Case Reports in Otolaryngology最新文献

A 68-year-old man previously treated for a large laryngeal neoplasm (pT4 pN0 squamous cell carcinoma) developed osteomyelitis of the medial third of the right clavicle with the formation of a fistula between the sternoclavicular joint and tracheal wall near the tracheostomy border. The clinical course was tedious, required prolonged antibiotic trials, and extended surgical bone resection to control the infection. The final outcome was favorable with wound closure although the patient was left with permanent limitation of shoulder abduction (his shoulder mobility had been normal prior to this process). Histopathological examination of the resected bone suggested a diagnosis of both osteoradionecrosis and osteomyelitis. Indeed, differential diagnosis between these two entities can be challenging after radiotherapy. Here, we present a review of the relevant academic literature and discuss the therapeutic options.

Background: Submucosal laryngeal carcinoma (SLC) is a rare subtype of transglottic laryngeal carcinoma (TLC) and usually originates from the center of the laryngeal ventricle. Nearly 70% of TLC cases are confined to the larynx and 30% show external laryngeal infiltrations. Early stage asymptomatic TLC usually shows occult lesions and tends to grow into lateral parapharyngeal space. Case Summary: We present an unusual case of submucosal moderately poor differentiated laryngeal squamous cell carcinoma (SCC) characterized by thyroid mass, hoarseness, and dyspnea as the main symptoms. In this case, a 60-year-old Chinese male was made a preliminary diagnosis of suspected thyroid carcinoma (TC) with laryngeal metastases to the cricoid cartilage. No laryngeal neoplasms were observed under nasopharyngo-fiberoscope. After giving 1-month therapy with anlotinib, the tumor lesion had minimal response while the patient insisted on surgical section to relieve dyspnea. Intraoperative frozen section biopsy confirmed that the tumor was moderately poor differentiated SCC of the larynx, and in this case, thyroid metastases might result in SLC penetration of cricothyroid membrane. Conclusion: SLC should be taken into consideration in the case of suspicious TC with laryngeal cartilage infiltration and subglottic area infiltration. Further coarse needle puncture or surgical biopsy should be carried out to clarify diagnosis to optimize treatment strategy.

We report a case of a septic, 21 day old, former 26-week neonate who had clinical and x-ray concern for an airway foreign body. 3D CT remodeling was used to identify the foreign body as the tip of a suction catheter. Preoperative planning to confirm optimal bronchoscopic instrumentation was done, and the foreign body was successfully removed in a single attempt. This case highlights the importance of preoperative radiographic evaluation and instrument rehearsal in high-risk airway foreign body cases.

Objective: Nontuberculosis mycobacteria (NTM) infection of cochlear implants are exceedingly rare. Here, we report one such case and review the literature surrounding previous reports. Methods: Case report. Case Report: A 76-year-old female underwent right cochlear implantation. Her course was complicated by wound dehiscence, three surgical debridements, and ultimately explantation. Cultures ultimately grew Mycobacterium abscessus, which was effectively treated with Azithromycin, Omadacycline, and 3 months of injectable Cefoxitin. At the latest follow-up, the patient is without evidence of further infection and pending reimplantation. Conclusion: NTM is a rare cause of postsurgical infections following cochlear implantation. It is especially important to consider this in cases of indolent, antibiotic-resistant infections to optimize patient treatment.

Relapsing polychondritis (RP) is a rare disease characterized by recurrent systemic inflammation affecting cartilaginous tissues and proteoglycan-rich tissues. The disease may present in several clinical variants, which can delay diagnosis. Corticosteroids are the treatment of choice for RP. In rare cases, RP can be paraneoplastic. The association of RP with thyroid cancer is unusual. We report the first Malagasy case of a 48-year-old man with RP type one diagnosed within less than a year, presenting with recurrent chondritis of the auricular cartilage, tracheobronchial chondritis, and recurrent episcleritis. The disease was associated with papillary thyroid carcinoma.

