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Kawaski disease: A diagnostic dilemma
Otolaryngology Head and Neck Surgery Volume 115 Number 2
Scientific Posters
P 199
tion. Physical examination was unremarkable except for complete right nasal obstruction. A CT scan revealed an expansile soft tissue density within a dilated right maxillary sinus. MRI demonstrated hyperplastic mucosal thickening of the right maxillary antrum consistent with a mucocele. The patient underwent a combined, endoscopic right anterior ethmoidectomy and right Caldwell-Luc antrostomy for evacuation of the cyst. Pathologic analysis revealed fragments of mucosa consistent with the diagnosis of mucocele. Results of a chloride sweat test were negative for CF. A review of the literature to date concerning mucoceles in the pediatric population will be presented. Further discussion will focus on the clinical presentation, etiology, and pathogenesis of mucoceles as related to this most unusual and previously undocumented case.
Results: We present a 65-year-old man with a persistent pharyngocutaneous fistula after multiple surgeries and radiation therapy. Several local and regional flaps were transferred in an attempt to close the fistula, but all were unsuccessful. Vascular access in the neck was severely limited. The patient required o n l y a small v o l u m e of wellvascularized tissue to close the fistula. We transposed the thoracordorsal vascular pedicle into the neck to serve as donor vessels to a radial forearm free flap. The flap survived completely and closed the fistula. Conclusion: This report represents a significant advance for expanding the scope of free tissue transfer to the head and neck when local vascular access is impossible.
129
Kawaskl Disease: A Diagnostic Dilemma ROBERT B. McLAUGHLIN, MD, JEFFREYL. KELLER, MD, RALPH F. WETMORE, MD, and LAWRENCE W. C. TOM, MD, Philadelphia, Pa.
The Stapes Footplate Fistula and Recurrent Meningitis T. OMA HESTER,MD, and RALEIGH O. JONES, MD, Lexington, Ky.
Meningitis secondary to a cerebrospinal fluid fistula with the middle ear is a recognized complication of temporal bone t r a u m a and chronic otitis media. Congenital malformations of the inner ear are often found to result in close association between the perilymphatic labyrinthine spaces and the intracranial subarachnoid space. Such congenital abnormalities of the inner ear are being recognized more frequently as a cause of recurrent meningitis. We present a case of a 7-year-old boy with two episodes of meningitis within 6 weeks who also had a history of profound hearing loss in one ear. Radiographic studies confirmed the diagnosis of a Mondini's deformity, and he was surgically explored and found to have a cerebrospinal fluid fistula through the footplate of the stapes. This case demonstrates the importance of the appropriate evaluation of children with recurrent meningitis and abnormal function of one or both ears. CT provides an excellent study of the temporal bone to allow the diagnosis of congenital anomalies that may require surgical intervention. The pathophysiology, diagnosis, and management of this interesting deformity are reviewed. 130
Microvascular Access in the Multiply Operated Neck JENNY CliO, MD, ROBERTDOLAN, MD, and JOHN GOOEY, MD, Boston, Mass.
Objective: Vascular access for the multiply operated neck may be problematic for complex reconstructions that require free tissue transfer. This report demonstrates the use of the thoracodorsal vessels for head and neck microvascular reconstruction. Methods: We report a novel method for obtaining donor vessels for free flap transfer that avoids extensive reoperation in the neck.
131
Kawasaki disease (KD) is an acute multisystem illness of unknown etiology that usually affects children less than 5 years of age. KD is now recognized as the most common cause of acquired heart disease among this age group. When KD is left untreated, coronary aneurysms may develop in 15% to 25% of children, whereas early intervention can reduce this complication to less than 7%. These cardiac sequelae may develop as early as the ninth day of febrile illness, necessitating early recognition and therapeutic intervention. Head and neck m a n i f e s t a t i o n s i n c l u d i n g cervical lymphadenitis, conjunctival injection, and oral mucosal changes are common presenting symptoms of KD, placing the otolaryngologist at the forefront of early diagnosis. Differentiating relatively common surgical conditions such as neck abscesses from the uncommon medical condition of KD can challenge the most astute clinician. We describe an unusual case of KD presenting as a retropharyngeal abscess and highlight aspects useful in distinguishing these two entities. 132
Sebaceous Gland Carclnoma: A Capricious Neoplasm SETH P. LINKER, MD, and K. THOMAS ROBBINS, MD, Memphis, Tenn.
