Other ENT Topics

The extended dorsal-shield graft in augmentation rhinoplasty

December 31, 2012     Giancarlo F. Zuliani, MD; Kailash Narasimhan, MD
article

Rhinoplasty in ethnic populations often warrants a graft versatile enough to correct dorsal deficiency, underprojection, malrotation, and cartilage deficiency.

Intraorbital erosion of a malar implant resulting in mastication-induced vision changes

October 31, 2012     Kyle Hatten, MD; Robert E. Morales, MD; Jeffrey S. Wolf, MD, FACS
article

Abstract

Complications of cosmetic malar augmentation are uncommon. We describe the unusual case of a 60-year-old woman who experienced vision disturbances (flashing lights and diplopia) while masticating. Ten years earlier, she had undergone bilateral malar enhancement with silicone implants. Imaging studies revealed that the implant on the right side had become displaced. The prosthesis had entered the orbit in the retrobulbar area and eroded the lateral zygomaticomaxillary buttress and the orbital floor. Both implants were removed, and the patient's symptoms immediately resolved. To the best of our knowledge, no case of vision changes secondary to erosion of the posterior orbit by a silicone malar implant has been previously described in the literature.

Sphenoethmoid sinusitis in a child resulting in a disastrous intracranial sequela

October 31, 2012     Aye Jane Sow, MS(ORL-HNS); Jeevanan Jahendran, MS(ORL-HNS); Charng Jeng Toh, MS(Neurosurg); Thean Yean Kew, FRCR
article

Abstract

Localized sphenoethmoid sinusitis in children is a rare occurrence. It is usually overlooked because of the misconception that the sinuses are not developed. We describe a case of localized acute sphenoid and right posterior ethmoid sinusitis that presented as right frontobasal subdural empyema and multiple deep cerebral abscesses. Morbidity from subdural empyema in children is high. Early diagnosis and treatment based on recognition that the etiology might involve the paranasal sinuses affects the overall prognosis.

Tongue base cyst in a 6-week-old boy

October 8, 2012     Joel Y. Sun, BA; Ron B. Mitchell, MD; Seckin O. Ulualp, MD
article

After excision, a histologic finding of an epithelial lining without ectopic thyroid tissue confirms the diagnosis of a lingual thyroglossal duct cyst.

Spontaneous cervicofacial subcutaneous emphysema secondary to pneumomediastinum in an otherwise asymptomatic child

October 4, 2012     Tripti Maithani, MS; Debraj Dey, MS; Chandermohan Sharma, MS
article

Abstract

A 12-year-old boy presented with subcutaneous emphysema of the face, neck, and upper chest. He had no significant history that suggested any specific cause, and initial investigations revealed no underlying pathology. Computed tomography of the chest detected pneumomediastinum. The patient was managed conservatively, and he responded. He was discharged 7 days after admission with a complete resolution of the emphysema. To the best of our knowledge, this is the first reported case of spontaneous pneumomediastinum presenting as cervicofacial swelling in a child without any other symptoms.

Juvenile xanthogranuloma of the tympanic membrane: A case report

September 7, 2012     Michael W. Chu, MD; Alice Werner, MD; Stephanie A. Moody-Antonio, MD
article

Abstract

Juvenile xanthogranuloma (JXG) is a benign, non-Langerhans cell histiocytic lesion that generally affects infants and children. These lesions characteristically appear as a solitary, yellow, cutaneous nodule of the head, neck, or trunk. Subcutaneous and extracutaneous forms can involve the gastrointestinal tract, kidney, lung, gonads, pericardium, central nervous system, temporal bone, larynx, and eye. We describe the clinical presentation, imaging, histochemical findings, and management of a solitary JXG of the tympanic membrane in a 17-month-old girl. The patient underwent surgical resection and was without disease several months following surgery and reconstruction of the defect. To the best of our knowledge, this is the first reported case of a JXG of the tympanic membrane.

