Case Reports in Otolaryngology The latest articles from Hindawi Publishing Corporation © 2016 , Hindawi Publishing Corporation . All rights reserved. Rhinosporidiosis: A Rare Cause of Proptosis and an Imaging Dilemma for Sinonasal Masses Wed, 30 Nov 2016 09:22:33 +0000 Background. Rhinosporidiosis is a common disease entity in tropical countries; however, it can be encountered in other parts of the world as well due to increasing medical tourism. It may mimic other more malignant and vigorous pathologies of the involved part. Case Report. We present a case of a 36-year-old male presenting with proptosis due to involvement of nasolacrimal duct which is rare. We will discuss typical CT and MRI features of the disease which were present in the case. Conclusion. For a surgeon and a radiologist, this is a necessary differential to be kept in mind for sinonasal masses. CT and MRI are invaluable investigations. However, FNAC is confirmatory. Both clinical and radiological aspects are required to reach correct diagnosis. Amit Kumar Dey, Rajaram Sharma, Kartik Mittal, Puneeth Kumar, Vivek Murumkar, Sumit Mitkar, and Priya Hira Copyright © 2016 Amit Kumar Dey et al. All rights reserved. Recurrent Massive Epistaxis from an Anomalous Posterior Ethmoid Artery Tue, 29 Nov 2016 06:26:27 +0000 A 50-year-old man, with no previous history of epistaxis, was hospitalized at our facility for left recurrent posterior epistaxis. The patient underwent surgical treatment three times and only the operator’s experience and radiological support (cranial angiography) allowed us to control the epistaxis and stop the bleeding. The difficult bleeding management and control was attributed to an abnormal course of the left posterior ethmoidal artery. When bleeding seems to come from the roof of the nasal cavity, it is important to identify the ethmoid arteries always bearing in mind the possible existence of anomalous courses. Marco Giuseppe Greco, Francesco Mattioli, Maria Paola Alberici, and Livio Presutti Copyright © 2016 Marco Giuseppe Greco et al. All rights reserved. Intra-Attack Vestibuloocular Reflex Changes in Ménière’s Disease Mon, 28 Nov 2016 08:08:54 +0000 Ménière’s attack has been shown to temporarily alter the vestibuloocular reflex (VOR). A patient with unilateral Ménière’s disease was serially evaluated with the video Head Impulse Test during single, untreated episodes of acute vertigo. Spontaneous nystagmus activity was concurrently recorded in order to establish the three typical phases of Ménière’s attack (irritative, paralytic, and recovery) and correlate them with VOR performance. The onset of attack was associated with a quick change in VOR gain on the side of the affected ear. While a rapidly progressive reduction of the VOR was evident at the paralytic nystagmus phase, in the recovery phase the VOR gain returned to normal and the direction of the previous nystagmus reversed. The membrane rupture potassium intoxication theory provides a good foundation with which to explain these dynamic VOR changes and the observed triphasic direction behavior of the spontaneous nystagmus. We additionally postulated that endolymphatic fluid displacement could have a synergic effect during the earliest phase of attack. Dario A. Yacovino and John B. Finlay Copyright © 2016 Dario A. Yacovino and John B. Finlay. All rights reserved. Sudden Sensorineural Hearing Loss in the Only Hearing Ear: Large Vestibular Aqueduct Syndrome Sun, 27 Nov 2016 09:23:30 +0000 Sudden hearing loss in the only hearing ear cases are rarely published in the English literature; most of the cases are idiopathic. It is an otologic emergency needing urgent treatment. Delayed diagnosis can interfere with patient’s social life with interrupting the verbal communication. In this case report we presented a 33-year-old female patient having sudden sensorineural hearing loss in the only hearing ear diagnosed as bilateral large vestibular aqueduct syndrome. Kemal Koray Bal, Onur Ismi, Helen Bucioglu, Yusuf Vayısoğlu, and Kemal Gorur Copyright © 2016 Kemal Koray Bal et al. All rights reserved. An Unusual Laryngeal Foreign Body in Adult Wed, 23 Nov 2016 14:04:27 +0000 The accidental aspiration