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A case of radiation-induced mucosal melanoma in an immunohistochemically S-100-negative patient

August 21, 2016  |  Michael Rodriguez, DO; Yash Patil, MD; Arun Gupta, DO, MPH


We report a case of radiation-induced mucosal melanoma in a 41-year-old woman with a history of childhood rhabdomyosarcoma of the nasal cavity that had been treated with radiotherapy. During the workup for the melanoma, the patient was found to be negative for S-100 protein on immunostaining. While many melanotic markers for the histologic confirmation of melanoma exist, they can be negative in some cases, such as ours. To the best of our knowledge, only 1 case of radiation-induced melanoma has been previously reported in the English-language literature, and in that case the patient was S-100-positive. Although our case is rare, it suggests another possible long-term adverse effect of radiotherapy. We also describe the morphologies and histology associated with diagnosing melanoma in an S-100-negative patient.

Blastomycosis of the nose: A case report

August 21, 2016  |  Thomas M. Jetmore, MD; Jennifer Phan, MD; Abideen O. Yekinni, MD, FACS


Blastomyces dermatitidis is a thermally dimorphic fungus endemic to the North American soil near the Mississippi, Ohio, and St. Lawrence river valleys, as well as the Great Lakes Basin. It is responsible for blastomycosis, a systemic pyogranulomatous disease. Blastomycosis of the head and neck is decidedly uncommon and often mistaken for cancer. There are only 3 previous case reports of blastomycosis presenting as an intranasal lesion. We report the unusual case of a 24-year-old man with blastomycosis presenting with a 4-week history of a progressively enlarging intranasal mass who had complete resolution of symptoms after treatment with itraconazole and surgical excision of the lesion.

Surgical management of a high jugular bulb

August 21, 2016  |  Daniel S. Roberts, MD, PhD; Brian Chen, MD; William Slattery, MD

Patient selection for surgical repair of a high dehiscent jugular bulb should include the presence of a codominant sigmoid sinus to avoid elevated postoperative intracranial pressure.

Idiopathic nasal bone osteitis: A preliminary report on a recently recognized entity

August 21, 2016  |  Yotam Shkedy, MD; Ohad Ronen, MD; Sarah Gips, MD; Avi Front†; Tal Marshak, MD; Nechama Uri, MD


Osteitis of the nasal bones is a rare disease; when it occurs, it usually has a known etiology. To the best of our knowledge, idiopathic nasal bone osteitis (NBO) has not been described before. We conducted a study to analyze the behavior of idiopathic NBO and its outcome and to determine a cutoff level for diagnosis using technetium-99m-methylene-diphosphonate (Tc-MDP) bone scanning. This retrospective, controlled analysis involved 9 women (mean age: 44 yr) who had been admitted to an otolaryngology department in Israel with idiopathic NBO over a 5-year period. Clinical evaluation, isotopic evaluation, and computed tomography were done. A lesion-to-nonlesion ratio was calculated between an area of interest on the nasal bone and a reference point (L/R ratio). The same ratio was calculated for a control group of 20 subjects. All the Tc-MDP scans in the study group were suggestive of osteitis. Intravenous antibiotic treatment was effective in all cases. A high degree of accuracy was achieved with cutoff L/R ratios of 2.05 for planar views and 2.34 for single-photon emission computed tomography views.

Balloon dilation of the sphenoid sinus ostium for recurrent sphenoid sinusitis

August 21, 2016  |  Ken Yanagisawa, MD, FACS; Dewey A. Christmas, MD; Joseph P. Mirante, MD, FACS; Eiji Yanagisawa, MD, FACS

The natural sphenoid sinus ostium is often amenable to balloon dilation, which can be performed in the office under local anesthesia or in the operating room under general anesthesia.

Epithelioid hemangioendothelioma of tongue presenting as a papilloangioma in a pregnant woman

August 21, 2016  |  Mainak Dutta, MS; Kuntal Roy, MD

Otolaryngologists dealing with proliferative, vessel-rich oral lesions should consider epithelioid hemangioendothelioma as one of the possibilities because it might recur or metastasize, requiring aggressive management.

