Synchronous or metachronous lymphoma and metastatic cutaneous squamous cell carcinoma in the head and neck region: a diagnostic and management dilemma.

OBJECTIVE: To review our experience of managing patients with a dual diagnosis of metastatic cutaneous squamous cell carcinoma in the head and neck region and low-grade non-Hodgkin lymphoma. The secondary aim was to evaluate the utility of 18F-fluorodeoxyglucose positron emission tomography during diagnosis. METHODS: Patients diagnosed with metastatic cutaneous squamous cell carcinoma of the head and neck and low-grade non-Hodgkin lymphoma, in a five-year period, were identified. Patient, tumour and treatment characteristics were identified. 18F-fluorodeoxyglucose positron emission tomography imaging was reviewed and correlated with histopathology findings. RESULTS: Eight patients were identified. There was a delay in diagnosis of metastatic squamous cell carcinoma in two patients. 18F-fluorodeoxyglucose positron emission tomography differentiated metastatic squamous cell carcinoma from low-grade non-Hodgkin lymphoma with a sensitivity of 88.2 per cent and a specificity of 94.7 per cent. In 38 per cent of patients, compromises in management had to be made. CONCLUSION: The management of metastatic squamous cell carcinoma can be challenging in patients with low-grade non-Hodgkin lymphoma. 18F-fluorodeoxyglucose positron emission tomography can be useful in the diagnosis of metastatic squamous cell carcinoma in patients with low-grade non-Hodgkin lymphoma.

Outcome and relative cost of transoral removal of submandibular calculi.

OBJECTIVE: To examine the outcomes and treatment cost of transoral removal of submandibular calculi, and to compare the outcomes and costs of other reported techniques. METHOD: Retrospective review of 60 consecutive patients undergoing transoral removal of submandibular calculi. All clinical, operative, post-operative and follow-up data were collated and outcomes analysed. RESULTS: A total of 61 submandibular glands were treated by the transoral approach. Patients with multiple stones (p = 0.034) and stones in the proximal submandibular duct (p = 0.0028) were at greater risk of requiring submandibular gland excision, compared with patients with single stones and stones in the distal duct, respectively. There was a significant difference between the gland preservation rate during the first versus the second half of the study (p = 0.028). Larger calculi were significantly more likely to be seen in the proximal duct (p < 0.001). The mean operating time (28 minutes) and length of hospital stay for transoral removal of submandibular calculi was much less than those for other treatment techniques.

A recurrent nasopharyngeal carcinoma with lacrimal sac involvement: a case report.

We report a very rare case of recurrent nasopharyngeal carcinoma with local involvement of lacrimal sac. The patient was treated with chemotherapy and there was no recurrence noted after 1 year of follow-up.

A review of parotid tumours and their management: a ten-year-experience.

To review the demographics, management and outcome of patients undergoing parotidectomy at a tertiary center. A total of 76 patients who underwent parotidectomies from January 1996 to December 2005 at the ORL department of our center were reviewed. All clinical, operative, postoperative, histology data were gathered and reviewed. Fine-needle aspiration cytology (FNAC) was diagnostic in 90% of patients with a sensitivity of 76% and specificity of 96%. Twenty-one patients had malignant tumours and the rest had benign or inflammatory lesions. There were a total of 48 superficial and 28 total parotidectomies performed. Facial nerve palsy occurred in 30 (39%) patients with 4% permanent palsy and 35% temporary palsy. The recurrence rate of pleomorphic adenoma was 2.6%. FNAC and CT scan were performed prior to the surgery were useful guidance in planning the operation but clinical judgment is more important. The most common surgery performed was superficial parotidectomy and the most common cause was due to pleomorphic adenoma. The incidence of complications and recurrence of tumour are comparable to other international studies. Prior knowledge of anatomy and careful planning is needed to decrease the incidence of facial nerve palsy.

Aneurysmal bone cyst of the maxilla.

An aneurysmal bone cyst is a rare bone lesion. Its origin and precise nature remain unknown. It is seen as a locally-destructive, rapidly expandable, benign multicystic mass. We report a 17-year-old boy with an aneurysmal bone cyst of the maxilla, with extensive local involvement and bony destruction that was treated surgically. There was no recurrence noted after four years of follow-up.

Juvenile nasopharyngeal angiofibroma in a tertiary centre: ten-year experience.

INTRODUCTION: This is a retrospective study that aimed to examine the outcomes of patients presenting with juvenile nasopharyngeal angiofibroma (JNA) at a tertiary centre in Malaysia. METHODS: The demographical data, clinical presentation, investigations as well as treatment of 13 JNA patients were reviewed and collected from the medical record office at our centre from 1995 to 2005. RESULTS: All JNA patients were male and the average age at diagnosis was 17 (range 14-28) years. They presented with recurrent painless spontaneous epistaxis, nasal obstruction, nasal discharge, a reduced sense of smell, snoring, headache and facial swelling. One patient was at stage I, eight were at stage II, three at stage III and one patient was at stage IV, based on the Fisch classification. Angiography showed that nine tumours were supplied by both internal maxillary arteries of the external carotid system, and only four tumours received blood supply from the ipsilateral internal maxillary artery. All 13 patients underwent primary surgical resection. The overall recurrence rate was 38.5 percent for the first procedure and 60 percent for the second procedure. No major complications occurred in this group of patients as a consequence of treatment, neither for the primary tumours nor for the recurrences. CONCLUSION: JNA is a rare vascular benign tumour with highly exclusive persistence and recurrence, and typically affects adolescent boys. The management of JNA presents a challenge to ENT surgeons. Preoperative angiography and embolisation minimise intraoperative blood loss and the current shift in the treatment to endoscopic excision in selected lesions reduces perioperative morbidity.

