Case Reports in Otolaryngology最新文献

Tonsillectomy is one of the most frequently performed procedures in ear, nose and throat (ENT) surgery, commonly indicated for recurrent tonsillitis, recurrent peritonsillar abscess, obstructive sleep apnoea or suspected malignancy. While generally safe, it carries recognised risks including haemorrhage, infection, pain and orodental trauma. Surgical emphysema is a rare but clinically significant complication, with fewer than 30 cases reported and an estimated incidence below 0.02%. It is hypothesised to result from mucosal or muscular disruption of the pharyngeal wall during dissection, particularly with electrocautery or aggressive technique, exacerbated by postoperative factors such as coughing, vomiting or Valsalva manoeuvres. We present the case of a 25-year-old woman who underwent elective tonsillectomy for recurrent tonsillitis. The procedure was uneventful, but she re-presented within 24 h with left-sided jaw and neck pain. Examination revealed cervicofacial crepitus, and CT imaging confirmed surgical emphysema extending from the submandibular region to the superior mediastinum and anterior chest wall. She was admitted for observation and treated conservatively with intravenous antibiotics and analgesia. Her symptoms resolved within 3 days, and she was discharged without further intervention. This case highlights the importance of early recognition and appropriate management of post-tonsillectomy surgical emphysema. Although rare, its potential severity, particularly in patients with respiratory comorbidities, warrants inclusion in preoperative counselling. In line with the Montgomery ruling, clinicians should consider individual risk factors when discussing consent. Greater awareness of this complication may support timely diagnosis and reinforce the value of nuanced risk communication in ENT practice.

Background and purpose: The purpose of this case report is to describe dizziness symptoms caused by sinusitis evaluated in outpatient physical therapy setting.

Case description: A 59-year-old man with chronic peripheral vertigo of the right ear was referred to our outpatient physical therapy for vestibular rehabilitation. He was diagnosed with chronic peripheral vertigo of the right ear. He experienced a spinning sensation lasting for several hours, with no clear or consistent trigger for the onset of his dizziness.

Intervention: Vestibular-ocular reflex (VOR) exercises were prescribed as part of a home exercise program.

Outcomes: The patient was unable to perform the prescribed VOR exercises due to his travel schedule. However, he reported complete resolution of dizziness symptoms following surgical intervention and pharmacological treatment for chronic rhinosinusitis.

Discussion: This case highlights the importance of a holistic approach when evaluating and treating patients with vestibular symptoms. Clinicians should consider sinus-related conditions, such as chronic rhinosinusitis, as potential contributors to dizziness.

Background: Choanal atresia (CA) is a congenital condition characterized by occlusion of the nasal airway due to failure of recanalization during embryological development. It is more commonly unilateral and typically presents during infancy. In contrast, bilateral CA is a neonatal emergency that often manifests as respiratory distress at birth. The presentation of bilateral CA in late adulthood is extremely rare.

Case description: This case presents an unusual case of an elderly patient diagnosed with bilateral CA at 65 years. She presented with a primary complaint of lifelong bilateral nasal obstruction and denied any symptoms suggestive of chronic rhinosinusitis. Examination revealed bilateral choanal obstruction with no visible openings in the nasal cavity. The patient underwent endoscopic transseptal repair of bilateral CA, which included perforation of the atretic plate, posterior septectomy, and flap reconstruction. Postoperative evaluation demonstrated bilaterally patent choanae, and the patient remained asymptomatic, with no further complications.

Conclusion: This case highlights a rare presentation of bilateral CA diagnosed in late adulthood. Although typically detected in the neonatal period, bilateral CA can occasionally remain undiagnosed for decades. This patient represents the oldest reported case of bilateral CA in the literature, emphasizing the variability in clinical presentation and the potential for delayed diagnosis.

Background: Parapharyngeal space masses are rare lesions identified in pediatric patients. The present case describes the clinical history and surgical treatment of a parapharyngeal space in a 32-month-old female.

Methods: The electronic medical record was used for this retrospective case report.

Results: A 32-month-old female had a nonsignificant clinical presentation and a negative flexible laryngoscopy. Upon imaging, a mass was seen in the left parapharyngeal space. Resection of the mass was conducted. The final pathology confirmed a benign simple cyst. The patient did not have any postoperative complications.

Conclusions: This case illustrates that surgical resection can be an adequate treatment method for a parapharyngeal space mass. It also adds to the literature on types of parapharyngeal space masses that may present in pediatric patients.

Paragangliomas (PGLs) are extremely rare endocrine tumors that arise from the autonomic nervous system. Their rarity contributes to their frequent misdiagnosis. Ultrasound and immunohistochemical findings are heavily relied on for correct diagnosis. We present a case of thyroid PGL in a 40-year-old female patient who presented with a 1-year history of anterior neck mass and a 4-month history of hemoptysis. Ultrasound findings showed a solitary, lobulated, hypoechoic, and vascular lesion in the right thyroid lobe. She underwent total thyroidectomy and tracheal end-to-end anastomosis. Histopathology showed cells organized in distinct nests (zellballen) pattern enclosed by a delicate fibrovascular stroma. On immunohistochemical analysis, the tumor was positive for synaptophysin, CD56, GATA-3, and S100. The patient is stable postoperatively and disease-free. The role of ultrasound is vital in forming a correct diagnosis of thyroid PGL preoperatively. We review the current literature regarding diagnostic findings and treatment of thyroid PGLs with the aim of supplementing the findings of the thyroid PGLs that have been previously reported. The creation of a robust imaging and immunohistochemical profile for this entity is needed to combat the frequent misdiagnoses that occur with thyroid PGLs.

