International Journal of Pediatric Otorhinolaryngology Extra RSS feed: Articles in Press. International Journal of Pediatric Otorhinolaryngology Extra is an online-only companion to the International Journal of Pediatric Otorhinolaryngology. International Journal of Pediatric Otorhinolaryngology Extra publishes case reports which have an important educational value but cannot be published in the printed journal due to lack of space. Case reports published in International Journal of Pediatric Otorhinolaryngology Extra are: •Peer reviewed to the usual high standards of IJPORL •Fully citable through digital object identifiers (DOI) •Rapidly available online via ScienceDirect, the world's leading online journal platform. Please note that as a new journal International Journal of Pediatric Otorhinolaryngology Extra is NOT currently covered by PubMed/MEDLINE® and does not have an impact factor.http://www.ijporlextra.com//inpress?rss=yesElsevier Inc.en © 2010 Published by Elsevier Inc. International Journal of Pediatric Otorhinolaryngology Extra1871-40482010-03-12 © 2010 Published by Elsevier Inc. healthpermissions@elsevier.comhttp://www.ijporlextra.com/article/PIIS1871404810000134/abstract?rss=yesAbstract: Development of a second malignant neoplasm is one of the most serious complications of cancer treatment. Second osteosarcoma developing after rhabdomyosarcoma has been reported rarely in literature. Here, we report a 8.5-year-old male presented with second osteosarcoma of the mandible 3 years after completion of treatment of rhabdomyosarcoma of the cheek.Second osteosarcoma of mandible after rhabdomyosarcoma of the cheek - Corrected ProofSerhan Küpeli, Ali Varan, Canan Akyüz, Mustafa Cengiz, Kader Karlı Oğuz, Gökhan Gedikoğlu, Münevver Büyükpamukçu10.1016/j.pedex.2010.02.001International Journal of Pediatric Otorhinolaryngology Extra (2010)2010-03-12International Journal of Pediatric Otorhinolaryngology Extra2010-03-12CASE REPORThttp://www.ijporlextra.com/article/PIIS1871404810000043/abstract?rss=yesAbstract: Background: Soft tissue sarcomas, including rhabdomyosarcomas (RMS) and non-RMS (NRSTS), are rare in children with less than 1000 new cases diagnosed yearly in the United States. RMS is the most common soft tissue sarcoma in young children and NRSTS is more common in adolescents and young adults. Alveolar soft part sarcoma (ASPS) is a form of NRSTS. ASPS is an extremely rare malignancy, comprising less than 0.1% of head and neck sarcomas. In children, ASPS has a tendency for the head and neck region (27%), with most cases involving the orbit and the tongue. Methods: A 2-year-old boy presented with respiratory distress. Imaging revealed a 5.5cm×4.0cm×2.5cm mass arising from the thyroid gland compressing the trachea and bilateral pulmonary metastases. Results: The patient underwent tracheostomy, thyroid lobectomy, and excision of paralaryngeal/paratracheal tissue. Pathology revealed positive margins and extensive lymphovascular permeation. Discussion: Cases of ASPS of the larynx, buccal space, paravertebral space, orbit, and tongue have been described. This is the first case of primary ASPS of the thyroid gland. Surgery is the mainstay of treatment for NRSTS, and radiation and chemotherapy are reserved for the subset of NRSTS that are high grade or unresectable. Median survival time of patients with ASPS is 3 years if metastatic disease is present at the time of diagnosis and 11 years if there is no metastatic disease at presentation. Our patient survived 2 years after diagnosis. Conclusion: Even though very rare, ASPS should be considered in the differential diagnosis of thyroid tumors.Alveolar soft part sarcoma of the thyroid gland in a child - Corrected ProofCourtney B. Shires, Rose Mary Stocks, Jerome Thompson, Merry Sebelik, Sandeep Samant10.1016/j.pedex.2010.01.002International Journal of Pediatric Otorhinolaryngology Extra (2010)2010-02-22International Journal of Pediatric Otorhinolaryngology Extra2010-02-22CASE REPORThttp://www.ijporlextra.com/article/PIIS1871404810000067/abstract?rss=yesAbstract: Tornwaldt's cyst is an uncommon midline nasopharyngeal cyst that arises from the pharyngeal bursa (pouch of Luschka) on the posterior nasopharynx. The pharyngeal bursa is the remnant of a communication between the nasopharynx and the notochord. Occlusion of this communication results in the formation of Tornwaldt's cyst. Development of these cysts has been linked to scarring from prior adenoidectomy and nasopharyngeal inflammation (Boucher et al, 1990 ). Often these cysts are found incidentally on rhinoscopy, computerized tomography (CT) or magnetic resonance imaging (MRI). However Tornwaldt's cysts, like other nasopharyngeal cysts, may become symptomatic once they become large or infected. Clinical symptoms of nasopharyngeal cysts may include fullness in the ear, tinnitus, nasal obstruction, dysphagia, dysarthria, dysphonia, odynophagia, halitosis, cephalgia, or stiffness of cervical muscles (Weissman, 1992 ; Miyahara and Matsunaga, 1994 ). This case report of a 6-year-old female with severe cephalgia and a Tornwaldt's cyst serves as a reminder that these cysts can be a cause of many symptoms seen in daily clinical practice. An unusual finding of cortical destruction of the clivus was noted in this case and thought to be associated with the Tornwaldt's cyst. Upon literature review, no prior cases of cortical destruction from a Tornwaldt's cyst have been noted.Tornwaldt's cyst: Clival erosion with reconstitution after treatment - Corrected ProofSpencer E. Voth, John P. Hanna, David Zwillenberg10.1016/j.pedex.2010.01.004International Journal of Pediatric Otorhinolaryngology Extra (2010)2010-02-15International Journal of Pediatric Otorhinolaryngology Extra2010-02-15CASE REPORThttp://www.ijporlextra.com/article/PIIS1871404810000055/abstract?rss=yesAbstract: We report a child who died after an attempt to remove a 4.5cm metallic angled nail from the bronchus of an 18-month-old child. This case highlights a number of problems which can complicate foreign body extraction in small children:The sudden deterioration requiring intubation was the critical point in this case. If at all possible intubation should be avoided.Multiple factors responsible for fatal outcome in 14-month-old child with 4.5cm right angled metallic nail in the bronchus - Corrected ProofN.N. Mathur, Anand Ghimire, Rupesh Raj Joshi, Laxmi Pathak10.1016/j.pedex.2010.01.003International Journal of Pediatric Otorhinolaryngology Extra (2010)2010-02-11International Journal of Pediatric Otorhinolaryngology Extra2010-02-11CASE REPORThttp://www.ijporlextra.com/article/PIIS1871404809000537/abstract?rss=yesAbstract: Extraskeletal Ewing's Sarcoma (EES) of head and neck region, is a rare soft tissue tumour morphologically similar to the commoner Ewing's Sarcoma arising from bone. We