Manifestations of AIDS in the head and neck.

BACKGROUND: A significant number of patients with the acquired immunodeficiency syndrome (AIDS) are initially seen with symptoms related to the head and neck. It is becoming increasingly challenging for clinicians to accurately diagnose new lesions, considering the vast array of manifestations of AIDS in this region and their many atypical presentations. A comprehensive review is a valuable clinical tool. METHODS: A MEDLINE search of the English language literature from 1984 to the present was done for this study. RESULTS: Dermatologic, otologic, nose/paranasal sinuses/nasopharynx, oral cavity/oropharynx, laryngeal, and neck manifestations are reviewed. The gross and microscopic appearances of lesions are described, with particular emphasis on various presentations of the same lesion and lesions that may mimic the appearance of others. Practical treatment strategies are also discussed. CONCLUSIONS: Accurate and early recognition of the many common and uncommon manifestations of AIDS in the head and neck is of critical importance to the timely and effective management of these patients.

Non-Hodgkin's lymphoma of the external auditory canal in an HIV-positive patient.

This is a case report of non-Hodgkin's lymphoma of the external auditory canal, and infratemporal fossa, which presented with multiple cranial nerve palsies. The diagnosis was achieved via biopsy of tissue from the external auditory canal, and treatment with radiation therapy led to improvement of the symptoms. The management of AIDS-related lymphoma of the skull base with cranial neuropathies is reviewed.

Lymphoma of the head and neck and acquired immunodeficiency syndrome: clinical investigation and immunohistological study.

The epidemic of acquired immunodeficiency syndrome (AIDS) has made an enormous impact in the practice of medicine within the past decade. Of the many associated problems, the increasing frequency of human immunodeficiency virus (HIV)-related malignancies, particularly lymphoma, has been both a fascinating area of study and a most difficult clinical condition to manage. This study investigates lymphoma of the head and neck with clinical studies, as well as immunohistochemical assessments from individual patients. Lymphomas of the head and neck, as they present to the otolaryngologist, can present difficult and challenging diagnostic and therapeutic dilemmas. It is well-known that a significant number of acquired immunodeficiency patients present initially with symptoms related to the otolaryngology field; it was also found that a certain number of lymphomas in the head and neck in HIV+ patients are the initial presentation. In addition, the associated disorders, such as related infections and synchronous additional neoplasms, are described. Also presented are recommendations for diagnosis and work-up of these conditions, based on the experience. In addition, the study of lymphoma as a neoplasm from the molecular biology viewpoint and its course in the immunodeficient state have been important areas of study in an effort to dissect the progression to oncogenesis. The rapidly expanding literature base in this area is discussed.

The radiographic incidence of chronic sinus disease in the pediatric population.

The otolaryngologist is frequently consulted for paranasal sinus disease which has been identified as an incidental finding on computed tomography (CT) in children. The significance of such a finding is difficult to interpret without prior knowledge of the actual incidence of chronic sinus mucosal hypertrophy in the general pediatric population. In this study of pediatric CT scans from busy otolaryngology and ophthalmology clinics, the radiographic incidence of sinus disease in the general pediatric population is estimated. One hundred forty-two CT scans of the orbits and temporal bones obtained over an 18-month period were reviewed. Fifty-eight (41%) scans showed some mucosal thickening or opacification in at least one sinus. When patients were stratified by age, or by the presence or absence of chronic otitis media or respiratory tract disease, exclusive of clinical sinusitis, there was no statistical difference between groups. The authors conclude that the asymptomatic child with an incidental paranasal sinus finding on CT scan need not be worked up further unless clinical symptoms and signs are elicited.

Radiation injury to the temporal bone.

Osteoradionecrosis of the temporal bone is an unusual sequela of radiation therapy to the head and neck. Symptoms occur many years after the radiation is administered, and progression of the disease is insidious. Hearing loss (sensorineural, conductive, or mixed), otalgia, otorrhea, and even gross tissue extrusion herald this condition. Later, intracranial complications such as meningitis, temporal lobe or cerebellar abscess, and cranial neuropathies may occur. Reported here are five cases of this rare malady representing varying degrees of the disease process. They include a case of radiation-induced necrosis of the tympanic ring with persistent squamous debris in the external auditory canal and middle ear. Another case demonstrates the progression of radiation otitis media to mastoiditis with bony sequestration. Further progression of the disease process is seen in a third case that evolved into multiple cranial neuropathies from skull base destruction. Treatment includes systemic antibiotics, local wound care, and debridement in cases of localized tissue involvement. More extensive debridement with removal of sequestrations, abscess drainage, reconstruction with vascularized tissue from regional flaps, and mastoid obliteration may be warranted for severe cases. Hyperbaric oxygen therapy has provided limited benefit.

First branchial cleft cysts: clinical update.

First branchial cleft cysts develop as a result of incomplete fusion of the cleft between the first and second branchial arches and give rise to two distinct anomalies, termed type I and type II anomalies. Type I anomalies are purely ectodermal while type II anomalies exhibit ectodermal and mesodermal elements. The type II anomaly incorporates some portion of the first and second arch as well as the cleft. Type I lesions are extremely rare. They appear histologically as cysts lined by squamous epithelium. Clinically, they present as a cystic mass or fistula posterior to the pinna and concha. The cyst is usually superior to the main trunk of the facial nerve and ends in a cul-de-sac on or near a bony plate at the level of the mesotympanum. Type II lesions are more numerous and represent a duplication of both membranous and cartilaginous portions of the external auditory canal. They contain skin as well as adnexal structures and cartilage and may be associated with the parotid gland. Most frequently they are associated with fistulae in the concha or external auditory canal as well as fistulous openings in the neck.

Chondrosarcoma of the head and neck.

A review of 23 cases of chondrosarcoma of the head and neck is presented. The sites of involvement include the gnathic bones, paranasal sinuses and orbit, nasopharynx, base of skull, larynx and the cervical spine. Histologic grading of the neoplasms into I, II, and III, primarily dependent on deviation from phenotypic cartilage and mitoses, afforded excellent correlation with prognosis and survival. While increasing size of the chondrosarcoma is not always associated with higher grade tumors, rapidly growing and extensive neoplasms are usually grade II or III chondrosarcoma.

Chronic mucormycosis.

Chronic rhinocerebral mucormycosis, as distinct from the acute fulminating form, has been previously unreported in the otolaryngology literature. We have observed two cases of chronic rhinocerebral mucormycosis with osteomyelitis and bony sequestration at 8 months and 2 years after apparent control of initial infection. In addition to the accepted management of early diagnosis, surgical debridement, an appropriate medical therapy, patients who have been successfully treated for acute and iulminating mucormycosis need long-term, close follow-up with further debridement should any chronic infection become evident.

Management of amyloidosis of the larynx and trachea.

Amyloidosis involving the upper portion of the respiratory tract is an uncommon disorder that may occur as an isolated phenomenon or, more unusually, as part of a systemic amyloidosis. This case of a 66-year-old man with amyloidosis of the larynx and trachea illustrates some recently developed concepts and techniques in the diagnosis and management of this problem.

Unilateral polyposis and mucoceles in children.

Children presenting with unilateral opacification of one or more of the paranasal sinuses must be considered at risk for serious disease. If an expansile lesion is noted, the most likely diagnosis is that of mucocele. Six children are presented with such findings and the diagnosis and treatment discussed. In five polyps were noted, indicating a probable allergic origin. Radiographic evaluation of the lesion is stressed with emphasis on the value of tomograms.