Case Reports in Otolaryngology The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Temporal Bone Fracture Causing Superior Semicircular Canal Dehiscence Wed, 10 Sep 2014 13:11:10 +0000 Importance. Superior semicircular canal dehiscence (SCD) is a third window lesion of the inner ear causing symptoms of vertigo, autophony, tinnitus, and hearing loss. A “two-hit” hypothesis has traditionally been proposed, whereby thinly developed bone overlying the superior canal is disrupted by a sudden change in intracranial pressure. Although the symptoms of SCD may be precipitated by head injury, no previous reports have described a temporal bone fracture directly causing SCD. Observations. Two patients sustained temporal bone fractures after closed head trauma, and developed unilateral otologic symptoms consistent with SCD. In each instance, computed tomography imaging revealed fractures extending through the bony roof of the superior semicircular canal. Conclusions and Relevance. Temporal bone fractures, which are largely treated nonoperatively, have not previously been reported to cause SCD. As it is a potentially treatable entity, SCD resulting from temporal bone fracture must be recognized as a possibility and diagnosed promptly if present. Kevin A. Peng, Sameer Ahmed, Isaac Yang, and Quinton Gopen Copyright © 2014 Kevin A. Peng et al. All rights reserved. Unusual Postrhinoplasty Complication: Nasal Dorsum Cyst Tue, 09 Sep 2014 00:00:00 +0000 Among all the possible complications of aesthetic rhinoplasty, a rare one is the development of cystic masses on the nasal dorsum: several theories suggest that cysts develop commonly by entrapment of nasal mucosa in the subcutaneous space, but they can also originate from foreign body reactions. This report deals with two cases of nasal dorsum cysts with different pathogenesis: both patients had undergone aesthetic rhinoplasty in the past (26 years ago and 14 years ago, resp.). Both cystic masses were removed via a direct open approach and nasal reconstruction was performed successfully with autologous vomer bone. The pathologic investigations showed a foreign body inclusion cyst associated with latex rubber in the first case and a sequestration of a mucosal-lined nasal bone was not removed at the time of primary rhinoplasty in the second case. A brief review of the literature focuses on the pathophysiology and treatment options for nasal dorsal cysts following aesthetic rhinoplasty. Pier Giorgio Giacomini, Davide Topazio, Roberta Di Mauro, Stelio Mocella, Matteo Chimenti, and Stefano Di Girolamo Copyright © 2014 Pier Giorgio Giacomini et al. All rights reserved. Case Study of a Parotid Gland Adenocarcinoma Dedifferentiated from Epithelial-Myoepithelial Carcinoma Tue, 09 Sep 2014 00:00:00 +0000 Dedifferentiation is defined as high-grade malignant tumor development out of a low-grade malignant tumor. We present an adenocarcinoma tumor of the parotid gland that was dedifferentiated from a low-grade epithelial-myoepithelial carcinoma and was followed up for 3 years. Our patient, a 46-year-old female, presented with a left parotid mass of 20-year duration. Histopathologic results showed that there was only one area of typical epithelial-myoepithelial carcinoma, with foci of poorly differentiated adenocarcinoma (not otherwise specified; NOS) and clear cytoplasm in the parotid gland. Immunohistochemical staining results showed SMA (+), P63 (+), CK8 (+), and S100 (+) on epithelial cells. A review of the literature revealed 22 previously reported cases of dedifferentiated epithelial-myoepithelial carcinoma. In these cases, the malignant tumors that dedifferentiated from epithelial-myoepithelial carcinoma were adenoid cystic carcinoma, actinic cell carcinoma, polymorphous low-grade adenocarcinoma, mucoepidermoid carcinoma, and intraductal carcinoma. In our case, the malignant tumor that dedifferentiated from the epithelial-myoepithelial carcinoma was a poorly differentiated adenocarcinoma. Histopathological results showed that metastases were not seen in the neck-dissection material. As a result, our