Pneumoperitoneum without Intestinal Perforation in a Neonate: Case Report and Literature Review

Pneumoperitoneum in a preterm neonate usually indicates perforation of the intestine and is considered a surgical emergency. However, there are cases of pneumoperitoneum with no evidence of rupture of the intestine reported in the literature. We report a case of pneumoperitoneum with no intestinal perforation in a preterm neonate with respiratory distress syndrome who was on high frequency oscillatory ventilation (HFOV). He developed bilateral pulmonary interstitial emphysema with localized cystic lesion, likely localized pulmonary interstitial emphysema, and recurrent pneumothoraces. He was treated with dexamethasone to wean from the ventilator. Pneumoperitoneum developed in association with left sided pneumothorax following mechanical ventilation and cardiopulmonary resuscitation. Pneumoperitoneum resolved after the pneumothorax was resolved with chest tube drainage. He died from acute cardiorespiratory failure. At autopsy, there was no evidence of intestinal perforation. This case highlights the fact that pneumoperitoneum can develop secondary to pneumothorax and does not always indicate intestinal perforation or require exploratory laparotomy.

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Laryngeal function-preserving operation for T4a laryngeal cancer with vocal cord paralysis — A case report

Publication date: Available online 14 April 2017
Source:Auris Nasus Larynx
Author(s): Yukinori Asada, Koreyuki Kurosawa, Ko Matsumoto, Takahiro Goto, Kengo Katoh, Takayuki Imai, Shigeru Saijo, Kazuto Matsuura
For locally advanced laryngeal cancers, the standard treatment of choice is chemoradiotherapy if organ function needs to be conserved. Surgical treatment with larynx preservation is conducted only for limited cases. For locally advanced laryngeal cancers such as those with vocal cord fixation and/or cricoid cartilage destruction, there is no apparent standardized organ-preserving surgery keeping the essential laryngeal functions, viz. the airway, deglutition and articulation, uncompromized.Recently, our surgical team saw a patient with T4a advanced laryngeal cancer with vocal cord fixation who aspired to maintain his laryngeal function. Driven by his eagerness, we contrived novel techniques for laryngeal function preservation and performed a two-staged operation.In the first stage, extended vertical partial laryngectomy was conducted including resection of the affected thyroid, arytenoid, and cricoid cartilages, followed by local closure of the hypopharynx. Additionally, laryngeal suspension surgery and cricopharyngeal myotomy were performed in addition to suturing the epiglottis with the intact arytenoid cartilage to enhance swallowing function. In the second stage, airway reconstruction was performed using a local skin flap.As of 10 months after operation, there has been no tumor recurrence, and the reconstructed larynx has been working satisfactorily.In this report we describe an innovative operation that was especially contrived for laryngeal function preservation.



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Bilateral spontaneous symptomatic temporomandibular joint herniation into the external auditory canal: A case report and literature review

Publication date: Available online 14 April 2017
Source:Auris Nasus Larynx
Author(s): Yong Won Lee, Yong Ho Park
Spontaneous temporomandibular joint (TMJ) herniation is the entity of protrusion of the retrodiscal contents of the TMJ into the external auditory canal (EAC) through a persistent Huschke's foramen. There have been a number of reports of spontaneous TMJ herniation, but there are no reports of bilateral symptomatic TMJ herniation. We report a case of a 70-year-old man who complained of a crunching sound in both ears during mastication. Examination showed bulging from the anterosuperior wall of the EAC on each side when the patient opened his mouth, which pushed the tympanic membrane medially. Bony defects in the corresponding area were seen on computed tomography. We describe a very rare case of bilateral spontaneous TMJ herniation that caused symptoms by having a direct impact on the tympanic membrane.



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Subcutaneous dermatofibrosarcoma protuberans, a rare subtype with predilection for the head: A retrospective series of 18 cases

Dermatofibrosarcoma protuberans (DFSP) typically affects the dermis and subcutaneous tissue. The subcutaneous variant is rare.

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The keys to conservative treatment of early-stage squamous cell carcinoma of the tonsillar region

Publication date: Available online 14 April 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): O. Laccourreye, P. Castelnau-Marchand, F. Rubin, C. Badoual, P. Halimi, P. Giraud
To analyze the medical literature devoted to work-up, epidemiology, local control, survival, complications and sequelae after conservative treatment for early-stage squamous cell carcinoma of the tonsillar region. An analysis of the PubMed (1975–2016) database was performed using the following keywords and associations: "tonsil/tonsillar region/oropharynx" AND "squamous cell carcinoma" AND "early-stage (I–II; T1–2N0M0)" AND "radiation therapy/radiotherapy" OR "conservative surgery/oropharyngectomy/transoral surgery/radical tonsillectomy". The search retrieved 10 retrospective series documenting local control and/or survival in series with more than 50 cases and a minimum 2 years' follow-up after conservative treatment; no prospective studies, meta-analyses and/or Cochrane analyses were found. Magnetic resonance imaging is the key radiological exam for local extension assessment. Human papilloma virus infection (HPV) is a risk factor that must be screened for systematically, since it induces tumoral radio-sensitivity and increases the risk of specific synchronous and metachronous second primaries. Whatever conservative treatment used, local control and survival rates higher than 85% were achieved. Implementing intensity-modulated radiation therapy reduced the incidence and severity of radiation-related complications and sequelae. Transoral surgery yielded very low morbidity/mortality rates, enabled association to ipsilateral neck dissection, and allowed radiation therapy to be reserved for the management of metachronous second primaries. Transoral surgery appeared to be the first-line option in the majority of cases. Lifetime follow-up adapted to HPV status is mandatory. The development of HPV vaccination does not mean that campaigns against smoking and alcohol abuse are of diminished importance.



