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Cao X, Chen X, Wang Y, Feng S, Wang Z. Case report: Cavernous hemangioma in the right frontoparietal junction. Front Surg 2022; 9:972641. [PMID: 36111232 PMCID: PMC9468221 DOI: 10.3389/fsurg.2022.972641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 07/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background Primary intraosseous cavernous hemangioma is a benign tumor with slow growth and is rarely seen in clinics. The clinical manifestations of most patients are progressive enlargement of the head mass. Case presentation We report a 30-year-old female patient with cavernous hemangioma at the frontoparietal junction. Upon admission, the right frontal lobe mass was progressively enlarged for 3 years and underwent lesion resection and stage I skull reconstruction. The postoperative outcome was good, with no recurrence at 1-year follow-up. Conclusion Primary intraosseous cavernous hemangioma is a relatively rare clinical tumor, the pathogenesis of which is still unclear, and most of them have no specific clinical manifestations. Characteristic imaging findings are highly suspicious of this disease, but the definitive diagnosis still depends on histopathological examination. Currently, total surgical resection of the tumor is a relatively effective and preferred treatment.
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Affiliation(s)
- Xuemin Cao
- Department of Neurosurgery, Weifang People's Hospital Affiliated to Weifang Medical University, School of Clinical Medicine, Weifang Medical University, Weifang, China
- These authors share first authorship
| | - Xiaoshuai Chen
- Department of Neurosurgery, Weifang People's Hospital Affiliated to Weifang Medical University, School of Clinical Medicine, Weifang Medical University, Weifang, China
- These authors share first authorship
| | - Yi Wang
- Department of Neurosurgery, Weifang People's Hospital Affiliated to Weifang Medical University, Weifang, China
| | - Shangang Feng
- Department of Neurosurgery, Weifang People's Hospital Affiliated to Weifang Medical University, Weifang, China
| | - Zengwu Wang
- Department of Neurosurgery, Weifang People's Hospital Affiliated to Weifang Medical University, Weifang, China
- Correspondence: Zengwu Wang
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Yarar S, Uyar I, Yildirim MEC, Dadacı M, Ince B. A Rare Case: Primary Venous Malformation in Parietal Bone. Skin Appendage Disord 2021; 7:322-325. [PMID: 34307483 DOI: 10.1159/000514697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 01/22/2021] [Indexed: 11/19/2022] Open
Abstract
Primary intraosseous vascular malformations (PIVMs) are rare intraosseous lesions, accounting for approximately 0.5-1% of all intraosseous tumours. In this case report, we aimed to present a rare case of intraosseous vascular malformation causing a large lytic area in the parietal bone. A 25-year-old male patient was admitted to the clinic with a mass on the parietal bone. On physical examination, it was observed that the hair density on the mass was decreased, the mass had a soft consistency, and there was no pain on palpation. The patient was operated under local anaesthesia with a provisional diagnosis of a trichilemmal cyst. However, intraoperative diagnosis was a vascular malformation. There was a 3-cm full-thickness defect on the parietal bone caused by the lesion. The mass was excised completely while preserving the integrity of the dura. The resulting defect was reconstructed with bilateral rotation advancement flaps. The calvarial defect was not reconstructed due to equipment inadequacy. No complications were encountered in the postoperative period. Ninety-three PIVM cases have been reported in the skull since 1845. In very few of these cases, the mass is located in the parietal bone. The pathogenesis of PIVMs is not completely understood. The definitive diagnosis is made by histopathological examination. The therapeutic gold standard is surgery. Surgeons should keep in mind that radiological examination before the operation could prevent undesirable complications.
