Head and neck paragangliomas present incidentally or with signs of mass effect. Approximately 30%-40% are hereditary, which typically present at a younger age. Given their proximity to vital structures, they are often inoperable, and alternative treatment options have significant side effects. We present a case of a paediatric patient with a glomus jugulare paraganglioma who received peptide receptor radionucleotide therapy (PRRT), a targeted molecular therapy. We observed a good molecular response stable disease at 12-month follow-up and radiologically stable disease at 15 months posttreatment. PRRT is not currently a widely accessible treatment option, and the literature reports a reasonable disease response in treatment of head and neck paraganglioma.
In this report, we present the unique case of an incidentally discovered hypopharyngeal mass later found to be papillary thyroid cancer in an 86-year-old woman with a past medical history of Parkinson's disease and papillary thyroid cancer. Though the patient presented with dysphagic and dysphonic symptoms, her history of Parkinson's disease, presenting symptoms of falls and weakness, and a lack of palpable nodules obscured the diagnosis. Our case emphasizes the importance of maintaining a high clinical index of suspicion for head and neck pathology in patients with a history of thyroid cancer to ensure early recognition of atypical disease presentations.
Background:Lemierre's syndrome is a rare but potentially life-threatening condition traditionally characterized by bacteremia, septic thrombophlebitis of the internal jugular vein, and metastatic septic emboli following pharyngotonsillitis. We report an atypical presentation originating from submandibular sialadenitis and complicated by external jugular vein thrombophlebitis. Case Presentation:A 26-year-old man presented with high-grade fever, sore throat, and right submandibular swelling persisting for 7 days. Contrast-enhanced CT revealed right submandibular sialadenitis, thrombosis of the right external jugular vein without abscess formation, and bilateral cavitary pulmonary lesions consistent with septic emboli. Blood cultures identified Fusobacterium necrophorum as the causative pathogen. The patient was managed in the intensive care unit with vasopressor support, high-flow nasal oxygen, weight-based therapeutic anticoagulation (enoxaparin), and targeted intravenous antibiotics. Complete clinical and radiological recovery, including venous recanalization, was achieved without surgical intervention. Conclusion:Clinicians must maintain a high index of suspicion for Lemierre's syndrome even when thrombosis involves noninternal jugular neck veins or when the primary infectious focus is nonpharyngeal. Prompt multidisciplinary management is key to favorable outcomes.
Laryngotracheal trauma is a rare but fatal cause of injury in patients involved in polytrauma. Most patients succumb on site due to airway compromise. Thus, a delay in instituting interventions in such patients often leads to poor outcomes. In the handful that do make it to the hospital, there is a paucity of literature with regard to the optimal management of such conditions. In this case report, we present our management approach and highlight the dangers of dealing with such a case. We present a case of a young Asian male with complete laryngotracheal transection following blunt trauma in a high-speed road traffic accident. Early and accurate diagnosis with expedient management by a multidisciplinary and experienced trauma team is paramount. We also discuss the salient points and pitfalls from initial assessment and stabilization of the patient to the technical details on the definitive management, as well as review the current literature in dealing with such an injury.
