Masculinization of the thyroid cartilage ("Adam's apple") is an important yet underreported component of gender-affirming surgery. Traditional augmentation techniques using autologous rib cartilage provide durable projection but introduce additional donor site morbidity. We describe a novel single-incision technique utilizing autologous thyroid alar cartilage grafts for thyroid cartilage augmentation. A 29-year-old transmale underwent augmentation via a high cervical incision. Bilateral thyroid alar cartilage grafts were harvested, fashioned into a neothryoid notch construct, and secured to the native cartilage to enhance anterior projection. The patient was discharged without complication and reported high satisfaction with both aesthetic and tactile outcomes at 15 days and 9.5 months postoperatively. This approach leverages the favorable properties of thyroid alar cartilage while avoiding the morbidity associated with distant donor sites. The technique allows for effective augmentation through a single, less-invasive operative field. Thyroid alar cartilage grafting represents a promising, less invasive alternative for masculinization of the thyroid cartilage in appropriately selected patients.
Esophageal innominate artery fistula (EIF) is a rare cause of life-threatening gastrointestinal hemorrhage. This condition occurs most often secondary to an aneurysm, tumor, or esophageal foreign body. After stabilization of airway and circulation, the management options vary from open to endoscopic and endovascular repair. The initial presentation, diagnosis and management of EIF in the literature focuses on adults primarily. In this case report, the clinical presentation of EIF in a pediatric patient, secondary to delayed recognition of a foreign body, highlights management considerations in this population.
Middle ear adenomatous neuroendocrine tumors (MEANT) are rare neoplasms frequently misdiagnosed due to their nonspecific clinical presentations. We present the case of a 25-year-old woman who reported a 2-month history of tinnitus, dizziness, and left-sided conductive hearing loss. Otoendoscopy and computed tomography revealed a well-circumscribed, vascular soft-tissue mass in the epitympanum extending to the mastoid antrum, which was subsequently managed with complete transcanal endoscopic excision. Histopathological evaluation confirmed a well-differentiated neuroendocrine tumor. A definitive diagnosis was established through comprehensive immunohistochemical profiling, demonstrating positive staining for INSM-1 and chromogranin-A, alongside a low Ki-67 proliferation index of less than 3%. Following the procedure, the patient exhibited stable hearing and no clinical or radiologic evidence of tumor recurrence over an 8-year follow-up period. Ultimately, this case highlights the critical importance of utilizing the 2022 WHO classification and immunohistochemical markers to accurately diagnose MEANT. Furthermore, it underscores a vital clinical caveat: while complete surgical excision is the definitive treatment, the tumor's established propensity for delayed recurrence mandates indefinite, long-term clinical and radiologic surveillance.
Acute mastoiditis is a recognized intratemporal complication of acute otitis media in children, but progression to frank temporal bone osteomyelitis with extensive cortical necrosis is exceptionally rare in infancy. This report presents a 1-year-old infant with refractory acute mastoiditis complicated by destructive temporal bone osteomyelitis. High-resolution computed tomography with 3D reconstruction demonstrated extensive cortical loss. Emergency subtotal mastoidectomy and radical debridement were performed. Deep intraoperative culture yielded multidrug-resistant Staphylococcus hominis, and histopathology confirmed osteomyelitis. The child improved rapidly on targeted linezolid therapy and completed a 4-week course with complete clinical and laboratory resolution. This case highlights the importance of early imaging, deep tissue sampling, and targeted therapy in rare infant temporal bone osteomyelitis.