report a case of EES in parapharyngeal space in a 6-year-old male; who presented with stridor. CT scan of neck showed soft tissue mass in right parapharyngeal space with intraorbital and intracranial extention. Histopathological examination showed round cell tumour and immunohistochemistry was positive for CD99 and Vimentin. The patient responded very well to Concurrent Chemoradiation. An extensive review of English literature, to the best of our knowledge, did not reveal any previous case of EES in parapharyngeal space in children; although one similar case in a 53-year male is reported.Extraskeletal Ewing's Sarcoma of parapharyngeal space - Corrected ProofNeena Chaudhary, Deepak Gupta, V. Natesh, Sarvejeet Singh10.1016/j.pedex.2009.08.004International Journal of Pediatric Otorhinolaryngology Extra (2010)2010-02-08International Journal of Pediatric Otorhinolaryngology Extra2010-02-08CASE REPORThttp://www.ijporlextra.com/article/PIIS1871404810000031/abstract?rss=yesAbstract: To characterize the auditory manifestations of patients diagnosed with Pelizaeus-Merzbacher Disease (PMD), a rare X-linked disorder of myelin classically characterized by nystagmus, spastic quadriparesis, ataxia, and cognitive delay in early childhood or progressive disease in adulthood. A prospective case study of 5 pediatric and 3 adult patients diagnosed with PMD who demonstrate varying degrees of abnormal auditory function. These patients underwent comprehensive audiological evaluations (audiometry, tympanometry, otoacoustic emissions), auditory processing tests (Dichotic Listening, Frequency Pattern Test, Duration Pattern Test), and electrophysiological measures (Auditory Brainstem Response). Abnormal electrophysiological findings with normal cochlear function were found in all test subjects. Further testing completed on adult subjects revealed further central auditory dysfunction via auditory processing tests. All the adult test subjects had abnormal results on auditory processing tests including significant left ear deficits on dichotic digits and poor duration pattern test scores. Auditory processing test results indicated strong right ear advantages for all adult PMD test subjects in Dichotic Digit testing. The degree of audiological central dysfunction findings was more severe in subjects with greater symptoms of the disease. Our findings indicate the need for a full audiological test battery on all patients with Pelizaeus-Merzbacher disease and other severe neurological disorders.Auditory testing profiles of Pelizaeus-Merzbacher disease - Corrected ProofJames M. Coticchia, M.A. Diane Roeder, Giancarlo F. Zuliani, Alexander Gow, James Y. Garbern10.1016/j.pedex.2010.01.001International Journal of Pediatric Otorhinolaryngology Extra (2010)2010-02-08International Journal of Pediatric Otorhinolaryngology Extra2010-02-08CASE REPORThttp://www.ijporlextra.com/article/PIIS187140481000002X/abstract?rss=yesAbstract: A mature teratoma is a neoplasm which rarely occurs in the Eustachian tube. A 10-month-old girl presented with persistent otorrhea and an increasing nasal obstruction was finally diagnosed as a Eustachian tube mature teratoma. The neoplasm was successfully resected transorally using an endoscope.Eustachian tube mature teratoma - Corrected ProofMin Chen, Peng Sun, Weiyi Liu, Shilin Liu, Yamei Zhang10.1016/j.pedex.2009.12.004International Journal of Pediatric Otorhinolaryngology Extra (2010)2010-01-22International Journal of Pediatric Otorhinolaryngology Extra2010-01-22CASE REPORThttp://www.ijporlextra.com/article/PIIS1871404809000689/abstract?rss=yesAbstract: Background: Vocal cord dysfunction (VCD) has been defined as adduction of the true vocal cords on inspiration with abduction on expiration. It is most common in females aged between 20 and 45 years. However, cases in children have been reported. Patients with vocal cord dysfunction present with distressing shortness of breath, inspiratory stridor and breathy dysphonia. VCD is most frequently diagnosed as asthma since the attacks in both begin and end suddenly and produce distressing breathing difficulties. Study design: Infants and children presented with respiratory distress secondary to vocal cord dysfunction were included in this study. Diagnosis of VCD depended mainly on direct laryngoscopy either using flexible laryngoscopy with topical anesthesia or direct laryngoscopy under general anesthesia with spontaneous respiration. The typical finding of adduction of the anterior two-third of the vocal cords during inspiration was the key point for diagnosis of VCD. Any further investigation was done according to the etiology of each case. Results: One infant and four children were included in this study. They were three boys and two girls. Their ages were 1, 12, 14, 10 and 2 years. The etiology of VCD was bulbar myasthenia gravis in one case, multiple system atrophy in one case, Laryngopharyngeal reflux in two cases, and post-nasal drip in one case. Diagnosis of VCD was done using pediatric flexible fibreoptic laryngoscopy with topical anesthesia in two cases and by direct laryngoscopy under general anesthesia with spontaneous respiration in three cases (in one of them the vocal cords were visualized during urgent intubation). Three cases were misdiagnosed as bronchial asthma and they were receiving treatment of asthma with no improvement. Conclusion: Vocal cord dysfunction represents a potentially overlooked differential diagnosis of recurrent dyspnea in children. It is always misdiagnosed as bronchial asthma. It should be suspected in every child with atypical or corticosteroid resistant asthma.Vocal cord dysfunction: A rare cause of stridor in children - Corrected ProofAlaa Hazem Gaafar, Nader Abdelmonem Fasyh10.1016/j.pedex.2009.12.002International Journal of Pediatric Otorhinolaryngology Extra (2010)2010-01-11International Journal of Pediatric Otorhinolaryngology Extra2010-01-11CASE REPORThttp://www.ijporlextra.com/article/PIIS1871404809000756/abstract?rss=yesAbstract: Rosai–Dorfman disease (RDD) otherwise known as sinus histiocytosis with massive lymphadenopathy (SHML) is a rare disease of unknown etiology that commonly involves cervical lymph nodes. Tonsillar involvement is extremely rare. We present a case of tonsillar involvement in a 4-year-old boy who presented with a 4-month history of cervical lymphadenopathy and enlarged tonsils causing hoarseness of voice. We also review the literature and discuss the pathologic and clinical characteristics of this disease.Rosai–Dorfman disease of the tonsil in a 4-year-old boy: Case report and review of the literature - Corrected ProofHoda Zeinab M. Amer, Vinay Prasad, Samir B. Kahwash10.1016/j.pedex.2009.12.003International Journal of Pediatric Otorhinolaryngology Extra (2010)2010-01-11International Journal of Pediatric Otorhinolaryngology