Case Reports in Otolaryngology The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Not Always Asthma: Clinical and Legal Consequences of Delayed Diagnosis of Laryngotracheal Stenosis Thu, 18 Dec 2014 06:48:45 +0000 Laryngotracheal stenosis (LTS) is a rare condition that occurs most commonly as a result of instrumentation of the airway but may also occur as a result of inflammatory conditions or idiopathically. Here, we present the case of a patient who developed LTS as a complication of granulomatosis with polyangiitis (GPA), which was misdiagnosed as asthma for 6 years. After an admission with respiratory symptoms that worsened to the extent that she required intubation, a previously well 14-year-old girl was diagnosed with GPA. Following immunosuppressive therapy, she made a good recovery and was discharged after 22 days. Over subsequent years, she developed dyspnoea and “wheeze” and a diagnosis of asthma was made. When she became pregnant, she was admitted to hospital with worsening respiratory symptoms, whereupon her “wheeze” was correctly identified as “stridor,” and subsequent investigations revealed a significant subglottic stenosis. The delay in diagnosis precluded the use of minimally invasive therapies, with the result that intermittent laser resection and open laryngotracheal reconstructive surgery were the only available treatment options. There were numerous points at which the correct diagnosis might have been made, either by proper interpretation of flow-volume loops or by calculation of the Empey or Expiratory Disproportion Indices from spirometry data. Adam C. Nunn, S. Ali R. Nouraei, P. Jeremy George, Guri S. Sandhu, and S. A. Reza Nouraei Copyright © 2014 Adam C. Nunn et al. All rights reserved. Osseous Choristoma of the Tongue: A Review of Etiopathogenesis Sun, 14 Dec 2014 10:55:12 +0000 Osseous choristoma is a normal bone tissue in an ectopic position. In the oral region lingual localization occurs more frequently and the mass is generally localized on the dorsum of the tongue. Definitive diagnosis is obtained only after histopathologic examination. The etiology remains already debatable. The treatment of choice is surgical excision. In this paper we present a case of tongue osseous choristoma and a review of the literature. Edoardo Gorini, Mauro Mullace, Luca Migliorini, and Emilio Mevio Copyright © 2014 Edoardo Gorini et al. All rights reserved. Osteoma of the Pharynx That Developed from the Hyoid Bone Thu, 11 Dec 2014 13:05:43 +0000 This paper reports on apparently the first case of a pharyngeal osteoma that developed from the hyoid bone. An 84-year-old man’s, presenting symptom was a slight throat pain. Endoscopic examination revealed a huge mass occluding the pharyngeal space. CT scan of the neck showed a large osseous mass adjacent to the hyoid bone. Transoral resection with tracheostomy was performed. Histopathologically, the tumor consisted of mature lamellar bone without a fibrous component. For two years postoperatively, the patient has been free from throat symptoms and signs of recurrence. Osteomas are benign, slow-growing tumors. They rarely develop symptoms or cause functional disturbance. We performed total resection to avoid further functional disturbance as the osteoma was huge. To the best of our knowledge, this is the first report on an osteoma that occupied the pharyngeal space and developed from the hyoid bone. Akira Hagiwara, Noriko Nagai, Yasuo Ogawa, and Mamoru Suzuki Copyright © 2014 Akira Hagiwara et al. All rights reserved. Recurrent Rhinosporidiosis: Coblation Assisted Surgical Resection—A Novel Approach in Management Wed, 10 Dec 2014 08:49:18 +0000 Recurrent rhinosporidiosis is a chronic granulomatous disease with a known tendency to reoccur. Coblation EVAC 70 is a novel surgical tool which seems to provide excellent option in management of this notorious disease. We present an interesting case and the innovative approach in its management, using Coblation system. Introduction. Rhinosporidiosis seeberi causes a chronic granulomatous disease of upper airway, usually involving the nose and nasopharynx, and has a notorious tendency to reoccur. The current line of management is surgical excision of the lesion along with cauterization of the base, which does not prevent reoccurrence of the disease. Case Presentation. A 65-year-old male resident of rural India reported a history of breathing difficulty and change in voice. Patient is a Hindu priest by profession, who according to their rituals has to take bath in local pond or river. Conclusion. Rhinosporidiosis is a difficult to treat pathology due to its tendency to reoccur. Till