Case Reports in Otolaryngology The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. A Rare Entity: Adult Asymptomatic Giant Vallecular Cyst Tue, 24 Nov 2015 11:17:59 +0000 Background. Cysts in the larynx are rare and generally asymptomatic. However, large cysts in adults can be symptomatic. If they are symptomatic, they typically present with respiratory and feeding difficulties. They are usually benign in terms of pathology. Several surgical techniques may be used for treatment. Case Report. A 56-year-old man presented to our clinic with hoarseness. Routine laryngeal examination revealed a giant mass and the larynx could not be visualized. At magnetic resonance imaging (MRI), a cystic mass originating from the vallecula was detected. There was no pathology at the glottic level. We planned tracheotomy for the airway and endoscopic surgery for excision. The mass was excised using CO2 laser and was reported as benign. Conclusion. An asymptomatic vallecular cyst may cause difficult intubation in any operation. It may also cause respiratory or other complications. Airway management should be led by an ear, nose, and throat surgeon, since tracheotomy may be required. Endoscopic excision with CO2 laser is a good choice for treatment in elective cases. In this report, we discuss the diagnosis and treatment of a patient with an asymptomatic giant vallecular cyst. Mümtaz Taner Torun, Ender Seçkin, Ümit Tuncel, Caner Kılıç, and Özalkan Özkan Copyright © 2015 Mümtaz Taner Torun et al. All rights reserved. Inverted Papilloma Originating Primarily from the Nasolacrimal Duct: A Case Report and Review of the Pertinent Literature Mon, 16 Nov 2015 09:41:07 +0000 Introduction. Inverted papilloma (IP) is an uncommon, benign yet aggressive neoplasm characterised by high recurrence rates and tendency towards malignant transformation. The majority of IP cases originate in the ethmoid region, lateral wall of the nasal fossa, and maxillary sinus. The authors report a case of an IP originating primarily from the nasolacrimal duct (NLD). Case. A 69-year-old Caucasian gentleman presented with a lump in his right medial canthal region, epiphora, and discharge bilaterally. Radiological investigation revealed a well-defined, heterogeneous mass within the proximal NLD eroding the bony canal, protruding into the middle meatus and into the right orbit. The tumour was excised en bloc utilizing a combined external and endoscopic approach based on its location. Histology revealed hyperplastic ribbons of basement membrane-enclosed epithelium growing endophytically into the underlying stroma with no evidence of invasive malignancy. The patient made an uneventful recovery with unchanged visual acuity and normal extraocular movements. Conclusion. The case demonstrates variability within the sinonasal tract that IP can develop and the individuality of each case necessitating tailored operative techniques for complete excision whilst minimising recurrence rates. We also present a combined endoscopic approach for the en bloc resection of a NLD IP with no clinical recurrence at 15-month follow-up. Hussein Z. Walijee, Sandeep Berry, Stuart Quine, Carol Lane, Daniel S. Morris, and Benedict Bowman Copyright © 2015 Hussein Z. Walijee et al. All rights reserved. Melkersson-Rosenthal Syndrome with Orofacial Swelling and Recurrent Lower Motor Neuron Facial Nerve Palsy: A Case Report and Review of the Literature Mon, 09 Nov 2015 09:25:03 +0000 Melkersson-Rosenthal Syndrome (MRS) is a rare otoneurologic condition, which is poorly understood and often underdiagnosed. Etiology and incidence are unclear, although infectious, inflammatory, and genetic causes have been implicated. Recurrent facial nerve palsy, facial swelling, and fissured tongue are the symptoms and signs of this condition. However, this triad is not typical in all patients as patients may present with one or more of the symptoms, which makes management of this condition difficult. Steroids may prove to be useful especially in patients who have facial nerve palsy. In this case report, we have described a 46 year-old Caucasian male who presented to the clinic for the evaluation of orofacial swelling and left facial deviation with a history of multiple treatments for recurrent lower motor neuron type facial nerve palsy. Jerome Okudo and Yemi Oluyide Copyright © 2015 Jerome Okudo and Yemi Oluyide. All rights reserved. Submandibular Lateral Ectopic Thyroid Tissue: Ultrasonography, Computed Tomography, and Scintigraphic Findings Sun, 08 Nov 2015 