Case Reports in Otolaryngology The latest articles from Hindawi Publishing Corporation © 2017 , Hindawi Publishing Corporation . All rights reserved. Internal Jugular and Subclavian Vein Thrombosis in a Case of Ovarian Cancer Tue, 17 Jan 2017 06:00:42 +0000 Central venous catheter insertion and cancer represent some of the important predisposing factors for deep venous thrombosis (DVT). DVT usually develops in the lower extremities, and venous thrombosis of the upper extremities is uncommon. Early diagnosis and treatment of deep venous thrombosis are of importance, because it is a precursor of complications such as pulmonary embolism and postthrombotic syndrome. A 47-year-old woman visited our department with painful swelling on the left side of her neck. Initial examination revealed swelling of the region extending from the left neck to the shoulder without any redness of the overlying skin. Laboratory tests showed a white blood cell count of 5,800/mm3 and an elevated serum C-reactive protein of 4.51 mg/dL. Computed tomography (CT) of the neck revealed a vascular filling defect in the left internal jugular vein to left subclavian vein region, with the venous lumina completely occluded with dense soft tissue. On the basis of the findings, we made the diagnosis of thrombosis of the left internal jugular and left subclavian veins. The patient was begun on treatment with oral rivaroxaban, but the left shoulder pain worsened. She was then admitted to the hospital and treated by balloon thrombectomy and thrombolytic therapy, which led to improvement of the left subclavian venous occlusion. Histopathologic examination of the removed thrombus revealed adenocarcinoma cells, indicating hematogenous dissemination of malignant cells. Hiroto Moriwaki, Nana Hayama, Shouko Morozumi, Mika Nakano, Akari Nakayama, Yoshiomi Takahata, Yuusuke Sakaguchi, Natsuki Inoue, Toshiki Kubota, Akiko Takenoya, Yoshiko Ishii, Haruka Okubo, Souta Yamaguchi, Tsuyoshi Ono, Toshiaki Oharaseki, and Mamoru Yoshikawa Copyright © 2017 Hiroto Moriwaki et al. All rights reserved. Metastatic Renal Cell Carcinoma Presenting as a Paranasal Sinus Mass: The Importance of Differential Diagnosis Wed, 11 Jan 2017 12:58:26 +0000 Metastases in the paranasal sinuses are rare; renal cell carcinoma is the most common cancer that metastasizes to this region. We present the case of a patient with a 4-month history of a rapidly growing mass of the nasal pyramid following a nasal trauma, associated with spontaneous epistaxis and multiple episodes of hematuria. Cranial CT scan and MRI showed an ethmoid mass extending to the choanal region, the right orbit, and the right frontal sinus with an initial intracranial extension. Patient underwent surgery with a trans-sinusal frontal approach using a bicoronal incision combined with an anterior midfacial degloving; histological exam was compatible with a metastasis of clear cell renal cell carcinoma. Following histological findings, a total body CT scan showed a solitary 6 cm mass in the upper posterior pole of the left kidney identified as the primary tumor. Although rare, metastatic renal cell carcinoma should always be suspected in patients with nasal or paranasal masses, especially if associated with symptoms suggestive of a systemic involvement such as hematuria. A correct early-stage diagnosis of metastatic RCC can considerably improve survival rate in these patients; preoperative differential diagnosis with contrast-enhanced imaging is fundamental for the correct treatment and follow-up strategy. Massimo Ralli, Giancarlo Altissimi, Rosaria Turchetta, and Mario Rigante Copyright © 2017 Massimo Ralli et al. All rights reserved. Two Cases of Ectopic Hamartomatous Thymoma Masquerading as Sarcoma Tue, 10 Jan 2017 12:56:20 +0000 Ectopic hamartomatous thymoma (EHT) is an extremely rare benign tumor. EHTs are difficult to differentiate from sarcomas, especially synovial sarcomas. We encountered two cases of EHT that were referred from other hospitals because sarcoma was suspected. In these cases, fusion gene detection via polymerase chain reaction or