Papillary carcinoma in a supra hyoid thyroglossal duct cyst — an unusual presentation

Carcinomatous transformation of ectopic thyroid elements within the thyroglossal tract is a rare entity. We report a case of primary papillary carcinoma of thyroid presenting within the thyroglossal duct cyst in a 23 year old gentleman. The patient presented to us, as a case of suprahyoid thyroglossal cyst with sub-lingual involvement and he underwent surgical excision of the entire thyroglossal tract by Sistrunk’s approach. The post-operative histopathological diagnosis was of a papillary carcinoma within the thyroglossal duct cyst. Hence, the patient was evaluated for a malignant focus in the thyroid which proved negative. He was counseled regarding the possibility of developing Carcinoma in the thyroid gland and offered two options of further management viz., total thyroidectomy followed by life long thyroid suppression or watchful observation and follow up. As the patient belonged to the low risk group, he opted for the second option. He is presently kept under meticulous follow up and remains asymptomatic till date. We present the pre- and post-operative imaging, intra-operative findings, histo-pathological features and review the present world literature on this rare entity.     

Parotid salivary duct carcinoma: a single institution’s 20-year experience

European Archives of Oto-Rhino-Laryngology - The aim of the study was to assess the treatment results of the parotid gland salivary duct carcinoma (SDC). A retrospective clinicopathological...     

Papillary thyroid carcinoma in a thyroglossal duct cyst: primary tumor or metastasis?

Thyroglossal duct cysts are the most common anomaly in thyroid development. The occurrence of carcinoma in a cyst is reported to be about 1% of cases. Histopathological examinations reveal a papillary thyroid carcinoma in about 94% of these. We report the case of 38-year-old female having a massive, cervical cystic mass over a period of 18 months. An ectopic papillary thyroid carcinoma was diagnosed. A total thyoidectomy and bilateral neck dissection were performed. This revealed a small thyroid carcinoma and three positive lymphatic nodes. Whether the cystic carcinoma is the primary or a metastasis of the thyroid carcinomais discussed.     

Orbital complications associated with paranasal sinus infections – A 10-year experience in Israel

ObjectiveOrbital involvement is the most common complication of sinus infections. The epidemiology of the disease is continuously changing in the antibiotic era.Materials and methodsData on patients who were hospitalized due to acute sinusitis and orbital complications were retrospectively collected and analyzed from four medical centers in Israel during the years 2002–2012.Results288 patients were included in the study, the average age was 14.4 years, 180 were males, and 220 were children. No significant annual increase in the number of patients was noted. The lowest number of patients was found during the summer 19.4%. A linear direct correlation was found between older age and prolonged hospital stay. Children were presented with a significantly higher Chandler score than adults. No patient had cavernous sinus thrombosis. 101 (35%) patients received antibiotics before hospital admission. Their average hospital stay was similar to those who were not treated prior to admission. 106 patients (39.8%) had fever. A direct correlation was found between older age and the presence of fever. 102 (35.4%) patients had leukocytosis. The difference in white blood cell count between patients younger than two years of age to the other groups was statistically significant. Forty four (15.3%) patients underwent surgical intervention. A direct correlation was found between leukocytosis and older age to surgery.ConclusionsPeriorbital cellulitis occurs mainly in children and males and is less frequent in the summer. Children tend to have worse orbital involvement with lower temperatures than adults. Older age and leukocytosis are associated with surgical intervention.     

Functional results in airflow improvement using a “flip-flap” alar technique: our experience

Introduction

Pinched nasal point can be arising as congenital malformation or as results of unsuccessfully surgery. The nasal valve alteration due to this problem is not only an esthetic problem but also a functional one because can modify the nasal airflow. Several surgical techniques were proposed in literature, we proposed our.

Post-tonsillectomy hemorrhage in children: a single surgeon’s experience with coblation compared to diathermy

The aim of this study was to compare coblation and diathermy techniques with respect to secondary post-tonsillectomy hemorrhage (PTH). A total of 1,397 children underwent tonsillectomies with or without adenoidectomy by a single surgeon in a single center from June 2005 through December 2011. A diathermy tonsillectomy was performed on 315 patients for the first 2 years, while a coblation tonsillectomy was performed on 1,082 for the next 5 years. All patients were followed-up within 28 days of surgery by the same surgeon. The characteristics of primary and secondary PTH were analyzed with a retrospective chart review. Primary PTH did not occur in both surgical technique groups. Secondary PTH occurred in 9 patients (2.9 %) in the diathermy group and in 30 patients (2.8 %) in the coblation group. The secondary PTH rates were 1.2, 2.5, 3.8, 3.1 and 4.5 % in the first, second, third, fourth and fifth years after employment of the coblation tonsillectomy, respectively (P = 0.243). Sex, age, tonsil size and severity of tonsillar embedding were not significant factors for PTH. The coblation technique was associated more with late secondary PTH than diathermy technique (odds ratio 9.14, P = 0.049). Analysis of the time of onset of PTH showed that secondary PTH occurred most commonly between 6 p.m. and 6 a.m. In summary, coblation technique has similar secondary PTH rate with diathermy technique although it has increased late secondary PTH rate in children. Coblation technique can be a good alternative to the diathermy technique.     

