Ent-Ear Nose & Throat Journal最新文献

An organized hematoma (OH) is a relatively rare benign lesion of the paranasal sinuses. Traditionally, it has been reported to occur following trauma, surgery, and sinus hemorrhagic lesions and in various bleeding predispositions. OHs are sometimes difficult to differentiate from malignancy because of the similar clinical symptoms and bone destruction. It is especially difficult when OHs occur in the same location as the primary tumor after treatment of a malignant tumor. In this paper, we report two cases of OH that occurred after intra-arterial chemoradiotherapy (IACRT) for maxillary sinus cancer. In one case, FDG accumulation was found in PET/CT and suspected to be a cancer recurrence. However, the postoperative pathology showed no malignant findings. This suggests that OH may show accumulation on 18 F-fluorodeoxyglucose positron emission tomography (FDG-PET). In both cases, bleeding from the maxillary sinus continued after surgery. In one case, recurrence was observed, and in the other, nasal irrigation prevented the pooling of blood in the maxillary sinus, and no recurrence was observed. These cases suggest that OH after IACRT may easily recur because the bleeding continues even after surgery. In such cases, nasal irrigation or preoperative embolization may be helpful to avoid recurrence.

Facial palsy in acute lymphoblastic leukemia (ALL) patients is diagnosed as tumor cell invasion of the central nervous system (CNS) following the ALL guidelines. Facial palsy in a 6-year-old ALL patient was diagnosed as leukemia cell invasion into the CNS by hemato-oncologists. Pretreatment magnetic resonance image (MRI) revealed gadolinium enhancement of the first genu and meatal portion of the facial nerve. After chemotherapy, although the ALL tumor cells disappeared from both the blood and the cerebrospinal fluid, and the facial palsy resolved, a posttreatment MRI showed no change in terms of enhancement of the facial nerve. These findings indicated the possibility of herpetic viral reactivation in the geniculate ganglion of the facial nerve. We must be aware and discuss with hemato-oncologists the possibility that not only tumor cell invasion into the CNS, in accordance with the guidelines, but also that herpetic virus reactivation arising in the facial nerve may be causes of facial palsy.

Bisphosphonates are used for the treatment of bone metastases of cancer and prevention of osteoporosis. Bisphosphonate-related osteonecrosis of the jaw (BRONJ) has unclear mechanisms, but its elucidation, prevention, and treatment are essential to improve patient outcomes.An 88-year-old woman who was taking oral bisphosphonates for 4 years presented with a 5-day history of gradual orbital pain. Computed tomography (CT) revealed bilateral maxillary sinusitis and bony destruction at the base of the right maxillary sinus and inferior orbital wall. We diagnosed her with bisphosphonate-related osteonecrosis of the maxilla. In addition to intravenous antibiotic treatment, an endoscopic sinus surgery was performed. The patient's postoperative course was uneventful.To the best of our knowledge, this is the first case report of BRONJ with orbital cellulitis. This condition should be considered among patients taking bisphosphonates, who manifest with symptoms of orbital cellulitis and bone destruction on imaging.

The most common sites of distant metastasis (DM) in squamous cell carcinoma (SCC) of the tongue are the lung, bone, and liver; the early identification of metastasis to other sites is difficult. This case report discusses a 48-year-old male initially diagnosed with advanced-stage left tongue SCC, which was treated with wide excision, left radical neck dissection, and adjuvant concurrent chemoradiotherapy. Two months after completing adjuvant therapy, multiple painful nodules without local erythematous changes or warmth were found in the bilateral posterior neck and right medial thigh. Ultrasonography of these nodules revealed a cystic structure. Fine needle aspiration cytology revealed metastatic SCC. The disease progressed despite salvage chemotherapy, and the patient passed away 4 months after the formation of the nodules. Subdermal and intramuscular cysts as the initial presentation of DM have rarely been reported. The identification of unusual cysts, even those outside the head and neck, should raise concern.

Introduction: To examine the potential predictive roles of the preoperative mean platelet volume (MPV), platelet count (PC), and platelet distribution width (PDW) in patients with oral cancer and their association with the depth of invasion (DOI).

Methods: This retrospective study included 122 patients (66 males, 56 females) diagnosed with oral cancer between January 2009 and January 2015 by our Otolaryngology Department. At diagnosis, the mean age was 64.6 ± 13.9 years. The average follow-up period was 39.2 ± 23.9 months.

Results: We found significant differences in all parameters (PDW, MPV, PC) based on the positivity of the lymph node and the tumor stage. The mean PDW, MPV, and PC were significantly higher in the exitus group than in the survivor group (P = .010, .036, and .047, respectively). In patients with high PDW, we observed a lower progression-free survival. We observed that PDW had a significant impact on the recurrence of the disease. Platelet distribution width, MPV, and PC were significant prognostic factors. A high PDW increased fatality 4.1 times, and a high MPV increased fatality 4.7 times (P = .040 and .032, respectively). We found in a univariate analysis that tumor grade, PDW, MPV, and PC were predictive factors for fatality. On multivariate analysis, we found that MPV, PC, and predictors were independent of tumor grade. We observed an association between MPV and DOI.

