Treatment of allergic rhinitis during and outside the pollen season using mobile technology. A MASK study

Background

The analysis of mobile health (mHealth) data has generated innovative insights into improving allergic rhinitis control, but additive information is needed. A cross-sectional real-world observational study was undertaken in 17 European countries during and outside the estimated pollen season. The aim was to collect novel information including the phenotypic characteristics of the users.

Methods

The Allergy Diary–MASK-air–mobile phone app, freely available via Google Play and App, was used to collect the data of daily visual analogue scales (VASs) for overall allergic symptoms and medication use. Fluticasone Furoate (FF), Mometasone Furoate (MF), Azelastine Fluticasone Proprionate combination (MPAzeFlu) and eight oral H1-antihistamines were studied. Phenotypic characteristics were recorded at entry. The ARIA severity score was derived from entry data. This was an a priori planned analysis.

Results

9037 users filled in 70,286 days of VAS in 2016, 2017 and 2018. The ARIA severity score was lower outside than during the pollen season. Severity was similar for all treatment groups during the pollen season, and lower in the MPAzeFlu group outside the pollen season. Days with MPAzeFlu had lower VAS levels and a higher frequency of monotherapy than the other treatments during the season. Outside the season, days with MPAzeFlu also had a higher frequency of monotherapy. The number of reported days was significantly higher with MPAzeFlu during and outside the season than with MF, FF or oral H1-antihistamines.

Conclusions

This study shows that the overall efficacy of treatments is similar during and outside the pollen season and indicates that medications are similarly effective during the year.

Correlation between work impairment, scores of rhinitis severity and asthma using the MASK-air® App

BACKGROUND

In allergic rhinitis, a relevant outcome providing information on the effectiveness of interventions is needed. In MASK-air (Mobile Airways Sentinel Network), a visual analogue scale (VAS) for work is used as a relevant outcome. This study aimed to assess the performance of the work VAS work by comparing VAS work with other VAS measurements and symptom-medication scores obtained concurrently.

METHODS

All consecutive MASK-air users in 23 countries from 1 June 2016 to 31 October 2018 were included (14 189 users; 205 904 days). Geolocalized users self-assessed daily symptom control using the touchscreen functionality on their smart phone to click on VAS scores (ranging from 0 to 100) for overall symptoms (global), nose, eyes, asthma and work. Two symptom-medication scores were used: the modified EAACI CSMS score and the MASK control score for rhinitis. To assess data quality, the intra-individual response variability (IRV) index was calculated.

RESULTS

A strong correlation was observed between VAS work and other VAS. The highest levels for correlation with VAS work and variance explained in VAS work were found with VAS global, followed by VAS nose, eye and asthma. In comparison with VAS global, the mCSMS and MASK control score showed a lower correlation with VAS work. Results are unlikely to be explained by a low quality of data arising from repeated VAS measures.

CONCLUSIONS

VAS work correlates with other outcomes (VAS global, nose, eye and asthma) but less well with a symptom-medication score. VAS work should be considered as a potentially useful AR outcome in intervention studies.

Guidance to 2018 good practice: ARIA digitally-enabled, integrated, person-centred care for rhinitis and asthma

Aims

Mobile Airways Sentinel NetworK (MASK) belongs to the Fondation Partenariale MACVIA-LR of Montpellier, France and aims to provide an active and healthy life to rhinitis sufferers and to those with asthma multimorbidity across the life cycle, whatever their gender or socio-economic status, in order to reduce health and social inequities incurred by the disease and to improve the digital transformation of health and care. The ultimate goal is to change the management strategy in chronic diseases.

Methods

MASK implements ICT technologies for individualized and predictive medicine to develop novel care pathways by a multi-disciplinary group centred around the patients.

Stakeholders

Include patients, health care professionals (pharmacists and physicians), authorities, patient’s associations, private and public sectors.

Results

MASK is deployed in 23 countries and 17 languages. 26,000 users have registered.

EU grants (2018)

MASK is participating in EU projects (POLLAR: impact of air POLLution in Asthma and Rhinitis, EIT Health, DigitalHealthEurope, Euriphi and Vigour).

Lessons learnt

(i) Adherence to treatment is the major problem of allergic disease, (ii) Self-management strategies should be considerably expanded (behavioural), (iii) Change management is essential in allergic diseases, (iv) Education strategies should be reconsidered using a patient-centred approach and (v) Lessons learnt for allergic diseases can be expanded to chronic diseases.

