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Mastoid subperiosteal abscess management in children
OtolaryngologyHead and Neck Surgery Volume 121 Number 2
with an acinic cell carcinoma of the nasal septum who underwent resection via a lateral rhinotomy with subsequent reconstrnction. The world literature is reviewed, and reconstructive aspects are discussed. Results: Previous reports of acinic cell carcinoma of the sinonasal tract have been rare. The lateral nasal wall and adjacent paranasal sinuses appear to be the sites of predilection in this area. This patient represents the first reported case of an acinic cell carcinoma of the nasal septum. There has been no evidence of recurrence in 2.5 years of follow-up. Conclusion: Acinic cell carcinoma of the sinonasal tract is a rare occurrence. There appears to be a female preponderance of 2:1. Wide local excision is the recommended treatment of these lesions, although postoperative radiation has been used. There have been no reported local recurrences or distant metastases with acinic cell carcinoma of the nose and paranasal sinuses.
Scientific Posters P223
Pathological findings were typical of Kikuchi-Fujimoto disease, and the diagnosis was made. The patient slowly improved and was discharge home on analgesics. Conclusion: Kikuchi-Fujimoto disease (necrotizing histiocytic lymphadenitis) is an often misdiagnosed disease. The disease presents mainly in women younger than 30 years. It usually manifests as localized cervical lymphadenopathy with patients reporting fever, chills, and malaise. Laboratory studies reveal granulocytopenia and an elevated ESR. This disease is often confused for lymphoma, so the diagnosis is made by lymph node biopsy. Characteristic histologic findings include patchy necrosis and karyorrhexis with fragments of nuclear debris. Patients improve within 4 to 6 months. The etiology is unknown, but it has been associated with EBV, Yersinia enterocolitica, and toxoplasmosis. There have been reports that it may be a self-limited form of SLE. Recognition by the head and neck surgeon will be critical given that many of these patients are referred for open biopsy.
68
Necrotizing Histiocytic Lymphadenitis: A Case Report and Overview
69
Mastoid Subper|osteal Abscess Management in Children
ANDREW H MURR MD; ALEXANDER RAMIREZ MD; JACOB JOHNSON MD; San Francisco CA
PAULW BAUER MD; DWIGHT T JONES MD; KARLA R BROWN MD; Waltham MA; Wellesley Hills MA; Brookline MA
Objectives: Many illnesses present as cervical lymphadenopathy to the head and neck surgeon. We report a case of necrotizing histiocytic lymphadenitis (Kikuchi-Fujimoto disease). We describe the clinical course and histologic features of this rarely diagnosed disease and review the current literature. Methods: A 27-year-old otherwise healthy Caucasian woman presented with fevers and an enlarging, painful neck mass for 1 week. She had been seen twice at an outside emergency department and given both oral and intramuscular antibiotics, but her symptoms failed to improve. On presentation to the university emergency department, she reported worsening fevers, chills, nausea, vomiting, and myalgia. She had a temperature of 40.4~ and a 5- x 7-cm firm, mobile, and tender right cervical lymph node with overlying skin erythema. Her admission WBC was 5.2. She was admitted for intravenous antibiotics, hydration, and evaluation. Results: Her fevers persisted despite broad-spectrum antibiotics and she had episodes of delirium. Laboratory studies including blood cultures, RPR, HIV, EBV, Yersinia pestis, and toxoplasma were all negative. A lumbar puncture and head CT were also negative. The CT of the neck revealed a 3.5-cm necrotic fight cervical lymph node with extension of lymphadenopathy down the right internal jugular and posterior cervical chains. FNA showed only reactive lymphocytosis. Cervical node cultures for bacteria, fungus, and AFB were negative. Excisional lymph node biopsy revealed zones of coagulative necrosis with surrounding proliferation of nongranulomatous histiocytes and foci of karyorrhectic debris.
Objectives: The management of acute mastoiditis complicated by a subperiosteal abscess has traditionally required mastoidectomy irrespective of the patient's age. With the improvement of antibiotic therapy, current literature supports the treatment of uncomplicated acute mastoiditis with myringotomy and intravenous antibiotic therapy. The method of managing complications of otitis media in early childhood may differ from the established treatment for all patients. Treatment of a mastoid subperiosteal abscess with tympanostomy tube insertion, intravenous antibiotics, and postauricular incision and drainage of the abscess would avoid the potential complications of mastoid surgery in young children. Method: The study included case series and retrospective analysis of 4 patients diagnosed with a mastoid subperiosteal abscess. All 4 were treated with insertion of tympanostomy tubes, appropriate intravenous antibiotics, and postauricular incision and drainage of the abscess. The clinical presentation and history, radiologic studies, and bacteriologic findings were reviewed. The outcome of their treatment has been documented with close otologic follow-up for at least 1 year in all patients. Results: Complete resolution of the patients' acute infectious processes was achieved in all cases. During the followup period 1 patient's tubes have extruded and subsequently required replacement. No other complications have occurred. Conclusion: Tympanostomy tube insertion, intravenous antibiotics, and postauricular incision and drainage are an effective option for managing a mastoid subperiosteal abscesses in young children.
