Head And Neck

Editors Picks

Giant jugular foramen tumor

April 17, 2013     Wen-Sen Lai, MD; Jih-Chin Lee, MD; Chih-Hung Wang, MD, PhD; Yueng-Hsiang Chu, MD, PhD
article

Jugular foramen syndrome is characterized by unilateral paralysis of the glossopharyngeal, vagus, and accessory nerves, which emerge in a line from the medulla oblongata and then run at the lateral part of the jugular foramen, where they leave the posterior cranial fossa.

Adult case of large sinonasal embryonal rhabdomyosarcoma with intracranial extension

April 17, 2013     Enrique Palacios, MD; Alexander Quiroz-Casian, MD; Lorena Garza Garcia, MD; Philip J. Daroca, MD; Harold R. Neitzschman, MD
article

Rhabdomyosarcomas often present with nonspecific symptoms such as headache, nasal congestion, proptosis, epistaxis, and cranial nerve palsies, reflecting extension to the base of the skull.

Extraosseous Ewing sarcoma and peripheral primitive neuroectodermal tumor of the thyroid gland: Case report and review

April 17, 2013     Magdalena Chirila, MD, PhD; Mihaela Muresan, MD; Elisabeta Ciuleanu, MD, PhD; and Marcel Cosgarea, MD, PhD
article

Abstract

The Ewing family of tumors and peripheral primitive neuroectodermal tumor (pPNET) represent different manifestations of the same entity. Immunohistochemical and cytogenetic studies suggest that these tumors have a common origin. Ewing sarcoma is more common in bone, while pPNET is more common in soft tissues. Extraosseous Ewing sarcoma (EoES) is rare. We present the case of a 48-year-old man who presented with acute obstructive respiratory failure secondary to a large thyroid swelling. The patient was initially diagnosed with giant B-cell non-Hodgkin lymphoma and treated with chemotherapy. However, subsequent immunohistochemical staining of biopsy specimens revealed that the patient actually had EoES/pPNET of the thyroid gland. We performed a nearly complete surgical resection of the tumor plus a total laryngectomy and resection of five tracheal rings. However, the patient died of a cerebral metastasis 1 month later after he had completed one cycle of postoperative chemotherapy.

Huge hibernoma of the neck with extension into the mediastinum

April 17, 2013     Ramanuj Sinha, MS, DNB; Saumik Das, MS, DNB; Pranabashish Banerjee, MS, MRCS; Atish Halder, DLO, MS; Mainak Dutta, MS
article

Abstract

Hibernomas are benign tumors made up of brown fat. They are rarely encountered in otolaryngologic clinical practice, as they are usually located in the interscapular area, axilla, thigh, mediastinum, and retroperitoneum. We report an extremely rare case of a very large hibernoma in a 45-year-old man who presented with a 4-year history of neck swelling. Radioimaging was suggestive of a mass in both parapharyngeal spaces; the lesion was more prominent on the left side. The mass extended from C2 into the retropharyngeal space and superior mediastinum. Fine-needle aspiration cytology failed to yield a diagnosis. On surgical exploration, a tumor measuring 17 x 16 x 5 cm was removed and sent for histopathologic examination. Light microscopy was suggestive of a hibernoma. Staining with oil red O confirmed the diagnosis. To the best of our knowledge, a large hibernoma with such massive extension has not been previously reported in the literature.

Anterior jugular phlebectasia and tinnitus: A case report

March 24, 2013     Roshan Kumar Verma, MS, DNB, MNAMS; Rahul Modi, MS; Naresh K. Panda, MS, DNB, FRCS
article

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.

Featured Links

ENT Journal Resource Directory

Sign-up for the ENT eNewsletter

Mucocele: Retention and extravasation types

March 24, 2013     Lester D.R. Thompson, MD
article

The extravasation type is the most common mucocele, more common in children and young adults, with a peak in the second decade of life.

Necrotizing cervical fasciitis: Prognosis based on a new grading system

March 24, 2013     Jagdeep Singh Thakur, MS; Neeti Verma, MS; Anamika Thakur, MD; Dev Raj Sharma, MS; Narinder Kumar Mohindroo, MS, DORL
article

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.

Ludwig angina progressing to fatal necrotizing fasciitis

March 24, 2013     Adam Blanchard, BS; Lorena Garza Garcia, MD; Enrique Palacios, MD, FACR; Bruce Bordlee Jr., MD; Harold Neitzschman, MD, FACR
article

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.

Internal carotid artery in zone IIb and its implications: A case report

March 24, 2013     Drew P. Plonk, MD; J. Dale Browne, MD, FACS
article

Abstract

The potential for aberrant anatomy in the neck should be respected in order to avoid unexpected and potentially devastating injury during surgical and other procedures. Anatomic variations involving the internal carotid artery are believed to exist in as much as 6% of the population. We describe a case of a tortuous internal carotid artery that was found in zone IIb during a neck dissection in a 60-year-old man, and we discuss the implications of this anomaly.

Malignant paraganglioma of the thyroid gland with synchronous bilateral carotid body tumors

February 25, 2013     Nadia Mohyuddin, MD; Karen Ferrer, MD; Urjeet Patel, MD, FACS
article

Abstract

We describe a case of primary malignant paraganglioma of the thyroid gland that was found in a 55-year-old woman who had undergone surgery for bilateral carotid body tumors. The paraganglioma was treated with a total thyroidectomy followed by radiation therapy, and the patient was disease-free after more than 2 years of follow-up. Malignant paragangliomas of the thyroid gland are extremely rare. The diagnosis of malignancy is based on histopathologic findings, tumor behavior, and metastasis. These tumors can be misdiagnosed as other types of thyroid malignancies, thus resulting in less than optimal treatment. A genetic etiology was suspected in our patient.

Recurrent Pindborg tumor of the maxilla: A case report and review of the literature

February 25, 2013     Gangadhara Somayaji, MS(ENT); Aroor Rajeshwary, MS(ENT); Sullia Ramesh, MDS; Sullia Dinesh, MDS
article

Abstract

We report a case of recurrent Pindborg tumor (calcifying epithelial odontogenic tumor) of the maxilla. The patient was a 34-year-old woman who had been previously diagnosed with Pindborg tumor and treated with curettage. She was subsequently referred to us for evaluation of nasal obstruction. Examination revealed the presence of a mass lesion in the right nasal cavity and right maxilla, which was identified as a recurrence of her earlier Pindborg tumor. The patient was treated with maxillectomy with orbital preservation. Pindborg tumor is a rare odontogenic tumor; when it does occur, it is more often seen in the mandible than in the maxilla. While this tumor is often treated with curettage alone, the aggressive nature of the recurrence in our patient necessitated radical surgery. We report this case to highlight the need to be suitably aggressive in treating these types of tumors in order to avoid recurrence.

A case of calcific retropharyngeal tendinitis: The significance of an early diagnosis

February 25, 2013     Kyoichi Terao, MD, PhD; Takeshi Kusunoki, MD, PhD; Kazunori Mori, MD, PhD; Kiyotaka Murata, MD, PhD; Katsumi Doi, MD, PhD
article

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.

more