case will make a contribution to the literature in terms of prognosis, because there are very few reported cases of dedifferentiated adenocarcinoma development arising from epithelial-myoepithelial carcinoma. Salih Aydın, Umit Taskin, Kadir Ozdamar, Kadir Yücebas, Mehmet Sar, Mehmet Faruk Oktay, and Ümit Seza Tetikkurt Copyright © 2014 Salih Aydın et al. All rights reserved. A Solitary Malignant Schwannoma in the Choana and Nasal Septum Tue, 09 Sep 2014 00:00:00 +0000 Malignant schwannoma is an extremely rare tumor and the risk of malignant schwannoma increases in patients with von Recklinghausen’s disease. Recently, we encountered a case of solitary malignant schwannoma in the choana and posterior nasal septum. Malignant schwannoma has not been previously reported in these locations. A 53-year-old man, who was immunologically healthy and showed no abnormal dermatological lesions, presented with a polypoid mass in the right nasal cavity and underwent endoscopic mass excision. The mass originated from the choana and the posterior portion of the right nasal septum. This mass was confirmed as a malignant schwannoma on histological examination and immunohistochemical staining. After endoscopic excision, postoperative adjuvant radiotherapy was administered, and there was no recurrence at 1 year after treatment. This case suggests that a solitary malignant schwannoma should be considered in the differential diagnosis of a mass in the posterior nasal cavity. Eun Jung Lee, Kee Jae Song, Yeon Suk Seo, and Kyung-Su Kim Copyright © 2014 Eun Jung Lee et al. All rights reserved. A Pediatric Case of Ramsay Hunt Syndrome Mon, 08 Sep 2014 06:20:50 +0000 Ramsay Hunt syndrome (RHS) is characterized by facial paralysis, inner ear dysfunction, periauricular pain, and herpetiform vesicles. The reported incidence in children is 2.7/100,000. The pathogenesis involves the reactivation of latent varicella zoster virus (VZV) in the geniculate ganglion of the facial nerve. The recovery rate is better in children than in adults. This paper discusses a 12-year-old girl with a rare case of peripheral facial paralysis caused by RHS and reviews the literature. Serhan Derin, Hatice Derin, Murat Sahan, and Hüseyin Çaksen Copyright © 2014 Serhan Derin et al. All rights reserved. Agenesis of Submandibular Glands: A Report of Two Cases with Review of Literature Mon, 01 Sep 2014 13:05:26 +0000 Background. Congenital absence of the submandibular gland (SMG) is a rare condition. Although complaints such as dry mouth, dental problems, or difficulty in swallowing may be seen, the subjects may also be asymptomatic. The absence of the SMG may be associated with hypertrophy of the contralateral SMG. Case Report. We report the case of a 44-year-old woman with incidentally detected left SMG aplasia, with contralateral SMG hypertrophy mimicking a mass, and the case of a 46-year-old woman with incidentally detected bilateral SMG aplasia, demonstrated by computerized tomography (CT) and magnetic resonance imaging (MRI). Conclusion. It is important for the clinician to know that this very rare abnormality may exist. When such a case is encountered, symptoms and findings should be reevaluated and, if necessary, conservative therapy should be initiated. The possibility of observing additional deformities should be kept in mind and an evaluation should be done for other cases in the family. Medine Kara, Oğuz Güçlü, Fevzi Sefa Dereköy, Mustafa Resorlu, and Gürhan Adam Copyright © 2014 Medine Kara et al. All rights reserved. Von-Willebrand Disease Presenting as Intractable Epistaxis after Nasal Polypectomy Mon, 25 Aug 2014 08:51:04 +0000 Von-Willebrand disease (VWD) is one of the platelet dysfunction disorders that results from a deficiency of Von-Willebrand factor, which is essential for hemostasis. VWD patients typically have normal laboratory results on screening for bleeding disorders. To suspect and diagnose VWD, a careful review of past medical history and laboratory tests is critical. A 59-year-old male patient presented with intractable nasal bleeding after nasal