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Juvenile xanthogranuloma of the nasal vestibule

October 8, 2012  |  Wan-Ling Ho, MD; Kai-Chieh Chan, MD

The histopathologic hallmark of juvenile xanthogranuloma is the Touton giant cell, a multinucleated giant histiocyte whose rings of nuclei separate a central homogeneous core from a foamy periphery.

Vocal fold atrophy and Reinke edema

October 8, 2012  |  Eliana Verghese, MD; Rima A. DeFatta, MD; Robert T. Sataloff, MD, DMA, FACS

If voice therapy does not improve vocal fold atrophy and muscle tension dysphonia, then medialization laryngoplasty by injection or thyroplasty may be indicated. 

Chronic focal Langerhans cell histiocytosis of the left mandibular condyle presenting as limited jaw opening: A case report

October 8, 2012  |  Juan F. Yepes, DDS, MD, DrPH; Mohd Khalaf, DDS; Larry Cunningham, DDS, MD, FACS; John Lindroth, DDS


Temporomandibular joint (TMJ) disorders are common in the general population, with a particularly high prevalence among girls and women aged 15 to 25 years. The presence of chronic focal Langerhans cell histiocytosis in the mandibular condyle is rare, as only a few cases have been reported in the literature. We present the case of a 23-year-old woman who was referred to the Orofacial Pain Center at the University of Kentucky College of Dentistry with a chief complaint of limited jaw opening of 7 months’ duration. She had previously received a preliminary diagnosis of a TMJ disorder and had been treated conservatively, but she did not improve. An initial panoramic film revealed a suspicious radiolucent area at the head of the left mandibular condyle. She was eventually diagnosed on histopathology with chronic focal Langerhans cell histiocytosis. She was treated with condylectomy and surgical curettage of the lesion.

Radiation-induced osteosarcoma of the larynx: Case report and literature review

October 8, 2012  |  Murat Ulusan, MD; Rasim Yilmazer, MD; Yasemin Ozluk, MD; Murat Enoz, MD; Yusufhan Suoglu, MD


Laryngeal osteosarcoma is an extremely rare disease. Only 23 cases have been published in the literature. Radiation-induced laryngeal osteosarcoma is even rarer; this is only the third such case to be reported. A 59-year-old man underwent radiotherapy for an in situ laryngeal squamous cell carcinoma at another institution. Five years later he developed a laryngeal osteosarcoma, and a total laryngectomy was performed. Although previous reports showed a poor prognosis, our patient was without disease at the 8-year follow-up. To the best of our knowledge, this is the longest disease-free follow-up to be reported in the literature. We also present a review of the world’s literature.

Malignant peripheral nerve sheath tumor of the superior cervical sympathetic ganglia

October 8, 2012  |  Juliette Thariat, MD, PhD; Pierre-Yves Marcy, MD; Isabelle Peyrottes, MD; Alexandre Bozec, MD, PhD; Nicolas Venissac, MD, PhD


The prevalence of malignant peripheral nerve sheath tumor (MPNST) among the general population is only 0.001%. Most cases originate in peripheral nerve root trunks in the extremities; MPNST rarely occurs in the head and neck. We describe the case of a 61-year-old man who presented with Horner syndrome, dysphonia, and enlarged neck nodes. Imaging detected a paraspinal mass of the deep superior cervical chain next to the internal carotid artery. The patient underwent an upfront modified radical neck dissection of the right-sided lymph nodes from levels II through V. Postoperative irradiation was performed. Two years after the initial diagnosis, the patient was found to have a pulmonary metastasis of the MPNST. A wedge resection was performed, and at 6 months of follow-up, the patient was alive without disease. However, he subsequently developed soft-tissue metastases in his buttocks, and he died 2 years later of brain metastases. In our case, the clinical symptoms suggested the anatomic location of the primary tumor, and imaging findings suggested the diagnosis, which was confirmed on histopathology. As far as we know, no case of MPNST of the superior ganglia of the sympathetic chain has been previously described in the literature.

