Case Reports in Otolaryngology The latest articles from Hindawi Publishing Corporation © 2016 , Hindawi Publishing Corporation . 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. Cardiovocal Syndrome Secondary to an Aortic Aneurysm Sun, 20 Mar 2016 09:54:35 +0000 We reported that a 68-year-old man presented to the ENT outpatient department complaining of hoarseness for more than 10 months. Clinical exam identified left vocal palsy in the paramedian position and atrophic vocal folds were noted. Chest radiography revealed a large bulging contour overlying aorta and left hilar shadow. Aortic aneurysm was proved by CT scanning. Contrast-enhanced chest computed tomography for further evaluation showed a broad-based aortic aneurysm at proximal descending aorta, projecting anterolaterally. Cardiovocal syndrome was proved. The syndrome is a rare clinical presentation. While a patient with unilateral vocal palsy is encountered, one might keep in mind the possibility of cardiovocal syndrome especially in an adult who had a cardiovascular disease. Hsing-Won Wang, Mei-Chien Chen, Pin-Zhir Chao, and Fei-Peng Lee Copyright © 2016 Hsing-Won Wang et al. All rights reserved. Growth Rate Analysis of an Untreated Glomus Vagale on MRI Thu, 17 Mar 2016 07:12:29 +0000 Paragangliomas are slow growing, hypervascular neuroendocrine tumors that develop in the extra-adrenal paraganglion tissues. Paraganglioma involving the vagus nerve ganglia is termed glomus vagale. The slow growth of head and neck paragangliomas especially in the absence of symptom may obviate the necessity for any active intervention, in which case, a “wait and scan” policy is implemented involving long-term clinical and radiologic follow-ups. We present a case of a 71-year-old female with an untreated left glomus vagale who underwent a conservative “wait and rescan” plan of management and the tumor was observed with 8 serial MRI scans over a period of 7.4 years. A growth rate analysis was conducted which demonstrated a slow growth. A literature review of radiologic studies examining the natural history of head and neck paragangliomas was also performed. Jeffrey Tzu-Yu Wang, Allen Yu-Yu Wang, Sheila Cheng, Lavier Gomes, and Melville Da Cruz Copyright © 2016 Jeffrey Tzu-Yu Wang et al. All rights reserved. Papillary Thyroid Cancer in a Child with Progressive Transformation of Germinal Centers Wed, 16 Mar 2016 11:08:42 +0000 Objectives. To describe the presentation and management of a child with Progressive Transformation of Germinal Centers (PTGC), an uncommon condition characterized by significant persistent lymphadenopathy, who developed papillary thyroid carcinoma and to explore and review potential links between PTGC and neoplastic processes in the head and neck. Methods. Case presentation and literature review are used. Results. A 10-year-old female presented with a right parotid mass and cervical lymphadenopathy. Multiple biopsies revealed PTGC without malignancy. Two years later, she developed fatigue and weight gain, and a thyroid nodule was found. Fine needle aspiration was strongly suggestive of papillary thyroid carcinoma. The patient underwent total thyroidectomy and central neck dissection without surgical management of the longstanding right lateral neck lymphadenopathy. Final pathology confirmed papillary thyroid carcinoma. She was treated with radioactive iodine therapy postoperatively and remains free of disease at three years of follow-up. Conclusions. PTGC is considered a benign condition but has previously been associated with Nodular Lymphocyte Predominant Hodgkin Lymphoma (NLPHL). This is the first reported case of papillary thyroid cancer in a child with preexisting cervical PTGC and no defined risk factors for thyroid malignancy. No link has been established with thyroid carcinoma, but patients with PTGC may have a defect in immune surveillance that predisposes them to malignancy. Suresh Mohan, Bradley DeNardo, Dariusz Stachurski, Jennifer Greene Welch, and Jan C. Groblewski Copyright © 2016 Suresh Mohan et al. All rights reserved. Voluminous Myoepithelioma of the Minor Salivary Glands Involving the Base of the Tongue Sun, 13 Mar 2016 07:23:47 +0000 Myoepithelioma is an extremely rare tumour subtype and diagnosis is based on a wide variation of cellular morphology. FNAC specimens do not always suffice for a definitive differential diagnosis which depends on histology and immunohistochemistry of the lesion. Case Presentation. A 54-year-old female came to our attention with dysphagia and dyslalia of 6-month standing. Ear, Nose, and Throat (ENT) examination revealed a voluminous mass on the right portion of the base of her tongue, where postcontrast T2-weighted Magnetic Resonance Imaging (MRI) evidenced a hyperintense lesion. The fine-needle aspiration specimen taken for cytology was not diagnostic, as a differential diagnosis between myoepithelioma and a