Marlen Mamanov

Acute ischemia of the parotid gland and auricle following embolization for epistaxis.

We report a case of ischemia of the auricle and acute parotitis that developed following embolization for epistaxis. A 53‐year‐old male was previously conservatively treated for epistaxis with bilateral posterior nasal packing due to hypertension. As the bleeding, continued the patient underwent bilateral embolization of the internal maxillary arteries. The bleeding was controlled but the patient developed acute ischemia of the ipsilateral parotid gland and the auricle that regressed with medical treatment. Laryngoscope, 2012

Primary marginal zone B-cell lymphoma of the larynx.

Extranodal non-Hodgkin lymphomas limited to the larynx are rare, accounting for less than 1% of all laryngeal neoplasms. The most common site of development of primary laryngeal lymphomas is the supraglottic region. In most cases, the presenting symptoms are hoarseness, dysphagia, dyspnea, and cervical lymphadenopathy. In these cases, larynx lymphoma was the mucosa-associated lymphoid tissue type and located in the supraglottic area.

Epidermal inclusion cyst of the larynx.

AbstractEpidermal inclusion cyst (EIC) is a benign cyst filled with keratin fibers, which can develop in any part of the body. It is commonly seen in the skin, especially on the face, scalp, neck, and trunk, and has the tendency to slowly grow toward deeper epidermis parts and to cause cystic expansion. Epidermal inclusion cysts are not common in mucosal sites such as the larynx; however, these can arise owing to squamous metaplasia of the glands. We present a 52-year-old man with a laryngeal EIC. This is a very rare case in the literature of EIC in the larynx.

High-grade mucoepidermoid carcinoma of the larynx.

Laryngeal mucoepidermoid carcinoma is rare. Approximately 85 cases have been reported in the literature. There is no standardized treatment because of the rarity of the disease. A case of a 55-year-old man with laryngeal mucoepidermoid carcinoma, who was treated with total laryngectomy and postoperative radiotherapy, is presented, and current literature is reviewed.

Lymphoepithelial carcinoma of the larynx.

To the Editor: A 58-year-old man was admitted to our department with complaint of hoarseness. On endoscopical examination, a partially ulcerated lesion of the right vocal cord extending to the anterior commissure was detected. The vocal cords were symmetrically mobile. Head and neck examination revealed no palpable neck masses, and the remainder of the otorhinolaryngologic examination was normal. He had no smoking history, and medical history was unremarkable. Magnetic resonance imaging (MRI) of the neck showed a mass involving the right vocal cord extending the anterior commissure. In addition, there was no pathologic lymph node in the MRI scans of the neck (Fig. 1). To gain additional information about the mass and to perform a biopsy for histopathological investigation, the patient underwent direct microlaryngoscopy under general anesthesia. Fragmented tissue biopsies were histologically investigated. Histologically, the surface epithelium is ulcerated by a tumor and infiltrated lesion is present in the subepithelial tissue. The tumor formed syncytial sheets and nests without evidence of squamous or glandular differentiation, and is densely surrounded by inflammatory cells, largely lymphocytes and plasma cells. Tumor cells are composed of epithelial cells, containing large central nuclei with prominent nucleoli and a large eosinophilic cytoplasm. Pathological study of the surgical specimen revealed an undifferentiated carcinoma with aspects of lymphoepithelioma (Fig. 2). The patient was treated with frontolateral laryngectomy. Right vocal cord and anterior commissure including cartilage piece of the left thyroid cartilage lamina as well as one-third anterior part of the left vocal cord were removed. Definitive histopathological diagnosis was a poorly differentiated squamous cell carcinoma with aspects of lymphoepithelioma. In situ hybridization for Epstein-Barr virus (EBV) and PCR EBVspecific amplification proved to be negative. At that time, after 18 months of follow-up, there was no evidence of recurrence. Lymphoepithelial carcinoma of the larynx accounts for 0.2% of all laryngeal cancers. These tumors are an exceedingly rare and aggressive neoplasm with a propensity for early cervical lymph node and distant metastasis. The most common site of development of primary laryngeal lymphoepithelial carcinoma is the supraglottic region. The relationship between EBV and lymphoepithelial carcinoma of the larynx remains controversial. Despite the small number of cases, the initial results suggest that EBV plays a limited role in the etiology of lymphoepithelial carcinoma of the larynx. The clinical course and optimal treatment of nonnasopharyngeal lymphoepithelioma of the head and neck have not been well described. Although most patients have been treated surgically, this tumor is radiosensitive and radiotherapy should be considered as the main treatment. Neoadjuvant chemotherapy may be recommended in patients with early regional adenopathy in order to decrease the distant metastasis rate. Metin Ibrahimov, MD, Mehmet Yilmaz, MD, Mehmet Halil Celal, MD, Marlen Mamanov, MD, Umur Yollu, MD, Husnu Ozek, MD, Istanbul University Istanbul, Turkey metinibrahimov@gmail.com

