Pneumocele of the maxillary sinus. Report of a case.

The first two cases of pneumocele of the maxillary sinus have been recently published. The expanded antrum produced a different initial complaint in each case. A third case, with yet another initial problem, middle ear effusion, is now reported. The roentgenographic and operative findings and the therapeutic effect of decompression by antrostomy would suggest that this is a specific disease entity, presumably due to a check valve obstruction of the sinus ostium.     

Epidermolysis bullosa and its E.N.T. manifestations. Two case reports

The present paper describes two rare cases of epidermolysis bullosa dystrophica (recessive), one with oesophageal stricture and another with laryngeal stenosis, along with other usual features of the disease. Different views on the line of treatment of the oesophageal stricture as a complication of this dreadful disease are discussed. Replacement of the strictured oesophagus by coloplasty may be contemplated in the first case, if the patient develops increasing dysphagia. In the second case, with cicatrical stenosis of the larynx and hoarseness of voice which is a rare complication of the disease, not reported in the literature so far, a tracheostomy is contemplated when the child develops acute respiratory distress. These two cases are under observation.     

Case assignment in agrammatism.

Agrammatic speech is characterized by the omission and substitution of grammatical morphemes. Some recent papers suggest that certain patterns of omission and substitution are ruled by linguistic, that is, syntactic processes (e.g., Hagiwara, 1995; Friedmann & Grodzinsky, 1997; Bastiaanse & Van Zonneveld, 1998). In the present paper, the omission pattern of case markers in the spontaneous speech of Dutch and German speakers with agrammatic aphasia is analyzed within the framework of Chomsky's (1986) case theory, which says that every phonetically realized NP must receive (abstract) case. The inflected verb (I) assigns nominative case to the subject in the sentence, and the verb (V) assigns dative and accusative case to the indirect and direct object, respectively. This, in combination with the knowledge that verbs and verb inflections are notoriously difficult for speakers with agrammatism, served as the basis for this study. We hypothesize that, if no case assigner is produced, the noun will receive nominative case by default or the case marking morpheme (i.e., the determiner) will be omitted. This hypothesis has been tested and was supported by the data.     

The Interesting Case No. 42. Differential diagnosis of epistaxis

Epistaxis is a symptom and one of the most frequent medical emergencies. In most cases haemorrhages concern the anterior parts of the septum, in particular the Locus Kiesselbachi. Thus they are harmless and therapy is easy to handle. We report a case of a 55-year-old lady with relapsing epistaxis due to a pseudoaneurysm after surgery of a meningioma of the sphenoid bone. This type of epistaxis is rare and may culminate into a life-threatening event. The case demonstrates the importance of an exact differential diagnostic evaluation by use of modern imaging techniques for severe and life-threatening symptomatic nose-bleeding.     

Pneumoparotitis.

Pneumoparotitis is a rare cause of parotid enlargement. It is due to a reflux of air through Stensen's duct into the acini of the parotid gland with subsequent dilatation. We report a case which followed a long history of autoinflation of the middle ears by the Valsalva manoeuvre. The plain radiographic, sialographic and ultrasound findings are presented.     

Diverticulum hypopharyngis lateralis with a record of one case.

A case of lateral hypopharyngeal diverticula is reported. This type of diverticula is comparatively rare. The diagnosis can be made clinically and confirmed by x-ray examination and hypopharyngoscopy. A pharyngocoele is of differential importance as this may be present in many patients during Valsalva, but does not indicate treatment. The reported case is most probably caused by a development defect in the third branchial cleft.     

Labyrinthine anomalies with normal cochlear function.

Three cases of labyrinthine anomaly confirmed by polytomography and CT scan are reported. They showed similar dysplasia of the bony labyrinth: dilation and fusion of the lateral semicircular canal (SCC) and of the vestibule with a normally shaped cochlea and other SCCs. One side was involved in 2 cases and both sides in 1 case. The 1st case showed normal hearing levels with markedly reduced response to caloric stimulation in the affected ear. The 2nd case showed conductive hearing loss due to cholesteatoma with normal bone conduction hearing levels and normal caloric response. The 3rd case showed bilateral conductive hearing loss of unknown cause. The classification of labyrinthine anomalies and labyrinthine functions is discussed. Labyrinthine anomaly detected by CT scan and polytomography can be present in patients with normal cochlear and/or vestibular function.     

