Pub Date : 2016-12-01DOI: 10.1177/014556131609501210
O. Güçlü, A. Muratlı, D. Arık, K. Tekin, H. Erdoğan, F. Dereköy
Oxytetracycline has been suggested as an alternate therapy for chronic recurrent sialadenitis and sialorrhea. We conducted an experimental study to investigate the sclerotic effect of this drug on the submandibular gland by histopathologic methods. Our subjects were 20 New Zealand white rabbits, which were divided into two groups of 10. The right submandibular gland of the rabbits in the active-treatment group was injected with 0.3 ml of oxytetracycline (100 mg/ml), and that of the controls was injected with saline. Four weeks after the injections, all the glands were removed. Histopathologic studies, including hematoxylin and eosin and Masson trichrome staining, were carried out. The glands were evaluated for tissue inflammation, congestion, fibrosis, edema, lipomatosis, and atrophy. To investigate apoptosis, terminal deoxynucleotidyl transferase-mediated dUTP-digoxigenin nick-end labeling (TUNEL) immunohistochemical staining was used. In the study group, inflammation (n = 9), congestion (n = 9), fibrosis (n = 6), edema (n = 6), and lipomatosis (n = 4) were observed; in the sham group, only lipomatosis was seen (n = 5). The TUNEL assay results for acinar cells were 4.51 ± 1.41% in the oxytetracycline group and 2.08 ± 1.76% in the control group (p = 0.006); the corresponding figures for the duct cells were 7.05 ± 0.87% and 3.10 ± 2.26% (p = 0.001). Based on our findings, we conclude that oxytetracycline might be a viable alternative for the treatment of chronic recurrent sialadenitis and sialorrhea. However, more research in this area is needed.
{"title":"Sclerotic Effect of Oxytetracycline on the Submandibular Gland: An Experimental Model","authors":"O. Güçlü, A. Muratlı, D. Arık, K. Tekin, H. Erdoğan, F. Dereköy","doi":"10.1177/014556131609501210","DOIUrl":"https://doi.org/10.1177/014556131609501210","url":null,"abstract":"Oxytetracycline has been suggested as an alternate therapy for chronic recurrent sialadenitis and sialorrhea. We conducted an experimental study to investigate the sclerotic effect of this drug on the submandibular gland by histopathologic methods. Our subjects were 20 New Zealand white rabbits, which were divided into two groups of 10. The right submandibular gland of the rabbits in the active-treatment group was injected with 0.3 ml of oxytetracycline (100 mg/ml), and that of the controls was injected with saline. Four weeks after the injections, all the glands were removed. Histopathologic studies, including hematoxylin and eosin and Masson trichrome staining, were carried out. The glands were evaluated for tissue inflammation, congestion, fibrosis, edema, lipomatosis, and atrophy. To investigate apoptosis, terminal deoxynucleotidyl transferase-mediated dUTP-digoxigenin nick-end labeling (TUNEL) immunohistochemical staining was used. In the study group, inflammation (n = 9), congestion (n = 9), fibrosis (n = 6), edema (n = 6), and lipomatosis (n = 4) were observed; in the sham group, only lipomatosis was seen (n = 5). The TUNEL assay results for acinar cells were 4.51 ± 1.41% in the oxytetracycline group and 2.08 ± 1.76% in the control group (p = 0.006); the corresponding figures for the duct cells were 7.05 ± 0.87% and 3.10 ± 2.26% (p = 0.001). Based on our findings, we conclude that oxytetracycline might be a viable alternative for the treatment of chronic recurrent sialadenitis and sialorrhea. However, more research in this area is needed.","PeriodicalId":11842,"journal":{"name":"ENT Journal","volume":"13 1","pages":"492 - 496"},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87798081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-12-01DOI: 10.1177/014556131609501203
Jae-Hoon Lee, Ha-Min Jeong
A 51-year-old woman was referred to the Department of Otolaryngology at Wonkwang University School of Medicine with right-sided headaches and postnasal drip. Although her physician at the local clinic had been prescribing medications for the previous 3 months, her condition had not improved. She denied having a history oflong-term steroid use or any underlying systemic diseases. Nasal endoscopy revealed an edematous uncinate process in the patient's right nasal cavity, and the right side of her middle meatus was almost completely obstructed. Coronal computed tomography (CT) scans also revealed opacities in the right agger nasi cell (ANC) (figure, A) and the maxillary sinus (figure, B). Endoscopic sinus surgery was performed under general anesthesia. After the uncinate process was removed, dark yellowish material was found near the right maxillary sinus ostium; the material was removed with a forceps. Through a middle meatal antrostomy, a small amount of pus was observed in the right maxillary sinus. Next, the right ANC was opened and another piece of dark yellowish material was discovered there (figure, C). The material was removed via curved suction (figure, D), and pathologic analysis Continuedon page476