ObjectivesLocally advanced laryngeal cancer (LALC) treatment options include surgery followed by postoperative radiotherapy (PORT) or chemoradiotherapy (POCRT) versus non-surgical definitive radiotherapy (RT) or chemoradiotherapy (CRT). Their comparative efficacy remains debated. This study aimed to evaluate survival outcomes and prognostic factors in LALC patients receiving postoperative (PORT/POCRT) versus definitive (RT/CRT) treatment.MethodsWe retrospectively enrolled 210 LALC patients treated at our hospital (2010-2021). Overall survival (OS) and progression-free survival (PFS) were analyzed. Prognostic factors were identified using multivariate Cox regression.ResultsMedian follow-up was 46 months. Median, 3- and 5-year OS was 70 months, 73.2%, and 57.7%, respectively, while the corresponding PFS was 45 months, 55.8%, and 41.3%. Multivariate analysis identified Karnofsky Performance Status (KPS) score, pathological differentiation, and pretreatment prognostic nutritional index (PNI) as independent risk factors for OS and PFS; second primary cancer and lesion site were independent risk factors for PFS. PORT/POCRT was associated with significantly higher local control and PFS than definitive CRT (P < 0.05). Both PORT/POCRT and definitive CRT were associated with significantly better OS and PFS than definitive RT alone (P < 0.05).ConclusionHigher KPS, moderate-to-high differentiation, and higher PNI predict better OS and PFS. Absence of a second primary cancer and presence of a glottic primary tumor predict better PFS. PORT/POCRT was most effective, followed by definitive CRT; definitive RT alone was least effective.
ObjectivesThis study aimed to examine the diffusion properties, signal characteristics and size of the parotid and submandibular gland in neck magnetic resonance (MR) imaging.MethodsIn the study, neck MRI images of 80 patients, 40 men and 40 women, were examined. Area and "Apparent Diffusion Coefficient (ADC)" measurements of bilateral parotid and submandibular glands were measured in MRI images. The findings were compared between genders and between two age groups: 18-50 years and 51-80 years.ResultsLeft submandibular area measurements in men (394.4±107.1 mm2) were found to be statistically significantly larger than in women (330.1±89.8 mm2) (p<0.05). A significant difference was detected in right and left submandibular and parotid gland heterogeneity degrees according to the age groups of the patients (p<0.05). While grade 0 and grade 1 were more common in the 18-50 age groups, grade 1 and grade 2 were more common in the 51-80 age groups. In each area; and ADC measurements of the parotid glands; and submandibular glands bilaterally, there were positive correlations (p<0.05). However, there were negative correlations between ADC and area measurements in parotid glands (p<0.05).ConclusionAs a result, it was observed that the heterogeneity in the gland increased as the age of the patients increased. Neck MRI is frequently used today in the diagnosis of salivary gland diseases, and it is thought that heterogeneity in the salivary gland with age may be helpful in the diagnostic steps in MRI.
Teratomas are germ cell tumors typically originating in the gonads. Extragonadal occurrences, particularly in the parotid gland, are exceedingly rare. Due to their nonspecific clinical presentation, these tumors often pose a diagnostic challenge. We report a rare case of a mature cystic teratoma of the parotid gland in an 18-year-old female, who presented with a painless, slow-growing mass in the right postauricular region persisting for over a decade. Magnetic resonance imaging (MRI) demonstrated a lobulated mass with high signal intensity on T1- and T2-weighted sequences. The patient underwent a successful right superficial parotidectomy without postoperative complications. Histopathological analysis confirmed the diagnosis of mature cystic teratoma. This case underscores the necessity of including teratoma in the differential diagnosis of parotid gland neoplasms, especially when presenting as a long-standing, asymptomatic mass.
ObjectivesTo report a diagnostically challenging case of refractory epistaxis in a 16-year-old male that mimicked juvenile nasopharyngeal angiofibroma (JNA), and to highlight critical perioperative lessons regarding coagulation disorders and postoperative wound healing.MethodsDetailed clinical, radiologic, surgical, pathologic, and hematologic data were reviewed.ResultsAn adolescent male presented with recurrent unilateral epistaxis and nasal obstruction. Imaging demonstrated a mildly enhancing posterior nasal mass, and laboratory testing revealed a persistently prolonged activated partial thromboplastin time (APTT). Based on a presumptive diagnosis of JNA, preoperative embolization followed by endoscopic resection was performed. Histopathology revealed an angiomatous nasal polyp. Despite adequate intraoperative hemostasis, the patient developed recurrent postoperative epistaxis refractory to repeated surgical exploration and nasal packing. Comprehensive coagulation studies ultimately demonstrated markedly reduced factor VIII activity, confirming moderate hemophilia A. Sustained hemostasis was achieved only after recombinant factor VIII replacement combined with prolonged, atraumatic nasal compression. No recurrent bleeding occurred during follow-up.ConclusionAngiomatous nasal polyp in adolescent males may closely mimic JNA, particularly when compounded by an unrecognized coagulation disorder. In patients with persistent APTT prolongation, postoperative epistaxis may reflect impaired wound healing rather than inadequate surgical hemostasis. Early hematologic evaluation and appropriate factor replacement are essential to prevent repeated unnecessary surgical interventions.
