Bilateral Basaloid Squamous Cell Carcinoma of the Parotid Gland: A Case Report and Review of the Literature.

INTRODUCTION: We describe the first known case of bilateral basaloid squamous cell carcinoma of the parotid gland, and we review existing literature. CASE PRESENTATION: A previously healthy, 70-year-old white man presented with a 2-cm enlarging mass in the tail of the right parotid gland. Magnetic resonance imaging and computed tomography showed ipsilateral pathologic adenopathy. Results of fine-needle aspiration revealed a high-grade malignancy with squamous features. The patient underwent a right total parotidectomy and modified radical neck dissection. Final pathologic findings revealed a basaloid squamous cell carcinoma. Four years after the initial resection, the patient presented with an enlarging left parotid mass. Findings of fine-needle aspiration and imaging were similar to those 4 years earlier. The patient received a left total parotidectomy and modified radical neck dissection. Postoperative radiation therapy was performed after each surgical intervention. He remains disease free at 4-year follow-up after the second mass was resected. DISCUSSION: Squamous cell carcinoma with basaloid features is a rare and aggressive type of squamous cell carcinoma. To our knowledge, this is the first case report of bilateral parotid basaloid squamous cell carcinoma.

Manual dexterity aptitude testing: a soap carving study.

IMPORTANCE: Currently there are few validated metrics for predicting surgical skill among otolaryngology residency applicants. OBJECTIVE: To determine whether manual dexterity aptitude testing in the form of soap carving during otolaryngology residency interviews at Kaiser Permanente Medical Center Oakland predicts surgical skill at the time of graduation from otolaryngology residency programs. DESIGN, SETTING, AND PARTICIPANTS: This study was conducted to determine how applicants with the best and worst soap carvings compared at the time of graduation with respect to various metrics including visuospatial ability and manual dexterity. Over the last 25 years, applicants to the residency program at Kaiser Permanente Oakland were required to carve soap during their residency interview. The 3 best and 3 worst soap carvings from 1990 through 2006 were determined. Of the individuals who carved those soaps, 62 qualified for the study and matriculated into otolaryngology residency programs. INTERVENTIONS: Surveys were sent to the 62 individuals' residency programs to evaluate those individuals on a 5-point Likert scale in various categories as well as to rank those individuals as being in the top 50% or bottom 50% of their graduating class. MAIN OUTCOMES AND MEASURES: All else being equal, we hypothesized that applicants who had the manual dexterity and visuospatial skills to accurately carve a bar of soap would more likely possess the skills necessary to become a good surgeon. RESULTS: There was no difference between individuals with the best soap carvings and those with the worst soap carvings in all categories: cognitive knowledge, visuospatial ability, manual dexterity, decision making, and overall score (P > .10 for all categories). There was a 95% response rate, with 35 of 37 residency programs responding and 59 of 62 surveys returned. CONCLUSIONS AND RELEVANCE: Manual dexterity aptitude testing in the form of soap carving does not appear to correlate with surgical skill at the time of graduation. Further studies need to be conducted to determine the role of manual dexterity and visuospatial aptitude testing in the otolaryngology application process.

Tympanostomy tubes for otitis media: quality-of-life improvement for children and parents.

We measured quality of life issues for both children and their parents on the premise that parental quality of life should be an aspect of cost-effectiveness in otitis media treatment. The patients were less than 18 years of age and had had myringotomy with tube insertion at the head and neck surgery department of a large health maintenance organization. Quality of life for patients, parents, and caregivers was evaluated by telephone survey of parents or caregivers and by retrospective chart review of the number of pre- and postoperative healthcare visits and antibiotic usage. Chart review showed a significant postoperative reduction in the number of clinic visits and in use of antibiotic drugs after insertion of tympanostomy tubes. Improved postoperative hearing was noted, and tympanostomy tube insertion was shown to be safe. The chart-review cost analysis showed that tympanostomy tube insertion is a cost-effective treatment for otitis media in children, and the telephone survey results showed that it improves quality of life for children and their parents or other caregivers.

Odontoma of the middle ear: case report with 25-year follow-up.

We report the 25-year follow-up on the first reported case of odontoma in the middle ear. Diagnosis of odontoma had been made on the basis of radiography films that showed a middle ear mass with multiple toothlike areas of radiopacity. No clinical intervention was recommended. At 25-year follow-up, audiometry showed progressive mixed hearing loss on the affected side and mild ipsilateral sensorineural hearing loss. Computed tomography better characterized the discrete mass, which was shaped similar to a dental crown. To avoid jeopardizing cochlear and facial nerve function, no surgical intervention was pursued, and we recommended use of a BiCROS (bilateral contralateral routing of signal) hearing aid.

Lymphatic mapping for staging of head and neck cancer.