{"title":"Fungus Ball in an Agger Nasi Cell","authors":"Jae-Hoon Lee, Ha-Min Jeong","doi":"10.1177/014556131609501203","DOIUrl":"https://doi.org/10.1177/014556131609501203","url":null,"abstract":"A 51-year-old woman was referred to the Department of Otolaryngology at Wonkwang University School of Medicine with right-sided headaches and postnasal drip. Although her physician at the local clinic had been prescribing medications for the previous 3 months, her condition had not improved. She denied having a history oflong-term steroid use or any underlying systemic diseases. Nasal endoscopy revealed an edematous uncinate process in the patient's right nasal cavity, and the right side of her middle meatus was almost completely obstructed. Coronal computed tomography (CT) scans also revealed opacities in the right agger nasi cell (ANC) (figure, A) and the maxillary sinus (figure, B). Endoscopic sinus surgery was performed under general anesthesia. After the uncinate process was removed, dark yellowish material was found near the right maxillary sinus ostium; the material was removed with a forceps. Through a middle meatal antrostomy, a small amount of pus was observed in the right maxillary sinus. Next, the right ANC was opened and another piece of dark yellowish material was discovered there (figure, C). The material was removed via curved suction (figure, D), and pathologic analysis Continuedon page476","PeriodicalId":11842,"journal":{"name":"ENT Journal","volume":"12 1","pages":"470 - 476"},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87988199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-12-01DOI: 10.1177/014556131609501202
I. King, P. Gilbert
National guidelines serve an important role in steering clinical practice. Accordingly, it is the duty of clinicians practicing evidence-based medicine to scrutinize and evaluate such guidelines to ensure that these recommendations are as firmly rooted as possible in the evidence available at the time so as to be useful to both surgeons and patients considering any procedure. In March 2012, the UK National Institute for Health and Care Excellence (NICE) published Interventional Procedure Guidance (IPG) 422, "Incisionless otoplasty:" The guidance states, "Incisionless otoplasty comprises a variety of surgical techniques, carried out via minimal percutaneous access, that have been poorly described in the evidence, which includes a very small number of patients. The evidence on efficacy and safety is inadequate both in quality and quantity, and therefore the procedure should only be used with special arrangements for clinical governance, consent and audit or research:' I We examined the evidence presented in this guideline to determine whether the information presented was suitably researched, focused on the subject of discussion, and well referenced, and therefore would serve as a suitable platform on which to base clinical practice. Although uncommonly performed in the present day, this procedure for correction of prominent ears using a minimally invasive approach has historical roots at our institution and, accordingly, we were interested in how clinicians elsewhere might perceive the technique. NICE guidelines are widely regarded as excellent sources of rigorously researched, evidence-based guidance and advice, and they shape practice within the National Health Service and beyond. The panel of specialist advisors who compiled this IPG 422 consisted of two plastic surgeons with a specialist interest in ear surgery and one ear, nose, and throat surgeon with an ear interest. One of these specialist advisors had performed an incisionless otoplasty at least once, but the other two had never performed the procedure. The literature search undertaken (listed in Appen-
{"title":"Incisionless Otoplasty: Illustrating the Importance of Critical Appraisal of National Treatment Guidelines for Head and Neck Surgery","authors":"I. King, P. Gilbert","doi":"10.1177/014556131609501202","DOIUrl":"https://doi.org/10.1177/014556131609501202","url":null,"abstract":"National guidelines serve an important role in steering clinical practice. Accordingly, it is the duty of clinicians practicing evidence-based medicine to scrutinize and evaluate such guidelines to ensure that these recommendations are as firmly rooted as possible in the evidence available at the time so as to be useful to both surgeons and patients considering any procedure. In March 2012, the UK National Institute for Health and Care Excellence (NICE) published Interventional Procedure Guidance (IPG) 422, \"Incisionless otoplasty:\" The guidance states, \"Incisionless otoplasty comprises a variety of surgical techniques, carried out via minimal percutaneous access, that have been poorly described in the evidence, which includes a very small number of patients. The evidence on efficacy and safety is inadequate both in quality and quantity, and therefore the procedure should only be used with special arrangements for clinical governance, consent and audit or research:' I We examined the evidence presented in this guideline to determine whether the information presented was suitably researched, focused on the subject of discussion, and well referenced, and therefore would serve as a suitable platform