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Mycobacterium abscessus infection of a cochlear implant insertion site
Abstracts / International Journal of Pediatric Otorhinolaryngology 77 (2013) 2088–2093
histopathology and GLUT-1 immunoreactivity confirmed the diagnosis of IH. The lesion was treated with direct injection of triamcinolone (40 mg/ml) and systemic propranolol therapy. The patient responded well, and her symptoms resolved quickly. Propanolol provides a promising therapy as a first line treatment to avoid surgery, tracheostomy, and prolonged use of steroids. http://dx.doi.org/10.1016/j.ijporl.2013.10.032
A rare cause of pediatric nasal obstruction and epistaxis: Nasal septal mixed hemangioma ¨ zkırıs¸ a, Reha Aydın a,*, Selda Sec¸kin b, Levent Saydam a Mahmut O a Department of Otolaryngology, Head and Neck Surgery, Bozok University Medical Faculty, Turkey b Department of Pathology, Bozok University Medical Faculty, Turkey
Hemangiomas are rare benign vascular endothelial tumors mostly arising in the head and neck area. The infantile cases are the most frequently seen pediatric tumors with an incidence of 5%. Usually, congenital lesions are located on the facial skin or oral mucosa, the nasal cavity is not a common site for hemangiomas. Histologically, there are three types including capillary, cavernous and mixed hemangiomas. Epistaxis and nasal obstruction are the most common presentations for nasal involvement. In this article we present the first reported case of pediatric capillary-cavernous hemangioma of the nasal cavity in the literature with a review of current theories regarding the etiology, diagnosis, and treatment of this rare type of hemangioma. http://dx.doi.org/10.1016/j.ijporl.2013.10.033
Lingual choristoma with gastric and respiratory epithelium in a neonate-prenatal MRI of lingual cyst Chang Ki Yeo * Keimyung University Dong San Medical Center, Department of Otolaryngology-Head and Neck Surgery, Daegu, South Korea
The lingual cyst lined by respiratory and gastrointestinal epithelium is unusual. There have been reports of respiratory or gastrointestinal epithelium-lined lingual cysts, but few report both features presenting within the same cyst. Prenatal diagnosis of lingual cysts is exceptional with only few case reported to date. Prenatal magnetic resonance imaging in utero is the best complete investigation of the nature and anatomical relationship of the congenital lingual cyst. It makes us to prepare for emergency situation and EXIT (Ex-utero intrapartum treatment) operation. http://dx.doi.org/10.1016/j.ijporl.2013.10.034
2091
Case report: A 12-year-old female Hausa child admitted through the accident and emergency room with about an hour history of stabbed nail to the right side of the neck while hawking on the street with associated pain at injury site, voice loss and neck swelling She had an emergency neck exploration and removal of the nail with satisfactory post-operative condition. Penetrating neck injury is an ENT emergency that required prompt attention resulting from assault and to draw attention of caregivers to hazards of child labour through street hawking. http://dx.doi.org/10.1016/j.ijporl.2013.10.035
Candida infection after tonsillectomy in a 12-year-old girl Isa Ozbay a,*, Hasan Huseyin Balikci b, Ahmet Alp c, Fulya Bayındır Bilman d a Department of ORL, Diyarbakir Research and Training Hospital, Diyarbakır, Turkey b Department of ORL, Susehri Government Hospital, Sivas, Turkey c Department of ORL, Eyu¨p Government Hospital, I˙stanbul, Turkey d Department of Microbiology, Diyarbakir Research and Training Hospital, Diyarbakır, Turkey
Tonsillectomy has been associated with complications such as bleeding, pain, dehydration, edema, airway obstruction, atlantoaxial subluxation and infection. However, fungal infection is a very rare complication of tonsillectomy. We describe the case of a 12-year-old girl who developed oral Candida infection as a complication of tonsillectomy. She had pain and difficulty in swallowing on the third postoperative day, and a local examination revealed an easily grazing, white plate on the tonsillar fossa. A culture of the lesion tissue identified Candida albicans. Local nystatin therapy was administered, and the lesion healed completely by postoperative day 12. We conclude that fungal infection, though rare, can occur as a complication of tonsillectomy. http://dx.doi.org/10.1016/j.ijporl.2013.10.036
Mycobacterium abscessus infection of a cochlear implant insertion site , Jason H. Anderson a,*, Thomas G. Boyce a,b, Nancy L. Wengenack c, Colin L.W. Driscoll d, Philip R. Fischer a a Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, United States b Division of Pediatric Infectious Diseases, Mayo Clinic, Rochester, MN, United States c Department of Clinical Microbiology, Mayo Clinic, Rochester, MN, United States d Department of Otolaryngology, Mayo Clinic, Rochester, MN, United States
An unusual penetrating stab injury in a child: Case report A.O. Suleiman a,*, O.A. Afolabi b, B.S. Alabi b a Department of ENT, Federal Medical Center, Katsina, Nigeria b Department of ENT, University of Ilorin/University of Ilorin Teaching Hospital, Ilorin, Nigeria
Penetrating neck wounds is an otolaryngologic and head and neck emergency.
