Volume 3 Issue 1 (2013)

A subset of metastatic squamous cell carcinoma of the head and neck presents as cystic masses in the neck. Often, distinguishing between these cystic metastases of squamous cell carcinoma from benign cystic neck lesions, such as branchial cleft cyst, can be very challenging. Squamous lining cells in benign cystic lesions may exhibit significant cytologic atypia, raising concern for squamous cell carcinoma. The challenge in distinguishing benign from malignant cystic squamous lesions of the neck is made more difficult when evaluating fine needle aspiration biopsies given the limited sample size. Herein, three patients with branchial cleft cysts are presented. All were initially diagnosed as metastatic squamous cell carcinomas. The importance of interpretation of fine needle aspiration cytology by an experienced cytologist is emphasized to avoid the possibility of excising metastatic squamous cell carcinomas, which could lead to unnecessary surgical procedures such as radical neck dissection.

Leukotriene receptor antagonists and antihistamines are efficient in reducing symptoms of allergic rhinitis and asthma when used alone or in combination. In patients with allergic rhinitis, H1-antihistamines prevent and relieve the sneezing, itching, rhinorrhea, and nasal congestion that characterize the early and the late response to allergen. H1-antihistamines are not medications of choice in asthmatic patients, but controlling rhinitis will improve asthma concomitantly. Leukotriene antagonist such as montelukast may be an alternative treatment for mild persistent asthma as monotherapy where inhaled corticosteroid cannot be administered or alternative to long-acting beta agonist as an add-on therapy to ICS for moderate to severe persistent asthma. Although montelukast is an effective drug in allergic rhinitis indicated as monotherapy, but widely recommended as adjunct to antihistamine or intranasal corticosteroid. Antileukotriene agents are also widely used in the treatment of pediatric asthma. In children, maintenance treatment with inhaled corticosteroids in pure episodic (viral) wheeze was ineffective, but maintenance as well as intermittent montelukast was shown to have an efficient role in both episodic and multi trigger wheeze. Furthermore, their advantage to inhaled corticosteroids is that leukotriene receptor antagonists do not affect short-term lower leg growth rate in prepubertal children.

Objective: Although bleeding due to head and neck cancer infiltration is a rare complication, it may be life threatening and requires urgent intervention. The aim of this study was to investigate the efficiency of carotid artery ligation applications on bleeding patients with advanced head and neck cancer.

Methods: Urgent carotid artery ligation performed in the last 8 years for abundant bleeding in 12 patients with advanced stage head and neck cancer were analyzed retrospectively. The patients were evaluated in terms of demographic characteristics, diagnoses, treatment approaches, neurological complications and mortality.

Results: Mean age of 12 patients included in the study was 49.7±9.4 (range 37-69), two of them were females (16.7%) and 10 were males (83.3%). Ten patients were diagnosed as carcinoma of larynx or hypopharynx, whereas one patient had nasal malign melanoma and one patient had buccal carsinoma. Abundant bleeding was observed in patients with recurrent disease after surgery and radiotherapy (n=7), applied radiotherapy or chemoradiotherapy as considered inoperable (n=2), received no treatment (n=2) and patient with recurrence after surgery (n=1). Common carotid artery ligation was performed in 10 patients and external carotid artery ligation was performed in two patients and hemostasis was achieved in all of them. No neurological complications or postoperative mortality were observed in any patients after ligation.

Conclusion: In our study, it was observed that application of urgent carotid artery ligation was successful in patients with bleeding due to advanced head and neck surgery. Therefore, it was concluded that carotid artery ligation was a safe and effective method for bleeding due to tumor infiltration.

Objective: The aim of this study is to investigated the relationship between H. pylori IgG positivity, total antioxidant capacity (TAC), total oxidant level (TOL) and oxidative stress index (OSI) in patients with laryngopharyngeal reflux (LPR).

Methods: A total of 48 patients with laryngopharyngeal reflux (LPR) were included into the study group. Of these patients, 20 with H. pylori IgG (-), LPR (+) were included into Group 2; and 28 patients with H. pylori IgG (+), LPR (+) were included into Group 3. The control group (Group 1) consisted of 19 healthy subjects. In all groups, total antioxidant capacity, total oxidant level and oxidative stress index were studied.

Results: Group 3's total oxidant level values were significantly higher than those of Group 1 (p=0.000) and Group 2 (p=0.000); and Group 2's total oxidant level values were significantly higher than Group 1. Group 3's oxidative stress index values were significantly higher than those of Group 1 (p=0.000) and Group 2 (p=0.000), and Group 2's oxidative stress index values were significantly higher than Group 1 (p=0.001).

Conclusion: The presence of LFR alone, or LFR and increase in the level of serum IgG antibody developed against H. pylori, lead to increase in total oxidant level and oxidative stress index. Both LPR and to be infected with H. pylori and development of H. pylori IgG antibodies lead to an increase in total oxidant level and oxidative stress index; and an increase in free radicals ultimately lead to an increase in oxidative stress in the body.

Objective: To review and evaluate clinically and histopathologically a wide spectrum of thyroid surgery cases in our hospital, and to make a comparison between the results obtained and the complications encountered to the available data in the pertinent literature.

Methods: A total of 462 patients who underwent thyroidectomy between January 2006 and June 2012 were evaluated retrospectively depending on their age, gender, scope of surgical operations, duration of surgery, complications involved, and the histopathological results.

