Laryngeal Schwannoma, Alarming Mass of Airway: A Case Report

Laryngeal schwannomas are rare tumors of neural sheath origin. They normally present as a slow-growing, encapsulated, submucosal mass commonly in the supraglottic region. We describe a 13-year-old boy presenting with a 4-month history of progressive worsening dysphagia. Fiber optic laryngoscopy and computed tomography revealed a polypoidal mass in the laryngeal surface of epiglottis abutting left the aryepiglottic fold, base of the tongue and hypopharyngeal wall. Direct laryngoscopic evaluation and microdebrider assisted debulking was performed with tracheostomy. Schwannoma was confirmed by histopathological study. In a regular follow-up after two months, 70 degree endoscopic evaluation revealed similar mass in the left aryepiglottic fold obscuring the vocal cord. Definite complete excision of the tumor was planned and endoscopic excision of the masswas performed with removal of ipsilateral aryepiglottic fold, arytenoid and false vocal cord with retracheotomy. Rapid occurrence of mass after debulking and biopsy was demonstrated in this case. Though rare, neurogenic tumors of the larynx are life-threatening and need complete removal.

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Stridor: a rare presentation of motor neuron disease

BMJ Case Reports ◽

10.1136/bcr-2021-241923 ◽

2021 ◽

Vol 14 (7) ◽

pp. e241923

Author(s):

Brian Gordon ◽

Eimear Joyce ◽

Timothy J Counihan

Keyword(s):

Motor Neuron ◽

Motor Neuron Disease ◽

Vocal Cord ◽

Poor Response ◽

Vocal Cord Palsy ◽

Pharmacological Therapy ◽

Rare Presentation ◽

Emergency Tracheostomy ◽

Life Threatening ◽

History Of

A 74-year-old farmer presented to the emergency department with a subacute history of progressive dyspnoea, wheeze and dysphonia. He was treated for an exacerbation of asthma with poor response to pharmacological therapy. Investigation of dysphonia via laryngoscopy identified a bilateral vocal cord palsy. Subsequently, the patient developed an episode of life-threatening stridor and hypercapnic respiratory failure requiring an emergency tracheostomy. Neurology input identified evidence of widespread muscle fasciculations on clinical examination. MRI of the brain and cervical spine were unremarkable. Electromyogram testing identified changes of acute denervation in several limbs consistent with a diagnosis of motor neuron disease (MND). Bilateral vocal cord palsy has been rarely reported in the literature as the heralding symptom resulting in the diagnosis of MND. In patients with a subacute onset of dysphonia, dyspnoea and stridor, MND should be a differential diagnosis.

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Schwannoma of False Vocal Cord - A Rare Entity

Nepal Journal of Health Sciences ◽

10.3126/njhs.v1i1.38735 ◽

2021 ◽

Vol 1 (1) ◽

pp. 60-63

Author(s):

Arju Deo ◽

Daisy Maharjan ◽

Alina Karna

Keyword(s):

Vocal Cord ◽

Postoperative Recovery ◽

Rare Entity ◽

Common Site ◽

Laryngeal Surgery ◽

Aryepiglottic Fold ◽

Laryngeal Tumors ◽

False Vocal ◽

Ventricular Folds

Laryngeal Schwannoma is rare comprising 0.1 – 1.5% of all benign laryngeal tumors. The most common site in larynx is aryepiglottic fold followed by arytenoids, ventricular folds, and vocal cord. Patients present with the symptoms of hoarseness, dysphagia or globus sensation. We present a 33-year-old male with supraglottic schwannoma who experienced hoarseness of voice for three months. The patient underwent micro laryngeal surgery and submucosal solid tumor of false vocal cord was removed. Postoperative recovery was uneventful and after one month of follow up the patient was improving with no hoarseness of voice.

