Cricotracheal resection

June 4, 2015     Amanda Hu, MD, FRCSC; James McCaffrey, MD; Al Hillel, MD

As much as half of the trachea can be resected with a low incidence of anastomotic complications.

A rare case of pleomorphic adenoma of the nasal septum

June 4, 2015     Tejinder Singh Anand, MS, PhD; Gautam Bir Singh, MS; Sunil Garg, MS; Garima Yadav, MBBS; Anita Nangia, MD

Pleomorphic adenomas of the nasal cavity differ from those found elsewhere in that they have more myoepithelial cells and little or no stromal component.

Bezold abscess

June 4, 2015     Yu-Hsuan Lin, MD; Ming-Yee Lin, MD

In some circumstances, the only sign or symptom of Bezold abscess is an unnoticed neck lump.

Bezold abscess is an extremely rare otogenic complication. However, its initial manifestation might appear to be fairly nonthreatening, which can lead to a delay in diagnosis. Maintaining a high level of clinical suspicion and the early use of radiologic imaging can guide clinicians in the diagnosis and surgical or medical management of this...

Maxillary myxoma: A case report and review

June 4, 2015     Matthew P. Connor, MD, Capt.; Michael Neilson, DMD, Maj.; Cecelia E. Schmalbach, MD


An odontogenic myxoma is a rare, benign tumor that is found almost exclusively in the facial bones, usually the mandible. The diagnosis poses a challenge because its features overlap with those of other benign and malignant neoplasms. We present an unusual case of odontogenic myxoma that involved the maxilla, and we review the clinical, radiographic, and histologic characteristics of this case. Even though it is benign, odontogenic myxoma can be locally invasive and cause significant morbidity. Complete surgical excision is the treatment of choice, but it can be challenging because of the tumor's indistinct margins.

Juvenile nasopharyngeal angiofibroma staging: An overview

June 4, 2015     Nada Ali Alshaikh, MD; Anna Eleftheriadou, MD, PhD


Staging of tumors is very important in treatment and surgical decision making, as well as in predicting disease recurrence and prognosis. This review focuses on the different available classifications of juvenile nasopharyngeal angiofibroma (JNA) and their impact on the evaluation, management, and prognosis of JNA. The literature was reviewed, and publications on JNA staging were examined. Our MEDLINE search of the entire English-language literature found no review article on the current available staging systems for JNA. In this article, we review the common JNA classification systems that have been published, and we discuss some of their advantages and disadvantages. The most commonly used staging systems for JNA are the Radkowski and the Andrews-Fisch staging systems. However, some newer staging systems that are based on advances in technology and surgical approaches-the Onerci, INCan, and UPMC systems-have shown promising utility, and they will probably gain popularity in the future.

Introduction Juvenile nasopharyngeal angiofibroma (JNA) is a rare benign nasopharyngeal tumor that accounts for 0.05 to 0.5% of all head and neck tumors.1 It exclusively affects adolescent boys.1 It was first described in 1906 by Chauveau, who gave it its name.2 However, the oldest recorded surgical procedure for JNA is attributed to Hippocrates...

Anaplastic large-cell lymphoma presenting as a nasopharyngeal mass and cervical lymphadenopathy

June 4, 2015     Gregory R. Dion, MD, MS, Capt.; Col. Mark D. Packer, MD


Cervical lymphadenopathy in adults has a broad differential diagnosis, including bacterial and viral infections, Kikuchi-Fujimoto disease, systemic lupus erythematosus, and various neoplasms. Many of its etiologies share similar symptomatology and presentations, which complicates the diagnosis. A thorough history and a comprehensive physical examination, to include nasopharyngoscopy and imaging as indicated by the specific case, are key to determining the origin of the lymphadenopathy and to avoid a missed or delayed diagnosis. Based on our review of the literature, we present the second reported case of anaplastic lymphoma kinase-positive anaplastic large-cell lymphoma presenting in an adult with an obstructing adenoid/nasopharyngeal mass and lymphadenopathy. The mass, which occurred in a 19-year-old woman of Asian descent, caused nasal airway obstruction in the setting of cervical lymphadenopathy that was initially ascribed to mononucleosis.