of a foreign body is a frequent domestic accident among children but a rare occurrence in adults. The laryngeal impaction of a coin is an unusual accident; only a few cases have been reported in the literature. Diagnosis is mostly achieved by clinicoradiological examinations. The authors report an uncommon case of laryngeal impaction of a coin in a 21-year-old patient, presenting with dysphonia without dyspnea or stridor. The extraction was performed by endoscopy. Cire Ndiaye, Eric Joel Regonne, Houra Ahmed, Evelyne Siga Diom, Richard Edouard Alain Deguenonvo, Aminata Mbaye, Yilkal Zemene, and Issa Cheikh Ndiaye Copyright © 2016 Cire Ndiaye et al. All rights reserved. A Case of Periodontal Necrosis following Embolization of Maxillary Artery for Epistaxis Mon, 21 Nov 2016 13:30:08 +0000 Embolization of the maxillary artery (MA) is a common treatment modality for refractory epistaxis. Tissue necrosis after embolization of the MA is a rare complication. Here, we reported the first case of the development of necrosis of soft tissue and alveolar bone in the periodontium after embolization. A 48-year-old man with poor oral hygiene and a heavy smoking habit was referred to our clinic due to intractable epistaxis. After treatment with anterior-posterior nasal packing (AP nasal packing), the epistaxis relapsed. Therefore, he underwent embolization of the MA. Although he did not experience epistaxis after embolization, periodontal necrosis developed gradually. The wound healed with necrotomy, administration of antibiotics and prostaglandin, and hyperbaric oxygen therapy. We speculated that the periodontal necrosis was provoked by reduction of blood supply due to embolization and AP nasal packing based on this preexisting morbid state in the periodontium. Poor condition of the oral cavity and smoking may increase the risk of periodontal necrosis after embolization. Kohei Nishimoto, Ryosei Minoda, Ryoji Yoshida, Toshinori Hirai, and Eiji Yumoto Copyright © 2016 Kohei Nishimoto et al. All rights reserved. Bilateral Nasoalveolar Cyst Causing Nasal Obstruction Thu, 17 Nov 2016 11:56:57 +0000 Nasoalveolar cysts, which originate from epithelial remnants of nasolacrimal duct, are nonodontogenic soft tissue lesions of the upper jaw. These cysts are thought to be developmental and are presented with fullness in the upper lip and nose, swelling on the palate, and sometimes nasal obstruction. Because of cosmetic problems, they are often diagnosed at an early stage. These lesions are mostly revealed unilaterally but also can be seen on both sides. In this case report, a patient who complained of nasal obstruction and then diagnosed with bilateral nasoalveolar cysts and treated by sublabial excision is presented and clinical features and treatment approaches are discussed with the review of literature. Uzeyir Yildizoglu, Fatih Arslan, Bahtiyar Polat, and Abdullah Durmaz Copyright © 2016 Uzeyir Yildizoglu et al. All rights reserved. A Rare Tumor in the Cervical Sympathetic Trunk: Ganglioneuroblastoma Mon, 14 Nov 2016 07:17:24 +0000 Ganglioneuroblastoma is a rare tumor with moderate malignancy, which is composed of mature ganglion cells and seen in sympathetic ganglia and adrenal medulla. The diagnosis is possible after cytological and immunohistochemical studies following a needle biopsy or surgical excision. There is no consensus regarding the need for chemo- or radiotherapy after surgery. In this case report, clinical behavior and diagnosis and treatment of the rare tumor cervical ganglioneuroblastoma were discussed. Ozan Erol, Alper Koycu, and Erdinc Aydin Copyright © 2016 Ozan Erol et al. All rights reserved. Transnasal, Transethmoidal Endoscopic Removal of a Foreign Body in the Medial Extraconal Orbital Space Sun, 13 Nov 2016 14:27:45 +0000 Intraorbital foreign bodies are located within the orbit but outside the ocular globe. Though not uncommon, removal of these objects poses a challenge for surgeons. External approaches have been the most frequently used but are associated with increased complications and morbidity. An endoscopic endonasal approach can be an appropriate and less complicated technique in these cases. We report a case of