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American Journal of Otolaryngology - Head and Neck Medicine and Surgery0196-0709343May 2013 © 2013 Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.amjoto.com/article/PIIS0196070912002475/abstract?rss=yesAbstract: Purpose: A fungal etiology has been proposed to underlie severe nasal polyps (NP). Dectin-1 is an innate immune pattern recognition receptor which is involved in the recognition of some pathogenic fungi. We investigated the Dectin-1 levels in NP in order to evaluate the implication of such expression with respect to the development of NP.Materials and methods: Normal inferior turbinate tissues were obtained from forty patients undergoing surgery for augmentation rhinoplasty. Nasal polyp tissues were obtained from 53 patients who underwent endoscopic sinus surgery for chronic polypoid rhinosinusitis. Real-time polymerase chain reaction and Western blot analysis were performed to evaluate the mRNA and protein level of Dectin-1, respectively. ELISA was carried out to evaluate the cytokine production (IL-4, IL-5, IL-10, and TNF-α) in NP.Results: Real-time polymerase chain reaction and Western-blot analysis showed that Dectin-1 expression in NP was increased compared with that in normal nasal inferior turbinate tissues. ELISA results suggest that the local expression of type-1 and type-2 inflammatory cytokine is skewed toward type-2 inflammatory cytokine in NP.Conclusions: These results suggest that Dectin-1 may play a role in the development of NP, and the production of Dectin-1, IL-4 and IL-5 (type-2 cytokines), may mainly participate in the inflammatory reaction in NP.Increased expression of dectin-1 in nasal polypsJian Gong, Pei Wang, Ze-heng Qiu, Qiu-jian Chen10.1016/j.amjoto.2012.10.003American Journal of Otolaryngology - Head and Neck Medicine and Surgery 34, 3 (2013)2013-01-21American Journal of Otolaryngology - Head and Neck Medicine and Surgery2013-01-21343S0196-0709(13)X0003-1Original Contributions183187http://www.amjoto.com/article/PIIS0196070912002499/abstract?rss=yesAbstract: Purpose: The vascularized pedicled nasoseptal flap (PNSF) represents a successful option for reconstruction of large skull base defects after expanded endoscopic endonasal approaches (EEA). This vascularized flap can be harvested early or late in the operation depending on the anticipation of high-flow CSF leaks. Each harvesting technique (early vs. late) is associated with different advantages and disadvantages. In this study, we evaluate our experience with early harvesting of the PNSF for repair of large skull base defects after EEA.Methods: A retrospective review was performed at a tertiary care medical center on patients who underwent early PNSF harvesting during reconstruction of intraoperative high-flow CSF leaks after EEA between December 2008 and March 2012. Demographic data, repair materials, surgical approach, and incidence of PNSF usage were collected.Results: Eighty-seven patients meeting the inclusion criteria were identified. In 86 procedures (98.9%), the PNSF harvested at the beginning of the operation was used. In 1 case (1.1%), the PNSF was not used because a high-flow intraoperative CSF leak was not encountered. This patient had recurrence of intradural disease 8months later, and the previously elevated PNSF was subsequent used after tumor resection.Conclusion: Based on our data, a high-flow CSF leak and need for a PNSF can be accurately anticipated in patients undergoing EEA for skull base lesions. Because of the advantages of early harvesting of the PNSF and the high preoperative predictive value of CSF leak anticipations, this technique represents a feasible harvesting practice for EEA surgeries.Early harvesting of the vascularized pedicled nasoseptal flap during endoscopic skull base surgeryJean Anderson Eloy, Amit A. Patel, Pratik A. Shukla, Osamah J. Choudhry, James K. Liu10.1016/j.amjoto.2012.10.005American Journal of Otolaryngology - Head and Neck Medicine and Surgery 34, 3 (2013)2013-01-18American Journal of Otolaryngology - Head and Neck Medicine and Surgery2013-01-18343S0196-0709(13)X0003-1Original Contributions188194http://www.amjoto.com/article/PIIS0196070912002608/abstract?rss=yesAbstract: