Case Reports in Otolaryngology The latest articles from Hindawi Publishing Corporation © 2016 , Hindawi Publishing Corporation . All rights reserved. Intramuscular Hemangioma of Thyrohyoid Muscle Sun, 28 Aug 2016 13:26:36 +0000 Intramuscular hemangiomas are rare benign vascular neoplasms. IMH accounts for less than 1% of all hemangiomas. These neoplasms commonly occur in trunk and extremities but are rare in head and neck region. The present case is a 17-year-old female patient, who presented with a painless, slowly enlarging mass in left sided upper neck for 4 years. Investigations were suggestive of vascular neoplasm. She underwent excision of the mass in toto under general anesthesia. Postoperative period was uneventful. Histopathological examination of the mass revealed it as mixed type of intramuscular hemangioma. She did not have any signs of recurrences on her last follow-up at 6 months postoperatively. This case report discusses the rare IMH arising from thyrohyoid strap muscle. Ramesh Parajuli, Suman Thapa, and Sushna Maharjan Copyright © 2016 Ramesh Parajuli et al. All rights reserved. Maxillary Osteomyelitis: A Rare Entity Thu, 25 Aug 2016 13:45:45 +0000 Osteomyelitis of the maxilla is now a rare event with the advent of antibiotics. The two predominant causes are odontogenic infections and sinusitis. Immunocompromised states such as diabetes, HIV, and malnutrition increase the risk of osteomyelitis. It is important to recognize this early as it is a difficult entity to treat with potentially serious consequences. We report an unusual case of right sided maxillary osteomyelitis in a lady with poorly controlled diabetes in rural Lincolnshire. Biopsy of the right maxillary bone showed features of acute osteomyelitis. This responded well to a prolonged course of oral antibiotics. Ayaaz Habib, Nagaraj Sivaji, and Tauseef Ashraf Copyright © 2016 Ayaaz Habib et al. All rights reserved. Primary Neuroendocrine Tumor of the Parotid Gland: A Case Report and a Comprehensive Review of a Rare Entity Tue, 16 Aug 2016 16:16:14 +0000 Neuroendocrine tumors (NETs) comprise a heterogeneous group of malignancies from cells derived from the neural crest with neuroendocrine differentiation. Despite the differences in the site of origin, nomenclature, biological behavior, and functional status, NETs share certain ultrastructural and immunohistochemical features. NETs are relative rare tumors with an annual incidence of 5.76 new cases per 100.000 inhabitants and they usually appear in the gastrointestinal tract or in the pulmonary system. Head and neck NETs are uncommon with limited information regarding frequency, most of them showing small cell carcinoma features. NETs that arise from the salivary glands are exceedingly rare. Regardless of their low frequency, it is imperative to accurately differentiate these tumors from the much more common squamous cell carcinomas and from metastasis from another primary tumor due to the completely different therapeutic approaches and prognosis. The diagnosis is based on the recognition of the typical neuroendocrine architecture and immunohistochemical staining and on an exhaustive work-up. Hereby, we report a case of a moderately differentiated NET of the parotid gland that was treated with a complete parotidectomy. We summarize the clues that led to the final diagnosis and major strategies that were employed to manage the patient. We also perform a comprehensive review of the scarce available literature on this topic. Olga Martínez-Sáez, Javier Molina-Cerrillo, Carmen Moreno García del Real, Rafael Barberá Durban, Juan J. Díez, Teresa Alonso-Gordoa, and Enrique Grande Pulido Copyright © 2016 Olga Martínez-Sáez et al. All rights reserved. A Case of Skull Base Osteomyelitis with Multiple Cerebral Infarction Thu, 11 Aug 2016 10:54:13 +0000 Skull base osteomyelitis is classically documented as an extension of malignant otitis externa. Initial presentation commonly includes aural symptoms and cranial nerve dysfunctions. Here we present a case that emerged with multiple infarctions in the right cerebrum. A male in his 70s with diabetes mellitus and chronic renal failure presented with left hemiparesis. Imaging studies showed that blood flow in the carotid artery remained at the day of onset