The Effect of Tumor Resection and Radiotherapy on the Expression of Stem Cell Markers (CD44 and CD133) in Patients with Squamous Cell Carcinoma.

Background: Head and Neck Squamous Cell Carcinomas (HNSCCs) are heterogeneous malignancies that comprise 90% of the head and neck cancers. HNSCCs originate from the mucosal lining epithelium of the upper aerodigestive tract. Cancer stem cells (CSCs) that generate HNSCCs with the CD44, CD133, and ALDH phenotype and are resistant to radiotherapy and chemotherapy. In the current, the quantitative alteration in CD44 and CD133 expression pre- and post-tumor resection and radiotherapy was evaluated in HNSCC patients. Moreover, the alterations in the expression of Bax, Bak, Bcl-2, ALDH, and PTEN genes were measured. Materials and Methods: Flow cytometry was performed to evaluate the alterations in CD44 and CD133 surface markers pre- and posttumor resection and radiotherapy. Quantitative real-time RT-PCR (qRT-PCR) was conducted to investigate the mRNA expression levels of Bax, Bak, Bcl-2, ALDH, and PTEN. Results: The results indicated that the cancer stem cell CD44 surface marker significantly decreased after tumor resection and radiotherapy in HNSCC cases, while the decrease was insignificant for CD133 marker expression. mRNA expression level of Bcl-2 and ALDH was increased, but Bax and Bak gene expressions were reduced significantly Conclusion: The results also indicated that the expression of CD44 significantly decreased after tumor resection and radiotherapy. The upregulation of mRNA level of Bcl-2 and ALDH, and the downregulation of Bax and Bak gene expression were noted in these cases when compared to the healthy control group.

Comparison of emotional intelligence, body image, and quality of life between rhinoplasty candidates and control group.

INTRODUCTION: Psychological factors affect the tendency of individuals toward cosmetic surgeries although their contribution has not been clearly understood. Therefore, the current study aimed at comparing the emotional intelligence, body image, and quality of life between rhinoplasty candidates and the control group. METHODS: The current case-control study was conducted on 160 individuals referring to Rhinoplasty Clinic of Imam Reza Hospital in Tabriz, Iran, from 2018 to 2019. The tools used in this study including demographic information, Schering's emotional intelligence questionnaire (α = 0.75-0.85), the 36-item Short Form Health Survey Questionnaire (α = 0.75), and body image (α = 0.77-0.91) were used to collect data. Data were analyzed by the Kolmogorov-Smirnov and t-tests for the two independent groups. P < 0.05 was considered as the level of significance. RESULTS: There was no significant difference between the groups in terms of the overall mean of emotional intelligence and its subcomponents (P > 0.05), except social skills, such as self-awareness (P = 0.019). Appearance evaluation and appearance orientation variables were statistically significant between the two groups (P < 0.05), while the quality of life was not statistically significant (P = 0.051). CONCLUSION: In the psychological parameters studied, we found that the appearance evaluation and social skills of the rhinoplasty applicants are low, and it is better to have interventions before the rhinoplasty in people who have difficulty with these variables.

Comparison of two-flap palatoplasty plus intravelar veloplasty technique with and without double-layer Z-plasty on the soft palate length in children with cleft palate.