fluorescence in situ hybridization was useful for differentiating EHT from synovial sarcoma. EHT requires accurate diagnosis before surgery to avoid excessive treatment. Both tumor location and the presence of fat inside the tumor are important imaging findings for EHT, and confirmation of spindle cells, epithelial cells, and mature adipose cells in the tumor is an important pathological finding. It is important to exclude synovial sarcoma from the differential diagnosis via fusion gene analysis. Takahito Kondo, Yukiko Sato, Hiroko Tanaka, Toru Sasaki, Kazuyoshi Kawabata, Hiroki Mitani, Hiroyuki Yonekawa, Hirofumi Fukushima, and Wataru Shimbashi Copyright © 2017 Takahito Kondo et al. All rights reserved. Myoepithelioma of the Nasal Septum: A Rare Case of Extrasalivary Gland Involvement Tue, 10 Jan 2017 08:54:05 +0000 Introduction. The myoepithelioma is a rare benign tumor, most frequently found in the salivary glands. The extrasalivary gland involvement is even rarer and few cases involving the nasal cavity have been reported in the literature. Case Report. MES, a 54-year-old woman, complaining of progressive nasal obstruction and mild epistaxis through the right nostril which had developed 1 year previously. Computed tomography scan showed tumor with heterogeneous contrast enhancement occupying the right nasal cavity, moving contralaterally in the nasal septum. Excisional biopsy was performed through endoscopic surgery of the mass that was inserted at the nasal septum. Pathological and immunohistochemical exams concluded myoepithelioma. Discussion. The main symptoms of nasal myoepitheliomas are nasal obstruction and epistaxis. Immunohistochemistry is necessary to confirm the diagnosis, typically positive for cytokeratin and S-100, calponin, smooth muscle actin, myosin, vimentin, glial fibrillary acidic protein (GFAP), and carcinoembryonic antigen. The main marker for myoepithelioma is the S-100 protein. In our case, it was positive for cytokeratin, S-100, calponin, actin smooth muscle, and GFAP. In all cases reported in the literature surgical treatment was performed and the recurrence was associated with incomplete tumor resection. Final Comments. The myoepithelioma is a rare differential diagnosis of nasal tumors and its treatment is the total lesion excision. Gustavo Barreto da Cunha, Tatiane Costa Camurugy, Thiago Cavalcante Ribeiro, Nara Nunes Barbosa Costa, Amanda Canário Andrade Azevedo, Eriko Soares de Azevedo Vinhaes, and Nilvano Alves de Andrade Copyright © 2017 Gustavo Barreto da Cunha et al. All rights reserved. Subglottic Metastatic Rectal Adenocarcinoma: A Specialist Multidisciplinary Airway Team Approach for Optimized Voice and Airway Outcome Thu, 05 Jan 2017 00:00:00 +0000 A 56-year-old female with a background of metastatic rectal adenocarcinoma presented with a subglottic mass causing biphasic stridor. Transoral laser microsurgery and the use of fibrin glue prevented the need for tracheostomy. Six months postoperatively there was no evidence of recurrence. Laryngeal metastasis of colorectal adenocarcinoma, although remarkably rare, is perhaps more prevalent than commonly perceived and the presence of laryngeal symptoms in a patient with colorectal adenocarcinoma should raise concern. This case is presented to aid physicians should they encounter a similar presentation of metastasis to the subglottis. Richard Heyes, Ramkishan Balakumar, Krishan Ramdoo, and Taran Tatla Copyright © 2017 Richard Heyes et al. All rights reserved. Case of Superficial Cancer Located at the Pharyngoesophageal Junction Which Was Dissected by Endoscopic Laryngopharyngeal Surgery Combined with Endoscopic Submucosal Dissection Thu, 05 Jan 2017 00:00:00 +0000 Aims. In order to determine the indications of transoral surgery for a tumor located at the pharyngoesophageal junction, the trumpet maneuver with transnasal endoscopy was used. Its efficacy is reported here. Material and Methods. An 88-year-old woman complaining of dysphagia, diagnosed with cervical esophageal cancer, and hoping to preserve her voice and swallowing function was admitted to our