Case Reports in Otolaryngology The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Aural Myiasis, a Rare Cause of Earache Mon, 24 Aug 2015 07:00:17 +0000 Myiasis of the ear is an infestation of the ear by maggots (the larval stage of flies). In the literature, there are only few cases reported about aural myiasis. It is more common to occur in tropical regions, where humidity and warm weather provide a good environment for this infestation. In this paper, a 12-year-old boy is reported to have unilateral earache for 3-day duration. Examination of the painful ear showed a tympanic membrane perforation with larvae (maggots) in the middle ear. They were removed by using a forceps and gentle irrigation of ear to expel any remnant. Further management included assessment of hearing, computed tomography (CT) scan, and outpatient follow-up. Ibrahim Al Jabr Copyright © 2015 Ibrahim Al Jabr. All rights reserved. Immunophenotype Heterogeneity in Nasal Glomangiopericytoma Mon, 17 Aug 2015 16:03:10 +0000 Nasal glomangiopericytoma is rare. The immunophenotype is heterogeneous, more frequently smooth-muscle-actin and CD34-positive. We report expression patterns for several vascular-related proteins such as CD99, CD146, Bcl2, and WT1 as well as for treatment-related proteins such as mTOR and EGFR in a nasal glomangiopericytoma. The patient (woman, 86 years) presented with a left nasal tumefaction. The resected specimen (1.5-cm) showed a glomangiopericytoma. Tumor cells expressed smooth-muscle-actin, CD31, CD34, and progesterone receptor. They also expressed the vascular-cell-related proteins Bcl2, CD99, CD146, and WT1, as well as mTOR and EGFR. Nasal glomangiopericytomas show immunohistochemical heterogeneity for vascular-related markers, suggesting a possible extensive pericytic differentiation. The expression of potential targets for drug treatments such as mTOR and EGFR may impact on the clinical follow-up of these tumors occurring at advanced ages, which may require complex surgery. Adriana Handra-Luca, Zakaria Y. Abd Elmageed, Christina Magkou, and Marick Lae Copyright © 2015 Adriana Handra-Luca et al. All rights reserved. Does Papillary Carcinoma of Thyroglossal Duct Cyst Develop De Novo? Sun, 16 Aug 2015 12:37:14 +0000 Backround. Thyroglossal duct cyst (TDC) is a developmental abnormality of the thyroid gland. Due to embryological remnants of thyroid tissue located in the TDC, the same malignant tumors that develop in the thyroid gland can also develop in the TDC. Methods. We present the unique case of a 39-year-old female with simultaneous de novo papillary carcinoma in a TDC and the thyroid gland. Results. With the suspicion of simultaneous papillary carcinoma in the TDC and the thyroid gland, Sistrunk procedure with total thyroidectomy and central neck exploration was performed. Conclusion. The clinician should have a high index of suspicion upon encountering papillary carcinoma of the TDC to differentiate de novo papillary carcinoma in the TDC from those originating from the thyroid gland, because papillary carcinoma in TDC may originate from an occult thyroid papillary carcinoma. Tekin Baglam, Adem Binnetoglu, Ali Cemal Yumusakhuylu, Berat Demir, Gokce Askan, and Murat Sari Copyright © 2015 Tekin Baglam et al. All rights reserved. Extratemporal Malignant Nerve Sheath Tumor of Facial Nerve with Coexistent Intratemporal Neurofibroma Mimicking Malignant Intratemporal Extension Sun, 09 Aug 2015 08:26:53 +0000 We present an extremely unusual case of an extratemporal facial nerve malignant peripheral nerve sheath tumor (MPNST) arising from preexistent intratemporal neurofibroma, illustrating a difficulty in discriminating between perineural spread of the MPNST and the preexistent intratemporal neurofibroma on preoperative radiographic images. The most interesting point was that preoperative CT scan and MR images led to misinterpretation that MPNST extended proximally along the facial nerve canal. It is important to recognize that the intratemporal perineural spread of neurofibromas and MPNST share common imaging characteristics. This is the first report (to our knowledge) of these 2 lesions