but was totally occluded 7 days later. However, collateral blood supply prevented severe infarction. These findings suggest that artery-to-artery embolization from the petrous and/or cavernous portion of the carotid artery caused the multiple infarctions observed on initial presentation. Osteomyelitis of the central skull base was diagnosed on the basis of the following findings taken together: laboratory results showing high levels of inflammation, presence of Pseudomonas aeruginosa in the otorrhea and blood culture, multiple cranial nerve palsies that appeared later, the bony erosion observed on CT, and the mass lesion on MRI. Osteomyelitis was treated successfully by long-term antibiotic therapy; however, the patient experienced cefepime-induced neurotoxicity during therapy. The potential involvement of the internal carotid artery in this rare and life-threatening disease is of particular interest in this case. Haruka Miyabe, Atsuhiko Uno, Takahiro Nakajima, Natsue Morizane, Keisuke Enomoto, Masayuki Hirose, Toshinori Hazama, and Yukinori Takenaka Copyright © 2016 Haruka Miyabe et al. All rights reserved. Massive Cerebrospinal Fluid Leak of the Temporal Bone Thu, 11 Aug 2016 10:48:57 +0000 Cerebrospinal fluid (CSF) leakage of the temporal bone region is defined as abnormal communications between the subarachnoidal space and the air-containing spaces of the temporal bone. CSF leak remains one of the most frequent complications after VS surgery. Radiotherapy is considered a predisposing factor for development of temporal bone CSF leak because it may impair dural repair mechanisms, thus causing inadequate dural sealing. The authors describe the case of a 47-year-old man with a massive effusion of CSF which extended from the posterior and lateral skull base to the first cervical vertebrae; this complication appeared after a partial enucleation of a vestibular schwannoma (VS) with subsequent radiation treatment and second operation with total VS resection. Giannicola Iannella, Alessandra Manno, Emanuela Pasqualitto, Andrea Ciofalo, Diletta Angeletti, Benedetta Pasquariello, and Giuseppe Magliulo Copyright © 2016 Giannicola Iannella et al. All rights reserved. Orbital Metastasis of Breast Cancer Mimicking Invasive Fungal Rhinosinusitis Mon, 01 Aug 2016 12:46:25 +0000 Introduction. A range of traumatic, vascular, inflammatory, infectious, and neoplastic processes can affect the orbit and its structures. In the area of otolaryngology, the rhino-orbital-cerebral involvement of invasive fungal rhinosinusitis can affect the orbit, which may look like initially a rhinosinusitis or even mimic malignancy. Case Presentation. Female patient, 32 years old, with headache and ocular proptosis. She was using prednisone in immunosuppressive doses for a year and had breast cancer treated three years earlier. The initial CT scan showed opacification of the sphenoid and ethmoid sinuses, left intraorbital involvement and contrast impregnation in the cavernous sinus. The biopsy resulted positive for invasive ductal carcinoma of the breast. Discussion. The initial CT scan of our patient showed both signs of early changes of invasive fungal rhinosinusitis (IFR) and possible metastatic involvement. The intracranial extension and ocular involvement are usually the most common signs of IFR (first hypothesis). Among metastases at the orbit and the eye, breast and lung carcinomas are the most frequent. Conclusion. Although several studies on the differential diagnosis of orbital lesions exist, especially when it concerns the involvement of the nasal cavity, the diagnosis by imaging is still a challenge. Mayara Tabai, Igor Moreira Hazboun, Emerson Taro Inoue Sakuma, Marcelo Hamilton Sampaio, and Eulalia Sakano Copyright © 2016 Mayara Tabai et al. All rights reserved. Use of a Rigid Curved Laryngoscope for Removal of a Fish Bone in the Hypopharynx Wed, 27 Jul 2016 05:51:05 +0000 Foreign body ingestion is a commonly encountered clinical problem. In particular, sharp foreign bodies lodged in the esophagus or hypopharynx can cause complications and require urgent removal. Removal by flexible esophagogastroduodenoscopy or rigid esophagoscopy is the treatment of choice and has high success rates, but cases in which these methods are unsuccessful must