Head and neck cancer: A humanitarian effort in your own backyard

February 2, 2015     Judith Fornadley, MS, CF-SLP; Wendy Stern, MD; Cherie-Ann O. Nathan, MD, FACS
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April 12-18 is Oral, Head and Neck Cancer Awareness Week (OHANCAW).

Head and neck cancer (HNC) accounts for 5% of all new cancers, or approximately 22,000 new cases every year.1 This is a serious disease that is treatable and preventable; outcomes are best with smaller tumors (up to 90% 5-year survival with stage I disease, 75 to 80% with stage II2), which means early detection is vital. Unfortunately, several...

Basaloid squamous cell carcinoma of the sinonasal tract with metastasis to the liver: A case report and literature review

February 2, 2015     Boon Ping Toe, FRCR(Lond); Norlisah Ramli, FRCR(Lond); Sze Yin Lam, MRad(Mal); Kum Thong Wong, FRCPath(Lond); Narayanan Prepageran, FRCS(Edin)
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Abstract

Basaloid squamous cell carcinoma (BSCC) is a rare subtype of squamous cell carcinoma. To date, only 95 cases of sinonasal BSCC have been reported in the English-language literature, and they account for 5% of all cases of head and neck BSCC. We describe what we believe is only the second reported case of a sinonasal tract BSCC that metastasized to the liver. The patient was a 36-year-old woman who presented with right-sided nasal obstruction and a foul-smelling discharge. Clinical examination and imaging identified a large lobulated enhancing mass in the right nasal cavity. Following excision of the mass, the patient was scheduled for radiotherapy. However, before it could be administered, follow-up imaging detected a metastasis to the liver and lung, and the patient was switched to chemotherapy. Initially, she responded well clinically, but at 5 months postoperatively, a follow-up CT showed an increasing metastatic presence in the liver and bone. The patient died of her disease 1 year after surgery.

Introduction Basaloid squamous cell carcinoma (BSCC), a rare subtype of squamous cell carcinoma, was first reported by Wain et al in 1986.1 BSCC commonly occurs in the upper aerodigestive tract.2 Metastases to bone, lung, and brain have been reported. To the best of our knowledge, only 1 case of BSCC of the sinonasal tract metastasizing to the...

Salivary gland choristoma of the middle ear

February 2, 2015     Shubin Chen, MD; Yongxin Li, MD
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Abstract

Salivary gland choristoma of the middle ear is a rare entity. It is believed to be a developmental abnormality that may be associated with anomalies of adjacent structures. We describe the case of a 6-year-old girl who had a salivary gland choristoma in the middle ear that was associated with an ossicular chain anomaly and a facial nerve anomaly. We discuss the clinical features and management of this condition, and we review the literature.

Introduction A choristoma is a mass of tissue that is histologically normal for an organ or a tissue but foreign to the tissue or site where it is located. For example, a salivary gland choristoma is normal salivary gland tissue that appears in a location other than the salivary gland. Its occurrence in the middle ear cavity is rather rare; only...

The efficacy of photodynamic therapy in the treatment of oral squamous cell carcinoma: A meta-analysis

February 2, 2015     Eric W. Cerrati, MD; Shaun A. Nguyen, MD, MA, CPI; Joshua D. Farrar, MD; Eric J. Lentsch, MD
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Abstract

We performed an extensive review of the literature to compare the efficacy of photodynamic therapy (PDT) to surgical resection, the current standard of care, in the treatment of adults with early-stage (T1-2N0M0) squamous cell carcinoma (SCC) of the oral cavity. Since patients who receive PDT are chosen with a high degree of selectivity, particular care was taken when extracting data for comparison. For outcomes measures, PDT was assessed in terms of a complete response to therapy, and surgery was evaluated in terms of locoregional control. Recurrences were also analyzed. We found 24 studies-12 for each treatment-to compare for this meta-analysis. In comparing a complete response to PDT and locoregional control with surgery, we found no statistically significant difference (mean difference [MD]: 1.166; 95% confidence interval [CI]: 0.479 to 2.839). With respect to recurrences, again no statistically significant difference was observed (MD: 0.552; 95% CI: 0.206 to 1.477). We conclude that PDT is as effective as primary surgical resection for the treatment of early-stage SCC of the oral cavity and that it is a valid function-preserving approach to treatment.

