Cervical presentation of peripheral T-cell lymphoma not otherwise specified

December 19, 2014     Alexander S. Misono, MD; Harrison W. Lin, MD; Linda N. Lee, MD; Judith A. Ferry, MD; James W. Rocco, MD, PhD
article

Peripheral T-cell lymphoma not otherwise specified (PTCL-NOS) is an uncommon type of lymphoma with a clinically aggressive course and a relatively poor prognosis. Many affected patients present with nodal involvement, and there is also potential for extranodal involvement of the liver, gastrointestinal tract, bone marrow, and/or skin. We describe the case of a 68-year-old woman who presented with a 6-week history of an intermittently tender left-sided neck mass. Findings on imaging and fine-needle aspiration biopsy were inconclusive. Pathologic studies of excisional biopsy specimens ultimately revealed the diagnosis of PTCL-NOS. Of the lymphomas, neither PTCL nor the PTCL-NOS subtype is frequently discussed or studied in prospective trials. However, these cases should be identified because of their substantial clinical management implications.

Introduction Lymphoma is the second most common extracranial primary head and neck malignancy, representing 3 to 5% of cancers in this region.1 Patients with head and neck lymphoma classically present with enlarged, nontender lymph nodes without necrosis on imaging.2 The head and neck is second only to the gastrointestinal tract as the most...

Amyotrophic lateral sclerosis presenting as bilateral abductor paralysis

December 19, 2014     Michelle Levian, DO; Reena Gupta, MD, FACS
article

Occasionally, patients who have amyotrophic lateral sclerosis initially present with vocal and respiratory signs and symptoms.

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease that involves both the upper and lower motor neurons. Most commonly, patients present with weakness, muscle atrophy, and fasciculation.

Superior omohyoid muscle flap repair of cervical esophageal perforation induced by spinal hardware

December 19, 2014     Christopher Chase Surek, DO; Douglas A. Girod, MD, FACS
article

Cervical esophageal perforation is a rare and life-threatening condition. Its prompt diagnosis and treatment require a high index of suspicion. Cervical spine hardware is an uncommon cause of posterior esophageal perforation. Management has included a variety of musculofascial flaps for surgical repair. We present 2 cases of cervical esophageal perforation induced by spinal hardware that were repaired with a superior omohyoid muscle (SOM) flap for closure and/or primary closure reinforcement. Advantages and techniques of the SOM flap are discussed.

Introduction Cervical esophageal perforation is a rare and complex condition. Potential etiologies include penetrating trauma, foreign body ingestion, iatrogenic processes, intubation, and erosion of bulky hardware, including spinal fusion hardware. Prompt diagnosis and treatment are critical to prevent multiple comorbidities and life-threatening...

Calcific tendinitis of the longus colli muscle

December 19, 2014     Sam S. Torbati, MD, FAAEM; Elaine M. Vos, BA; Daniel Bral, BA; Joel M. Geiderman, MD, FACEP; Benjamin Broukhim, MD, FAAOS
article

Presenting signs and symptoms of acute calcific tendinitis of the longus colli musclegenerally include severe, often debilitating, neck pain and odynophagia without any recent associated trauma.

Acute calcific tendinitis of the longus colli muscle (CTLC) is a rare and self-limiting inflammatory disorder of the tendon insertions. It is characterized by an acute onset of severe neck pain and odynophagia that mimic signs and symptoms of retropharyngeal infections. Familiarity with the clinical presentation and characteristic findings on...

Sinus transillumination, then and now

December 19, 2014     Dewey A. Christmas, MD; Joseph P. Mirante, MD, FACS; Eiji Yanagisawa, MD, FACS
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In recent years, a new use has been found for transillumination in sinus surgical procedures involving balloon dilation. In these procedures, it is used to identify a sinus and to confirm that the balloon has entered the sinus correctly.

Cerebrospinal fluid leaks following septoplasty

December 19, 2014     Naren N. Venkatesan, MD; Douglas E. Mattox, MD; John M. Del Gaudio, MD
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We conducted a retrospective review to identify the characteristics of cerebrospinal fluid (CSF) leak in patients who had undergone septoplasty and in selected patients who had experienced a spontaneous CSF leak. CSF leak is a known but infrequently reported complication of septoplasty; to the best of our knowledge, only 4 cases have been previously published in the literature. A review of our institution's database revealed 3 cases of postseptoplasty CSF leak. We reviewed all the available data to look for any commonalities among these 7 cases. In addition, we reviewed 6 cases of spontaneous CSF leak selected from our database for the same purpose. For all patients, we noted the side of the cribriform plate defect, its size and, for the postseptoplasty cases, the interval between the septoplasty and the leak repair. Overall, we found that leaks were much more common on the right side than on the left. The sizes of the leaks in the 2 postseptoplasty groups were comparable (mean: 14.0 x 6.4 mm). The interval between septoplasty and leak repair ranged from 2.5 to 20 years in our cases and from 3 days to 22 weeks in the previously published cases. All 3 of the postseptoplasty patients in our database presented with clear rhinorrhea. Two of the 3 patients had meningitis; 1 of these 2 also had pneumocephalus. Of the 6 cases of spontaneous CSF leaks, 4 occurred on the right and 2 on the left; the average size of the defect was 5.8 mm in the greatest dimension. The finding that cribriform plate defects after septoplasty were typically right-sided likely reflects the prevalence of left-sided surgical approaches. Also, the fact that the defects were larger in the postseptoplasty cases than in the spontaneous cases is likely attributable to the torque effect toward the thin skull base that occurs when the perpendicular plate is twisted during septoplasty.

