Poland’s syndrome and head-and-neck tumour: an unusual association causing a reconstruction dilemma

Poland's syndrome is a rare congenital anomaly characterized by unilateral chest wall hypoplasia and ipsilateral hand abnormalities. The literature data suggest its sporadic nature. The prevailing theory concerning its cause is hypoplasia of the subclavian artery or its branches, which may lead to a range of developmental changes. Relationships have been demonstrated between tumours and Poland's syndrome and also between tumours and other developmental defects. The explanation may lie in abnormal homeobox and tumour suppressor genes. This paper presents the first literature report of a malignant tonsillo-lingual tumour with metastatic neck involvement in a patient with partial Poland's sequence. In consequence of the aplasia of the pectoralis major muscle, an alternative (a free radical forearm flap) to the routine head-and-neck reconstruction (pedicled pectoralis major flap) was necessitated following tumour excision and radical neck dissection. This case report surveys the diagnostic and therapeutic considerations when previously unnoticed Poland's syndrome is diagnosed in a patient with head-and-neck cancer. One year following major head-and-neck surgery, our patient is tumour-free.

Congenital teratoma of the tongue: a case report and review of the literature

Teratomas of the head and neck are rare. They develop in neonates and are associated with feeding difficulty, airway obstruction, and difficulty in swallowing (which may cause polyhydramnios). Although some tumors consist of immature elements, teratomas of the head and neck are mature in nature, and excision is the most effective treatment. We present a case report of a neonate with a polypoid mass protruding from his mouth. He exhibited respiratory arrest immediately after birth and underwent intubation. The mass, which was completely excised, was histologically identified as a mature teratoma.

Significance of eosinophil counting in tumor associated tissue eosinophilia (TATE)

Eosinophils are present in large numbers in some squamous cell carcinomas of the oral cavity. Whilst it is proposed that they have an 'immuno-protective' effect, this remains unproven. The contradictory reports may be due to inconsistencies in eosinophil counting. Eighty-one cases of squamous cell carcinoma (SSC) of oral tongue were examined. Two methods of eosinophil counting were performed. In the first method (classical), the eosinophils were counted per 10 HPF. In the second method (our so-called density method), the highest eosinophil density per surface area was counted for each case. The two methods were correlated. Using the classical method a number of fields in cases ranked low, contained more than 10 eosinophils. Likewise, some moderate cases contained more than 100 eosinophils. There is poor correlation between the classical and density counts. Nevertheless, good correlation between the two methods could be achieved if the boundaries of the classical method are modified. Eosinophils invariably appear in clusters. We feel that an assessment of density may well be better than classical counting, and have more relationship with function.

[A rare cause of dyspnea on exertion. A 76-year-old retired woman]

Es wird eine 76-jährige Nichtraucherin mit Gesichtshämangiomen und Anstrengungsdyspnoe vorgestellt. Krankheitsbild, Diagnose und Behandlung der pulmonalen AV-Malformation werden diskutiert und ein kurzer Überblick über den Morbus Osler vermittelt.

Anesthésie maternofœtale pour « ex utero intrapartum » traitement (EXIT) procédure : à propos de deux cas

The ex utero intrapartum treatment (EXIT) procedure is a surgical procedure maintaining utero-placental circulation during caesarean section. Anaesthetic implications are described: foetal transplacental anaesthesia to avoid first breathing and to permit surgical procedure on obstructed foetal airway, deep maternal haemodynamically stable anaesthesia to relax uterine smooth muscle during a long caesarean procedure but avoiding post-partum haemorrhage. Volatile anaesthesia with sevoflurane seems to be adequate for these aims. Two cases are described.

Treatment of hemorrhagic lymphatic malformation of the tongue with a pulsed-dye laser

Hemorrhagic lymphatic malformation (formerly called hemolymphangioma) of the tongue is an uncommon malformation that may pose both functional and cosmetic problems for the patient. The challenge has been to find a conservative treatment with low morbidity and better results than those achieved with surgical excision, which has been the mainstay of therapy. We report a case of successful treatment of a hemorrhagic lymphatic malformation of the tongue with a variable-pulse 595-nm pulsed-dye laser (Vbeam; Candela Corp, Wayland, Mass). In this patient, pulsed-dye laser treatment of the hemorrhagic lymphatic malformation achieved satisfactory functional and cosmetic outcomes. Its use in superficial vascular lesions of the mucosa should be considered.

Epignathus combined with cleft palate, lobulated tongue, and lingual hamartoma: Report of a case

A case of epignathus combined with cleft palate, lobulated tongue, and lingual hamartoma is reported. A newborn female presented with a large skin-covered mass arising from the palate, cleft palate, and lobulated tongue with a soybean-sized lingual lesion. The palatal and lingual masses were removed on the 9th day after birth. A cystic lesion was also found on the nasal septum after removal of the palatal mass; this lesion was resected at its base. Glossoplasty was performed after excision of the lingual lesion. Histologically, the palatal mass was diagnosed as epignathus. The cystic lesion was suspected to be meningothelial tissues on the basis of hematoxylin-eosin (HE) and immunohistochemical staining: Vimentin and epithelial membrane antigen were positive, and factor VIII was negative. The mass of the tongue dorsum was diagnosed as hamartoma. No recurrence of epignathus or evidence of meningocele have been observed after 5 years of follow up.

