Bilateral sternocleidomastoid tumor of infancy

The sternocleidomastoid tumor of infancy (STOI), also known as fibromatosis colli, presents as a firm well circumscribed mass within the sternocleidomastoid muscle (SCM) in infants of 1-8 weeks of age. Some of these lesions are associated with torticollis, facial and cranial asymmetry. Incidence of STOI is approximately 0.4% of live births and usually 90% of the patients will have a good prognosis if therapy is initiated and continued for the appropriate period of time. This paper presents two cases of bilateral involvement of STOI, which is very rare. The bilateral nature of the masses added to the uncertainty of the clinical diagnosis and the unusual features of these cases are discussed.     

Focal myositis. A new cause for the pediatric neck mass

Focal myositis is an inflammatory pseudotumor of skeletal muscle that may involve the head and neck. It can closely mimic either a neoplastic or infectious process. We present the case of a 7-year-old boy with a 2-week history of a painful, unilateral neck swelling, fever, and torticollis. He failed to respond to antibiotic therapy and required an open neck exploration. An incisional biopsy of the indurated, inflammatory tissue adherent to his sternocleidomastoid muscle showed focal myositis. Focal myositis is an unusual, but important possibility in the differential diagnosis of any neck mass and especially one in a child. Although its cause is unknown, it is a self-limited disease and neither excisional biopsy nor radical resection is justified.     

The sternocleidomastoid tumor of infancy

The sternocleidomastoid tumor of infancy is an uncommon clinical entity which has received little attention in the otolaryngological literature. The diagnosis must be considered in any infant presenting with a lateral neck mass. Although its natural history favors spontaneous regression, the mass may initially grow in size. The purpose of treatment is the prevention of torticollis and craniofacial asymmetry. The initial treatment is non-surgical, passive and active exercises. Only when this treatment fails should surgery be performed. The disappearance of the lesion is not always a predictable sign. A small number of children will develop delayed torticollis or craniofacial asymmetry. It is important that parents be informed of this possibility and of the necessity for long term follow-up.     

Congenital muscular torticollis. A spectrum of disease

Sternocleidomastoid muscle fibrosis has been recognized for centuries, but its pathogenesis and treatment remains controversial. Pseudotumor of infancy is a firm fibrous mass in the sternocleidomastoid muscle appearing at 2 to 3 weeks of age. Congenital muscular torticollis is less common and appears later in life. Pseudotumor and congenital muscular torticollis probably represent different manifestations of sternocleidomastoid muscle fibrosis. Pseudotumor will usually resolve with conservative therapy; however, some patients will subsequently develop torticollis. Congenital muscular torticollis usually requires surgical release of the sternocleidomastoid muscle to achieve a good cosmetic result and to prevent plagiocephaly, facial asymmetry, and scoliosis. This report provides guidelines for the management of congenital muscular torticollis and pseudotumor of infancy based on the authors' experience and review of the medical literature. Representative case histories from the neonate through the adult are presented, and the pathogenesis, diagnosis, treatment, and prognosis are discussed.     

Fibromatosis colli,overlooked cause of neonatal torticollis: A case report

Fibromatosis colli or sternocleidomastoid tumor of infancy is also known as pseudotumor of the sternocleidomastoid muscle of infancy. Its symptoms show a palpable mass in the muscle and cause neonatal torticollis. This paper reports a case of fibromatosis colli, and typical ultrasonographic examination which is the non-invasive diagnostic intervention of choice. Conservatively continuous physiotherapy at the appropriate time will prevent and/or reverse neonatal torticollis.     

An unusual neck lump: intramuscular haemangioma of the sternocleidomastoid muscle

Neck lumps can often present a diagnostic dilemma, with a wide pre-operative differential diagnosis. We present an unusual case of an intramuscular haemangioma arising in the sternocleidomastoid muscle. Pre operative diagnosis is often difficult, as these lesions are extremely rare in the head and neck region and only few sporadic cases have been reported in the literature. We report the presentation diagnosis and management of intramuscular haemangiomas of the sternocleidomastoid muscle.     