Hereditary enamel dysplasia. Therapeutic approach apropos of 2 cases]

Two cases of hereditary dysplasia in the same generation of a family are presented. The genetic line is suggestive of a dominant transmission. The therapeutic attitude in each case: --Orthodontic, endodontic and prosthetic rehabilitation in the 1st case. At the patient's strong urging, a total fixed denture was made, which made it possible to correct moderate protrusion of the incisors and to obtain the aesthetic result desired by the patient. This work was carried out in the Stomatological Clinic of Lyon, by students working for their specialty certificate in stomatology. --In the case of the younger sister, the presence of a markde skeletal open-bite and the refusal of any surgical solution led to the total extractions requested by the patient. A mobile denture was made by her own dentist. Thus complete assessment and knowledge of the patient's precise wishes make it possible to adopt the most desirable therapeutic approach in each case.     

Internal carotid artery dissection following rigid esophagoscopy.

A case of internal carotid artery dissection that developed after rigid esophagoscopy is described. The diagnosis was suggested by the clinical presentation and confirmed by the findings of radiological examinations. Internal carotid artery dissection is a rare condition of controversial etiology. Most frequently, the cause is unknown and the condition is termed idiopathic. A few cases have occurred after forceful cervical extensions and manipulations. The pathogenesis in our case is uncertain: while the rigid esophagoscopy is the most probable cause, the intubation and spontaneous carotid artery dissection cannot be ruled out.     

Retropharyngeal mediastinal pneumatocele. Report of a case.

We report the case of an infant with penetrating neck trauma followed by an upper respiratory tract obstruction. This case presented a diagnostic and management dilemma because of the development of an unusual retropharyngeal collection of air. In our review of the medical literature, we were unable to find any other case with a similar manifestation and clinical course.     

Tuberculosis of the larynx.

Tuberculosis of the larynx, once a common disease, has become quite rare with the advent of anti-tuberculous chemotherapy. In the pre-antibiotic era two modes of laryngeal infection were recognized; bronchogenic and hematogenous. The literature is briefly reviewed. Thirteen patients in the past 15 years in whom tuberculous laryngitis was diagnosed upon indirect laryngoscopy by members of the University of Michigan Department of Otorhinolaryngology are presented. Bronchogenic infection was present in 11, and in two patients the disease was consistent with hematogenous spread. Tissue biopsy from a case of bronchogenic contamination demonstrated epithelioid tubercles, while numerous subepithelial acid-fast bacilli without typical tuberculous histological change were present in a case of hematogenous laryngeal infection. A case of cicatricial laryngeal stenosis was successfully treated surgically by laryngofissure, excision of fibrosis with arytenoidectomy, and free mucous membrane grafting. Finally, the initial subtle presentation of many of our patients emphasizes the importance of a consideration of tuberculosis in the differential diagnosis of chronic laryngitis.     

Traumatic esophagopericardial fistula.

The pathological state of esophagopericardial fistula is a rare phenomenon. Its etiology may be either traumatic or disease induced. In either event, it is a most serious condition with a frequently fatal outcome. This case report concerns itself with an iatrogenic induced esophagopericardial fistula which was successfully treated by a thoracotomy and pericardotomy.     

Malignant oncocytoma of the nasal cavity: a case report.

Malignant oncocytoma is a rare clinical entity and is most commonly seen in the salivary glands. Its occurrence in the nasal cavity is extremely rare, and only 4 such cases have been reported in the literature. The authors report one such case in a 60-year-old woman, which presented as a slow-growing nasal mass arising from the nasal septum, with no lymph node metastasis, which was successfully managed by a combined modality of treatment-surgery followed by radiation therapy. The relevant literature has been reviewed. The case is discussed as a possible differential diagnosis for a mass in the nose.     

