Case Reports in Otolaryngology最新文献

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.

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.