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Myeloid sarcomas of the head and neck in pediatric patients with myeloid leukemia

September 19, 2016  |  David W. Cuthbertson, MD; Jyotinder Nain Punia, MD; Vicki L. Owczarzak, MD


Myeloid sarcoma is a rare extramedullary tumor composed of malignant myeloid cells that occur in the presence of myeloid leukemia. We report a case series of pediatric head and neck myeloid sarcomas representative of the epidemiology, symptomatology, laboratorial correlations, prognoses, and treatment of extramedullary leukemia. Presented are 3 cases involving patients ranging from 17 months to 11 years of age. Two patients were successfully treated with chemotherapy, and in the third patient, a large lytic lesion was treated palliatively with proton beam therapy. Knowledge and recognition of myeloid sarcomas is important as they can be locally invasive, and they may also be used as a diagnostic tool or a prognostic indicator for leukemia.

Endoscopic view of a polyp in a concha bullosa

September 19, 2016  |  Nurdoğan Ata, MD; Fatih Güzelkara, MD

Polyps originating within a concha bullosa are uncommon, with only 5 cases reported in the English literature.

An unusual cause of tinnitus

September 19, 2016  |  Po-Jun Chen, MD; Hsin-Chien Chen, MD, PhD

Live insects found in the outer ear canal should be immobilized or killed before removal.

Reverse omega technique for single-stage ear lobule reconstruction

September 19, 2016  |  Mofiyinfolu Sokoya, MD; Andrew A. Winkler, MD

The design of the reverse omega flaps leads to a lack of visible scars, and no major complications have been encountered.

Hailey-Hailey disease

September 19, 2016  |  Lester D. Thompson, MD

Careful correlation of clinical findings with histologic and immunofluorescence findings usually assists in reaching the diagnosis.

Impact of nasal septal perforations of varying sizes and locations on the warming function of the nasal cavity: A computational fluid-dynamics analysis of 5 cases

September 19, 2016  |  Lifeng Li, MD; Demin Han, MD, PhD; Luo Zhang, MD, PhD; Yunchuan Li, MD, PhD; Hongrui Zang, MD, PhD; Tong Wang, MD, PhD; Yingxi Liu, PhD


Patients with a nasal septal perforation often exhibit symptoms associated with disturbed airflow, which can have an adverse effect on the warming function of the nasal cavity. The impact of this effect is not fully understood. The warming function is an important factor in the maintenance of nasal physiology. We conducted a study to investigate the impact of septal perforations of various sizes and locations on the warming function during inspiration in 5 patients-3 men and 2 women, aged 25 to 47 years. Three-dimensional computed tomography and computational fluid dynamics were used to model the flux of communication and temperature, and differences among patients were compared. All 5 patients exhibited an impairment of their nasal warming function. As the size of the perforation increased, the flux of communication increased and the warming function decreased. Perforations located in an anterior position were associated with greater damage to the warming function than those in a posterior position. In patients with a large or anteriorly located perforation, airflow temperature in the nasopharynx was decreased. Our findings suggest that septal perforations not only induce airflow disturbance, but they also impair the nasal warming function. Further analysis of warming function is necessary to better explore flow mechanisms in patients with structural abnormalities.

Sensorineural hearing loss after otitis media with effusion and subacute mastoiditis after viral infections of the upper respiratory tract: A comparative study of conservative and surgical treatment

September 19, 2016  |  Thomas Wilhelm, MD, PhD; Tim Stelzer, MD; Rudolf Hagen, MD, PhD


