Laryngology

Editors Picks

Fusobacterium necrophorum in a pediatric retropharyngeal abscess: A case report and review of the literature

December 19, 2014     Jeffrey Cheng, MD; Andrew J. Kleinberger, MD; Andrew Sikora, MD, PhD
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We present the case of a 17-year-old boy who developed a deep space neck infection following cervical trauma. He was initially managed conservatively with broad-spectrum antibiotics, but when he failed to improve clinically, he required surgical drainage. Wound cultures grew Fusobacterium necrophorum, an uncommon pathogen that can cause pediatric deep neck space infections, especially when it is not associated with Lemierre syndrome. The prognosis for this infection is favorable when it is identified early. Treatment with culture-directed antibiotics and surgical drainage as indicated is appropriate. When treating a pediatric deep neck space infection empirically, physicians should avoid treatment with a macrolide antibiotic, since Fusobacterium spp may be involved and they are often resistant to this class of drugs.

Amyotrophic lateral sclerosis presenting as bilateral abductor paralysis

December 19, 2014     Michelle Levian, DO; Reena Gupta, MD, FACS
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Occasionally, patients who have amyotrophic lateral sclerosis initially present with vocal and respiratory signs and symptoms.

Retropharyngeal masses in neurofibromatosis type 1: Imaging findings in 2 cases

December 19, 2014     Roy Riascos, MD; Jennifer Dodds, MD; Nirav Patel, MD
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Neurofibromatosis type 1 (NF-1) affects mesenchymal development via multisystemic manifestations. We present 2 cases of NF-1 that manifested as a retropharyngeal mass-1 as a lateral cervical meningocele in a 60-year-old man and the other as a focal neurofibroma in a 37-year-old man. Contrast-enhanced magnetic resonance imaging (MRI) was invaluable in identifying the exact nature of the 2 lesions; no contrast enhancement was seen in the case of the meningocele, and enhancement was seen in the case of the neurofibroma. These 2 cases illustrate the importance of the history and contrast-enhanced MRI in managing NF-1 patients with a retropharyngeal mass.

Superior omohyoid muscle flap repair of cervical esophageal perforation induced by spinal hardware

December 19, 2014     Christopher Chase Surek, DO; Douglas A. Girod, MD, FACS
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Cervical esophageal perforation is a rare and life-threatening condition. Its prompt diagnosis and treatment require a high index of suspicion. Cervical spine hardware is an uncommon cause of posterior esophageal perforation. Management has included a variety of musculofascial flaps for surgical repair. We present 2 cases of cervical esophageal perforation induced by spinal hardware that were repaired with a superior omohyoid muscle (SOM) flap for closure and/or primary closure reinforcement. Advantages and techniques of the SOM flap are discussed.

Adult presentation of laryngeal cleft: Utility of the modified barium swallow study in diagnosis and management

December 19, 2014     Genevieve Houdet-Cote, MHSc; Simon R. McVaugh-Smock, MHSc
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We present a case of laryngeal cleft in a 41-year-old man to illustrate the co-occurrence of laryngeal cleft and tracheoesophageal fistula. We advocate the use of the modified barium swallow study in the diagnosis of laryngeal cleft. We also review the advantages and limitations of the various diagnostic methods, as well as the potential for known tracheoesophageal fistula to mask laryngeal cleft. Finally, we discuss the importance of early identification of laryngeal cleft in the context of its potentially serious health implications.

Laryngeal inflammatory myofibroblastic tumor

December 19, 2014     Fábio M. Girardi, MD, MSc; Ciro W. Fontana, MD; Ricardo G. Kroef, MD; Marinez B. Barra, MD; Felipe O. Detanico, MD; Nilton T. Herter, MD
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Inflammatory myofibroblastic tumor seldom involves the larynx, as only about 50 to 60 cases have been described in the literature. Even though these tumors are often not aggressive, they have the potential for invasion and local recurrence. We describe the case of a 27-year-old man who was admitted to an emergency department with signs of upper airway obstruction secondary to an obstructive mass. Histology identified the mass as an inflammatory myofibroblastic tumor of the subglottis. The patient underwent an emergency tracheotomy followed by a partial laryngectomy. During 14 months of follow-up, he remained free of active disease.