11:47:12 +0000 Ectopic thyroid can be encountered anywhere between the base of tongue and pretracheal region. The most common form is euthyroid neck mass. Herein, we aimed to present the findings of a female case with ectopic thyroid tissue localized in the left submandibular region. A 44-year-old female patient, who underwent bilateral subtotal thyroidectomy four years ago with the diagnosis of multinodular goiter, was admitted to our hospital due to a mass localized in the left submandibular area that gradually increased in the last six months. Neck ultrasonography, contrast-enhanced computed tomography, and scintigraphic examination were performed on the patient. On thyroid scintigraphy with Tc-99m pertechnetate, thyroid tissue activity uptake showing massive radioactivity was observed in the normal localization of the thyroid gland and in the submandibular localization. The focus in the submandibular region was excised. Pathological examination of the specimen showed normal thyroid follicle cells with no signs of malignancy. The submandibular mass is a rarely encountered lateral ectopic thyroid tissue. Accordingly, ectopic thyroid tissue should also be considered in the differential diagnosis of masses in the submandibular region. Metin Çeliker, Fatma Beyazal Çeliker, Arzu Turan, Mehmet Beyazal, and Hatice Beyazal Polat Copyright © 2015 Metin Çeliker et al. All rights reserved. Undiagnosed Hepatocellular Carcinoma Presenting as Nasal Metastases Thu, 05 Nov 2015 14:29:18 +0000 Hepatocellular carcinoma (HCC) is a primary malignancy of the liver with up to half of cases suffering from extrahepatic metastasis in the later stages of the disease. Commonly reported and encountered metastatic sites include the lymph nodes, lung, bone, and adrenal glands. This is an effort to throw a spotlight on a rare case of metastatic HCC which presented to us as two distinct lesions in the nose. It focuses on the presentation and the steps that were taken to reach this rare and unusual diagnosis. It sparks interest from a clinical and histopathology perspective. Our cynosure is the findings of the case coupled with a probe on the possible routes of spread of HCC to sinonasal region. Hassen Mohammed, Rashid Sheikh, Waheed Rahman, Sally Sheta, and Zeynel Dogan Copyright © 2015 Hassen Mohammed et al. All rights reserved. A Case of Hyalinizing Clear Cell Carcinoma, So-Called Clear Cell Carcinoma, Not Otherwise Specified, of the Minor Salivary Glands of the Buccal Mucosa Tue, 27 Oct 2015 09:51:55 +0000 Hyalinizing clear cell carcinoma (HCCC), so-called clear cell carcinoma, not otherwise specified (CCC (NOS)), of the salivary glands is a rare and low-grade malignant tumor. We report a case of HCCC so-called CCC (NOS) (referred to as HCCC) of the minor salivary gland of the buccal mucosa. A 52-year-old woman had presented with a gradually growing and indolent mass in the right buccal mucosa for about two years. The first biopsy histopathologically suggested the possibility of malignancy derived from the minor salivary glands. A month later, she visited our hospital. The tumor measured approximately 1.5 cm in diameter and was elastic hard, smooth, and well movable. Image examinations demonstrated internal homogeneity of the lesion, which had a smooth margin, in the right buccal mucosa. Complete tumor resection followed by covering with a polyglycolic acid sheet and fibrin glue spray was performed without surgical flap reconstruction. Histopathological findings revealed proliferating tumor cells with clear cytoplasm surrounded by hyalinizing stroma in the submucosal minor salivary glands. Immunohistochemical stains revealed these tumor cells to be positive for epithelial cell markers but negative for myoepithelial ones. These findings confirmed the diagnosis of HCCC. Good wound healing and no evidence of local recurrence and metastasis have been shown since surgery. Takahiro Yamanishi, Kiwako Kutsuma, and Keisuke Masuyama Copyright © 2015 Takahiro Yamanishi et al. All rights reserved. Mucoepidermoid Carcinoma Associated with Osteosarcoma in a True Malignant Mixed Tumor of the Submandibular Region Tue, 27 Oct 2015 07:23:11 +0000 Introduction. True malignant mixed tumor, also known as carcinosarcoma, is a rare tumor of the salivary gland composed of both malignant epithelial and malignant mesenchymal elements. Frequently carcinosarcoma arises in the background of a preexisting pleomorphic adenoma; however, if no evidence of benign mixed tumor is present, the lesion is known as