Airway obstruction due to metastatic renal cell carcinoma to the tongue

Metastatic lesions in the tongue are extremely rare. Renal cell carcinoma is the most frequent kidney neoplasm, with a high tendency to metastasize. It is the third most frequent neoplasm to metastasize to the head and neck region. We report a case of a rapidly enlarging tongue metastasis causing airway obstruction in a patient with widespread disease. Local excision was the elected treatment to provide palliation of the obstruction.

Dental Care Management of a Young Patient with Extensive Lymphangioma of the Tongue: A Case Report

Lymphangiomas are benign tumors resulting from a congenital malformation of the lymphatic system. Relatively uncommon, lymphangiomas are usually diagnosed at birth and develop within the first years of life. When these tumors occur in the oral cavity, the tongue is the most frequently affected site. Lymphangioma of the tongue is a common cause of macroglossia in children, which may lead to a dry/cracked tongue with ulcerating secondary infections, difficulty in swallowing and mastication, speech disturbances, exclusive nasal breathing, airway obstruction, mandibular prognathism and other possible deformities of maxillofacial structures. This paper discusses the most relevant features, clinical manifestations, disease-related impairments and treatment options for lymphangioma of the tongue. It presents the case report of a five-year-old child diagnosed with this lesion, including a description of the patient's dental care management.

[Palatograms and linguograms for studying misarticulation following surgery for tumors of the tongue and oral cavity floor]

This work deals with the mechanism of misarticulation following surgery for malignancies in the oral cavity. The underlying cause was dysfunction of the tongue due to partial or total resection, consequences of the resection of the mandible together with the oral cavity floor, or dysfunkction of the lower lip failing to seal the space of Donders. Anatomic alternations reveal themselves as shifts in the points of contact between structures of the articulation system noticeable on palatograms or linguograms. Limited mobility of tongue tip may affect speech, particularly in the case of sounds of the first and second articulation zone.

[The untold suffering. Psychosocial consequences of tongue tumor]

It is evident from literature that is no clear picture of the psychosocial factors that play a role in the way patients with tongue neoplasms cope with their defects and their treatment. The most significant component of the impact of postoperative disfigurement and dysfunction appears within a social context where the drastic alteration in anatomic contour interrupts the visual impression ordinarily provided by the face in social interation. Physological, psychological, and social adaptation to postsurgical defects can indeed be facilitated with proper intervention. The deepest and initial suffering is often silent and unarticulated. The tendency toward silence appeared to have been reinforced by emotionally traumatic expierences in early life. . In the existential dimension of suffering, one is searching for one's own of giving the suffering meaning and the fight for hope and life. The struggling act of suffering demads a compassonate other to confirm suffering.

[Evaluation of oral and pharyngeal phase of swallowing after glossectomy due to neoplasm]

INTRODUCTION

Glossectomy is a disability that leads to dysphagia.

AIM

To define oral and pharyngeal dysfunctions with regard to the extent of tongue excision and swallowing efficiency.

MATERIAL AND METHODS

62 patients were videofluoroscopically examined 2 weeks to 3 months after surgery. Oral and pharyngeal disturbances were analyzed according to W.J. Dodd.

RESULTS

Impaired tongue movement and absence of oral transport were the most frequent oral dysfunctions. Lack of glossopharyngeal closure and abnormal epiglottis mobility were the most frequent pharyngeal dysfunctions.

CONCLUSIONS

Oral phase abnormalities are the result of resection of anatomical structures, while pharyngeal abnormalities are due to a delay in pharyngeal phase initiation and defect of synchronization. Videofluoroscopy is a fundamental method to define oral and pharyngeal dysfunction.

Hemimacroglossia Caused by Isolated Plexiform Neurofibroma: A Case Report

OBJECTIVES

The present case is a diffuse isolated plexiform neurofibroma of the tongue that was not associated with neurofibromatosis that we treated with intraoral surgery.

STUDY DESIGN

A case report.

METHODS

We present a 5-year-old girl with isolated plexiform neurofibroma of the tongue with infiltration of the tongue base and review treatment approaches for this very rare tumor.

RESULTS

An intraoral approach appears to be a good alternative method that allows both an acceptable exposure for total excision and limited postoperative sequelae.

CONCLUSIONS

Isolated plexiform neurofibroma of the tongue is very rare. It causes a massive macroglossia that is progressive with advance of years and disturbs the patient's speech, occlusion, and tongue movements. Involvement of the tongue may be associated with infiltration into the deep structures of the neck by the tumor, thereby presenting considerable operative difficulties.