a chronic intraorbital foreign body located within the medial extraconal space lateral to the lamina papyracea and behind the lacrimonasal duct, which was successfully removed using a transnasal, transethmoidal endoscopic technique. Neither postoperative complications nor ocular impairment was reported. The patient improved and remains asymptomatic. The transnasal transethmoidal endoscopic approach can be used as a safer and less invasive alternative when removing foreign bodies from the medial orbital compartment. Diego Escobar Montatixe, José Miguel Villacampa Aubá, Álvaro Sánchez Barrueco, Beatriz Sobrino Guijarro, and Carlos Cenjor Español Copyright © 2016 Diego Escobar Montatixe et al. All rights reserved. Angiofibroma Originating outside the Nasopharynx: A Management Dilemma Sun, 13 Nov 2016 14:18:31 +0000 Background. Angiofibroma is a benign tumor, consisting of fibrous tissue with varying degrees of vascularity, characterized by proliferation of stellate and spindle cells around the blood vessels. It most commonly arises from the nasopharynx, although it may rarely arise in extranasopharyngeal sites. Case Report. A 46-year-old male presented with left side nasal obstruction and epistaxis for one month. Clinical nasal examination revealed left sided polypoidal mass arising from the vestibular region of the lateral nasal wall. Results. CT scan and MRI showed highly vascular soft tissue mass occupying the anterior part of the left nostril. Preoperative selective embolization followed by transnasal excision was performed. Histopathological examination confirmed the diagnoses of nasal vestibular angiofibroma. Conclusion. Extranasopharyngeal angiofibroma is a very rare pathology. It should be kept in mind as a differential diagnosis with any unilateral nasal vestibular mass causing nasal obstruction and epistaxis. A biopsy without further investigation can cause life threatening bleeding in the patient. Ashraf Nabeel Mahmood, Rashid Sheikh, Hamad Al Saey, Sarah Ashkanani, and Shanmugam Ganesan Copyright © 2016 Ashraf Nabeel Mahmood et al. All rights reserved. Refractory Obstructive Sleep Apnea in a Patient with Diffuse Idiopathic Skeletal Hyperostosis Wed, 09 Nov 2016 09:54:52 +0000 Diffuse Idiopathic Skeletal Hyperostosis (DISH) can cause ossification of ligaments and may affect the spine. We report a case of obstructive sleep apnea in a patient with significant upper airway narrowing secondary to cervical DISH. This patient had an initial apnea-hypopnea index (AHI) of 145 events/hour and was treated with uvulopalatopharyngoplasty, genial tubercle advancement, hyoid suspension, septoplasty, inferior turbinoplasties, and radiofrequency ablations to the tongue base which reduced his AHI to 40 events/hour. He redeveloped symptoms, was started on positive airway pressure (PAP) therapy, and later underwent a maxillomandibular advancement which improved his AHI to 16.3 events/hour. A few years later his AHI was 100.4 events/hour. His disease has gradually progressed over time and he was restarted on PAP therapy. Despite PAP titration, years of using PAP therapy, and being 100 percent compliant for the past three months (average daily use of 7.6 hours/night), he has an AHI of 5.1 events/hour and has persistent hypersomnia with an Epworth Sleep Scale questionnaire score of 18/24. At this time he is pending further hypersomnia work-up. DISH patients require prolonged follow-up to monitor the progression of disease, and they may require unconventional measures for adequate treatment of obstructive sleep apnea. Ara Darakjian, Ani B. Darakjian, Edward T. Chang, and Macario Camacho Copyright © 2016 Ara Darakjian et al. All rights reserved. Tortuous Carotid Artery Extended to Neck Level IIb Mimicking the Metastatic Mass Mon, 07 Nov 2016 09:33:45 +0000 Specifically in neck level IIb, the expected normal anatomy does not contain any vital structures and consequently it might direct a surgeon to perform rapid surgical dissection of tissues. Therefore aberrant anatomy of the vessels in the patients may be overlooked during neck dissection. Unexpected and potentially devastating injuries can be avoided by respecting the possible aberrant