Malignant ossifying fibromyxoid tumor of the parapharyngeal space

October 4, 2012  |  Neil Tanna, MD, MBA; Nisha Chadha, MD; Raman R. Sharma, BS; Joseph F. Goodman, MD; Nader Sadeghi, MD


Ossifying fibromyxoid tumor (OFMT) is a rare, recently described entity. As such, there is a paucity of information in the literature regarding this neoplasm. According to most reports, the tumor usually develops subcutaneously in the soft tissues of the extremities. Malignant forms of the tumor are far more rare than their benign counterparts. We present a new case of a malignant OFMT of the parapharyngeal space in a 33-year-old Pakistani man. The tumor was excised, and the patient did well with no complications. This case represents a rare occurrence of OFMT of the parapharyngeal space.

Primary meningioma of the middle turbinate: A case report

October 4, 2012  |  Pradipta K. Parida, MS, DNB; Ramandeep Singh Virk, MS;



Meningioma of the sinonasal tract is a rare entity. Meningioma of the nose and paranasal sinuses may occur in one of two ways: (1) by secondary extension of a primary tumor in the cranial cavity or orbit or (2) primarily in the nose and paranasal sinuses de novo from the ectopic meningocytes derived from pluripotent mesenchymal cells. Primary sinonasal meningiomas are often difficult to diagnose because of their infrequent occurrence. The final diagnosis rests on the histologic examination. We report what is to our knowledge the first case of primary meningioma of the middle turbinate.

Spontaneous cervicofacial subcutaneous emphysema secondary to pneumomediastinum in an otherwise asymptomatic child

October 4, 2012  |  Tripti Maithani, MS; Debraj Dey, MS; Chandermohan Sharma, MS


A 12-year-old boy presented with subcutaneous emphysema of the face, neck, and upper chest. He had no significant history that suggested any specific cause, and initial investigations revealed no underlying pathology. Computed tomography of the chest detected pneumomediastinum. The patient was managed conservatively, and he responded. He was discharged 7 days after admission with a complete resolution of the emphysema. To the best of our knowledge, this is the first reported case of spontaneous pneumomediastinum presenting as cervicofacial swelling in a child without any other symptoms.

Embryogenic cervico-thyro-piriform tract

October 4, 2012  |  J. Madana, MS, DNB; Deeke Yolmo, MS; Sunil Kumar Saxena, MS; S. Gopalakrishnan, MS


Branchial cleft fistulae are rare congenital anomalies that arise from the abnormal persistence of branchial remnants. Branchial arch anomalies are rare. They usually present as a lateral neck mass or abscess in the form of acute suppurative thyroiditis. A complete fistula of the third arch is extremely rare. We describe such a case in a 13-year-old girl who presented with a small opening in the left lower neck, from which a mucoid discharge had been present since birth. The fistula was accompanied by recurrent neck swelling. Computed tomography with contrast injection into the external skin opening revealed a continuous tract that extended to the base of the piriform sinus. Total excision of the tract up to the piriform sinus with a left hemithyroidectomy was performed. At follow-up 28 months postoperatively, the patient exhibited no evidence of recurrence.

Nasal tip angiolipoma: The “Pinocchio” nasal deformity

October 4, 2012  |  David A. De Poortere, MD; Boris M. De Poortere, MD; Noam A. Cohen, MD, PhD


Angiolipoma is a rare, benign variant of lipoma; its distinctive feature is its prominent vascularity. It presents as a subcutaneous nodule of white adipose tissue; pain, which may be exacerbated by pressure, is the chief symptom. The anatomic distribution predominantly involves the trunk and extremities. Because of the rarity of this condition in otorhinolaryngology, our understanding of its diagnosis, treatment, and follow-up is limited. Microscopically, two different histopathologic forms of angiolipomas exist: circumscribed and infiltrating. The diagnosis of angiolipoma can be aided by ultrasound, computed tomography, or magnetic resonance imaging. Surgical excision remains the treatment of choice. Sites of previously reported otolaryngologic cases include the cheek, palate, mandible, nasal septum, and cervical area. We describe what we believe to be the second case of a nasal tip angiolipoma in a 78-year-old woman complaining of progressive aesthetic deformity.