polypectomy. The bleeding was controlled by platelet transfusion, and he was later diagnosed with VWD. Jeong Jin Park, Chang-Hoon Kim, Jeung-Gweon Lee, and Hyung-Ju Cho Copyright © 2014 Jeong Jin Park et al. All rights reserved. Intracranial Complication of Rhinosinusitis from Actinomycosis of the Paranasal Sinuses: A Rare Case of Abducens Nerve Palsy Thu, 21 Aug 2014 08:28:51 +0000 Sinonasal actinomycosis should be suspected when a patient with chronic sinusitis does not respond to medical therapy or has a history of facial trauma, dental disease, cancer, immunodeficiency, long-term steroid therapy, diabetes, or malnutrition. Radiological evaluation with computed tomography and magnetic resonance imaging are important in differential diagnosis, evaluating the extent of disease, and understanding clinical symptoms. Endoscopic sinus surgery associated with long-term intravenous antibiotic therapy is the gold standard for treatment of sinonasal actinomycosis. We report an unusual case of abducens nerve palsy resulting from invasive sinonasal actinomycosis in a patient with an abnormally enlarged sphenoid sinus. A review of the current literature highlighting clinical presentation, radiological findings, and treatment of this uncommon complication is also presented. G. L. Fadda, M. Gisolo, E. Crosetti, A. Fulcheri, and G. Succo Copyright © 2014 G. L. Fadda et al. All rights reserved. Transoral Robotic Surgery in Retrostyloid Parapharyngeal Space Schwannomas Mon, 18 Aug 2014 07:06:20 +0000 Parapharyngeal space (PPS) tumors are very rare, representing about 0.5% of head and neck neoplasms. An external surgical approach is mainly used. Several recent papers show how transoral robotic surgery (TORS) excision could be a prospective tool to remove mainly benign lesions in PPS; no cases of neurogenic tumors from the retrostyloid space treated with TORS have been reported. We present two cases which underwent TORS for schwannomas from the retrostyloid compartment of the parapharyngeal space. Clinical diagnosis of schwannoma was performed by magnetic resonance imaging (MRI). In the first case a 6 cm neurogenic tumor arose from the vagus nerve and in the second case a 5 cm mass from the sympathetic chain was observed. Both cases were treated successfully by the TORS approach using a new “J”-shaped incision through the mucosa and superior pharyngeal constrictor muscle. Left vocal cord palsy and the Claude Bernard Horner syndrome, respectively, were observed as expected postsurgical sequelae. In case 1 the first bite syndrome developed after three months, while no complications were observed in case 2. Both patients regained a normal swallowing function. TORS seems to be a feasible mini-invasive procedure for benign PPS masses including masses in the poststyloid space. Mohssen Ansarin, Marta Tagliabue, Francesco Chu, Stefano Zorzi, Michele Proh, and Lorenzo Preda Copyright © 2014 Mohssen Ansarin et al. All rights reserved. Laryngeal Chondrosarcoma as a Rare Cause of Subglottic Stenosis Wed, 13 Aug 2014 13:30:18 +0000 Laryngeal chondrosarcoma (CS) is a very rare entity. It is usually seen in 50–80-year olds. It is developed from cricoid cartilage largely. Patients have laryngeal CS complaint of respiratuvar distress, dysphonia, and dysphagia generally. A submucous mass is usually seen in physical examination with an intact mucosa. Distant metastasis is rare in CSs. Main treatment is surgical excision. An 82-year-old patient who has respiratuvar distress is presented in this paper and laryngeal CS is reviewed in the light of the literature. Kerem Kökoğlu, Özlem Canöz, Serap Doğan, Emrah Gülmez, İmdat Yüce, and Sedat Çağlı Copyright © 2014 Kerem Kökoğlu et al. All rights reserved. Intraosseous Hemangioma of the Middle Turbinate Misdiagnosed As a Nasal Polyp Wed, 06 Aug 2014 07:20:12 +0000 Intraosseous hemangiomas account for 1% of all bone tumors and primarily originate from the vertebral column and skull bones. However, intraosseous hemangiomas of the nasal cavity are extremely rare. Here, we report a case of intraosseous hemangioma with a cavernous