Acoustic neuroma: An investigation of associations between tumor size and diagnostic delays, facial

August 27, 2014     Marc Olshan, MD, MBA; Visish M. Srinivasan, MD; Tre Landrum, DO; Robert T. Sataloff, MD, DMA, FACS


We conducted a retrospective case review to ascertain the clinical characteristics associated with acoustic neuromas and their treatment. Our study population was made up of 96 patients-41 men and 55 women, aged 17 to 84 years (mean: 54)-who had undergone treatment for acoustic neuromas and for whom necessary data were available. We compiled data on presenting symptoms, the interval from symptom onset to diagnosis, tumor size at diagnosis, facial weakness, the interval from diagnosis to surgery, the type of surgical approach, and surgical complications. Our primary goals were to determine if tumor size was correlated to (1) the interval from symptom onset to diagnosis, (2) the degree of preoperative facial weakness, and (3) surgical complications. We also sought to document various other clinical characteristics of these cases. The mean interval from the first symptom to diagnosis was 4.5 years; the time to diagnosis did not correlate with tumor size. Nor was tumor size correlated with the degree of preoperative facial weakness as determined by facial electroneurography. Surgical complications occurred in 15 of the 67 patients who underwent surgery (22.4%), and they did correlate with tumor size. The most common complications were postoperative facial weakness (13.4% of operated patients), cerebrospinal fluid leak (6.0%), and infection (3.0%). Since tumors typically grow about 2 mm per year and since larger tumors are associated with more severe symptoms and surgical complications, we expected that the time to diagnosis would correlate with tumor size, but we found no significant association.

Non-otogenic lateral sinus thrombosis: A complication of acute sphenoid sinusitis

August 27, 2014     Jessica M. Somerville, MD; Erik Lyman, MD; Jerome W. Thompson, MD, MBA; Rosemary Stocks, MD, PharmD


The consequences of intracranial spread of sinus infection can be dismal. The subtle presentation of sphenoid sinusitis often leads to a delay in diagnosis. The disease may go unrecognized until complications are severe enough to cause more localizing symptoms. Often infections in the head and neck spread into the cranial cavity, leading to a localized effect. For example, otogenic infections can spread to the mastoid or lateral venous sinus. We report a case of sphenoid sinusitis complicated by lateral and sigmoid venous sinus thrombosis.

Survival characteristics of injected human cartilage slurry in a nude mouse model: A preliminary study

July 13, 2014     Bounmany Kyle Keojampa, MD; Jacob Pieter Noordzij, MD; Bohdana Burke, MD; Joseph Alroy, DVM; Vartan Mardirossian, MD; Alphi Elackttu, MD; Zhi Wang, MD


We conducted a study to examine the viability, host response, and volume retention characteristics of drilled human septal cartilage slurry when injected into an athymic nude mouse model. We injected 0.2 ml of the slurry into the hind limbs of 6 mice. The mice were sequentially sacrificed over a period of 180 days. Histologic reviews of the hind limbs were performed to determine the viability of injected chondrocytes, host response, and volume retention. Specimens were obtained and histomorphologic analysis was performed at 1, 30, 90, and 180 days after injection. We identified viable cartilage throughout the study. Cartilage injection was well tolerated, and minimal inflammatory reaction occurred without significant adverse effects. The injected bolus of cartilage was found to have progressively dispersed throughout the muscle over time. Our findings warrant further investigation with a larger cohort of nude mice or possibly human subjects.

Introduction Unilateral vocal fold paralysis is a significant cause of morbidity. Nerve injury can occur in a variety of ways: as an iatrogenic recurrent laryngeal nerve injury during surgery, as a complication of endotracheal intubation, and as the result of blunt chest/neck trauma, a viral infection, or a tumor of the skull, neck and chest;...

Angiolipoleiomyoma located in the earlobe

July 13, 2014     Sirin Yasar, MD; Zehra Asiran Serdar, MD; Fatih Goktay, MD; Burcu Barutcugil, MD; Selvinaz Ozkara, MD; Pelin Demirturk, MD


Angiolipoleiomyoma (ALLM) is a solid tumor that is mostly derived from muscle tissue. It is often located in the kidneys of patients with tuberous sclerosis; ALLMs located outside the kidneys are very rare. Among the rare presentations are cutaneous ALLMs, which manifest as 1- to 4-cm asymptomatic, acquired, solitary, subcutaneous nodules that have a strong predilection for males. To the best of our knowledge, only 22 cases of ALLM of the skin have been previously reported in the literature; in 5 of these cases, the tumor was located on the ear. Histologically, tumoral proliferation is observed with smooth muscle, fat tissue, and vascular channels surrounded by a fibrous capsule; cellular atypia is not observed. We report the case of a 67-year-old man who presented for evaluation of a purplish nodular lesion that had been present on his right earlobe for 10 years. Analysis of an excisional biopsy specimen revealed a nodular formation that consisted mostly of thick-walled veins within a fibromyxoid stroma; smooth-muscle tissue and fat globules were observed in places. The lesion was diagnosed as a cutaneous ALLM.

