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Head and neck manifestations of disseminated coccidioidomycosis: Case report and literature review
P 192
Otolaryngology Head and Neck Surgery August 1996
Sclentlflc Posters
Conclusions: Vesiculobullous diseases can be difficult to differentiate. Photographic documentation of cicatricial pemphigoid is important in teaching the clinical manifestations of this disease.
Head and Neck Manifestations of Disseminated Coccidioidomycosis: Case Report and Literature Review
103
JOHN BENNEI-I, MD, and J. K. THIRINGER, LCDR, MC, USN, Lackland AFB, Tex.
Ethanol Embolizatlon: A Safe, Simple Alternative to Surgical Resection of Head and Neck Vascular Malformations RICHARD L. PANG, MD, Honolulu, Hawaii
Management of head and neck vascular malformations is challenging because of the close relationship of many vital structures in this area. For this reason, head and neck vascular malformations are often surgically unresectable. Therefore the head and neck surgeon is in search of a simple and safe procedure to manage these challenging tumors. We have found direct puncture phlebography and ethanol embolization to be safe, simple, and highly effective. A case report, review of the literature, and management of head and neck vascular malformations will be discussed. 104
Relapsing Polychondrltls of the Larynx wlth an Associated Unilateral Facial Nerve Paresis: A Case Report and Review of the Literature ARTHUR N. FALK, MD, GIULIO I. CAVALLI, MD, and LAWRENCE Z. MEITELES,MD, New York and Valhalla, N.Y.
Relapsing polychondritis is a rare, presumed autoimmunemediated inflammatory disorder of the cartilaginous skeleton, with significant otolaryngologic manifestations. The auricle is the most common site of chondritis, with involvement of the septum and upper airway, including the larynx and trachea, to a lesser extent. Audiovestibular damage in the form of tinnitus, sensory neural hearing loss, and vertigo is well documented. Other systemic manifestations include arthritis, ocular inflammation, vasculitis, and hematopoietic derangement. The most recent diagnostic criteria incorporated a constellation of symptoms, histopathology, and favorable response to treatment with immunosuppressants. An interesting case of relapsing polychondritis of the larynx is presented. In addition to ocular and audiovestibular symptoms, the patient developed a unilateral facial nerve paresis, which is a finding rarely seen in association with this disorder. Photographic, radiographic, and audiometric documentation are provided, along with a literature review focusing on the differential diagnosis of autoimmune inflammatory disorders of the head and neck.
105
Coccidioidomycosis is a fungal disease endemic to semiarid regions in the Southwestern United States, Northern Mexico, and other parts of Central and South America. Although coccidioidomycosis is primarily a pulmonary disease, approximately 0.5% of infected individuals will develop disseminated disease affecting skin, subcutaneous tissue, bone, joints, and meninges. Virtually all cases of disseminated disease involve the skin, with a strong predilection for tissues of the central face. The morphology of the skin lesions is highly variable, and other symptoms of disseminated disease such as fever and cough are often subtle, making the diagnosis difficult. The number of patients with coccidioidomycosis can be expected to increase due to population growth in endemic areas and an increase in the number of immunosuppressed patients due to AIDS and organ transplantation. Otolaryngologists will be increasingly called on to diagnose and manage head and neck manifestations of this disease. We report on two siblings with disseminated coccidioidomycosis who presented with facial bony-cutaneous lesions but no other symptoms. Diagnosis of disseminated coccidioidomycosis was made only after surgical excision of destructive lesions of the nasal dorsum and skull that were found in one of the siblings. This paper reviews the presenting complaints, workup, and treatment of these two patients who had otherwise silent, but disseminated, disease. In addition, a synopsis of the current literature and treatment guidelines will be reviewed. 106
Imaglng and Surgical Technlque of Cochlear Implantation for Obllteratlve Otosclerosls RANDALL A. OW, MD, MARK PACKER, and MOISES A. ARRIAGA, MD, Laokland AFB, Tex., and Dayton, Ohio
Otosclerosis is an osseous dyscrasia found only in the human temporal bone. The most common clinical manifestation is a low-frequency conductive hearing loss. Less frequently, otosclerosis can progress to obliterative otosclerosis, with stapes and cochlear involvement resulting in profound, bilateral mixed hearing loss. In patients for whom amplification and stapedectomy are inadequate, cochlear implantation can be considered. Preoperative temporal bone imaging is necessary to define otic capsule anatomy. Extensive ossification of the cochlear duct may require significant modification in electrode placement technique. Cochlear ossification is most frequently found in association with postmeningitic labyrinthitis ossificans. The typical findings of otosclerosis on high-resolution CT and MRI vary with the stage of the disease pro-
Otolaryngology Head and Neck Surgery August 1996
Sclentlflc Posters
Conclusions: Vesiculobullous diseases can be difficult to differentiate. Photographic documentation of cicatricial pemphigoid is important in teaching the clinical manifestations of this disease.
