Otolaryngology - Head and Neck Surgery - Articles in Press

Intranasal mycetoma-induced Splendore-Hoeppli phenomenon - Corrected Proof

Ju Wan Kang, Ja Seung Ku, Chang-Hoon Kim, Joo-Heon Yoon — 2009-11-06

The Splendore-Hoeppli phenomenon represents eosinophilic radiate structures surrounded by inflammatory cells, such as eosinophils and lymphocytes, and has been reported in infectious and noninfectious (inflammatory reactions to silk suture material) processes. This reaction can occur at various regions, such as the skin, subcutaneous tissue, and conjunctiva. To our knowledge, a case of intranasal Splendore-Hoeppli phenomenon has not been reported to date.

Changing practice models in otolaryngology–head and neck surgery: The role for collaborative practice - Corrected Proof

Christine Reger, David W. Kennedy — 2009-11-02

Abstract: The increased complexity of medicine, the imperative of reducing health care costs, and the goals of improving quality and patient satisfaction require that we rethink current models of practice. Such reevaluation will receive additional impetus from workforce changes within medicine and the specialty. Furthermore, as chronic disorder care becomes more complex, it may increasingly be provided within a specialty setting. Our goal is to stimulate discussion regarding the potential for alternative health care delivery models within the specialty in the face of predicted workforce shortages and the impetus toward health care reform. A collaborative practice model utilizing midlevel health care providers increases productivity and patient satisfaction and provides the potential to deliver an exceptionally high level of care for chronic disorders when such care is sufficiently complex to require specialty management.

Seronegative Wegener Granulomatosis - Corrected Proof

Michael S. Harris, Michael G. Moore — 2009-11-02

A 57-year-old woman was referred for bilateral hearing loss, left-sided facial weakness, and a destructive process of the nose and paranasal sinuses. Physical examination was pertinent for House-Brackmann VI/VI facial nerve paresis, a draining left parotid abscess, saddle nose deformity, and bilateral mixed hearing loss (). Contrast-enhanced computed tomography (CT) imaging disclosed destruction of the roof of the sphenoid sinus, cribiform plate, fovea ethmoidalis, and nasal septum, and enlargement of the left lacrimal, parotid, and submandibular glands. Upon surgical debridement, nearly complete septal destruction was noted, with necrosis of the remaining septal tissue and eschar encasing the maxillary, ethmoid, and sphenoid sinuses. Multiple paranasal sinus and parotid biopsies revealed nonspecific necrosis. Antineutrophil cytoplasmic antibodies (ANCAs), both classic (c-ANCA) and perinuclear, were negative. No immunophenotypic evidence of lymphoma was seen. Cultures for erosive fungal processes were likewise negative. Biopsy of the submandibular gland, however, revealed patchy areas of necrosis accompanied by vasculitis of small arteries and venules, as well as focal collections of giant cells, highly suggestive of Wegener granulomatosis (). Subsequent chest CT disclosed multiple cavitary pulmonary nodules. Renal function was normal. Steroid and cyclophosphamide therapy followed.

Facelift approach to upper cervical surgery - Corrected Proof

Jonathan Hughes, Joanna Stephens, Kwamena Amonoo-Kuofi, George Mochloulis — 2009-11-02

Interest among surgeons in cosmetic approaches to non-aesthetic head and neck surgery has developed as a result of the often visible scarring following procedures in this region. This is especially true for incisions made above the collar line and in non–hair-bearing skin, as well as in patients with a tendency for hypertrophic/keloid scarring. There is also evidence that patients are increasingly aesthetically aware, as indicated by the increased rates of cosmetic surgery reported in recent years, further driving this interest into routine practice.

The relationship between the air-bone gap and the size of superior semicircular canal dehiscence - Corrected Proof

Heng-Wai Yuen, Rudolf Boeddinghaus, Robert H. Eikelboom, Marcus D. Atlas — 2009-11-02

Abstract: Objective: To examine the relationship between the air-bone gap (ABG) and the size of the superior semicircular canal dehiscence (SSCD) as measured on a computed tomography (CT) scan.Study design: Case series with chart review.Setting: Tertiary referral center.Patients: Twenty-three patients (28 ears) diagnosed with SSCD.Main outcome measures: The size of the dehiscence on CT scans and the ABG on pure-tone audiometry were recorded.Results: The size of the dehiscence ranged from 1.0 to 6.0 mm (mean, 3.5 ± 1.6 mm). Six ears with a dehiscence measuring less than 3.0 mm did not have an ABG (0 dB). The remaining 18 ears showed an average ABG at 500, 1000, and 2000 Hz (AvABG500-2000) ranging from 3.3 to 27.0 dB (mean, 11.6 ± 5.7 dB). The analysis of the relationship between the dehiscence size and AvABG500-2000 revealed a correlation of R2 = 0.828 (P < 0.001, quadratic fit) and R2 = 0.780 (P < 0.001, linear fit). Therefore, the larger the dehiscence, the larger the ABG at lower frequencies on pure-tone audiometry.Conclusions: In SSCD patients, an ABG is consistently shown at the low frequency when the dehiscence is larger than 3 mm. The size of the average ABG correlates with the size of the dehiscence. These findings highlight the effect of the dehiscence size on conductive hearing loss in SSCD and contribute to a better understanding of the symptomatology of patients with SSCD.