be treated with an external incision. A 62-year-old man was referred for a fish bone lodged in the hypopharynx that could not be removed by flexible esophagogastroduodenoscopy. We removed the bone transorally using a specially designed rigid curved laryngoscope. Based on our experience, this method may have clear practical value due to advantages of a wide field of view and use of multiple rigid forceps. Indications may be limited, but this novel method may reduce the limitations of noninvasive removal of foreign bodies. Hiroshi Sakaida, Kazuki Chiyonobu, Hajime Ishinaga, and Kazuhiko Takeuchi Copyright © 2016 Hiroshi Sakaida et al. All rights reserved. Comment on “Original Solution for Middle Ear Implant and Anesthetic/Surgical Management in a Child with Severe Craniofacial Dysmorphism” Mon, 25 Jul 2016 12:37:09 +0000 Ivo Joachim Kruyt, Ann-Louise Mc Dermott, and Myrthe Karianne Sophie Hol Copyright © 2016 Ivo Joachim Kruyt et al. All rights reserved. Granulomatosis with Polyangiitis with Bilateral Facial Palsy and Severe Mixed Hearing Loss Thu, 14 Jul 2016 06:21:31 +0000 Granulomatosis with polyangiitis is autoimmune and rare disease. It affects many organs, but the most often affected organs are the nose, lungs, and kidneys. It is part of vasculitis and causes an autoimmune attack by an abnormal type of circulating antibody termed ANCAs against small blood vessels. Disease concerns both men and women with a peak age of presentation in the sixth and seven decades. Typically upper and lower respiratory tract and kidneys are involved. Otitis externa, otitis media, or mastoiditis rarely occurs in granulomatosis with polyangiitis. Deafness is the most dangerous aural complication. Histological examination of biopsy is often not specific. A case of GPA with bilateral otitis media, bilateral deafness, and bilateral facial palsy with fatal course is presented. Agnieszka Wawrzecka, Anna Szymańska, Radosław Jeleniewicz, and Marcin Szymański Copyright © 2016 Agnieszka Wawrzecka et al. All rights reserved. Metastatic Malignant Melanoma of Parotid Gland with a Regressed Primary Tumor Tue, 05 Jul 2016 07:47:19 +0000 Malignant melanoma of the parotid gland is often metastatic and mainly originates from malignant melanomas in the head and neck. Nevertheless, some malignant melanomas may metastasize and subsequently regress. Therefore, it may not be possible to observe a metastatic malignant melanoma and its primary melanoma simultaneously. The investigation of a patient’s old photographs may help in the detection of preexisting and regressed pigmented lesions in the facial and neck regions. M. Mustafa Kılıçkaya, Giray Aynali, Ali Murat Ceyhan, and Metin Çiriş Copyright © 2016 M. Mustafa Kılıçkaya et al. All rights reserved. Neuroendocrine Adenoma of the Middle Ear: A Rare Histopathological Diagnosis Mon, 27 Jun 2016 07:42:16 +0000 Neuroendocrine tumours occur throughout the body but are rare in the head and neck region and particularly rare in the middle ear. Clinical findings are often nonspecific and therefore pose a diagnostic challenge. Furthermore, the nomenclature of neuroendocrine tumours of the middle ear is historically controversial. Herein a case is presented of a middle ear adenoma in a 33-year-old patient who presented with otalgia, hearing loss, and facial nerve palsy. A brief discussion is included regarding the histopathological features of middle ear adenomas and seeks to clarify the correct nomenclature for these tumours. Zubair Hasan, Sam McGinness, Dakshika A. Gunaratne, Hedley Coleman, Winny Varikatt, and Melville da Cruz Copyright © 2016 Zubair Hasan et al. All rights reserved. Concurrent Human Papillomavirus-Positive Squamous Cell Carcinoma of the Oropharynx in a Married Couple Wed, 22 Jun 2016 11:58:36 +0000 Background. Although alcohol and tobacco use are known risk factors for development of squamous cell carcinoma in the head and neck, human papillomavirus (HPV) has been increasingly associated with this group of cancers. We describe the case of a married couple who presented with HPV-positive oropharynx squamous cell carcinoma within two months of each other. Methods. Tumor biopsies were positive for p16 and high-risk HPV in both patients. Sanger sequencing showed a nearly identical HPV16 strain in