Endoscopic view of osteogenesis imperfecta of the maxilla

June 8, 2014     Dewey A. Christmas, MD; Joseph P. Mirante, MD, FACS; Eiji Yanagisawa, MD, FACS

Osseous lesions in the maxilla can represent ossifying fibroma, fibrous dysplasia, amelogenesis imperfecta, or osteogenesis imperfecta.

A 43-year-old woman presented with recurrent right cheek and facial pain and recurrent sinusitis. She reported no discomfort or complaints regarding the left side of her face. Evaluation included computed tomography (CT) of the sinuses. CT showed an opacified right maxillary sinus, obliteration of the right middle meatus by soft tissue, and an...

Extensive basal cell carcinoma of the face: An extreme case of denial

June 8, 2014     Soroush Zaghi, MD; Pedram Ghasri, MD; Paul Busse, MD, PhD; John Clark, MD; Kevin Emerick, MD


Patients with head and neck cancer are particularly susceptible to using denial as a coping mechanism. While some forms of denial may help patients achieve better levels of physical functioning, persistent denial can serve as a major barrier to treatment. We report a case of extreme denial by a 60-year-old woman with an extensive basal cell carcinoma of the face that had been neglected for more than 20 years. We present this case to raise awareness of the potential danger of denial, and we discuss strategies that physicians can undertake to properly manage patients who engage in it. Since the diagnosis and treatment of head and neck cancer can result in profound psychological trauma, gaining an appreciation for how patients cope with it is an important part of the comprehensive care of head and neck oncology patients.

Rhabdomyosarcoma of the supraglottis in an adult

June 8, 2014     Alex Fernandez, MS; Reena Gupta, MD; Hootan Zandifar, MD

Primary laryngeal rhabdomyosarcoma is an extremely uncommon malignant neoplasm in adults, accounting for relatively few documented cases compared with squamous cell carcinoma.

A 50-year-old morbidly obese black man presented with a 6-month history of progressive dyspnea. He denied dysphagia and unexpected weight loss. He was breathing comfortably but with audible inspiratory breath sounds. He was tolerating his secretions, but he could speak in spurts of only 4 or 5 words.

An unusual presentation of anterior subglottic stenosis

June 8, 2014     Harry V. Wright, MD; Kenneth C. Fletcher, MD

Acquired subglottic stenosis should be suspected in any patient with unexplained dyspnea weeks to months following decannulation.

A 44-year-old woman presented with a 10-day history of dyspnea and stridor. Two weeks earlier, she had undergone tracheostomy decannulation; the tracheostomy had been performed 2 months earlier to accommodate mechanical ventilation secondary to pneumonia. Her medical history was also significant for diabetes, hypertension, and chronic obstructive...

How do pediatric adenoidectomy and adenotonsillotomy influence maternal psychological status?

June 8, 2014     Olaf Zagolski, MD, PhD and Jan Kulisiewicz, MD, PhD


We conducted a study to determine the impact that pediatric adenoidectomy or adenotonsillotomy (adenoidectomy with a partial tonsillectomy) had on the short-term psychological status of the children's mothers. Mothers of 100 treated children were examined with the 14-item Hospital Anxiety and Depression Scale (HADS) questionnaire immediately before the operation and 3 days afterward; to establish a baseline for control purposes, they completed another questionnaire 10 days postoperatively. We also compiled data for the mothers' demographic information and the children's physical status. In the preoperative period, we found that (1) the anxiety scores of half the mothers were abnormal, (2) depression scores were higher in the adenotonsillotomy group, and (3) anxiety and depression scores were lower in the mothers with more education and in the mothers who had a personal or family history of previous surgery. At 3 days postoperatively, anxiety and depression scores were again lower in the more educated mothers, and lower in the absence of postoperative fever. We conclude that mothers whose children are undergoing adenoidectomy or adenotonsillotomy, particularly the latter, and those with less education may require some psychological intervention. Such help may also be needed when postoperative complications occur.

Metastatic ovarian sex-cord stromal tumor with annular tubules in a patient without Peutz-Jeghers syndrome

June 8, 2014     Kimi Dart, DO; Ted Schwartzenfeld, DO; Warren Brandes, DO; Anthony D'Errico, DO; Michael Stender, MD


Sex-cord stromal tumors (SCSTs) with annular tubules (SCTATs) are a small class of ovarian lesions that possess histologic features of both Sertoli and granulosa cells. Approximately one-third of patients with SCTAT also have Peutz-Jaghers syndreome, which makes these cases especially rare. Patients with non-PJS-associated SCTAT make up the remaining two-thirds; 20% of these cases have a metastatic presentation. Metastasis of these tumors to the head and neck region has only been reported in a few instances. In this article we report a case of a 25-year-old woman who presented with “a lump in her throat” and was ultimately diagnosed with SCTAT. We also discuss the current protocols in the diagnosis and treatment of this entity.