ObjectiveThis study was performed to analyze the clinical effect of tragus perichondrium in endoscopic myringoplasty with underlay and overlay techniques for the repair of chronic tympanic membrane (TM) perforation.Subjects and MethodsA total of 120 patients with chronic otitis media who underwent endoscopic TM repair with tragus perichondrium were analyzed. The cases were randomly divided into an overlay group (n=60) and an underlay group (n=60). The intraoperative duration, intraoperative blood loss, graft uptake rate, postoperative TM morphology, hearing outcomes and postoperative complications were compared between the two groups.ResultsOperative time and mean estimated blood loss were significantly lower in the underlay group than in the overlay group (χ2=4.82, p=0.0475)). At 12 months postoperatively, the overall graft uptake rate was significantly higher in the overlay group (98.4%) than in the underlay group (89.3%) (χ2=3.914, p=0.0281. 2 cases were found to have the formation of epithelial cholesteatoma bead in the overlay group, In addition, there were no significant differences between the two groups in the pre- or postoperative mean air-bone gap (postoperative air-bone gap: 11.25±2.71dB for underlay vs. 10.92±3.89dB for overlay, p=0.652). CT examination revealed no cholesteatoma in the middle ear.ConclusionsIn the treatment of chronic TM perforation, endoscopic tragus perichondrium overlay myringoplasty improves the graft success rate compared to the underlay technique. However, the probability of the formation of epithelial cholesteatoma bead will increase, and it requires a higher level of surgical precision. The underlay method is less invasive,takes less surgical time, and is easier to master than the overlay method.
IntroductionReconstruction of complex nasal defects involves restoring external skin, internal lining, and support within a 3D framework. While the forehead flap is considered the gold standard, free tissue transfer is used when local tissues are unavailable. Historically, the radial forearm flap (RFF) was favored for its thinness and pliability. The anterolateral thigh (ALT) flap, once limited by bulkiness, has been refined. This study examines the evolution and current role of the ALT flap in the nasal reconstruction algorithm.MethodsA sequence of patients with nasal defects received reconstruction with a free ALT flap. Additionally, a targeted literature review was performed to explore recent advances in perforator dissection, flap thinning, and chimeric design relevant to nasal reconstruction. The study assessed flap configuration, thinning techniques, structural repair, complications, and long-term results.ResultsEighteen flaps were performed: twelve for nasal reconstruction and six for adjacent facial subunits. Five patients required total nasal reconstruction. The mean flap thickness decreased from 24.6 ± 5.5 mm to 5.7 ± 2.4 mm after combined primary and microdissection thinning, a 77% reduction. Chimeric and multi-paddle configurations enabled simultaneous restoration of skin, lining, and composite defects. Flaps were viable with no partial necrosis. Long-term follow-up over 1 to 8 years demonstrated stable airway function and maintained satisfactory contour.ConclusionsThe ALT flap has evolved from a secondary reconstructive option to a refined material for complex nasal defects. Advances in perforator-based thinning and hybrid designs have expanded its use, making it a viable alternative to traditional forearm reconstruction in some patients.
Epiglottic inclusion cysts are extremely rare benign laryngeal lesions. A 41-year-old woman suffered from persistent pharyngeal foreign body sensation for one year. Laryngoscopy detected a giant epiglottic cyst, and contrast-enhanced cervical CT showed the typical pedunculated 'apple sign'. Under fiber optic intubation, complete resection was performed by suspension laryngoscopic coblation. Histopathology verified epiglottic inclusion cyst. Pathognomonic apple sign significantly contributes to precise preoperative diagnosis and individualized surgical planning. Transoral plasma resection provides a safe, effective and low recurrence therapeutic option for this rare laryngeal disease.
