Search

We evaluated a modified technique of administering anesthesia without a tube and with spontaneous respiration during video-assisted tele-laryngo-tracheo-bronchoendoscopy (TLTBE). The endoscopy was performed as an alternative to rigid ventilatory bronchoscopy during screening for synchronous tumors in the tracheobronchial tree in patients who had head and neck malignancies. Thirty consecutive patients who required diagnostic panendoscopy were selected for this study. During direct-suspension laryngoscopy, anesthesia was delivered by administering intravenous bolus injections of propofol at 0.5 to 2 mg/kg every 5 to 10 minutes. A good view of the larynx, trachea, and main bronchi was obtained with a 50-cm 0° Hopkins telescope, which caused no obstruction of the airway. During laryngoscopy, arterial oxygen saturation levels, pulse rates, and blood pressures were stable in all patients. No apnea was associated with the use of propofol during any procedure, and we observed no intraoperative or postoperative complication in any patient. Video-assisted TLTBE is appropriate for patients with a grade 1 or 2 larynx, good cardiopulmonary function, and no significant airway obstruction. It is a safe and time-saving alternative to rigid ventilatory bronchoscopy for staging primary tumors and for screening for synchronous tumors in the respiratory tract.

Cowden's disease is a hereditary disorder characterized by oropharyngeal fibrosis and multiple hamartomas with potential malignant changes. We treated a 47-year-old man who had fibrotic lesions on the left vocal fold and an extensive amount of papillomatous lesions on the mucosa of the lips, tongue, and pharyngeal wall and on the skin of the axillae and buttocks. The pattern of distribution and the histopathologic features of these mucocutaneous lesions were diagnostic of Cowden's disease. To the best of our knowledge, this is the first reported case of Cowden's disease involving a vocal fold.

In an attempt to gain a better understanding of the prevalence of otitis media with effusion (OME) in the Hong Kong community, and to compare the characteristics of the disease here with OME as it is described in the Western literature, we screened more than 6,000 6- and 7-year-old children with both clinical and audiologic examinations. The initial positive screening rate was 5.3%. Upon further evaluation, we determined that the overall prevalence of persistent OME was 2.2%. We found that the disease pattern and natural history of persistent OME in Hong Kong children are similar to those reported in the Western literature.

We treated a patient with a giant squamous papilloma in the nasal cavity and maxillary sinus that extended through a bony defect into the oral cavity. The mass was excised with a combined endoscopic, Caldwell-Luc, and transoral approach. Lesions of this type are rare, but when they do occur, the rate of recurrence is high. Therefore, long-term followup, including endoscopic examination, is important.

A case of extramedullary plasmacytoma with its unusual appearance is reported. This is the second reported case in world literature affecting the paranasal sinuses with intracranial extension. The role of surgery is to obtain tissue for diagnosis and to excise residual disease. Radiotherapy is the treatment of choice and long-term follow-up is necessary for monitoring disease recurrence. The overall 10-year survival is about 50%. The case is discussed with a general review of the management of this pathology.

We report a rare case of a mucocele occuring in a naturally compartmentalized maxillary sinus in a 50-year-old woman. Sinus computerized tomography (CT) showed the antrum to be divided by a vertical bony septum, producing a mucocele within an isolated and non-draining anterolateral compartment. Accidental trauma to the thin bony shell precipitated rapid swelling of the pre-existing mass, leading to her initial consultation. A wide sublabial surgical approach allowed complete excision with a good cosmetic result.

Osteoradionecrosis of the temporal bone after external-beam radiotherapy for nasopharyngeal carcinoma is not uncommon following a long posttreatment interval. We describe the case of a man who had experienced this complication 13 years after he had undergone such radiotherapy. His condition resolved after removal of dead bone from the external auditory canal, followed by antibiotic therapy and periodic aural toileting.

We describe the case of a patient who was originally diagnosed with an antrochoanal polyp. During avulsion of the mass by endoscopic polypectomy, it was discovered that the stalk of the polyp actually arose from the mucosa of the right superior turbinate rather than from the mucosa of the maxillary antrum. A diagnosis of choanal polyp was made.

We report a case of a pregnant woman who had a pyogenic granuloma that had caused chronic epistaxis for 1 week's duration. The lesion was excised and the patient recovered fully.