A case of syryngocystadenoma papilliferum (SCAP) involving middle ear, presenting with otomastoiditis and cerebral abscess

Syryngocystadenoma papilliferum (SCAP) is an uncommon cutaneous adnexal neoplasm of apocrine gland origin. Until now, fewer than 200 cases have been reported in international literature, of which 12 cases involved the external ear. No cases of SCAP involving the middle ear have been reported. We describe a case of SCAP of external and middle ear, presenting with otomastoiditis and cerebral abscess; this aggressive behavior, never reported for a benign adenoma of the external or middle ear, could lead to a differential diagnosis with cholesteatoma or malignancies.     

Validation of the Screening Test for Auditory Processing (STAP) on school-aged children

Objectives

The present study focussed on validating the Screening Test for Auditory Processing (STAP) that contains four subsections: speech-in-noise, dichotic consonant vowel, gap detection and auditory memory. The sensitivity and specificity were ascertained by comparing the results of the screening test with that of diagnostic tests for auditory processing.

Methods

The STAP was administered on 500 school going children in the age range of 8–13 years. These consisted of 141 children who were found at-risk on the Screening Checklist for Auditory Processing (SCAP). Diagnostic APD tests (speech-in-noise, dichotic CV, gap detection and auditory memory) were administered on 152 of the children referred and/or passed on the screening procedures.

Results

The results from the STAP indicated that the auditory memory subsection of the STAP was the most affected followed by dichotic CV and speech-in-noise. Gap detection was the least affected among the four subsections. A high and significant correlation was noted between the subsections of the STAP and the APD diagnostic tests. The sensitivity and specificity of the STAP on comparison with the diagnostic tests was found to be 76.6% and 72%, respectively. It was found that when a combination of SCAP and STAP was used for screening, the sensitivity and specificity were higher.

Conclusion

Based on the findings of the study, it is recommended that both SCAP and STAP be administered. Further, there was also a good test–retest reliability of the SCAP, STAP and the APD diagnostic tests.     

Magnetic resonance imaging of syringocystadenoma papilliferum of the external auditory canal

Syringocystadenoma papilliferum (SCAP) usually occurs on the face or the scalp and is very rare in the external auditory canal (EAC). There has been no information on magnetic resonance (MR) imaging of this tumor irrespective of its site. We report here a case of 57-year-old man having this tumor, which was surgically removed and its histopathology was confirmed. MR imaging demonstrated a lobulated 4-cm mass with clearly defined margins in the EAC. Although the tumor was bulky, these MR findings were different from the malignancies. The mass lesion showed intermediate signal intensity both on T1- and T2-weighted MR images and showed slight enhancement on gadolinium-enhanced T1-weighted images. Signal intensities on T2-weighted images of this tumor were low compared to those of pleomorphic adenoma. All ceruminous gland tumors including SCAP are thought to be potentially malignant; therefore, pre-operative biopsy should not be performed. Even though incisional biopsy is sometimes needed as in our case, the current MR features would be helpful for differential diagnosis of this rare condition and assessing the extension of the tumor.     

How we do it: A novel approach to the skin–abutment interface of the bone‐anchored hearing aid: use of local skin flaps

? Various techniques involving skin grafts have been described to obtain thin hairless immobile skin at the abutment interface of the bone‐anchored hearing aid (BAHA), but none are without significant complications such as necrosis and/or infection leading to total graft failure. ? A novel technique involving four local thin skin flaps was developed to prevent serious complications. ? The procedure essentially involves raising skin flaps at the intradermal level leaving the hair follicles in the subcutaneous tissue, which is subsequently excised. ? We have used the skin‐flap approach around 21 BAHAs on 19 patients (two patients had bilateral devices) and the only complications were minor skin loss immediately adjacent to the implants in two patients and mild skin infections, which settled with topical antibiotics, in three patients. ? The innovative technique described is simple and straightforward, and does not require any special instrumentation. Furthermore, it may have specific advantages, in terms of morbidity, over contemporary skin grafting methods primarily because of the retained intrinsic blood supply of the skin flaps.     

Nasal manifestations of self-destructive behaviour

Self-destructive behaviour is prevalent in a variety of different psychiatric disorders. Most common manifestations are self-inflicted cuts to the skin, especially the skin of the forearms. Manifestations of self-destructive behaviour involving the nasal area are rather rare. A series of cases is presented in which nasal diseases were initially misinterpreted, but could finally be identified as factitious disorders. Presented symptoms were foreign body insertions, hemodynamically relevant epistaxis and impetiginous inflammations of the paravestibular skin of the nose. Factitious disorders of the nose should be identified as such for the following reasons: avoiding unnecessary operations, adequate symptomatic rhinologic therapy and the initiation of psychiatric consultation.     