MASK 2017: ARIA digitally-enabled, integrated, person-centred care for rhinitis and asthma multimorbidity using real-world-evidence

mHealth, such as apps running on consumer smart devices is becoming increasingly popular and has the potential to profoundly affect healthcare and health outcomes. However, it may be disruptive and results achieved are not always reaching the goals. Allergic Rhinitis and its Impact on Asthma (ARIA) has evolved from a guideline using the best evidence-based approach to care pathways suited to real-life using mobile technology in allergic rhinitis (AR) and asthma multimorbidity. Patients largely use over-the-counter medications dispensed in pharmacies. Shared decision making centered around the patient and based on self-management should be the norm. Mobile Airways Sentinel networK (MASK), the Phase 3 ARIA initiative, is based on the freely available MASK app (the Allergy Diary, Android and iOS platforms). MASK is available in 16 languages and deployed in 23 countries. The present paper provides an overview of the methods used in MASK and the key results obtained to date. These include a novel phenotypic characterization of the patients, confirmation of the impact of allergic rhinitis on work productivity and treatment patterns in real life. Most patients appear to self-medicate, are often non-adherent and do not follow guidelines. Moreover, the Allergy Diary is able to distinguish between AR medications. The potential usefulness of MASK will be further explored by POLLAR (Impact of Air Pollution on Asthma and Rhinitis), a new Horizon 2020 project using the Allergy Diary.

Geolocation with respect to personal privacy for the Allergy Diary app - a MASK study

Background

Collecting data on the localization of users is a key issue for the MASK (Mobile Airways Sentinel networK: the Allergy Diary) App. Data anonymization is a method of sanitization for privacy. The European Commission's Article 29 Working Party stated that geolocation information is personal data.To assess geolocation using the MASK method and to compare two anonymization methods in the MASK database to find an optimal privacy method.

Methods

Geolocation was studied for all people who used the Allergy Diary App from December 2015 to November 2017 and who reported medical outcomes. Two different anonymization methods have been evaluated: Noise addition (randomization) and k-anonymity (generalization).

Results

Ninety-three thousand one hundred and sixteen days of VAS were collected from 8535 users and 54,500 (58.5%) were geolocalized, corresponding to 5428 users. Noise addition was found to be less accurate than k-anonymity using MASK data to protect the users' life privacy.

Discussion

k-anonymity is an acceptable method for the anonymization of MASK data and results can be used for other databases.

Association between the increase in incidence of papillary thyroid carcinoma in Crete and exposure to radioactive agents

The mean gamma-ray distribution in Crete during the years after the nuclear accident at Chernobyl and its correlation with the Papillary Thyroid Cancer (PTC) distribution was identified. A total of 4285 patients underwent total thyroidectomy in our centre between 1990 and 2012. Data of gamma-ray (nSv/h) distribution were selected from the Greek Statistical Authorisation. A geo-spatial statistical model was used to estimate the expected number of patients with PTC and Kriging interpolation prediction model to estimate their distribution. Geographical weighted regression was performed to estimate the risk of PTC in relation to gamma ray distribution. All factors that were examined were found to be statistically significant for PTC distribution in Crete. Gamma-ray was determined as a significant risk factor (OR = 2.89; 95% CI = 1.682-4.989; p value = 0.03). There is a significant correlation between gamma-ray exposure and the increased prevalence of the PTC suggesting that the former may have been a significant risk factor.

SCUAD and chronic rhinosinusitis. Reinforcing hypothesis driven research in difficult cases

BACKGROUND

Our objective is to present recent research findings on recalcitrant chronic rhinosinusitis (CRS) in relation to "Severe Chronic Upper Airway Disease" (SCUAD).

METHODOLOGY

Literature review using Medline and Em base databases (search terms 'chronic rhinosinusitis'; "chronic sinusitis" or"Severe Chronic Upper Airway Disease") limited to articles published in the English language.

RESULTS

Complex pathophysiological mechanisms characterize various forms of chronic rhinitis and rhinosinusitis (CRS), where inflammation persists in spite of adequate medical treatment. In these cases, a multifactorial etiology often underlies the development of sino-nasal inflammation. The interaction between chronic upper and lower airway inflammation via neurogenic and systemic pathways may complicate the therapy of these patients, and lead to insufficient symptom control.

CONCLUSION

The recently introduced definition of"Severe Chronic Upper Airway Disease" (SCUAD) increases awareness of those patients with persistent inflammation and symptoms despite guideline-driven pharmacologic treatment. The concept of SCUAD may prove helpful in directing research towards clarifying the definition, diagnosis and pathophysiology of rhinitis and rhinosinusitis,their limits and overlap. In this review, a hypothesis on SCUAD immunopathology is also presented.

The golden ratio in facial symmetry

Symmetry is believed to be a hallmark of appealing faces. However, this does not imply that the most aesthetically pleasing proportions are necessary those that arise from the simple division of the face into thirds or fifths. Based on the etymology of the word symmetry, as well as on specific examples and theories of beauty, we conclude that φ-value, a ratio also known as the golden ratio or the divine proportion, can also characterize symmetrical forms. Therefore, we propose the utilization of this ratio in facial aesthetics.

