Case Reports in Otolaryngology The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Late Pneumolabyrinth May Be Induced by Old Penetrating Injury: Possibility of Undiagnosed Posttraumatic Perilymphatic Fistula Thu, 26 Mar 2015 12:37:18 +0000 Traumatic pneumolabyrinth is a relatively rare entity. We report the case of a unilaterally deaf woman with pneumolabyrinth who had suffered penetrating injury 15 years ago. This past history indicated that the case was late pneumolabyrinth occurring from undiagnosed old posttraumatic perilymphatic fistula. In Japan, most cases of traumatic pneumolabyrinth are caused by penetrating injury with an ear pick. Dizziness often improves within several months. Immediate surgical intervention is recommended for hearing loss, but the hearing outcome is not satisfactory. An appropriate strategy should be selected based on the interval to surgery, bone conduction hearing level at disease onset, stapes lesions, and location of air. Takahiro Nakashima, Keiji Matsuda, Takumi Okuda, Tetsuya Tono, Minoru Takaki, Tamon Hayashi, and Yutaka Hanamure Copyright © 2015 Takahiro Nakashima et al. All rights reserved. Meningitis and Brain Abscess Presenting with Epistaxis in a Woman with Prior Head and Neck Cancer Thu, 26 Mar 2015 09:08:43 +0000 It is estimated that more than 60% of people have epistaxis in their lifetimes, and as such it is a common complaint encountered in emergency medicine. Although epistaxis is usually self-limited and benign, it can occasionally be a sign of serious underlying pathology. We report a case of epistaxis secondary to invasive squamous cell cancer, ultimately leading to pneumocephalus and brain abscess. We recommend a low threshold for neuroimaging in patients with known prior head and neck cancers presenting with epistaxis, as even resolved epistaxis may be related to serious pathology. Danielle Cross and Rebecca Jeanmonod Copyright © 2015 Danielle Cross and Rebecca Jeanmonod. All rights reserved. Management of Congenital Midline Nasofrontal Masses: Case Report and Review of Literature Wed, 25 Mar 2015 14:23:11 +0000 Epidermoid cysts, dermoids, gliomas, and meningo-/encephaloceles are the most important differential diagnoses in congenital nasofrontal masses. Since they arise from an abnormal fusion during fetal development, intracranial extension of the lesion has to be ruled out radiologically before therapy. Dermoids are the most common entity. We report about a congenital epidermoid cyst of the glabella and nasion that had been growing over the last two years before presentation in a 24-year-old patient. We discuss radiological imaging and the different surgical approaches described in literature. A. C. Volck, G. A. Suárez, and A. J. Tasman Copyright © 2015 A. C. Volck et al. All rights reserved. Spindle Cell Lipoma of the Soft Palate Tue, 24 Mar 2015 09:51:23 +0000 Intraoral spindle cell lipomas (SCL) are very rare and comprise ranging between 1.4%–9.8% of all intraoral lipomas. To our knowledge, no case of a SCL located on the soft palate has been reported in the English-language literature. A 31-year-old female was admitted with a swelling in her soft palate. On examination, a 3 cm sessile, nontender swelling was observed on her soft palate. After surgical excision, it was diagnosed as a SCL. Ahmet Hançer, Can Özbay, Serap Karaarslan, and Muzaffer Balaban Copyright © 2015 Ahmet Hançer et al. All rights reserved. Laryngeal Preservation in Managing Advanced Tracheal Adenoid Cystic Carcinoma Tue, 24 Mar 2015 08:30:23 +0000 A 37-year-old male athlete was diagnosed with primary tracheal adenoid cystic carcinoma following investigation for dyspnea, wheeze, and eventual stridor. Preoperative bronchoscopy revealed a highly vascular tumor 4 cm distal to the cricoid with no gross disease extending to the carina. Imaging revealed circumferential tracheal irregularity immediately inferior to the cricoid, with no definite cricoid invasion. Locoregional extension of disease was noted invading the thyroid and abutment of the carotid approximately 180°. Intraoperative findings identified tracheal mucosal disease extending distal to the carina and proximally at the cricothyroid joints where bilateral functional recurrent nerves were preserved. A decision made to preserve the larynx given the inability to fully resect distal tracheal disease. A 5 cm sleeve resection of the trachea was made with a cricotracheal anastomosis following