Central Retinal Artery Occlusion Due to Subperiosteal Orbital Abscess Caused

Case Report
Central Retinal Artery Occlusion Due to Subperiosteal Orbital Abscess Caused by Acute Sinusitis in a Child: A Case ReportXiumei Chen, MD, Xuejing Man, MD, Lei Dong, MD, Jiangang Luan, MD, Yuanbin Li, MM, and Xicheng Song, MDDOI: 10.1177/01455613211016731AbstractCentral retinal artery occlusion (CRAO) is an ophthalmic emergency and has poor visual prognosis. It is commonly found in elderly people and very rare in child. We reported an 8-yearold girl who suffered from acute sinusitis, periorbital swelling, and the visual acuity of her right eye was only light perception. She was diagnosed with CRAO, SPOA (subperiosteal orbital abscess), and acute sinusitis. Emergency treatments including surgery, antibiotics, glucocorticoids, intraocular-pressure-lowering drugs, and vasodilators were taken immediately in order to save the eyesight. The visual acuity of the right eye returned to 20/400. Conclusions: Severe intraorbital complications of acute sinusitis can lead to CRAO. Timely drainage, strong antibiotics, and glucocorticoids are the most effective methods for the treatments.Dividing RulePediatric ClinicFirst Branchial Cleft Anomalies: Rare Work Type I and Type II EntitiesKonstantinos Tarazis, MD, Konstantinos Garefis, MD, MSc, Maria Garefi, MD, Vasilios Nikolaidis, MD, PhD, Angelos Chatziavramidis, MD, and Konstantinos Markou, MD, PhDDOI: 10.1177/01455613211015737Significance Statement
First branchial cleft anomalies (FBCAs) are the most infrequent malformations that occur during the development of the branchial apparatus, appearing in less than 8% of all branchial anomalies. Traditionally, they are classified into Work type I and II, depending on their origin. We present a pair of rare FBCAs: a case of a preauricular Work type I cyst with twin fistulae coursing toward the parotid gland and a Work type II cyst of significant dimensions.Dividing Rule-1692886648Pediatric ClinicNasal Septum Hemangioma in a 9-Year-Old BoyMaria Garefi, MD, Konstantinos Garefis, MD, MSc, Vasilios Nikolaidis, MD, PhD, Angelos Chatziavramidis, MD, Iordanis Konstantinidis, MD, PhD, Elisavet Pazarli, MD, PhD, and Konstantinos Markou, MD, PhDDOI: 10.1177/01455613211018128Significance Statement
Hemangiomas of the head and neck account for about 7% of all benign tumors in children. They are rare in the nasal cavity and especially in the nasal septum. Only 16 cases of intranasal hemangiomas in childhood have been previously described in the literature and 6 of them arising from the nasal septum. We present a rare case of a nasal septum hemangioma (NSH) in a 9-year-old boy who was treated with transnasal endoscopic resection.Dividing Rule-1692886651ClinicPediatric Oral Neurovascular Hamartoma of the Hard Palate: A Clinicopathologic ReportCatherine F. Roy, MD, Sarah Khalife, MD, Mariya Kuk, MD, Van-Hung Nguyen, MD, FRCPC, and Sam J. Daniel, MD, FRCSCDOI: 10.1177/01455613211014302Significance Statement
We hereby present the first-reported pediatric case of a hard palate neurovascular hamartoma in a male newborn, in which the diagnosis was established following an initial nondiagnostic biopsy, extensive radiological investigations, and eventual wide local excision. These benign lesions can easily be mistaken for malignant diagnoses, leading to increased parental and child anxiety as well as avoidable diagnostic and therapeutic interventions.Dividing Rule-1692886652Case ReportA Pediatric Lateral Submental Mass: A Rare Presentation of Dermoid CystAdam Sauer, BS, Anish Abrol, MD, Claudia I. Cabrera, MD, MS, and Jay Shah, MDDOI: 10.1177/01455613211019787Abstract
