Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts - P272

P272
Otolaryngology-Head and Neck Surgery 163(1S)
Presentation schedule is subject to change. The Official Program Abstracts supplement does not reflect changes made after August 10, 2020.
surgery is the primary treatment modality, usually followed
by radiation therapy.
Methods: Case report and literature review.
Results: A 20-year-old woman with a history of NF1 presented
to otolaryngology for evaluation of a right supraclavicular mass.
She had previously undergone resection of a right-sided supraclavicular mass at age 12 and pathology showed neurofibroma. She stated that the mass had been present for about
8 years, with significant enlargement in size during the last
2 years. She underwent resection, at which time 3 masses
were removed. Pathology of the lesions returned as plexiform
neurofibroma with transformation into low-grade MPNST in
the largest mass and atypia with concern for transformation in
the 2 smaller masses. Postoperatively, she was discussed at
our institution's sarcoma tumor board, and she was referred to
radiation oncology and medical oncology. Radiation therapy
was recommended.
Conclusions: Here, we present a case report of a very rare
neoplasm that manifested in a young adult patient with a history of NF1. Given the rarity of this entity, the literature
remains limited on prognostic factors and treatment algorithms. This case raises considerations for earlier resection of
neurofibromas, if possible, before the occurrence of potential
transformation.

Pediatric

Chloroma of the Head and Neck in Pediatric
Patients
Mohammad I. Al-Alawneh (Presenter); John Glyesteen, MD;
Daniel C. Chelius Jr, MD; Jeffrey C. Rastatter, MD;
Jamie Flerlage; Anthony Sheyn, MD
Objectives: Extramedullary sarcomas (chloromas) are rare
tumors of immature myeloid cells related to acute nonlymphocytic leukemia or myelodysplastic syndrome. Approximately
5.4% occur within the head, neck, and paranasal sinus. The
current incidence is 1 per 450,000 patients. The incidence in
children is reportedly higher. Most series to date have small
numbers, making it difficult to propose recommendations
based on these studies alone. The current study evaluated the
experience of treating chloromas at a tertiary pediatric hospital
over the past 13 years.
Methods: Following approval by the institutional review
board, a retrospective chart review was performed between
the years 2005 to 2019. Data were collected on site: primary
malignancy, demographics, treatment type, and outcomes.
Results: Twenty-three patients were identified. The age
range was 5 months to 18 years, and the male to female ratio
was 1:1. In 21 of 23 cases, the primary diagnosis was acute
myeloblastic leukemia, and 2 were acute lymphoblastic leukemia. In 12 of 23 patients, a chloroma was the initial presentation for leukemia; the remaining cases developed after patients
were diagnosed with leukemia. The most common presentation was orbital edema, facial mass, or an incidental image
finding. In addition, 14 of 23 patients underwent biopsy, confirming that the mass represented a leukemic infiltrate. All

patients underwent chemotherapy with or without radiotherapy; 65% of patients succumbed to the disease.
Conclusions: Although rare, head and neck chloromas should
be in the differential diagnosis in patients presenting with
orbital swelling or a facial mass in the setting of leukemia.
Despite advances in the treatment of childhood leukemia,
chloromas of the head and neck usually portend a poor
prognosis.
Chronic Suppurative Otitis Media due to
Nontuberculous Mycobacteria: A Case Series
Eve Sedillot (Presenter); Beatrice Voizard; Owen Woods, MD;
Marie-Claude Quintal, MD
Objectives: Eight new cases of chronic otitis media due to
atypical mycobacteria were reported at the Centre Hospitalier
Universitaire (CHU) Sainte-Justine between 2008 and 2018.
In the literature, only 89 cases have been described since
1972. This case series aimed to define the clinical presentation, infectious strains, as well as diagnostic and therapeutic
means employed in cases of nontuberculous mycobacteria
encountered in our tertiary reference center.
Methods: All cases of atypical mycobacteria diagnosed at
the CHU Sainte-Justine between 2008 and 2018 were
reviewed. Strain identification was retrieved from the
Laboratoire de Santé Publique du Québec, our provincial public health laboratory.
Results: All 8 cases were immunocompetent. Clinical features were chronic tympanostomy tube otorrhea with abundant
granulation tissue in 7 cases. Computed tomography scan demonstrated coalescent mastoiditis in 3 cases. The average delay
between initial presentation and identification of atypical mycobacteria was 124 days. Seven patients had a Mycobacterium
abscessus infection. Treatment consisted of weekly microscopic granulation debridement, a combined systemic antibiotic
therapy for an average duration of 21 weeks, as well as instillation of boric acid into the middle ear. Whereas 3 cases required
at least 1 mastoidectomy, 2 cases were treated only medically.
Conclusions: Atypical mycobacteria otitis is a rare clinical
entity, for which high clinical suspicion could minimize diagnostic delay. The use of boric acid as a desiccating agent may
allow for better local control.
Clinical Analysis of Type II First Branchial
Cleft Anomalies in Children
Wei Liu, MD (Presenter); Jie Zhang
Objectives: To analyze the clinical characters of type II first
branchial cleft anomalies (FBCAs) in children and introduce a
new classification method for good protection of the facial
nerve.
Methods: A retrospective analysis of type II FBCAs in
Beijing Children's Hospital was performed. The patients were
divided into 3 subtypes by the result of magnetic resonance
imaging: type IIa (FBCA located between the subcutaneous

Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts

Table of Contents for the Digital Edition of Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts