Obstructive sleep apnea in an infant with prominent glossopharyngeal muscles: therapy and outcome

We present a case of prominent glossopharyngeal muscles causing severe obstructive symptoms in a 3-month-old child. Preoperative sleep studies and dynamic microdirect laryngoscopy were used in evaluation of the patient. Postoperative sleep studies confirmed a substantial reduction in apneic events after release of the muscle folds. The literature addresses the variant anatomy, and treatment options are discussed. To our knowledge, this is the first case report of prominent glossopharyngeal muscles leading to apneic events. We propose that in patients with prominent glossopharyngeal folds, surgical release may significantly improve symptoms of sleep apnea and in severe cases prevent tracheostomy.     

Consequences of neural asynchrony: A case of auditory neuropathy

Abstract The neural representation of sensory events depends upon neural synchrony. Auditory neuropathy, a disorder of stimulus-timing-related neural synchrony, provides a model for studying the role of synchrony in auditory perception. This article presents electrophysiological and behavioral data from a rare case of auditory neuropathy in a woman with normal hearing thresholds, making it possible to separate audibility from neuropathy. The experimental results, which encompass a wide range of auditory perceptual abilities and neurophysiologic responses to sound, provide new information linking neural synchrony with auditory perception. Findings illustrate that optimal eighth nerve and auditory brainstem synchrony do not appear to be essential for understanding speech in quiet listening situations. However, synchrony is critical for understanding speech in the presence of noise.     

Sir Morell Mackenzie revisited

The story of Sir Morell Mackenzie and his famous pnticnt, Frederick III, Crown Prince of Germany naturally divides itself into four segments: the physician, his famous patient, the illness, and its consequences both medically and historically. The circumstances of Frederick's death have affected us all. Medically, the cause of biopsy for carcinoma of the larynx was set back many years. For generations biopsy was considered unnecessary to the diagnosis. Had Frederick lived and remained Emperor, and had he encouraged Bismarck to continue a more liberal government and constitutional monarchy; had he continued the non-aggression treaty between Russia and Germany; had he honored his pledge to Queen Victoria for a “close and lasting friendship between our two nations,” how different our history might have been.     

The biology of tumor invasion, angiogenesis and lymph node metastasis

It is now well established that the development of cervical metastases, in particular those with extranodal extension of tumor, negatively impacts both regional control and survival of patients with laryngeal carcinoma. This chapter will begin with an introduction of the important molecular events associated with the transition of the squamous epithelium of the upper aerodigestive tract to metastatic squamous cell carcinoma. We will then review the critical cellular events identified as the tumor progresses from an in situ to invasive and finally a metastatic head and neck squamous cell carcinoma. Finally we will review data from our own and other laboratories which are studying the process of new blood vessel growth (angiogenesis) induced by tumor-derived growth factors. As we develop a better understanding of the cellular and molecular mechanisms of metastasis in head and neck squamous cell carcinoma, new therapies effective at preventing the development of secondary tumors can be realized ultimately increasing the patient's survival.     

Long-term efficacy of weekly paclitaxel therapy in unresectable primary squamous cell carcinoma of the thyroid

Primary squamous cell carcinoma of the thyroid (PSCCT) is a rare disease with a poor prognosis. Because of its rarity, there is no established therapeutic regimen in unresectable cases. We report a case of PSCCT treated with weekly paclitaxel (wPTX) for more than 2 years. A 59-year-old woman presented to our hospital with a progressively enlarging neck mass. CT and MRI scans showed a tumor arising from the right lobe of the thyroid, invading the esophagus and trachea, as well as partially surrounding and invading the right common carotid artery. It was deemed unresectable. Biopsy revealed poorly differentiated squamous cell carcinoma. wPTX therapy was initiated. The patient achieved a partial response and is still undergoing treatment 28 months later. Adverse events included grade 3 neutropenia and grade 2 peripheral sensory neuropathy, which were manageable. Long-term wPTX therapy has been effective in this case of unresectable PSCCT.     

