Ear, nose, & throat journal最新文献

Lipomas are benign soft tissue tumors frequently observed throughout the body. Lipomas rarely cause health concerns; however, when symptomatic, it is often related to their location and size. A 65-year-old male patient presented with a non-tender, enlarging mass in the anterior floor of the mouth, which was otherwise asymptomatic. Computed tomography evaluation revealed an unusually large hypolucent mass, posterior to the inner table of the right anterior mandible. Surgical excision was uncomplicated. Upon follow-up, the right anterior floor of the mouth wound healed without compromise of the lingual or hypoglossal nerves or Wharton's duct. This discussion highlights the infrequent occurrence of lipomas in the oral cavity, particularly in the floor of the mouth, including patient presentation, preoperative evaluation, and surgical planning.

Relapsing polychondritis (RP) is a rare chronic inflammatory disease characterized by recurrent inflammation of cartilages throughout the body, with treatment-resistant dizziness and hearing loss in 40%-50% of patients with RP. Although rare, severe binaural hearing loss in RP is an indication for cochlear implantation (CI). Therefore, there are only a few reports on CI insertion in cases of RP. This report describes a 68-year-old woman who developed binaural hearing loss due to RP. She was treated with steroids and immunosuppressive drugs; however, her hearing did not improve significantly, and she relied on written communication for conversation. Subsequently, the patient underwent CI in the right ear. The patient showed improvement in speech perception; at 14 months postoperatively, she was able to speak with lipreading, and at 2 years postoperatively, she was able to speak without lipreading. Previous case reports on CI in patients with RP have shown varying degrees of postoperative hearing improvement. Our case demonstrates the effectiveness of CI in improving hearing and speech recognition in patients with RP having semicircular canal calcification. However, previous reports have shown that speech recognition declines 13 years after CI for RP. Therefore, continuous long-term follow-up is necessary.

Middle ear trauma from foreign body (FB) impaction or its removal can lead to tympanic membrane (TM) perforations and ossicular chain disruption. We present a case of a 29 year-old male who developed acute right-sided hearing loss, aural fullness, and tinnitus after an attempt at removing a cotton-tipped applicator (Q-tip) impaction in the ear canal. Physical examination revealed a dislocated incus protruding through the TM, and audiometry confirmed moderate conductive hearing loss. The patient underwent tympanoplasty with ossicular chain reconstruction with incus interposition, which resulted in significant hearing improvement and resolution of tinnitus. This case highlights the importance of proper diagnosis and intervention in trauma-related ossicular dislocation.

Actinomycosis is common in the head and neck region but rarely occurs in the nasal septum. A 75-year-old male patient with an edentulous maxilla, hypertension, and diabetes developed actinomycosis confined to the nasal septum and showed mucosal necrosis and septal bony sequestration. The patient underwent surgery and medication therapy; this case was reported using endoscopic photographs and radiographs and a literature review was conducted to provide further context and understanding of the condition of the patient.

The management of refractory chronic rhinosinusitis (CRS) in children with cystic fibrosis (CF) remains a challenge, especially in those who are not candidates for highly effective modulator therapy. These patients often have severe sinus disease that does not improve with medical treatment, requiring surgery as the definitive treatment. We report a case of a 9-year-old female patient with CF and refractory CRS presenting with significant nasal obstruction, postnasal drainage, and frontal headaches that severely impacted her quality of life. A hybrid technique that involved balloon catheter dilation (BCD) along with endoscopic sinus surgery (ESS) allowed the management of complex anatomical problems associated with the severe polyposis, copious purulence, and narrow frontal recesses during the surgery. This improved our ability to visualize the surgical field, minimize blood loss, and better preserve the mucosa, which ultimately led to better surgical and clinical outcomes. Our findings suggest that hybrid BCD-assisted ESS may offer an effective solution to manage severe CRS in pediatric CF patients, particularly for those who have limited therapeutic options.

