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Four cystic parathyroid adenomas in a 71-year-old man

January 22, 2016  |  Darrin V. Bann, MD, PhD; David Goldenberg, MD, FACS

Management of hyperparathyroidism-jaw tumor syndrome centers on parathyroidectomy to control the complications of hyperparathyroidism, but the extent of the parathyroidectomy that should be performed is controversial.

Vocal fold immobility after finger sweep self-extrusion of impacted food in a choking victim with resolution following laryngeal mask ventilation

January 22, 2016  |  Shaum Sridharan, MD; Milan R. Amin, MD; Ryan C. Branski, PhD


We report a case of unilateral vocal fold immobility in a 57-year-old woman that occurred subsequent to a choking episode, which she resolved by removing impacted food with a finger sweep. Other than the unilateral immobility, no abnormality of the laryngeal mucosa or framework was detected on physical examination, laryngoscopy, and computed tomography. Weeks later, the patient underwent an unrelated surgical procedure necessitating laryngeal mask airway ventilation. When she emerged from the procedure, she noted full resolution of her voice symptoms. Office laryngoscopy confirmed the full return of vocal fold function. We discuss possible explanations for the return of function in the context of this unusual onset and resolution. We also review the literature regarding unilateral vocal fold immobility, including its etiology, presentation, workup, and treatment.

Huge lipoma of the right parotid gland: Case report and review of 42 cases

January 22, 2016  |  Timuçin Baykul, DDS, PhD; M. Asım Aydın, DDS, DMD, PhD; Yavuz Fındık, DDS, PhD; Derya Yıldırım, DDS, PhD


Lipomas are rarely found in the parotid gland region. Because of their rarity at this site, they are not often considered in the differential diagnosis of parotid tumors. The parotid lipoma is a slowly growing, asymptomatic, freely movable, soft mass. Preoperative diagnosis is generally difficult. We present a case of a slowly enlarging mass of the parotid region in a 44-year-old man that proved to be a lipomatous tumor of the parotid gland. We also review 42 other cases from the literature. Our patient's huge tumor was located in the superficial lobe of the gland, and a parotidectomy with preservation of the facial nerve was performed. There was no complication or recurrence of the tumor after a follow-up of 1 year.

Physician liability issues and telemedicine: Part 3 of 3

January 22, 2016  |  Steven T. Kmucha, MD, JD, FACS

While many states (and many specialties) are gradually moving toward a more national concept of standard of care, some regions and states still use a “local” standard of care. These differences may be significant.

A useful technique for adjusting nasal tip projection in Asian rhinoplasty: Trapezoidal caudal extension cartilage grafting

January 22, 2016  |  Shao-Cheng Liu, MD; Deng-Shan Lin, MD; Hsing-Won Wang, MD; Chuan-Hsiang Kao, MD


The purpose of this article is to present our experience with Asian patients in (1) using a trapezoidal caudal extension cartilage graft to adjust the tip projection in tip refinement for augmentation rhinoplasty, especially for the correction of short nose, and (2) avoiding complications of augmentation rhinoplasty with alloplastic implants. We conducted a retrospective chart review of 358 rhinoplasties that were performed by the corresponding author from January 2004 through July 2009. Patients were included in this study if they had undergone open rhinoplasty with a trapezoidal caudal extension cartilage graft as the only tip-modifying procedure. Patients in whom any additional grafting was performed that might have altered the nasal tip position were excluded. The surgical results were analyzed in terms of the degree of satisfaction judged separately by investigators and by patients. A total of 84 patients-46 males and 38 females, all Asians, aged 13 to 61 years (mean: 29.3)-met our eligibility criteria. Postoperative follow-up for 24 months was achieved in 62 patients. At the 24-month follow-up, the surgeons judged the results to be good or very good in 57 of the 62 patients (91.9%); at the same time, 56 patients (90.3%) said they were satisfied or very satisfied with their aesthetic outcome. Good nasal tip projection, a natural columellar appearance, and improvement in the nasolabial angle were achieved for most patients. Two patients required revision rhinoplasty to correct an insufficient augmentation and migration of the onlay graft. No severe complications were observed during the 2-year follow-up. We have found that trapezoidal caudal extension cartilage grafting in nasal tip refinement is an easy technique to learn and execute, its results are predictable, and it has been associated with no major complications. We recommend trapezoidal caudal extension cartilage grafting for Asian patients as a good and reliable alternative for managing tip projection and support.