Purpose: The aim of this study is to rigorously evaluate the role of auditory brainstem response (ABR) testing in the diagnosis of vestibular schwannomas (VS).Materials and methods: Searches were conducted in multiple online databases, supplemented by hand searches. From the studies chosen for final inclusion, relevant data were extracted and meta-analysis of pooled data was performed.Results: 623 studies were identified from which 43 met inclusion criteria for analysis (1978 to 2009) including 3314 patients. Pooled sensitivity for ABR detection of vestibular schwannomas was 93.4% (95% CI 92.6–94.3, P=0.0000). For tumors less than 1cm (8 studies, 176 patients) sensitivity was 85.8% (95% CI 80.6–90.1, P=0.0116). For tumors greater than 1cm (6 studies, 251 patients) pooled sensitivity was 95.6% (95% CI 93.1–98.2, P=0.0660). Sensitivity of ABR to detect extracanalicular tumors was higher than for intracanalicular tumors, though pooled data were not statistically valid. Pooled specificity (8 studies, 2432 patients) was 82.0% (95% CI 80.5–83.6, P=0.0000).Conclusions: Although MRI remains the gold standard, emerging trends towards more conservative management coupled with limited financial resources may prompt many clinicians to review the role of ABR testing in screening for retrocochlear pathology. In light of the high sensitivity and specificity of ABR testing for VS, we strongly urge its reconsideration as a useful diagnostic tool for patients with clinically suspected VS.ABR in the diagnosis of vestibular schwannomas: A meta-analysisPaul D. Koors, Leroy R. Thacker, Daniel H. Coelho10.1016/j.amjoto.2012.11.011American Journal of Otolaryngology - Head and Neck Medicine and Surgery 34, 3 (2013)2013-01-16American Journal of Otolaryngology - Head and Neck Medicine and Surgery2013-01-16343S0196-0709(13)X0003-1Original Contributions195204http://www.amjoto.com/article/PIIS019607091200261X/abstract?rss=yesAbstract: Purpose: To determine whether patients with clinically node negative (cNo) high grade salivary gland carcinomas benefit from an elective neck dissection prior to postoperative radiotherapy (RT).Material/Methods: Between October 1964 and October 2009, 59 previously untreated patients with cNo high-grade salivary gland carcinomas (squamous cell carcinomas were excluded) were treated with curative intent using elective neck dissection (END; n=41), or elective neck irradiation (ENI; n=18) at the University of Florida College of Medicine (Gainesville, FL). All patients underwent resection of the primary cancer followed by postoperative RT. The median follow-up period was 5.2years (range, 0.3–34years).Results: Occult metastases were found in 18 (44%) of the 41 patients in the END group. There were 4 recurrences (10%) in the END group and 0 recurrence in the ENI group. Neck control rates at 5years were: END, 90%; ENI, 100%; and overall, 93% (p=0.1879). Cause-specific survival was 94% in the ENI group, 84% in the END group, and 86% for all patients (p=0.6998). There were 3 reported grade 3 or 4 toxicities. Two patients had a postoperative fistula and one patient had a grade 4 osteoradionecrosis that required a partial mandibulectomy.Conclusions: Patients with cNo high grade salivary gland carcinomas who are planned to undergo surgery and postoperative RT likely do not benefit from a planned neck dissection.Elective neck management for high-grade salivary gland carcinomaMichael P. Herman, John W. Werning, Christopher G. Morris, Jessica M. Kirwan, Robert J. Amdur, William M. Mendenhall10.1016/j.amjoto.2012.11.012American Journal of Otolaryngology - Head and Neck Medicine and Surgery 34, 3 (2013)2013-01-16American Journal of Otolaryngology - Head and Neck Medicine and Surgery2013-01-16343S0196-0709(13)X0003-1Original Contributions205208http://www.amjoto.com/article/PIIS0196070912002724/abstract?rss=yesAbstract: Objective: Magnesium is proved to attenuate acoustic trauma, and reactive oxygen species (ROS) formation is a critical role that involves hearing loss induced by impulse noise. We aimed to investigate the relationship between the cochlea magnesium content, ROS formation and hearing loss induced by impulse noise.Methods: Ninety pigmented guinea pigs were exposed to impulse noise. Auditory thresholds were assessed by sound-evoked auditory brainstem response (ABR) 24h before and 72h after exposure to impulse noise. 