coexisting in the facial nerve, leading to misinterpretation on preoperative images. Mitsuhiko Nakahira, Naoko Saito, and Masashi Sugasawa Copyright © 2015 Mitsuhiko Nakahira et al. All rights reserved. Mal de Debarquement Syndrome: A Rare Entity—A Case Report and Review of the Literature Wed, 05 Aug 2015 12:51:49 +0000 Mal de Debarquement Syndrome (MDS) is a rare, understudied, underdiagnosed, and self-limiting condition. Etiology and incidence are unknown. It is characterized by abnormal sensation of motion/balance reported after travel by air, land, and sea; being reexposed to motion/activity relieves it. Symptoms may last from minutes to years. Workup though required reveals no findings; it is a diagnosis of exclusion. While no efficacious treatment exists, amitriptyline and benzodiazepines as well as supportive therapy have proved to be useful. We have described a 40-year-old Caucasian female who presented for the evaluation of persistent rocking and swaying sensation after a ship cruise which lasted for one week. Patient was treated with benzodiazepines after extensive workup and is now stable. A high index of suspicion is required to make a diagnosis. Veronica Nwagwu, Rakesh Patel, and Jerome Okudo Copyright © 2015 Veronica Nwagwu et al. All rights reserved. Metastatic Prostate Cancer to the Left Temporal Bone: A Case Report and Review of the Literature Thu, 30 Jul 2015 12:41:21 +0000 Breast, lung, and prostate cancers are the three most common malignancies to metastasize to the temporal bone. Still, metastatic prostate cancer of the temporal bone is a rare finding, with approximately 21 cases reported in the literature and only 2 cases discovered more than 10 years after initial treatment of the primary. This disease may be asymptomatic and discovered incidentally; however, hearing loss, otalgia, cranial nerve palsies, and visual changes can all be presenting symptoms. We present the case of a 95-year-old man with history of primary prostate cancer treated 12 years earlier that was seen for new-onset asymmetric hearing loss and otalgia. The tympanic membranes and middle ears were normal; however, based on radiologic findings and eventual biopsy, the patient was diagnosed with extensive metastatic prostate cancer to the left temporal bone. This case (1) demonstrates that a high index of suspicion for unusual etiologies of seemingly benign symptoms must be maintained in elderly patients having prior history of cancer and (2) substantiates the value of temporal bone imaging when diagnosis may be unclear from history and physical exam. Erynne A. Faucett, Hal Richins, Rihan Khan, and Abraham Jacob Copyright © 2015 Erynne A. Faucett et al. All rights reserved. Fetal Rhabdomyoma of the Right Tonsil with Polyp-Like Appearance Mon, 13 Jul 2015 11:09:35 +0000 Skeletal muscle neoplasms, in contrast to other groups of tumors, are almost malignant. The benign variant, rhabdomyoma, is distinctly rare. Rhabdomyomas can be classified generally into two types: cardiac and extracardiac. Extracardiac rhabdomyoma can be further divided into three subtypes: adult, fetal, and genital type. Adult rhabdomyoma is the most common subtype of rhabdomyoma even though it remains relatively rare. Fetal rhabdomyomas are less common than the adult type. In this paper we report a rare case of a fetal rhabdomyoma with polyp-like appearance originating from right tonsil. Punch biopsy and then right tonsillectomy were performed for complete excision. There was no obvious recurrence. Ching-Ping Wang, Yi-Hao Chang, and Ya-Ting Chang Copyright © 2015 Ching-Ping Wang et al. All rights reserved. Mature Nasopharyngeal Teratoma in a Child Thu, 09 Jul 2015 13:37:57 +0000 Teratomas are neoplasms derived from the germ cell with components of all the three embryonic layers. These are rare neoplasms in head and neck region which can occur in any age group but are more prevalent in children. The present case is an 11-year-old girl who was brought with history of painless and progressive swelling in the oropharynx for 3 years with the associated left sided nasal blockage and nasal discharge. CT scan was suggestive of benign