Management of an Atypical Lipomatous Tumor/Well-Differentiated Liposarcoma of the Left Laterocervical Region: Report of a Rare Case.

Liposarcomas are among the most usual cancerous growths of mesenchymal tissues and represent about 1% of head and neck sarcomas. They are extremely rare in childhood and are mostly seen between 30 and 60 years of age. The biologic behavior and histologic features of liposarcomas vary. Although these tumors grow very slowly and have a benign behavior, sometimes they grow rapidly and metastasize early, with fatal results. This case report presents a 63-year-old man with a tumor of the left side of the cervical region which has grown to a large size over four years. For an accurate diagnosis, fine needle aspiration biopsy (FNA) biopsy was performed. The cytological examination showed an adipose tumor. Surgical removal was done under local anesthesia and the pathologic examination showed a well-differentiated liposarcoma. These are usually early stage tumors, with fewer metastases than other sarcomas. Surgical abscission is the gold standard for the treatment of liposarcomas. The efficacy of postoperative radiotherapy or/and chemotherapy is controversial.

Pyogenic Granuloma Gravidarum of the Nasal Cavity Causing Recurrent Epistaxis. A Case Report and Review of the Literature.

Pyogenic granuloma is a benign proliferative fibrovascular lesion commonly arising from the skin and mucous membranes of the head and neck region. Histologically, this tumor is characterized by vascular proliferation and a circumscribed group of capillaries organized in lobules. It is usually located in the oral cavity and nasal location is less frequent. When it occurs in pregnant women, it is usually referred as pyogenic granuloma gravidarum. In this article we present the case of a pyogenic granuloma gravidarum in a young woman with intermittent epistaxis during the last trimester of pregnancy that did not resolve after childbirth and was treated with transnasal endoscopic resection and cautery at the base of the lesion for hemostasis under local anesthesia.

Combined Laryngocele and External Approach.

Laryngocele, a dilation of the laryngeal saccule, is an uncommon and benign air-filled lesion that expands upwards into the ventricle of Morgagni. A unilateral growth within the larynx that is in communication with the laryngeal lumen typically signals its presence. The exact cause of the disorder remains uncertain, although there are three main theories which suggest congenital reasons, increased pressure in the larynx, or mechanical obstruction of the ventricle of Morgagni. The classification for laryngoceles is based upon their location with respect to the thyrohyoid membrane, and they may be internal, external, or combined. A laryngocele, along with a gradually enlarging submandibular mass, was located in the region from below the hyoid bone to the anterior sternocleidomastoid muscle on the right side of the neck. The diagnosis of a laryngocele may be confirmed through clinical examination, endoscopic investigation and imaging tests. For cases of combined laryngocele, we recommend its removal using an external approach, which not only ensures safety and accuracy but also allows for a complete removal of the laryngocele. Additionally, this approach guarantees that the surgical intervention is carried out with maximum precision and effectiveness, as all procedures will be performed under direct visualization.

The Utility of Stroboscopy in Evaluating Patients with Benign Vocal Fold Lesions.

Purpose: The present study aims to provide a comprehensive analysis of the use of stroboscopy as an assessment tool for patients with benign lesions of the vocal folds. Methods: The current study was based on an extensive review of the international bibliography regarding the evaluation of voice in patients with benign lesions of the vocal cords using videostroboscopy. Results: Stroboscopy is a convenient technique used by otolaryngologists that has been established as a valuable diagnostic tool for assessing patients with dysphonia and benign vocal cords lesions. Conclusions: Stroboscopy is recommended in the literature as the preferred method for assessing vocal cord vibratory function. The future poses challenges in standardizing guidelines and quantifying measurements of stroboscopic findings.

Hereditary Hemorrhagic Telangiectasia With Multiple Ear, Nose, and Throat (ENT) Manifestations: A Case Report.

Hereditary hemorrhagic telangiectasia (HHT), also known as Rendu-Osler-Weber syndrome, is a rare autosomal dominant multisystem disorder. It is a mucocutaneous and fibrovascular dysplasia, the diagnosis of which is based on the fulfillment of the four Curaçao criteria: 1) recurrent epistaxis; 2) dermatovascular mucosal telangiectasias at characteristic sites: skin of the face, ears, fingertips, lips, tongue, and oral and nasal cavity; 3) arteriovenous malformations (AVMs) of visceral organs and central nervous system; and 4) family history: diagnosis of HHT in a first-degree relative. We describe a case of a 76-year-old patient who presented to our department with clinical manifestations of HHT in the skin (face, fingertips), lips, hard palate, tongue, ears, and nasal cavities. Individual and family history was obtained, as well as clinical laboratory examination, pan-endoscopy of the ear, nose, and throat (ENT) systems, and treatment of active foci of bleeding from the above areas. The otolaryngologist may be the first doctor to suspect Rendu-Osler-Weber syndrome and the one responsible for treating patients with HHT since recurrent epistaxis is the most frequent (90-96% of patients) and the earlier manifestation of the disease and the main reason for the arrival of these patients in the Emergency Department. The purpose of this study is to present a clinical case of Rendu-Osler-Weber syndrome with multiple ENT manifestations, as well as a review of the literature on their management and treatment.

