Adult epiglottitis cases have increased in incidence in recent years. Epiglottic abscess, a rare but potentially life-threatening complication of epiglottitis, has traditionally been managed with urgent surgical intervention, including drainage and airway stabilization. We report the case of an otherwise healthy female without significant comorbidities who presented with odynophagia and was found to have an epiglottic abscess. Despite the presence of an abscess, she exhibited mild symptoms and had a stable airway. The patient was successfully managed conservatively with antibiotics and airway monitoring without surgical interventions. We additionally review the existing literature on diagnosis and management of epiglottic abscess, highlighting considerations for conservative management in carefully selected patients.
Dysphagia may be a prominent manifestation of myasthenia gravis (MG), yet objective visualization of swallowing recovery after treatment has rarely been reported. We describe a patient with generalized MG in whom serial flexible endoscopic evaluation of swallowing (FEES) documented marked improvement of pharyngeal dysfunction following immunotherapy. A 67-year-old foreign woman presented with progressive dysphagia and weight loss. FEES demonstrated saliva pooling, impaired pharyngeal contraction, and marked pharyngeal residue. Intravenous edrophonium improved the swallowing function observed on FEES, and elevated anti-acetylcholine receptor antibody levels confirmed generalized MG. Following steroid pulse therapy, intravenous immunoglobulin, oral corticosteroid taper, and subcutaneous efgartigimod, repeat FEES demonstrated restoration of salivary pooling, improved pharyngeal contraction, and effective pharyngeal clearance. Functional outcomes improved substantially: the Functional Oral Intake Scale level increased from 2 to 7, the Hyodo score improved from 5 to 0, the MG-ADL score improved from 19 to 1, and the MGFA classification improved from class IIIb to class I. This case highlights the value of serial FEES for objectively monitoring treatment-responsive dysphagia in MG and for facilitating multidisciplinary dysphagia management, including in patients with communication barriers.
Background Trichoblastic carcinoma (TBC) is a rare malignancy originating from hair follicle germinative cells. Although it histologically resembles basal cell carcinoma, TBC follows a more aggressive clinical course, making accurate differentiation essential for appropriate management and follow-up. Due to its rarity and relatively recent recognition, TBC is frequently underdiagnosed, and no standardized management guidelines currently exist. Case report We describe the case of a 72-year-old man presenting with a progressively enlarging and painful lesion of the right pinna, initially suspected to be basal cell carcinoma. Histopathological examination revealed high-grade trichoblastic carcinoma. The patient experienced multiple aggressive locoregional recurrences involving the auricular and preauricular regions. Management consisted of repeated wide local excisions, superficial parotidectomy, and selective adjuvant radiotherapy, while deliberately avoiding radical parotidectomy in accordance with the patient's preference. Conclusion Despite multiple recurrences, satisfactory locoregional disease control was achieved through a conservative, organ-preserving treatment strategy, with preservation of facial nerve function and acceptable functional and cosmetic outcomes. This case highlights the importance of individualized, patient-centered decision-making in the management of recurrent trichoblastic carcinoma and suggests that conservative surgical approaches may be a viable option in selected cases when combined with close follow-up and tailored adjuvant therapy.
Background Mucoepidermoid carcinoma (MEC) of the accessory parotid gland (APG) is exceedingly rare in children: only five cases have been reported individually. APG tumors are nonetheless malignant in approximately 24% to 39% of cases and are closely related to the buccal branches of the facial nerve. We describe a sixth case, to our knowledge the first excised as a presumed benign cyst and then re-excised through a combined pre-auricular and trans-facial approach in a previously violated field. Case presentation A 9-year-old boy presented with a 4-month left cheek mass. MRI demonstrated a thick-walled cystic lesion in the APG territory, interpreted as a mucous retention cyst, and excisional biopsy was undertaken on that basis. Histopathology and immunohistochemistry confirmed intermediate-grade MEC with positive margins. At definitive re-excision, a pre-auricular incision first permitted identification of the facial nerve in unoperated tissue; the scar and tumor bed were then excised en bloc through a trans-facial extension, down to the preserved parotid duct. Two small residual foci were excised with a close (<1 mm) deep margin and clear remaining margins. After multidisciplinary discussion, surveillance was preferred to radiotherapy. At 13 months, the patient was disease-free, with House-Brackmann grade I facial nerve function. Conclusion A mid-cheek mass in the APG territory in a child warrants cytology and assessment by a surgeon experienced in parotid and facial nerve surgery before any incision, however reassuring the imaging. Where revision surgery is needed in a violated field, this combined approach may permit oncological resection with facial nerve preservation.