carcinosarcoma “de novo.” We reported the first case of true malignant mixed tumor of the submandibular gland composed of high grade mucoepidermoid carcinoma associated with osteosarcoma. Case Presentation. A 69-year-old Caucasian male came to our department complaining of the appearance of an asymptomatic left submandibular neoformation progressively increasing in size over 3 months. We opted for surgical treatment. Histological examination confirmed the diagnosis of carcinosarcoma with the coexistence of high grade mucoepidermoid carcinoma and osteosarcoma. Conclusion. To the best of our knowledge, in the true malignant mixed tumor of the submandibular gland, mucoepidermoid carcinoma associated with osteosarcoma has never been previously reported. Dario Marcotullio, Marco de Vincentiis, Giannicola Iannella, Bruna Cerbelli, and Giuseppe Magliulo Copyright © 2015 Dario Marcotullio et al. All rights reserved. A Rare Differential Diagnosis of a Nasal Tumor: Case Report and Literature Review Mon, 19 Oct 2015 09:52:28 +0000 Vascular leiomyomas or angioleiomyomas are rare tumors that can be found in the nasal cavity. The etiology of angioleiomyoma remains poorly understood and there are several hypotheses to explain the origin of sinonasal leiomyoma. We here describe the clinical and histological findings in a case study along with the feasibility of surgical treatment using a radiofrequency instrument. In particular, we describe the case of an adult patient with recurrent epistaxis because of a nasal angioleiomyoma and the performed treatment in the form of complete surgical excision. Radiological imaging is a helpful tool to give an indication of the extension of the tumor, as well as for the proper planning of the surgical approach. Either MRI or CT scans are found to be best suited for this purpose. This case report recommends the complete surgical excision of the angioleiomyoma, by either an endoscopic or an open procedure. This can be safely performed using a radiofrequency instrument as shown in this case with no recurrence during a follow-up of 12 months. S. Burkart and U. Schoenenberger Copyright © 2015 S. Burkart and U. Schoenenberger. All rights reserved. Castleman’s Disease Presenting as a Parotid Mass in the Pediatric Population: A Report of 2 Cases Mon, 05 Oct 2015 09:55:53 +0000 Introduction. Angiofollicular lymph node hyperplasia (Castleman’s disease) is a nonmalignant lymphoproliferative disorder that generally involves the lymph nodes of young adults, most commonly in the mediastinum. Rarely, Castleman’s disease may present in the parotid gland. The disease can be further classified into unicentric or multicentric forms, with considerable differences in presentation, treatment, and prognosis. Case(s). We present cases of two pediatric patients, aged 7 and 11, who both presented with a slow-growing, painless parotid mass. In each case, the mass was excised via a superficial parotidectomy and the diagnosis made postoperatively upon further pathologic examination. At 6 months of follow-up, both had fully intact facial nerve function and no evidence of recurrence. Discussion. Castleman’s disease presents a diagnostic challenge in the head and neck region, as radiographic characteristics and fine needle aspiration results are often inconclusive. Definitive diagnosis requires surgical excision for pathologic examination. The unicentric form generally presents as a painless mass and can be successfully treated with complete excision. The multicentric form is associated with constitutional symptoms and its treatment remains controversial. Conclusion. Although rare, clinicians should be aware of both forms of Castleman’s disease when creating a differential diagnosis for parotid masses. Sean W. Delaney, Shengmei Zhou, and Dennis Maceri Copyright © 2015 Sean W. Delaney et al. All rights reserved. Original Solution for Middle Ear Implant and Anesthetic/Surgical Management in a Child with Severe Craniofacial Dysmorphism Tue, 29 Sep 2015 08:47:32 +0000 We describe the novel solution adopted in positioning middle ear implant in a child with bilateral congenital aural atresia and craniofacial dysmorphism that have posed a significant challenge for the safe and correct management of deafness. A five-year-old child, affected by a rare congenital disease (Van Maldergem Syndrome), suffered from conductive hearing loss. Conventional skin-drive bone-conduction device, attached with a steel spring headband, has been applied but auditory restoration was not optimal. The