March 24, 2013 Adam Blanchard, BS; Lorena Garza Garcia, MD; Enrique Palacios, MD, FACR; Bruce Bordlee Jr., MD; Harold Neitzschman, MD, FACR
Ludwig angina will appear as a diffuse swelling of the soft tissue of the floor of the mouth with adjacent subcutaneous fat stranding, and thickening of the platysma with gas or pus formation.
Ludwig angina is a rapidly progressing, necrotizing cellulitis of the submandibular space.1 Predisposing factors include poor dental hygiene, recent dental procedures, diabetes mellitus, alcoholism, tobacco smoking, malnutrition, intravenous drug use, and immunosuppression.1 Ludwig angina is typically a polymicrobial infection that includes both...
March 24, 2013 Min-Tsan Shu, MD; Kang-Chao Wu, MD; Yu-Chun Chen, MD
The retention cyst originates from the obstruction of a glandular structure and contains fluid, while the cholesteatoma contains keratinizing squamous epithelium.
A 58-year-old man was referred to our clinic for a right ear discharge and hearing disorder he had experienced since childhood. The otoscopic examination showed total perforation of his right eardrum, erosion of the ossicular chain, and a mucosa-lined, whitish, oval lesion at the anteroinferior portion of the middle ear (figure). Pure-tone...
March 24, 2013 Roshan Kumar Verma, MS, DNB, MNAMS; Rahul Modi, MS; Naresh K. Panda, MS, DNB, FRCS
Abstract
Abnormal dilation of a normal anterior jugular vein is a rare anomaly and usually presents as a neck lump. To the best of our knowledge, this is the first report in the literature of such a case in which the patient presented with severe tinnitus. Excision of the dilated portion of the anterior jugular vein in our patient alleviated the severe tinnitus.
Introduction
Abnormalities of the jugular venous system are uncommon. Phlebectasia refers to an isolated abnormal fusiform or saccular dilation of a vein.1,2 The internal jugular vein is the most commonly involved, followed by the external jugular vein; rarely is the anterior jugular vein involved.2,3
March 24, 2013 Jagdeep Singh Thakur, MS; Neeti Verma, MS; Anamika Thakur, MD; Dev Raj Sharma, MS; Narinder Kumar Mohindroo, MS, DORL
Abstract
We conducted a 10-year retrospective study to determine the prognosis of necrotizing cervical fasciitis (NCF). Our study population included 38 patients-32 males and 6 females, aged 10 months to 70 years (mean: 55 yr)-who had presented for management of NCF at our tertiary care hospital between Jan. 1, 2000, and Dec. 31, 2009. We classified each case into four categories based on the duration of disease prior to presentation, the severity of disease, and other factors that influence outcomes. We found that the most important factor in determining prognosis was the time interval between the onset of NCF and subsequent presentation for specialist or surgical intervention. Patients with a higher grade of NCF had longer hospital stays. Although aggressive surgical and medical intervention is the gold standard for the management of NCF, many of our patients presented with a relatively healthy appearing wound, which could mislead the evaluating clinician and delay prompt management. We believe that our new grading system will help obviate this problem and make clinicians more vigilant when faced with a new case of necrotizing fasciitis.
March 24, 2013 Rodrigo Bayon, MD; Sandra K. Banas, MD; Barry L. Wenig, MD, MPH
Abstract
Although carcinoma of the breast has a propensity toward distant metastasis, metastasis to the head and neck is uncommon. Most patients with metastasis to the head and neck region present with cervical lymphadenopathy; however, spread to the upper aerodigestive tract has been described previously. We present a case of a patient found to have a pedunculated mass in her right piriform sinus. When she swallowed, the mass would completely prolapse into the esophagus and cause symptoms. Subsequent workup revealed widespread metastatic disease, for which the patient was treated with chemoradiotherapy. Microlaryngoscopy with excision of the mass was performed for palliation of her dysphagia, and a diagnosis of metastatic breast carcinoma was obtained. The patient healed well from the excision and went on to be treated for the metastatic breast cancer. To our knowledge, our report represents the first case of metastatic breast carcinoma presenting as severe dysphagia.
March 24, 2013 Gisele da Silva Dalben, DDS, MSc; Vivian Patricia S. Vargas, DDS; Bruno A. Barbosa, MSc; Marcia R. Gomide, PhD; Alberto Consolaro, PhD
Abstract
We report the case of a 9-year-old girl who presented with a complaint of a malodorous bloody discharge from the left naris. The patient had previously undergone a complete repair of left-sided cleft lip and palate. Clinical examination revealed hyperplasia of the nasal mucosa on the left side. X-ray examination of the nasal cavity demonstrated a radiopaque structure that resembled a tooth and a radiopaque mass similar to an odontoma that was adherent to the root of the suspected tooth. With the patient under general anesthesia, the structure was removed. On gross inspection, the structure was identified as a tooth with a rhinolith attached to the surface of its root. Microscopic examination revealed normal dentin and pulp tissue. A nonspecific inflammatory infiltrate was observed around the rhinolith, and areas of regular and irregular mineralization were seen. Some mineralized areas exhibited melanin-like brownish pigmentation. Areas of mucus with deposits of mineral salts were also observed. Rare cases of an intranasal tooth associated with a rhinolith have been described in the literature. We believe that this case represents only the second published report of an intranasal tooth associated with a rhinolith in a patient with cleft lip and palate.