Inner ear malformations (IEMs) present significant challenges for cochlear implantation (CI), particularly the common cavity deformity, in which the cochlea and vestibule merge into a single space. Surgical and audiological outcomes in such cases depend on accurate electrode placement, nerve integrity, and tailored surgical strategies. We report the case of a pediatric patient with bilateral common cavity deformities who underwent sequential bilateral CI using the double posterior transmastoid labyrinthotomy (TML) approach with custom-made electrodes. The patient, diagnosed with profound bilateral sensorineural hearing loss at 1 year of age, showed bilateral common cavities with identifiable but reduced caliber seventh and eighth cranial nerves on radiological imaging and absent responses on auditory brainstem response testing. Based on preoperative imaging, a custom-made MED-EL FORM19 electrode (Innsbruck, Austria) was selected and adapted to match the patient's anatomy, aiming to optimize placement and reduce intraoperative complications. A staged implantation was performed. Surgery was uneventful, with intraoperative neural response telemetry confirming responses in both ears. At four-year follow-up, aided thresholds were stable in the speech frequency range (right ear: 40-60 dB HL; left ear: 50-65 dB HL). Speech audiometry in quiet demonstrated good detection and recognition, and language development was appropriate for hearing age, with significant improvement from baseline. This case illustrates that double posterior TML with custom-made electrodes is a safe and effective strategy for CI in complex IEMs such as common cavity deformities. The technique offers precise electrode placement, minimizes risks to the facial nerve, and ensures stable fixation. Early bilateral stimulation, active family involvement, multidisciplinary care in specialized centers, and tailored electrode design are critical to achieving favorable long-term outcomes. Multicenter studies are needed to further validate these findings and refine patient selection.
Introduction:Tonsillar lymphangiomatous polyps are rare benign lesions characterized histologically by dilated lymphatic channels within a fibrous, adipose, or lymphoid stromal background. Although these lesions are more commonly reported in children and young adults, they are uncommon in older adults and may mimic other oropharyngeal or laryngeal lesions, including vallecular cysts. Case Presentation:We report the case of a 42-year-old previously healthy male who was incidentally found to have a mass at the base of the tongue. Preoperative clinical and radiologic assessment suggested a laryngeal vallecular cyst, as computed tomography demonstrated a well-defined lesion occupying the left epiglottic vallecula with partial airway narrowing. However, intraoperative examination revealed that the lesion was pedunculated and originated from the left tonsil rather than the vallecula. The patient underwent surgical excision with left tonsillectomy. Histopathologic examination demonstrated a lesion covered by squamous epithelium and composed of multiple dilated lymphatic vascular channels within a fibrous stromal background. Immunohistochemical staining showed endothelial positivity for D2-40, supporting lymphatic differentiation and confirming the diagnosis of a tonsillar lymphangiomatous polyp. Conclusion:This case highlights the diagnostic challenge of tonsillar lymphangiomatous polyps, particularly when a pedunculated tonsillar lesion projects toward the vallecula and clinically or radiologically mimics a vallecular cyst. Careful intraoperative assessment of the lesion's attachment site is essential for accurate localization and diagnosis. Complete surgical excision remains both diagnostic and therapeutic.
Background:Synovial sarcoma is a mesenchymal malignancy that most commonly arises in the lower extremities. Fewer than 5% of cases originate in the head and neck, and laryngeal involvement is exceptionally rare. Case Presentation:A 22-year-old man presented with a 6-month history of progressive hoarseness and hemoptysis. Direct laryngoscopy was performed, and biopsies were obtained. Histopathological examination established the diagnosis of laryngeal synovial sarcoma. The patient received three cycles of neoadjuvant chemotherapy, followed by total laryngectomy with bilateral neck dissection. Adjuvant radiotherapy was initiated postoperatively, and the patient remained recurrence-free at 12 months of follow-up. Discussion:Fewer than 5% of synovial sarcomas occur in the head and neck, and laryngeal involvement is rare. Three histopathological subtypes are recognized: monophasic, biphasic, and poorly differentiated. Immunohistochemistry and detection of the t(X; 18) translocation play a key role in diagnosis. Surgical resection remains the mainstay of treatment, although chemoradiotherapy may also be beneficial. Recurrence is a major concern, with local recurrence reported in up to 45% of patients and distant metastasis in approximately 33%. Conclusion:Because laryngeal synovial sarcoma is rare, reporting such cases may improve future diagnosis, evaluation, and management of this uncommon entity.