decision made was to position Vibrant Soundbridge, a middle ear implant, with an original surgical application due to hypoplasia of the tympanic cavity. Intubation procedure was complicated due to child craniofacial deformities. Postoperative hearing rehabilitation involved a multidisciplinary team, showing improved social skills and language development. Giovanni Bianchin, Lorenzo Tribi, Aronne Reverzani, Patrizia Formigoni, and Valeria Polizzi Copyright © 2015 Giovanni Bianchin et al. All rights reserved. Sporadic Multifocal Venous Malformations of the Head and Neck Mon, 21 Sep 2015 11:47:26 +0000 Objective. To report a case of unusually widespread sporadic venous malformations of the head and neck associated with normal D-dimer levels and, due to the protean clinical manifestations and increased risk of coagulopathy of these lesions, to review their diagnosis and clinical management. Case Report. A 25-year-old man presented with a one-year history of intermittent right-sided neck swelling and tongue swelling. Physical exam revealed additional lesions present throughout the head and neck. There was no family history suggestive of heritable vascular malformations. Radiographic imaging demonstrated 15 lesions located in various tissue layers consistent with venous malformations. A coagulation screen showed a normal prothrombin time, activated partial thromboplastin time, international normalized ratio, D-dimer level, and fibrinogen level. It was determined that the patient was not at increased risk for intraoperative coagulopathy and preoperative heparin administration would not be necessary. The patient’s buccal and tongue lesions were subsequently excised with no complications. The patient also underwent sclerotherapy evaluation for his neck mass. Conclusion. This case describes a unique presentation of sporadic multifocal venous malformations. It also emphasizes the importance of prompt diagnosis and workup when multiple venous malformations are present to prevent morbidity during surgical excision secondary to intravascular coagulopathy. Michael V. Amato, Neha A. Patel, Shirley Hu, and Harry Pantelides Copyright © 2015 Michael V. Amato et al. All rights reserved. Coblator Arytenoidectomy in the Treatment of Bilateral Vocal Cord Paralysis Thu, 17 Sep 2015 13:40:39 +0000 A 77-year-old female with bilateral vocal cord paralysis and dependent tracheostomy status after total thyroidectomy presented to clinic for evaluation of decannulation via arytenoidectomy. Preliminary data suggests coblation versus standard CO2 laser ablation in arytenoidectomy may provide benefits in terms of decreased tissue necrosis and patient outcome. The patient elected to proceed with arytenoidectomy by coblation. The initial procedure went well but postoperative bleeding required a return trip to the operating room for hemostasis. In the coming months the patient’s tracheostomy tube was gradually downsized and eventually capped. She was decannulated eight months after surgery, speaking well and without complaints. Details of the surgical procedure and outcome will be discussed. Benjamin Googe, Andrew Nida, and John Schweinfurth Copyright © 2015 Benjamin Googe et al. All rights reserved. Lithium Battery Ingestion: An Unusual Cause of Bilateral Cord Palsy Thu, 17 Sep 2015 12:31:08 +0000 Bilateral vocal cord palsy is a rare but life threatening complication of lithium battery ingestion in children. This complication is mostly missed by otorhinolaryngologists due to lack of awareness on the cited subject. We present one such rare case in an infant, where the clinical presentation was found to be unique but hitherto unreported in the medical literature. This clinical record discusses this case in light of the scant current medical literature on the subject and highlights the importance of cautious monitoring of patients presenting with signs of respiratory distress after lithium battery removal. Gautam Bir Singh, Ravinder Chauhan, Deepak Kumar, Rubeena Arora, and Shruti Ranjan Copyright © 2015 Gautam Bir Singh et al. All rights reserved. Withdrawal of Continuous Positive Airway Pressure Therapy after Malar Advancement and Le Fort II Distraction in a Case of Apert Syndrome with Obstructive Sleep Apnea Mon, 14 Sep 2015 11:47:01 +0000 Apert syndrome is a congenital syndrome characterized by craniosynostosis and craniofacial dysostosis, among other features, and is reported to cause obstructive sleep apnea (OSA) because of upper airway narrowing associated with midfacial dysplasia. We