Prevalence, incidence, and risk factors for shoulder and neck dysfunction after neck dissection: A systematic review.

INTRODUCTION: Shoulder pain and dysfunction may occur following neck dissection among people being treated for head and neck cancer. This systematic review aims to examine the prevalence and incidence of shoulder and neck dysfunction after neck dissection and identify risk factors for these post-operative complications. METHODS: Electronic databases (Pubmed, CINAHL, EMBASE, Cochrane) were searched for articles including adults undergoing neck dissection for head and neck cancer. Studies that reported prevalence, incidence or risk factors for an outcome of the shoulder or neck were eligible and assessed using the Critical Review Form - Quantitative Studies. RESULTS: Seventy-five articles were included in the final review. Prevalence rates for shoulder pain were slightly higher after RND (range, 10-100%) compared with MRND (range, 0-100%) and SND (range, 9-25%). The incidence of reduced shoulder active range of motion depended on surgery type (range, 5-20%). The prevalence of reduced neck active range of motion after neck dissection was 1-13%. Type of neck dissection was a risk factor for shoulder pain, reduced function and health-related quality of life. CONCLUSIONS: The prevalence and incidence of shoulder and neck dysfunction after neck dissection varies by type of surgery performed and measure of dysfunction used. Pre-operative education for patients undergoing neck dissection should acknowledge the potential for post-operative shoulder and neck problems to occur and inform patients that accessory nerve preservation lowers, but does not eliminate, the risk of developing musculoskeletal complications.

Cellular and molecular mechanisms of chronic rhinosinusitis and potential therapeutic strategies: review on cytokines, nuclear factor kappa B and transforming growth factor beta.

BACKGROUND: Chronic rhinosinusitis is characterised by persistent inflammation of the sinonasal mucosa. Multiple pathophysiological mechanisms are likely to exist. Previous research has focused predominantly on T-helper type cytokines to highlight the inflammatory mechanisms. However, proteins such as nuclear factor kappa B and transforming growth factor beta are increasingly recognised to have important roles in sinonasal inflammation and tissue remodelling. OBJECTIVE: This review article explores the roles of T-helper type cytokines, nuclear factor kappa B and transforming growth factor beta in the pathophysiological mechanisms of chronic rhinosinusitis. An understanding of these mechanisms will allow for better identification and classification of chronic rhinosinusitis endotypes, and, ultimately, improved therapeutic strategies.

Primary choroid plexus papilloma of the cerebellopontine angle: magnetic resonance imaging, computed tomographic and angiographic appearances.

The computed tomographic, angiographic and magnetic resonance imaging (MRI) appearances of a benign primary choroid plexus papilloma of the cerebellopontine angle are reported. Although benign, this tumour showed local invasion of the petrous temporal bone and mastoid air cells. The differential diagnosis of cerebellopontine angle lesions is discussed. Papilloma is suggested by the presence of a vascular, calcified, enhancing extra-axial mass in or around the cerebellopontine angle. MRI may show evidence of high vascularity and internal haemorrhage. Differentiation from other cerebellopontine tumours, most particularly meningioma, may not be possible on radiological features.

Choroid plexus papilloma of the cerebellopontine angle.

We report a case of a transdural choroid plexus papilloma of the cerebellopontine angle in a 23-year-old woman. Choroid plexus papillomas are rare intracranial tumors, usually occurring intraventricularly. Those found in the cerebellopontine angle are uncommon and almost always subdural. The investigation, treatment, and follow-up are discussed.