Head And Neck

Editors Picks

A study of mucosal melanoma of the oral cavity in India: A rare tumor

August 27, 2014     Pankaj Chaturvedi, MS; Sandeep Lerra, MS(ENT); Piyush Gupta, MS; Prathamesh S. Pai, MS(ENT), DNB; Devendra A. Chaukar, MS, DNB; Jai Prakash Agarwal, MD; Anil K. D'Cruz, MS, DNB
article

Abstract

Malignant melanomas involving the mucosa are rare and aggressive lesions. Their rarity has made the formulation of staging and treatment protocols very difficult, as most of the available information comes from case reports and small case series. We conducted a retrospective study to analyze the behavior of melanomas of the oral mucosa in patients who were treated at Tata Memorial Hospital in Mumbai, a tertiary care referral center for malignancies and one of the largest cancer centers on the Indian subcontinent. During the 22-year period from January 1986 through December 2007, we found only 13 such cases, which had occurred in 8 men and 5 women, aged 26 to 70 years (mean: 37.5). All patients had been offered surgery with curative intent. Mucosal melanomas have exhibited a greater tendency for distant recurrence than for local treatment failure, which is why adjuvant radiation therapy has not been shown to confer any consistent benefit. In our study, only 3 of the 13 patients (23.1%) remained alive 2 years after diagnosis, despite aggressive treatment. Tumor staging, optimal treatment, and prognostic factors for oral mucosal melanoma are far from clear, and further research is needed. Despite the small number of patients in this study, it still represents one of the largest series of oral mucosal melanoma patients in India.

Paragangliomas of the head and neck: Imaging assessment

August 27, 2014     Alejandro Zuluaga, MD; Daniel Ocazionez, MD; Roy Riascos, MD; Enrique Palacios, MD; Carlos S. Restrepo, MD
article

Abstract

Paragangliomas are uncommon tumors that arise from the parasympathetic neuroectodermal ganglionic cells and have been described in numerous anatomic locations, most commonly in the abdomen. Head and neck paragangliomas are classified into carotid body (most common), vagal, and jugulotympanic types. Computed tomography is the initial imaging modality of choice for the preoperative assessment of the extent of paragangliomas. Magnetic resonance imaging and selective angiography provide more detail of the surrounding tissues and vasculature. Surgical resection is the treatment of choice.

Transnasal endoscopic resection of a calcifying cystic odontogenic tumor

August 27, 2014     Daniel Schuster, MD; Joel Cure, MD; Bradford A. Woodworth, MD
article

Abstract

Calcifying cystic odontogenic tumor (CCOT) is a rare histologic subtype of odontogenic tumor. Treatment requires complete enucleation. We report what we believe is the first case of CCOT to be removed via a transnasal endoscopic approach. A 16-year-old boy was referred to our department by his dentist for evaluation of an expansile mass of the left maxillary sinus. The dentist had noted an area of hyperlucency of the left palate during a routine examination. Computed tomography confirmed the presence of a large tumor. Complete resection of the tumor was achieved via a transnasal endoscopic surgical approach. Resection of odontogenic tumors is necessary because of their tendency to expand and produce a mass effect on surrounding structures. We believe resection via an entirely transnasal endoscopic approach is a valuable and important technique in the treatment of odontogenic tumors that leaves the patient with a more cosmetically acceptable postoperative appearance.

Petrosquamosal sinus discovered during mastoidectomy, and its radiologic appearance on temporal bone CT: Case report and brief review

July 13, 2014     Hyun Joon Shim, MD; Seong Jun Song, MD; Ki Woong Chung, MD; Sang Won Yoon, MD
article

Abstract

We report the case of a 47-year-old woman who underwent a mastoidectomy. Preoperative computed tomography demonstrated an unusually distended bony canal that passed through the superolateral portion of the right petrous bone. Intraoperatively, we identified the anomaly as a petrosquamosal sinus (PSS). This unusually dilated venous channel had arisen from the adjacent sigmoid sinus. A PSS is an emissary vein of the posterior fossa that courses along the petrosquamosal junction, connecting the sigmoid or transverse sinus with the extracranial venous system. While it usually regresses during fetal life, a dilated PSS occasionally persists into adulthood. Its anatomic course may lead to problematic bleeding during mastoidectomy.