both patients. Both patients received chemoradiation, and one patient also underwent transoral robotic tongue base resection with bilateral neck dissection. Results. Both patients showed no evidence of recurrent disease on follow-up PET imaging. Conclusions. New head and neck symptoms should be promptly evaluated in the partner of a patient with known HPV-positive oropharynx cancer. This case expands the limited current literature on concurrent presentation of HPV-positive oropharynx squamous cell carcinoma in couples. Tyler D. Brobst, Joaquín J. García, Katharine A. Price, Ge Gao, David I. Smith, and Daniel L. Price Copyright © 2016 Tyler D. Brobst et al. All rights reserved. Symmetric Lipomatosis Arising in the Tongue Presenting as Macroglossia and Articulatory Disorder Sun, 19 Jun 2016 09:49:43 +0000 Symmetric lipomatosis is definitively characterized by symmetric, tumorous lipomatous proliferation of adipose tissue that often develops in the head and neck, shoulders, and upper trunk. However, in the oral region, symmetric lipomatosis of the tongue (SLT) is an extremely rare condition related to generalized lipidosis that is often caused by chronic alcoholism. It is characterized by multiple symmetric lipomatous nodules and diffuse bilateral swelling located within the tongue. We report an extremely rare case of SLT arising in an 80-year-old man with a long history of alcoholic liver cirrhosis. He exhibited multiple soft nodular protrusions on the bilateral margin of the tongue presenting as macroglossia for years. Although MR imaging showed multiple fatty masses on both sides of the tongue, there was no elevated tumor mass on the bilateral margin. The patient underwent bilateral partial glossectomy under general anesthesia. Histopathologically, the resected tumor exhibited diffuse infiltration with mature adipose tissue lacking a fibrous capsule. Due to the lipidosis and the unusual presentation of multiple lesions, the lesion was ultimately diagnosed as SLT. At present, after surgery, the patient wears a full-denture and is in excellent condition, with no sign of recurrence, improved QOL, and recovery of masticatory, articulatory, and speech intelligibility functions. Masanori Kudoh, Ken Omura, Arata Satsukawa, Koshi Matsumoto, Takahide Taguchi, Hiroyuki Harada, and Yoshimasa Ishii Copyright © 2016 Masanori Kudoh et al. All rights reserved. Pediatric Myofibroma of the Palate with Ulceration and Bone Destruction Tue, 14 Jun 2016 10:25:15 +0000 Myofibroma is a rare benign neoplasm occurring in the head and neck, arising primarily in infants and children. Frequently, myofibromas grow rapidly leading to suspicion of malignancy and the potential for overaggressive surgical excision. We aim to report a rare case of myofibroma with ulceration and bone destruction. A nine-year-old female presented with an ulcerated left hard palate mass. Open biopsy was performed with pathology suggestive of myofibroma. A left partial maxillectomy and reconstruction with a buccal advancement flap were performed. Final pathology confirmed the diagnosis of a benign myofibroma. Myofibroma is a rare benign tumor of the head and neck which must be considered in the differential diagnosis by the clinician and the pathologist in order to prevent inappropriate and/or overaggressive treatment. Joseph A. Capo, Dina Moubayed, Sami P. Moubayed, Juan C. Hernandez-Prera, Azita Khorsandi, Daniel Buchbinder, and Mark L. Urken Copyright © 2016 Joseph A. Capo et al. All rights reserved. Giant Primary Schwannoma of the Left Nasal Cavity and Ethmoid Sinus Thu, 09 Jun 2016 08:55:42 +0000 A unilateral tumour in the nasal cavity or paranasal sinuses is commonly caused by polyps, cysts, and mucoceles, as well as invasive tumours such as papillomas and squamous cell carcinomas. Schwannomas, in contrast, are rare lesions in this area (Minhas et al., 2013). We present a case of a 52-year-old female who presented with a 4-year progressive history of mucous hypersecretion, nasal obstruction, pain, and fullness. Imaging of the paranasal sinuses showed complete opacification of the entire left nasal cavity and sinuses by a tumour causing subsequent obstruction of the frontal and maxillary sinuses. The tumour was completely excised endoscopically. Histopathology was