PURPOSE: Velopharyngeal failure occurs as a result of a nasopharyngeal gap following inadequate velopharyngeal closure for structural or functional cause. We aimed to compare the soft palate length in two-flap palatoplasty with intravelar veloplasty (IVV) and two-flap palatoplasty with IVV plus double-layer Z-plasty combination in patients with cleft palate. METHODS: This clinical trial was conducted on infants aged 9 to 12 months with cleft palate in two groups. The method of two-flap palatoplasty with IVV technique and two-flap palatoplasty with IVV plus double-layer Z-plasty was compared in terms of soft palate length which was measured during operation and short-term complications. RESULTS: This study was conducted on 62 infants including 30 patients in two-flap palatoplasty with IVV group and 32 patients in two-flap palatoplasty with IVV plus double-layer Z-plasty group. The soft palate length in two-flap palatoplasty and IVV with and without Z-plasty groups before surgery was 17.56 ± 2.05 and 17.68 ± 1.88 mm, respectively (P = 0.561). After surgery, the soft palate length was significantly higher in two-flap palatoplasty with IVV plus Z-plasty group (22.43 ± 2.73 mm vs. 20.56 ± 2.42 mm) (P = 0.032). CONCLUSION: The two-flap palatoplasty with IVV plus Z-plasty technique is a suitable method for increasing the palatal length in infants with cleft palate. On the other hand, the addition of Z-plasty method could increase the length of the palate. Moreover, the complications are very low and further trials for development of this method on patients with cleft palate are recommended. TRIAL REGISTRATION NUMBER (TRN): IRCT2017032423559N11.

Asymmetry of Height and Width of Ethmoid Sinus and Its Association with Chronic Sinusitis: A Cross Sectional Study.

BACKGROUND: In this study, we aimed to investigate the association between chronic anterior sinusitis with the width and height of ethmoid sinus and also assess the ethmoid length and roof asymmetry in the Iranian adult population. Material and Methods: This cross-sectional study was carried out on 422 patients who were referred with clinical signs of rhinosinusitis to the ENT Center of Tabriz University of Medical Sciences. Study participants were divided into healthy and sinusitis groups based on the level of sinus involvement. Computed tomography images were applied to calculate ethmoid height and width. A paired t-test was used to assess the roof and width asymmetry and an independent t-test was used to investigate the association between ethmoid height and width with the incidence of rhinosinusitis. RESULTS: The mean age of sinusitis and healthy groups was 42.5±18.9 and 38.4±17.1 years, respectively. Of a total 422 subjects, 63.4% of whom were men. The overall prevalence of rhinosinusitis was 28.0%. We observed a statistically significant difference in terms of ethmoid height, and in both healthy and sinusitis group right ethmoid roof was statistically lower (P<0.05). However, no statistical difference was observed between the left and right side regarding the ethmoid sinus width (P>0.05). We also estimated correlation coefficients for rhinosinusitis score and ethmoid sinus height and width, which were not statistically significant (P>0.05). CONCLUSION: Our study shows that the right side of the ethmoid roof was lower in comparison to the left side, and it should be fully understood and regarded in rhino sinus surgery. We also observed no association between sinusitis score and height and width of the ethmoid sinus.

Comparison of Tympanoplasty Results in Dry and Wet Ears.

INTRODUCTION: Tympanoplasty is the standard and well established procedure for closure of tympanic membrane perforations .This paper compares the results of tympanoplasty in terms of hearing improvement and graft incorporation in patients with chronic perforation of the tympanic membrane between two groups with and without active drainage at the time of surgery. MATERIALS AND METHODS: Sixty referring patients to specialty and subspecialty clinics between the age 15 to 60 years-old were selected. All patients suffered from Chronic Otitis Media and they were categorized into two groups: a) those with wet ears and b) those with dry ears. Tympanoplasty surgery was performed through the use of embedding technique of temporalis fascia graft and in medial position (Medial Graft Technique). Finally, the data about the level of hearing improvement and the repair of tympanic membrane were analyzed. RESULTS: Although there was hearing improvement in both groups - with wet or dry ear - no statistically significant difference was observed between two groups. Following the surgery, tympanic membrane in two patients with wet ear and one with dry ear was not repaired, however according to the statistical analysis this difference was not significant. CONCLUSION: The results of this study showed that in contrast to the common perception that tympanoplasty results in the patients with wet ear is poorer than those with dry ear, there was little difference in the results of the operations performed on two groups.

Evaluation of Factors Affecting the Surgical Outcome in Tympanoplasty.