malignant neoplasm of the salivary glands necessitates parameters that cytology alone cannot provide. Therefore, the whole lesion was excised by diode laser through a transoral approach. Histology and immunohistochemistry of the completely excised lesion confirmed a myoepithelioma. Mario Policarpo, Valentina Longoni, Pietro Garofalo, Paolo Spina, and Francesco Pia Copyright © 2016 Mario Policarpo et al. All rights reserved. Surgical Approaches to First Branchial Cleft Anomaly Excision: A Case Series Mon, 29 Feb 2016 12:05:41 +0000 Objectives. First branchial cleft anomalies (BCAs) constitute a rare entity with variable clinical presentations and anatomic findings. Given the high rate of recurrence with incomplete excision, identification of the entire tract during surgical treatment is of paramount importance. The objectives of this paper were to present five anatomic variations of first BCAs and describe the presentation, evaluation, and surgical approach to each one. Methods. A retrospective case review and literature review were performed. We describe patient characteristics, presentation, evaluation, and surgical approach of five patients with first BCAs. Results. Age at definitive surgical treatment ranged from 8 months to 7 years. Various clinical presentations were encountered, some of which were atypical for first BCAs. All had preoperative imaging demonstrating the tract. Four surgical approaches required a superficial parotidectomy with identification of the facial nerve, one of which revealed an aberrant facial nerve. In one case the tract was found to travel into the angle of the mandible, terminating as a mandibular cyst. This required en bloc excision that included the lateral cortex of the mandible. Conclusions. First BCAs have variable presentations. Complete surgical excision can be challenging. Therefore, careful preoperative planning and the recognition of atypical variants during surgery are essential. Lourdes Quintanilla-Dieck, Frank Virgin, Chistopher Wootten, Steven Goudy, and Edward Penn Jr. Copyright © 2016 Lourdes Quintanilla-Dieck et al. All rights reserved. Hyperprolactinemia Secondary to Allergic Fungal Sinusitis Compressing the Pituitary Gland Sun, 21 Feb 2016 06:50:33 +0000 Objective. We aim to describe the first case in the literature of allergic fungal sinusitis (AFS) presenting with hyperprolactinemia due to compression of the pituitary gland. Case Presentation. A 37-year-old female presented with bilateral galactorrhea and occipital headaches of several weeks. Workup revealed elevated prolactin of 94.4, negative pregnancy test, and normal thyroid function. MRI and CT demonstrated a 5.0 × 2.7 × 2.5 cm heterogeneous expansile mass in the right sphenoid sinus with no pituitary adenoma as originally suspected. Patient was placed on cabergoline for symptomatic control until definitive treatment. Results. The patient underwent right endoscopic sphenoidotomy, which revealed nasal polyps and fungal debris in the sphenoid sinus, consistent with AFS. There was bony erosion of the sella and clivus. Pathology and microbiology were consistent with allergic fungal sinusitis caused by Curvularia species. Prolactin levels normalized four weeks after surgery with resolution of symptoms. Conclusion. Functional endoscopic sinus surgery alone was able to reverse the patient’s pituitary dysfunction. To our knowledge, this is the first case of AFS presenting as hyperprolactinemia due to pituitary compression. Nikita Chapurin, Cynthia Wang, David M. Steinberg, and David W. Jang Copyright © 2016 Nikita Chapurin et al. All rights reserved. The Clinical Understaging of Recurrent Glottic Carcinoma after Radiation Failure Thu, 18 Feb 2016 11:34:37 +0000 Background. Recurrent glottic squamous cell carcinomas following radiation therapy for early staged tumors are oftentime early staged tumors. Management of these early stage recurrences presents a dilemma for the head and neck surgeon. Difficulties in appropriate tumor mapping, preoperative analysis, and poor understanding of the virulent pathologic nature of the recurrence may impede surgical decision-making. Methods. This is a single surgeon case report, presenting a patient with rapid recurrence following salvage transoral resection for an early stage recurrence, necessitating a total laryngectomy. Results. A review of the literature was performed, identifying studies that expound on the pathologic behavior of radiation recurrent disease. Conclusions. Radiation recurrent glottic squamous cell carcinoma has a distinct pathologic behavior and aggressive nature. Disease virulence, coupled with difficulty in appropriate staging and preoperative tumor mapping, should guide the surgeon when deciding the surgical management in the salvage setting. Moustafa Mourad, Sami P. Moubayed, Ilya Likhterov, and Mark Urken Copyright © 2016 Moustafa Mourad et al. All rights reserved.