pattern arising from the middle turbinate that was preoperatively misdiagnosed as chronic rhinosinusitis with polyps. Except for nasal obstruction, there were no specific rhinologic symptoms. The tumor was excised en bloc by the endoscopic endonasal approach without preoperative embolization. Tae Hoon Kim, Eun Jung Lim, Jun-Ki Lee, Jin Gul Lee, and Man-Hoon Han Copyright © 2014 Tae Hoon Kim et al. All rights reserved. T-Cell Lymphoblastic Lymphoma in a Child Presenting as Rapid Thyroid Enlargement Thu, 24 Jul 2014 07:23:38 +0000 The majority of lymphomas of the head and neck in children present as an enlarged cervical lymph node; however, malignant lymphoma arising from the thyroid gland is extremely rare. We report a case of a 12-year-old child who was admitted to our hospital because of a history of rapidly progressive anterior neck swelling. Histopathological studies revealed this case to be T-cell lymphoblastic lymphoma. We performed chemotherapy and the patient has kept recurrence-free survival for 18 months after the beginning of the treatment. This is the 2nd case of T-cell lymphoblastic lymphoma in the thyroid gland in a child. Shintaro Yoshihara, Muneo Nakaya, and Tomoya Ichikawa Copyright © 2014 Shintaro Yoshihara et al. All rights reserved. Pleomorphic Adenomas of the Parapharyngeal Space Tue, 22 Jul 2014 10:21:34 +0000 Background. Parapharyngeal space is one of potential facial planes for neoplasms and infections and represents less than 1% of all head and neck tumours. Occurrence of the pleomorphic adenoma in the parapharyngeal space is a rarity. Case Presentation. Here, three giant pleomorphic adenomas of different sizes occupying the parapharyngeal space in three patients are reported. Extensive preoperative diagnostic workup was done in order to verify the nature and size of the tumour and the proximity to the large vessels. Review of the literature, clinical features, pathology, radiological findings, and treatment of these tumours are discussed. Conclusion. The excision of the tumor through submandibular transcervical approach, without cutting the mandible, turned out to be a safe and radical approach in all three cases. İstemihan Akın, Tuğba Karagöz, Murad Mutlu, Mehmet Şahan, and Evrim Önder Copyright © 2014 İstemihan Akın et al. All rights reserved. A Case of Conservatively Managed Invasive Ceruminoma and a Review of the Literature Tue, 22 Jul 2014 09:43:36 +0000 Ceruminomas are rare tumours arising from the apocrine sweat glands of the ear canal. We present a case of a malignant ceruminoma, which was managed with local surgical excision only rather than the wider clearance more commonly undertaken with these invasive neoplasms. We present the clinical case, histological analysis, and clinical progression for this patient and review the literature on this uncommon pathology. T. F. C. Saunders and P. Monksfield Copyright © 2014 T. F. C. Saunders and P. Monksfield. All rights reserved. Tegmen Tympani Defect and Brain Herniation Secondary to Mastoid Surgery: Case Presentation Mon, 21 Jul 2014 11:29:06 +0000 Brain herniation into the middle ear is very rarely seen. In addition to reasons like congenital factors, trauma, and infection, tegmen defect may develop as a result of iatrogenic events secondary to chronic otitis media surgery with or without cholesteatoma. Since it may cause life-threatening complications, patients must be evaluated and monitored for tegmen defect. In this paper, diagnosis and treatment of a brain herniation case due to iatrogenic tegmen defect were described along with relevant literature. Oguz Kadir Egilmez, Fatih Mehmet Hanege, M. Tayyar Kalcioglu, Tuncay Kaner, and Numan Kokten Copyright © 2014 Oguz Kadir Egilmez et al. All rights reserved. A Rare Tumor of Nasal Cavity: Glomangiopericytoma Sun, 20 Jul 2014 09:05:11 +0000 Glomangiopericytoma is a rare vascular neoplasm characterized by a pattern of prominent perivascular growth. A 72-year-old woman was admitted to our clinic complaining of nasal obstruction, frequent epistaxis, and facial pain. A reddish tumor filling the left