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Endoscopic view of a total ethmoidectomy prior to the FESS era

October 31, 2015  |  Eiji Yanagisawa, MD, FACS; Dewey A. Christmas, MD; Joseph P. Mirante, MD, FACS

Before the development of functional endoscopic sinus surgery (FESS), total intranasal ethmoidectomy was performed without the aid of telescopes.

Langerhans cell histiocytosis involving the external auditory canal: An unusual ear tumor

October 31, 2015  |  Kang-Wei Fan, MD; Cheng-Chien Yang, MD; Chia-I Chou, MD; Min-Tsan Shu, MD

Langerhans cell histiocytosis has an unpredictable natural history, which ranges from rapidly fatal progressive disease to spontaneous resolution.

Noninvasive intraoperative angiography for reconstruction of head and neck defects

October 31, 2015  |  Shiva P. Daram, MD; Justin M. Sacks, MD; Michael E. Kupferman, MD


Reconstruction of head and neck defects after cancer resection involves the use of local, pedicled musculocutaneous, and free flaps. Flap failure is often caused by vascular insufficiency, and it is associated with the presence of cardiovascular or peripheral vascular disease, a history of smoking, and previous radiation and/or surgery. Failure rates may be reduced by the use of indocyanine green near-infrared fluorescence laser angiography, which detects perfusion deficits intraoperatively. Although this technology has been validated in other fields, there is limited experience in the head and neck region. We present 3 cases in which different head and neck flaps were used along with this technology in patients at high risk for flap failure. All flaps were successfully implanted without perioperative or long-term complications. The increasing complexity, age, and comorbidities of the head and neck cancer population pose significant reconstructive challenges. This report demonstrates the feasibility of employing intraoperative angiography for local, pedicled, and free flaps. This noninvasive tool optimizes intraoperative planning and assesses viability, potentially lowering failure rates in high-risk patients. Identification of patients who most benefit from this technology warrants further investigation.

Unusual primary tumors presenting as papillary carcinomas metastatic to the neck

October 31, 2015  |  Agnes Dupret-Bories, MD, PhD; Marc Wilt, MD; Pierre Kennel, MD; Anne Charpiot, MD, PhD; Jean-Francois Rodier, MD, FACS


The presence of a metastatic papillary carcinoma in the neck is presumptive evidence of a primary thyroid neoplasm since neck metastases of other primary tumors are uncommon. Immunohistochemical studies may be required to diagnose these metastases. We report 2 cases in which an unrelated tumor mimicked a thyroid malignancy. Both patients had been referred for evaluation of enlarged lymph neck nodes without any other symptoms. In both cases, a lymph node biopsy identified a metastatic papillary adenocarcinoma that was believed to be consistent with a thyroid primary. Thyroidectomy was not performed in either case. Further investigations led to the diagnosis of other primary tumors that were unrelated to the thyroid; the unrelated primaries were an ovarian serous tumor in one patient and a papillary renal cell carcinoma in the other.

An imaging study of the facial nerve canal in congenital aural atresia

October 31, 2015  |  Shouqin Zhao, PhD; Demin Han, PhD; Zhenchang Wang, PhD; Jie Li, MD; Yanni Qian, MD; Yuanyuan Ren, MD; Jiyong Dong, MD


We conducted a prospective study to investigate the abnormalities of the facial nerve canal in patients with congenital aural atresia by computed tomography (CT). Our study population was made up of 99 patients-68 males and 31 females, aged 6 to 22 years (mean: 13.5)-who had unilateral congenital aural atresia without any inner ear malformations. We compared our findings in these patients with those in 50 controls-33 males and 17 females, aged 5 to 22 years (mean: 15.0)-who had normal ears. We classified the congenital aural atresia patients into three groups (A, B, and C) according to their Jahrsdoerfer grading scale score (≥8; 6 or 7; and ≤5, respectively). The course of the facial nerve canal in both the controls and the study patients was determined by temporal bone CT with multiplanar reconstruction. The distances from different parts of the facial nerve canal to surrounding structures were also measured. The course of the facial nerve canal in the normal ears did not vary much, and there were no statistically significant differences according to head side and sex. In groups B and C, the tympanic segment, mastoid segment, and angle of the second genu of the facial nerve canal were all significantly smaller than those of the controls (p < 0.01 in all cases). Statistically, the tympanic segment of the facial nerve canal in patients with congenital aural atresia was downwardly displaced. The mastoid segment of the facial nerve canal in these patients was more anterior than that of the controls. We conclude that congenital aural atresia is often accompanied by abnormalities of the facial nerve canal, especially in the tympanic segment, the mastoid segment, and the second genu. We found that the lower the Jahrsdoerfer score was, the shorter the tympanic segment was and the more forward the mastoid segment was.

A hyperpneumatized frontal sinus with middle meatal obstruction

October 31, 2015  |  Dewey A. Christmas, MD; Joseph P. Mirante, MD, FACS; Eiji Yanagisawa, MD, FACS

In this case, the narrowing of the middle meatus by the hypertrophic polypoid middle turbinate resulted in intermittent frontal sinusitis and headaches.

Laryngofissure for resection of a recurrent saccular cyst

October 31, 2015  |  Reed C. Gilbow, BS; J. Mark Reed, MD; Jeffrey D. Carron, MD

Congenital saccular cysts represent a rare cause of airway obstruction and inspiratory stridor in infants.

Masseter flap for reconstruction of defects after excision of buccal mucosa cancers with intact mandible

October 31, 2015  |  Pankaj Chaturvedi, MS; Sandeep Lerra, MS(ENT); Farheen Ustad, MS; Prathamesh S. Pai, MS(ENT); Devendra A. Chaukar, MS; Anil K. D'Cruz, MS


Among the reconstructive options available for buccal mucosa defects with an intact mandible, free flap with microvascular anastomosis is the best option. However, in the developing world, with poor resources, limited infrastructure, and high patient load, this cannot be offered to all patients. We report on the success of the masseter flap for reconstruction of such defects in carefully selected patients. Despite some known limitations, this flap is easy to learn and carries acceptable complications. The results of this flap may not be comparable to those of microvascular reconstructions, but they are better than those from other options such as skin graft, nasolabial flap, submental flap, etc., in terms of surgical time required, no donor site morbidity, and minimal aesthetic deformity.

Laryngeal neurofibroma

October 31, 2015  |  Andreas Anagiotos, MD; Dirk Beutner, MD

Neurofibromas are rarely seen in the larynx. Common symptoms are stridor, hoarseness, dysphagia, dysphonia, and globus sensation.

Angiolymphoid hyperplasia with eosinophilia

October 31, 2015  |  Lester D. Thompson, MD

Angiolymphoid hyperplasia with eosinophilia (ALHE) is a benign vascular tumor that features immature blood vessels lined by epithelioid endothelial cells with a prominent inflammatory infiltrate, frequently showing a conspicuous eosinophil component.