consistent with that of a schwannoma. Eugene Wong, Justin Kong, Lawrence Oh, Daniel Cox, and Martin Forer Copyright © 2016 Eugene Wong et al. All rights reserved. Supraglottic Kaposi’s Sarcoma in HIV-Negative Patients: Case Report and Literature Review Wed, 08 Jun 2016 10:32:15 +0000 This paper presents a case report of an HIV-negative, supraglottic Kaposi’s sarcoma patient. The 80-year-old male patient was admitted with complaints of hoarseness, difficulty in swallowing, and a stinging sensation in his throat for approximately six months. The endoscopic larynx examination revealed a lesion which had completely infiltrated the epiglottis, reached right aryepiglottic fold, was vegetating, pink and purple in color, multilobular, fragile, and shaped like a bunch of grapes, and partially blocked the bleeding airway passage. The case was discussed by the hospital’s head-neck cancer committee and a surgery decision was made. A tracheotomy was performed under local anesthesia before the operation due to respiratory distress and endotracheal intubation difficulty. Direct laryngoscopy showed that the mass was limited in the supraglottic area, had invaded the entire left aryepiglottic fold and one-third of the front right aryepiglottic fold, and completely covered epiglottis. It should be remembered that although rare, Kaposi’s sarcoma may be encountered in larynx malignancy cases. Disease-free survival may be achieved through local excision and postoperative radiotherapy. Ela A. Server, Yusuf M. Durna, Ozgur Yigit, and Erol R. Bozkurt Copyright © 2016 Ela A. Server et al. All rights reserved. Case Report of Atlantoaxial Rotatory Fixation after Cochlear Implantation Thu, 02 Jun 2016 11:25:22 +0000 Atlantoaxial rotatory fixation (AARF) is a relatively rare condition and is mainly seen in children. We report of a 7-year-old girl suffering from AARF after cochlear implantation (CI). Fortunately, early diagnosis based on three-dimensional computed tomography (3DCT) was made, and the patient was cured with conservative therapy. Nontraumatic AARF, which is also known as Grisel’s syndrome and occurs subsequent to neck infections or ear, nose, and throat (ENT) surgery, represents only a small fraction of AARF cases. Two factors are mainly thought to contribute to the pathogenesis of the condition estimated, namely, (i) neck immaturity in children and (ii) infiltration by inflammatory mediators around the upper neck joint, easily permitted by the neck vasculature. AARF should be suspected in case of torticollis developing after ENT surgery. Takahiro Nakashima, Keiji Matsuda, Takumi Okuda, Tetsuya Tono, Minoru Takaki, Tamon Hayashi, and Yutaka Hanamure Copyright © 2016 Takahiro Nakashima et al. All rights reserved. Ewing Sarcoma of the External Ear Canal Mon, 30 May 2016 10:00:21 +0000 Background. Ewing sarcoma (ES) is a high-grade malignant tumor that has skeletal and extraskeletal forms and consists of small round cells. In the head and neck region, reported localization of extraskeletal ES includes the larynx, thyroid gland, submandibular gland, nasal fossa, pharynx, skin, and parotid gland, but not the external ear canal. Methods. We present the unique case of a 2-year-old boy with extraskeletal ES arising from the external ear canal, mimicking auricular hematoma. Results. Surgery was performed and a VAC/IE (vincristine, adriamycin, cyclophosphamide alternating with ifosfamide, and etoposide) regimen was used for adjuvant chemotherapy for 12 months. Conclusion. The clinician should consider extraskeletal ES when diagnosing tumors localized in the head and neck region because it may be manifested by a nonspecific clinical picture mimicking common otorhinolaryngologic disorders. Adem Binnetoglu, Tekin Baglam, Gulnur Tokuc, Kiymet Kecelioglu Binnetoglu, Fatma Gerin, and Murat Sari Copyright © 2016 Adem Binnetoglu et al. All rights reserved. A Rare Case of Congenital Ranula in an Infant Sun, 22 May 2016 14:27:04 +0000 Ranula is a mucus extravasation cyst originating from the sublingual gland on the floor of the mouth. Congenital ranula is very rare. We report a case of a 4-month-old girl with a congenital ranula in the floor of mouth. The ranula was treated first by marsupialization, but the cyst recurred after 1 week. Excision of