A case of myoepithelioma mimicking a parotid cyst

January 19, 2015     Haldun Onuralp Kamburoglu, MD, FEBOPRAS; Aycan U. Kayikcioglu, MD; Cigdem Himmetoglu, MD
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Abstract

Myoepithelioma is an uncommon tumor of the myoepithelial cells that is considered to represent a distinct category of tumor by the World Health Organization. It accounts for less than 1% of all tumors that develop in the salivary glands. We describe the case of a 35-year-old woman who presented to us with a painless swelling on the right side of her face. She was diagnosed with a parotid gland cyst by ultrasonography and computed tomography. Following excision of the mass, however, the pathology report identified the tumor as a solid myoepithelioma. To the best of our knowledge, this is the first reported case of a myoepithelioma that exhibited cystic features on radiologic examination even though it had a solid architecture. We also discuss the preoperative diagnostic aspects of the myoepitheliomas.

Introduction Myoepithelial cells are specialized basal epithelial cells that are found in the secretory endpieces and intercalated ducts of the normal exocrine glands, such as the salivary glands, respiratory tract glands, lacrimal glands, mammary glands, prostate glands, and sweat glands. Histologically, they are situated between basement...

A case of transient cortical blindness associated with hypercapnia as a result of extremely enlarged adenoid tissue

January 19, 2015     Baris Malbora, MD; Nihan Malbora, MD; Zekai Avci, MD; Asburce Olgac, MD; Alper Nabi Erkan, MD
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Abstract

Adenotonsillar hypertrophy is common among children, but it can lead to serious complications if left untreated. Among the well-known complications are obstructive sleep apnea syndrome, growth failure, cor pulmonale, and hypertension. One complication of adenotonsillar hypertrophy that has not been previously reported in the English-language literature is transient cortical blindness. We describe such a case, which occurred in a 6-year-old boy who presented with a sudden loss of vision and subsequent unconsciousness. He had experienced hypercapnia and was resuscitated via endotracheal tube ventilation. Laboratory and radiologic assessments found no pathology except for extremely enlarged adenoid tissue. Once the patient was stabilized, an urgent adenotonsillectomy was performed. The patient recovered well, and his vision and respiratory symptoms resolved. Severe hypertrophy of the adenoid tissue can cause hypercapnia and acidosis secondary to upper airway obstruction. The possibility of adenoid hypertrophy and hypercapnia should be kept in mind in cases of transient cortical blindness. Aggressive treatment, including early intubation and adenoidectomy, may lead to a rapid resolution of symptoms.

Metastatic squamous cell carcinoma of the tonsil presenting as otorrhea: A case report

January 19, 2015     Eelam Adil, MD; Dhave Setabutr, MD; Soha N. Ghossaini, MD; David Goldenberg, MD, FACS
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Abstract

We describe the case of a 52-year-old man with a history of squamous cell carcinoma (SCC) of the tonsil who presented with right subacute otalgia and otorrhea. Dedicated computed tomography of the temporal bones showed opacification within the mastoid process with destruction of bony mastoid septations consistent with coalescent mastoiditis. Preoperative imaging showed no destruction or expansion of the bony eustachian tube that would indicate that a direct spread had occurred. An urgent cortical mastoidectomy was performed. Intraoperatively, a friable white mass surrounded with purulence and granulation tissue was biopsied and returned as SCC. The discrete metastasis was removed without complication. Postoperatively, the patient was prescribed palliative chemotherapy. This case shows that a metastatic SCC can be masked by an overlying mastoiditis, and thus it should be considered in the differential diagnosis of a patient with a history of oropharyngeal cancer.

Introduction The incidence of oropharyngeal squamous cell carcinoma (SCC) in the United States is 11.18 per 100,000 population; the tonsil is the most common subsite within this region.1 Distant metastases are usually found in the lung or liver.2 We describe an unusual case of tonsillar cancer metastatic to the temporal bone.

Impact factor: What is it and is it still relevant?

January 19, 2015     David Goldenberg, MD, FACS; Neerav Goyal, MD, MPH
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There are many reasons to publish, publish in, and read medical journals. Some are intended to promulgate state-of-the-art research, others focus on practical clinical writings, and most present a combination of both. It is important for authors to choose journals that will not only reach the desired audience, but also have sufficient prestige to...

Reconstructive and rehabilitation challenges following a cranio-orbital gunshot wound

January 19, 2015     Sachin S. Pawar, MD; John S. Rhee, MD, MPH; Timothy S. Wells, MD
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Abstract

We present a case of a 26-year-old man who sustained a close-range gunshot wound to the head. His injuries included significant left orbital injury resulting in a ruptured, blind eye and severely comminuted fractures of the left orbital roof, superior and inferior orbital rims, and orbital floor. Associated injuries included left frontal lobe injury, anterior and posterior table fractures of the left frontal sinus, and a comminuted left zygomaticomaxillary complex fracture. We employed an interdisciplinary surgical approach with collaboration among the Otolaryngology, Neurosurgery, and Oculoplastic Surgery services performed in two stages. Management of such extensive craniofacial injuries can be challenging and requires a coordinated, interdisciplinary approach.