suprahyoidal muscle release and laryngeal drop-down. The patient was treated with adjuvant radiotherapy including platinum based chemotherapy in an effort to maximise local control. PET scanning three months after therapy revealed no FDG uptake locally or distally. Thavakumar Subramaniam, Paul Lennon, John Kinsella, and James Paul O’Neill Copyright © 2015 Thavakumar Subramaniam et al. All rights reserved. Giant Orbitoethmoidal Osteoma: When an Open Surgical Approach Is Required Mon, 23 Mar 2015 13:50:55 +0000 Giant orbitoethmoidal osteoma in children is considered to be rare. This type of pathology can be associated with significant disfiguring proptosis and limitation of eye movement. Here, we report on a child who presented with a giant orbitoethmoidal osteoma that was removed through an orbitofrontal approach. The cosmetic result was excellent and evident immediately after surgery. A review of the literature complements this report. Hussam Abou Al-Shaar, Turki El Arjani, Michael S. Timms, and Faisal Al-Otaibi Copyright © 2015 Hussam Abou Al-Shaar et al. All rights reserved. Carotid Sheath Abscess Caused by a Tooth Decay Infection on the Opposite Side Mon, 23 Mar 2015 08:24:07 +0000 Deep neck infections are mortal diseases that need emergency treatment. It can occur at any age but usually in pediatric ages. In this report, a left cervical carotid space abscess of a pediatric patient was discussed. It was interesting that the only origin of the left carotid sheath abscess was right inferior first molar tooth decay. Right neck spaces were all clean. Patient had no immunosupression and also there were no congenital masses such as branchial cleft cysts, foreign bodies, or masses suspicious for malignancies in cervical ultrasound and MRI. We discussed this rare condition under the light of the literature. F. Ruya Tuncturk, Lokman Uzun, M. Tayyar Kalcioglu, Oguz Kadir Egilmez, Emine Timurlenk, and Muferet Erguven Copyright © 2015 F. Ruya Tuncturk et al. All rights reserved. Endoscopic Endonasal Approach of Congenital Meningoencephalocele Surgery: First Reported Case in Lithuania Thu, 19 Mar 2015 13:51:59 +0000 Meningoencephalocele is a rare condition that usually occurs in children and is treated by neurosurgeons with occasional help from ENT doctors. The symptoms of meningoencephalocele might not develop until adulthood, but usually they are apparent immediately after birth. The case of small anterior basal transethmoidal meningoencephalocele in a 24-year-old patient who had headaches and runny nose since childhood is presented. Endonasal endoscopic approach for meningoencephalocele removal and skull base defect reconstruction was used. It was concluded that endoscopic endonasal approach is less invasive and provides an acceptable operative outcome with short recovery time and less postoperative complications in comparison with other external microsurgical approaches. Svajūnas Balseris, Giedrius Strazdas, Saulius Ročka, and Tomas Jakštas Copyright © 2015 Svajūnas Balseris et al. All rights reserved. Management of Dysphagia Pre- and Postoperatively in a Case of Eagle’s Syndrome Tue, 17 Mar 2015 07:12:23 +0000 Eagle’s syndrome (ES) is rare condition, most frequently described within the context of case study presentation. ES results from elongation of the styloid process, contributing to symptoms such as globus sensation in the throat, as well as pain localized to the ear, neck, face, or tongue. Additional symptoms can include hypersalivation, change in vocal quality, submandibular swelling, and dysphagia. This report discusses evaluation, diagnosis, and surgical intervention with respect to Eagle’s Syndrome in a patient presenting with moderate-severe dysphagia. Vicki Lewis, Bari Hoffman Ruddy, Jeffrey Lehman, Erin Silverman, and Brian Spector Copyright © 2015 Vicki Lewis et al. All rights reserved. Extravasation Mucocele Arising from a Lingual Thyroglossal Duct Remnant Thu, 12 Mar 2015 11:24:01 +0000 Although a thyroglossal duct cyst is a congenital anomaly, it can also appear in adults. Despite the presence of embryological remnants, it is still unclear why the cyst should suddenly develop later in life. We report a case of a 46-year-old male with an extravasation mucocele arising from a long-standing lingual thyroglossal duct remnant. MRI demonstrated a lingual cystic lesion near the hyoid bone associated with a suprahyoid tract-like structure masquerading as a thyroglossal