Papillary thyroid cancer in a gravid woman

July 13, 2014     Darrin V. Bann, PhD; Neerav Goyal, MD, MPH; David Goldenberg, MD, FACS
article

All attempts should be made to preserve the recurrent laryngeal nerve with resection of all gross tumor, particularly in cases of known contralateral RLN dysfunction.

Primary cervical thoracic duct cyst: A case report and review of the literature

July 13, 2014     Ameet Kumar, MS; T.S. Ramakrishnan, MS; Samaresh Sahu, MD, DNB
article

Abstract

Thoracic duct cysts are uncommon entities that are usually found in the thoracic segments of the thoracic duct. The presence of a thoracic duct cyst in the cervical area has been rarely reported. Etiologically, these cysts can arise either as a primary growth or secondary to trauma, obstruction, or inflammation. This entity was first described in 1964, and only 33 cases have been previously reported in literature. Of these, 16 cases involved a primary cyst. We report a new case of a primary thoracic duct cyst, and we discuss its presentation, diagnosis, and management, with an emphasis on meticulous surgical technique. We also review the relevant literature.

Transoral removal of a large parapharyngeal space neurofibroma with the Harmonic Scalpel

July 13, 2014     Marcel Marjanovic Kavanagh, MD; Zlatko Sabol, MD, PhD, MSc; Sasa Janjanin, MD, PhD; Drago Prgomet, MD, PhD
article

Abstract

We report the case of a 19-year-old man with neurofibromatosis type 1 who presented for evaluation of odynophagia, left-sided hemiparesis, multiple café au lait spots all over his body, and numerous subcutaneous and cutaneous neurofibromas. Imaging revealed the presence of two large neurofibromas-a 60 x 50 x 35-mm tumor in the left parapharyngeal space and an intradural tumor measuring 25 mm in diameter. We removed the larger tumor via a transoral route with the Harmonic Scalpel. The size of this tumor far exceeded the size of any other reported tumor removed in this manner. Various approaches to the parapharyngeal space have been described in the literature. To the best of our knowledge, this case represents the first report of a transoral removal of a huge parapharyngeal space neurofibroma with a Harmonic Scalpel.

Leiomyosarcoma of the parapharyngeal space: A very rare entity

July 13, 2014     Haim Gavriel, MD; Eyal Yeheskeli, MD; Gratiana Hermann, MD; Ephraim Eviatar, MD
article

Abstract

Leiomyosarcoma of the head and neck is very rare, as only about 100 cases have been reported; of these, only 3 cases have been previously reported in the parapharyngeal space. We report the fourth such case, and we review the features of this entity. The patient was an 84-year-old woman who presented to the emergency department for treatment of an 18-month history of right-sided headache, a 6-month history of right-sided hearing loss and nasal obstruction, and a 2-month history of dysphagia. Physical examination revealed a bulge in the right side of the soft palate and the right lateral nasopharyngeal wall and complete obstruction of the right eustachian tube. Indirect laryngoscopy detected a bulge in the right lateral hypopharyngeal wall. Otoscopy revealed otitis media with effusion in the right ear. Imaging demonstrated a space-occupying lesion in the right parapharyngeal space that extended from the base of the skull to the level of the hypopharynx. Biopsy and histology identified the mass as a leiomyosarcoma. Metastasis to the brain was discovered shortly thereafter, and the patient died 10 months later. The unusual presentation of head and neck leiomyosarcoma requires a high index of suspicion and appropriate diagnostic imaging. Surgical excision is the recommended treatment when feasible; chemoradiotherapy does not appear to affect disease progression.