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Tapia's syndrome caused by a neurofibroma of the hypoglossal and vagus nerves

Journal of Neurosurgery ◽

10.3171/jns.1980.52.5.0730 ◽

1980 ◽

Vol 52 (5) ◽

pp. 730-732 ◽

Cited By ~ 16

Author(s):

Giancarlo Andrioli ◽

Luca Rigobello ◽

Salvatore Mingrino ◽

Vito Toso

Keyword(s):

Vocal Cord ◽

Cranial Nerves ◽

Complete Removal ◽

Nodose Ganglion ◽

Vagus Nerves ◽

Content Type ◽

Tapia’S Syndrome ◽

History Of ◽

The Right ◽

Fine Print

✓ Tapia's syndrome is characterized by unilateral paralysis of the tongue and vocal cord, and is caused by a lesion of the 10th and 12th cranial nerves below the nodose ganglion, without involvement of the pharyngeal branches of the 10th nerve. The authors report the case of a 25-year-old man who presented with a 4-year history of progressive glossolaryngeal paralysis. Operation through the right laterocervical region allowed complete removal of a neurofibroma involving the 10th and 12th nerves at their crossing below the nodose ganglion.

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Very rare giant adrenal myelolipoma: a tumor mimic

International Surgery Journal ◽

10.18203/2349-2902.isj20200321 ◽

2020 ◽

Vol 7 (2) ◽

pp. 586

Author(s):

Aditya Prasad Padhy ◽

Abinash Kanungo ◽

Deepak Kumar Das ◽

Sunny .

Keyword(s):

Abdominal Pain ◽

Unusual Case ◽

Benign Neoplasm ◽

Chronic Abdominal Pain ◽

Histopathological Study ◽

Main Role ◽

Adrenal Myelolipoma ◽

Invasive Approach ◽

Life Threatening ◽

History Of

Adrenal myelolipoma is a very rare benign neoplasm usually unilateral, and nonsecreting, occurring in the adrenal gland which consist of fatty tissues and hematopoietic elements. Some cases of this type may cause symptoms like chronic abdominal pain however usually these tumors are small and asymptomatic. Surgery is the modality of treatment where there are severe symptoms with life threatening progression with size of tumor reaching more than 6 cm. Here we report an unusual case of a 59-year-old male with history of chronic abdominal pain from a growing right-sided large adrenal mass. With all possible hematological, histo-pathological as well as imaging investigations warranted a high suspicion for tumor mass, hence decided for surgically excision, which was both diagnostic as well as curative. The histopathological study of the excised mass confirmed the initial diagnosis of adrenal myelolipoma. Surgery is the diagnostic and curative modality of treatment for adrenal myelolipoma after all possible investigations to reach for a clinical diagnosis as well for proper planning for surgery. By this we can prevent complications like spontaneous rupture and hemorrhage of the mass, and subsequent cardiovascular shock. Management varies from individual to individual. Open radical adrenalectomy is the standard treatment for giant myelolipomas (size >10 cm), while the minimally invasive approach has been used in only few cases of small sized tumors. Although it is a benign tumor, surgery plays main role for symptomatic cases and high suspicion of malignancy.

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Cholesteatoma of the Frontal and Ethmoid Areas

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348947908800412 ◽

1979 ◽

Vol 88 (4) ◽

pp. 518-523 ◽

Cited By ~ 16

Author(s):

Ruth S. Campanella ◽

David D. Caldarelli ◽

Stanton A. Friedberg

Keyword(s):

Benign Lesion ◽

Complete Removal ◽

Epithelial Lining ◽

Life Threatening ◽

History Of ◽

One Year ◽

Squamous Tissue ◽

Cyst Lining ◽

Slow Growing ◽

Growing Mass

Cholesteatomas of the frontoethmoid region must always be considered in the differential diagnosis of a mass in the frontoethmoid region. A painless, slow-growing mass, often accompanied by proptosis and diplopia, but without history of trauma or infection, should make one suspect of this pathologic entity. Although histologically a benign lesion, the keratinizing squamous epithelial lining will continue to desquamate and expand, leading to erosion of surrounding structures which could be life-threatening. In order to prevent recurrence, complete removal of the cyst lining is mandatory. Cosmetic reconstruction, often requiring obliteration of the surgical cavity, should be delayed for one year to insure against recurrence of the covering of active squamous tissue adjacent to dura, cribriform plate or ocular structures.