Sebaceous gland carcinoma is a rare adnexal neoplasm accounting for 0.2% of cutaneous malignancies. The majority of cases are ocular arising from meibomian glands of the tarsus, glands of Zeis of the lid, and pilosebaceous glands of the caruncle, eyebrow, and eyelid. Thirty cases of parotid gland origin have also been reported. Although the majority of lesions present as local disease, the high rate of recurrence at regional distant sites raises the issue of whether initial treatment should address these sites. We recently treated a patient with sebaceous gland carci-
Scientific Posters
P 199
tion. Physical examination was unremarkable except for complete right nasal obstruction. A CT scan revealed an expansile soft tissue density within a dilated right maxillary sinus. MRI demonstrated hyperplastic mucosal thickening of the right maxillary antrum consistent with a mucocele. The patient underwent a combined, endoscopic right anterior ethmoidectomy and right Caldwell-Luc antrostomy for evacuation of the cyst. Pathologic analysis revealed fragments of mucosa consistent with the diagnosis of mucocele. Results of a chloride sweat test were negative for CF. A review of the literature to date concerning mucoceles in the pediatric population will be presented. Further discussion will focus on the clinical presentation, etiology, and pathogenesis of mucoceles as related to this most unusual and previously undocumented case.
Results: We present a 65-year-old man with a persistent pharyngocutaneous fistula after multiple surgeries and radiation therapy. Several local and regional flaps were transferred in an attempt to close the fistula, but all were unsuccessful. Vascular access in the neck was severely limited. The patient required o n l y a small v o l u m e of wellvascularized tissue to close the fistula. We transposed the thoracordorsal vascular pedicle into the neck to serve as donor vessels to a radial forearm free flap. The flap survived completely and closed the fistula. Conclusion: This report represents a significant advance for expanding the scope of free tissue transfer to the head and neck when local vascular access is impossible.
129
Kawaskl Disease: A Diagnostic Dilemma ROBERT B. McLAUGHLIN, MD, JEFFREYL. KELLER, MD, RALPH F. WETMORE, MD, and LAWRENCE W. C. TOM, MD, Philadelphia, Pa.
The Stapes Footplate Fistula and Recurrent Meningitis T. OMA HESTER,MD, and RALEIGH O. JONES, MD, Lexington, Ky.
Meningitis secondary to a cerebrospinal fluid fistula with the middle ear is a recognized complication of temporal bone t r a u m a and chronic otitis media. Congenital malformations of the inner ear are often found to result in close association between the perilymphatic labyrinthine spaces and the intracranial subarachnoid space. Such congenital abnormalities of the inner ear are being recognized more frequently as a cause of recurrent meningitis. We present a case of a 7-year-old boy with two episodes of meningitis within 6 weeks who also had a history of profound hearing loss in one ear. Radiographic studies confirmed the diagnosis of a Mondini's deformity, and he was surgically explored and found to have a cerebrospinal fluid fistula through the footplate of the stapes. This case demonstrates the importance of the appropriate evaluation of children with recurrent meningitis and abnormal function of one or both ears. CT provides an excellent study of the temporal bone to allow the diagnosis of congenital anomalies that may require surgical intervention. The pathophysiology, diagnosis, and management of this interesting deformity are reviewed. 130
Microvascular Access in the Multiply Operated Neck JENNY CliO, MD, ROBERTDOLAN, MD, and JOHN GOOEY, MD, Boston, Mass.
Objective: Vascular access for the multiply operated neck may be problematic for complex reconstructions that require free tissue transfer. This report demonstrates the use of the thoracodorsal vessels for head and neck microvascular reconstruction. Methods: We report a novel method for obtaining donor vessels for free flap transfer that avoids extensive reoperation in the neck.
131
Kawasaki disease (KD) is an acute multisystem illness of unknown etiology that usually affects children less than 5 years of age. KD is now recognized as the most common cause of acquired heart disease among this age group. When KD is left untreated, coronary aneurysms may develop in 15% to 25% of children, whereas early intervention can reduce this complication to less than 7%. These cardiac sequelae may develop as early as the ninth day of febrile illness, necessitating early recognition and therapeutic intervention. Head and neck m a n i f e s t a t i o n s i n c l u d i n g cervical lymphadenitis, conjunctival injection, and oral mucosal changes are common presenting symptoms of KD, placing the otolaryngologist at the forefront of early diagnosis. Differentiating relatively common surgical conditions such as neck abscesses from the uncommon medical condition of KD can challenge the most astute clinician. We describe an unusual case of KD presenting as a retropharyngeal abscess and highlight aspects useful in distinguishing these two entities. 132
Sebaceous Gland Carclnoma: A Capricious Neoplasm SETH P. LINKER, MD, and K. THOMAS ROBBINS, MD, Memphis, Tenn.
Sebaceous gland carcinoma is a rare adnexal neoplasm accounting for 0.2% of cutaneous malignancies. The majority of cases are ocular arising from meibomian glands of the tarsus, glands of Zeis of the lid, and pilosebaceous glands of the caruncle, eyebrow, and eyelid. Thirty cases of parotid gland origin have also been reported. Although the majority of lesions present as local disease, the high rate of recurrence at regional distant sites raises the issue of whether initial treatment should address these sites. We recently treated a patient with sebaceous gland carci-