Intraosseous hemangioma is a benign, rare neoplasm that accounts to 0.5 - 1% of all benign tumors of bones.1, 2 While most hemangiomas arise from soft tissues, it is uncommon for it to arise from bones.2 The most common sites of growth are in the vertebral body and the calvarium with frontal bone making up approximately 45% of calvarial cases.2,3 However, they are also encountered in the head and neck with sites such as the skull (53%), mandible (10.7%), nasal bones (9%), and cervical spine (6%).4 In the mandible, the body is mostly affected and 65% are found in the molar and premolar region.1 They are more common in adult females with peaks at the second and fifth decades of life.1-3 Hemangioma of the mandible is difficult to diagnose due to its nonspecific clinical presentation and radiographic features. It mimics various mass lesions in the mandible such as giant cell granuloma, fibrous dysplasia, multiple myeloma, osteosarcoma, ameloblastoma and keratocysts. Therefore, a comprehensive history taking and physical examination plus examination of the imaging studies available and tissue biopsy all play important roles in arriving at the final diagnosis.5 We present the case of an aggressive mandibular hemangioma in a young boy and our management involving a failed fibular free flap reconstruction.
Sirolimus ; Sirolimus

OBJECTIVE: To determine the sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of FNAB in detecting parotid malignancies in our institution.
METHODS:
Design: Restrospective Chart Review
Setting: Tertiary Government Hospital
Participants: Postoperative records of seventy six (76) patients with tumors of the parotid gland preoperatively diagnosed by FNAB.
RESULTS: The sensitivity of FNAB was 46%. The specificity and positive predictive value were both 100% and negative predictive value was 90%. Overall accuracy in diagnosing malignant parotid tumor was 91%.
CONCLUSION: FNAB in this institution is a poor predictor of malignancy, having a sensitivity rate of only 46%. While this may serve as a basis for not recommending pre-operative FNAB for patients with parotid tumors in the interim, other factors should also be considered, including concerns with the actual performance and interpretation of FNAB in our institution.

 

Human ; General Surgery ; Parotid Gland ; Diagnosis

OBJECTIVES: To describe a rare case of chemodectoma, its clinical features and management, and to discuss its relationship chronic hypoxia from Tetralogy of Fallot.

METHODS:
Design: Case Report

Setting: Tertiary Government Hospital

Patient: One

RESULTS: A 23-year-old woman presented with a painless, slow growing, movable right submandibular mass, initially diagnosed as a lipoma by fine needle aspiration biopsy.  Computed tomography scan showed a solid nodule with ill-defined margins from the angle of the mandible to the level of the hyoid bone along the carotid sheath. There was also an incidental finding of patent ductus arteriosus and Tetralogy of Fallot on pre-operative clearance. Excision of the mass under general anesthesia revealed adherence to the posterior portion of the carotid trunk enveloping both the internal & external carotid artery. Final histopathological diagnosis was chemodectoma.

CONCLUSION: Although rare, chemodectoma should be considered as one of the differentials in a patient with a submandibular mass. Hyperplastic chemodectoma may result from chronic hypoxia due to Tetralogy of Fallot.  Surgical excision is the treatment of choice.

Human ; Female ; Adult ; Carotid Body Tumor ; Paraganglioma ; Tetralogy of Fallot

OBJECTIVES: To report a benign tonsillar lesion presenting as a pedunculated polyp and discuss its diagnosis and management.
METHODS:
Design: Case Report
Setting: Tertiary Government Hospital
Patient: One
RESULTS: A 14-year-old lad presented with a seven-year history of an elongated right tonsillar mass without  associated  bleeding, pain,  dysphagia or obstructive sleep  apnea.  Physical  examination revealed  a  pedunculated  mass  about  2  x  1  x  0.5cm  in  size  located  in  the  superior  pole.  After unilateral  tonsillectomy, histopathological  examination  revealed  lymphangectatic  lipomatous fibrotic polyp.
CONCLUSION: Lymphangiomatous polyp of the palatine tonsils  is  an  unusual benign lesion of the head and neck. These  are  commonly  present  as  unilateral,  polypoidal  mass  that  cannot be clinically  differentiated  from  other  benign  tonsillar  lesions. Tonsillectomy  is  the  recommended surgical  approach  for  both  diagnostic  and  therapeutic  purposes.  Histopathological  study  must be done to confirm diagnosis.