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Affiliation(s)
- Serhat Yarar
- Plastic Reconstructive and Aesthetic Surgery Clinic, Konya Numune Hospital, Konya, Turkey.,Department of Plastic Reconstructive and Aesthetic Surgery, School of the Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Ilker Uyar
- Department of Plastic Reconstructive and Aesthetic Surgery, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey.,Department of Plastic Reconstructive and Aesthetic Surgery, School of the Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Mehmet Emin Cem Yildirim
- Department of Plastic Reconstructive and Aesthetic Surgery, School of the Medicine, Necmettin Erbakan University, Konya, Turkey.,Plastic Reconstructive and Aesthetic Surgery Clinic, Bilecik State Hospital, Bilecik, Turkey
| | - Mehmet Dadacı
- Department of Plastic Reconstructive and Aesthetic Surgery, School of the Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Bilsev Ince
- Department of Plastic Reconstructive and Aesthetic Surgery, School of the Medicine, Necmettin Erbakan University, Konya, Turkey
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Mohammad A, Iqbal M, Wadhwania A. Schwannomas of the head and neck region: A report of two cases with a narrative review of the literature. CANCER RESEARCH, STATISTICS, AND TREATMENT 2020. [DOI: 10.4103/crst.crst_149_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Temerek AT, Ali S, Shehab MF. Computer guided resection and reconstruction of intra-osseous zygomatic hemangioma: Case report and systematic review of literature. Int J Surg Case Rep 2019; 66:240-256. [PMID: 31874384 PMCID: PMC6931065 DOI: 10.1016/j.ijscr.2019.12.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 11/30/2019] [Accepted: 12/10/2019] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES to systemically integrate the available data on various published treatment strategies for intraosseous hemangioma of the zygoma in an updated comprehensive systematic review, and to present a new case of treated resection and immediate reconstruction using computer guided patient specific composite graft. CASE PRESENTATION A 29 years old female patient with intraosseos zygomatic hemangioma treated using computer guided resection and immediate reconstruction. The resection was performed using a resection template constructed based on preoperative 3D planning. The reconstruction was performed using ramus bone graft and titanium mesh. The patient was followed up for 3 years with no complications. METHODS An electronic search was performed on 3 data bases; additional hand search of bibliographies of selected articles was performed. Eligibility criteria include human studies presenting intraosseous zygomatico-orbital hemangioma with clearly reported therapeutic strategies. RESULTS 53 articles with 73 cases were included. The lesion was highly prevalent in females compared to males (2.28:1). Fifth decade represents the highest prevalence with mean age of 44.1 ± 1.8 years. The main patient concern was swelling and facial deformity. Total tumor resection can assure no recurrence, while partial resection and curettage are associated with high recurrence rate.
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Affiliation(s)
- Ahmed Talaat Temerek
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, South Valley University, Qena, Egypt.
| | - Sherif Ali
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Cairo University, Cairo, Egypt.
| | - Mohamed Farid Shehab
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Cairo University, Cairo, Egypt.
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5
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Bocchialini G, Castellani A, Bozzola A, Rossi A. A Hemangioma of the Zygomatic Bone: Management Ensuring Good Reconstructive and Aesthetic Results. Craniomaxillofac Trauma Reconstr 2017; 10:332-336. [PMID: 29109848 DOI: 10.1055/s-0036-1594274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 08/27/2016] [Indexed: 12/30/2022] Open
Abstract
Hemangiomas are benign tumors representing only 0.7 to 1% of all bone tumors; those that arise in the zygomatic region are rarely described in the literature. Here, we describe the case of a 55-year-old woman with a mass in the right orbitozygomatic region. She was diagnosed on the basis of preoperative clinical manifestations, data from an earlier histopathological examination, and computed tomography (CT). The CT scan revealed a lesion in the right zygomatic region at the level of the cancellous component. This caused thinning and remodeling of the deformed cortex both medially and laterally. Surgery was performed. We describe the clinical characteristics of our case with an emphasis on surgical management of the lesion using a titanium grid prepared by reference to a stereolithographic model.
