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Is Nuclear Imaging Important in the Management of Head and Neck Paragangliomas? Laryngoscope 2023; 133:2443-2444. [PMID: 37725317 DOI: 10.1002/lary.30729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/15/2023] [Accepted: 04/18/2023] [Indexed: 09/21/2023]
Abstract
Nuclear medical imaging is indicated in most, but not all, patients with suspected paragangliomas of the head and neck. Advances in technology and somatostatin receptor analogs have improved the selectivity and sensitivity of this imaging.
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Perceived value drives use of routine asymptomatic surveillance PET/CT by physicians who treat head and neck cancer. Head Neck 2020; 42:974-987. [PMID: 31919944 DOI: 10.1002/hed.26071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 12/19/2019] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Why physicians use surveillance imaging for asymptomatic cancer survivors despite recommendations against this is not known. METHODS Physicians surveilling head and neck cancer survivors were surveyed to determine relationships among attitudes, beliefs, guideline familiarity, and self-reported surveillance positron-emission-tomography/computed-tomography use. RESULTS Among 459 responses, 79% reported using PET/CT on some asymptomatic patients; 39% reported using PET/CT on more than half of patients. Among attitudes/beliefs, perceived value of surveillance imaging (O.R. 3.57, C.I. 2.42-5.27, P = <.0001) was the strongest predictor of high imaging, including beliefs about outcome (improved survival) and psychological benefits (reassurance, better communication). Twenty-four percent of physicians were unfamiliar with guideline recommendations against routine surveillance imaging. Among physicians with high perceived-value scores, those less familiar with guidelines imaged more (O.R. 3.55, C.I. 1.08-11.67, P = .037). CONCLUSIONS Interventions to decrease routine surveillance PET/CT use for asymptomatic patients must overcome physicians' misperceptions of its value. Education about guidelines may modify the effect of perceived value.
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Perioperative Management of Total Laryngectomy Patients: A Survey of American Head and Neck Society Surgeons. Ann Otol Rhinol Laryngol 2019; 128:534-540. [DOI: 10.1177/0003489419830118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: Standards of care for total laryngectomy (TL) patients in the postoperative period have not been established. Perioperative care remains highly variable and perhaps primarily anecdotally based. The aim of this study was to survey members of the American Head and Neck Society to capture management practices in the perioperative care of TL patients. Methods: In this survey study, an electronic survey was distributed to the international attending physician body of the American Head and Neck Society. Forty-five-question electronic surveys were distributed. A total of 777 members were invited to respond, of whom 177 (22.8%) fully completed the survey. The survey elicited information on management preferences in the perioperative care of TL patients. Differences in management on the basis of irradiation status and pharyngeal repair (primary closure vs regional or free flap reconstruction) were ascertained. Main outcomes and measures were time to initiate oral feeding, perioperative antibiotic selection and duration, and estimated pharyngocutaneous fistula rates. These measures were stratified by patient type. Results: Most respondents completed head and neck fellowships (77.0%) and practice at academic tertiary centers (72.3%). Ampicillin/sulbactam was the most preferred perioperative antibiotic (43.2%-49.1% depending on patient type), followed by cefazolin and metronidazole in combination (32.0%-33.7%) and then clindamycin (10.8%-12.6%). Compared with nonirradiated patients, irradiated patients were significantly more likely to have longer durations of antibiotics ( P < .05), longer postoperative times to initiate oral feeding ( P < .05), and higher estimated fistula rates ( P < .05). Additionally, in nonirradiated patients, flap-repaired patients (vs primary repair) were significantly more likely to have longer durations of antibiotics (odds ratio, 1.29; 95% confidence interval, 1.13-1.48) and postoperative times to initiate oral feeding (odds ratio, 2.24; 95% confidence interval, 1.76-2.84). Conclusions: Perioperative management of TL patients is highly variable. Management of antibiotics and oral feeding are significantly affected by irradiation status and scope of pharyngeal repair. Further studies are needed to standardize perioperative care for this unique patient population.
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Factors predictive of the development of surgical site infection in thyroidectomy – An analysis of NSQIP database. Int J Surg 2018; 60:273-278. [DOI: 10.1016/j.ijsu.2018.11.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 10/29/2018] [Accepted: 11/12/2018] [Indexed: 01/19/2023]
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The Effect of an Oral Care Intervention in Decreasing the Expression of Proinflammatory Cytokines in Patients Receiving Chemoradiation for Oral Cancer: A Randomized Clinical Trial. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2015.12.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Metformin inhibits salivary adenocarcinoma growth through cell cycle arrest and apoptosis. Am J Cancer Res 2015; 5:3600-3611. [PMID: 26885449 PMCID: PMC4731634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 10/16/2015] [Indexed: 06/05/2023] Open
Abstract
The inhibitory effects of metformin have been observed in many types of cancer. However, its effect on human salivary gland carcinoma is unknown. The effect of metformin alone or in combination with pp242 (an mTOR inhibitor) on salivary adenocarcinoma cells growth were determined in vitro and in vivo. We found that metformin suppressed HSY cell growth in vitro in a time and dose dependent manner associated with a reduced expression of MYC onco-protein, and the same inhibitory effect of metformin was also confirmed in HSG cells. In association with the reduction of MYC onco-protein, metformin significantly restored p53 tumor suppressor gene expression. The distinctive effects of metformin and PP242 on MYC reduction and P53 restoration suggested that metformin inhibited cell growth through a different pathway from PP242 in salivary carcinoma cells. Furthermore, the anti-tumor efficacy of metformin was confirmed in vivo as indicated by the increases of tumor necrosis and reduced proliferation in xenograft tumors from metformin treated group. For the first time, the inhibitory effect of metformin on human salivary gland tumor cells was documented. Moreover, metformin inhibitory effects were enhanced by mTOR inhibitor suggesting that metformin and mTOR inhibitor utilize distinctive signaling pathways to suppress salivary tumor growth.