Extra2010-01-11CASE REPORThttp://www.ijporlextra.com/article/PIIS1871404809000677/abstract?rss=yesAbstract: Objectives: Report a rare congenital salivary gland tumor and its clinical, radiological and histopathologic aspects. Discuss the differential diagnosis and treatment. Methods: A case report is described. A literature review of the incidence, disease course, radiological and histopathologic aspects and treatment are presented. Results: This case report presents a neonate with an asymptomatic left cervical mass. Ultrasounds and MRI showed a circumscribed soft tissue mass measuring 60mm×42mm×52mm and extending from the left parotid region to the left submandibular region, but radiological exams could not lead to a diagnosis. A biopsy demonstrated a sialoblastoma. The treatment consisted in a surgical resection with no adjuvant therapy. One year after surgery there is no clinical nor radiological sign of recurrence. Conclusion: Sialoblastomas are rare congenital epithelial salivary tumors and have been reported to occur predominantly in the parotid gland. They are locally aggressive with a high recurrence rate needing a prolonged follow up. When they are completely resectable, surgical resection is the mainstay for treatment of these tumors and no adjuvant therapy is needed.Management and treatment of a sialoblastoma of the submandibular gland in a neonate - Corrected ProofCarine Fuchsmann, Loic Viremouneix, Sophie Collardeau-Frachon, Sonia Ayari-Khalfallah, Raymonde Bouvier, Laurent Guibaud, Patrick Froehlich10.1016/j.pedex.2009.12.001International Journal of Pediatric Otorhinolaryngology Extra (2009)2009-12-31International Journal of Pediatric Otorhinolaryngology Extra2009-12-31CASE REPORThttp://www.ijporlextra.com/article/PIIS1871404809000641/abstract?rss=yesAbstract: Objective: Symptoms of pediatric eosinophilic esophagitis (EoE) include dysphagia, emesis, regurgitation and feeding difficulties. This symptom complex has been mistaken for refractory gastroesophageal reflux disease (GERD). Whether EoE and GERD are related is controversial. Recently, EoE has been associated with upper airway manifestations including recurrent sinusitis, cough, wheezing, pneumonia, laryngeal edema, and subglottic stenosis. Laryngospasm secondary to EoE has not been reported. The purpose of this study is to increase the awareness of laryngospasm as a presenting symptom in this population. Methods: A 1-year retrospective chart review of 2 children with laryngospasm as the presenting symptom with endoscopic and histopathologic evidence of EoE. Results: Two patients presented to an otolaryngologist with a history consistent with laryngospasm in addition to GI complaints. Laryngospasm was identified during endoscopy. Both patients presented with GERD and symptoms refractory to medical management. Esophagoscopy and biopsy revealed >20 eosinophils per high power field. Symptoms were completely resolved following oral fluticasone therapy at follow-up. Conclusions: The eosinophilic esophagitis symptom complex includes airway manifestations. Pediatric eosinophilic esophagitis should be considered in the differential diagnosis of patients with laryngospasm, dysphagia and gastroesophageal reflux refractory to treatment.Laryngospasm and pediatric eosinophilic esophagitis - Corrected ProofCarrie L. Francis, Troy Gibbons, Gresham T. Richter10.1016/j.pedex.2009.11.001International Journal of Pediatric Otorhinolaryngology Extra (2009)2009-12-21International Journal of Pediatric Otorhinolaryngology Extra2009-12-21CASE REPORThttp://www.ijporlextra.com/article/PIIS1871404809000665/abstract?rss=yesAbstract: Dentigerous cysts are benign odontogenic cysts that arise from the dental follicle of an unerupted or developing tooth. They are the second most common odontogenic cysts after radicular cysts. Multiple dentigerous cysts have been reported on occasion in association with syndromes such as cleidocranial dysplasia, mucopolysaccharidosis and basal cell nevus syndrome. We report the clinical and radiologic findings of bilateral maxillary dentigerous cysts in a nonsyndromic 10-year-old boy, a condition that, to our knowledge has only been reported twice. The importance of early diagnosis and management is highlighted.Nonsyndromic bilateral maxillary dentigerous cysts: Review of literature and report of an unusual case - Corrected ProofVikram Prabhakar, Simarpreet Virk Sandhu10.1016/j.pedex.2009.11.003International Journal of Pediatric Otorhinolaryngology Extra (2009)2009-12-21International Journal of Pediatric Otorhinolaryngology Extra2009-12-21CASE REPORThttp://www.ijporlextra.com/article/PIIS1871404809000604/abstract?rss=yesAbstract: Johanson–Blizzard syndrome is a hereditary disorder extremely rare. The characteristic features include aplastic alae nasi, midline ectodermal scalp defects, deafness, dental abnormalities and malabsorption related to pancreatic exocrine deficiency. This paper presents a case of an 18-year-old patient with Johanson–Blizzard syndrome and emphasizes the importance of knowledge of the potential anaesthetic concerns of this syndrome for providing appropriate treatment for these patients.Johanson–Blizzard syndrome—A case study of oral and systemic manifestations - Corrected ProofKeila Martha Amorim Barroso, Debora Farias Batista Leite, Pollianna Muniz Alves, Paula Frassinetti Vasconcelos de Medeiros, Gustavo Pina Godoy10.1016/j.pedex.2009.10.002International Journal of Pediatric Otorhinolaryngology Extra (2009)2009-12-07International Journal of Pediatric Otorhinolaryngology Extra2009-12-07CASE REPORThttp://www.ijporlextra.com/article/PIIS1871404809000653/abstract?rss=yesAbstract: Oropharyngeal foreign bodies penetrating into parapharyngeal space of neck are rare and may cause extensive neurovascular injuries and their management tests the skills of both surgeon and anesthetist. In this article we report a child who presented with impacted metallic foreign body penetrating the oropharynx and entering into the parapharyngeal space of neck after causing injury to lower incisors and canine teeth and fracturing mandible. The difficulties encountered during intubation and precautions taken are discussed. Exploration of the wound using cervical transpharyngeal approach resulted in uneventful extraction of metallic foreign body with no neurological sequel and morbidity.Managing oropharyngeal penetrating metallic foreign body into parapharyngeal space in a child: A case report - Corrected ProofRoshan Kumar Verma, Zareen A. Lynrah, Sateesh K. Naidu, Naresh K. Panda10.1016/j.pedex.2009.11.002International Journal of Pediatric Otorhinolaryngology Extra (2009)2009-12-07International Journal of Pediatric Otorhinolaryngology Extra2009-12-07CASE REPORThttp://www.ijporlextra.com/article/PIIS1871404809000380/abstract?rss=yesAbstract: Congenital tracheal stenosis is an