INTRODUCTION: Tympanoplasty is a standard procedure to repair tympanic membrane perforation. The aim of this study is to evaluate the results of tympanoplasty (hearing improvement and tympanic membrane closure rate) in patients suffering from chronic perforation of the tympanic membrane by considering the prognostic factors. MATERIALS AND METHODS: In a prospective study, based on the results of tympanoplasty with temporal graft fascia in 60 patients in the ENT department of the Medical Science University of Tabriz, we evaluated prognostic factors, such as age, sex, smoking, size, and site of perforation, for the outcome of this surgery. RESULTS: The rate of surgical success- integration of the graft- was 93.3%. Improvement of hearing, as demonstrated through audiometry, occurred in 93% of cases. We did not find any factors to be statistically significant to affect surgical outcome. CONCLUSION: Even by considering the influence of different factors on the results of a tympanoplasty operation, according to the statistical results of this study, there is not a significant difference in the results of the operation, neither in the health of the tympanic membrane after surgery nor in hearing development.

Prevalence of Associated Anomalies in Cleft Lip and/or Palate Patients.

INTRODUCTION: Orofacial clefts are among the most common congenital anomalies. Patients presenting with orofacial clefts often require surgery or other complex procedures. A cleft lip or palate can be a single anomaly or a part of multiple congenital anomalies. The reported prevalence of cleft disease and associated anomalies varies widely across the literature, and is dependent on the diagnostic procedure used. In this study we determined the prevalence of associated anomalies in patients with a cleft lip and/or palate, with a specific focus on cardiac anomalies. MATERIALS AND METHODS: In this cross-sectional study, 526 patients with a cleft lip and /or palate admitted to the children's referral hospital between 2006 and 2011 were evaluated. All associated anomalies were detected and recorded. Patient information collected included age, gender, type and side of cleft, craniofacial anomalies and presence of other anomalies, including cardiac anomalies. Data were analyzed using SPSS version 16. RESULTS: Of the 526 patients enrolled in the study, 58% (305) were male and 42% (221) were female. In total, 75% of patients (396) were aged between 4 and 8 years and 25% (130) were aged less than 4 years. The most common cleft type in our study was bilateral cleft palate. The most commonly associated anomaly among cleft patients, in 12% of cleft patients, was a cardiac anomaly. The most common cardiac anomaly was atrial septal defect (ASD). CONCLUSION: The prevalence of associated anomalies among orofacial cleft patients is high. The most common associated anomaly is cardiac anomaly, with ASD being the most common cardiac anomaly. There are no significant relationships between type of cleft and associated cardiac anomalies.

Serum Level of Interleukin-6 in Patients with Oral Tongue Squamous cell Carcinoma.

INTRODUCTION: The clinical outcome of patients with squamous cell carcinoma (SCC) located in the head and neck has remained poor despite ongoing advances in diagnosis and management. Interleukin-6(IL-6) is a multi-functional cytokine that plays an important role in the process of cell differentiation and is increased in several malignancies. The aim of this study was to investigate the serum levels of interleukin-6 in patients with oral tongue SCC. MATERIALS AND METHODS: In a cross-sectional study, 17 patients with oral tongue SCC were compared with the same number of age- and gender-matched healthy subjects. Serum IL-6 level fluctuation was determined using an immunological technique, before detecting its possible association with the subjects' age, gender, drinking and smoking history, cancer site, and disease severity. RESULTS: The intensity of serum IL-6 in patients with oral tongue SCC was statistically significantly higher than that in healthy subjects (P<0.001). Serum IL-6 level was independent of the patients' age, gender, smoking and drinking history as well as cancer stage. CONCLUSION: IL-6 is a valuable biomarker in the diagnosis of oral tongue SCC. Its high sensitivity makes prediction of this condition possible, while this biomarker can also be used to screen high-risk patients.

A bilateral tessier number 4 and 5 facial cleft and surgical strategy: a case report.