Hemorrhage of Upper Digestive and Respiratory Tracts in a Child with Glanzmann Thrombasthenia.

Glanzmann thrombasthenia (GT) is an autosomal recessive platelet disorder that could cause mild to severe bleeding episodes. The incidence is approximately 1 per 1,000,000 births. Patients with GT frequently have mucocutaneous bleeding with absent platelet aggregation in response to all physiologic stimuli, but a normal platelet count and morphology. Specifically, the glycoprotein IIb/IIIa (GP IIb/IIIa) complex is either inadequate or dysfunctional. This case reports a 3.5-year-old boy with Glanzmann thrombasthenia who had two episodes with uncontrolled hemorrhage from upper digestive and respiratory tracts, the first with the bleeding point found in the left tonsil and the second in the adenoids.

Resection of Primary and Recurrent Parapharyngeal Space Pleomorphic Adenomas via a Combined Transcervical-Transparotid Approach: A Case Series.

Primary parapharyngeal space tumors are rare, and due to the complex anatomy of the parapharyngeal space, their diagnosis and treatment are challenging. Pleomorphic adenoma is the most common histologic type followed by paragangliomas and neurogenic tumors. They can present as a neck lump or an intraoral submucosal mass with the displacement of the ipsilateral tonsil or might be asymptomatic and discovered incidentally on imaging obtained for other reasons. Magnetic resonance imaging (MRI) with gadolinium is the imaging of choice. Surgery remains the treatment of choice and many approaches have been described. In this study, we present three patients with PPS pleomorphic adenoma (two primary and one recurrent), which were resected successfully with a transcervical-transparotid approach without mandibulotomy. Division of the following anatomical structures: the posterior belly of the digastric muscle, stylomandibular ligament, stylohyoid muscle and ligament, and styloglossus muscle is a very important tip for the surgeons because enables displacement of the mandible providing excellent exposure for complete tumor excision. The only postoperative complication was temporary facial nerve palsy in two patients who fully recovered within two months. The aim of this mini case series is to present our experience, together with some tips and benefits of the transcervical-transparotid approach for the resection of pleomorphic adenomas of the PPS.

Differential Diagnosis of Cervical Lymph Nodes with Ultrasound and Virtual Touch Imaging Quantification: a Report of Three Cases.

Cervical lymphadenopathy is a common clinical presentation, and its differential diagnosis is challenging. In this article we present three cases with enlarged cervical lymph nodes evaluated with combination of ultrasound (US) and virtual touch imaging quantification (VTIQ) performed by the head and neck surgeon G.P. with a 10-year experience in ultrasound elastography (USE). In the first two cases, US and VTIQ evaluation showed predominance of areas with increased stiffness and higher share wave velocities compared with those in the third case. Malignancy was suspected in the first and second cases. The histology report revealed metastatic squamous cell carcinoma in the first two cases and chronic non-specific lymphadenopathy in the third case. The development of VTIQ share wave elastography has improved the diagnostic accuracy of ultrasonography and can guide clinical decision when dealing with cervical lymphadenopathy.

Management of an Acute Airway Obstruction Due to Tracheal Carcinoma in a Patient With Severe Glottic Stenosis.

In this paper, we present the case of acute airway obstruction due to tracheal carcinoma in a patient with glottic stenosis due to previously treated laryngeal carcinoma. Because of severe dyspnea from the obstructive endotracheal mass, tracheotomy under local anesthesia was immediately performed. Intubation with pediatric size (I.D. 4.5 mm) cuffed endotracheal tube was performed by the surgeon through tracheostomy under endoscopic visualization. Blakesley forceps and electrocautery were used for tumor debulking. Postoperatively there were no complications and the patient was discharged after four days. The histopathology report showed a squamous cell carcinoma. The tumor board decided on adjuvant chemoradiotherapy for the treatment of the patient.

Nasal Valve Management in Rhinoseptoplasty.