uncommonly associated malformation in children with congenital heart defects. Airway symptomatology should prompt immediate work-up to prevent a delay in diagnosis. Although results to date show acceptable mortality and morbidity for simultaneous repair of tracheal stenosis and cardiac anomalies there are cases where the severity of the lesion in association with other anomalies increases the mortality significantly.We report about a newborn diagnosed with transposition of the great vessels and several other anomalies who developed progressively worsening respiratory distress. Imaging revealed long-segment tracheal stenosis. The family was offered the option of slide tracheoplasty but decided not to pursue any further surgical intervention. The patient soon thereafter died.A newborn with transposition of the great vessels and long-segment tracheal stenosis - Corrected ProofIris Toedt-Pingel, Chhavi Katyal, Alfin G. Vicencio, Sanjay Parikh, H. Michael Ushay10.1016/j.pedex.2009.06.002International Journal of Pediatric Otorhinolaryngology Extra (2009)2009-11-20International Journal of Pediatric Otorhinolaryngology Extra2009-11-20CASE REPORThttp://www.ijporlextra.com/article/PIIS1871404809000616/abstract?rss=yesAbstract: Nontuberculous mycobacterial infections are seen frequently in the head and neck region in immunocompetent young children in their toddler years. These infections usually present as an inflammatory neck mass that is refractory to standard antibiotic therapy. We describe a previously healthy 16-month-old boy presenting with persistent wheezing despite treatment for reactive airway disease. At bronchoscopy a large carinal mass compressing both main stem bronchi was found. Subsequent thoracoscopic biopsy and culture revealed Mycobacterium avium complex. The rationale for serial bronchoscopies as well as diagnostic, medical and surgical management options are discussed.Mediastinal nontuberculous mycobacteria as a cause of pediatric airway obstruction - Corrected ProofCristian M. Slough, Sagila George, Holger Link, Carol J. MacArthur10.1016/j.pedex.2009.10.003International Journal of Pediatric Otorhinolaryngology Extra (2009)2009-11-13International Journal of Pediatric Otorhinolaryngology Extra2009-11-13CASE REPORThttp://www.ijporlextra.com/article/PIIS1871404809000628/abstract?rss=yesAbstract: Intracochlear schwannoma (ICS) is a rare tumor that can cause significant hearing loss. Previous clinical reports on ICS have described this disease in adults. We present a pediatric patient with left-sided ICS who initially presented with a mild conductive hearing loss. We demonstrate the progression of the hearing loss over a span of several years through serial audiograms, as well as the process of diagnosis and treatment. This rare and unique case demonstrates that ICS can be found in young children.Atypical presentation of intracochlear schwannoma in a child - Corrected ProofMarilyn Neault, Guangwei Zhou, Margaret Kenna, Dennis Poe10.1016/j.pedex.2009.10.004International Journal of Pediatric Otorhinolaryngology Extra (2009)2009-11-09International Journal of Pediatric Otorhinolaryngology Extra2009-11-09CASE REPORThttp://www.ijporlextra.com/article/PIIS187140480900063X/abstract?rss=yesAbstract: Peripheral facial nerve paralysis is relatively common in the pediatric age group. Infectious agents convincingly associated with acute facial palsy include varicella-zoster virus, herpes simplex virus, cytomegalovirus, Epstein–Barr virus, rubella virus, and more recently, human immunodeficiency virus. However, facial palsy has rarely been documented in patients with mumps virus infection. Facial palsy caused by mumps infection is believed to exist in two distinct forms, one representing an initial infection with mumps parotitis and another representing a reinfection without parotitis. We recently saw the two different forms of mumps-associated facial palsy with and without parotitis.Two different forms of mumps-associated facial palsy - Corrected ProofTatsuo Fuchigami, Ikuko Kimura, Junichi Suzuki, Michio Miyashita, Kenichi Watanabe, Koji Hashimoto, Yukihiko Fujita, Yasuji Inamo, Hideo Mugishima10.1016/j.pedex.2009.10.005International Journal of Pediatric Otorhinolaryngology Extra (2009)2009-11-09International Journal of Pediatric Otorhinolaryngology Extra2009-11-09CASE REPORThttp://www.ijporlextra.com/article/PIIS1871404809000598/abstract?rss=yesAbstract: Occipital teratomas are anecdotal and may mimic meningoencephaloceles in children. We describe a neonate presenting with an occipital mass that was diagnosed to be a mature teratoma and discuss its differentiation from neural tube defects in the region.Mature occipital teratoma in a neonate - Corrected ProofS.R. Raghu, A.M. Shubha, Kanishka Das10.1016/j.pedex.2009.10.001International Journal of Pediatric Otorhinolaryngology Extra (2009)2009-11-05International Journal of Pediatric Otorhinolaryngology Extra2009-11-05CASE REPORThttp://www.ijporlextra.com/article/PIIS1871404809000562/abstract?rss=yesAbstract: Cystic fibrosis (CF) is one of the most common inherited life-shortening diseases with an incidence of 1:2.500–3500 and a carrier frequency of 4–5% . It is caused by mutations in the CF transmembrane conductance regulator (CFTR) gene, which encodes a protein expressed in the apical membrane of exocrine epithelial cells, resulting in changes to the fluid and electrolytes on cell surface. More than 1500 mutations have been described so far in the CFTR gene, grouped in 5 classes on the basis of the impact on protein synthesis or activity .In the last years a mounting number of reports described patients that did not meet all diagnostic criteria for CF ; in particular, atypical or nonclassic CF is characterized by normal or borderline sweat test, pancreatic sufficiency and a monosymptomatic phenotype; the most studied forms are: congenital bilateral absence of vasa deferentes, acute or chronic recurrent pancreatitis, idiopathic bronciectasis . These patients typically bear a severe and a mild (classes 4–5) CFTR mutation, the latter being dominant .The involvement of upper airways is observed in up to 100% of classic CF patients, including recurrent sinusitis and rhinitis. Nasal polyps are present in 6–48% of overall CF patients and in 5–15.2% of less than 10 years old CF patients.Surgery is required for syntomatic polyps. It is the second most common class of operations performed on CF patients. In spite of the best of operations CF patients will have recurrence, because of systemic disease.We describe a patient diagnosed as “atypical CF” on the basis of persisting chronic rhinosinusitis, that showed a very rare CFTR genotype.Nasal polyposis in atypical cystic fibrosis: A case report - Corrected ProofMassimo Mesolella, Mariano Cimmino, Elena Cantone, Rossella Grassia, Rossella Tomaiuolo, Giuseppe