PurposeHead and neck unicentric Castleman disease (HN-UCD) often lacks specific clinical and laboratory markers, leading to frequent preoperative misdiagnoses. While surgical resection typically offers a favorable prognosis, the management of atypical postoperative outcomes, such as new regional lymphadenopathy or persistent systemic symptoms, remains poorly defined. This study aimed to identify the characteristic imaging features of HN-UCD and explore effective management strategies for these atypical postoperative scenarios.MethodsA retrospective analysis was conducted on 24 patients diagnosed with HN-UCD at the Peking Union Medical College Hospital over the past 20 years. The preoperative imaging characteristics and postoperative clinical outcomes were systematically evaluated.ResultsImaging confirmed significant hypervascularity as a hallmark of HN-UCD: 94.4% (17/18) of lesions exhibited abundant and disordered blood flow signals on ultrasound, and 71.4% (10/14) of lesions presented with prominent feeding vessels on CT. Postoperatively, 87.5% (21/24) of the patients achieved complete remission within the surgical field. For the two patients exhibiting atypical outcomes (new regional lymphadenopathy and persistent fever), a strategy of rigorous follow-up was adopted after multidisciplinary exclusion of malignancy and infection; both patients remained clinically stable.ConclusionProminent feeding vessels and marked hypervascularity are characteristic preoperative imaging markers for HN-UCD. For patients with atypical postoperative outcomes, a management protocol based on multidisciplinary evaluation and close clinical observation is recommended.
Middle ear salivary gland choristoma (SGCh) is an exceptionally rare benign tumor characterized by middle ear malformations accompanied by unilateral conductive hearing loss. Early diagnosis remains particularly challenging, and surgical excision constitutes the primary therapeutic approach. We present a 13-year-old male with congenital hearing impairment diagnosed with SGCh and surgically managed. This report describes the first documented case of SGCh coexisting with middle ear lipoma, analyzing its clinical presentation, imaging differential diagnostic challenges, and surgical management strategy to advance precise diagnostic and therapeutic interventions.
IntroductionTo evaluate short-term postoperative intralaryngeal findings and subjective voice outcomes following transcervical chondrolaryngoplasty with endoscopic vocal fold localization.MethodsA retrospective review was performed of 35 patients undergoing transcervical chondrolaryngoplasty by a single surgeon. Three patients were excluded because of incomplete documentation, leaving 32 patients for analysis. All patients underwent preoperative and 1-week postoperative flexible laryngoscopy and completed the Voice Handicap Index-10 (VHI-10) at both time points. Postoperative endoscopic findings, including anterior commissure integrity, true vocal fold injury, and false vocal fold (FVF) hemorrhage, were recorded and compared with changes in patient-reported voice outcomes.ResultsNo patients demonstrated anterior commissure detachment, true vocal fold injury, or visible glottic damage on postoperative endoscopy. FVF hemorrhage was observed in 12 of 32 patients (37.5%). Mean VHI-10 score increased by 0.5 points postoperatively (SE 0.85), which was not statistically significant (p = 0.5), with a median change of 0. No significant association was observed between postoperative FVF hemorrhage and change in VHI-10 score. All hemorrhages resolved spontaneously without intervention.ConclusionIn this small single-institution series, transcervical chondrolaryngoplasty with endoscopic vocal fold localization was associated with no observed anterior commissure injury and no significant short-term change in patient-reported VHI-10 scores. FVF hemorrhage was relatively common on early postoperative endoscopy but was self-limited and not associated with worsened short-term subjective voice outcomes.
ObjectiveTo assess the relationship between nasal septal deviation characteristics, sinonasal variations, and nasolacrimal duct (NLD) obstruction in primary Acquired Nasolacrimal Duct Obstruction (PANDO) and chronic dacryocystitis.MethodsA total of 142 patients (48 PANDO, 46 chronic dacryocystitis, 48 controls) who underwent paranasal sinus computed tomography were included. Septal deviation characteristics and sinonasal variations were evaluated. Associations with NLD obstruction were analyzed using univariate and multivariate logistic regression.ResultsThe septal deviation was significantly associated with NLD obstruction (p = 0.005). Multivariate analysis identified a higher classification of Mladina (OR = 1.37, 95% CI = 1.10-1.71; p = 0.006) and a lower coronal deviation (OR = 1.73, 95% CI = 1.00-2.99; p = 0.049) as independent predictors. Other deviation parameters and sinonasal variations were not independently associated with laterality or severity obstruction. In deviation-positive patients, morphological features did not predict the obstruction side.ConclusionsInferior septal deviation and higher Mladina scores showed independent associations with NLD obstruction; however, the general contribution of septal morphology appears limited. These findings may have implications for preoperative evaluation and surgical planning in patients with PANDO and chronic dacryocystitis.