Introduction:The suprasternal space, termed Burns space, lies between the sternocleidomastoid and sternohyoid muscles. Although metastasis in this area frequently involves papillary thyroid carcinoma, it is rarely reported in head and neck squamous cell carcinoma. Case Presentation:We report a case of a 79-year-old man who underwent a partial glossectomy for tongue cancer, followed by neck dissection and radiotherapy. One year posttreatment, the patient developed suprasternal (Burns space) lymph node metastasis accompanied by bone invasion of the sternum and clavicle. An en bloc resection, which included the sternoclavicular joint, was performed, followed by reconstruction with a pectoralis major flap. Conclusion:To our knowledge, this is the first documented case of suprasternal lymph node metastasis with osseous extension from lingual cancer. A careful preoperative assessment of the suprasternal region is recommended, particularly in patients with a history of neck dissection (post-ND).
While nasal and palatal necrosis secondary to intranasal cocaine use is well documented in the literature, similar presentations linked to heroin abuse are rarely described. To the best of our knowledge, laryngeal involvement has not previously been reported. We present the case of a 48-year-old man with a 25-year history of smoking heroin, who presented with necrotic debris on the vocal cords and in the subglottic region. Debridement was performed, after which the symptoms subjectively improved. After one year, a subglottic adenocarcinoma was diagnosed. Substance abuse, including smoking heroin, should be considered in the differential diagnosis when necrotic laryngeal tissue is observed during laryngoscopic evaluation of patients with dysphonia and dyspnea. Biopsy and debridement are crucial for both diagnosis and symptom management. Long-term follow-up is essential, especially in patients with ongoing substance abuse, as malignancy can develop over time.
Pleomorphic adenomas (PAs) are the most common benign salivary gland tumors but rarely present in ectopic locations. When ectopic PAs occur in the head and neck, they most often arise from minor salivary gland tissue of the oral or nasal cavities. PAs of the external nose are exceedingly rare, and this is the first report of a PA arising from the nasal bridge. Here, we report a case of an African American man in his mid-20s with no pertinent medical history who presented with a slowly enlarging left nasal bridge mass that had grown over the past two to three years. Initially attributed to prior facial trauma and managed as a keloid with steroid injections, the lesion failed to improve, prompting referral to otolaryngology. Ultrasound demonstrated a 1.1 × 1.7 × 1.2 cm heterogeneously hypoechoic subcutaneous mass, and MRI showed a T2 hyperintense, avidly enhancing mass closely associated with but not communicating with the nasolacrimal duct. En bloc excision was performed, and histopathology confirmed PA via characteristic biphasic morphology and diffuse PLAG1 positivity. This case represents the most superiorly located nasal PA in the literature, and the absence of nasolacrimal duct involvement suggests true ectopic origin rather than extension from recognized salivary elements. This case highlights the importance of maintaining a broad differential for external nasal masses, particularly when lesions fail to respond to treatment as expected.
Red ear syndrome (RES) is a rare disorder characterized by episodic erythema, warmth, and burning pain of the external ear. RES is frequently associated with migraine. We report the case of a 35-year-old male with a long-standing history of poorly controlled migraine who presented with recurrent bilateral auricular erythema and burning pain, predominantly affecting the left ear. Symptoms were triggered by migraine attacks, heat exposure, and ear manipulation and relieved by cooling measures. Clinical examination, laboratory investigations, and imaging were normal. RES was diagnosed after excluding infectious and inflammatory causes. Treatment with indomethacin and magnesium resulted in complete symptom resolution. RES should be considered in patients with recurrent auricular erythema and burning pain, particularly in those with migraine. Careful clinical assessment and systematic exclusion of alternative diagnoses are crucial for identifying RES and preventing inappropriate management.
