Renal Cell Carcinoma in the Head and Neck: Case Presentation of a Patient With a Rare Metastatic Pattern.

Renal cell carcinoma is known for its metastatic potential, however, metastasis to the head and neck are rare. We present a 71-year-old man who presented with a palpable tongue mass. The positron-emission tomographic-computed tomographic scan revealed enhancements in the left tongue base, left thyroid, left shoulder musculature, right upper thigh, and right paratracheal mediastinal lymph nodes. Subsequent tongue and trapezius muscle biopsies had immunochemical stains consistent with renal cell carcinoma metastasis. This article discusses an uncommon metastatic pattern of renal cell carcinoma to the tongue and what is the second reported metastasis of renal cell carcinoma to the trapezius muscle.

The "midface-lift" as a misnomer for correctly identifying procedures designed to lift and rejuvenate the cheeks and malar regions of the face.

OBJECTIVE: To demonstrate that a classic temporal cheek rhytidectomy results in substantial and acceptable rejuvenation of the so-called midface and that additional surgery is not necessary to improve a sagging cheek, the melolabial fold, and the position of the corner of the mouth and the lateral corner of the eye. DESIGN: A retrospective observational study of 53 patients seen at the McCollough Plastic Surgery Clinic between 2005 and 2007. Each patient underwent temporal and cheek face-lifting surgery for various indications. All procedures were performed by the same surgeon, and the surgical technique was identical in all cases. Patient photographs were evaluated by 3 unbiased plastic surgeons who were asked to compare preoperative and postoperative elevation of the cheek mound, melolabial fold, oral commissure, and lateral canthus. Each anatomic area was appraised for improvement by each reviewer using a 4-point scale. RESULTS: The average patient age was 57 years, and the average patient follow-up was 11 months. Patients achieved excellent or significant improvement in a sagging cheek, melolabial fold, oral commissure, and lateral canthus in 79% (n = 42), 70% (n = 37), 72% (n = 38), and 65% (n = 34) of cases, respectively. CONCLUSIONS: It has been written often that standard face-lifting techniques fail to address many of the aging changes seen in the cheeks. Many authors argue that a separate, unique procedure is required to effectively rejuvenate the cheek, nasolabial fold, and corner of the mouth. Our experience is contrary to this notion. The middle third facial rejuvenation can be achieved by our standard temporal cheek face-lift, and the term midface-lift may be a misnomer.

Neuroendocrine carcinoma of the jugular foramen.

We describe what might have been the first reported case of a neuroendocrine carcinoma of the jugular foramen. A 50-year-old woman presented with progressive left-sided sensorineural hearing loss, vertigo, pulsatile tinnitus, headaches, and ataxia. Magnetic resonance imaging revealed a 4-cm left-sided jugular foramen tumor. The patient underwent near-total resection of the tumor. Despite lower cranial nerve preservation, postoperative paralysis of cranial nerves IX and X occurred, and vocal fold medialization was performed 5 days later. The final pathologic diagnosis was neuroendocrine carcinoma. The patient was treated with concurrent chemotherapy and intensity-modulated radiation therapy. This article will discuss the pathologic features and the management of jugular foramen tumors, along with the differential diagnosis of these rare tumors.

Surgical management of facial neuromas: lessons learned.

OBJECTIVE: Primary tumors of the facial nerve are rare, representing 1% of all intrapetrous lesions. We analyzed the management and surgical outcomes of 16 patients with multisegment facial neuromas treated at our institution during a 16-year period. STUDY DESIGN: A retrospective chart review. SETTING: Tertiary referral center. PATIENTS: All patients included in the study had surgical management of their facial neuroma. There were 9 women and 7 men. The mean age was 46 years, with a mean follow-up period of 3 years. INTERVENTION: Surgical excision (n = 15) or decompression (n = 1) of facial neuroma. MAIN OUTCOME MEASURES: Tumor location, presenting symptoms, hearing outcomes, and facial function. RESULTS: Thirteen (81%) patients had facial paresis as their presenting symptom. Unilateral hearing loss was present in 9 (56%) patients. Most tumors (n = 15) involved multiple segments of the facial nerve and ranged in size from 1.5 to 7 cm. Fifteen (94%) patients had the tumor completely excised, and 1 (6%) patient underwent needle decompression of the cystic component of the tumor. The geniculate ganglion was the most commonly involved (11 patients, 69%) segment of the nerve, followed by the labyrinthine and tympanic segments. Despite multiple types of reconstructive options used, the best recovery of facial function was a House-Brackmann Grade III in 12 patients. CONCLUSION: Treatment of facial neuromas depends on the extent of tumor, degree of facial paresis, and hearing function. We advocate complete resection of tumor when facial palsy exists. Patients with normal facial function and hearing may be advised on a more conservative treatment option such as radiologic observation, drainage of any cystic component of the tumor for histologic diagnosis, and/or bony decompression of the tumor.

Surgical outcomes following the endoscopic modified Lothrop procedure.

