Abstract
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Schwannomas are rare, benign, slowly growing neurogenic tumors that originate in peripheral, spinal, or cranial nerves other than the optic and olfactory nerves. In the head and neck, these tumors usually arise from the vagus nerve and the cervical sympathetic chain in the parapharyngeal space. Cervical sympathetic chain schwannomas represent a rare subgroup of schwannomas; fewer than 60 cases have been reported in the literature. These tumors are rarely seen in children and adolescents. Because patients typically present with an asymptomatic neck mass and vague complaints, clinical suspicion is important in making the diagnosis. Neural deficits at presentation are uncommon….
Schwannomas of the nasal cavity are rare benign tumors, and those that arise from the nasal septum are even rarer. When they do occur, they usually become symptomatic early because of the close confines of the nasal cavity. We describe a case of nasal septal schwannoma that was noteworthy in that the patient—a 28-year-old woman—waited 8 months after the onset of symptoms to seek medical care. Her symptoms included complete right-sided nasal obstruction, occasional epistaxis, and hemifacial pain. The tumor was completely removed via an endoscopic approach. We discuss the clinical presentation, differential diagnosis, and treatment of this rarely encountered neoplasm.
We describe a rare case of necrotizing fasciitis of the ear in an otherwise generally healthy 39-year-old man. The ear is rarely involved in this often-fatal disease. The diagnosis was suspected on the basis of clinical examination and confirmed by computed tomography and pathology of a biopsy specimen, which revealed subcutaneous gas formation and dermal infiltration of inflammatory cells, respectively. The patient was promptly treated with surgical debridement, intravenous antibiotics, and hyperbaric oxygen. He recovered well and subsequently underwent otoplastic reconstruction with very satisfactory results….
Sriram Iyer, MRCP; Joseph Collum, MRCP; Marta Babores, FRCP
Descending necrotizing mediastinitis (DNM) is a now-rare complication of dental and pharyngeal infections. Reports in the literature have emphasized the need for early, aggressive surgical intervention. We present a case of DNM with bilateral empyemas that arose secondary to a perforated pharyngeal abscess. The patient was successfully managed conservatively with intravenous antibiotics and intercostal drainage. We conclude that conservative management with antibiotics and image-guided percutaneous pleural drainage may be initially appropriate for the stable patient.
Granular cell tumor (GCT) is an uncommon, primarily benign lesion. We describe 2 cases of GCT. Patient 1 was a 38-year-old man who presented with a reddish, vegetative lesion that involved the posterior third of the left true vocal fold. Patient 2 was an 18-year-old girl who presented with a firm, slightly extruded submucosal mass in the posterior lateral third of the tongue. Both lesions were identified as GCTs on biopsy. Both tumors were removed surgically, and both patients exhibited no signs of recurrence during follow-up. It is important that otolaryngologists be familiar with GCT and its management. Although the length of follow-up has varied substantially in the literature, we recommend long-term surveillance, including regular clinical examinations….
Necrotizing fasciitis is an uncommon, rapidly progressive soft-tissue infection that is associated with a high incidence of morbidity and mortality. It is usually caused by bacteria and rarely caused by or complicated by a fungus. We report 3 cases of necrotizing fasciitis of the head and neck in patients with uncontrolled diabetes. Fungi were isolated in all 3 cases. In 1 fatal case, the invasive zygomycete Apophysomyces elegans was isolated. Keys to the management of this condition are (1) early isolation of the causative organism by fungal smear and culture, (2) adequate control of diabetes, (3) maintenance of electrolyte balance, and (4) controlled aggressive surgical…
We review 2 cases of surgically and pathologically confirmed paraganglioma of the cervical sympathetic chain. Both patients—a 46-year-old man and a 33-year-old woman—were treated surgically. Intraoperatively, both tumors were found to be hypervascular and arising from the cervical sympathetic chain. Histopathologic analysis confirmed both as paragangliomas. Paragangliomas arising from the cervical sympathetic chain are exceptionally rare, but they must be considered in the differential diagnosis of parapharyngeal masses. They often present with ipsilateral Horner syndrome and oropharyngeal fullness, and they may be associated with a higher rate of catecholamine secretion. Typical imaging characteristics include anterolateral or lateral displacement of both the carotid and jugular vessels.
Plasma cell granuloma of the larynx is a rare benign lesion of unknown etiology, with only 21 cases reported previously. We report an additional case of plasma cell granuloma in which a 26-year-old man experienced a 1.5 × 3.4-cm, completely obstructing subglottic lesion. Because of the patient's young age, history of hemoptysis, bleeding from his tracheostomy, and the rarity of plasma cell granulomas, the patient was assumed to have hemangioma until proven otherwise. He presented with a partially obstructing glottic lesion 4 months later. Both the subglottic and glottic lesions were excised endoscopically. Multiple modalities have been used to treat plasma cell granulomas, including radiation, endoscopic CO2 laser ablation, high-dose prednisone, and open excision. In our case, steroids were given in the interim between the 2 excisions. This is the first report of a patient with two laryngeal plasma cell granulomas and the 22nd reported case of laryngeal plasma cell granuloma.
Endoscopic view of an inferior meatal polyp Jae Hoon Lee, MD