1/155. Fourth branchial arch sinus: clinical presentation, diagnostic workup, and surgical treatment.OBJECTIVES/HYPOTHESIS: Abnormalities of the fourth branchial arch are much less common than those of the second arch and present in a different manner. The authors report their experience with five cases of fourth arch sinuses. methods: Retrospective chart review of patients at a tertiary care center. RESULTS: All patients presented in the first or second decade of life, and all but one had left-sided neck involvement. Four patients presented with recurrent low neck inflammatory episodes, and one with respiratory compromise. Diagnostic studies performed included ultrasound, computed tomography (CT) scan, barium swallow, magnetic resonance imaging, and fine-needle aspiration. barium contrast studies and CT scan were the most useful in demonstrating a fourth arch sinus tract preoperatively. Surgical treatment with an emphasis on complete exposure of the recurrent laryngeal nerve and exposure of the lateral piriform sinus to facilitate complete sinus tract excision was successful in all patients. CONCLUSION: The clinical history of recurrent low neck inflammatory episodes in young patients, especially on the left side, should raise the suspicion of this entity. Investigation using barium swallow in combination with CT scanning is useful. Excision of the sinus tract taking care not to injure the recurrent laryngeal nerve is curative.- - - - - - - - - - ranking = 1keywords = sinus (Clic here for more details about this article) |
2/155. Aberrant second branchial cleft fistula.Second branchial cleft cysts and sinuses rarely present diagnostic problems to the pediatric otolaryngologist as their course is usually predictable based on consistent embryologic development. However, we evaluated two fistula tracts that did not fit the classic description of second branchial tract fistulas. Upon radiographic and intraoperative evaluation, their eventual course ending in the tonsillar fossa was identified. Realizing the potential for aberrancy and using preoperative radiographic evaluation will assist the surgeon in the excision of these developmental anomalies with little risk to underlying neurovascular structures.- - - - - - - - - - ranking = 0.11111111111111keywords = sinus (Clic here for more details about this article) |
3/155. The role of positron emission tomography in occult primary head and neck cancers.PURPOSE: To evaluate the utility of positron emission tomography (PET) fluorodeoxyglucose (FDG) imaging in the workup of unknown primary head and neck tumors. methods: Fourteen patients with squamous cell carcinoma of cervical lymph node metastasis of unknown primary origin (clinical stage N2-N3) were studied prospectively. The patients underwent conventional workup, including physical examination, computed tomography, and random biopsies of the potentially suspected sites. If no primary site was found, 8 to 13 mCi of FDG was given intravenously, and whole-body scans with standardized uptake values were obtained. The results of FDG-PET imaging were compared with clinical, CT, and histopathologic findings. To eliminate bias, PET scans were reviewed by nuclear medicine physicians who had no previous knowledge of the other findings. RESULTS: PET identified the location of primary tumor in three patients: lung hilum, base of tongue, and pyriform sinus. These lesions were pathologically confirmed. All these primary sites were not visualized on CT or physical examination, except for a pyriform sinus lesion, which was seen on CT, but initial biopsy result was negative. In one patient, the initial PET did not identify a primary tumor, but a nasopharyngeal carcinoma was identified in post-radiation therapy follow-up PET. In the remaining nine patients, a primary lesion was never found. All cervical lymph nodes detected by CT were identified by PET. DISCUSSION: A previously unknown primary tumor can be identified with FDG-PET in about 21% of the patients in our prospective series. PET can be of value in guiding endoscopic biopsies for histologic diagnosis and treatment options.- - - - - - - - - - ranking = 0.22222222222222keywords = sinus (Clic here for more details about this article) |
4/155. Fourth branchial cyst presenting with neonatal respiratory distress.Fourth branchial cysts are quite rare. A neonate with a left lateral neck mass and respiratory distress was found to have a fourth branchial cyst, which was diagnosed with computed tomography and endoscopy. The characteristic computed tomography findings included an air-containing neck cyst, which was located at the anteromedial site of the common carotid artery with mediastinal extension. Endoscopic examination revealed an internal opening at the apex of the pyriform sinus, communicating with the cyst. Total excision of the cyst was performed, and the specimen, which showed ciliated columnar epithelium with a subepithelial lymphoid infiltrate, thyroid follicles, and thymic tissue, histologically confirmed the diagnosis.- - - - - - - - - - ranking = 0.11111111111111keywords = sinus (Clic here for more details about this article) |
