Case Reports in Otolaryngology最新文献

Vestibular migraine (VM) requires a migraine history according to ICHD-3, but recurrent vertigo may also develop in secondary headache disorders. We report a 52-year-old man who experienced persistent headache and recurrent vertigo following a traffic accident. His headache fulfilled criteria for chronic posttraumatic headache and later medication-overuse headache. Vertigo attacks lasted minutes to 1 h and were accompanied by photophobia, phonophobia, and motion sensitivity, resembling VM despite no migraine history. Preventive therapy with amitriptyline and valproate reduced vertigo frequency and analgesic overuse. This case suggests that VM-like syndromes can occur with secondary headaches, where migraine-oriented prophylaxis may be useful.

During rhinoplasty surgery, tiny bone spicules (BSs) can form, particularly if blunt tools are used. If these BSs are not noticed and removed intraoperatively, they can cause cosmetic problems and nasal swelling postoperatively. A patient who underwent open rhinoplasty 2 years ago presented with a painless swelling causing cosmetic problems near the left medial canthus. A BS was detected by paranasal sinus computerized tomography and removed using an endonasal endoscopic approach (EEA). At 13 months of postoperative follow-up, the patient reported no complaints. The use of sharpened osteotomes or powered instruments, capable of creating the precise and desired osteotomies, is crucial to prevent the formation of BS. Detecting these BS intraoperatively is also desirable. Administering intravenous corticosteroids, such as prednisolone (1 mg/kg), maintaining hypotensive anesthesia, applying ice packs, and elevating the head 30° during surgery can help reduce edema and aid in the identification of BS. Saline irrigation and surgical field aspiration can facilitate the removal of BS. Final inspection and palpation of the nose from different angles under proper lighting are essential. In cases where BSs are overlooked, an EEA with minimal dissection and no skin scar may be preferred for their extraction. EEA is a minimally invasive, practical, and successful treatment option for BS extraction.

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.