[ case of subglotitic adenoid cystic carcinoma and medical literature review]

Adenoid cystic carcinoma [ACC] is the second most common salivary glands tumor and the most common malignant tumor of minor salivary glands and also submandibular glands; however ACC of the larynx and trachea is rare. These tumors generally present in subglottic region as smooth submucosal solid mass without ulceration. Their primary symptoms are often as respiratory problems. This study was done on a woman, 54 years, with subglottic ACC that presented with exertional dyspnea, stridor, cough and hoarseness. After confirmation of diagnosis with biopsy, the patient underwent a total laryngectomy and then postoperative radiotherapy. During one year follow up, the patient did not show any evidence of local recurrence or distant metastasis. Surgery with free margins in combination with postoperative radiotherapy was recommended to treat laryngeal ACC in order to obtain better survival

[Treatment of carotid paraganglioma: review of a 15 - years experience]

Carotid body tumor is a highly vascular mass occurring between the origins of the internal and external carotid arteries, and should be considered in the evaluation of all lateral neck masses. The aim of this study is to review an institutional experience in the management of this tumor. 16 patients with carotid paragonglioma were treated in our institution during a period of 15 years. There were 12 women and 4 men with a mean age of 44 years. A slow growing painless lateral neck mass was the main finding in all patients. There was no evidence of a functional or malignant tumor. Carotid angiography and CT scan with contrast was performed in near all patients to define the vascular anatomy of the lesion. None of them underwent embolization. Complete tumor resection was done in all patients vascular reconstruction was necessary in two patients. Hypoglossal nerve was sacrificed in one patient and transient marginal nerve deficit was existed in one. No stroke occurred. High index of suspicion and earlier detection by radiologic finding and early surgical resection by an experienced team offer a safe and effective method for complete excision of tumor with a reduced morbidity rate

[Etiologic evaluation and treatment progress in necrotizing fasciitis of the head and neck]

Necrotizing fasciitis is an overwhelming infection common to perineum, abdominal wall, and extremities. It is a surgical emergency related to a high mortality rate that is more often seen in elderly and immunocompromised patients. Necrotizing fasciitis occurs uncommonly in the head and neck region. A retrospective study conducted on fasciitis necrotizing patients that were treated at Ghaem hospital since 2002-2005. Over a 4-year period, 4 cases of necrotizing fasciitis of the head and neck region collected at Ghaem hospital. The demographic, predisposing factors, clinical presentation and management were analyzed. The most common associated systemic disease was diabetes. Local swelling and erythematous changes was the most common sign. The cornerstones of proper management include early diagnosis, aggressive surgical debridement, broad-spectrum antibiotics and intensive supportive care. Necrotizing fasciitis mostly occurs in old patients with systemic disease specially diabetes mellitus which the common cause was dental infection

[Peripheral blood monocytes responsiveness in aggressive periodontitis patients by comparison of Interleukin-6 production before and after stimulation by E. Coli lipopolysacharide]

Results of other studies suggests that hyper-responsiveness of monocytes to the products of dental plaque especially the endotoxin of Gram negative bacteria and secretion of high levels of pro-inflammatory cytokines may have a role in the pathogenesis of AP. To investigate this possibility, we evaluated the IL-6 production by cultured peripheral blood monocytes before and after stimulation by E.coli lipopolysacharide [LPS] in AP patients and healthy controls. Fifteen patients with AP were compared to 15 periodontal healthy controls in a case control study. Mononuclear layer was obtained from peripheral blood samples and monocytes were isolated and cultured. The reaction of monocytes was studied by IL-6 production before and 6 hours after stimulation by 0.1 micro g/ml E.coli. LPS. The IL-6 concentration in the culture supernatant was measured with ELISA [Enzyme linked Immunosorbent Assay]. Wilcoxon and Mann-Whitney U-tests were used to compare the groups. There was no significant difference in IL-6 production levels before LPS stimulation between patients and controls [P = 0.5]. The IL-6 production after LPS stimulation in the patients was higher than controls, and the difference approached the significance threshold [P = 0.07]. However, the increase in the IL-6 production as a result of LPS stimulation was significantly higher in patients compared to controls [P = 0.029]. Our results suggest that increase in monocyte responsiveness may play a potential role in the pathogenesis of AP. Elevation in cytokines elicited at the site of infection in response to a minimal bacterial challenge can exert significant effects locally and systemically. An over aggressive immune response can provide the basis of explanation for the observed severe tissue damage. and bone loss in periodontium, familial nature of aggressive periodontitis and other immunological findings associated with the pathogenesis of this disease. Future investigations through longitudinal monitoring of monocyte responsiveness over time and following successful treatment are required to elucidate the role of this phenomenon in the pathogenesis of periodontitis

