Synchronous tonsillar tumors with differing histopathology: A case report and review of the literature.

BACKGROUND: Tonsillar squamous cell carcinoma (TSCC) due to human papillomavirus (HPV) infection has seen a dramatic increase in recent years. Bilateral tonsillar squamous cell carcinoma (biTSCC) has a much lower incidence than unilateral TSCC and three main hypotheses of biTSCC pathogenesis prevail: field carcinogenesis, single-clone, and multiple HPV infections. CASE: A 49-year-old Male with a remote history of chewing tobacco presented with symptoms of spitting up tissue and occasional hemoptysis. Physical exam showed a sole left tonsillar mass which was confirmed to be TSCC on biopsy. The patient's computed tomographic (CT) scan was consistent with this finding; however, positron emission tomography (PET) scan indicated a second tumor in the contralateral right tonsil. Surgical resection of both masses and selective neck dissection was performed, and the specimens were sent for further pathological analysis. No complications of surgery were noted and the final diagnosis of synchronous biTSCC was made. The tumors were a T2N0M0 left poorly differentiated TSCC (p16+, EGFR+, bcl2+) with basaloid features, and a T1N0M0 right well to moderately differentiated TSCC (p16+, EGFR+, bcl2-). CONCLUSION: Our present case was notable for differing tumor pathology and karyotype analysis between the right and left masses, directly supporting the multiple HPV infections hypothesis of biTSCC pathogenesis. Further genetic characterization of tonsillar tumors is needed to better characterize TSCC and best guide medical/surgical therapy.

Retroperitoneal Hematoma as a Complication of Endovascular Embolization of Tumor Epistaxis: A Case Report.

Retroperitoneal hematomas are a rare and fatal complication of endovascular embolization. We report a case of an 89-year-old woman who was referred to interventional radiology for percutaneous embolization for intractable epistaxis as a result of a left nasal cavity mucosal melanoma. After successful embolization of the left sphenopalatine artery, the patient became hypotensive and was transferred to the intensive care unit. Post-operative CT abdomen and pelvis angiogram showed a large right perinephric hematoma, which is an extremely uncommon complication of endovascular embolization for epistaxis. Practitioners should be aware of this life-threatening complication in weighing the risks and benefits of embolization versus direct surgical ligation, and they should identify and intervene promptly if a retroperitoneal hematoma should occur.

Comparison of steroid-releasing stents vs nonabsorbable packing as middle meatal spacers.

BACKGROUND: A randomized controlled trial was held to compare nonabsorbable packs to steroid-eluting absorbable stents as middle meatal spacers after endoscopic sinus surgery in patients with chronic rhinosinusitis (CRS). METHODS: CRS patients were randomly assigned to receive either nonabsorbable Merocel packs wrapped in non-latex glove material (packing type A) or Propel steroid eluting stents (packing type B). Twenty-two-item Sino-Nasal Outcome Test (SNOT-22) scores were collected preoperatively and postoperatively during the initial 4 debridements up to 3 months. Recording of the nasal endoscopy was also collected during all postoperative visits. In addition, Lund-Kennedy scores and middle turbinate lateralization scores, using a new visual analogue scale, were compared between the 2 types of packing. RESULTS: Forty CRS patients were prospectively enrolled in this institutional review board (IRB)-approved study. Patients with packing type A had significantly lower middle turbinate lateralization scores at their first (∼10 days) postoperative visit (p = 0.02 and p = 0.04, for left and right sides, respectively). This difference disappeared by later postoperative visits (from 20 days to 3 months). Overall, patients receiving packing type A had significant lower SNOT-22 scores at 20 days postsurgery (p = 0.05). This difference also disappeared at 1 and 3 months postoperation. There were no statistically significant differences in Lund-Kennedy scores. CONCLUSION: In this study, nonabsorbable packing materials showed significant superior middle meatal spacing capacities as evidenced by greater middle turbinate medialization capability at the first postoperative visit. Additionally, patients with this type of packing saw improvements in their SNOT-22 scores at the 20-day postoperative visit. This study showed that there was no significant improvement in postoperative outcomes with drug-eluting stents when compared to nonabsorbable packing.

Intraseptal Mucocele as a Long-term Complication of Revision Septorhinoplasty: A Case Report and Review of a Rare Entity.

Paranasal sinus mucoceles are benign, expansive, cystic lesions which arise from retention of mucus secretions. They arise primarily in the setting of cystic degeneration of the sinus mucosa or secondarily in the setting of obstruction of the sinus ostium due to mucosal trauma or chronic inflammation. Septal mucoceles are rare. Only 10 cases to our knowledge have previously been reported. Patients are exclusively male, in their middle years, usually with a history of nasal trauma or nasal surgery. Nasal obstruction followed by headache present for 3 months to a year are the most common presenting symptoms. Here, we present a case of septal mucocele with dystrophic bone formation in a 57-year-old man arising 35 years after open septorhinoplasty treated successfully with total excision via an endoscopic, endoseptal approach. A review of the available literature was conducted to provide a consolidated update on diagnosis and management.

Clinical and quality-of-life outcomes following gland-preserving surgery for chronic sialadenitis.

OBJECTIVES/HYPOTHESIS: Gland-preserving salivary surgery utilizing salivary endoscopy has been proposed as a treatment alternative in the management of chronic sialadenitis. This study seeks to determine medium-term clinical and quality-of-life (QOL) outcomes following a gland-preserving approach for chronic sialadenitis. STUDY DESIGN: Cross-sectional survey with retrospective chart review. METHODS: All patients undergoing attempted gland-preserving salivary surgery with salivary endoscopy for chronic sialadenitis at a tertiary, academic salivary referral center between October 2008 and April 2013 were identified from a quality assurance database. A research database was constructed to examine clinical factors of interest. A clinical outcomes and QOL survey was mailed to all eligible patients in order to obtain long-term follow-up data. RESULTS: A total of 206 of 306 (67%) eligible patients returned the survey. The median length of follow-up was 17 months (3-54 months). The majority of patients (89%) endorsed symptom improvement after gland-preserving therapy. Surgical excision was performed on 8% of affected glands. Patients with chronic sialadenitis due to stones reported a greater incidence of symptom resolution (P = 0.0004) and more favorable QOL outcomes (P = 0.0001) than patients with nonstone etiologies. CONCLUSIONS: Patients undergoing gland-preserving salivary surgery with salivary endoscopy for chronic sialadenitis have favorable long-term symptom improvement and gland retention rates. Although patients with stones demonstrated the best outcomes, improvement was documented for all etiologies of chronic sialadenitis. LEVEL OF EVIDENCE: 4.