Castaldo, Valeria Raia10.1016/j.pedex.2009.09.003International Journal of Pediatric Otorhinolaryngology Extra (2009)2009-11-02International Journal of Pediatric Otorhinolaryngology Extra2009-11-02CASE REPORThttp://www.ijporlextra.com/article/PIIS1871404809000586/abstract?rss=yesAbstract: Hypoglossal nerve palsy frequently occurs with other cranial nerve palsies; an isolated hypoglossal nerve palsy is rare. Most hypoglossal nerve palsies are caused by tumors. However, several reports have shown an association with oropharyngeal manipulation such as intubation, laryngeal mask airway or as a complication of surgery such as carotid endarterectomy, and tooth extraction. When the nerve was injured, a deviation to the affected side, atrophy, and tongue fasciculation could be observed. We treated a patient with isolated hypoglossal nerve palsy after open repair of a fracture of the humerus in the beach-chair position.Isolated hypoglossal nerve palsy following open surgery in the beach-chair position under general anesthesia: A case report - Corrected ProofJun-Yeon Hwang, Ho-Ryun Won, Young-Ho Hong, Seog-Kyun Mun10.1016/j.pedex.2009.09.005International Journal of Pediatric Otorhinolaryngology Extra (2009)2009-11-02International Journal of Pediatric Otorhinolaryngology Extra2009-11-02CASE REPORThttp://www.ijporlextra.com/article/PIIS1871404809000574/abstract?rss=yesAbstract: The third arch branchial fistula is a rare congenital abnormality that presents as an inflammatory process in the anterior neck, often in the region of the left lobe of thyroid. Incomplete fistula is not an uncommon finding extending from base of pyriform sinus to the thyroid or perithyroidal space, which predisposes to recurrent suppurative thyroiditis during episodes of upper respiratory infection. Complete fistula of third arch is extremely uncommon, especially of congenital origin. A 10-year-old male child presented with a small opening in the anterior neck since birth, with a swelling around it. Computerized tomography revealed a patent tract from neck skin to base of pyriform sinus. Total excision of the tract up to the left pyriform sinus with hemithyroidectomy was performed. There was no recurrence at 22 months of follow-up.Thyroid abscess with branchial anomaly - Corrected ProofJ. Madana, Deeke Yolmo, Sunil Kumar Saxena, S. Gopalakrishnan10.1016/j.pedex.2009.09.004International Journal of Pediatric Otorhinolaryngology Extra (2009)2009-10-26International Journal of Pediatric Otorhinolaryngology Extra2009-10-26CASE REPORThttp://www.ijporlextra.com/article/PIIS1871404809000446/abstract?rss=yesAbstract: Thyroglossal duct cysts are unusual neck lesions in neonates. Most cysts are first noticed in preschool-aged children as a small midline neck swelling, and can become infected causing inflammation, erythema, and external drainage. In this patient population respiratory symptoms are frequently part of the initial presentation, and respiratory failure due to cyst mass effect is often fatal in newborns. The case presented here is unusual in terms of age at presentation (4 days), type of infecting bacteria (GBS), rapid cyst enlargement, and prominent respiratory symptoms (previously unreported in cysts inferior to hyoid bone). Although rare, TGDCs should be included in the differential diagnosis of congenital neck masses or unexplained respiratory compromise in neonates, especially when the presentation includes positional, intermittent, or progressively worsening obstructive respiratory symptoms. As this case illustrates, infection of these cysts is common but does not always manifest with visible neck inflammation and swelling. With rapid diagnosis the potentially fatal complications of TGDCs can be avoided in neonatal patients.The thyroglossal duct cyst and respiratory failure in neonates: Case report and review of an unusual entity - Corrected ProofMatthew Barton, Andrew Bozeman, Mark Herndon, Rogelio dela Cruz10.1016/j.pedex.2009.07.006International Journal of Pediatric Otorhinolaryngology Extra (2009)2009-10-21International Journal of Pediatric Otorhinolaryngology Extra2009-10-21CASE REPORThttp://www.ijporlextra.com/article/PIIS1871404809000525/abstract?rss=yesAbstract: Introduction: Neuroglial heterotopia is a rare condition in which mature neuroglial tissue is found in the body other than in the central nervous system. Nasal glioma is neuroglial heterotopia in the nasal cavity. We report an extremely rare case of heterotopic neuroglial tissue in the temporal bone with tumoral transformation. Case report: Our patient was a 1-year-old Chinese girl. She was born with a left facial swelling. CT and MRI revealed a heterogeneous mass with cystic component occupying the parapharyngeal space. The upper airway was significantly compromised by the mass which extended into the middle cranial fossa. A combined approach to its resection was undertaken by ENT and neurosurgeons which was uneventful with all cranial nerves in its vicinity preserved. Intraoperative findings confirmed the absence of direct communication between the mass and the brain. Pathological examination confirmed mature neural tissue with tumoral differentiation. Conclusion: Heterotopic neuroglial tissue is a rare condition in the temporal bone. Ganglioglioma formation within the heterotopic neuroglial tissue is an even rarer condition. Careful pre-operative investigations and planning is the key to successful and complete excision of the abnormal tissue whilst preserving normal function.Parapharyngeal space neuroglial heterotopia with tumoral differentiation - Corrected ProofJoseph Y. Chan, Chris K.C. Lai, Victor J. Abdullah, Micheal C.F. Tong, C.A. vanHasselt10.1016/j.pedex.2009.08.005International Journal of Pediatric Otorhinolaryngology Extra (2009)2009-10-16International Journal of Pediatric Otorhinolaryngology Extra2009-10-16CASE REPORThttp://www.ijporlextra.com/article/PIIS1871404809000550/abstract?rss=yesAbstract: Ascaris lumbricoides is found in various parts of the world, mainly in poor sanitation conditions and in developing countries with very crowded areas. Although the prevalence of ascariasis has decreased in Iran due to improved hygiene situation and the use of pesticides in farms, we recently encountered a rare case complication in which the worm was found exiting the middle ear.Ascariasis into the middle ear: Report of two cases from Iran - Corrected ProofD.V.M. Mehdi Vejdani, Farangis Namvar10.1016/j.pedex.2009.09.002International Journal of Pediatric Otorhinolaryngology Extra (2009)2009-10-05International Journal of Pediatric Otorhinolaryngology Extra2009-10-05CASE REPORThttp://www.ijporlextra.com/article/PIIS1871404809000549/abstract?rss=yesAbstract: Duplication cyst of the cervical esophagus represents a rare congenital anomaly. The children with esophageal duplication cyst usually