A Rare De Novo Myoepithelial Carcinoma Ex Pleomorphic Adenoma in a Young WomanRead the full article
Case Reports in Otolaryngology publishes case reports and case series in all areas of otolaryngology, including head and neck surgery, facial plastic and reconstructive surgery, maxillofacial surgery, and pediatric otolaryngology.
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Needle Tract Seeding of Thyroid Follicular Carcinoma after Fine-Needle Aspiration
Introduction. Fine-needle aspiration (FNA) biopsies are fundamental procedures in the diagnoses of thyroid tumours. Reports of needle tract tumour seeding, however, question its practice regarding patient safety and potentially jeopardizing its widespread usage. Case Report. We describe a case of a 50-year-old lady with known multinodular goitre, and previous fine-needle aspiration (FNA) biopsies of her thyroid nodules in 2010, who developed palpable right neck nodules 8 years after the initial FNA. Imaging and histological biopsies revealed suspicious right sternocleidomastoid (SCM) nodules that are likely needle tract tumour deposits. She underwent a total thyroidectomy with central compartment clearance and excision of the right SCM nodules and received radioactive iodine therapy thereafter. Discussion. Contrary to other forms of malignancies, needle tract seeding is an uncommon occurrence for thyroid cancers. Nevertheless, there is speculation regarding its potential in cutaneous spread of malignancy with studies investigating its optimal techniques and application. Conclusion. While FNA remains an indisputable tool in the management of thyroid tumours, precautions must be taken to safeguard patient safety and improve patient outcomes.
Gradenigo’s Syndrome with Carotid Septic Stenosis
Gradenigo’s syndrome was firstly described in 1907 by Giusseppe Gradenigo and is defined as the clinical triad of suppurative otitis media, ipsilateral abducens nerve palsy, and pain in the distribution of the first and the second branches of the trigeminal nerve. Since the advent of antibiotics, the incidence of this potentially life-threatening complication has diminished, but occasional cases still occur. We herein report a pediatric case of otitis media associated with Gradenigo’s syndrome complicated by ipsilateral septic cavernous sinus thrombosis and infectious arteritis of the internal carotid artery.
Unusual Mechanism of Facial Nerve Palsy Caused by Penetrating Neck Trauma
We present a case of a low energy penetrating neck injury with only facial nerve (FN) palsy in the clinical finding. A 32-year-old male patient was admitted to the emergency department with a penetrating injury on the right side of the neck just behind the right ear, accompanied by evident right (FN) palsy, evaluated as House Brackmann grade IV. Computed tomography demonstrated an isolated soft tissue injury in the right retroauricular region without bone fracture, parotid gland lesion, or vascular structure involvement. The FN palsy was treated with corticosteroids (CS), and the patient had an uneventful and complete recovery. This case report presents an unusual mechanism of isolated, extratemporal, blunt injury of the FN after a penetrating neck injury followed by complete recovery.
Electrode Afterload: A Valuable Technique in a Case of Short Electrode Insertion
Introduction. The location of the electrode inside the cochlea is important for speech performance. However, many variables, including array length, insertion depth, and individual anatomy, may affect the intracochlear position of the electrode. Insertion deeper than 20 mm and revision surgery are critical situations in which residual hearing and electrode integrity may be at risk. This case report challenges this hypothesis and raises the following question: is it possible to achieve a better speech understanding with an electrode afterload without compromising residual hearing? Case Report. A 73-year-old female patient showed up for evaluation of hearing loss. The patient was operated four times in an external hospital due to cholesteatoma formation in the right ear. Related to a poor aided speech understanding, a CI-surgery was performed. 5 months after the surgery, the subject returned with poor speech understanding. A revision surgery was performed, where the first white marker of the electrode was seen in the round window (20 mm). The electrode was inserted 4 mm deeper into the cochlea. After six and twelve months, the results of the Freiburger monosyllabic speech test improved till 25% and 45%, respectively. Discussion. Hearing preservation is possible with a revisional deeper insertion from 20 mm to 24 mm. In this case, a partial obliteration of an open cavity made the electrode surgically easily accessible. This allowed the deeper insertion during the revision surgery. In a regular surgical field with a posterior tympanotomy, the revision surgery is more challenging and brings the electrode into the risk of an iatrogenic destruction. Conclusion. This case of an electrode afterload after having inserted the electrode initially to mm, demonstrates that hearing can be preserved and speech perception can improve after performing this maneuver.
Successful Treatment of a Mixed Neuroendocrine-Nonneuroendocrine Neoplasm of the Colon with Metastases to the Thyroid Gland and Liver
Patients with mixed neuroendocrine-nonneuroendocrine neoplasms (MiNENs) of the colon have poor prognosis. Herein, we report a patient with MiNEN of the colon with metastases to the liver and the thyroid gland, with long-term survival. A 45-year-old man presented with anterior neck swelling. Histopathological examination of the thyroid tumor revealed neuroendocrine carcinoma (NEC), suggesting that a primary NEC in another organ had metastasized to the thyroid gland. Computed tomography to identify a primary NEC revealed two tumors: one in the liver and one in the transverse colon. A biopsy revealed that the histopathology of the liver and colon tumors was NEC and adenocarcinoma, respectively. Thereafter, the patient underwent surgical resection of the colon tumor and was finally diagnosed as colon MiNEN with metastases to the thyroid and liver. The surgical resection of the metastatic liver tumor was performed after several courses of systemic chemotherapy, and the patient survives presently without any recurrence for approximately seven years after the diagnosis. Surgical resection of each metastatic lesion combined with systematic chemotherapy apparently improved the prognosis of MiNEN of the colon with distant metastases.
Surgical Management of Bilateral Venous Malformation (Cavernous Hemangiomas) of the Maxillary Sinus
According to International Society for the Study of Vascular Anomalies classification 2018, “hemangioma” should be classified as either vascular tumor or vascular malformation (VM). So-called “cavernous hemangioma” is categorized as VM. VM rarely involves the mucous membranes of the sinonasal cavity and typically arises unilaterally from the sinonasal cavity. Bilateral VM of the maxillary sinus is extremely rare. To the best of our knowledge, there is no previous report of bilateral VM of the maxillary sinus. Here, we describe the surgical treatment of bilateral cavernous hemangiomas of the maxillary sinus. These tumors were successfully resected by endoscopic modified medial maxillectomy (EMMM) after embolization. Endoscopic sinus surgery, particularly EMMM, produces access to the bilateral maxillary sinus and can prevent several complications.