Internal Laryngocele and Zenker’s Diverticulum Masquerading as a Laryngeal Fracture and Esophageal Perforation and Rupture

We present an interesting case of concomitant laryngocele and Zenker’s diverticulum found incidentally after sustained blunt anterior neck trauma. Our service was consulted to evaluate free air on a CT scan in the paralaryngeal space and also the paraesophageal area of the cervical esophagus. The trauma surgery service had concern for laryngeal fracture and esophageal rupture. The patient’s lack of complaint except for a very stiff neck and failure to reveal abnormal findings on a complete head and neck exam, in addition to detecting no abnormal findings on flexible laryngoscopy, alluded that this air seen on the initial CT scan was not due to the injury. The formal CT scan of the larynx and trachea in addition to esophagram led us to a diagnosis of simultaneous laryngocele and Zenker’s diverticulum. This is a very unusual coincidental diagnosis; however it still raises the importance for maintaining a high level of suspicion and due diligence in assessing the upper aerodigestive tract in blunt anterior neck trauma.

Treatment of Recurrent Vocal Cord Granuloma with Percutaneous Steroid Injection

Vocal cord granulomas are areas of chronic inflammation, usually located near the vocal process, caused by a variety of conditions such as intubation, gastroesophageal reflux disease, and vocal abuse. They are often difficult to eradicate. Treatments range from conservative management using anti-reflux medications, inhaled steroids, and voice therapy, to more invasive measures such as surgical excision, botulinum toxin injection, and steroid injection. Surgical treatment often leads to a high rate of recurrence. Botulinum toxin injections have shown promise in preliminary studies, but are not appropriate for all patients due to potential adverse effects. Percutaneous steroid injection offers a safe, minimally invasive, yet effective method of treating and preventing recurrence of both primary and recurrent vocal cord granulomas.

This paper reports successful treatment of a recurrent vocal cord granuloma using percutaneous steroid injection in a patient who failed both medical management and multiple surgical excisions. Complete resolution was seen two months after the second steroid injection. The patient has remained disease free one year from the final treatment, maintained only on daily proton pump inhibitor therapy. This case demonstrates there are multiple options available to treat this disease, and more prospective research is needed to establish a consistent treatment algorithm for all subsets of patients.

Nasal Resurfacing with Xenographic Bladder Bioscaffold Following Excision of Massive Rhinophyma

Massive rhinophyma is a disfiguring advanced form of rosacea. Due to the size of the tumor, full thickness excision is often necessary requiring reconstruction for optimal cosmetic results. We present the first report of nasal resurfacing using urinary bladder matrix bioscaffolding following excision of massive rhinophyma.Massive rhinophyma is a disfiguring advanced form of rosacea. Due to the size of the tumor, full thickness excision is often necessary requiring reconstruction for optimal cosmetic results. We present the first report of nasal resurfacing using urinary bladder matrix bioscaffolding following excision of massive rhinophyma.

Primary Diffuse Large B-Cell Lymphoma Presenting as Chronic Otomastoiditis

Primary presentation of lymphoma of the middle ear is rare, with only 18 cases being reported in the literature. Diagnosis of middle ear and mastoid tumors may be delayed because symptoms mimic more common otologic conditions. Only after clinical deteriorationdo patients often undergo further workup and evaluation that iscritical to definitive diagnosis. We describe a case of diffuse largeB-cell lymphoma presenting as unresolved chronic otitis media and mastoiditis. Isolated presentation of primary lymphoma in the middle ear and mastoid without associated cranial nerve deficits or vestibular symptoms has rarely been described previously. Even without advanced symptomatology, it is imperative to exclude the possibility of temporal bone malignancy through proper neurotologic examination and appropriate imaging.

Osteoma of the Internal Auditory Canal: Presentation of a Case with Literature Review

Osteoma of the internal auditory canal is a rare lesion, which is usually asymptomatic. Its growth is very slow and the diagnosis is usually made incidentally on computed tomography (CT) scans of temporal bones. However, there is not a single golden standard for treatment managements. Herein, a case which was diagnosed incidentally on CT scans performed due to chronic otitis media is presented, wherein the relationship between tumor localization and symptoms was investigated.