Preservation of the external jugular venous drainage system in neck dissection - Corrected Proof

2009-11-02

Abstract: Objective: To investigate whether preserving the external jugular vein (EJV) in neck dissection reduces postoperative edema of the face and neck.Study design: A prospective, randomized controlled trial.Setting: A tertiary hospital.Subjects and methods: Thirty-eight subjects were randomly assigned to two groups: EJV preservation versus sacrifice during neck dissection after stratification according to the neck dissection extent and type, the previous treatment, the primary site, and the reconstruction type. The relative soft-tissue thickness was evaluated by follow-up computed tomography (CT) scans at one week and four to five weeks postoperatively and compared with preoperative findings. The preserved EJV patency was also determined by contrast enhancement of EJV on follow-up CT scans. In addition, the scores for pain/discomfort on the upper neck/face and laryngeal edema were recorded at each time point.Results: Relative soft-tissue thickness reached up to 160 percent of preoperative status at the hyoid and cricoid levels at one week postoperatively but resolved at four to five weeks. EJV preservation reduced the soft-tissue thickness significantly compared with EJV sacrifice (P < 0.05) at one week postoperatively, particularly at the mandible and hyoid level. All preserved EJVs remained patent at one week, and 18 of 19 remained patent at four to five weeks. In addition, EJV preservation diminished the discomfort/pain of the upper neck/face compared with EJV sacrifice at one week (P = 0.036). The extent of laryngeal edema did not differ between the two groups.Conclusion: EJV preservation may reduce immediate postoperative neck edema and pain/discomfort related to neck dissection.

Evaluating postoperative pain in monopolar cautery versus harmonic scalpel tonsillectomy - Corrected Proof

Sharon L. Cushing, Oakley Smith, Albino Chiodo, William Elmasri, Pam Munro-Peck — 2009-10-28

Abstract: Objectives: To compare postoperative pain between monopolar cautery tonsillectomy and harmonic scalpel tonsillectomy (HST).Study design: Randomized controlled trial using paired organs.Setting: Community hospital with academic affiliation.Subjects: One hundred and fourteen consecutive patients six years of age or older undergoing tonsillectomy for indications of hypertrophy or recurrent infection.Methods: For each subject, monopolar cautery tonsillectomy was performed by four senior surgeons on one side and HST was performed on the other side. Allocation of technique to side was randomized and revealed to the surgeon at the start of the operation. Validated visual analog pain scales were used to quantify pain at rest and with swallowing for each side and were completed daily for 14 days. All subjects were prescribed weight-equivalent doses of analgesics. Secondary outcome measures included postoperative complications (hemorrhage and readmission).Results: Pairwise comparisons of pain scores revealed no significant difference between monopolar cautery tonsillectomy and HST (P < 0.05).Conclusions: Subjects undergoing monopolar cautery tonsillectomy do not experience increased postoperative pain in comparison to HST.

Blunt trauma of the larynx and pneumomediastinum - Corrected Proof

Dimitrios Assimakopoulos, Georgios Tsirves — 2009-10-09

Blunt injuries to the larynx can lead to problems involving aspiration, phonation, or respiration. Females tend to have slimmer, longer necks, predisposing them to a higher susceptibility to laryngeal injury, in particular supraglottic injury. Overall, males (77% vs 33%) tend to present with the highest percentage of traumatic laryngeal injuries, secondary to greater participation in violent sports and other activities. A predisposition to comminuted fractures in older persons is attributed to calcification. Minor lacerations, small hematomas, and nondisplaced single fractures may be managed with observation and serial examination.

Traumatic incus dislocation into the external auditory canal - Corrected Proof

Yao-Te Tsai, Kai-Chieh Chan — 2009-10-01

A 50-year-old woman presented with right conductive hearing loss of 50 dB with an air-bone gap of 40 dB after a head injury. Otoscopy revealed a tympanic membrane (TM) bony protrusion into the external auditory canal (EAC) (). Computed tomography (CT) showed a right longitudinal temporal bone fracture with dislodgement of the incus penetrating through the TM into the EAC (). Intraoperatively, a fracture line of the posterosuperior EAC extending to the fossa incudis was identified, and the dislocated incus body was seen penetrating through the pars flaccida of the TM. In addition, the long process of the incus located toward the tympanic isthmus was found over the chorda tympanic nerve. Because the malleus and stapes had normal structures with fair mobility, a myringoplasty and ossiculoplasty with the sculpted incus interposition were performed simultaneously. Twelve months later, the postoperative air-bone gap was reduced to 15 dB. Approval of the case study was obtained from the Institutional Review Board in Chang Gung Memorial Hospital.