Evaluation of effect of topical phenytoin on wound healing [increasing wound tensile strength and collagen deposition] in rats

Background: Delyed healing and dehiscence of operative wounds represent a significant clinical problem. Sporadic reports indicate that phenytoin may significantly promote wound healing following topical application

Material and Methods: Ten male rats each received 4 dorsal skin incisions and were sutured immediately on proliferative and early maturation phase. The incisions were infiltrated with phenytoin or normal saline for controls randomly. The wounds were harvested 18 days after wounding and were assessed by tensiometric measurement and microscopic examination. Data was expressed as mean [sd] and were analysed using student's paired T test

Results: Application of phenytoin, in both proliferative and maturation phases, resulted in a significant increase in wound tensile strength [34.16[8.15] N and 32.18 [7.43] N in treated wound versus 28.58 N and 26.7[4.93] N controls respectively, n = 20; P<0.01]. Application of phenytoin in these two phases had no difference. The rise in wound tensile strength was associated with increase in wound collagen deposition

[Giant fibrovascular polyp of the hypopharynx and esophagus; a report of one case]

Fibrovascular polyp is a benign a benign and very rare tumor in the hypopharynx and esophagus. It is more common in elderly men. This lesion, in spite of its large size, could be asymptomatic for a long time. We are reporting here a 65 - year - old woman with this tumor from the ENT Department of Ghaem Hospital, Mashhad. IT may be the first reported case in Iranian publications. Her chief complain which brought her to us was feling a mass in the oral cavity upon straining

[ one year clinical study on the frequency of odontogenic sinusitis at ENT department of Ghaem Hospital in Mashhad]

Introduction: although odontogenic sinusitis is a rare entity when compared to the sinus diseases of rhinogenic origin, it is extremely important to identify a dental etiology when it occurs. The offending tooth or teeth would thus require endodontic treatment or extraction, and the sinus disease should carefully be assessed and appropriately managed. In the patients with pain and tenderness on the maxillary sinuses, odontogenic origin is suspicious

Materials and Methods: this is a one-year retrospective study on 38 patients followed in the ENT ward of Ghaem Hospital, Mashhad University of Medical Sciences. Most of patients were 20-30 years old

Results: In all, sinusitis was most common in ethmoid and maxilla, with the symptoms of mostly nasal obstruction and postnasal discharge in the last 3-6 years. 5 patients out of 38 [13.2%] had odontogenic sinusitis. An important point is that patients who had sinusitis with odontogenic origin were older than 35 years [more than the average age of these 38 patients]. Their most complaints were a local pain and tenderness on their cheek and upper jaw

Conclusion: an exact attention to the patient with complaints of pain and tenderness on the maxillary sinus sometimes reveals the odontogenic origin for the sinusitis. In these cases, a close cooperation between the ENT specialist and the dentist is an essential factor

Unusual and rare teratomas of the head and neck: a report of three cases

Teratomas are bulky lesions that rarely occur in the head and neck regions. They are composed of tissues from all germ layers with varying degrees of differentiation. They arise from pluripotential stem cells and ectopic embryonic non-germ cells. The most common sites of occurrence in the head and neck are the cervical region and the nasopharynx. Three cases of these tumors are reported here that were found in the nasopharynx, cervical region and the base of the tongue