Positive findings on barium swallow in patients presenting with a “sensation of a lump in the throat”

Our objective is to evaluate the pickup rate of a significant pathology, on barium swallow, in patients who present to our clinic with a feeling of a lump in the throat (globus symptoms). Hospital—secondary referral centre. This is a retrospective study of 192 patients who had barium swallow in our department between August 2009 and August 2010. We revised 500 case notes to rule in 192 who presented with only a feeling of a lump in their throat. All patients with positive clinical findings, such as dysphagia, odynophagia, referred otalgia, hoarseness of voice, weight loss, neck swelling or vocal cord palsy, were ruled out. Eight patients were diagnosed on barium swallow as having significant pathology: five with diverticulae and three patients with oesophageal web. The percentage of significant pathology in our study is 4.17% (eight patients). Out of those eight cases, there was no malignant pathology identified on further panendoscopy. Our conclusion is that barium swallow adds very little to the diagnosis of Globus Pharyngeus, but it plays a role in the reassurance particularly from the patients’ perspective.     

Postextubation stridor in a child with asymptomatic trifid epiglottis with polydactyly – A rare case report

Trifid epiglottis is an extremely rare congenital laryngeal anomaly. Trifid anomaly of epiglottis has not been described in literature. In the embryo, epiglottis, hypothalamus, and digital buds develop synchronously. Some disturbances during this stage may account for the concurrence of trifid epiglottis and polysyndactyly. We report a trifid epiglottis in a 6 year old child with congenital bilateral polydactyly of hand and foot who was asymptomatic and developed postexubation mild stridor after general anesthesia for excision of the extra digit which was managed conservatively.     

Does intervention improve the natural course of glomus tumors? A series of 108 patients seen in a 32-year period.

To acquire more insight into the results of treatment versus the "natural" course of glomus tumors, we studied the clinical data of 108 patients, in 58 of whom the disease was hereditary. During a period of 32 years (1956 to 1988), 175 tumors were diagnosed: 52 glomus jugulotympanic tumors, 32 vagal body tumors, and 91 carotid body tumors. The results of radical surgical treatment were disappointing for tumors located at the skull base, ie, nonradical in 59% (n = 23) of the cases, but very good for the carotid body tumors, for which 96% (n = 68) radical excision was achieved. Moreover, surgery at the level of the skull base dramatically increased morbidity, since it frequently induced cranial nerve palsy. During the follow-up period (maximal observation time 32 years, mean 13.5 years) none of the patients died of residual or recurrent tumor or developed distant metastases, irrespective of the mode and outcome of treatment. When these results are combined with the results of pedigree analysis, a realistic approximation of the "natural" course of the disease for both hereditary and nonfamilial tumors can be made. The results raise the question of whether this natural behavior is really improved by intervention. We conclude that removal of carotid body tumors and solitary vagal body tumors should be considered in order to prevent future morbidity. However, for skull base and bilateral glomus tumors a more conservative monitored "wait and see" policy can be sensible and should be considered in any proposal for treatment of head and neck paragangliomas.(ABSTRACT TRUNCATED AT 250 WORDS)     

16 years of experience in laryngeal microsurgery with use laser CO₂: cooperation between laryngologist and anesthesiologist - in material of ENT Department of Silesian Medical University

Laryngeal microsurgery is currently the primary method of treatment of many diseases of the larynx. Breakthrough for the development of laryngeal microsurgery was the introduction of laser technology. The laryngeal microsurgery is used mainly laser CO?. Endoscopic laryngeal microsurgery using the laser poses a unique challenge to the anesthesiologist, ensuring safe conditions of anesthesia, the patient and simultaneously appropriate operating conditions for the surgeon for precisely perform the procedure. MATERIAL AND METHODS: Between 1995 and 2010 carried out in the Department of Otolaryngology SUM 832 microsurgical operations of the larynx using a CO? laser. CONCLUSION:The perioperative management and close cooperation with the surgeon and anesthesiologist are essential for safe and efficient conduct of the operation the larynx using a microsurgical CO? laser.     