The use of a bioresorbable implant to medialize the middle turbinate in sinus surgery - Corrected Proof

Ronald B. Kuppersmith, James H. Atkins — 2009-10-01

Management of the middle turbinate during endoscopic sinus surgery has been a topic of discussion for many years. Initial debate surrounded whether to partially resect the middle turbinate or preserve it. In most cases, surgeons now prefer to preserve the middle turbinate. Recent discussions in the literature have focused on techniques to keep the middle turbinate “medialized” after surgery and to prevent synechiae formation to the lateral nasal wall while preserving the middle turbinate as a surgical landmark, preserving its function, and reducing potential risks related to middle turbinate resection.

Rapid development of an infectious aneurysm of the internal carotid artery from orbital apex syndrome - Corrected Proof

Sang-Chul Lim, Jeong-Uk Choi, Soon-Ho Bae — 2009-09-28

Orbital apex syndrome (OAS) is a complex of symptoms resulting from damage to cranial nerves III, IV, V1, and VI in association with optic nerve dysfunction. Development of an infectious internal carotid artery (ICA) aneurysm after OAS is extremely rare. Herein, we report on a patient with OAS caused by invasive fungal sphenoiditis in whom an infectious aneurysm of the supraclinoid portion of the ICA occurred within five days and resulted in death.

Metastatic esophageal adenocarcinoma presenting as an external auditory canal mass - Corrected Proof

Kevin W. Lollar, Charles A. Parker, Benjamin D. Liess, Jessica Wieberg — 2009-09-28

Metastatic tumors to the external auditory canal (EAC) are exceedingly rare. In the vast majority of cases, these metastases occur in the latter stages of the disease process. To the best of our knowledge there has been only one case report of metastatic esophageal adenocarcinoma to the EAC. We present the first reported case of an EAC mass as the initial presenting symptom of a metastatic esophageal adenocarcinoma. Institutional review board approval was obtained.

Cholesterol granuloma of the orbit - Corrected Proof

Raúl González-García, Leticia Román-Romero — 2009-09-28

Cholesterol granuloma (CG) of the orbit is a rare entity caused by a foreign body reaction against cholesterol crystals. It has been reported in several locations, such as the peritoneum, lungs, breast, lymph nodes, kidney, and testis. Within the head and neck location, it has been mostly reported in association with bony structures, such as the mastoid antrum and air cells of the temporal bone. It has also been reported in the jaw, nasal sinuses, and base of the skull. We present two new cases of CG of the orbit and focus on controversial treatment considerations.

A dual nodular thyroid ectopy, presenting with massive bleeding during pregnancy, treated by Sistrunk procedure - Corrected Proof

2009-09-17

Embryologically, the thyroid gland originates from the lingual foramen cecum. Its migration through the neck leads to the formation of the thyroglossal tract, which degenerates during embryological life.

An atypical case of chronic invasive fungal sinusitis and its management - Corrected Proof

2009-09-07

Chronic invasive fungal sinus infection is a rare disease that usually occurs in immunocompetent patients, may progress slowly, and poses a diagnostic dilemma. We report a patient with chronic rhinosinusitis who was found to have superficially invasive fungal rhinosinusitis secondary to a dematiaceous mold. Massachusetts Eye and Ear Infirmary Institutional Review Board exemption was obtained for this study.

Preliminary results of the application of a silk fibroin scaffold to otology - Corrected Proof

2009-09-07

Abstract: The surgical treatment to repair chronic tympanic membrane perforations is myringoplasty. Although multiple autologous grafts, allografts, and synthetic graft materials have been used over the years, no single graft material is superior for repairing all perforation types. Recently, the remarkable properties of silk fibroin protein have been studied, with biomedical and tissue engineering applications in mind, across a number of medical and surgical disciplines. The present study examines the use of silk fibroin for its potential suitability as an alternative graft in myringoplasty surgery by investigating the growth and proliferation of human tympanic membrane keratinocytes on a silk fibroin scaffold in vitro. Light microscopy, immunofluorescent staining, and confocal imaging all reveal promising preliminary results. The biocompatibility, transparency, stability, high tensile strength, and biodegradability of fibroin make this biomaterial an attractive option to study for this utility.