Neuropathic pain from a nasal valve suspension suture

June 4, 2015     Tyler P. Swiss, DO; Douglas S. Ruhl, MD, MSPH; Scott B. Roofe, MD, FACS

Surgeons should maintain a high index of suspicion when a patient who has undergone nasal valve suspension complains of postoperative neuropathic pain.

Disclaimer: The views expressed herein are those of the authors and do not necessarily reflect the official policy or position of the U.S. Army, the Department of Defense, or the U.S. Government.

Laryngeal findings and acoustic changes in light cigar smokers

June 4, 2015     Abdul-latif Hamdan, MD, FACS; Randa Al-Barazi, MD; Jihad Ashkar, MD; Sami Husseini, MD; Alexander Dowli, MD; Nabil Fuleihan, MD


The aim of this prospective study was to look at the laryngeal findings and acoustic changes in light cigar smokers in comparison to nonsmokers, in the setting of a voice clinic. A total of 22 cigar smokers and 19 nonsmokers used as controls were enrolled in the study. Demographic data included age, number of years smoking, number of cigars per week, history of allergy, and history of reflux. The confounding effects of allergy and reflux were accounted for in the control group. Subjects underwent laryngeal endoscopy and acoustic analysis. On laryngeal endoscopy, the most common laryngeal finding was thick mucus. There was no significant difference in the prevalence of any of the laryngeal findings in cigar smokers vs. controls. In comparison with the control group, both the fundamental frequency and habitual pitch were significantly lower in cigar smokers (p value = 0.034 and 0.004, respectively). We conclude that cigar smokers have lower fundamental frequency and habitual pitch compared to nonsmokers.

Sleep problems of adolescents: A detailed survey

June 4, 2015     Nuray Bayar Muluk, MD; Selda Fatma Bulbul, MD; Mahmut Turgut, MD; Gulsah Agirtas, MD


We investigated the sleep problems and sleep habits of adolescents at three public primary schools and two high schools. Our study included 428 Turkish school children (244 girls and 184 boys). We used a questionnaire to determine the time they went to sleep at night; waking time in the morning; incidence of nightmares, snoring, daytime sleepiness, and intrafamilial physical trauma; concentration difficulty in class; and school success. The students were divided into age-related groups (group 1 = 11 to 13 years of age; group 2 = 14 to 15 years; group 3 = 16 to 18 years). The time they went to sleep was mostly between 10 and 11 p.m. in groups 1 and 2, and 11 to 12 p.m. in group 3. Difficulty in falling asleep was reported by 16.8 to 19.6% of the students in the three groups. Difficulty in waking up in the morning was reported by 12.7% of group 1, 16.0% of group 2, and 16.8% of group 3. Snoring was present in 12.1% of females and 22.0% of males. The occurrence of one nightmare in the preceding 3 months was reported by 11.3% of the students; 17.9% of the students reported having nightmares several times. Daytime sleepiness was present in 65.1%, and concentration difficulty was present in 56.8% of the students. We conclude that difficulty in falling asleep, snoring, and daytime sleepiness may be seen in adolescents who are in both primary and high schools. Watching inappropriate programs and movies on television and intrafamilial physical trauma may cause nightmares and sleeping problems in these adolescents. Students and families should be educated about the importance of sleep in academic performance. Countries' public health policies should address sleep problems and related educational activities.

Introduction Sleep disorders are common, affecting about one-third of all people,1 and they can cause depression, impaired performance at school or work, and reduced quality of life and relationships. Despite our substantial knowledge about sleep problems, health professionals are still insufficiently trained in preventing, assessing, and...

ACE-inhibitor-related angioedema

June 4, 2015     Norman J. Chan, MD; Ahmed M.S. Soliman, MD

There is debate regarding whether patients who experience ACE-inhibitor-related angioedema can be safely switched to angiotensin receptor blockers.

  Otolaryngologists are called upon frequently to care for patients with potentially life-threatening angioedema. This condition usually is associated with angiotensin-converting enzyme (ACE) inhibitors. ACE inhibitors are among the most commonly prescribed medications worldwide because they are indicated in the management of hypertension,...
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