August 10, 2012 Johnathan B. Sataloff; Rima A. DeFatta, MD; Mary J. Hawkshaw, BSN, RN, CORLN; Robert T. Sataloff, MD, DMA, FACS
article
Sulcus vocalis causes stiffness of the vibratory margin of the vocal folds, and often in adynamic segments. Patients can experience hoarseness, breathiness, increased phonation threshold pressures, decreased vocal efficiency and, commonly, voice fatigue.
August 10, 2012 Joshua I. Warrick, MD; David S. Brink, MD; Ronald B. Mitchell, MD
article
Abstract
Paragangliomas of the head and neck are rare. We describe the case of an 11-year-old girl who presented with an enlarged right palatine tonsil (grade 4). After a bilateral tonsillectomy, microscopic examination of the right tonsillar tissue revealed well-formed nests of polygonal epithelial cells separated by a collagenous stroma. The tumor cell nuclei were centrally placed and featured finely clumped chromatin and moderate anisonucleosis. Occasional mitotic figures were present. No necrosis was seen. An immunohistochemical staining panel showed no label for keratin, epithelial membrane antigen, HMB-45, or Melan-A; there was a strong label of tumor cells with chromogranin A, synaptophysin, and neuron-specific enolase. The S-100 protein label was strongly positive in the surrounding stromal cells and weakly positive in the polygonal tumor cells. Given the classic histology and the immunohistochemical staining profile, the diagnosis of paraganglioma was made. At 7 months postoperatively, the patient exhibited no evidence of recurrence or metastasis. To the best of our knowledge, no case of a paraganglioma of the palatine tonsil has been previously described in the literature.
August 10, 2012 Nilantha De Zoysa, MRCS, DOHNS, BS; Belinda Sandler, MRCP, BSc; Kwame Amonoo-Kuofi, MRCS; Rajiv Swamy, FRCPath; Prasad Kothari, MDS, FDSRCS, FRCS(ORL–HNS); George Mochloulis, MD, CCST(ORL–HNS)
article
Abstract
We report a rare case of extramedullary plasmacytoma (EMP) of the true vocal fold. Our patient, a 62-year-old woman, presented with dysphonia. On workup, fiberoptic laryngoscopy detected a lesion arising from the anterior half of her left true vocal fold. No evidence of other pathology was noted. The patient underwent radical radiotherapy, and the lesion resolved. Follow-up revealed no sign of recurrence. A type of myeloma, EMP is rare, especially in the larynx. To the best of our knowledge, our patient represents the sixth case of glottic EMP to be reported in the literature.
August 10, 2012 Selmin Karataylı-Özgürsoy, MD; Alp Demireller, MD
article
Abstract
We report our experience with hyoid suspension surgery in patients with obstructive sleep apnea (OSA) diagnosed on the basis of polysomnographic criteria. We conducted a prospective, observational study of 20 patients—18 males and 2 females, aged 15 to 52 years (mean: 42.1)—who were treated at our tertiary care center. All patients underwent hyoid suspension surgery and uvulopalatopharyngoplasty (UPPP) in a single session. Postoperative success was defined as either (1) a reduction in the apnea-hypopnea index (AHI) from 20 or higher to less than 20 or (2) a reduction in AHI of at least 50%. Postoperative follow-up polysomnography indicated that surgery was successful in 18 of 20 patients (90%). No important complications were observed. We conclude that hyoid suspension surgery is an effective procedure with low morbidity for the treatment of OSA in selected patients with hypopharyngeal obstruction. We believe it is a good option for those patients who will not or cannot tolerate therapy with continuous positive airway pressure.
August 10, 2012 Yekaterina A. Koshkareva, MD; Michael Cohen, MD; John P. Gaughan, PhD; Vincent Callanan, MD; Wasyl Szeremeta, MD
article
Abstract
We conducted a 3-year retrospective study to examine the results of preoperative
hematologic screening, the incidence of postoperative bleeding, and the possible
relationship between the two factors in patients who had undergone tonsillectomy
with or without adenoidectomy. Our study population was made up of 875 patients—441
boys and 434 girls, aged 2 to 18 years (mean: 7.52 ± 4.25)—who had been treated at
our institution from January 2004 through December 2006. In addition to demographic
data, we compiled information on each patient’s medical and surgical history, personal
and family history of abnormal bleeding, indication for tonsillectomy, and preoperative
hematologic screening results. The latter included determinations of the prothrombin
time, activated partial thromboplastin time, international normalized ratio (INR), and
platelet count. A total of 748 patients (85.5%) had normal findings on preoperative
hematologic screening, and 127 (14.5%) had at least one abnormality. Postoperatively,
hemorrhagic complications occurred in 31 children (3.5%)—in 22 of the 748 patients
with normal screening results (2.9%) and in 9 of the 127 with a screening abnormality
(7.1%); the difference between the two groups was statistically significant (p = 0.041).
The abnormalities in the latter group consisted of an elevated INR but no otherwise
identifiable coagulopathy. Another 14 patients with an abnormal screening result
(11.0%) were found to have at least one coagulopathy that was newly diagnosed during
our preoperative evaluation; they were treated perioperatively, and none bled
postoperatively. Of 21 patients who had a personal or family history of abnormal
bleeding, 5 (23.8%) were found to have a coagulopathy, but none bled following surgery.
In conclusion, we found that preoperative hematologic screening identified patients
with undiagnosed coagulopathies, and with appropriate treatment our surgeons were able
to prevent some bleeding events in these patients. Our finding that patients with a
mildly elevated INR had a higher incidence of postoperative hemorrhage warrants
further study.
