Sporadic Multifocal Venous Malformations of the Head and Neck.

Objective. To report a case of unusually widespread sporadic venous malformations of the head and neck associated with normal D-dimer levels and, due to the protean clinical manifestations and increased risk of coagulopathy of these lesions, to review their diagnosis and clinical management. Case Report. A 25-year-old man presented with a one-year history of intermittent right-sided neck swelling and tongue swelling. Physical exam revealed additional lesions present throughout the head and neck. There was no family history suggestive of heritable vascular malformations. Radiographic imaging demonstrated 15 lesions located in various tissue layers consistent with venous malformations. A coagulation screen showed a normal prothrombin time, activated partial thromboplastin time, international normalized ratio, D-dimer level, and fibrinogen level. It was determined that the patient was not at increased risk for intraoperative coagulopathy and preoperative heparin administration would not be necessary. The patient's buccal and tongue lesions were subsequently excised with no complications. The patient also underwent sclerotherapy evaluation for his neck mass. Conclusion. This case describes a unique presentation of sporadic multifocal venous malformations. It also emphasizes the importance of prompt diagnosis and workup when multiple venous malformations are present to prevent morbidity during surgical excision secondary to intravascular coagulopathy.

Partial and double-array implantation of the ossified cochlea.

OBJECTIVE: To review our experience with partial standard and double-array cochlear implantation in the ossified cochlea. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral center. PATIENTS: Twenty cochleae in 19 adult and pediatric patients with ossified cochleae. INTERVENTION(S): Patients underwent either partial insertion of a standard electrode array or double-array electrode insertion for their cochlear implantation. MAIN OUTCOME MEASURE(S): Number of electrodes inserted, number of active electrodes at follow-up, and open-set speech performance. RESULTS: Twelve patients (four children and eight adults) had partial insertion of standard array electrode. The mean number of electrodes inserted and active at follow-up was 14.8 and 11.3, respectively. Eight patients (four children and four adults) had a double-array electrode implanted. The mean number of electrodes inserted and active at follow-up was 18.1 and 16.3, respectively. Open-set speech recognition was better in children regardless of duration of deafness. There were no complications. CONCLUSION: These findings suggest that the double array allows for more usable electrodes than in partially inserted cochlear implant. Compared with adults, children with ossified cochlea do well both in partial standard and double-array insertion. Both insertion techniques are safe, with no complications occurring in our patients. Straight and double arrays should be available in the operating suite for any patient in whom suspected cochlear ossification is confronted.