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Endoscope-assisted approach to excision of branchial cleft cysts. Laryngoscope 2015; 126:1339-42. [DOI: 10.1002/lary.25711] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 08/27/2015] [Accepted: 09/08/2015] [Indexed: 11/10/2022]
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Thyroid lymphoma: A case report and literature review. World J Otorhinolaryngol 2015; 5:82-89. [DOI: 10.5319/wjo.v5.i3.82] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 07/19/2015] [Accepted: 08/14/2015] [Indexed: 02/06/2023] Open
Abstract
Thyroid lymphoma is an unusual pathology. Different subtypes of lymphoma can present as primary thyroid lymphoma. This review illustrates via imaging, findings and treatment the need for accurate diagnosis and timely treatment. Patients and methods: patient’s chart, pathological findings and radiological images were reviewed in a retrospective analysis. Over several days, this 80 years old woman developed airway obstruction and rapid enlargement of her thyroid secondary to diffuse large B-cell lymphoma. She rapidly responded to her oncological protocol. Primary thyroid lymphoma is a rare disease. It is an important diagnosis to consider in patients presenting with rapidly enlarging neck masses. It is a treatable condition with fairly favorable overall survival even with the most aggressive histological subtypes.
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Necessity for lifelong follow-up of patients with familial paraganglioma syndrome: A case report. Head Neck 2015; 37:E174-8. [DOI: 10.1002/hed.24047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2015] [Indexed: 01/21/2023] Open
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Guideline Familiarity Predicts Variation in Self-Reported Use of Routine Surveillance PET/CT by Physicians Who Treat Head and Neck Cancer. J Natl Compr Canc Netw 2015; 13:69-77. [DOI: 10.6004/jnccn.2015.0010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Relationship of the recurrent laryngeal nerve to the superior parathyroid gland during thyroidectomy. J Laryngol Otol 2014; 128:1-4. [PMID: 24666972 DOI: 10.1017/s0022215114000358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Design: The relationship of the recurrent laryngeal nerve to the superior parathyroid gland during consecutive thyroidectomies was prospectively evaluated. When one structure was noted, careful dissection was performed to locate the other structure, to preserve their natural anatomical relationship. Patients: In total, 103 consecutive thyroid lobectomies were performed on 73 patients. The distance from the superior parathyroid gland to the recurrent laryngeal nerve was recorded. Results: In 88 cases (88.9 per cent), the superior parathyroid gland was identified within 5 mm of the recurrent laryngeal nerve. In 62 cases (62.6 per cent), the gland was within 1 mm of the recurrent laryngeal nerve. The height of the thyroid lobe was positively associated with the distance between the two structures (p = 0.001), as was the incidence of cancer (p = 0.033). The incidence of recurrent laryngeal nerve paresis was less than 4 per cent. Conclusion: In most cases, the recurrent laryngeal nerve was found in close proximity to the superior parathyroid gland. In a thyroid gland with a large height, or in a cancerous lobe, this relationship is less reliable.
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Aggressive squamous cell carcinoma of the oral tongue in a woman with metastatic giant cell tumor treated with pegylated liposomal doxorubicin. Oncologist 2013; 17:1596-7. [PMID: 23263922 DOI: 10.1634/theoncologist.2012-0429] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Abstract
Objective This contemporary review aims to categorize the disease entities that cause bilateral parotid enlargement and to develop a question-based algorithm to improve diagnosis of bilateral parotid masses. Data Sources A PubMed search for bilateral and parotid showed 818 results. Of these, 68 relevant studies were reviewed to compile a list of disease processes that can cause bilateral parotid enlargement. Review Methods A total of 22 diseases entities were reviewed. The disease processes were initially grouped into 6 categories based on etiology: sialadenosis, infection, neoplasm, autoimmune, iatrogenic, and miscellaneous. For each lesion, the incidence, history, and physical examination were compiled in a matrix. Conclusion After reviewing the matrix, it was clear that grouping diseases based on specific history and physical findings limits the differential diagnosis. The most important factors included disease incidence, timing of onset, nodular or diffuse, pain, and overlying skin changes. With this algorithm, the differential diagnosis can be limited from 28 to 7 or fewer likely diagnoses for a given presentation. Implications for Practice Bilateral parotid disease has a wide differential diagnosis with an expanding number of available tests. An algorithm, based solely on data obtained from the history and physical examination in the first patient encounter, may reduce the differential and aid the clinician in deciding on further workup and treatment. Following the algorithm presented here should allow the clinician to arrive at a diagnosis rapidly without ordering unnecessary tests and wasting resources.
