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Synchronous lesions of the right accessory parotid gland and left main parotid gland

June 20, 2017  |  Ba D. Nguyen, MD

Tumoral involvement of parotid glands is usually solitary; multifocality is rare

Correlation among external auditory canal anomaly, temporal bone malformation, and hearing levels in patients with microtia

June 20, 2017  |  Kun Chen, MS; Liu Liu, MS; Runjie Shi, MD; Peihua Wang, MD; Dong Chen, MD; Hua Xiao, MD


We conducted a retrospective study to evaluate the relationship between external auditory canal (EAC) anomaly, temporal bone abnormality, and hearing levels using objective scoring systems in Chinese patients with microtia. The study population consisted of 106 ears of 94 Chinese patients (67 male and 27 female) aged 5 to 45 years (mean: 12.6) with microtia. The EAC abnormalities were classified into 4 types according to Schuknecht's criteria: type A, type B, type C, and type D. Developmental anomalies of the temporal bone were evaluated by Jahrsdoerfer computed tomography (CT) scoring system using high-resolution CT scans of the temporal bone. Temporal bone malformation parameters were divided into 4 subgroups: ossicular chain development, windows connected to the cochlea, aeration development of the middle ear, and facial nerve aberration. Hearing levels (air conduction and bone conduction) were examined. Outcomes parameters included correlation coefficients (r) and a number of other variables. The total points (10 points) and subtotal points related to ossicles (4 points), windows (2 points), aeration (2 points), and facial nerve (1 point) correlated inversely with the EAC abnormalities. The hearing levels (air conduction, r = 0.396, p <0.01; bone conduction, r = 0.21, p = 0.03) correlated significantly with the EAC abnormalities of Schuknecht's classification. We conclude that the better developed the external auditory canal, the better developed the temporal bone and the better developed the external auditory canal, the better hearing level. The hearing level also can serve as an indicator to determine whether a patient will be suitable for reconstructive surgery.

The protective effect of intratympanic dexamethasone on streptomycin ototoxicity in rats

June 20, 2017  |  Aylin Gul, MD; Engin Sengul, MD; Beyhan Yilmaz, MD; Fazil Emre Ozkurt, MD; Mehmet Akdag, MD; Aysenur Keles, MD; Ismail Topcu, MD


The purpose of this experimental study was to investigate the protective role of intratympanically administered dexamethasone on the inner ears of rats that were exposed to streptomycin ototoxicity. Twenty-four adult Wistar albino rats were separated into 4 groups: Group 1 (only streptomycin), Group 2 (only intratympanic dexamethasone), Group 3 (streptomycin and intratympanic dexamethasone), and Group 4 (streptomycin and intratympanic saline). All rats were evaluated with distortion product otoacoustic emissions (DPOAE) tests before the start of treatment and on the day it ended. On the 45th day, after the final DPOAE tests, animals of all groups were sacrificed under general anesthesia. The differences between the amplitudes of DPOAE results were determined, and hearing results were statistically analyzed. Also, the cochleas of each rat were histopathologically evaluated under a light microscope with hematoxylin and eosin staining. In the intratympanic dexamethasone group it was observed that cochlear hair cells were mostly protected. No significant difference was seen between the DPOAE results before and after treatment (p >0.05). On the other hand, loss was observed in the hearing functions and hair cells of the rats that received streptomycin and streptomycin plus intratympanic saline (p <0.05). In the streptomycin plus intratympanic dexamethasone group, the cochlear hair cells were partially protected. A significant difference was observed when the DPOAE results (DP-grams) of the streptomycin plus intratypmanic dexamethasone group were compared to those of the streptomycin plus intratympanic saline group (p <0.05). After the experimental study, ototoxic effects of the administration of streptomycin and intratympanic dexamethasone were observed on the rats' cochlear hair cells. We conclude that intratympanic dexamethasone has protective effects against this cochlear damage in rats.

Is computed tomography perfusion a useful method for distinguishing between benign and malignant neck masses?

June 20, 2017  |  Fatih Duzgun, MD; Serdar Tarhan, MD; Gulgun Yilmaz Ovali, MD; Gorkem Eskiizmir, MD; Yuksel Pabuscu, MD


Evaluation of neck masses is frequent in ear, nose, and throat clinics. Successful outcomes associated with neck mass are directly related to rapid diagnosis and accurate treatment for each patient. Late diagnosis of a malignant mass increases the magnitude of morbidity and the rate of mortality of the disease. Although magnetic resonance imaging and computed tomography (CT) examinations are important tools for evaluating head and neck pathologies, they do not allow functional evaluation. For this reason, CT perfusion (CTP) as a method of functional evaluation for distinguishing benign from malignant masses is gaining attention. The utility of CTP for distinguishing between benign and malignant mass lesions was investigated in 35 patients with masses in the neck (11 benign, 24 malignant). CTP was shown to be a useful method for identifying head and neck tumors and blood volume values to enable the differential diagnosis of benign and malignant head and neck tumors.