OBJECTIVES:To explore the correlation between the posterior airway space (PAS) in children with adenoid hypertrophy and the acoustic impedance test indicators, in order to provide a reference for clinical assessment of middle ear dysfunction in these children. METHODS:A retrospective analysis was conducted on 160 children diagnosed with adenoid hypertrophy in the otolaryngology department of our hospital from January 2024 to January 2025. They were divided into 4 groups based on the PAS value (Grade 1: >12 mm, Grade 2: 8-12 mm, Grade 3: 5-8 mm, Grade 4: ≤5 mm), with 40 cases in each group. All underwent acoustic impedance testing, and the middle ear pressure, compliance, and distribution of the tympanogram were compared. Receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic value. RESULTS:There was no significant difference in the general data among the 4 groups (P > .05); as the PAS grade increased, the average absolute value of middle ear pressure increased (Grade 1: -3.48 ± 20.01 daPa, Grade 4: -124.03 ± 84.92 daPa, P < .001), the average compliance decreased (Grade 1: 0.68 ± 0.09 mL, Grade 4: 0.23 ± 0.04 mL, P < .001), the proportion of type B and C tympanogram increased (P < .01); the area under the curve (AUC) of type B and C tympanogram were 0.654 and 0.650 respectively (P < .01). CONCLUSIONS:PAS was significantly correlated with the impedance index. The smaller the PAS value (indicating a more severe degree of adenoid hypertrophy), the more obvious the middle ear dysfunction.
IntroductionFew studies have analyzed the operative length of pediatric adenotonsillectomy (AT) due to obesity. This study bridges this gap by characterizing differences in operative times associated with AT in pediatric patients with and without obesity.MethodsThis retrospective study included demographic and clinical data for patients aged 3 to 17 years who underwent an AT between February and December 2016. Induction time, time required to complete the AT (operative time), time from procedure completion until extubation (emergence time), and total time spent in the operating room (OR) were determined. Two-sample t-tests and Pearson's tests were used to compare patient data by obesity. Multivariable linear regressions were performed to compare outcome variables by demographic and clinical variables.ResultsOur study included 499 patients with an average age of 7.0±3.6 years. Three hundred sixty-three (73%) patients were not obese, and 136 (27%) patients were obese. Obese patients were more likely than non-obese patients to be older (median [IQR]: 8 [6-10] years old vs 6 [4-9] years old, p<0.001) and exhibit asthma or reactive airway disease (30.9% vs 17.4%, p=0.001) but less likely to have private insurance (22.1% vs 33.6%, p=0.012) or identify as White (66.9% vs 77.4%, p=0.017). Obese patients exhibited higher induction time (13.5±4.0 minutes vs 15.2±4.4 minutes, p<0.0001), operative time (18.0±9.6 minutes vs 21.1±10.1 minutes, p=0.001), emergence time (9.27±5.0 minutes vs 11.8±6.6 minutes, p<0.0001), and total OR time (40.7±12.1 minutes vs 48.1±13.4 minutes, p<0.0001). On multivariable linear regression, obesity was associated with higher induction time (β [95% CI]: 1.69 [0.84, 2.54], p<0.001), operative time (β [95% CI]: 2.37 [0.38, 4.36], p=0.020), emergence time (β [95% CI]: 2.21 [1.08, 3.33], p<0.001), and total OR time (6.27 [3.74, 8.80], p<0.001).ConclusionOur results suggest that obesity is associated with increased AT operative times, thereby impacting appropriate scheduling and perioperative counseling.
