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A case of pediatric parapharyngeal space ganglioneuroma

April 30, 2016  |  Natalie Garzorz, MD; Gillian R. Diercks, MD; Harrison W. Lin, MD; William C. Faquin, MD, PhD; Laura V. Romo, MD; Christopher J. Hartnick, MD, MS


Ganglioneuromas are rare, benign neoplasms derived from sympathetic neural crest progenitor cells. In the pediatric population, ganglioneuromas usually develop in the mediastinum or retroperitoneum. We report the case of a 3-year-old boy who presented with a painless enlarging neck mass, which was found to be a parapharyngeal space ganglioneuroma that extended to the skull base. We summarize the current principles regarding the diagnostic workup and treatment of these neoplasms, and we briefly review the literature.

Sympathetic hearing loss: A review of current understanding and report of 2 cases

April 30, 2016  |  Patrick F. Morgan, MD; Peter G. Volsky, MD; Barry Strasnick, MD, FACS


Sympathetic hearing loss (SHL) is a rare complication that appears to occur when the immune system is primed against sequestered inner ear antigens. SHL has been implicated in delayed hearing loss after acoustic tumor removal, revision stapedectomy, and temporal bone fractures. We present 2 cases of suspected SHL after excision of skull base tumors during which the surgical approach had violated the otic capsule. Both patients experienced delayed contralateral sensorineural hearing loss. In comparing our cases with those previously reported, we hope to inspire others to do likewise and to develop an understanding of this clinical entity.

An extended toboggan technique for resection of substernal thyroid goiters

April 30, 2016  |  Catherine F. Sinclair, MD; Glenn E. Peters, MD; William R. Carroll, MD


We describe our technique for the safe resection of substernal thyroid goiters. Early mobilization of the thyroid gland from tracheal attachments anteriorly and laterally facilitates extraction of the goiter from the mediastinum. Retrograde dissection through the ligament of Berry on the ipsilateral side can also facilitate identification of the recurrent laryngeal nerve and delivery of the substernal portion of the gland. We describe 2 representative cases in which we successfully used this technique.

If cytology of Warthin tumor is accurate, can management be conservative?

April 30, 2016  |  Alexander C. Vlantis, FCS(SA)ORL; Siu Kwan Ng, FRCSEd; Chi Keung Mak, MRCS(Ed); Jackie M. Cheung, MBChB; Amy B. Chan, FHKC Path; C. Andrew van Hasselt, MMed(Otol)


We conducted a retrospective study to assess the accuracy of fine-needle aspiration cytology (FNAC) in the diagnosis of Warthin tumor and to evaluate the subsequent risk of conservative nonsurgical management. We reviewed the records of 75 patients (76 tumors) with a parotid mass that had been diagnosed as a Warthin tumor by FNAC. This patient population was made up of 64 men and 11 women, aged 46 to 93 years (mean: 67). Of the 76 tumors, 40 were treated with surgical excision and 36 with conservative measures. Histology of the 40 excised parotid masses revealed that 38 (95%) were indeed Warthin tumors, 1 (2.5%) was a low-grade adenocarcinoma, and 1 was benign-not otherwise specified. None of the 36 tumors underwent malignant transformation either clinically or on repeat FNAC (if performed) during a follow-up of 4 to 120 months (mean: 55.5 ± 32.2). We conclude that conservative management of Warthin tumors confidently diagnosed on FNAC may be an option for patients who are unwilling or unable to undergo surgical excision.

Lichen nitidus on the dorsal tongue

April 30, 2016  |  Pedro Costa de Araujo, MD; Jerome R. Lechien, MD

This relatively uncommon, asymptomatic, idiopathic inflammatory eruption is usually found on the abdomen, pelvic area, or extremities, but rarely on the tongue.

Cervical disc herniation causing difficulty swallowing

April 30, 2016  |  Sheng-Yao Cheng, MD; Jih-Chin Lee, MD

Anterior cervical disc herniation is relatively rare and is usually asymptomatic until a certain degree of hypopharyngeal and esophageal compression leads to dysphagia.

