Lipoid proteinosis of the larynx

March 2, 2015     Jagdeep Singh Virk, MA(Cantab), MRCS, DOHNS; Sonal Tripathi, BSc, MBChB; Ann Sandison, FRCPath; Guri Sandhu, MD, FRCS, FRCS(ORL-HNS)
article

here is no accepted gold standard of management, but surgery should be used judiciously in selected patients to improve voice function and maintain the airway. Long-term follow-up and repeat procedures are usually required for disease control, and genetic counseling may be needed.

Necrotizing tonsillitis caused by group C beta-hemolytic streptococci

March 2, 2015     Jassem M. Bastaki, DMD, MPH
article

Abstract

Tonsillitis and pharyngitis are among the most common infections in the head and neck. Viral tonsillitis is usually caused by enterovirus, influenza, parainfluenza, adenovirus, rhinovirus and Epstein-Barr virus (causing infectious mononucleosis). Acute bacterial tonsillitis is most commonly caused by group A beta-hemolytic streptococci. On the other hand, pseudomembranous and necrotizing tonsillitis are usually caused by fusiform bacilli and spirochetes. Here we report what is, to our knowledge, the first case of necrotizing tonsillitis caused by group C beta-hemolytic streptococci.

Septic arthritis: A unique complication of nasal septal abscess

March 2, 2015     Steven M. Olsen, MD; Cody A. Koch, MD, PhD; Dale C. Ekbom, MD
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Abstract

Nasal septal abscesses (NSAs) occur between the muco-perichondrium and the nasal septum. They most often arise when an untreated septal hematoma becomes infected. The most commonly reported sequela is a loss of septal cartilage support, which can result in a nasal deformity. Other sequelae include potentially life-threatening conditions such as meningitis, cavernous sinus thrombosis, brain abscess, and subarachnoid empyema. We report the case of a 17-year-old boy who developed an NSA after he had been struck in the face with a basketball. He presented to his primary care physician 5 days after the injury and again the next day, but his condition was not correctly diagnosed. Finally, 7 days after his injury, he presented to an emergency department with more serious symptoms, and he was correctly diagnosed with NSA. He was admitted to the intensive care unit, and he remained hospitalized for 6 days. Among the abscess sequelae he experienced was septic arthritis, which has heretofore not been reported as a complication of NSA. He responded well to appropriate treatment, although he lost a considerable amount of septal cartilage. He was discharged home on intravenous antibiotic therapy, and his condition improved. Reconstruction of the nasal septum will likely need to be pursued in the future.

Introduction A hematoma in the nasal cavity is an excellent medium for bacterial growth. In such cases, the nasal cavity frequently becomes infected, causing nasal septal abscess (NSA). Abscess formation results in rapid cartilage destruction and can lead to many additional complications. Previous presentation: The information in this article has...

Plexiform schwannoma of the posterior pharyngeal wall in a patient with neurofibromatosis 2

March 2, 2015     Luca Raimondo, MD; Massimiliano Garzaro, MD; Jasenka Mazibrada, MD, PhD; Giancarlo Pecorari, MD; Carlo Giordano, MD
article

Abstract

We report a case of plexiform schwannoma of the posterior pharyngeal wall that occurred in a 37-year-old man who had been previously diagnosed with neurofibromatosis type 2 (NF2). Plexiform schwannoma has been rarely reported in association with NF2. Moreover, as far as we know, only 6 cases of posterior pharyngeal wall schwannoma have been previously reported in the literature, none of which was associated with NF2 and none of which was histopathologically differentiated in schwannoma or plexiform schwannoma. The patient was treated with laser excision of the tumor via a transoral route, and at 6 and 12 months of follow-up, he exhibited no signs of recurrence. To the best of our knowledge, our patient represents the first reported case of a posterior pharyngeal wall schwannoma that occurred in association with NF2 and the first case in which the schwannoma was removed via transoral laser excision. This case illustrates that plexiform schwannoma is a possible finding in NF2 and that transoral laser excision is a safe surgical procedure in such a case.

The paramedian forehead flap for nasal lining reconstruction

March 2, 2015     Joshua D. Rosenberg, MD; Nikita Gupta, MD
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The importance of reconstructing nasal lining defects cannot be overstated, especially for composite defects also involving the framework and skin soft-tissue envelope.