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Patient perspectives on dysphonia after thyroidectomy for thyroid cancer. J Voice 2012; 27:111-4. [PMID: 22925427 DOI: 10.1016/j.jvoice.2012.07.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2012] [Accepted: 07/18/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To determine the frequency and consequences of patient-reported post-thyroidectomy voice disorder (PTVD) after surgery for thyroid cancer. STUDY DESIGN Retrospective review of data gathered from a survey. PARTICIPANTS Members of the Thyroid Cancer Survivors' Association (ThyCa). METHODS ThyCa members were asked about their thyroid disease and surgery, voice disturbance, impact on quality of life, treatment, and non-identifying demographics in a 36-item electronic questionnaire. Patients with preoperative voice disturbance or vocal fold immobility and those reporting postoperative vocal fold paralysis were excluded. RESULTS A total of 4426 members responded (37% response rate), and PTVD was reported by 51.1% of responders. Most were temporary (85.9%), with a minority reporting permanent hoarseness. Rates of postoperative dysphonia were similar between the extent of surgery and histology. Patients with PTVD predominantly characterized their impairment as loss of loudness and an inability to shout or sing. Nearly a quarter of patients reporting PTVD identified detrimental impact to their professional or personal lives. Only 57 patients (3.4%) were offered voice therapy; however, more than two-thirds of them (73.7%) experienced at least partial improvement. CONCLUSIONS We report the results of a large-scale patient survey to underscore the commonness of postoperative hoarseness and its impact on patients. LEVEL OF EVIDENCE 4.
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The impact of interventions on provider and treatment delays in head and neck cancer patients. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.e16052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e16052 Background: Diagnosis and management of squamous cell carcinoma of head and neck (SCCHN) involves a multidisciplinary approach. Navigation at a public hospital can be difficult and lead to delays. In a previous study, we reported English-speaking and employed patients having longer provider delays (Lai 2011). In July 2010, we instituted the use of patient navigators, bimonthly management conferences, and improved inter-disciplinary communication in order to improve the patient experience. Aims: 1. Study differences in “provider delay” (time between first contact with health care provider and positive biopsy) between patients in cohort A (diagnosed between 1/2007 and 6/2010) and cohort “B” (diagnosed between 7/2010 and 6/ 2011). 2. Study differences in “treatment delay” (time between biopsy and initiation of treatment) between the two cohorts. 3. Determine what factors influence delays in both cohorts. Methods: The delays of the two cohorts were compared using the student t-test. Independent t-test and chi-square tests were used to examine associations between delays and the following characteristics: language, employment, presence of partner, gender, ethnicity, age, cancer sub-site, staging, number of co-morbidities, tobacco use, and alcohol use. The likelihood ratio test was used for multivariate analysis. Results: 133 patients in cohort A and 20 patients in cohort B were evaluable. Both provider and treatment delays in cohort B (50.5 and 39.3 days, respectively) were shorter than cohort A (60.2 and 41.6 days), but this was not statistically significant. The standard deviations of both delays were lower in cohort B, pointing towards a greater consistency in this group. In cohort A, provider delay was significantly shorter (p-value=0.003) for non-English speakers than English speakers on univariate and multivariate analysis. Other trends were not observed. Conclusions: Simple interventions can reduce provider and treatment delays. Our observations suggest that these interventions can mitigate the effect of patient factors on provider and treatment delay. However, our results may be affected by small sample size and demographic shifts. With time, we will accrue more patients to address these issues.
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Abstract
BACKGROUND Xeroderma pigmentosum, an autosomal recessive disease that occurs with a frequency of 1:250,000, is caused by a genetic defect in nucleotide excision repair enzymes. Mutation of these enzymes leads to the development of multiple basal cell and squamous cell carcinomas. OBJECTIVES We present a case of xeroderma pigmentosum in a patient with cervical and intraparotid metastatic disease from recurrent cutaneous squamous cell carcinomas of the face and scalp, treated with neck dissection and re-irradiation. With the illustrative case report, we include a literature review of diagnosis, prognostic factors, and treatment, with emphasis on surgical and radiation treatment of cervical metastatic disease from recurrent skin carcinomas. CASE PRESENTATION A xeroderma pigmentosum patient presented to our clinic with a 2-cm right submental and 1-cm right infra-auricular mass after resection of multiple squamous cell carcinomas of the scalp and face, and external-beam radiation therapy to the right face and neck. Fine-needle aspiration biopsy of the submental mass revealed poorly differentiated squamous cell carcinoma. The patient was brought to the operating room for a right modified radical neck dissection and excision of the right submental and intraparotid mass. Surgical pathology revealed 3 level ia and supraclavicular lymph nodes that were positive for metastatic squamous cell carcinoma. Re-irradiation to the entire right hemi-neck and left submandibular nodal region was performed using opposed oblique portals for the upper neck and a low anterior en face hemi-neck portal. The left parotid region was also included in the re-irradiation volume. Treatment was completed without delayed complications or recurrences to date. CONCLUSIONS To our knowledge, this is the first case report in the literature of a patient with xeroderma pigmentosum who subsequently developed metastatic disease from recurrent cutaneous squamous cell carcinoma. Because of the rarity of xeroderma pigmentosum, this case report is also the first to describe re-irradiation to treat cervical and intraparotid metastatic disease in a xeroderma pigmentosum patient.