Dermoid cysts are benign cutaneous neoplasms that contain germ cells from the ectoderm and mesoderm. Approximately 70% are diagnosed during childhood before the age of 5. Although they can present throughout the body, the prevalence is 7% for those arising from the head and neck. These lesions present primarily as midline masses and are classified as sublingual, submental, or overlapping depending on their relationship with the muscles of the floor of mouth. A 10-year-old female presented with a 2-week history of right submental swelling. She denied pain, dysphagia, odynophagia, or respiratory distress. Physical examination showed nontender fullness of the submental region without erythema or induration and no palpable cervical lymphadenopathy. Ultrasound showed an ovalshaped cystic mass measuring 4.8 × 4.0 × 2.6 cm. After a course of clindamycin, a computed tomography was obtained which showed a right 4.5 × 4.0 × 2.6 cm fluid filled lesion, within the right lateral floor of mouth. Intraoral resection was performed and the mass was freed from the geniohyoid and mylohyoid. Histopathology was consistent with a dermoid cyst. Submental masses have a broad differential, but rarely are they dermoid cysts if they arise lateral to the midline. With appropriate diagnosis and total surgical excision, patients and their families can be reassured in similar cases.Dividing Rule-1692886654Imaging ClinicMetastatic Melanoma of the Tongue BaseKai-Fen Chuang, MD, Cheng-Ping Shih, MD, PhD, Yi-Ming Chang, MD, and Che-Jui Lee, MDDOI: 10.1177/01455613211014288Significance Statement
Metastatic melanoma of the upper aerodigestive tract is rare, and cases with metastatic melanoma of the tongue base are considered exceptionally uncommon. The prognosis of metastatic mucosal melanoma is extremely poor in the head and neck region. Herein, we reported the case of metastatic melanoma of tongue base with regional symptoms and was diagnosed through laryngoscopy.Dividing Rule-1692887245Imaging ClinicThe Moth-Eaten Mandible: OsteomyelitisGalal Omami, BDS, MSc, MDentSc, FRCD(C)DOI: 10.1177/01455613211014289Significance Statement
Inflammatory lesions such as osteomyelitis of the jaw may share some of the radiographic features of malignancy; however, a demonstrable dental cause for it usually exists. In addition, inflammatory lesions generally stimulate a sclerotic bone reaction, which is uncommon in malignancy. The imaging modality of choice for aiding in the differential diagnosis is computed tomography imaging because of its ability to clearly delineate sequestra and periosteal new bone formation.Dividing Rule-1692887247Clinical StudySafety of a New Sinus Irrigation Device in Rhinosinusitis: A Pilot StudyIsaac Shochat, MD, Golda Grinblat, MD, Howard Levine, MD, and Itzhak Braverman, MDDOI: 10.1177/01455613211015417Abstract Background:
Puncture and lavage of the paranasal sinuses, previously the primary treatment for unresponsive acute bacterial rhinosinusitis before surgery, has been abandoned due to procedural discomfort and advancements in antibiotic efficacy and endoscopic surgery. The rise in antibiotic-resistant bacteria has renewed the interest in minimally invasive sinus lavage to both avoid aggressive surgical interventions and identify appropriate antibiotic therapy. In this article, we describe the safety and feasibility of a new device in human patients and evaluate its efficacy as a treatment before the traditional sinus surgery in acute rhinosinusitis. Methods: The device with its seeker-shaped guiding tube and rotating wire can enter the sinus cavity through the natural ostium, pulverize the inspissated mucus, and enable lavage and culture sampling without the need for sinus puncturing. It was tested in 6 patients with chronic sinusitis under general anesthesia during endoscopic sinus surgery and in additional 10 patients with maxillary acute bacterial rhinosinusitis in outpatient settings under local anesthesia. Results: The device enabled rapid, efficient, and atraumatic insertion of the wire into the occluded sinuses. The rotating wire permitted pulverization of the thick mucus, which enabled irrigation without mucosal damage or adverse events. Overall, 9 of 10 patients with acute bacterial rhinosinusitis demonstrated remarkable improvements and were discharged the following day with no acute symptoms. The visual analog scale score for pain dropped from 8.9 to 0.4. The remaining one patient underwent endoscopic sinus surgery subsequently. None of the patients treated during endoscopic sinus surgery developed any adverse events.Dividing Rule-1692887248Laryngoscopic ClinicBilateral Vocal Fold Granuloma and Anterior Glottic Web After Papilloma ExcisionBenjamin T. Ostrander, MD, MSE, Vanessa Yu, BS, and Andrew Vahabzadeh-Hagh, MDDOI: 10.1177/01455613211012112Abstract
