Case Reports in Otolaryngology http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Three Cases of Organized Hematoma of the Maxillary Sinus: Clinical Features and Immunohistological Studies for Vascular Endothelial Growth Factor and Vascular Endothelial Growth Factor Receptor 2 Expressions Thu, 29 Jan 2015 11:23:57 +0000 http://www.hindawi.com/journals/criot/2015/846832/ Objectives. Organized hematoma (OH) is a rare, nonneoplastic, hemorrhagic lesion causing mucosal swelling and bone thinning, mainly in the maxillary sinus. We aimed to clarify the clinical presentation and treatment of OH. Methods. Three cases of maxillary sinus OH and a literature review are presented. Results. Three men aged 16–40 years complained of nasal obstruction, frequent epistaxis, and/or headache. Clinical and radiological examinations revealed a maxillary sinus OH. They were cured in a piecemeal fashion via endoscopic middle meatal antrostomy. Furthermore, vascular endothelial growth factor and its receptor were expressed in the lesion. Conclusions. The pathogenesis of OH is unclear and it presents various histological and imaging findings; however, it is not difficult to rule out malignant tumors. Minimally invasive surgery such as endoscopic sinus surgery can cure it completely. Thus, it is important to determine the diagnosis using CT and MRI and to quickly provide surgical treatment. Shoichiro Imayoshi, Takeharu Kanazawa, Noriyoshi Fukushima, Hisashi Kikuchi, Masayo Hasegawa, Takafumi Nagatomo, and Hiroshi Nishino Copyright © 2015 Shoichiro Imayoshi et al. All rights reserved. Nasal Dermoplasty for Recurrent Polyps in a Patient with Churg-Strauss Syndrome Tue, 27 Jan 2015 11:18:13 +0000 http://www.hindawi.com/journals/criot/2015/192804/ Nasal dermoplasty for recurrent polyps (NDRP) is a new technique for the surgical treatment of this condition. Churg-Strauss syndrome is characterized by the presence of nasal polyps with a great tendency for relapse after surgical or pharmaceutical treatment. It is the first time that we use NDRP to treat nasal polyps in a patient with Churg-Strauss syndrome. The patient was a 33-year-old female suffering from Churg-Strauss syndrome having had multiple operations in the past for recurrent polyps. NDRP was performed on the left nostril only. The mucosa of the left nasal vault was replaced by a split-thickness skin graft (modified dermoplasty). On the right nostril, polyps were removed and the ostia of the paranasal sinuses were enlarged as in typical endoscopic sinus surgery. The skin graft had a successful take and eight months after the operation no polyps are detected on the left side while polyps have recurred on the right nasal cavity. Applying the technique to a single nostril has several advantages, namely, the reduction of the operational time and therefore the risks for the patient from a prolonged general anaesthetic and the ability to judge the efficacy of the technique on the same patient. George Anastasopoulos, Theophanis Machas, Sofia Kegioglou, and Demetra Rapti Copyright © 2015 George Anastasopoulos et al. All rights reserved. A Case of Chondrosarcoma Arising in the Temporomandibular Joint Mon, 26 Jan 2015 13:01:43 +0000 http://www.hindawi.com/journals/criot/2015/832532/ Chondrosarcoma is a malignant tumor originating in cartilaginous cells. And there are only few reports of the case of chondrosarcoma in temporomandibular joint. We discuss a case of chondrosarcoma in temporomandibular joint in a 28-year-old man. Tumor was in contact with the dura, but en bloc resection was performed. After surgical resection of the tumor, face defect was reconstructed by rectus abdominis-free flap. And there is no recurrence after ten years from the resection. Tsutomu Nomura, Tadaharu Kobayashi, Susumu Shingaki, and Chikara Saito Copyright © 2015 Tsutomu Nomura et al. All rights reserved. Radiofrequency Coblation of Congenital Nasopharyngeal Teratoma: A Novel Technique Thu, 22 Jan 2015 14:28:31 +0000 http://www.hindawi.com/journals/criot/2015/634958/ Introduction. Congenital nasopharyngeal teratomas are rare tumours that pose difficulties in diagnosis and surgical management. We report the first use of radiofrequency