Infectious complications of cochlear implantation are unusual but can be severe, often requiring implant removal. We report a child who underwent cochlear implant revision and developed a post-operative infection with Mycobacterium abscessus complex. The patient’s symptoms were refractory to empiric antibacterial therapy. After more than 2 weeks incubation, M. abscessus complex grew in culture. Resolution of the infection was achieved utilizing prolonged multi-drug therapy and device removal with the intracochlear leads remaining in place. Clinical signs of an infectious
2092
Abstracts / International Journal of Pediatric Otorhinolaryngology 77 (2013) 2088–2093
process with concomitant sterile bacterial cultures should raise concern for a potential mycobacterial infection in association with cochlear implantation. http://dx.doi.org/10.1016/j.ijporl.2013.10.037
An intracranial complication of acute isolated sphenoid sinusitis Ireneusz Bielecki *, Agata Gierlotka, Mariusz Cofała Department of Pediatric Surgery, Division of Otolaryngology, Medical University of Silesia, Upper Silesian Center for Child Health, Medyko´w 16 Street, 40-752 Katowice, Poland
Intracranial complications of acute sphenoid sinusitis are a rare, but severe condition. Due to subclinical and non-specific symptomatology it is usually diagnosed with delay or after neurological manifestation is present. A case of temporal epidural abscess secondary to isolated sphenoid sinusitis in a 14-year-old boy is presented. Immediate endoscopic sinus surgery was performed. Early diagnosis and aggressive therapy to guarantee drainage of the sinus is recommended. http://dx.doi.org/10.1016/j.ijporl.2013.10.038
Fibrodysplasia ossificans progressiva presenting as a neck mass Robert J. Tibesar a,d,*, Lindsay Eisler b,d, Mona M. LaPlant c, James D. Sidman a,d a Children’s ENT and Facial Plastic Surgery, Children’s Hospitals and Clinics of Minnesota, CSC Suite 450, 2530 Chicago Avenue South, Minneapolis, MN 55404, United States b USF Health South Tampa Campus, 2 Tampa General Circle, 2nd Floor, #10, Tampa, FL 33606, United States c Rheumatology, Children’s Hospitals and Clinics of Minnesota, Garden View Medical Building Suite 504, Room 5007, 347 North Smith Avenue, St. Paul, MN 55102, United States d Department of Otolaryngology, University of Minnesota, Minneapolis, MN, United States
Objective: To report a case of fibrodysplasia ossificans progressiva (FOP) initially presenting as a neck mass and alert the practicing otolaryngologist to the imperative to avoid harmful biopsy. Case: A 2-year-old male presented with a firm left posterior neck mass and bilateral great toe malformations. Imaging was non-diagnostic and after 2 weeks of antibiotics the lesion was larger. At surgical biopsy, the mass was pale, firm, and avascular. Histopathology showed low grade fibromyxoid tissue. Rheumatology service diagnosed FOP based on clinical examination of neck mass, bilateral great toe deformities, stiff joints. Biopsy proved unnecessary and the patient developed heterotopic ossification at the site of surgical trauma. The patient was started on anti-inflammatories and steroids with minimal benefit. This case highlights the need for a broader understanding among clinicians who may encounter patients with FOP regarding the clinical aspects of diagnosis and the potential harm caused by surgical interventions. http://dx.doi.org/10.1016/j.ijporl.2013.10.039
Crohn’s supraglottitis – The presenting feature of otherwise asymptomatic systemic disease S.E. Price a,*, S.J. Frampton b, T. Coelho b, D.J. Fowler b, S. Holden b, R.M. Beattie b, H. Ismail-Koch b, A. Burgess a a Hampshire Hospitals NHS Foundation Trust, Royal Hampshire County Hospital, Romsey Road, Winchester, Hampshire SO22 5DG, United Kingdom b University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Tremona Road, Southampton, Hampshire SO16 6YD, United Kingdom We present the unique case of a 15 year old boy with upper airway obstruction found to have Crohn’s disease in the absence of gastrointestinal symptoms. Laryngeal manifestations of Crohn’s disease are extremely rare. Only 11 cases have been reported in the literature, of which only one is in a child. Laryngeal Crohn’s disease usually occurs accompanied by gastrointestinal symptoms or in patients with a prior diagnosis of Crohn’s disease. The literature on the clinical features and management of laryngeal Crohn’s is discussed along with a summary of the reported otolaryngological manifestations and associations with Crohn’s disease. http://dx.doi.org/10.1016/j.ijporl.2013.08.040