4-Hydroxynonenal(HNE) used as a marker of ROS was determined immunohistochemically. The cochlea magnesium content was examined with the method of energy dispersive x-ray analysis, and the cochlea was also detected with scanning electron microscope. The relationship between the cochlea magnesium content, ROS formation and hearing loss was analyzed.Results: There was loss of outer hair cell cilia accompanying with significant auditory threshold shift after impulse noise exposure. ROS was positive in the organ of Corti of all animals. The cochlea magnesium content was negatively correlated with ROS formation and hearing loss.Conclusions: Inhibiting ROS formation is one of the mechanisms for magnesium to reduce acoustic trauma, and difference in cochlea magnesium contents is one of the factors that induce varying degrees of cochlear damage among each individual after acoustic trauma.The cochlea magnesium content is negatively correlated with hearing loss induced by impulse noiseMin Xiong, Jian Wang, Chuanhong Yang, Huangwen Lai10.1016/j.amjoto.2012.11.015American Journal of Otolaryngology - Head and Neck Medicine and Surgery 34, 3 (2013)2013-01-18American Journal of Otolaryngology - Head and Neck Medicine and Surgery2013-01-18343S0196-0709(13)X0003-1Original Contributions209215http://www.amjoto.com/article/PIIS0196070912002748/abstract?rss=yesAbstract: Purpose: The purpose of this study was to assess the role of minimally invasive endoscopic diverticulostomy in patients who develop hypopharyngeal diverticulum after cervical spine surgery/fixation.Materials and methods: This is a retrospective case series of seven patients who underwent endoscopic management of a symptomatic hypopharyngeal diverticulum. The patients were analyzed for diverticulum size, pre-operative and post-operative dysphagia and regurgitation scores, and complications. The overall success with the endoscopic approach was compared to the prior experience with traditional Zenker's diverticulum.Results: Of the seven patients with hypopharyngeal diverticulum, four were successfully managed with minimally invasive endoscopic diverticulostomy (57%). These four patients all demonstrated clinically significant improvement in both dysphagia and regurgitation scores at a minimum of 6months postoperatively. Complications were minimal and consisted of one case with postoperative subcutaneous air. There were no cases of fistula, mediastinitis, or nerve injury.Conclusions: Minimally invasive endoscopic diverticulotomy can be successfully applied to patients who develop hypopharyngeal diverticulum after cervical spine surgery/fixation.Hypopharyngeal diverticulum after cervical spine surgery; The role of endoscopic managementSheena M. Rippentropp, Frank R. Miller10.1016/j.amjoto.2012.12.001American Journal of Otolaryngology - Head and Neck Medicine and Surgery 34, 3 (2013)2013-01-14American Journal of Otolaryngology - Head and Neck Medicine and Surgery2013-01-14343S0196-0709(13)X0003-1Original Contributions216218http://www.amjoto.com/article/PIIS0196070912002578/abstract?rss=yesAbstract: Cervical radiotherapy for treatment of head and neck cancer can result in the delayed carotid vasculopathy. Surgical management for an ensuing hemorrhage is challenging due to the associated high mortality and morbidity. We present a case of a relative rapid formation of common carotid pseudoaneurysm formation with subsequent carotid blowout syndrome in previously irradiated neck. Successful treatment in our patient is highlighted by the fact that multiple, contiguous endovascular stents were placed emergently to obtain control of pseudoaneurysm rupture.Rare treatment of radiation induced carotid pseudoaneurysm and ensuing carotid blowout syndrome with placement of multiple contiguous endovascular stents: A case reportSamip N. Patel, Eric Sauvageau, Tapan A. Padhya10.1016/j.amjoto.2012.11.008American Journal of Otolaryngology - Head and Neck Medicine and Surgery 34, 3 (2013)2013-01-16American Journal of Otolaryngology - Head and Neck Medicine and Surgery2013-01-16343S0196-0709(13)X0003-1Clinical Radiology219222http://www.amjoto.com/article/PIIS0196070913000161/abstract?rss=yesAbstract: Divided nevus, which is also known as “kissing nevus,” “split ocular nevus” and “panda nevus” is a rare congenital dermatological abnormality that occurs on opposing margins of upper and lower eyelids. There is a paucity of literature on this rare anomaly, with most knowledge from this disease process derived from isolated case reports and series. The purpose of this study is to report a new case of divided nevus of the eyelid and to discuss the unique embryology, pathology, and potential treatment options for this rare entity. A systematic review of literature was performed of the English literature on PubMed and Medline with just under 150 cases reported in the literature. The vast majority of the divided nevi seen in this review were medium sized and of the melanocytic intradermal type. There were no described cases of malignant transformation in any of the documented cases. Numerous methods for reconstruction were described including the entire reconstructive ladder with both one and two staged approaches. In this review, we present basic guidelines to the reconstruction of these complicated defects, although ultimate treatment should be individualized and dependent on surgeon comfort.Divided nevus of the eyelid: Review of embryology, pathology and treatmentShaun C. Desai, Scott Walen, John B. Holds, Gregory Branham10.1016/j.amjoto.2013.01.004American Journal of Otolaryngology - Head and Neck Medicine and Surgery 34, 3 (2013)2013-02-04American Journal of Otolaryngology - Head and Neck Medicine and Surgery2013-02-04343S0196-0709(13)X0003-1Current Review223229http://www.amjoto.com/article/PIIS0196070912002517/abstract?rss=yesAbstract: This report describes a three generation family with late onset bilateral sensorineural hearing impairment (BLSNHI) and tinnitus in which a novel mutation in the COCH gene was identified after a genome-wide linkage approach. The COCH gene is one of the few genes clinically examined when investigating the etiology of autosomal dominant late onset hearing impairment. Initially mutations in the COCH gene were only reported in exons 4 and 5, coding for the LCCL protein domain. More recently, additional mutations have been identified in exon 12, the only mutations identified outside of the LCCL domain. Currently clinical genetic testing for the COCH gene primarily focuses on identifying mutations in these three exons. In this study, we identify a novel mutation in the COCH gene in exon 11, which, like the exon 12 mutations, falls within the vWFA2 protein domain. This finding reinforces the need for clinical genetic screening of the COCH gene to be expanded beyond the current limited exon screening, as there is now more evidence to support that mutations in other areas of this gene are also causative of a similar form of late onset BLSNHI.Novel COCH mutation in a family with autosomal dominant late onset sensorineural hearing impairment and tinnitusEmily Gallant, Lauren Francey, Heather Fetting, Maninder Kaur, Hakon Hakonarson, Dinah Clark, Marcella Devoto, Ian D. Krantz10.1016/j.amjoto.2012.11.002American Journal of Otolaryngology - Head and Neck Medicine and Surgery 34, 3 (2013)2013-01-31American Journal of Otolaryngology - Head and Neck Medicine and Surgery2013-01-31343S0196-0709(13)X0003-1Case Reports230235http://www.amjoto.com/article/PIIS0196070912002554/abstract?rss=yesAbstract: Herpes simplex virus infection of the larynx is an exceedingly rare clinical entity, most frequently reported in the pediatric population or in immunocompromised adults. We present a 62-year-old woman presented with neck pain, hoarseness, crepitus over the larynx, and what appeared to be a necrotic mass of the right true vocal cord on laryngoscopy. Due to near-complete destruction of the cartilaginous framework of the larynx, a total laryngectomy was performed. The final pathology report showed squamous mucosal changes consistent with herpes simplex infection, confirmed by immunohistochemical staining. Though herpes simplex laryngitis is uncommon, this case shows