nasal cavity was observed on endoscopy and treated with endoscopic excision. Microscopically, closely packed cells interspersed with numerous thin-walled, branching staghorn vessels were seen. Glomangiopericytoma is categorized as a borderline low malignancy tumor by WHO classification. Long-term follow-up with systemic examination is necessary due to high risk of recurrence. Aysegul Verim, Cigdem Kalaycik Ertugay, Cigdem Tepe Karaca, Pembegul Gunes, Shahrouz Sheidaei, and Cagatay Oysu Copyright © 2014 Aysegul Verim et al. All rights reserved. Endoscopic CO(2) Laser Horizontal Partial Laryngectomy in Larynx Carcinosarcoma Mon, 14 Jul 2014 12:02:54 +0000 Background. Carcinosarcoma is an extremely rare malignant neoplasm, with both a malignant epithelial and mesenchymal component, that rarely affects the larynx. Aim. Aim of this paper is to describe the case of a patient affected by a larynx carcinosarcoma treated by endoscopic horizontal partial laryngectomy with CO(2) laser and particularly discuss the histogenetic hypothesis as well as the possible treatment modalities of this rare lesion. Methods. Case report and literature review. Discussion and Conclusion. Still little is known about the biology of carcinosarcoma and there is still no consensus in the literature on the treatment of these tumors. Endoscopic horizontal partial laryngectomy could represent another treatment option in selected cases. Andrea Ciorba, Chiara Bianchini, Valeria Iannini, Antonio Faita, Enzo Bianchini, Francesco Stomeo, Stefano Pelucchi, and Antonio Pastore Copyright © 2014 Andrea Ciorba et al. All rights reserved. A Rare Presentation of Retiform Hemangioendothelioma in the External Auditory Canal Sun, 13 Jul 2014 11:54:56 +0000 Retiform hemangioendothelioma is a rare intermediate or borderline neoplasm of the blood vessels that mostly occurs in extremities. Here we report a unique case of retiform hemangioendothelioma presented in the external auditory canal. 58-year-old male patient presented with the complaint of right ear swelling for 4 years. On examination, a spherical swelling in the right ear was found occluding the view of external auditory canal. The tumor was removed surgically. Intraoperatively, the mass was found attached to the outer part of the right external auditory canal near the root of helix. Histopathology of the resected tumor showed typical features of retiform hemangioendothelioma. In addition, immunohistochemical analysis revealed that tumor was positive for endothelial cell marker CD34 and occasionally positive for cell proliferative marker Ki-67. Ezhil Arasan Jothi, Muthuchitra Sundaram, Jeyalakshmidevi Namasivayam, and Mathivanan Jothi Copyright © 2014 Ezhil Arasan Jothi et al. All rights reserved. Informed Consent in Otolaryngologic Surgery: Case Scenario from a Nigerian Specialist Hospital Tue, 08 Jul 2014 13:05:50 +0000 Informed consent is a foundational concept necessary for ethical conduct of clinical research and practice. It is a technical tool that shifts the autonomy to decide whether a medical procedure should be performed—from the doctor to the patient. However there is an ongoing discussion in bioethical circles on the level of comprehension of the informed consent process by the patients and research participants. We present this case vignette and the discussion afterwards to explore the question of to what extent a patient comprehends the information given to him/her before a surgical procedure is carried out. In other words, the question being asked here is how informed is informed consent in the context of oto-laryngological practice. O. A. Afolabi, J. O. Fadare, and O. T. Ajiboye Copyright © 2014 O. A. Afolabi et al. All rights reserved. Congenital Intralabyrinthine Cholesteatoma Thu, 26 Jun 2014 08:38:56 +0000 A patient with a congenital intralabyrinthine cholesteatoma is presented. High-resolution computerized tomographic scans and intraoperative photomicrographs display features of intralabyrinthine extension. We discuss pathogenetic theories for the development of congenital intralabyrinthine