Common carotid artery dissection: A rare cause of acute neck swelling

March 2, 2015     Muhammad Adil Abbas Khan, MBBS, MRCS, DOHNS, FCPS(Plast); Alasdair Moffat, MBBS; Waseem Ahmed, MBBS, MRCS, DOHNS; Julian Wong, MBBS, FRCS(Vasc); Changez Jadun, MBBS, FRCR
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Abstract

Spontaneous carotid artery dissection is a rare condition with potentially devastating consequences. Internal carotid artery and vertebral artery dissections have been implicated as the cause of 20% of strokes occurring in patients younger than 45 years. We describe a very rare case of a nontraumatic common carotid artery dissection in a 45-year-old man that was initially misdiagnosed as a sternocleidomastoid hematoma. This case highlights the need for vigilance for this often-missed diagnosis, as well as the indication for noninvasive imaging in unidentified neck swellings.

Introduction Dissections of the carotid artery are rare. Studies have shown that the annual incidence ranges from 2.5 to 3 per 100,000 population.1 They are most common in the fifth decade of life.2

Streamlined bilateral otologic surgery: How I do it

March 2, 2015     Tara E. Brennan, MD; Miriam I. Redleaf, MD
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Abstract

Bilateral simultaneous otologic surgery is being performed more commonly among otologists. The benefits of performing bilateral simultaneous cochlear implants in the pediatric population, in particular, have become increasingly recognized as the safety and efficacy of this operation have been recognized in the literature. Here we present a streamlined method of performing bilateral simultaneous otologic surgery that emphasizes midline placement of facial nerve electrodes and a method of sterile preparation and draping that affords direct exposure to both ears at one time, without the need to turn the head or adjust the drapes multiple times throughout the operation. Our approach facilitates frequent and efficient alternation between ears throughout the operation, optimizing efficiency of motion and instrumentation for the surgeon, and reducing overall operative and general anesthesia time for the patient.

World Voice Day 2015

March 2, 2015     Robert T. Sataloff, MD, DMA, FACS, Editor-in-chief
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The 2015 theme is “Voice: The original social media.”

  World Voice Day 2015  

Previous gastric bypass surgery complicating total thyroidectomy

March 2, 2015     Bianca Alfonso, MD; Adam S. Jacobson, MD; Eran E. Alon, MD; Michael A. Via, MD
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Abstract

Hypocalcemia is a well-known complication of total thyroidectomy. Patients who have previously undergone gastric bypass surgery may be at increased risk of hypocalcemia due to gastrointestinal malabsorption, secondary hyperparathyroidism, and an underlying vitamin D deficiency. We present the case of a 58-year-old woman who underwent a total thyroidectomy for the follicular variant of papillary thyroid carcinoma. Her history included Roux-en-Y gastric bypass surgery. Following the thyroid surgery, she developed postoperative hypocalcemia that required large doses of oral calcium carbonate (7.5 g/day), oral calcitriol (up to 4 μg/day), intravenous calcium gluconate (2.0 g/day), calcium citrate (2.0 g/day), and ergocalciferol (50,000 IU/day). Her serum calcium levels remained normal on this regimen after hospital discharge despite persistent hypoparathyroidism. Bariatric surgery patients who undergo thyroid surgery require aggressive supplementation to maintain normal serum calcium levels. Preoperative supplementation with calcium and vitamin D is strongly recommended.

Introduction Over the past decade, there has been an exponential increase in the number of bariatric surgical procedures performed worldwide. Approximately 200,000 bariatric surgeries are performed annually in the United States alone.1,2 Bariatric procedures are either restrictive, malabsorptive, or both (table 1). The most common procedure is...

Maxillary sinus cyst containing a bone chip

March 2, 2015     Jae-Hoon Lee, MD
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If bone fragments in the sinus can be removed, the patient's prognosis is usually excellent.

A 24-year-old woman presented for evaluation of a 5-month history of a persistent right-sided pressure sensation in her cheek. She denied any history of underlying systemic disease, relevant facial trauma, or sinus surgery. Nasal endoscopy found no evidence of disease, as no polyps or nasal masses were visible during the examination.

A case of solitary fibrous tumor arising from the palatine tonsil

March 2, 2015     Takeharu Kanazawa, MD, PhD; Kozue Kodama, MD; Mitsuhiro Nokubi, MD, PhD; Kazuo Gotsu, MD; Akihiro Shinnabe, MD; Masayo Hasegawa, MD; Gen Kusaka, MD, PhD; Yukiko Iino, MD, PhD
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Abstract

Solitary fibrous tumor (SFT) is a distinctive, relatively uncommon soft-tissue neoplasm that usually arises from the pleura. It occurs at various sites; head and neck lesions are very rare. While most of these tumors have a benign course, a small number have malignant potential. We describe a rare case of SFT arising from the left palatine tonsil in a 66-year-old Japanese woman. The mass was completely resected. Immunohistochemical studies were strongly positive for CD34 and bcl-2, mildly positive for phosphorylated protein kinase B and phosphorylated extracellular signal-regulated kinase 1/2, and negative for platelet-derived growth factor receptor alpha and p53. These findings suggested that this tumor was benign. The patient showed no evidence of recurrence during 2 years of follow-up. We believe that the candidate prognostic marker should be checked to distinguish malignant from benign SFTs.

