Ear,Nose & Throat Journal

We present a case of a 49 year-old male who suffered from a homicide attempt with a crossbow arrow, resulting in a retained foreign body through his mandible, pterygoids, nasopharynx, and parotid gland. The patient was being managed conservatively with antibiotics to manage symptoms of recurrent infections prior to transfer to our center. The patient developed worsening congestion, foul drainage from the arrow exit wound, as well as developing worsening facial pain. The Head and Neck Oncology, Rhinology, as well as the Neurointerventional radiology services collaborated in a case for the subsequent safe removal of the crossbow arrow. The patient recovered well 3 months post-operatively with improvement in his pain and nasal symptoms.

Cholesteatomas can grow aggressively within the temporal bone due to the accumulation of keratin. If not treated, they can destroy surrounding structures and, therefore, cause many comorbidities. Surgery is the mainstay of treatment. We present a case of massive cholesteatoma involving the facial nerve (FN) with extension into the neck around the FN. The patient underwent a planned multidisciplinary resection of the cholesteatoma without postoperative morbidity.

Iatrogenic displacement of third molars is a rare but significant complication of dental extractions, particularly in children where unique anatomic and developmental factors pose additional challenges. This report describes the case of a 12-year-old female who presented with a displaced maxillary third molar crown into the left maxillary sinus following dental extraction. This displacement resulted in acute orbital cellulitis, which was initially managed with oral antibiotic therapy. Endoscopic endonasal retrieval of the foreign body 4 months later was recommended after the initial infection was treated to reduce the risk of recurrent orbital and/or sinonasal infections. Surgical planning incorporated intraoperative navigation with existing cone beam computed tomography to minimize radiation exposure. The procedure was successful with no perioperative complications. This case highlights the importance of prompt recognition, careful surgical planning, and utilization of minimally invasive approaches to optimize outcomes while minimizing craniofacial morbidity in pediatric patients.

We present a case of an encephalocele of the lateral recess of the sphenoid sinus and detail the utilization of a nerve-sparing, windowed, pterygopalatine fossa approach to the lateral sphenoid sinus recess in a 37 year-old patient. The patient presented with 15 years of headaches that worsened with stress and head position and 2 weeks onset of unilateral clear rhinorrhea that was similarly worsened by head position. Collected rhinorrhea was positive for β-2 transferrin, and computed tomography was notable for erosion of the roof of the sphenoid sinus at the lateral recess with soft tissue extending into the sphenoid sinus. Magnetic resonance imaging confirmed the presence of a sphenoid encephalocele. The patient underwent a nerve-sparing windowed transpterygoid approach to the skull-base defect. Intraoperatively, 2 discreet skull-base defects were encountered, each with exposed dural tissue that were then repaired with septal cartilage underlay grafts and overlay mucosal grafts. The patient started acetazolamide in the postoperative period and recovered without the recurrence of cerebrospinal fluid leak.

Middle ear trauma from foreign body (FB) impaction or its removal can lead to tympanic membrane (TM) perforations and ossicular chain disruption. We present a case of a 29 year-old male who developed acute right-sided hearing loss, aural fullness, and tinnitus after an attempt at removing a cotton-tipped applicator (Q-tip) impaction in the ear canal. Physical examination revealed a dislocated incus protruding through the TM, and audiometry confirmed moderate conductive hearing loss. The patient underwent tympanoplasty with ossicular chain reconstruction with incus interposition, which resulted in significant hearing improvement and resolution of tinnitus. This case highlights the importance of proper diagnosis and intervention in trauma-related ossicular dislocation.

The management of refractory chronic rhinosinusitis (CRS) in children with cystic fibrosis (CF) remains a challenge, especially in those who are not candidates for highly effective modulator therapy. These patients often have severe sinus disease that does not improve with medical treatment, requiring surgery as the definitive treatment. We report a case of a 9-year-old female patient with CF and refractory CRS presenting with significant nasal obstruction, postnasal drainage, and frontal headaches that severely impacted her quality of life. A hybrid technique that involved balloon catheter dilation (BCD) along with endoscopic sinus surgery (ESS) allowed the management of complex anatomical problems associated with the severe polyposis, copious purulence, and narrow frontal recesses during the surgery. This improved our ability to visualize the surgical field, minimize blood loss, and better preserve the mucosa, which ultimately led to better surgical and clinical outcomes. Our findings suggest that hybrid BCD-assisted ESS may offer an effective solution to manage severe CRS in pediatric CF patients, particularly for those who have limited therapeutic options.

Surgical management of head and neck sarcomas presents significant challenges, particularly in advanced stages where curative options are limited. In such cases, palliative care becomes essential to alleviate symptoms and enhance the patient’s quality of life. When chemoradiation therapy fails to provide adequate symptom control, palliative surgery may be a viable option. We report the case of a 24-year-old male diagnosed with an extensive and aggressive maxillary chondroblastic osteosarcoma. Despite multiple chemoradiation regimens, the disease progressed rapidly. Due to the substantial deterioration in the patient’s quality of life, he underwent major palliative surgery. The procedure involved a left total maxillectomy, right subtotal maxillectomy, left segmental mandibulectomy, orbital exenteration, and resection of the left upper lip, cheek, and nose. Reconstruction was performed using an osteocutaneous fibula free flap and an anterolateral thigh flap. Postoperatively, the patient experienced significant symptom relief without major complications. He was followed for 12 months before being lost to follow-up, remaining disease-free for approximately 8 to 10 months. This case illustrates that in select patients with unresectable and extensively invasive tumors, major palliative resections combined with microvascular reconstruction may offer meaningful improvements in quality of life.