nasopharyngeal mass highly suspicious for lipoma. Excision of the mass was done under general anaesthesia. Peroperatively, it was a smooth, pedunculated mass arising from the left lateral wall in the nasopharynx. On cut section, it was solid to cystic mass similar to fatty tissue. Her HPE report came out to be mature teratoma of nasopharynx. Ramesh Parajuli, Suman Thapa, and Sushna Maharjan Copyright © 2015 Ramesh Parajuli et al. All rights reserved. Papillary Thyroid Microcarcinoma with a Large Cystic Dilated Lymph Node Metastasis to the Neck Mimicking a Branchial Cleft Cyst: A Potential Pitfall Thu, 09 Jul 2015 08:19:01 +0000 Lateral cervical cystic mass in a young adult very rarely could be a first sign of an occult thyroid papillary microcarcinoma metastasis. In this paper, we presented a 37-year-old male patient whose preoperative 6 cm left lateral cervical cystic mass was initially diagnosed as branchial cleft cyst, but then the postoperative histopathological examination of the mass was revealed as papillary thyroid carcinoma metastasis. Preoperative fine needle aspiration biopsy was relevant with a branchial cleft cyst. In the left thyroid lobe there were 3 solid nodules with 4, 6, and 12 mm dimensions, respectively. One of the nodules had malignant well-differentiated cells diagnosed after fine needle aspiration biopsy. After total thyroidectomy, histopathologic evaluation of biopsy material’s showed papillary thyroid microcarcinomas. This case indicates that especially in a young adult lateral cervical cystic mass should be carefully considered preoperatively for the possibility of metastatic occult thyroid carcinoma, especially for papillary carcinoma in differential diagnosis, and evaluation of the thyroid gland should be taken into account. Osman Ilkay Ozdamar, Gul Ozbilen Acar, Cigdem Kafkasli, M. Tayyar Kalcioglu, Tulay Zenginkinet, and H. Gonca Tamer Copyright © 2015 Osman Ilkay Ozdamar et al. All rights reserved. Solitary Fibrous Tumour of the Parotid Gland: A Case Report and Review of the Literature Mon, 06 Jul 2015 12:16:02 +0000 Introduction. Solitary fibrous tumours (SFT) of the parotid gland are a very rare group of spindle-cell tumours with only 28 cases reported in the literature. This review aims to report an additional case of parotid SFT and provide a review of all reported cases of this rare condition. Case Presentation. A 26-year-old male presented a 3 cm well-demarcated, slowly enlarging mass which was completely excised, revealing histological and immunohistochemical features of SFT. Discussion. Reviews of all reported cases suggest that histology and immunohistochemistry are paramount in the diagnosis of SFT. These features, along with clinical presentation and management of this rare condition, will be discussed. Matthew M. Kwok, Muthukumar Subramaniyan, and Sor Way Chan Copyright © 2015 Matthew M. Kwok et al. All rights reserved. Solitary Laryngeal Metastasis from Transitional Cell Carcinoma of the Kidney: Clinical Case and Review of the Literature Mon, 06 Jul 2015 11:23:56 +0000 The urogenital tract is a rare origin of laryngeal metastasis; transitional cell carcinoma with laryngeal metastases had never been reported previously. In this paper, we describe the clinical and pathological characteristics, evolution, and treatment of the first reported case of a laryngeal metastasis of a TCC followed by a brief review of the literature. Tarek Assi, Elie El Rassy, Amine Haddad, and Joseph Kattan Copyright © 2015 Tarek Assi et al. All rights reserved. Partial Recurrent Laryngeal Nerve Paralysis or Paresis? In Search for the Accurate Diagnosis Mon, 06 Jul 2015 10:14:27 +0000 “Partial paralysis” of the larynx is a term often used to describe a hypomobile vocal fold as is the term “paresis.” We present a case of a dysphonic patient with a mobility disorder of the vocal fold, for whom idiopathic “partial paralysis” was the diagnosis made after laryngeal electromyography, and discuss a proposition for a different implementation of the term. Alexander Delides, Panagiotis Kokotis, and Pavlos Maragoudakis Copyright © 2015 Alexander Delides et al. All rights reserved. Pediatric