Tonsillectomy-induced changes in anti-keratin antibodies in patients with pustulosis palmaris et plantaris: a clinical correlation

Summary Titers of anti-keratin antibodies (AKA) involving IgG and IgM fractions were determined by a solid-phase enzyme-linked immunosorbent assay (ELISA) and were found to be significantly higher on average in patients with pustulosis palmaris et plantaris (PPP) than in normal controls. Positive rates of IgG-AKA and IgM-AKA in sera of PPP patients were 50% and 66%, respectively. Following tonsillectomies, patients with high IgM-AKA titers that decreased after surgery were found to benefit by a marked improvement in their skin lesions. There was a close relationship between the degree of this improvement in the skin lesions and the changes in IgM-AKA titers after the operation. These results suggest that PPP may be a tonsil-related immunological skin disease.     

Tonsillectomy-induced changes in anti-keratin antibodies in patients with pustulosis palmaris et plantaris: a clinical correlation

Titers of anti-keratin antibodies (AKA) involving IgG and IgM fractions were determined by a solid-phase enzyme-linked immunsorbent assay (ELISA) and were found to be significantly higher on average in patients with pustulosis palmaris et plantaris (PPP) than in normal controls. Positive rates of IgG-AKA and IgM-AKA in sera of PPP patients were 50% and 66%, respectively. Following tonsillectomies, patients with high IgM-AKA titers that decreased after surgery were found to benefit by a marked improvement in their skin lesions. There was a close relationship between the degree of this improvement in the skin lesions and the changes in IgM-AKA titers after the operation. These results suggest that PPP may be a tonsil-related immunological skin disease.     

Lipoid proteinosis of larynx: review of four cases

Lipoid proteinosis is a rare autosomal recessive disorder characterized by intercellular deposition of an amorphous hyaline material. It mainly involves skin and mucosal membranes of upper aerodigestive tract as well as central nervous system, lung, lymph nodes and striated muscles. Etiology and pathogenesis are unknown. Infantile hoarseness is a common presenting feature of the disease due to infiltration of larynx. In two-thirds of the cases, voice changes are present at birth or in early infancy as the first manifestation. We present four patients with lipoid proteinosis involving skin, oropharynx and larynx.     

Management of the ear canal in head and neck surgery

The management of the ear canal in the treatment of tumors occurring in the area of the head and neck is a highly specialized problem. The material for this report is a derivative of the treatment of tumors involving the auricle, tragus, the skin of the cheek, temple, mastoid, parotid gland, ear canal, and middle ear. The extensive variety of histopathologic conditions and positions of the various tumors creates special problems in preserving and reconstructing the ear canal, saving the tympanic membrane, and rehabilitating the area of the ear canal when these structures have had to be resected. Six basic techniques have been used in rehabilitating this unique area, by using regional skin, free skin grafts, regional flaps, cervical flaps, combinations of these techniques, and large cutaneous and myocutaneous chest and back flaps for the larger ablations.     

Granuloma faciale. Comparison of different treatment modalities

Granuloma faciale is an uncommon cutaneous condition characterized by brownish-red macules, papules, nodules, and plaques. Separate areas of granuloma faciale involving the nasal skin of a 32-year-old man were treated using electrosurgery, carbon dioxide laser, and dermabrasion. All modalities provided good cosmetic and functional outcomes. The relative advantages and disadvantages of each technique are presented.     

Quincke's edema, revisited

Angioneurotic edema involving the uvula is sometimes referred to as Quincke's edema. The term angioneurotic edema describes several closely related diseases manifested by recurrent, acute edema of the skin or mucosa. We report a case of uvular edema secondary to food allergy, treated successfully with steroids. A short review of angioneurotic edema and its management is also presented.     

Anterior craniofacial resection for ethmoid and nasal cancer with free flap reconstruction

Two surgical approaches were used for nasal and ethmoid cancers involving the anterior skull base. A craniofacial operation with the assistance of a neurosurgeon was employed when the cribriform plate was infiltrated. A frontofacial operation through the frontal sinus was preferred when the cribriform plate was radiologically intact. Thirty patients underwent radical surgery with a minimum three-year follow-up. Thirteen of 16 patients with adenocarcinoma survived. Since 1980, nine patients have had their surgical defects repaired with a revascularized tensor fascia lata muscle and skin flap. The flap is tailored to support the cranial contents, provide muscle bulk for the orbitomaxillectomy cavity, and provide skin for the face, nasal, and palatal surfaces. There were two free flap failures.     