Aural cholesteatoma with upper neck extension

We report the case of a 32-year-old Chinese woman who presented with a large cholesteatoma in her right upper neck after a history of ipsilateral chronic otitis media since childhood. Intraoperatively, a cholesteatoma was found in the mastoid cavity, and the mass in her neck was attached to the mastoid cortex by a stalk. Direct erosion of the mastoid tip may have led the cholesteatoma epidermis to enter the deep surface of the sternocleidomastoid muscle, allowing debris accumulation to form the mass, similar to the propagation of pus in a Bezold's abscess. Neck cholesteatoma secondary to aural cholesteatoma is fairly rare. Only five reports were identified before 1989 followed by no reports in the past 20 years. The case we reported is a reminder to otolaryngologists that this unusual condition still occurs.     

Bilateral vestibular hypofunction in neurosarcoidosis: a case report

We describe the case of a 59-year-old woman who presented with progressive bilateral vestibular hypofunction and who was found to have bilateral granulomatous mass lesions of the mesial temporal lobe. Initially, her condition stabilized neurologically with corticosteroids, but a diagnosis of neurosarcoidosis was delayed because of the unusual presentation and persistently normal chest imaging results and serum angiotensin-converting enzyme (ACE) levels. Approximately 1 year after her initial presentation, the patient died of complications of a myocardial infarction and pulmonary embolism. Sarcoidosis should be considered in the differential diagnosis of idiopathic bilateral vestibular hypofunction even if the chest imaging and serum ACE levels are normal, particularly when there is evidence of a multisystem process.     

Spinal myxopapillary ependymoma metastatic to bilateral internal auditory canals

OBJECTIVES: We report a rare case of spinal myxopapillary ependymoma metastatic to both internal auditory canals (IACs) and its implications for diagnosing neurofibromatosis type 2 (NF2). METHODS: We present a detailed clinical history, magnetic resonance imaging (MRI), intraoperative photographs, and histopathologic findings from a patient with bilateral IAC lesions, and review the diagnostic criteria for NF2. RESULTS: An 11-year-old boy with surgically resected spinal myxopapillary ependymoma, treated with total spine irradiation for recurrence, later showed bilaterally enhancing IAC lesions on T1-weighted MRI with contrast. The diagnosis of NF2 with bilateral vestibular schwannomas was entertained. Close examination of T2-weighted MRI, however, demonstrated the masses to be isointense to cerebrospinal fluid. This finding raised the possibility of other, more unusual IAC lesions. The patient underwent sequential suboccipital craniotomies for tissue diagnosis, and both IAC lesions were found to be myxopapillary ependymomas. CONCLUSIONS: This is the youngest reported patient with metastatic myxopapillary ependymoma. Although vestibular schwannomas account for the majority of contrast-enhancing T1-weighted IAC lesions, other uncommon lesions may present in a similar manner. A T2 fast-spin echo screening MRI would have missed this patient's lesions. Therefore, both T1-weighted MRI with or without contrast and T2-weighted MRI may be necessary to distinguish vestibular schwannoma from other, more unusual IAC lesions.     

Non-pulsatile aneurysm of the superficial temporal artery: a report of a case

Aneurysms of the superficial temporal artery are an uncommon cause for preauricular or parotid masses. Trauma is the most frequent etiology for a pseudoaneurysm and atheromatosis for the true aneurysm. The diagnosis is clinical due to their vascular signs (pulsatile mass, thrill...), these signs care not present when the aneurysmnas thrombosed, being this an unusual event that will make difficult a proper diagnosis. Radiological investigations are needed and helpful under these circumstances. Surgery is curative and recommended, being the excision after proximal and distal ligation of the artery the most accepted procedure. Aneurysms of the superficial temporal artery are rarely reported in the literature. We report a case that showed up as a non-pulsatile preauricular mass to highlight this unusual condition.     