coblation in the management of such tumours. Case Report. A premature baby with a perinatal diagnosis of a large, obstructing nasooropharyngeal mass was referred to the ENT service for further investigations and management. The initial biopsy was suggestive of a neuroblastoma, but the tumour demonstrated rapid growth despite appropriate chemotherapy. In a novel use of radiofrequency coblation, the nasooropharyngeal mass was completely excised, with the final histopathology revealing a congenital nasopharyngeal teratoma. Conclusion. We report the first use of radiofrequency coblation to excise a congenital nasopharyngeal teratoma and discuss its advantages. Sang Yun Hwang, Niall Jefferson, Alok Mohorikar, and Ian Jacobson Copyright © 2015 Sang Yun Hwang et al. All rights reserved. A Three-Generation Family with Idiopathic Facial Palsy Suggesting an Autosomal Dominant Inheritance with High Penetrance Sun, 18 Jan 2015 07:17:17 +0000 http://www.hindawi.com/journals/criot/2015/683938/ Idiopathic facial palsy (IFP), also known as Bell’s palsy, is a common neurologic disorder, but recurrent and familial forms are rare. This case series presents a three-generation family with idiopathic facial palsy. The mode of inheritance of IFP has previously been suggested as autosomal dominant with low or variable penetrance, but the present family indicates an autosomal dominant trait with high or complete penetrance. Chromosome microarray studies did not reveal a pathogenic copy number variation, which could enable identification of a candidate gene. Christian Grønhøj Larsen, Mette Gyldenløve, Aia Elise Jønch, Birgitte Charabi, and Zeynep Tümer Copyright © 2015 Christian Grønhøj Larsen et al. All rights reserved. An Endoscopic Endonasal Approach for Early-Stage Olfactory Neuroblastoma: An Evaluation of 2 Cases with Minireview of Literature Sun, 11 Jan 2015 14:21:43 +0000 http://www.hindawi.com/journals/criot/2015/541026/ We describe the clinical findings in two patients with pathologically diagnosed olfactory neuroblastoma (ONB) of the sinonasal area and the surgical methods used for its treatment. Using an endoscopic endonasal approach (EEA) without dura resection, along with radiotherapy, we successfully treated ONB at the Kadish stage A. One of our patients, however, experienced tumor recurrence 24 years after open surgery with radiotherapy that was conducted at another hospital. This patient was no longer eligible for radiotherapy, and the tumor was therefore resected with dura resection using an EEA combined with duraplasty. The dura resection with duraplasty using fascia lata and a pedicled nasal septal flap was minimally invasive. As with surgery without duraplasty, a postoperative computed tomography (CT) examination revealed that EEA with duraplasty led to quick improvement of the postoperative inflammatory response as well as pneumocranium. Here, we investigated whether to modify the method of surgery depending upon the primary site of early-stage ONB. We suggest that, in early-stage ONB, an endoscopic endonasal approach is an effective and less invasive method. It is also advisable to perform dura mater resection of the lesion site despite the absence of obvious intracranial invasions in image findings. Hidenori Yokoi, Satoru Kodama, Yasunao Kogashiwa, Yuma Matsumoto, Yasuo Ohkura, Takayuki Nakagawa, and Naoyuki Kohno Copyright © 2015 Hidenori Yokoi et al. All rights reserved. Removal of a Wire Brush Bristle from the Hypopharynx Using Suspension, Microscope, and Fluoroscopy Sun, 11 Jan 2015 09:47:58 +0000 http://www.hindawi.com/journals/criot/2015/925873/ Wire brush bristles are an increasingly recognized hazard that can present as a foreign body in the aerodigestive tract. Due to their small size and tendency to become embedded in surrounding tissue, these small metallic bristles present a unique operative challenge to otolaryngologists. Here we present a case of a 40-year-old woman who underwent endoscopic extraction of a wire bristle from the posterior pharyngeal wall using suspension, microscopy, and C-arm fluoroscopy. We believe this is the first published case of an endoscopic removal of a buried foreign body in the hypopharynx using these methods