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Computerized Tomographic Assessment of Vocal Cord Palsy: Otolaryngologist's Purview

International Journal of Phonosurgery & Laryngology ◽

10.5005/jp-journals-10023-1123 ◽

2016 ◽

Vol 6 (2) ◽

pp. 57-63

Author(s):

Apoorva K Pandey ◽

Tripti Maithani ◽

Arvind Varma ◽

Sharad Gangrade ◽

Ankur Malhotra

Keyword(s):

Vocal Cord ◽

Three Dimensional ◽

Vocal Cord Palsy ◽

Pyriform Sinus ◽

Radiologic Evaluation ◽

Aryepiglottic Fold ◽

Key Points ◽

Dimensional Reconstruction ◽

Life Threatening ◽

Axial Ct

ABSTRACT Aims and objectives Vocal cord palsy (VCP) can be definitely depicted on computed tomograpy (CT) scan by identifying key points at the level of true vocal cords and aryepiglottic folds. There are various VCP mimics and imaging shortcomings, and these can usually be circumvented by thoughtfully assessing the scan plan and level, and a diligent search for additional characteristics. Materials and methods This retrospective study consisted of 10 cases of unilateral VCP, who all had been clinically diagnosed of VCP and further evaluated by CT. Pre- and postcontrast enhanced axial CT from skull base to aorto-pulmonary window were done and multiplanar three-dimensional reconstruction of images in coronal and sagittal planes along with volume-rendered imaging was done. Results Most consistent findings in VCP were thickening of ipsilateral aryepiglottic fold and medialization of ipsilateral aryepiglottic fold (100%), followed by dilation of ipsilateral pyriform sinus (90%) and dilatation of ipsilateral laryngeal ventricle (80%). Etiologic causes were ascertained in three cases: Thyroid malignancy, tuberculosis, and pyriform sinus malignancy. The last etiology was probably a VCP mimic. Conclusion Radiologic evaluation is inarguably useful for determining the etiology of VCP, particularly for lesions within neck and thoracic cavity. Most crucial objective in assessing a case of VCP is to exclude the presence of a life-threatening primary lesion as the cause of VCP. How to cite this article Pandey AK, Gangrade S, Malhotra A, Varma A, Maithani T. Computerized Tomographic Assessment of Vocal Cord Palsy: Otolaryngologist's Purview. Int J Phonosurg Laryngol 2016;6(2):57-63.

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Catheter Ablation of Life-Threatening Ventricular Arrhythmias in Athletes

Medicina ◽

10.3390/medicina57030205 ◽

2021 ◽

Vol 57 (3) ◽

pp. 205

Author(s):

Nicola Tarantino ◽

Domenico G. Della Rocca ◽

Nicole S. De Leon De La Cruz ◽

Eric D. Manheimer ◽

Michele Magnocavallo ◽

...

Keyword(s):

Catheter Ablation ◽

Ventricular Arrhythmias ◽

Individual Factors ◽

Substantial Part ◽

Arrhythmogenic Substrate ◽

Life Threatening ◽

History Of ◽

Anatomic Distribution ◽

Artery Disease ◽

Surveillance Analysis

A recent surveillance analysis indicates that cardiac arrest/death occurs in ≈1:50,000 professional or semi-professional athletes, and the most common cause is attributable to life-threatening ventricular arrhythmias (VAs). It is critically important to diagnose any inherited/acquired cardiac disease, including coronary artery disease, since it frequently represents the arrhythmogenic substrate in a substantial part of the athletes presenting with major VAs. New insights indicate that athletes develop a specific electro-anatomical remodeling, with peculiar anatomic distribution and VAs patterns. However, because of the scarcity of clinical data concerning the natural history of VAs in sports performers, there are no dedicated recommendations for VA ablation. The treatment remains at the mercy of several individual factors, including the type of VA, the athlete’s age, and the operator’s expertise. With the present review, we aimed to illustrate the prevalence, electrocardiographic (ECG) features, and imaging correlations of the most common VAs in athletes, focusing on etiology, outcomes, and sports eligibility after catheter ablation.