Pneumatization of all three nasal turbinates

January 22, 2016  |  Jae Hoon Lee, MD

Clinically, it is difficult to distinguish pneumatization of the inferior turbinate from hypertrophy of the inferior turbinate without a CT scan.

Management of sinonasal undifferentiated carcinoma with intracerebral invasion: Clinical experience at a single institution and review of the literature

January 22, 2016  |  Valerie Zielinski, MD; Simon Laban, MD; Silke Tribius, MD; Phillipe Schafhausen, MD; Simon Veldhoen, MD; Rainald Knecht, PhD; Till Clauditz, MD; Adrian Muenscher, MD


Sinonasal undifferentiated carcinoma (SNUC) represents less than 1% of all malignancies. Most of the tumors are diagnosed at an advanced stage, when they have already invaded neighboring tissue structures. We describe the cases of 2 patients with a substantial intracerebral extension of SNUC who were treated at our institution. One was treated with surgery followed by chemoradiotherapy. The other was primarily treated with induction chemotherapy with a combination of docetaxel, cisplatin, and 5-fluorouracil followed by concurrent chemo- and radiotherapy. In view of the rarity of SNUC, no prospective clinical trials have been performed and a gold standard for treatment has not yet been established. Therefore, treatment recommendations are based on level IV evidence. These recommendations are diverse and controversial. In our 2 cases, the patient who was treated with induction chemotherapy had a better outcome. In cases of intracerebral extension, radical surgery is necessary and induction chemotherapy should be considered.

Case series: Internal jugular vein ectasia in pediatric patients

January 22, 2016  |  Neha A. Patel, MD; Shai Shinhar, MD


Jugular vein ectasia is a dilation of the vein without tortuosity. This finding can easily be misdiagnosed or overlooked. Because of its rarity, many pediatricians, otolaryngologists, and pediatric surgeons are unfamiliar with this diagnosis and how to manage it. We report a series of 2 cases of internal jugular vein ectasia in pediatric patients and discuss its clinical findings, simple and noninvasive method of diagnosis, and treatment.

Laryngotracheal mucormycosis: Report of a case

January 22, 2016  |  Jillian Mattioni, DO; Joel E. Portnoy, MD; Jaime Eaglin Moore, MD; David Carlson, DO; Robert T. Sataloff, MD, DMA, FACS


Airway mucormycosis is a deadly opportunistic infection that affects immunocompromised persons, particularly diabetics and those undergoing chemotherapy. Although it is typically a pulmonary or sinonasal infection, mucormycosis can affect the larynx and trachea, with devastating results. We report the case of a 46-year-old man with human immunodeficiency virus infection, hepatitis C infection, neurosyphilis, and recently diagnosed Burkitt lymphoma who presented with dysphonia and stridor after receiving one dose of intrathecal chemotherapy. Flexible laryngoscopy detected the presence of fibrinous material that was obstructing nearly the entire glottis. Surgical debridement revealed a firm mucosal attachment; there was little bleeding when it was removed. After debridement, the patient's dyspnea improved only to recur 2 days later. After an awake tracheotomy, laryngoscopy and bronchoscopy identified necrosis extending from the supraglottic area to the carina tracheae. Biopsies demonstrated hyphal architecture consistent with mucormycosis. Despite continued debridements, the fibrinous material reaccumulated. The patient was placed in hospice care; his airway remained patent, but he died from other causes several weeks after presentation. The management of airway mucormycosis is challenging and complex. Fungal airway infections should be considered in the differential diagnosis of an immunosuppressed patient who presents with dyspnea, dysphonia, and vocal fold immobility. Timely diagnosis and management are critical for a successful outcome, although the prognosis is poor if the infection is widespread, even with the best of efforts.

Congenital choristoma (hairy polyp) of the eustachian tube: Surgical management of a rare clinical entity

January 22, 2016  |  Jonathan M. Melzer, MD, LT, MC, USN; Austin Morgan, MD, LT, MC, USN; David Darrow, MD

Macroscopically, choristomas can appear as soft, pedunculated masses that are hairy with a white or a violaceous hue. They can measure up to 6 cm in diameter.