the ranula was done and was successful. Sirin Mneimneh, Randa Barazi, and Mariam Rajab Copyright © 2016 Sirin Mneimneh et al. All rights reserved. Schwannoma Located in Nasopharyngeal Region Tue, 17 May 2016 14:21:45 +0000 Schwannoma is a tumor which has neuroectoderm origins, is hard, well-circumscribed, encapsulated, and slow growing benign cranial tumor, and may autonomously grow out of the nerve sheath of peripheral nerves. It is mostly seen in the head and neck region. In the paranasal sinus and nose areas, it is seen at a rate of 4%. The diagnosis is mostly made after histopathological examination. In this paper, a Schwannoma case observed in the nasopharyngeal region was presented in a 20-year-old female who had complaints of sleeping with open mouth, snoring, foreign body feeling in throat, and swallowing difficulties. The tumor was extracted via transoral approach. No recurrence was observed during follow-up over the next year. This case presentation is presented for the first time in the literature in English. Fadlullah Aksoy, Alper Yenigun, Erol Senturk, and Orhan Ozturan Copyright © 2016 Fadlullah Aksoy et al. All rights reserved. Ectomesenchymal Chondromyxoid Tumour of the Dorsal Tongue Presenting with Impaired Speech Thu, 28 Apr 2016 13:38:39 +0000 Ectomesenchymal chondromyxoid tumours (ECTs) are rare mesenchymal soft tissue neoplasms that typically present as a slow-growing asymptomatic mass on the anterior dorsum of the tongue. Our patient presented with impaired speech articulation and pain associated with upper respiratory tract infections when the lesion on his dorsal tongue would swell, and he would accidentally bite down on it. Microscopically, ECTs appear as unencapsulated, well-circumscribed proliferations of uniform round to fusiform cells embedded within chondromyxoid matrices. Most cases of ECT have been detected in the third to the sixth decades of life, with no sex preference. ECT may cause a range of symptoms that negatively impact patients’ quality of life, including pain, dysphagia, odynophagia, bleeding, and, in the case of our patient, impairment of speech. We provide a unique preoperative clinical photograph and case description that should help readers in recognizing this neoplasm. Considering the rarity of ECT presenting clinically as well as in the literature, we believe this report will add to our growing understanding of ECT and its management. We report a case of ECT presenting on the anterior dorsal tongue that was successfully surgically resected under local anesthesia with clear margins, accompanied by a review of the pertinent literature. Laura A. Schep, Martin J. Bullock, and S. Mark Taylor Copyright © 2016 Laura A. Schep et al. All rights reserved. An Unusual Presentation of B-Cell Lymphoma as a Large Isolated Epiglottic Mass: Case Report and Literature Review Tue, 26 Apr 2016 13:29:06 +0000 Extranodal presentation of B-cell lymphoma is uncommon. Isolated primary epiglottic B-cell lymphoma is even rarer. To our knowledge, there has been only one description of isolated B-cell lymphoma presenting as a large epiglottic mass. We report an unusual type of B-cell lymphoma of the epiglottis, as it could not be subtyped based on routine staining and hybridization. The lymphoma presented as a large isolated globular mass pedicled to the epiglottis, occupying most of the oropharynx, but did not have any ball-valving effect or increased respiratory efforts. Initial radiographic findings were nonspecific. The diagnosis of B-cell lymphoma was determined by transoral incisional biopsy under local anesthesia. The condition was treated successfully with chemoradiation. The current standard of treatment for high grade B-cell lymphoma is concurrent chemoradiotherapy, with excellent prognosis. Although rare, B-cell lymphoma should be considered when investigating pedunculated hypopharyngeal masses. Changxing Liu, Sean Delaney, and Tamara N. Brown Copyright © 2016 Changxing Liu et al. All rights reserved. Horner’s Syndrome Incidental to Medullary Thyroid Carcinoma Excision: Case Report and Brief Literature Review Thu, 21 Apr 2016 12:48:08 +0000 Horner’s syndrome is characterized by a combination of ipsilateral miosis, blepharoptosis, enophthalmos, facial anhidrosis, and iris heterochromia