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Core biopsy as a simple and effective diagnostic tool in head and neck focal myositis

December 14, 2015  |  Chun Yee Tan, MBBS; Sheldon Chong, MBBS, MS; Chi-Kee Leslie Shaw, MBBS, MS, FRACS


Most unilateral head and neck masses are benign, although malignancy is a possibility in some cases. However, there are other rare causes of unilateral neck masses, such as focal myositis, which is a rare, benign condition belonging to the family of inflammatory pseudotumors of the skeletal muscles, with rare presentations in the head and neck region. Focal myositis presents as a rapidly enlarging neck mass that can be misdiagnosed by fine-needle aspiration biopsy and/or radiologic imaging as either an infective or a neoplastic process. To date, there are only 5 reported cases of adult focal myositis of the sternocleidomastoid muscle in the medical literature. In this article, the authors present 2 cases involving patients with focal myositis of the sternocleidomastoid muscle that were successfully diagnosed with core-needle biopsy and managed conservatively. The pros and cons of fine-needle aspiration biopsy and core-needle biopsy are discussed. Based on the authors' results, fine-needle aspiration biopsy universally fails to provide the diagnosis of focal myositis. In contrast, core-needle biopsy successfully diagnosed focal myositis in both of our patients. Both of them had complete resolution with conservative management.

Pleomorphic adenoma of the frontal sinus masquerading as a mucocele

December 14, 2015  |  Yok Kuan Chew, MBBS; Sushil Brito-Mutunayagam, MS; Aun Wee Chong, MS; Narayanan Prepageran, FRCS; Patricia Ann Chandran, MPath; Baharudin Khairuzzana, MS; Omkara Rubini Lingham, MS


Pleomorphic adenoma is the most common type of benign salivary gland tumor. It can also be found in the larynx, ear, neck, and nasal septum. It is rarely found in the maxillary sinus, and it has never been reported in the frontal sinus. We report a case of pleomorphic adenoma of the frontal sinus that masqueraded as a mucocele. We discuss the clinical presentation, diagnosis, and treatment of this patient, and we review the literature.

Nasal obstruction and recurrent sinusitis caused by bilateral pneumatized ethmoid bullae

December 14, 2015  |  Meir Warman, MD; Seth Willen, MD; Peter J. Catalano, MD, FACS, FARS


The presentation of an enlarged pneumatized bulla ethmoidalis (BE) that obstructs the ethmoid infundibulum has not been previously reported. We report such a case in a 23-year-old woman who presented with recurrent acute rhinosinusitis and chronic rhinosinusitis. The obstruction had been caused by inferior and anterior pneumatization of the BE. Surgery was successful in alleviating all symptoms, and the patient remained symptom-free at 10 months of follow-up. We describe the radiologic and endoscopic findings in this case, and we discuss the possible mechanisms by which BE is involved in the pathogenesis of recurrent acute and chronic rhinosinusitis.

Bone-anchored hearing aid implantation in a patient with Goldenhar syndrome

December 14, 2015  |  Griffin Santarelli, MD; Roberta E. Redfern, PhD; Aaron G. Benson, MD


Patients with Goldenhar syndrome exhibit a number of characteristic symptoms, including middle and internal ear malformations that may cause profound hearing loss. Bone-anchored hearing aids have been used to treat these patients in the past, although complications may arise due to the nature of the disease. Herein we present the case of a pediatric patient with Goldenhar syndrome whose hearing aid abutment extruded spontaneously because of poor bone quality, despite adequate thickness. We provide a brief review of the literature and suggest a flexible surgical plan for any syndromic pediatric patient.

The Potter technique for cleft lip rhinoplasty

December 14, 2015  |  Joseph J. Rousso, MD, FACS

The Potter technique is a simpler method than the Dibbell technique to achieve nasal symmetry when the alar base width is harmonious.