date the management of the disease is far from satisfactory. Coblation system which has already found its roots in otorhinolaryngology can be used as a novel tool in surgical resection of recurrent rhinosporidiosis and has added advantage of low temperature dissection along with clear surgical field due to constant suctioning. Iram Khan, Shweta Gogia, Alok Agarwal, and Ajay Swaroop Copyright © 2014 Iram Khan et al. All rights reserved. Magnifying Endoscopy with Narrow Band Imaging to Determine the Extent of Resection in Transoral Robotic Surgery of Oropharyngeal Cancer Wed, 10 Dec 2014 00:10:49 +0000 Transoral robotic surgery (TORS) is a less invasive treatment that is becoming popular all over the world. One of the most important factors for achieving success in TORS is the ability to determine the extent of resection during the procedure as the extent of resection in the laryngopharynx not only affects oncological outcomes but also directly affects swallowing and voice functions. Magnifying endoscopy with narrow band imaging (ME-NBI) is an innovative optical technology that provides high-resolution images and is useful in detecting early superficial pharyngeal cancers, which are difficult to detect by standard endoscopy. A 55-year-old male with superficial oropharyngeal cancer has been successfully treated by combining MB-NBI with TORS and MB-NBI was useful in determining the extent of resection. ME-NBI with TORS will make it possible to achieve a higher ratio of minimally invasive treatment in pharyngeal cancer. Ichiro Tateya, Seiji Ishikawa, Shuko Morita, Hiroyuki Ito, Tatsunori Sakamoto, Toshinori Murayama, Yo Kishimoto, Tomomasa Hayashi, Makiko Funakoshi, Shigeru Hirano, Morimasa Kitamura, Mami Morita, Manabu Muto, and Juichi Ito Copyright © 2014 Ichiro Tateya et al. All rights reserved. Wholly Endoscopic Permeatal Removal of a Petrous Apex Cholesteatoma Sun, 07 Dec 2014 09:35:42 +0000 We report a case of a petrous apex cholesteatoma which was managed with a wholly endoscopic permeatal approach. A 63-year-old Caucasian male presented with a 10-year history of right-sided facial palsy and profound deafness. On examination in our clinic, the patient had a grade VI House-Brackmann paresis, otoscopic evidence of attic cholesteatoma behind an intact drum, and extensive scarring of the face from previous facial reanimation surgery. Imaging review was suggestive of petrous apex cholesteatoma. An initial decision to manage the patient conservatively was later reviewed on account of the patient suffering recurrent epileptic seizures. A wholly endoscopic permeatal approach was used with successful outcomes. In addition to the case report we also provide a brief description of the technique and a review of the relevant literature. Todd Kanzara, Jagdeep Singh Virk, Sanjiv Chawda, and Anthony O. Owa Copyright © 2014 Todd Kanzara et al. All rights reserved. Malignant Peripheral Nerve Sheath Tumors of the Head and Neck: A Case Series and Literature Review Thu, 04 Dec 2014 06:45:19 +0000 Background. Malignant peripheral nerve sheath tumors (MPNSTs) of the head and neck are rare aggressive neoplasms with a poor prognosis. This study describes the management and outcomes of 3 of our patients with MPNSTs of the head and neck. Methods. We identified 3 patients presenting with MPNST of the head and neck and treated at the University of North Carolina. We compared our results to the literature from 1963 to 2014. Results. Mean follow-up was 31 months. Average age at diagnosis was 44.7 years of age. All patients received wide-local excision and adjuvant radiotherapy. No patients recurred during the series. Recurrence-free survival time for the patients was 45, 37, and 3 months, respectively. Conclusions. Our data series confirms that a combined-modality approach with complete surgical resection and adjuvant radiotherapy leads to improved outcomes in MPNSTs of the head and neck. Nonetheless, due to historically poor outcomes, continued research into newer therapies needs to be explored. Brandon T. Mullins and Trevor Hackman Copyright © 2014 Brandon T. Mullins and Trevor Hackman. All rights reserved. A Rare Case of Splenic Marginal Zone B-Cell Lymphoma Mimicking Relapsing Polychondritis of the Ear Tue, 02 Dec 2014 09:08:55 +0000 Relapsing polychondritis (RPC) is a poorly understood phenomenon associated with cartilaginous inflammation of the ear, nose, tracheobronchial tree, and peripheral joints. Many cases of RPC respond to anti-inflammatories and resolve with no further complications. However, RPC has also been linked to more insidious conditions such as malignancies, autoimmune