duct cyst. However, histopathological examination demonstrated a mucocele secondary to a rupture of a thyroglossal duct remnant with numerous intramural heterotopic salivary glands. We propose a new mechanism of an acquired cystic formation of this congenital disease that excessive production of mucus from heterotopic salivary glands and a physical trauma such as swallowing may lead to extravasation of mucus from the thyroglossal duct. Mitsuhiko Nakahira and Hiroaki Nakatani Copyright © 2015 Mitsuhiko Nakahira and Hiroaki Nakatani. All rights reserved. Adult-Onset Woakes’ Syndrome: Report of a Rare Case Tue, 10 Mar 2015 11:53:19 +0000 Introduction. Woakes’ syndrome, commonly defined as severe recurrent nasal polyps with consecutive destruction of the nasal pyramid, is rare with only a few reports in the literature documenting surgical treatment of the external nose. Case Presentation. We describe the case of an adult patient with Samter’s triad who had been surgically treated from nasal polyposis since 2002. By 2014 a conspicuous deformity of the nasal pyramid had progressively occurred due to a recurrence. The patient underwent revision endoscopic sinus surgery and narrowing of the bony nasal vault by digital compression without osteotomies. Discussion. Having been described over 130 years ago, the etiology of Woakes’ syndrome remains poorly understood. Treatment includes endoscopic sinus surgery and topical treatment. Surgical treatment of the external nose deformity by rhinoplasty is rarely addressed. Conclusion. This case illustrates that the widening of the bony nasal vault may be successfully corrected by digital compression, if the nasal bones are substantially thinned, in combination with surgical treatment of nasal polyps. U. Schoenenberger and A. J. Tasman Copyright © 2015 U. Schoenenberger and A. J. Tasman. All rights reserved. Massive Temporal Lobe Cholesteatoma Wed, 04 Mar 2015 07:39:42 +0000 Introduction. Intracranial extension of cholesteatoma is rare. This may occur de novo or recur some time later either contiguous with or separate to the site of the original cholesteatoma. Presentation of Case. A 63-year-old female presented to a tertiary referral hospital with a fluctuating level of consciousness, fever, headache, and right-sided otorrhoea, progressing over several days. Her past medical history included surgery for right ear cholesteatoma and drainage of intracranial abscess 23 years priorly. There had been no relevant symptoms in the interim until 6 weeks prior to this presentation. Imaging demonstrated a large right temporal lobe mass contiguous with the middle ear and mastoid cavity with features consistent with cholesteatoma. The patient underwent a combined transmastoid/middle fossa approach for removal of the cholesteatoma and repair of the tegmen dehiscence. The patient made an uneventful recovery and remains well over 12 months later. Conclusion. This case presentation details a large intracranial cholesteatoma which had extended through a tegmen tympani dehiscence from recurrent right ear cholesteatoma treated by modified radical mastoidectomy over two decades priorly. There was a completely asymptomatic progression of disease until several weeks prior to this presentation. Pasan Waidyasekara, Samuel A. Dowthwaite, Ellison Stephenson, Sandeep Bhuta, and Brent McMonagle Copyright © 2015 Pasan Waidyasekara et al. All rights reserved. Acute Traumatic Injury of the Larynx Tue, 03 Mar 2015 11:56:05 +0000 Laryngeal trauma is rare but serious and potentially deadly injury. The prompt diagnosis and management of acute laryngeal trauma is necessary because the clinical presentation is variable depending on the location, severity, and mechanism of injury. Two case histories are presented: (1) case history A: a 53-year-old male, after motor vehicle accident, fractured the mid anterior thyroid cartilage and both aspects of the cricoid cartilage; however, this patient was asymptomatic from the above fractures; and (2) case history B: a 41-year-old male who sustained trauma to the chest, neck, and left arm after being struck by a large lead pipe which fractured the left aspect of the cricoid cartilage was symptomatic. The type rather than the severity of acute laryngeal injury and the mechanism of injury may be related to symptomatology. Acute laryngeal trauma should be recognized by trauma radiologists and emergency room physicians. Early diagnosis and