present with respiratory distress or as asymptomatic thoracic mass found on incidental chest X-ray. We here present a case of a 3-month-old male infant who presented with noisy breathing and progressive respiratory distress and with no other abnormality. After laryngoscopy, barium esophagography and MRI study, congenital esophageal duplication cyst was diagnosed. Transcervical excision of the cyst was done using a harmonic scalpel. Histopathological examination of the specimen confirmed the diagnosis. The patient remains asymptomatic after one year of follow up.Congenital esophageal duplication cyst: A rare cause of infantile stridor and a diagnostic challenge - Corrected ProofV. Kumar, A.P. Singh, R. Meher, A. Raj, S.K. Aggarwal10.1016/j.pedex.2009.09.001International Journal of Pediatric Otorhinolaryngology Extra (2009)2009-09-30International Journal of Pediatric Otorhinolaryngology Extra2009-09-30CASE REPORThttp://www.ijporlextra.com/article/PIIS1871404809000513/abstract?rss=yesAbstract: Lemierre's syndrome is characterised by an oropharyngeal infection leading to secondary septic thrombophlebitis of the internal jugular vein. Most of the cases are caused by Fusobacterium necrophorum. Here, we report an unusual variant of Lemierre's syndrome developed after modified radical mastoidectomy. There was right sigmoid sinus and right internal jugular vein thrombosis along with multiple abscess foci seen in bilateral lung with right pyopneumothorax. The organism isolated from chest foci was Citrobacter freneli. We also briefly review the literature of Lemierre's syndrome.Lemierre's syndrome after modified radical mastoidectomy: An unusual variant caused by Citrobacter freneli - Corrected ProofPrakash Adhikari, Rajendra P. Guragain, Chop Lal Bhusal, Rabindra B. Pradhananga10.1016/j.pedex.2009.08.003International Journal of Pediatric Otorhinolaryngology Extra (2009)2009-09-25International Journal of Pediatric Otorhinolaryngology Extra2009-09-25CASE REPORThttp://www.ijporlextra.com/article/PIIS1871404809000458/abstract?rss=yesAbstract: Minor salivary gland neoplasms are rare in children. Only 5% of pleomorphic adenomas of the minor salivary glands have been reported in patients under 20 years of age. We report a case of a 13-year-old female who presented with a rapidly growing hard palatal mass, confirmed to be a myoepithelial cell-rich pleomorphic adenoma with cytological atypia. Pleomorphic adenomas should be included in the differential diagnosis of rapidly growing palatal masses in children and adolescents. Surgical excision is curative, and long-term follow-up is indicated as recurrence is frequent.Rapidly progressing palatal pleomorphic adenoma in an adolescent - Corrected ProofSami P. Moubayed, Fahad AlSaab, Sam J. Daniel10.1016/j.pedex.2009.08.001International Journal of Pediatric Otorhinolaryngology Extra (2009)2009-09-17International Journal of Pediatric Otorhinolaryngology Extra2009-09-17CASE REPORThttp://www.ijporlextra.com/article/PIIS187140480900046X/abstract?rss=yesAbstract: Although actinomycosis may occur anywhere in the body, the most common site of this infection is the head and neck region. Actinomyces, the usual cause of actinomycosis, is a commensal bacterium with low pathogenicity that is a normal resident in the oral cavity, thus odontogenic injury is a common antecedent event. Therefore, cervicofacial actinomycosis commonly occurs in the mandibular area, submandibular gland, and tongue in order of decreasing frequency.The authors encountered a case of a child with a history of slowly progressing swelling in the left side of the lower neck and no history of oral or odontogenic trauma. A pyriform sinus fistula found in this patient could be the unusual root of the cervicofacial actinomycosis occurring in the perithyroidal region, via a direct connection between the site of infection and the upper aerodigestive tract.A case of perithyroidal actinomycosis in a child with pyriform sinus fistula - Corrected ProofBon Seok Koo, Gun Ho Lee, Sung Tae Seo, Yeo-Hoon Yoon10.1016/j.pedex.2009.08.002International Journal of Pediatric Otorhinolaryngology Extra (2009)2009-09-02International Journal of Pediatric Otorhinolaryngology Extra2009-09-02CASE REPORThttp://www.ijporlextra.com/article/PIIS1871404809000409/abstract?rss=yesAbstract: Rhabdomyosarcoma (RMS) represents the third most common neoplasm in children. RMS most commonly presents in the head and neck region, at a rate of 35%. Within the head and neck, however, the tongue is an uncommon site for this tumor. We present a report of a congenital rhabdomyosarcoma of the tongue treated with neo-adjuvant chemotherapy followed by surgical resection. A discussion with a review of the literature follows.Congenital rhabdomyosarcoma of the tongue: A case report - Corrected ProofLesley F. Childs, Steven L. Goudy10.1016/j.pedex.2009.07.004International Journal of Pediatric Otorhinolaryngology Extra (2009)2009-09-01International Journal of Pediatric Otorhinolaryngology Extra2009-09-01CASE REPORThttp://www.ijporlextra.com/article/PIIS1871404809000434/abstract?rss=yesAbstract: Lipoblastomas are rare benign tumors originating from embryonic fat cells that continue to proliferate in the postnatal period. Most tumors occur around age three and are found predominantly in the extremities and trunk. Less than fifteen cases have been reported in the head and neck region. We present a case of lipoblastoma arising in the soft palate, a site that has not been previously reported. By doing so, we hope to promote awareness of this pathology and emphasize the importance of using histological and cytogenetic analysis to obtain the correct diagnosis.Lipoblastoma: A rare soft palate mass - Corrected ProofMyriam Loyo, Alejandro Rivas, David Brown10.1016/j.pedex.2009.07.005International Journal of Pediatric Otorhinolaryngology Extra (2009)2009-08-20International Journal of Pediatric Otorhinolaryngology Extra2009-08-20CASE REPORThttp://www.ijporlextra.com/article/PIIS1871404809000355/abstract?rss=yesSummary: Heterotopic salivary gland tissue (HSGT) is a rare finding in the lower neck. Bilateral lesions are even more exceptional. It is generally accepted HSGT originates from defective embryogenesis within the branchial apparatus and are closely related to branchial cysts and sinuses. The true aetiology however is not fully understood.Here we report a rare case with bilateral lesions in the neck that drained a clear substance after drinking. Surgical resection of a 2cm upwards fistula tracks was performed under general anaesthesia. Microscopic examination of resection peaces showed arguments for HSGT on both sides. Several aetiological theories are also discussed.Bilateral heterotopic salivary gland tissue (HSGT) in the lower neck: A report of a rare case with review of literature - Corrected ProofVedat