A new approach for crooked nose: Separated spreader graft “puzzle graft”

IntroductionThe nasal septum takes an important role in nasal shape and function. The term “crooked nose” is commonly used for all of the clinical conditions involving deviation of the nasal axis from the midline. This situation leads to both aesthetic concerns and breathing problems. In this study, we describe a new method in order to nasal dorsum on the midline and improving airway function in crooked nose patients, that will be contribute to the literature.Materials and methodsThis study enrolled 50 (fifty) patients who had undergone open septorhinoplasty operation were included in our study. The puzzle graft, which was prepared as a spreader graft consisting of three separate parts, was used to correct crooked nose in all patients. Anterior rhinoscopic examination, photographs and Nasal Obstruction and Septoplasty Effectiveness (NOSE) scores for the pre-operative and post-operative 1 year were compared and evaluated in this study.ResultsThe new approach was used successfully in all of the patients. Anterior rhinoscopic and 1 year photographic evaluations revealed a significantly correction of external appearance post-operatively. None of the patients had any additional complaints and complications during the post-operative period. We observed that NOSE scores, with which the post-operative nasal obstruction was evaluated, were significantly better in all 50 patients.ConclusionCrooked nose deformity is one of the most difficult problems in rhinoplasty. There is no absolute true technique for solving this situation. Each method works properly in appropriate cases. Sometimes we should use more than one technique in the same operation to correct the pathology. Our purpose is to present a new option to help surgeons in “crooked nose”; to provide a new method that can work safe and effective in convenient conditions.     

A novel mitochondrial mutation, 1556C→T,in a Japanese patient with streptomycin-induced tinnitus

Objective Aminoglycoside antibiotics are associated with ototoxicity. The 1555A→G mutation in the 12S ribosomal RNA gene of mitochondrial DNA has been considered to be associated with susceptibility to aminoglycoside antibiotics. In this study we examined a 79-year-old Japanese patient with a 45-year history of streptomycin-induced tinnitus in an attempt to find a mitochondrial mutation.

Materials and Methods DNA was extracted from the patient's leukocytes. Polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) screening for the 1555A→G mutation was done in order to detect a mitochondrial mutation and then nucleotide sequencing analysis was performed to identify the mutation.

Results PCR-RFLP screening detected the presence of a mitochondrial mutation in the patient. However, the nucleotide sequencing analysis showed that the mutation was not the 1555A→G mutation but a novel mutation, 1556C→T. The mutation was not found in 112 unrelated Japanese control subjects, suggesting that the mutation was specific to our patient.

Conclusions The 1556C→T mutation may be a genetic risk factor for aminoglycoside-induced hearing impairment. Our result also suggests that patients with the 1556C→T mutation exist among those expected to have the 1555A→G mutation as a result of PCR-RFLP analysis.     

Comment on “Sarcopenia is a prognostic factor for overall survival in elderly patients with head-and-neck cancer”

European Archives of Oto-Rhino-Laryngology -     

“Post intubation Laryngeal injuries in a pediatric intensive care unit of tertiary hospital in India: A Fibreoptic endoscopic study”

Study objectivesTo identify acute laryngeal injuries among pediatric patients intubated for more than 48 hours, and to correlate these injuries with clinical variables.SettingPediatric Intensive Care Unit (PICU) of a tertiary level hospital in India.Patients and MethodsProspective, observational study. Thirty-four children meeting the inclusion and exclusion criteria were recruited into the study after obtaining informed consent from the parents. A bedside, flexible, fiberoptic laryngoscopy was done within the first 24 hours of extubation. Laryngeal injuries were documented and graded. Individual types of laryngeal injuries were correlated to the duration of intubation, size of the tube, the experience of the intubator and the patient's demographics. A repeat endoscopy was done in the outpatient department, 3-4 weeks after extubation, and findings noted.Results97% had acute laryngeal injury, of which 88% were significant. Erythema was the most common form of injury. Duration of intubation, with a mean of 4.5 days, showed a trend towards significance (p = 0.06) for association with subglottic narrowing. Laryngeal injuries were similar with both cuffed and uncuffed tubes. Age of the subject, size of the tube and skill level of the intubator did not correlate with the laryngeal injuries. 18% required intervention for post-extubation laryngeal lesions. Three (10%) children had post-extubation stridor, and of these, two needed surgical intervention (6%).ConclusionPost-extubation laryngeal injuries are not uncommon. Fiberoptic endoscopy is an inexpensive and cost-effective tool for bedside evaluation of post-intubation status in pediatric larynx. Early diagnosis of post-intubation laryngeal injuries in children can prevent long term sequelae. Hence, post-extubation fiberoptic laryngoscopy should be done routinely in pediatric population.