Abnormal CT temporal bone findings in a case of Kallmann syndrome presenting with conductive hearing loss Chak Yuen Fung a,*, Abhilash Balakrishnan a, Tiong Yong Tan b a Department of Otolaryngology, Kandang Kerbau Women’s and Children’s Hospital, Singapore b Department of Diagnostic Radiology, Changi General Hospital, Singapore Kallmann syndrome is characterised by hypogonadotrophic hypogonadism and hyposmia. Sensorineural hearing loss is a frequently described association with this syndrome. We report a case of Kallmann syndrome presenting with conductive hearing loss and the CT temporal bone findings of absence of all the semicircular canals. We also postulated the causes for the conductive hearing loss and reviewed the relevant literature. http://dx.doi.org/10.1016/j.ijporl.2013.10.040
Bilateral keratocystic odontogenic tumor of mandible – A unique pediatric lesion: Case report and review Reena Radhikaprasad Sarkar a,*, G.P. Rathod b a Professor and Head, Department of Oral and Maxillofacial Pathology and Microbiology, National Dental College, Derabassi, Mohali, Punjab, India b Professor, Head and Postgraduate Teacher, Oral Pathology, PDM Dental College, Bahadurgarh, Haryana, India The keratocystic odontogenic tumor (KCOT) is the most common cystic neoplasm in the maxillofacial region. Multiple odontogenic keratocyst are usually associated with Nevoid Basal Cell Carcinoma (NBCC) syndrome. A variant of this neoplasm is the sporadic multiple KCOT in pediatric population. Presented here is a case of bilateral keratocystic odontogenic tumor in a fourteen year old. Multiple keratocysts in the pediatric population is rare, aggressive, and recurrent and the first sign of NBCC or the solo presentation of human homologue of the PTCH (Drosophila segment polarity gene Patched) gene mutation. http://dx.doi.org/10.1016/j.ijporl.2013.10.041
histopathology and GLUT-1 immunoreactivity confirmed the diagnosis of IH. The lesion was treated with direct injection of triamcinolone (40 mg/ml) and systemic propranolol therapy. The patient responded well, and her symptoms resolved quickly. Propanolol provides a promising therapy as a first line treatment to avoid surgery, tracheostomy, and prolonged use of steroids. http://dx.doi.org/10.1016/j.ijporl.2013.10.032
A rare cause of pediatric nasal obstruction and epistaxis: Nasal septal mixed hemangioma ¨ zkırıs¸ a, Reha Aydın a,*, Selda Sec¸kin b, Levent Saydam a Mahmut O a Department of Otolaryngology, Head and Neck Surgery, Bozok University Medical Faculty, Turkey b Department of Pathology, Bozok University Medical Faculty, Turkey
Hemangiomas are rare benign vascular endothelial tumors mostly arising in the head and neck area. The infantile cases are the most frequently seen pediatric tumors with an incidence of 5%. Usually, congenital lesions are located on the facial skin or oral mucosa, the nasal cavity is not a common site for hemangiomas. Histologically, there are three types including capillary, cavernous and mixed hemangiomas. Epistaxis and nasal obstruction are the most common presentations for nasal involvement. In this article we present the first reported case of pediatric capillary-cavernous hemangioma of the nasal cavity in the literature with a review of current theories regarding the etiology, diagnosis, and treatment of this rare type of hemangioma. http://dx.doi.org/10.1016/j.ijporl.2013.10.033
Lingual choristoma with gastric and respiratory epithelium in a neonate-prenatal MRI of lingual cyst Chang Ki Yeo * Keimyung University Dong San Medical Center, Department of Otolaryngology-Head and Neck Surgery, Daegu, South Korea
The lingual cyst lined by respiratory and gastrointestinal epithelium is unusual. There have been reports of respiratory or gastrointestinal epithelium-lined lingual cysts, but few report both features presenting within the same cyst. Prenatal diagnosis of lingual cysts is exceptional with only few case reported to date. Prenatal magnetic resonance imaging in utero is the best complete investigation of the nature and anatomical relationship of the congenital lingual cyst. It makes us to prepare for emergency situation and EXIT (Ex-utero intrapartum treatment) operation. http://dx.doi.org/10.1016/j.ijporl.2013.10.034
2091
