Anatomical variations of the recurrent laryngeal nerve according to the inferior thyroid artery and their clinical impact in patients undergoing thyroidectomy.

BACKGROUND: Recurrent laryngeal nerve identification is the 'gold standard' in thyroidectomy, to determine nerve function security and prevent severe complications. This study assessed the topographical relationship between the recurrent laryngeal nerve and the inferior thyroid artery in patients undergoing total thyroidectomy, and determined its clinical impact. METHODS: A retrospective study was performed of patients undergoing total thyroidectomy in a single tertiary centre over a six-month period. RESULTS: Sixty-four patients were included. Among the 128 recurrent laryngeal nerve dissections, the nerve was identified traversing the inferior thyroid artery anteriorly in 27.3 per cent, with equal distribution between the two sides. No significant sex association was reported. One patient had transient vocal fold palsy, and hypocalcaemia was observed in 21.9 per cent, yet there was no statistical association with the topographical variation of the recurrent laryngeal nerve. CONCLUSION: Almost one-third of patients had an anatomical variation in which the recurrent laryngeal nerve ran superiorly to the inferior thyroid artery. Recurrent laryngeal nerve variation had no clinical impact on local complications or hypocalcaemia.

Microscopic versus endoscopic stapes surgery: systematic review and meta-analysis.

OBJECTIVE: To compare the efficacy and safety characteristics of endoscopic and microscopic stapes surgery based on current evidence. METHODS: A systematic literature search was conducted of three medical databases, focusing on randomised, controlled studies or observational studies. Data related to the efficacy and safety of each technique were extracted. Outcome data were summarised using the pooled mean differences or pooled odds ratios, along with their 95 per cent confidence intervals. RESULTS: Thirteen studies were included in the meta-analysis. Success rate was evaluated by estimating air-bone gap improvement; this revealed comparable outcomes for the two techniques (mean difference = -0.20; 95 per cent confidence interval = -0.53, 0.14). No statistically significant difference was detected concerning post-operative complications, except for dysgeusia (odds ratio = -1.12; 95 per cent confidence interval = -1.97, -0.28) and pain (odds ratio = -2.00; 95 per cent confidence interval = -2.97, -1.04), which favoured the endoscopic approach. CONCLUSION: Though both techniques result in commensurate outcomes concerning success rate, post-operative pain and dysgeusia favour the endoscopic approach. Further high-quality studies are needed to adequately compare the two methods.

Diagnostic accuracy of fine needle aspiration cytology in parotid gland lesions.

BACKGROUND: This study aimed to estimate the fine needle aspiration cytology's (FNAC) diagnostic accuracy in differentiating neoplastic from inflammatory lesions (Q1) and malignant from their benign counterparts (Q2). METHODS: We present a retrospective case series covering a single University Hospital and six attending head and neck surgeons over eight years (January 2011 to July 2017). We concentrated on adults with clinically suspected parotid gland lesions. We offered all patients FNAC biopsy preoperatively, and the final diagnosis was established based on the findings of the final histology. The FNAC and histology results were cross-tabulated in a 2 x 2 contingency table, from which we calculated the diagnostic accuracy, sensitivity, specificity, and positive and negative predictive values. RESULTS: From 212 consecutive patients reviewed, and after excluding thirteen cases (8 %) of valid but non-diagnostic FNAC, 161 cases (50 females and 111 males) fulfilled set eligibility criteria. The most common diagnosis was Warthin tumors (53 patients, 34 %), followed by pleomorphic adenomas (52 patients, 33.5 %). The sensitivity and specificity of FNAC in differentiating neoplastic from non-neoplastic lesions and in segregating malignant from benign conditions were estimated to be as high as 50 % and 97 %, and 98 % and 93 %, respectively. CONCLUSION: FNAC is moderately effective in differentiating non-neoplastic from neoplastic disease and highly accurate in selecting malignant lesions from benign ones. Although the lack of FNAC sensitivity can occasionally be problematic, it still comprises a valuable tool in salivary gland surgery. HIPPOKRATIA 2022, 26 (1):25-31.

