Ferit Tovi

The aberrant cervical thymus. Embryology, Pathology, and clinical implications.

Cervical thymic anomalies are not as rare as previously suggested. Six cases were encountered over a relatively short period of time, prompting us to report them and emphasize the importance of this entity. Five of the six patients were children, two of them infants less than one year old. The occurrence of thymic remnants in the neck of young children is not surprising, considering the nature and behavior of the thymus at different stages of life. After a brief embryologic survey, the various types of cervical thymus (solitary ectopic, cystic, or partially arrested descent) and their pathogenesis are discussed. The rare occurrence of thyroid and parathyroid tissue within the mass of a large cervical thymic cyst is reported and evaluated. Cervical thymic lesions can either be symptomless or cause severe dyspnea and dysphagia, especially in the young infant. Accurate diagnosis and an intelligent surgical approach in the child with a cervical mass can avoid the obvious parental apprehension and lead to the correct treatment. Symptoms due to pressure on neighoring structures are promptly eliminated after excision, and prognosis is excellent.

Safety of total thyroidectomy: Review of 100 consecutive cases

During a 6‐year period (June 1982 to June 1988), 100 consecutive total thyroidectomies were performed at Mount Sinai Hospital, University of Toronto, for benign and malignant disease. There were five permanent complications: one deliberate sacrifice of the recurrent laryngeal nerve and four cases of persistent hypoparathyroidism. Four of these five complications occurred in extracapsular carcinoma and resulted from oncologic wide‐field resection and/or deliberate sacrifice. One patient with benign disease suffered initially transient hypoparathyroidism which has now become permanent. Interestingly, two patients actually underwent deliberate sacrifice of a recurrent laryngeal nerve; one patient has made a surprising recovery at 16 months postoperative and now has full vocal cord mobility.

Early treatment of orbital floor fractures with catheter balloon in children

Fifteen pediatric patients with orbital floor fractures were successfully treated early, following injury by a transantrally introduced catheter-balloon technique. The latter stabilizes and supports the torn, but still vascularized periosteum at the edges of the fracture and also serves as a guide for its further proliferation and new bone formation. Apart from a transient anesthesia in the dermatome of the infraorbital nerve in certain patients no complication or sequela was noted in this series. Accordingly early repair with the use of catheter-balloon appears to be a viable alternative in the repair of orbital floor fracture in children.

Teeth in the maxillary sinus--imaging and management.

PURPOSE To evaluate the images obtained by CT in diagnosis and treatment plan of teeth in the maxillary sinus. METHODS Twelve patients with teeth in the maxillary sinus were studied by plain film radiography (PFR) and by CT with a dental software programme, which displays multiple panoramic and cross-sectional views of the mandible and maxilla. The three-dimensional morphology of the tooth, its inclination, proximity to the sinus wall, surgical planning and prediction of prognosis and complications were estimated on both PFR and on CT scans and scored. RESULTS The radiographical features interpreted from PFR were fair or poorly diagnosed whereas CT provided excellent features. The surgical approach of choice was based on CT interpretation. CONCLUSION CT is useful for diagnosis and treatment planning of teeth in the maxillary antrum.

Necrotizing soft‐tissue infections in the head and neck: A clinicopathological study

The clinicopathological aspects of 15 patients with necrotizing soft‐tissue infections in the head and neck are reviewed. Our relatively large series suggests that the disease occurs more frequently than described in the literature.

Osteoblastic osteitis of the maxillary sinus

Osteoblastic osteitis is a rare kind of bone infection typified by a proliferative reaction of the periosteum and by exuberant bone formation. In the maxillary sinus, it occurs as a consequence of chronic or recurrent sinusitis. It usually manifests with a vague facial discomfort, followed by complications in the deep facial spaces or fossae. The diagnosis is a radiological one. Eradication of this bone infection necessitates removal of the precipitating condition as well as the long‐term administration of appropriate antibiotics. In the case of a deep facial fossae abscess, drainage is mandatory.

Pseudoaneurysm of the internal carotid artery secondary to tonsillectomy

A case of pseudoaneurysm of the cervical internal carotid artery secondary to tonsillectomy is presented and the pathogenesis of this vascular abnormality is discussed. Due to morphologic and inflammatory changes in the lateral pharyngeal wall, the entrapment aneurysm was maintained. The internal carotid artery was initially occluded above the carotid bifurcation. The transcatheter occlusion of the distal stump of this vessel, by steel coils, replaced a mutilating approach for exposure and ligation near the base of the skull.

Recurrent suppurative thyroiditis due to fourth branchial pouch sinus

Acute suppurative thyroiditis is a rare disease in childhood. The etiology of this condition is not always obvious. The description of a pharyngeal pouch fistula extending from the pyriform sinus to the thyroid gland or perithyroid area, high-lighted the etiopathogenesis of some of the thyroiditis cases. Presented here are the clinical, radiological and pathological aspects of an internal pharyngeal fistula manifesting with recurrent suppurative thyroiditis, until it was completely removed. The clinical features of caudal branchial pouch remnants and their role in the development of acute suppurative thyroiditis is reviewed.

Cystic metastases of the neck from occult thyroid adenocarcinoma

In 9 of 118 patients with differentiated thyroid carcinomas, a solitary cystic lateral cervical mass simulating a branchial cleft anomaly was the sole presenting sign of the disease. These masses were nodal metastases of occult papillary adenocarcinoma of the thyroid that underwent liquefaction necrosis. Sonographically, the masses presented a complex pattern. Accordingly, it is suggested that, in patients presenting with an asymptomatic solitary lateral cystic cervical mass, the possibility of metastasis from an occult thyroid malignancy should be considered, and consent for definitive surgery should be obtained. The ultrasonic pattern of the cystic mass is of importance in the differentiation of a cavitated lymph node from a branchial cleft cyst.

Painful ophthalmoplegia associated with lymphoid hyperplasia of the nasopharynx

In the last ten years three patients presented with a subacute syndrome characterized by unilateral frontal headache, ipsilateral external ophthalmoplegia, Va or Vb hypoesthesia and peripheral facial palsy. In all of them, plain X-ray and/or CT revealed a nasopharyngeal mass. Orbital venography failed to fill the superior orbital vein ipsilateral to the ophthalmoplegia, suggesting a unilateral cavernous sinus pathology. Biopsy demonstrated lymphoid hyperplasia. Two patients recovered spontaneously, and in one, steroid treatment resulted in fast pain relief and progressing complete disappearance of the mass. In one patient a high titer of Epstein-Barr viral antibodies was detected.