Masked Mastoiditis Associated with Multiple Intracranial Complications Sun, 28 Jun 2015 14:15:09 +0000 Masked mastoiditis is a distinct form of mastoiditis with little or no symptomatology, characterized by its potential to generate severe otogenic complications. Therefore, suspected masked mastoiditis should be diagnosed and treated without delay. This study reports a rare case of masked mastoiditis, manifested by multiple intracranial complications in an immunocompetent girl. The child exhibited headache and neurological symptomatology. Imaging studies revealed an epidural and a large cerebellar abscess and the patient was immediately treated with a triple antibiotic therapy. Mastoid surgery and drainage of the epidural abscess took place after the stabilization of the patient’s neurologic status, on the 3rd hospitalization day. The cerebellar abscess was treated by craniectomy and ultrasound-guided needle aspiration in the 3rd week of hospitalization. The girl was finally discharged in excellent condition. Two years later, she is still in good health, without otological or neurological sequelae. Masked mastoiditis is an insidious disease which requires increased clinical awareness and adequate imaging. Should clinical and/or radiological findings be positive, mastoidectomy must follow in order to prevent severe otogenic complications that can be triggered by masked mastoiditis. Charalampos Voudouris, Ioannis Psarommatis, Ioannis Nikas, Dimitrios Kafouris, and Konstantina Chrysouli Copyright © 2015 Charalampos Voudouris et al. All rights reserved. Operative Management of OSAS in a Complex Case of Proteus Syndrome Tue, 23 Jun 2015 10:00:11 +0000 Obstructive sleep apnea syndrome (OSAS) is a common disorder in childhood with high prevalence in syndromic subjects with craniofacial malformations. Proteus Syndrome (PS) is a rare hamartoneoplastic disorder associated with disproportionate and asymmetric overgrowth of body parts and hypertrophy or malformation of lymphatic tissues, such as palatine tonsils. We report a case of a 12-year-old boy diagnosed with Proteus Syndrome (PS) and suffering from OSAS due to asymmetric palatine tonsillar hypertrophy, treated with partial resection of left tonsil. To avoid the risk of a general anesthesia and remove only the obstructive portion of the palatine tonsil bipolar radiofrequency-induced thermotherapy (RFITT) under local anesthesia was performed. Recovery of the obstructive respiratory disease was obtained. To our knowledge, this is the first case reported in the literature of partial tonsillar resection performed in a patient with PS suffering from OSAS under local anesthesia. Elena Cantone, Michele Cavaliere, Giovanni Castagna, Anna Marino, Luigi Del Vecchio, and Maurizio Iengo Copyright © 2015 Elena Cantone et al. All rights reserved. An Unusual Case of Bony Styloid Processes That Extend to the Hyoid Bone Mon, 22 Jun 2015 10:56:00 +0000 The embryological origin of the hyoid bone is a point of uncertainty, with controversy surrounding the relative contribution of the second pharyngeal arch to hyoid development. We encountered a 52-year-old male with bilateral bony styloid extension to the lesser cornu of the hyoid bone during the workup of a patient with laryngeal cancer. This embryological malformation clearly supports the hypothesis that the second pharyngeal arch gives rise to the lesser cornu and demonstrates an unusual clinical finding that may be encountered by otolaryngologists. We demonstrate the imaging findings and surgical management of this unusual anatomical variant and review the embryological basis for this rare malformation. Shekhar K. Gadkaree, Christopher G. Hyppolite, Aisha Harun, Ryan H. Sobel, and Young Kim Copyright © 2015 Shekhar K. Gadkaree et al. All rights reserved. Thyroid Hemiagenesis Associated with Hyperthyroidism Mon, 22 Jun 2015 06:07:11 +0000 Thyroid hemiagenesis (TH), very rare congenital anomaly, is generally asymptomatic. We report two cases of TH with hyperthyroidism. Case One. The patient presented with signs and symptoms of thyrotoxicosis. Physical examination revealed asymmetric nodular goitre at