Mark F. Sheridan

Endoscopic Sinus Surgery Complications in Residency

Otolaryngology has seen a rapid proliferation of functional endoscopic sinus surgery, and there is variability in the teaching of the procedure, in part because of the seriousness of the complications. A retrospective review of 106 consecutive cases was conducted at a teaching program to evaluate complications. Complication rates were combined and compared with the reported complication rates of other teaching programs and practicing otolaryngologists. The complication rate in our program was 13.9%; all were minor complications. This compared favorably with the rates of other programs (6% to 29%). The combined complication rate for residency training programs (16.6%) was significantly greater than the nonresident complication rate (10.5%). When divided into major and minor complications, the resident minor complication rate (15.9%) was significantly greater than the nonresident rate (8%), yet the major complication rates were significantly less for the resident group (0.7%) than for the nonresident group (2.5%). In addition, complications were significantly greater when procedures were performed under general anesthesia as compared with local anesthesia, and estimated blood loss was significantly greater under general anesthesia.

Hairy polyp in the oropharynx of a 5-week-old infant with sudden-onset respiratory distress.

A5-week-old boy presented with sudden onset respiratory distress. The child was born at term by spontaneous vaginal delivery. He had no prior episodes of respiratory or feeding difficulties. On further questioning, the child’s mother noted that the patient seemed to spit up frequently but that he also had been gaining weight appropriately. At the time of initial intubation, no masses or lesions were noted. Direct laryngoscopy and bronchoscopy were performed without any identifiable lesion except for a fullness found in the membranous tracheal wall. Esophagoscopy was attempted but could not be completed because of a mass that was obstructing the esophagus. The mass appeared to be pedicled from the oropharynx. The patient was kept intubated, and a CT scan was performed. This examination revealed a mass originating in the oropharynx and extending into the esophageal inlet. The patient was returned to the operating room, where the mass was found to originate from the superior portion of palatopharyngeus. It was excised in total. The patient recovered uneventfully and had no further episodes of respiratory difficulty or dysphagia. Final pathology revealed a hairy polyp.

Papillary Thyroid Carcinoma in a Branchial Cleft Cyst without a Thyroid Primary: Navigating a Diagnostic Dilemma

We report a rare case of papillary thyroid carcinoma incidentally found within a branchial cleft cyst. Only four other cases have been described in the literature. A total thyroidectomy and selective neck dissection was performed, and no evidence of occult primary disease was found after review of fine sections. Branchial cleft cysts are the most common lateral neck masses. Ectopic thyroid tissue within a branchial cleft cyst is an unusual phenomenon, and papillary thyroid carcinoma arising from this tissue is extremely rare. Clinicians are left with a diagnostic dilemma when presented with thyroid tissue neoplasm within a neck cyst in the absence of a thyroid primary—is this a case of metastatic disease with a missed primary or rather carcinoma arising in ectopic thyroid tissue? A thorough discussion of the etiologies of these lateral neck masses is reviewed including the embryogenesis of thyroid tissue in a branchial cleft cyst. The prognosis of patients with papillary thyroid carcinoma in lateral neck cysts without a primary site identified appears to be good following excision of the cyst and total thyroidectomy. Other management recommendations regarding these unique lateral neck malignancies are also presented.

Laryngeal myxedema: An unusual etiology of infant stridor

Abstract Objectives: We report the clinical findings of a child with laryngeal myxedema and stridor due to untreated congenital hypothyroidism. A review of the literature regarding the incidence, radiologic findings, and clinical characteristics of this rare, but life-threatening disease are presented. Methods: Case presentation of a 7-month-old infant from Micronesia who presented to our service with stridor and severe hypoxemia. The clinical features of untreated congenital hypothyroidism will be presented along with a review of the literature. Results: A 7-month-old male was admitted to the pediatric service for stridor and hypoxemia. Examination of the infant revealed biphasic stridor in all positions, reduced oxygen saturation on room air, retractions, and grunting. On nasopharyngoscopic exam, the patient had diffuse edema of the larynx and supraglottis that obscured the normal anatomy. He also had diffuse hypotonia and generalized weakness. Thyroid function tests were obtained, and the patient was found to have severe hypothyroidism. He was started on levothyroxine therapy, and subsequently had a decrease in his laryngeal edema and improvement in his oxygenation. Conclusion: Although most stridor in infants is due to laryngomalacia, vocal cord paralysis, or congenital subglottic stenosis, less common etiologies are still encountered and must be kept within a broad differential diagnosis in order to achieve appropriate patient care.