Introduction
The ectopic development of teeth occurs in different areas in and around the oral cavity, as well as at distant sites. The literature contains reports of tooth development in the maxillary sinus, mandibular condyle, coronoid process, orbits, palate, mentum, and skin, as well as less common locations such as the ovaries, testes,...
February 25, 2013 Kyoichi Terao, MD, PhD; Takeshi Kusunoki, MD, PhD; Kazunori Mori, MD, PhD; Kiyotaka Murata, MD, PhD; Katsumi Doi, MD, PhD
Abstract
The clinical presentation of calcific retropharyngeal tendinitis, a rare entity, can mimic more serious disorders. We describe the case of a 35-year-old man who was referred to us for evaluation of a suspected retropharyngeal abscess. At presentation, the patient reported severe cervical pain and stiffness. He exhibited mild fever, torticollis, and a moderately elevated white blood count; no swelling of the retropharyngeal wall was observed. Based on the results of plain radiography and computed tomography (CT), we diagnosed the patient with calcific retropharyngeal tendinitis. He was treated with a 7-day course of a nonsteroidal anti-inflammatory drug and a 3-day course of a steroid, and he recovered well. We suggest that the true incidence of calcific retropharyngeal tendinitis is actually higher than what is generally believed because this diagnosis is frequently missed. Contrast-enhanced CT can aid in diagnosing calcific retropharyngeal tendinitis. CT should be performed in patients who present with nonspecific symptoms such as severe neck pain, sore throat, odynophagia, and mild fever.
Introduction
Calcific retropharyngeal tendinitis is a rare clinical entity. Affected patients generally present with an inflammation of the longus colli muscle tendon.1,2 This tendon is located on the anterior surface of the vertebral column, and it extends from the atlas to the third thoracic vertebra.
February 25, 2013 Parvathidevi K. Gollahalli, SSAHE; Panduranga Chikkannaiah, MD, SSAHE; Vamseedhar Annam, MD, SSAHE
Abstract
We report a case of papillary carcinoma of the thyroid that arose in a branchial cyst. The patient, a 45-year-old woman, presented with a left lateral neck mass of 3 months' duration. The cyst was removed intact. Because we could not rule out the possibility that a small primary malignancy was present within the gland, we performed a total thyroidectomy; however, no occult primary tumor of the thyroid was found. The patient was placed on thyroid hormone replacement therapy, and she was well at 2 years of follow-up. We briefly review the literature regarding the possible embryologic origin of such a phenomenon and the role of fine-needle aspiration cytology in differentiating a branchial cyst from a metastatic lymph node. To the best of our knowledge, this is only the 11th reported case of a thyroid papillary carcinoma arising in ectopic thyroid tissue within a branchial cyst, and the second such report from India.
February 25, 2013 Robert T. Sataloff, MD, DMA, FACS
February 25, 2013 Leyla Kansu, MD; Ismail Yilmaz, MD; Volkan Akdogan, MD; Suat Avci, MD; Levent Ozluoglu, MD
Abstract
We evaluated ossicular chain reconstruction in patients with idiopathic incus necrosis who have conductive hearing loss and an intact ear drum. The study included four patients (3 women and 1 man; the ages of the patients were 22, 31, 35, and 56 years, respectively) with unilateral conductive hearing loss, no history of chronic serous otitis media, an intact ear drum, normal middle ear mucosa, and necrosis of the long processes of the incus. On preoperative pure tone audiometry, air-bone gaps were 24, 25, 38, and 33 dB. Bilateral tympanometry and temporal bone computed tomography results were normal. All 4 patients underwent an exploratory tympanotomy. During the operation, the mucosa of the middle ear was normal, with a mobile stapes foot plate and malleus. No evidence of any granulation tissue was found; however, necrosis of the incus long processes was seen. For ossicular reconstruction, we used tragal cartilage between the incus and the stapes in 1 patient; in the other 3 patients, glass ionomer bone cement was used (an interposition cartilage graft also was used in the patients who received the glass ionomer bone cement). In all patients, air-bone gaps under 20 dB were established in the first year after surgery. In the ossicular disorders within the middle ear, the incus is the most commonly affected ossicle. While, the most common cause of these disorders is chronic otitis media, it may be idiopathic rarely. Several ossicular reconstruction techniques have been used to repair incudostapedial discontinuity.
Introduction
Owing to its varied causes and management options, diagnosing and treating conductive hearing loss is a challenge for ear surgeons. The cause of conductive hearing loss may be an ossicular disorder in the middle ear. The incus is the most commonly affected ossicle. The lenticular and distal long processes of the incus are most...