recently encountered a case involving a patient with Apert syndrome complicated by OSA who began to receive continuous positive airway pressure (CPAP) therapy at the age of 4. OSA resolved after maxillofacial surgery performed at the age of 11, and CPAP was eventually withdrawn. In pediatric patients with maxillofacial dysplasia complicated by OSA, a long-term treatment plan including CPAP in addition to maxillofacial plastic and reconstructive surgery should be considered in view of the effects of OSA on growth. Nobuto Onda, Shintaro Chiba, Hiroto Moriwaki, Rika Sawai, Akira Yoshigoe, Subaru Watanabe, Yuji Ando, Ryo Uchida, Takeshi Miyawaki, and Kota Wada Copyright © 2015 Nobuto Onda et al. All rights reserved. Noncholesteatomatous Cyst of the Tympanic Membrane: A Nonpublished Entity? Wed, 09 Sep 2015 08:59:10 +0000 Introduction. The presence of a serous cyst in the tympanic membrane implies the description of a new or unpublished entity based on our knowledge whose origin may be very unlikely explained on actual embryologic and anatomic background. Clinical Case. We present a case of a 45-year-old woman with progressing right hearing loss. Physical examination revealed a whitish, round-shaped malformation in the posterior-inferior quadrant of the right tympanic membrane. The cyst was removed with a transcanal tympanoplasty. Discussion. A thorough PubMed search that involved the terms tympanic membrane gland, epithelial inclusion cysts, mucous-secreting cyst, and tympanic cyst has shown no positive results. The first description of an unknown entity, such as a tympanic membrane serous cyst, may be the key for clinicians to start paying attention to patients who suffer from similar pathologies and may pass unnoticed because of their rarity or peculiarity. Rafael Ramírez-Camacho, Isabel Salas, Almudena Trinidad, and Ithzel Maria Villarreal Copyright © 2015 Rafael Ramírez-Camacho et al. All rights reserved. Pediatric Ramsay Hunt Syndrome: Analysis of Three Cases Mon, 07 Sep 2015 06:43:04 +0000 Ramsay Hunt syndrome (RHS) is a disorder characterized by herpetic eruptions on the auricle, facial paralysis, and vestibulocochlear dysfunction and is attributed to varicella zoster virus (VZV) infection in the geniculate ganglion. Although it is a common cause of acute peripheral facial paralysis, children are not usually affected. The diagnosis is based on history and physical findings. Treatment of RHS uses a combination of high-dose corticosteroids and acyclovir. This paper presents three cases diagnosed as RHS in the pediatric age group in association with the literature review. The aim of this paper is to emphasize the importance of careful examination and early initiation of therapy in suspected cases of RHS. İmran Aydoğdu, Enes Ataç, Ziya Saltürk, Yavuz Atar, Erdi Özdemir, Yavuz Uyar, Ahmet Arslanoğlu, and Güler Berkiten Copyright © 2015 İmran Aydoğdu et al. All rights reserved. Aural Myiasis, a Rare Cause of Earache Mon, 24 Aug 2015 07:00:17 +0000 Myiasis of the ear is an infestation of the ear by maggots (the larval stage of flies). In the literature, there are only few cases reported about aural myiasis. It is more common to occur in tropical regions, where humidity and warm weather provide a good environment for this infestation. In this paper, a 12-year-old boy is reported to have unilateral earache for 3-day duration. Examination of the painful ear showed a tympanic membrane perforation with larvae (maggots) in the middle ear. They were removed by using a forceps and gentle irrigation of ear to expel any remnant. Further management included assessment of hearing, computed tomography (CT) scan, and outpatient follow-up. Ibrahim Al Jabr Copyright © 2015 Ibrahim Al Jabr. All rights reserved. Immunophenotype Heterogeneity in Nasal Glomangiopericytoma Mon, 17 Aug 2015 16:03:10 +0000 Nasal glomangiopericytoma is rare. The immunophenotype is heterogeneous, more frequently smooth-muscle-actin and CD34-positive. We report expression patterns for several vascular-related proteins such as CD99, CD146, Bcl2, and WT1 as well as for treatment-related proteins such as mTOR and EGFR in a nasal glomangiopericytoma. The patient (woman, 86 years) presented with a left nasal tumefaction. The resected specimen (1.5-cm) showed a glomangiopericytoma. Tumor cells expressed smooth-muscle-actin, CD31, CD34, and progesterone receptor. They also expressed the vascular-cell-related proteins Bcl2, CD99, CD146, and WT1, as well as mTOR and EGFR. Nasal glomangiopericytomas show