Glottic myxoma presenting as chronic dysphonia: A case report and review of the literature

January 19, 2015     Christopher G. Tang, MD; Daniel L. Monin, MD; Balaram Puligandla, MD; Raul M. Cruz, MD
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Abstract

Myxomas of the vocal fold are rare benign tumors often presenting with chronic dysphonia and less frequently with airway obstruction. The current consensus is that all laryngeal myxomas should be totally excised with clear margins to prevent recurrences. The recommendation for complete excision, however, has to be balanced with consideration of preserving vocal fold phonatory and sphincteric function. We report a case of vocal fold myxoma recurring twice after subtotal excision via two surgical approaches. This case illustrates a benign lesion with potential for recurrence and the need for a balanced treatment approach.

Osteoradionecrosis of the temporal bone

January 19, 2015     Edmund W. Lee, BA; Robert W. Jyung, MD
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The pathogenesis of osteoradionecrosis is not completely understood, but it has been thought that radiation causes tissues to become hypoxic, hypovascular, and hypocellular, leading to tissue breakdown and a nonhealing wound.

A 66-year-old man was referred to our clinic for evaluation of a sensation of excessive wax in his left ear that had worsened over the previous 3 years. He had a history of a left parotid malignancy 20 years earlier that required a parotidectomy and postoperative radiation therapy. Following the irradiation, he felt an altered pattern of wax...

Unusual presentation of a midline neck mass

January 19, 2015     Yann-Fuu Kou, MD; Gopi Shah, MD, MPH; Ronald Mitchell, MD; Larry L. Myers, MD
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Venous malformations are usually visible at birth, although deeper lesions may have normal overlying skin or a bluish discoloration. They grow proportionately with the child and can expand in adulthood.

A 13-year-old girl presented with a 2-week history of a low midline neck mass that had caused her intermittent pain and some difficulty breathing. It enlarged on straining. She denied dysphagia, odynophagia, voice changes, weight loss, fever, chills, and cough. She had no significant medical or surgical history.

Cherubism

January 19, 2015     Lester D.R. Thompson, MD
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When there is significant infraorbital maxillary involvement, the inferior rim of the sclera is more prominent, resulting in the classic “eyes to heaven” appearance.

Cherubism is an autosomal-dominant inherited disease with variable expression. It is characterized by a progressive, painless, and symmetric expansion of the jaws. The disease is caused by a point mutation in the SH3BP2 gene (chromosome 4p16.3), which leads to dysregulation of the Msx-1 gene; this gene is involved in regulating mesenchymal...

Arrested development: Lingual thyroid gland

January 19, 2015     Mark R. Williams, MRCS(ENT); Vivek Kaushik, FRCS(ORL-HNS)
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Most patients with lingual thyroid are asymptomatic and are diagnosed incidentally following a radiologic investigation for another condition of the head and neck.

Most patients with a lingual thyroid gland are asymptomatic, as it rarely manifests clinically with aerodigestive symptoms, malignancy, or endocrine dysfunction. It is therefore usually diagnosed as an incidental finding, more so now with the increased use of cross-sectional imaging in the head and neck region.

Endoscopic view of nasopharyngeal scarring

January 19, 2015     Joseph P. Mirante, MD, FACS; Dewey A. Christmas, MD; Eiji Yanagisawa, MD, FACS
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A finding of fibrous or scar tissue in the nasopharynx usually indicates previous trauma or surgery in the area. The most common iatrogenic cause is adenoidectomy.

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