on which to base clinical practice. Although uncommonly performed in the present day, this procedure for correction of prominent ears using a minimally invasive approach has historical roots at our institution and, accordingly, we were interested in how clinicians elsewhere might perceive the technique. NICE guidelines are widely regarded as excellent sources of rigorously researched, evidence-based guidance and advice, and they shape practice within the National Health Service and beyond. The panel of specialist advisors who compiled this IPG 422 consisted of two plastic surgeons with a specialist interest in ear surgery and one ear, nose, and throat surgeon with an ear interest. One of these specialist advisors had performed an incisionless otoplasty at least once, but the other two had never performed the procedure. The literature search undertaken (listed in Appen-","PeriodicalId":11842,"journal":{"name":"ENT Journal","volume":"22 1","pages":"466 - 469"},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77667711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-12-01DOI: 10.1177/014556131609501205
Lester D. R. Thompson
Secretory carcinoma, first described as mammary analogue secretory carcinoma (MASC), is a recently described, distinctive malignant salivary gland tumor that is quite similar to secretory breast carcinoma, defined by the t(l2;15)(p13;q25) translocation resulting in an ETV6-NTRK3 fusion product. The vast majority of these tumors used to be included in the acinic cell carcinoma category. The tumor is considered uncommon, but as it is recently recognized, it may be under-reported or underrecognized at present. There is a slight male-to-female predominance (1.3:1), with a wide age range at presentation (7 to 88 years; mean 47 years). The majority (65%) develop in the parotid gland, with the submandibular gland and buccal mucosa less frequently affected. Patients present with a slowly growing, painless mass. Metastatic disease to neck lymph nodes may be seen in as many as 30% of patients at presentation. Figure 2. A high-power view demonstrates the open to vesicular nuclearchromatinwith verysmall nucleoli. There is "colloid-like" material in the lumen, with scalloping artifacts.
{"title":"Secretory Carcinoma","authors":"Lester D. R. Thompson","doi":"10.1177/014556131609501205","DOIUrl":"https://doi.org/10.1177/014556131609501205","url":null,"abstract":"Secretory carcinoma, first described as mammary analogue secretory carcinoma (MASC), is a recently described, distinctive malignant salivary gland tumor that is quite similar to secretory breast carcinoma, defined by the t(l2;15)(p13;q25) translocation resulting in an ETV6-NTRK3 fusion product. The vast majority of these tumors used to be included in the acinic cell carcinoma category. The tumor is considered uncommon, but as it is recently recognized, it may be under-reported or underrecognized at present. There is a slight male-to-female predominance (1.3:1), with a wide age range at presentation (7 to 88 years; mean 47 years). The majority (65%) develop in the parotid gland, with the submandibular gland and buccal mucosa less frequently affected. Patients present with a slowly growing, painless mass. Metastatic disease to neck lymph nodes may be seen in as many as 30% of patients at presentation. Figure 2. A high-power view demonstrates the open to vesicular nuclearchromatinwith verysmall nucleoli. There is \"colloid-like\" material in the lumen, with scalloping artifacts.","PeriodicalId":11842,"journal":{"name":"ENT Journal","volume":"192 1","pages":"474 - 476"},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79675828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-12-01DOI: 10.1177/014556131609501208
A. Shupak, Y. Holdstein, M. Kaminer, I. Braverman
Intralabyrinthine schwannomas (ILSs) are uncommon benign tumors that originate in the Schwann cell sheath of the intralabyrinthine distal branches of the vestibulocochlear nerve. They have no initial involvement in the internal auditory canal although that might develop later. These lesions can arise inside the cochlea, originate in the vestibule or, in rare cases, develop in the semicircular canals. From these sites, spread might take place via the anatomic connections between the perilymphatic spaces in the scala vestibuli and the anterior vestibule. Thus, ILSs centered in the cochlea might involve the vestibule, and those originating in the vestibular end organs would reach the cochlea. Presenting signs and symptoms include a progressive or sudden sensorineural hearing loss (which occurs in more than 95% of patients), as well as tinnitus and vertigo. Magnetic resonance imaging characteristics include sharp circumscription and hypointensity on thin, heavily T2-weighted 3D images and strong enhancement after gadolinium administration on TI-weighted images. We describe a series of 7 cases of primary ILS that were managed at two of our institutions. We also discuss the need for a comprehensive otoneurologic evaluation that encompasses the functional derangement and the tumor location as delineated by MRI, and we describe the treatment options.