anatomy in any level of the neck. In this case report, a 74-year-old man was presented with laryngeal carcinoma who was treated with laryngectomy and bilateral neck dissection. During the left side neck dissection, tortuous internal carotid artery imitating a metastatic mass was unexpectedly encountered in level IIb. As in this case, surgeons should keep in mind possible aberrant anatomy during the neck dissection and perform surgery staying in surgical principles to be safe for an unforeseen and potential dangerous injuries. Lokman Uzun, Oğuz Kadir Eğilmez, M. Tayyar Kalcioglu, and Muhammet Tekin Copyright © 2016 Lokman Uzun et al. All rights reserved. Blue Ear Cyst: A Rare Eccrine Hidrocystoma of the Ear Canal and Successful Endoscopic Excision Sun, 06 Nov 2016 13:32:09 +0000 Aims. Hidrocystomas are benign cystic growths of the apocrine and eccrine sweat glands. These cystic lesions have been well documented on the face, head, and neck, but rarely in the external auditory canal. Presentation of Case. A 67-year-old woman presented with a bluish cystic mass partially occluding the external auditory canal and interfering with hearing aid use. Lesion was excised completely via a transcanal endoscopic approach with excellent cosmetic results, no canal stenosis, and no recurrence at 1-year follow-up. Discussion. We present a rare eccrine hidrocystoma of the external auditory canal and successful excision of this benign lesion. We describe the surgical management using a transcanal endoscopic approach and follow-up results. An eccrine gland cyst that presents as a mass occluding the external auditory canal is quite rare. There are only a few such cases reported in the literature. These masses can be mistaken for basal cell carcinomas or cholesterol granulomas but can be easily differentiated using histopathology. Conclusion. Eccrine hidrocystoma is a cystic lesion of sweat glands, rarely found in the external auditory canal. A characteristic bluish hue aids in diagnosis and surgical excision using ear endoscopy provides excellent control. Taha A. Mur, Ronald Miick, and Natasha Pollak Copyright © 2016 Taha A. Mur et al. All rights reserved. A Case of Ameloblastic Fibroodontoma Extending Maxillary Sinus with Erupted Tooth: Is Transcanine Approach with Alveolectomy Feasible? Sun, 06 Nov 2016 09:59:56 +0000 Ameloblastic fibroodontoma (AFO) is a rare entity of mixed odontogenic tumors and frequently arises from posterior portion of the maxilla or mandible in first two decades of life. Herein, a 35-year-old woman with a noncontributory medical history who presented with a progressive left maxillary toothache, left maxillary first molar tooth mobility, and swelling in the left maxillary molar area for the last 2 months was reported. Radiologically, a tumor that originated from periapical area of the second mature molar teeth of maxilla was seen and additively unerupted tooth was not detected. The histopathologic examination revealed AFO. The patient is disease-free for five years after treated with limited segmental alveolectomy combining with Caldwell-Luc procedure. Mustafa Aslıer, Mustafa Cenk Ecevit, Sülen Sarıoğlu, and Semih Sütay Copyright © 2016 Mustafa Aslıer et al. All rights reserved. Primary Lymphangioma of the Palatine Tonsil in a 9-Year-Old Boy: A Case Presentation and Literature Review Sun, 30 Oct 2016 11:28:51 +0000 Primary lymphangiomas or lymphangiomatous polyps of the palatine tonsil are rare benign lesions that are described infrequently in the literature. The majority of the published cases concern adults. We report a case of a lymphangiomatous lesion of the right palatine tonsil of a 9-year-old boy. Our clinical suspicion was confirmed by the histological examination after tonsillectomy and the diagnosis of primary lymphangioma of the tonsil was made. In this case we discuss the clinical and histopathological features of this lesion and present a short review of the current literature. Eleftheria Iliadou, Nektarios Papapetropoulos, Eleftherios Karamatzanis, Panagiotis Saravakos, and Konstantinos Saravakos Copyright © 2016 Eleftheria Iliadou et al. All rights reserved. Filariasis of Stensen’s Duct: An Index Case Thu, 