Evaluation of Cases Who Underwent Reconstruction Through Pectoralis Major Myocutaneous Flap after Laryngopharyngectomy.

OBJECTIVE: In this retrospective study, we discussed the results of patients who underwent hypopharynx reconstruction through a pectoralis major myocutaneous flap (PMMF) after laryngopharyngectomy. METHODS: Twenty-three patients who underwent total laryngectomy, subtotal pharyngectomy, and/or esophagus upper segment resection due to advanced-stage (T3 and T4) laryngeal, hypopharyngeal, and esophagus upper segment-located squamous cell carcinoma and subsequent reconstruction with PMMF were retrospectively evaluated. While the minor complications were determined to be wound site infection, hemorrhage, and disruption of suture at the donor site, major complications were determined to be anastomotic line disruption, fistula, and dysphagia. RESULTS: Eighteen (78.2%) patients were male and five (21.7%) were female; their ages varied between 33 and 72 years (mean: 60.1). According to lesion localization, 11 patients were evaluated as having laryngeal cancer, seven as having hypopharyngeal cancer, and five as having esophagus upper segment-located cancer. The rate of minor complications was 30.4%: fistula was observed in 11 (47.8%) patients and 13 (56.5%) patients mentioned difficulty swallowing only solid foods. The total follow-up period ranged from 4 to 60 (mean: 31.6) months. CONCLUSION: PMMF is continuing to be a good alternative reconstruction method for the reconstruction of partial hypopharyngeal defects because it is easily obtainable, one surgical team is sufficient when using the flap, and it is associated with low morbidity and mortality rates.

A Unique Case of Intranasal Metastasis from Occult Poorly Differentiated Thyroid Carcinoma.

BACKGROUND: Poorly differentiated thyroid carcinomas (PDTCs) lie, both morphologically and behaviorally, between well-differentiated and undifferentiated carcinomas. Metastasis of poorly differentiated thyroid carcinoma to the intranasal cavity has not been reported previously in the literature. CASE REPORT: A 48-year-old male patient presented with massive epistaxis and nasal obstruction. On nasal examination, a bleeding, vascular mass was seen filling the left nasal cavity. The histopathological report of the nasal mass was well-differentiated thyroid carcinoma metastasis. Whole body scintigraphy, ultrasonography and positron emission tomography were done to rule out other possible metastases in the body and determine the origin of the tumor, which was identified as the left lobe of the thyroid gland, and there were multiple metastases involving the lung, sacroiliac area, and left humerus. Histopathological examination of a thyroidectomy specimen revealed PDTC consisting of insular, follicular, and papillary components. Postoperatively, the patient received radioactive iodine ablation therapy (iodine-131) and a course of external beam radiation therapy to the sacroiliac area and other metastatic regions. No recurrences were observed in a follow-up period of 5 years after surgery. CONCLUSION: The metastasis of differentiated thyroid carcinoma as a component of PDTC to the intranasal cavity has not been reported before. It is interesting that the well-differentiated component of the tumor was metastasized in our patient. Due to the aggressiveness of PDTC and the poor survival rates in patients who undergo surgery alone, a multidisciplinary treatment approach is required.

Nasal packing and transseptal suturing techniques: surgical and anaesthetic perspectives.

The objective of this study is to compare the nasal packing and the transseptal suturing techniques regarding the extubation difficulty evaluation scores, follow-up times in post-anaesthesia care unit (PACU), pain scores, and postoperative complications. Two hundred patients who underwent septoplasty from January 2009 to October 2009 were randomly assigned either to have nasal packs (n: 100) or transeptal sutures (n: 100). In the transseptal suture group, extubation was easier and PACU follow-up times were shorter, when compared to the nasal packing group (p < 0.001). Patients with nasal packing had significantly higher pain scores (p < 0.001). Minor bleeding was significantly higher in the transseptal group with seven cases, compared to the nasal packing group without any bleeding cases (p = 0.014). There were two patients who had postoperative major bleeding, and two patients who had septal hematoma in the transseptal suture group. One patient with nasal packing had postoperative infection. Septal perforation was not seen in any of the cases. While patients in both groups experienced postoperative crusting, patients in the transseptal suture group also complained about foreign body sensation. Extubation was more comfortable; post-anaesthesia monitorization duration was shorter, and postoperative pain was less, but minor bleeding was seen more with transseptal sutures. There was no significant difference in terms of major bleeding, hematoma, infection or perforation. Foreign body sensation was the main cause of postoperative discomfort in the transseptal suture group. Transseptal suturing might be a significantly comfortable, cost-effective and reliable alternative to nasal packing.

Computed tomography virtual laryngoscopy: comparison between radiological and otolaryngological evaluations for laryngeal carcinoma.

