Otolaryngology最新文献

A 58-year-old man had an enlarging right fronto-orbital mass. A biopsy specimen of a right nasal cavity tumor was reported as meningioma. Preoperative evaluation including skull roentgenograms, tomograms of the paranasal sinuses, brain scan, computerized axial tomography, and carotid angiography substantiated a large subfrontal mass with paranasal sinus and orbital extension. A combined approach through a right frontal craniotomy and right lateral rhinotomy was used for a complete removal of this tumor. A review of the literature is contained herein.

Frontal sinus mucocele was our preoperative diagnosis in a patient who had frontal swelling and downward displacement of the eye. Supporting this were typical roentgenogram changes, a long history of asthma, pansinusitis, and previous multiple-polypectomy surgery. Frontal sinus exploration revealed a locally eroding lesion. It was composed of spindled cells and lipid-laden histiocytes with a pattern of fibrous xanthoma and was treated conservatively. It should not be confused with true malignancies such as fibrous histiocytoma having a similar histopathologic appearance and requiring more aggressive surgical treatment.

Functional electrical stimulation is being explored in the extremities. A major obstacle is found in programming the firing sequence. In 1976, David Zealear proposed using the activity on the normal side in axial muscle pairs that normally function symmetrically to act as a template to control the stimulator. This method was demonstrated in laryngeal muscles in dogs, and is now demonstrated in the face with future applications being proposed. The facial nerve on one side was sectioned in a series of rabbits. Implanted electrodes received electrical potentials from selected muscles on the normal side. Bursts of electrical activity on the normal side during a blink or a twitch were used to trigger a muscle stimulator, which was routed to matching muscles on the paralyzed side. This technique restored symmetric function to the hemiparalyzed side. This technique restored symmetric function to the hemiparalyzed face.

A case of fatal disseminated aspergillosis in a renal transplant patient is presented. The initial manifestation of the disease was consistent with thyroiditis. Autopsy findings are shown and support this unique presentation. The diagnosis of aspergillosis is difficult to make and may require pulmonary biopsy. Early diagnosis and treatment with amphotericin B are the keys to successful management of the disease.

A lethal case of rhino-orbital-cerebral phycomycosis (mucormycosis) in an otherwise healthy man is presented. The clinical, radiologic, and ante mortem surgical pathology associated with microbiologic examinations failed to yield the diagnosis of fungal infection as the cause of a clinical presentation of acute sphenoid sinusitis with a fulminant cavernous sinus thrombosis. No similar case report was found in review of the literature. There is a need for a high degree of suspicion in this condition to improve the uniformly poor prognosis in this devastating infectious disease. Emphasis is placed on the necessity for early tissue or microbiologic diagnosis with appropriate histologic stains and fungal cultures. Treatment consists of extensive surgical excision of all necrotic or questionably viable tissue in conjunction with alternate-day amphotericin B therapy.

Lymphomas are statistically the second most common malignant tumor of the head and neck, following squamous cell carcinoma. They may present in the cervical lymph nodes or in extranodal areas. This paper presents an unusual case of a non-Hodgkins lymphoma that presented in the infratemporal fossa of a 25-year-old woman. The anatomy of the infra-temporal fossa is reviewed, and evaluation and therapy of lesions in this area are discussed.

Hemangiomas consist of a spectrum of benign vascular tumors with variable clinical behavior and microscopic morphology, which usually occur in infancy. A rare variant of these tumors is the invasive subcutaneous hemangioma, which shows an aggressive growth pattern by invading subcutaneous structures and recurring after apparent excision. The authors describe an adult patient with a large submandibular invasive hemangioma who was treated by preoperative embolization and surgical excision.

This paper presents a case report of a 67-year-old man who was seen in the Otolaryngology Clinic, University of Wisconsin Medical Center with a seven-month history of dyspnea and laryngeal stridor. On examination there were several slightly tender firm submucosal nodules in the soft palate and left tonsilar area and a 1.5-cm polypoid subglottic mass arising from the body of the cricoid cartilage. Because of the marked airway obstruction, a tracheotomy was necessary. The laryngeal polypoid mass was removed and biopsies were obtained from the submucosal nodular masses of the palate. Microscopic examination of the tissue revealed the lesions to be caseating granulomas, and actinomycosis was identified on the cultures. The patient received long-term penicillin therapy and has remained asymptomatic. A discussion of the biologic and clinical aspects of actinomycosis is included. A review of the literature revealed only one other description of endolaryngeal actinomycosis.

The transcochlear approach is described for resection of lesions arising anterior or medial to the internal auditory canal as well as for those arising directly from the clivus. Through an extended complete mastoidectomy the facial nerve is totally decompressed and re-routed posteriorly from the stylomastoid foramen to the internal auditory canal. The fallopian canal, promontorium, and cochlea are removed anteriorly and medially as far as the internal carotid artery, obtaining exposure to a triangular area limited by the superior petrosal sinus, inferior petrosal sinus, carotid, and internal auditory canal, giving adequate exposure to the structures of the clivus and the midline (basilar artery, vertebral arteries, and the sixth cranial nerves).