Objectives: To provide a detailed description and evaluation of therapeutic techniques for the management of nasal valve in rhinoseptoplasty. Method:An extensive review of the international bibliography has been conducted to highlight published articles on nasal valve pathology and therapeutic measures to address it. Results:To date, many techniques have been described for increasing the cross-sectional area of the nasal valve. Selection of the appropriate technique poses a significant challenge to the nasal valve surgeon. Long-term correction of NVD requires surgical intervention. Correction typically involves the use of various grafts or suture techniques to enlarge and/or support the nasal valve. Selection of the appropriate technique depends on the location and type of dysfunction (dynamic/static). Conclusion:The nasal valve plays an important role in nasal airflow. It is important for the otolaryngologist not only consider, but also fully evaluate the nasal valve when seeing a patient with nasal obstruction. If it is not the primary cause of obstruction, it is often a contributing factor. If NVD is discovered, it should be addressed during surgical intervention (functional rhinoplasty) to avoid a suboptimal outcome.

Can Ultrasound in Combination with Virtual Touch Imaging Quantification Predict the Dignity of a Parotid Tumor?

Pre-operative evaluation of a parotid gland tumor is crucial in guiding treatment. This study evaluates the diagnostic performance of B-mode ultrasound in combination with Virtual Touch imaging quantification (VTIQ) in the assessment of parotid lesions. A prospective study of 268 patients with parotid lesions was conducted. Pre-operative ultrasound findings and VTIQ data were compared against histologic results. Ill-defined margins on ultrasound were associated with a significantly higher risk of malignancy (odds ratio [OR] = 1224.0, 95 % confidence interval [CI]: 151.8-9872.7). Faster mean shear waves on VTIQ (OR = 1.81, 95% CI: 1.47-2.23, per 1 m/s increase) and an area with shear wave velocity >6.0 m/s involving >70 % of the lesion (OR = 19.80, 95 % CI: 6.22-63.07) were associated with higher risk of malignancy. Addition of VTIQ to routine pre-operative B-mode ultrasound can provide supplemental information on the dignity of a parotid tumor, allowing for peri-operative procedural optimization.

Ultrasonography techniques in the preoperative diagnosis of parotid gland tumors - an updated review of the literature.

.

Review of surgical techniques and guide for decision making in the treatment of benign parotid tumors.

PURPOSE: Surgical treatment of benign parotid tumors has developed in the direction of less invasive procedures in recent years and has raised great debate about the best surgical approach. Aim of this article is to analyse anatomical and other factors that are important in selection of the appropriate surgical technique in treatment of benign parotid tumors. Furthermore, to discuss the risk of complications and recurrent disease according to selected operation. Finally, to define patient selection criteria to facilitate decision making in parotid surgery and become a guide for younger surgeons. METHODS: Literature review and authors' personal opinions based on their surgical experience. RESULTS: All possible surgical techniques for benign parotid surgery with advantages and disadvantages are being described. An algorithm with anatomical and other criteria influencing decision making in benign parotid surgery is presented. CONCLUSION: Surgeons nowadays have many options to choose from for benign parotid surgery. ECD is one of the many surgical techniques available in parotid surgery and can achieve excellent results with proper training and if used for proper indications. PSP is mainly indicated in large tumors of the caudal part of the PG (ESGS level II). SP represents a universal solution in parotid surgery and should be the first technique young surgeons learn. TP has only few but important indications in benign parotid surgery. Surgeons need to carefully consider the patient and his/her preoperative imaging as well as her or his own special expertise to select the most appropriate surgical technique.

Significance of Extranodal Extension in Surgically Treated HPV-Positive Oropharyngeal Carcinomas.

Squamous cell carcinomas of the head and neck are the subject of numerous current studies, especially in view of the increasing incidence of tumors induced by human papillomavirus (HPV) and the latest changes to the TNM classification of oropharyngeal squamous cell carcinoma (OPSCC). In addition to HPV status, the presence of extranodal extension of lymph node metastases represents an important risk and prognostic factor, which has now been integrated into the staging algorithm of the eighth edition of TNM classification for HPV-negative OPSCC. In the past numerous studies had shown a lack of prognostic significance of extranodal extension in HPV-associated tumors. However, extranodal extension-as a possible risk factor even in HPV-positive OPSCC-remains an important subject of current studies, which are now particularly characterized by high numbers of cases. In this paper, diagnostic methods and the prognostic significance of extranodal extension in surgically treated HPV-positive OPSCC are presented and discussed based on relevant literature, and the results of current publications are summarized. Further development of diagnostic criteria and procedures as well as international standardization of clinical diagnostics of extranodal extension should be encouraged. Several studies demonstrate that extranodal extension results in worse survival outcomes even in HPV-positive tumors, in contrast to results of previous studies. Consequently, whether the prognostic significance of extranodal extension is not actually relevant to outcome and the staging algorithm of HPV-positive OPSCC should be questioned and further analyzed.

Multimodal Ultrasound Including Virtual Touch Imaging Quantification for Differentiating Cervical Lymph Nodes.