{"title":"Primary Solitary Intralabyrinthine Schwannoma: A Report of 7 Cases and a Review of the Literature","authors":"A. Shupak, Y. Holdstein, M. Kaminer, I. Braverman","doi":"10.1177/014556131609501208","DOIUrl":"https://doi.org/10.1177/014556131609501208","url":null,"abstract":"Intralabyrinthine schwannomas (ILSs) are uncommon benign tumors that originate in the Schwann cell sheath of the intralabyrinthine distal branches of the vestibulocochlear nerve. They have no initial involvement in the internal auditory canal although that might develop later. These lesions can arise inside the cochlea, originate in the vestibule or, in rare cases, develop in the semicircular canals. From these sites, spread might take place via the anatomic connections between the perilymphatic spaces in the scala vestibuli and the anterior vestibule. Thus, ILSs centered in the cochlea might involve the vestibule, and those originating in the vestibular end organs would reach the cochlea. Presenting signs and symptoms include a progressive or sudden sensorineural hearing loss (which occurs in more than 95% of patients), as well as tinnitus and vertigo. Magnetic resonance imaging characteristics include sharp circumscription and hypointensity on thin, heavily T2-weighted 3D images and strong enhancement after gadolinium administration on TI-weighted images. We describe a series of 7 cases of primary ILS that were managed at two of our institutions. We also discuss the need for a comprehensive otoneurologic evaluation that encompasses the functional derangement and the tumor location as delineated by MRI, and we describe the treatment options.","PeriodicalId":11842,"journal":{"name":"ENT Journal","volume":"126 1","pages":"481 - 491"},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84917795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-12-01DOI: 10.1177/014556131609501207
K. Parham, K. Kost
An 83-year-old female resident of an assisted living facility presented to the emergency department at UCONN Health with 1 week of a sore throat and 2 days of shortness of breath, mild stridor, and dysphagia. Physical examination showed a well-nourished elderly woman with no significant medical history. She had' a fixed right thyroid mass. Mental status assessment showed no cognitive impairment, and a depression screen was negative. Fiberoptic nasolaryngoscopy revealed an immobile right vocal fold. Computed tomography (CT) with contrast showed a 3.8 x 3.9 x 4.8-cm mass centered in the right thyroid lobe (figure). The mass had eroded the lateral margin of the thyroid cartilage and produced moderate to severe mass effect on the glottis and airway. It also showed a 2.6-cm left suprahilar density. Fine-needle aspiration of the thyroid mass showed squamous cell carcinoma. We discussed the prognosis of stage 4 cancer and management options with the patient. She wanted no surgical intervention and opted for "do not resuscitate/
一名住在辅助生活设施的83岁女性患者因1周的喉咙痛和2天的呼吸急促、轻度喘鸣和吞咽困难而就诊于康涅狄格大学健康中心急诊科。体格检查显示为营养良好的老年妇女，无明显病史。她有一个固定的右侧甲状腺肿块。精神状态评估显示没有认知障碍，抑郁筛查呈阴性。纤维鼻咽喉镜检查显示右声带不动。计算机断层扫描(CT)显示一个3.8 x 3.9 x 4.8 cm的肿块，以右甲状腺叶为中心(图)。肿块已侵蚀甲状腺软骨外侧缘，对声门和气道产生中度至重度肿块效应。左侧门上密度为2.6 cm。细针穿刺甲状腺肿块显示鳞状细胞癌。我们与患者讨论了4期癌症的预后和治疗方案。她不希望手术干预，选择了“不复苏”
{"title":"End-of-Life Decision Making in Geriatric Terminal Head and Neck Cancer","authors":"K. Parham, K. Kost","doi":"10.1177/014556131609501207","DOIUrl":"https://doi.org/10.1177/014556131609501207","url":null,"abstract":"An 83-year-old female resident of an assisted living facility presented to the emergency department at UCONN Health with 1 week of a sore throat and 2 days of shortness of breath, mild stridor, and dysphagia. Physical examination showed a well-nourished elderly woman with no significant medical history. She had' a fixed right thyroid mass. Mental status assessment showed no cognitive impairment, and a depression screen was negative. Fiberoptic nasolaryngoscopy revealed an immobile right vocal fold. Computed tomography (CT) with contrast showed a 3.8 x 3.9 x 4.8-cm mass centered in the right thyroid lobe (figure). The mass had eroded the lateral margin of the thyroid cartilage and produced moderate to severe mass effect on the glottis and airway. It also showed a 2.6-cm left suprahilar density. Fine-needle aspiration of the thyroid mass showed squamous cell carcinoma. We discussed the prognosis of stage 4 cancer and management options with the patient. She wanted no surgical intervention and opted for \"do not resuscitate/","PeriodicalId":11842,"journal":{"name":"ENT Journal","volume":"1 1","pages":"479 - 480"},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90082969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-12-01DOI: 10.1177/014556131609501201
A. Poletti, S. Dubey, G. Colombo, G. Cugini
Ear, Nose & Throat Journal's website is easy to navigate and provides readers with more editorial content each month than ever before. Access to everything on the site is free of charge to physicians and allied ENT professionals. To take advantage of all our site has to offer, go to www.entjournal.com and click on the “Registration” link. Once you have filled out the brief registration form, you will have full access. Explore and enjoy!
