Case Reports in Otolaryngology最新文献

Primary solitary sphenoid sinus mucocele is rare, generally presenting with headaches or eye symptoms at the anatomical site. We report the case of a 39-year-old woman incidentally diagnosed with sphenoid sinus mucocele during a complete medical checkup. Imaging revealed that the cystic wall had developed from the rear sphenoid sinus and had spread expansively to diminish the clivus; however, no symptoms were reported, and the patient was managed with close observation. During the follow-up period, diplopia developed suddenly due to isolated left-sided abducens nerve paralysis. An endoscopic endonasal approach was used to open the frontal cystic wall, and fascia lata and fat were used for cranial base reinforcement to avoid future cerebrospinal fluid leakage, resulting in improvement during the early stages of follow-up. Treatment options for sphenoid sinus mucoceles include close observation or surgery. In our case, we chose surgery because of an acute symptomatic manifestation during observation.

Cervical cystic lymphangiomas are rare benign tumors that pose a formidable challenge to surgeons confronted with managing this uncommon entity. Due to the intimacy with which these cystic lesions blend with critical cervical structures, a considerable number of patients who undergo surgical management are often plagued with recurrence and morbidity. As a result, doxycycline sclerotherapy has become an attractive, safe, and effective alternative as a primary treatment modality in a select group of pediatric patients. This case report presents an 18-month-old patient with a large cervical cystic hygroma that was effectively treated with exclusive doxycycline sclerotherapy.

Collision tumors are two independent, distinct tumors occupying the same anatomical space. This case presents a pituitary adenoma-craniopharyngioma collision tumor presenting with hemianopsia. A 60-year-old with a past history of a nonsecretory pituitary adenoma presented with progressive headaches, bitemporal hemianopsia, and nausea. Previously, in 2008, his adenoma was effectively treated with nasal septal flap and transsphenoidal pituitary resection. A magnetic resonance imaging (MRI) was ordered for concern of recurrence, given his history and neurologic complaints. The MRI revealed a suprasellar mass extending into the third ventricle with displacement of the hypothalamus and optic chiasm. Laboratory testing revealed no indicators of endocrinopathy. The neurosurgical and otolaryngologic teams were elected to perform tumor resection given the ongoing symptoms. An image-guided transsphenoidal tumor resection with abdominal fat graft harvest and septal mucosal flap CSF leak repair was performed. Histopathological examination revealed two tumor components within the resection including an adamantinomatous craniopharyngioma and recurrent pituitary adenoma.

Acquired hemophilia A (AHA) is an extremely rare and serious bleeding disorder caused by autoantibodies against coagulation factor VIII (FVIII). Approximately, 10% of patients with AHA have an underlying malignancy. We report on a 46-year-old man with AHA and advanced oral cancer who presented with massive bleeding after surgery. Preoperative blood coagulation tests showed no abnormalities. He underwent radical tumor resection followed by reconstruction using a free rectus abdominal musculocutaneous flap. Massive subcutaneous hemorrhage developed in his neck and abdomen on the first postoperative day. The hemorrhage remained uncontrolled, despite embolization of the responsible vessels. Subsequent laboratory data showed prolonged activated partial thromboplastin time and decreased FVIII levels. On the basis of his clinical course and the presence of the FVIII inhibitor, we speculated that the patient suffered from AHA. We administered recombinant activated factor VII and prednisolone, after which the spontaneous bleeding stopped and the subcutaneous hemorrhage resolved. A review of the literature identified only three previous documented cases of AHA associated with head and neck cancer. This case indicates that AHA should not be ruled out in patients with uncontrolled postoperative bleeding, while attempting to ensure bleeding control and preventing potentially catastrophic fatal consequences.

Introduction: Frontal sinus surgery remains challenging to manage because of its complex anatomy and narrow outflow tract. A number of studies suggest the success of frontal sinus stenting to reduce postoperative complications in endoscopic frontal sinus surgery. However, failure and complications of frontal sinus stenting may occur.

Method: We present a case of frontal sinus stenting with migration of the stent and erosion of the lamina papyracea together with a granulomatous reaction around the stent. PubMed and Medline search was also conducted to study the current evidence on frontal sinus stenting benefits and complications.

Results: Still there are no guidelines or universally accepted indications for the use of frontal sinus stenting in the literature. A limited number of studies suggest the success of frontal sinus stenting to reduce postoperative stenosis in endoscopic frontal sinus surgery. However, failure and complications of frontal sinus stenting may occur. Infection, pain, edema, and stent obstruction may also occur. Our case report also highlights the potential of orbital complications as well as the consequences of inducing a granulomatous reaction.

