Diagnosis of carotid body tumors by dynamic computerized tomography.

The carotid body tumor, although uncommon, is frequently considered in the differential diagnosis of cervical masses. When this lesion becomes a serious diagnostic possibility, angiography must be considered. Currently angiography is the only nonsurgical modality that can reliably confirm the clinical diagnosis. We describe the case of a patient in whom a carotid body tumor was diagnosed preoperatively by dynamic computerized tomography. Dynamic computerized tomography, a relatively noninvasive technique, should now be deemed the technique of choice for diagnosis of carotid body tumors, thus avoiding the potential morbidity of angiography. In patients for whom tumor removal is indicated, however, preoperative angiography is still mandatory in order to plan the best operative procedure.

Florid dermal cylindroma (turban tumor).

A florid case of dermal cylindroma is presented as representative of the natural history and usual clinical findings in a patient afflicted by this tumorous growth. Although histologically and clinically benign, dermal cylindroma can result in considerable disfigurement of the patient. Treatment varies from isolated primary resection to serial resections with subsequent electrocautery or cryosurgery for small recurrences. Total scalping with skin grafting is reserved for only the most severe cases where normal integument has been completely involved by the disease process.

The fourth branchial cleft anomaly.

The fourth branchial cleft anomaly has long been postulated. A case in which a lower neck sinus tract extended under the clavicle near the subclavian vessels is presented. The distinguishing features of bronchogenic and branchogenic anomalies are discussed. It appears that unless a complication (e.g., abscess, inflammatory process) of the fourth branchial cleft sinus tract occurs within the mediastinum, mandating full exploration, the complete form of the anomaly may continue to remain undocumented.

Nasopharyngeal lipoma.

Though lipoma is a common tumor in many anatomic sites throughout the body, its occurrence in the nasopharynx is extremely rare, with only several cases being reported in the literature. We describe a 17-year-old female with a nasopharyngeal lipoma. The mass had been present for at least 5 years and, despite its large size, was asymptomatic.

The otolaryngologic presentation of botulism.

Botulism, although an uncommon disease, may nonetheless present to the otolaryngologist. The clinical signs of a severely erythematous, parched tongue, oropharynx, hypopharynx and larynx, especially when associated with bilateral cranial nerve deficits, should arouse suspicion of this disorder. Once the presumptive diagnosis of botulism is made, the otolaryngologist should expeditiously act to ensure appropriate airway control, as respiratory collapse may be imminent.

An unusual foreign body of the tongue masquerading as malignancy.

Foreign bodies within the tongue are a rare finding. The history is often not helpful as it is usually remote. Presented is a case of an unusual foreign body in the tongue which masqueraded as a malignancy. The differential diagnosis of an asymptomatic tongue swelling or tongue pain should include foreign body.

Management of paranasal sinus schwannomas.

Schwannomas arising in the nasal cavities and paranasal sinuses are rare entities, with only sporadic cases appearing in the world literature. The lesion most commonly arises in the ethmoid and maxillary sinuses, with two cases having been reported in the sphenoid sinus. There are no reported cases of frontal sinus schwannoma. Four illustrative cases are presented which demonstrate the clinical features. The radiological investigation should include plain films and anteroposterior and lateral polytomography. Computerized tomography appears to be useful in planning surgery. An operative approach is approach is proposed which emphasizes a meticulous and complete removal of the lesion with preservation of adjacent structures and repair of any resultant dural defect.

Alternaria sinusitis.

Alternaria is a fungus of the class Deuteromycetes and the family Dematiaceae. Fungi of this genus have generally been regarded as nonpathogenic and as contaminants when isolated from clinical specimens. Hypersensitivity to Alternaria spores, however, has long been recognized as a cause of allergic pulmonary disease. More recently, the organism has also been demonstrated to have potential for opportunistic invasion of immunosuppressed and debilitated patients. Presented is a case in which this organism was repeatedly isolated from naso-oral tissue specimens from an otherwise healthy patient. The organism was seen in biopsies from a granulomatous hyperplastic destructive disease of the maxilla and soft tissues of the face which extended to the ethmoid sinus and fistulized through the hard palate. The clinical course, pathophysiology and therapeutic approach are discussed. The management of this disease requires a multidisciplinary approach involving the otolaryngologist, infectious disease specialist and pathologist.

Myositis ossificans following radical neck dissection.

Myositis ossificans traumatica is an uncommon disorder in which there is posttraumatic bone formation in muscle and other soft tissues near bone. The lesion is exceedingly rare in the head and neck. A case is presented in which myositis ossificans of the platysma occurred following radical neck dissection. Because recurrence may follow excision of the abnormal bone, removal is recommended only if there are significant symptoms associated with the lesion. If surgery is indicated, it should be delayed for 6 to 12 months following the initial trauma to allow for maturation of the lesion.

Coexistant lesions of the pediatric airway.

Congenital stridor is frequently a perplexing clinical problem. The diagnosis is often elusive and can prove challenging. Two case presentations illustrate the difficulties involved when more than one lesion is present. The need for complete evaluation of the airway including laryngoscopy, bronchoscopy and barium swallow is stressed.

Growth of human head and neck squamous cell carcinoma stem cells in agarose.

An in vitro human tumor cell assay was used in an attempt to culture head and neck tumors from patients with squamous cell carcinomas. Initially, specimens from nine head and neck tumors were disaggregated by mechanical methods and assayed in soft agar. Five of nine tumors grew in the soft-agar system yielding a cloning success rate of 56%. Plating of 5 X 10(5) cells resulted in 12 to 255 colonies per plate after 21 days in culture, with a cloning efficiency between 0.002% and 0.08%. Recently, the authors replaced the agar with an agarose culture matrix. Of 10 specimens with positive pathology, 9 have shown colony growth (greater than 20 cells). Cloning efficiency in agarose improved approximately 2-fold. Morphologic assessment of tumor colonies in culture showed the same characteristics as those of the original tumor. Overall success rate of growing head and neck tumors in agar and agarose has been 14 of 19 patients (74%). The development of a soft agarose assay for head and neck tumor cells should provide an in vitro technique for predicting in vivo response to anticancer drugs and other therapeutic modalities such as radiotherapy and hyperthermia.

Necrotizing sialometaplasia.

Necrotizing sialometaplasia is a benign inflammatory disease of salivary gland origin. Because of its clinical and histologic resemblance to squamous cell carcinoma, this disease must be recognized. The cause is unknown, but it may be related to oral trauma, tobacco use or inadequate blood supply. The lesion heals spontaneously, regardless of therapy, in two to eight weeks.

High resolution and dynamic sequential computed tomography. Use in the evaluation of glomus complex tumors.

Computed tomography (CT) has been used to investigate the presence, site, and extent of glomus complex tumors. High resolution CT scanning can accurately evaluate invasion of cervical soft tissues, intratympanic or intracranial extension, and bony involvement of the skull base. Glomus tumors can be differentiated by CT angiographic dynamic study from most other tumors in the head and neck because of their profuse vascularity and their intense enhancement seen on dynamic CT during arterial phase. A glomus tympanicum or extension of a glomus jugulare into the hypotypanum can be best demonstrated by high resolution CT using target review image reconstruction. Glomus tumor in the middle ear can be differentiated from other masses by CT dynamic study and the computer-generated density time curves.