disorders, vasculitis, or underlying infections. Given the spectrum of associated disorders, patients with RPC may need to be monitored for more insidious underlying conditions. In this case, we report a unique case of bilateral auricular inflammation and nasal inflammation mimicking RPC as the only presenting symptom of splenic marginal zone B-cell lymphoma and we survey related cases in the literature. Gary J. Huang, Bryan Mendes, and Kianoush Sheykholeslami Copyright © 2014 Gary J. Huang et al. All rights reserved. Bilateral Triple Concha Bullosa: A Very Rare Anatomical Variation of Intranasal Turbinates Sun, 30 Nov 2014 11:41:25 +0000 Pneumatization of the intranasal turbinates or concha bullosa is an anatomic variation of the lateral nasal wall. Concha bullosa is defined as the presence of air cells in turbinates. It can be best diagnosed with paranasal sinus computed tomography. Concha bullosa is a possible etiologic factor for recurrent sinusitis due to its negative effect on paranasal sinus ventilation and mucociliary clearance. Concha bullosa is most commonly seen in the middle turbinate and less frequently in the inferior or superior turbinate. Pneumatization of all turbinates is very rare. To our knowledge, there are only two publications about a case with concha bullosa in all turbinates in the current literature. Here, we present a woman with bilateral pneumatization in all three intranasal turbinates. Turhan San, Selma San, Emre Gürkan, and Barış Erdoğan Copyright © 2014 Turhan San et al. All rights reserved. Delayed Diagnosis of Pharyngeal Perforation following Exploding Tyre Blast Barotrauma Wed, 26 Nov 2014 11:18:25 +0000 Introduction. Pharyngoesophageal perforation secondary to barotrauma is a rare phenomenon that can have serious complications if identified late. It is challenging to detect due to nonspecific symptoms. We present a case in which detection proved difficult leading to delayed diagnosis. Case Report. A 27-year-old mechanic presented with haemoptysis, dysphonia, and odynophagia after a car tyre exploded in his face. Flexible nasoendoscopy (FNE) revealed blood in the pharynx, thought to represent mucosal haemorrhage. Initial treatment consisted of IV dexamethasone and antibiotics. After 3 days, odynophagia persisted prompting a CT scan. This revealed a defect in the posterior hypopharynx and surgical emphysema in the deep neck tissues. Contrast swallow confirmed posterior hypopharyngeal leak. NG feeding was commenced until repeated contrast swallow confirmed resolution of the defect. Discussion. Prompt nonsurgical management of pharyngoesophageal perforation has good outcomes but untreated perforation can have serious complications. FNE should be performed routinely, but only a contrast swallow can diagnose a functional perforation. Clinicians should have a high index of clinical suspicion when patients present with barotrauma and odynophagia. Patients should be kept nil by mouth until perforation has been excluded. Conclusion. When faced with cases of facial barotrauma, clinicians should have a low threshold for further imaging to exclude pharyngoesophageal perforation. Samantha M. Field, Joseph G. Manjaly, S. Krishan Ramdoo, Huw A. S. Jones, and Taran S. Tatla Copyright © 2014 Samantha M. Field et al. All rights reserved. Perineural Spread of Salivary Duct Carcinoma to the Internal Auditory Canal Wed, 26 Nov 2014 09:44:11 +0000 Salivary duct carcinomas (SDCs) are high-grade malignant tumors exhibiting aggressive growth with early regional and distant metastasis. We report a case of SDC in a 63-year-old male with early recurrent disease in the cerebellopontine angle (CPA) after total parotidectomy and adjuvant radiotherapy. The tendency of the tumor to recur or metastasize despite radical surgical measures and radiotherapy continues to pose a therapeutic challenge. Winfred Kitavi, Ulrich Hamberger, and Holger Sudhoff Copyright © 2014 Winfred Kitavi et al. All rights reserved. Calcific Tendonitis of the Longus Colli Muscle: A Noninfectious Cause of Retropharyngeal Fluid Collection Mon, 24 Nov 2014 12:48:12 +0000 Calcific tendonitis of the longus colli (CTLC) muscle is an underrecognized cause of spontaneous acute or subacute neck pain, dysphagia, or odynophagia. Imaging may reveal a retropharyngeal fluid collection leading to the presumed diagnosis of retropharyngeal abscess. Recognition of this uncommon presentation is important to prevent unnecessary surgical incision and drainage. A 44-year-old otherwise healthy male presented with a 2-week history of progressive neck pain, stiffness, and odynophagia. A noncontrast CT scan of the cervical spine revealed a