Adult presentation of laryngeal cleft: Utility of the modified barium swallow study in diagnosis and management

December 19, 2014     Genevieve Houdet-Cote, MHSc; Simon R. McVaugh-Smock, MHSc
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We present a case of laryngeal cleft in a 41-year-old man to illustrate the co-occurrence of laryngeal cleft and tracheoesophageal fistula. We advocate the use of the modified barium swallow study in the diagnosis of laryngeal cleft. We also review the advantages and limitations of the various diagnostic methods, as well as the potential for known tracheoesophageal fistula to mask laryngeal cleft. Finally, we discuss the importance of early identification of laryngeal cleft in the context of its potentially serious health implications.

Introduction Laryngeal clefts are congenital abnormalities caused by an interruption of cricoid fusion in utero, which results in the arrested development of the tracheoesophageal septum.1 Its prevalence is estimated to be less than 0.1% of the general population.2 The most commonly accepted classification system categorizes laryngeal cleft into...

Fusobacterium necrophorum in a pediatric retropharyngeal abscess: A case report and review of the literature

December 19, 2014     Jeffrey Cheng, MD; Andrew J. Kleinberger, MD; Andrew Sikora, MD, PhD
article

We present the case of a 17-year-old boy who developed a deep space neck infection following cervical trauma. He was initially managed conservatively with broad-spectrum antibiotics, but when he failed to improve clinically, he required surgical drainage. Wound cultures grew Fusobacterium necrophorum, an uncommon pathogen that can cause pediatric deep neck space infections, especially when it is not associated with Lemierre syndrome. The prognosis for this infection is favorable when it is identified early. Treatment with culture-directed antibiotics and surgical drainage as indicated is appropriate. When treating a pediatric deep neck space infection empirically, physicians should avoid treatment with a macrolide antibiotic, since Fusobacterium spp may be involved and they are often resistant to this class of drugs.

Introduction Retropharyngeal abscesses are common in the pediatric population. Deep space neck infections in pediatric patients often occur as a result of acute tonsillitis complicated by extension into the peritonsillar space. Management of such cases is not standardized, and treatments vary among different institutions.1

Solitary peritoneal lymph node metastasis of head and neck cancer diagnosed with FDG-PET/CT imaging

December 19, 2014     Yong-Wan Kim, MD; Byung-Joo Lee, MD; Jin-Choon Lee, MD; Tae-Yong Jeon, MD; Hak-Jin Kim, MD
article

Distant metastasis of head and neck squamous cell carcinoma (SCC) to the infraclavicular lymph nodes-with the exception of the upper mediastinal lymph nodes-is rare. We report the case of a 44-year-old man who was treated with surgery and radiotherapy for SCC of the floor of the mouth. During regular follow-up 6 months after the cessation of radiotherapy, F18-fluorodeoxyglucose positron-emission tomography/computed tomography (FDG-PET/CT) detected a hypermetabolic lesion in the left lobe of the liver that was diagnosed as a metastasis of the head and neck SCC; no locoregional recurrence was found. The metastasis was surgically removed and more radiotherapy was administered, but the SCC recurred at the same site and the patient died of disseminated disease 12 months after the appearance of the first metastasis. To the best of our knowledge, this is the first reported case of a solitary peritoneal lymph node metastasis from an SCC of the floor of the mouth. We believe that regular FDG-PET/CT follow-up scans are useful for the detection of unusual distant metastases of head and neck cancers.

Temporal bone chondrosarcoma: Presentation of 4 cases and review of the literature

December 19, 2014     Duoduo Tao, MD; Matthew R. Hoffman, MD; Bing Chen, MD, PhD
article

We describe 4 cases of chondrosarcoma of the temporal bone, which occurred in a 66-year-old man and in 3 women aged 34, 37, and 47 years. One of these patients was originally diagnosed with an epithelial cyst and another with a middle ear neoplasm. Three patients underwent surgical removal of their tumor, while the other patient declined (a craniotomy for biopsy was performed in this case). An accurate diagnosis in all 4 cases was not made until histopathologic examination was performed. None of the patients received postoperative radiotherapy for various reasons. However, the male patient experienced a tumor recurrence, which necessitated a second surgery, and he did receive radiotherapy after the second operation. All 3 operated patients were doing well at the most recent follow-up, and the other patient was soon lost to follow-up. Because of its rarity and potential for severe complications, temporal bone chondrosarcoma remains a difficult disease to diagnose and manage.

Introduction Chondrosarcoma is a malignant tumor of cartilage-forming tissues.1 Within the skull, these masses arise where endochondral bone ossifies intramembranously.2 These rare, slowly growing tumors account for less than 1% of all intracranial neoplasms and roughly 6% of all skull base tumors.1,3 Funding/support: This research was supported...
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