In the era of endoscopic sinus surgery, is there still a place for the Caldwell-Luc procedure?.

In the era of endoscopic sinus surgery, is there still a place for the Caldwell-Luc procedure? In this report, we present evidence in favor of the Caldwell-Luc approach to the maxillary antrum in selected cases where endoscopic techniques are inadequate to allow full resolution of the problem. Although this procedure is not as popular as it was in the past, its role in the management of benign paranasal sinus diseases is still important. We focus in particular on use of the Caldwell-Luc procedure for conditions such as fungal mycetoma, foreign body removal, empyema, and benign nasal tumours in areas that are not fully accessible by endoscopy alone. Advantages of this technique are its safety and simplicity; no special instrumentation is necessary. It can be performed with surgical equipment widely available in operating rooms in Greece and elsewhere.

Clarithromycin induced reversible sensorineural hearing loss.

OBJECTIVE: We present a rare case of reversible sensorineural hearing loss caused by clarithromycin. METHODS: We present a case report of hearing loss following clarithromycin administration; we also review the current literature and case reports concerning macrolides and, in particular, clarithromycin induced hearing loss. RESULTS: A young pregnant woman presented with sensorineural hearing loss after clarithromycin intake. The subject's hearing returned to normal limits after drug discontinuation and short-term treatment with low dose steroids. CONCLUSION: Newer macrolides are considered to be safer regarding ototoxic effects, and a few cases have been previously described. The present case adds to the body of knowledge concerning clarithromycin ototoxicity. Clinicians should be aware of this rare complication and a thorough otologic history should be established prior to macrolide administration. A baseline audiogram and close observation for patients at higher risk is suggested to identify patients with prior hearing loss and serve as baseline for future reference.

Hypomethylation along with increased H19 expression in placentas from pregnancies complicated with fetal growth restriction.

The expression of imprinted genes is regulated by epigenetic modifications, such as DNA methylation. Many imprinted genes are expressed in the placenta and affect nutrient transfer capacity of the placental exchange barrier. The H19 gene is abundantly expressed by the human placenta and is implicated in the pathogenesis of congenital growth disorders such as Beckwith-Wiedemann (BWS) and Silver-Russell (SRS) syndromes. The aim of this study was to investigate the role of DNA methylation on H19 transcription and imprinting, in the pathophysiology of fetal growth restriction (FGR). Thirty one and 17 placentas from FGR-complicated and normal pregnancies were collected, respectively. We studied gene transcription, genotyping and methylation analysis of the AluI H19 on exon 5 polymorphism. Placental expression levels of H19 were significantly increased in the FGR group. The H19 mRNA levels were similar between normal placental samples that demonstrated loss and maintenance of imprinting. Placentas from growth-restricted pregnancies had lower methylation levels compared to normals, in the H19 promoter region. We have demonstrated an increased H19 transcription in the FGR group of placentas. The hypomethylation of the H19 promoters is compatible with the aberrant expression. The association of these two findings is reported for the first time in placental tissues, however, its significance remains unknown. Whether the results of this study represent an adaptation of the placenta to hypoperfusion, or they are part of FGR pathophysiology has to be further investigated.

Maxillary sinusitis of dental origin due to oroantral fistula, treated by endoscopic sinus surgery and primary fistula closure.

AIM: To present the current treatment approach for oroantral fistula causing maxillary sinusitis. DESIGN: Case series. Four cases of oroantral fistula (diameters: 6, 9, 11 and 13 mm) due to chronic maxillary sinusitis were treated by excision of all diseased oroantral fistula tissue, followed by endoscopic creation of a large middle antrostomy and closure of the fistula using buccal flaps. A synthetic surgical glue and local alveolar bone were used. RESULTS: Patients were followed up for six months to three years; all were considered cured. CONCLUSION: Most surgeons use buccal or palatal flaps, combined with the Caldwell-Luc procedure, to treat chronic odontogenic sinusitis and to repair fistulae more than 5 mm in diameter. This study supports the hypothesis that an endoscopic technique could be successfully used in patients with oroantral fistula causing chronic maxillary sinusitis of dental origin, instead of the Caldwell-Luc procedure, at least in patients with a small to medium-sized oroantral fistula.

