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Desmoid tumors of the head and neck: Two decades in a single tertiary care unit and review of the literature

November 8, 2018  |  Aleksi Schrey, MD, PhD; Maria Gardberg, MD, PhD; Riitta Parkkola, MD, PhD; Ilpo Kinnunen, MD, PhD


Desmoid tumors (DTs) of the head and neck have typically been classified as extra-abdominal, although the anatomic challenges of the head and neck warrant consideration of these DTs as a special entity. We present a review of DTs and describe our series of five patients with DTs of the head and neck treated within 2 decades. Altogether, 53 patients with DTs treated surgically at a tertiary care center over a 20-year period were retrospectively reviewed. Outcomes of the treatment of DTs of the head and neck (n = 5) were analyzed as a case series. DTs are rare, histologically benign, but locally aggressive tumors. In our series of 5 patients with head and neck DTs, no patient experienced a recurrence during a median follow-up of 47.5 months (range 13 to 150), although all had positive histologic margins. The functional integrity of vital structures over meticulous radicality of the tumor resection must be considered, especially in the head and neck.

Long-term use of Le Fort I osteotomy for the management of nasopharyngeal rhinosporidiosis: A case series

November 8, 2018  |  Vikram Shetty, DNB; Akshaya Kulkarni, MDS; Suman Banerjee, MDS


Rhinosporidiosis is a rare, chronic, granulomatous infection of the mucous membranes that mainly involves the nose and nasopharynx; it occasionally involves the pharynx, conjunctiva, larynx, trachea and, rarely, the skin. The characteristic clinical features of this disease include the formation of painless polyps in the nasal mucosa or the nasopharynx that bleed easily on touch. At our center, excision of the lesion with a Le Fort I osteotomy is carried out in patients (1) in whom two or more previous attempts at excision of biopsy-proven rhinosporidiosis arising from the nasal mucosa was carried out or (2) in whom the rhinosporidiosis arises from the nasophayrngeal mucosa and/or extranasal sites. In this article we retrospectively present 7 cases in which, according to our inclusion criteria, complete excision of the lesion was carried out with a Le Fort I osteotomy. Excellent visualization of the entire maxillary and ethmoidal air cells after the down-fracture of the maxilla helped in the total removal of the lesions. Most of these lesions had multiple points of origin through the nasal, maxillary, and ethmoidal mucosa; the excellent visualization enabled direct cauterization of all these points of origin. The mean follow-up period was 7.96 years, and all patients were disease-free by the time the study was prepared. This article presents details of the treatment protocol and technique followed at our center for the treatment of nasopharyngeal rhinosporidiosis and the details of long-term follow-up. Through this study we hope to prove the efficacy of Le Fort I osteotomy in the definitive management of nasopharyngeal rhinosporidiosis.

Oropharyngeal histoplasmosis in an HIV-negative patient

November 8, 2018  |  Mohamedkazim Alwani, MD; Todd J. Wannemuehler, MD; Don-John Summerlin, DMD, MS; Marion E. Couch, MD, PhD, FACS

The occurrence of histoplasmosis in immunocompetent patients presents a unique diagnostic challenge due to its rarity and mimicry of other disease processes.

Eagle syndrome: Transient ischemic attack and subsequent carotid dissection

November 8, 2018  |  Thomas Sullivan, MD; Jordan Rosenblum, MD

Prophylactic contralateral styloidectomy was considered for this patient, but he was deemed a poor surgical candidate given his underlying cardiomyopathy and anticoagulation.

Iatrogenic external auditory canal cholesteatoma with mastoid erosion

November 8, 2018  |  Yen-Hui Lee, MD; Chih-Yu Hu, MD; Wen-Yu Chuang, MD; Kai-Chieh Chan, MD

Large, complicated iatrogenic EAC cholesteatomas usually require surgical management, with the selected technique generally based on the extent of disease and the surgeon's preference.

Endoscopic view of a posterior nasal and nasopharyngeal vascular plexus

November 8, 2018  |  Dewey A. Christmas, MD; Joseph P. Mirante, MD, MBA, FACS; Eiji Yanagisawa, MD, FACS

Woodruff described a predominantly venous plexus in the posterior nasal mucosa located in the posteroinferior meatus beneath and posterior to the inferior turbinate.