of localization concurrently. By leveraging multiple techniques for visualization, surgeons can avoid open exploration while ensuring complete removal of the object. Additionally, this case highlights the importance of regulatory oversight and consumer awareness of the hazards of grill brushes. Matthew R. Naunheim, Matthew M. Dedmon, Matthew C. Mori, Ahmad R. Sedaghat, and Jayme R. Dowdall Copyright © 2015 Matthew R. Naunheim et al. All rights reserved. Acute Contained Ruptured Aortic Aneurysm Presenting as Left Vocal Fold Immobility Sun, 11 Jan 2015 09:42:43 +0000 http://www.hindawi.com/journals/criot/2015/219090/ Objective. To recognize intrathoracic abnormalities, including expansion or rupture of aortic aneurysms, as a source of acute onset vocal fold immobility. Methods. A case report and review of the literature. Results. An 85-year-old female with prior history of an aortic aneurysm presented to a tertiary care facility with sudden onset hoarseness. On laryngoscopy, the left vocal fold was immobile in the paramedian position. A CT scan obtained that day revealed a new, large hematoma surrounding the upper descending aortic stent graft consistent with an acute contained ruptured aortic aneurysm. She was referred to the emergency department for evaluation and treatment by vascular surgery. She was counseled regarding surgical options and ultimately decided not to pursue further treatment. Her vocal fold immobility was subsequently treated via office-based injection medialization two weeks after presentation and again 5 months after the initial injection which dramatically improved her voice. Follow-up CT scan at 8 months demonstrated a reduction of the hematoma. The left vocal cord remains immobile to date. Conclusion. Ortner’s syndrome, or cardiovocal syndrome, is hoarseness secondary to left recurrent laryngeal nerve palsy caused by cardiovascular pathology. It is a rare condition and, while typically presenting gradually, may also present with acute symptomatology. Sharon H. Gnagi, Brittany E. Howard, Joseph M. Hoxworth, and David G. Lott Copyright © 2015 Sharon H. Gnagi et al. All rights reserved. Pediatric Synovial Sarcoma in the Retropharyngeal Space: A Rare and Unusual Presentation Tue, 06 Jan 2015 09:59:25 +0000 http://www.hindawi.com/journals/criot/2015/587386/ Synovial sarcomas in the head and neck are extremely rare tumors, especially in the pediatric population. 3–5% of synovial sarcomas occur in the head and neck region displaying varied imaging and histopathological features resulting in frequent misdiagnosis. These tumors have a poor prognosis; hence early diagnosis and accurate classification based on imaging, histopathology, and immunohistochemistry are critical for prompt treatment. To the best of our knowledge, imaging findings of pediatric retropharyngeal lipomatous synovial sarcoma have not been reported to date in English medical literature. We report, for the first time, a rare case of retropharyngeal lipomatous synovial sarcoma in a ten-year-old child and discuss the case-specific imaging findings in our patient using magnetic resonance imaging and computed tomography. Sanjay Vaid, Neelam Vaid, Sanjay Desai, and Varada Vaze Copyright © 2015 Sanjay Vaid et al. All rights reserved. A Case of Oropharyngeal Bullous Pemphigoid Presenting with Haemoptysis Tue, 06 Jan 2015 09:11:09 +0000 http://www.hindawi.com/journals/criot/2015/631098/ Objective. Bullous pemphigoid is well known for its cutaneous features; however in rare cases it may present with mucosal involvement. We report a case of bullous pemphigoid presenting with haemoptysis, initially presenting to the Ear, Nose and Throat Department for investigation. Methods. An 87-year-old lady was admitted with haemoptysis. She also complained of a spreading, pruritic, bullous rash, which first began three weeks previously. Initial investigations, which included nasendoscopy, revealed a normal nasal mucosa and a normal postnasal space. A large deroofed blister was observed on the soft palate. The presenting symptoms and signs raised the suspicion of an immunobullous disease including bullous pemphigoid. Conclusion. Bullous pemphigoid (BP) is a subepidermal immunobullous