Background:Supralabyrinthine petrous bone cholesteatoma is a rare subtype in which hearing preservation may be achievable depending on the anatomical extent and surgical approach. Appropriate selection of surgical strategy is essential. Case Presentation:A 31-year-old man presented with a 2-year history of persistent left otorrhea. Otoscopic examination revealed pars flaccida cholesteatoma. Pure-tone audiometry demonstrated hearing loss with an air-bone gap of 35 dB. Computed tomography showed soft-tissue density extending from the tympanic cavity and mastoid air cells to the supralabyrinthine petrous apex. Inner ear function was almost preserved. Intervention:A staged surgical approach was adopted due to active inflammation. First, canal wall-down tympanomastoidectomy via a transmastoid approach was performed to control infection. Six months later, second-stage surgery was performed using the middle cranial fossa approach for complete removal of the supralabyrinthine cholesteatoma, along with ossicular chain reconstruction. Outcome:No intraoperative or postoperative complications occurred. Postoperative non-echo-planar diffusion-weighted MRI at 4 months showed no residual disease. At 22 months, hearing improved with an air-conduction threshold of 21.7 dB, and no tympanic membrane findings suggestive of recurrence were observed. Conclusion:In supralabyrinthine petrous bone cholesteatoma, selecting the surgical approach based on lesion extent, inflammatory status, and the need for hearing preservation is important for optimizing outcomes. In cases with extensive disease and significant inflammation, a staged strategy incorporating the middle cranial fossa approach may represent a safe and effective option for achieving disease eradication while minimizing the risk of inner ear dysfunction and postoperative complications.
The submandibular glands are salivary glands located under the mandible that secrete saliva into the oral cavity. The occurrence of heterotopic submandibular glands is an uncommon anatomical variation that is usually found unilaterally. There are few known reports of bilateral heterotopic submandibular glands; this paper describes a rare case of bilateral heterotopic submandibular glands that were discovered incidentally during routine dissection of a cadaver for medical education purposes and subsequent histological examination. The heterotopic glands were located in the carotid triangle at the level of the hyoid bone and appeared to receive blood supply from the facial artery and innervation from the facial nerve, similar to that of typical submandibular glands in normal anatomical location. Venous drainage was into the facial vein and communicating jugular vein. Dissection of each bilateral heterotopic submandibular gland revealed a duct oriented toward the oral cavity, suggesting that it was a functional salivary gland. Histological analysis of the glands and nearby deep cervical chain lymph nodes revealed normal salivary gland and lymph node structure, with no evidence of neoplasia. Encountering such anatomical variations during cadaveric dissection as part of medical education is an irreplaceable learning experience that increases the understanding of pathologies and clinical competency.
Carotid blowout syndrome (CBS) is a rare but life-threatening complication of head and neck cancer, with endovascular intervention as the preferred treatment, while surgical ligation remains critical when endovascular management is not feasible. We describe a 59-year-old man with oropharyngeal carcinoma (cT4bN0M0) who had achieved clinical remission after concurrent chemoradiation. Two months after completing treatment, he experienced his first episode of CBS. As immediate endovascular intervention was not feasible at that time, surgical ligation of the left common carotid artery (CCA) was performed as a life-saving measure. He remained stable for 2 months until massive oral bleeding recurred, originating from a pseudoaneurysm of the extracranial internal carotid artery (ICA) distal to the previous ligation. As the proximal CCA had already been ligated and thus occluded, endovascular management was not possible in the second instance of CBS. Therefore, surgical ligation was performed via a preauricular infratemporal approach with intraoperative navigation. The pseudoaneurysm was successfully controlled by ligating the proximal and distal feeding vessels. The patient remained free from rebleeding for 3 years. This case demonstrates that infratemporal ICA ligation is a feasible and life-saving option when CBS occurs distal to a previously sacrificed carotid artery and endovascular treatment is not practical.
We present contrast-enhanced CT images of the neck and chest from a gentleman in his 70s who presented with fever, malaise, and left knee pain. He was diagnosed with septic arthritis and Staphylococcus aureus bacteremia. During admission, he developed new-onset hoarseness. Flexible laryngoscopy confirmed left vocal cord palsy. CT neck and thorax with contrast revealed a saccular aneurysm of the aortic arch (Standring, 2020; Netter, 2022; Paquette et al., 2012). Urgent surgical repair revealed an aortic abscess with rupture into the pericardial cavity. He was treated for infective endocarditis with intravenous flucloxacillin. Postoperatively, he developed a superficial sternotomy wound infection due to Candida albicans, successfully managed with fluconazole and negative-pressure wound therapy. Follow-up CT angiogram confirmed stability of the repaired aortic arch (Standring, 2020; Netter, 2022; Paquette et al., 2012). Ongoing dysphonia raised concern for persistent left recurrent laryngeal nerve palsy, prompting SALT referral for rehabilitation.