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Affiliation(s)
- Gabriele Bocchialini
- Unit of Maxillo-Facial Surgery, Azienda Ospedaliera Spedali Civili di Brescia, Brescia, Lombardia, Italy
| | - Andrea Castellani
- Unit of Maxillo-Facial Surgery, Azienda Ospedaliera Spedali Civili di Brescia, Brescia, Lombardia, Italy
| | - Anna Bozzola
- Department of Molecular and Translational Medicine, Section of Pathology, University Spedali Civili of Brescia, Brescia, Italy
| | - Alessandro Rossi
- Unit of Maxillo-Facial Surgery, Azienda Ospedaliera Spedali Civili di Brescia, Brescia, Lombardia, Italy
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Elif B, Derya Y, Gulperi K, Sevgi B. Intraosseous Cavernous Hemangioma in the Mandible: A Case Report. J Clin Exp Dent 2017; 9:e153-e156. [PMID: 28149481 PMCID: PMC5268109 DOI: 10.4317/jced.52864] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 03/02/2016] [Indexed: 11/07/2022] Open
Abstract
Intraosseous vascular lesions are rare conditions. They are most commonly seen in the vertebral column and skull; nevertheless, the mandible is a quite rare location. In this report, we present a case of intraosseous cavernous hemangioma in the mandible and discuss the clinical and radiological features. A 28-year-old male patient attended to our clinic with a complaint of painless swelling of mandible. Clinical evaluation revealed a bone-hard, smooth-surfaced, immobile mass in the left mandibular lingual area. The patient was evaluated with panoramic and occlusal radiography and computed tomography. The lesion surgically excised and pathological examination revealed an intraosseous cavernous hemangioma. Follow-up imaging 1 year later with cone beam computed tomography revealed recurrence of the lesion. The conclusion of this paper; when a bone hard, well-shaped mass was seen in the mandible, the possibility of intraosseous hemangioma must be remembered and before surgical procedure detailed radiographic evaluation should be performed.
Key words:Hemangioma, intraosseous, mandible, cavernous, cbct.
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Affiliation(s)
- Bilgir Elif
- PhD, Research Assistant; Suleyman Demirel University, Faculty of Dentistry, Department of Dentomaxillofacial Radiology, Isparta, Turkey
| | - Yildirim Derya
- DDS, PhD, Associated Professor; Suleyman Demirel University, Faculty of Dentistry, Department of Dentomaxillofacial Radiology, Isparta, Turkey
| | - Kocer Gulperi
- DDS, PhD, Associated Professor; Suleyman Demirel University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Isparta, Turkey
| | - Bozova Sevgi
- MD, Specialist Doctor of Medicine; Ministry of Health Turkish Public Hospitals Institution Association of Antalya Public Hospitals Serik State Hospital, Department of Pathology, Antalya/Turkey
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7
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Powers DB, Fisher E, Erdmann D. Zygomatic Intraosseous Hemangioma: Case Report and Literature Review. Craniomaxillofac Trauma Reconstr 2016; 10:1-10. [PMID: 28210401 DOI: 10.1055/s-0036-1592087] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 04/10/2016] [Indexed: 10/20/2022] Open
Abstract
Intraosseous hemangiomas are uncommon intrabony lesions, representing approximately 0.5 to 1% of all intraosseous tumors. Their description varies from "benign vasoformative neoplasms" to true hamartomatous proliferations of endothelial cells forming a vascular network with intermixed fibrous connective tissue stroma. These commonly present as a firm, painless swelling. Intraosseous hemangiomas present more commonly in females than in males and most likely occur in the fourth decade of life. The most common etiology of intraosseous hemangioma is believed to be prior trauma to the area. They have a tendency to bleed briskly upon removal or biopsy, making preoperative detection of the vascular nature of the lesion of significant importance. There are four variants: (1) capillary type, (2) cavernous type, (3) mixed variant, and (4) scirrhous type. Generally most common in the vertebral skeleton, they can also present in the calvarium and facial bones. In the head, the most common site is the parietal bone, followed by the mandible, and then malar and zygomatic regions. Intraosseous hemangiomas of the zygoma are rare entities with the first case reported in 1950 by Schoenfield. In this article, we review 49 case reports of intraosseous hemangioma of the zygoma, and also present a new case treated with excision followed by polyether-ether ketone implant placement for primary reconstruction.
