Delayed granulomatous reaction to hyaluronic acid gel injection

Injectable hyaluronic acid (HA) derivatives are the most used resorbable dermal fillers used for soft tissue augmentation. While their use is considered safe, there have been reports of cutaneous granulomatous reactions.We describe the clinical, radiological, and cytological findings in a patient who presented a full year after cosmetic treatment with HA injections and discuss the various treatment options. Level of Evidence: Level V, therapeutic study

Partial recovery of audiological, vestibular, and radiological findings following spontaneous intralabyrinthine haemorrhage

The diagnosis, work-up, and treatment of sudden sensorineural hearing loss and sudden vestibular loss vary widely between units. With the increasing access to both magnetic resonance imaging and objective vestibular testing, our understanding of the various aetiologies at hand is increasing. Despite this, the therapeutic options are limited and without a particularly strong evidence base. We present a rare, yet increasingly diagnosed, case of intralabyrinthine haemorrhage (ILH) together with radiological, audiological, and vestibular test results. Of note, this occurred spontaneously and has shown partial recovery in all the mentioned modalities

Airway management in head and neck cancer patients undergoing microvascular free tissue transfer: delayed extubation as an alternative to routine tracheotomy

QUESTIONS UNDER STUDY: The aim of this study was to evaluate two practices of airway management in patients undergoing head and neck cancer (HNC) resection and microvascular free tissue transfer (MFTT), and to assess the advantages and disadvantages of the two approaches. METHODS: Patients undergoing a delayed extubation approach (NO-TRACH group) and patients undergoing primary tracheotomy (PRIM-TRACH group) were retrospectively evaluated in terms of perioperative and postoperative outcome measures. RESULTS: Not performing routine tracheotomy was safe and no perioperative airway complications occurred. NO-TRACH patients were extubated after 1.1 ± 0.9 days (mean ± standard deviation) and secondary tracheotomy was necessary in three patients (13%). NO-TRACH patients revealed decreased duration of surgery (p <0.05) and showed trends to earlier resumption of oral feeding and decreased length of hospitalisation. Flap complication rates were similar in both groups, with an overall flap survival rate of 97.5% (n = 39/40). CONCLUSIONS: With appropriate postoperative care, carefully selected patients undergoing major HNC resections with MFTT can be safely managed without routine tracheotomy

Fatally invasive actinomycosis masquerading as a tonsillar carcinoma.

BACKGROUND Actinomyces is a bacterial rod found in the normal oral flora. It can gain entry to the submucosa via trivial wounds and ultimately lead to slow growing lesions which may mimic cancerous lesions. METHODS AND RESULTS We present the case of an elderly, immunosuppressed woman who presented with a herald bleed from a tonsillar lesion. Despite initial operative arrest of the hemorrhage, she died of a carotid blowout. At autopsy, no sign of cancer was found, but rather an invasive actinomycosis. CONCLUSION Although actinomycosis of the tonsil is well known and has even been described as mimicking tonsillar cancer, this is, to our knowledge, the first report of a carotid blowout secondary to actinomycosis. © 2014 Wiley Periodicals, Inc. Head Neck 36: E129-E130, 2014

Epithelial cyst in the posterior triangle of the neck: atypical branchial cyst or cystic lymph node metastasis?

We report the case of a 66-year-old man with a cervical neck mass located behind the left sternocleidomastoid muscle. To exclude malignancy, a full workup, including clinical, radiological, and cytological examination, was performed but failed to provide a definitive diagnosis. Histological analysis following excisional biopsy revealed a benign epithelial cyst, consistent with an atypically located branchial cyst. We describe an approach to the management of these neck masses and discuss several theories of the etiology of branchial cysts and how they may come to be abnormally located

Dilation after laryngectomy : Incidence, risk factors and complications

Background: Neopharyngeal stenosis is a recognized sequela of total laryngectomy (TL). We aim to investigate the incidence of stenosis requiring dilation, risk factors for stenosis and complications of dilation. Methods: Retrospective cohort study of patients undergoing TL in two dedicated head and neck centers in the Netherlands. Results: A total of 477 patients, (81% men, median age of 64 at TL) were included. Indication for TL was previously untreated primary tumor in 41%, salvage following (chemo)radiotherapy (CRT) in 44%, dysfunctional larynx in 9% and a second primary tumor in 6%. The cumulative incidence of dilatation at 5 years was 22.8%, and in total 968 dilatations were performed. Median number of dilations per patient was 3 (range 1–113). Female gender, a hypopharynx tumor, and (C)RT before or after the TL were significantly associated with stenosis requiring dilation. We observed 8 major complications (0.8%) predominantly during the first dilation procedures. Use of general anesthesia is a risk factor for complications. The most frequent major complication was severe esophageal perforation (n = 6 in 5 patients). Conclusion: The cumulative incidence of pharyngeal stenosis needing dilation was 22.8% at 5 years. Roughly half of these patients could be treated with a limited number of dilations, the rest however needed ongoing dilations. Major complications are rare (0.8%) but can be life threatening. General anesthetics is a risk factor for complications, and complications occurred predominantly during the first few dilations procedures. This should alert the physician to be extra careful in new patients