Involvement of the middle ear after viral infections of the upper airways may lead to serous otitis media with effusion in the absence of bacterial infection. This can be accompanied by a concomitant shading of the mastoid air cells, which could manifest as a reduced opacity on computed tomography (CT) in the absence of a history of chronic mastoiditis or acute inflammatory signs. This can lead to a subsequent impairment of inner ear function. CT scans reveal an extended pneumatization of the temporal bones in affected patients. Inner ear hearing impairment can probably be attributed to a concomitant labyrinthine reaction-the so-called toxic inner ear lesion. If no remission occurs within 5 days after initial conservative treatment (paracentesis or hemorrheologic infusions), surgical treatment with a mastoidectomy can accelerate hearing restoration. We conducted a retrospective, nonrandomized study of short- and long-term hearing outcomes in patients with a toxic inner ear lesion who had been treated with conservative measures alone (CONS group) or with surgery (SURG group) in a tertiary care referral center. Our study group was made up of 52 consecutively presenting patients (57 ears) who had been seen over a 10-year period; there were 20 patients (21 ears) in the CONS group and 32 patients (36 ears) in the SURG group. Initially, 15 CONS patients (75%) and 18 SURG patients (56%) complained of dizziness or a balance disorder. The initial averaged sensorineural hearing loss (over 0.5, 1.0, 2.0, and 3.0 kHz) was 32.4 ± 15.6 dB in the CONS group and 35.4 ± 12.0 dB in the SURG group. At follow-up (mean: 31.7 mo), the SURG group experienced a significantly greater improvement in hearing (p = 0.025). We conclude that patients with viral otitis media and concomitant noninflammatory mastoiditis with impairment of inner ear function (sensorineural hearing loss) experience a better hearing outcome when a mastoidectomy is performed during primary treatment.

Hemorrhagic polyp with large occult sulcus vocalis in a singer

September 19, 2016  |  Meghan O'Brien, DO; Libby J. Smith, DO

A sulcus can decrease the functional vibratory property of the vocal fold free edge and result in dysphonia.

Parotid gland metastasis in Merkel cell carcinoma of the head and neck: A series of 14 cases

September 19, 2016  |  Kristine E. Day, MD; William R. Carroll, MD; Eben L. Rosenthal, MD


Merkel cell carcinoma (MCC) is a rare cutaneous cancer of neuroendocrine cell origin that occurs frequently on the head and neck. With a high incidence of local recurrence and regional and distant metastasis, it carries a poor prognosis. We performed a retrospective study to determine the prognostic implications of parotid gland metastasis in MCC of the head and neck. Our study population was made up of 14 patients-13 men and 1 woman, aged 62 to 87 years (mean: 75.9)-who underwent a parotidectomy for the diagnosis of MCC over a period of 10 years and 9 months. Ten patients had a primary skin lesion of the head and neck and 4 presented with a parotid mass and an unknown primary. In all, 13 of the 14 patients were found to have parotid involvement-either a direct extension of MCC into the gland or a positive intraparotid lymph node; some patients had both. All patients underwent tumor excision, and 10 underwent neck dissection. Eleven patients received adjuvant radiotherapy; none received adjuvant chemotherapy. Of the 10 patients who underwent a neck dissection, 6 were found to have a cervical lymph node metastasis on pathologic examination. Follow-up ranged from 1.3 to 39.2 months (mean: 12.4). Three patients were lost to follow-up shortly after surgery, although some information was available on 2 of them. At the final follow-up, mortality data were available on 12 patients; of these, 11 had died. The lone survivor was the patient without a parotid metastasis. Among those known to have died, survival ranged from 1.6 to 49.2 months (mean: 16.0). We conclude that parotid metastasis in patients with MCC of the head and neck is associated with a dismal survival rate that is even worse than the poor survival associated with cervical node involvement.

Primary salivary duct carcinoma arising from the Stensen duct

September 19, 2016  |  Kenji Noda, MD; Takashi Hirano, MD, PhD; Tomoyo Okamoto, MD; Masashi Suzuki, MD, PhD


This report describes a salivary duct carcinoma (SDC) arising from the extraglandular portion of the Stensen duct. The patient was a 56-year-old man who presented with a palpable, elastic, hard mass without tenderness in the right cheek. Computed tomography revealed a tumor of the extraglandular portion of the Stensen duct. Supraomohyoid right neck dissection and total right parotidectomy were performed, and the histologic diagnosis was SDC of the Stensen duct. Postoperatively, the patient received no additional treatment. Neither recurrence nor metastasis was observed during 4 years of follow-up examination. SDC of the Stensen duct is extremely rare. To our knowledge, there is no report that describes primary SDC arising from that location. We also believe this is the first report that describes the clinical course of primary SDC arising from a Stensen duct.