Results: The number of near-total thyroidectomy surgeries performed was161 (34.84%), Dunhill procedure was 156 (33.76%), subtotal thyroidectomy was 91 (19.69%), and total thyroidectomy was 54 (11.68%). In the histopathological evaluation, 435 of them were (94.1%) benign and 27 (5.8%) of them were of malignant thyroid mass. The number of benign thyroid pathologies was reported as 25 (5:41%) for Hashimoto's thyroiditis, 40 (8.65%) for chronic lymphocytic thyroiditis, 2 (0.43%) for granulomatous thyroiditis, 33 (7.14%) for follicular adenoma, and 335 (72.5%) for nodular regenerative hyperplasia. Twenty-seven patients (6.2%) were diagnosed as malignant and 26 of them were papillary carcinoma and1 of them was follicular carcinoma. Follow-up thyroidectomy was performed in 8 cases of malignancies and3 of them underwent neck dissection. Complications were seen in 39 (8.44%) patients in the postoperative period. Unilateral permanent vocal cord paralysis was detected in 14(3.03%) and bilateral permanent vocal cord paralysis were detected in 2 (0.43%) patients.

Conclusion: Differentiation of thyroid masses as benign or malignant through ultrasound-guided fine needle aspiration biopsy should be performed more often to avoid unnecessary thyroidectomies. If any suspicious thyroid mass suggesting malignancy is present, near-total thyroidectomy or total thyroidectomy has to be performed firstly.

Objective: This study is performed to compare thermal welding tonsillectomy (TWT) technique versus cold knife tonsillectomy (CKT) technique under consideration of postoperative pain, intraoperative bleeding, operation time, and tonsil size.

Methods: One hundred and three patients underwent tonsillectomy aged between 5 and 39 years were included into the study. Tonsil sizes were classified with Brodsky’s tonsil scale system ranging from 0-4. Duration of the operation and the amount of bleeding were recorded. Postoperative pain was evaluated via visual analogue scale and face pain scale on the 1st, 3rd, 7th and 14th postoperative days.

Results: Mean operative time was lower in TWT group than CKT group (p0.05).

Conclusion: In the present study, it was concluded that the tonsil size does not affect the amount of intraoperative bleeding however increase in the tonsil size decreases the postoperative pain.

Objective: To evaluate the oncologic results from our experience in performing laryngectomy for patients with supraglottic laryngeal cancer.

Methods: Seventy five consecutive patients who underwent laryngectomy for laryngeal cancer in our department from January 1998 to December 2006 have been reviewed. Seventy two males and 3 females were involved. Their ages ranged from 35 to 70 (average 53.64±8.27) years. Reports of the site and stage of tumor, preoperative or postoperative radiotherapy, complications and the histopathologic examination were reviewed.

Results: All tumors were squamous cell carcinoma originating at the supraglottis. Most cancers (73.4%) were classified as stage III/IV. Surgical techniques were including supraglottic partial laryngectomy (n=15, 20%), supracricoid partial laryngectomy (n=3, 4%), total laryngectomy (n=57, 76%). Bilateral (73, 97.3%) and unilateral (2, 2.7%) neck dissections were performed. Fourty patients were treated by radiotherapy after surgery. Regional recurrence occurred in 5 cases. Local recurrence occurred in 2 patients. Median follow-up time was 46.25±23.90 months. The overall survivals were 86.6% for all stages.

Conclusion: Stage of tumor and neck should be evaluated carefully before the treatment of laryngeal cancer. Treatment should be specific for patient and ideas of patient must be taken into consideration.

Objective: To evaluate the prevalence and types of both concha bullosa and nasal septal deviation and determine their potential relationships with maxillary rhinosinusitis.

Methods: Patients admitted to the outpatient clinic of the otorhinolaryngology department with symptoms of rhinosinusitis between January 2009 and April 2010, were retrospectively enrolled in the study. Paranasal sinus computed tomography scans were reviewed for the presence, side and type of concha bullosa, and nasal septal deviation along with rhinosinusitis.

Results: Totally 162 patients (324 sides) were studied. Concha bullosa and nasal septal deviation incidences were 42.6% and 46.9%, respectively. The relationship between nasal septal deviation and the presence of concha bullosa was not statistically significant (p=0.06). A total of 45.1% of patients had evidence of maxillary rhinosinusitis. The involvement of the other sinuses was frontal in 28 (17.3%), ethmoid in 48 (29.6%) and sphenoid in 26 (16%) patients. When the location of sinus involvement was taken into consideration, the maxillary rhinosinusitis was more frequently involved in cases with concha bullosa (p=0.04). There was a relationship between right concha bullosa (p=0.013), left concha bullosa (p=0.034), presence of reverse curvature (p=0.043), obliteration of osteomeatal complex (p=0.0008) and rhinosinusitis. There was a relationship between the degree and type of concha bullosa and rhinosinusitis (p=0.030). Rhinosinusitis was detected more frequently (55.5%) in cases with extensive type concha bullosa.

Conclusion: Concha bullosa is a frequently encountered variation and leads to susceptibility to rhinosinusitis. For this reason, preoperative and premedicative computed tomography scan is important for the sinus, especially extensive type concha bullosa.