hospital. Conventional endoscopy showed that the tumor had invaded the hypopharynx. When inspecting the hypopharynx and the orifice of the esophagus, we asked the patient to blow hard and puff her cheeks with her mouth closed (trumpet maneuver). After the trumpet maneuver, the pharyngeal mucosa was stretched out. The pedicle of the tumor arose from the left-anterior wall of the pharyngoesophageal junction, so we decided to perform endoscopic resection. Result. Under general anesthesia, the curved laryngoscope made it possible to view the whole hypopharynx, including the apex of the piriform sinus and the orifice of the esophagus. The cervical esophageal cancer was pulled up to the hypopharynx. Under collaboration between a head and neck surgeon and an endoscopist, the tumor was resected en bloc by endoscopic laryngopharyngeal surgery combined with endoscopic submucosal dissection. Conclusion. Transnasal endoscopy using the trumpet maneuver is useful for a precise diagnosis of the pharyngoesophageal junction. Close collaboration between head and neck surgeons and endoscopists can provide good results in treating tumors of the pharyngoesophageal junction. Kenro Kawada, Tatsuyuki Kawano, Taro Sugimoto, Kazuya Yamaguchi, Yuudai Kawamura, Toshihiro Matsui, Masafumi Okuda, Taichi Ogo, Yuuichiro Kume, Yutaka Nakajima, Andres Mora, Takuya Okada, Akihiro Hoshino, Yutaka Tokairin, Yasuaki Nakajima, Ryuhei Okada, Yusuke Kiyokawa, Fuminori Nomura, Takahiro Asakage, Ryo Shimoda, and Takashi Ito Copyright © 2017 Kenro Kawada et al. All rights reserved. Endoscopic Resection of Skull Base Teratoma in Klippel-Feil Syndrome through Use of Combined Ultrasonic and Bipolar Diathermy Platforms Wed, 04 Jan 2017 06:22:39 +0000 Klippel-Feil syndrome (KFS) is associated with numerous craniofacial abnormalities but rarely with skull base tumor formation. We report an unusual and dramatic case of a symptomatic, mature skull base teratoma in an adult patient with KFS, with extension through the basisphenoid to obstruct the nasopharynx. This benign lesion was associated with midline palatal and cerebral defects, most notably pituitary and vertebrobasilar arteriolar duplications. A multidisciplinary workup and a complete endoscopic, transnasal surgical approach between otolaryngology and neurosurgery were undertaken. Out of concern for vascular control of the fibrofatty dense tumor stalk at the skull base and need for complete teratoma resection, we successfully employed a tissue resection tool with combined ultrasonic and bipolar diathermy to the tumor pedicle at the sphenoid/clivus junction. No CSF leak or major hemorrhage was noted using this endonasal approach, and no concerning postoperative sequelae were encountered. The patient continues to do well now 3 years after tumor extirpation, with resolution of all preoperative symptoms and absence of teratoma recurrence. KFS, teratoma biology, endocrine gland duplication, and the complex considerations required for successfully addressing this type of advanced skull base pathology are all reviewed herein. Justin A. Edward, Alkis J. Psaltis, Ryan A. Williams, Gregory W. Charville, Robert L. Dodd, and Jayakar V. Nayak Copyright © 2017 Justin A. Edward et al. All rights reserved. Bilateral Non-Hodgkin’s Lymphoma of the Temporal Bone: A Rare and Unusual Presentation Mon, 26 Dec 2016 12:35:53 +0000 Primary lymphoma of the temporal bone is an unusual finding in clinical practice and bilateral affection is even more rare. To the best of our knowledge, there are no reports of bilateral primary temporal bone lymphoma without middle ear involvement in the English medical literature so far. We report, for the first time, a case of primary lymphoma involving both temporal bones which presented with left-sided infranuclear facial palsy. A combination of contrast enhanced magnetic resonance imaging (MRI) and high resolution computed tomography (HRCT) was used to characterize and to map the extent of the lesion, as well as to identify the exact site of facial nerve affection. An excision biopsy and immunohistochemistry revealed diffuse