A variety of lymphomatoid granulomatosis, pseudosarcoid granulomatosis. An anatomo-clinical observation with an ultrastructural study

A case of sarcoid-like granulomatosis involving the lung, skin and a large cervical vessel is presented. The patient died 4 years after the beginning of the disease with a diffuse angioimmunoblastic lymphadenopathy and a sarcomatous change. Although peculiar histological lesions were seen, with a majority of epithelioid and giant Langhans cells, the extra-pulmonary involvement and the poor prognosis were similar to those of the typical lymphomatoid granulomatosis (Liebow's disease).     

Hemangiopericytoma of the parotid gland: a case report with autopsy

Hemangiopericytoma is a vascular tumor first described by Murray and Stout in 1942 and featuring Zimmerman's pericytes. The tumor is relatively rare and occurs primarily in the skin and musculo-skeletal system. It is now apparent that this tumor is potentially very malignant and at least half of them metastasize. A case report involving the parotid gland is presented, and pathological and clinical features are described.     

外鼻部分缺损的鼻唇沟瓣分区修复方式

鼻唇沟皮瓣是常用的局部皮瓣修复方法,可用于修复外鼻缺损。通过选择鼻唇沟区皮肤作为修复材料,可以获得较为满意的面部形态和美学效果,因为该区域的皮肤与邻近的外鼻皮肤在色泽、质地和类型上相似。鼻唇沟皮瓣的分区修复方式包括鼻唇沟推进瓣、易位瓣、折叠瓣、瓦合瓣、岛状瓣和双瓣等。在修复鼻侧面或鼻翼缺损时,根据创面大小可选择推进瓣、易位瓣、瓦合瓣或岛状瓣等方法;针对鼻翼及前鼻孔等部位的洞穿型缺损,可选择鼻唇沟折叠瓣及瓦合瓣;针对鼻下部的组织缺损,可选择鼻唇沟双瓣进行修复。在选择适合的鼻唇沟瓣类型和分区修复方式时,术者需要综合考虑多个因素,包括缺损程度和位置、血供情况、组织可塑性以及术后外观和功能要求等。     

Idiopathic Hypereosinophilic Syndrome Involving the Middle Ear: Clinical Case Report and Discussion

Multiple organ system involvement is seen in the idiopathic hypereosinophilic syndrome (HES). Cardiovascular, lung and upper airway, liver, spleen, skin and nervous systems are frequently involved. In this article, we describe two cases of HES involving the middle ear and lung. In both cases, the histological pictures showed an increase of eosinophils in the tissue of the tympanic cavity.     

Idiopathic hypereosinophilic syndrome involving the middle ear: clinical case report and discussion

Multiple organ system involvement is seen in the idiopathic hypereosinophilic syndrome (HES). Cardiovascular, lung and upper airway, liver, spleen, skin and nervous systems are frequently involved. In this article, we describe two cases of HES involving the middle ear and lung. In both cases, the histological pictures showed an increase of eosinophils in the tissue of the tympanic cavity.     

Neurothekeoma of the paranasal sinuses in a 3-year-old boy

Neurothekeoma is a benign soft tissue tumor commonly located on the skin. In this report, a 3-year-old boy presented with restricted right eye movement and decrease in visual acuity. The patient was found to have a 6-cm neurothekeoma involving the maxillary and ethmoid sinuses. To our knowledge, this is the first reported case of neurothekeoma with involvement of the maxillary and ethmoid sinuses. This uncommon lesion should be considered as the differential diagnosis of pediatric soft tissue tumors in the head and neck region.     

Initial presentation and fatal complications of linear IgA bullous dermatosis in the larynx and pharynx

Two cases of linear IgA bullous dermatosis initially presenting as ulcerative lesions in the larynx and pharynx are reported. It was difficult to diagnose and treat the lesions, but they were finally diagnosed from the histopathological findings of accompanying skin lesion specimens. One of the patients required a tracheostomy due to increased airway stenosis by a laryngeal lesion. Despite general corticosteroid administration this could not be completely resolved, although partial opening of the glottis was observed, and the patient died of accidental tracheostomy tube complications during home care. Although there are no reports of this disease in the otolaryngological field, these rare diseases involving the skin and entire body should be considered in the differential diagnosis of laryngeal and pharyngeal ulcerative lesions, including airway stenosis. Furthermore, simple and safe procedures for relieving airway stenosis should be selected for rare and difficult-to-diagnose airway disease, prior to the final diagnosis.     

Craniofacial fibrous dysplasia

Fibrous dysplasia is a benign localized bone disorder of unknown aetiology in which endocrinopathies, abnormal pigmentation of the skin and mucous membranes may form part of the disease. Five cases involving the facial and cranial bones are described to illustrate the various presentations and radiological appearances including computerized tomography and magnetic resonance imaging. Some of these cases demonstrate that serial radiology may be adequate for diagnosis and management without the necessity for histological confirmation. The place of limited surgical treatment for the craniofacial sites is debated.