ObjectiveThe role of hearing loss (HL) in surgical outcomes is not well studied and could greatly impact the lives of patients in the post-operative setting.Study DesignThis is a retrospective cohort study of adults who underwent subspecialty surgeries in Otolaryngology. Patients were recruited from 58 health care organizations in the TriNetX Research Network.MethodsAnalysis was performed on data from January 2004 to January 2024. Patients with a history of subspecialty otolaryngologic surgical procedures with HL. Cohorts were matched for demographics, comorbidities, and hearing aid use. Post-surgical complications within 30 days of procedure were compared between patients with HL and those without.ResultsRates of post-op surgical site infection (SSI) were higher in patients who had HL after Head and Neck (HN) procedures compared to those who did not (AR 2.03%, OR 1.22, [1.01 - 1.48], P < 0.01). Emergency Department (ED) visits after surgery were higher in the HL cohort for HN (AR 8.12%, OR 1.31, [1.20 - 1.49], P < 0.01), and Facial Plastic and Reconstructive Surgery (FPRS) (AR 4.58%, OR 1.13, [1.05 - 1.22], P < 0.01). Rates of wound disruption was higher in patients who had HL after HN procedures compared to those who did not (AR 1.34%, OR 1.27, [1.01 - 1.61], P < 0.05). In otology, HL patients had lower rates of cellulitis and abscess, and wound disruption (P < 0.05), along with lower rates of ED visits and readmission (P < 0.01.ConclusionPatients with HL had a higher risk of ED visits with HN, and FPRS procedures. The rate of SSI and dehiscence was higher in the HL cohort for HN.Level of evidenceLevel III (retrospective cohort study).
Birt-Hogg-Dubé syndrome (BHD) is a rare autosomal dominant disorder caused by germline mutations in the FLCN gene, characterized by cutaneous fibrofolliculomas, pulmonary cysts, and an increased risk of renal neoplasms. Parotid oncocytoma is an infrequently reported extracutaneous manifestation of the syndrome. A 30-year-old man with a prior history of testicular embryonal cell carcinoma presented with a right-sided neck mass. Workup of the parotid lesion ultimately led to a new diagnosis of BHD, confirmed by FLCN germline mutation testing. The patient underwent right parotidectomy, which was technically complex due to parapharyngeal extension and adherence to the facial nerve. Final pathology confirmed oncocytoma with clear cell features; all three lymph nodes were negative for metastatic carcinoma. The patient has remained without evidence of disease at over two years of postoperative follow-up. This case illustrates the diagnostic challenges posed by BHD-associated parotid oncocytoma, particularly when clear cell morphology raises concern for metastatic renal cell carcinoma or recurrent germ cell tumor. Clinicians should consider BHD in younger patients presenting with oncocytic parotid tumors, as recognition carries important implications for long-term renal and pulmonary surveillance.
IntroductionOrbital involvement is a serious complication of ethmoiditis in children, often occurring because the ethmoid sinuses are very close to the orbit. Our work aimed to report the clinical presentation, treatment modalities and the outcome of orbital complications of acute ethmoiditis to identify common indicators for surgery.MethodsRetrospective observational study to review cases that were hospitalized in pediatrics and otorhinolaryngology departments of the Farhat Hached Hospital in Sousse, Tunisia, during the period from January 2013 to December 2023.ResultsWe collected 79 cases. The mean age was 4,55±3,64 years old. Five of our patients had anemia, six had allergic rhinitis, and one had asthma. Two other patients had undergone recent dental care. Palpebral edema and fever were the most frequently reported symptoms. A palpebral abscess was present in five cases, while nineteen cases exhibited exophthalmos. Seven children had limited occulomotricity, and one child had ophthalmoplegia.In addition, reduced visual acuity was reported in 3 cases. Referring to Chandler's stratification, we report 37 cases of preseptal cellulitis, 10 cases of orbital cellulitis and, 31 cases of subperiosteal abscess. Eleven patients required surgical treatment consisting of orbitotomy. Age equal to or above 5 years old was more associated with surgical treatment (p<0.001). The outcome was generally favorable.ConclusionOrbital complications of acute ethmoiditis are a low-prevalence high risk disease. Most patients are successfully treated without long-term complications. Younger children (<5 years) are less likely to undergo surgery.