management of acute laryngeal trauma may prevent unnecessary specialty consults and long-term complications. K. O. Kragha Copyright © 2015 K. O. Kragha. All rights reserved. A Surprising Finding after External Ear Polypectomy in a Deaf Mute Patient Sat, 28 Feb 2015 07:56:56 +0000 Introduction. External auditory canal polyps usually reflect an inflammatory process. Rarely, they may reflect a serious condition that warrants urgent intervention. Case Report. A 19-year-old deaf mute female presented to our department with persistent left ear discharge and a reddish mass in the ear. After surgery, the cause was identified as a neglected foreign body. Tympanic membrane was intact. Conclusion. Aural polyp that is resistant to medical treatment should raise the suspicion of an inflammatory polyp with underlying chronic suppurative otitis media or foreign body. Rarer neoplastic and immunological causes should also be considered. Hazem M. Abdel Tawab, Ravi Kumar V, and Salim M. Sloma Tabook Copyright © 2015 Hazem M. Abdel Tawab et al. All rights reserved. Thoracocervicofacial Emphysema after Heimlich’s Maneuvre Thu, 26 Feb 2015 08:34:40 +0000 We report an extremely rare example of a thoracocervicofacial subcutaneous emphysema after Heimlich maneuver case. Salim Bouayed, Kishore Sandu, Pedro S. Teiga, and Bassel Hallak Copyright © 2015 Salim Bouayed et al. All rights reserved. Enteric Duplication Cyst Located at the Posterior Tongue: A Rare Case Report and Review of the Literature Mon, 23 Feb 2015 11:52:03 +0000 The lingual localization of an enteric duplication is extremely rare but may present with respiratory and feeding problems that require emergency intervention. A 7-month-old boy was brought to our clinic with feeding difficulties and tongue swelling. Physical examination showed a cystic lesion located near the left side of the tongue base that caused tongue protrusion to the contralateral side. During surgery, a 3-cm diameter opaque thick-walled cyst was found to be very closely adherent to the base of tongue, which was excised in its entirety. Following surgery, the patient fed during the early postoperative period and no complications were observed other than hypersalivation. On histological examination, a cystic lesion lined with intestinal mucosa and goblet cells was found. We present the rare case of a duplication cyst of the posterior tongue, with a literature review. Bircan Savran, Cuneyt Kucur, Cengiz Kocak, Isa Ozbay, Mehmet Huseyin Metineren, and Yasin Tugrul Karakus Copyright © 2015 Bircan Savran et al. All rights reserved. Conservative Management for Lingual Thyroid Ectopic Sun, 15 Feb 2015 08:38:06 +0000 Lingual thyroid gland is a rare clinical entity. The presence of an ectopic thyroid gland located at the base of the tongue may be presented with symptoms like dysphagia, dysphonia, and upper airway obstruction. We are introducing a case of an 8-year-old girl who had lingual thyroid that presented dysphagia and foreign body sensation in the throat. The diagnostic was reached with clinical examination, thyroid scintigraphy with and ultrasound. A laryngoscopy was performed which confirmed a spherical mass at base of tongue. Investigation should include thyroid function tests. In this case we observed subclinical hypothyroidism. There are different types of surgical approaches for the treatment of this condition; however, the treatment with Levothyroxine Sodium allowed the stabilization of TSH levels and clinical improvement of symptoms in a follow-up of 2 years. Eder Alberto Sigua-Rodriguez, Douglas Rangel Goulart, Luciana Asprino, and Afonso Celso de Moraes Manzano Copyright © 2015 Eder Alberto Sigua-Rodriguez et al. All rights reserved. IgG4-Related Nasal Pseudotumor Thu, 12 Feb 2015 09:58:05 +0000 IgG4-related disease is recognized as one form of autoimmune pancreatitis. During the last ten years, it has also been described in several other organs. We present two patients with lesions showing a histological picture of fibrosis and lymphoplasmacytic infiltrations with abundant IgG4 positive plasma cells at hitherto unreported symmetrical nasal locations. The symmetrical complex consisted of one central lesion in the anterior nasal septum and the two others in each of the lateral nasal walls. The lesions extended from the anterior part of the inferior concha into the vestibulum and caused severe nasal obstruction. L. K. Døsen, P. Jebsen, B. Dingsør, and R. Haye Copyright © 2015 L. K. Døsen et al. All rights reserved. Osteoma Presenting as a Painless Solitary Mastoid Swelling Thu, 12 Feb 2015 06:45:12 +0000 Introduction. Osteoma of the temporal bone is a very uncommon benign tumor of bone. Osteomas may occur in the external auditory canals but are reported to be very rare in the mastoid bone. Case Report. A 36-year-old male presented to our department with a hard swelling behind the right ear diagnosed as osteoma. Complete excision was done through a postauricular approach. Histopathology confirmed the diagnosis of osteoma. Conclusion. Osteomas, although rare, should be considered when dealing with any hard mastoid swelling. Complete removal can be ensured by drilling till the normal cortical bone is reached to avoid recurrence. A cortical mastoidectomy should be done if the mastoid air cell system is involved. Hazem M. Abdel Tawab, Ravi Kumar V, and Salim M. Sloma Tabook Copyright © 2015 Hazem M. Abdel Tawab et al. All rights reserved. Recurrent Laryngeal Edema Imitating Angioedema Caused by Dislocated Screw after Anterior Spine Surgery Tue, 10 Feb 2015 12:38:13 +0000 The anterior cervical spine surgery is a common procedure to stabilize vertebrae damaged by various diseases. The plates and screws are usually used in the spine fixation. This kind of instrumentation may detach from the bones which is a rare but well-known complication. A 77-year-old male presented to the otorhinolaryngology department with throat pain, choking, and dysphagia. At first the angioedema was diagnosed and he was treated conservatively. The endoscopy revealed laryngeal edema, being more defined on the right side with right vocal fold paresis. CT scans showed the stabilizing plate with two screws attached tightly and the back-out of the third screw toward soft tissue of the neck. In the meantime, his condition deteriorated and he needed tracheotomy. In few days the surgical removal of the dislocated screw was performed successfully. Although two-month follow-up reported no obstruction of the larynx, the vocal folds paresis with gradual functional improvement was observed. Long-term complication of anterior spine surgery sometimes may suggest laryngeal angioedema at first. If the conservative treatment is ineffective and there is a history of anterior spine surgery, the clinicians should consider the displacement of the plate or screws in differential diagnosis. Piotr Wójtowicz, Tomasz Szafarowski, Ewa Migacz, and Antoni Krzeski Copyright © 2015 Piotr Wójtowicz et al. All rights reserved. Isolated Kaposi Sarcoma of the Tonsil: A Case Report and Review of the Scientific Literature Tue, 10 Feb 2015 10:25:40 +0000 Kaposi sarcoma is a tumour caused by human herpes virus 8, also known as Kaposi sarcoma-associated herpes virus. It usually affects the skin and oral mucosa; however, it can also sometimes affect the lungs, the liver, the stomach, the bowel, and lymph nodes. Several body sites may be affected simultaneously. The involvement of the tonsils is rare. We described an isolated localization of Kaposi’s sarcoma of the right tonsil in a HIV-positive patient. Barbara Pittore, Carlo Loris Pelagatti, Francesco Deiana, Francesco Ortu, Elena Maricosu, Sergio Cossu, and Giovanni Sotgiu Copyright © 2015 Barbara Pittore et al. All rights reserved. Hybrid Tumor of the Parotid Gland: A Case Report and Review of the Literature Mon, 09 Feb 2015 08:32:07 +0000 The parotid gland is the most common location of benign neoplasms affecting major salivary glands. Hybrid tumors are very rare tumor entities which are composed of two different tumor types, each of which conforms to an exactly defined tumor category. The tumor entities of a hybrid tumor are not separated but have an identical origin within the same topographical area. This report describes a 51-year-old male with three neoplasms occurring within a single parotid gland tumor. The clinical, radiological, and histologic features are described in addition to a review of the literature. Alain Sabri, Ibrahim Bawab, Ibrahim Khalifeh, and Elie Alam Copyright © 2015 Alain Sabri et al. All rights reserved. Nasal Bridge Intramuscular Hemangioma Mon, 02 Feb 2015 12:47:49 +0000 Intramuscular haemangioma (IMH) is a benign mesenchymal tumour. It appears as a deep, nontender mass within the soft tissue, particularly in the extremities. This tumour may not be obvious on clinical examination. Head and neck IMHs represent only 13.5% of