with an acinic cell carcinoma of the nasal septum who underwent resection via a lateral rhinotomy with subsequent reconstrnction. The world literature is reviewed, and reconstructive aspects are discussed. Results: Previous reports of acinic cell carcinoma of the sinonasal tract have been rare. The lateral nasal wall and adjacent paranasal sinuses appear to be the sites of predilection in this area. This patient represents the first reported case of an acinic cell carcinoma of the nasal septum. There has been no evidence of recurrence in 2.5 years of follow-up. Conclusion: Acinic cell carcinoma of the sinonasal tract is a rare occurrence. There appears to be a female preponderance of 2:1. Wide local excision is the recommended treatment of these lesions, although postoperative radiation has been used. There have been no reported local recurrences or distant metastases with acinic cell carcinoma of the nose and paranasal sinuses.
Scientific Posters P223
Pathological findings were typical of Kikuchi-Fujimoto disease, and the diagnosis was made. The patient slowly improved and was discharge home on analgesics. Conclusion: Kikuchi-Fujimoto disease (necrotizing histiocytic lymphadenitis) is an often misdiagnosed disease. The disease presents mainly in women younger than 30 years. It usually manifests as localized cervical lymphadenopathy with patients reporting fever, chills, and malaise. Laboratory studies reveal granulocytopenia and an elevated ESR. This disease is often confused for lymphoma, so the diagnosis is made by lymph node biopsy. Characteristic histologic findings include patchy necrosis and karyorrhexis with fragments of nuclear debris. Patients improve within 4 to 6 months. The etiology is unknown, but it has been associated with EBV, Yersinia enterocolitica, and toxoplasmosis. There have been reports that it may be a self-limited form of SLE. Recognition by the head and neck surgeon will be critical given that many of these patients are referred for open biopsy.
68
Necrotizing Histiocytic Lymphadenitis: A Case Report and Overview
69
Mastoid Subper|osteal Abscess Management in Children
ANDREW H MURR MD; ALEXANDER RAMIREZ MD; JACOB JOHNSON MD; San Francisco CA
PAULW BAUER MD; DWIGHT T JONES MD; KARLA R BROWN MD; Waltham MA; Wellesley Hills MA; Brookline MA
Objectives: Many illnesses present as cervical lymphadenopathy to the head and neck surgeon. We report a case of necrotizing histiocytic lymphadenitis (Kikuchi-Fujimoto disease). We describe the clinical course and histologic features of this rarely diagnosed disease and review the current literature. Methods: A 27-year-old otherwise healthy Caucasian woman presented with fevers and an enlarging, painful neck mass for 1 week. She had been seen twice at an outside emergency department and given both oral and intramuscular antibiotics, but her symptoms failed to improve. On presentation to the university emergency department, she reported worsening fevers, chills, nausea, vomiting, and myalgia. She had a temperature of 40.4~ and a 5- x 7-cm firm, mobile, and tender right cervical lymph node with overlying skin erythema. Her admission WBC was 5.2. She was admitted for intravenous antibiotics, hydration, and evaluation. Results: Her fevers persisted despite broad-spectrum antibiotics and she had episodes of delirium. Laboratory studies including blood cultures, RPR, HIV, EBV, Yersinia pestis, and toxoplasma were all negative. A lumbar puncture and head CT were also negative. The CT of the neck revealed a 3.5-cm necrotic fight cervical lymph node with extension of lymphadenopathy down the right internal jugular and posterior cervical chains. FNA showed only reactive lymphocytosis. Cervical node cultures for bacteria, fungus, and AFB were negative. Excisional lymph node biopsy revealed zones of coagulative necrosis with surrounding proliferation of nongranulomatous histiocytes and foci of karyorrhectic debris.
Objectives: The management of acute mastoiditis complicated by a subperiosteal abscess has traditionally required mastoidectomy irrespective of the patient's age. With the improvement of antibiotic therapy, current literature supports the treatment of uncomplicated acute mastoiditis with myringotomy and intravenous antibiotic therapy. The method of managing complications of otitis media in early childhood may differ from the established treatment for all patients. Treatment of a mastoid subperiosteal abscess with tympanostomy tube insertion, intravenous antibiotics, and postauricular incision and drainage of the abscess would avoid the potential complications of mastoid surgery in young children. Method: The study included case series and retrospective analysis of 4 patients diagnosed with a mastoid subperiosteal abscess. All 4 were treated with insertion of tympanostomy tubes, appropriate intravenous antibiotics, and postauricular incision and drainage of the abscess. The clinical presentation and history, radiologic studies, and bacteriologic findings were reviewed. The outcome of their treatment has been documented with close otologic follow-up for at least 1 year in all patients. Results: Complete resolution of the patients' acute infectious processes was achieved in all cases. During the followup period 1 patient's tubes have extruded and subsequently required replacement. No other complications have occurred. Conclusion: Tympanostomy tube insertion, intravenous antibiotics, and postauricular incision and drainage are an effective option for managing a mastoid subperiosteal abscesses in young children.