27 Oct 2016 13:46:30 +0000 Filariasis, a neglected tropical disease, is a global health problem and is endemic to 73 countries including India. It is caused by nematodes of Filariodidea family, namely, W. bancrofti and B. malayi in India, which have a predilection for the lower limbs and testis. We report a never before reported case of filariasis of the main parotid duct in a 25-year-old male that resolved on medical management, exemplifying the importance of maintaining a high index of suspicion and careful examination of cytological smears in endemic countries, allowing for an early diagnosis and treatment, decreasing the morbidity of this debilitating disease. Eishaan K. Bhargava, Nikhil Arora, Varun Rai, Ravi Meher, Prerna Arora, and Ruchika Juneja Copyright © 2016 Eishaan K. Bhargava et al. All rights reserved. A Case of Reactive Cervical Lymphadenopathy with Fat Necrosis Impinging on Adjacent Vascular Structures Thu, 20 Oct 2016 10:20:51 +0000 A tender neck mass in adults can be a diagnostic challenge due to a wide differential diagnosis, which ranges from reactive lymphadenopathy to malignancy. In this report, we describe a case of a young female with an unusually large and tender reactive lymph node with fat necrosis. The diagnostic imaging findings alone mimicked that of scrofula and malignancy, which prompted a complete workup. Additionally, the enlarged lymph node was compressing the internal jugular vein in the setting of oral contraceptive use by the patient, raising concern for Lemierre’s syndrome or internal jugular vein thrombosis. This report shows how, in the appropriate clinical context, and especially with the involvement of adjacent respiratory or neurovascular structures, aggressive diagnostic testing can be indicated. Albert Y. Han, Jacob F. Lentz, Edward C. Kuan, Hiwot H. Araya, and Mohammad Kamgar Copyright © 2016 Albert Y. Han et al. All rights reserved. Nonodontogenic Cervical Necrotizing Fasciitis Caused by Sialadenitis Sun, 16 Oct 2016 06:46:29 +0000 Necrotizing fasciitis is a rapidly progressive infectious disease of the soft tissue with high mortality and morbidity rates. Necrotizing fasciitis is occasionally located in the head and neck region and develops after odontogenic infections. Factors affecting treatment success rates are early diagnosis, appropriate antibiotic treatment, and surgical debridement. We present a necrotizing fasciitis case located in the neck region that developed after sialoadenitis. It is important to emphasize that necrotizing fasciitis to be seen in the neck region is very rare. Nonodontogenic necrotizing fasciitis is even more rare. Alper Yenigun, Bayram Veyseller, Omer Vural, and Orhan Ozturan Copyright © 2016 Alper Yenigun et al. All rights reserved. Tortuous Common Carotid Artery: A Report of Four Cases Observed in Cadaveric Dissections Thu, 13 Oct 2016 12:49:28 +0000 A tortuous common carotid artery poses a high risk of injury during tracheotomy. Preoperative diagnosis is therefore important to avoid serious complications. We found four cases of tortuous common carotid artery during an anatomical dissection course for students. The first case was a 91-year-old woman who had bilateral tortuous common carotid arteries without arteriosclerosis. Case was a 78-year-old woman who had bilateral tortuous common carotid arteries without arteriosclerosis. Case was an 86-year-old woman who died from bladder cancer and who also had a right tortuous common carotid artery without arteriosclerosis. Case was an 89-year-old woman who had bilateral tortuous common carotid arteries and a tortuous brachiocephalic artery with severe arteriosclerosis. Case was also examined using computed tomography to evaluate the arteriosclerosis. Computed tomography revealed severe calcification of the vascular wall, which was confirmed in the aortic arch and origins of its branches. In all four cases, the tortuosity was located below the level of the thyroid gland. Based on prior study results indicating that fusion between the carotid sheath and visceral fascia was often evident at the level of the thyroid gland, we speculated that the major region in which tortuosity occurs is at the same