July 5, 2012 Draško Cikojević, MD, PhD; Ivo Glunčić, MD, PhD; Valdi Pešutić-Pisac, MD, PhD; Marisa Klančnik, MD, PhD; Zaviša Čolović, MD
article
Abstract
The estimated prevalence of extranodal non-Hodgkin lymphoma ranges from 10 to 35% of all cases; a finding in the larynx is extremely rare. We describe the case of a 77-year-old man who presented for evaluation of a 1-month history of minor swallowing difficulty, cough, and a foreign-body sensation in the throat. Fiberoptic endoscopy detected a tumor mass on the left aryepiglottic fold. Vocal fold mobility was normal. A biopsy specimen was obtained, and microscopic analysis revealed that the stratified squamous epithelium was partially eroded by abundant infiltrate that had occupied the entire submucosa. The submucosal infiltration consisted of lymphatic cells, including small, medium-sized, and large cells with an anaplastic appearance. On immunohistochemical analysis, the lymphoma cell population stained positive for CD3 and CD2, focally positive for CD56, and negative for CD4, CD5, and CD7. In addition, tumor cells expressed TIA-1, perforin, and granzyme B. A complete radiologic, pulmonologic, and hematologic workup found no other tumor. The patient underwent two cycles of chemotherapy followed by radiotherapy, and he experienced complete tumor regression. At the 1-year follow-up, findings on fiberoptic endoscopy of the larynx were normal, and positron-emission tomography found no evidence of a recurrence. The prognosis for this type of tumor is good when the diagnosis is made in the early phase of the disease. Long-termfollow-up is advisable for the timely detection of possible local or distant recurrences, which are common.
July 5, 2012 Pradipta Kumar Parida, MBBS, MS; Jaimanti Bakshi, MBBS, MS; Sanjeev Bhagat, MBBS, MS; Ramandeep Singh Virk, MBBS, MS
article
Abstract
Leiomyosarcoma is usually found in the female genital tract, the retroperitoneum, the wall of the gastrointestinal tract, and subcutaneous tissues. An appearance of this malignant tumor in the parapharyngeal space is extremely rare and may be difficult to diagnose. Because of its rarity, little information exists on management and prognosis. We report the case of a 50-year-old man with a parapharyngeal space leiomyosarcoma who was treated with total excision of the tumor and postoperative radiotherapy. At follow-up 6 months postoperatively, he was well and free of disease. To the best of our knowledge, this is only the third case of a leiomyosarcoma in the parapharyngeal area to be reported in the literature. We discuss the diagnosis and treatment of leiomyosarcoma in this aspect.
July 5, 2012 Andrew Mallon, DO; Rima A. DeFatta, MD; Robert T. Sataloff, MD, DMA, FACS
article
Use of inhaled steroids has been identified as a risk factor for the development of laryngeal candidiasis. Therefore, if dysphonia, cough, and general laryngeal irritation occur in a patient using inhaled steroids, the possibility of laryngeal candidiasis should be considered.
June 4, 2012 Rima A. DeFatta, MD; Tre Landrum, DO; Joseph Whitten, MD; Robert T. Sataloff, MD, DMA, FACS
June 4, 2012 Mridula Shukla, DipNB; Vinay Kumar, MS; Manoj Pandey, MS
article
Abstract
Squamous cell carcinoma is the most common malignant neoplasm of the upper aerodigestive tract. The disease is characterized by frequent lymphatic spread; however, blood-borne distant metastasis is rare. Isolated cutaneous metastasis is even rarer. We present two cases of oropharyngeal carcinoma that presented with cutaneous metastasis in the absence of disease recurrence. Both patients were treated with wide excision of the metastatic nodule and were disease-free at the 1.5-year follow-up. This article highlights the importance of cutaneous metastasectomy.
June 4, 2012 Christopher Y. Chang, MD; Richard Thrasher, MD
article
Abstract
We introduce a novel and potentially effective approach in the treatment of tonsil stones using Coblation technology. A retrospective pilot case series was performed demonstrating the effectiveness of a technique that we call Coblation tonsil cryptolysis. This technique is unique in that it can be performed in adult patients without sedation using only local anesthesia, much like laser tonsil cryptolysis. As with laser cryptolysis, pain is significant for only a few days and most adults can resume normal diet and activity within 1 week. In contrast, tonsillectomy entails significant morbidity for several weeks. However, Coblation avoids the significant disadvantages of laser use, including the potential for airway fire, retinal damage from reflected scatter, dealing with plume from vaporized tissues, oral/facial burns, and the high cost of purchasing and maintaining laser equipment. After a single session of Coblation tonsil cryptolysis, a significant decrease and even elimination of tonsil stones can potentially be achieved.
April 30, 2012 J. Madana, MS, DNB; Deeke Yolmo, MS; Sunil Kumar Saxena, MS; S. Gopalakrishnan, MS
article
Abstract
Tracheocele-an outpouching of tracheal mucous membrane-is an uncommon entity. It can occur as a congenital or acquired form. The congenital entity remains mostly dormant until adulthood, and then it typically presents as a herniation with multiple air-filled sacs. The acquired form develops as the result of blunt trauma, recurrent pulmonary infection, intubation, instrumentation, or surgery, and it typically presents as a single paratracheal cavity. We present an extremely rare case of a tracheocele associated with multiple congenital anomalies involving the face, limbs, and heart.
