Duplication of the right internal jugular vein: A case report

June 4, 2015     Srinivasalu Bathala, FRCS(ORL-HNS); Zvoru G. Makura, FRCS(ORL-HNS)
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Abstract

We present a case of duplication of the right internal jugular vein (IJV) in a patient who underwent neck dissection as part of the management of carcinoma of the larynx. The patient was a 63-year-old man who presented to the otolaryngology department with a 7-month history of hoarseness and a 3-week history of noisy breathing. Flexible endoscopy detected a transglottic tumor that had extended beyond the vocal folds. The patient underwent a total laryngectomy and bilateral selective neck dissection at levels II-VI. Intraoperatively, the right IJV was noted to be duplicated. The duplicate segment was approximately 10 cm in length, and it rejoined the normal vein before the normal vein joined the subclavian vein.

Introduction Duplication of the internal jugular vein (IJV) is very rare. Its incidence is only 4 per 1,000 unilateral neck dissections,1 and only a handful of cases have been previously reported in the literature.1-10 We describe a case of duplication of about 10 cm of the IJV, which we believe is the largest such duplication to be reported thus...

Use of fluoroscopic guidance to remove a migrating esophageal foreign body

June 4, 2015     Ramanuj Sinha, MS; Utpal Jana, MS; Soumya Ghatak, MS; Gautam Biswas, MS; Jayanta Saha, MS; Indranil Sen, MS
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Abstract

Ingested foreign bodies that migrate extraluminally are rare. In such cases, exploration of the neck via an external approach is the recommended procedure to remove the object. However, locating such a foreign body can be a difficult task. We report what we believe is the first adult case of fluoroscopically guided localization of an accidentally ingested foreign body that had migrated into the soft tissues of the neck. We also review the other methods used to locate a migrating foreign body.

Dehiscent high jugular bulb attached to the tympanic membrane

June 4, 2015     Hiroshi Sakaida, MD, PhD; Kazuhiko Takeuchi, MD, PhD
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The differential diagnosis of high jugular bulb includes cholesterol granuloma, aberrant carotid artery, and tumors such as paraganglioma or schwannoma.

[Editor's note: A partial version of this article was published in the March 2015 issue of ENT Journal as the result of a computer error.]

Nonossifying fibroma (metaphyseal fibrous defect) of the mandible in a 15-year-old boy

June 4, 2015     Abul Ala Syed Rifat Mannan, MD; N. Gopendro Singh, MD; Salah Al-Waheeb, MBBCh, FRCPC, FRCPath; Taher N.M. Taher, MBBCh, BDS, MOMS; Emad El Din A.M. Mohammed, BDS, MSc, PhD
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Abstract

We describe a rare case of nonossifying fibroma of the mandible in a 15-year-old boy who presented with a left mandibular swelling. Conventional imaging showed an expansile radiolucent lesion involving the angle and the body of the left mandible. The lesion was curetted, and a miniplate was implanted at the excision site. Microscopic examination of the removed specimen revealed a cellular lesion characterized by a proliferation of uniform spindle-shaped cells in a vague but prominent storiform pattern, which represented the classic appearance of nonossifying fibroma. Three months later, radiography detected a fracture of the implantation plate. The area was re-explored with curettage of the soft tissue, which on microscopy demonstrated findings similar to the initial curettage findings. Follow-up radiology revealed satisfactory healing of the jaw, and no further recurrence was seen 2 years after the initial surgery. We present this case to highlight the importance of recognizing nonossifying fibroma in the mandible, which can be easily confused with more common mandibular lesions.

Cricotracheal resection

June 4, 2015     Amanda Hu, MD, FRCSC; James McCaffrey, MD; Al Hillel, MD
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As much as half of the trachea can be resected with a low incidence of anastomotic complications.