right lobe. Biochemical analysis revealed the diagnosis of hyperthyroidism. Ultrasound showed multinodular hypertrophy in the right lobe and absence of the left lobe. Nuclear scan, confirming absence of the left lobe, showed hot nodules in the right one. The diagnosis was toxic multinodular goitre. Case Two. The thyroid was not palpable in this patient presented with signs and symptoms of thyrotoxicosis. Biochemical analysis revealed the diagnosis of autoimmune thyrotoxicosis. Ultrasound showed mild diffuse hyperplasia of the right lobe and agenesis of the left lobe. Nuclear scan, confirming absence of the left lobe, showed increasing diffuse uptake of radiotracer in the right one. The diagnosis was Graves’ disease in this patient. After antithyroid medication, the patients were surgically treated with total excision of the thyroid tissue. TH is sometimes associated with disorders of the thyroid. Hyperthyroidism makes TH cases symptomatic. During evaluation of patients, ultrasound and nuclear scan usually report agenesis of one lobe and establish the diagnosis of TH. The surgical treatment is total removal of hyperactive tissue and total excision of the remaining lobe. Gunay Gurleyik and Emin Gurleyik Copyright © 2015 Gunay Gurleyik and Emin Gurleyik. All rights reserved. An Inflammatory Pseudotumor Arising from Pterygopalatine Fossa with Invasion to the Maxillary Sinus and Orbital Cavity Thu, 18 Jun 2015 12:35:59 +0000 We report a patient who had an inflammatory pseudotumor (IPT) that invaded to the maxillary sinus and orbital cavity, with the left pterygopalatine fossa as the principal site; this is a very rare case. The patient was an 83-year-old woman who suddenly became aware of impairment in the eyesight and visual field of the left eye. CT images showed a neoplastic lesion that invaded to the maxillary sinus and orbital cavity, with the left pterygopalatine fossa as the principal site, and also showed contrast effects. To obtain a definitive diagnosis from histopathological analysis, the lesion was biopsied, and she was diagnosed as the inflammatory pseudotumor with the immunohistochemical study and multiplex polymerase chain reaction-based clonality assays. The patient had a lymphoid-predominant lesion that responded to radiotherapy but corticosteroids were not effective. It is important to scrutinize the pathology to avoid unnecessary and mutilating surgery. Hidenori Yokoi, Takuya Yazawa, Yuma Matsumoto, Tetsuya Ikeda, Masachika Fujiwara, Yasuo Ohkura, and Naoyuki Kohno Copyright © 2015 Hidenori Yokoi et al. All rights reserved. A Puzzle of Vestibular Physiology in a Meniere’s Disease Acute Attack Thu, 18 Jun 2015 09:23:21 +0000 The aim of this paper is to present for the first time the functional evaluation of each of the vestibular receptors in the six semicircular canals in a patient diagnosed with Meniere’s disease during an acute attack. A 54-year-old lady was diagnosed with left Meniere’s disease who during her regular clinic review suffers an acute attack of vertigo, with fullness and an increase of tinnitus in her left ear. Spontaneous nystagmus and the results in the video head-impulse test (vHIT) are shown before, during, and after the attack. Nystagmus was initially left beating and a few minutes later an upbeat component was added. No skew deviation was observed. A decrease in the gain of the vestibuloocular reflex (VOR) and the presence of overt saccades were observed when the stimuli were in the plane of the left superior semicircular canal. At the end of the crisis nystagmus decreased and vestibuloocular reflex returned to almost normal. A review of the different possibilities to explain these findings points to a hypothetical utricular damage. Marta Martinez-Lopez, Raquel Manrique-Huarte, and Nicolas Perez-Fernandez Copyright © 2015 Marta Martinez-Lopez et al. All rights reserved. Isolated Sensorineural Hearing Loss as a Sequela after Lightning Strike Tue, 16 Jun 2015 12:15:39 +0000 In most of the surviving patients after a lightning strike, audiovestibular abnormalities have been reported. The most frequently reported type of abnormalities is a tympanic membrane