Sinonasal tract mucosal melanoma

October 17, 2014     Lester D.R. Thompson, MD
article

Patients with obstructive symptoms, multiple sites of involvement, tumors of 3 cm or larger, an undifferentiated tumor on histology, a high mitotic count, and an elevated stage are more likely to have a poor prognosis.

Mucosal melanoma is a neural-crest-derived neoplasm that originates in melanocytes and demonstrates melanocytic differentiation. Exposure to formalin and ultraviolet light are known etiologic factors; another possible factor is exposure to radiation. Approximately 15 to 20% of all skin melanomas develop on the head and neck, but less than 1% of...

Mucormycosis (Mucor fungus ball) of the maxillary sinus

October 17, 2014     Hang Sun Cho, MD; Hoon Shik Yang, MD, PhD; Kyung Soo Kim, MD, PhD
article

Abstract

A fungus ball is an extramucosal fungal proliferation that completely fills one or more paranasal sinuses and usually occurs as a unilateral infection. It is mainly caused by Aspergillus spp in an immunocompetent host, but some cases of paranasal fungal balls reportedly have been caused by Mucor spp. A Mucor fungus ball is usually found in the maxillary sinus and/or the sphenoid sinus and may be black in color. Patients with mucormycosis, or a Mucor fungal ball infection, usually present with facial pain or headache. On computed tomography, there are no pathognomonic findings that are conclusive for a diagnosis of mucormycosis. In this article we report a case of mucormycosis in a 56-year-old woman and provide a comprehensive review of the literature on the “Mucor fungus ball.” To the best of our knowledge, 5 case reports (8 patients) have been published in which the fungus ball was thought to be caused by Mucor spp.

Transoral approach to a deep-lobe parotid tumor

October 17, 2014     Lyndon Gonzalez, BS; Alex Fernandez, MS; Belinda Mantle, MD
article

Because of their location in this potential space, parapharyngeal tumors tend to be asymptomatic and remain undetected for a long time.

Neoplasms within the parapharyngeal space are rare, accounting for only 0.5% of all malignant head and neck tumors.1 Some 70 to 80% of all parapharyngeal-space tumors are benign; one-third of the benign tumors are pleomorphic adenomas that arise from the deep lobe of the parotid gland.2

Complete second branchial cleft anomaly presenting as a fistula and a tonsillar cyst: An interesting congenital anomaly

October 17, 2014     Prasad John Thottam, DO; Samba S. Bathula, MD; Janet M. Poulik, MD; David N. Madgy, DO
article

Abstract

Branchial cleft anomalies make up 30% of all pediatric neck masses, but complete second branchial cleft anomalies are extremely rare. We report an unusual case of a complete second branchial cleft anomaly that presented as a draining neck fistula and a tonsillar cyst in an otherwise healthy 3-month-old girl. At the age of 7 months, the patient had been experiencing feeding difficulties, and there was increasing concern about the risk of persistent infections. At that point, the anomaly was excised in its entirety. Our suspicion that the patient had a complete second branchial cleft anomaly was confirmed by imaging, surgical excision, and histopathologic analysis.

Black thyroid

October 17, 2014     Darrin V. Bann, PhD; Neerav Goyal, MPH, MD; Henry Crist, MD; David Goldenberg, MD, FACS
article

Despite the benign impact of minocycline on thyroid function, several studies have reported an association between black thyroid and thyroid cancer.

A rare occurrence of a fungus ball in the sphenoethmoid recess

October 17, 2014     Jae-Hoon Lee, MD; Ha-Min Jeong, MD
article

A fungus ball usually appears as a calcification within the sinus, suggesting the presence of a foreign body.

A 70-year-old woman with purulent nasal discharge and postnasal drip was referred to our hospital. Although she had been on medication for 2 months, her condition had not improved. She had no history of notable facial trauma or nasal surgery, and her other medical conditions were noncontributory.

Lingual hamartoma associated with a cleft palate in a newborn

October 17, 2014     Opeyemi O. Daramola, MD; Mariko Suchi, MD, PhD; Robert H. Chun, MD
article

Abstract

A hamartoma is a benign malformation of native tissue that may occur in any area of the body. Hamartoma of the tongue is a rare developmental lesion. We describe the case of a pendulant lingual hamartoma in a 2-day-old girl that had not been identified on prenatal ultrasonography. We also review the utility of prenatal imaging options, the role of preoperative imaging, the mechanical relationship between lingual hamartoma and cleft palate, the histopathology of this tumor, surgical treatment, and emergency airway management.

Introduction A lingual hamartoma, first described by Stamm and Tauber1 in 1945, is a rare benign congenital malformation of the tongue. This growth is usually located on the posterior dorsal surface. A lingual hamartoma can be an isolated finding or occur with other signs as part of a syndrome. To provide optimal care, the physician must reach a...

Management of soft palate agenesis in Nager syndrome with an elongated, superiorly based pharyngeal flap

October 17, 2014     Oneida A. Arosarena, MD; Troy Hemme, DO
article

Abstract

Nager syndrome, or preaxial acrofacial dysostosis, is associated with aberrant development of the first and second branchial arch structures, as well as abnormal development of the limb buds. It is a rare disorder, and its clinical manifestations have not been completely defined. Absence of the soft palate has been reported in patients with Nager syndrome. In this report we describe the use of an elongated, superiorly based pharyngeal flap for the treatment of severe velopharyngeal insufficiency in a patient with Nager syndrome and absence of the soft palate. We also describe the dysmorphisms associated with Nager syndrome and present a differential diagnosis for the condition.

Primary laryngeal tuberculosis: An unusual cause of hoarseness

October 17, 2014     Peter Fsadni, MD, MRCP(UK); Claudia Fsadni, MD, MRCP(UK), MSc(Lond); Brendan Caruana Montaldo, MD, FACP
article

Abstract

Tuberculosis (TB) of the larynx is usually associated with concomitant pulmonary TB, but approximately 20% of cases represent primary disease. We report the case of an 85-year-old woman with asthma who presented with a 6-month history of persistent hoarseness. Bronchoscopy confirmed the presence of a lesion in the hemilarynx, and histology identified tuberculoid granulomas that were suggestive of TB. Treatment with a combination of isoniazid, rifampicin, pyrazinamide, and ethambutol led to a complete resolution of symptoms. A high index of suspicion for laryngeal TB is required in patients who present with hoarseness.

Introduction Most cases of laryngeal tuberculosis (TB) occur in association with pulmonary TB. However, approximately 20% of cases occur as isolated entities.1,2 We report a new case of primary laryngeal TB.

An unusual case of acute periorbital swelling

October 17, 2014     Sara Torretta, MD; Alessandra Brevi, MD; Davide Pagani, MD; Lorenzo Pignataro, MD
article

Abstract

Periorbital swelling is frequently encountered in ear, nose, and throat practices and, as it may be secondary to acute sinusitis, delayed diagnosis may lead to significant morbidity. We describe the case of a 24-year-old man with acute ethmoid-maxillary sinusitis and ipsilateral facial swelling particularly involving the periorbital area. We also discuss the workup that led to the formulation of an unusual diagnosis.

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