Volume 12 Issue 1 - 2019

Adenotonsillectomy is a first line treatment for children with obstructive sleep apnoea (OSA). OSA has a significant impact on children’s quality of life and health, and can lower IQ, lower emotional liability, decrease attention span, and worsen school performance.

A 55 year old male presents with a 3 month history of an anterior neck lump. What does the image show?

This is a clinical photograph of an adult male with an anterior neck swelling, consistent with a thyroid goitre. The differential diagnosis includes lymphadenopathy, a branchial cleft anomaly or a dermoid cyst.

This is a clinical photograph showing an adult male with a 3-4 cm right submandibular swelling. There is no overlying erythema or skin changes.

This is a clinical photograph of a young boy drooling/dribbling (saliva incontinence). He also appears to be breathing with mouth open at rest and his tongue appears slightly large. If this is true macroglossia, it may be associated with an underlying syndrome such as Down’s. There is also evidence of nasal discharge and excoriation around oral cavity.

This is a clinical photograph showing a standard transverse cervical collar incision which appears to be halfway between the suprasternal notch and cricoid cartilage. The incision is approximately 5-6 centimetres in length and is usually performed during thyroid surgery or 4-gland exploration for parathyroid disease. It appears that tissue glue has been applied for skin closure and a surgical drain can be seen emerging below the incision. The presence of a drain suggests that the patient may have had a total thyroidectomy as there is a move away from using drains for a standard diagnostic hemithyroidectomy.

Middle ear adenoma is a relatively rare entity in routine otolaryngology practice. As per our knowledge, this condition has not been reported in the United Kingdom since last 16 years. Latest report was by Jones SE10 in 2001. We report a case of middle ear adenoma which was initially been treated as a chronic ear infection. In this article, we have discussed the presentation, diagnosis and management options for this condition. The primary purpose of the article is highlight that although rare, middle ear adenoma should be considered as a differential diagnosis in treating middle ear masses.

Laryngeal lipomas are rare and generally present as progressive dyspnea or hoarseness.1,2 We discuss a case of a large laryngeal lipoma with unusual presentation causing delayed diagnosis. 

The patient initially presented with respiratory failure following narcotic administration for an unrelated condition, which ultimately led to tracheotomy after repeatedly failed extubation. 

Following decannulation, the patient experienced hoarseness and a progressive neck mass. Imaging demonstrated a large, submucosal mass with dimensions of 5.5x4.2x4.6 cm that was successfully excised with trans-cervical excision.

Medical record review indicates the patient’s lipoma was most likely present at the time of respiratory failure. Delayed diagnosis allowed for continual growth requiring invasive excision, which emphasizes the need to maintain a broad differential for respiratory failure, including obstructive masses.

This is a case report of a rare manifestation of sarcoidosis presented for the first time as left recurrent laryngeal nerve palsy. It has been only few reports of such cases in literature. 46 years lady presented to the ENT department with hoarseness of voice of acute duration without other symptoms related and generally of good wellbeing. Suffers only of obesity. Naso-endoscopic examinations showed no abnormalities were related to a local pathology involving the laryngeal region.

Imaging studies of neck and chest showed mediastinal masses diagnosed later with biopsies as lymphatic tissues confirming a sarcoid granuloma. The mediastinal mass showed no compression phenomimes over the recurrent laryngeal nerve and the aetiology was relegated to the inflammatory mechanisms affect the nerve secondary to sarcoidosis. The patient was treated with local vocal cord injection and steroids were not suggested considering patient’s obesity and weight gain which worsening patient health status.

Objective: To report an unusual case of spinal metastasis following surgical resection and adjuvant radiotherapy for primary acinic cell carcinoma of the parotid gland.

Case Report: A 42-year-old gentleman was referred to our institution with a left parotid mass. Total parotidectomy and selective neck dissection was performed, confirming a diagnosis of acinic cell carcinoma. Recommendation following histological margin review was for adjuvant radiotherapy. Four months following completion of treatment the patient presented with lower limb neurological deficit. Magnetic resonance imaging identified multifocal spinal deposits within the thoracic and cervical vertebrae. Subsequent unresectable local and regional recurrence was detected on routine review.

