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Lichen nitidus on the dorsal tongue

April 30, 2016  |  Pedro Costa de Araujo, MD; Jerome R. Lechien, MD

This relatively uncommon, asymptomatic, idiopathic inflammatory eruption is usually found on the abdomen, pelvic area, or extremities, but rarely on the tongue.

Cervical disc herniation causing difficulty swallowing

April 30, 2016  |  Sheng-Yao Cheng, MD; Jih-Chin Lee, MD

Anterior cervical disc herniation is relatively rare and is usually asymptomatic until a certain degree of hypopharyngeal and esophageal compression leads to dysphagia.

Pneumocephalus after insertion of an inflatable nasal tampon for the management of epistaxis

April 30, 2016  |  Adam J. Kimple, MD, PhD; Michael O. Ferguson, MD


While the fundamental principles of epistaxis management have not changed over the decades, the methods by which tamponade is achieved have been evolving. Inflatable nasal tampons are being used and seen with increasing frequency in our ENT clinic. They are usually placed by emergency department personnel, who then refer patients to our clinic for removal. The classically described complications of nasal packs are induction of the nasopulmonary reflex, toxic shock syndrome, and discomfort. In this article, we describe a case of pneumocephalus following placement of an inflatable nasal tampon. To the best of our knowledge, this is the first report of pneumocephalus after placement of an inflatable nasal tampon.

Efficacy of allograft fascia lata in tympanic membrane repair

April 30, 2016  |  Ashley O'Connell Forster, MD; Joel Jones, MD; John Davis, AuD; Brittany Weber, MD; Mary Hawkshaw, RN, BSN, CORLN; Robert T. Sataloff, MD, DMA, FACS


We conducted a retrospective study to determine the efficacy of allograft fascia lata in both primary and revision tympanic membrane surgery (myringoplasty). Our patient population included 64 patients-31 men and 33 women, aged 19 to 98 years (mean: 49.5)-who had undergone tympanic membrane surgery with allograft fascia lata. Patients were grouped according to whether they had undergone primary surgery (n = 47) or revision surgery (n = 17). Data were compiled at preoperative and immediate postoperative visits, as well as at 3, 6, 9, and 12 months postoperatively. Residual perforations were defined as those present for less than 6 weeks postoperatively, and recurrent perforations were defined as those that occurred more than 6 weeks postoperatively. A residual perforation was found in only 1 patient (1.6%), a primary surgery patient. Recurrent perforations were found in 8 of the 64 patients (12.5%), including 5 in the primary group (10.6%) and 3 in the revision group (17.6%). We conclude that allograft fascia lata is a comparable alternative to other graft materials for performing myringoplasty.

Commentary on "The aging physician and surgeon" by Sataloff et al

April 30, 2016  |  Richard V. Homan, MD

Is unenhanced 18F-FDG-PET/CT better than enhanced CT in the detection of retropharyngeal lymph node metastasis in nasopharyngeal carcinoma?

April 30, 2016  |  Iuan-Sheng Wu, MD; Guang-Uei Hung, MD; Bo-Ling Chang, MD; Chi-Kuang Liu, MD; Tung-Hao Chang, MD; Hong-Shen Lee, PhD; Mu-Kuan Chen, MD, MS, PhD


