ABSTRACT
INTRODUCTION: Orocutaneous fistulae of dental origin are uncommon but well documented in the literature. This condition is often misdiagnosed because of the multiplicity of manifestations and the atypically presentation of the condition. Dental symptoms are rare. This makes diagnosis and treatment a challenging process. PRESENTATION OF A CASE: A 67-year-old patient presented in the emergency room with an abscess in the parotid area. After incision and drainage the patient developed a non-healing fistula in the region of the parotid. Multiple treatment attempts and several investigations did not solve the problem. Finally, a panoramic x-ray showed a hidden, infected and displaced tooth in the right mandibular angle. After surgical extraction of the tooth and fistula excision, healing was uneventful and there was no recurrence. DISCUSSION: Given the diagnostic challenge, the real origin of the condition is frequently only discovered after several unnecessary interventions that may have harmed the patient. The key to early diagnosis is dental examination and dental radiographs. The goal of treatment is the elimination of the infection by surgical extraction of the tooth or non-surgical endodontic therapy. CONCLUSION: Early diagnosis and rapid treatment minimize patient discomfort and reduce the probability of further complications. The differential diagnosis of sinus tract of dental origin should be considered in any case of unclarified non-healing skin lesion in the head and neck area, especially if initial treatments have failed. An early interdisciplinary approach is essential.
ABSTRACT
Salivary gland tumors are a rare, histologically heterogeneous group of tumors which constitute approximately 46 % of all head and neck neoplasms. In 2/3 of cases they are benign, especially in the parotid gland. We report about a rare tumor of the parotid gland presenting as an extraskeletal chondroma. Histologically there were multiple S 100 protein-positive nests of chondrocytes. The externally completed cytology suspected a pleomorphic adenoma, nevertheless, the final histopathological findings showed another tumor entity.
Subject(s)
Chondroma/diagnosis , Parotid Neoplasms/diagnosis , Adenoma, Pleomorphic/diagnosis , Adenoma, Pleomorphic/pathology , Biomarkers, Tumor/analysis , Biopsy, Fine-Needle , Chondroma/pathology , Chondroma/surgery , Diagnosis, Differential , Female , Humans , Magnetic Resonance Imaging , Middle Aged , Parotid Neoplasms/pathology , Parotid Neoplasms/surgery , S100 Proteins/analysis , UltrasonographyABSTRACT
Malignant peripheral nerve sheath tumors (MPNST) are rare. But especially in patients with known neurofibromatosis type 1 (von Recklinghausen), this entity of tumors should not be forgotten. The indication for open biopsy or excision should be made generously. In the following, we report a rare case of MPNST, which highlights the importance of rapid diagnosis and treatment.
Subject(s)
Head and Neck Neoplasms/diagnostic imaging , Head and Neck Neoplasms/surgery , Neoplasms, Multiple Primary/diagnostic imaging , Neoplasms, Multiple Primary/surgery , Nerve Sheath Neoplasms/diagnostic imaging , Neurofibromatosis 1/diagnostic imaging , Neurofibromatosis 1/surgery , Tomography, X-Ray Computed , Biopsy, Fine-Needle , Combined Modality Therapy , Diagnosis, Differential , Disease Progression , Head and Neck Neoplasms/pathology , Humans , Male , Middle Aged , Neoplasms, Multiple Primary/pathology , Nerve Sheath Neoplasms/pathology , Nerve Sheath Neoplasms/surgery , Neurofibromatosis 1/pathology , Radiotherapy, AdjuvantABSTRACT
OBJECTIVE: To assess Eustachian tube balloon dilation in the treatment of Eustachian tube dysfunction by objective analysis, especially tubomanometry. STUDY DESIGN: Retrospective cohort study. SETTING: Tertiary referral hospital. PATIENTS: Patients undergoing Eustachian tube balloon dilation for treatment of Eustachian tube dysfunction. INTERVENTION: Eustachian tube balloon dilation. MAIN OUTCOME MEASURES: Subjective improvement, otomicroscopic findings, tympanogram, air-bone gap in pure-tone audiogram, R-value in tubomanometry at three pressure measurements (30, 40, and 50 mbar) and the Eustachian Tube Score (ETS). RESULTS: Eustachian tube balloon dilation was performed in 21 patients. The Eustachian Tube Score including the R-values, tympanogram, and air-bone gap all showed a statistically positive outcome (p < 0.005) after Eustachian tube balloon dilation. Subjective improvement was seen in 76%. Normal R-values were achieved in 57%. Retraction processes of the tympanic membrane improved in 18% of patients. Only one minor bleeding complication occurred. CONCLUSION: Eustachian tube balloon dilation constitutes a safe and very promising treatment option for patients with Eustachian tube dysfunction based on early-outcome analysis. ETS and specifically tubomanometry appear promising as assessment tools but await validation for use in the diagnostic workup and outcome analysis after ETBD. The pathophysiologic mechanism of Eustachian tube balloon dilation remains unclear. Long-term analysis and stratification of patients are needed to better evaluate the definite value of Eustachian tube balloon dilation.
Subject(s)
Catheterization/methods , Ear Diseases/therapy , Eustachian Tube/physiopathology , Adult , Aged , Ear Diseases/physiopathology , Female , Hearing Tests , Humans , Male , Middle Aged , Retrospective Studies , Treatment Outcome , Young AdultABSTRACT
Orthonasal and retronasal olfaction processes differ. The aim of this study was to examine whether congruent and incongruent simultaneous gustatory stimuli influence orthonasal and retronasal odorant perception, using olfactory event-related potentials as a measure. Thirty-two young, healthy subjects (16 men, 16 women) took part in two test sessions. Olfactory event-related potentials were recorded in response to a food-like odor, vanillin, and to an odor usually not associated with foods, the rose-like phenylethylalcohol. Each session consisted of four randomized blocks of 15 stimuli each which were applied either orthonasally or retronasally. Simultaneously, sweet or sour gustatory stimuli were applied. In response to retronasal vanillin, stimuli latencies P2 of the event-related potentials were significantly shorter in the congruent "sweet condition" than the incongruent "sour condition". In contrast, with orthonasal stimulation, shorter P2 latencies were seen for both odorants in the incongruent condition. Intensity of both odorants was perceived as less pronounced after retronasal stimulation than after orthonasal stimulation. In conclusion, application of a sweet taste significantly enhanced the processing of a congruent olfactory stimulus when presented through the retronasal route. Incongruent simultaneous gustatory stimulation applied during orthonasal olfaction seemed to induce conflict priming, also resulting in faster processing.
Subject(s)
Brain/physiology , Food , Odorants , Olfactory Perception , Smell , Taste , Adult , Benzaldehydes , Evoked Potentials, Somatosensory , Female , Humans , Male , Mouth/physiology , Nose/physiology , Phenylethyl Alcohol , Physical Stimulation , Young AdultABSTRACT
The trigeminal and olfactory nerves share overlapping innervation areas in the nasal cavity and seem to work in an interactive way. Loss of olfactory function leads to a decreased trigeminal sensitivity, as shown in anosmic subjects. To report the impact of disturbed trigeminal sensitivity on the olfactory function, we present a patient with unilateral loss of trigeminal function resulting from a meningeoma. Thresholds to a selective olfactory stimulus were elevated by a factor of 64 on the affected side. Recordings of event-related potentials in response to olfactory stimuli showed a significantly reduced response on the affected side. This report indicates that loss of trigeminal function may affect the sense of smell.