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Exploring factors in diagnostic delays of head and neck cancer at a public hospital. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.5544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Management of a Novel Parotid Collision Tumor. Laryngoscope 2011. [DOI: 10.1002/lary.22018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Techniques to Achieve Minimally Invasive Endoscopic Excision of Second Branchial Cleft Cysts. Laryngoscope 2010. [DOI: 10.1002/lary.21195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Improved detection does not fully explain the rising incidence of well-differentiated thyroid cancer: a population-based analysis. Am J Surg 2010; 200:454-61. [PMID: 20561605 DOI: 10.1016/j.amjsurg.2009.11.008] [Citation(s) in RCA: 146] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2009] [Revised: 10/30/2009] [Accepted: 11/02/2009] [Indexed: 11/25/2022]
Abstract
BACKGROUND The increasing incidence of thyroid cancer may be an artifact of increased diagnostic scrutiny, permitting detection of smaller, subclinical thyroid cancers. Our objective was to examine trends in the incidence of well-differentiated thyroid cancers with large size and adverse pathological features. METHODS Detailed population-based analysis of incidence trends in well-differentiated thyroid carcinoma (1973-2006) in the Surveillance Epidemiology and End Results (SEER) cancer registry, using weighted least squares and Joinpoint regression models. RESULTS The incidence of well-differentiated thyroid cancer (WDTC) in the United States has tripled since 1973 (P < .0001). Incidence trends differ significantly between geographic regions and racial groups. Large WDTCs, including those >4 cm or >6 cm, have more than doubled in incidence (P < .0001). Cancers with extrathyroidal extension and with cervical metastases have also more than doubled in incidence (P < .0001). CONCLUSIONS While the model of improving screening does explain increased diagnoses of small thyroid cancers, significant rises in the incidence of large cancers, and cancers with clinically significant pathological adverse features, are harder to explain. Alternative hypotheses, including a true increase in cancer incidence, would seem to merit exploration.
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Radiology quiz case 2. Intramuscular capillary hemangioma (small-vessel subtype). ACTA ACUST UNITED AC 2010; 136:96. [PMID: 20083788 DOI: 10.1001/archoto.2009.183-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Integrated PET/CT in Head and Neck Cancer: Controversies and Challenges. Otolaryngol Head Neck Surg 2009. [DOI: 10.1016/j.otohns.2009.06.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
A 50-year-old woman who had undergone cervical spine fixation 6 years earlier presented with dysphagia, regurgitation of undigested food, halitosis, and weight loss. Operative examination demonstrated a hypopharyngeal diverticulum with spinal hardware visible in a defect in the mucosa. She underwent an open cervical approach to removal of the hardware. Endoscopic staple diverticulotomy as described by Scher and Richtsmeier was performed 8 weeks later in the ambulatory surgical setting. After a period of enteral feeding via a nasogastric tube in the initial postoperative period, she was able to resume oral nutrition in the interim between the surgical procedures. After the second procedure, she was able to resume a normal diet immediately and she experienced minimal symptoms. It is established that traction diverticulum is appropriately treated by removing the inciting anatomic factor(s). We propose that staged surgical management begin with the removal of the nidus followed by marsupialization of the diverticulum pouch. Standard staple diverticulotomy is a viable option for the second stage. This technique allows the patient to minimize the length of, or avoid, the second hospitalization for diverticulum management.
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The basis of racial differences in the incidence of thyroid cancer. Ann Surg Oncol 2008; 15:1169-76. [PMID: 18246401 DOI: 10.1245/s10434-008-9812-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2007] [Revised: 12/30/2007] [Accepted: 01/01/2008] [Indexed: 11/18/2022]
Abstract
BACKGROUND The incidence of thyroid cancer in black Americans is half that in white Americans. It is unknown whether this gap represents a population difference in disease or is attributable to inferior cancer screening in the black population. METHODS A population-based cohort study of 53,990 patients (1973-2003) was performed using the National Cancer Institute's Surveillance Epidemiology End Results database. Socioeconomic variables were explored using the Healthcare Cost and Utilization Project database and macroeconomic data. RESULTS Since 1973, thyroid cancer incidence among whites has increased 150.2% (4.0 to 9.9 of 100,000), while incidence among blacks has increased 73.2% (3.0 to 5.1 of 100,000). Across 17 regions, the incidence correlated with the percentage of the population with health insurance (r = 0.56, P = .02). Regression analysis suggested that half of the black-white incidence gap might be attributable to differences in health insurance status. Patients with thyroid cancer were more likely to be insured or reside in wealthier ZIP codes. Black patients were more likely to present at advanced age (RR 1.08, P < .0001) and with tumors >4 cm in size (RR 1.13, P <.0001). Black patients were slightly less likely to present with advanced disease (RR 0.96, P = .0008). Cancer-specific mortality was identical in the two populations. DISCUSSION Sociodemographic data and differences at presentation support a small detection disparity in thyroid cancer, which may contribute to part of the incidence gap. However, this effect is not sufficiently strong to fully explain the incidence gap. A population difference in the incidence of disease may be coexistent.