the total IMHs. The most common site for a head and neck IMH is the masseter muscle, followed by trapezius, sternocleidomastoid, and very rarely temporalis muscle. We present a patient with left nasal bridge swelling which was excised and histologically confirmed as intramuscular hemangioma. Zulkifli Hamir Basah, Irfan Mohamad, Ramiza Ramza Ramli, Maha Khadum Gayadh, and Samarendra Singh Mutum Copyright © 2015 Zulkifli Hamir Basah et al. All rights reserved. Three Cases of Organized Hematoma of the Maxillary Sinus: Clinical Features and Immunohistological Studies for Vascular Endothelial Growth Factor and Vascular Endothelial Growth Factor Receptor 2 Expressions Thu, 29 Jan 2015 11:23:57 +0000 Objectives. Organized hematoma (OH) is a rare, nonneoplastic, hemorrhagic lesion causing mucosal swelling and bone thinning, mainly in the maxillary sinus. We aimed to clarify the clinical presentation and treatment of OH. Methods. Three cases of maxillary sinus OH and a literature review are presented. Results. Three men aged 16–40 years complained of nasal obstruction, frequent epistaxis, and/or headache. Clinical and radiological examinations revealed a maxillary sinus OH. They were cured in a piecemeal fashion via endoscopic middle meatal antrostomy. Furthermore, vascular endothelial growth factor and its receptor were expressed in the lesion. Conclusions. The pathogenesis of OH is unclear and it presents various histological and imaging findings; however, it is not difficult to rule out malignant tumors. Minimally invasive surgery such as endoscopic sinus surgery can cure it completely. Thus, it is important to determine the diagnosis using CT and MRI and to quickly provide surgical treatment. Shoichiro Imayoshi, Takeharu Kanazawa, Noriyoshi Fukushima, Hisashi Kikuchi, Masayo Hasegawa, Takafumi Nagatomo, and Hiroshi Nishino Copyright © 2015 Shoichiro Imayoshi et al. All rights reserved. Nasal Dermoplasty for Recurrent Polyps in a Patient with Churg-Strauss Syndrome Tue, 27 Jan 2015 11:18:13 +0000 Nasal dermoplasty for recurrent polyps (NDRP) is a new technique for the surgical treatment of this condition. Churg-Strauss syndrome is characterized by the presence of nasal polyps with a great tendency for relapse after surgical or pharmaceutical treatment. It is the first time that we use NDRP to treat nasal polyps in a patient with Churg-Strauss syndrome. The patient was a 33-year-old female suffering from Churg-Strauss syndrome having had multiple operations in the past for recurrent polyps. NDRP was performed on the left nostril only. The mucosa of the left nasal vault was replaced by a split-thickness skin graft (modified dermoplasty). On the right nostril, polyps were removed and the ostia of the paranasal sinuses were enlarged as in typical endoscopic sinus surgery. The skin graft had a successful take and eight months after the operation no polyps are detected on the left side while polyps have recurred on the right nasal cavity. Applying the technique to a single nostril has several advantages, namely, the reduction of the operational time and therefore the risks for the patient from a prolonged general anaesthetic and the ability to judge the efficacy of the technique on the same patient. George Anastasopoulos, Theophanis Machas, Sofia Kegioglou, and Demetra Rapti Copyright © 2015 George Anastasopoulos et al. All rights reserved. A Case of Chondrosarcoma Arising in the Temporomandibular Joint Mon, 26 Jan 2015 13:01:43 +0000 Chondrosarcoma is a malignant tumor originating in cartilaginous cells. And there are only few reports of the case of chondrosarcoma in temporomandibular joint. We discuss a case of chondrosarcoma in temporomandibular joint in a 28-year-old man. Tumor was in contact with the dura, but en bloc resection was performed. After surgical resection of the tumor, face defect was reconstructed by rectus abdominis-free flap. And there is no recurrence after ten years from the resection. Tsutomu Nomura, Tadaharu Kobayashi, Susumu Shingaki, and Chikara Saito Copyright © 2015 Tsutomu Nomura et al. All rights reserved. Radiofrequency Coblation of Congenital Nasopharyngeal Teratoma: A Novel Technique Thu, 22 Jan 2015 14:28:31 +0000 Introduction. Congenital nasopharyngeal teratomas are rare tumours that pose difficulties in diagnosis and surgical management. We report the first use of radiofrequency coblation in the management of such tumours. Case Report. A premature baby