Prevalence of nasopharyngeal carcinoma among patients with nasopharyngeal mass in a Philippine tertiary training hospital

@#<p style="text-align: justify;"><strong>OBJECTIVES:</strong> To determine the prevalence and identify the types of Nasopharyngeal Carcinoma (NPCA) among patients with nasopharyngeal mass seen at a tertiary university training hospital in  the  Philippines  from  January  2006  -  July  2012  and  identify  possible  factors associated  with nasopharyngeal carcinoma.<br /><strong>METHODS:</strong> A  retrospective  cross-sectional  study  was  performed  at  a  tertiary  university  training hospital among cases (n=179) seen with nasopharyngeal mass at the ENT outpatient department. Histopathology results and patient medical charts were collected and reviewed after IRB approval. The  age  at  diagnosis,  sex,  place  of  residence,  occupation  and  chief  complaint  was  compared among patients with positive histopathology of NPCA only. <br /><strong> Design:</strong> Retrospective, cross sectional study<br /><strong> Setting:</strong> Tertiary Private University Training Hospital<br /> <strong>Participants:</strong> One hundred seventy nine (179) patients with nasopharyngeal mass<br /><strong>RESULTS:</strong> Ninety six (54%) cases with nasopharyngeal mass seen at the ENT outpatient department were positive for nasopharyngeal malignancy. The remaining 83 (46%) cases with nasopharyngeal mass had a benign histopathology. NPCA was more common among males (58%) than females (42%).  The  most  common  form  of  NPCA  was  non-keratinizing  undifferentiated  NPCA  (47%) followed by poorly differentiated squamous cell carcinoma in 18 (19%). The most common chief complaint was a neck mass, followed by decreased hearing.<br /><strong>CONCLUSION:</strong> There  was  a  higher  proportion  of  nasopharyngeal  malignancy  among  male patients  with  nasopharyngeal  mass,  and  the  most  common  chief  complaint  was  a  neck  mass. Future  research  should  integrate  data  with  other  hospital  institutions  to  obtain  more  accurate demographic  data  of  the  local  prevalence  of  NPCA.  A  detailed  record  of  the  ethnicity,  diet, occupation, smoking history and family history of cases should be obtained to correlate possible risk factors of NPCA among patients with nasopharyngeal mass in our setting.</p>

Head and neck dog bites in children.

OBJECTIVES: 1) Demonstrate patterns of dog bite injury to the head and neck in children. 2) Identify treatment outcomes of dog bite injuries to the head and neck. STUDY DESIGN: Case series with chart review. SUBJECTS AND METHODS: Children aged 0 to 19 years, treated for head and neck dog bites at our tertiary care children's hospital (1999-2007), were included. Demographics, dog breed and ownership, seasonal incidence, wound location, characteristics, management, and complications were recorded. RESULTS: Eighty-four children, aged 10 months to 19 years (mean, 6.19 years) underwent primary repair of head and neck dog bite injuries. The cheek (34%) and lips (21%) were involved most commonly. Average wound length was 7.15 cm. Dog bite incidence peaked during summer months. Infection occurred in 10.7 percent. Pulsed dye laser was used to improve cosmesis. CONCLUSIONS: Children are vulnerable to head and neck dog bite injuries. Wound healing is excellent despite a contaminated wound. Infections occur infrequently. Pulsed dye laser improves cosmesis.

Revision adenoidectomy--a retrospective study.

BACKGROUND: Adenoid "re-growth" is a poorly understood phenomenon. While parents often express concerns regarding the potential for adenoid "re-growth", little information exists in the literature about its incidence and causation. PURPOSE: To establish the incidence and possible contributing factors leading to adenoid re-growth in children. DESIGN: Retrospective case series review. SETTING: Tertiary care children's hospital. METHODS: The charts of 106 patients who underwent revision adenoidectomy between 1995 and 2006 were reviewed. Thirty-four patients were excluded because the primary adenoidectomy was performed elsewhere or initially only a partial adenoidectomy was performed. In the remaining 72 patients, demographic data, clinical presentation, associated medical conditions and findings at surgery were studied. RESULTS: During the 11-year study period. 13,005 adenoidectomies or adenotonsillectomies were performed; 72/13,005 (0.55%) underwent revision adenoidectomy. The mean (+/-S.D.) age at presentation for primary adenoidectomy was 3.68+/-2.9 and 7.69+/-4.04 years for secondary ("revision") adenoidectomy with an average time interval of 4.3 years between surgeries. Age at initial adenoidectomy was not a significant factor in predicting revision adenoid surgery. 29/72 (40%) underwent a reflux work up including scintiscan with gastric emptying, 24h pH probe, or laryngoscopy. 28/29 (96%) were diagnosed with reflux. At least 15/72 (21%) were reported to have symptoms consistent with adenoid re-growth which were found to be caused by tubal tonsil hyperplasia. CONCLUSIONS: Revision adenoidectomy rarely needs to be performed. Tubal tonsillar hyperplasia, as opposed to re-growth of residual adenoid tissue previously removed, accounts for some cases. Extraesophageal reflux is a possible cause in some and requires further study.