Parathyroid adenoma

July 13, 2014     Lester D.R. Thompson, MD
article

Most of these lesions are identified in glands within their usual anatomic location instead of in an ectopic or supernumerary site.

Bacteriology and antimicrobial susceptibility of ENT infections in a tropical hospital

June 8, 2014     Yok Kuan Chew, MBBS; Jack Pein Cheong, MBBS; Nambiar Ramesh, MBBS; Mohamad Din Noorafidah, MPath; Sushil Brito-Mutunayagam, MS; Abdullah Khir, MS; Narayanan Prepageran, FRCS
article

Abstract

We conducted a retrospective observational study to determine the spectrum and antibiotic sensitivity pattern of organisms isolated in otorhinolaryngologic (ORL) infections. We reviewed the laboratory culture and sensitivity records of 4,909 patients-2,773 males (56.5%) and 2,136 females (43.5%), aged 2 to 90 years (mean: 45.3 ± 12.6)-who had been seen at two government hospitals in Malaysia. Of this group, 4,332 patients had a respiratory tract infection (88.2%), 206 had an ear infection (4.2%), 188 had a deep neck infection (3.8%), and 183 had an oropharyngeal infection (3.7%). The most common isolated organisms were Klebsiella spp, Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus, methicillin-susceptible S aureus, coagulase-negative S aureus, and Acinetobacter baumannii. We also identified the antimicrobial susceptibility of these organisms. We conclude that since the spectrum of causative pathogens in some infections differs between tropical and nontropical areas of the world, tropical hospitals should not completely adopt the antibiotic guidelines for ORL infections that have been recommended for hospitals in nontropical regions. We hope that our review and analysis of local data will help practitioners in Malaysia develop an appropriate prescribing policy with respect to ORL pathogens and antimicrobial susceptibility. The goal is to reduce the morbidity and mortality associated with these infections.

Ossifying fibromyxoid tumor metastatic to the thyroid: A case report and review of the literature

June 8, 2014     Ricardo R. Lastra, MD; Jason G. Newman, MD; John S. Brooks, MD; Jui-Han Huang, MD, PhD
article

Abstract

Ossifying fibromyxoid tumors are rare soft-tissue neoplasms, usually with an indolent course. However, atypical/malignant variants have been described, showing either local recurrence after complete excision or metastasis to the lungs, mediastinum, adrenals, or soft tissue. We report the case of an ossifying fibromyxoid tumor of the left ankle that metastasized to the lung and thyroid gland 12 years after the initial diagnosis and surgical treatment. To our knowledge, this is the first reported case of this neoplasm metastasizing to the thyroid gland.

Helical tomotherapy of the complete scalp and the ipsilateral lymph nodes in a case of scalp angiosarcoma

June 8, 2014     Sonja Katayama, MD; Markus Hantschke, MD; Steffen Lissner, PhD; Katja Lindel, MD; Dieter Oetzel, PhD; Klaus Herfarth, MD; Juergen Debus, MD, PhD; Florian Sterzing, MD
article

Abstract

Scalp angiosarcoma represents a therapeutic challenge to all disciplines. This case report demonstrates the potential usefulness of helical tomotherapy (HT) as a new radiotherapeutic treatment option. A 71-year-old woman presented with a superficial angiosarcoma of the scalp, forehead, and left pre- and postauricular areas, with several nodular ulcerating and bleeding lesions. Irradiation of the gross tumor was performed with a total dose of 70 Gy in 2-Gy fractions and of the left cervical lymph nodes with 56 Gy in 1.6-Gy fractions. Good target coverage was achieved without compromising organs at risk, notably the brain. Treatment was very fast (661 seconds per fraction) and was administered with minimal acute toxicity (National Cancer Institute Common Toxicity Criteria: grade 2 erythema and grade 2 dysphagia). During treatment, tumor nodules dissolved into hyperkeratosis. We conclude that with HT, irradiation of the scalp and cervical lymph nodes can be conducted with minimal acute toxicity and without junction problems.