Impact of a pediatric anesthesiologist on operating room efficiency during pediatric tonsillectomies and adenotonsillectomies

June 20, 2017  |  Nicholas A. Dewyer, MD; Yoseph A. Kram, MD; Stephen Long, MD; Marika D. Russell, MD, FACS


We conducted a retrospective case review to determine if the presence of an Accreditation Council for Graduate Medical Education (ACGME) fellowship-trained pediatric anesthesiologist improves efficiency during pediatric tonsillectomies and adenotonsillectomies in hospitals that do not have dedicated pediatric operating rooms and, if so, to determine which specific anesthesia practices might account for such a difference. We reviewed the charts of all patients aged 12 years and younger who had undergone a tonsillectomy or adenotonsillectomy from Jan. 1, 2008, through Aug. 1, 2013, at San Francisco General Hospital. A total of 75 cases met our eligibility criteria. We compiled information on patient demographics, surgical time, anesthesia time, and anesthesia practices. Our primary study outcome was the amount of anesthesia-controlled time (ACT), which is the sum of time spent in induction and emergence. Cases were grouped according to whether the operation was staffed by an ACGME fellowship-trained pediatric anesthesiologist or a general anesthesiologist. Data were analyzed for 1 pediatric anesthesiologist and 23 general anesthesiologists. We found that ACT was significantly shorter during the cases staffed by the ACGME fellowship-trained pediatric anesthesiologist, although there were no major differences in anesthesia practices between the types of anesthesiologist. We suggest that staffing pediatric tonsillectomy operations with a fellowship-trained pediatric anesthesiologist may be an effective strategy for increasing operating room efficiency.

Parathyroid carcinoma in a patient with three prior parathyroid adenomas

June 20, 2017  |  Michael Goldenberg, MA; Henry Crist, MD; Darrin V. Bann, MD, PhD

Fine-needle aspiration is contraindicated because of its inability to distinguish parathyroid carcinoma from benign disease and the risk of seeding tumor along the biopsy tract.

Idiopathic pretracheal deep neck space infection with mediastinal extension: A series of 3 cases and review of the literature

June 20, 2017  |  Samuel Roberts, BMed; Lyndon Chan, MBBS (Hons); Robert Eisenberg, MBBS, FRACS


Idiopathic pretracheal deep neck space infection is an extremely rare condition with potentially devastating complications. We present a series of 3 cases of pretracheal deep neck space infection that arose in the absence of trauma or a congenital lesion and that exhibited mediastinal spread. To the best of our knowledge, these cases represent the first reported series of this rare condition to be published in the English-language literature. All cultures grew Streptococcus milleri, and all patients had a favorable outcome. A high index of suspicion for a deep neck space infection is warranted in view of the devastating complications of this condition. Computed tomography is the investigation of choice. Treatment with intravenous antibiotics and surgical drainage, particularly when mediastinitis is present, is recommended. This rare presentation warrants a thorough investigation to identify the source of infection.

Massive auricular cutaneous horn

June 20, 2017  |  Christopher P. Nyte, DO

The importance of preoperative histologic examination of the horn base with a suitable shave or punch biopsy cannot be overstated given the risk of underlying malignancy.

Adenoid cystic carcinoma of the head and neck area: Oncologic treatment and plastic-reconstructive options

June 20, 2017  |  Johannes A. Veit, MD; Julia Thierauf, MD; Thomas K. Hoffmann, PhD, MD; Jens Greve, PhD, MD; Nicole Rotter, PhD, MD; Patrick J. Schuler, PhD, MD; Marc O. Scheithauer, PhD, MD


Adenoid cystic carcinoma of the head and neck area is a rare malignant tumor with acceptable short-term but mediocre long-term prognosis. Radical tumor excision with clear resection margins, and sometimes resection of the facial nerve due to perineural growth, remains the fundamental therapy. We present 3 distinct clinical cases and discuss the current therapeutic options with special focus on plastic-reconstructive techniques. For reconstruction, the full armament of local and free flaps, as well as prosthetics, may be necessary. Adjuvant radiotherapy increases local control in advanced stages or close resection margins. However, systemic treatment options are limited. Further multicenter clinical trials are necessary due to the rare occurrence of the tumor.

Aggressive differentiated thyroid cancer in the geriatric patient

June 20, 2017  |  Kourosh Parham, MD, PhD, FACS; Karen M. Kost, MD, FRCSC

Although differentiated thyroid cancer is typically considered a relatively indolent disease, this is not the case in older adults.