Case Reports in Otolaryngology The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Massive Temporal Lobe Cholesteatoma Wed, 04 Mar 2015 07:39:42 +0000 Introduction. Intracranial extension of cholesteatoma is rare. This may occur de novo or recur some time later either contiguous with or separate to the site of the original cholesteatoma. Presentation of Case. A 63-year-old female presented to a tertiary referral hospital with a fluctuating level of consciousness, fever, headache, and right-sided otorrhoea, progressing over several days. Her past medical history included surgery for right ear cholesteatoma and drainage of intracranial abscess 23 years priorly. There had been no relevant symptoms in the interim until 6 weeks prior to this presentation. Imaging demonstrated a large right temporal lobe mass contiguous with the middle ear and mastoid cavity with features consistent with cholesteatoma. The patient underwent a combined transmastoid/middle fossa approach for removal of the cholesteatoma and repair of the tegmen dehiscence. The patient made an uneventful recovery and remains well over 12 months later. Conclusion. This case presentation details a large intracranial cholesteatoma which had extended through a tegmen tympani dehiscence from recurrent right ear cholesteatoma treated by modified radical mastoidectomy over two decades priorly. There was a completely asymptomatic progression of disease until several weeks prior to this presentation. Pasan Waidyasekara, Samuel A. Dowthwaite, Ellison Stephenson, Sandeep Bhuta, and Brent McMonagle Copyright © 2015 Pasan Waidyasekara et al. All rights reserved. Acute Traumatic Injury of the Larynx Tue, 03 Mar 2015 11:56:05 +0000 Laryngeal trauma is rare but serious and potentially deadly injury. The prompt diagnosis and management of acute laryngeal trauma is necessary because the clinical presentation is variable depending on the location, severity, and mechanism of injury. Two case histories are presented: (1) case history A: a 53-year-old male, after motor vehicle accident, fractured the mid anterior thyroid cartilage and both aspects of the cricoid cartilage; however, this patient was asymptomatic from the above fractures; and (2) case history B: a 41-year-old male who sustained trauma to the chest, neck, and left arm after being struck by a large lead pipe which fractured the left aspect of the cricoid cartilage was symptomatic. The type rather than the severity of acute laryngeal injury and the mechanism of injury may be related to symptomatology. Acute laryngeal trauma should be recognized by trauma radiologists and emergency room physicians. Early diagnosis and management of acute laryngeal trauma may prevent unnecessary specialty consults and long-term complications. K. O. Kragha Copyright © 2015 K. O. Kragha. All rights reserved. A Surprising Finding after External Ear Polypectomy in a Deaf Mute Patient Sat, 28 Feb 2015 07:56:56 +0000 Introduction. External auditory canal polyps usually reflect an inflammatory process. Rarely, they may reflect a serious condition that warrants urgent intervention. Case Report. A 19-year-old deaf mute female presented to our department with persistent left ear discharge and a reddish mass in the ear. After surgery, the cause was identified as a neglected foreign body. Tympanic membrane was intact. Conclusion. Aural polyp that is resistant to medical treatment should raise the suspicion of an inflammatory polyp with underlying chronic suppurative otitis media or foreign body. Rarer neoplastic and immunological causes should also be considered. Hazem M. Abdel Tawab, Ravi Kumar V, and Salim M. Sloma Tabook Copyright © 2015 Hazem M. Abdel Tawab et al. All rights reserved. Thoracocervicofacial Empysema after Heimlich’s Maneuvre Thu, 26 Feb 2015 08:34:40 +0000 We report an extremely rare example of a thoracocervicofacial subcutaneous emphysema after Heimlich maneuver case. Salim Bouayed, Kishore Sandu, Pedro S. Teiga, and Bassel Hallak Copyright © 2015 Salim Bouayed et al. All rights reserved. Enteric Duplication Cyst Located at the Posterior Tongue: A Rare Case Report and Review of the Literature Mon, 23 Feb 2015 11:52:03 +0000 The lingual localization