Common carotid artery dissection: A rare cause of acute neck swelling

March 2, 2015     Muhammad Adil Abbas Khan, MBBS, MRCS, DOHNS, FCPS(Plast); Alasdair Moffat, MBBS; Waseem Ahmed, MBBS, MRCS, DOHNS; Julian Wong, MBBS, FRCS(Vasc); Changez Jadun, MBBS, FRCR
article

Abstract

Spontaneous carotid artery dissection is a rare condition with potentially devastating consequences. Internal carotid artery and vertebral artery dissections have been implicated as the cause of 20% of strokes occurring in patients younger than 45 years. We describe a very rare case of a nontraumatic common carotid artery dissection in a 45-year-old man that was initially misdiagnosed as a sternocleidomastoid hematoma. This case highlights the need for vigilance for this often-missed diagnosis, as well as the indication for noninvasive imaging in unidentified neck swellings.

Introduction Dissections of the carotid artery are rare. Studies have shown that the annual incidence ranges from 2.5 to 3 per 100,000 population.1 They are most common in the fifth decade of life.2

Streamlined bilateral otologic surgery: How I do it

March 2, 2015     Tara E. Brennan, MD; Miriam I. Redleaf, MD
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Abstract

Bilateral simultaneous otologic surgery is being performed more commonly among otologists. The benefits of performing bilateral simultaneous cochlear implants in the pediatric population, in particular, have become increasingly recognized as the safety and efficacy of this operation have been recognized in the literature. Here we present a streamlined method of performing bilateral simultaneous otologic surgery that emphasizes midline placement of facial nerve electrodes and a method of sterile preparation and draping that affords direct exposure to both ears at one time, without the need to turn the head or adjust the drapes multiple times throughout the operation. Our approach facilitates frequent and efficient alternation between ears throughout the operation, optimizing efficiency of motion and instrumentation for the surgeon, and reducing overall operative and general anesthesia time for the patient.

World Voice Day 2015

March 2, 2015     Robert T. Sataloff, MD, DMA, FACS, Editor-in-chief
article

The 2015 theme is “Voice: The original social media.”

  World Voice Day 2015  

Previous gastric bypass surgery complicating total thyroidectomy

March 2, 2015     Bianca Alfonso, MD; Adam S. Jacobson, MD; Eran E. Alon, MD; Michael A. Via, MD
article

Abstract

Hypocalcemia is a well-known complication of total thyroidectomy. Patients who have previously undergone gastric bypass surgery may be at increased risk of hypocalcemia due to gastrointestinal malabsorption, secondary hyperparathyroidism, and an underlying vitamin D deficiency. We present the case of a 58-year-old woman who underwent a total thyroidectomy for the follicular variant of papillary thyroid carcinoma. Her history included Roux-en-Y gastric bypass surgery. Following the thyroid surgery, she developed postoperative hypocalcemia that required large doses of oral calcium carbonate (7.5 g/day), oral calcitriol (up to 4 μg/day), intravenous calcium gluconate (2.0 g/day), calcium citrate (2.0 g/day), and ergocalciferol (50,000 IU/day). Her serum calcium levels remained normal on this regimen after hospital discharge despite persistent hypoparathyroidism. Bariatric surgery patients who undergo thyroid surgery require aggressive supplementation to maintain normal serum calcium levels. Preoperative supplementation with calcium and vitamin D is strongly recommended.

Introduction Over the past decade, there has been an exponential increase in the number of bariatric surgical procedures performed worldwide. Approximately 200,000 bariatric surgeries are performed annually in the United States alone.1,2 Bariatric procedures are either restrictive, malabsorptive, or both (table 1). The most common procedure is...

Maxillary sinus cyst containing a bone chip

March 2, 2015     Jae-Hoon Lee, MD
article

If bone fragments in the sinus can be removed, the patient's prognosis is usually excellent.

A 24-year-old woman presented for evaluation of a 5-month history of a persistent right-sided pressure sensation in her cheek. She denied any history of underlying systemic disease, relevant facial trauma, or sinus surgery. Nasal endoscopy found no evidence of disease, as no polyps or nasal masses were visible during the examination.
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