Diplopia: An uncommon presentation of silent sinus syndrome

July 20, 2015     Juan Gomez, MD; David Liu, MD; Enrique Palacios, MD; Jeremy Nguyen, MD
article

The etiology of the disease is based on the primary predisposing factor, which is an obstruction of the ostiomeatal complex that results in hypoventilation of the maxillary sinus gases

A 53-year-old woman presented to our institution with a 2-month history of diplopia, followed by bouts of intermittent vertical diplopia that were more pronounced later in the day. She also reported drooping of her left eyelid, occasional gait instability, and headaches that were possibly indicative of myasthenia gravis.

Intratympanic membrane congenital cholesteatoma

July 20, 2015     Hiroshi Sakaida, MD, PhD; Kazuhiko Takeuchi, MD, PhD
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Cholesteatoma should be differentiated from other conditions with similar otoscopic findings, such as myringosclerosis.

The ostium of the posterior ethmoid sinus seen in the superior meatus

July 20, 2015     Dewey A. Christmas, MD; Joseph P. Mirante, MD, FACS; Eiji Yanagisawa, MD, FACS
article

The division of the anterior from the posterior ethmoid cells is determined by the basal lamella of the middle turbinate.

The ethmoid sinus is divided into two anatomic sections, the anterior and the posterior sections. The division of the anterior ethmoid cells from the posterior ethmoid cells is determined by the basal lamella of the middle turbinate. The anterior ethmoid cells drain into the middle meatus, and the posterior ethmoid cells usually drain into the...

Cervical necrotizing fasciitis as a complication of acute epiglottitis managed with minimally aggressive surgical intervention: Case report

July 20, 2015     Rajesh Babu Gollapalli, MBBS, MS(ENT), DORL; Ana Nusa Naiman, FRACS; David Merry, FRACS
article

Abstract

Cervical necrotizing fasciitis secondary to epiglottitis is rare. The standard treatment of this severe condition has long been early and aggressive surgical debridement and adequate antimicrobial therapy. We report the case of an immunocompetent 59-year-old man who developed cervical necrotizing fasciitis as a complication of acute epiglottitis. We were able to successfully manage this patient with conservative surgical treatment (incision and drainage, in addition to antibiotic therapy) that did not involve aggressive debridement.

Oncocytic mucoepidermoid carcinoma of the parotid gland: A case report and review of the literature

July 20, 2015     Deepali Jain, MD; Nabeen C. Nayak, MD
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Abstract

Oncocytic metaplasia rarely has been reported in mucoepidermoid carcinomas. Most salivary gland lesions with oncocytic change are benign; therefore, it is important to distinguish mucoepidermoid carcinoma from other entities that may show prominent oncocytic change. We report a rare case of oncocytic mucoepidermoid carcinoma in a 65-year-old woman.

Two cases of thyroid rupture after blunt cervical trauma

July 20, 2015     Ji Hoon Shin, MD; Yong Bae Ji, MD; Jin Hyeok Jeong, MD; Seung Hwan Lee, MD; Kyung Tae, MD
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Abstract

The consequences of thyroid gland rupture following blunt cervical trauma can be quite grave. Almost all of these cases are associated with preexisting thyroid lesions; the traumatic rupture of a previously normal thyroid gland is very rare. Both surgical and nonsurgical management techniques have been advocated for thyroid injuries, but there is still no consensus on treatment. We report cases of thyroid gland rupture following blunt cervical trauma in 2 patients: a 24-year-old man with a previously normal thyroid and an 8-year-old boy with a preexisting thyroid nodule. The man was treated surgically and the boy was treated conservatively. Based on our experience with these cases and our review of the literature, we propose treatment guidelines for thyroid injuries.

Salivary gland adenoid cystic carcinoma

July 20, 2015     Lester D.R. Thompson, MD
article

Tumors are poorly circumscribed with an infiltrative border, including extracapsular extension beyond the salivary gland.

Adenoid cystic carcinoma (ACC) is a malignant epithelial salivary gland tumor with myoepithelial and ductal differentiation. Salivary gland tumors account for only about 5% of all head and neck carcinomas, with ACC the fourth most common salivary gland malignancy. ACC has a 3:2 female-to-male ratio. Patients tend to be adults, with a peak...

Anthracosis: An unusual cause of vocal fold paralysis

July 20, 2015     Sedat Aydin, MD; Ozlem Celebi, MD; Merve Kiroglu, MD; Mehmet Gökhan Demir, MD
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Abstract

Anthracotic pigmentation in the bronchial mucosa is a bronchoscopic finding of pneumoconiosis, or evidence of heavy atmospheric soot. This pigmentation in the tracheobronchial mucosa is surrounded by calcified or noncalcified lymph nodes. Anthracosis is not a previously known cause of left vocal fold paralysis. We present what we believe to be the first reported case of anthracosis-caused vocal fold paralysis.

Introduction Anthracosis, a form of pneumoconiosis, is most commonly seen in coal miners, and it is also caused by environmental factors such as air pollution, biomass smoke, and cigarette smoke.1,2 Intrapulmonary lymph-adenopathy (LAP) often occurs in anthracosis, while mediastinal or axillary LAP is rare.3 Dark anthracotic pigmentation in the...

Cervical lipoblastoma: An uncommon presentation

July 20, 2015     Rohaizam Jaafar, MD; Tang Ing Ping, MS(ORL-HNS); Doris Evelyn Jong Yah Hui, MS(ORL-HNS); Mohammad Zulkarnaen Ahmad Narihan, MPath
article

Abstract

Lipoblastoma is extremely rare and mainly occurs in children younger than 3 years old. It is predominantly found in the extremities and trunk. Head and neck region occurrences are rare; only 4 such cases involving patients who presented with stridor have been previously reported. We report the fifth case of lipoblastoma of the neck with stridor in a 9-year-old girl, which had gradually worsened over the previous year. Imaging showed a retrotracheal mass extending superiorly to the thyroid level and inferiorly to below the carina of the trachea. Total resection of the tumor was performed, and the histopathologic findings were consistent with lipoblastoma. Postoperatively, the patient was well with no complications.

Introduction Lipoblastomas are rare, benign, adipose tumors primarily seen in infants and children younger than 3 years old. They are frequently seen in the trunk and extremities. Lipoblastoma has an immature cellular composition and closely resembles low-grade liposarcoma. Symptoms of the lesions in the head and neck vary from painless neck...

Maxillary sinus angiomyolipoma: A case report and overview

July 20, 2015     Steven M. Weindling, MD; David M. Menke, MD; William E. Bolger, MD, FACS
article

Abstract

Otolaryngologists are called upon to evaluate and treat sinonasal masses discovered incidentally on imaging studies. Although common conditions such as sinonasal polyps and mucus retention cysts predominate, it is prudent practice to formulate a differential diagnosis to identify unusual conditions. We present a case of a maxillary sinus mass in a 78-year-old man that was discovered incidentally on brain imaging and subsequently identified on biopsy as an angiomyolipoma (AML). AMLs are benign hamartomatous tumors that rarely occur in extrarenal locations. Only a few cases have been reported in the nasal cavity. We believe our case represents the first reported instance of AML arising within a maxillary sinus. Identification of intratumoral fat within the mass on imaging studies may suggest the diagnosis of AML preoperatively. Close interdisciplinary collaboration among the otorhinolaryngology, radiology, and pathology services is beneficial for patient management. We report this case to raise awareness that AML can arise in this previously unreported location. Moreover, we wish to emphasize that AML should be considered in the differential diagnosis when imaging studies demonstrate a well-defined, heterogeneous, fat-containing solitary mass in the nasal cavity or maxillary sinus.

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