OBJECTIVE: We performed a systematic review of 97 patients in whom an entirely endoscopic modified Lothrop procedure (EMLP) was performed. We studied the safety, efficacy, need for revision surgery, and rate of complication following an EMLP. STUDY DESIGN: The study design was a retrospective chart analysis. METHODS: We performed a retrospective chart review and patient survey of 97 patients who underwent an EMLP at our institution from January 1999 to March 2006. Main outcomes measured were the need for revision surgery including an osteoplastic flap (OPF), improvement in patients' symptoms, and rate of cerebrospinal fluid (CSF) leak. RESULTS: The most common indication for the procedure was chronic frontal sinusitis and/or formation of mucocele. The frontal recess and floor of the frontal sinus were the most common areas of persistent disease. CSF leak rate was 1% (1/97) and was managed successfully at the time of surgery without any long-term sequelae. Twenty-two (23%) patients required revision surgery. Three (3%) patients required revision with an OPF. Some degree of symptomatic clinical improvement was reported by 98% (95/97) of patients. CONCLUSION: EMLP is a safe and effective surgical alternative to OPF for patients with recalcitrant frontal sinus disease. Major complications are rare. A large percentage of patients may require revision surgery.

Activity of nasal amphotericin B irrigation against fungal organisms in vitro.

BACKGROUND: The role of fungi in chronic rhinosinusitis has been described in recent reports. Controversy exists on the use of topical amphotericin B therapy as a treatment modality for this condition. The effect of various concentrations of amphotericin B nasal irrigation on actively growing fungi was studied in vitro. METHODS: Ten species of fungi commonly found in the nasal cavity were grown on growth media plates. Each fungi was exposed to 20 mL of amphotericin B nasal irrigation at concentrations of either 100, 200, or 300 microg/mL or sterile water two times daily for 6 weeks. Each plate was subcultured on a weekly basis to examine for any viable fungi. RESULTS: Fungi growth was not arrested in the 100-microg/mL amphotericin B and sterile water groups at the end of 6 weeks. Use of the 300-and 200-microg/mL amphotericin B solutions showed failure of the subcultured fungi to grow at 5 and 6 weeks, respectively. CONCLUSION: Nasal amphotericin B irrigation is ineffective in killing fungi in vitro at a concentration of 100 microg/mL over a 6-week period. Concentrations of 200 and 300 lig/mL successfully prevented fungi growth at the conclusion of the study. The current concentration of commercially available topical amphotericin B (100 microg/mL) seems ineffective in eradicating fungi in vitro.

Intracranial schwannomas of the lower cranial nerves.

OBJECTIVE: To present our experience in the diagnosis and management of 39 patients with lower cranial nerve schwannomas of the posterior fossa. STUDY DESIGN: A retrospective chart review of patient medical records. SETTING: Tertiary care, academic medical center. PATIENTS: All patients with intracranial lower cranial nerve schwannomas treated surgically in our institution between July 1998 and July 2005. INTERVENTION: A retrosigmoid, transcondylar, or combined approach was used for tumor recurrence. RESULTS: Thirty-nine patients underwent surgical resection, with complete tumor removal in 32, near-total resection in 5 patients, and subtotal tumor excision in 2 patients. Long-term (mean, 8.2 years) magnetic resonance imaging surveillance demonstrated recurrent tumor in 2 of 32 complete resections and slow regrowth in 2 of 7 patients with known residual disease. Only one of these four patients required reoperation. DISCUSSION: Intracranial schwannomas of the lower cranial nerves are relatively uncommon and may present with subtle or no clinical symptoms. Successful surgical resection with low risk of tumor recurrence can be achieved with the retrosigmoid or transcondylar approach. Morbidity, in this series, was primarily related to lower cranial nerve deficits.

Surgical treatment of pediatric cholesteatomas.

OBJECTIVE: : Management of pediatric cholesteatomas remains controversial. We reviewed our 16-year experience in the surgical treatment of cholesteatomas in children and describe a treatment paradigm. STUDY DESIGN: : The authors conducted a retrospective review. METHODS: : A total of 106 mastoidectomies (86 for an acquired cholesteatoma and 20 for a congenital cholesteatoma) were performed in children 16 years old and younger from 1988 to 2003. Follow up ranged from 2 years to 12 years with a mean follow-up period of 6 years. Hearing outcomes, cholesteatoma recidivism, and dry mastoid cavity were the main outcomes measured. RESULTS: : Seven (7%) patients had revision surgery for cholesteatoma recidivism. Rates of cholesteatoma recurrence for canal all up (CWU) and canal wall down (CWD) mastoidectomy groups were similar (8% vs. 6%). The percentage of patient with good serviceable hearing (pure-tone average

Perioperative complications with the bone-anchored hearing aid.

OBJECTIVE: To discuss perioperative complications associated with the bone-anchored hearing aid (BAHA) and their management. STUDY DESIGN AND SETTING: A retrospective review of 58 patients who underwent implantation of BAHA for unilateral conductive, mixed, or sensorineural hearing losses was performed at a tertiary referral center. RESULTS: Between September 2003 and June 2005, 58 patients underwent implantation of a BAHA. There were 30 female and 28 male patients, with a mean age of 48 years (range 8-80 years). Complications occurred in 19% (11/58) of patients. Most adverse events were seen early in the series. The most common complication, partial or complete loss of the skin graft, occurred in 10% (6/58) of patients. These were managed successfully with local wound care. Five percent (3/58) of patients had skin growth over the abutment. Two of these cases were managed with office debridement, whereas 1 patient required revision under general anesthesia. There was implant extrusion in 3% (2/58) of patients, and both of these patients later underwent successful reimplantation. All patients had their implant activated 3 months after surgery. There were no perioperative or postoperative deaths. CONCLUSION: Complications related to BAHA implantation are relatively minor and usually involve partial or complete loss of the skin graft. Most complications were successfully managed in the office.