with a perinatal diagnosis of a large, obstructing nasooropharyngeal mass was referred to the ENT service for further investigations and management. The initial biopsy was suggestive of a neuroblastoma, but the tumour demonstrated rapid growth despite appropriate chemotherapy. In a novel use of radiofrequency coblation, the nasooropharyngeal mass was completely excised, with the final histopathology revealing a congenital nasopharyngeal teratoma. Conclusion. We report the first use of radiofrequency coblation to excise a congenital nasopharyngeal teratoma and discuss its advantages. Sang Yun Hwang, Niall Jefferson, Alok Mohorikar, and Ian Jacobson Copyright © 2015 Sang Yun Hwang et al. All rights reserved. A Three-Generation Family with Idiopathic Facial Palsy Suggesting an Autosomal Dominant Inheritance with High Penetrance Sun, 18 Jan 2015 07:17:17 +0000 Idiopathic facial palsy (IFP), also known as Bell’s palsy, is a common neurologic disorder, but recurrent and familial forms are rare. This case series presents a three-generation family with idiopathic facial palsy. The mode of inheritance of IFP has previously been suggested as autosomal dominant with low or variable penetrance, but the present family indicates an autosomal dominant trait with high or complete penetrance. Chromosome microarray studies did not reveal a pathogenic copy number variation, which could enable identification of a candidate gene. Christian Grønhøj Larsen, Mette Gyldenløve, Aia Elise Jønch, Birgitte Charabi, and Zeynep Tümer Copyright © 2015 Christian Grønhøj Larsen et al. All rights reserved. An Endoscopic Endonasal Approach for Early-Stage Olfactory Neuroblastoma: An Evaluation of 2 Cases with Minireview of Literature Sun, 11 Jan 2015 14:21:43 +0000 We describe the clinical findings in two patients with pathologically diagnosed olfactory neuroblastoma (ONB) of the sinonasal area and the surgical methods used for its treatment. Using an endoscopic endonasal approach (EEA) without dura resection, along with radiotherapy, we successfully treated ONB at the Kadish stage A. One of our patients, however, experienced tumor recurrence 24 years after open surgery with radiotherapy that was conducted at another hospital. This patient was no longer eligible for radiotherapy, and the tumor was therefore resected with dura resection using an EEA combined with duraplasty. The dura resection with duraplasty using fascia lata and a pedicled nasal septal flap was minimally invasive. As with surgery without duraplasty, a postoperative computed tomography (CT) examination revealed that EEA with duraplasty led to quick improvement of the postoperative inflammatory response as well as pneumocranium. Here, we investigated whether to modify the method of surgery depending upon the primary site of early-stage ONB. We suggest that, in early-stage ONB, an endoscopic endonasal approach is an effective and less invasive method. It is also advisable to perform dura mater resection of the lesion site despite the absence of obvious intracranial invasions in image findings. Hidenori Yokoi, Satoru Kodama, Yasunao Kogashiwa, Yuma Matsumoto, Yasuo Ohkura, Takayuki Nakagawa, and Naoyuki Kohno Copyright © 2015 Hidenori Yokoi et al. All rights reserved. Removal of a Wire Brush Bristle from the Hypopharynx Using Suspension, Microscope, and Fluoroscopy Sun, 11 Jan 2015 09:47:58 +0000 Wire brush bristles are an increasingly recognized hazard that can present as a foreign body in the aerodigestive tract. Due to their small size and tendency to become embedded in surrounding tissue, these small metallic bristles present a unique operative challenge to otolaryngologists. Here we present a case of a 40-year-old woman who underwent endoscopic extraction of a wire bristle from the posterior pharyngeal wall using suspension, microscopy, and C-arm fluoroscopy. We believe this is the first published case of an endoscopic removal of a buried foreign body in the hypopharynx using these methods of localization concurrently. By leveraging multiple techniques for visualization, surgeons can avoid open exploration while ensuring complete removal of the object. Additionally, this case highlights the importance of regulatory oversight and consumer awareness of the hazards of grill brushes. Matthew R. Naunheim, Matthew M. Dedmon, Matthew C. Mori, Ahmad R. Sedaghat, and Jayme R. Dowdall Copyright © 2015 Matthew R. Naunheim et al. All rights reserved.