April 17, 2013 Wen-Sen Lai, MD; Jih-Chin Lee, MD; Chih-Hung Wang, MD, PhD; Yueng-Hsiang Chu, MD, PhD
Jugular foramen syndrome is characterized by unilateral paralysis of the glossopharyngeal, vagus, and accessory nerves, which emerge in a line from the medulla oblongata and then run at the lateral part of the jugular foramen, where they leave the posterior cranial fossa.
April 17, 2013 Magdalena Chirila, MD, PhD; Mihaela Muresan, MD; Elisabeta Ciuleanu, MD, PhD; and Marcel Cosgarea, MD, PhD
Abstract
The Ewing family of tumors and peripheral primitive neuroectodermal tumor (pPNET) represent different manifestations of the same entity. Immunohistochemical and cytogenetic studies suggest that these tumors have a common origin. Ewing sarcoma is more common in bone, while pPNET is more common in soft tissues. Extraosseous Ewing sarcoma (EoES) is rare. We present the case of a 48-year-old man who presented with acute obstructive respiratory failure secondary to a large thyroid swelling. The patient was initially diagnosed with giant B-cell non-Hodgkin lymphoma and treated with chemotherapy. However, subsequent immunohistochemical staining of biopsy specimens revealed that the patient actually had EoES/pPNET of the thyroid gland. We performed a nearly complete surgical resection of the tumor plus a total laryngectomy and resection of five tracheal rings. However, the patient died of a cerebral metastasis 1 month later after he had completed one cycle of postoperative chemotherapy.
April 17, 2013 Jagdeep S. Thakur, MS; N.K. Mohindroo, MS, DLO; D.R. Sharma, MS; Shobha Mohindroo, MD; Anamika Thakur, MD
Abstract
Worldwide, tonsillitis is very common. The most common etiology is cross-infection with bacteria and viruses. These cases are managed with antibiotics and anti-inflammatory drugs without any further investigation because the diagnosis is based on simple clinical examination. Usually, leukemia presents with bleeding, weight loss, lymphadenopathy, fever, and frequent infection. Tonsillitis is a rare first presentation of leukemia. We present 3 cases in which the diagnosis of leukemia was made on routine examination, and in 1 case diagnosis was suspected during tonsillectomy.
April 17, 2013 Ramanuj Sinha, MS, DNB; Saumik Das, MS, DNB; Pranabashish Banerjee, MS, MRCS; Atish Halder, DLO, MS; Mainak Dutta, MS
Abstract
Hibernomas are benign tumors made up of brown fat. They are rarely encountered in otolaryngologic clinical practice, as they are usually located in the interscapular area, axilla, thigh, mediastinum, and retroperitoneum. We report an extremely rare case of a very large hibernoma in a 45-year-old man who presented with a 4-year history of neck swelling. Radioimaging was suggestive of a mass in both parapharyngeal spaces; the lesion was more prominent on the left side. The mass extended from C2 into the retropharyngeal space and superior mediastinum. Fine-needle aspiration cytology failed to yield a diagnosis. On surgical exploration, a tumor measuring 17 x 16 x 5 cm was removed and sent for histopathologic examination. Light microscopy was suggestive of a hibernoma. Staining with oil red O confirmed the diagnosis. To the best of our knowledge, a large hibernoma with such massive extension has not been previously reported in the literature.
April 17, 2013 Lester D.R. Thompson, MD
Endolymphatic sac tumor (ELST) is a papillary epithelial neoplasm arising within the endolymphatic sac/duct that shows a high association with von Hippel-Lindau disease (VHL). There is usually a VHL tumor suppressor gene germline mutation with an autosomal dominant inheritance pattern. Approximately 1 in 35,000 to 40,000 people have VHL, of which...
April 17, 2013 Allison N. Rasband-Lindquist, MD; Rodney Lusk, MD
Abstract
Foreign bodies embedded in the palate are exceedingly rare, and may imitate oral lesions. The majority of cases occur in infants and children. The following report discusses the unique presentation of a foreign body in the hard palate of an infant. This report emphasizes that foreign bodies must be considered in the differential of lesions found in the oral cavity of children.
