with subglottic extension (LCSE) and pathologically negative lymph nodes (pN0) following total laryngectomy and neck dissection (TLND). These patients had undergone surgery during a 17-year period from 1986 through 2002. Of this group, 9 did not receive postoperative radiotherapy (non-RT group) and 10 did (RT group). Adjuvant irradiation had been administered to those with additional histopathologic risk factors for recurrence. We found that recurrence rates in the neck were 44% in the non-RT group and 11% in the RT group (1 of 9 evaluable patients), and the corresponding 5-year disease-free survival rates were 51 and 89%. While both of these differences were clinically significant, neither was statistically significant (p = 0.29 and p = 0.14, respectively). The presence of LCSE was not known prior to or during TLND in 4 non-RT patients and in 7 RT patients; their corresponding neck recurrence rates were 50 and 0%. Two of 8 patients (25%) whose ipsilateral lobe of the thyroid gland was not removed experienced a stomal recurrence. We conclude that three factors can be used to identify patients with pN0 LCSE who may be candidates for adjuvant postoperative radiotherapy: (1) a failure to remove the ipsilateral thyroid gland lobe during TLND, (2) a failure to examine the level VI lymph node for metastatic disease status, and (3) unfavorable histopathologic findings.

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