Incidence of Facial Nerve Paralysis After Parotidectomy: Our Experience.

Facial nerve palsy (FNP) is a well-recognized complication following parotidectomy, with varying reported incidence rates in the literature. Understanding the incidence and factors contributing to FNP is crucial for optimizing patient care and surgical outcomes. A retrospective analysis was conducted on 78 patients who underwent parotidectomy at a tertiary care institution (Hospital de Especialidades Carlos Andrade Marin, Quito) over a 36-month period. Demographic data, preoperative pathology reports, surgical details, and postoperative outcomes, including FNP incidence and severity, were analyzed. The mean age of the cohort was 53 years, with a male-to-female ratio of 0.8:1. Fine needle aspiration revealed benign pathology in 70.5% of cases, with superficial parotidectomy being the most common surgical approach (84.6%). Postoperatively, FNP was observed in 51.2% of cases, with transient paralysis in 62.5% and persistent paralysis in 37.5%. The majority of FNP cases were classified as grade II and III according to the House-Brackmann grading system. A tumor size larger than 4 cm was associated with a higher incidence of FNP (57.5%). This study provides valuable insights into the incidence and severity of FNP following parotidectomy. Despite efforts to standardize surgical techniques, persistent paralysis remains a significant concern.

Synchronous Gastric and Colon Cancer.

Colorectal cancer (CRC) and gastric cancer, ranking as the third and fifth most prevalent global cancers, respectively, have seen increased diagnoses due to advancements in early detection and extended lifespans. Synchronous and metachronous cancers, with a rare incidence, are notable, with CRC being the predominant synchronous occurrence in gastric cancer patients. Screening CRC patients for gastric cancer is debated due to its low incidence, underscoring the crucial role of early diagnosis. Distinguishing between metastatic adenocarcinoma and synchronous tumors is challenging, relying on techniques such as immunohistochemistry. Surgery is the primary treatment for synchronous cancer, with successful single-stage surgeries reported. A case presentation of a 68-year-old female highlights these complexities. The final diagnosis encompassed stage I gastric cancer and stage IV colon cancer, leading to adjuvant chemotherapy. Synchronous gastric cancer and CRC present a unique clinical challenge, necessitating tailored approaches. Collaboration between surgical and oncological teams is crucial for comprehensive treatment planning and optimizing patient outcomes.

Unusual Anatomic Variant of the Biliary Tree.

Accurate identification of anatomical variations in the biliary tree is crucial in hepatobiliary surgeries, including the widely performed laparoscopic cholecystectomy. Coexisting anomalies, though rare, present challenges for surgeons. This case study follows a 43-year-old female post-sleeve gastrectomy, diagnosed with mild gallstone pancreatitis and choledocholithiasis, who underwent early cholecystectomy. Intraoperatively, a 3 mm aberrant right hepatic duct and three 1 mm subvesicular ducts were identified. Recognizing these variants is pivotal for surgical success. Utilizing preoperative imaging, intraoperative vigilance, and advanced techniques like cholangiography are essential in preventing complications. Continuous education and collaborative experiences among surgical teams are integral in enhancing patient safety in these complex procedures.

Collision Tumor of the Appendix.

This report discusses the case of a 20-year-old female patient who presented with acute abdominal pain, nausea, and vomiting. Initial laboratory analyses suggested an inflammatory process, but imaging studies failed to reveal pathologies. The patient underwent a diagnostic laparoscopy, which showed a thickened and multicystic appendix with signs of acute inflammation. Pathology indicated a positive cytology for malignancy, with a grade 1 mixed well-differentiated neuroendocrine tumor (NET) and high-grade mucinous neoplasm identified in the middle and distal thirds of the appendix. Finding both tumors in the same patient is extremely rare and has been reported in a few cases. The case emphasizes the importance of considering appendiceal tumors in the differential diagnosis of acute abdominal pain, even in young patients, and highlights the value of laparoscopy in their diagnosis. The early detection and appropriate management of appendiceal tumors are crucial for improving patient outcomes.

Perforated Meckel's Diverticulum Caused by a Toothpick: A Case Report and Review of Literature.

Although Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract, it is rare in the general adult population. When it does become symptomatic, it is usually due to complications such as perforation. We report the case of a 38-year-old man who presented with acute abdominal pain in the right iliac fossa, fever, and tachycardia. Complementary exams at the emergency department showed leukocytosis and elevated C-reactive protein. Acute appendicitis was suspected, so he was taken to the operating room for a diagnostic laparoscopy. During surgical exploration, a perforated Meckel's diverticulum caused by a toothpick was found. Surgery was converted to laparotomy with resection of the small bowel segment containing the diverticulum, followed by a primary anastomosis. The postoperative period was uneventful, and the patient was discharged on day seven. No abnormalities were reported in the histopathology study. In this report, we review and discuss similar cases found in the literature, all of them male with acute abdomen and suspicion of appendicitis. We aim to remark on the importance of keeping in the differential of such patients a perforated Meckel's diverticulum.

Synchronous Acute Appendicitis and Acute Cholecystitis.

The occurrence of synchronous acute cholecystitis and appendicitis is rare. There are few cases reported and small series in the literature. We report the case of a 77-year-old male who presented to the emergency department with right-sided abdominal pain. He was diagnosed preoperatively with acute calculous cholecystitis. During the initial laparoscopy, a complicated appendiceal phlegmon was found and was treated with a one-step laparoscopic approach and subsequent antibiotics. The patient had an uneventful recovery and was discharged on postoperative day (POD) 2. The pathology report confirmed both diagnoses and an incidental low-grade appendiceal mucinous neoplasm. Although uncommon, it is important to be aware of the possibility of both simultaneous pathologies in a patient who presents to the emergency department with abdominal pain.