cholesteatoma. The distinction of this condition from congenital cholesteatoma with labyrinthine erosion is discussed. Sanjay Prasad, Kiran Prasad, and Roya Azadarmaki Copyright © 2014 Sanjay Prasad et al. All rights reserved. Primary Atypical Carcinoid Tumour of the Sphenoid Sinus Rostrum Thu, 26 Jun 2014 00:00:00 +0000 Primary carcinoid tumors of the nasal cavity and sinuses are exceedingly rare. An accurate histopathological diagnosis is crucial to optimal investigation and management. We present a case of a primary atypical carcinoid tumor arising from the sphenoid rostrum without evidence of associated carcinoid syndrome. This rare but important differential diagnosis of a nasal tumor is discussed and important unique management issues are highlighted. Kate A. Stephenson and Darlene E. Lubbe Copyright © 2014 Kate A. Stephenson and Darlene E. Lubbe. All rights reserved. Squamous Cell Carcinoma Arising from Inverted Schneiderian Papilloma: A Case Report with Oral Involvement Wed, 25 Jun 2014 05:51:33 +0000 Inverted Schneiderian papilloma is an uncommon benign tumor that presents tendency to recur and propensity to be associated with malignancy in approximately 10% of the cases. Some of these lesions are isolated in the maxillary sinus, and predominantly affect white males with mean age of 50 years. We report a case of squamous cell carcinoma arising from inverted Schneiderian papilloma in the maxillary sinus extending to the mouth. The patient was submitted to extraction of a maxillary molar tooth four months before the exacerbation of the symptoms of nasal airway obstruction and facial enlargement. Computed tomography scan revealed a sinonasal mass causing opacification of the right maxillary sinus with destruction of the lateral nasal wall and maxillary sinus floor. The patient was referred to an oncology center for treatment and died from tumor progression one year after the cancer was diagnosed. The intention of this report is to alert dentists to include the inverted Schneiderian papilloma, either associated with squamous cell carcinoma, or not, in the differential diagnosis of maxillary sinus tumors with aggressive behavior, which may extend to the oral cavity or involve roots of teeth. Alexandre Simões Garcia, Diego Maurício Bravo-Calderón, Mariana Pisinato Ferreira, and Denise Tostes Oliveira Copyright © 2014 Alexandre Simões Garcia et al. All rights reserved. Middle Ear Adenoma: Case Report and Discussion Sun, 22 Jun 2014 13:03:05 +0000 Introduction. Despite modern radiological workup, surgeons can still be surprised by intraoperative findings or by the pathologist’s report. Materials & Methods. We describe the case of a 52-year-old male who was referred to our clinic with a single sided conductive hearing loss. He ultimately underwent middle ear exploration and excision of a middle ear tumour followed by second look and ossiculoplasty a year later. Results. Though preoperative CT and MRI scanning were suggestive of a congenital cholesteatoma, the pathologist’s report diagnosed a middle ear adenoma. Discussion. Middle ear glandular tumors are extremely rare and, despite numerous histological techniques, continue to defy satisfactory classification. Most surgeons advocate surgical excision though evidence of the tumour’s natural course and risk of recurrence is lacking. D. Isenring, T. F. Pezier, B. Vrugt, and A. M. Huber Copyright © 2014 D. Isenring et al. All rights reserved. Bilateral Congenital Absence of the Stapes Superstructure in Two Siblings Sun, 22 Jun 2014 07:14:08 +0000 Middle ear ossicle malformations are an uncommon event. Among them, the congenital absence of the stapes is a very rare condition that is seldom described in the literature. We report the cases of two women, aged 19 and 22 , who presented with a long history of conductive deafness. An exploratory tympanotomy was performed and the absence of the stapes superstructure and an abnormal position of the facial nerve could be observed. A bone anchored hearing aid (BAHA) was implanted in both patients with good results. It is believed that stapes