Conclusion: We describe an interesting case of parotid actinic cell carcinoma metastasising to the thoracic spine, presenting with acute spinal cord compression. Treatment modalities, outcomes and prevalence of metastatic disease are discussed.

Background: Adenocarcinoma arising from an inverted schneiderian papilloma originating in the frontal sinus is rare.

Methods: The patient presented with right eye proptosis, hyposmia, bilateral nasal congestion. CT scan, MRI, and endoscopic biopsy of a mass was performed, finding adenocarcinoma. Anterior craniofacial resection, right orbital exenteration, right neck dissection and right anterolateral thigh free flap reconstruction was performed.

Results: Inverted Schneiderian papillomas can transform into squamous cell carcinoma. They uncommonly originate in the frontal sinus, or for them to transform into adenocarcinoma. Both benign and malignant inverted papillomas have the potential to be locally invasive, so in patients presenting with the non-specific clinical features associated with inverted papillomas, a high clinical index of suspicion must be maintained.

We present a case of a 69 year old female with a spontaneous, diffuse, painful, swollen and bruised anterior neck. She also had concurrent use of a direct oral anticoagulant (DOAC), apixaban. We discuss the investigation and management of a spontaneous neck haematoma, as well as the management dilemmas with DOACs and severe bleeding.

Dehiscence of the superior semicircular canal (SSC) as a cause of disequilibrium was first described by Minor et al in 1998 (Minor et al., 1998). In the subsequent two decades a large body of information has been generated and the condition has become well recognized. In this review we will examine the characteristic clinical manifestations of superior semicircular canal dehiscence (SSCD) and the current diagnostic modalities and treatment options.

Background: Voice outcomes following intervention for early glottic tumours have been reported but in small cohorts with short term follow-up.

Design: A non-randomised, comparative study involving retrospective review of T1 to T3 glottic lesions was performed with a 5 year follow-up period.

Results: 67 patients were identified. 31 underwent laser resection, and 36 had radiotherapy. Improved voice outcomes were seen in radiotherapy patients in the first year and long term recovery to a normal voice was statistically faster with radiotherapy.

Conclusions: Long term voice outcomes for radiotherapy and laser treatment are comparable although radiotherapy patients experience worse voice in the first year post treatment. The single treatment event and fewer side effects of laser excision make it a preferred option.

Temporal bone malignancies (TBM) are a rare but distinct group of conditions accounting for less than 0.2% of head and neck cancers and have an estimated annual incidence of less than 6 in 1 million. Squamous cell carcinoma (SCC) accounts for the majority of these malignancies, which is reflected in the literature since there are 21 published case series on temporal bone SCC and only case reports for non-squamous malignancies. TBMSCC has a poor prognosis in part due to their locally aggressive nature and complex anatomy. Progress in treatment remains slow given the rarity of this condition. Additionally, two main issues remain: 1. Lack of prognostic factors; 2. Multiple treatment strategies with little evidence on their effectiveness.

I hope you enjoyed a well-deserved break over Christmas and New Year and have returned to work rejuvenated. The one comment that busy doctors often say is how quickly the years pass by and Francis Vaz and I realised that we have been enjoying editing the journal for over 10 years now. Therefore we felt it was time for a new Editor for the journal. Lifestyle gurus often quote that one should make changes to professional roles every 5 years so we felt 10 years has been a good stint as Co-Editors of The Otorhininolaryngologist. I am sure the new team chosen by RILA will continue to move the journal on and there are further plans to improve the website and article processing. We have enjoyed excellent support from the reviewers and would like to thank them very much for their hard work over the years. Some of them will continue to contribute to the review process; James Moor and Claire Hopkins will step down and both have been excellent reviewers and we are very grateful to them for their help over the years.

This issue has plenty of interesting articles and we hope you find it an enjoyable and useful read. For those of you who are submitting articles I would encourage you to do so on line via the website.

With best wishes for 2020,

Sanjai Sood

Editor in Chief

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