Background: The unusual disorder known as Langerhans cell histiocytosis (LCH), which is most frequently observed in children and young adults, is caused by the clonal proliferation of Langerhans cells. This disease is classified into several types depending on the extent of the lesion. Because it is rare diseases, there is no established standard treatment of this disease. In this report, we describe an extremely rare case of LCH that developed in the mandible of an older male. This is the first report in the world of a favorable outcome following surgical resection and local steroids administration.

Case report: The patient was a 75-year-old male who complained of swelling and pain in his mandible; however, there were no abnormal findings upon intraoral examination. Panoramic radiograph, computed tomography (CT), and magnetic resonance imaging (MRI) revealed osteolytic tumors. A diagnosis of LCH was confirmed based on the pathological findings of a cluster of Langerhans cells in a biopsy specimen of a submucosal tumor. Because the patient was elderly and the primary tumor was in the mandible, radiation therapy, chemotherapy, and systemic steroid administration were difficult to tolerate due to side effects. We performed combined treatment with surgical resection and local steroids injection. He was discharged from the hospital 1 week after the operation; the intraoral wound healed after 2 months, and the pain improved.

Conclusions: This report suggests that a combination of surgical resection and local steroids administration is effective in treating LCH of the mandible in elderly patients.

Follicular dendritic cell sarcoma is a rare malignant tumor originating from follicular dendritic cells. We present the first report of such a sarcoma of the palatine tonsils that developed as a radiation-induced sarcoma. A 78-year-old man, who had undergone chemoradiotherapy for hypopharyngeal and esophageal cancer 7 years prior, presented with discomfort during swallowing. Endoscopic pharyngeal examination revealed a tumor in the right palatine tonsil which was histopathologically diagnosed as a follicular dendritic cell sarcoma. The tumor also met the diagnostic criteria for radiation-induced sarcoma. Positron emission tomography/computed tomography revealed abnormal uptake in the right palatine tonsil and bilateral cervical lymph nodes; no distant metastases were detected. The patient underwent tumor resection using the mandibular swing approach, pharyngeal reconstruction using an anterolateral thigh flap, bilateral neck lymph node dissection, and tracheostomy. Postoperative radiotherapy was not administered because of previous irradiation; however, no apparent recurrence or metastasis was observed 4 years after surgery. Follicular dendritic cell sarcoma can develop over an extended period after previous irradiation. Extended resection with a negative margin may be pivotal in treating follicular dendritic cell sarcoma when postoperative radiotherapy cannot be administered.

Sinonasal teratocarcinosarcoma (SNTCS) is a rare, aggressive malignancy with epithelial, mesenchymal, and neuroectodermal components. We report the case of a 66-year-old man with right nasal obstruction and epistaxis. Imaging revealed a mass in the right nasal cavity and ethmoid sinus. Histopathology revealed immature squamous nests with clear cytoplasm, and immunohistochemistry confirmed multiphenotypic differentiation. Therefore, SNTCS was diagnosed. Owing to inoperability, the patient underwent chemoradiotherapy, which resulted in stable disease at 6 months. This case highlights the diagnostic complexity of SNTCS and suggests that nonsurgical management may be effective in select cases.

Tracheostomal myiasis, the infestation of a tracheostomy site by fly larvae, is an uncommon and challenging condition, with limited cases reported in the medical literature. This case report aims to describe both the clinical presentation and management of tracheostomal myiasis in a patient with multiple comorbidities. The patient presented with foul-smelling discharge and visible maggots at the tracheostomy site. Management involved manual removal of larvae, surgical debridement, irrigation with iodine solution, and sealing the stoma with paraffin ointment. This case highlights the need for clinician awareness of this rare complication, particularly in patients with compromised health, and highlights the importance of preventive care and early intervention. As a single case report, it reflects the experience within a broader context of managing tracheostomy-related complications.

Introduction: Hydatid cyst disease is an endemic parasitic infection caused by Echinococcus granulosus. Hydatid cysts occur mainly in the liver and lungs and are rare in the head and neck region, even in endemic areas. Due to their nonspecific clinical manifestations, diagnostic challenges are encountered in such atypical presentations. Case Presentation: We report the case of a 6-year-old girl who presented with a progressively enlarging, painless left postauricular mass. Radiological assessment revealed a well-circumscribed, unilocular cystic lesion at level V of the neck. Surgical resection was performed, and histopathology confirmed a hydatid cyst. Postoperatively, the patient was treated with albendazole. No recurrence was observed at follow-up. Clinical Discussion: Hydatid cysts in the cervical region are exceptionally rare, with only a few cases documented in the literature. The disease can remain asymptomatic for years, often presenting as a slow-growing mass. Imaging with ultrasound and CT is critical in preoperative diagnosis. The gold standard of treatment remains complete surgical excision, reinforced by anthelmintic therapy to prevent recurrence. Conclusion: Although rare, hydatid cyst disease should remain among the differential diagnoses of cystic neck masses, especially in endemic areas. Early diagnosis and intervention are essential in evading complications of the disease such as anaphylaxis or recurrence. Ultimately, prevention remains the most effective strategy, emphasizing the need for community awareness, hygienic practices, and coordinated control efforts to break the parasite's life cycle.