Pneumocephalus after insertion of an inflatable nasal tampon for the management of epistaxis

April 30, 2016  |  Adam J. Kimple, MD, PhD; Michael O. Ferguson, MD


While the fundamental principles of epistaxis management have not changed over the decades, the methods by which tamponade is achieved have been evolving. Inflatable nasal tampons are being used and seen with increasing frequency in our ENT clinic. They are usually placed by emergency department personnel, who then refer patients to our clinic for removal. The classically described complications of nasal packs are induction of the nasopulmonary reflex, toxic shock syndrome, and discomfort. In this article, we describe a case of pneumocephalus following placement of an inflatable nasal tampon. To the best of our knowledge, this is the first report of pneumocephalus after placement of an inflatable nasal tampon.

Efficacy of allograft fascia lata in tympanic membrane repair

April 30, 2016  |  Ashley O'Connell Forster, MD; Joel Jones, MD; John Davis, AuD; Brittany Weber, MD; Mary Hawkshaw, RN, BSN, CORLN; Robert T. Sataloff, MD, DMA, FACS


We conducted a retrospective study to determine the efficacy of allograft fascia lata in both primary and revision tympanic membrane surgery (myringoplasty). Our patient population included 64 patients-31 men and 33 women, aged 19 to 98 years (mean: 49.5)-who had undergone tympanic membrane surgery with allograft fascia lata. Patients were grouped according to whether they had undergone primary surgery (n = 47) or revision surgery (n = 17). Data were compiled at preoperative and immediate postoperative visits, as well as at 3, 6, 9, and 12 months postoperatively. Residual perforations were defined as those present for less than 6 weeks postoperatively, and recurrent perforations were defined as those that occurred more than 6 weeks postoperatively. A residual perforation was found in only 1 patient (1.6%), a primary surgery patient. Recurrent perforations were found in 8 of the 64 patients (12.5%), including 5 in the primary group (10.6%) and 3 in the revision group (17.6%). We conclude that allograft fascia lata is a comparable alternative to other graft materials for performing myringoplasty.

Commentary on "The aging physician and surgeon" by Sataloff et al

April 30, 2016  |  Richard V. Homan, MD

Is unenhanced 18F-FDG-PET/CT better than enhanced CT in the detection of retropharyngeal lymph node metastasis in nasopharyngeal carcinoma?

April 30, 2016  |  Iuan-Sheng Wu, MD; Guang-Uei Hung, MD; Bo-Ling Chang, MD; Chi-Kuang Liu, MD; Tung-Hao Chang, MD; Hong-Shen Lee, PhD; Mu-Kuan Chen, MD, MS, PhD


Positron-emission tomography/computed tomography (PET/CT) has been proposed as a means to enhance the pretreatment evaluation of cervical lymph node status in patients with nasopharyngeal carcinoma (NPC). We conducted a prospective study to compare PET/CT and enhanced CT for the detection of retropharyngeal lymph node (RLN) metastasis in NPC, and to ascertain the factors that affect its diagnostic performance. Our study population was made up of 33 patients-24 men and 9 women, aged 30 to 81 years (mean: 52)-with newly diagnosed NPC who had been treated over a 2-year period. All patients underwent enhanced CT first, followed by unenhanced 18F-fluorodeoxyglucose (FDG) PET/CT. The detection rate of RLN metastasis on PET/CT was significantly lower than that on enhanced CT (36.4 vs. 75.8%; p < 0.001). A total of 25 of 26 nodes with a discordant finding were negative on PET/CT; they included 13 metastatic lymph nodes with low FDG uptake, 9 that were located close to the primary tumor, 2 that were confluent RLNs, and 1 that was adjacent to the physiologic FDG-avid prevertebral muscle. The maximum standardized uptake value (SUVmax) of RLNs was positively correlated with the minimum axial diameter (r = 0.803, p < 0.001). The PET/CT detection rate was 0% for lymph nodes smaller than 5 mm, 9% for those 5 to 10 mm, and 73% for those 1 cm or larger. The detection rate of PET/CT at level C1 was significantly lower than that at C2 (22 vs. 67%; p = 0.035). We conclude that unenhanced PET/CT is markedly inferior to enhanced CT for detecting RLN metastasis in NPC, especially in lymph nodes with a minimum axial diameter of less than 1 cm and those in proximity to the primary tumor. Using enhanced CT in PET/CT is justified to improve the recognition of RLN metastasis in patients with NPC.