agenesis is related to an abnormal development of the facial nerve, which by the 5th to 6th week of gestation would interpose between the otic capsule and the stapes blastema, preventing these structures from contacting. A long history of nonprogressive hearing loss from birth or early childhood is the key to reach a diagnosis. Several treatment options have been described. The authors opted for a hearing aid due to the high risk of facial nerve lesion, with good functional results. Jose Ignacio Undabeitia, José Undabeitia, Laura Cianci, Luis Padilla, Eduardo Petreñas, and Antonio Municio Copyright © 2014 Jose Ignacio Undabeitia et al. All rights reserved. Massive Multinodular Head and Neck Recurrence of Parotid Gland Pleomorphic Adenoma: A Case Report Sun, 22 Jun 2014 00:00:00 +0000 Introduction. The optimal initial management of parotid pleomorphic adenomas reduces the risk of recurrence and malignant transformation. Surgery of recurrence can be difficult in multinodular disseminated forms. Case Report. A 67-years-old patient was referred for management of a large multifocal recurrence of a pleomorphic adenoma operated on 23 years ago. The clinical and radiological assessment found parapharyngeal, infratemporal, and prestyloid invasion, with nodules in the sternocleidomastoid muscle. Excision by transmandibular approach was performed. The pathologist found a multinodular recurrent pleomorphic adenoma without criteria of malignancy. Postoperative radiotherapy was performed. Discussion. Multinodular forms and incomplete resections are the most important factors that are thought to predispose to recurrence. A precise analysis of the extension by preoperative MRI is essential. Adjuvant radiotherapy can be given in these recurrent multifocal forms. Pierre Philouze, Nicolas Sigaux, Anne Frédérique Manichon, Jean-Christian Pignat, and Marc Poupart Copyright © 2014 Pierre Philouze et al. All rights reserved. Carbon Ion Beam Radiotherapy for Sinonasal Malignant Tumors Invading Skull Base Mon, 09 Jun 2014 08:54:04 +0000 Objective. To evaluate the treatment outcome and prognostic factors in patients with sinonasal malignant tumors invading skull base. Study Design and Setting. A retrospective clinical study at the Yamagata University School of Medicine. Subjects and Methods. Three patients with sinonasal malignant tumors invading skull base were presented in present study. All patients were treated with carbon ion beam radiotherapy. The prescribed dose to the center of the clinical target volume was 64.0 GyE/16 fractions over 4 weeks at 4.0 GyE/fraction per day. Results. All patients completed carbon ion beam radiotherapy without an interval. The mean observation period was 39.6 months (range: 11–54 months). There were no local or regional recurrences in all cases; however, one patient had a metastasis in distant organs. Regarding the complications, visual loss was observed in one eye of one patient whose optic nerve was entirely involved by the tumor and field of carbon ion beam radiotherapy. Radiation induced brain injury was observed in two patients; however, these patients do not complain about neurological abnormality and had no treatment for radiation induced brain necrosis. Conclusions. Carbon ion beam radiotherapy for sinonasal malignant tumors invading the skull base showed therapeutic effectiveness. Nobuo Ohta, Yusuke Suzuki, Azusa Hasegawa, Masaru Aoyagi, and Seiji Kakehata Copyright © 2014 Nobuo Ohta et al. All rights reserved. Diagnostic Challenge of a Deep Minor Salivary Gland Neoplasm Mon, 09 Jun 2014 00:00:00 +0000 Core needle biopsy represents a safe and cheap alternative diagnostic method to open biopsy and fine-needle aspiration cytology in head and neck tumors. There is little evidence in the literature about the use of core needle biopsy in minor salivary gland lesions. This single case report presents a 60-year-old woman with a painless swelling in the soft palate, breathing and swallowing difficulties, and a feeling of suffocation. Two open biopsies had inconclusive diagnosis and the lesion could only be assessed