large B-cell non-Hodgkin’s lymphoma (DLBCL). Whole body fluorodeoxyglucose (FDG) positron emission tomography-computed tomography study (PET-CT) was performed to stage the disease. The patient was treated with chemotherapy and radiation therapy and is now on regular follow-up. The patient is alive and asymptomatic without disease progression for the last twenty months after initial diagnosis. Sanjay Vaid, Jyoti Jadhav, Aparna Chandorkar, and Neelam Vaid Copyright © 2016 Sanjay Vaid et al. All rights reserved. Functional and Aesthetic Tragal Reconstruction in the Age of Mobile Electronic Devices Thu, 22 Dec 2016 07:46:12 +0000 We present a method to create a tragus using the patient’s conchal cartilage. It is a simplified, single-stage technique with well-hidden incisions, yet it maintains the rigidity of a natural tragus. This patient did not have a history of radiation to the area, which may compromise healing with this technique. The cosmetic importance of the tragus has been described, but its functionality in accommodating modern technology has not been previously discussed. The main treatment goal for this patient was to gain the ability to wear earphones (clinical question/level of evidence: therapeutic, V). Colleen F. Perez and Curtis W. Gaball Copyright © 2016 Colleen F. Perez and Curtis W. Gaball. All rights reserved. Acoustic Neuroma Mimicking Orofacial Pain: A Unique Case Report Wed, 07 Dec 2016 06:23:22 +0000 Acoustic neuroma (AN), also called vestibular schwannoma, is a tumor composed of Schwann cells that most frequently involve the vestibular division of the VII cranial nerve. The most common symptoms include orofacial pain, facial paralysis, trigeminal neuralgia, tinnitus, hearing loss, and imbalance that result from compression of cranial nerves V–IX. Symptoms of acoustic neuromas can mimic and present as temporomandibular disorder. Therefore, a thorough medical and dental history, radiographic evaluation, and properly conducted diagnostic testing are essential in differentiating odontogenic pain from pain that is nonodontogenic in nature. This article reports a rare case of a young pregnant female patient diagnosed with an acoustic neuroma located in the cerebellopontine angle that was originally treated for musculoskeletal temporomandibular joint disorder. Praveenkumar Ramdurg, Naveen Srinivas, Vijaylaxmi Mendigeri, and Surekha R. Puranik Copyright © 2016 Praveenkumar Ramdurg et al. All rights reserved. Acute Marjolin’s Ulcer in a Postauricular Scar after Mastoidectomy Tue, 06 Dec 2016 12:37:05 +0000 Background. Marjolin’s ulcer is a rare, aggressive cutaneous malignancy that arises primarily in burn scars but can occur in other types of scars. Squamous cell carcinoma is the most common variant, and while malignant degeneration usually takes a long time, it can develop acutely. Case Report. a 30-year-old man who developed Marjolin’s ulcer acutely in a right postauricular scar after mastoidectomy and the incision and drainage of a mastoid abscess. To the best of our knowledge, this report is the first to describe a Marjolin’s ulcer in a postauricular surgical scar. However, it has been reported in others areas in the head and neck. Conclusion. Marjolin’s ulcer is most commonly observed after postburn scars, but it may be observed after any type of scars, as our patient developed an SCC with a postsurgical scar. Early diagnosis is essential, and a biopsy should be performed on any nonhealing wound or chronic wound that undergoes a sudden change. Tissue samples should be taken from both the centre and the margins of the wound. Kholoud A. Alhysoni, Sumaiyah M. Bukhari, and Mutawakel F. Hajjaj Copyright © 2016 Kholoud A. Alhysoni et al. All rights reserved. Response to: Comment on “Original Solution for Middle Ear Implant and Anesthetic/Surgical Management in a Child with Severe Craniofacial Dysmorphism” Mon, 05 Dec 2016 06:34:45 +0000 Giovanni Bianchin, Lorenzo Tribi, Aronne Reverzani, Patrizia Formigoni, and Valeria Polizzi Copyright © 2016 Giovanni Bianchin et al. 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.