Mucoepidermoid carcinoma presenting as a large cyst of the parotid gland in HIV disease.

Cystic lesions of the parotid gland may be the presenting symptom in human immunodeficiency virus (HIV)-positive patients. The most common lesion is the benign lymphoepithelial cyst. Malignant lesions may also be associated with-or be hidden by-a cystic mass. We report a case of mucoepidermoid carcinoma in a 40-year-old HIV-positive woman who presented with a large cystic mass of the parotid that had been previously misdiagnosed as benign on several fine-needle aspiration biopsies. On our histologic examination, the true pathologic nature of the lesion was revealed. We suggest that an image-guided fine-needle aspiration biopsy of the thickened wall of cystic masses of the parotid may be more diagnostic than a random sampling of the contents.

Atypical carcinoid (moderately differentiated neuroendocrine carcinoma) of the uvula.

Carcinoid (neuroendocrine) tumors of the head and neck rarely occur outside the larynx and, until now, none has been reported in the oral cavity. We describe what we believe is the first reported case of an atypical carcinoid tumor, or any other type of neuroendocrine carcinoma, of the uvula.

Our experience with 171 open tracheostomies.

PURPOSE: Tracheotomy is one of the oldest surgical procedures known. There are multiple indications for tracheostomies. Operative complications have ranged between 5-40%. This manuscript describes our experience with 171 open tracheostomies at a major academic medical center. METHODS: A retrospective review of all patients' records who underwent an open tracheostomy by the Division of OMS between July 1, 2007 to December 31, 2010 was performed. Specific information including indication for procedure, age of patient, type and size of tracheostomy tube, and any post-operative complications were compiled. Based on the data gathered, statistical analysis was performed to establish incidence of complications and its correlation to the specific indication for the tracheostomy. Trends and outcome assessments were then determined. RESULTS: Median age for tracheostomy in the group was 36 (17-89). Majority of tracheostomies were performed in conjunction with head and neck oncologic procedures (51%). Complication rate was 4.1% (7 patients out of 171). CONCLUSION: Open tracheostomy is an extremely useful surgical procedure. If performed appropriately, it is associated with a low complication rate.

Chemical closure of chronic tympanic membrane perforations.

BACKGROUND: The purposes of closing chronic dry perforations of the tympanic membrane are to improve hearing and prevent middle ear infections. Before the use of the operating microscope and improved instrumentation, tympanic membrane perforations were closed by application of chemicals or with a temporary patch. Today, although surgery is the treatment of choice, small dry perforations may be successfully closed by chemical means in an office setting. METHODS: Twenty-eight of the 69 patients with chronic dry tympanic membrane perforations on the surgical waiting list at Hawke's Bay Regional Hospital, Hastings, New Zealand, underwent attempts at chemical myringoplasty. Two techniques were used: (i) cautery of the rim of the perforation with a silver nitrate bead on a metal probe and (ii) application of a urea ointment patch covering and overlapping the perforation. RESULTS: Eighteen of the 28 patients (64%) treated by chemical means experienced closure of their tympanic membrane perforations. Successful closure was achieved in 26% of the patients on the waiting list during the 6-month period. CONCLUSION: Chemical myringoplasty is not only of historical interest. It is an effective means of tympanic membrane closure in selected patients, thereby reducing the surgical waiting list and saving time and money for the patient, surgeon and hospital.