Faculty Bibliography

Patient-satisfaction surveys can call attention to the importance of treating patients with dignity and respect, but good ratings depend more on manipulable patient perceptions than on good medicine. In fact, the pressure to get good ratings can lead to bad medicine.

Primary cutaneous mucoepidermoid carcinoma remains a rare occurrence. This is the first report of a case of primary cutaneous mucoepidermoid carcinoma originating on the scalp and subsequently metastasizing to the parotid gland. The patient was a 53-year-old female who presented with a purple mass on her scalp since 5 months prior to examination. Histopathology revealed nests and islands of atypical epithelioid cells with pleomorphism, medium to prominent nucleoli, and scattered mucin deposition highlighting with a mucicarmine stain. The atypical cells demonstrated intravascular involvement. These findings were compatible with metastatic adenocarcinoma. Later, fine needle aspiration of the patient's parotid lesion revealed malignant cells from a poorly differentiated carcinoma that appeared similar to the patient's previously excised scalp lesion. In addition to summarizing this patient's presentation, clinical course, and management, we discuss the diagnostic challenges posed by this atypical presentation. Primary cutaneous mucoepidermoid carcinoma should be considered in the differential diagnosis of patients presenting with a scalp mass. Moreover, patients with primary cutaneous mucoepidermoid carcinoma originating on the scalp should be evaluated for possible metastases.

Enophthalmos, the posterior displacement of a normal-size ocular globe relative to the orbital cavity, is usually repaired using autogenous grafts or alloplastic materials. We present the case of a 40-year-old man with bilateral idiopathic enophthalmos whose symptoms recurred 8 years after initial successful surgical repair. We describe the successful and safe use of a bilateral temporoparietal adipofascial flap in the treatment of recurrent idiopathic enophthalmos.

OBJECT/OBJECTIVE:A study was conducted to elucidate anatomical variations of the GON and surrounding occipital tissues. METHODS:Anatomical and surgical variations were prospectively recorded for 272 patients who underwent greater occipital nerve (GON) decompression by a single surgeon between 2003 and 2012. Data collection was performed intraoperatively and specifically for the purposes of this study. Documented anatomical variations of the GON and surrounding occipital region included the extension of trapezius musculature to the midline, abnormal lymph nodes, and GON branching. Necessary variations in the surgical procedure were also noted, including resection of a lateral portion of semispinalis capitis muscle and occipital arterectomy. RESULTS:The GON pierced the semispinalis muscle in all patients bilaterally. The extension of trapezius musculature to the midline was discovered in 67.3 percent of patients and lymph node enlargement was discovered in 1.5 percent of patients. Branching of the GON was noted in 7.4 percent of patients and muscles or vessels between GON branches were noted in 3.7 percent of patients. Occipital arterectomy was required in 64.0 percent of patients and resection of a lateral segment of semispinalis muscle was required in 10.7 percent of patients. CONCLUSIONS:The new anatomical variations described in this study improve understanding of the intraoperative anatomy of the occipital region and prevent difficulty in finding the GON due to dissection in the wrong plane, ensuring that MH patients receive maximal benefit from surgical treatment.