Temporal bone fracture

January 21, 2014     Danielle M. Blake, BA; Senja Tomovic, MD; Robert W. Jyung, MD

Transverse fractures account for approximately 20% of temporal bone fractures. They occur secondary to frontal or occipital head trauma, and they run perpendicular to the petrous pyramid.

A 55-year-old woman presented to us with a history of left-sided hearing loss that had been present since she sustained a skull fracture in a motor vehicle accident 30 years earlier. She had undergone a hearing aid trial but remained dissatisfied. She had not undergone any surgical intervention for her hearing loss. She denied tinnitus, otalgia,...

Recurrent chondro-osseous respiratory epithelial adenomatoid hamartoma of the nasal cavity in a child

January 21, 2014     Kazuhiro Nomura, MD, PhD; Takeshi Oshima, MD, PhD; Atsuko Maki, MD, PhD; Takahiro Suzuki, MD, PhD; Kenjiro Higashi, MD; Mika Watanabe, MD, PhD; Toshimitsu Kobayashi, MD, PhD


Chondro-osseous respiratory epithelial adenomatoid hamartoma (COREAH) is an extremely rare type of hamartoma. To the best of our knowledge, only 1 case has been previously reported. A 7-year-old girl presented with a case of COREAH of the bilateral nasal cavities. Polypous masses in both nasal cavities were resected endoscopically, and they were histologically diagnosed as COREAH. A large polypous mass recurred 1 year postsurgically on the right side only. A second endoscopic surgery was performed, and the lesion was confirmed to be recurrent COREAH. Hamartoma of the nasal cavity is rare and is generally considered to be self-limiting. This case suggests that nasal hamartomas may have neoplastic characteristics, and therefore require complete resection.

Cervical accessory tragus: An unusual pediatric neck mass

January 21, 2014     Thomas R. Lowry, MD

An accessory tragus occurs as the result of a developmental anomaly of the first branchial arch, and it may be associated with other branchial cleft abnormalities.

A 3-year-old girl was brought to the otolaryngology clinic by her mother for evaluation of a left-sided anterior neck mass that had been present since birth. The size of the growth had not changed since birth, and the child did not complain of any symptoms related to it.

Unusual rhabdomyolysis of the masticator space

January 21, 2014     Jason Rodulfa, BS; Enrique Palacios, MD, FACR; Jeremy Nguyen, MD; Harold Neitzschman, MD, FACR

Head and neck rhabdomyolysis can mimic other head and neck conditions such as an inflammatory process, blunt trauma, a neoplasm, and autoimmunity disorders, among others.

Recurrent pyogenic granuloma in a noncompliant patient

January 21, 2014     David Galos, MD; Farhad R. Chowdhury, DO; Reena Gupta, MD; Yolanda D. Heman-Ackah, MD; and Robert T. Sataloff, MD, DMA, FACS

Patients occasionally develop multiple recurrent granulomas even after excellent reflux control (including fundoplication), voice therapy, surgical removal (including steroid injection into the base of the granuloma), angiolytic laser therapy, and other treatments.

Stroboscopic examination of a 14-year-old boy with a 10-month history of dysphonia detected a sessile vocal fold mass that originated near the left vocal process and extended along the proximal one-third of the superior surface of the musculomembranous vocal fold. Examination also revealed the presence of reflux laryngitis.

Clinical management of a patient with advanced mucosal malignant melanoma in the sinonasal area

January 21, 2014     Marco Fusetti, MD; Alberto Eibenstein, MD; Ettore Lupi, MD; Enzo Iacomino, MD; Tiziana Pieramici, MD; Alessandra Fioretti, MD, PhD


We describe a case of mucosal malignant melanoma in the sinonasal area of a 65-year-old woman. She presented with a history of nasal obstruction and epistaxis with subsequent tenderness, facial anesthesia involving cranial nerve V2, red eye, proptosis, diplopia, and conjunctival chemosis. Computed tomography detected a nonspecific solid mass that had involved the left maxillary sinus and surrounding tissues, with extension into the nasal cavity and invasion of the orbital floor and eye muscles. Histopathologic examination of the neoplasm revealed that it was a malignant melanoma. We performed a radical hemimaxillectomy that extended to the orbit, which allowed for radical excision of the tumor. Postoperatively, the patient received adjuvant chemotherapy and radiotherapy. Mucosal melanoma in the head and neck is a rare and highly malignant neoplasm. We suggest that malignant melanoma be suspected when a small-round-cell tumor is found on light microscopy, and we confirm the usefulness of immunohistochemical investigations.

