颌下腺移位术预防鼻咽癌放疗后口干燥症的长期效果

目的:评价颌下腺移位术预防鼻咽癌放疗后口干燥症的长期效果.方法:70例鼻咽癌患者随机分为试验组36例和对照组34例.试验组在行常规放疗前将颌下腺移位至颏下区,放疗时颏下区设置挡块.~(99)T_c核素扫描检测放疗前后颌下腺功能,测定放疗前后唾液分泌量,放疗后60个月进行口干程度问卷调查,统计5年生存率.结果:放疗后60个月:试验组颌下腺摄取、分泌功能均明显较对照组好,两者之间有显著性差异,P值分别为0.000和0.000;试验组和对照组唾液量的平均值分别为1.65g和0.73g(P=0.000);试验组中度至重度口干燥症的发生率亦显著低于对照组(12.9% vs 78.6%,P=0.000);试验组和对照组的5年生存率分别为86.1%和82.4%,两者之间无显著性差异(P=0.67).结论:颌下腺移位术不影响鼻咽癌远期疗效,预防鼻咽癌放疗后口干燥症的长期效果良好,可改善鼻咽癌患者放疗后的生存质量.     

Deep and Unusual Sialolithiasis of Submandibular Duct and Gland: A Surgical Dilemma

Giant solitary submandibular duct calculus and multiple calculi of the gland are extremely rare. This occurrence along with more deep and proximally placed common calculi in submandibular gland may occasionally cause a dilemma in selection of the appropriate surgical approach in the present era of sialoendoscopic surgery. There is a high chance of fracture of the stone in a proximally placed stone in the gland followed by likely dissemination of fragments of the stone into the gland parenchyma during the procedure of sialoendoscopy which is a matter of grave concern. We authors believe that excision of the submandibular gland with the stone in such a situation should still be preferred as the gold standard of treatment leaving the ductal stone for endoscopic removal.     

Malignant Salivary Gland Tumors and Epstein-Barr Virus (EBV) Infection: A Systematic Review and Meta-analysis

Background: Salivary gland tumors are rare head and neck tumors with lymphoepithelial carcinoma (LEC) as a particularly infrequent variant. This study was an evaluation of the incidence of EBV infection in malignant salivary gland tumors with the emphasis on tumor type and geographical area. Methods: Five databases (PubMed, ScienceDirect, Scopus, Web of Science and Cochrane library) were searched for data on the prevalence of EBV in malignant salivary gland tumors. A random-effects meta-analysis was conducted with Comprehensive Meta-Analysis software version 2.0 (CMA 2.0) using the event rate (ER) for estimation of the incidence of EBV in the salivary gland tumor patients. Publication bias was lacking as assessed through funnel plot analysis with the Begg’s and Egger’s tests (P>0.05). Results: Out of 618 studies searched in databases, 19 reported the prevalence of EBV in malignant salivary gland tumors and were included in the present meta-analysis. The pooled ER of all studies was 44% [95%CI=21.5-69.2%] with extreme heterogeneity that for the studies in America was 44.2% [95%CI=4.1-93.6%], in Asia (249 patients) was 70% [95%CI= 33.4-91.6%] and in Europe was 11.8% [95%CI=7.4-85.5%] with extreme heterogeneity for three subgroups. The pooled ER for patients with undifferentiated carcinoma was 86.7% [95%CI=71.5-94.4%] compared with 6.6% [95%CI=2.5-16.5%] for other carcinomas. Conclusions: The incidence of EBV infection in malignant salivary gland tumors in Asia was greater than in Europe and America and the higher presence of EBV infection in LEC cases implies that EBV may be a major factor in its etiology or pathogenesis. Genetic, environmental and other geographic factors may also be involved.     

Prevention of Radiation Induced Xerostomia and Improved Quality of Life: Submandibular Salivary Gland Transfer

Over 60,000 new cases of head and neck cancers, and approximately 15,000 deaths occur every year in the United States (1). Head and neck cancers affect more men then women by a factor of 2:1, although the incidence of women is increasing as a result of increased tobacco use (2). Over 90% of all head and neck cancers are squamous cell carcinomas; most of the remaining cancers are adenocarcinomas. A combination of radiation therapy and surgery is used as the standard, primary treatment modality. Xerostomia occurs when the salivary glands are affected by irradiation. Patients experiencing xerostomia are at an increased risk for a wide variety of oral problems; all adversely affecting one's quality of life. Currently patients make lifestyle changes, dietary modifications, and use artificial salivas, sprays, gels, and lozenges to help mask their xerostomia. However, none of these products stimulate natural salivary production and act as a replacement therapy rather then a cure for xerostomia. A new protocol, RTOG 1083 has been approved by the Radiation Therapy Oncology Group, which involves a surgical transfer of a submandibular salivary gland to the submental space (where it can be easily shielded) as a method of prevention of radiation induced xerostomia.     

Serum Levels of Zinc,Copper and Ferritin in Patients with Salivary Gland Tumors

Background: Variation in serum levels of trace elements including zinc, copper and ferritin has been reported incancer patients. The aim of this study was to evaluate these trace elements in the patients’ sera with benign and malignantsalivary gland tumors (SGTs) and compare them with normal individuals. Methods: In this cross-sectional study, 60patients with SGTs including 16 pleomorphic adenoma and 44 malignant SGTs, as well as 28 healthy controls, wereenrolled. Serum levels of zinc, copper and ferritin were determined by atomic absorption and ELISA methods. Datawere analyzed using one way ANOVA, Chi-square, Kruskal-Wallis and Mann- Whitney tests. Results: The meanconcentration of zinc, copper, ferritin was1.5± 2 ppm, 1.2± 0.5 ppm, and 96.7± 65.7 ng/ml in PA, 1.5± 1.4,1.3± 0.4,and 111.2± 112 in malignant SGTs, and1.1±0.3, 1.2± 0.23 and 124±135.8 in normal control groups. There was nostatistically significant difference between the patients and control groups, and between benign and malignant SGTs(P>0.05). Conclusion: The serum levels of trace elements in SGTs were not different from normal individuals. Theresults might have been affected by some interventional factors. Therefore, designing cohort complementary studiesmight result in obtaining more accurate data.     

