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Two cases of sublingual hematoma as a manifestation of child abuse

December 14, 2015  |  Muneesh Mehra, MD; Antonia E. Chiesa, MD; Andrew P. Sirotnak, MD


Common intraoral manifestations of child abuse include tears of the frenula, burns, and pharyngeal perforations. Sublingual hematomas can also occur as a result of trauma, but to the best of our knowledge, only 1 case has been previously described in the context of child abuse. We report 2 new cases of sublingual hematoma in infants that were the result of physical abuse. Cases of sublingual hematoma in infants and children without a clear and legitimate explanation of the cause should prompt consideration of child abuse.

Raeder syndrome: Paratrigeminal oculosympathetic syndrome presenting as a manifestation of chronic sinusitis

December 14, 2015  |  Cedric V. Pritchett, MD; Mark A. Zacharek, MD


Raeder syndrome (paratrigeminal oculosympathetic syndrome) is a rare clinical entity characterized by ipsilateral trigeminal sensory deficits, ptosis, and miosis, with an absence of anhidrosis secondary to interruption of the postganglionic oculosympathetic pathway. Going back to its original description, this constellation of physical examination findings has historically been associated with intracranial pathology involving the middle cranial fossa. Understanding this pathway is important in distinguishing Raeder syndrome from Horner syndrome, as the presentation of the former is now recognized to accompany a number of other disease entities in the head and neck region. We present an unusual case of Raeder syndrome associated with bacterial sinusitis, and we discuss its management and review the literature.

Physician liability issues and telemedicine: Part 2 of 3

December 14, 2015  |  Steven T. Kmucha, MD, JD, FACS

Written policies and procedures should be maintained at the same standard as traditional face-to-face encounters for documentation, maintenance, and transmission of the medical record of the telemedicine encounter.

Hemangioma of the soft palate

December 14, 2015  |  Yu-Hsuan Lin, MD; Yaoh-Shiang Lin, MD

Hemangioma is not commonly seen in the soft palate. A variety of symptoms may be present.

Endoscopic view of an osteoma of the maxillary sinus

December 14, 2015  |  Joseph P. Mirante, MD, FACS; Robert A. Merrell, MD; Dewey A. Christmas, MD; Eiji Yanagisawa, MD, FACS

Surgical removal of osteomas is generally indicated when they grow and cause symptoms or threaten structures.

Sensorineural hearing loss associated with a factitious disorder

December 14, 2015  |  Ayako Maruyama, MD; Yoshihiro Noguchi, MD; Taku Ito, MD; Kenji Narushima, MD; Ken Kitamura, MD


Factitious disorders are characterized by intentionally abnormal physical and/or psychological behavior, and affected patients often make up their symptoms and clinical histories. The most serious and chronic type of factitious disorder is Munchausen syndrome. We report the case of a 24-year-old woman with a 2-year history of sensorineural hearing loss (SNHL) who later confessed to feigning her hearing loss. She was eventually diagnosed with a factitious disorder. During those 2 years, she was able to induce her SNHL by exposing herself to excessive noise or high doses of aspirin. To the best of our knowledge, this is the first report describing an association between a factitious disorder and SNHL.

An unusual tongue base mass in an infant: Tongue base sialolipoma

December 14, 2015  |  Dawn T. Teo, MBBS; Romaine F. Johnson, MD, MPH; John E. McClay, MD


Sialolipoma is a rare tumor that occurs in the head and neck. We present a case arising from a minor salivary gland in an infant. The 6-month-old infant presented with difficulty swallowing, frequent reflux, and snoring that had been worsening several weeks before presentation. Physical examination showed a large mass arising from the tongue base. The patient was taken to the operating room for transoral removal of a presumed cyst. Histologic examination of the lesion showed a well-circumscribed lesion composed of lobules of mature adipose tissue and nodules of entrapped, non-neoplastic acini and ductules separated by thin, fibrous septae, consistent with a sialolipoma. To the best of our knowledge, this is the first reported case of a sialolipoma at the tongue base in a child. The patient has had no evidence of recurrence at 1 year of follow-up.

Reconstruction after resection of a lower lip squamous cell carcinoma with a submental island flap

December 14, 2015  |  Jin Pyeong Kim, MD; Hyun Woo Park, MD; Jung Je Park, MD; Seung Hoon Woo, MD


Lip cancer is the most common malignancy of the oral cavity and the second most common cancer in the head and neck. Typically, squamous cell carcinoma of the lower lip is an ulcerated lesion with raised margins. Surgery is the best treatment for lower lip cancer. The lips are important aesthetically because of their prominent location on the face and functionally because of the essential mechanism of the sphincter in assisting mastication, swallowing, phonation, and expressing emotions. Depending on the location and size of a lip tumor, different types of reconstructive flaps are used. We describe our technique for reconstructing the lower lip with a submental island flap.

Pemphigus vulgaris: An underdiagnosed cause of oral ulcer

December 14, 2015  |  Avijit Choudhury, MBBS; Tamoghna Jana, MBBS, DLO; Saumik Das, MBBS, DLO, MS, DNB; Ramanuj Sinha, MBBS, DLO, MS, DNB

Diagnosis of pemphigus vulgaris requires a high degree of clinical suspicion, along with timely mucosal biopsy for histopathologic examination and a direct immunofluorescence study.

Button battery injuries in the pediatric aerodigestive tract

December 14, 2015  |  Abhinav R. Ettyreddy, BS; Matthew W. Georg, BS; David H. Chi, MD; Barbara A. Gaines, MD; Jeffrey P. Simons, MD


Children with a button battery impaction present with nonspecific symptoms that may account for a delay in medical care. We conducted a retrospective study of the clinical presentation, management, and complications associated with button battery ingestion in the pediatric aerodigestive tract and to evaluate the associated long-term morbidity. We reviewed the medical records of 23 patients who were treated for button battery impaction at our tertiary care children's hospital from Jan. 1, 2000, through July 31, 2013. This population was made up of 14 boys and 9 girls, aged 7 days to 12 years (mean: 4 yr). Patients were divided into three groups based on the site of impaction; there were 9 impactions in the esophagus and 7 each in the nasal cavity and stomach. We compiled information on the type and size of each battery, the duration of the impaction, presenting symptoms, treatment, and outcomes. The mean duration of battery impaction was 40.6, 30.7, and 21.0 hours in the esophagus, nasal cavity, and stomach, respectively. We were able to identify the specific type of battery in 13 cases; 11 of these cases (85%) involved a 3-V 20-mm lithium ion battery, including all cases of esophageal impaction in which the type of battery was identified. The most common presenting signs and symptoms were vomiting (n = 7 [30%]), difficulty feeding (n = 5 [22%]), cough (n = 5), and bloody nasal discharge (n = 5); none of the presenting signs and symptoms predicted the severity of the injury or the outcome. The median length of hospital stay was far greater in the esophageal group (12 days) than in the nasal and stomach groups (1 day each; p = 0.006). Battery impaction in the esophagus for more than 15 hours was associated with a significantly longer postoperative hospital stay than impaction for less than 15 hours (p = 0.04). Esophageal complications included strictures (n = 5), perforation (n = 3), and tracheoesophageal fistula formation (n = 2). Clinicians should consider battery impaction in the upper aerodigestive tract as an emergency that can lead to significant long-term morbidity, and therefore immediate surgical intervention is required.