Serum levels of oxidative stress indicators and antioxidant enzymes in Bell palsy

November 8, 2018  |  Nazim Bozan, MD; Ömer Faruk Kocak, MD; Canser Yılmaz Demir, MD; Mehmet Emre Dinc, MD; Koray Avcı, MD; Halit Demir, PhD; Ahmet Faruk Kıroglu, MD


We conducted a prospective study to comparatively evaluate serum levels of malondialdehyde, an oxidative stress indicator, and the antioxidant enzymes glutathione, catalase, and superoxide dismutase in patients with Bell palsy. Our study population was made up of 30 patients with Bell palsy-15 men and 15 women, aged 25 to 68 years (mean: 50.4)-who were seen in the Department of Otorhinolaryngology at a tertiary care medical center. For comparison purposes, we recruited 26 healthy age- and sex-matched controls-16 men and 10 women, aged 40 to 67 years (mean: 54.3). Serum samples were obtained from all participants before the initiation of steroid treatment to the Bell palsy patients. A correlation was sought between demographic data and serum levels of malondialdehyde, glutathione, catalase, and superoxide dismutase. We found that the serum level of malondialdehyde was significantly higher in the Bell palsy group and that the levels of glutathione, catalase, and superoxide dismutase were all significantly lower (p < 0.001 for all comparisons). Correlation analysis revealed that only superoxide dismutase levels were positively correlated with age (r = 0.347, p = 0.009). We suggest that oxidative stress and antioxidant mechanisms may be involved in the pathogenesis of Bell palsy. In this context, serum levels of malondialdehyde, glutathione, catalase, and superoxide dismutase may serve as biomarkers in the diagnosis and follow-up of Bell palsy. Confirmation of the validity, reliability, and reproducibility of these findings necessitates further prospective, randomized clinical trials in larger populations.

Risk of developing sudden sensorineural hearing loss in patients with hepatitis B virus infection: A population-based study

November 8, 2018  |  Yao-Te Tsai, MD; Ku-Hao Fang, MD; Yao-Hsu Yang, MD, MSc; Meng-Hung Lin, PhD; Pau-Chung Chen, MD, PhD; Ming-Shao Tsai, MD; Cheng-Ming Hsu, MD


Sudden sensorineural hearing loss (SSNHL) has significant impact on quality of life. It may result from viral infection, but the relationship between hepatitis B virus (HBV) infection and SSNHL remains uncertain. To investigate the risk of developing SSNHL in patients with HBV, we conducted a nationwide, population-based, retrospective cohort study from the Taiwan National Health Insurance Research Database. A total of 33,234 patients diagnosed with HBV infection and 132,936 control subjects without viral hepatitis were selected from claims made from 2000 to 2008. Each patient was followed for at least 5 years to identify new-onset SSNHL. Among the 166,170 patients, 279 patients (303,793 person-years) from the HBV cohort and 845 patients (1,225,622 person-years) from the control cohort were diagnosed with SSNHL. The incidence of SSNHL was 1.33-fold higher in the HBV group than in the control group (0.92 vs. 0.69 per 10,000 person-years), with an adjusted hazard ratio (HR) of 1.315 (95% confidence interval [CI] = 1.148 to 1.506) calculated using a Cox proportional hazard regression model. We also observed that HBV patients in the 50 to 64 years of age subgroup showed the highest incidence of SSNHL and the highest adjusted hazard ratio (HR = 2.367; 95% CI = 1.958 to 2.861). Patients with HBV infection had a higher risk of acquiring SSNHL than patients without viral hepatitis. For the early detection and timely treatment of SSNHL, clinicians should be aware of the increased risk of SSNHL in HBV patients and arrange auditory examinations for those complaining about acute hearing change.

A rare case of coexisting lacrimal sac adenocarcinoma and transitional cell carcinoma

November 8, 2018  |  Tsutomu Nomura, MD, DDS, PhD; Daisuke Maki, MD; Fumihiko Matsumoto, MD, PhD; Taisuke Mori, DDS, PhD; Seichi Yoshimoto, MD, PhD


Lacrimal sac tumors are rare and difficult to diagnose. We present a case of coexisting lacrimal sac adenocarcinoma and transitional cell carcinoma in a 73-year-old woman who presented with swelling of the inner canthus. Biopsy identified the growth as an adenocarcinoma. After dissection of the lacrimal carcinoma via a lateral rhinotomy, histopathologic examination confirmed the adenocarcinoma and identified a coexisting transitional cell carcinoma. A recurrence developed, but only of the adenocarcinoma component. For the recurrence, the patient was treated with wide resection, including the orbital contents, and subsequent irradiation. At 49 months postoperatively, the patient remained alive but with a lung metastasis. Wide resection was the key to treatment.

Primary cutaneous histoplasmosis

November 8, 2018  |  Blake Raggio, MD

Diagnosis of cutaneous histoplasmosis hinges on evidence of fungus in the wound and absence of systemic disease.