Cochlear implantation leading to successful stapedectomy in the contralateral only-hearing ear

March 2, 2015     Samantha J. Mikals, MD; Gerald I. Schuchman, PhD; Joshua G.W. Bernstein, PhD; Arnaldo L. Rivera, MD
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Abstract

Cochlear implants have recently begun to be offered to patients with single-sided deafness (SSD). Implantation in these patients has led to good results in suppressing ipsilateral tinnitus and in providing audiologic benefits in terms of speech perception in noise and localization. One previously unreported benefit of cochlear implantation in patients with SSD is the restoration of functional hearing in the previously deaf ear, which may allow for surgical opportunities in the contralateral hearing ear. We report a case in which cochlear implantation in the deaf left ear of a 50-year-old man allowed for surgical intervention in the previously only-hearing right ear, which in turn led to the restoration of normal middle ear function. Further studies may be warranted to consider the surgical candidacy of the contralateral only-hearing ear as another potential indication for cochlear implantation in patients with SSD.

Septic arthritis of the temporomandibular joint caused by Aspergillus flavus infection as a complication of otitis externa

March 2, 2015     Lalee Varghese, MS, DLO, DNB; Rabin Chacko, MDS, FDS, FCPS; George M. Varghese, MD, DNB, DTMH; Anand Job, MS, DLO, MNAMS
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Abstract

Septic arthritis of the temporomandibular joint (TMJ) is a very rare complication of otitis externa that can lead to ankylosis and destruction of the joint. We report the case of a 74-year-old man who developed aspergillosis of the TMJ following otitis externa. To the best of our knowledge, this is the first reported case of TMJ septic arthritis secondary to otitis externa caused by Aspergillus flavus. The patient was successfully managed with condylectomy, debridement, and drug treatment with voriconazole.

Progression of autoimmune inner ear disease to labyrinthitis ossificans: Clinical and radiologic correlation

March 2, 2015     Jenn Nee Khoo, FRCR; Tiong Yong Tan, FRCR
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Abstract

We report the case of a 42-year-old man who presented with fluctuating bilateral sensorineural hearing loss that subsequently progressed to a complete hearing loss, and we describe the correlation between the clinical and radiologic features of this case. To the best of our knowledge, this is the first report to demonstrate imaging evidence of progression from autoimmune inner ear disease to labyrinthitis ossificans. This is also the first reported case of a reversal of a loss of labyrinthine CISS (constructive interference in a steady state) signal, suggesting that T2-weighted hyposignal may be attributable to an alteration in labyrinthine fluid content and not to fibrosis only.

Introduction Autoimmune inner ear disease (AIED) is a known cause of sensorineural hearing loss (SNHL) that often progresses to irreversible hearing loss. In this report, we present the clinical and radiologic features in the progression of AIED to labyrinthitis ossificans over a period of more than 10 years, and we discuss the implications of...

Metastatic breast carcinoma presenting as unilateral pulsatile tinnitus: A case report

February 2, 2015     Andrew Moore, MRCS, DOHNS; Max Cunnane, BMBS, BMedSci; Jason C. Fleming, MRCS, DOHNS, MEd
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Abstract

Pulsatile tinnitus is a rare symptom, yet it may herald life-threatening pathology in the absence of other symptoms or signs. Pulsatile tinnitus tends to imply a vascular cause, but metastatic disease also can present in this way. Clinicians should therefore adopt a specific diagnostic algorithm for pulsatile tinnitus and always consider the possibility of metastatic disease. A history of malignant disease and new cranial nerve palsies should raise clinical suspicion for skull base metastases. We describe the case of a 63-year-old woman presenting with unilateral subjective pulsatile tinnitus and a middle ear mass visible on otoscopy. Her background included the diagnosis of idiopathic unilateral vagal and hypoglossal nerve palsies 4 years previously, with normal magnetic resonance imaging (MRI). Repeat MRI and computed tomography imaging were consistent with metastatic breast carcinoma. This case raises important questions about imaging protocols and the role of serial scanning in patients at high risk of metastatic disease.

Introduction Tinnitus can be defined broadly as the perception of sound when there is no external stimulus. It is possible to further categorize tinnitus as to whether it is unilateral or bilateral and whether it is subjective or objective, or by the quality of the perceived sound.
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