Knowledge of primary care doctors about laryngopharyngeal reflux disease

OBJECTIVES

Many patients with reflux disease present with atypical symptoms (globus pharyngeus, constant throat clearing, chronic cough, hoarseness, catarrh, dysphagia, halitosis, choking episodes, or asthma-like symptoms) due to laryngopharyngeal reflux (LPR). Because such patients can be easily misdiagnosed, doctors in primary care should be aware of LPR and its proper treatment. This study aimed to determine whether doctors working in the primary care setting are aware of the atypical manifestations of reflux and the differences in treatment between LPR and gastroesophageal reflux disease (GERD).

METHODOLOGY

This study was conducted among primary care doctors referring to the Ear, Nose, and Throat department of Karditsa (Greece) General Hospital. A questionnaire regarding the clinical manifestation and treatment of GERD and LPR was supplied to 60 doctors working in the primary care setting of Karditsa prefecture.

RESULTS

Fifty-one doctors returned the questionnaire. Twenty-three (45%) were acquainted with the entity of LPR and 8 (15.7%) were acquainted with the Reflux Symptom Index (RSI). The most common symptoms, for which proton pump inhibitors (PPIs) were prescribed, were: heartburn (76.5%), heartburn combined with other symptoms (17.6%), halitosis (1.96%), hoarseness (1.96%), and choking episodes (1.96%). Most of the surveyed doctors prescribed PPIs for fewer than 12 weeks (92%), once daily (70.6%), and preferably in the morning (50%). Forty-seven (92%) provided advice regarding lifestyle modifications.

CONCLUSION

The majority of surveyed doctors were unaware of LPR or the RSI. More awareness is required in the primary care setting to recognize LPR early and treat it properly.

Applications of image-guided navigation in the middle cranial fossa: an anatomic study

Determining the location of pertinent anatomic structures (ie, the internal auditory canal [IAC]) in middle cranial fossa surgery is commonly based on indirect inferences from bony landmarks. Several methods have been proposed for identification of the IAC, each using bony landmarks coupled with geometric formulation. Identification of the IAC based on bony architecture and geometry may be severely limited when a mass lesion is present. Image-guided surgery has the advantage of rapid localization and may be helpful in navigating a complex surgical field which has been distorted by tumor. This study evaluates the feasibility and accuracy of the ISG viewing wand in determining pertinent anatomic landmarks in the middle fossa of the human cadaver. High-resolution (1 mm) computed tomography was performed on a preserved human cadaver head in which fixed fiducial markers had been placed. Subsequently, the cadaver head was registered in a simulated operative field, and middle fossa craniotomy was performed. The foramen spinosum, foramen ovale, greater superficial petrosal nerve, internal carotid artery, arcuate eminence, and IAC were identified visually, and three independent localizations of each structure were performed with the viewing wand. Accurate localizations were consistently performed within 1 mm for each anatomic landmark. Image-guided navigation is both feasible and accurate in determining intraoperative landmarks in the middle fossa. Image-guidance may enhance surgical accuracy and efficiency. Further clinical studies evaluating image-guided techniques in the middle fossa are warranted.

From ancient Greek medicine to EP³OS

The manuscripts of eminent Byzantine physicians from the 4th to the 14th century contain extensive information on various otorhinolaryngological issues. In their work, the early knowledge of rhinological disease from definition and symptoms to conservative treatment and surgical intervention is intriguing. Most of this meticulous knowledge was developed through time, beginning mainly from Hippocrates and the Hellenistic period. Thereafter, medicine developed through Roman and Byzantium times to finally influence European medicine and later the rest of the Western world. History of medicine reflects the history of mankind itself, and otorhinolaryngology follows closely this path. Our goal is to slim down and illuminate the most challenging of the vast amount of information on rhinological issues contained in the original Greek text of Hippocrates, and mainly in the hagiographical texts of Byzantine medical writers. In particular, we focus on rhinological diseases from antiquity till the time being, following the journey of evolution of topical and nebulizer therapy for sinonasal inflammatory diseases in Greece, from "milothris" to modern nasal sprays, leading to an understanding of the philosophy of our predecessors and the roots of modern rhinology.

From ancient Greek medicine to EP³OS

The manuscripts of eminent Byzantine physicians from the 4th to the 14th century contain extensive information on various otorhinolaryngological issues. In their work, the early knowledge of rhinological disease from definition and symptoms to conservative treatment and surgical intervention is intriguing. Most of this meticulous knowledge was developed through time, beginning mainly from Hippocrates and the Hellenistic period. Thereafter, medicine developed through Roman and Byzantium times to finally influence European medicine and later the rest of the Western world. History of medicine reflects the history of mankind itself, and otorhinolaryngology follows closely this path. Our goal is to slim down and illuminate the most challenging of the vast amount of information on rhinological issues contained in the original Greek text of Hippocrates, and mainly in the hagiographical texts of Byzantine medical writers. In particular, we focus on rhinological diseases from antiquity till the time being, following the journey of evolution of topical and nebulizer therapy for sinonasal inflammatory diseases in Greece, from "milothris" to modern nasal sprays, leading to an understanding of the philosophy of our predecessors and the roots of modern rhinology.