Head and Neck Manifestations of Disseminated Coccidioidomycosis: Case Report and Literature Review
103
JOHN BENNEI-I, MD, and J. K. THIRINGER, LCDR, MC, USN, Lackland AFB, Tex.
Ethanol Embolizatlon: A Safe, Simple Alternative to Surgical Resection of Head and Neck Vascular Malformations RICHARD L. PANG, MD, Honolulu, Hawaii
Management of head and neck vascular malformations is challenging because of the close relationship of many vital structures in this area. For this reason, head and neck vascular malformations are often surgically unresectable. Therefore the head and neck surgeon is in search of a simple and safe procedure to manage these challenging tumors. We have found direct puncture phlebography and ethanol embolization to be safe, simple, and highly effective. A case report, review of the literature, and management of head and neck vascular malformations will be discussed. 104
Relapsing Polychondrltls of the Larynx wlth an Associated Unilateral Facial Nerve Paresis: A Case Report and Review of the Literature ARTHUR N. FALK, MD, GIULIO I. CAVALLI, MD, and LAWRENCE Z. MEITELES,MD, New York and Valhalla, N.Y.
Relapsing polychondritis is a rare, presumed autoimmunemediated inflammatory disorder of the cartilaginous skeleton, with significant otolaryngologic manifestations. The auricle is the most common site of chondritis, with involvement of the septum and upper airway, including the larynx and trachea, to a lesser extent. Audiovestibular damage in the form of tinnitus, sensory neural hearing loss, and vertigo is well documented. Other systemic manifestations include arthritis, ocular inflammation, vasculitis, and hematopoietic derangement. The most recent diagnostic criteria incorporated a constellation of symptoms, histopathology, and favorable response to treatment with immunosuppressants. An interesting case of relapsing polychondritis of the larynx is presented. In addition to ocular and audiovestibular symptoms, the patient developed a unilateral facial nerve paresis, which is a finding rarely seen in association with this disorder. Photographic, radiographic, and audiometric documentation are provided, along with a literature review focusing on the differential diagnosis of autoimmune inflammatory disorders of the head and neck.
105
Coccidioidomycosis is a fungal disease endemic to semiarid regions in the Southwestern United States, Northern Mexico, and other parts of Central and South America. Although coccidioidomycosis is primarily a pulmonary disease, approximately 0.5% of infected individuals will develop disseminated disease affecting skin, subcutaneous tissue, bone, joints, and meninges. Virtually all cases of disseminated disease involve the skin, with a strong predilection for tissues of the central face. The morphology of the skin lesions is highly variable, and other symptoms of disseminated disease such as fever and cough are often subtle, making the diagnosis difficult. The number of patients with coccidioidomycosis can be expected to increase due to population growth in endemic areas and an increase in the number of immunosuppressed patients due to AIDS and organ transplantation. Otolaryngologists will be increasingly called on to diagnose and manage head and neck manifestations of this disease. We report on two siblings with disseminated coccidioidomycosis who presented with facial bony-cutaneous lesions but no other symptoms. Diagnosis of disseminated coccidioidomycosis was made only after surgical excision of destructive lesions of the nasal dorsum and skull that were found in one of the siblings. This paper reviews the presenting complaints, workup, and treatment of these two patients who had otherwise silent, but disseminated, disease. In addition, a synopsis of the current literature and treatment guidelines will be reviewed. 106
Imaglng and Surgical Technlque of Cochlear Implantation for Obllteratlve Otosclerosls RANDALL A. OW, MD, MARK PACKER, and MOISES A. ARRIAGA, MD, Laokland AFB, Tex., and Dayton, Ohio
Otosclerosis is an osseous dyscrasia found only in the human temporal bone. The most common clinical manifestation is a low-frequency conductive hearing loss. Less frequently, otosclerosis can progress to obliterative otosclerosis, with stapes and cochlear involvement resulting in profound, bilateral mixed hearing loss. In patients for whom amplification and stapedectomy are inadequate, cochlear implantation can be considered. Preoperative temporal bone imaging is necessary to define otic capsule anatomy. Extensive ossification of the cochlear duct may require significant modification in electrode placement technique. Cochlear ossification is most frequently found in association with postmeningitic labyrinthitis ossificans. The typical findings of otosclerosis on high-resolution CT and MRI vary with the stage of the disease pro-