Rhino sinusal bilateral hamartoma: a case report

The hamartoma is a benign rare tumor constituted by a mixture of tissue. It is very unusual in the nasal cavity.The objective of the study is to describe an unusual case of bilateral nasal hamartoma. We report a 52-year-old male patient with a bilateral paranasal hamartoma of the ethmoid and maxillary sinus. Functional endoscopic sinus surgery was performed to completely remove the masses.The reported localization is unusual because the most common site in the nose is the posterior septum. Although hamartoma arising from the rhino sinusal region is very rare, head and neck surgeons must know this entity in order to differentiate it from inverted papilloma and adenocarcinoma. Misinterpretation of this lesion may result in aggressive surgery for a benign lesion.     

Bilateral peritonsillar abscess: case report and presentation of its clinical appearance.

Although there is no consensus on its incidence, bilateral peritonsillar abscess is an unusual variant of an otherwise relatively common otolaryngologic disease. A bilateral peritonsillar abscess can be differentiated from other oropharyngeal pathology with a detailed physical examination and complementary imaging. Its diagnosis should always be considered in patients who have signs and symptoms that are suggestive of peritonsillar abscess but whose intraoral examination yields atypical findings, as well as in patients with marked distress or trismus. This article describes the case of a young man who came to the emergency room with bilateral peritonsillar abscess. The author believes that this report contains the only published photograph of the intraoral appearance of this condition.     

Fever and acquired torticollis in hospitalized children

Acute torticollis due to non-traumatic atlanto-axial subluxation (AAS) is often seen in children presenting with inflammatory conditions of the upper respiratory tract and the neck. Grisel's syndrome is the eponym given to this condition. These patients may present earlier in the disease process without evident subluxation. Thus, early recognition of the condition with prompt commencement of appropriate conservative treatment could halt the progression into Grisel's syndrome. The purpose of this study is to address the importance of early recognition of inflammatory torticollis that can be treated successfully by conservative methods. A retrospective review was made of the case files and radiological investigations of 13 children with fever and torticollis who were treated in the neurosurgery unit of Hamad General Hospital in Qatar, over a two-year period from July 1996 to July 1998. The children were aged between three and 12 years with a male to female ratio of 3:1. All patients arrived at the hospital within 48 hours of onset of torticollis and almost all had manifestations of upper respiratory tract or head and neck infections. Radiological examination by cervical spine X-rays, computerized tomography (CT) or magnetic resonance images (MRI) revealed that only three cases out of 13 had AAS. All patients underwent conservative treatment that included rest, neck collar, simple analgesics and antibiotics, where appropriate. A muscle relaxant was used in nine cases and Halter traction was applied to the three with AAS. All patients responded well to treatment and none required surgical intervention for AAS. We conclude that the majority of children presenting acutely with inflammatory torticollis have rotational deformity only without AAS. Progression to the latter, i.e. Grisel's syndrome, may be aborted should the diagnosis be made early and conservative treatment initiated in time. On the other hand, delay in diagnosis would deprive these children an opportunity of receiving effective conservative treatment.     

Well-circumscribed intramuscular lipoma of the sternocleidomastoid muscle

Intramuscular lipomas are unusual benign mesenchymal tumours, which infiltrate the skeletal muscle, and are exceedingly rare in the head and neck region. They commonly infiltrate the skeletal muscle fibres from which they arise and are rarely well circumscribed. We present the only documented case of well-circumscribed intramuscular lipoma arising from the sternocleidomastoid muscle. Although the recurrence is commoner in the infiltrative variety the surgeon should be aware that differentiation between infiltrative and well circumscribed is based on histological diagnosis, and hence wide excision in all cases of intramuscular lipomas is essential.     