We present a case of delayed vocal process granulomas and anterior glottic web after treatment of vocal fold papillomas with a laryngeal microdebrider and CO2 laser ablation. This case highlights a risk of vocal fold granuloma in the setting of recurrent respiratory papillomatosis and microdebrider use, warranting close followup and consideration of prophylactic voice therapy, anti-reflux medications, and steroid injection in cases of violation of vocal cord epithelium.Dividing Rule-1692887523Case ReportDelayed Tracheal Perforation After Partial Thyroidectomy: A Case Report and Review of the LiteratureShaghauyegh S. Azar, BS, Evan Patel, BS, Lauran K. Evans, MD, MPH, Timothy C. Blood, MD, Brooke M. Su-Velez, MD, MPH, and Dinesh K. Chhetri, MDDOI: 10.1177/01455613211019785Abstract
Tracheal perforation is an extremely rare and potentially dangerous complication of a partial thyroidectomy. The current case represents a unique presentation of delayed tracheal perforation following an uncomplicated thyroid isthmusectomy for tissue diagnosis of an aggressive appearing thyroid mass in the setting of high-dose steroid administration and recent intubation and selfextubation. While conservative management of tracheal perforation can sometimes be appropriate, our patient was successfully managed via primary closure and infrahyoid muscle transposition flap to cover a 5 mm right lateral tracheal wall defect. We recommend caution be exercised following thyroid surgery in the setting of intubation and high-dose steroids.Dividing Rule-1692887525Clinical StudyPrecisely Closed Reduction of Nasal Bone Fracture Assisted With Plain Film Measurements Under the Picture Archiving and Communication SystemTzu-Hsien Yang, MD, Chien-Liang Fang, MD, Chong-Bin Tsai, MD, PhD, Ming-Shan Chen, MD, Chih-Hsuan Changchien, MD, Hsin-Yi Yang, PhD, and Kai-Jan FangDOI: 10.1177/01455613211012111Abstract Objectives:
To prevent aesthetic and functional deformities, precisely closed reduction is crucial in the management of nasal fractures. Plain film radiography (PF), ultrasonography (USG), and computed tomography can help confirm the diagnosis and classification of fractures and assist in performing closed reduction. However, no study in the literature reports on precisely closed reduction assisted with PF measurements under the picture archiving and communication system (PACS). Methods: We retrospectively evaluated 153 patients with nasal bone fracture between January 2013 and December 2017. Surgeons conducted precisely closed reduction assisted with PF measurement of the distance between the fracture site and nasal tip under PACS on 34 patients (group A). Another group on 119 patients were reduced under surgeon’s experience (group B). Results: No significant differences in age, gender, Arbeitsgemeinschaft fur Osteosynthesefragen (AO) classification, and reduction outcome were observed between group A and group B (P > .05). The operative time of the group A was significantly lower (12.50 ± 4.64 minutes) compared to group B (23.78 ± 11.20 minutes; P < .001). After adjusted age, gender, and AO classification, patients in group A scored 10.46 minutes less on the operative time than those in group B (P < .001). In addition, the severity of nasal bone fracture (AO classification, β = 3.37, P = .002) was positive associated with the operative time. Conclusions: In this study, closed reduction in nasal bone fracture assisted with PF measurements under PACS was performed precisely, thereby effectively decreasing operative time and the occurrence of complications. This procedure requires neither the use of new instruments or C-arm nor USG or navigation experience. Moreover, reduction can be easily performed using this method, and it requires short operative time, helps achieve great reduction, less radiation exposures, and is cost-effective.Dividing Rule-1692887526
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