Globus sensation and laryngopharyngeal reflux

October 30, 2015     Michael J. Knabel, BS; Jonathan M. Bock, MD, FACS

Some study results have suggested that psychological factors such as depression and anxiety can influence the etiology of globus.

A 61-year-old man was evaluated for a 2-month history of globus sensation and throat irritation. He also complained of daily reflux and heartburn that had not responded to ranitidine therapy; to that point, he had not tried a proton-pump inhibitor (PPI). He described a feeling of food sticking in his chest while eating, which he often cleared...

Laryngeal neuromas in a case of multiple endocrine neoplasia type 2B

October 30, 2015     Stanley W. McClurg, MD; Paul E. Wakely Jr., MD; Eugene G. Chio, MD


Mucosal neuromas of the larynx in the setting of multiple endocrine neoplasia type 2B (MEN-2B) are extremely rare; to the best of our knowledge, only 2 other cases have been previously reported in the world literature. We describe a new case, which occurred in a 30-year old woman who presented with dysphagia, dysphonia, and cough. On examination, she was found to have multiple laryngeal mucosal neuromas throughout the glottis and supraglottis. She underwent surgical resection of these lesions with resolution of her symptoms.

Introduction Multiple endocrine neoplasia type 2B (MEN-2B) is an autosomal dominant syndrome that is commonly associated with medullary thyroid carcinoma (MTC), pheochromocytoma, marfanoid habitus, and mucosal neuromas. These mucosal neuromas commonly occur on the lips, tongue, and buccal mucosa of patients with MEN-2B; only rarely do they affect...

An unusual presentation of a lingual dermoid cyst

October 30, 2015     Megan L. Durr, MD; Annemieke van Zante, MD, PhD; Steven D. Pletcher, MD


Dermoid cysts are rare lesions of the head and neck that usually present in children as an asymptomatic, slowly growing mass. We report a case that demonstrates that dermoid cysts can present later in life as a recurrent acute infection. Our patient was a 48-year-old man with a 22-year history of recurrent abscesses of the tongue and floor of the mouth that had required a tracheotomy and multiple hospitalizations. Magnetic resonance imaging performed between acute episodes revealed the presence of a 1.8-cm lesion within the tongue musculature. The patient underwent resection, and pathology was consistent with a lingual dermoid cyst. At 2 years of follow-up, he experienced no recurrence of symptoms.

Introduction Dermoid cysts are rare benign lesions that are found throughout the body. Approximately 7% of all dermoid cysts occur in the head and neck, and 1.6% occur in the oral cavity.1,2 The floor of the mouth is the most common site involved in the oral cavity; dermoid cysts have also been reported in the tongue, lips, and buccal mucosa.3

Endoscopic view of a total ethmoidectomy prior to the FESS era

October 30, 2015     Eiji Yanagisawa, MD, FACS; Dewey A. Christmas, MD; Joseph P. Mirante, MD, FACS

Before the development of functional endoscopic sinus surgery (FESS), total intranasal ethmoidectomy was performed without the aid of telescopes.

Langerhans cell histiocytosis involving the external auditory canal: An unusual ear tumor

October 30, 2015     Kang-Wei Fan, MD; Cheng-Chien Yang, MD; Chia-I Chou, MD; Min-Tsan Shu, MD

Langerhans cell histiocytosis has an unpredictable natural history, which ranges from rapidly fatal progressive disease to spontaneous resolution.

A 10-year-old boy presented to our clinic with a 1-month history of left postauricular pain accompanied by otorrhea. On physical examination, left mastoid tenderness was noted. Otoscopic examination revealed that a soft-tissue mass with a smooth surface was occupying the entire external auditory canal, and a stalk was adhering to the posterior...

Noninvasive intraoperative angiography for reconstruction of head and neck defects

October 30, 2015     Shiva P. Daram, MD; Justin M. Sacks, MD; Michael E. Kupferman, MD


Reconstruction of head and neck defects after cancer resection involves the use of local, pedicled musculocutaneous, and free flaps. Flap failure is often caused by vascular insufficiency, and it is associated with the presence of cardiovascular or peripheral vascular disease, a history of smoking, and previous radiation and/or surgery. Failure rates may be reduced by the use of indocyanine green near-infrared fluorescence laser angiography, which detects perfusion deficits intraoperatively. Although this technology has been validated in other fields, there is limited experience in the head and neck region. We present 3 cases in which different head and neck flaps were used along with this technology in patients at high risk for flap failure. All flaps were successfully implanted without perioperative or long-term complications. The increasing complexity, age, and comorbidities of the head and neck cancer population pose significant reconstructive challenges. This report demonstrates the feasibility of employing intraoperative angiography for local, pedicled, and free flaps. This noninvasive tool optimizes intraoperative planning and assesses viability, potentially lowering failure rates in high-risk patients. Identification of patients who most benefit from this technology warrants further investigation.