Symmetric sensorineural progressive hearing loss from chronic idiopathic pachymeningitis

We present the case of a 68 year-old man with a diffused hypertrophic pachymeningitis (HP) involving both internal auditory canals. The clinical symptoms were headache, decreased vision in one eye, progressive bilateral and symmetrical sensory-neural hearing loss (PSNHL) responsive to steroid treatment. Although hearing loss is a frequent manifestation of HP, only few studies reported an adequate audiological assessment and follow-up. Mechanisms related to the auditory involvement are discussed on the basis of audiological data. Gadolinium enhanced MRI is the most adequate technique for HP detection and for the differential diagnosis. A delay in the diagnosis of HP seems to be quite common and the consequences may be severe, especially in cases of optic nerve involvement. For these reasons, a cerebral MRI should probably be included in the assessment of PSNHL, especially when neurological signs coexist or are reported in the medical history.     

Giant-cell reparative granuloma of the temporal bone: a case report and review of the literature

Giant-cell reparative granuloma (GCRG) is an unusual, non-neoplastic fibrous lesion that most often arises in the mandible and maxilla. GCRG of the temporal bone is exceedingly rare. To the best of our knowledge, only 17 cases have been previously reported in the international medical literature. Although no case of metastasis has been reported, this malignancy can be locally aggressive, and it often recurs following incomplete excision. We report the case of a young woman with a very large GCRG of the right temporal bone. We discuss the clinical picture, differential diagnosis, histologic evaluation, appearance on computed tomography and magnetic resonance imaging, and treatment options. We also review the cases of temporal bone GCRG that have been reported in the literature so far.     

A rare case of Rosai-Dorfman disease of the paranasal sinuses

An unusual case of a 6-year-old male child presenting with a history of bilateral nasal obstruction of 3 years duration is reported. Endoscopic surgery was performed and the specimen sent for histopathological examination. The report revealed the surprise diagnosis of Rosai-Dorfman disease. This case of isolated extranodal involvement (paranasal sinuses) by this disease is presented and the literature available reviewed.     

Congenital stridor caused by redundant arytenoid mucosa

Two cases of congenital stridor caused by merely unusual redundancy of the mucosa covering the arytenoids are reported in this paper. The stridor was noted only when the patients were awake, and was not affected by postural changes of patients. The patients who did not reach their full mental and physical development had congenital abnormalities: cleft palate in one case, and hypertrichiasis, short palpebral fissures of camptodactyly in the other. No abnormalities were revealed in the patients on examinations of chromosomes, thyroid hormones and brains using the techniques of computerized axial tomographic scanning and electroencephalography. The diagnosis of these cases should be confirmed by a direct laryngoscopy or a laryngofiberscopy.Although the etiology of redundant arytenoid mucosa is not known, it may be suggested that this condition is incidental to other congenital abnormalities.     

The leishmaniasis - a parasitel infection as differential diagnosis of malignant tumours of oral mucosa. A case report and review of literature]

Although parasitel infections in northern Europe are rare, it must be considered as differential diagnosis of malignant tumours of mucous membrane.With increasing tourisms in endemic areas, infections with parasite pathogen are spreading in non-endemic areas as well. In this case a mucous membrane malignancy with clinical feature of ulcer on unusual location was imitated. In this reported case the patient suffers with hepatitis c, causing cirrhosis of the liver and making a liver transplantation necessary. In this patient a history of a leishmaniosis which had been treated successful by the tropical institute is reported, but because of a new actually leishmaniosis-infection a liver transplantation is contraindicated. Under oral therapy with Miltefosin (IMPADIVO) a remission was successful.The leishmaniosis is a classical tropical disease. WHO reported a morbidity of nearly 12 million people in 88 countries around the world especially in tropical areas. Repeatedly infections in northern Europe caused by the phlebotonus-sandflies are described.Therefore leishmaniosis must be considered as differential diagnosis in suspect lesions of mucous membrane.     

Hamartoma of the middle ear: a case study

Hamartomas and teratomas are rare tumors in children. Its location in head and neck is quite exceptional. An unusual case of hamartoma in the middle ear is reported in a 5-month-old child. The tumor was isolated without associated malformation. Definitive diagnosis was made after surgery and based on histological results. At 2 years follow-up, no recurrence was observed. CT-scan is useful in order to reach a final diagnosis. Although rare, this type of tumor should be considered in the differential diagnosis of a middle ear mass during childhood.