Presentation and clinical outcome of patients with malignant salivary gland tumors

Salivary gland cancer is a rare disease and comprises approximately 5 to 6% of cancers of the head and neck and 0.3% of all cancers. These tumors display a diverse biological behaviors and clinical presentation. Currently, many series has described site, size stage, histology and grade of the tumors as important prognostic factors affecting the outcome. Aim of the work was to evaluate the presentation and management outcome of patients presented with salivary gland cancer in search of prognostic factors for locoregionl control, disease free survival, and overall survival. The records of all patients with malignant salivary gland tumors presenting for treatment at our institution between October 1997 and October 2002 were reviewed. Variables were collected and outcome measures were defined in terms of locoregional, and distant control, and overall survival and disease-free survival [DFS], in 5 years follow up. Survival was described using the Kaplan-Meier method. This study included 46 patients [24 males and 22 females] ranging in age from 22 to 86 years with mean age of 53 +/- 18 years. The disease-free survival and overall survival rate were 65.5% and 69.5%, at 5 years, respectively. We found that survival was significantly better in younger patients [P = 0.05], male patients [P = 0.001] early stage [P = 0.001], patients with parotid cancer [P = 0.004], low/intermediate grade [P = 0.0006] and patients who received postoperative adjuvant radiation [P = 0.003]. The majority of our patients presented in advanced stage, which necessitated aggressive surgical treatment. Postoperative adjunctive radiotherapy seems to play an important role in those patients. However, the benefits of combined modality therapy await prospective clinical trials. This study confirmed the contributions of age, sex, site, stage, and grade for locoregional control and survival

Facial nerve dysfunction following conservative primary parotid surgery

Aim: The aim of this study is to analyse the incidence and highlight the risk factors associated with facial nerve dysfunction after conservative primary parotidectomy

Methods: The study included 41 patients, who were initially with normal facial nerve function and had been treated by conservative primary parotidectomy [42 procedures] for parotid neoplasms in Sohag University Hospital, during the period from March 2002 to March 2005. Facial nerve function was assessed on admission before surgery; and then at one day, one month and six months following the parotidectomy. Extent of the surgery, size of the parotid neoplasm, and histopathological type of the neoplasm were correlated with the incidence of postoperative facial nerve dysfunction

Results: The rate of postoperative facial nerve dysfunction was 35.7% in the first post-operative day, 19% and 4.8% at one month and six months, respectively. Cases treated with total parotidectomy with or without neck dissection showed poorer facial nerve function [p < 0.001], [p < 0.01], and [p < 0.04] at one day, one month, and 6months, respectively. Overall, neoplasms with size >/= 5 cm had a higher prevalence of facial nerve paresis [p < 0.03 at one day, and 0.04 at one month postoperative]. Patients with malignant parotid neoplasms had more tendency to develop facial nerve dysfunction [p < 0.02], [p < 0.001], and [p < 0.03] at one day, one month, and 6months, respectively

Conclusion: In our study, the following were associated with higher risk of facial nerve dysfunction: extensive surgery; large sized neoplasms; parotid cancer, when treated with · total parotidectomy or combined with neck dissection; chronic sialadenitis; and vascular malformation

Evaluation of the different technique for repair of distal hypospadias

Hypospadias is one of the most common congenital anomalies occurring in approximately 1:520 to 1:300 live births [Baskin, 2000]. Hypospadias in boys, may be defined classically as an association of the penis: 1. An abnormal ventral opening of the urethral meatus, 2. An abnormal ventral curvature of the penis [chordee]; 3. An abnormal distribution of the foreskin, with a hood present dorsally and deficient foreskin ventrally [Mouriquand et al, 1950]. The aim of this work was to adequately describe the abnormal anatomy met with distal hypospadias cases and to evaluate the results of repair of distal hypospadias comparing the results of the different techniques of repair to be aware about the most suitable technique. This study was done on 40 patients with distal hypospadias in the age range 6 months to 12 years in the period from October 2004 to October 2005 in Plastic Surgery Department, Sohag university Hospital. Full history, clinical examination and routine investigations was done for every patients. We used three operative procedures: a-Tubularized incised plate urethroplasty [Snodgrass] [TIP], be-Meatal based flap [Mathieu] repair, and c-Meatal advancement and glanuloplsty incorporated technique [MAGPI]. Pin hole meatus was the commonest finding to be present in association with hypospadias in this study [12.5%]. Edema is the most common complication in the early postoperative period; represent, 83% in Mathieu, 80% in TIP75% in MGAPL. As regard the chronic complication, fistula is the most important complication of hyospadius repair, it was recorded in 4 out of 20 cases with TIP repair, 3 out of 12 cases with Mathieu repair and one case out of 8 cases with MAGPI repair