perforation with hearing loss and external ear canal burn. However a sensor neural hearing loss and mixed type hearing loss can also occur, but these occur rarely. A nineteen-year-old female patient had, after a lightning strike, serious burns on the left ear, behind the ear, and on the chest and neck. She also had in her left ear 108 dB hearing loss with irregular central perforation and in her right ear 52 dB sensorineural hearing loss. There was no hearing loss before the strike. A hearing aid was recommended for the right ear and good care and follow-up were recommended for the left ear. A lightning strike can cause serious audiological damage. Therefore, it is necessary to make a careful audiovestibular evaluation of the patients. Although there exist rarely healed cases from sensorineural hearing loss after lightning strike in literature, in our case hearing loss occurred bilaterally and then it healed unilaterally. This condition is quite rare in literature. Mahfuz Turan, Ferhat Kalkan, Nazım Bozan, İsa Özçalimli, Mehmet Zeki Erdem, Abdülaziz Yalınkılıç, and Mehmet Fatih Garca Copyright © 2015 Mahfuz Turan et al. All rights reserved. Bilateral Facial Paralysis Caused by Bilateral Temporal Bone Fracture: A Case Report and a Literature Review Sun, 14 Jun 2015 09:57:16 +0000 Bilateral facial paralysis caused by bilateral temporal bone fracture is a rare clinical entity, with seven cases reported in the literature to date. In this paper, we describe a 40-year-old male patient with bilateral facial paralysis and hearing loss that developed after an occupational accident. On physical examination, House-Brackmann (HB) facial paralysis of grade 6 was observed on the right side and HB grade 5 paralysis on the left. Upon temporal bone computed tomography (CT) examination, a fracture line exhibiting transverse progression was observed in both petrous temporal bones. Our patient underwent transmastoid facial decompression surgery of the right ear. The patient refused a left-side operation. Such patients require extensive monitoring in intensive care units because the presence of multiple injuries means that facial functions are often very difficult to evaluate. Therefore, delays may ensue in both diagnosis and treatment of bilateral facial paralysis. Sultan Şevik Eliçora, Aykut Erdem Dinç, Sultan Bişkin, Murat Damar, and Ergin Bilgin Copyright © 2015 Sultan Şevik Eliçora et al. All rights reserved. Isolated Nasal Tip Metastasis from Esophageal Squamous Cell Carcinoma: Case Report and Literature Review Sun, 14 Jun 2015 08:35:43 +0000 Objectives. Cutaneous metastases can be the first sign of a malignant disease and have an unfavorable prognostic significance. The external nose is rarely affected. The uncommon clinical presentation of these cutaneous metastases may lead to the wrong diagnosis and treatment. Methods. We present the case of a 59-year-old patient with a small indolent tumor on the tip of the nose that turned out to be the first sign of an extended esophageal cancer. Conclusion. The differential diagnosis of tumors of the facial skin and the nasal tip includes metastases from an unknown primary tumor. In rare cases, squamous cell carcinoma of the esophagus needs to be considered. Georg J. Ledderose and Anna S. Englhard Copyright © 2015 Georg J. Ledderose and Anna S. Englhard. All rights reserved. Primary Small Cell Carcinoma of the Hypopharynx: A Case Report of a Rare Tumor Sun, 07 Jun 2015 06:28:57 +0000 Introduction. Primary hypopharynx involvement of small cell carcinoma is very rare and very few cases have been reported in the literature. Here, we report a case of primary small cell carcinoma of the hypopharynx in a male patient. Case Report. A 50-year-old man presented with a 6-month history of sore throat and swellings in the right side of the neck. Direct laryngoscopy and biopsy revealed small cell carcinoma of the hypopharynx located in the right pyriform sinus. Discussion. Small cell carcinoma of the hypopharynx has no clear treatment modality due to the rarity of the disease. Systemic chemotherapy and radiotherapy should have priority among the therapy regimens because