Group A beta streptococcal infections in children after oral or dental trauma: A case series of 5 patients

January 19, 2015     Brittany E. Goldberg, MD; Cecile G. Sulman, MD; Michael J. Chusid, MD
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Abstract

Group A streptococcus (GAS) produces a variety of disease processes in children. Severe invasive diseases such as necrotizing fasciitis can result. Traumatic dental injuries are common in the pediatric population, although the role of dental injuries in invasive GAS disease is not well characterized. In this article, we describe our retrospective series of 5 cases of GAS infection following oral or dental trauma in children.

Contralateral hearing loss after vestibular schwannoma excision: A rare complication of neurotologic surgery

January 19, 2015     Robert H. Deeb, MD; Jack P. Rock, MD; Michael D. Seidman, MD, FACS
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Abstract

We report a rare case of contralateral hearing loss after vestibular schwannoma excision in a 48-year-old man who underwent surgery via a suboccipital approach for removal of a nearly 2-cm lesion involving the right cerebellopontine angle. Postoperatively, the patient awoke with bilateral deafness, confirmed by both audiometry and spontaneous otoacoustic emissions. The patient was treated aggressively with high-dose intravenous steroids, vitamins E and C, and oxygen. Over the next several months he had gradual recovery of most of the hearing in his left (unoperated) ear. Contralateral hearing loss may develop after vestibular schwannoma excision; multiple pathophysiologic mechanisms for this occurrence have been proposed.

Introduction Contralateral hearing loss after vestibular schwannoma surgery is extremely uncommon. Although there are sporadic reports, a literature review reveals this occurrence to be quite rare. Possible explanations include compensatory endolymphatic hydrops, occlusion or vasospasm of the internal auditory artery, sympathetic...

Primary calcitonin-secreting neuroendocrine carcinoma of the supraglottic larynx

January 19, 2015     Arsheed H. Hakeem, MBBS, MS; Sultan Pradhan, MS, FRCS; Sanica Bhele, MD; Jagadish Tubachi, MS
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The most troubling differential diagnosis for calcitonin-secreting neuroendocrine carcinoma of the larynx is medullary carcinoma of the thyroid, as these two tumors can be morphologically indistinguishable.

Effect of low-level laser therapy in the treatment of cochlear tinnitus: A double-blind, placebo-controlled study

January 19, 2015     Mahboobeh Adami Dehkordi, MD; Sasan Einolghozati, MD; Seyyed Mohsen Ghasemi, PhD; Samaneh Abolbashari, MD; Mojtaba Meshkat, MSc; Hadi Behzad, MSc
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Abstract

Many treatments for chronic tinnitus have been attempted, but the condition remains difficult to cure, especially in the case of cochlear tinnitus. We conducted a prospective, double-blind, placebo-controlled study to assess the effect of low-dose laser therapy on chronic cochlear tinnitus. Our study population was made up of 66 patients-33 who received active laser treatment (case group) and 33 who received inactive dummy treatment (control group). Patients in the laser group received 5 mV with a wavelength of 650 nm for 20 minutes a day, 5 days a week, for 4 weeks. The controls followed the same schedule, but they were “treated” with an inactive device. The degree of tinnitus was evaluated before and after treatment in each group in three ways: (1) the Tinnitus Severity Index (TSI), (2) a subjective 10-point self-assessment scale for tinnitus loudness, and (3) the Tinnitus Evaluation Test (TET). At study's end, we found no statistically significant differences between the case and control groups in the number of patients who experienced a reduction in TSI values (p = 0.589) or a reduction in subjective self-assessment scores (p = 0.475). Nor did we find any significant reductions in the loudness (p = 0.665) and frequency (p = 0.396) of tinnitus as determined by the TET. We conclude that 5-mV laser therapy with a wavelength of 650 nm is no better than placebo for improving hearing thresholds overall or for treating tinnitus with regard to age, sex, environmental noise level, and the duration of tinnitus.

Cutaneous malignant melanoma metastatic to the sphenoid sinus

December 19, 2014     Silviu Albu, MD; Opincariu Iulian, MD; Sorin Necula, MD
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While metastases to the paranasal sinuses are unusual, metastases to the sphenoid sinus are exceedingly rare, especially metastases of a cutaneous melanoma to the mucosa. We report the case of a 38-year-old man who presented with a solitary sphenoid sinus metastasis that had spread from a cutaneous malignant melanoma. The metastasis was removed via a wide, endoscopically assisted sphenoidotomy. The patient was further treated with external radiotherapy, and at 8 months of follow-up he was free of disease. However, he experienced a recurrence at 3 years that proved to be fatal. We review the pathogenesis and histopathology of sinus metastases, and we discuss the imaging features that characterize melanoma metastatic to the upper respiratory tract. While complete cure of patients with a sphenoid sinus metastasis has not been reported, significant palliation with radiation therapy is possible in many patients. Therefore, patients with sphenoid sinus symptoms suggestive of a sphenoid sinus malignancy should be vigorously evaluated for the possibility of a primary malignancy as well as a metastasis to the sinus.

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