Spindle cell carcinoma of the larynx following spindle cell pulmonary carcinoma: second primary or metastasis?

lipoblastomatosis, liposarcoma, hemangioma, arteriovenous malformation, nodular fasciitis, and herniation of the buccal fat pad, all of which are rare. A preoperative ultrasound and MRI must be always performed to determine the potential origin of the buccal fat pad, to visualize its extent in the various directions, and to exclude liposarcoma. The gold standard treatment for lipoma of the buccal fat pad is surgical removal. Pediatric lipoma of the buccal fat pad is very rare and little is known about its biologic behavior. This study would be helpful in reaching a conclusion about the correct diagnosis and adequate treatment for lipoma of the buccal fat pad.

Simultaneous idiopathic bilateral sudden hearing loss – characteristics and response to treatment ☆

INTRODUCTION The aetiology of sudden hearing loss is poorly defined; however, infectious, vascular and neoplastic aetiologies are presumed to be responsible. In addition, the aetiology of bilateral sudden hearing loss is also unknown. OBJECTIVE The objective of this study is identify the characteristics and treatment response of simultaneous bilateral sudden hearing loss. METHODS This is a case-control study that practised in tertiary care academic centre. 132 patients with sudden hearing loss who were treated with systemic steroid and hyperbaric oxygen together were included. 26 patients had bilateral sudden hearing loss and 106 patients had unilateral sudden hearing loss. Patients were evaluated with clinical, audiological and radiological examinations and laboratory tests were done. Findings and response to treatment of the patients were compared. RESULTS The mean ages of patients with unilateral and bilateral sudden hearing loss were 42.0 years and 24.5 years respectively with a statistically significant difference (p<0.001). Immune response markers were more prevalent in bilateral sudden hearing loss. Pre-treatment audiologic thresholds were 69.1dB for unilateral sudden hearing loss and 63.3dB for the left ears and 67.6dB for the right ears for bilateral sudden hearing loss without significant difference. Post-treatment average hearing threshold in unilateral sudden hearing loss was 47.0dB and 55.4dB for the left ears and 59.0 for the right ears in bilateral sudden hearing loss. Average hearing improvement in unilateral sudden hearing loss group was significant (p<0.001) in spite of it was not significant in bilateral sudden hearing loss group for both ears. Between the groups; there was a significant difference for hearing improvement favouring unilateral sudden hearing loss (p<0.001). Tinnitus scores decreased significantly in both groups of patients (p<0.001) in spite of there was no significant difference between the groups of patients. CONCLUSION Patients with bilateral sudden hearing loss showed lower age, worse prognosis and higher rate of positive immune response markers. Cardiovascular risk factors seem to have an important role in the aetiology of unilateral cases whereas this importance was not present in bilateral ones.

Effect of Spreader Graft on Nasal Functions in Septorhinoplasty Surgery

Objective: The authors aimed to investigate the effect of spreader grafts on nasal function in septorhinoplasty (SRP). Methods: A prospective randomized double-blind study was conducted. Thirty patients who underwent SRP operation between October 2011 and January 2013 were divided into 2 equal groups randomly. Fifteen patients underwent SRP surgery without spreader graft technique (Group I) and 15 patients underwent SRP surgery with spreader grafts (Group II). Preoperative and postoperative evaluation included visual analog score (VAS) and acoustic rhinometry test. Results: Visual analog scores and acoustic rhinometry measurements of Group I and Group II patients were compared. Statistically significant difference was found for VAS scores of both the sides of the nasal cavity (both before and after topical decongestion) (P < 0.05), except for the VAS on the right side of the nasal cavity before decongestion (P > 0.05). On acoustic rhinometry test the difference was statistically significant for minimal cross-sectional area (MCA) and volumetric values (VOL)—MCA1, MCA2, VOL1, VOL2 values on the left side of the nasal cavity (both before and after topical decongestion) (P < 0.05) but not on the right side of the nasal cavity (P > 0.05). Conclusions: Performing spreader graft technique in SRP surgery can prevent the narrowing of the internal nasal valve area after surgery and maintain adequate airway for respiration.