Conclusion: The value of frontal sinus stenting is still a subject of debate. Complications of frontal sinus stenting are not uncommon and thus necessitate regular follow-up.

This case report describes a unique nasal mass that was difficult to diagnose clinically and histologically. The patient was a middle-aged man employed as a metalworker, and he presented with a unilateral nasal obstruction and a mass arising from the right middle meatus. After a series of investigations, he underwent right-sided sphenoethmoidectomy with excision of a nasal lesion. The surgical specimen presented a major diagnostic challenge for the pathologists and clinicians involved. A series of discussions amongst two different head and neck expert teams combined with detailed clinicopathological correlation resulted in a diagnosis of a granulomatous lesion or pseudotumour related to the ingestion of water-soluble cutting oils, or "Suds oil," as they are more commonly called. Although occupational exposures to certain inhalants, such as wood dust and formaldehyde, are well-known risk factors for sinonasal lesions, here we present a rare association between a sinonasal lesion and another inhalant, Suds oil, that has not been previously reported in the literature.

Salivary gland choristoma is an extremely rare middle ear mass and is hypothesized to be caused by second branchial arch developmental anomalies. We present a 14-year-old girl with Dandy-Walker syndrome and conductive hearing loss. Middle ear exploration revealed a large middle ear mass with absent incus and stapes and displaced facial nerve. The mass was completely excised with histological confirmation of salivary gland choristoma. Her hearing was improved with bone-anchored hearing aids (BAHA). As facial nerve involvement is common, physicians should consider partial excision to avoid facial nerve palsy. Hearing restoration can be achieved with OCR or BAHA.

Selective IgA deficiency is the most common type of primary immunodeficiency, but there is not yet a specific effective treatment. The most prevalent clinical manifestations are infectious diseases of the respiratory system. We report herein the case of an 11-year-old female with selective IgA deficiency and recurring episodes of respiratory infections associated with rhinitis and asthma. We evaluated the efficacy of sublingual immunotherapy combined with inactivated whole-cell bacterial extract and Der p1-specific immunotherapy. After 18 months of clinical follow-up, we observed a significant reduction in the number of episodes of respiratory infections associated with control of atopic diseases. We also observed a 3-fold increase in serum IgA levels compared to treatment initiation. This case demonstrates the potential utility of the concurrent use of sublingual immunotherapy with inactivated whole-cell bacterial extract and Der p1 for successful control of allergy and infection in partial selective IgA deficiency.

Background: Mucosa-associated lymphoid tissue (MALT) lymphomas are a subtype of non-Hodgkin lymphoma stemming from marginal zone B-cells. In this case report, we present two patients with an extremely rare localization of MALT lymphoma to the larynx.

Methods: Case 1 is of a 78-year-old male presenting with a six-month history of progressive hoarseness with a past medical history significant for marginal zone lymphoma of the right orbit. Diagnosis was confirmed with a biopsy for extranodal marginal zone B-cell lymphoma of MALT type. An FDG-PET scan was done but did not show any sign of FDG avid malignancy, including at the primary site. Case 2 is a 60-year-old female presenting with one year of worsening throat discomfort, intermittent cough, and dyspnea with exertion. Pathology confirmed a diagnosis of extranodal marginal zone B-cell lymphoma of MALT type.

Results: Case 1 was treated with low-dose radiation at 4 Gy delivered over two fractions of 2 Gy each. Upon completion of radiation treatment, he reported a resolution of his hoarseness and normalization of his voice. A four-month follow-up in May 2018 with flexible nasolaryngoscopy revealed a normal exam with fully mobile vocal folds bilaterally and no evidence of left false vocal fold submucosal mass. At seven months following treatment, the patient died unexpectedly of unknown causes. Case 2 was treated with radiation at 30 Gy in 15 fractions over the course of one month. Following completion of radiation therapy, she had improvement of her sore throat, nausea, dysphagia, dysgeusia, and dry mouth. At 21-month follow-up, she had no evidence of disease.

Conclusion: This case report demonstrates that MALT lymphoma can present with much more benign and subtle symptoms. This highlights the importance of clinicians to keep broad differentials and consider MALT lymphomas in the setting of laryngeal masses.

Coronavirus disease 2019 (COVID-19) is a highly infectious respiratory illness caused by SARS-CoV-2. Not much is yet known about this new viral disease. In our early encounter with the COVID-19, before the pandemic and during the early days of dealing with this novel viral disease in our country, we saw some cases of anosmia in patients infected by SARS-CoV-2. In many cases, this chemosensitive dysfunction persisted after the negativization of the nasopharyngeal swab. We report effective treatment of anosmia by oral corticosteroid therapy in a patient recovered from COVID-19.