of an enteric duplication is extremely rare but may present with respiratory and feeding problems that require emergency intervention. A 7-month-old boy was brought to our clinic with feeding difficulties and tongue swelling. Physical examination showed a cystic lesion located near the left side of the tongue base that caused tongue protrusion to the contralateral side. During surgery, a 3-cm diameter opaque thick-walled cyst was found to be very closely adherent to the base of tongue, which was excised in its entirety. Following surgery, the patient fed during the early postoperative period and no complications were observed other than hypersalivation. On histological examination, a cystic lesion lined with intestinal mucosa and goblet cells was found. We present the rare case of a duplication cyst of the posterior tongue, with a literature review. Bircan Savran, Cuneyt Kucur, Cengiz Kocak, Isa Ozbay, Mehmet Huseyin Metineren, and Yasin Tugrul Karakus Copyright © 2015 Bircan Savran et al. All rights reserved. Conservative Management for Lingual Thyroid Ectopic Sun, 15 Feb 2015 08:38:06 +0000 Lingual thyroid gland is a rare clinical entity. The presence of an ectopic thyroid gland located at the base of the tongue may be presented with symptoms like dysphagia, dysphonia, and upper airway obstruction. We are introducing a case of an 8-year-old girl who had lingual thyroid that presented dysphagia and foreign body sensation in the throat. The diagnostic was reached with clinical examination, thyroid scintigraphy with and ultrasound. A laryngoscopy was performed which confirmed a spherical mass at base of tongue. Investigation should include thyroid function tests. In this case we observed subclinical hypothyroidism. There are different types of surgical approaches for the treatment of this condition; however, the treatment with Levothyroxine Sodium allowed the stabilization of TSH levels and clinical improvement of symptoms in a follow-up of 2 years. Eder Alberto Sigua-Rodriguez, Douglas Rangel Goulart, Luciana Asprino, and Afonso Celso de Moraes Manzano Copyright © 2015 Eder Alberto Sigua-Rodriguez et al. All rights reserved. IgG4-Related Nasal Pseudotumor Thu, 12 Feb 2015 09:58:05 +0000 IgG4-related disease is recognized as one form of autoimmune pancreatitis. During the last ten years, it has also been described in several other organs. We present two patients with lesions showing a histological picture of fibrosis and lymphoplasmacytic infiltrations with abundant IgG4 positive plasma cells at hitherto unreported symmetrical nasal locations. The symmetrical complex consisted of one central lesion in the anterior nasal septum and the two others in each of the lateral nasal walls. The lesions extended from the anterior part of the inferior concha into the vestibulum and caused severe nasal obstruction. L. K. Døsen, P. Jebsen, B. Dingsør, and R. Haye Copyright © 2015 L. K. Døsen et al. All rights reserved. Osteoma Presenting as a Painless Solitary Mastoid Swelling Thu, 12 Feb 2015 06:45:12 +0000 Introduction. Osteoma of the temporal bone is a very uncommon benign tumor of bone. Osteomas may occur in the external auditory canals but are reported to be very rare in the mastoid bone. Case Report. A 36-year-old male presented to our department with a hard swelling behind the right ear diagnosed as osteoma. Complete excision was done through a postauricular approach. Histopathology confirmed the diagnosis of osteoma. Conclusion. Osteomas, although rare, should be considered when dealing with any hard mastoid swelling. Complete removal can be ensured by drilling till the normal cortical bone is reached to avoid recurrence. A cortical mastoidectomy should be done if the mastoid air cell system is involved. Hazem M. Abdel Tawab, Ravi Kumar V, and Salim M. Sloma Tabook Copyright © 2015 Hazem M. Abdel Tawab et al. All rights reserved. Recurrent Laryngeal Edema Imitating Angioedema Caused by Dislocated Screw after Anterior Spine Surgery Tue, 10 Feb 2015 12:38:13 +0000 The anterior cervical spine surgery is a common procedure to stabilize vertebrae damaged by various diseases. The plates and screws are usually used in the spine fixation. This kind of