Origins of theory of mind, cognition and communication.

There has been a revolution in our understanding of infant and toddler cognition that promises to have far-reaching implications for our understanding of communicative and linguistic development. Four empirical findings that helped to prompt this change in theory are analyzed: (a) Intermodal coordination--newborns operate with multimodal information, recognizing equivalences in information across sensory-modalities; (b) Imitation--newborns imitate the lip and tongue movements they see others perform; (c) Memory--young infants form long-lasting representations of perceived events and use these memories to generate motor productions after lengthy delays in novel contexts; (d) Theory of mind--by 18 months of age toddlers have adopted a theory of mind, reading below surface behavior to the goals and intentions in people's actions. This paper examines three views currently being offered in the literature to replace the classical framework of early cognitive development: modularity-nativism, connectionism, and theory-theory. Arguments are marshaled to support the "theory-theory" view. This view emphasizes a combination of innate structure and qualitative reorganization in children's thought based on input from the people and things in their culture. It is suggested that preverbal cognition forms a substrate for language acquisition and that analyzing cognition may enhance our understanding of certain disorders of communication.     

Manometry and electromyography of the pharyngeal muscles in patients with dysphagia

Simultaneous recording of the electromyographic activity of the pharyngeal muscles and the intraluminal pressure in the upper sphincter zone was performed routinely in patients with swallowing problems for the first time, to our knowledge. This technique was found to be very useful for the localization of the "site of lesion." The procedure is safe, easy to master, and causes minimal inconvenience. It can reveal, in the most direct way, whether the disturbance is in the hypopharyngeal musculature (represented by the inferior constrictor muscle), in the cricopharyngeal muscle (spasm or lack of relaxation), or in the synchronization between them. Simultaneous recording of intraluminal pressure adds valuable information about the mechanical events associated with electromyographic activity. It was found that in pathologic cases there is quite often no correlation between the electrical and mechanical events. Thus, simultaneous recording of both electrical and mechanical events is essential for the understanding of the pathophysiology of disturbances of deglutition.     

Timing of glottic closure during swallowing: a combined electromyographic and endoscopic analysis

OBJECTIVES: We performed a case series to enhance our understanding of the coupling between neuromuscular events and glottic closure. METHODS: We performed combined flexible video laryngoscopy and electromyography in 4 healthy human subjects. Hooked-wire electrodes were placed in the superior pharyngeal constrictor, longitudinal pharyngeal, cricopharyngeus, thyroarytenoid, genioglossus, suprahyoid, and posterior cricoarytenoid muscles. A flexible endoscope tip was positioned in the oropharyngeal-hypopharyngeal region. The subjects performed multiple trials each of 10-mL normal and super-supraglottic liquid swallows. RESULTS: Arytenoid movement consistently preceded full glottic closure and was associated with cessation of activity of the posterior cricoarytenoid muscle. In 89% of normal swallows, the glottis was partially open in the video frame before bolus passage. The maximum amount of thyroarytenoid electromyographic activity occurred during endoscopic whiteout. When subjects executed a super-supraglottic swallow, early thyroarytenoid activity coincided with arytenoid contact. CONCLUSIONS: The initial medialization of the arytenoids is due to a decrease in motor tone of the posterior cricoarytenoid muscle. Full glottic closure typically occurs late in the process of swallowing, with activation of the thyroarytenoid muscle. Shifting of arytenoid medialization and glottic closure earlier in the super-supraglottic swallow indicates that glottic closure is under significant voluntary control.     