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Affiliation(s)
- David B Powers
- Division of Plastic, Reconstructive, Maxillofacial and Oral Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Elda Fisher
- Department of Oral and Maxillofacial Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Detlev Erdmann
- Division of Plastic, Reconstructive, Maxillofacial and Oral Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
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Dincer Kose O, Tanyel C, Kose TE, Erdem MA, Cankaya AB. Tooth extraction from a patient with cavernous hemangioma in maxillofacial region: case report. J Istanb Univ Fac Dent 2016; 50:51-54. [PMID: 28955555 PMCID: PMC5573453 DOI: 10.17096/jiufd.77437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 02/25/2015] [Indexed: 11/15/2022] Open
Abstract
Hemangiomas are benign vascular tumors which
represent a rapid growth pattern followed by the
involution phase. Generally, they are located in the
soft tissues and are usually diagnosed in the first
decade of life. Hemangiomas are mostly asymptomatic
and rarely affect jaw bones. Mandible is affected more
often than maxilla. If there is no complication present,
treatment may not be necessary. Treatment planning
of hemangiomas should be done by considering the
location and the size of the lesion as well as the
proximity to vital anatomical structures. The aim of
this case report is to describe the procedures of tooth
extraction in a patient who had been diagnosed as
having maxillary cavernous hemangioma.
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Affiliation(s)
- Onur Dincer Kose
- Department of Oral and Maxillofacial Surgery Faculty of Dentistry Istanbul University Turkey
| | - Cem Tanyel
- Department of Oral and Maxillofacial Surgery Faculty of Dentistry Istanbul University Turkey
| | - Taha Emre Kose
- Department of Oral and Maxillofacial Radiology Faculty of Dentistry Istanbul University Turkey
| | - Mehmet Ali Erdem
- Department of Oral and Maxillofacial Surgery Faculty of Dentistry Istanbul University Turkey
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Ren JG, Chen G, Zhu JY, Zhang W, Sun YF, Jia J, Zhang J, Zhao YF. Downregulation of the transforming growth factor-β/connective tissue growth factor 2 signalling pathway in venous malformations: its target potential for sclerotherapy. Br J Dermatol 2014; 171:242-51. [PMID: 24655310 DOI: 10.1111/bjd.12977] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2014] [Indexed: 01/04/2023]
Affiliation(s)
- J.-G. Ren
- The State Key Laboratory Breeding Base of Basic Science of Stomatology and Key Laboratory of Oral Biomedicine Ministry of Education; School and Hospital of Stomatology; Wuhan University; Wuhan China
| | - G. Chen
- The State Key Laboratory Breeding Base of Basic Science of Stomatology and Key Laboratory of Oral Biomedicine Ministry of Education; School and Hospital of Stomatology; Wuhan University; Wuhan China
- Department of Oral and Maxillofacial Surgery; School and Hospital of Stomatology; Wuhan University; Wuhan China
| | - J.-Y. Zhu
- The State Key Laboratory Breeding Base of Basic Science of Stomatology and Key Laboratory of Oral Biomedicine Ministry of Education; School and Hospital of Stomatology; Wuhan University; Wuhan China
| | - W. Zhang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology and Key Laboratory of Oral Biomedicine Ministry of Education; School and Hospital of Stomatology; Wuhan University; Wuhan China
| | - Y.-F. Sun
- The State Key Laboratory Breeding Base of Basic Science of Stomatology and Key Laboratory of Oral Biomedicine Ministry of Education; School and Hospital of Stomatology; Wuhan University; Wuhan China
- Department of Oral and Maxillofacial Surgery; School and Hospital of Stomatology; Wuhan University; Wuhan China
| | - J. Jia
- The State Key Laboratory Breeding Base of Basic Science of Stomatology and Key Laboratory of Oral Biomedicine Ministry of Education; School and Hospital of Stomatology; Wuhan University; Wuhan China
- Department of Oral and Maxillofacial Surgery; School and Hospital of Stomatology; Wuhan University; Wuhan China
| | - J. Zhang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology and Key Laboratory of Oral Biomedicine Ministry of Education; School and Hospital of Stomatology; Wuhan University; Wuhan China
| | - Y.-F. Zhao
- The State Key Laboratory Breeding Base of Basic Science of Stomatology and Key Laboratory of Oral Biomedicine Ministry of Education; School and Hospital of Stomatology; Wuhan University; Wuhan China
- Department of Oral and Maxillofacial Surgery; School and Hospital of Stomatology; Wuhan University; Wuhan China
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10