Sinonasal inverted papilloma is an expansive, benign mass derived from the Schneiderian membrane. It may undergo malignant transformation and most commonly originates from the maxillary sinuses or the lateral walls of the nasal corridors. This case outlines the case of a sinonasal inverted papilloma, which clearly arises from the posterior ethmoid sinus, bordering the skull base. This abnormal originating point was able to be identified during endoscopic excision of the mass and involved mucosa. The ethmoid bone was not resected as it would expose the dura mater, risking CSF leak and complications. This case further supports the use of endoscopy in the investigation of sinonasal inverted papilloma rather than the gold standard approach of lateral rhinotomy. An endoscopic approach allowed for improved safety when accessing the posterior ethmoid cavity. This case also highlights the possibility of novel origins of sinonasal inverted papilloma, such as the membrane of the posterior ethmoid cavity.

The occurrence of tracheoesophageal fistula (TEF) in children is commonly attributed to the presence of foreign bodies. This paper presents a unique case admitted to the Children's Hospital of Nanjing Medical University on August 9, 2022, where a plastic fragment resembling a doll's eye was identified as the precipitating factor. The report investigates the unusual trajectory of this case-examining the pathway through which the foreign body became lodged in the trachea, followed by the subsequent development of TEF-and provides valuable insights into its pathogenesis and clinical significance.

The following case potentially provides insight into the mechanisms of lymphogenic metastasis in sinonasal cancer. A 63-year-old patient who presented with progressive diplopia and left-sided periocular pain was diagnosed with a cT4bN0M0 mucosal melanoma of the ethmoid sinus. She underwent a combined endonasal and transcranial tumor resection, and an orbital exenteration. Upon histopathological examination, besides the primary tumor, two separate localizations of melanoma surrounded by lymphoid tissues and lymph follicles were identified. The tumor was upstaged to pT4bN1, and the patient received a combination of adjuvant immunotherapy and radiotherapy. At present, the patient displays no evidence of disease. The presence of orbital lymph nodes has previously never been confirmed. These findings indicate the potential involvement of lymphatic drainage through the retrobulbar fat in the regional spread of sinonasal tumors closely associated with the orbit.

Peripheral nerve sheath tumors (PNSTs), while uncommon, can have a significant impact on appearance and quality of life, especially when they form in prominent areas such as the nose dorsum. We discuss a case of a 29-year-old woman who developed a benign PNST on the right side of her nasal ala. This tumor gradually grew, impairing her face appearance. Diagnostic tests, such as computed tomography (CT) and magnetic resonance imaging (MRI), revealed the tumor as a slowly growing, well-defined mass. The tumor was removed via open rhinoplasty under general anesthesia, and pathological investigation verified its benign nature. After surgery, the patient's quality of life improved significantly, and there were no evidence of tumor recurrence after eight months. This case emphasizes the need of including PNST in the differential diagnosis of nasal tumors.

Background: Lemierre syndrome (LS) is a rare complication of upper aerodigestive tract infections characterized by proximal and distal septic emboli, commonly including internal jugular vein (IJV) thrombosis. Diagnosis can be challenging, and treatment delays can result in increased patient morbidity and mortality. We present a rare case of LS with extensive thrombosis and multiple sites of distal infection and a narrative review of the literature. Case Presentation. A 52-year-old Caucasian male was transferred to the emergency department (ED) with an altered level of consciousness and clinical findings of acute bacterial pharyngotonsillitis. Medical history included cervical spine disorder and traumatic brain injury in the past, as well as the recent use of pain relievers due to acute cervical pain. Imaging studies revealed left IJV thrombosis that extended into multiple venous cerebral sinuses and infiltrates of the right lung. LS was considered the most likely diagnosis. The patient was intubated and transferred to the intensive care unit (ICU). Treatment included intravenous broad-spectrum antibiotics and anticoagulation therapy. Response to treatment was satisfactory. After extubation, he was transferred to a ward and discharged with resolution of clinical and imaging findings.

Conclusion: LS is a rare disease and may have an insidious course. Timely diagnosis and appropriate treatment strategies, mainly broad-spectrum antibiotics, offer favorable outcomes in otherwise healthy individuals. The indications for anticoagulation therapy still remain controversial. Anticoagulants are usually administered to patients with extensive thrombosis. Surgical treatment includes abscess drainage, while IJV ligation and excision are reserved for nonresponders to medical treatment.