Primary amelanotic melanoma of the nasal cavity: A case report

January 21, 2014     Seema Gupta, MD; Mohan Chand Pant, MD; Nuzhat Husain, MD; Sham Sundar, MD; Huma Khan, PhD


Primary mucosal malignant melanomas of the nose are rare, accounting for only 0.3 to 2% of all cases of malignant melanoma and about 4% of all head and neck melanomas. The amelanotic variant of mucosal malignant melanoma is even more rare, and the prognosis is poor. This variant usually arises in locations in which it is not noticeable, and therefore it is usually diagnosed at an advanced clinical stage when symptoms eventually manifest. We report a case of locally advanced amelanotic melanoma of the nasal cavity in a 55-year-old woman who presented with complaints of nasal obstruction and intermittent bleeding on the right side of the nose for 3 months and a gradually progressive diffuse swelling over the right periorbital and maxillary areas for 2 months with associated pain for 15 days. She was diagnosed with amelanotic melanoma on the basis of clinical, radiologic, and pathologic findings. In view of her advanced disease, she declined surgery and was treated with chemoradiotherapy, and she experienced a significant alleviation of her symptoms.

Introduction Primary mucosal malignant melanomas of the nose are rare, accounting for only 0.3 to 2% of all cases of malignant melanoma and about 4% of all head and neck melanomas.1,2 Lucke first described malignant melanoma of the nose in 1869.3 In 1965, Kutty and Sreedharan reported the first case in India.4

Basaloid squamous cell carcinoma of the pinna: Report of a rare case

January 21, 2014     Anil Jain, MS; Ashish Katarkar, MS; Pankaj Shah, MS; Jignasa Bhalodia, MD; Sanyogita Jain, MD; Sapna Katarkar, DA


Basaloid squamous cell carcinoma (BSCC) is rare. We report a case of BSCC in a 60-year-old woman who presented with a bleeding vascular growth on the left pinna. To the best of our knowledge, no case of BSCC of the pinna has been previously reported in the literature. We present this case to alert physicians that this highly aggressive variant of squamous cell carcinoma can appear on the pinna and therefore it should be considered in the differential diagnosis of lesions in this area.

Introduction Basaloid squamous cell carcinoma (BSCC) is a rare, histologically distinctive, highly aggressive variant of squamous cell carcinoma.1,2 BSCC primarily affects men in the sixth and seventh decades of life.2 Affected patients usually present with advanced-stage disease and widespread metastases.

Polymorphous low-grade adenocarcinoma

January 21, 2014     Lester D.R. Thompson, MD

PLGA affects the palate (60% of cases) most commonly, especially at the mucosal junction of the hard and soft palates; the next most common sites are the cheek and the lip, often the upper lip.

Polymorphous low-grade adenocarcinoma (PLGA) is a low-grade malignant epithelial tumor characterized by an infiltrative growth of cytologically uniform cells arranged in a multitude of architectural patterns. While it is an uncommon tumor, it accounts for about 25% of all intraoral minor salivary gland malignancies. Most patients come to clinical...

Vocal fold fixation caused by penetration of a high-velocity steel projectile

January 21, 2014     Chau-Shiang Guo, MD; Chi-Kung Ho, MD, MPH; and Ruey-Fen Hsu, MD, MPH


Vocal fold fixation as a result of trauma caused by a foreign body is rare. We report a unique case of vocal fold fixation caused by traumatic penetration of a shard of steel in a 31-year-old steelworker. While the patient was at work, an airborne projectile suddenly pierced his neck and entered his larynx, causing progressive hoarseness and dyspnea. Flexible laryngoscopy detected no obvious foreign body, but it did reveal that the right vocal fold had become immobile. Computed tomography revealed that a 2.5-cm sliver of steel had become impacted in the right cricoarytenoid joint, which made the arytenoid cartilage unable to rotate. An emergency tracheostomy was performed with local anesthesia to construct a functioning airway, and then rigid laryngoscopy was performed with general anesthesia. The foreign body was removed with the assistance of a microscope and microscissors. Postoperatively, the patient immediately regained control of his right vocal fold, and he experienced no permanent injury.

Introduction The vast majority of cases of vocal fold immobility are caused by recurrent laryngeal nerve paralysis.1-7 To the best of our knowledge, only 2 cases caused by mechanical fixation have been previously reported in the literature.8,9 As far as we know, no case of vocal fold fixation caused by traumatic penetration of a foreign body has...
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