Positron-emission tomography/computed tomography (PET/CT) has been proposed as a means to enhance the pretreatment evaluation of cervical lymph node status in patients with nasopharyngeal carcinoma (NPC). We conducted a prospective study to compare PET/CT and enhanced CT for the detection of retropharyngeal lymph node (RLN) metastasis in NPC, and to ascertain the factors that affect its diagnostic performance. Our study population was made up of 33 patients-24 men and 9 women, aged 30 to 81 years (mean: 52)-with newly diagnosed NPC who had been treated over a 2-year period. All patients underwent enhanced CT first, followed by unenhanced 18F-fluorodeoxyglucose (FDG) PET/CT. The detection rate of RLN metastasis on PET/CT was significantly lower than that on enhanced CT (36.4 vs. 75.8%; p < 0.001). A total of 25 of 26 nodes with a discordant finding were negative on PET/CT; they included 13 metastatic lymph nodes with low FDG uptake, 9 that were located close to the primary tumor, 2 that were confluent RLNs, and 1 that was adjacent to the physiologic FDG-avid prevertebral muscle. The maximum standardized uptake value (SUVmax) of RLNs was positively correlated with the minimum axial diameter (r = 0.803, p < 0.001). The PET/CT detection rate was 0% for lymph nodes smaller than 5 mm, 9% for those 5 to 10 mm, and 73% for those 1 cm or larger. The detection rate of PET/CT at level C1 was significantly lower than that at C2 (22 vs. 67%; p = 0.035). We conclude that unenhanced PET/CT is markedly inferior to enhanced CT for detecting RLN metastasis in NPC, especially in lymph nodes with a minimum axial diameter of less than 1 cm and those in proximity to the primary tumor. Using enhanced CT in PET/CT is justified to improve the recognition of RLN metastasis in patients with NPC.

Effectiveness of steroid injections for bamboo nodules: A case report

April 30, 2016  |  Mitsuyoshi Imaizumi, MD, PhD; Yasuhiro Tada, MD; Wataru Okano, MD; Akiko Tani, MD; Koichi Omori, MD


Vocal nodules are generally caused by vocal abuse, and conservative treatments such as voice therapy have been advocated as a first-choice treatment for vocal nodules. Reports of vocal fold lesions related to autoimmune diseases, such as bamboo nodules, are rare in the literature. Here we report a very rare case of bamboo nodules in a 30-year-old woman treated by steroid injection into the vocal folds by videoendoscopic laryngeal surgery in an outpatient setting. She was successfully treated without further recurrence. This report indicates that a steroid injection into bamboo nodules might be a useful treatment option, especially in patients who have not shown any improvement after conservative treatments.

The rare fourth branchial cleft anomaly

April 30, 2016  |  Jonathan A. Harounian, MD; David Goldenberg, MD; Jason G. May, MD

The treatment for fourth branchial anomalies is complete surgical excision because of the risk of infection and life-threatening abscesses.

Nasal polyp with osseous metaplasia

April 30, 2016  |  Jacky Wai-Kei Lam, MBBS(HK), FHKCORL, FHKAM(ORL); Leah Lai Lau, MBBS(HK)

The differential diagnosis of sinonasal pathologies with highly radiodense materials includes rhinolith, mycetoma, inverted papilloma with calcifications, chondrosarcoma, osteosarcoma, and fibro-osseous lesions.

Primary NK/T-cell lymphoma of the larynx: Report of 2 cases and review of the English-, Japanese-, and Chinese-language literature

April 30, 2016  |  Su-Yu Zhu, MD; Yuan Yuan, MD; Ke Liu, MD, MSc; Liang Zeng, MD, PhD; Ju-Mei Zhou, MD, PhD; Qiong-Hui Lu, MD; Zai-Jie Huang, MD


Natural killer/T (NK/T) -cell lymphoma in the larynx is extremely rare, as only 29 cases have been previously reported in the English-language, Japanese-language, and Chinese-language literature. Its characteristics have never been systematically illustrated. We report 2 new cases of laryngeal NK/T-cell lymphoma, and we discuss the process of the diagnosis of this disease, the choice of treatment, and treatment outcomes. We also summarize all 31 cases reported thus far. Symptoms of laryngeal NK/T-cell lymphoma are difficult to differentiate from those of other laryngeal diseases. The most common laryngeal subsite in the reported cases was the supraglottis, and roughly one-third of these cases involved the cervical lymph nodes. Because of our limited experience with this disease and the difficulties encountered in interpreting the pathologic findings, most patients required multiple biopsies over a few months before their diagnosis was confirmed. The outcome of treatment was generally poor. Radiotherapy, alone or combined with chemotherapy, was superior to chemotherapy alone in treating this disease in its early stages. In view of the frequency of local lymph node metastasis, irradiation fields should cover the entire cervical area. We believe that prompt diagnosis and treatment with radiotherapy are both critical to improving survival for patients with laryngeal NK/T-cell lymphoma.