the potential for herpes simplex to cause extensive damage and compromise airway patency when left untreated.Herpes simplex infection of the larynx requiring laryngectomyJohn R. Sims, Nicole A. Massoll, James Y. Suen10.1016/j.amjoto.2012.11.006American Journal of Otolaryngology - Head and Neck Medicine and Surgery 34, 3 (2013)2013-01-16American Journal of Otolaryngology - Head and Neck Medicine and Surgery2013-01-16343S0196-0709(13)X0003-1Case Reports236238http://www.amjoto.com/article/PIIS0196070912002566/abstract?rss=yesAbstract: Castleman disease is a rare lymphoproliferative disorder with two primary subtypes that vary in presentation and course. Unicentric Castleman disease (UCD) presents as a solitary mass, most commonly in the mediastinum, and rarely in the head and neck. In contrast to multicentric Castleman disease (MCD), which features peripheral lymphadenopathy and numerous systemic symptoms, UCD is not typically associated with generalized symptoms. Here, we present an unusual case of UCD presenting as a slowly expanding, isolated neck mass in a 29-year-old woman. This case demonstrates the distinguishing clinical, radiologic, and histologic findings unique to UCD, which is often misdiagnosed as lymphoma or other malignant process. These findings stand in contrast to those observed in MCD patients, and hence, offer insight into the practical aspects of diagnosis and management of Castleman disease in the head and neck.Castleman disease presenting in the neck: Report of a case and review of the literatureSidharth V. Puram, Robert P. Hasserjian, William C. Faquin, Harrison W. Lin, James W. Rocco10.1016/j.amjoto.2012.11.007American Journal of Otolaryngology - Head and Neck Medicine and Surgery 34, 3 (2013)2013-02-04American Journal of Otolaryngology - Head and Neck Medicine and Surgery2013-02-04343S0196-0709(13)X0003-1Case Reports239244http://www.amjoto.com/article/PIIS019607091200258X/abstract?rss=yesAbstract: We report on a patient with Lyme disease who presented with chronic bilateral otitis media and cranial neuropathy with rapid progresive hearing loss. After ceftriaxone and high-dose intravenous immunglobulins, the disease was controlled only with methylprednisolone and cyclophosphamide. The relationship between Lyme disease and granulomatous vasculitis is discussed. Lyme disease should be kept in mind in the differential diagnosis of various otolaryngological and neurological presentations.Rapid progressive bilateral hearing loss due to granulomatous otitis media in Lyme diseaseAlma Maniu, Laura Damian10.1016/j.amjoto.2012.11.009American Journal of Otolaryngology - Head and Neck Medicine and Surgery 34, 3 (2013)2013-01-14American Journal of Otolaryngology - Head and Neck Medicine and Surgery2013-01-14343S0196-0709(13)X0003-1Case Reports245247http://www.amjoto.com/article/PIIS0196070912002591/abstract?rss=yesAbstract: Vestibulopathy is a condition characterized by the onset of vertigo, nausea and vomiting, in the absence of hearing loss or tinnitus. The differential diagnosis includes peripheral otologic disorders and central disorders such as vascular insufficiency. Modified Blalock–Taussig (B–T) shunt, a polytetrafluoroethylene graft from the subclavian artery to the pulmonary artery, has become the palliative procedure of choice in cyanotic congenital heart disease patients. This palliative surgery creates a similar vascular haemodynamic to that seen in the subclavian steal syndrome and when associated with aplasia, hypoplasia or stenosis of the contralateral carotid, vertebral or posterior communicating arteries it may predispose to vascular hypoperfusion and peripheral hypofunctioning of the vestibular system. We report the case of a cyanotic congenital heart disease patient with vertigo and dizziness who underwent a modified B–T fistula on childhood and developed, many years later, a vertiginous syndrome probably of vascular origin.Vestibulopathy after a modified Blalock–Taussig procedure in a cyanotic congenital heart disease patientEfrén Martínez-Quintana, Fayna Rodríguez-González10.1016/j.amjoto.2012.11.010American Journal of Otolaryngology - Head and Neck Medicine and Surgery 34, 3 (2013)2013-02-11American Journal of