disease that typically manifests in elderly patient populations. Although rare, BP can present in a mucocutaneous fashion akin to its more aggressive variant, mucous membrane pemphigoid (MMP). Differentiation of the two is based on clinical grounds, with the prevailing feature for the latter being the predominance of mucosal involvement, which may be extensive. The mainstay of treatment for bullous pemphigoid is steroid therapy, which may be administered both topically and systemically. A deeper understanding into the pathophysiology of the various immunobullous diseases may assist in our understanding of how the various disease entities manifest themselves. C. M. Lee, H. K. Leadbetter, and J. M. Fishman Copyright © 2015 C. M. Lee et al. All rights reserved. A Rare Stapes Abnormality Mon, 05 Jan 2015 12:33:45 +0000 http://www.hindawi.com/journals/criot/2015/387642/ The aim of this study is to increase awareness of rare presentations, diagnostic difficulties alongside management of conductive hearing loss and ossicular abnormalities. We report the case of a 13-year-old female reporting progressive left-sided hearing loss and high resolution computed tomography was initially reported as normal. Exploratory tympanotomy revealed an absent stapedius tendon and lack of connection between the stapes superstructure and footplate. The footplate was fixed. Stapedotomy and stapes prosthesis insertion resulted in closure of the air-bone gap by 50 dB. A review of world literature was performed using MedLine. Middle ear ossicular discontinuity can result in significant conductive hearing loss. This can be managed effectively with surgery to help restore hearing. However, some patients may not be suitable or decline surgical intervention and can be managed safely conservatively. Hala Kanona, Jagdeep Singh Virk, Gaurav Kumar, Sanjiv Chawda, and Sherif Khalil Copyright © 2015 Hala Kanona et al. All rights reserved. Hair Barrette Induced Cochlear Implant Receiver Stimulator Site Infection with Extrusion Mon, 05 Jan 2015 09:06:03 +0000 http://www.hindawi.com/journals/criot/2015/510741/ Background. Cochlear implant infections and extrusion are uncommon but potentially devastating complications. Recent literature suggests conservative management can be employed. Local measures inclusive of aggressive surgical debridement with vascularized flaps and parenteral antibiotics represent a viable option and often permit device salvage. However, explantation should be considered if there is evidence of systemic, intracranial, or intractable infection. Method. A Case report and literature review. Case Report. This case illustrates a complicated local wound infection associated with cochlear implantation due to transcutaneous adherence of a ferrous hair barrette to a cochlear implant magnet. Reconstruction of computed tomography (CT) data with 3D volume rendering significantly improved the value of the images and facilitated patient counseling as well as operative planning. Conclusion. Cochlear implant infections can be associated with foreign bodies. CT images are beneficial in the evaluation of cochlear implant complications. 3D CT images provide a comprehensive view of the site of interest, displaying the relationship of the hardware to the skull and soft tissues, while minimizing associated artifacts. Cochlear implant patients should consider use of nonmetallic hair devices. Trung N. Le, Jordan Hochman, and Darren Leitao Copyright © 2015 Trung N. Le et al. All rights reserved. Intractable Persistent Direction-Changing Geotropic Nystagmus Improved by Lateral Semicircular Canal Plugging Thu, 01 Jan 2015 10:11:22 +0000 http://www.hindawi.com/journals/criot/2015/192764/ Antigravitational deviation of the cupula of the lateral semicircular canal, which is also called light cupula, evokes persistent direction-changing geotropic nystagmus with a neutral point. No intractable cases of this condition have been reported. In our case, a 67-year-old man complained of positional vertigo 3 months after developing idiopathic sudden hearing loss in the right ear with vertigo. He showed a persistent direction-changing geotropic nystagmus with a leftward beating nystagmus in the