Case Reports in Otolaryngology最新文献

Introduction: Nasal chondromesenchymal hamartoma (NCMH) is a rare cause of nasal mass in infants and children. It was first described in 1998, and since then, only 63 previous cases have been reported.

Case report: Here, we report a case of a 4-day-old neonate with a right-sided nasal mass presenting with respiratory distress since birth. MRI was suggestive of chondromesenchymal hamartoma, for which endoscopic excision was done with complete removal of the tumor. The patient was diagnosed and successfully managed in our setup.

Discussion: NCMH is a rare cause of nasal obstruction in neonates, with a similar clinical presentation to other known nasal masses. Physical examination, imaging, histopathology, and molecular tests are combined to diagnose such cases. The curative management currently recommended is surgery.

Conclusion: It is always prudent to consider all possible differentials in neonates presenting with a nasal mass. Our report focuses on the role of proper examination, imaging techniques, and histologic evaluation for proper diagnosis and follow-up in a resource-limited setup.

Osteomas of the external ear canal are rare but benign bony growths. We present a case report of an external auditory canal osteoma in a 74-year-old female that spontaneously extruded from the ear. The patient was evaluated after the lesion dislodged from her ear canal without physical manipulation or operative intervention, and she presented the specimen intact. The diagnosis of osteoma was made clinically, radiographically, and pathologically. We propose that certain external ear canal osteomas may resolve spontaneously or be amenable to in-office removal.

"Rhinophyma" comes from the Greek words "rhis," meaning nose, and "phyma," meaning growth, which reflects its clinical presentation; overgrowth of sebaceous glands results in disfigurement or even nasal obstruction, in more severe cases. Nonsurgical treatments are the standard care, with dermabrasion, laser therapy, and ablative treatments being the most commonly preferred options. For advanced or recurrent cases, surgical intervention is the gold standard. Various surgical techniques have been described, including skin grafts, flaps, and skin substitutes. Surprisingly, there are only a few case reports in the literature regarding the surgical management of rhinophyma. We present two cases of severe and recurrent rhinophyma treated surgically in one stage procedure under local anesthesia by two different surgical techniques, one flap reconstruction and one dermal substitute and split-thickness skin graft reconstruction. Both patients had breathing difficulties, which were resolved after the surgical intervention. No major complications were detected during the 2 years of follow-up. Patients were satisfied with the aesthetic and functional outcomes. The surgical approach of rhinophyma should be the standard of care for recurrent cases or cases with nasal obstruction. Different surgical techniques have been described. As long as surgical planning is concerned, it is essential to consider practical and clinical factors such as patient's preferences, one or more stages of reconstruction, healing time, safety, and recurrence rates.

A 35-year-old man with uncontrolled human immunodeficiency virus (HIV) infection presented with a pharyngeal plaque-like lesion after recommencing antiretroviral treatment (ART). Rapid localized growth of the lesion paralleled his rising CD4+ T-cell count, suggesting immune reconstitution-mediated deterioration. The diagnosis of the lesion as angiolymphoid hyperplasia with eosinophilia was made more challenging by the atypical immune response that accompanies the HIV-associated immune reconstitution inflammatory syndrome.

Cricotracheostomy is a modified tracheostomy technique that involves partial resection of the anterior cricoid cartilage, which enables high-level airway access while minimizing the risk of subglottic stenosis. This report describes two adult cases of congenital scoliosis with complex skeletal deformities, including tracheal deviation and restricted neck extension, wherein conventional tracheostomy was challenging. In both cases, cricotracheostomy successfully provided stable airway access without complications such as granulation tissue formation, infection, or subglottic stenosis during follow-up. This report supports the utility of cricotracheostomy as the primary surgical approach in patients with severe skeletal deformities.

We report a minimally invasive transnasal endoscopic approach via the inferolateral periorbital periosteal line, which allows for safer surgery in the inferolateral orbital region without external incisions. This method enables better visibility while preserving physiological function and reducing cosmetic risks by minimizing fat deviation and avoiding problems such as ocular compression and orbital bone resection commonly encountered in open and transorbital surgery. This technique may be an optimal alternative or complement to traditional open surgery.

Background: We report a case of osteosarcoma of the mastoid process.

Methods: The tumor was identified after the patient presented with progressive hearing loss 5 years after radiotherapy treatment for parotid mucoepidermoid carcinoma. A CT scan revealed a mass invading the middle ear and mastoid process. The diagnosis of osteosarcoma was confirmed by biopsy.

Results: The mass was surgically excised, and the patient was treated with postoperative cisplatin and doxorubicin. The patient also developed a postauricular abscess that was treated with incision and drainage and antibiotics. This abscess ultimately resolved, and the patient is otherwise well postoperatively.

Conclusion: This case demonstrates the extent to which osteosarcomas can invade into surrounding tissues as this one had reached the middle ear. Moreover, this case highlights the need for multicenter studies to develop an approach to treatment of these rare tumors as they are not well studied currently.