INTRODUCTION: Tessier facial cleft is among the rarest facial clefts reported in literatures and there are many issues arguing about its multidisciplinary repairing techniques. Tessier number 4 and 5 are extremely rare facial anomalies. There are few literatures describing these clefts and their surgical modalities. Number 5 Tessier cleft begins medial to oral commissure in the upper lip and extends superiorly as a groove through the cheek and ends at the middle third of lower eyelid. Bonny involvement consists of alveolar ridge, maxillary bone lateral to infra orbital foramen and orbits lower rim and floor. Number 4 Tessier facial cleft begins between cupid bow and oral commissure; skirting the nose and pass through cheek and lateral to lacrimal duct. Bonny involvement consists of alveolar ridge, maxillary bone medial to infra orbital foramen and orbital rim and floor. CASE REPORT: This paper represents a patient with bilateral number 4 and 5 Tessier cleft lip with unilateral complete cleft palate and surgical approach on her. CONCLUSION: We recommended early repair using autogenously tissues and minimal discarding healthy tissues as possible.

Proper size of endotracheal tube for cleft lip and palate patients and intubation outcomes.

OBJECTIVES: The aim of the current study was to identify the proper size of endotracheal tube for intubation of cleft lip and palate patients and intubation outcomes in these patients. PATIENTS AND METHODS: In this analytic cross-sectional study, 60 nonsyndromic cleft lip and palate patients were selected who had surgery between April 2010 and April 2012 at Pediatrics Hospital, Tabriz University of Medical Sciences, Iran. Demographic findings, previous admissions, and surgical history were registered. The proper tube size was measured by normal children formulas. Then tube size was confirmed by patients' minimum resistance to intubation, proper ventilation reported by anesthesiologist, and appropriate air leakage at an airway pressure of 15-20 cm H2O. If intubation was unsuccessful then smaller size of endotracheal tube would be tried. Frequency of intubation trials and the biggest endotracheal tube size were recorded. RESULTS: Their average age, weight and height were 21.39 ± 4.95 months, 9.97 ± 1.18 kg and 74.30 ± 26.61 cm, respectively. The average tracheal tube size and frequency of intubation trials were 4.34 ± 0.78 and 1.63 ± 0.80, respectively. Seven cases required an endotracheal tube size smaller than the recommended size for that age including one case in unilateral cleft palate, three cases in unilateral cleft lip, one case in unilateral cleft lip and palate, and two cases in bilateral cleft lip and palate. CONCLUSIONS: Findings proved that considering subglottic stenosis incidence in these children, it is reasonable to determine the tube size for nonsyndromic cleft lip and palate patients by applying the currently available standards for normal children.

A case report: nager acrofacial dysostosis.

INTRODUCTION: Nager syndrome is a malformation resulting from problems in the development of the first and second branchial arches and limb buds. The cause of the abnormal development of the pharyngeal arches in Nager syndrome is unknown. It is also unclear why affected individuals have bone abnormalities in their arms and legs. Nager syndrome is thought to have an autosomal recessive inheritance pattern when unaffected parents have more than one affected child. The purpose of this report is to present a case of Nager syndrome where the patient exhibited upper limb shortening, an unusual feature that has been reported as coexisting in some individuals with Nager syndrome. CASE REPORT: A 3.5-year-old girl was referred to our Department of Pediatric Otorhinolaryngology due to a cleft palate. Her craniofacial anomalies included malar hypoplasia, severe mandibular hypoplasia with retrognathia, downward slanted palpebral fissures, a high narrow hard palate, absent soft palate, small retroplaced tongue, bilateral external auditory canal atresia, and dysplastic ears. There was no evidence of mental retardation. Based on the craniofacial characteristics and the coexisting upper limb preaxial anomalies, a diagnosis of Nager syndrome was confirmed. CONCLUSION: Nager syndrome is a rare disorder resulting from developmental abnormalities of the first and second branchial arches. It is linked to five other similar syndromes: Miller syndrome, Treacher-Collins, Pierre-Robin, Genee-Wiedemann, and Franceschetti-Zwahlen-Klein. Multidisciplinary management by a craniofacial team is needed. Early intervention, intensive education, new surgical techniques, and an emphasis on coordinated care have improved the quality of life in this patient with Nager syndrome.