Laryngology

Case report: Paraneoplastic neurologic syndrome associated with squamous cell carcinoma of the tonsil

October 23, 2013     Jeffrey R. Janus, MD; Sivakumar Chinnadurai, MD; Eric J. Moore, MD
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Abstract

Paraneoplastic syndromes include a variety of disorders that affect the neurologic, endocrine, mucocutaneous, hematologic, and other systems as a result of neoplastic disease. Although their presentations vary, syndromes occur when tumor antigens exhibit cross-reactivity to similar antigens expressed by these systems. The antigens in the nervous system are called “onconeural” antigens. Although many disorders are associated with a comparatively high incidence of paraneoplastic neurologic syndromes, only a few cases have been associated with squamous cell carcinoma (SCC) of the tonsil. We report the case of a 69-year-old man who initially presented with weakness and spastic gait. He was subsequently found to have a characteristic paraneoplastic tractopathy on thoracic magnetic resonance imaging. The subsequent workup and operative intervention identified a T2N0M0 SCC of the tonsil. Following resection, the patient's overall symptoms were significantly alleviated, and his gait improved. A thorough literature search yielded no other report of a tonsillar SCC with associated paraneoplastic thoracic spine tractopathy.

Office assessment of vocal fold hypomobility

October 23, 2013     Ronak Shah, MD; Rima A. DeFatta, MD; Robert T. Sataloff, MD, DMA, FACS
article

Even though abductor-adductor fiber mismatch often leads to net vocal fold immobility, the preserved muscle tone sometimes permits glottic closure through compensation by the normal vocal fold.

A case of cicatricial pemphigoid of the larynx successfully treated with plasmapheresis therapy

October 23, 2013     Takeshi Kusunoki, MD; Katsuhisa Ikeda, MD
article

Conventional therapy for cicatricial pemphigoid has consisted of the administration of a steroid alone or a steroid plus an immunosuppressant.

Arteriovenous malformation of the neck: An unusual cause of hoarseness successfully treated with endovascular techniques

October 23, 2013     Joseph J. Gemmete, MD; Neeraj Chaudhary, MD; Aditya S. Pandey, MD; Dheeraj Gandhi, MD; Sameer A. Ansari, MD, PhD
article

Abstract

Hoarseness is a common presenting symptom in patients referred to the otolaryngology clinic. An arteriovenous malformation (AVM) in the neck is a previously unreported cause of hoarseness. We describe the case of a 61-year-old woman who presented with hoarseness and vocal fold paralysis, which was caused by an AVM. She was successfully treated with endovascular embolization. Devascularization of the AVM resulted in symptomatic relief of the hoarseness and resolution of the vocal fold paralysis, presumably secondary to interval reduction in edema and venous congestion.

Esophageal perforation in a patient with diverticulum following anterior discectomy and fusion

October 23, 2013     Aasif A. Kazi, PharmD; Nancy L. Solowski, MD; Gregory N. Postma, MD; Paul M. Weinberger, MD
article

 Most perforations are thought to result from esophageal retraction, direct injury during manipulation, hardware failure, or movement of cervical vertebral bodies during hyperextension.

Larynx: Nodules and polyps

September 18, 2013     Lester D.R. Thompson, MD
article

Nodules usually affect the anterior to middle thirds of the true vocal folds, and they are nearly always bilateral.

Ice-cream stick injury resembling torus palatinus

September 18, 2013     Rumi Khajotia, MBBS, MD, FAMA, FAMS; S.T. Kew, FRCP
article

The size of a torus palatinus usually varies from barely discernible to very large, and it may be flat or lobular.

Hemangiopericytoma of the parapharyngeal space

September 18, 2013     Brian A. Fishero, MD; Kelly M. Guido, MD; Howard S. McGuff, DDS; Josefine M. Heim-Hall, MD; Frank R. Miller, MD, FACS
article

Abstract

Hemangiopericytomas of the head and neck are rarely found in the parapharyngeal space. We report the case of a 53-year-old woman who presented with a globus sensation in her throat. Imaging detected a left submucosal oropharyngeal mass that extended into the prestyloid parapharyngeal space. The tumor was surgically excised en bloc. Histopathologic examination identified it as a hemangiopericytoma. We discuss the diagnosis and management of this rare entity.

Vocal fold atrophy after paralysis

September 18, 2013     Adam Rubin, MD; Jason D. Chesney, DO
article

Much debate currently exists as to the timing of vocal fold atrophy following denervation and as to why some patients maintain excellent muscle tone despite long-standing nerve injury.

Transnasal esophagoscopy and the diagnosis of a mediastinal foregut duplication cyst

August 21, 2013     Amarbir S. Gill, BS and Jennifer L. Long, MD, PhD
article

Foregut duplication cysts are true mucus-filled cysts lined with a thin epithelial layer, arising from either bronchogenic, esophageal, or neuroenteric precursor tissue.

Iatrogenic epiglottic inversion during intubation

August 21, 2013     Adam Rourke, DO and Adam Rubin, MD
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The otolaryngologist must recognize when the epiglottis is inverted or risk inserting the laryngoscope too far and traumatizing the vocal folds.

Multilevel treatment of moderate and severe obstructive sleep apnea with bone-anchored pharyngeal suspension sutures

August 21, 2013     Eric E. Berg, MD; Frederick Bunge, MD; and John M. DelGaudio, MD
article

Abstract

Success rates for the surgical treatment of obstructive sleep apnea (OSA) vary, with phase I surgical success ranging from 40 to 75%. Pharyngeal suspension suture procedures are minimally invasive techniques with a reported efficacy of 20 to 78%. We conducted a study to evaluate the effectiveness of pharyngeal suspension suture procedures in conjunction with uvulopalatopharyngoplasty (UPPP) as a multilevel treatment for OSA. We retrospectively reviewed the charts of 30 adults-22 men and 8 women, with a mean age of 49 years and a mean BMI of 30.6-who were treated at a tertiary care academic medical center and a private otolaryngology practice. All patients had moderate or severe OSA, and all had failed continuous positive airway pressure therapy. Of this group, 20 patients underwent tongue base and hyoid suspension (TBHS) and 10 underwent tongue base suspension (TBS) alone; 23 patients had undergone concurrent or previous UPPP, 13 in the TBHS group and all 10 in the TBS group. Polysomnography was performed an average of 3.9 months postoperatively. Surgical success was defined as a reduction in respiratory distress index (RDI) of more than 50% and a postoperative RDI of 20 or less. The overall surgical success rate was 63% (19/30). In the surgical success group, the mean RDI fell from 44.6 to 9.4 (p < 0.0001); in the surgical failure group, the mean RDI rose from 41.3 to 48.9 (p = 0.58). There were 6 complications: 3 seromas, 2 suture breaks, and 1 dislodged screw. We conclude that pharyngeal suspension suture procedures as part of the multilevel treatment of moderate and severe OSA yields better outcomes than conventional surgical treatments with the added benefit of being minimally invasive.

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