Case report: A 12-year-old female Hausa child admitted through the accident and emergency room with about an hour history of stabbed nail to the right side of the neck while hawking on the street with associated pain at injury site, voice loss and neck swelling She had an emergency neck exploration and removal of the nail with satisfactory post-operative condition. Penetrating neck injury is an ENT emergency that required prompt attention resulting from assault and to draw attention of caregivers to hazards of child labour through street hawking. http://dx.doi.org/10.1016/j.ijporl.2013.10.035
Candida infection after tonsillectomy in a 12-year-old girl Isa Ozbay a,*, Hasan Huseyin Balikci b, Ahmet Alp c, Fulya Bayındır Bilman d a Department of ORL, Diyarbakir Research and Training Hospital, Diyarbakır, Turkey b Department of ORL, Susehri Government Hospital, Sivas, Turkey c Department of ORL, Eyu¨p Government Hospital, I˙stanbul, Turkey d Department of Microbiology, Diyarbakir Research and Training Hospital, Diyarbakır, Turkey
Tonsillectomy has been associated with complications such as bleeding, pain, dehydration, edema, airway obstruction, atlantoaxial subluxation and infection. However, fungal infection is a very rare complication of tonsillectomy. We describe the case of a 12-year-old girl who developed oral Candida infection as a complication of tonsillectomy. She had pain and difficulty in swallowing on the third postoperative day, and a local examination revealed an easily grazing, white plate on the tonsillar fossa. A culture of the lesion tissue identified Candida albicans. Local nystatin therapy was administered, and the lesion healed completely by postoperative day 12. We conclude that fungal infection, though rare, can occur as a complication of tonsillectomy. http://dx.doi.org/10.1016/j.ijporl.2013.10.036
Mycobacterium abscessus infection of a cochlear implant insertion site , Jason H. Anderson a,*, Thomas G. Boyce a,b, Nancy L. Wengenack c, Colin L.W. Driscoll d, Philip R. Fischer a a Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, United States b Division of Pediatric Infectious Diseases, Mayo Clinic, Rochester, MN, United States c Department of Clinical Microbiology, Mayo Clinic, Rochester, MN, United States d Department of Otolaryngology, Mayo Clinic, Rochester, MN, United States
An unusual penetrating stab injury in a child: Case report A.O. Suleiman a,*, O.A. Afolabi b, B.S. Alabi b a Department of ENT, Federal Medical Center, Katsina, Nigeria b Department of ENT, University of Ilorin/University of Ilorin Teaching Hospital, Ilorin, Nigeria
Penetrating neck wounds is an otolaryngologic and head and neck emergency.
Infectious complications of cochlear implantation are unusual but can be severe, often requiring implant removal. We report a child who underwent cochlear implant revision and developed a post-operative infection with Mycobacterium abscessus complex. The patient’s symptoms were refractory to empiric antibacterial therapy. After more than 2 weeks incubation, M. abscessus complex grew in culture. Resolution of the infection was achieved utilizing prolonged multi-drug therapy and device removal with the intracochlear leads remaining in place. Clinical signs of an infectious
2092
Abstracts / International Journal of Pediatric Otorhinolaryngology 77 (2013) 2088–2093
process with concomitant sterile bacterial cultures should raise concern for a potential mycobacterial infection in association with cochlear implantation. http://dx.doi.org/10.1016/j.ijporl.2013.10.037
An intracranial complication of acute isolated sphenoid sinusitis Ireneusz Bielecki *, Agata Gierlotka, Mariusz Cofała Department of Pediatric Surgery, Division of Otolaryngology, Medical University of Silesia, Upper Silesian Center for Child Health, Medyko´w 16 Street, 40-752 Katowice, Poland
Intracranial complications of acute sphenoid sinusitis are a rare, but severe condition. Due to subclinical and non-specific symptomatology it is usually diagnosed with delay or after neurological manifestation is present. A case of temporal epidural abscess secondary to isolated sphenoid sinusitis in a 14-year-old boy is presented. Immediate endoscopic sinus surgery was performed. Early diagnosis and aggressive therapy to guarantee drainage of the sinus is recommended. http://dx.doi.org/10.1016/j.ijporl.2013.10.038