Mulberry hypertrophy and accompanying sinonasal pathologies: A review of 68 cases

August 21, 2016  |  Davut Akduman, MD; Mehmet Haksever, MD; Muhammed Yanilmaz, MD; Fevzi Solmaz, MD


Mulberry hypertrophy occasionally coexists with sinonasal pathologies. There are very few reports in the literature on this clinical entity. We conducted a retrospective study to draw attention to this condition in the context of accompanying sinonasal pathologies. Our study group was made up of 68 patients-51 males and 17 females, aged 13 to 57 years (mean: 34.9)-who had been diagnosed with mulberry hypertrophy and at least one accompanying sinonasal pathology. All patients had a long-standing chronic discharge. Forty-nine of these patients (72.1%) had unilateral mulberry hypertrophy. The most common concomitant pathologies were chronic rhinosinusitis and ostiomeatal complex disease; others included septal deviation, nasal polyposis, allergic rhinitis, and concha bullosa. Thirty-six patients (52.9%) with varying degrees of choanal/nasal obstruction were operated on with endoscopic excision to treat the mulberry hypertrophy. In all, most patients underwent some sort of surgery to treat either the mulberry hypertrophy or the accompanying sinonasal pathology. Based on our findings, we suggest a clinical staging system to serve as a way to standardize management and guide future basic and clinical research.

Audiologic changes after pinna augmentation

August 21, 2016  |  Kavit Amin, MBBS, BSc(Hons), MRCS(Eng); Robert Hone, MBBS, MRCS; Rahul Kanegaonkar, BSc, DLO, FRCS(ORL-HNS)


No studies to date have objectively assessed whether pinna morphology affects sound intensity detected within the external auditory canal (EAC). Commonly performed procedures on the EAC are carried out for acquired and congenital pathology, together with correction of ear deformities. Our aim was to use an experimental model to identify whether a relationship exists between pinna shape and its subsequent effect on the hearing subject. An anatomically accurate and life-size model made of rubber composite was used for this study. Serial sections (small wedge, defect open; small wedge, defect closed; large wedge, defect open; large wedge, defect closed [equivalent to a protruding ear]; and pinnectomy) were undertaken, and the sound intensity changes assessed at the junction between the EAC and middle ear (tympanic membrane position) using an AURICAL Plus (Otometrics; Taastrup, Denmark) sound processor. A statistically significant loss was demonstrated for wedge-excised models, which was greatest at 180° azimuth. This loss was significantly reduced when the wedge defects were closed. A statistically significant improvement was demonstrated in the protruding (“bat”) ear model compared with the normal ear at 0° azimuth. In this model, gain in sound intensity is adversely affected by pinna wedge resection. Because this change may be increased in those with protruding ears, this factor is important to consider for all cosmetic and noncosmetic operations to the pinna, and it supports the notion that the pinna is not a simple funnel.

Postoperative hypofunctioning of the thyroid gland after total laryngectomy

August 21, 2016  |  Sirshak Dutta, MS, DLO; Kaustuv Das Biswas, MS, DLO; Soumya Ghatak, MS; Dibakar Haldar, MD; Indranil Sen, MS; Ramanuj Sinha, MS, DNB


Primary laryngeal carcinoma is a common cancer, predominantly affecting males. Hypothyroidism is an undesirable sequela of both surgery and radiotherapy, the two most commonly used modalities of treatment. For advanced cases, standard treatment protocol includes total laryngectomy and neck dissection along with pre- or postoperative radiotherapy. Hemithyroidectomy is also routinely performed as an integral part of total laryngectomy. In the present study, assessment of the function of the remaining half of the thyroid gland has been done in cases of total laryngectomies in combination with uni- or bilateral neck dissection and pre- or postoperative radiotherapy. This prospective, observational study was carried out for a period of 5 years in the Otolaryngology Department of R.G. Kar Medical College and Hospital, Kolkata, India, involving a dynamic cohort of patients with advanced laryngeal carcinoma (stage T3 or T4a) who underwent total laryngectomy (including hemithyroidectomy) and bilateral or unilateral neck dissection for primary laryngeal cancer along with preoperative and postoperative radiotherapy. Assessment of the thyroid function was based on the measurement of serum thyroid-stimulating hormone and free thyroxine levels. The results revealed that 23.8%, 45.2%, and 73.8% patients developed either clinical or subclinical hypothyroid state at 6, 12, and 24 weeks, respectively, after the surgery. The estimation of relative risk (RR) was found to be most prominent among the group belonging to the “preoperative radiation with bilateral neck dissection” group at all levels of assessments, but all of the RRs were found to be insignificant per their 95% confidence intervals. Superiority of any method could not be established or refuted firmly due to the small sample size of the study. We presume that in the future, a study with a larger sample size, involving a meta-analysis of multicentric data, would be the most suitable method to throw some light on this issue.

Vocal fold granulomas

August 21, 2016  |  Helen Lesser, BS; Amy Rutt, DO; Robert T. Sataloff, MD, DMA, FACS

Occasionally, even after excellent reflux control, surgical removal and steroid injection into the base of the granulomas, application of mitomycin C, and voice therapy, patients develop recurrent granulomas.