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Congenital granular cell tumor in a child with tetralogy of Fallot

July 18, 2016  |  Felicity Lenes-Voit, MD; Anthony Sheyn, MD; Debra Weinberger, MD

Although congenital granular cell tumors are always benign, they can cause feeding difficulties and airway obstruction.

Epitympanic meningoencephalocele presenting as a growing middle ear mass

July 18, 2016  |  James G. Naples, MD; John W. House, MD; Benjamin J. Wycherly, MD

This patient had a subtle middle ear mass without an obvious effusion at the initial presentation; on repeat examination, it became more obvious that this was a meningoencephalocele

Spontaneous bleeding from a thyroid adenoma

July 18, 2016  |  Tsung-Jung Liang, MD; Shiuh-Inn Liu, MD, PhD

Massive thyroid hemorrhage with airway obstruction warrants urgent management, and the importance of definite airway establishment for ventilation and oxygenation cannot be overemphasized.

Malignant transformation of a high-grade osteoblastoma of the petrous apex with subcutaneous metastasis

June 14, 2016  |  Casey T. Kraft, BS; Robert J. Morrison, MD; H. Alexander Arts, MD, FACS


We describe the clinical presentation, management, and pathologic findings in a case of osteosarcoma of the petrous apex with an atypical metastasis to the lower abdominal wall. We retrospectively reviewed the record of a 49-year-old man who was diagnosed with a right petrous apex lesion, which biopsy identified as a high-grade osteoblastoma. After two attempts at en bloc resection were not curative, radiation and chemotherapy were recommended. The patient subsequently developed a cutaneous lower abdominal mass that was diagnosed as an osteosarcoma. Meanwhile, the petrous apex tumor continued to grow despite treatment until the patient died from the burden of disease. Temporal bone osteoblastomas and osteosarcomas are both extremely rare, and they can be difficult to differentiate histologically. Our case illustrates this difficulty and demonstrates the possibility of a high-grade osteoblastoma's malignant conversion to an osteosarcoma.

Aberrant position of nonrecurrent inferior laryngeal nerve: Report of 3 cases and a review of the literature

June 14, 2016  |  Thomas J. Willson, MD; Jayne Stevens, MD; Nathan Salinas, MD; Joseph A. Brennan, MD


The presence of a nonrecurrent inferior laryngeal nerve (NRILN) is a significant risk factor for nerve injury during thyroid, parathyroid, and vascular surgeries involving the paratracheal area of the head and neck. The objective of this report is to review the association between an aberrant right subclavian artery (SCA) identified on preoperative imaging and an NRILN identified intraoperatively during thyroid and parathyroid surgery. We reviewed 3 selected cases in which we preoperatively identified an aberrant right SCA and determined the intraoperative position of the inferior laryngeal nerve on the right. It is important to note that 1 of these cases demonstrated that the inferior laryngeal nerve may be found in its normal anatomic position, coursing inferiorly through the tracheoesophageal groove. This anatomic finding is unexpected in a patient with a preoperatively identified aberrant right SCA. We also performed a literature review of more than 250 cases to investigate the association between an intraoperative finding of NRILN and vascular anomalies on imaging. We found 5 reported cases that involved an aberrant right SCA, predictive of NRILN, with the nerve identified in the tracheoesophageal groove.

Twenty-four years of powered endoscopic nasal polypectomy

June 14, 2016  |  Dewey A. Christmas, MD; Joseph P. Mirante, MD, FACS; Eiji Yanagisawa, MD, FACS

Powered endoscopic nasal polypectomy with a microdebrider can be performed with either local or general anesthesia.

Investigation of diagnosis and surgical treatment of mucosal contact point headache

June 14, 2016  |  Jia Wang, MD; Jin-Shu Yin, MD; Hong Peng, MD


We aimed to investigate the differences in incidence of nasal anatomic abnormalities between patients with and without headache and the outcome of surgical treatment for the headache patients with mucosal contact points. We conducted the observational study and recruited 107 subjects without headache (nonheadache group) and 78 patients with recurrent headache for more than 2 years (headache group). Study participants underwent high-resolution sinus computed tomography scans, and the incidence of nasal anatomic abnormalities was calculated in both groups. An additional 25 patients with recurrent headache underwent endoscopic surgical treatment. Mucosal contact points were observed in 85.9% of patients with recurrent headache and also in 80.4% of participants without headache. The most common mucosal contact point was between a deviated nasal septum and lateral nasal wall (41.1%). The incidence of deviated nasal septum contacting with lateral nasal wall was significantly different between the headache group (55.1%) and the nonheadache group (40.2%) (p < 0.05). The postoperative pain scores of the additional 25 headache patients with recurrent headache and mucosal contact point who were treated with endoscopic surgery decreased significantly compared with their preoperative measurements (p < 0.001), but only 44% of patients had recovered from headache 7 days postoperatively. We conclude that some patients with recurrent headache may not have a mucosal contact point, and some patients with mucosal contact points may not meet the diagnostic criteria of mucosal contact point headache since pain was not resolved within 7 days after surgical treatment. The diagnostic criteria of mucosal contact point headache before surgery should be reevaluated.

Unconventional fix for an orocutaneous fistula

June 14, 2016  |  Laura Garcia-Rodriguez, MD; Rahil Dharia, BS; Cameron Heilbronn, MD; Tamer Ghanem, MD, PhD

Local risk factors for OCF and PCF secondary to total laryngectomy include infections, exposure of salivary fluids, and radiation.

Asymptomatic medial vocal fold hemorrhagic polyp

June 14, 2016  |  Ozlem E. Kantarcioglu, MD; Amy L. Rutt, DO; Robert T. Sataloff, MD, DMA, FACS

This patient did not realize that her voice was pathologic until after she had been treated.

Case of a tick as an unusual animate aural foreign body

June 14, 2016  |  Chao-Hsun Huang, MD; Min-Tsan Shu, MD

The risk of acquiring a tick foreign body in the external auditory canal is generally related to geographic and climatic factors, such as warmer months and areas with forests, high grass, and leaf litter.