We present a case of an encephalocele of the lateral recess of the sphenoid sinus and detail the utilization of a nerve-sparing, windowed, pterygopalatine fossa approach to the lateral sphenoid sinus recess in a 37 year-old patient. The patient presented with 15 years of headaches that worsened with stress and head position and 2 weeks onset of unilateral clear rhinorrhea that was similarly worsened by head position. Collected rhinorrhea was positive for β-2 transferrin, and computed tomography was notable for erosion of the roof of the sphenoid sinus at the lateral recess with soft tissue extending into the sphenoid sinus. Magnetic resonance imaging confirmed the presence of a sphenoid encephalocele. The patient underwent a nerve-sparing windowed transpterygoid approach to the skull-base defect. Intraoperatively, 2 discreet skull-base defects were encountered, each with exposed dural tissue that were then repaired with septal cartilage underlay grafts and overlay mucosal grafts. The patient started acetazolamide in the postoperative period and recovered without the recurrence of cerebrospinal fluid leak.

Rosai-Dorfman disease (RDD) is characterized by sinus histiocytosis with massive lymphadenopathy, and the tissue exhibits positive results for S100 and CD68. This lesion typically affects the lymph nodes and rarely involves the nasal soft tissues. This report aims to present a case of RDD involving the nasal soft tissues, presenting with nasal congestion and rhinorrhea as the primary complaints. The patient underwent surgery navigated by nasal endoscope did not report recurrence after operation.

The Castleman Disease (CD), also recognized as giant lymph node hyperplasia or vascular follicular lymphoid hyperplasia, is an infrequent lymphoproliferative disorder with substantial clinical variability. Parapharyngeal location of this disease is very rare and in pediatric population it is even rarer. This article presents a case of Unicentric CD (hyaline vascular type) in an 8-year-old female, where the disease was localized within the parapharyngeal space. Clinical manifestations were limited to the presence of a local mass, with no other specific symptoms observed. Laboratory assessments revealed no significant abnormalities. She underwent surgery using a cervical-parotid approach and experienced a good postoperative recovery. Histopathological analysis confirmed the diagnosis. This case underscores the need for a comprehensive evaluation and consideration of uncommon etiologies in the assessment of parapharyngeal masses, even in pediatric patients.

A 45-year-old man presented with a history of chronic left nasal congestion. Nasal endoscopy revealed a pedunculated polypoid mass with glandular epithelium surface on the posterior nasal septum. Computed tomography revealed a 25-mm mass-like growth in the left posterior nasal cavity attached to the nasal septum with a stalk. The patient underwent transnasal endoscopic surgery, and the tumor was removed under a block with safety margin. The final pathological diagnosis was sinonasal seromucinous hamartoma (SH). Sinonasal SH is a rare tumor with only 31 reported cases. Transnasal endoscopic surgery is currently the first-line treatment for sinonasal SH. Differential diagnoses of this lesion include inflammatory polyps, respiratory epithelial adenomatoid hamartoma, and adenocarcinoma. Although SH is a benign tumor, its progression to adenocarcinoma has been reported. Therefore, unilateral posterior nasal tumors must be diagnosed precisely.

Surgical management of head and neck sarcomas presents significant challenges, particularly in advanced stages where curative options are limited. In such cases, palliative care becomes essential to alleviate symptoms and enhance the patient's quality of life. When chemoradiation therapy fails to provide adequate symptom control, palliative surgery may be a viable option. We report the case of a 24-year-old male diagnosed with an extensive and aggressive maxillary chondroblastic osteosarcoma. Despite multiple chemoradiation regimens, the disease progressed rapidly. Due to the substantial deterioration in the patient's quality of life, he underwent major palliative surgery. The procedure involved a left total maxillectomy, right subtotal maxillectomy, left segmental mandibulectomy, orbital exenteration, and resection of the left upper lip, cheek, and nose. Reconstruction was performed using an osteocutaneous fibula free flap and an anterolateral thigh flap. Postoperatively, the patient experienced significant symptom relief without major complications. He was followed for 12 months before being lost to follow-up, remaining disease-free for approximately 8 to 10 months. This case illustrates that in select patients with unresectable and extensively invasive tumors, major palliative resections combined with microvascular reconstruction may offer meaningful improvements in quality of life.