Six cases of laryngocele are reported including 2 bilateral, external laryngoceles, 1 internal laryngocele associated with amyloidosis, and 3 combined laryngoceles. Laryngoceles occur predominantly in males. Cervical mass and hoarseness were the most common signs and symptoms. Bilateral, external laryngoceles that decompress spontaneously when intralaryngeal air pressure returns to normal were managed conservatively. Combined and internal laryngoceles should be removed surgically through an external, lateral neck approach. This approach is preferable to anterior laryngofissure because it avoids trauma to the anterior commissure and the true vocal cords. In addition, blunting of the anterior commissure and the risk of subglottic stenosis are avoided.

Adult↗

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Aneurysmal bone cyst of the ethmoid.

Although nearly 500 cases of aneurysmal bone cyst have been recorded in the English literature, involvement of the facial bone is uncommon. To our knowledge, this is the first case of extragnathic, facial aneurysmal bone cyst to be reported in the English literature. A left ethmoid aneurysmal bone cyst was found in a 20-year-old pregnant woman who had a 5-month history of progressive left periorbital swelling, left cystic nasal mass, progressive nasal obstruction, blurred vision, and occasional diplopia. The diagnostic evaluation included a sinus series, facial lamiograms, and an EMI scan. Needle aspirates taken frequently from the intranasal cyst consisted of a dark bloody fluid. The surgical procedure, using external rhinotomy approaches, pathologic findings, and a literature review are presented.

Adult↗

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MR findings in normal-pressure hydrocephalus: significance and comparison with other forms of dementia.

This study was undertaken to identify findings on magnetic resonance (MR) imaging that might possibly differentiate among several dementia states in the elderly or predict response to shunt therapy in patients with normal-pressure hydrocephalus (NPH). The MR findings were retrospectively reviewed in 54 patients who were divided into four clinical categories: NPH (17 patients), obstructive hydrocephalus (eight patients), Alzheimer disease (eight patients), and non-Alzheimer dementia (21 patients). Three MR findings were evaluated in each case: increased periventricular (PVS) and white matter (WMS) signal on T2-weighted images, CSF flow void sign (CFVS) in the aqueduct, and corpus callosum thinning. Neither the PVS/WMS nor corpus callosum thinning patterns were useful for distinguishing among the four clinical groups. At low field strength, the absence of a marked or moderate CFVS, however, may militate against a diagnosis of NPH. All 17 patients with NPH underwent a shunt procedure after the MR study. A better response to shunt therapy occurred in patients without WMS and with more severe PVS.

Adult↗

PubMedDate not supplied

Otosclerosis: vestibular symptoms and sensorineural hearing loss.

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Adult↗

PubMedDate not supplied

Superficial temporal arteriography in patients suspected of having temporal arteritis.

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Aged↗

PubMedDate not supplied

Evaluation of bone scan by scintigraphy to detect subclinical invasion of the mandible by squamous cell carcinoma of the oral cavity.

A prospective study using scintigraphy was performed to compare the sensitivity of the Panorex roentgenogram and the bone scan in detecting subclinical invasion of the mandible by squamous cell carcinoma of the oral cavity and floor of the mouth. Twenty-five patients with squamous cell carcinoma of the floor of the mouth were evaluated preoperatively by both the Panorex and scintigraphic techniques and the results compared with postoperative pathologic findings. In 13 (52%) of the cases, Panorex and scintigraphic techniques were comparable in detecting tumor involvement in bone. In eight cases (32%) all three modalities had normal pathologic indications of the mandible. However, in four cases (16%) results of the scintigraphic techniques were abnormal and the Panorex, normal. In four separate cases, the extent of lesion demonstrable by scintiscanning was greater than delineated by Panorex; surgical specimen confirmed this finding. Pathologic examination of operative specimens confirmed tumor involvement. These data lead us to believe that the scintigraphic techniques may be more sensitive in detecting early mandibular involvement with squamous cell carcinoma than the Panorex technique and may help alter the therapeutic approach.

Adult↗

PubMedDate not supplied

Computer analysis of orbital fat and muscle volumes in Graves ophthalmopathy.

A technique using special computer programs and data from high-resolution computed tomographic scans has been developed that provides accurate and reproducible volume measurements for muscle and fat in the orbit. Normal values for retrobulbar fat and muscle were established in 19 adults. Nineteen patients with Graves exophthalmopathy were then studied, and a spectrum of change was found that included varying degrees of increased muscle volume or increased volume of both muscle and fat. Further categorization of these changes related to clinical characteristics should lead to a better understanding of the mechanism for ophthalmopathy in Graves disease.

Adipose Tissue↗

PubMedDate not supplied

Spontaneous cervical cephalic arterial dissection and its residuum: angiographic spectrum.

Cervical cephalic dissections are uncommon acute disruptions of the arterial wall occurring predominantly in middle-aged women. Clinically, most patients present with unilateral headache, oculosympathetic palsy, or ischemic neurologic symptoms. Usually, a single internal carotid artery, predominantly the right, is affected, but simultaneous multivessel dissections are evident in about one-third of patients. Angiographically, the appearance of the dissection varies, depending on its severity, extent, and the interval between onset and angiography. In the patients reported, the disruption was manifested initially by eccentric tapered stenosis in 47%, tapered stenosis and a dissecting aneurysm in 28%, occlusion in 18%, or a dissecting aneurysm alone in 7%. Subsequently, stenotic dissections resolved in 60%, improved in 20%, and progressed in 15%, while dissecting aneurysms diminished in half and resolved in one-fourth of patients. An angiographic residuum, temporally remote to its onset, was evident in 25% of dissections. Hence, carotid arterial dissections tend to resolve, sometimes progress, but seldom recur.

Adult↗