Masseter flap for reconstruction of defects after excision of buccal mucosa cancers with intact mandible

October 30, 2015     Pankaj Chaturvedi, MS; Sandeep Lerra, MS(ENT); Farheen Ustad, MS; Prathamesh S. Pai, MS(ENT); Devendra A. Chaukar, MS; Anil K. D'Cruz, MS


Among the reconstructive options available for buccal mucosa defects with an intact mandible, free flap with microvascular anastomosis is the best option. However, in the developing world, with poor resources, limited infrastructure, and high patient load, this cannot be offered to all patients. We report on the success of the masseter flap for reconstruction of such defects in carefully selected patients. Despite some known limitations, this flap is easy to learn and carries acceptable complications. The results of this flap may not be comparable to those of microvascular reconstructions, but they are better than those from other options such as skin graft, nasolabial flap, submental flap, etc., in terms of surgical time required, no donor site morbidity, and minimal aesthetic deformity.

Laryngeal neurofibroma

October 30, 2015     Andreas Anagiotos, MD; Dirk Beutner, MD

Neurofibromas are rarely seen in the larynx. Common symptoms are stridor, hoarseness, dysphagia, dysphonia, and globus sensation.

A 72-year-old woman was referred to our department for evaluation of a laryngeal lesion that had been detected incidentally during a routine ENT examination. The patient denied hoarseness, dyspnea, and dysphagia. The laryngologic examination found a solid mass in the interarytenoid area; the lesion protruded into the laryngeal lumen and was...

Angiolymphoid hyperplasia with eosinophilia

October 30, 2015     Lester D. Thompson, MD

Angiolymphoid hyperplasia with eosinophilia (ALHE) is a benign vascular tumor that features immature blood vessels lined by epithelioid endothelial cells with a prominent inflammatory infiltrate, frequently showing a conspicuous eosinophil component.

Angiolymphoid hyperplasia with eosinophilia (ALHE), sometimes called epithelioid hemangioma, is a benign vascular tumor. It features immature blood vessels lined by epithelioid endothelial cells with a prominent inflammatory infiltrate, frequently showing a conspicuous eosinophil component. There is controversy about whether this lesion is a...

Laryngeal tuberculosis: A public health concern

October 30, 2015     Matthew B. Zavod, MD, FACS

Physical examination findings in patients with laryngeal tuberculosis vary, but they can include edema, hyperemia, nodularity, ulcerations, exophytic mass, and obliteration of anatomic landmarks.

Vascular malformation with phleboliths involving the parotid gland: A case report with a review of the literature

October 30, 2015     Caleb Ho, MD; Benjamin L. Judson, MD; Manju L. Prasad, MD


Phleboliths within the parotid gland are exceedingly rare. We report a case of a venous malformation with multiple phleboliths that involved the left parotid gland and extended into the extraparotid tissue in a 43-year-old woman. We also review 13 similar cases that have been reported since 1948, and we highlight the significance of distinguishing phleboliths from sialoliths because management of the two can be entirely different. Phleboliths in and around the salivary glands primarily affect the parotid and submandibular glands in adult women. Patients can present with recurrent, intermittent swelling that may be associated with food intake and hyposalivation. Any sialolithiasis located outside of its most common location in the submandibular glands must be investigated thoroughly before surgery.

Introduction Obstruction of salivary gland ducts that results in gland enlargement and inflammation is a common problem frequently caused by intraductal sialoliths, mucous plugs, and strictures.1 In rare cases, venous vascular malformations with phleboliths resemble sialolithiasis clinically and radiologically, leading to a considerable...

Comparison of SPECT/CT and planar MIBI in terms of operating time and cost in the surgical management of primary hyperparathyroidism

October 30, 2015     Dhave Setabutr, MD; Kavita Vakharia, MD; Stephen J. Nogan, MD; George N. Kamel, MD; Thomas Allen, MD; Brian D. Saunders, MD; David Goldenberg, MD