Lidocaine spray versus tetracaine solution for monopolar submucosal diathermy for inferior turbinate hypertrophy.

OBJECTIVE: To compare the efficacy of lidocaine spray 10% to tetracaine 2% solution, as a local anaesthetic for patients undergoing monopolar submucosal diathermy of the inferior turbinate. METHODS: A prospective study was conducted on 48 patients undergoing submucosal diathermy of the inferior turbinate. Patients were randomly assigned to receive tetracaine 2% solution (24 patients) or to receive lidocaine spray 10% (24 patients). Patients were asked to evaluate the severity of pain during the procedure using a visual analogue scale. Patient data, pain scores, and potential complications were assessed statistically. RESULTS: The tetracaine group had significantly lower mean pain scores compared to the lidocaine group: 2.29 vs. 3.04 (p < 0.001). There were no complications or side effects from tetracaine. CONCLUSION: Tetracaine 2% solution applied locally is an easy, safe, inexpensive, and effective analgesia for submucosal diathermy for inferior turbinate hypertrophy.

Increased frequency of rhinitis medicamentosa due to media advertising for nasal topical decongestants.

AIM: The aim of this study was to investigate the frequency of rhinitis medicamentosa (RM) in patients attending the ENT outpatient clinic of the General Hospital of Rethymnon (Crete, Greece) before and after the launch of an intensive nasal decongestant advertising campaign in Greece. METHODS: We reviewed the medical records of the patients with RM seen at the ENT outpatient clinic in May, June and July of 2003 and 2006. We analyzed and recorded the gender, age, and related clinical information of the patients with RM. RESULTS: In May, June and July of 2003, 41 patients out of a total of 1780 patients attending the ENT outpatient clinic were diagnosed with RM (2.3%). In the same months in 2006, 161 patients out a total of 1898 patients were diagnosed with RM (8.5%). The frequency of RM in these groups was therefore found to have increased significantly between 2003 and 2006. In 2006, 8 out of 10 patients with RM reported that they had made their purchasing decision solely on the basis of the information supplied by the drug advertisement without consulting their doctor or pharmacist. CONCLUSION: We suggest that the intensive media advertising campaign for nasal topical decongestants (particularly on TV) which started in 2004 is probably the main reason for this "endemic" RM.

Intraparotid lymph node tuberculosis.

PROBLEM: Parotid gland Mycobacterial infection is a rare disease that causes parotid swelling without disease-specific manifestations. CASE REPORT: We present a case of intraparotid lymph node tuberculosis that mimicked a tumour. Computed tomography of the head and neck indicated a left parotid enlargement involving two intraparotid lymph nodes. The cervical lymph nodes of the ipsilateral posterior triangle and the submandibular and jugulodigastric areas were also enlarged. Contrast enhancement indicated homogenous tissue with no necrotic areas. A biopsy revealed a caseating granuloma most likely due to tuberculosis. A purified protein derivative test gave strong positive results (35 mm). After one month of antituberculous treatment, the cervical lymphadenopathy and left parotid lumpiness disappeared. CONCLUSIONS: Tuberculous parotitis and neoplasms have similar clinical manifestations. In patients with a mass in the parotid gland, a high clinical suspicion of underlying tuberculosis is crucial for establishing an accurate diagnosis and the proper management.

Cavernous haemangioma of the left nasal cavity.