retropharyngeal fluid collection with a small area of calcification anterior to C2. There was a presumed diagnosis of retropharyngeal abscess. The patient was afebrile with normal vital signs. Flexible nasolaryngoscopy was unremarkable. C-reactive protein was elevated but all other bloodwork was normal with no evidence of an infective process. A CT scan was repeated with IV contrast showing no enhancement around the fluid collection. A diagnosis of CTLC was made. The patient was successfully managed with a short course of intravenous steroids and oral NSAIDs with complete resolution of symptoms. Clinically CTLC can mimic more serious disease processes. Identifying pathognomonic imaging findings often confirms the diagnosis. Awareness of this condition by the otolaryngologist will ensure proper patient management and avoidance of unnecessary procedures. Ronak Rahmanian and Chris Diamond Copyright © 2014 Ronak Rahmanian and Chris Diamond. All rights reserved. Residual Fistula of Fourth Branchial Arch Anomalies and Recurrent Left-Side Cervical Abscess: Clinical Case and Review of the Literature Mon, 24 Nov 2014 00:00:00 +0000 Congenital fourth branchial arch anomalies are uncommon entities. Most of these anomalies are diagnosed in childhood. The majority of cases occur on the left side. The clinical presentation of these anomalies varies with age. A respiratory distress is the usual clinical presentation in neonates, cervical cutaneous fistulas in late childhood or acute suppurative thyroiditis. Multiples diagnostic options have been described with different modalities of treatment. The majority of cases of fourth branchial arch anomalies are described only in case reports. We report a clinical case of recurrent cervical abscess in a young woman due to a residual fistula of fourth branchial arch. Bassel Hallak, Salim Bouayed, Crispin Leishman, and Kishore Sandu Copyright © 2014 Bassel Hallak et al. All rights reserved. Chronologic Presentation of a Severe Case of Progressive Hemifacial Atrophy (Parry-Romberg Syndrome) with the Loss of an Eye Tue, 18 Nov 2014 08:23:18 +0000 Progressive hemifacial atrophy, also known as Parry-Romberg syndrome, is a slowly advancing degenerative disease that mostly affects the cutaneous, subcutaneous fatty tissue, muscle tissue, and bone structures on one side of the face. We describe the chronological progression of this very rare syndrome from early childhood until adulthood in a patient who developed severe atrophy and lost one eye. We also discuss the aetiology and pathophysiology of this syndrome. Mesut Kaya, Ceyda Sel Yilmaz, Hanifi Kurtaran, and Mehmet Gunduz Copyright © 2014 Mesut Kaya et al. All rights reserved. Myocardial Infarction as a Rare Cause of Otalgia Thu, 13 Nov 2014 09:56:20 +0000 Aim. To present a case referred to our clinic with severe right ear pain but without any abnormal finding during otological examination and diagnosed as myocardial infarction and also to draw attention to otalgia which can occur secondary to myocardial infarction. Case Report. An 87-year-old female admitted with right ear pain lasting for nearly 12 hours and sweating on the head and neck region. On otolaryngologic examination, any pathological finding was not encountered. Her electrocardiogram revealed findings consistent with myocardial infarction. Her troponin values were 0.175 ng/L at 1 hour, and 0.574 ng/L at 3 hours. The patient was diagnosed as non-ST MI, and her required initial therapies were performed. On cardiac angiography, very severe coronary artery stenosis was detected, and surgical treatment was recommended for the patient. The patient who rejected surgical treatment was discharged with prescription of medical treatment. Conclusion. Especially in elderly patients with complaints of ear pain but without any abnormal finding on otoscopic examination, cardiac pathologies should be conceived. Riza Dundar, Erkan Kulduk, Fatih Kemal Soy, Ersin Sengul, and Faruk Ertas Copyright © 2014 Riza Dundar et al. All rights reserved. Osteoma of the Medial Wall of the Maxillary Sinus: A Primary Cause of Nasolacrimal Duct Obstruction and Review of the Literature Tue, 11 Nov 2014 08:22:12 +0000 A 74-year-old male patient presented to the outpatient department with left-sided epiphora and chronic dacryocystitis, without any history of head trauma or previous nasal or paranasal sinuses surgery. No abnormalities were noted at the time with the use of nasal endoscopy. The computed tomography scan however revealed an osteoma of the medial wall of the left maxillary sinus. An endonasal endoscopic dacryocystorhinostomy (DCR) with osteoma removal by using a drill