instrumentation may detach from the bones which is a rare but well-known complication. A 77-year-old male presented to the otorhinolaryngology department with throat pain, choking, and dysphagia. At first the angioedema was diagnosed and he was treated conservatively. The endoscopy revealed laryngeal edema, being more defined on the right side with right vocal fold paresis. CT scans showed the stabilizing plate with two screws attached tightly and the back-out of the third screw toward soft tissue of the neck. In the meantime, his condition deteriorated and he needed tracheotomy. In few days the surgical removal of the dislocated screw was performed successfully. Although two-month follow-up reported no obstruction of the larynx, the vocal folds paresis with gradual functional improvement was observed. Long-term complication of anterior spine surgery sometimes may suggest laryngeal angioedema at first. If the conservative treatment is ineffective and there is a history of anterior spine surgery, the clinicians should consider the displacement of the plate or screws in differential diagnosis. Piotr Wójtowicz, Tomasz Szafarowski, Ewa Migacz, and Antoni Krzeski Copyright © 2015 Piotr Wójtowicz et al. All rights reserved. Isolated Kaposi Sarcoma of the Tonsil: A Case Report and Review of the Scientific Literature Tue, 10 Feb 2015 10:25:40 +0000 Kaposi sarcoma is a tumour caused by human herpes virus 8, also known as Kaposi sarcoma-associated herpes virus. It usually affects the skin and oral mucosa; however, it can also sometimes affect the lungs, the liver, the stomach, the bowel, and lymph nodes. Several body sites may be affected simultaneously. The involvement of the tonsils is rare. We described an isolated localization of Kaposi’s sarcoma of the right tonsil in a HIV-positive patient. Barbara Pittore, Carlo Loris Pelagatti, Francesco Deiana, Francesco Ortu, Elena Maricosu, Sergio Cossu, and Giovanni Sotgiu Copyright © 2015 Barbara Pittore et al. All rights reserved. Hybrid Tumor of the Parotid Gland: A Case Report and Review of the Literature Mon, 09 Feb 2015 08:32:07 +0000 The parotid gland is the most common location of benign neoplasms affecting major salivary glands. Hybrid tumors are very rare tumor entities which are composed of two different tumor types, each of which conforms to an exactly defined tumor category. The tumor entities of a hybrid tumor are not separated but have an identical origin within the same topographical area. This report describes a 51-year-old male with three neoplasms occurring within a single parotid gland tumor. The clinical, radiological, and histologic features are described in addition to a review of the literature. Alain Sabri, Ibrahim Bawab, Ibrahim Khalifeh, and Elie Alam Copyright © 2015 Alain Sabri et al. All rights reserved. Nasal Bridge Intramuscular Hemangioma Mon, 02 Feb 2015 12:47:49 +0000 Intramuscular haemangioma (IMH) is a benign mesenchymal tumour. It appears as a deep, nontender mass within the soft tissue, particularly in the extremities. This tumour may not be obvious on clinical examination. Head and neck IMHs represent only 13.5% of the total IMHs. The most common site for a head and neck IMH is the masseter muscle, followed by trapezius, sternocleidomastoid, and very rarely temporalis muscle. We present a patient with left nasal bridge swelling which was excised and histologically confirmed as intramuscular hemangioma. Zulkifli Hamir Basah, Irfan Mohamad, Ramiza Ramza Ramli, Maha Khadum Gayadh, and Samarendra Singh Mutum Copyright © 2015 Zulkifli Hamir Basah et al. All rights reserved. Three Cases of Organized Hematoma of the Maxillary Sinus: Clinical Features and Immunohistological Studies for Vascular Endothelial Growth Factor and Vascular Endothelial Growth Factor Receptor 2 Expressions Thu, 29 Jan 2015 11:23:57 +0000 Objectives. Organized hematoma (OH) is a rare, nonneoplastic, hemorrhagic lesion causing mucosal swelling and bone thinning, mainly in the maxillary sinus. We aimed to clarify the clinical presentation and treatment of OH. Methods. Three cases of maxillary sinus OH and a literature review are presented. Results. Three men aged 16–40 years complained of nasal obstruction, frequent