Actinomycosis of the middle turbinate: an unusual cause of nasal obstruction

Actinomycosis is a rare chronic infectious disease caused by Actinomyces israelii, which is an anaerobic filamentous, gram-positive saprophyte organism of the oral cavity. Historically, these bacteria were known as fungi because of their light microscopic appearance. Actinomycosis consists of three different forms: cervico-facial (the most common form), abdominal and pulmonothoracic. It commonly involves the head and neck region including the mandible, paranasal sinuses, lacrimal gland, parotid gland and orbit. Poor oral hygiene and dental diseases have been known to be the source of actinomycosis. Actinomycosis is diagnosed with positive culture or detecting actinomyces colonies and sulfur granules in histopathologic specimens. The treatment of choice is surgical excision of the lesion and long-term penicillin therapy. Actinomycosis of the internal nose is extremely rare. There was only one nasal septum actinomycosis reported in the English literature, but there was no lateral nasal wall actiomycosis regarding the turbinate. Therefore, actinomycosis should not be overlooked for the differential diagnosis of intra-nasal lesions for the initiation of appropriate and early treatment.     

Chronic bone abscess as an unusual cause of dysphagia.

Chronic infections following cervical spine surgery are rare. Here we describe an unusual case presenting five years after anterior spinal fusion.     

Rheumatoid pannus of the cervical spine: a case report of an unusual cause of dysphagia

Dysphagia as an initial complaint in rheumatoid arthritis is rare. We describe the case of a 69-year-old woman with rheumatoid arthritis who presented with a 2-day history of acute dysphagia. Our evaluation revealed the cause of the dysphagia was the presence of rheumatoid pannus that involved the anterior cervical spine and compressed the esophagus. Although the otolaryngologic manifestations of rheumatoid arthritis usually relate to synovial involvement of the temporomandibular and cricoarytenoid joints, our case establishes that a rheumatoid pannus on the anterior cervical spine can cause dysphagia. We believe that this may be the first reported case of this clinical entity.     

A rare case of dysphagia: hypopharyngeal amyloidosis masquerading as a post-cricoid tumour

Amyloidoses are a group of disorders in which deposition of abnormal amounts of protein complexes (amyloid) occurs in a variety of tissues. The upper aerodigestive tract may be affected, particularly the larynx, but hypopharyngeal involvement is rarely reported. We present a unique case of amyloidosis of the post-cricoid region causing dysphagia. This case report highlights the need for otolaryngologists to consider the possibility of submucosal amyloid deposition, in the absence of mucosal lesions, in patients who present with dysphagia secondary to an obstructive lesion of the post cricoid region.     

Cerebrospinal fluid leak after anterior cervical disc fusion: an unusual cause of dysphagia and neck mass

OBJECTIVE: Dysphagia after anterior cervical disc fusion (ACDF) is a common complaint. We present two cases of dysphagia caused by a rare complication after ACDF: cerebrospinal fluid (CSF) leak into the neck. STUDY DESIGN: A case series of two patients. METHODS: Both patients underwent a chart review, comprehensive history, physical examination, flexible nasolaryngoscopy, and radiographic imaging. A literature review of the MEDLINE database (1966-2006), using key words "dysphagia" and "anterior discectomy," was performed. RESULTS: We present two patients with persistent dysphagia after ACDF surgery caused by CSF leak into the neck. Their clinical presentation, physical and radiographic examination findings, and hospital course will be discussed. CONCLUSIONS: CSF collection presenting as dysphagia and neck mass after ACDF must be included in the differential diagnosis because incision and drainage is contraindicated, and fine needle aspiration (FNA) must be performed under sterile conditions. Treatment including lumbar drain or re-exploration is appropriate.     

Parathyroid hyperplasia: an unusual cause of neonatal hypercalcemia.

Primary hyperparathyroidism (PHPT) in infants is caused by parathyroid chief cell hyperplasia. Patients present with symptoms of chronic hypercalcemia, such as failure to thrive, irritability, abdominal pain, and anorexia. Medical therapy is inadequate, often resulting in chronic hypercalcemia or death. Partial or total surgical removal of the parathyroid gland is the preferred treatment. We describe a case of a 7-month-old infant with PHPT secondary to hyperplasia successfully treated with a subtotal parathyroidectomy.     

Rhinolithiasis: an unusual cause of nasal obstruction

Rhinoliths are foreign bodies of the nose, which may be encountered during the course of a routine examination. If undetected for a long time, they may grow large enough to cause symptoms of nasal obstruction, mimicking sinusitis. We report four patients with rhinoliths presenting with diverse clinical findings. Removal was easy and uneventful in all cases.     

Epiglottic cysts: an unsuspected cause of dysphagia. Anatomo-clinical study and treatment options

Laryngeal cysts represent a defined group of benign lesions with an actual not well know pathogenesis although fibrosis and glandular obstruction or congenital origin are presumed rather than new growths. When such cysts occur, as a general rule, with the exception of some particular locations, they develop with very few symptoms until very large size is reached or a fast growth is produced due to bleeding or infection. Under these conditions, these cysts may represent a potential treatening lesion and so surgery is recommended under any circunstance and anaesthetic procedure should be case-addapted. A case of an impressive large epiglottic cyst is presented and a revision and discusion on the controversies and available literature are provided.     

Report of an unusual cause of rhinolithiasis: an 'opioma'

We report an unusual case of unilateral rhinolith. The patient was a 21-year-old man who had a history of left-sided nasal obstruction and recurrent bouts of fetid, purulent rhinorrhea of several years'duration. The rhinolith, which had formed around an impacted foreign body, was extracted in several pieces under local anesthesia. Laboratory evaluation revealed that the foreign body was a hardened mixture of codeine and opium wrapped in a small sheet of nylon-what we called an "opioma."     

Hamartoma of the larynx: an unusual cause of dyspnea

We present a rare case of cartilaginous hamartoma involving the subglottic larynx and presenting as respiratory distress. The symptoms were initially attributed to asthma; however, the clinical picture progressed to stridor with significant airway obstruction. After the airway was secured with a tracheostomy, the tumor was resected with a CO2 laser. We present relevant aspects of this benign airway condition and its surgical management.     

Unusual cause of dysphagia

A case report of Cervical Hyperostoses or Forestiers disease causing dysphagia and dysphonia is presented.     

Intraoral lipoma. A rare cause of dysphagia

Lipomas of the oral cavity are rare and in most cases asymptomatic. A case of lipoma in the floor of the mouth in a 89-year-old man, causing severe dysphagia and difficulty with speech, is presented. After surgical excision of the lipoma, the symptoms disappeared. Histologically, lipomas are composed of mature fat cells. Their aetiology is uncertain. Recurrence after surgical excision is unusual.     

Paradoxical vocal cord motion: an unusual cause of stridor

Stridor due to obstructive causes is relatively common. Functional airway obstruction with paradoxical vocal cord motion is uncommon. Only 12 cases have been reported in the literature in the past 15 years. The majority were young female patients. We have recently encountered two cases. Lack of awareness of this condition caused several problems in management.