Introduction Surgical resection of locally advanced head and neck cancers frequently leads to soft-tissue and bony defects, resulting in both cosmetic and functional impairments. Placement of local flaps, pedicled fascio- and musculocutaneous flaps, and microsurgical free flaps has become the standard of care for managing such deficits.

Unusual primary tumors presenting as papillary carcinomas metastatic to the neck

October 30, 2015     Agnes Dupret-Bories, MD, PhD; Marc Wilt, MD; Pierre Kennel, MD; Anne Charpiot, MD, PhD; Jean-Francois Rodier, MD, FACS


The presence of a metastatic papillary carcinoma in the neck is presumptive evidence of a primary thyroid neoplasm since neck metastases of other primary tumors are uncommon. Immunohistochemical studies may be required to diagnose these metastases. We report 2 cases in which an unrelated tumor mimicked a thyroid malignancy. Both patients had been referred for evaluation of enlarged lymph neck nodes without any other symptoms. In both cases, a lymph node biopsy identified a metastatic papillary adenocarcinoma that was believed to be consistent with a thyroid primary. Thyroidectomy was not performed in either case. Further investigations led to the diagnosis of other primary tumors that were unrelated to the thyroid; the unrelated primaries were an ovarian serous tumor in one patient and a papillary renal cell carcinoma in the other.

An imaging study of the facial nerve canal in congenital aural atresia

October 30, 2015     Shouqin Zhao, PhD; Demin Han, PhD; Zhenchang Wang, PhD; Jie Li, MD; Yanni Qian, MD; Yuanyuan Ren, MD; Jiyong Dong, MD


We conducted a prospective study to investigate the abnormalities of the facial nerve canal in patients with congenital aural atresia by computed tomography (CT). Our study population was made up of 99 patients-68 males and 31 females, aged 6 to 22 years (mean: 13.5)-who had unilateral congenital aural atresia without any inner ear malformations. We compared our findings in these patients with those in 50 controls-33 males and 17 females, aged 5 to 22 years (mean: 15.0)-who had normal ears. We classified the congenital aural atresia patients into three groups (A, B, and C) according to their Jahrsdoerfer grading scale score (≥8; 6 or 7; and ≤5, respectively). The course of the facial nerve canal in both the controls and the study patients was determined by temporal bone CT with multiplanar reconstruction. The distances from different parts of the facial nerve canal to surrounding structures were also measured. The course of the facial nerve canal in the normal ears did not vary much, and there were no statistically significant differences according to head side and sex. In groups B and C, the tympanic segment, mastoid segment, and angle of the second genu of the facial nerve canal were all significantly smaller than those of the controls (p < 0.01 in all cases). Statistically, the tympanic segment of the facial nerve canal in patients with congenital aural atresia was downwardly displaced. The mastoid segment of the facial nerve canal in these patients was more anterior than that of the controls. We conclude that congenital aural atresia is often accompanied by abnormalities of the facial nerve canal, especially in the tympanic segment, the mastoid segment, and the second genu. We found that the lower the Jahrsdoerfer score was, the shorter the tympanic segment was and the more forward the mastoid segment was.

Introduction The incidence of facial nerve canal malformation in congenital aural atresia is high, and the development of the temporal bone tends to be poor. The risks of surgery are accordingly increased. So far, there exist no sufficiently complete data about facial nerve canal malformation that can function as reference data. Funding/support:...

A hyperpneumatized frontal sinus with middle meatal obstruction

October 30, 2015     Dewey A. Christmas, MD; Joseph P. Mirante, MD, FACS; Eiji Yanagisawa, MD, FACS

In this case, the narrowing of the middle meatus by the hypertrophic polypoid middle turbinate resulted in intermittent frontal sinusitis and headaches.

A 40-year-old man presented with a history of recurrent right frontal headaches and right nasal congestion. He had been treated medically numerous times for sinusitis and had used intranasal steroid sprays. Sinus computed tomography (CT) revealed a hyperpneumatized right frontal sinus (figure, A). An endoscopic nasal exam showed a hypertrophic,...

Laryngofissure for resection of a recurrent saccular cyst

October 30, 2015     Reed C. Gilbow, BS; J. Mark Reed, MD; Jeffrey D. Carron, MD

Congenital saccular cysts represent a rare cause of airway obstruction and inspiratory stridor in infants.

A 5-year-old girl was brought to us for evaluation of hoarseness and noisy breathing of 2 weeks' duration. Her history included three previous endoscopic procedures at another institution. The first two of those procedures had involved laser marsupialization, and the third involved direct laryngoscopy with an attempted removal of the cyst. At...
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