level or inferior to the level of the thyroid gland. Joe Iwanaga, Koichi Watanabe, Saga Tsuyoshi, Yoko Tabira, and Koh-ichi Yamaki Copyright © 2016 Joe Iwanaga et al. All rights reserved. Lipoma of Piriform Sinus: A Case Report and Review of the Literature Tue, 04 Oct 2016 07:00:46 +0000 The lipomas of oropharynx, hypopharynx, and larynx are so rare that up to now approximately there have been 100 cases reported. The lipomas are slow-growing lesions that are capable of reaching considerable dimensions and are often detected at a late stage. The symptoms can vary both in dimension and in location, semiobstructing the aerodigestive tract or exerting compression on adjacent structure. In this case, the lesion, which originated from the piriform sinus, was removed endoscopically urgently due to obvious signs of tissue suffering caused by stretching of the pedicle as a result of displacement of the mass. The two aims of this case report are to expose an interesting and rare case study mainly for an Emergency Room Specialist and an ENT (Ear, Nose, and Throat) Specialist involved in solving the problem and to demonstrate that the choice of an endoscopic approach is useful in order to have an optimal visualization of the lesion and to perform a total eradication. The use of endoscopic devices also allows a rapid postoperative recovery, compared to external access and optimum locoregional control in the follow-up procedures to prevent possible relapses. Gilberto Acquaviva, Theodoros Varakliotis, Stefano Badia, Francesco Casorati, Alberto Eibenstein, and Gianluca Bellocchi Copyright © 2016 Gilberto Acquaviva et al. All rights reserved. Juvenile Nasopharyngeal Angiofibroma Presenting with Acute Airway Obstruction Mon, 26 Sep 2016 13:29:19 +0000 We describe a case of a 24-year-old male presenting urgently with a juvenile nasopharyngeal angiofibroma (JNA) with difficulty breathing, inability to swallow, and respiratory distress following throat swelling. The swelling was reduced with administration of dexamethasone and the JNA was surgically resected within 48 hours. This presentation was atypical given the acuity of presentation and the patient’s older age. Chikoti Wheat, Ryan J. Bickley, Erik Cohen, Danya Wenzler, Nancy Hunter, and Donna Astiz Copyright © 2016 Chikoti Wheat et al. All rights reserved. Contralateral Cochlear Labyrinthine Concussion without Temporal Bone Fracture: Unusual Posttraumatic Consequence Wed, 21 Sep 2016 11:33:20 +0000 Introduction. Labyrinthine concussion is a term used to describe a rare cause of sensorineural hearing loss with or without vestibular symptoms occurring after head trauma. Isolated damage to the inner ear without involving the vestibular organ would be designated as a cochlear labyrinthine concussion. Hearing loss is not a rare finding in head trauma that involves petrous bone fractures. Nevertheless it generally occurs ipsilateral to the side of the head injury and extraordinarily in the contralateral side and moreover without the presence of a fracture. Case Report. The present case describes a 37-year-old patient with sensorineural hearing loss and tinnitus in his right ear after a blunt head trauma of the left-sided temporal bone (contralateral). Otoscopy and radiological images showed no fractures or any abnormalities. A severe sensorineural hearing loss was found in his right ear with a normal hearing of the left side. Conclusion. The temporal bone trauma requires a complete diagnostic battery which includes a neurotologic examination and a high resolution computed tomography scan in the first place. Hearing loss after a head injury extraordinarily occurs in the contralateral side of the trauma as what happened in our case. In addition, the absence of fractures makes this phenomenon even more unusual. I. M. Villarreal, D. Méndez, J. M. Duque Silva, and P. Ortega del Álamo Copyright © 2016 I. M. Villarreal et al. All rights reserved. Oncocytoma of the Submandibular Gland: Diagnosis and Treatment Based on Clinicopathology Mon, 19 Sep 2016 06:07:44 +0000 Background. Submandibular oncocytomas are rare benign salivary gland neoplasms. They are typically found in Caucasian patients aged 50–70 