Odontogenic fibromyxoma is a rare benign tumor that arises from mesenchymal components of the tooth-forming apparatus and typically occurs in the alveolar process of the jaws. We are reporting an atypical case of an incidental tumor located in the mandibular condyle of a child, an area not associated with odontogenic tissue. The lesion was identified through imaging and confirmed histopathologically after surgical excision. To our knowledge, this is the first reported case of an odontogenic fibromyxoma in the condyle of a pediatric patient.
Intraosseous hemangiomas account for 1% of all primary bone tumors and most frequently affect the skull base and vertebrae. Rarely are they reported in the nasal cavity. We report a case of a 51-year-old male who complained of bilateral nasal obstruction. Nasal endoscopic examination showed a significantly enlarged right inferior turbinate with normal mucosal membranes. A CT scan revealed a well-defined heterogeneous mass with osseous borders originating from the bony lamella of the right inferior turbinate, with a honeycombed appearance. An en bloc transnasal endoscopic resection of the mass and turbinate was performed, revealing an intraosseous hemangioma of the inferior turbinate with a cavernous pattern. The postoperative period was uneventful with no recurrence. A literature review of intranasal intraosseous hemangiomas revealed 2 other cases resected endoscopically successfully.
Synechiae are abnormal adhesions or scar tissue that develop between two normally separate anatomical surfaces. Here, we present a rare case in which oropharyngeal and nasopharyngeal synechiae resulted in partial stenosis and functional impairments in speech, swallowing, and airway patency. The patient underwent surgical lysis of the scar bands, in which the bilateral bands connecting the tongue base to the posterior palate and pharyngeal wall were released using needle-tip Bovie cautery. Follow-up demonstrated significant improvement in breathing and swallowing. This case highlights the importance of understanding the healing process following traumatic injury to the oral and nasopharyngeal mucosa to better recognize and manage postoperative complications arising from abnormal adhesions. Further studies should investigate predisposing factors that increase susceptibility to such formations, as well as techniques and practices to prevent complications similar to the one presented here.
Inverted papillomas (IPs) derived from the lacrimal sac are a rare pathology, with only seven cases reported in the literature.1,2 “Mixed” endophytic and exophytic papillomas of the lacrimal sac are even more rare, with no reports in the literature. We present the case of a 55-year-old man who presented to the clinic with unilateral hemolacria. Multiple imaging modalities revealed a mass in the lacrimal sac, which was subsequently surgically excised by an otolaryngologist and oculoplastic surgeon. Pathologic analysis of the specimen demonstrated both exophytic and endophytic growth patterns, suggestive of a mixed papilloma subtype. This case highlights the importance of prompt, accurate diagnosis and interdisciplinary management, as patients require regular clinical follow-up to monitor recurrence and malignant transformation.
Bacterial meningitis in neonates may lead to profound sensorineural hearing loss and rapid postinflammatory cochlear changes that complicate auditory rehabilitation. We present two infants with bilateral profound hearing loss following neonatal bacterial meningitis who underwent early bilateral cochlear implantation. Radiological findings were limited or subtle, but intraoperative findings confirmed cochlear obstruction/ossification requiring adapted surgical management. Full electrode insertion was achieved in both children. Postoperative outcomes showed auditory benefit in both cases, although further development was strongly influenced by associated neurological comorbidities. These cases highlight the importance of early hearing assessment, repeated audiological follow-up, prompt imaging, and timely cochlear implantation in postmeningitic hearing loss.