immunohistochemical heterogeneity for vascular-related markers, suggesting a possible extensive pericytic differentiation. The expression of potential targets for drug treatments such as mTOR and EGFR may impact on the clinical follow-up of these tumors occurring at advanced ages, which may require complex surgery. Adriana Handra-Luca, Zakaria Y. Abd Elmageed, Christina Magkou, and Marick Lae Copyright © 2015 Adriana Handra-Luca et al. All rights reserved. Does Papillary Carcinoma of Thyroglossal Duct Cyst Develop De Novo? Sun, 16 Aug 2015 12:37:14 +0000 Backround. Thyroglossal duct cyst (TDC) is a developmental abnormality of the thyroid gland. Due to embryological remnants of thyroid tissue located in the TDC, the same malignant tumors that develop in the thyroid gland can also develop in the TDC. Methods. We present the unique case of a 39-year-old female with simultaneous de novo papillary carcinoma in a TDC and the thyroid gland. Results. With the suspicion of simultaneous papillary carcinoma in the TDC and the thyroid gland, Sistrunk procedure with total thyroidectomy and central neck exploration was performed. Conclusion. The clinician should have a high index of suspicion upon encountering papillary carcinoma of the TDC to differentiate de novo papillary carcinoma in the TDC from those originating from the thyroid gland, because papillary carcinoma in TDC may originate from an occult thyroid papillary carcinoma. Tekin Baglam, Adem Binnetoglu, Ali Cemal Yumusakhuylu, Berat Demir, Gokce Askan, and Murat Sari Copyright © 2015 Tekin Baglam et al. All rights reserved. Extratemporal Malignant Nerve Sheath Tumor of Facial Nerve with Coexistent Intratemporal Neurofibroma Mimicking Malignant Intratemporal Extension Sun, 09 Aug 2015 08:26:53 +0000 We present an extremely unusual case of an extratemporal facial nerve malignant peripheral nerve sheath tumor (MPNST) arising from preexistent intratemporal neurofibroma, illustrating a difficulty in discriminating between perineural spread of the MPNST and the preexistent intratemporal neurofibroma on preoperative radiographic images. The most interesting point was that preoperative CT scan and MR images led to misinterpretation that MPNST extended proximally along the facial nerve canal. It is important to recognize that the intratemporal perineural spread of neurofibromas and MPNST share common imaging characteristics. This is the first report (to our knowledge) of these 2 lesions coexisting in the facial nerve, leading to misinterpretation on preoperative images. Mitsuhiko Nakahira, Naoko Saito, and Masashi Sugasawa Copyright © 2015 Mitsuhiko Nakahira et al. All rights reserved. Mal de Debarquement Syndrome: A Rare Entity—A Case Report and Review of the Literature Wed, 05 Aug 2015 12:51:49 +0000 Mal de Debarquement Syndrome (MDS) is a rare, understudied, underdiagnosed, and self-limiting condition. Etiology and incidence are unknown. It is characterized by abnormal sensation of motion/balance reported after travel by air, land, and sea; being reexposed to motion/activity relieves it. Symptoms may last from minutes to years. Workup though required reveals no findings; it is a diagnosis of exclusion. While no efficacious treatment exists, amitriptyline and benzodiazepines as well as supportive therapy have proved to be useful. We have described a 40-year-old Caucasian female who presented for the evaluation of persistent rocking and swaying sensation after a ship cruise which lasted for one week. Patient was treated with benzodiazepines after extensive workup and is now stable. A high index of suspicion is required to make a diagnosis. Veronica Nwagwu, Rakesh Patel, and Jerome Okudo Copyright © 2015 Veronica Nwagwu et al. All rights reserved. Metastatic Prostate Cancer to the Left Temporal Bone: A Case Report and Review of the Literature Thu, 30 Jul 2015 12:41:21 +0000 Breast, lung, and prostate cancers are the three most common malignancies to metastasize to the temporal bone. Still, metastatic prostate cancer of the temporal bone is a rare finding, with approximately 21 cases reported in the literature and only 2 cases discovered more than 10 years after initial treatment of the primary. This disease may be asymptomatic and discovered incidentally; however, hearing loss, otalgia, cranial nerve palsies, and visual changes can all be presenting symptoms. We present the case of a 95-year-old man with history of primary prostate cancer treated 12 years earlier that was seen for new-onset asymmetric hearing loss and otalgia. The