Background: The parapharyngeal space is a surgically challenging anatomic compartment with critical neurovascular structures with limited access options that often requires an open transcervical skull base approach, often in combination with parotidectomy and/or a transoral approach. As such, lesions in this area must be carefully approached and represent a challenge even for experienced surgeons. Isolated transoral approaches have been used but are often limited by visualization of the deeper structures of the parapharyngeal space. While transoral robotic resection has been used to approach the parapharyngeal space, it must be performed after careful patient selection.

Case presentation: We present a patient with massive bilateral rhabdomyoma of the parapharyngeal space who presented following dysphagia. A minimally invasive transoral approach was used to successfully remove both tumors simultaneously. This patient successfully underwent removal of bilateral tumors using a completely transoral robotic-assisted approach. The patient experienced no long-term sequela including dysphagia, bleeding, cranial neuropathy, and airway distress. A literature search regarding bilateral parapharyngeal space tumors and transoral approaches to the parapharyngeal space was performed to examine the rarity, safety, and efficacy of the approach. This represents the only report of such pathology as well as the only report of a simultaneous bilateral parapharyngeal space approach with transoral robotic surgical assistance.

Conclusion: Bilateral parapharyngeal space tumors are an incredibly rare phenomenon. Following careful patient selection and postoperative monitoring, removal of bilateral tumors can be performed in a safe and successful manner without complication, morbidity, or external incision.

Background: Juvenile nasopharyngeal angiofibroma (JNA) is a rare, highly vascular benign tumor primarily affecting adolescent males. It accounts for 0.05%-0.5% of head and neck tumors and is typically diagnosed in its early stages due to symptoms such as recurrent epistaxis and nasal obstruction. However, atypical presentations with minimal bleeding can delay the diagnosis, leading to advanced tumor progression. Surgical management of advanced-stage JNA is challenging due to its aggressive local invasion, high vascularity, and potential for intracranial extension.

Case presentation and management: We report the case of an 11-year-old male who presented with progressive right nasal obstruction, headaches, and only a few episodes of mild epistaxis (3-4 times per year) over three years. This atypical presentation led to a delayed diagnosis, allowing the tumor to progress to an advanced stage. Imaging studies, including contrast-enhanced CT and MRI, revealed a large lobulated, highly vascularized stage 4B JNA with extensive invasion into the pterygopalatine fossa, infratemporal fossa, orbit, and intracranial structures, abutting the cavernous sinus. Given the tumor's extensive involvement, a multidisciplinary approach was adopted. An endoscopic endonasal approach was chosen for tumor resection to minimize facial scarring, preserve normal anatomy, and reduce perioperative morbidity. A meticulous stepwise dissection was performed, addressing the tumor's extension into the orbit, infratemporal fossa, and skull base. Hemostasis was carefully managed, and no major intraoperative complications were encountered.

Results: The patient demonstrated an uneventful postoperative recovery, with no significant bleeding or cerebrospinal fluid (CSF) leakage. Postoperative imaging confirmed near-total resection, and follow-up evaluations at one, three, and 6 months showed no evidence of recurrence. The patient's nasal obstruction resolved, facial symmetry improved significantly, and no neurological deficits were observed.

Conclusion: This case highlights the importance of considering atypical presentations of JNA, as minimal epistaxis can delay diagnosis and lead to extensive tumor spread. Endoscopic surgical techniques provide an effective and minimally invasive alternative for managing advanced-stage JNA, offering superior cosmetic and functional outcomes while reducing perioperative risks. A multidisciplinary approach, integrating advanced radiological imaging and precise surgical planning, remains crucial in optimizing patient outcomes.

Introduction: Cerebellar syndromes are rare yet potentially serious presentations in the emergency department, requiring timely diagnosis and intervention. The differential diagnosis is wide, encompassing stroke, multiple sclerosis, toxic reactions, and metabolic imbalances such as hypomagnesemia. Proton pump inhibitors (PPIs) have been increasingly recognized as a cause of severe hypomagnesemia, which can lead to reversible cerebellar syndrome.

Case reports: We present two cases of reversible cerebellar syndrome caused by hypomagnesemia. The first case involves a 65-year-old man with a two-week history of weakness, dizziness, and inappetence. After extensive investigation, including normal MRI and vestibular testing, his symptoms were attributed to severe hypomagnesemia secondary to esomeprazole use. Magnesium supplementation led to clinical improvement. The second case is a 68-year-old man with progressively worsening dizziness, nausea, and instability. Hypomagnesemia related to omeprazole use was identified as the cause, and intravenous magnesium supplementation significantly improved his condition.

Discussion: Hypomagnesemia is an often overlooked but important cause of cerebellar dysfunction. Magnesium deficiency leads to neuronal hyperexcitability, particularly affecting the cerebellum. In both cases, PPI use was the primary cause of hypomagnesemia, with magnesium supplementation reversing most symptoms. Cerebellar symptoms from hypomagnesemia may fluctuate, complicating diagnosis, and normal brain imaging does not rule out this condition. Regular monitoring of serum magnesium levels in patients on long-term PPI therapy is essential. These cases illustrate that PPI-induced hypomagnesemia should be considered in patients presenting with atypical dizziness and balance disorders. Early diagnosis and treatment with magnesium supplementation can reverse symptoms, although some residual effects may persist. Continuous monitoring is crucial for patients requiring long-term PPI therapy to prevent recurrence.