[Teratoid cyst: a rare tongue tumor in children]

BACKGROUND

Dermoid cysts are rare benign tumours (only 20 cases have been reported) with 3 different histological types. Only 5 cases of teratoid cyst of the tongue have been described in the world literature, characterized by a respiratory cilied epithelium.

OBSERVATION

We report the sixth case, in a one-year-old boy with a macroglossia and permanent protrusion of the tongue. Ultrasonography showed a kystic, ovoid, homogeneous cyst. Treatment was a surgical resection.

DISCUSSION

This case is similar to the other cases reported in the literature.

[Diagnosis image (251). A man with a tongue ulcer]

A 23-year-old man presented with a left-sided tongue ulcer caused by a squamous cell carcinoma.

Oral lymphangioma: a case report

Lymphangiomas are congenital malformations of lymphatic vessels filled with a clear protein-rich fluid containing few lymph cells. It can also occur in association with hemangioma. Large lymphangioma extending into the tissue spaces of neck is referred to as cystic hygroma. Herewith, we present a case of cystic hygroma associated with lymphangioma of tongue leading to macroglossia in a 5-year-old boy.

Increased incidence of carcinoma of the tongue in patients with systemic sclerosis

OBJECTIVE

To describe the incidence of carcinoma of the tongue in a large cohort of patients with systemic sclerosis (SSc).

METHODS

In total, 769 patients with SSc were prospectively followed over 16 years for the development of cancer. Patients with a diagnosis of carcinoma of the tongue were identified to determine the incidence of this cancer in SSc. The results were compared to the incidence of tongue cancer in the SEER cancer registries.

RESULTS

A total of 3775 patient-years of followup of 769 patients with SSc (392 diffuse cutaneous, 377 limited cutaneous) prospectively evaluated for the occurrence of cancer disclosed 9 patients who were diagnosed with oral cavity and pharyngeal carcinomas. Six of these patients had squamous cell carcinoma of the tongue. One of these had both pharyngeal and tongue squamous cell carcinomas within a 4-year period, and another had 3 separate squamous cell carcinomas of the tongue. The standardized incidence ratio of squamous cell carcinoma of the tongue observed in this cohort of patients with SSc was 25-fold higher than that expected in an age adjusted population from the SEER cancer registries. All patients with SSc identified within this cohort with oral cavity carcinomas had the diffuse subset of the disease.

CONCLUSION

There is a highly significant increase in the incidence of squamous cell carcinoma of the tongue in patients with SSc. A remarkable observation was that all patients within this cohort who developed oral cancer had the diffuse subset of SSc. This suggests a relationship between the etiology or pathogenesis of the diffuse form of SSc and development of squamous cell carcinoma of the tongue in this group of patients.

Decreased tongue mobility -- an explanation for difficult endotracheal intubation?

Established parameters predictive of difficulty in airway management were inconclusive in five ear, nose and throat (ENT) patients. All presented with degrees of tongue fixation - restriction of movement. Initially, experienced anaesthetists concluded that conventional endotracheal intubation would present no problems. Later, there were adjustments to this conclusion, with the ultimate being that four of the patients underwent fibre-optic intubation: one electively, two after repeated failed conventional attempts and one after a failed attempt of retrograde intubation. The last patient underwent elective retrograde intubation. All intubations were performed uneventfully in anaesthetized or sedated patients under spontaneous respiration. We found that tongue fixation was a direct cause of failed conventional endotracheal intubation, and recommend that a detailed tongue status investigation should be routine during Mallampati evaluation. Any abnormality should be seen as predictive of difficult/impossible conventional direct laryngoscopic intubation.

[Two tracheal tubes inserted for endotracheal tube replacement in a patient with severe obstructive sleep apnea: a case report]

A 34-year-old obese, small-jawed and short-necked woman, had severe obstructive sleep apnea syndrome (OSAS) with bronchial asthma. A surgical removal of a lingual tumor using a laser knife was scheduled under general anesthesia with sevoflurane. A small diameter tracheal tube for laser surgery (internal diameter (ID) of 5.5 mm) was used. The tube was inserted using bronchofiberscopy under spontaneous respiration. Extubation was designed to be performed when the patient resumed adequate spontaneous respiration and was awake. However, her ventilation deteriorated postoperatively as spontaneous breathing continued (PaO2 98 mmHg, PaCO2 88 mmHg at FIO2 1.0). This seemed to have been induced by worsened patient-ventilator synchrony and increased airway resistance due to the use of a small diameter tube. We decided to replace the tube with the one with larger diameter. An ID 7.5 mm tube was inserted with the use of fiberscope through the opening of the vocal cord while the tube for laser surgery was left in space. After confirming that the two tubes were inserted securely, the tube for laser surgery was withdrawn. The patient's ventilation improved significantly afterwards and the extubation was performed successfully. Our method for replacing a tracheal tube seemed to be effective and safe.