We conducted a retrospective study to compare operating times and costs in patients who underwent guided parathyroidectomies with either (1) technetium-99m (99mTc) multiplex ion-beam imaging (MIBI) parathyroid scintigraphy with single-photon emission computed tomography/computed tomography (SPECT/CT) fusion images or (2) sestamibi dual-phase 99mTc MIBI planar parathyroid scintigraphy alone preoperatively. Our study population was made up of the first 24 patients at our facility who had undergone SPECT/CT parathyroid imaging with technetium-99m (99mTc) MIBI and a group of 24 patients who had undergone MIBI planar imaging alone. Patient demographics, preoperative laboratory test results, operating times, and hospital charges were analyzed. We found that less operating time was required for the planar MIBI group than in the SPECT/CT group (mean: 135 vs. 158 min), although the difference was not statistically significant. Likewise, the total cost of treatment was lower in the planar MIBI group (mean: $10,035 vs. $11,592); the difference was statistically significant by one measure (p x 0.02, Wilcoxon rank sum test) but not by another (p x 0.06, Student t test). Although SPECT/CT is efficient for patients with small and difficult-to-localize adenomas, it has yet to demonstrate greater efficacy or cost-effectiveness than planar MIBI for routine parathyroidectomy in patients with primary hyperparathyroidism when an easily identifiable parathyroid adenoma is localized.

Introduction Primary hyperparathyroidism remains the third most common endocrine disorder, as approximately 1 in 500 women and 1 in 2,000 men are affected.1 The disease is seen with increasing age; the peak incidence occurs in patients in their fifth through seventh decades of life, and its highest incidence is in postmenopausal women.2 The most...

Inferior turbinate augmentation with auricular cartilage for the treatment of empty nose syndrome

October 30, 2015     Angela A. Chang, MD; Deborah Watson, MD


Empty nose syndrome (ENS) is a potential complication of excessive resection of turbinate tissue. Patients with ENS complain of nasal obstruction despite a widely patent nasal cavity. Various implants, including autologous bone and biomaterials, have been used to reduce the width of the nasal cavity. Implantation of these grafts, however, has been limited by extrusion, infection, and resorption. We introduce a novel surgical technique that uses autologous auricular cartilage to augment the turbinate and to restore the natural airflow patterns of the nasal cavity. We present a representative case of ENS caused by excessive inferior turbinate reduction that was improved by turbinate augmentation with autologous auricular cartilage.

Introduction Empty nose syndrome (ENS) is a chronic, debilitating condition characterized by paradoxical nasal obstruction in a patient with a widely patent nasal cavity.1 It has been described as an iatrogenic form of atrophic rhinitis, consisting of a constellation of symptoms including nasal congestion, crust formation, and sometimes pain....

Pitfalls in imaging the submandibular glands with PET/CT

October 30, 2015     Enrique Palacios, MD, FACR; Michael Ellis, MD, FACS; Edward C. Lam, MD; Harold Neitzschman, MD, FACR, FACNM; Morgan Haile, MD


Imaging of the submandibular glands can provide vital information about malignant neoplastic processes. One of these modalities, fluorine-18 fluorodeoxyglucose-positron-emission tomography/computed tomography (FDG-PET/CT), has become very important in the detection of malignancies because it provides functional and metabolic information as well as anatomic localization. However, there are several pitfalls associated with FDG-PET/CT in terms of salivary gland imaging. For example, a normal increase in the uptake of radiotracer might be mistaken for a neoplastic process. Other routine findings may include normal physiologic uptake in some structures, benign tumors and medical conditions, and iatrogenic abnormalities. We review a case in which compensatory hypertrophy of a submandibular gland was suspected to be a possible malignancy.

Introduction Positron emission tomography (PET) with fluorine-18 fluorodeoxyglucose (FDG) is widely used in the diagnosis of oncologic abnormalities. It provides metabolic information not available in other imaging modalities. FDG is a glucose analogue that is taken up into all metabolically active cells and becomes trapped within the cells after...

An intrathyroidal thyroglossal duct cyst

October 30, 2015     Robert Saadi, BS; David Goldenberg, MD, FACS

Thyroglossal duct cysts  are classically midline, associated with the hyoid bone, move with swallowing or tongue protrusion, and often initially present with some degree of inflammation.

A previously healthy 48-year-old man presented with a painless midline neck mass. He was found to have a 1-cm, round, soft, and mobile mass located in the thyroid gland isthmus that elevated with swallowing and tongue protrusion. An ultrasound revealed a round, cystic lesion protruding from the right aspect of the thyroid isthmus.

Soft palate mass

October 30, 2015     Evan Longfield, MD; Matthew W. Stark, MD; Anita Jeyakumar, MD, FACS

Although pleomorphic adenomas are mostly benign, they have the potential to grow very large yet remain asymptomatic.

An 8-year-old girl presented with an incidentally discovered mass in her palate. She denied any dysphagia, hemoptysis, dyspnea, fevers, or weight loss. She had some new-onset snoring. Her medical history was unremarkable; she had no history of surgeries or hospitalizations. She was born full-term and was very healthy. The mass was noted to be...
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