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Myxoid malignant fibrous histiocytoma presenting as a midline nasal mass

April 1, 2012  |  Jaimie DeRosa, MD and Jeffrey R. Smit, MD


Myxoid malignant fibrous histiocytoma is a rare type of pediatric non-rhabdomyosarcoma soft-tissue sarcoma. The case of a 5-year-old girl is presented, highlighting the potential for multiple pitfalls and aberrant differential diagnoses that need to be identified for successful treatment of pediatric myxofibrosarcomas. An awareness of these tumors and a call for standardized postsurgical treatment protocols is necessary in order to successfully treat children with this disease.

Germ cell tumor metastatic to the oral cavity

April 1, 2012  |  Luis Lee, MD, Randy Oppenheimer, MD, and Lakshmi Jayaram, MD


Neoplasms metastatic to the oral cavity are rare, accounting for less than 1% of all malignancies found there. When they do occur, they are usually found in the soft tissue or mandible. Metastatic malignancies involving the gingival, alveolar, or buccal mucosa are very rare. We present a case of what appeared to be a benign epulis in a 25-year-old man. Biopsy revealed that the lesion represented metastatic testicular cancer.

Congenital os vomer agenesis: Case report and literature review

April 1, 2012  |  Ediz Yorgancilar, MD, Muzeyyen Yildirim, MD, Ramazan Gun, MD, Faruk Meric, MD, and Ismail Topcu, MD


Defects of the nasal septum occur as a result of a variety of causes, including tuberculosis, irritation, neoplasia, trauma, infection, and chronic inflammatory diseases. Congenital os vomer agenesis as a cause is very rare. We report the case of a 28-year-old man with a defect in the posteroinferior part of the nasal septum that was discovered incidentally during a routine endoscopic examination. The patient was diagnosed with congenital os vomer agenesis, and the diagnosis was confirmed by computed tomography. We discuss the features of this case and review the literature on this rare anomaly.

Intracranial sarcoid granuloma as an extension of severe sinonasal sarcoidosis

April 1, 2012  |  Stephen M. Wold, MD and John T. Sinacori, MD


Sarcoidosis is a chronic, multisystem, granulomatous disease of unknown etiology. It manifests with a wide range of symptoms and clinical findings, including some that occur in the head and neck. Sinonasal sarcoidosis, in particular, frequently demonstrates a rather recalcitrant course and a potential for severe complications if left untreated. We present the case of a 46-year-old woman with extensive sinonasal sarcoidosis that progressed to involve the skull base and olfactory tract and ultimately led to the formation of a granuloma within the frontal lobe that required craniotomy and excision. Although surgery is not considered the primary treatment modality for sarcoidosis, it may have a role in managing this highly variable disease in certain patients.

Topical measles-mumps-rubella vaccine in the treatment of recurrent respiratory papillomatosis: Results of a preliminary randomized, controlled trial

April 1, 2012  |  Jin Lei, MD, Wang Yu, MD, Lin Yuexin, MD, Chen Qi, MD, Sun Xiumin, MD, and Zhang Tianyu, PhD


We conducted a study to test the hypothesis that the measles-mumps-rubella (MMR) vaccine can either prevent further recurrences of recurrent respiratory papillomatosis (RRP) or prolong its remission. Our study population was made up of 26 children with RRP. All patients underwent surgical excision of their lesions. After the lesions were removed, half of these patients were prospectively randomized to receive a topical coating of the MMR vaccine on the site of their excised lesion (intervention group); the other half were treated with excision alone (control group). The patients in the intervention group experienced a longer period of recurrence-free remission than did those in the control group (median: 160 and 133 days, respectively), but the difference was not statistically significant. Therefore, it appears that topical MMR vaccine as an adjunct to routine surgical management may not be beneficial in preventing or slowing the return of RRP. However, we believe that further studies with larger patient populations are warranted.

Poorly differentiated small-cell neuroendocrine carcinoma of the submandibular gland: A case report

April 1, 2012  |  Mary Scaduto, MD, Laura Matrka, MD, Manisha Shah, MD, Paul Wakely Jr., MD, and Enver Ozer, MD


Neuroendocrine carcinoma (NEC) is uncommon in the head and neck and rare in the salivary glands. In the latter location, it may manifest as pain or a palpable mass. These tumors can be quite aggressive, with a tendency toward recurrence and regional and distant metastasis. Because of the limited number of reported cases in the literature, no reliable treatment has been established. We describe the case of a 79-year-old man who presented with a persistent submandibular mass that was suspicious for a malignancy on imaging. Following surgical resection and histopathologic analysis, a diagnosis of poorly differentiated small-cell NEC was made. The patient was further treated with postoperative chemotherapy, and he exhibited no evidence of recurrence or metastasis on follow-up.

Endoscopic view of the ostium of the posterior ethmoid sinus

April 1, 2012  |  Eiji Yanagisawa, MD, FACS, Dewey A. Christmas, MD, and Joseph P. Mirante, MD, FACS

The anterior cells of the ehtmoid sinus, located anterior to the basal lamella, vary in number and size and always drain into the middle meatus. The posterior ethmoid cells, located posterior to the basal lamella, drain into the superior meatus.The drainage pathway of the posterior ethmoid cells is usually not easily visualized from within the ethmoid sinus as an ostium leading into the nasal cavity.

Palatoglossal flap: A novel approach to cover herniated fat during tonsillectomy

April 1, 2012  |  Parker A. Velargo, MD and Jerome W. Thompson, MD

Although herniation of parapharyngeal fat into the tonsillar fossa during a tonsillectomy is uncommon, such deftects need to be closed when they occur. One approach is to use a local flap for repair.

Lateral ectopic thyroid: A case diagnosed preoperatively

April 1, 2012  |  Héctor Prado, MD, Alejandro Prado, MD, and Bertha Castillo, MD


Ectopic thyroid is an uncommon condition defined as the presence of thyroid tissue at a site other than the pretracheal area. When the process of embryologic migration is disturbed, aberrant thyroid tissue may appear. In most cases, ectopic thyroid is located along the embryologic descent path of migration as either a lingual thyroid or a thyroglossal duct cyst. In rare cases, aberrant migration can result in lateral ectopic thyroid tissue. Approximately 1 to 3% of all ectopic thyroids are located in the lateral neck. Ectopic tissue frequently represents the only presence of thyroid tissue; a second site of orthotopic or ectopic thyroid tissue is found in other cases. The presentation of ectopic thyroid as a lateral mass should be differentiated from metastatic thyroid cancer; other differential diagnoses include a submandibular tumor, branchial cleft cyst, carotid body tumor, and lymphadenopathy of various etiologies. In addition to the history and physical examination, the workup for a patient with a submandibular mass suspicious for ectopic thyroid should include (1) technetium-99m or iodine-131 scintigraphy, (2) ultrasonography and either computed tomography or magnetic resonance imaging, (3) fine-needle aspiration biopsy, and (4) thyroid function testing. No treatment is required for asymptomatic patients with normal thyroid function and cytology, but hypothyroid patients should be placed on thyroid hormone replacement therapy. Most cases are diagnosed postoperatively. Surgical treatment of ectopic thyroid should be considered when a malignancy is suspected or diagnosed, when the patient is symptomatic, or when thyroid suppression therapy fails.

How will academic health centers define success in 2025?

April 1, 2012  | 

Survival will require performing enough cases to achieve and satisfy minimum standards in quality, patient safety, economic efficiency, and heightened governmental oversight.