tympanic membranes and middle ears were normal; however, based on radiologic findings and eventual biopsy, the patient was diagnosed with extensive metastatic prostate cancer to the left temporal bone. This case (1) demonstrates that a high index of suspicion for unusual etiologies of seemingly benign symptoms must be maintained in elderly patients having prior history of cancer and (2) substantiates the value of temporal bone imaging when diagnosis may be unclear from history and physical exam. Erynne A. Faucett, Hal Richins, Rihan Khan, and Abraham Jacob Copyright © 2015 Erynne A. Faucett et al. All rights reserved. Fetal Rhabdomyoma of the Right Tonsil with Polyp-Like Appearance Mon, 13 Jul 2015 11:09:35 +0000 Skeletal muscle neoplasms, in contrast to other groups of tumors, are almost malignant. The benign variant, rhabdomyoma, is distinctly rare. Rhabdomyomas can be classified generally into two types: cardiac and extracardiac. Extracardiac rhabdomyoma can be further divided into three subtypes: adult, fetal, and genital type. Adult rhabdomyoma is the most common subtype of rhabdomyoma even though it remains relatively rare. Fetal rhabdomyomas are less common than the adult type. In this paper we report a rare case of a fetal rhabdomyoma with polyp-like appearance originating from right tonsil. Punch biopsy and then right tonsillectomy were performed for complete excision. There was no obvious recurrence. Ching-Ping Wang, Yi-Hao Chang, and Ya-Ting Chang Copyright © 2015 Ching-Ping Wang et al. All rights reserved. Mature Nasopharyngeal Teratoma in a Child Thu, 09 Jul 2015 13:37:57 +0000 Teratomas are neoplasms derived from the germ cell with components of all the three embryonic layers. These are rare neoplasms in head and neck region which can occur in any age group but are more prevalent in children. The present case is an 11-year-old girl who was brought with history of painless and progressive swelling in the oropharynx for 3 years with the associated left sided nasal blockage and nasal discharge. CT scan was suggestive of benign nasopharyngeal mass highly suspicious for lipoma. Excision of the mass was done under general anaesthesia. Peroperatively, it was a smooth, pedunculated mass arising from the left lateral wall in the nasopharynx. On cut section, it was solid to cystic mass similar to fatty tissue. Her HPE report came out to be mature teratoma of nasopharynx. Ramesh Parajuli, Suman Thapa, and Sushna Maharjan Copyright © 2015 Ramesh Parajuli et al. All rights reserved. Papillary Thyroid Microcarcinoma with a Large Cystic Dilated Lymph Node Metastasis to the Neck Mimicking a Branchial Cleft Cyst: A Potential Pitfall Thu, 09 Jul 2015 08:19:01 +0000 Lateral cervical cystic mass in a young adult very rarely could be a first sign of an occult thyroid papillary microcarcinoma metastasis. In this paper, we presented a 37-year-old male patient whose preoperative 6 cm left lateral cervical cystic mass was initially diagnosed as branchial cleft cyst, but then the postoperative histopathological examination of the mass was revealed as papillary thyroid carcinoma metastasis. Preoperative fine needle aspiration biopsy was relevant with a branchial cleft cyst. In the left thyroid lobe there were 3 solid nodules with 4, 6, and 12 mm dimensions, respectively. One of the nodules had malignant well-differentiated cells diagnosed after fine needle aspiration biopsy. After total thyroidectomy, histopathologic evaluation of biopsy material’s showed papillary thyroid microcarcinomas. This case indicates that especially in a young adult lateral cervical cystic mass should be carefully considered preoperatively for the possibility of metastatic occult thyroid carcinoma, especially for papillary carcinoma in differential diagnosis, and evaluation of the thyroid gland should be taken into account. Osman Ilkay Ozdamar, Gul Ozbilen Acar, Cigdem Kafkasli, M. Tayyar Kalcioglu, Tulay Zenginkinet, and H. Gonca Tamer Copyright © 2015 Osman Ilkay Ozdamar et al. All rights reserved. Solitary Fibrous Tumour of the Parotid Gland: A Case Report and Review of the Literature Mon, 06 Jul 2015 12:16:02 +0000 Introduction. Solitary fibrous tumours (SFT) of the parotid gland are a very rare group of spindle-cell tumours with only 28 cases reported in the literature. This review aims to report an additional case of parotid SFT and provide a review of all reported cases of this rare condition. Case Presentation. A 26-year-old male presented a 3 cm well-demarcated, slowly enlarging