Topsakal, Olaf Michel, Annieta Goossens, Frans Gordts10.1016/j.pedex.2009.06.004International Journal of Pediatric Otorhinolaryngology Extra (2009)2009-08-17International Journal of Pediatric Otorhinolaryngology Extra2009-08-17CASE REPORThttp://www.ijporlextra.com/article/PIIS1871404809000410/abstract?rss=yesAbstract: Congenital nasal anomalies are rare disorders. An 11-year-old girl presented to our clinic with a left sided nasal obstruction and chronic nasal discharge since birth. Clinical evaluation revealed membranous septa which divided the left nasal cavity into two blind pouch and left sided choanal atresia with alar cartilage asymmetry. This congenital anomaly was not defined in the English literature. The membranous septa in the left nasal cavity were excised, alar reconstruction were performed and the choanal atresia were repaired by a transnasal endoscopic approach. In this article we reported a case of membranous septa which divided the left nasal cavity into two blind pouch associated with unilateral choanal atresia and alar cartilage asymmetry. Also the nasal anomalies and associated disorders in the literature were reviewed.Congenital unilateral intranasal membranous septa with choanal atresia dividing the nasal cavity into two blind pouch: A case report - Corrected ProofSüleyman Yilmaz, Ender Güçlü, Elif Karali, Bugra Subaşı10.1016/j.pedex.2009.07.002International Journal of Pediatric Otorhinolaryngology Extra (2009)2009-08-12International Journal of Pediatric Otorhinolaryngology Extra2009-08-12CASE REPORThttp://www.ijporlextra.com/article/PIIS1871404809000422/abstract?rss=yesAbstract: Parathyroid cysts are extremely rare in children, with only a handful of cases ever reported. The majority of parathyroid cysts are asymptomatic. Few, however, can be symptomatic presenting with hoarseness, airway compression and dysphagia. We present a case of a 13 year old male with a history right neck swelling and hoarseness for one week. He also reported a 6 month history of worsening snoring and wheezing for which he was diagnosed with asthma.A computed tomography (CT) revealed a cystic mass arising from the thyroid causing significant tracheal compression. The tracheal compression was managed by aspiration of the cyst followed by surgical excision one week later. Histopathologic examination of the surgical specimen revealed parathyroid tissue within the cyst.Asthma secondary to tracheal obstruction by parathyroid cyst - Corrected ProofWaqar Haque, Jess Roberts, Megan Dishop, Tulio Valdez10.1016/j.pedex.2009.07.003International Journal of Pediatric Otorhinolaryngology Extra (2009)2009-08-12International Journal of Pediatric Otorhinolaryngology Extra2009-08-12CASE REPORThttp://www.ijporlextra.com/article/PIIS1871404809000392/abstract?rss=yesAbstract: Infantile myofibromatosis is a common fibrous tumor of infancy, however still considered a rarity. A newborn boy was examined due to inspiratory stridor and subcostal retractions since birth. Several subcutaneous nodules were present on the trunk and legs. Transnasal fiberoptic laryngoscopy and trachea-laryngoscopy showed discrete edema of the anterior part of the vocal cords but no other apparent abnormality. MRI raised suspicion of a laryngeal tumor. Through an external laryngofissure a lesion extending from the right hemilarynx was exposed and excised in fractions. Pathological examination showed infantile myofibromatosis.Stridor in newborns is frequently caused by congenital laryngeal anomalies, i.e. laryngomalacia but a neoplastic process should be considered as a differential diagnosis.Stridor in a newborn caused by infantile myofibromatosis—A case review - Corrected ProofJonas Rickers, Steen Baerentzen, Ulrik Pedersen, Therese Ovesen10.1016/j.pedex.2009.07.001International Journal of Pediatric Otorhinolaryngology Extra (2009)2009-08-10International Journal of Pediatric Otorhinolaryngology Extra2009-08-10CASE REPORTShttp://www.ijporlextra.com/article/PIIS1871404809000379/abstract?rss=yesAbstract: Neglected cervical tuberculosis (TB) in a 13-year-old girl with extensive prevertebral abscess extending from C1-T4 is presented along with the plain radiographic and computed tomographic findings. The tuberculous infection progresses to cause multiple vertebral destructions and quadriplegia due to delayed diagnosis. The diagnosis was made on radiological imaging and confirmed by positive mycobacterium bacilli culture. This case illustrated that delayed diagnosis and treatment of cervical spinal TB can be catastrophic. Hence, we suggest consideration of TB of the spine in the differential diagnosis of any patient presenting with neck/back pain since it can be successfully treated, especially if detected early. We advocated the use of easy operating and low-cost examinations such as tuberculin skin test, abscess puncture (not cut) and pus cultivation especially in developing countries for early diagnosis TB infection.Tuberculous retropharyngeal abscess with posterior mediastinal extension and quadriplegia in a 13-year-old Nigerian girl - Corrected ProofSule K. Idris, Adekunle Y. Abdulkadir10.1016/j.pedex.2009.06.003International Journal of Pediatric Otorhinolaryngology Extra (2009)2009-08-03International Journal of Pediatric Otorhinolaryngology Extra2009-08-03CASE REPORThttp://www.ijporlextra.com/article/PIIS1871404809000367/abstract?rss=yesAbstract: Canal wall down mastoidectomy is the treatment of choice for attico antral ear disease with intracranial complication. It is done after the treatment of intracranial complication, to prevent any further complication due to attico antral ear disease. A second intracranial complication occurring after the surgical treatment of an ear disease is rare. A 12-year-old female patient, who developed brain abscess 6 weeks after undergoing surgical treatment for lateral sinus thrombosis with attico antral ear disease, is reported. The brain abscess was drained through a burr hole. Patient recovered completely and at the sixth month of follow up mastoid cavity was well epithelialised.Unsafeness of surgically safe ear - Corrected ProofB. Viswanatha10.1016/j.pedex.2009.06.001International Journal of Pediatric Otorhinolaryngology Extra (2009)2009-07-23International Journal of Pediatric Otorhinolaryngology Extra2009-07-23CASE REPORThttp://www.ijporlextra.com/article/PIIS187140480900032X/abstract?rss=yesAbstract: Myiasis or infestation of living tissues by Diptera (two winged) fly larvae is primarily a problem of cattle and livestock in tropics. Human infestation is rare, occurs accidentally in persons at extremes of age, who are debilitated or not able to ensure basic hygiene and wound cleanliness. Necrotic tissue in wounds of whatever origin provides ideal substrate for the developing larvae. Depending upon the anatomic sites affected it presents clinically