Defining the entity of cervical lymph nodes (LNs) is essential for the diagnosis and staging of head and neck malignancies. Virtual Touch imaging quantification (VTIQ) is a relatively new method of elastography that measures tissue stiffness quantitatively. A prospective study was conducted that included 108 patients (57 benign and 51 metastatic lymph nodes [MLNs]). Shear wave velocities (SWVs) were analyzed using VTIQ and were compared with the histopathological results. Both maximum and minimum SWVs within the LNs significantly differed between benign masses and MLNs (p < 0.001). Percentage areas of the node with SWVs >6 m/s and <3.5 m/s differed significantly (p < 0.001). Intralesional areas with SWVs ≤3.5 m/s of 0-29% (odds ratio: 93.7) and 30%-69% (odds ratio: 46.3) were predictive of malignant LNs as well as ill-defined tumor (odds ratio: 5.2). VTIQ can provide more information on the entity of cervical LNs.

Warthin's tumour seems to be the most common benign neoplasm of the parotid gland in Germany.

PURPOSE: Recent reports indicate an increase in the prevalence of Warthin's tumours (adenolymphoma) with percentages which exceed that of pleomorphic adenomas (PA) in the same registries. The purpose of this study is to analyse a large cohort of benign parotid tumours in relation to various demographic and other patients' characteristics that might affect their incidence. METHODS: A retrospective review of prospective collected data was performed on all patients who have been operated for a parotid mass in the last 5 years. A total of 474 patients with benign lesion were included in the study. Age, gender, smoking status, histological diagnosis, site of lesion, and size of tumour were recorded. RESULTS: Warthin's tumours were the most common benign lesions, found in 201 (42.4%) parotic glands followed by pleomorphic adenomas found in 138 (29.1%) of these surgical cases. Patients with WT had a mean age of 61.6 years instead of 52 years for PA patients (t = 6.589, p < 0.001). The vast majority (93%) of patients with WT had a current or previous history of smoking compared with 47% of PA patients (p = 0.001). There was a male predominance regarding WT with a male:female (M:F) ratio of 2.3:1, whereas the corresponding ratio of PA was 1:1.4. CONCLUSIONS: This study confirms the increased regional prevalence of WT reported in studies mainly carried out in central Europe. This could affect future management of WT, which remains largely controversial due to the extremely low malignant potential reported, concurrently with its higher rates of multiplicity and recurrence, as well as the moderately accurate results of FNA biopsies.

Ultrasound can help to indirectly predict contact of parotid tumors to the facial nerve, correct intraglandular localization, and appropriate surgical technique.

BACKGROUND: The purpose of this prospective study is to evaluate the role of ultrasound in benign parotid tumor surgery, particularly by helping to identify the tumor location and its relationship to the facial nerve (FN) and by predicting the appropriate surgical approach. METHODS: Fifty patients underwent preoperative ultrasound. The course of the FN was indirectly defined, and the following predictions were made: contact of the tumor with the FN, the necessity for intraoperative nerve exposure, localization in the correct parotid lobe, and choice of the appropriate surgical technique. RESULTS: Contact of parotid tumors with the FN was determined with an accuracy of 96%. The need for intraoperative nerve exposure was incorrectly determined only once. The appropriate surgical technique was correctly predicted in 98% of the patients. CONCLUSIONS: Ultrasound is helpful for indirectly predicting the relationship between parotid tumors and the FN. The retromandibular vein is the most important landmark.

Cervical Hyperostosis Leading to Dyspnea, Aspiration and Dysphagia: Strategies to Improve Patient Management.

Diffuse idiopathic skeletal hyperostosis (DISH) is a rare but well known cause of dysphagia. In very few cases aspiration and dyspnea are described as a clinical manifestation. An 82-year-old man presented himself in our clinic with severe dyspnea, aspiration, and pneumonia. After performing a microlaryngoscopy an emergency tracheotomy became necessary. In laryngoscopy a severe bulging of the posterior oropharyngeal and hypopharyngeal wall was detected. The glottis area was not observable and immobilisation of the right vocal cord could be detected. The CT showed anterior osteophytes and ossification of the anterior longitudinal ligament from C2-C7. We performed a panendoscopy in order to explore the upper aerodigestive area. Postoperatively an emergency tracheotomy was needed due to the development of laryngeal edema. The osteophytes were removed in cooperation with the department of orthopaedics. Three months postoperative the patient had no dyspnea or dysphagia, so the tracheotomy could be closed. Cervical hyperostosis is commonly described in elderly patients and usually presenting without symptoms, therefore a surgical treatment is usually not necessary. Nevertheless it can lead to severe morbidity and dyspnea with airway obstruction. Therefore it is essential that cervical hyperostosis is recognized early enough and appropriate treatment is initiated. Flexible endoscopy should be preferred over direct panendoscopy because it could lead to life-threatening edema and a prophylactic tracheostomy should be strongly considered in patients that present with severe dyspnea.