Otolaryngology - Head and Neck Medicine and Surgery2013-02-11343S0196-0709(13)X0003-1Case Reports248251http://www.amjoto.com/article/PIIS0196070912002621/abstract?rss=yesAbstract: Inflammatory pseudotumor of the nasopharynx is a rare diagnosis that is often misinterpreted as carcinoma or lymphoma. It has been referred to as a tumefactive fibroinflammatory lesion, idiopathic pseudotumor, and fibrosing inflammatory pseudotumor. We present a rare case of a 40-year-old African American female from Kenya with inflammatory pseudotumor of the nasopharynx with perineural spread of disease along the trigeminal nerve to discuss the diagnosis and treatment of such an uncommon entity.Inflammatory pseudotumor of the nasopharynx with spread along the trigeminal nerveJudith Gadde, Bryan Franck, Xiang Liu, Michael Teixido, Habib Rizk10.1016/j.amjoto.2012.11.013American Journal of Otolaryngology - Head and Neck Medicine and Surgery 34, 3 (2013)2013-01-31American Journal of Otolaryngology - Head and Neck Medicine and Surgery2013-01-31343S0196-0709(13)X0003-1Case Reports252254http://www.amjoto.com/article/PIIS0196070912002633/abstract?rss=yesAbstract: The emissary veins are residual connections between intracranial venous sinuses and their extracranial drainage, which if not diagnosed preoperatively could be a cause of severe hemorrhage at the time of surgery which may be life threatening. The petrosquamosal emissary sinus (PSS) which is a rare embryonic emissary vein along the petrosquamosal fissure of the temporal bone connects dural sinuses with external jugular venous system. The PSS has been known to regress during fetal and early postnatal life. The imaging diagnosis of the PSS has been rarely reported in humans. We report the presence of the PSS with laterally located sigmoid sinus in patient with chronic otitis media. Our hope is that this report will be useful to the otologist during surgery.The neglected emissary vein in mastoidectomy; persistent petrosquamosal sinus in the laterally located sigmoid sinusJeong Hwan Choi, Hoon Young Woo10.1016/j.amjoto.2012.11.014American Journal of Otolaryngology - Head and Neck Medicine and Surgery 34, 3 (2013)2013-01-16American Journal of Otolaryngology - Head and Neck Medicine and Surgery2013-01-16343S0196-0709(13)X0003-1Case Reports255257http://www.amjoto.com/article/PIIS0196070912002736/abstract?rss=yesAbstract: Facial nerve schwannoma (FNS) is an extremely rare benign tumour that may arise anywhere along the course of the facial nerve; the standard treatment is total removal via microsurgery. Stereotactic radiotherapy has been shown to be effective in the treatment of skull base tumours, in particular for acoustic neuromas; it is interesting to notice that also the few data existing in literature about the use of radiotherapy for non acoustic schwannomas show an excellent local control rate and few adverse effects. Here we report a case of facial nerve neuroma, involving the nerve sheath from the geniculate ganglion to the parotid gland, treated with fractionated stereotactic radiotherapy after debulking surgery.Intra-parotid facial nerve schwannoma with intra-temporal extension; a case report. Is there a role for stereotactic radiotherapy?Gianluca Ingrosso, Elisabetta Ponti, Daniela di Cristino, Sara Terenzi, Sara Cicchetti, Pasquale Morelli, Roberto Miceli, Ernesto Bruno, Riccardo Santoni10.1016/j.amjoto.2012.11.016American Journal of Otolaryngology - Head and Neck Medicine and Surgery 34, 3 (2013)2013-01-14American Journal of Otolaryngology - Head and Neck Medicine and Surgery2013-01-14343S0196-0709(13)X0003-1Case Reports258261http://www.amjoto.com/article/PIIS0196070912002773/abstract?rss=yesAbstract: Castleman’s disease (CD) is a rare, benign lymphoproliferative disorder. The association of human herpes virus 8 (HHV8) and human immunodeficiency virus infections with CD is well established however the role of Epstein-Barr Virus in CD is less well understood. We present a unique case of Castleman’s disease in a patient with concomitant EBV infection, which mimicked the clinical presentation of Nasopharyngeal Carcinoma (NPC) versus lymphoma. After a delayed diagnosis, the patient underwent a left superficial