Figure 1. Catheter insertion and drainage of the parotid sialocele. Puncturing and aspirating the cystic content of the sialocele confirmed the correct position of the catheter.
J uvenile nasopharyngeal angiofibromas (JNAs) are benign tumors that mainly develop in male adolescents between the ages of 14 and 25 years. They grow in an unpredictable pattern and may involve the nasal cavity, nasopharynx, paranasal sinuses, pterygopalatine fossa, infratemporal fossa, orbit, and cranial cavity. Patients with JNA typically present with unilateral tumor masses. We present a case of a 24-year-old man with a second primary angiofibroma 5 years after removal of the primary tumor through a completely endoscopic approach. To the best of our knowledge, this is the first case of a second primary angiofibroma reported in the English literature. CaseWe obtained exemption from the Institutional Review Board at the University of Puerto Rico, School of Medicine. The patient is a 24-year-old man who was first evaluated in our clinics in September 2005 because of progressive right nasal obstruction and epistaxis for several years. Initial endoscopic evaluation revealed a large, encapsulated mass that completely occluded the right posterior nasal cavity and nasopharynx. A preoperative computed tomography (CT) scan revealed a heterogeneously enhancing mass (3.4 3 3.6 3 3.5 cm) involving the posterior right nasal cavity and extending to the nasopharynx, the right ethmoid, and the right sphenoid sinuses (Figure 1). Preoperative embolization was deferred after a 6-vessel angiogram revealed a stenosis at the takeoff of the right external carotid artery and a feeder into the tumor from the right cavernous carotid. Normal vascular anatomy was noted on the left internal and external carotid systems.The patient was taken to the operating room in November 2005 with a working diagnosis of JNA. Resection of the angiofibroma was accomplished through a completely endoscopic approach. Postoperative pathology results confirmed the diagnosis of angiofibroma.The patient was seen in our clinics for follow-up. Nasal endoscopy evaluations were unremarkable until 2009, when a small purplish nasal mass was found attached to the posterior edge of the left middle turbinate. A CT scan revealed a heterogeneously enhancing left nasal mass, limited to the posterior left nasal cavity, with extension to the left choana ( Figure 2).
Objective: Tonsillectomy is a common surgery performed on pediatric patients. Patients and their caregivers may search the Internet for information related to this procedure, and YouTube is a popular Web site that they may consult. We investigated YouTube as an information source on pediatric tonsillectomy.Method: YouTube was searched on February 17, 2012, for videos containing relevant information about tonsillectomies in pediatric patients using the keywords pediatric tonsillectomy, tonsillectomy and tonsil surgery. Non-English videos were excluded. Two physician reviewers watched each video and assessed for content (useful, misleading, personal experience). The StatsDirect software will analyze measures. Results:The search for each keyword identified over 2555 videos (pediatric tonsillectomy = 91, tonsillectomy = about 1800, tonsil surgery = 664). The first 200 videos were screened for each keyword on the assumption that most users would not go beyond the first 10 pages. Therefore, 491 videos were screened for inclusion and exclusion criteria, and duplicates were removed. At the time of abstract submission, final data analysis was not yet available. Outcomes included content assessment and characteristics, and video total viewership, number of days since upload, total duration, viewer rating, and source of upload. Reviewer degree of agreement and relevant statistical analysis will be reported. Conclusion:YouTube has a substantial number of videos on pediatric tonsillectomy with a variety of content ranging from useful to misleading. Health care professionals must recognize the potential influence that these user-generated video Web sites may have on the attitudes of patients and their caregivers. Rhinology/Allergy a Case of atrophic Rhinitis Caused by Klebsiella ozaenae Brian C. Rodgers, MD (presenter); Kim BakerObjective: To educate clinicians on the presentation and management of this uncommon pathogen as it pertains to atrophic rhinitis and to review the role of autoimmune tendencies in the development of ozena in this patient with nasal infection by Klebsiella ozaenae.Method: This case report describes a 17-year-old Somalian female with ozena (atrophic rhinitis). She presented to our tertiary care center in Kansas City, Missouri, in November 2011 with classic symptoms of atrophic rhinitis and was diagnosed based on a positive surgical culture of K ozanae. She was noted to have bilateral middle turbinate destruction preoperatively and has been treated thus far with serial surgical debridements, topical nasal rinses and an oral fluoroquinolone. We are measuring cure of her disease with multiple parameters including improved nasal obstruction (symptomatic), endoscopic documentation of resolution of rhinitis, and pathologic/ microbiologic confirmation of cure.Results: Our patient experienced temporary relief of her symptoms after endoscopic debridement. Recurrence of her symptoms was delayed by topical nasal rinses and steroids. A prolonged course of therapy with an oral fluoroquinolone augmented by serial na...
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