Penetrating Traumas to the Parotid Region.

Penetrating trauma to the parotid gland is a rare condition. Mostly, gunshot wounds to the parotid area are seen. Facial paralysis and sialocele formation are particular concerns and may cause significant morbidities. Early diagnosis and early exploration are crucial in the setting of facial paralysis following penetrating trauma. Sialocele formation and fistulas can be managed conservatively or surgically.

Concurrent medullary and papillary carcinoma of thyroid.

Simultaneous occurrence of papillary thyroid carcinoma (PTC) and medullary thyroid carcinoma (MTC) in the same thyroid gland is a rare condition. These tumors derive from different cells; PTC originates from follicular cells whereas MTC originates from parafollicular cells. Because of this, the treatment of these tumors also differs. This article describes two rare cases of the simultaneous occurrence of MTC and PTC in the thyroid gland.

Sensorineural hearing loss in pediatric patients with celiac disease.

Sensorineural hearing loss (SNHL) as an extraintestinal manifestation of celiac disease (CD) has been reported in several studies. The aim of this study was to determine presence of subclinical sensorineural hearing loss associated with CD in pediatric patients. Otoscopy, tympanometry and pure tone audiometry were performed in 44 patients with CD and 20 healthy age and sex-matched controls. Pure tone audiometry did not show significant sensorineural hearing loss over all frequencies in patients with CD compared with controls (P > 0.05). SNHL was detected in only three (6.8 %) patients with CD. In conclusion, subclinical sensorineural hearing loss was demonstrated in adult patients with CD; therefore, we recommend to perform audiometric examinations in pediatric patients for recognizing hearing loss early during the course of the disease.

Sensorineural hearing loss in pediatric patients with inflammatory bowel disease.

OBJECTIVES: Sensorineural hearing loss as an extraintestinal manifestation of inflammatory bowel disease has been reported in several studies, including adult patients. The aim of this study is to determine the presence of subclinical sensorineural hearing loss associated with inflammatory bowel disease in pediatric patients. METHODS: Otoscopy, tympanometry, and pure tone audiometry were performed in 24 patients with disease and 20 healthy age- and sex-matched controls. RESULTS: Pure tone audiometry did not show significant sensorineural hearing loss over all frequencies in patients with inflammatory bowel disease compared with controls (P > 0.05). CONCLUSIONS: Subclinical sensorineural hearing loss was demonstrated in adult patients with inflammatory bowel disease; therefore we recommend performing audiometric examinations in pediatric patients to recognize hearing loss early during the course of the disease.

Laryngeal mucoepidermoid carcinoma: report of two cases.

Mucoepidermoid carcinoma (MEC) of the larynx is a rare neoplasm, with a review of the literature having disclosed only 83 documented cases. These tumours are believed to develop from ductal elements of the submucosal glands [Gomes V, Costarelli L, Cimino G, Magaldi L, Bisceglia M. Mucoepidermoid carcinoma of the larynx. Eur Arch Otorhinolaryngol 1990;248:31-4]. The most common sites are the floor of the laryngeal ventricle, false vocal folds and anterior comissure [Alavi S, Namazie A, Calcaterra TC, Blackwell KE. Glandular carcinoma of the larynx: the UCLA experience. Ann Otol Rhinol Laryngol 1998;108:485-9]. We describe two cases of MEC of the larynx. One of them was a transglottic and the other one a supraglottic tumour. First patient was treated with total laryngectomy (TL) and right extended radical neck dissection (RND). Second case was treated with supracricoid laryngectomy (SCL) and bilateral posterolateral neck dissection (PLND). Both patients received radiotherapy (RT) and their 1-year follow-up showed no evidence of recurrence or metastasis. The diagnostic and therapeutic aspects of these cases are discussed.

Heterotopic gastric mucosa in the cervical esophagus: could this play a role in the pathogenesis of laryngopharyngeal reflux in a subgroup of patients with posterior laryngitis?