as cutaneous myiasis, myiasis of external orifices (oral, nasal, ocular, aural, anal, genital), and myiasis of internal organs (intestinal, urinary). Cutaneous myiasis is perhaps the most commonly reported entity. Species causing skin, subcutaneous and mucosal myiasis include Gastrophilus intestinalis (horse botfly), Hypoderma bovis (cattle botfly), and Dermatobia homonis (human botfly). Musca domestica, the common house fly, is a rare cause of myiasis despite its presence in abundance.This paper describes oral myiasis in a 16-year-old girl of hypotonic cerebral palsy. She had episodic fever, fetid breath, erythematous, tender and ulcerated swelling over anterior palate from which pus and maggots were coming out. She had lip incompetence and bad orodental hygiene. Radiologic and laboratory investigations revealed no abnormality. The maggots were removed manually and she was treated with orodental hygiene sessions, wound care, antibiotics and nutritional supplements. The larval specimens were identified as early instar of M. domestica. Prevention of human myiasis is important and involves control of fly population, general cleanliness, basic sanitation and health education with a special emphasis on oral health care in patients with special needs.Oral myiasis caused by Musca domestica larvae in a child - Corrected ProofSunder Singh Dogra, Vikram K. Mahajan10.1016/j.pedex.2009.05.002International Journal of Pediatric Otorhinolaryngology Extra (2009)2009-06-26International Journal of Pediatric Otorhinolaryngology Extra2009-06-26CASE REPORThttp://www.ijporlextra.com/article/PIIS1871404809000331/abstract?rss=yesAbstract: We report the case of an uncommon pathological condition affecting a previously healthy 14-year-old boy, who came to the Emergency Room because of sudden, acute lateral-cervical neck pain not related to any other symptom, disease, traumatic event or dangerous behaviour.The diagnosis of spontaneous retropharyngeal and upper mediastinal emphysema was made by means of neck X-ray and neck and thorax CT scan, while the X-ray of the upper digestive tract and the fiberoptic laryngoscopy did not detect any oesophageal fistula or lesions of the pharynx and larynx.Antibiotics and only fluids intake in order to avoid more dangerous complications was the unique successful treatment; in 3 days time the boy was completely pain-free and back to normal activities.Spontaneous retropharyngeal and mediastinal emphysema: case report - Corrected ProofG. Terrosu, A. Rossetto, V. Bresadola, M. Robiony10.1016/j.pedex.2009.05.003International Journal of Pediatric Otorhinolaryngology Extra (2009)2009-06-17International Journal of Pediatric Otorhinolaryngology Extra2009-06-17CASE REPORThttp://www.ijporlextra.com/article/PIIS1871404809000276/abstract?rss=yesAbstract: A sphenochoanal polyp is a rare lesion that originates in the sphenoid sinus and protrudes through the choana into the nasopharynx. It can occur at any age but is especially common in adolescents and young adults. We present a case of a sphenochoanal polyp in a seven-year-old girl who presented with bilateral nasal obstruction and an altered voice. The presentation of a sphenochoanal polyp is similar to that of the more common antrochoanal polyp, but the two can only be differentiated on cross-sectional imaging (computed tomography and/or magnetic resonance imaging). Endoscopic sinus surgery allows for complete removal and minimizes the risk of recurrence.Sphenochoanal polyp—Surgical review - Corrected ProofH. Al Okbi, Rajeev Jain, Rashid Al-Abri10.1016/j.pedex.2009.04.003International Journal of Pediatric Otorhinolaryngology Extra (2009)2009-06-15International Journal of Pediatric Otorhinolaryngology Extra2009-06-15CASE REPORThttp://www.ijporlextra.com/article/PIIS1871404809000288/abstract?rss=yesAbstract: Objective: To describe the approach to the problem of open safety pin impacted in the esophagus in the pediatric population which constitutes a challenging and unusual situation. Methods: Presentation of three cases of open safety pins lodged to the esophagus and description of the techniques used for their removal. Results: In two cases rigid endoscopy was employed for the removal of the foreign body while in one of them a small gastrotomy was necessary. Recovery was uneventful in all three cases. Conclusions: Rigid endoscopy is a safe technique with minimal morbidity in experienced hands. Alternatively flexible endoscopy can be used with equally reported efficacy. Occasionally open surgery techniques might be necessary.Safe extraction of an impacted open safety pin from the esophagus: Report of three cases - Corrected ProofCharalampos Skoulakis, Jiannis Hajiioannou, Chaido Dava, Argyro Bizaki, Dimitris Valagiannis, John Bizakis10.1016/j.pedex.2009.05.001International Journal of Pediatric Otorhinolaryngology Extra (2009)2009-06-08International Journal of Pediatric Otorhinolaryngology Extra2009-06-08CASE REPORThttp://www.ijporlextra.com/article/PIIS1871404809000264/abstract?rss=yesAbstract: Mycobacterial infections are the group of disease caused by Mycobacterium tuberculosis and atypical mycobacterium. Tuberculosis is a systemic disease, which causes common cervical lymphadenitis as extrapulmonary symptoms. Differential diagnosis of atypical mycobacterial infection and tuberculosis by scanning techniques/radiographing imaging, histopathological evaluation and culturing is important due to their different treatments. Most of this systemic disease is curable with antituberculosis therapy. Atypical mycobacteria generally cause local cervical infections. These microorganisms are resistant to the medical therapy, treated by surgical management.In this article, 12-year-old boy admitted with tonsil hypertrophy and unknown bilateral jugulodigastric mass presented. Histopathologic examination of tonsillectomy material was reported as granulomatous inflammation considered primarily tuberculosis and nontuberculosis mycobacterium (NTM). Atypical mycobacteria were isolated from fine needle aspiration biopsy of cervical lymph node. Although antituberculosis regimen had been given to the patient for 18 months, there was no regression in lymphadenopathies. So bilateral selective cervical lymph node dissection was performed and all lymph nodes at this region were excised. There is no recurrence during 3-year follow-up period. The present case showed us, NTM can infect oral cavity and mucosa and spread to cervical area.Simultaneous mycobacterial infection of tonsil and cervical lymph node: Evidence to portal of entry - Corrected ProofCengiz Durucu, Tekin Baglam, Erkan Karatas, Arzu Oz, Kemal Bakir, Muzaffer Kanlikama10.1016/j.pedex.2009.04.002International Journal of Pediatric Otorhinolaryngology Extra (2009)2009-05-18International Journal of Pediatric Otorhinolaryngology Extra2009-05-18CASE REPORT