epistaxis, and/or headache. Clinical and radiological examinations revealed a maxillary sinus OH. They were cured in a piecemeal fashion via endoscopic middle meatal antrostomy. Furthermore, vascular endothelial growth factor and its receptor were expressed in the lesion. Conclusions. The pathogenesis of OH is unclear and it presents various histological and imaging findings; however, it is not difficult to rule out malignant tumors. Minimally invasive surgery such as endoscopic sinus surgery can cure it completely. Thus, it is important to determine the diagnosis using CT and MRI and to quickly provide surgical treatment. Shoichiro Imayoshi, Takeharu Kanazawa, Noriyoshi Fukushima, Hisashi Kikuchi, Masayo Hasegawa, Takafumi Nagatomo, and Hiroshi Nishino Copyright © 2015 Shoichiro Imayoshi et al. All rights reserved. Nasal Dermoplasty for Recurrent Polyps in a Patient with Churg-Strauss Syndrome Tue, 27 Jan 2015 11:18:13 +0000 Nasal dermoplasty for recurrent polyps (NDRP) is a new technique for the surgical treatment of this condition. Churg-Strauss syndrome is characterized by the presence of nasal polyps with a great tendency for relapse after surgical or pharmaceutical treatment. It is the first time that we use NDRP to treat nasal polyps in a patient with Churg-Strauss syndrome. The patient was a 33-year-old female suffering from Churg-Strauss syndrome having had multiple operations in the past for recurrent polyps. NDRP was performed on the left nostril only. The mucosa of the left nasal vault was replaced by a split-thickness skin graft (modified dermoplasty). On the right nostril, polyps were removed and the ostia of the paranasal sinuses were enlarged as in typical endoscopic sinus surgery. The skin graft had a successful take and eight months after the operation no polyps are detected on the left side while polyps have recurred on the right nasal cavity. Applying the technique to a single nostril has several advantages, namely, the reduction of the operational time and therefore the risks for the patient from a prolonged general anaesthetic and the ability to judge the efficacy of the technique on the same patient. George Anastasopoulos, Theophanis Machas, Sofia Kegioglou, and Demetra Rapti Copyright © 2015 George Anastasopoulos et al. All rights reserved. A Case of Chondrosarcoma Arising in the Temporomandibular Joint Mon, 26 Jan 2015 13:01:43 +0000 Chondrosarcoma is a malignant tumor originating in cartilaginous cells. And there are only few reports of the case of chondrosarcoma in temporomandibular joint. We discuss a case of chondrosarcoma in temporomandibular joint in a 28-year-old man. Tumor was in contact with the dura, but en bloc resection was performed. After surgical resection of the tumor, face defect was reconstructed by rectus abdominis-free flap. And there is no recurrence after ten years from the resection. Tsutomu Nomura, Tadaharu Kobayashi, Susumu Shingaki, and Chikara Saito Copyright © 2015 Tsutomu Nomura et al. All rights reserved. Radiofrequency Coblation of Congenital Nasopharyngeal Teratoma: A Novel Technique Thu, 22 Jan 2015 14:28:31 +0000 Introduction. Congenital nasopharyngeal teratomas are rare tumours that pose difficulties in diagnosis and surgical management. We report the first use of radiofrequency coblation in the management of such tumours. Case Report. A premature baby with a perinatal diagnosis of a large, obstructing nasooropharyngeal mass was referred to the ENT service for further investigations and management. The initial biopsy was suggestive of a neuroblastoma, but the tumour demonstrated rapid growth despite appropriate chemotherapy. In a novel use of radiofrequency coblation, the nasooropharyngeal mass was completely excised, with the final histopathology revealing a congenital nasopharyngeal teratoma. Conclusion. We report the first use of radiofrequency coblation to excise a congenital nasopharyngeal teratoma and discuss its advantages. Sang Yun Hwang, Niall Jefferson, Alok Mohorikar, and Ian Jacobson Copyright © 2015 Sang Yun Hwang et al. All rights reserved. A Three-Generation Family with Idiopathic Facial Palsy Suggesting an Autosomal Dominant Inheritance with High Penetrance