Conclusion: High PC, MPV, and PDW could be meaningful prognostic predictors for low survival rates. Mean platelet volume appears to be a more effective marker because it is associated with the DOI and prognosis. However, further research is required to confirm our findings.

This case series presents 2 Caucasian females that underwent orbital decompression surgery for symptomatic exophthalmos and postoperatively developed a change in their perception of pitch during vocal performance. One patient went as far as to undergo voice lessons in attempt to regain her pre-operative pitch perception; however, the attempt was unsuccessful. We propose the etiology of this complication is anatomic changes within the ethmoid sinus. Temporary changes in nasalance have previously been reported with functional endoscopic sinus surgery literature, but this specific complication of change in pitch perception has not.

Objectives: We investigated the relationship between olfactory function and depression and suggested future research in this area from rhinology.

Methods: We independently searched 5 databases (PubMed, SCOPUS, Embase, the Web of Science, and the Cochrane database) for recent studies published from December 2019 to the present. From the obtained studies, we reviewed the findings on olfactory function and depression using a questionnaire to measure depression and olfactory tests.

Results: The olfactory function test score based on the UPSIT-40 (standardized mean difference = -.37 [-.66; -.08], P = .0123) was significantly lower in the depression group than in the control group. The olfactory function score based on the Sniffin' sticks test for identification, discrimination, and threshold was lower in the depression group than in the control. A meta-analysis of the studies showed that depressed patients showed lower olfactory function than the control group.

Conclusions and significance: The findings revealed that an understanding of the relationship between olfaction and depression can be determined using an analysis methodology and a standardized olfactory test. Olfactory functioning and processing are highly integrated with emotion and memory through projections from the olfactory bulb to the central areas.

Septoplasty is among the most frequently performed procedures in the field of otorhinolaryngology. Adhesion is known to be the most common complication occurring after septoplasty. Post-surgical insertion of silicone splints is a widely used measure for the prevention of postoperative complications. Recently, we encountered a case where the silicone splint was dislocated and further displaced to the level of the upper esophageal sphincter. Although it was safely removed using fiberoptic gastroendoscopy, delayed removal could have induced other serious sequelae. Since no similar cases have been previously reported, we believe that this may be a very rare complication induced by a loose absorbable suture. Therefore, we suggest that otorhinolaryngologists should pay attention to the fixation of a silicone splint with sutures under appropriate tension to prevent the dislocation of the silicone splint and its subsequent sequelae.

Although hemangiomas are common in the head and neck area, they are uncommon in the temporal bone. External auditory canal (EAC) hemangiomas are a relatively uncommon otologic condition. In the English literature, only 29 cases of temporal bone hemangioma have been reported. We also present the case of a 32-year-old male patient who presented with an 8-month history of decreased hearing, tinnitus, and aural fullness on the right side. Otoscopic examination of the right ear revealed a smooth, oval, well-circumscribed, reddish, pulsatile, nontender mass, which was about 1 cm in diameter and occupied two-thirds of the EAC. It was soft in consistency, compressible, and appeared to be arising from the right posterior-superior portion of the bony canal wall; the tympanic membrane seemed to be uninvolved. The patient had mild conductive hearing loss of the right ear with an average air-bone gap of 20 dB; the left side was normal. High-resolution contrast-enhanced computed tomographic scanning of the temporal bone showed well-defined, rounded, homogenously enhancing lesions at the posterior-superior aspect of right EAC measuring 0.7 × 0.8 cm. Angiography was performed and there was evidence of vascular blush in the region of the right EAC. Three blood vessels were identified and embolized. The mass was completely removed by the endaural approach, and a retroauricular skin graft to restore cutaneous integrity was not required. Histopathology indicated a capillary hemangioma without cytological atypia or mitotic activity. There was no recurrence 1 year after the surgery.

Neck-mediastinum foreign body (FB) is a common emergency in otorhinolaryngology head and neck surgery departments, and it can be lethal. We present a case of an uncommon foreign body in the neck-mediastinum. The FB was metallic and about 12 cm long. A 74-year-old male accidentally swallowed a metallic FB that lodged in his throat for > 3 days. The intake of the object was associated with smoking a peace pipe, and was an indication for surgery. Aerodermectasia was observed in the neck upon physical examination, and a high-density foreign body was found in the neck-mediastinum through cervicothoracic computed-tomography (CT) scan. Electronic laryngoscopy showed a white pseudo-membrane adhering to the surface of the bilateral piriform fossa in the right laryngeal vestibule, and the root of the tongue, and mucosa were swollen. Cervicothoracic CT revealed dense shadows in the neck-mediastinum. However, electronic laryngoscopy showed no FB in the larynx or piriform fossa. The metal FB was removed by surgery via the parapharyngeal space approach instead of endoscopy. After preoperative assessment and preparation, we successfully removed the metal FB from the neck-mediastinum via the parapharyngeal space approach. The patient was doing well at one-month follow-up. Neck-mediastinum FB is an emergency but rare case necessitating otorhinolaryngology head and neck surgery. It can easily lead to mediastinal and lung infection; given its location in the body, it may lead to aortic arch rupture if not handled promptly.