Human ; Male ; Adolescent ; Palatine Tonsil ; Hamartoma ; Tonsillectomy ; Lymphangioma ; Deglutition Disorders ; Neck ; Head ; Sleep Apnea, Obstructive ; Polyps ; Pain ; Physical Examination

OBJECTIVES: To report a case of foreign lodged within the sphenoid sinus and its extraction.METHODS:Design: Case report Setting: Tertiary Government Hospital Patient: OneRESULTS: An 11-year-old girl was hit in the eye by an unknown object from an improvised slingshot. She had loss of vision of the left eye and headache without loss of consciousness. A plain craniofacial Computed Tomography (CT) scan showed a round opaque foreign body abutting the left sphenoid sinus, left posterior ethmoid cells and medial aspect of the left orbital region with adjacent soft tissue densities extending into the apparently ruptured, irregular left globe. The left posterior part of the lamina papyracea was not visualized probably fractured or ruptured. Transorbital enucleation of the left eye and endoscopy-assisted removal of the foreign body (a glass marble) were performed with no intra-operative and post - operative complications.CONCLUSION:Foreign body of the sphenoid sinus is a rare condition. Adequate imaging is important for localization and planning the optimal surgical approach. Endoscopic guidance may aid in extraction.
Human ; Female ; Child ; Sphenoid Sinus ; FOREIGN BODIES ; Tomography Scanners, X-Ray Computed

Objective: To present a rare case of facial schwannoma manifesting as a parotid mass and discuss its diagnosis and treatment. Methods: Design: Case Report Setting: Tertiary Government Hospital Patient: One Results: A 48-year-old female was seen for a 2-year progressive left hemifacial paralysis and a 5-month gradually enlarging left infraauricular mass with episodes of tinnitus but intact hearing and balance. Physical examination showed a left-sided House Brackmann grade VI facial paralysis and a 5 x 4 x 3 cm soft, ill-defined, slightly movable, nontender, left infraauricular mass. Gadolinium-enhanced magnetic resonance imaging revealed a 5 cm heterogeneouslyenhancing lobulated mass centered within the deep lobe of the left parotid gland extending to the left mastoid, with facial nerve involvement. A diagnosis of a facial nerve tumor, probably a schwannoma, was entertained. Pure tone audiometry revealed normal hearing thresholds for both ears with dips at 6-8 KHz on the left. The patient underwent total parotidectomy with facial nerve tumor resection via transmastoid approach, with simultaneous facial – hypoglossal nerve anastomosis reconstruction. Histopathologic findings confirmed the diagnosis of a schwannoma. Postoperative facial function was Grade VI. Hearing and hypoglossal nerve function were preserved. Conclusion A progressive hemifacial paralysis of chronic duration with or without the presence of an infra-auricular mass should raise the suspicion of a facial nerve tumor. Gadolinium-enhanced magnetic resonance imaging is valuable since intraparotid facial nerve schwannomas are mostly diagnosed intraoperatively when the neoplasm and the nerve are exposed and determined to be contiguous. The clinician should be aware that not all parotid masses are salivary gland in origin.
Human ; Female ; Middle Aged ; NEURILEMMOMA ; PARALYSIS ; NEUROLOGIC MANIFESTATIONS ; FACIAL PARALYSIS ; MAGNETIC RESONANCE IMAGING ; DIAGNOSTIC IMAGING ; PHYSICAL EXAMINATION ; DIAGNOSIS ; THERAPEUTICS ; THERAPY