Fibrodysplasia ossificans progressiva presenting as a neck mass Robert J. Tibesar a,d,*, Lindsay Eisler b,d, Mona M. LaPlant c, James D. Sidman a,d a Children’s ENT and Facial Plastic Surgery, Children’s Hospitals and Clinics of Minnesota, CSC Suite 450, 2530 Chicago Avenue South, Minneapolis, MN 55404, United States b USF Health South Tampa Campus, 2 Tampa General Circle, 2nd Floor, #10, Tampa, FL 33606, United States c Rheumatology, Children’s Hospitals and Clinics of Minnesota, Garden View Medical Building Suite 504, Room 5007, 347 North Smith Avenue, St. Paul, MN 55102, United States d Department of Otolaryngology, University of Minnesota, Minneapolis, MN, United States
Objective: To report a case of fibrodysplasia ossificans progressiva (FOP) initially presenting as a neck mass and alert the practicing otolaryngologist to the imperative to avoid harmful biopsy. Case: A 2-year-old male presented with a firm left posterior neck mass and bilateral great toe malformations. Imaging was non-diagnostic and after 2 weeks of antibiotics the lesion was larger. At surgical biopsy, the mass was pale, firm, and avascular. Histopathology showed low grade fibromyxoid tissue. Rheumatology service diagnosed FOP based on clinical examination of neck mass, bilateral great toe deformities, stiff joints. Biopsy proved unnecessary and the patient developed heterotopic ossification at the site of surgical trauma. The patient was started on anti-inflammatories and steroids with minimal benefit. This case highlights the need for a broader understanding among clinicians who may encounter patients with FOP regarding the clinical aspects of diagnosis and the potential harm caused by surgical interventions. http://dx.doi.org/10.1016/j.ijporl.2013.10.039
Crohn’s supraglottitis – The presenting feature of otherwise asymptomatic systemic disease S.E. Price a,*, S.J. Frampton b, T. Coelho b, D.J. Fowler b, S. Holden b, R.M. Beattie b, H. Ismail-Koch b, A. Burgess a a Hampshire Hospitals NHS Foundation Trust, Royal Hampshire County Hospital, Romsey Road, Winchester, Hampshire SO22 5DG, United Kingdom b University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Tremona Road, Southampton, Hampshire SO16 6YD, United Kingdom We present the unique case of a 15 year old boy with upper airway obstruction found to have Crohn’s disease in the absence of gastrointestinal symptoms. Laryngeal manifestations of Crohn’s disease are extremely rare. Only 11 cases have been reported in the literature, of which only one is in a child. Laryngeal Crohn’s disease usually occurs accompanied by gastrointestinal symptoms or in patients with a prior diagnosis of Crohn’s disease. The literature on the clinical features and management of laryngeal Crohn’s is discussed along with a summary of the reported otolaryngological manifestations and associations with Crohn’s disease. http://dx.doi.org/10.1016/j.ijporl.2013.08.040
Abnormal CT temporal bone findings in a case of Kallmann syndrome presenting with conductive hearing loss Chak Yuen Fung a,*, Abhilash Balakrishnan a, Tiong Yong Tan b a Department of Otolaryngology, Kandang Kerbau Women’s and Children’s Hospital, Singapore b Department of Diagnostic Radiology, Changi General Hospital, Singapore Kallmann syndrome is characterised by hypogonadotrophic hypogonadism and hyposmia. Sensorineural hearing loss is a frequently described association with this syndrome. We report a case of Kallmann syndrome presenting with conductive hearing loss and the CT temporal bone findings of absence of all the semicircular canals. We also postulated the causes for the conductive hearing loss and reviewed the relevant literature. http://dx.doi.org/10.1016/j.ijporl.2013.10.040
Bilateral keratocystic odontogenic tumor of mandible – A unique pediatric lesion: Case report and review Reena Radhikaprasad Sarkar a,*, G.P. Rathod b a Professor and Head, Department of Oral and Maxillofacial Pathology and Microbiology, National Dental College, Derabassi, Mohali, Punjab, India b Professor, Head and Postgraduate Teacher, Oral Pathology, PDM Dental College, Bahadurgarh, Haryana, India The keratocystic odontogenic tumor (KCOT) is the most common cystic neoplasm in the maxillofacial region. Multiple odontogenic keratocyst are usually associated with Nevoid Basal Cell Carcinoma (NBCC) syndrome. A variant of this neoplasm is the sporadic multiple KCOT in pediatric population. Presented here is a case of bilateral keratocystic odontogenic tumor in a fourteen year old. Multiple keratocysts in the pediatric population is rare, aggressive, and recurrent and the first sign of NBCC or the solo presentation of human homologue of the PTCH (Drosophila segment polarity gene Patched) gene mutation. http://dx.doi.org/10.1016/j.ijporl.2013.10.041