parotidectomy and neck dissection and has had no recurrence of disease.A unique presentation of Epstein-Barr virus-associated Castleman's diseaseHeather Gomes, Phillip Huyett, Nora Laver, Richard O. Wein10.1016/j.amjoto.2012.12.003American Journal of Otolaryngology - Head and Neck Medicine and Surgery 34, 3 (2013)2013-02-11American Journal of Otolaryngology - Head and Neck Medicine and Surgery2013-02-11343S0196-0709(13)X0003-1Case Reports262264http://www.amjoto.com/article/PIIS0196070913000112/abstract?rss=yesAbstract: We report a case of near-complete remodeling of the anterior table of the frontal sinus after treatment for an erosive Pott's Puffy Tumor. A 61-year-old male presented with progressive swelling of his left forehead. Examination showed a doughy left forehead mass, and a sinus CT showed a lateral left frontal sinus mucocele with complete anterior table erosion. Frontal trephination with marsupialization of the mucocele was performed, and at 8 month follow-up, the patient had no visible defect and only minimally palpable bony defect. The anterior table had remodeled with no additional intervention resulting in a cosmetic outcome imperceptible from the patient's baseline.Anterior table remodeling after treatment for Pott's Puffy TumorCorbin D. Sullivan, David M. Poetker10.1016/j.amjoto.2012.12.018American Journal of Otolaryngology - Head and Neck Medicine and Surgery 34, 3 (2013)2013-01-28American Journal of Otolaryngology - Head and Neck Medicine and Surgery2013-01-28343S0196-0709(13)X0003-1Case Reports265267http://www.amjoto.com/article/PIIS0196070913000094/abstract?rss=yesAbstract: Introduction: Sarcoidosis is a multisystem granulomatous disease of unknown etiology, occasionally presenting with signs and symptoms that occur within the head and neck. Recently, granulomatous reactions and cases of sarcoidosis have been reported in patients treated with anti-TNF agents.Methods: This report describes a 56-year-old man who developed sarcoidosis in the hypopharynx during adalimumab therapy for psoriatic arthritis. A retrospective review of the literature was performed using the PubMed database.Results: In our patient, a chronic granulomatous reaction consistent with sarcoidosis developed after 2 years of continuous treatment with adalimumab. The diagnosis of sarcoidosis was established by the typical well-formed non caseating granulomas on biopsy, after excluding all other granulomatous conditions. Following withdrawal of anti-TNF agents and a course of steroids, the clinical picture resolved.Conclusions: The development of sarcoidosis during treatment with TNF-a antagonists represents a rare and paradoxical adverse event. To our knowledge this is the first case of sarcoidosis of the hypopharynx reported in the literature.Sarcoidosis-like granulomatosis of the hypopharynx as a complication of anti-TNF therapyArtemis Christoforidou, John Goudakos, Mattheos Bobos, Efthimios Lefkaditis, Victor Vital, Konstantinos Markou10.1016/j.amjoto.2012.12.016American Journal of Otolaryngology - Head and Neck Medicine and Surgery 34, 3 (2013)2013-01-28American Journal of Otolaryngology - Head and Neck Medicine and Surgery2013-01-28343S0196-0709(13)X0003-1Case Reports268272http://www.amjoto.com/article/PIIS0196070913000847/abstract?rss=yesEditorial Board10.1016/S0196-0709(13)00084-7American Journal of Otolaryngology - Head and Neck Medicine and Surgery 34, 3 (2013)2013-05-01American Journal of Otolaryngology - Head and Neck Medicine and Surgery2013-05-01343S0196-0709(13)X0003-1FrontmatterA1A1http://www.amjoto.com/article/PIIS0196070913001087/abstract?rss=yesTable of Contents10.1016/S0196-0709(13)00108-7American Journal of Otolaryngology - Head and Neck Medicine and Surgery 34, 3 (2013)2013-05-01American Journal of Otolaryngology - Head and Neck Medicine and Surgery2013-05-01343S0196-0709(13)X0003-1FrontmatterA2A3http://www.amjoto.com/article/PIIS0196070913000859/abstract?rss=yesGuidelines for Contributing Authors10.1016/S0196-0709(13)00085-9American Journal of Otolaryngology - Head and Neck Medicine and Surgery 34, 3 (2013)2013-05-01American Journal of Otolaryngology - Head and Neck Medicine and Surgery2013-05-01343S0196-0709(13)X0003-1FrontmatterA4A5