Squamous cell carcinoma presenting with trigeminal anesthesia: An uncommon presentation of head & neck cancer with unknown primary.

BACKGROUND: The differential diagnosis of facial anesthesia is vast. This may be secondary to trauma, neoplasm, both intracranial and extracranial, infection, and neurologic disease. When evaluating a patient with isolated facial anesthesia, the head and neck surgeon often thinks of adenoid cystic carcinoma, which has a propensity for perineural invasion and spread. When one thinks of head and neck squamous cell carcinoma with or without unknown primary, the typical presentation involves dysphagia, odynophagia, weight loss, hoarseness, or more commonly, a neck mass. Squamous cell carcinoma presenting as facial anesthesia and perineural spread, with no primary site is quite rare. METHODS: Case presentations and review of the literature. CONCLUSIONS: Trigeminal anesthesia is an uncommon presentation of head and neck squamous cell carcinoma with unknown primary. We present two interesting cases of invasive squamous cell carcinoma of the trigeminal nerve, with no primary site identified. We will also review the literature of head and neck malignancies with perineural spread and the management techniques for the two different cases presented.

An unusual and rare cause of acute airway obstruction in the elderly: Forestier's disease.

BACKGROUND: Diffuse idiopathic skeletal hyperostosis (DISH), also known as Forestier's disease, is an ossifying disease of unknown etiology affecting mainly elderly men. It is characterized by hypertrophic anterior vertebral osteophytes with ossification of the spinal anterior longitudinal ligament. Hypertrophic osteophytes can encroach on the aerodigestive tract, leading to significant swallowing and respiratory symptoms. OBJECTIVE: Acute stridor and respiratory compromise requiring a surgical airway have rarely been reported in patients with DISH. This entity, although rare, should be in the differential diagnosis of acute airway obstruction, particularly in the elderly. CASE REPORT: We describe a case of a 91-year-old patient who was transferred to the Emergency Department at Tufts Medical Center with acute stridor. A computed tomography scan of the neck prior to transfer revealed a large anterior cervical osteophyte causing significant airway narrowing. Fiberoptic evaluation confirmed the radiologic finding of near-complete airway obstruction. The patient's respiratory status rapidly deteriorated and he subsequently underwent an emergent awake tracheostomy to secure his airway. CONCLUSION: Given the rarity of DISH and the increase in life expectancy, clinicians should be aware of this disease entity and its potential for acute life-threatening respiratory presentation.

Cervical Lymphatic Filariasis in a Pediatric Patient: Case Report and Database Analysis of Lymphatic Filariasis in the United States.

Lymphatic filariasis is a mosquito-borne parasitic infection caused by Wuchereria bancrofti and Brugia spp. Commonly seen in tropical developing countries, lymphatic filariasis occurs when adult worms deposit in and obstruct lymphatics. Although not endemic to the United States, a few cases of lymphatic filariasis caused by zoonotic Brugia spp. have been reported. Here we present a case of an 11-year-old female with no travel history who was seen in our clinic for a 1-year history of painless left cervical lymphadenopathy secondary to lymphatic filariasis. We review the literature of this infection and discuss the management of our patient. Using the National Inpatient Sample (NIS), the largest publicly available all-payer inpatient care database in the United States, we also examine the demographics of this infection. Our results show that chronic lymphadenopathy in the head and neck is the most common presenting symptoms of domestic lymphatic filariasis. Diagnosis is often made after surgical lymph node excision. Examination of the NIS from 2000 to 2014 revealed 865 patients admitted with a diagnosis of lymphatic filariasis. Most patients are in the mid to late sixties and are located on the eastern seaboard. Eight hundred and twenty six cases (95.5%) were likely due to zoonotic Brugia spp. and 39 (4.5%) due to W. bancrofti. Despite being rare, these data highlight the need to consider filariasis in patients presenting with chronic lymphadenopathy in the United States.

Recurrent facial nerve paralysis: an unusual presentation of fibrous dysplasia of the temporal bone.

Facial nerve paralysis (FNP) is a rare occurrence in fibrous dysplasia (FD) of the temporal bone (FDTB). Eight such cases have been described in the literature. In none of these cases was the FNP the presenting symptom, and in all, a direct etiology for the paralysis was identified. We present the first case of recurrent, unilateral FNP as the sole otological manifestation of FDTB. We discuss possible etiological factors for the paralysis favoring a compressive, transient ischemia of the facial nerve. The authors suggest adding FDTB to the differential diagnosis of recurrent FNP.