Purely vertical upbeat nystagmus in bilateral posterior canal benign paroxysmal positional vertigo: A case report

Vertical nystagmus occurs in patients with central vestibular system pathology. Lesions of the pons, medulla, and cerebellum lead to vertical nystagmus. Given this association, vertical nystagmus is considered pathognomonic in nature. We present a case of benign paroxysmal positional vertigo (BPPV) with positive Dix‐Hallpike bilaterally, but also with upbeat purely vertical nystagmus in the straight back head hanging position. Computed tomography imaging of the typically pathologic structures in vertical nystagmus (brainstem/posterior fossa) revealed normal anatomy. We propose this case as an instance of peripheral‐associated purely vertical nystagmus without central pathology, while building on our previous understanding of BPPV physiology. Laryngoscope, 2010     

Tumors of the accessory lobe of the parotid gland: a 10-year experience

OBJECTIVES/HYPOTHESIS: The differential diagnosis of midcheek masses include pathology arising from normal anatomic structures or from variations of normal accessory parotid gland tissue. Accessory parotid gland tissue has been described as salivary tissue adjacent to Stenson's duct that is separate from the main body of the parotid gland. We report our 10-year experience with the diagnosis and treatment of eight accessory parotid gland neoplasms that have been followed by the senior authors. STUDY DESIGN: This is a retrospective review of our experience with eight accessory parotid gland neoplasms. METHODS: A literature review and retrospective chart review of our experience with accessory parotid gland tumors over the past 10 years. The presentation, evaluation, management, treatment, and outcome were recorded. RESULTS: Eight cases of accessory lobe parotid tumors were identified, which have been followed since the date of initial treatment. All of the patients presented with a slowly growing cheek mass. There was one case of carcinoma expleomorphic adenoma, one case of undifferentiated carcinoma (small cell carcinoma), one case of basal cell adenocarcinoma, one case of benign salivary cyst, two cases of pleomorphic adenoma, and two cases of monomorphic adenoma. A standard facelift approach or modified Blair incision was used to excise these tumors. CONCLUSIONS: Neoplasms of the accessory parotid gland are rare. Management of these tumors include a high index of suspicion, good understanding of the anatomy, and meticulous surgical approach.     

T/NK cell non-Hodgkin's lymphoma of the sinonasal tract.

Non-Hodgkin's lymphoma of the sinonasal tract is now recognized as an important cause of destructive midfacial lesions formally designated as idiopathic inflammatory processes, and commonly treated with local radiotherapy in a bid to halt the destructive process. However, left untreated, the natural history of this disease remains largely unknown. We report a case which demonstrates the slow and apparently indolent natural course that these lymphomas, if left untreated, may display, before finally evolving into overwhelming and fatal disease. We also take the opportunity to present a brief synopsis of the evolution of our understanding of this condition and to review the modern literature on it.     

口咽部鳞状细胞癌与性行为和人乳头状瘤病毒感染

高危型人乳头状瘤病毒感染(high risk human papillomavirus, HR HPV)是头颈部鳞状细胞癌发生的一个重要相关因素,特别是原发口咽部、缺少烟酒等危险因素的患者。口咽肿瘤中确认发现HR HPV,以及流行病学病例对照研究明确HR HPV与口咽癌发病风险的关系,已阐明了二者的联系。重点论述口咽癌患者与非口咽癌患者在口腔、喉腔和下咽部位的比较及性行为方式的影响。明确头颈肿瘤的性行为危险因素对未来肿瘤预防是必不可少的,同时以利于理解现有的HPV疫苗对未来头颈肿瘤预防的潜在作用。同时还扩展到性行为作为口咽癌发生的一个危险因素以及其作为HPV暴露标记的作用,强调HR HPV是通过性行为传播到上呼吸消化道,增加HPV相关的口咽癌的发病风险。     

Acute suppurative parotitis associated with orbital and vascular complications: A case report

Complications arising from acute suppurative parotitis (ASP) are rare but can be morbid. We report the case of a young female who presented with facial swelling, trismus and diplopia. She was found to have ASP complicated by orbital abscess, cavernous sinus thrombosis, carotid arteritis, and cerebral infarction. Cultures from parotid abscess needle aspiration, orbitotomy and blood sampling returned fusobacterium necrophorum. After a lengthy course of antibiotics and anticoagulation, the patient recovered to near-baseline status. To the best of our knowledge, this is the first case of ASP with such extensive orbital and vascular complications, and highlights the importance of awareness for such events.