Kevin C. Huoh

Etiologic Factors in Sialolithiasis

Objectives. The purpose of this study was to investigate etiologic factors for sialolithiasis in a population of patients from the United States. Study Design. Retrospective, cohort study. Setting. Tertiary university. Materials and Methods. Charts for all patients diagnosed with sialolithiasis between January 2001 and February 2010 were retrospectively reviewed. Demographic factors, smoking history, comorbid medical conditions, and medication history were recorded. Statistical analyses were then performed on the collected data. Population prevalences of smoking, diuretic usage, cholelithiasis, and nephrolithiasis were obtained through literature review. Results. A total of 153 patients with sialolithiasis were identified. Of these patients, 125 (82%) had submandibular sialolithiasis, and 28 (18%) had parotid sialolithiasis. Positive smoking histories were present in 67 individuals (44%). Both the current rate of smoking and the rate of a history of smoking were higher in our cohort when compared with the general population, although the differences did not reach statistical significance. Smoking history did not correlate with the size of the primary sialolith. Diuretic usage in the cohort was observed at a rate of 20%, higher than reported population rates of diuretic use of 8.7%. The prevalences of cholelithiasis and nephrolithiasis were not different from observed population rates. Conclusions. Sialolithiasis is an uncommon condition of unclear etiology. This study represents an initial attempt to quantify the prevalence of smoking and diuretic therapy in a population of patients with sialolithiasis.

Airway hemangiomas in PHACE syndrome

To describe the clinical presentation and airway characteristics of infants with airway hemangiomas and concomitant PHACE syndrome and to determine the prevalence of airway hemangiomas in PHACE subjects at our institution.

Maxillofacial (Midface) Fractures

Recognizing typical midface fracture injuries and describing the imaging findings that are relevant to the maxillofacial surgeon are important. Particular attention should be paid to findings that potentially result in significant cosmetic or functional complications. Radiologists should evaluate facial fractures in multiple planes with coronal and sagittal reformats, which are especially helpful for horizontally oriented facial fractures, such as injuries to the orbital floor and the hard palate. 3-D images can also facilitate a broader understanding of the fracture impact on facial width, height, and projection and are useful for an overview of more complex fracture patterns that involve multiple facial bones.

Chorda tympani neuroma.

A 24-year-old woman with neurofibromatosis Type 2 presented to clinic for evaluation and discussion of management options for her bilateral vestibular schwannomas (VSs). The patient reported bilateral progressive hearing loss for more than a decade. The right ear became mostly deaf 2 years ago. The left ear was her better hearing ear. Tonal-type tinnitus was referable to both ears. Right facial weakness was present early in childhood, possibly from birth trauma. The patient did not offer a lucid account. No taste disturbance complaint was elicited. Otoscopic examination was notable for an intact right tympanic membrane with a rather thick chorda tympani nerve tumor that was more than thrice the expected cross-sectional diameter (Fig. 1A). Cranial nerve examination revealed right facial paresis at House-Brackmann Grade 4/6. Preoperative head and spine magnetic resonance imaging studies showed expected multiple extra-axial masses, including bilateral VSs (Fig. 1, BYD). The left VS measured 1.6 1.4 2 cm, and the right measured 1.4 1.4 2 cm. A right 1-cm perisigmoid mass along the anterolateral aspect of the cerebellar hemisphere was consistent with meningioma (Fig. 1D). Other extra-axial masses were present at the anterior aspect of the temporal lobe, cervicomedullary junction, optic chiasm, and cisterna magna. There was also a large lobulated enhancing lesion at the lateral aspect of left C1Y2. Some unexpected findings were identified on T1 with gadolinium images: chorda tympani and facial nerve tumors. A coronal image showed enhancement of the right vertical segment of the facial nerve (vertical facial nerve [vFN]; Fig. 1B). Axial images demonstrated enhancement of the geniculate ganglion (Fig. 1C) and vFN (Fig. 1D). Chorda tympani neuroma enhancement was also evident just anterior to the vFN (Fig. 1D) and represented the imaging correlate to the clinical photograph in Figure 1A. A right retrosigmoid craniotomy for near-total excision of her VS and perisigmoid meningioma was performed. The preoperative diagnoses were verified by pathologic review of tumor specimens. A postoperative magnetic resonance imaging with gadolinium demonstrated enhancement of the right geniculate ganglion, and intratemporal facial and chorda tympani tumors, which were unchanged compared with preoperative images that were obtained 4 months ago. The patient’s postoperative facial nerve function remained at House-Brackmann Grade 4/6. Although facial nerve schwannomas are welldocumented lesions, chorda tympani schwannomas are quite rare. There are only 7 cases reported in the English literature (1Y4). Most of the cases were isolated chordatympani neuromas, with only 1 case reporting multiple neuromas in a patient with neurofibromatosis Type 1 reported by Nager in 1969 (2). The presenting symptoms of isolated chorda tympani neuromas were hearing loss, tinnitus, and facial palsy (2). Interestingly, taste disturbance was not documented in any previous case (3), which is in accordance with this patient. To our knowledge, this is the first clinical photograph in the literature showing a chorda tympani neuroma. The patient underwent uncomplicated excision of her intracranial right VS. No attempt was made to resect the represented chorda tympani tumor because she was symptom free. Notwithstanding, some authors have advocated transmastoid or transcanal excision of chorda Address correspondence and reprint requests to Kevin C. Huoh, M.D., Department of OtolaryngologyYHead and Neck Surgery, 400 Parnassus Avenue, ACC 7th Floor, San Francisco CA 94143; E-mail: khuoh@ohns.ucsf.edu Otology & Neurotology 31:1172Y1173 2010, Otology & Neurotology, Inc.