Outcome of patients presenting with idiopathic facial nerve paralysis (Bell's palsy) in a tertiary centre--a five year experience.

This is a retrospective study. The objective of this study is to review the factors influencing the outcome of treatment for the patients presented with idiopathic facial nerve paralysis. The demographic data, clinical presentation and management of 84 patients with idiopathic facial nerve paralysis (Bell's palsy) were collected from the medical record office, reviewed and analyzed from 2000 to 2005. Thirty-four (72.3%) out of 47 patients who were treated with oral prednisolone alone, fully recovered from Bell's palsy meanwhile 36 (97%) out of 37 patients who were treated with combination of oral prednisolone and acyclovir fully recovered. The difference was statistically significant. 42 (93.3%) out of 45 patients who presented within three days to our clinic, fully recovered while 28 (71.8%) out of 39 patients presented later then three days had full recovery from Bell's palsy. The difference was statistically significant. The outcome of full recovery is better with the patients treated with combined acyclovir and prednisolone compared with prednisolone alone. The patients who were treated after three days of clinical presentation, who were more than 50 years of age, who had concurrent chronic medical illness and facial nerve paralysis HB Grade IV to VI during initial presentation have reduced chance of full recovery of facial nerve paralysis.

Endoscopic orbital decompression for Graves' ophthalmopathy.

We report a male patient of Graves' Disease with bilateral exophthalmos who had undergone bilateral transnasal endoscopic orbital decompression with subsequent improvement of 3 mm in orbital proptosis bilaterally without any complications. Transnasal endoscopic orbital decompression is recommended as an alternative to traditional decompression techniques especially for purely cosmetic reasons.

Outcome of patients with head and neck cancers: 10-year experience of a otorhinolaryngology--head and neck unit in a tertiary hospital of a developing country.

Being a rapidly developing country, a study was needed to see how we faired in treating head and neck cancer patients compared with international standards. Although being a retrospective study, this research shows that there is still a lot to be done in our developing nation in educating the general public about head and neck cancers as most of them presented in the later stages to us. There also needs to be a proper review about the treatment modality offered to patient as our survival results are far behind in certain categories of cancers compared with the developed nations.

Fracture synthetic tracheostomy tube: an ENT emergency.

A synthetic tracheostomy tube [non-metallic type] fracturing within three days of insertion is very rare but it could lead to serious complications such as acute asphyxia or sudden death. We report three such cases at our centre. Recommendations are made to closely observe patients on tracheostomy tube in the first seven days post-insertion of the tube.

Foreign body in the middle ear, a hearing aid complication.

A 12-year-old boy with moderate to severe bilateral mixed hearing loss was planned for hearing aid placement. During the process of making ear mould impression, the impression material accidentally entered the right middle ear. Removal of the ear mould impression was possible permeatally under general anaesthesia.

Outcome of patients presenting with preauricular sinus in a tertiary centre--a five year experience.

We reviewed the recurrence rate and possible factors influencing recurrence of preauricular sinus after excision. Seventy-one patients with 73 preauricular sinuses seen at our centre from year 2000 to 2005 were reviewed in this study. The overall recurrence rate was 14.1%. Twelve sinuses needed to be drained for an abscess prior to a definitive surgery. Different modalities used in demonstrating the sinus tract between methylene blue alone and probing together with methylene blue, showed different outcomes, which were statistically significant with a p value of < 0.05(chi-square test). A preauricular sinus with a previous history of infection or actively infected during the definitive surgery may have a higher tendency of recurrence. Meanwhile demonstrating the sinus tract by probing with lacrimal probe/sinus probe followed by injection of methylene blue reduces the recurrence rate (p < 0.05 with chi-square test).

Intermittent respiratory obstruction secondary to an antro chonal polyp: a rare late presentation.

We describe a child who presented with intermittent respiratory obstruction especially in supine position. Examination revealed a fleshy post nasal mass extending up to the oropharynx. The mass was removed surgically and histopathology revealed an antrochonal polyp. Patient was relieved of his symptoms and has been well ever since.

Intermittent respiratory obstruction secondary to a solitary fibrous tumour.

There have been fourteen cases of solitary fibrous tumour reported as originating from the paranasal sinuses. Here we report a case of solitary fibrous tumour that involved the right nasal cavity with extension into the oropharynx causing stertor and intermittent respiratory obtruction. Histopathology examination revealed the tumuor cells expressed CD34 turnout marker.