Cavernous haemangioma of the nose is a rare lesion but it has to be added to the differential diagnosis of an intra-nasal bleeding mass. A high index of suspicion, upon computed tomography delineation of the extent of the mass, including the presence of bone remodelling plus histological evaluation can be usefully employed to define an accurate diagnosis. In the present case of an adult female with a huge cavernous haemangioma arising from the mucosa of the left middle nasal meatus, the two most interesting points were the rarity as a site of occurrence of this tumour and the successful extirpation of this lesion with the minimally invasive trans-nasal endoscopic technique. We recommend the minimal invasive trans-nasal endoscopic technique for adequate exposure, sufficient control of bleeding and for complete removal of a nasal haemangioma reaching the nasopharynx and paranasal sinuses.

Otitis media with effusion: what parents want to know.

INTRODUCTION: Otitis media with effusion is a common condition of childhood. The development of an information leaflet for parents of children with the condition, and its impact on clinical management, have not previously been examined. PATIENTS AND METHODS: Eighteen doctors and 38 parents assessed the content of an information leaflet on otitis media with effusion, by applying two rounds of the modified Delphi technique. A qualitative assessment of content items was also performed. RESULTS: From the 23-item list used in the first assessment round, four items had a low doctor-parent agreement and seven were excluded. Differences were also noticed in comments on the value of such leaflets, with parents being more positive about the value of leaflet distribution. CONCLUSION: During the consultation, doctors may not tell parents what they want to know, especially regarding daily care of their child. An information leaflet, developed using the Delphi technique, can help reduce this discrepancy and increase parents' satisfaction.

Mumps epidemic among young British citizens on the island of Crete.

BACKGROUND: Mumps is an infectious disease, occurring rarely in many countries including Greece, where approximately 50 cases are reported each year. In Crete, Greece's biggest island, an average number of four cases are reported annually. PATIENTS AND METHODS: The study population consists of all patients hospitalised because of mumps in our clinic. Clinical, laboratory and serological confirmation of the disease has been performed. RESULTS: During the tourist summer periods of 2004 and 2005, 39 patients with mumps have been hospitalized in our clinic in Crete. All patients but one were young tourists from Britain. The patients presented with parotid gland swelling and fever and some developed complications of the disease as well. CONCLUSION: The above findings are consistent with the mumps epidemic, now occurring in the UK. The disease is spreading among the Greek population as well, since six cases have been reported. This study investigates the reasons for this epidemic, focusing on the role of MMR vaccination.

Cocaine versus tetracaine in septoplasty: a prospective, randomized, controlled trial.

BACKGROUND: Successful local anaesthesia is of critical importance for the success of septoplasty, and many surgeons prefer to use cocaine for this purpose. The aim of this study was to evaluate the efficacy of cocaine 4 per cent solution, compared with tetracaine 2 per cent plus adrenaline, as a local anaesthetic for patients undergoing septoplasty. METHODS: From December 2002 to February 2005, a prospective, randomized, controlled trial was conducted. One hundred and eight patients underwent septoplasty under local anaesthesia. Patients were randomly classified into group A and group B, in which was used respectively cocaine 4 per cent solution and tetracaine 2 per cent solution plus adrenaline. A visual analogue scale was used to evaluate the severity of patients' pain during their procedure. RESULTS: Group B (tetracaine; mean rank=43.77) reported significantly less pain (p<0.001) compared with group A (cocaine; mean rank=65.23). CONCLUSIONS: On the basis of these findings, we recommend tetracaine as the first choice anaesthetic for nasal septoplasty; the use of cocaine should be limited.

The combined endoscopic CO(2) laser posterior cordectomy and total arytenoidectomy for treatment of bilateral vocal cord paralysis.

Upper airway obstruction, because of bilateral vocal cord paralysis, presents a serious challenge to the Otolaryngologist. Various surgical techniques have been advocated for the management of patients with vocal cord paralysis. Among these techniques, the individual use of laser CO(2) arytenoidectomy and posterior cordotomy has gained wide acceptance. In this report, we describe our experience in the management of bilateral vocal cord paralysis by combining posterior partial cordotomy as described by Dennis and Kashima, with total arytenoidectomy as described by Ossoff et al. We report the long-term results in the management of 18 patients treated in our department during the last 8 years.