Introduction
The detection of a foreign body in the hard palate is exceedingly rare with limited reports in the literature.1 Most frequently these are discovered incidentally by a parent or dentist.2-4
March 24, 2013 Ozan Seymen Sezen, MD; Utku Kubilay, MD; Yusuf Erzin, MD; Murat Tuncer, MD; Seref Unver, MD
Abstract
Eradication of Helicobacter pylori, which is associated with diverse gastroduodenal pathologies of varying severity, is sometimes challenging. We conducted a prospective study to determine the effect of tonsillectomy on the eradication of H pylori from the gastrointestinal tract. Our study population was made up of 46 patients-32 females and 14 males, aged 14 to 58 years (mean: 28.84 ± 9.65)-who had chronic tonsillitis and concomitant dyspepsia. An initial gastrointestinal endoscopy was performed to obtain specimens for histology and a rapid urease test. These gastroscopies revealed that 32 patients were H pylori-positive (69.6%) and 14 were H pylori-negative (30.4%); these groups were designated A and B, respectively. The 32 H pylori-positive patients were divided into three subgroups based on the sequence in which they underwent drug therapy and tonsillectomy. All 3 subgroups received the same 14-day combination-drug regimen for eradication of gastric H pylori. The patients in group A1 (n = 12) underwent tonsillectomy prior to receiving drug treatment; 2 months after the cessation of drug therapy, they underwent a second gastroscopy. The patients in group A2 (n = 10) received drug treatment first followed by tonsillectomy; 2 months later, they underwent their second gastroscopy. The patients in group A3 (n = 10) received drug treatment first, then they underwent a second gastroscopy, and then they were taken for tonsillectomy. The success or failure of H pylori eradication was determined by the second gastroscopy. Also, analyses were performed after tonsillectomy to look for H pylori infection in tonsillar specimens. Eradication of gastric H pylori was achieved in 9 of the 12 group A1 patients (75.0%), 8 of the 10 group A2 patients (80.0%), and 7 of the 10 group A3 patients (70.0%); there were no statistically significant differences among the three groups. Likewise, there were no significant differences between any subgroups or combination of subgroups in terms of tonsillar positivity. As far as we know, this is the first study to investigate the effect of tonsillectomy on the outcome of H pylori eradication treatment. In light of our findings, we may speculate that tonsillar tissue does not seem to be a reservoir for H pylori infection. Although tonsillectomy had no significant effect on gastric H pylori eradication in our study, our results might have been skewed by the relatively small size of our sample.
March 24, 2013 Drew P. Plonk, MD; J. Dale Browne, MD, FACS
Abstract
The potential for aberrant anatomy in the neck should be respected in order to avoid unexpected and potentially devastating injury during surgical and other procedures. Anatomic variations involving the internal carotid artery are believed to exist in as much as 6% of the population. We describe a case of a tortuous internal carotid artery that was found in zone IIb during a neck dissection in a 60-year-old man, and we discuss the implications of this anomaly.
Introduction
The expectation of normal anatomy in neck zone IIb-specifically, an absence of vital structures there-might lead a surgeon to overlook the risks of a rapid surgical dissection of nodal and adjacent soft tissue should the patient have aberrant anatomy. As this case report illustrates, the potential for aberrant anatomy throughout the...
March 24, 2013 Karen B. Teufert, MD; William H. Slattery, MD
Abstract
Spontaneous cerebrospinal fluid (CSF) leaks from the fallopian canal are extremely rare, as only a few cases have been reported in the world literature. We describe a case of spontaneous CSF otorrhea through an enlarged geniculate fallopian canal. The patient was a 45-year-old woman who presented with a history of CSF rhinorrhea and otorrhea from the right ear. Myringotomy and tube insertion revealed CSF otorrhea. Contrast-enhanced computed tomography revealed that the geniculate fossa was smoothly enlarged (demonstrating remodeling of bone). A middle fossa craniotomy with temporal bone exploration was performed. Intraoperative inspection detected the presence of a fistula secondary to a lateral extension of the subarachnoid space through the labyrinthine segments of the fallopian canal. We discuss the management of this unusual finding, which involves sealing the fistula while preserving facial nerve function.
March 24, 2013 Adam Blanchard, BS; Lorena Garza Garcia, MD; Enrique Palacios, MD, FACR; Bruce Bordlee Jr., MD; Harold Neitzschman, MD, FACR
Ludwig angina will appear as a diffuse swelling of the soft tissue of the floor of the mouth with adjacent subcutaneous fat stranding, and thickening of the platysma with gas or pus formation.
Ludwig angina is a rapidly progressing, necrotizing cellulitis of the submandibular space.1 Predisposing factors include poor dental hygiene, recent dental procedures, diabetes mellitus, alcoholism, tobacco smoking, malnutrition, intravenous drug use, and immunosuppression.1 Ludwig angina is typically a polymicrobial infection that includes both...
