Ventilation and clearance of the middle ear.

OBJECTIVE: To investigate the ventilation and drainage mechanism of the middle ear. STUDY DESIGN: Prospective. SETTING: We observed 304 (of 337) middle ears with tympanic membrane perforation or myringotomy (102 normal, 90 with otitis media with effusion and 112 with chronic otitis media); 912 observations were recorded overall. Perforations were covered with solution, creating a fluid film, and inspected for gas bubbling at rest, and for outward and inward movement of the fluid film during swallowing. We also noted the inflammatory condition of the ear (i.e. dry, wet or purulent) and the perforation size. RESULTS: Ears sometimes reacted differently in various sessions. Due to these differences, reactions were classified as 'types' of reactions rather than 'ears'. We refer to 449 'types' of 304 ears. Spontaneous gas bubbling at rest (indicating gas production) was observed in 98 per cent of normal types, 68 per cent of otitis media with effusion types and 65 per cent of chronic otitis media types. Evacuation towards the eustachian tube was observed in 47 per cent, no movement in 46 per cent and outward movement in 9 per cent. During swallowing, inward movement of the fluid film was observed in 74 per cent of normal types, 41 per cent of otitis media with effusion types and 32 per cent of chronic otitis media types. CONCLUSIONS: We found no support for the theory that the eustachian tube supplies air to the middle ear during swallowing. The normal middle ear produces gas which is evacuated by the Eustachian tube. In ears with otitis media, this mechanism appears to be impaired.

Merkel cell carcinoma of unknown primary site.

Merkel cell carcinoma is an uncommon and aggressive primary neuroendocrine skin malignancy which mostly affects the extremities and the head and neck region of elderly patients. Merkel cell carcinoma occurs with increased frequency in sun-exposed areas, in individuals exposed to arsenic and in immunosuppressed patients. Many patients with Merkel cell carcinoma present with other malignancies, mainly skin cancers. Characteristic features are frequent recurrences and regional and distant metastases. Mortality rates range from 20 to 65 per cent. The mainstay of treatment is surgery, with wide local excision, and adjuvant radiotherapy is usually administered. Merkel cell carcinoma of unknown primary site is rare, and the majority of the few cases described have not been from head and neck areas. We present a case of Merkel cell carcinoma of unknown primary site, with upper neck and distant metastases.

Sialadenitis following radioiodine therapy - a new diagnostic and treatment modality.

OBJECTIVES: To explore the usage of salivary gland endoscope technique as a diagnostic tool as well as a novel treatment modality for sialadenitis following radioiodine therapy. SUBJECTS AND METHODS: Fifteen patients suffering from sialadenitis of the major salivary glands after I131 therapy for thyroid carcinoma underwent a single procedure of sialoendoscopy under local anesthesia. RESULTS: All the patients were free of sialadenitis after one sialoendoscopy procedure with no complications accompanied. CONCLUSIONS: Sialoendoscopy is an efficient technique with low morbidity as well as a relatively simple surgical method for diagnosing and treating sialadenitis induced by radioiodine therapy for thyroid cancer patients.

[Nerve injury following implant placement: prevention, diagnosis and treatment modalities].

Nerve injury is a well-known complication following oral and maxillofacial surgery. Direct trauma, inflammation and infection are postoperative neural disturbances main causes. The most inflicted nerves associated with endosseous implant placement are those innervating the mandible: the inferior alveolar nerve, the mental nerve and the lingual nerve. Evaluation of the nerve injury characteristics and severity as early as possible has always imposed a great challenge for clinicians. We demonstrate a reliable yet simple way of dealing with this kind of problem in conjunction with comparing preoperative and postoperative sensation of the chin, the tongue and the lower lip. On the other hand, it is considerably important to take preventive measures for such injuries by using appropriate radiographic images. If a nerve damage has occurred, best prognosis is to be expected by early and appropriate treatment. It is imperative to treat such injuries in four months following the injury, otherwise a permanent nerve damage may occur. Further investigation of nerve damage risks following implant placement should be performed in order to enable patient to decide whether having implants dependent rehabilitation or choosing an alternative.