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Intraorbital Abscess: A Rare Cause of Orbit Compression

FACE ◽

10.1177/27325016211005062 ◽

2021 ◽

pp. 273250162110050

Author(s):

Samuel Ruiz ◽

Rizal Lim

Keyword(s):

Pediatric Population ◽

Rare Complication ◽

Disease Process ◽

Rare Condition ◽

External Drainage ◽

Direct Extension ◽

Life Threatening ◽

History Of ◽

High Index Of Suspicion ◽

Prompt Diagnosis

Introduction: Intraorbital abscess is a rare complication of rhinosinusitis that affects most commonly the pediatric population. It is thought to be caused by direct extension or venous spread of infections from contiguous sites and can lead to life-threatening complications, like permanent visual loss and cerebral abscesses. Objectives: Intraorbital abscess is a rare condition that requires prompt diagnosis and treatment to avoid serious complications. Our objectives are to provide an overview of this rare disease process and its management including our successful treatment experience. Case Description: We present a 2 case report of a 13-year-old pediatric male and a 66-year-old male with history of chronic sinusitis who presented with a right intraorbital abscess successfully treated with external drainage with decompression of the orbit. Conclusion: When intraorbital abscess is encountered, a high index of suspicion is needed to allow prompt and accurate diagnosis for this infrequent condition. Timely surgical drainage of the abscess is needed to prevent the development of fatal complications.

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Endoscopy-assisted removal of periorbital inclusion cysts in children

Journal of Neurosurgery Pediatrics ◽

10.3171/2010.11.peds10332 ◽

2011 ◽

Vol 7 (2) ◽

pp. 161-164 ◽

Cited By ~ 5

Author(s):

George Chater-Cure ◽

Caitlin Hoffman ◽

Jared Knopman ◽

Samuel Rhee ◽

Mark M. Souweidane

Keyword(s):

High Speed ◽

Complete Removal ◽

Skin Incision ◽

Clinical Findings ◽

Complete Excision ◽

Alternative Approach ◽

Cyst Recurrence ◽

Scalp Incision ◽

Access Technique

Object Surgical treatment for periorbital inclusion cysts typically involves a brow, pterional, or partial bicoronal scalp incision for sufficient exposure. The authors have recently employed an endoscopy-assisted technique as an alternative approach intended to minimize the length of the skin incision and avoid scarring in the brow. Methods Children having typical clinical findings of a dermoid cyst located on the hairless forehead were selected to undergo endoscopy-assisted cyst removal. For suspected intradiploic lesions, MR imaging was used to assess osseous involvement. After induction of general anesthesia, a 1–2-cm curvilinear incision was made posterior to the hairline. A 30°-angled endoscope (4 mm) was then used for dissection in the subgaleal compartment. Subgaleal dissection was followed by a circumferential periosteal incision in which the authors used an angled needle-tip unipolar cautery. For lesions within the diploe, a high-speed air drill was used to expose the lesion. Complete removal was accomplished with curettage of either the skull or dural surface. Results Eight patients (5–33 months of age) underwent outpatient endoscopic resection. Seven cysts were extracranial, and 1 cyst extended through the inner table. In all patients complete excision of the cyst was achieved. There was negligible blood loss, no dural violation, and no postoperative infection. There have been no recurrences at a mean follow-up of 15 months. Conclusions Endoscopy-assisted resection of inclusion cysts of the scalp and calvaria is a safe and effective surgical approach. The technique results in negligible incisions with less apparent scarring compared with previously described incisions. This limited-access technique does not appear to be associated with a higher incidence of cyst recurrence.

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Asymptomatic mediastinal extra-adrenal paraganglioma as a cause of sudden death: a case Report

Open Life Sciences ◽

10.1515/biol-2019-0062 ◽

2019 ◽

Vol 14 (1) ◽

pp. 564-567

Author(s):

Qiancheng Xu ◽

Yingya Cao ◽

Hongzhen Yin ◽

Rongrong Wu ◽

Tao Yu ◽

...

Keyword(s):

Blood Pressure ◽

Case Report ◽

Respiratory Failure ◽

Pressure Drop ◽

Thoracic Cavity ◽

Severe Hypotension ◽

Life Threatening ◽

History Of ◽

Posterior Mediastinal ◽

Extra Adrenal Paraganglioma

AbstractA 23-year-old female patient was referred for treatment of a posterior mediastinal tumour. There was no history of hypertension or headache and no other complaints. The patient’s blood pressure increased to 210/125 mmHg after surgically manipulating the tumour, subsequently reversing to severe hypotension (25/15 mmHg) immediately after the tumour was removed. The life-threatening and irreversible blood pressure drop was difficult to treat with fluid and vasopressors, and the patient ultimately died of cardio-respiratory failure. Asymptomatic paraganglioma can be non-functional but can also be fatal. For any lump in the thoracic cavity, paraganglioma should be ruled out.

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