in existence of congenital lesions. The syndrome results from a disruption of the ipsilateral sympathetic innervation of the eye and ocular adnexa at different levels. Though rare, thyroid and neck surgery could be considered as possible causes of this clinical entity. We present a case of Horner’s syndrome in a patient after total thyroidectomy and neck dissection for medullary thyroid cancer with neck nodal disease and attempt a brief review of the relevant literature. Nicholas S. Mastronikolis, Sofia P. Spiliopoulou, Vassiliki Zolota, and Theodoros A. Papadas Copyright © 2016 Nicholas S. Mastronikolis et al. All rights reserved. Osseointegrated Implants: An Alternative Approach in Patients with Bilateral Auricular Defects due to Chemical Assault Wed, 20 Apr 2016 08:03:30 +0000 Acid attacks committed as crimes of passion are unfortunately becoming far from infrequent occurrence. The injuries sustained in such attacks mainly involve the face and trunk, with the acid causing cutaneous and subcutaneous tissue burns that can result in permanent scarring, loss of the nose or external ear, and severe visual impairment. Different surgical solutions have been proposed for reconstruction of the auricle following loss of the ear through traumatic injury or cancer or in patients with congenital defects: surgical reconstruction may involve the insertion of an autogenous rib cartilage framework or the use of a porous polymer material inserted into an expanded postauricular flap. Reconstruction with rib cartilage has given good results but requires more than one surgical step and may be associated with adverse events involving both the donor site and the recipient site, while rejections of polymeric prostheses have been reported following their insertion into expanded postauricular flaps. The use of a titanium dowel-retained silicone prosthesis, in which the dowel is anchored to the temporal bone, is a surgical possibility, indicated particularly in cases of pinna resection due to tumour or auricular scarring following traumatic injury. Emilio Mevio, Mauro Mullace, Luca Facca, and Stefano Schettini Copyright © 2016 Emilio Mevio et al. All rights reserved. Congenital Temporomandibular Joint Ankylosis: Case Report and Literature Review Wed, 13 Apr 2016 13:58:40 +0000 Congenital temporomandibular joint (TMJ) ankylosis is an uncommon condition that presents itself at or soon after birth in the absence of acquired factors that could have contributed to the ankylosis such as infection and trauma. The experience of managing one such case is reported in light of a review of the literature on this condition. Key management principles include adequate removal of the ankylotic mass, costochondral grafting, and post-op physiotherapy. Most patients reported in the literature with the condition experienced relapse. This echoes our own experience where there was recurrence of the ankylosis. However, after removal of the ankylotic mass, the patient maintains a satisfactory maximal incisal opening (MIO) till the present day. The additional challenges faced in the congenital form in addition to the already complex management of acquired paediatric temporomandibular joint ankylosis are (1) much earlier insult to the TMJ, (2) reduced opportunity for neuromuscular development of the muscles of mastication, and (3) reduced compliance with postoperative physiotherapy programmes due to the younger age of these patients. Ryan Chin Taw Cheong, Karim Kassam, Simon Eccles, and Robert Hensher Copyright © 2016 Ryan Chin Taw Cheong et al. All rights reserved. Revision Stapedectomy in a Female Patient with Inner Ear Malformation Wed, 06 Apr 2016 08:13:53 +0000 Objectives. We describe an unusual case of surgical management of congenital mixed hearing loss in a female patient with inner ear malformation. This report outlines the role of temporal bone imaging and previous surgical history in evaluating a patient’s risk of perilymph gusher during stapes surgery. Methods. A 68-year-old female patient with a history of profound bilateral mixed hearing loss due to ossicular and cochlear malformation presented to our otology clinic. She had undergone multiple unsuccessful previous ear surgeries. Computed tomography revealed bilateral inner ear malformations. She