Lisa T. Galati

More aggressive behavior of squamous cell carcinoma of the anterior tongue in young women.

Objective To review the combined experience from two large medical centers in treating young female patients with anterior tongue cancer to determine the clinical course of this unique subset of patients.

The Efficacy of Mitomycin C in the Treatment of Laryngotracheal Stenosis: Results and Experiences with a Difficult Disease Entity

Background/Aims: Laryngotracheal stenosis (LTS) is a difficult entity to treat, with many patients requiring multiple procedures. Our study assessed the efficacy of mitomycin C (MMC) application as complimentary treatment of LTS. Methods: We reviewed clinical charts of patients with operative procedures for LTS between January 2005 and May 2013. Patients were grouped according to mitomycin use. Several outcome measures were assessed, including the number of procedures and time between procedures. Results: Seventy-one patients were included in the study (30 MMC, 41 non-MMC). They underwent similar numbers of procedures (2.3 MMC, 2.0 non-MMC, p > 0.05). The average time between procedures was 360 (MMC) and 178 (non-MMC) days (p = 0.015). Multiple treatments with mitomycin increased the duration between procedures (366 vs. 340 days, multiple vs. single application, p > 0.05). Fewer mitomycin patients underwent procedures for respiratory distress than non-MMC patients (6.6 vs. 19.5%, p > 0.05). Mitomycin use increased the duration between procedures in patients treated specifically for subglottic stenosis (375 vs. 186 days, p > 0.05). Conclusion: Our results and experiences with mitomycin demonstrate it is an effective agent for adjuvant treatment of LTS. Its use lengthens the symptom-free period, with further improvement demonstrated when patients expected to undergo multiple surgeries receive multiple mitomycin treatments.

Nasoseptal flap for reconstruction after robotic radical tonsillectomy

The nasoseptal flap has revolutionized reconstruction of ventral skull base defects. The past decade is also noticeable by the evolution of transoral robotic surgery (TORS). Reconstruction of the oropharyngeal defect is challenging. Good reconstructive options with less cicatricial retraction are desirable and still lacking in the literature.

A necrotic tonsillar lesion: An unusual presentation of disseminated histoplasmosis

We report a case of tonsillar histoplasmosis with hematogenous dissemination in a woman receiving infliximab for Crohns disease. She also had a history of sarcoidosis. Due to the unusual location and confounding medical history, our case provided a diagnostic dilemma. Histoplasma infection was confirmed histologically, and the patient responded well to appropriate treatment.

Submucosal Bulge in the Hypopharynx Causing Dysphagia

A 54-year-old male presented to our clinic for consultation due to a new onset of dysphagia. The current symptoms of dysphagia had started 2 years prior to the visit and had been progressively getting worse. He also had severe pain and tightness in the left neck and occasionally had the sensation of choking resulting in the patient requiring a soft diet. The patient did not complain of any trouble with breathing. He had been medically treated for gastroesophageal reflux disease (GERD) in the past which was not successful in relieving his symptoms. A previous swallow study had been performed and the results showed no abnormalities. He also has a history of multiple surgeries and had previously been treated by multiple Otolaryngologists for extensive neck arteriovenous malformations (AVMs). The AVMs were located in the nasopharynx, left neck at levels II and III, as well as the sublingual, submandibular and parotid regions. His previous surgeries include a left neck dissection, mandibulotomy, parotidectomy and sclerotherapy for the treatment of the AVMs. His last surgery for the AVMs was 7 years prior to the patient’s presentation to our clinic. On physical exam, there was scarring from his previous surgeries on the left side of the neck as well as residual AVM on the left side of the neck. A transnasal flexible laryngoscopy exam was performed in our clinic which showed a bulge in the submucosa of the left supraglottic area and in the left nasopharynx. This supraglottic bulge extended towards the midline touching the epiglottis. The submucosal lesion also partially obstructed the left piriform sinus opening. The patient had several MRIs of the neck which showed residual AVM in the left nasopharynx and soft tissue density in the left supraglottic area. A computed tomography angiography (CTA) was ordered to for evaluation of the extension of the AVM towards the supraglottic area and piriform sinus opening, however, no AVM was identified in that area (Fig. 1).