Lymphoepithelial carcinoma of the nasolacrimal duct - Corrected Proof

Yuan-Yun Tam, Li-Yu Lee, Kai-Ping Chang — 2009-09-02

Lymphoepithelial carcinoma (LEC), an uncommon lesion in the head and neck, consists of undifferentiated carcinoma cells within the lymphoid stroma. This malignancy has been found in the major salivary glands, but it has also been sporadically reported in the larynx and soft palate. Some studies suggested that LEC of the salivary gland and Epstein-Barr virus (EBV) are strongly correlated. To the best of our knowledge, this neoplasm derived from the nasolacrimal duct has never been addressed in any English literature. We present a rare case of a LEC originating from the nasolacrimal duct and address its differential diagnosis, management, and association with EBV. Institutional Review Board approval was obtained.

Uvulopalatopharyngoplasty funded by the Australian government's Medicare scheme (1995-2007) - Corrected Proof

Nathaniel S. Marshall, Stuart MacKay, Richard Gallagher, Sam Robinson — 2009-09-02

Abstract: Objective: To describe the provision, through the Australian state-funded Medicare system, of uvulopalatopharyngoplasty (UPPP) and its laser-assisted variation (LAUP) to the population of Australia between 1995 and 2007.Study design: Case series using a comprehensive national administrative database.Setting: The Commonwealth of Australia.Subjects: The population of Australia.Methods: The raw numbers of procedures, reimbursement amounts in Australian dollars, and per capita adjustment nationwide and in each state/territory for UPPP and LAUP for each calendar year from 1995 to 2007 were downloaded from a publicly accessible database run by Medicare.Results: The Australian federal government paid AUD 8.2 million for 19,534 UPPP procedures and AUD 1.1 million for 3270 LAUP procedures in the calendar years 1995 to 2007, inclusive. There is substantive variability between states in provision. Over time, provision of UPPP has declined slightly compared with population growth and overall Medicare provision. LAUP provision has declined markedly.Conclusion: Provision of UPPP under Medicare in Australia has declined slowly relative to population growth and overall growth in Medicare per capita provision. Laser-assisted UPPP (LAUP) has steadily declined and is now rarely used compared with the peak in its provision in the mid 1990s.

Intermittent self-limiting epistaxis: Not always a triviality - Corrected Proof

2009-09-02

Epistaxis is commonly seen in medical practice, and it is estimated that almost 60 percent of people experience an episode of epistaxis in their life. Only a minority of them need medical attention. Although it is seldom life threatening, delay in diagnosis can be lethal for these patients.

Kimura's disease of the epiglottis: Resection by a lateral pharyngotomy approach - Corrected Proof

2009-09-02

Kimura's disease is a chronic non-neoplastic entity first described by Kimura et al in 1948. It predominantly occurs in Asian males during the second and third decades of life. The major physical manifestation is slowly enlarging subcutaneous masses often found in the head and neck, especially in the salivary glands, usually in association with peripheral blood and tissue eosinophilia and a markedly increased serum IgE concentration. Although many cases have been reported, development in the larynx is very rare, possibly leading to difficulties in diagnosis. We report a case of Kimura's disease presenting as an epiglottic mass, which was resected by a lateral pharyngotomy approach (LPA).

Secondary middle turbinate - Corrected Proof

Rony K. Aouad, E. Bradley Strong — 2009-08-28

An otherwise healthy 65-year-old patient presented for evaluation of chronic nasal obstruction. She had undergone nasal surgery 30 years ago. Endoscopy () and CT scan () revealed a large polypoid mass originating from the lamina papyracea and extending over the base of the left inferior turbinate, without disturbing the left maxillary ostium. The patient had an uneventful endoscopic resection.

Orbital cavernous hemangioma: Transnasal endoscopic management - Corrected Proof

Aldo Stamm, João Flávio Nogueira — 2009-08-28

Cavernous hemangiomas (CHs) are the most common intraorbital tumors found in adults. Although histologically benign, they can encroach on intraorbital or adjacent structures and be considered anatomically or positionally malignant.

Pelvic metastasis in a patient with hypopharyngeal SCC - Corrected Proof

Khalil Esfandiari, Hassan Tavakoli, Jalal Rezaii, Patricia Khashayar — 2009-08-12

Head and neck malignancies, particularly hypopharyngeal squamous cell carcinomas (SCC), are commonly associated with a high incidence of distant metastases, and usually occur late in the ailment course.

Laryngeal solitary fibrous tumor treated with a transcervical approach - Corrected Proof

2009-08-03

Solitary fibrous tumor (SFT) is a relatively rare mesenchymal tumor that usually arises from the pleura. With respect to the head and neck regions, SFT in the larynx is extremely rare. To date, only seven patients with supraglottic laryngeal SFT have been described in the literature. However, no patient with laryngeal SFT present in the subglottic space has yet been described. We herein report the first case of laryngeal SFT localized in the subglottic space.