OBJECTIVE: Acid secretion produced by a heterotopic gastric mucosal patch (HGMP) in the proximal esophagus, instead of gastric acid, may be responsible for laryngopharyngeal reflux (LPR), passing the upper esophageal sphincter. The aim of this study was to investigate the prevalence of HGMP in the proximal esophagus in patients with posterior laryngitis indicating the presence of LPR in comparison with a control group and to elucidate the possible role of this lesion in the pathogenesis of LPR. MATERIAL AND METHODS: A total of 36 consecutive patients with posterior laryngitis diagnosed on laryngoscopic examination were enrolled in the study. Esophagoscopy and ambulatory 24-h intra-esophageal dual-probe pH monitoring were performed in all patients. During endoscopy, special attention was paid to the proximal part of the esophagus, and the proximal electrode for pH monitoring was placed in this region under endoscopic view. The control group comprised 660 consecutive patients who had undergone upper gastrointestinal endoscopy for the usual indications. When HGMP was found, biopsies were taken for histological confirmation. RESULTS: HGMP was detected in 5 out of 36 patients. One out of five patients with patches was excluded from the study because the histopathology of this patient's patch revealed antral-type mucosa, which is not capable of acid secretion. Thus a total of 35 patients were included in the study, yielding a HGMP prevalence of 11.4% (4/35). Compared with the prevalence of the control group (1.6%), a significant difference was observed (p<0.005). pH monitoring showed that 45.4% of the patients had abnormal proximal acid reflux. All of four HGMP (+) patients with posterior laryngitis revealed significantly higher abnormal proximal reflux compared to the patients without patches (p<0.05). CONCLUSIONS: This first preliminary study may suggest that HGMP in the cervical esophagus could play a role in the pathogenesis of LPR, at least in a minor group of patients with posterior laryngitis, depending on its capability to produce acid in situ, although isolated proximal reflux could not be demonstrated. This finding may need to be supported by further studies with larger patient populations and using acid stimulation tests.

Sensorineural hearing loss in patients with inflammatory bowel disease: a subclinical extraintestinal manifestation.

Isolated case reports in which symptomatic hearing loss develops suddenly during the course of inflammatory bowel disease (IBD) have been reported, but the presence of subclinical sensorineural hearing loss (SNHL) associated with IBD has been investigated in only two preliminary studies. In order to research this further, we aimed to investigate the presence of subclinical SNHL in IBD by comparison with a control group and to examine possible relations between the bowel disease parameters and hearing loss.Otoscopy, tympanometry, and pure tone audiometry were carried out in 39 patients with IBD (21 Crohn's disease [CD], 18 ulcerative colitis [UC]) and 25 healthy age- and sex-matched controls. All patients and control subjects had normal otoscopy findings and tympanometry was unremarkable, excluding middle ear disease and conductive hearing loss. Analysis of each frequency examined showed that the average hearing thresholds were increased significantly in the study group compared to those of the control group at higher frequencies (2, 4, and 8 kHz). When these parameters were compared with the control group according to subgroups of IBD, a significant difference was determined for the UC group at frequencies of 2, 4, and 8 kHz and for the CD group only at the frequency of 4 kHz. Although there was a trend of increment in SNHL as the age of the patient and duration and extent of UC increased, no significant correlation was observed between SNHL and these parameters or sex, activity, involvement site, medication history of IBD, and coexistence of other extraintestinal manifestations. In conclusion, it was demonstrated that a subclinical SNHL may be associated with UC and somewhat with CD, affecting mainly the high frequencies. In light of this finding, it may be advisable to investigate labyrinth functions as well as other extraintestinal manifestations in patients with IBD.

Microscopic thyroidectomy: a prospective controlled trial.