Serum levels of advanced oxidation protein products in response to allergen exposure in allergic rhinitis

August 10, 2012     Fadlullah Aksoy, MD; Yavuz Selim Yıldırım, MD; Bayram Veyseller, MD; Hasan Demirhan, MD; Orhan Özturan, MD
article

Abstract

Patients with asthma, allergic rhinitis, or atopic dermatitis experience increased oxidative stress. We conducted a prospective study to examine the levels of advanced oxidation protein products (AOPPs) as an indicator of oxidative stress in 97 patients with allergic rhinitis who were followed in our clinic during a 3.5-month period. Of these 97 patients, 51 were treated with subcutaneous immunotherapy (SCIT), and 46 did not receive any treatment until the study was concluded. In each patient, allergic rhinitis and allergic sensitization were documented by the history, the findings on clinical examination, and the results of blood and skin-prick tests. Blood samples from each patient were analyzed to determine AOPP levels. We found that the mean serum AOPP level was significantly higher in the SCIT group than in the non-SCIT group (258.55 vs. 163.83 µmol/L; p = 0.0015). We conclude that as a known indicator of protein oxidation, the serum AOPP level is a marker of increased oxidative stress in response to allergen exposure in allergic rhinitis.

Allergic fungal rhinosinusitis in children

July 5, 2012     Ross Shockley, MD; Soham Roy, MD
article

Allergic fungal rhinosinusitis most often occurs in adolescents or young adults who exhibit nasal obstruction, congestion, purulent or clear rhinorrhea, anosmia, and headache--classic manifestations of chronic sinusitis.

Mesenchymal hamartomas of the pediatric head and neck

July 5, 2012     Matthew L. Carlson, MD; Amy M. Saleh, MD; Keith J. Kaplan, MD; Shelagh A. Cofer, MD
article

Abstract

We describe the fifth published report of a mesenchymal hamartoma presenting as a cheek mass. A 5-month-old infant was brought to our institution for evaluation of an enlarging left-sided congenital cheek mass. Over time, the lesion had begun to cause significant facial asymmetry and oral incompetence. Radiologic imaging revealed an approximate 2.5 x  3.5-cm, noncystic lesion located in the left buccal space, separate from the mandible and surrounding the salivary glands. Magnetic resonance imaging (MRI) sequences demonstrated an isointense, T1-weighted lesion with avid gadolinium uptake, and increased intensity of T2-weighted sequences. The patient subsequently underwent biopsy and subtotal resection through a left gingivobuccal incisionwith the goal of improving lip contour and facial symmetry.Histologic examination revealed an admixed arrangement of mature smooth muscle, vascular, adipose, and neural tissue elements within a slightly myxoid stroma, consistent with a mixed mesenchymal hamartoma. An 8-month postoperative MRI demonstrated near-total removal without evidence of regrowth. While rare, hamartomas should be included in the differential diagnosis of a slow-growing pediatric head and neck mass. Gross total resection may provide cure; however, given this lesion’s benign nature, less-than-complete resection should be considered when lesions infiltrate opposing critical structures. Thorough clinical and histologic evaluation is critical to avoid overly aggressive treatment and unnecessary morbidity.

Simplified approach to auricular cartilage grafts

June 4, 2012     Ivan Wayne, MD
article

A posterior approach to harvesting auricular cartilage--used to correct both functional and aesthetic problems in facial plastic surgery--minimizes visible scars and postoperative contour deformities. This method also permits the simultaneous harvesting of perichondrium and soft-tissue for use as a thin onlay graft.

Telemedicine in otolaryngology–head and neck surgery

June 4, 2012    
article

Telemedicine holds a practical place in the field of otolaryngology. Programs in Alaska and Queensland, Australia, have been found beneficial and cost-effective.

Bilateral congenital lacrimal fistulae: A case report

April 30, 2012     Lei Zhuang, MD; Christin L. Sylvester, DO; Jeffrey P. Simons, MD
article

Abstract

A congenital lacrimal fistula is a rare developmental anomaly, usually unilateral. While it is often asymptomatic, some patients present with epiphora or discharge. We report the case of a 4-year-old boy with bilateral lacrimal fistulae. No other systemic, nasal, or ocular anomalies were found. In the absence of significant symptoms, we decided on a course of observation. In this article, we discuss the embryologic basis of congenital lacrimal fistulae, as well as the typical presentation and possible treatment modalities. The presence of a lacrimal fistula is an indication to search for a variety of underlying systemic and ocular anomalies.

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