5/155. Imaging of nonlaryngeal neuroendocrine carcinoma.The imaging and pathologic features of three cases of nonlaryngeal neuroendocrine carcinoma of the head and neck are described. Neuroendocrine carcinomas represent malignant epithelial neuroendocrine neoplasms and are classified as three types: typical carcinoid (well differentiated), atypical carcinoid (moderately differentiated), and small cell neuroendocrine (poorly differentiated) carcinomas. The CT and MR imaging features of these tumors are nonspecific. Paranasal sinus neuroendocrine carcinomas showed expansion and destruction of the sinus, whereas metastatic neuroendocrine carcinomas to an intraparotid lymph node presented as a circumscribed parotid mass on CT scans.- - - - - - - - - - ranking = 0.22222222222222keywords = sinus (Clic here for more details about this article) |
6/155. The use of intensity modulated radiotherapy for the treatment of extensive and recurrent juvenile angiofibroma.These case series are presented to describe the application and advantages of intensity modulated radiotherapy (IMRT) for the treatment of extensive and/or recurrent juvenile angiofibroma. Two patients were diagnosed with recurrence at 11 and 13 months postoperatively, and one was surgically unresectable. The affected areas included the base of skull, cavernous sinus, pterygopalatine fossa, infratemporal fossa, posterior orbit and nasopharynx. Highly conformal IMRT was delivered with limited radiation doses to the optic nerves, optic chiasm, brainstem, brain, spinal cord, lens, retina, mandible, and parotid. The total dose delivered to the tumor varied from 3400 to 4500 cGy. The tumor shrunk radiographically in all three cases and there was no endoscopic evidence of disease in two cases at 15 months and 40 months. There was no acute toxicity. Late toxicity was limited to one episode of epistaxis and persistent rhinitis in one patient. In conclusion, IMRT provides several advantages over conventional radiotherapy in the treatment of recurrent juvenile angiofibroma.- - - - - - - - - - ranking = 0.11111111111111keywords = sinus (Clic here for more details about this article) |
7/155. Fatal cerebral venous sinus thrombosis as major complication of metastatic cervical mass: computed tomography and magnetic resonance findings.Cerebral venous sinus thrombosis is an uncommon but potentially lethal condition, with mortality between 5.5-30 per cent. It was previously associated with infections of the orbit, mastoid or face, but, after the advent of antibiotics, the most common causes include neoplasms, dehydration, oral contraceptives, coagulopathies, collagen diseases, and pregnancy and the puerperium. We report a case of fatal cerebral venous sinus thrombosis in a 68-year-old patient with a metastatic cervical mass, who developed internal jugular vein thrombosis that progressed cranially to transverse and sagittal sinus thrombosis.- - - - - - - - - - ranking = 0.77777777777778keywords = sinus (Clic here for more details about this article) |
8/155. carotid sinus syndrome secondary to head and neck malignancy: case report and literature review.We report two cases of carotid sinus syndrome secondary to head and neck malignancy. The underlying mechanisms unique to head and neck malignancy and treatments of the syndrome are discussed.- - - - - - - - - - ranking = 0.55555555555556keywords = sinus (Clic here for more details about this article) |
9/155. Haemangiopericytoma of infratemporal fossa.Haemangiopericytomas (HPCs) are rare vascular tumours that commonly involve the soft tissues of the trunk and lower extremities. In the head and neck, the most common sites are the nasal cavity and the paranasal sinuses, and unusually, the orbital region, the parotid gland, and the neck. We report a patient with HPC that originated in the infratemporal fossa and involved the pterygopalatine and the middle cranial fossae, apparently the first such case to be reported. Although the patient has undergone resection on three separate occasions, the tumour recurred. We then performed an extended resection using the infratemporal fossa approach type D. The patient has shown no recurrence in the past five years. Although histopathologic confirmation of this malignancy may be difficult, extensive resection remains the most effective treatment in such cases.- - - - - - - - - - ranking = 2.148943829851keywords = paranasal sinus, paranasal, sinus (Clic here for more details about this article) |
10/155. Benign cervical cystic teratoma.Teratomas of the neck are rare in adults. Nine adult patients have been previously reported on in the world literature; six had malignant and three had benign lesions. Most of the lesions were seen as a mass in the neck, but teratoma is rarely considered in the differential diagnosis of neck lesions. A tenth patient, whose case we are presenting, had a supraclavicular sinus mass that was diagnosed at surgical exploration. The tumor was successfully resected and proved to be benign.- - - - - - - - - - ranking = 0.11111111111111keywords = sinus (Clic here for more details about this article) |
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