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Jugular foramen fibromatosis in a 3-month-old male. Int J Pediatr Otorhinolaryngol 2006; 70:2119-23. [PMID: 16989908 DOI: 10.1016/j.ijporl.2006.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2005] [Accepted: 08/09/2006] [Indexed: 10/24/2022]
Abstract
A 3-month-old male with a chief complaint of episodic choking with feeds and a hoarse cry is presented. Left eye ptosis and asymmetric soft palate elevation were detected on physical examination. Fiberoptic examination showed a left vocal fold paresis and pooling of secretions in the pyriform sinuses. MRI demonstrated an ill-defined lesion at the left jugular foramen extending into the left carotid sheath. A fine needle biopsy revealed spindle shaped cells consistent with fibromatosis. The histopathology of fibromatosis and the differential diagnosis of jugular foramen masses in children will be described. To our knowledge, this represents the earliest reported case of fibromatosis in the jugular foramen.
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Value of positron emission tomography (PET) scan in treatment decision making for nodal metastases in head and neck squamous cell cancer. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.5577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5577 Background: Management of neck disease in patients with Head and Neck Squamous cell cancer (HNC) who are initially treated with combined radiation and chemotherapy (CRT) remains controversial. Standard treatment options include neck dissection (ND) or close observation. More recently PET scans have been used to stage and monitor response to therapy in patients with HNC. We performed a retrospective analysis of patients diagnosed with HNC stages N2b or higher, treated with combined CRT, and who were monitored for disease response by PET scans. Our observations on the utility of PET scans in monitoring response to therapy and in determining the role of elective NDs in this setting are reported. Methods: A retrospective review of medical records of all patients diagnosed at our institution with HNC Stages TxN2b, N2c or N3 between the years 2002 and 2005 was undertaken. IRB approval was obtained for this study.To be eligible for this analysis, patients must have had baseline and follow up PET scans at the end of CRT and prior to ND. Data regarding age, gender, primary tumor site, stage, baseline and follow up PET scan results, operative pathology of ND when performed, and local control were recorded. Results: Fifteen patients were identified. Median age was 55 years (range 37–76). Male: Female ratio was 13:2. Primary site of tumor was Pharynx (Base of tongue: n = 3, tonsil: n = 11); Lip and oral cavity: n = 1. Stages: IVa : n = 12; IVb: n = 3. N stage: N2b: n = 12; N2c: n = 1; N3: n = 2. Post CRT, all patients were followed with serial clinical examinations, PET ± CT scans. 13 of 15 patients had negative PET activity in the neck at the completion of CRT and remain disease free in the neck at a median follow up of one year. Post treatment PET scans were positive at the primary site in 2 of 15 patients; and positive in the neck in 2 of 15 patients. These 4 patients underwent ND after completing CRT. Operative pathology was positive for nodal disease in 2 of 4 patients who had persistent mild or significant activity on PET scan either at the primary site or in the neck. Conclusions: Post CRT PET negativity in the neck and at the site of primary tumor is associated with continued disease free status in the neck and these patients may be managed conservatively without requiring a neck dissection. No significant financial relationships to disclose.
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Abstract
OBJECTIVE West Nile virus has recently become a public health concern in the United States, after an outbreak in New York City in 1999. It is a mosquito-borne virus that causes a spectrum of disease from flu-like symptoms to encephalopathy, muscle weakness, and, in some cases, death. STUDY DESIGN Case Report. METHODS A patient infected with West Nile virus presented with progressive muscle weakness, and later developed bilateral vocal fold paresis. His clinical presentation, physical and laboratory examination findings, and course of illness will be discussed. RESULTS After a prolonged hospital stay, and presumptive treatment for Guillain-Barré, repeat CSF analysis revealed infection with the West Nile virus. The patient developed bilateral vocal fold paralysis during his hospital course. At long-term follow-up, the patient's left vocal fold paralysis persisted, while the right vocal fold paralysis had resolved. CONCLUSIONS Although several viruses have been associated with recurrent laryngeal nerve injury, this is the first report of West Nile virus induced vocal fold paralysis.
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Abstract
Laryngeal paragangliomas, although rare, are lesions that warrant appropriate diagnosis and treatment secondary to their location and high risk of bleeding when violated. This article describes a method to workup patients with solid submucosal lesions of the larynx to diagnose a paraganglioma without a biopsy. When recognized preoperatively, a lateral approach to removal can be performed, decreasing the risk of significant bleeding and the need for tracheotomy or permanent laryngostoma. This article also adds two more cases to the reported literature of 75.