Facial nerve neurofibroma presenting with external auditory canal tumor and facial palsy

December 14, 2015  |  Yao-Ying Tseng, MD; Cheng-Chien Yang, MD; Chen-Chuan Li, MD; Min-Tsan Shu, MD

Facial nerve neurofibromas are benign and rare, and they generally present with facial palsy; however, hearing loss, tinnitus, and vertigo are also observed occasionally.

Sensorineural hearing loss in beta-thalassemia patients treated with iron chelation

December 14, 2015  |  Ustun Osma, MD; Erdal Kurtoglu, MD; Hulya Eyigor, MD; Mustafa Deniz Yilmaz, MD; Nurdan Aygener


The predictive value of pure-tone audiometry (PTA) in the early detection of ototoxicity has been questioned, particularly in the higher frequencies. Otoacoustic emissions testing appears to be more sensitive to cochlear insult than conventional PTA. We conducted a cross-sectional descriptive study to compare the efficacy of distortion-product otoacoustic emissions (DPOAE) testing with that of PTA as a method of audiologic monitoring. Our study group was made up of 159 patients (318 ears)-69 males (43.4%) and 90 females (56.6%), aged 5 to 61 years (mean: 23.59 ± 12.55). All patients had been diagnosed with either β-thalassemia major (BTM) or β-thalassemia intermedia (BTI), and all had received at least 1 year of treatment within the previous year with an iron chelator-either deferasirox, desferrioxamine (deferoxamine in the United States), deferiprone, or a combination of desferrioxamine and deferiprone. PTA and DPOAE evaluations were performed by the same audiologist using the same audiometer for all patients. In the right ears, the overall incidence of ototoxicity as manifested by sensorineural hearing loss was 39.0% on PTA and 22.0% on DPOAE testing; in the left ears, the corresponding figures were 27.7 and 19.5%, respectively. There were no statistically significant differences in the incidence of ototoxicity between the BTM and BTI groups with any of the four different drug regimens on PTA (p = 0.765, p = 0.378, p = 0.265, and p = 0.579, respectively) or on DPOAE testing (p = 0.890, p = 0.263, p = 0.390, and p = 0.340, respectively). Based on these data, we found no significant difference between PTA and DPOAE testing in their ability to detect ototoxicity. We conclude that periodic testing with both PTA and DPOAE is necessary for patients with suspected β-thalassemia in order arrive at a prompt diagnosis and initiate timely management.

Globus sensation and laryngopharyngeal reflux

October 31, 2015  |  Michael J. Knabel, BS; Jonathan M. Bock, MD, FACS

Some study results have suggested that psychological factors such as depression and anxiety can influence the etiology of globus.

Laryngeal neuromas in a case of multiple endocrine neoplasia type 2B

October 31, 2015  |  Stanley W. McClurg, MD; Paul E. Wakely Jr., MD; Eugene G. Chio, MD


Mucosal neuromas of the larynx in the setting of multiple endocrine neoplasia type 2B (MEN-2B) are extremely rare; to the best of our knowledge, only 2 other cases have been previously reported in the world literature. We describe a new case, which occurred in a 30-year old woman who presented with dysphagia, dysphonia, and cough. On examination, she was found to have multiple laryngeal mucosal neuromas throughout the glottis and supraglottis. She underwent surgical resection of these lesions with resolution of her symptoms.

An unusual presentation of a lingual dermoid cyst

October 31, 2015  |  Megan L. Durr, MD; Annemieke van Zante, MD, PhD; Steven D. Pletcher, MD


Dermoid cysts are rare lesions of the head and neck that usually present in children as an asymptomatic, slowly growing mass. We report a case that demonstrates that dermoid cysts can present later in life as a recurrent acute infection. Our patient was a 48-year-old man with a 22-year history of recurrent abscesses of the tongue and floor of the mouth that had required a tracheotomy and multiple hospitalizations. Magnetic resonance imaging performed between acute episodes revealed the presence of a 1.8-cm lesion within the tongue musculature. The patient underwent resection, and pathology was consistent with a lingual dermoid cyst. At 2 years of follow-up, he experienced no recurrence of symptoms.