with temporary silicone stenting of the nasolacrimal duct system was performed. Due to a granuloma formation at the DCR-window site 2 months postoperatively a revision-DCR was performed and the new window remained patent at control 6 months after surgery. Athanasios Saratziotis and Enzo Emanuelli Copyright © 2014 Athanasios Saratziotis and Enzo Emanuelli. All rights reserved. Rising Methicillin-Resistant Staphylococcus aureus Infections in Ear, Nose, and Throat Diseases Thu, 06 Nov 2014 09:12:30 +0000 The increasing incidence of methicillin-resistant Staphylococcus aureus infections (MRSA) in ENT diseases is becoming a big clinical concern. Here two patients are described who developed MRSA infections presented with unusual post-FESS epistaxis and postmastoidectomy perichondrial abscess and failed treatment with broad spectrum intravenous antibiotics. Following treatment with oral linezolid combined with local mupirocin dressing both patients fully recovered. Sangeetha Thirumazhisi Sachithanandam Copyright © 2014 Sangeetha Thirumazhisi Sachithanandam. All rights reserved. Oncocytoma of Oral Cavity Mimicking as Jaw Tumor Sun, 02 Nov 2014 11:36:28 +0000 Oncocytoma of major salivary gland is a fairly common benign tumour encountered, but its occurrence in oral minor salivary gland is a rare entity. Here we report a case of a giant minor salivary gland oncocytoma mimicking a jaw tumour which was successfully excised along with a review of literature. Aloke Bose Majumdar, Shib Shankar Paul, Gautam Sarker, and Souradeep Ray Copyright © 2014 Aloke Bose Majumdar et al. All rights reserved. Vallecular Cyst in Neonates: Case Series—A Clinicosurgical Insight Tue, 28 Oct 2014 06:17:55 +0000 The objective of the case series is to understand the clinical and surgical aspects of new minimally invasive technique of coblation in cases of vallecular cysts in neonates. Method of Study. Four neonates underwent surgery for vallecular cyst by using Arthrocare ENT coblator system. Results Obtained. All the four cases presented in stridor and difficult intubation was also a concern which necessitated a swift, high precision instrument with almost immediate results. Coblation excision includes direct contact with vallecular cyst, improved targeting of the cyst, and preservation of normal tissue. All the four cases had an uneventful postoperative period and smooth recovery and had an early discharge from the hospital. Conclusions. Early diagnosis and intervention hold the key for an early recovery and for minimizing nutritional disturbances secondary to poor feeding in cases of neonatal vallecular cysts. Shweta Gogia, Sangeet Kumar Agarwal, and Alok Agarwal Copyright © 2014 Shweta Gogia et al. All rights reserved. A Case of Pyriform Sinus Fistula Infection with Double Tracts Mon, 27 Oct 2014 12:47:47 +0000 Pyriform sinus fistula is a rare clinical entity and the precise origin remains controversial. The fistula is discovered among patients with acute suppurative thyroiditis or deep neck infection of the left side of the neck and is usually located in the left pyriform sinus. To the best of our knowledge, only a single tract has been reported to be responsible for pyriform sinus fistula infection. We present a case of a 13-year-old female patient with a pyriform sinus fistula that caused a deep infection of the left side of the neck and showed double-tract involvement discovered during surgical resection of the entire fistula. Both tracts arose around the pyriform sinus and terminated at the upper portion of the left lobe of the thyroid. Masato Shino, Yoshihito Yasuoka, Kyoko Nakajima, and Kazuaki Chikamatsu Copyright © 2014 Masato Shino et al. All rights reserved. A Method of Transoral Finger Dissection for a Giant Epiglottic Lipoma Mon, 27 Oct 2014 00:00:00 +0000 Background. Subcutaneous lipomas that occur in the trunk and proximal extremities are commonly dissected by low-invasive method. However, a standard surgical method for lipomas of the epiglottis has been absent. Microscopic laryngeal surgery is appropriate to extirpate small epiglottic lipomas. However, microscopic laryngeal surgery may be insufficient for giant epiglottic lipomas because there is restricted visualization of the operating field of the tumor under the microscope. Furthermore, microscopic surgical instruments are very small to manipulate giant lipomas, and it would be excessive to approach these lipomas via external cervical incisions. Case Presentation. A 57-year-old female presented with a giant lipoma on the lingual surface of the epiglottis. Following a tracheotomy, microscopic surgery was inadequate to manipulate the epiglottic