of the high metastatic potential of the tumor. Ali Bayram, Ebru Akay, Sema S. Göksu, and İbrahim Özcan Copyright © 2015 Ali Bayram et al. All rights reserved. Extramedullary Plasmacytoma of the Larynx Treated by a Surgical Endoscopic Approach and Radiotherapy Thu, 04 Jun 2015 09:18:46 +0000 Extramedullary plasmacytoma (EMP) is a rare variant of plasma cell myeloma that affects soft tissues. The head and neck region are the most affected sites, although others have also been described. Herein we report an uncommon case of EMP of the larynx in a 65-year-old male who presented with a history of progressive dysphonia and hoarseness. Laryngeal fiberscopy evidenced a reddish pedicled voluminous mass in the left false cords and ventricle. Microscopic suspension laryngoscopy was performed under general anaesthesia and a 4 W Acublade CO2 Laser was used for transoral resection of the lesion. This was followed by adjuvant radiotherapy, with the widely recommended doses on the supraglottic region, to achieve better local control. Diagnosis of EMP is based on immunohistochemistry and the exclusion of systemic plasma cell proliferative disorders. Diagnosis of solitary EMP can be made only if studies for disseminated disease and X-ray and/or magnetic resonance imaging of the spine, pelvis, femurs, and humerus and bone marrow biopsy are negative. As there are no internationally established guidelines, treatment of EMP is mainly based on consensus of expert opinion. Massimiliano Pino, Filippo Farri, Pietro Garofalo, Fausto Taranto, Andrea Toso, and Paolo Aluffi Copyright © 2015 Massimiliano Pino et al. All rights reserved. Endoscopic Modified Medial Maxillectomy for Resection of an Inverted Papilloma Originating from the Entire Circumference of the Maxillary Sinus Wed, 03 Jun 2015 06:09:16 +0000 For treatment of a sinonasal inverted papilloma (IP), it is essential to have a definite diagnosis, to identify its origin by computed tomography (CT) and magnetic resonance imaging (MRI), and to select the appropriate surgical approach based on the staging system proposed by Krouse. Recently, a new surgical approach named endoscopic modified medial maxillectomy (EMMM) was proposed. This approach can preserve the inferior turbinate and nasolacrimal duct. We successfully treated sinonasal IP with EMMM in a 71-year-old female patient. In this patient, the sinonasal IP originated from the entire circumference of the maxillary sinus. EMMM is not a difficult procedure and provides good visibility of the operative field. Lacrimation and empty nose syndrome do not occur postoperatively as the nasolacrimal duct and inferior turbinate are preserved. EMMM is considered to be a very favorable approach for treatment of sinonasal IP. Kota Wada, Takashi Ishigaki, Yutaro Ida, Yuki Yamada, Sachiko Hosono, and Hideo Edamatsu Copyright © 2015 Kota Wada et al. All rights reserved. Internal Carotid Artery Aneurysm Mimicking Peritonsillar Abscess Mon, 01 Jun 2015 12:10:04 +0000 The extracranial internal carotid artery aneurysm (EICAA) is an uncommon arterial lesion. Patients typically present with neurologic symptoms resulting from impaired cerebral perfusion and compression symptoms of cranial nerves. Often EICAA presents as a pulsatile neck mass, which is otherwise asymptomatic. We present a case of an 84-year-old female, who was initially referred to the Emergency Department for Otolaryngology with suspected peritonsillar abscess. The patient had a history of recent upper airway infection and cardiovascular comorbidities, including hypertension and ischaemic stroke complicated by extensive neurologic deficits. Physical examination revealed a compact, nonpulsatile mass in the lateral parapharyngeal space and local erythema of the mucosa. Duplex Doppler Ultrasonography and Computed Tomography revealed an atherosclerotic aneurysm of the right internal carotid artery, measuring  mm, stretching from the skull base to the angle of the mandible. Jacek Brzost, Anna M. Cyran, Martyna Waniewska, and Miroslaw J. Szczepanski Copyright © 2015 Jacek Brzost et al. All rights reserved. A New Variant of Posterior Canal Benign Paroxysmal Positional