Infantile Hemangiomas of the Head and Neck

Infantile hemangiomas (IHs) are benign vascular tumors. Clinical history and physical examination are the most important factors for diagnosis, with most IHs having a typical presentation. Treatment is required for some IHs that cause significant cosmetic deformity or functional compromise. Propranolol is the first-line treatment of most IHs. Ongoing research is increasing our understanding of the pathophysiology of these tumors and should help to identify future potential therapeutic targets.

Comparison of imaging modalities in pediatric thyroglossal duct cysts

To determine and compare the accuracy of different imaging modalities including ultrasound (US), magnetic resonance imaging (MRI), and computed tomography (CT) in the diagnosis of thyroglossal duct cysts (TGDC) in children.

Lip Abscess Associated With Isotretinoin Treatment of Acne Vulgaris

IMPORTANCE Isotretinoin is frequently prescribed for the treatment of acne vulgaris. Among the numerous documented adverse effects, most common are xerostomia and cheilitis. Lip abscesses as a consequence of cheilitis present dramatically and may pose a diagnostic challenge. OBSERVATIONS We present a case of a 15-year-old boy with a severe lip abscess requiring incision and drainage and hospital admission for intravenous antibiotic treatment of methicillin-resistant Staphylococcus aureus. We discuss the pathophysiologic characteristics of isotretinoin therapy and the likely causative role that the medication played in the development of the lip abscess. CONCLUSIONS AND RELEVANCE Although rare, lip abscesses related to isotretinoin therapy present with substantial morbidity and should be promptly recognized. Misdiagnosis of mucositis and angioedema may delay appropriate therapy.

Extramedullary Plasmacytoma of the Tonsil

Plasma cell tumors are a diverse group of neoplasms characterized by monoclonal proliferation of plasma cells. Extramedullary plasmacytoma (EMP) is a rare form of localized plasma cell tumor that arises most often in the head and neck region. We present an unusual case of EMP of the palatine tonsil from a tertiary care university hospital. We discuss the histopathologic and radiologic evaluation as well as treatment of EMP.

Retained Denture in Oropharynx

Purpose: To describe an unusual case of a denture retained in the oropharynx for one year and highlight current management of airway foreign bodies. Study design: A case report and brief review of the literature. Results: A 27 year old man sustained a gunshot wound to the neck and underwent exploratory surgery and tracheotomy at an outside hospital. Nine months after this injury, he presented to our clinic with dysphagia, aphonia, and tracheotomy dependence. Normal anatomic landmarks were not visible by indirect laryngoscopy and imaging suggested a possible plate-like prosthesis in the oropharynx. Diagnostic direct laryngoscopy revealed a foreign body firmly lodged in the base of tongue and vallecula. Removal of the foreign body revealed a partial denture. Postoperatively, the patient reported that he could not locate the denture after his injury and had obtained a new prosthetic. The missing partial denture was lodged in his oropharynx for one year. Conclusions: While aspiration or dislodgement of dental appliances is common, this is an interesting case of a young man with a retained denture in his oropharynx for 12 months. During this time, the patient tolerated a near regular diet although swallowing was uncomfortable. Suspicion of a denture foreign body was low in this instance owing to the fact that the patient was young at presentation and did not endorse or disclose the loss of a dental appliance at the time of initial injury.

Poor Outcomes in Head and Neck Non-Melanoma Cutaneous Carcinomas

Objectives: Head and neck nonmelanoma cutaneous carcinomas (NMCC) may have poor outcomes, such as metastasis and recurrence. It remains unclear which patients are at increased risk for poor outcomes. We characterize a population of NMCC seen in a head and neck surgical practice. We sought to identify predictors of poor outcome in head and neck NMCC. Study Design: A retrospective cohort study of 161 patients with head and neck NMCC who presented to a university based otolaryngology-head and neck surgery practice over a 13 year period was performed. The study group included 127 men and 34 women, age range: 33 - 92 years. Subjects and Methods: Tumor characteristics of the study population were recorded, and statistical analysis and Kaplan- Meier survival calculations were performed to determine predictors of poor outcomes. Results: 113 squamous cell carcinomas (SCC) and 48 basal cell carcinomas (BCC) were identified. Among SCC patients, there was a 44% incidence of metastasis and a 47% incidence of recurrence. Among BCC patients, there was a 10% incidence of metastasis and a 50% incidence of recurrence. Twenty percent of SCC patients had a history of immunosuppression. Among SCC patients with immunosuppression, 83% had metastasis or recurrence. Survival for SCC patients with metastatic disease was significantly worse than patients without metastases. The presence of parotid metastases in SCC conferred a survival advantage when compared to other sites of metastases. Conclusion: The incidence of poor outcomes in NMCC was higher in our series than reported in the literature. Survival patterns of our study parallel those of similar studies in the literature.