OBJECTIVES: We evaluated the utility of computed tomography virtual laryngoscopy (CTVL) in identifying endolaryngeal lesions in laryngeal tumors. PATIENTS AND METHODS: Virtual laryngoscopic images were obtained from axial CT scans of 21 patients with known laryngeal carcinoma. Findings from rigid telescopic videolaryngoscopy (RTV) and CTVL images were evaluated and compared with reference to operative records. RESULTS: Lesions localized in the base of the tongue, pyriform sinus, aryepiglottic folds, and arytenoids were well visualized by both RTV and CTVL. The two techniques were not found effective in identifying lesions of the ventricular bands, ventricular cavities, and the anterior commissure. Virtual laryngoscopy was superior to RTV in the visualization of the subglottic area and vocal cords. CONCLUSION: Virtual laryngoscopy is a noninvasive and reliable technique that provides visualization of endolaryngeal surfaces and tumor extension. It may be beneficial in staging larynx carcinoma and planning the most appropriate surgical procedure.

[Three cases of mucosal malignant melanoma of the nose and paranasal sinuses]. / Uç olguda burun ve paranazal sinüs mukozal malign melanomlari

We evaluated the clinical course and treatment of three patients who were found to have mucosal malignant melanoma of the nose and paranasal sinuses. The presenting complaint was recurrent epistaxis in all the patients. One patient had been followed-up for nasal polyposis for a long time. In older patients with recurrent epistaxis, endoscopic examination of the nasal cavity and obtaining a biopsy from suspected regions are essential for early diagnosis of mucosal malignant melanomas.

Peritonsillar abscess: a comparison of outpatient i.m. clindamycin and inpatient i.v. ampicillin/sulbactam following needle aspiration.

In an attempt to assess the effect of antibiotic choice on the treatment of peritonsillar abscess, we compared the clinical efficacy of empiric intramuscular clindamycin and intravenous ampicillin/sulbactam (following needle aspiration of the abscess) in a prospective, randomized study of 58 patients. Patients in the clindamycin group were treated on an outpatient basis, whereas those in the ampicillin/sulbactam group were hospitalized for the duration of their treatment (minimum: 7 days). Comparison of clinical outcomes with respect to the posttherapeutic duration of fever and throat pain and the time to resumption of eating revealed no statistically significant difference between the two groups. These results suggest that intramuscular clindamycin is an excellent choice and can be safely prescribed on an outpatient basis following needle aspiration, thereby reducing both antibiotic and hospital costs.

Use of steroids in the treatment of peritonsillar abscess.

Peritonsillar abscess is the most common deep infection of the head and neck that occurs in adults; the treatment of the disease remains controversial. A prospective study using a single high dose steroid treatment for peritonsillar abscess, was undertaken in 62 patients to determine the treatment's effectiveness in relieving symptoms such as fever, throat pain, dysphagia and trismus. All patients were randomly assigned to two groups: 28 patients received intravenous antibiotic therapy and a single dose placebo and 34 patients were treated with single use of high dose steroid in addition to intravenous antibiotic. Patients were hospitalized after needle aspiration and therefore their clinical courses and responses to therapy could be rigorously assessed. Comparison of clinical outcomes with respect to hours hospitalized, throat pain, fever, trismus were assessed between the two groups. Clinical outcomes revealed a statistically significant difference between the two groups (p < 0.01), indicating that single use of high dose steroid prior to antibiotic therapy is more effective than the use of an antibiotic alone. These results suggest that single intravenous use of steroid in addition to antibiotic therapy is an excellent choice for the management of peritonsillar abscess.

Prophylactic effect of pentoxifylline on radiotherapy complications: a clinical study.

OBJECTIVE: The purpose of this study was to assess the prophylactic effect of pentoxifylline (Ptx) on complications related to radiation. STUDY DESIGN AND SETTING: Seventy-eight patients who had postoperative radiotherapy for squamous cell carcinoma of the head and neck were enrolled into a prospective study. Patients were randomly assigned to the Ptx group (40 patients) and the control group (38 patients). Ptx was given to the patients at a dose of 400 mg 3 times a day orally to a total of 1200 mg. We noted radiotherapy complications in each group. RESULTS: Four patients were not able to tolerate this drug due to the development of gastrointestinal symptoms and dizziness. Late skin changes, fibrosis, and soft tissue necrosis were more severely in the control group than in the Ptx group (P < 0.05). We could find no positive effects on acute skin reactions and pain (P > 0.05). CONCLUSION: Our study suggests that Ptx has a prophylactic effect on the radiation complications. This can be explained by protective effect of Ptx against vascular pathology.