elected to proceed with revision stapedectomy. Results. The patient received modest benefit to hearing, and no operative complications occurred. Conclusions. Although stapedectomy has been shown to improve hearing in patients with stapes fixation, there is risk of perilymph gusher in patients with inner ear abnormalities. Evaluation and counseling of the risk of gusher during stapes surgery should be done on a case-by-case basis. Tirth R. Patel and Aaron C. Moberly Copyright © 2016 Tirth R. Patel and Aaron C. Moberly. All rights reserved. Laryngeal Langerhans Cell Histiocytosis Presenting with Neck Mass in an Adult Woman Tue, 05 Apr 2016 09:52:16 +0000 Langerhans cell histiocytosis (LCH) is a very rare condition that commonly affects the head and neck region. There are very few cases of isolated laryngeal involvement by LCH, mostly reported in pediatric patients. Here, we report a case of laryngeal LCH in a 62-year-old woman presenting with a neck mass several weeks ago. The clinical and histopathological findings are reported with a brief discussion about the disease. Hesam Jahandideh, Yasser Nasoori, Sara Rostami, and Mahdi Safdarian Copyright © 2016 Hesam Jahandideh et al. All rights reserved. Thyroglossal Duct Papillary Thyroid Carcinoma and Synchronous Lingual Thyroid Atypia Mon, 28 Mar 2016 16:24:12 +0000 Thyroglossal duct and lingual thyroid ectopic lesions are exceedingly rare synchronous findings. Papillary thyroid carcinoma of these ectopic thyroid sites is well understood but still a rare finding. This case points to some management nuances in regard to ectopic thyroid screening with imaging and also shows the effectiveness of minimally invasive transoral robotic surgery for lingual thyroid. Timothy Yoo, Yohanan Kim, Alfred Simental, and Jared C. Inman Copyright © 2016 Timothy Yoo et al. All rights reserved. Volumes of Velopharyngeal and Glossopharyngeal Airway Were Not Changed after Uvulopalatopharyngoplasty: Report of Three Cases Thu, 24 Mar 2016 09:30:01 +0000 Objective. The aim of this study was to investigate the changes in velopharyngeal and glossopharyngeal airway morphology and volume after uvulopalatopharyngoplasty in three adult obstructive sleep apnea syndrome patients who had bilateral large tonsils using three-dimensional computed tomography. Case Report. All three patients (one male and two females) who presented with a history of heavy snoring and excessive daytime sleepiness were examined with overnight nocturnal polysomnography, which indicated moderate-to-severe obstructive sleep apnea syndrome. Because all patients had large tonsils, uvulopalatopharyngoplasty was expected to enlarge the pharyngeal airway. Polysomnography and three-dimensional computed tomography scanning were performed and compared, both before and 3 months after uvulopalatopharyngoplasty. Results. Unexpectedly, although the morphology of the glossopharyngeal airway clearly changed after UPPP, the volume changes in the velopharyngeal and glossopharyngeal airways were negligible. Yoichi Nishimura, Naoko Fujii, Takahisa Yamamoto, Mahmood A. Hamed, Misato Nishimura, Takuro Kojima, Noboru Iwata, Kenji Suzuki, and Seiichi Nakata Copyright © 2016 Yoichi Nishimura et al. All rights reserved. Noninvasive Free Flap Monitoring Using Eulerian Video Magnification Tue, 22 Mar 2016 16:02:34 +0000 Eulerian Video Magnification (EVM) can enhance subtle changes in videos to reveal what was once invisible to the naked eye. In this proof of concept study, we investigated using EVM as a novel form of free flap monitoring. Free flaps with skin paddles were filmed in the operating room with manipulation of their pedicles. In a representative 77-year-old female who received a latissimus dorsi-serratus-rib composite free flap, EVM was able to detect blockage of arterial or venous supply instantaneously, providing a visible representation through degree of color change in videos. EVM has the potential to serve as a powerful free flap monitoring tool with the benefit of being noninvasive, sensitive, easy-to-use, and nearly cost-free. Yuan Fang Liu, Christopher Vuong, Paul Charles Walker, Nathaniel Ray Peterson, Jared Christian Inman, Pedro Alcantara Andrade Filho, and Steve Choon-Sung Lee Copyright © 2016 Yuan Fang Liu et al. All rights reserved.