Otologic manifestation of Samter triad

July 13, 2014     Danielle M. Blake, BA; Alejandro Vazquez, MD; Senja Tomovic, MD; Robert W. Jyung, MD

It is important for otolaryngologists to be aware of the mucoid quality of these middle ear effusions, as they tend to be persistent and they do not respond well to myringotomy and tube placement, which usually results in tube obstruction.

Acute vocal fold hemorrhage after phonosurgery

July 13, 2014     Joel E. Portnoy, MD; Catherine Capo, BS; Robert T. Sataloff, MD, DMA, FACS

In this case, the KTP laser was used to vaporize the bilateral vocal fold varicosities.

A 48-year-old truck driver presented with hoarseness, vocal fatigue, volume disturbance, and a loss of range following an upper respiratory infection 6 months earlier. Five years previously, he had undergone removal of vocal fold “polyps” elsewhere; he had received no postoperative voice therapy.

Parathyroid adenoma

July 13, 2014     Lester D.R. Thompson, MD

Most of these lesions are identified in glands within their usual anatomic location instead of in an ectopic or supernumerary site.

A parathyroid adenoma is a benign neoplasm of parathyroid parenchymal cells. There is an association with the HRPT2 gene (1q25-q31), which is associated with hyperparathyroidism-jaw tumor syndrome (an autosomal dominant disorder). Parathyroid adenoma is the single most common cause of hyperparathyroidism. It is usually seen in patients in the...

Large osteoma of the maxillary sinus accompanied by an unerupted tooth

July 13, 2014     Jae-Hoon Lee, MD

CT of the maxillofacial region is required for patients with an osteoma to rule out Gardner syndrome, which should be considered when a patient has more than one osteoma.

A 17-year-old boy presented with a 1-year history of intermittent localized pain over his right cheek. He had no history of notable facial trauma or nasal surgery, and his medical conditions were noncontributory. He had no history of sinonasal symptoms.

Endoscopic view of a middle meatal cyst

July 13, 2014     Dewey A. Christmas, MD; Joseph P. Mirante, MD, FACS; Eiji Yanagisawa, MD, FACS

Obstruction of the middle meatus and ethmoid infundibulum can occur as a result of swelling of the mucosal surfaces of the soft tissues, although most such obstructions are caused by polyps. Obstruction from a cystic mass is less common.

A 29-year-old man presented to us with a 2-year history of recurring right sinusitis. His most recent symptoms included right nasal congestion and persistent right facial discomfort. Endoscopic examination revealed the presence of a large polypoid cystic mass that had filled the right middle meatus (figure, A). Findings on examination of the left...

Leiomyosarcoma of the parapharyngeal space: A very rare entity

July 13, 2014     Haim Gavriel, MD; Eyal Yeheskeli, MD; Gratiana Hermann, MD; Ephraim Eviatar, MD


Leiomyosarcoma of the head and neck is very rare, as only about 100 cases have been reported; of these, only 3 cases have been previously reported in the parapharyngeal space. We report the fourth such case, and we review the features of this entity. The patient was an 84-year-old woman who presented to the emergency department for treatment of an 18-month history of right-sided headache, a 6-month history of right-sided hearing loss and nasal obstruction, and a 2-month history of dysphagia. Physical examination revealed a bulge in the right side of the soft palate and the right lateral nasopharyngeal wall and complete obstruction of the right eustachian tube. Indirect laryngoscopy detected a bulge in the right lateral hypopharyngeal wall. Otoscopy revealed otitis media with effusion in the right ear. Imaging demonstrated a space-occupying lesion in the right parapharyngeal space that extended from the base of the skull to the level of the hypopharynx. Biopsy and histology identified the mass as a leiomyosarcoma. Metastasis to the brain was discovered shortly thereafter, and the patient died 10 months later. The unusual presentation of head and neck leiomyosarcoma requires a high index of suspicion and appropriate diagnostic imaging. Surgical excision is the recommended treatment when feasible; chemoradiotherapy does not appear to affect disease progression.

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