Sun, 18 Jan 2015 07:17:17 +0000 Idiopathic facial palsy (IFP), also known as Bell’s palsy, is a common neurologic disorder, but recurrent and familial forms are rare. This case series presents a three-generation family with idiopathic facial palsy. The mode of inheritance of IFP has previously been suggested as autosomal dominant with low or variable penetrance, but the present family indicates an autosomal dominant trait with high or complete penetrance. Chromosome microarray studies did not reveal a pathogenic copy number variation, which could enable identification of a candidate gene. Christian Grønhøj Larsen, Mette Gyldenløve, Aia Elise Jønch, Birgitte Charabi, and Zeynep Tümer Copyright © 2015 Christian Grønhøj Larsen et al. All rights reserved. An Endoscopic Endonasal Approach for Early-Stage Olfactory Neuroblastoma: An Evaluation of 2 Cases with Minireview of Literature Sun, 11 Jan 2015 14:21:43 +0000 We describe the clinical findings in two patients with pathologically diagnosed olfactory neuroblastoma (ONB) of the sinonasal area and the surgical methods used for its treatment. Using an endoscopic endonasal approach (EEA) without dura resection, along with radiotherapy, we successfully treated ONB at the Kadish stage A. One of our patients, however, experienced tumor recurrence 24 years after open surgery with radiotherapy that was conducted at another hospital. This patient was no longer eligible for radiotherapy, and the tumor was therefore resected with dura resection using an EEA combined with duraplasty. The dura resection with duraplasty using fascia lata and a pedicled nasal septal flap was minimally invasive. As with surgery without duraplasty, a postoperative computed tomography (CT) examination revealed that EEA with duraplasty led to quick improvement of the postoperative inflammatory response as well as pneumocranium. Here, we investigated whether to modify the method of surgery depending upon the primary site of early-stage ONB. We suggest that, in early-stage ONB, an endoscopic endonasal approach is an effective and less invasive method. It is also advisable to perform dura mater resection of the lesion site despite the absence of obvious intracranial invasions in image findings. Hidenori Yokoi, Satoru Kodama, Yasunao Kogashiwa, Yuma Matsumoto, Yasuo Ohkura, Takayuki Nakagawa, and Naoyuki Kohno Copyright © 2015 Hidenori Yokoi et al. All rights reserved. Removal of a Wire Brush Bristle from the Hypopharynx Using Suspension, Microscope, and Fluoroscopy Sun, 11 Jan 2015 09:47:58 +0000 Wire brush bristles are an increasingly recognized hazard that can present as a foreign body in the aerodigestive tract. Due to their small size and tendency to become embedded in surrounding tissue, these small metallic bristles present a unique operative challenge to otolaryngologists. Here we present a case of a 40-year-old woman who underwent endoscopic extraction of a wire bristle from the posterior pharyngeal wall using suspension, microscopy, and C-arm fluoroscopy. We believe this is the first published case of an endoscopic removal of a buried foreign body in the hypopharynx using these methods of localization concurrently. By leveraging multiple techniques for visualization, surgeons can avoid open exploration while ensuring complete removal of the object. Additionally, this case highlights the importance of regulatory oversight and consumer awareness of the hazards of grill brushes. Matthew R. Naunheim, Matthew M. Dedmon, Matthew C. Mori, Ahmad R. Sedaghat, and Jayme R. Dowdall Copyright © 2015 Matthew R. Naunheim et al. All rights reserved. Acute Contained Ruptured Aortic Aneurysm Presenting as Left Vocal Fold Immobility Sun, 11 Jan 2015 09:42:43 +0000 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 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 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 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 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 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 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 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 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.