Vertigo: A Nonampullary or Common Crus Canalolithiasis Sun, 31 May 2015 14:04:48 +0000 Clockwise or counterclockwise, rotational, upbeating nystagmus is seen in patients with posterior canal benign paroxysmal positional vertigo during left or right head-hanging test, respectively. Rotating of nystagmus in opposite direction to the ear tested or even reversal of initial positioning rotational nystagmus is not usual and has never been reported before. We propose a new variant of posterior canal benign paroxysmal positional vertigo due to unusual behavior and location of the otoliths inside the membranous labyrinth. Unexpected rotational direction may lead to confusion about the site. The examiner should be aware of this abnormal or atypical variant of posterior canal benign paroxysmal positional vertigo. Sertac Yetiser Copyright © 2015 Sertac Yetiser. All rights reserved. Pleomorphic Adenoma of the External Auditory Canal: A Rare Presentation Wed, 27 May 2015 14:12:52 +0000 A 55-year-old male presented with a nine-month history of gradually enlarging, painless mass in the right external auditory canal associated with hearing loss and occasional bleeding. Examination demonstrated complete obstruction of the outer 1/3 of the external auditory canal by a firm, pink, rubbery mass. CT scan of the temporal bone showed tumor mass with no evidence of bone destruction. The tumor was excised and histopathology confirmed a diagnosis of ceruminous pleomorphic adenoma of the external auditory canal. Six months following the surgery, patient is free of any recurrent disease. Samir Jaber, Milan Rudic, and Ivan James Keogh Copyright © 2015 Samir Jaber et al. All rights reserved. Ossifying Parotid Carcinoma ex Pleomorphic Adenoma Sun, 17 May 2015 12:46:09 +0000 We present a unique case of an extensively ossified carcinoma ex pleomorphic adenoma (CXPA) in a 76-year-old man with a five-year history of a slowly growing parotid mass. Fine-needle aspiration of the mass was nondiagnostic. A computed tomography (CT) scan of the lesion revealed a well-circumscribed mass with peripheral calcification. Initial pathological analysis suggested a benign parotid mass, but rigorous decalcification revealed noninvasive CXPA. The patient underwent complete resection of the mass and remained disease-free nine months later. Extensive ossification of a seemingly benign parotid mass may mask areas of carcinoma that may progress if left untreated. Suresh Mohan, Sidharth V. Puram, Bharat Yarlagadda, Vania Nosé, and Daniel G. Deschler Copyright © 2015 Suresh Mohan et al. All rights reserved. Rare Head and Neck Benign Mesenchymoma in Close Proximity to Submandibular Gland in a Pediatric Patient: Case Report and Review of the Literature Tue, 12 May 2015 11:22:16 +0000 Pediatric head and neck masses are commonly congenital in origin or of infectious etiology. We present a rare case of benign mesenchymoma in close proximity to the submandibular gland in an otherwise asymptomatic child. Computerized tomography (CT) scan of the head and neck area revealed a benign lesion, which was later determined to be a benign mesenchymoma on histopathology. The child did well after surgery without any reported recurrence. We discuss the salient features of a benign mesenchymoma in a child and also discuss relevant imaging and management. Priyanka Jain and Shraddha Mukerji Copyright © 2015 Priyanka Jain and Shraddha Mukerji. All rights reserved. Rosai-Dorfman Disease Originating from Nasal Septal Mucosa Sun, 10 May 2015 14:34:29 +0000 Rosai-Dorfman disease is a rarely seen disease with unknown etiology. Extranodal involvement is most commonly seen in the head and neck region. Histopathologically, it is characterized by histiocytic cell proliferation. This paper presents a case of a 15-year-old male patient who presented with nasal obstruction and was surgically treated for a mass filling in the left nasal meatus that was diagnosed to be Rosai-Dorfman disease by histopathological examination. Abdulvahap Akyigit, Hadice Akyol, Oner Sakallioglu, Cahit Polat, Erol Keles, and Ozkan Alatas Copyright © 2015 Abdulvahap Akyigit et al. All rights reserved.