mass which was completely excised, revealing histological and immunohistochemical features of SFT. Discussion. Reviews of all reported cases suggest that histology and immunohistochemistry are paramount in the diagnosis of SFT. These features, along with clinical presentation and management of this rare condition, will be discussed. Matthew M. Kwok, Muthukumar Subramaniyan, and Sor Way Chan Copyright © 2015 Matthew M. Kwok et al. All rights reserved. Solitary Laryngeal Metastasis from Transitional Cell Carcinoma of the Kidney: Clinical Case and Review of the Literature Mon, 06 Jul 2015 11:23:56 +0000 The urogenital tract is a rare origin of laryngeal metastasis; transitional cell carcinoma with laryngeal metastases had never been reported previously. In this paper, we describe the clinical and pathological characteristics, evolution, and treatment of the first reported case of a laryngeal metastasis of a TCC followed by a brief review of the literature. Tarek Assi, Elie El Rassy, Amine Haddad, and Joseph Kattan Copyright © 2015 Tarek Assi et al. All rights reserved. Partial Recurrent Laryngeal Nerve Paralysis or Paresis? In Search for the Accurate Diagnosis Mon, 06 Jul 2015 10:14:27 +0000 “Partial paralysis” of the larynx is a term often used to describe a hypomobile vocal fold as is the term “paresis.” We present a case of a dysphonic patient with a mobility disorder of the vocal fold, for whom idiopathic “partial paralysis” was the diagnosis made after laryngeal electromyography, and discuss a proposition for a different implementation of the term. Alexander Delides, Panagiotis Kokotis, and Pavlos Maragoudakis Copyright © 2015 Alexander Delides et al. All rights reserved. Pediatric Masked Mastoiditis Associated with Multiple Intracranial Complications Sun, 28 Jun 2015 14:15:09 +0000 Masked mastoiditis is a distinct form of mastoiditis with little or no symptomatology, characterized by its potential to generate severe otogenic complications. Therefore, suspected masked mastoiditis should be diagnosed and treated without delay. This study reports a rare case of masked mastoiditis, manifested by multiple intracranial complications in an immunocompetent girl. The child exhibited headache and neurological symptomatology. Imaging studies revealed an epidural and a large cerebellar abscess and the patient was immediately treated with a triple antibiotic therapy. Mastoid surgery and drainage of the epidural abscess took place after the stabilization of the patient’s neurologic status, on the 3rd hospitalization day. The cerebellar abscess was treated by craniectomy and ultrasound-guided needle aspiration in the 3rd week of hospitalization. The girl was finally discharged in excellent condition. Two years later, she is still in good health, without otological or neurological sequelae. Masked mastoiditis is an insidious disease which requires increased clinical awareness and adequate imaging. Should clinical and/or radiological findings be positive, mastoidectomy must follow in order to prevent severe otogenic complications that can be triggered by masked mastoiditis. Charalampos Voudouris, Ioannis Psarommatis, Ioannis Nikas, Dimitrios Kafouris, and Konstantina Chrysouli Copyright © 2015 Charalampos Voudouris et al. All rights reserved. Operative Management of OSAS in a Complex Case of Proteus Syndrome Tue, 23 Jun 2015 10:00:11 +0000 Obstructive sleep apnea syndrome (OSAS) is a common disorder in childhood with high prevalence in syndromic subjects with craniofacial malformations. Proteus Syndrome (PS) is a rare hamartoneoplastic disorder associated with disproportionate and asymmetric overgrowth of body parts and hypertrophy or malformation of lymphatic tissues, such as palatine tonsils. We report a case of a 12-year-old boy diagnosed with Proteus Syndrome (PS) and suffering from OSAS due to asymmetric palatine tonsillar hypertrophy, treated with partial resection of left tonsil. To avoid the risk of a general anesthesia and remove only the obstructive portion of the palatine tonsil bipolar radiofrequency-induced thermotherapy (RFITT) under local anesthesia was performed. Recovery of the obstructive respiratory disease was obtained. To our knowledge, this is the first case reported in the literature of partial tonsillar resection performed in a patient with PS suffering from OSAS under local anesthesia. Elena Cantone, Michele Cavaliere, Giovanni Castagna, Anna Marino, Luigi Del Vecchio, and Maurizio Iengo Copyright © 2015 Elena Cantone et al. All rights reserved.