{"title":"Online Exclusives","authors":"A. Poletti, S. Dubey, G. Colombo, G. Cugini","doi":"10.1177/014556131609501201","DOIUrl":"https://doi.org/10.1177/014556131609501201","url":null,"abstract":"Ear, Nose & Throat Journal's website is easy to navigate and provides readers with more editorial content each month than ever before. Access to everything on the site is free of charge to physicians and allied ENT professionals. To take advantage of all our site has to offer, go to www.entjournal.com and click on the “Registration” link. Once you have filled out the brief registration form, you will have full access. Explore and enjoy!","PeriodicalId":11842,"journal":{"name":"ENT Journal","volume":"294 1","pages":"464 - 465"},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79058922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-10-01DOI: 10.1177/014556131609510-1102
Sheng-Chiao Lin, Ting-Shou Chang
Although patients with dermatologic diseases sometimes present at ENT clinics, few ENT specialists encounter cutaneous malignancies. The most common skin cancers of the head and neck are non-melanoma skin cancers (NMSC).1 These cancers are good mimics of inflammation. Herein we report the case of an 88-year-old man presenting with a 4-month history of progressive redness, swelling, and pain of the left face and neck (figure, A). Physical examination showed multiple lymphadenopathies over the left level II to V, with a fixed and elastic quality. Laboratory data revealed mild leukocytosis (10,640/μl), elevated C-reactive protein (6.01 mg/dl) and erythrocyte sedimentation rate (35 mm/hr), and hyperkalemia (6.0 meq/L). Because of our initial impression of left neck lymphadenitis with facial cellulitis, the patient was administered parenteral amoxicillin and clavulanic acid. Because this intervention did not resolve the complaint, the patient underwent magnetic resonance imaging (MRI), which showed skin thickening, septation of the subcutaneous fat, and thickening of the superficial fascia (figure, B). These features were consistent with lymphadenitis and cellulitis of the left face and neck. However, because the patient was afebrile, it was thought best to evaluate him further to rule out other diagnoses. Thus, an excisional biopsy of one lymph node from the left neck level III was performed. Pathology revealed irregular, anastomosing vascular structures lined by rhabdoid-featured, large, atypical cells with positive immunohistochemical stains for CD34 and CD31 (figure, C), indicating poorly differentiated angiosarcoma. A review of previous images led to the lesion’s finally being staged at T2N1M0. Chemoradiotherapy was recommended rather than extensive surgery because the patient was elderly and the tumor was diffuse. However, the patient declined
{"title":"Cutaneous Angiosarcoma of the Scalp Mimicking Facial Cellulitis","authors":"Sheng-Chiao Lin, Ting-Shou Chang","doi":"10.1177/014556131609510-1102","DOIUrl":"https://doi.org/10.1177/014556131609510-1102","url":null,"abstract":"Although patients with dermatologic diseases sometimes present at ENT clinics, few ENT specialists encounter cutaneous malignancies. The most common skin cancers of the head and neck are non-melanoma skin cancers (NMSC).1 These cancers are good mimics of inflammation. Herein we report the case of an 88-year-old man presenting with a 4-month history of progressive redness, swelling, and pain of the left face and neck (figure, A). Physical examination showed multiple lymphadenopathies over the left level II to V, with a fixed and elastic quality. Laboratory data revealed mild leukocytosis (10,640/μl), elevated C-reactive protein (6.01 mg/dl) and erythrocyte sedimentation rate (35 mm/hr), and hyperkalemia (6.0 meq/L). Because of our initial impression of left neck lymphadenitis with facial cellulitis, the patient was administered parenteral amoxicillin and clavulanic acid. Because this intervention did not resolve the complaint, the patient underwent magnetic resonance imaging (MRI), which showed skin thickening, septation of the subcutaneous fat, and thickening of the superficial fascia (figure, B). These features were consistent with lymphadenitis and cellulitis of the left face and neck. However, because the patient was afebrile, it was thought best to evaluate him further to rule out other diagnoses. Thus, an excisional biopsy of one lymph node from the left