Isolated microtia as a marker for unsuspected hemifacial microsomia.

OBJECTIVE: To determine the proportion of hemifacial microsomia (HFM) in patients with unilateral or bilateral "isolated" microtia. DESIGN: Prospective cohort clinical study. SETTING: University-affiliated, tertiary referral clinic for patients with microtia. PATIENTS: One hundred consecutive patients with isolated microtia. INTERVENTIONS: All the patients underwent a clinical examination and audiologic evaluation. The OMENS classification system was used to grade the severity of craniofacial features: orbital deformity, mandibular hypoplasia, ear deformity, nerve (cranial nerve VII) involvement, and soft-tissue deficiency. Each anatomical abnormality was graded from 0 (normal) to 3 (most severe) (score range, 0-15). MAIN OUTCOME MEASURES: The OMENS scores, percentage of patients with isolated microtia and undiagnosed HFM, and isolated microtia as an early clinical marker for HFM. RESULTS: Forty patients (40%) with microtia were determined to have HFM (31 unilateral and 9 bilateral). Mean patient age was 9.2 years (range, 6 weeks to 41 years), with male predominance (27 males and 13 females). The OMENS scores were less than 5 in 24 patients and 6 to 10 in 16 patients. Thirty patients had cranial nerve deficits, and 37 had mandibular asymmetry. Thirty-seven patients demonstrated conductive hearing loss, and 1 had sensorineural hearing loss. CONCLUSIONS: Isolated microtia served as an early clinical marker for asymmetrical facial growth in 40% of the patients. Isolated microtia and HFM could represent a spectrum of expression of the same developmental phenomenon.

Tissue engineered cartilage "bioshell" protective layer for subcutaneous implants.

OBJECTIVE: One current technique to reconstruct an ear for microtia involves the use of a high density polyethylene auricular implant; however, the implant can extrude if not covered in a temporoparietal fascia flap. Theoretically, an autologous tissue engineered cartilage "bioshell" protective coating around a permanent biocompatible implant might reduce potential extrusion to avoid the flap requirement. We hypothesized that if subjected to intentional exposure, a bioshell coating over an implant would provide enhanced wound healing. METHODS: Six sheets of high density polyethylene and six sheets of 24 carat pure gold wire-mesh measuring 19 mm x 25 mm were implanted subcutaneously in an immunocompetent swine model. Half of each implant group were coated with chondrocytes (50-70 million cells/cm(3)) which were suspended in Pluronic F-127 30% hydrogel; the remaining implants without chondrocytes were used as controls. At 10 weeks post-implantation, partial implant exposure via excision of overlying skin was performed to simulate extrusion and the sites were allowed to heal secondarily. RESULTS: All (6/6) of bioshell implants achieved wound closure after exposure by the seventh post-operative day; controls achieved closure at approximately 10 days. Bioshell neocartilage was evaluated and confirmed histologically using hematoxylin and eosin and safranin O stains. Histochemically, neocartilage approximated native cartilage with 60% glycosaminoglycans content. CONCLUSION: A 'proof-of-principle' tissue engineered bioshell around subcutaneous high density polyethylene and gold implants generated an elastic neocartilage coating, elicited a low inflammatory reaction, and was associated with 30% faster wound healing.

Butterfly cartilage graft inlay tympanoplasty for large perforations.

OBJECTIVE: Butterfly graft inlay tympanoplasty is a well-established technique for the repair of small perforations. However, the efficacy of the technique for medium and large tympanic membrane perforations remains unknown. STUDY DESIGN: Retrospective case series. METHODS: Postauricular tympanoplasty and tympanomastoidectomy using a large butterfly cartilage inlay graft (>4 mm diameter to total drum replacement) were analyzed in 90 pediatric patients (99 ears). RESULTS: Patient ages ranged from 2 to 20 years; mean follow-up duration was 27.6 months. Successful closure occurred in 92% of the ears. No graft lateralized nor displaced into the middle ear. No retraction pocket occurred during the follow-up period. In 62 cases, intact canal wall or canal wall window tympanomastoidectomy was performed; Fifty-one (82.2%) of the patients having mastoidectomy procedures had chronic otitis media with cholesteatoma. The mean preoperative to postoperative four-tone air-bone gap improved from 23 to 21 dB; the number of patients with 0 to 10 dB hearing results increased from 16 ears preoperatively to 32 ears postoperatively. Postoperative suboptimal results included eight patients with postoperative perforations in the residual tympanic membrane adjacent to an intact cartilage graft; two of these patients were the only individuals who exhibited otorrhea. CONCLUSIONS: Cartilage butterfly graft inlay tympanoplasty is effective in the vast majority of patients with moderate to large perforations. The closure rate exceeded 90% with no graft displacement, postoperative adverse events were respectably low, and hearing results improved or remained stable despite the need for concurrent mastoidectomy in the majority of patients.