years with no gender preference. Due to the overlapping histological and clinical features of head and neck tumors, they are often misdiagnosed. Methods. We report a case of unilateral submandibular gland oncocytoma in a 63-year-old Caucasian man. Results. The patient underwent unilateral submandibular gland resection and histopathologic analysis of the tumor specimen. On follow-up at 2 weeks and 1 year, no recurrence was identified. Conclusion. Submandibular oncocytomas are best diagnosed with preoperative FNA and CT imaging and have distinctive findings on cytology and histology. CT followed by fine-needle aspiration cytology would be the preferred diagnostic modalities. Due to its low rate of malignant transformation and recurrence, the best treatment is local resection with follow-up as necessary. Betty Chen, Joshua I. Hentzelman, Ronald J. Walker, and Jin-Ping Lai Copyright © 2016 Betty Chen et al. All rights reserved. Lymphoepithelial Cyst in the Palatine Tonsil Sun, 18 Sep 2016 16:16:54 +0000 Lymphoepithelial cyst (LEC) is the most commonly encountered congenital neck pathology in the lateral part of the neck. A 66-year-old woman presented to the ENT clinic due to difficulty in swallowing persisting for approximately 1 year. Magnetic resonance imaging revealed a cystic mass at right tonsil. Surgery was performed due to this unilateral tonsillar mass, which was excised together with the right tonsil. LEC was diagnosed at histopathological examination. LEC in the palatine tonsil is rare, and only a few cases have been reported in the literature. We report a rare case of LEC in the palatine tonsil. Fatih Bingöl, Hilal Balta, Buket Özel Bingöl, Recai Muhammet Mazlumoğlu, and Korhan Kılıç Copyright © 2016 Fatih Bingöl et al. All rights reserved. Chronic Invasive Nongranulomatous Fungal Rhinosinusitis in Immunocompetent Individuals Thu, 15 Sep 2016 13:36:33 +0000 Chronic invasive nongranulomatous fungal rhinosinusitis is a well-described but uncommon type of fungal rhinosinusitis (FRS). While the prevalence of chronic FRS is 0.11% in healthy individuals, only 1.3% of them are in nongranulomatous invasive nature. The majority of the cases in the literature have been reported from developing countries mostly located in the tropical regions, as typically occurring in the background of diabetes mellitus or corticosteroid treatment. The current paper reports four consecutive cases, who were diagnosed within a short period of six months at a single center of a country located outside the tropical climate zone. None of the patients had a comorbid disease that may cause immune suppression or a history of drug use. The only risk factor that may have a role in development of chronic invasive nongranulomatous FRS was that all of our patients were people working in greenhouse farming. Three cases underwent endoscopic sinus surgery, and one case underwent surgery with both endoscopic and external approaches. Systemic antifungal therapy was initiated in all cases in the postoperative period with voriconazole 200 mg orally twice a day. All patients achieved a complete clinical remission. Chronic invasive nongranulomatous FRS should be kept in mind in the presence of long-standing nonspecific sinonasal symptoms in immunocompetent individuals, particularly with a history of working in greenhouse farming. Ozge Turhan, Asli Bostanci, Irem Hicran Ozbudak, and Murat Turhan Copyright © 2016 Ozge Turhan et al. All rights reserved. Oral Neurothekeoma of the Right Buccal Mucosa Thu, 08 Sep 2016 17:45:57 +0000 Oral neurothekeoma or nerve sheath myxoma is a rare benign oral tumour of nerve sheath origin. Historically, this tumour has been subclassified as myxoid (classic), mixed, or the cellular type, depending on the amount of myxoid stroma and cellularity. We present a case of oral neurothekeoma (mixed type) of the buccal mucosa. The tumour was completely excised. No recurrence was detected in the last 3 years after local excision. Alex C. Tham, Nandini L. Chilagondanahalli, Manish M. Bundele, and Jeevendra Kanagalingam Copyright © 2016 Alex C. Tham et al. All rights reserved. Leiomyosarcoma Ex Pleomorphic Adenoma of the Parotid Gland: A Case Report