The purpose of this prospective study was to evaluate microsurgical thyroidectomy by comparing it with traditional thyroidectomy. Before surgery, patients were assigned either to the microscopic thyroidectomy group (MT group), with the use of the surgical microscope, or the traditional thyroidectomy group (TT group), without the use of visual magnification. Outcome measures were operative time, intraoperative bleeding and complication rates including injury to the recurrent laryngeal nerve (RLN), the external branch of the superior laryngeal nerve (EBSLN) or the parathyroid glands. Ninety-eight patients underwent thyroid surgery (58 patients in the MT group, 40 patients in the TT group). The two groups were similar in age, sex, surgical procedures and histological findings. There was no difference between the two techniques regarding the operative time and the amount of blood loss. Neither permanent nerve palsy nor persistent hypocalcemia occurred in either group. Transient nerve palsies (RLN and EBSLN) were lower in the MT group (1.7%) compared to the TT group (7.5%), but the difference did not reach statistical significance (P>0.05). Overall transient hypocalcemia was significantly lower in the MT group (1.7%) compared with the TT group (12.5%, P=0.032). If the population was restricted to total thyroidectomy, the rate of transient hypocalcemia was 4.1% in the MT group and 33.3% in the TT group, respectively (P=0.022). In conclusion, microsurgical thyroidectomy is a feasible and efficacious surgical procedure. It significantly reduces the complications without increasing the operating time in thyroid surgery procedures. A major advantage of this technique is the possibility of attaching a camera to the microscope, thereby greatly facilitating teaching.

A randomized controlled trial of early oral feeding in laryngectomized patients.

OBJECTIVE: To evaluate the safety and efficacy of early oral feeding by comparing it with feeding through primary tracheoesophageal puncture after total laryngectomy with primary pharyngeal closure. STUDY DESIGN: A prospective, randomized, controlled study. METHODS: Patients who underwent total laryngectomy with primary pharyngeal closure and who were candidates for primary voice restoration (an in whose cases primary tracheoesophageal puncture [TEP] was created) were included. After total laryngectomy, patients were randomly assigned to either the oral group (study group) or the TEP group (control group). Patients in the oral group were fed orally with a clear liquid diet on the first postoperative day, then advanced to a regular diet, whereas patients in the TEP group were fed through tracheoesophageal puncture and received nothing orally until the seventh postoperative day; then they were fed orally if fistula had not occurred. Standard criteria for discharge were used for all the patients. RESULTS: During a 3-year period, 67 patients were enrolled in the trial, and complete data were available for 65 patients (32 patients in the oral group, 33 patients in the TEP group). The two groups were similar for factors reported to influence the rate of pharyngocutaneous fistula. In three (9%) patients in the TEP group, fistula occurred on the 5th, 7th, and 14th postoperative days, respectively. Two (6.2%) fistulas occurred in the oral group on the sixth and eighth postoperative days, respectively. In patients without fistula, the mean length of hospital stay was 7.6 days (range, 4-19 d [SD = 3.1 d]) for the oral group and 8.2 days (range, 7-18 d [SD = 2.6 d) for the TEP group. There was no significant difference between two groups for either the incidence of fistula or the length of hospital stay. CONCLUSIONS: Initiation of oral feeding on the first postoperative day in patients undergoing total laryngectomy with primary pharyngeal closure is a safe clinical practice. However, it does not shorten the length of hospital stay for these patients.

Pulmonary thromboembolism following total laryngectomy and neck dissection: a case report.

A fifty-five-year-old male patient underwent total laryngectomy, bilateral modified radical neck dissection, and primary voice restoration for squamous cell carcinoma of the supraglottic larynx. During surgery the left internal jugular vein was found to be thrombosed and, therefore, ligated and resected. In the early postoperative period, pulmonary thromboembolism was suspected and confirmed by lung perfusion scintigraphy which showed bilateral segmental and subsegmental perfusion defects. The patient was successfully treated by anticoagulant therapy. It may be advisable to consider thromboprophylaxis in head and neck surgery in patients with clinically suspected pulmonary thromboembolism, if no contraindication exists.

Synovial sarcoma arising from the hypopharynx: a case report.

Synovial sarcoma is a relatively rare soft tissue tumor. About 3 to 10% of cases arise in the head and neck, with the majority in the parapharyngeal region. We hereby report a 22-year-old male patient with synovial sarcoma confined to the hypopharynx. Treatment included wide surgical excision followed by radiotherapy. It is of interest that the lesion recurred 12 years after the initial primary surgery for synovial sarcoma at the same site. The patient has been disease-free for five years.