Subdural empyema complicating acute frontal sinusitis. Four cases report

OBJECTIVE: Subdural empyema is a collected cranioencephalic suppuration between arachnoid and dura meninge space. Subdural empyema occurring after sinusitis is an uncommon but serious complication of paranasal sinus infections. The purpose of this study is to aware the clinician about this condition. MATERIAL ET METHOD: Four young male children had been admitted with expressed fronto-ethmoid sinusitis. The intracranial infection was confirmed by computed tomography scan of brain and sinus. Both drainage of the sinus and intracranial suppuration was performed at the same time surgical procedure and antibiotics administered during 4 weeks. RESULTS: The subdural empyema was localized in the right temporoparietal region in 1 case, in the frontal lobe in the others cases. In 1 case, the frontal subdural empyema was associated with an inerhemispherique collection. One patient underwent a second drainage. Immediate post-operative outcomes were temporally complicated with convulsions and focal neurological deficit, in 1 case. This symptoms had regressed spontaneously. There was no case of death. The functional prognosis was bad, marked by lost vision in 2 cases, which was bilateral in 1 case. CONCLUSION: A high index of suspicion of intracranial extension of sinus infection must recommended neuroradiological investigations. When suppurative collection is confirmed, an appropriated management of the infection between otorhinolaryngologists and neurosurgeons is necessary.     

Granular cell myoblastoma of the larynx.

Two cases of granular cell myoblastoma of the larynx are presented. In the first case the tumour was excised by laryngofissure, and in the second case by microlaryngoscopy. Based on this experience a review of this interesting tumour is made, and emphasis is given to the fact that this neoplasm may be mistaken for squamous cell carcinoma.     

Hiccups. A case presentation and etiologic review.

Hiccups (singultus) usually present as a common annoyance lasting for short periods. Rarely, they may be the harbinger of a serious disease. We present the case of a 19-year-old man in which intractable hiccups was the first and most prominent symptom of a serious underlying neurologic disorder. The patient had been examined by his pediatrician, and despite multiple medical regiments and physical maneuvers, his symptoms persisted. A thorough head and neck examination revealed a right-sided vocal cord paralysis. This finding prompted obtaining a magnetic resonance imaging scan, which demonstrated a type I Arnold-Chiari malformation associated with a large cervicothoracic syringomyelia. The patient was referred to the neurosurgical service and subsequently underwent a ventriculoperitoneal shunt placement. There was considerable initial improvement in his neurologic status and cessation of the hiccups. However, the symptoms recurred within 1 month. The case report as well as a brief review of the relevant pathophysiologic and etiologic considerations and several treatment modalities for hiccups is presented.     

Ameloblastoma of the mandible with intracranial metastasis. A case study.

Ameloblastoma is an aggressive locally recurring neoplasm of odontogenic epithelium. We describe a case of a mandibular ameloblastoma with a 17-year history of local recurrences followed by two metachronous intracranial metastases. Central nervous system metastasis without pulmonary involvement is previously unreported in a living patient with ameloblastoma. The behavior of this tumor qualifies it as a malignant ameloblastoma.     

Augmentation rhinoplasty in nasal sarcoidosis.

We present a case of nasal deformity due to sarcoidosis. The surgical management is discussed. The risk of secondary involvement of implanted autologous cartilage by the disease is emphasized. For this reason an inert allograft (silastic) is recommended for augmentation in this group of patients.     

Primary nasopharyngeal paraganglioma: a case report.

We report a 49-year-old man with a paraganglioma involving the nasopharynx, which according to the literature is the fourth case in Japan and the twentieth in the world. The initial histopathologic findings of the biopsy specimen from the nasopharyngeal tumor suspected a carcinoid tumor. However, the final histopathologic diagnosis from the surgically resected specimen was paraganglioma, determined by electron microscopy and using several stains, such as Grimelius and Neuron-specific enolase (NSE) stains. We wish to add this case of "primary" nasopharyngeal paraganglioma to the literature, and to report the pathologic findings and clinical course of this unusual case.     

Lymphomatoid granulomatosis of the larynx in a renal transplant recipient.

This is a case of lymphomatoid granulomatosis in a renal transplant patient, which presented as an ulcerating pharyngeal lesion and caused death by exsanguination from carotid artery erosion. The diagnosis was established at limited necropsy on the basis of a characteristic vaso-infiltrative and atypical lymphoreticular infiltration as defined by Liebow, et al, in 1972. As far as can be ascertained, this is the second reported case of lymphomatoid granulomatosis in an immunosuppressed patient and also is a presumed localized extrapulmonary form of this disorder which has recently been reported. The striking histologic similarities to midline malignant reticulosis are discussed.