and Literature Review Thu, 08 Sep 2016 17:33:02 +0000 There is only one previously reported incident in the English literature of sarcoma ex pleomorphic adenoma of the parotid and there are only 8 cases of primary parotid leiomyosarcoma. In our case, a 79-year-old female patient presented to our care with left preauricular pain, swelling, and facial weakness. After CT imaging, she underwent left total parotidectomy. A spindle cell lesion was identified intraoperatively and the facial nerve was sacrificed. Subsequent analysis of the lesion yielded a diagnosis of leiomyosarcoma ex pleomorphic adenoma. After 30 fractions of radiation therapy, scans were negative for tumor. However, 18 months after first experiencing symptoms, she was found to have metastases to the brainstem and lung. When diagnosing sarcoma ex pleomorphic adenoma of the parotid gland, it is important to perform thorough immunohistochemical staining and exclude a previous history of sarcoma or other sources of metastases. Complete resection is critical due to the tumor’s local aggressiveness and metastatic potential. Although these tumors are not very responsive to chemotherapy or radiation, adjuvant treatment is commonly used when margins are unclear. Michael Coulter, Jingxuan Liu, and Mark Marzouk Copyright © 2016 Michael Coulter et al. All rights reserved. Persistent Down-Beating Torsional Positional Nystagmus: Posterior Semicircular Canal Light Cupula? Wed, 07 Sep 2016 14:37:06 +0000 A 16-year-old boy with rotatory positional vertigo and nausea, particularly when lying down, visited our clinic. Initially, we observed vertical/torsional (downward/leftward) nystagmus in the supine position, and it did not diminish. In the sitting position, nystagmus was not provoked. Neurological examinations were normal. We speculated that persistent torsional down-beating nystagmus was caused by the light cupula of the posterior semicircular canal. This case provides novel insights into the light cupula pathophysiology. Akihide Ichimura and Koji Otsuka Copyright © 2016 Akihide Ichimura and Koji Otsuka. All rights reserved. Case of Chronic Otitis Media with Intracranial Complication and Contralateral Extracranial Presentation Wed, 07 Sep 2016 12:26:08 +0000 Intracranial complications of chronic otitis media have been on the decline with advent of antibiotics. Septic thrombosis of the sigmoid sinus is rarer compared to commoner complications such as otogenic brain abscesses and meningitis. This patient presented with recurrent infection after left mastoidectomy secondary to cholesteatoma and a contralateral internal jugular vein thrombosis with parapharyngeal abscess, which was drained. He recovered well postoperatively with antibiotics. X. Y. Yeoh, P. S. Lim, and K. C. Pua Copyright © 2016 X. Y. Yeoh et al. All rights reserved. Bilateral Vocal Cord Paralysis and Cervicolumbar Radiculopathy as the Presenting Paraneoplastic Manifestations of Small Cell Lung Cancer: A Case Report and Literature Review Wed, 07 Sep 2016 09:21:20 +0000 Introduction. Bilateral vocal cord paralysis (BVCP) is a potential medical emergency. The Otolaryngologist plays a crucial role in the diagnosis and management of BVCP and must consider a broad differential diagnosis. We present a rare case of BVCP secondary to anti-Hu paraneoplastic syndrome. Case Presentation. A 58-year-old female presented to an Otolaryngology clinic with a history of progressive hoarseness and dysphagia. Flexible nasolaryngoscopy demonstrated BVCP. Cross-sectional imaging of the brain and vagus nerves was negative. An antiparaneoplastic antibody panel was positive for anti-Hu antibodies. This led to an endobronchial biopsy of a paratracheal lymph node, which confirmed the diagnosis of small cell lung cancer. Conclusion. Paraneoplastic neuropathy is a rare cause of BVCP and should be considered when more common pathologies are ruled out. This is the second reported case of BVCP as a presenting symptom of paraneoplastic syndrome secondary to small cell lung cancer. Jeffrey C. Yeung, C. Elizabeth Pringle, Harmanjatinder S. Sekhon, Shaun J. Kilty, and Kristian Macdonald Copyright © 2016 Jeffrey C. Yeung et al. All rights reserved.