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Pediatric sialolithiasis is not related to oral or oropharyngeal infection: A population-based case control study using the Korean National Health Insurance Database

Publication date: June 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 97
Author(s): Seong Jun Won, Eunkyu Lee, Hee Jung Kim, Hyun-kyung Oh, Han-Sin Jeong
ObjectivesPoor oral hygiene is one of the risk factors for sialolithiasis particularly in adults; however the etiology of sialolithiasis in pediatric patients remains largely unknown. The purpose of this study is to identify the association between sialolithiasis and the oral/oropharyngeal infections in the pediatric population, as surrogate indicators for oral hygiene and retrograde infections to the affected salivary gland.MethodsThis was a population based case-control study using the Korean National Health Insurance Database. We identified 10,095 pediatric patients, diagnosed with sialolithiasis, as cases (study period 2011–2015) and 50,475 age/gender/residence matched subjects without sialolithiasis, but with unrelated diseases (e.g., simple trauma in extremities) were set as controls. Logistic regression analyses were conducted to evaluate the association of sialolithiasis with oral or oropharyngeal infections.ResultsThe morbidity rate of sialadenitis was much higher in the cases than the controls (32.92% vs 0.72%, p < 0.0001). By contrast, the prevalence of oral or oropharyngeal infections (stomatitis, gingivitis, periodontitis, and pharyngo-tonsillitis) was significantly lower in pediatric sialolithiasis patients in all age (0–18) groups. The adjusted odds ratios of the multivariate analyses also confirmed significantly less prevalence of the oral and oropharyngeal infections in pediatric sialolithiasis patients.ConclusionOral or oropharyngeal infections were inversely associated with pediatric sialolithiasis, suggesting that pediatric sialolithiasis may result from the intrinsic factors of the salivary gland itself, not from oral or oropharyngeal infections.



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Iatrogenic trichloroacetic acid injury causing necrotizing otitis media and deafness

Publication date: June 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 97
Author(s): Tyler R. Halle, N. Wendell Todd, Jolie Fainberg




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Excision of sublingual gland as treatment for ranulas in pediatric patients

Publication date: June 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 97
Author(s): Brittany N. Nguyen, Barbara N. Malone, James D. Sidman, Brianne Barnett Roby
ObjectiveThe aim of this case study is to demonstrate that post-operative complication rates of sublingual gland excision for treatment of ranulas are equal to or less than alternative methods with a lower recurrence rate than other surgical methods.MethodsThis was a retrospective review of pediatric patients from 2004 to 2015 at Children's Hospitals and Clinics of Minnesota. Sixteen ranulas and 6 plunging ranulas were treated via sublingual gland excision during this time frame. Data examined included age, gender, scans of the lesion, location and size of lesion, surgical procedures, complications, and recurrence.ResultsThere were 22 patients who met criteria. Only one patient had recurrence of the lesion (4.5%). One patient reported lateral tongue numbness post-operatively, and one patient had a hypoglossal nerve injury, with tongue deviation upon exam. Both of these complications were temporary and resolved within months of the procedure.ConclusionAlthough sublingual gland excision is a definitive treatment for ranulas, many surgeons still utilize other methods such as marsupialization, drainage of the cyst, or excision of ranula alone as the primary method of treatment due to concerns about complications. This retrospective study demonstrates that excision of the sublingual gland is both a safe and effective method of treatment for ranulas.



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Clinical manifestations of neuroblastoma with head and neck involvement in children

Publication date: June 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 97
Author(s): Sameer Alvi, Omar Karadaghy, Michelle Manalang, Robert Weatherly
ObjectiveThe purpose of our study is to review our 15-year experience with pediatric patients who have been diagnosed with neuroblastoma, and to determine their most frequent head and neck manifestations and symptoms.Study designRetrospective chart review of electronic medical record.SettingAn academic, tertiary care pediatric hospital.Subjects and MethodsIRB approval from the Office of Research Integrity at Children's Mercy Hospital was obtained. The hospital tumor database was analyzed to identify patients with neuroblastoma, ganglioneuroblastoma, and esthesioneuroblastoma diagnosed between 1997 and 2012. We recorded the various clinical signs and symptoms these patients displayed at their initial presentation, focusing on patients with head and neck involvement. We then determined the relative incidence of these various findings.ResultsOur review yielded 118 patients diagnosed with neuroblastoma, ganglioneuroblastoma, or esthesioneuroblastoma over our 15 year study period. 7 of the 118 patients were diagnosed with primary tumors of the head and neck. Another 19 patients had metastatic head and neck involvement. For those with primary disease, presence of a neck mass and signs of Horner's syndrome were the most common findings. For metastatic disease, craniofacial bony metastasis was the most frequent finding in our study.ConclusionsBased on our data, there are a handful of findings that occur frequently in pediatric head and neck neuroblastoma. Any persistent neck mass, unexplained Horner's syndrome, or periorbital ecchymosis should be carefully evaluated. This study should serve as an aid for the otolaryngologist to be aware of the possible manifestations of this malignancy in children.



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Frosted branch angiitis and cerebral venous sinus thrombosis as an initial onset of neuro-Behçet’s disease: a case report and review of the literature

Frosted branch angiitis is a rare, severe condition. It can be either a primary or a secondary condition and is characterized by rapid deterioration of vision and fulminant retinal vasculitis that manifests as...

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Primary adrenal non-Hodgkin lymphoma: a case report and review of the literature

Lymphomas are cancers that arise from the white blood cells and have been traditionally divided into two large subtypes: Hodgkin and non-Hodgkin lymphoma. B-cell lymphoma is the most common subtype of non-Hodg...

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