Lymphatic malformation of the parapharyngeal space.

Lymphatic malformations are rare benign congenital lesions. A 28-month-old girl presented with a parapharyngeal lymphatic malformation. A cystic lesion had been diagnosed at 18 weeks' gestation by ultrasonography and she had been followed up conservatively until her referral to our department. We used a transcervical approach to excise the parapharyngeal lesion and 1 year later, there was no sign of recurrence.

Endolaryngeal resection of laryngeal chondrosarcoma.

Chondrosarcoma is a rare tumor. In this study, we present a case with laryngeal chondrosarcoma that was treated by an endolaryngeal approach using an operation microscope. The patient remains disease-free to date, with no evidence of new or recurrent disease more than 3 years after the endolaryngeal surgery. The computerized tomography and endoscopic examinations did not reveal any recurrent disease, indicating the success of the endolaryngeal approach.

[Reconstruction of nasal cutaneous defects with the use of supratrochlear artery-based paramedian forehead flap]. / Nazal kutanöz defektlerin rekonstrüksiyonunda supratroklear arter bazli paramedyan alin flebi uygulamasi.

OBJECTIVES: We evaluated oncologic and functional results of paramedian forehead flap in the reconstruction of nasal cutaneous defects. PATIENTS AND METHODS: Supratrochlear artery-based paramedian forehead flap was employed in 14 patients (13 men, 1 woman; mean age 57 years; range 46 to 63 years) for the reconstruction of nasal cutaneous defects resulting from excision of squamous or basal cell carcinoma. No other treatment modalities were performed other than removal of the primary lesion. The mean follow-up was 42.4 months (range 8 to 83 months). RESULTS: None of the patients developed flap necrosis, local recurrences, or distant metastasis. Airway problems of varying extent were observed in 10 patients (71.4%), the severity of which became attenuated in time as the flap gained proper contraction. CONCLUSION: Acceptable functional and successful oncologic results can be obtained in the reconstruction with the use of paramedian forehead flap.

[Functional outcomes after supracricoid partial laryngectomy]. / Suprakrikoid parsiyel larenjektomi sonrasi fonksiyonel sonuçlar.

OBJECTIVES: We evaluated functional outcomes in patients undergoing supracricoid partial laryngectomy (SCPL). PATIENTS AND METHODS: The study included 20 male patients (mean age 61.5 years; range 43 to 76 years) who underwent SCPL for advanced laryngeal carcinoma. Correlations were sought between variables (age, medical history, reconstruction techniques such as cricohyoidopexy or cricohyoidoepiglottopexy, arytenoid resection) and decannulation time, duration for oral feeding, weight change, and complications. The mean follow-up was 20.9 months (range 7 to 39 months). RESULTS: All patients were decannulated in a mean of 19.9 days. Eighty-five percent of patients achieved normal deglutition without aspiration or weight loss within six months postoperatively. The nasogastric feeding tube was removed in a mean of 39.7 days. Voice quality of patients was sufficient for their social communications. CONCLUSION: Our functional results suggest that SCPL is an alternative technique to total laryngectomy in patients in whom other partial laryngectomy techniques are not considered.

[A case of auricular malignant melanoma]. / Auriküler malign melanoma.

We performed auricular excision, total parathyroidectomy, and extended radical neck dissection in a 36-year-old male patient who developed auricular malignant melanoma. Reconstruction of the surgical defect was made with a split-thickness skin graft. The patient received radiotherapy and chemotherapy after surgery. No evidence of local recurrences or distant metastasis was detected during a follow-up period of 14 months.

Papillary thyroid carcinoma metastasis to the parapharyngeal space.

Thyroid papillary carcinoma presenting as a pharyngeal mass is a rare clinical occurrence and has only been reported sporadically. We present here two patients who had papillary carcinoma metastasis of the thyroid gland to the parapharyngeal space. Each patient had a different clinical progress. Upward lymphatic spread of the tumor to involve the parapharyngeal space via the lateral retropharyngeal nodes was indicated. This pattern of spread is in keeping with Rouviere's description of a direct lymphatic pathway from the thyroid gland to the retropharyngeal nodes and parapharyngeal space.

Hypervascular parapharyngeal schwannoma: an unusual case.

This report describes a 13-year-old girl who had a right pulsatile neck mass of the parapharyngeal space. We examined the patient with computerized tomography and angiography preoperatively and a heterogeneous, hypervascular mass was detected on her right neck. Intraoperative findings and the postoperative histopathologic diagnosis showed that this mass was a schwannoma that originates from cervical sympathetic chain and the superior thyroid artery supplied the mass. After careful scrutiny of English literature, this clinical manifestation is an unusual event.