and diagnosed as pleomorphic adenoma through core needle biopsy. Recognizing the correct indication of core needle biopsy can benefit both health professionals and patients; thus, it is important to consider the possibility of performing this method to diagnose minor salivary gland tumors. Vivian P. Wagner, Manoela D. Martins, Bruna Genari, Fernando B. do Amaral, Antônio C. Maciel, Marco A. T. Martins, and Maria C. Munerato Copyright © 2014 Vivian P. Wagner et al. All rights reserved. Facial Pain Associated with CPAP Use: Intra-Sinusal Third Molar Thu, 05 Jun 2014 12:28:56 +0000 Objective. This paper describes a patient with left hemifacial pain elicited by the use of a CPAP mask. Case Report. A 74-year-old man was referred with a history of pain in the left maxillary sinus related to the use of his CPAP interface, thereby prohibiting the use of the latter. Computed tomography revealed an intra-sinusal ectopic third molar in the left maxillary sinus floor corresponding to the painful area. After removal of the ectopic tooth under local anesthesia by a Caldwell-Luc approach, the patient was relieved of his symptoms. Conclusion. Although an ectopic tooth in the maxillary sinus is rare, this case points out the importance of actively looking for a regional problem if patients cannot tolerate the CPAP interface since this can lead to issues of incompliance and medical complications due to the untreated obstructive sleep apnoea syndrome. Maxime Mermod, Martin Broome, Remy Hoarau, and Daniel Zweifel Copyright © 2014 Maxime Mermod et al. All rights reserved. A Rare Case of Endolymphatic Sac Tumour: Clinicopathologic Study and Surgical Management Wed, 04 Jun 2014 10:22:07 +0000 Objective. Endolymphatic sac tumor (ELST) is a rare neoplasm arising from the intrapetrous portion of the endolymphatic sac, either isolated or in association with the von Hippel-Lindau disease. We report a sporadic case of ELST with an overview of the literature and a discussion of clinic-radiological, histopathologic, and surgical findings. Case Report. A young woman presented with a progressive hearing loss in the left ear. Otoscopy showed a reddish, bleeding hypotympanic mass. CT demonstrated an expansile lytic mastoid lesion extending to the middle ear, with bone erosion. MRI confirmed a lesion of increased signal on T1-weighted sequences. The patient underwent a canal wall-down tympanoplasty with complete removal of the tumor. Histopathology was consistent with a papillary ELST. Immunohistochemistry was positive for cytokeratin and chromogranin A. Conclusion. This paper highlights the rarity of ELST, the need for an accurate neuroradiological and immunohistochemical study at the early stages, and the timeliness of surgical treatment. Emanuele Ferri, Maurizio Amadori, Enrico Armato, and Ida Pavon Copyright © 2014 Emanuele Ferri et al. All rights reserved. Extensive Frontoparietal Abscess: Complication of Frontal Sinusitis (Pott’s Puffy Tumor) Sun, 25 May 2014 11:02:11 +0000 First described in 1768, the Pott’s puffy tumor is a subperiosteal abscess associated with frontal bone osteomyelitis, resulting from trauma or frontal sinusitis. The classic clinical presentation consists of purulent rhinorrhea, fever, headache, and frontal swelling. The diagnosis is confirmed by CT scan and treatment requires intravenous antibiotics, analgesia, and surgical intervention. Early diagnosis and aggressive medical and surgical approach are essential for a good outcome. It rare and the early diagnosis is important; we describe the case of a 14-year-old adolescent with Pott’s puffy tumor who was initially treated inadequately, evolving with extensive frontoparietal abscess. The patient underwent surgical treatment with endoscopic endonasal and external approaches combined. Intravenous antibiotics were prescribed for a prolonged time, with good outcome and remission of the complaints. Raquel Andrade Lauria, Fernando Laffitte Fernandes, Thiago Pires Brito, Pablo Soares Gomes Pereira, and Carlos Takahiro Chone Copyright © 2014 Raquel Andrade Lauria et al. All rights reserved.