Galectin-3 Serum Levels Could Help Clinicians Screen for Salivary Gland Tumor Patients

analysis was performed on serum specimens from 105 patients with salivary gland cancer and 56 healthy persons.Methods: Enzyme-linked immunosorbent assay (ELISA) was used to measure levels of galectin-3 (GAL-3). Serumlevels were compared between patients with salivary gland tumors and healthy control. A total of 105 patients wereenrolled in the study (55 men, 50 women). Result: Mean age was45.5 years. Thirty-nine patients with malignant and66 cases with benign tumors were compared with 56 healthy participants with a mean age of 51.7. No statisticallysignificant differences were observed when comparing GAL-3 serum levels between malignant and benign salivary glandtumor patients, but a statistically significant difference was found between case and control patients with p-values of0.02. Serum levels of galectin-3 protein were elevated in patients with salivary gland cancer compared with the healthypopulation. Conclusion: The difference between benign and malignant tumor patients was significant, but revealedno clinic pathological characteristics in malignant tumors. To the best of the authors’ knowledge, this is the first timea study suggests that GAL-3 serum levels could help clinicians screen for salivary gland cancer.     

Accuracy,Sensitivity and Specificity of Fine Needle Aspiration Biopsy for Salivary Gland Tumors: A Retrospective Study from 2006 to 2011

Objective: This article concerns evaluation of the sensitivity, specificity and accuracy of FNAB for pre-surgical diagnosis of benign and malignant lesions of major and minor salivary glands of patients treated in the Department of Head and Neck Surgery of Erasto Gartner Hospital. Methods: This retrospective study analyzed medical records from January 2006 to December 2011 from patients with salivary gland lesions who underwent preoperative FNAB and, after surgical excision of the lesion, histopathological examination. Results: The study had a cohort of 130 cases, but 34 cases (26.2%) were considered unsatisfactory regarding cytology analyses. Based on the data, sensitivity was 66.7% (6/9), specificity was 81.6% (71/87), accuracy was 80.2% (77/96), the positive predictive value was 66,7% (6/9) and the negative predictive value was 81.6% (71/87). Conclusion: Despite the high rate of inadequate samples obtained in the FNAB in this study the technique offers high specificity, accuracy and acceptable sensitivity.     

Primary Tuberculosis of Tonsil Mimicking Carcinoma Tonsil

Tuberculosis is one of the major causes of ill health and death worldwide. Primary tuberculosis of the oral cavity and oropharynx is usually uncommon. Among tuberculosis of oral cavity and oropharynx, primary tuberculosis of tonsil in the absence of active pulmonary tuberculosis is a very rare clinical entity which presents difficulties in diagnosis because of similarity of presentation of carcinoma tonsil. Diagnosis mainly relies on the treating surgeon having a high index of suspicion. Although rare, tuberculosis should be kept in mind and considered in the differential diagnosis of any patient presenting with ulcer over tonsil.     

Primary Tuberculosis of Upper Airway: Case Report of 3 Rare Presentation

Tuberculosis of the upper airway is usually seen in conjunction with primary pulmonary tuberculosis. Primary tuberculosis of this area without involvement of the lung is very rare and often mistaken for malignancies. We report here three patients (2 male & 1 female) who presented with different symptoms and on investigations revealed to be suffering from tuberculosis of the upper airway (nasopharynx, tonsil & epiglottis). Further investigations revealed that no other area was involved. All the patients were started on standard anti tubercular therapy and showed complete cure on completion of therapy.     

Primary nasal Tuberculosis — A case report

During the past two decades, Tuberculosis — both pulmonary and extrapulmonary have re-emerged as a major health problem worldwide. Nasal tuberculosis may be primary, or secondary to pulmonary tuberculosis or facial lupus. However all of them are rare entities. Nasal tuberculosis should be considered in the differential diagnosis of chronic nasal granulomas. We report a case of primary nasal tuberculosis in an adult female who presented with a polypoidal lesion in the nasal cavity. The diagnosis was based upon smear study, histopathology, culture & polymerase chain reaction. The patient successfully responded to antituberculous therapy and is presently disease free. Given the resurgence of tuberculosis in recent times, it is important that otolaryngologists remain aware of this rare clinical entity.     

Post-Laminectomy Pseudomeningocele: An Unusual Cause of Bone Erosion

Pseudomeningocele is a rare complication of laminectomy, which can cause recurrent back pain with or without radicular signs. A case of bone erosion of the posterior vertebral elements by a pseudomeningocele is discussed.     

Tuberculosis of Oral Cavity: A Series of One Primary and Three Secondary Cases

Tuberculosis is one of the most common diseases in India resulting in significant mortality and morbidity. The disease has varied presentations. The clinical spectrum ranges from usual primary tuberculosis of the lungs to the very rare of oral cavity. We are reporting four cases of tuberculosis of oral cavity one of which is primary and three are secondary. All the patients were adult males. The primary tuberculosis case was sputum and biopsy negative for acid fast bacilli. All the secondary oral tuberculosis cases showed cavitary lesions in lungs and were sputum positive for acid fast bacilli however the biopsies were negative for the same.