A rare case of pleomorphic adenoma of the nasal septum

June 4, 2015     Tejinder Singh Anand, MS, PhD; Gautam Bir Singh, MS; Sunil Garg, MS; Garima Yadav, MBBS; Anita Nangia, MD
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Pleomorphic adenomas of the nasal cavity differ from those found elsewhere in that they have more myoepithelial cells and little or no stromal component.

Bezold abscess

June 4, 2015     Yu-Hsuan Lin, MD; Ming-Yee Lin, MD
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In some circumstances, the only sign or symptom of Bezold abscess is an unnoticed neck lump.

Bezold abscess is an extremely rare otogenic complication. However, its initial manifestation might appear to be fairly nonthreatening, which can lead to a delay in diagnosis. Maintaining a high level of clinical suspicion and the early use of radiologic imaging can guide clinicians in the diagnosis and surgical or medical management of this...

Maxillary myxoma: A case report and review

June 4, 2015     Matthew P. Connor, MD, Capt.; Michael Neilson, DMD, Maj.; Cecelia E. Schmalbach, MD
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Abstract

An odontogenic myxoma is a rare, benign tumor that is found almost exclusively in the facial bones, usually the mandible. The diagnosis poses a challenge because its features overlap with those of other benign and malignant neoplasms. We present an unusual case of odontogenic myxoma that involved the maxilla, and we review the clinical, radiographic, and histologic characteristics of this case. Even though it is benign, odontogenic myxoma can be locally invasive and cause significant morbidity. Complete surgical excision is the treatment of choice, but it can be challenging because of the tumor's indistinct margins.

Juvenile nasopharyngeal angiofibroma staging: An overview

June 4, 2015     Nada Ali Alshaikh, MD; Anna Eleftheriadou, MD, PhD
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Abstract

Staging of tumors is very important in treatment and surgical decision making, as well as in predicting disease recurrence and prognosis. This review focuses on the different available classifications of juvenile nasopharyngeal angiofibroma (JNA) and their impact on the evaluation, management, and prognosis of JNA. The literature was reviewed, and publications on JNA staging were examined. Our MEDLINE search of the entire English-language literature found no review article on the current available staging systems for JNA. In this article, we review the common JNA classification systems that have been published, and we discuss some of their advantages and disadvantages. The most commonly used staging systems for JNA are the Radkowski and the Andrews-Fisch staging systems. However, some newer staging systems that are based on advances in technology and surgical approaches-the Onerci, INCan, and UPMC systems-have shown promising utility, and they will probably gain popularity in the future.

Introduction Juvenile nasopharyngeal angiofibroma (JNA) is a rare benign nasopharyngeal tumor that accounts for 0.05 to 0.5% of all head and neck tumors.1 It exclusively affects adolescent boys.1 It was first described in 1906 by Chauveau, who gave it its name.2 However, the oldest recorded surgical procedure for JNA is attributed to Hippocrates...

Anaplastic large-cell lymphoma presenting as a nasopharyngeal mass and cervical lymphadenopathy

June 4, 2015     Gregory R. Dion, MD, MS, Capt.; Col. Mark D. Packer, MD
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Abstract

Cervical lymphadenopathy in adults has a broad differential diagnosis, including bacterial and viral infections, Kikuchi-Fujimoto disease, systemic lupus erythematosus, and various neoplasms. Many of its etiologies share similar symptomatology and presentations, which complicates the diagnosis. A thorough history and a comprehensive physical examination, to include nasopharyngoscopy and imaging as indicated by the specific case, are key to determining the origin of the lymphadenopathy and to avoid a missed or delayed diagnosis. Based on our review of the literature, we present the second reported case of anaplastic lymphoma kinase-positive anaplastic large-cell lymphoma presenting in an adult with an obstructing adenoid/nasopharyngeal mass and lymphadenopathy. The mass, which occurred in a 19-year-old woman of Asian descent, caused nasal airway obstruction in the setting of cervical lymphadenopathy that was initially ascribed to mononucleosis.

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