neck level III was performed. Pathology revealed irregular, anastomosing vascular structures lined by rhabdoid-featured, large, atypical cells with positive immunohistochemical stains for CD34 and CD31 (figure, C), indicating poorly differentiated angiosarcoma. A review of previous images led to the lesion’s finally being staged at T2N1M0. Chemoradiotherapy was recommended rather than extensive surgery because the patient was elderly and the tumor was diffuse. However, the patient declined","PeriodicalId":11842,"journal":{"name":"ENT Journal","volume":"38 1","pages":"438 - 443"},"PeriodicalIF":0.0,"publicationDate":"2016-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75783168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-10-01DOI: 10.1177/014556131609510-1105
Kai-Chieh Chan
A 26-year-old man presented to our clinic with a left progressive hearing loss of several years’ duration. His tympanic membrane appeared normal, and no significant otologic history was discovered. Pure-tone audiometry and tympanometry of the left ear showed a conductive hearing loss of 70 dB with an air-bone gap of 60 dB and a type AS tympanogram. Computed tomography (CT) of the temporal bones revealed no temporal bone anomalies. Exploratory tympanotomy revealed that a bony bar was extending from the pyramidal eminence to the posterior crus of the stapes, with involvement of the stapedius tendon, leading to stapes fixation (figure). The mobility of the footplate was normal. Therefore, resection of the bony bar and the ossified stapedius tendon was performed with a microdrill. The postoperative course was uneventful, and the air-bone gap had been reduced to 18 dB by the time of the 2-year follow-up. In isolated congenital ankylosis of the stapes, fixation of the footplate is by far most commonly encountered. Other congenital ankyloses include fixation of the suprastructure by a separate bony bridge to the pyramid or facial canal, elongation of pyramidal eminence, or ossification of the stapedial tendon.1 Ossification of the stapedius tendon giving rise to
{"title":"Stapes-Pyramidal Fixation by a Bony Bar","authors":"Kai-Chieh Chan","doi":"10.1177/014556131609510-1105","DOIUrl":"https://doi.org/10.1177/014556131609510-1105","url":null,"abstract":"A 26-year-old man presented to our clinic with a left progressive hearing loss of several years’ duration. His tympanic membrane appeared normal, and no significant otologic history was discovered. Pure-tone audiometry and tympanometry of the left ear showed a conductive hearing loss of 70 dB with an air-bone gap of 60 dB and a type AS tympanogram. Computed tomography (CT) of the temporal bones revealed no temporal bone anomalies. Exploratory tympanotomy revealed that a bony bar was extending from the pyramidal eminence to the posterior crus of the stapes, with involvement of the stapedius tendon, leading to stapes fixation (figure). The mobility of the footplate was normal. Therefore, resection of the bony bar and the ossified stapedius tendon was performed with a microdrill. The postoperative course was uneventful, and the air-bone gap had been reduced to 18 dB by the time of the 2-year follow-up. In isolated congenital ankylosis of the stapes, fixation of the footplate is by far most commonly encountered. Other congenital ankyloses include fixation of the suprastructure by a separate bony bridge to the pyramid or facial canal, elongation of pyramidal eminence, or ossification of the stapedial tendon.1 Ossification of the stapedius tendon giving rise to","PeriodicalId":11842,"journal":{"name":"ENT Journal","volume":"3 1","pages":"E40 - E41"},"PeriodicalIF":0.0,"publicationDate":"2016-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84209017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-10-01DOI: 10.1177/014556131609510-1101
D. Christmas, J. P. Mirante, E. Yanagisawa
{"title":"More than 20 Years of Powered Endoscopic Ethmoidectomy","authors":"D. Christmas, J. P. Mirante, E. Yanagisawa","doi":"10.1177/014556131609510-1101","DOIUrl":"https://doi.org/10.1177/014556131609510-1101","url":null,"abstract":"","PeriodicalId":11842,"journal":{"name":"ENT Journal","volume":"13 1","pages":"430 - 430"},"PeriodicalIF":0.0,"publicationDate":"2016-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75124138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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