supine position. The nystagmus resolved when his head was turned approximately 30° to the right. He was diagnosed with light cupula of the right lateral semicircular canal and was subsequently treated with an antivertiginous agent. However, his symptoms and positional nystagmus did not improve, so the right lateral semicircular canal was plugged by surgery. One month after surgery, his positional vertigo and nystagmus were completely resolved. We speculated that the cause of the patient’s intractable light cupula was an enlarged cupula caused by his idiopathic sudden hearing loss. Toru Seo, Kazuya Saito, and Katsumi Doi Copyright © 2015 Toru Seo et al. All rights reserved. Congenital Epidermoid Cyst Results in Muscle Fusion Defect in the Upper Lip Wed, 31 Dec 2014 14:17:11 +0000 http://www.hindawi.com/journals/criot/2014/540910/ Epidermoid cysts are rarely detected malformations in the oral cavity. Their development sites are the sublingual, submaxillary, and submandibular spaces. In this paper, we report a three-month-old infant who was admitted to our hospital due upper lip swelling. Magnetic resonance imaging showed that she had a two-centimeter cystic lesion and fusion defects of orbicularis oris muscle. The cyst was surgically removed and histopathological diagnosis was “epidermoid cyst.” In recent literature, we could not find reports related to orbicularis oris muscle fusion defects because of epidermoid cyst. Fatih Dogan and Ibrahim Hakan Bucak Copyright © 2014 Fatih Dogan and Ibrahim Hakan Bucak. All rights reserved. Olfactory Loss after Uvulopalatopharyngoplasty: A Report of Two Cases with Review of the Literature Wed, 31 Dec 2014 11:11:06 +0000 http://www.hindawi.com/journals/criot/2014/546317/ Uvulopalatopharyngoplasty (UPPP) has been a popular surgical method for treating obstructive sleep apnea syndrome since it was introduced in the early 1980s. Olfactory loss has been reported as a rare side effect in several cases. However, the olfactory test results and the prognosis were not mentioned in these cases. We present two patients who complained of loss of olfactory function after UPPP. Their olfactory function was evaluated by the phenyl ethyl alcohol odor detection threshold test and the University of Pennsylvania Smell Identification Test. After treatment with steroid and zinc salt, their olfactory function was improved but not recovered completely. Rong-San Jiang and Yi-Hao Chang Copyright © 2014 Rong-San Jiang and Yi-Hao Chang. All rights reserved. Not Always Asthma: Clinical and Legal Consequences of Delayed Diagnosis of Laryngotracheal Stenosis Thu, 18 Dec 2014 06:48:45 +0000 http://www.hindawi.com/journals/criot/2014/325048/ 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 http://www.hindawi.com/journals/criot/2014/373104/ 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 http://www.hindawi.com/journals/criot/2014/732096/ 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 http://www.hindawi.com/journals/criot/2014/609784/ 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 http://www.hindawi.com/journals/criot/2014/604737/ 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 http://www.hindawi.com/journals/criot/2014/184230/ 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 http://www.hindawi.com/journals/criot/2014/368920/ 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 http://www.hindawi.com/journals/criot/2014/139386/ 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 http://www.hindawi.com/journals/criot/2014/851508/ 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 http://www.hindawi.com/journals/criot/2014/382495/ 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 http://www.hindawi.com/journals/criot/2014/476317/ 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 http://www.hindawi.com/journals/criot/2014/286190/ 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 http://www.hindawi.com/journals/criot/2014/931279/ 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 http://www.hindawi.com/journals/criot/2014/703017/ 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 http://www.hindawi.com/journals/criot/2014/106938/ 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.