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Warthin-like Tumor of the Thyroid Gland: An Uncommon Variant of Papillary Thyroid Cancer. EAR, NOSE & THROAT JOURNAL 2006. [DOI: 10.1177/014556130608500118] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Several variants of papillary thyroid cancer have been described, including, most recently, Warthin-like tumor of the thyroid gland. To bring attention to this uncommon variant, we review previous reports on this entity and we add 5 new cases to the literature. We retrospectively reviewed the records of all patients who had undergone thyroidectomy at our institution during a 7-year period. Among these cases, we identified 5 patients who had had a Warthin-like tumor of the thyroid. From their charts, we compiled data on age, sex, lymphadenopathy, distant spread, and treatment. Pathologic specimens were reviewed for tumor size, capsular invasion, and vascular invasion. All 5 patients were women (mean age: 51.6 yr). Tumor size ranged from 0.9 to 2.0 cm. Multifocality was seen in 1 of the 5 patients; this patient was also the only one who experienced capsular and vascular invasion. No patient had lymph node spread or distant metastasis. Because the follow-up period among these patients was still short, we were unable to analyze long-term survival data.
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Warthin-like tumor of the thyroid gland: an uncommon variant of papillary thyroid cancer. EAR, NOSE & THROAT JOURNAL 2006; 85:56-9. [PMID: 16509248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
Several variants of papillary thyroid cancer have been described, including, most recently, Warthin-like tumor of the thyroid gland. To bring attention to this uncommon variant, we review previous reports on this entity and we add 5 new cases to the literature. We retrospectively reviewed the records of all patients who had undergone thyroidectomy at our institution during a 7-year period. Among these cases, we identified 5 patients who had had a Warthin-like tumor of the thyroid. From their charts, we compiled data on age, sex, lymphadenopathy, distant spread, and treatment. Pathologic specimens were reviewed for tumor size, capsular invasion, and vascular invasion. All 5 patients were women (mean age: 51.6 yr). Tumor size ranged from 0.9 to 2.0 cm. Multifocality was seen in 1 of the 5 patients; this patient was also the only one who experienced capsular and vascular invasion. No patient had lymph node spread or distant metastasis. Because the follow-up period among these patients was still short, we were unable to analyze long-term survival data.
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Abstract
OBJECTIVES/HYPOTHESIS Peptide receptor imaging with Indium pentetreotide is useful in the diagnosis of diffuse neuroendocrine system tumors (DNEST) of the head and neck. Uses of Indium pentetreotide scintigraphy include tumor and metastases detection, familial tumor screening, and surveillance for recurrence. Using target to background ratios (TBR) could generate a comparative scale for these tumors. STUDY DESIGN A retrospective study evaluated the size, TBR, conventional imaging, and outcomes of patients imaged with Indium pentetreotide scintigraphy for suspected head and neck DNEST. METHODS Patients with head and neck tumors imaged by Indium pentetreotide scintigraphy during a nine-year period were reviewed. Data analyzed were age, sex, scintigraphy, pathology, and conventional radiology. Tumor data included dimension, multiplicity, metastases, and tumor and brain counts. RESULTS Fifty-three patients underwent 58 scans. The sensitivity and specificity were 93% and 92%. Several different DNEST were successfully evaluated, including familial paragangliomas and multiple paragangliomas. TBRs were variable depending on type of DNEST. CONCLUSIONS Indium pentetreotide scintigraphy is accurate in determining the presence of paragangliomas, carcinoid tumors, esthesioneuroblastomas, small cell neuroendocrine tumors, andmetastases. It is an excellent surveillance tool. Screening patients for familial paragangliomas can be accomplished. No reliable comparative scale to distinguish amongst the various DNEST could be developed using TBR.
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Low pretreatment hemoglobin and advanced age: Important adverse prognostic factors in head and neck cancer independent of treatment modality. A large single institutional study. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.5524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
OBJECTIVES/HYPOTHESIS Hemophilic pseudotumors are rare clinical entities in otolaryngology. An unusual case of a pediatric hemophilic pseudotumor of the paranasal sinus in a previously undiagnosed hemophiliac is presented. STUDY DESIGN Case report. METHODS A 6-month-old, otherwise healthy boy was admitted for evaluation of a rapidly expanding left-sided cheek mass. The patient's initial presentation, imaging workup, and intraoperative and postoperative courses are discussed. RESULTS Imaging workup revealed a large, heterogeneous, dense lesion in the patient's left-side maxillary sinus with distortion of the orbital floor and hard palate. Because of the concern for an aggressive malignancy, a biopsy was performed. After a Caldwell-Luc approach, a large amount of greenish fluid leaked from an otherwise empty maxillary sinus. The patient continued to bleed from his intraoral incision postoperatively and required two packed erythrocyte transfusions. Subsequent hematological testing led to a diagnosis of severe hemophilia type A with factor VIII levels less than 1% of normal. After treatment with recombinant coagulation factors hemostasis was achieved, and the patient clinically improved. CONCLUSION The study presents the first report of a pediatric hemophilic pseudotumor in the paranasal sinuses leading to a diagnosis of hemophilia. It is a rare entity characterized by a cycle of repeated hemorrhage with subsequent encapsulation of the coagulum leading to pressure-induced distortion of adjacent bone. In the correct clinical setting, hemophilic pseudotumor should be considered in the differential diagnosis of a rapidly expanding mass in children.