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Chen G, Ren JG, Zhang W, Sun YF, Wang FQ, Li RF, Zhang J, Zhao YF. Disorganized vascular structures in sporadic venous malformations: a possible correlation with balancing effect between Tie2 and TGF-β. Sci Rep 2014; 4:5457. [PMID: 24966004 PMCID: PMC4071312 DOI: 10.1038/srep05457] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 06/09/2014] [Indexed: 12/20/2022] Open
Abstract
Venous malformations (VMs) are among the most common slow-flow vascular malformations characterized by irregular venous channels, luminal thrombi, and phleboliths. To systematically manifest the disorganized vascular structures in sporadic VMs, we initially evaluated histopathological characteristics, perivascular cell coverage, adhesion molecules expression and vascular ultrastructures. Then, the expression of Tie2 and TGF-β in VMs was detected. Meanwhile, the in vitro studies were performed for mechanism investigation. Our data showed that the perivascular α-SMA+ cell coverage and expression of adhesion molecules in VMs were significantly decreased compared with those in the normal skin tissues. We also found that the expression and phosphorylation levels of Tie2 were upregulated, whereas TGF-β was downregulated in VMs, and they were negatively correlated. Moreover, the in vitro results also revealed a possible balancing effect between Tie2 and TGF-β, as demonstrated by the findings that Ang-1 (agonist of Tie2) treatment significantly downregulated TGF-β expression, and treatment with recombinant TGF-β could also suppress Tie2 expression and phosphorylation. This study provided strong evidence supporting the disorganized vascular structures and dysregulation of related molecules in sporadic VMs, and demonstrated a possible balancing effect between Tie2 and TGF-β, which might help to develop novel therapeutics for vascular disorganization-related disorders.
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Affiliation(s)
- Gang Chen
- 1] The State Key Laboratory Breeding Base of Basic Science of Stomatology & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China [2] Department of Oral and Maxillofacial Surgery, School & Hospital of Stomatology, Wuhan University, Wuhan, China [3]
| | - Jian-Gang Ren
- 1] The State Key Laboratory Breeding Base of Basic Science of Stomatology & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China [2]
| | - Wei Zhang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Yan-Fang Sun
- 1] The State Key Laboratory Breeding Base of Basic Science of Stomatology & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China [2] Department of Oral and Maxillofacial Surgery, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Feng-Qin Wang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Rui-Fang Li
- The State Key Laboratory Breeding Base of Basic Science of Stomatology & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Jian Zhang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Yi-Fang Zhao
- 1] The State Key Laboratory Breeding Base of Basic Science of Stomatology & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China [2] Department of Oral and Maxillofacial Surgery, School & Hospital of Stomatology, Wuhan University, Wuhan, China
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Marcinow AM, Provenzano MJ, Gurgel RK, Chang KE. Primary Intraosseous Cavernous hemangioma of the Zygoma: A Case Report and Literature Review. EAR, NOSE & THROAT JOURNAL 2012; 91:210, 212, 214-5. [DOI: 10.1177/014556131209100512] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Intraosseous hemangiomas are rare. We report the case of a 47-year-old man who presented with a gradually enlarging left zygomatic mass that had caused pain, deformity, and superficial soft-tissue swelling. Computed tomography revealed a well-circumscribed 2.0 × 2.5-cm mass with a ground-glass matrix in the left zygoma. Following surgical excision, the patient's symptoms resolved. Findings on pathologic examination of the excised tissue were consistent with an intraosseous cavernous hemangioma. We describe the features of this rare case, we discuss the pertinent radiologic features and pathophysiology of intraosseous hemangiomas, and we review the available literature.
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Affiliation(s)
- Anna M. Marcinow
- Department of Otolaryngology–Head and Neck Surgery The Ohio State University School of Medicine, Columbus
| | - Matthew J. Provenzano
- Division of Pediatric Otolaryngology–Head and Neck Surgery Cincinnati Children's Hospital Medical Center
| | - Richard K. Gurgel
- Department of Otolaryngology (Head and Neck Surgery), Stanford University Medical Center, Stanford, Calif
| | - Kristi E. Chang
- Department of Otolaryngology–Head and Neck Surgery, University of Iowa College of Medicine, Iowa City
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