Lymphatic mapping with sentinel lymph node (SLN) biopsy can accurately stage the nodal basins in patients with melanoma of the trunk and extremities and has become a routine, well-accepted diagnostic method for melanoma at these anatomic locations. Melanoma of the head and neck (16% of all cases of melanoma) is complex and difficult to manage because of the rich abundant interlacing lymphatic drainage patterns, as well as watershed areas, which can lead to unusual and unexpected drainage patterns. Radioguided surgery in combination with blue dye facilitates localization of the SLN in the head and neck; however, this type of radioguided surgery is an evolving technique of some difficulty and thus requires careful coordination among the surgeon, nuclear medicine physician, and pathologist. Applications of this technique to other sites in the head and neck are currently being investigated for conditions including squamous cell carcinoma (SCC) of the oral cavity, thyroid cancer, and Merkel cell cancer. More studies of patients with head and neck cancer are needed--and technical issues must be resolved--before radioguided surgery can be recommended as the standard of care for these patients.

Lipoblastomatosis of the neck causing hemiparesis: a case report and review of the literature.

BACKGROUND: Lipoblastoma and lipoblastomatosis are rare pediatric adipose tumors that sometimes affect the neck or spinal cord. This case is the third report of lipoblastoma extending into the spinal canal, the first report of intradural tumor extension, and the first report of hemiparesis resulting from lipoblastoma compressing the spinal cord. METHODS: A 13-month-old boy was seen by a pediatrician for a firm, supraclavicular neck mass on the left side. After being evaluated by CT and MRI scanning, the tumor was partially resected. RESULTS: Postoperative microscopic examination of the tumor showed adipose cells with mature nuclei and well-formed fat vacuoles interspersed with fibrovascular septa, a finding consistent with maturing lipoblastoma. CONCLUSIONS: Although lipoblastomatous tumors are treated with complete surgical resection when possible, location of these tumors in the neck may dictate partial resection to avoid intraoperative injury to the spinal cord.

Submandibular gland squamous metaplasia mimicking recurrent squamous cell carcinoma: diagnostic dilemma.

New masses in the head and neck region of previously treated patients with cancer are considered suggestive of potential recurrence. Fine-needle aspiration is an excellent primary tool for evaluating these masses but may show atypical squamous cells that mislead clinicians to pursue aggressive treatment. We describe 3 patients in whom submandibular gland masses developed after radiation therapy for squamous cell carcinoma and for whom subsequent excisional biopsy findings showed benign squamous metaplasia. We review distinguishing clinical and histopathologic features that may allow these lesions to be identified. We also propose a treatment algorithm for this uncommon clinical scenario.

Radiographic comparison of three methods for nasal saline irrigation.

OBJECTIVE: To compare intranasal distribution of saline solution delivered by three popular methods for nasal saline irrigation. STUDY DESIGN: Prospective, controlled comparison. METHODS: Eight healthy adult volunteers received nasal irrigation with 40 mL of isotonic, nonionic contrast material immediately before having coronal computed tomography to visualize distribution of solution in the paranasal sinuses. For each study subject, three methods of irrigation were used: irrigation using positive-pressure irrigation, irrigation using negative-pressure irrigation, and irrigation using a nebulizer. For each subject, three-dimensional computer reconstructions of the irrigated paranasal sinus airspaces were used to compare contrast solution volume and distribution achieved by the three methods. RESULTS: Of the three methods used, two methods, positive-pressure and negative-pressure irrigation, distributed contrast solution widely to ethmoid and maxillary sinuses, but distribution of contrast solution was more uniform using positive-pressure irrigation than using negative-pressure irrigation. The nebulization method distributed contrast solution poorly and resulted in a significantly lower volume of retained contrast solution (P <.05). CONCLUSION: Judged solely on the basis of solution distribution in the nasal sinuses, nasal irrigation is effective when either positive-pressure or negative-pressure irrigation is used but is ineffective when a nebulizer is used.

Comparison of ThinPrep versus conventional smear cytopreparatory techniques for fine-needle aspiration specimens of head and neck masses.

OBJECTIVES: Diagnostic accuracy of the ThinPrep process (Cytyc, Boxborough, MA) was compared with that of conventional (smear) cytopreparation for fine-needle aspiration (FNA) of head and neck masses. METHODS: In a prospective, randomized, single-blinded study, 209 patients served as their own controls and underwent 236 FNAs using ThinPrep and conventional (smear) cytopreparatory techniques. RESULTS: ThinPrep produced less air-drying artifact and less mechanical distortion than the conventional method. The conventional technique was diagnostic in 63% of samples; the ThinPrep technique was diagnostic in 55% of samples. When all results were combined, pathologists subjectively preferred the conventional technique but accepted use of ThinPrep as the only cytopreparatory technique for most head and neck masses. CONCLUSIONS: For adequately experienced cytopathologists, ThinPrep is acceptable for FNA of salivary masses, neck cysts, metastatic lymph nodes, and thyroid lesions. Conventional smear technique should be used for FNA of nonmetastatic lymphoid lesions. Use of ThinPrep can complement use of the conventional (smear) cytopreparatory technique when aspirate is nondiagnostic or bloody, when the patient has a blood-borne infectious disease, when the clinician is inexperienced, or when aspirate has entered the syringe.