March 24, 2013 Mark E. Fons, DO; David Poetker, MD; Paul E. Wakely Jr., MD
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Abstract
Oncocytomas arising in the nasal cavity are quite rare. These entities more commonly occur in the major salivary glands, minor salivary glands, respiratory seromucinous glands, and endocrine organs. Very few cases of oncocytoma in the nasal cavity have been reported, with only 5 diagnosed as malignant. This article describes a case involving an 81-year-old man with a nasal oncocytoma that was completely resected with an endoscopic medial maxillectomy. The diagnostic rationale is discussed, along with a review of the literature.
March 24, 2013 Rodrigo Bayon, MD; Sandra K. Banas, MD; Barry L. Wenig, MD, MPH
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Abstract
Although carcinoma of the breast has a propensity toward distant metastasis, metastasis to the head and neck is uncommon. Most patients with metastasis to the head and neck region present with cervical lymphadenopathy; however, spread to the upper aerodigestive tract has been described previously. We present a case of a patient found to have a pedunculated mass in her right piriform sinus. When she swallowed, the mass would completely prolapse into the esophagus and cause symptoms. Subsequent workup revealed widespread metastatic disease, for which the patient was treated with chemoradiotherapy. Microlaryngoscopy with excision of the mass was performed for palliation of her dysphagia, and a diagnosis of metastatic breast carcinoma was obtained. The patient healed well from the excision and went on to be treated for the metastatic breast cancer. To our knowledge, our report represents the first case of metastatic breast carcinoma presenting as severe dysphagia.
March 24, 2013 Jinsu Choi, MD; Bosung Kim, MD
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Extrahepatic metastasis is a major independent predictor of a poor prognosis in patients with HCC.
February 25, 2013 Tanya Rogo, MD, FIDSA; Richard H. Schwartz, MD, FAAP
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Abstract
We describe the case of a 5-year-old girl with a Pott puffy tumor on her forehead. Computed tomography confirmed frontal sinusitis and an epidural abscess. This case is unusual in that the patient's age at presentation was younger than the age when the frontal sinuses are believed to develop.
February 25, 2013 Subhash C. Gupta, MS; Sachin Jain, MS; Ravi Mehrotra, MD; Himanshu P. Singh, MBBS
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Abstract
Central giant cell reparative granuloma is an infrequent, benign, proliferating lesion affecting the maxilla, mandible and, rarely, cranial bones. A 16-year-old girl presented with a 6-month history of recurrent nasal bleeding, a mass in the nose, difficulty in nasal breathing, a change in voice, and bilateral proptosis. Radiologically, an extensive ethmoidal mass was seen. Histologic examination revealed a central giant cell reparative granuloma. After endoscopic removal, the patient was symptom-free at the 12-month follow-up. The clinical picture of central giant cell reparative granuloma of the ethmoids is discussed, along with the differential diagnosis, histologic evaluation, appearance on computed tomography, and endoscopic management of this lesion.
February 25, 2013 Dewey A. Christmas, MD; Joseph P. Mirante, MD, FACS; Eiji Yanagisawa, MD, FACS
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The empty nose syndrome usually is defined by excessive loss of normal nasal tissue and loss of anatomic landmarks, which results in a widely patent airway with excessive crusting (ozena) and easy nasal bleeding and dryness of the nasal mucosa. Functional endoscopic sinus surgery for chronic sinus disease has diminished the possibility of the difficult empty nose.
January 24, 2013 Jae Hoon Lee, MD; Ha Min Jeong, MD
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Nasal septal perforations or defects have a variety of causes, including previous septal surgery, infection, collagen vascular disease, granulomatous disease, the use of irritant inhalants, and neoplasia; the most common of these is previous septal surgery.
January 24, 2013 Lester D.R. Thompson, MD
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Wegener granulomatosis presents clinically as ulcerative and crusted lesions with tissue destruction.
January 24, 2013 Murat Songu, MD; Nazan Can, MD; Fazil Gelal, MD
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Abstract
The precise location of the sneeze center in the human brain has not been definitively identified. The aim of this report is to contribute to the effort to detect its location. We report the case of a 13-year-old boy who presented to our outpatient clinic for evaluation of an inability to sneeze. In an attempt to trigger the afferent (nasal) phase of the sneeze reflex, we first applied a cotton swab and later a silver nitrate stick to the patient's nasal mucosa. Once that was accomplished, we observed that the patient could not complete the efferent (expiratory) phase of the sneeze reflex, and thus he did not sneeze. Cranial magnetic resonance imaging (MRI) revealed that his cerebellar tonsils extended approximately 10 mm inferiorly through the foramen magnum, which represented a type I Arnold-Chiari malformation. The tonsils were noted to have compressed the posterolateral portion of the medulla oblongata. At follow-up 21 months later, we noted that the patient was able to sneeze spontaneously as well as with nasal stimulation. Repeat MRI revealed that the Arnold-Chiari malformation had undergone a spontaneous partial regression, which resulted in relief of the compression of the medulla oblongata. We believe that the patient's earlier inability to sneeze might have been attributable to the compression of the medulla oblongata by the cerebellar tonsils and that the site of the compression might represent the location of his sneeze center.
December 31, 2012 Suja Sreedharan, MS; Kishore Chandra Prasad, MS, FACS; Mahesh Chandra Hegde, MS; Kausalya Sahoo, MS; and Arathi Alva, MS
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Abstract
A 52-year-old woman presented to the ENT clinic with a huge swelling on the right side of her face that had originated 6 years earlier. The mass was ultimately diagnosed as a carcinoma ex pleomorphic adenoma of the maxillary sinus. Carcinoma ex pleomorphic adenoma itself is uncommon, and its origin in the maxillary sinus is very rare. We discuss the presentation, histopathologic picture, and management of this case.
December 31, 2012 Jeffrey D. Suh, MD; Vijay Ramakrishnan, MD; Jennifer Y. Lee, MD; Alexander G. Chiu, MD
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Abstract
Silent sinus syndrome is a rare clinical entity associated with progressive enophthalmos, collapse of the maxillary sinus, and hypoglobus. We report a case of bilateral silent sinus syndrome in a 29-year-old man. Representative radiographic and intraoperative images are presented. The purpose of this article is to illustrate a new presentation of the disease and to review the current diagnostic and treatment modalities.
December 31, 2012 Shafik N. Wassef, MD; Payal Kapur, MBBS, MD; Samuel L. Barnett, MD; Larry L. Myers, MD, FACS
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Abstract
Sinonasal teratocarcinosarcoma (SNTCS) is an extremely rare malignancy of the paranasal sinuses that possesses the histopathologic features of both teratomas and carcinosarcomas. We report the case of a 58-year-old white man who presented with a 1-year history of a gradually enlarging left-sided nasal mass. The patient had previously undergone endoscopic sinus surgery at another facility, and the final pathologic specimen was reported as an SNTCS with positive margins. He was then referred to our institution, where he underwent a craniofacial resection combined with endoscopic intranasal resection. Postoperatively, he received combined chemotherapy and irradiation. At 48 months of follow-up, he was alive without evidence of disease.