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Abstract
Laryngeal paragangliomas are rare submucosal lesions that arise from paraganglion cells located in the false vocal fold and subglottic larynx. To date, 76 recognized cases have been reported in the world literature. Symptoms arise when the lesions become large enough to impair function. Supraglottic paragangliomas cause hoarseness and deglutition disorders, whereas subglottic tumors become symptomatic when they obstruct the airway. Evaluation of these tumors includes obtaining a complete history. Familial paragangliomas and hypertension should be sought but are rarely, if ever, associated with laryngeal paragangliomas. MRI can detect these lesions and permit characterization of the vascularity of the lesion. Adding 111In pentetreotide scanning can distinguish neuroendocrine tumors from other submucosal laryngeal lesions, making the preoperative diagnosis clearer and obviating the need for biopsy. The biggest dilemma regarding laryngeal paragangliomas is making the correct pathologic distinction between paraganglioma, typical carcinoid, atypical carcinoid and medullary thyroid cancer. Immunohistochemical markers, supplementing standard histopathologic evaluation, can distinguish paragangliomas from the aforementioned tumors. This distinction is critical as the prognosis for treated paragangliomas is excellent compared to that for other neuroendocrine neoplasms. Almost all alleged malignant paragangliomas of the larynx are in reality atypical carcinoid tumors that have been misdiagnosed. Treatment should always comprise excision. Thyrotomy has the best chance of achieving a sustained cure without damaging phonation or deglutition. Laser excision has been used successfully but there is no great experience with this modality. Surgery is preferable to radiation for paragangliomas in all locations but especially so in the larynx, due to issues such as swelling, airway protection and destruction of cartilage. With increased clinical suspicion and the use of modern imaging techniques, laryngeal paragangliomas should be routinely diagnosed and treated without loss of laryngeal functions.
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Abstract
Etiologies of adult vocal paralysis are varied by the site of the lesion as well as the extent and cause of the damage. Most large series point to surgery and neoplastic causes for recurrent nerve paralysis. A detailed history is important when working up a patient with this voice disorder. Knowledge of the anatomy of the head, neck, and chest as well as the mechanisms behind vocal fold paralysis is essential in the evaluation and treatment of recurrent nerve paralysis. Many of the surgical and traumatic causes of hoarseness are from compression type injuries. Recovery is dependent on the type, extent, and site of nerve lesion. Familiarity with this data allows the otolaryngologist to tailor management to suit each patient with vocal fold paralysis.
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Abstract
Paragangliomas are neuroendocrine tumors derived from the extra-adrenal paraganglia of the autonomic nervous system. Within the head and neck, they are generally defined and named according to their site of origin, and may be found frequently neighboring vascular structures. Physiologic activity is rare in these neoplasms and they may exhibit patterns of inheritance which predispose their occurrence in families, often with multicentricity. These tumors generally exhibit a slow rate of growth, most often presenting asymptomatically as a space occupying mass lesion noted clinically or radiographically. The most common paraganglioma of the head and neck is the carotid body tumor followed by the jugulo-tympanic and vagal varieties. Other rare sites where this tumor may occur include; the larynx, sinonasal chambers and orbit. Diagnosis is generally made through a combination of clinical findings and radiographic studies. Magnetic resonance represents the most important imaging modality for the evaluation and characterization of suspected head and neck paraganglioma. Definitive management for these lesions should be carefully considered in relation to both tumor and patient-oriented factors, especially in regard to the potential morbidity of treatment. Surgery and radiation therapy represent the main treatment modalities for paraganglioma. The selection of treatment depends on the size, location, and biologic activity of the tumor as well as the overall fitness of the patient. Although radiotherapy may be effective in arresting growth of these tumors, rarely is the neoplasm eliminated without surgical resection. Surgery may be associated with significant morbidity, primarily as a consequence of incurring major cranial nerve injury. Patient selection (relative to age and medical condition) should be carefully considered prior to recommending aggressive surgery for paragangliomas of head and neck, especially in those patients at risk for disabling surgical morbidity.
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Which paragangliomas of the head and neck have a higher rate of malignancy? Oral Oncol 2004; 40:458-60. [PMID: 15006616 DOI: 10.1016/j.oraloncology.2003.08.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2003] [Accepted: 08/28/2003] [Indexed: 10/26/2022]
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Pathology quiz case. Sarcomatoid carcinoma. ARCHIVES OF OTOLARYNGOLOGY--HEAD & NECK SURGERY 2003; 129:1243. [PMID: 14623759 DOI: 10.1001/archotol.129.11.1243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
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Left cervical chyloma following right thyroidectomy. EAR, NOSE & THROAT JOURNAL 2003; 82:522-4. [PMID: 12955839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
Cervical chylomas are rare entities, as only four cases have been previously reported. All of these previous cases involved the left side, all were related to the thoracic duct, and all occurred following trauma or surgery. We report a new case of a left-sided chyloma that was unusual because it arose following a right-sided subtotal thyroidectomy. The chyloma arose as a left supraclavicular mass within 3 months of the thyroidectomy, and it slowly enlarged over a period of 9 years. Following evaluation by computed tomography, the mass was excised, and the patient recovered uneventfully. We also review what is known about the diagnosis and treatment of cervical chylomas.
