Despite the characteristic of extensive destruction of the temporal bone in this disease, the facial nerve is surprisingly resistant to destruction, and facial nerve palsy is rare.
The possibility of a tracheal bronchus should be entertained when a patient presents with recurrent right upper lobe pneumonia or right upper lobe collapse.
An 11-month-old infant boy presented to the otolaryngology service for evaluation of recurrent acute otitis media, persistent middle ear effusions, and reactive airway disease. He was a former 33-week premature infant with a cardiac history of patent foramen ovale and had been intubated for 1 week after birth. Over the subsequent 11 months, he...
Chronic subdural hematoma as a complication of lumbar drain placement for the management of iatrogenic cerebrospinal fluid (CSF) leak has not been previously documented in the literature. We describe such a case in a 69-year-old man who presented with right nasal obstruction secondary to an inverted papilloma involving the paranasal sinuses. The patient underwent endoscopic sinus surgery, which included a medial maxillectomy. Surgery was complicated by a small CSF leak, which was repaired intraoperatively. Five days later, the patient experienced CSF rhinorrhea, and a lumbar drain was inserted. He developed overdrainage symptoms but was well when he was discharged. However, 22 days later he returned with right hemiparesis. Computed tomography of the brain showed a left frontoparietal subdural hematoma with a mass effect. The neurosurgical team performed an emergency drainage procedure, and the patient experienced a complete neurologic recovery. We discuss the pitfalls of lumbar drainage, the possible pathophysiology of overdrainage, and the lessons learned from this case.
As more anterior skull base surgeries are being performed endoscopically by otorhinolaryngologists, we are faced with a greater likelihood of encountering neurosurgical complications. Cerebrospinal fluid (CSF) rhinorrhea at the anterior skull base is a rare complication of such endoscopic endeavors. A lumbar drain is sometimes placed...
Patients who have a cochlear implant are considered to be at a higher risk of developing meningitis following otitis media. Whether this occurs along the electrode going from the middle ear into the cochlea or through a blood-borne pathway is unclear.
[Editor's note: This Guest Editorial has been adapted with permission from an article entitled “Implants in Otology” that appeared in the Fall 2012 issue of Soundings, the Pennsylvania Academy of Otolaryngology-Head and Neck Surgery's newsletter.]
Esthesioneuroblastoma (ENB) is a rare tumor of the olfactory mucosa. We treated a 50-year-old man with an ENB in the right ethmoid sinus who had been diagnosed 16 years earlier with syndrome of inappropriate antidiuretic hormone secretion (SIADH) of unknown cause. When the ENB was surgically removed, the patient's osmoregulation returned to normal-that is, his SIADH resolved completely, which suggested that the SIADH was paraneoplastic in nature. These events prompted us to review the literature to determine if there is an association between our patient's ENB and his SIADH in general and between long-standing SIADH that precedes ENB in particular. Based on our review and an extrapolation of data, we have estimated that 1,300 cases of ENB have occurred since it was first described in 1924. Of these cases, SIADH was reported in 26 cases, including ours, which represents an estimated prevalence of 2% (although we believe this is actually an underestimation of the true prevalence). Of the 26 cases, SIADH had already been present in 14 patients (54%) prior to their diagnosis of EBN for a median duration of 3.5 years. We recommend that patients with newly diagnosed EBN be evaluated for SIADH. In those who are SIADH-positive, a resolution of SIADH should be expected once the ENB has been removed. If this does not occur, one should suspect that the ENB was not completely removed. If SIADH resolves but later recurs during follow-up, then a relapse should be suspected. In long-standing SIADH of unknown etiology, nasal sinus imaging should be considered.
A frontocutaneous fistula is a rare sequela of frontal sinus pathology. Management via an endoscopic approach is not frequently reported in the literature. We describe such an approach with the aid of still photography and imaging plus videoendoscopy, and we discuss the current literature.
Frontocutaneous fistulas are rare. In addition to a fistula, affected patients may present with local pain, pressure, headache, nasal congestion, swelling, vision disturbances, and/or neurologic complaints. Possible causes include the spread of a sinus infection to the frontal bone, the presence of a tumor, and/or trauma.
Nasal fractures are usually diagnosed by clinical examination, with or without the support of imaging studies. While plain-film radiography lacks sensitivity and specificity for diagnosing nasal fractures, and computed tomography (CT) is not always practical or cost-effective, ultrasonography (US) may be useful in this regard. The criteria by which adult nasal fractures are reliably identified on US must be clear. We conducted a preliminary prospective, controlled, observational study to define the appearance of nasal fractures on US. We used US to image 12 patients with a clinical or radiologic (CT or x-ray) diagnosis of nasal fracture. All patients presented within 2 weeks of their injury. For comparison purposes, we also obtained US images from 12 control subjects who had no history of nasal trauma or surgery. We found that we could confidently diagnose nasal fractures on lateral-view US on the basis of a disruption of bone continuity and/or displacement of fracture segments. However, our findings were not as consistent with dorsal-view US, and we do not believe it is adequate for diagnosis. We conclude that lateral US can be used to detect nasal fractures in adults, but further studies are needed to assess its sensitivity, specificity, cost-effectiveness, and practicality.
Histologically, undifferentiated thyroid carcinomas show a variety of patterns, from sheet-like, storiform, fascicular, angiomatoid, and meningothelial to solid, exhibiting extensive lymph-vascular invasion.
Undifferentiated carcinoma (also known as anaplastic carcinoma) of the thyroid gland is a highly aggressive malignant neoplasm composed of undifferentiated cells that exhibit immunohistochemical or ultrastructural epithelial differentiation. Nearly all patients report a long history of thyroid gland disease, often goiter or Hashimoto thyroiditis...
We present a case of diffuse sphenoid bone cavernous hemangioma in a 22-year-old primigravid woman. Her disease first manifested clinically as progressively decreasing vision in her left eye during her third trimester of pregnancy. We also discuss the known causes and some theoretical causes of cavernous hemangioma enlargement during pregnancy.
Several cases of vertebral osseous hemangioma that enlarged during pregnancy have been reported.1-5 Intramedullary thoracic spinal cord cavernous hemangioma with symptomatic enlargement during pregnancy has also been noted.6 Most cases have manifested during the third trimester of pregnancy with postpartum improvement in symptoms in...
Expanded endonasal approaches to the skull base are becoming more common, and closure of CSF leaks with reliable separation of the sinonasal tract from the cranial cavity is critical to a successful outcome.
An 80-year-old woman presented with right-sided epistaxis of several months' duration. A mass was noted in the right nasal cavity (figure 1, A), and biopsy demonstrated squamous cell carcinoma. She underwent complete endoscopic resection of the tumor, including the overlying dura. The skull base defect extended from the posterior table of the...