Metastatic hepatocellular carcinoma presenting as a sphenoid sinus mass and meningeal carcinomatosis

June 8, 2014     Hilwati Hashim, MBBCh, MRad; Kartini Rahmat, MBBS, MRad; Yang Faridah Abdul Aziz, MBBS, MRad; Patricia Ann Chandran, MD, MPath


We report the case of a 30-year-old woman who was referred to us for evaluation of a 2-week history of fever, headache, vomiting, bilateral ptosis, and blurred vision. Imaging obtained by the referring institution had identified a sphenoid sinus mass and diffuse meningeal infiltration, which was thought to represent an infective process. We subsequently identified the mass as a metastatic hepatocellular carcinoma (HCC). The patient was placed under palliative care, and she died 1 month later. Metastases to the sphenoid sinus from any primary source are very rare, and they are generally not considered in the radiologic differential diagnosis. HCC is known to metastasize to the lung, lymph nodes, and musculoskeletal system; again, reported cases of metastasis to the sphenoid sinus are rare. Indeed, our review of the English-language literature found only 6 previously reported cases of sinonasal metastasis of a primary HCC. A diagnosis of a sinonasal metastasis is more difficult in a patient who has no previous diagnosis of a primary malignancy. In presenting this case, our aim is to remind readers of this possibility.

Introduction Hepatocellular carcinoma (HCC) is the seventh most common cancer in the world, with 782,000 new cases diagnosed in 2012.1 HCC commonly metastasizes to the lungs (34 to 70% of cases), regional lymph nodes (16 to 41%), and musculoskeletal system (1.6 to 16%).2,3 Sinonasal metastasis from a primary HCC is very rare, as our review of the...

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

June 8, 2014     Alexander Manteghi, DO; Seth Zwillenberg, MD; Vivian Arguello-Guerra, MD


Sebaceous carcinoma is a rare malignancy primarily affecting the periocular sebaceous glands. Sebaceous carcinoma of the parotid gland is exceedingly rare, with only 30 cases reported in the literature. Our case brings this total to 31. We present a case involving a 57-year-old man with a slowly enlarging, right tail-of-parotid mass abutting the ear lobule with overlying skin discoloration. Excision of the mass with superficial parotidectomy was performed, and microscopic examination demonstrated sebaceous carcinoma with positive margins. Subsequently, the patient underwent a completion parotidectomy and inferior auriculectomy with no evidence of residual tumor. Six months after postoperative adjuvant radiotherapy, the patient remains tumor-free. The clinical and morphologic features of this tumor are discussed.

Introduction Sebaceous carcinoma (SC) is a rare malignant tumor that is characterized by aggressive behavior ranging from local invasion to regional spread to distant metastasis.1-9 The great majority of SCs occur in the periocular region, most commonly in the eyelid.5,6 However, approximately 25% of SC cases occur in other regions of the body,...

Mitek bone-anchored static suture suspension of the oral commissure

June 8, 2014     Candace Hrelec, MD; Stephen Smith Jr., MD

Static facial suspension plays an important role in long-standing facial nerve paralysis, and techniques continue to evolve. Although other procedures are less morbid and invasive than our dynamic facial technique, they also have their complications and limitations.

We describe our technique for treating facial nerve paralysis (figure 1, A) with a novel procedure to achieve lower-face suspension and regional muscle transfer using a Mitek bone-anchored static suture. Our technique is effective in providing satisfactory suspension of the oral commissure (figure 1, B).

Ossifying fibromyxoid tumor metastatic to the thyroid: A case report and review of the literature

June 8, 2014     Ricardo R. Lastra, MD; Jason G. Newman, MD; John S. Brooks, MD; Jui-Han Huang, MD, PhD


Ossifying fibromyxoid tumors are rare soft-tissue neoplasms, usually with an indolent course. However, atypical/malignant variants have been described, showing either local recurrence after complete excision or metastasis to the lungs, mediastinum, adrenals, or soft tissue. We report the case of an ossifying fibromyxoid tumor of the left ankle that metastasized to the lung and thyroid gland 12 years after the initial diagnosis and surgical treatment. To our knowledge, this is the first reported case of this neoplasm metastasizing to the thyroid gland.

Introduction Ossifying fibromyxoid tumors of soft parts (OFMTs) are rare soft-tissue neoplasms.1 They are usually small, painless, and well circumscribed, and commonly arise in the subcutis or muscle of the extremities; less often, they arise from the trunk or head and neck region.1
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