lipoma. Instead, we performed macroscopic surgery in which the epiglottic lipoma was pulled into the oral cavity with forceps and then separated from the surrounding tissues using the surgeon’s finger to dissect the tumor en bloc. Conclusion. The low-invasive method of transoral finger dissection enabled the giant lipoma to be extirpated without leaving any remnants or causing excessive epiglottic damage. Toshizo Koizumi, Katsunari Yane, Toshiaki Yamanaka, and Tadashi Kitahara Copyright © 2014 Toshizo Koizumi et al. All rights reserved. Cutaneous Carcinosarcoma with Metastasis to the Parotid Gland Thu, 25 Sep 2014 07:59:25 +0000 Cutaneous carcinosarcoma is a rare malignancy that exhibits both mesenchymal and epithelial components. It is similar to nonmelanoma skin cancers in terms of risk and prognostic factors. However, these malignancies are known to have a propensity for local recurrence and metastasis, even with adequate resection margins. Here we report a case of metastatic cutaneous carcinosarcoma to the parotid gland and review the relevant literature. Tze Ling Loh, Jeanne Tomlinson, Ronald Chin, and Guy D. Eslick Copyright © 2014 Tze Ling Loh et al. All rights reserved. Adult Dermatomyositis with Bleeding Ulcer in the Pharynx Mon, 22 Sep 2014 09:07:55 +0000 Dermatomyositis (DM) is one of the idiopathic inflammatory myopathies caused by complement-mediated vasculopathy or vasculitis in the muscle. Although the gastrointestinal (GI) mucosa has been reported to be involved as a result of vasculitis or vasculopathy, ulceration in the pharynx is a rare manifestation of DM. A 54-year-old woman complaining of muscle weakness in the extremities, low-grade fever, and dysphagia was diagnosed as having DM. Despite medical treatment with corticosteroids and immunosuppressive agents, her DM progressed rapidly, leading to exacerbation of the dysphagia. About 3 weeks after undergoing tracheostomy as a preventive measure against aspiration, the patient developed intractable respiratory tract hemorrhage. Repeated laryngoendoscopy revealed a bleeding ulceration in the pharynx that required hemostasis with electric cautery under general anesthesia. No bleeding recurred thereafter. Histopathologically, the pharynx exhibited nonspecific inflammatory cell infiltration in the muscle tissue. This rare manifestation may be considered in cases of DM with unexplainable airway bleeding. Junko Kusano, Yuka Takahashi, Yoshikata Misaki, and Norihiko Murai Copyright © 2014 Junko Kusano et al. All rights reserved. Repair of Temporal Bone Encephalocele following Canal Wall Down Mastoidectomy Mon, 22 Sep 2014 00:00:00 +0000 We report a rare case of a temporal bone encephalocele after a canal wall down mastoidectomy performed to treat chronic otitis media with cholesteatoma. The patient was treated successfully via an intracranial approach. An enhanced layer-by-layer repair of the encephalocele and skull base deficit was achieved from intradurally to extradurally, using temporalis fascia, nasal septum cartilage, and artificial dural graft. After a 22-month follow-up period the patient remains symptom free and no recurrence is noted. Sarantis Blioskas, Ioannis Magras, Stavros Polyzoidis, Konstantinos Kouskouras, Georgios Psillas, Stamatia Dova, and Konstantinos Markou Copyright © 2014 Sarantis Blioskas et al. All rights reserved. Periorbital Necrotising Fasciitis after Minor Skin Trauma Sun, 21 Sep 2014 07:05:34 +0000 Necrotizing fasciitis (NF) is a fatal and rare disease, mainly located in extremity and body. Due to the good blood supply, the occurrence of this infective disease of skin and subcutaneous tissue/fascia is much rarer in the head and neck region. In this study, we represent periorbital necrotizing fasciitis case in a patient with normal immune system. The patient applied the emergency clinic with the complaints of swelling and redness on the left eye. It was found out that a skin incision occurred at 2 cm below the left eye with razor blade 2 days ago. After taking swab culture sample, patient was started on parenteral Vancomycin + Ampicillin-Sulbactam treatment. It was observed that necrosis spread within hours and an emergent deep surgical debridement was performed. Following the debridement, it was observed that periorbital edema began to regress prominently on the 1st day of the treatment. Treatment was carried on with daily wound care and parenteral antibiotherapy. The patient was discharged from the hospital with slightly cosmetic defect. Ceren Günel, Aylin Eryılmaz, Yeşim Başal, and Ali Toka Copyright © 2014 Ceren Günel et al. 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.