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Abstract
Cervical chylomas are rare entities, as only four cases have been previously reported. All of these previous cases involved the left side, all were related to the thoracic duct, and all occurred following trauma or surgery. We report a new case of a left-sided chyloma that was unusual because it arose following a right-sided subtotal thyroidectomy. The chyloma arose as a left supraclavicular mass within 3 months of the thyroidectomy, and it slowly enlarged over a period of 9 years. Following evaluation by computed tomography, the mass was excised, and the patient recovered uneventfully. We also review what is known about the diagnosis and treatment of cervical chylomas.
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Abstract
OBJECTIVE: We sought to evaluate the association of intraoperative facial nerve stimulation and postoperative facial nerve paresis/paralysis.
STUDY DESIGN AND SETTING: Eighty-nine consecutive patients who underwent parotidectomy by a single surgeon were retrospectively analyzed for age, gender, size of tumor, tumor histology, and intraoperative use of a facial nerve stimulator.
RESULTS: Facial paresis developed in 22% (10 of 46) of the patients who were stimulated and 22% (5 of 23) of the nonstimulated patients. These results were not statistically significant ( P = 1.0000). There was no permanent paralysis in either group. The tumor type and size and gender and age of the patient did not affect the outcome.
CONCLUSION: There was no difference in the incidence of postoperative facial nerve paresis or paralysis between the stimulated and nonstimulated patients. Routine use of a stimulator is not necessary during parotid surgery because its use does not prevent or promote facial nerve injury.
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Abstract
OBJECTIVES/HYPOTHESIS Hurthle cell tumors are a variant of follicular cell neoplasms. The purpose of the study was to determine the reliability of intraoperative frozen-section analysis for diagnosing Hurthle cell carcinoma and Hurthle cell neoplasm and to evaluate age, gender, and tumor size differences in the incidence of Hurthle cell carcinoma. STUDY DESIGN Retrospective chart review. METHODS The records of all patients undergoing thyroid surgery at Long Island Jewish Medical Center (Long Island Campus of the Albert Einstein College of Medicine, New Hyde Park, NY) from 1990 to 2000 were reviewed. Patients were identified whose final pathological finding was Hurthle cell neoplasm or Hurthle cell carcinoma. Age at diagnosis, gender, tumor size, and correlation between frozen-section analysis and final pathological finding was determined. RESULTS One hundred sixteen patients had Hurthle cell tumors on final pathological finding (49 had Hurthle cell carcinoma and 67 had Hurthle cell neoplasm). Eleven of these patients had incidental papillary carcinoma. There were 24 men and 92 women. Sixty-seven percent of the men (16 of 24) and 36% of the women (33 of 92) had Hurthle cell carcinoma on final pathological finding. The mean ages for Hurthle cell neoplasm and Hurthle cell carcinoma groups were 53 (median age, 50 y) and 58 years (median age, 61 y), respectively. One hundred eleven patients had intraoperative frozen-section analysis. Of the 49 patients with Hurthle cell carcinoma, 9 (19%) were diagnosed by frozen-section analysis, 36 (75%) had indeterminate frozen-section analysis, 3 (6%) were discovered to have papillary carcinoma on frozen-section analysis, and 1 did not have a frozen-section analysis. Multivariate analysis indicated that size correlated with malignancy and that gender did not (P =.0015). CONCLUSIONS In the study population, only 19% of patients were discovered to have Hurthle cell carcinoma on frozen-section analysis. Sixty-seven percent of men with Hurthle cell neoplasm had malignancies, compared with 36% of women, and this difference was statistically significant.
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Total Thyroidectomy Is Overly Aggressive Treatment for Papillary Carcinoma in a Thyroglossal Duct Cyst. ACTA ACUST UNITED AC 2002. [DOI: 10.1001/archotol.128.4.464] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Abstract
OBJECTIVE To present an unusual case of recurrent facial palsy resulting from acute leukemic infiltration of the parotid gland. STUDY DESIGN Case report. METHODS An 11-year-old boy who had been treated for acute lymphoblastic leukemia (ALL) from 3 to 6 years of age presented with intermittent left facial nerve palsy with concurrent ipsilateral parotid fullness. The initial findings at diagnosis and workup are presented, and the disease progression and resolution with therapy are documented. RESULTS The patient had been off therapy when this finding developed. A workup for central and viral etiologies for the facial palsy was unrevealing. Biopsy of the parotid gland demonstrated a lymphoblastic leukemic infiltrate. The patient was placed on a chemotherapy protocol for relapsed leukemia, resulting in complete resolution of the facial palsy. CONCLUSION Isolated facial nerve dysfunction, albeit rare, has been documented as a sign of central nervous system involvement in leukemia, but until now this presentation has not been described in the setting of leukemic relapse presenting with acute infiltration of the parotid gland.
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