Management of soft palate agenesis in Nager syndrome with an elongated, superiorly based pharyngeal flap

October 17, 2014     Oneida A. Arosarena, MD; Troy Hemme, DO
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Abstract

Nager syndrome, or preaxial acrofacial dysostosis, is associated with aberrant development of the first and second branchial arch structures, as well as abnormal development of the limb buds. It is a rare disorder, and its clinical manifestations have not been completely defined. Absence of the soft palate has been reported in patients with Nager syndrome. In this report we describe the use of an elongated, superiorly based pharyngeal flap for the treatment of severe velopharyngeal insufficiency in a patient with Nager syndrome and absence of the soft palate. We also describe the dysmorphisms associated with Nager syndrome and present a differential diagnosis for the condition.

Primary laryngeal tuberculosis: An unusual cause of hoarseness

October 17, 2014     Peter Fsadni, MD, MRCP(UK); Claudia Fsadni, MD, MRCP(UK), MSc(Lond); Brendan Caruana Montaldo, MD, FACP
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Abstract

Tuberculosis (TB) of the larynx is usually associated with concomitant pulmonary TB, but approximately 20% of cases represent primary disease. We report the case of an 85-year-old woman with asthma who presented with a 6-month history of persistent hoarseness. Bronchoscopy confirmed the presence of a lesion in the hemilarynx, and histology identified tuberculoid granulomas that were suggestive of TB. Treatment with a combination of isoniazid, rifampicin, pyrazinamide, and ethambutol led to a complete resolution of symptoms. A high index of suspicion for laryngeal TB is required in patients who present with hoarseness.

Rapid growth of a laryngeal oncocytic cyst after surgical irritation

October 17, 2014     John T. Sinacori, MD; Robert A. Jack II, MD; Jonathan R. Workman, MD
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The origin of oncocytic lesions remains controversial. They occur more frequently with increasing age, and patients commonly present with a prolonged duration of hoarseness

Hypopharyngeal hemangioma in an adult: A case report

October 17, 2014     Lindsay Reder, MD; Sunil Verma, MD; Niels Kokot, MD
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Abstract

Hemangiomas of the postcricoid region have been reported almost exclusively in infants and young children. Our adult patient with symptoms of dysphagia and weight loss underwent transoral CO2 laser microsurgery of a postcricoid mass, and final pathologic examination confirmed the presence of a hemangioma. She is doing well after surgery, with an excellent voice, resolution of dysphagia, and no evidence of recurrence. There have been few cases of hypopharyngeal hemangioma in the adult population; to our knowledge, there have been no reports in the English-language literature of adult patients diagnosed specifically with a postcricoid hemangioma. Otolaryngologists should be familiar with the presentation and treatment of this unusual entity.

Synchronous double cancers of the hypopharynx: Malignant fibrous histiocytoma and squamous cell carcinoma

October 17, 2014     Shao-Cheng Liu, MD; Wan-Fu Su, MD
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Abstract

We report a unique case of synchronous double hypopharyngeal tumors in a 39-year-old man. The patient presented with a 1-year history of a muffled voice and mild odynophagia. Laryngoscopy detected two grossly different tumors in the hypopharynx: a malignant fibrous histiocytoma (MFH) in the postcricoid area and a squamous cell carcinoma (SCC) in the posterior pharyngeal wall. Chemoradiotherapy was administered, and the patient was free of disease at 23 months of follow-up. Synchronous double cancers of the hypopharynx that feature different oncotypes are very rare, especially those that include an MFH. In fact, to the best of our knowledge, no case of synchronous MFH and SCC of the hypopharynx has been previously reported in the literature. Because the number of reported cases of MFH in the hypopharynx is so small, no consensus exists with respect to the preferred option among the various treatment choices.

Fish bone impaction in the supraglottis

October 17, 2014     Willis S.S. Tsang, FRCSEd(ORL); John K.S. Woo, FRCS(ORL); C. Andrew van Hasselt, M Med (Otol)
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The most common sites of fish bone impaction are the tonsils, tonsillar pillars, tongue base, valleculae, and piriform fossa. Impaction in the supraglottic area is extremely uncommon.