The use of the Ligasure vessel sealing system in head and neck surgery: a report on six years of experience and a review of the literature

BACKGROUND

The Ligasure Vessel Sealing System (LVSS) is a bipolar electrosurgical device with integrated active feedback control, sealing vessels up to 7 mm in diameter. It facilitates surgery by achieving the efficient haemostasis of blood vessels encountered during dissection, and allowing the rapid and secure division of vascularised tissues, while minimising thermal injury to adjacent tissues.

OBJECTIVE

To report on our experience and review studies relating to the use of LVSS in Otolaryngology-Head and Neck Surgery.

TYPE OF REVIEW

Retrospective series. Search strategy and evaluation method: LVSS has been widely used in our department since 2002. All patient records relating to the use of LVSS were reviewed, and compared to surgical procedures done by our team without the use of LVSS, with special regard to operation time and post-operative complications. Furthermore, a Medline search and thorough review was conducted for all pertinent articles on LVSS in Otolaryngology-Head and Neck Surgery, and those articles were reviewed.

RESULTS

In our department, LVSS is used for thyroidectomy, laryngectomy, neck dissection, parotidectomy, tonsillectomy procedures, congenital cysts, thryroglossal cysts, and excisions of submandibular gland and parapharyngeal space tumours. LVSS provided sufficient haemostasis, operating time was shorter, and post-operative complications did not differ compared to similar surgical procedures performed without the LVSS. The Medline search revealed 16 studies published by other colleagues regarding the use of LVSS in Otolaryngology Head and Neck Surgery procedures (15 studies in thyroid and 1 study in parotid surgery). The results published were similar to ours.

CONCLUSIONS

The use of LVSS in Otolaryngology-Head and Neck Surgery may have several advantages over standard methods. It is a reliable and safe device, providing sufficient haemostasis and reducing operating time.

Basaloid squamous cell carcinoma of the soft palate: case report

Basaloid squamous cell carcinoma (BSCC) is a histologically distinct variant of squamous cell carcinoma. It occurs in various sites of the head and neck region and is believed to carry a dismal prognosis. The palate is a very rare site of BSCC development and only three cases have been reported in the international literature. In this report, we present a case of basaloid squamous cell carcinoma of the soft palate. The therapeutic strategy and histological findings are described in detail, including immunohistochemistry with the use of involucrin, an agent used for the first time for BSCC diagnosis. In addition, a brief review of the literature is presented.

The risk of foreign body aspiration in children can be reduced with proper education of the general population

OBJECTIVE

To evaluate the effect of a campaign for proper education of the public on the risk of foreign body aspiration in children.

METHODS

A retrospective analysis of 87 endoscopic foreign body removals in children was performed at the Department of Otorhinolaryngology, Head and Neck Surgery of the University Hospital of Crete, during the period between January 2000 and December 2004. Results were compared with those of a previous study conducted by the same Department during the period between 1991 and 1999.

RESULTS

A foreign body was discovered in 44 cases, while in 43 cases there were no findings. Twenty-one foreign bodies (47.73%) were found in the right main bronchus, 20 foreign bodies (45.45%) were found in the left main bronchus and 3 (6.82%) in the trachea. Both crude and age-standardized bronchoscopy rates appear to be lower in the time period 2000-2004, as compared to the time period prior to the educational program.

CONCLUSIONS

The decline in the total number of bronchoscopies during recent years has been a result of a campaign for proper education of the public and especially parents, caretakers and families. All aspects of the educational campaign are described in detail. The risk of high morbidity and mortality from foreign body aspiration makes it mandatory to increase even more the awareness of the general population.

In vitro ear cartilage shaping with carbon dioxide laser: an experimental study

Deformed cartilage remodeling appears to be a challenge, as cartilage tends to keep its initial shape because of internal stresses. Cartilage can be remodeled with heat, and this report describes the use of a CO2 laser beam for in vitro cartilaginous tissue remodeling. Straight cartilage samples were removed from the ears of 21 rabbits deprived of perichondrium and remodeled with the CO2 laser at an output power of 3 W, a spot diameter of 2 mm, and an exposure time of 0.5 second. The remodeled cartilages and control samples were implanted into the rabbits' backs and retrieved 6 to 12 months later. Histologic and morphological analysis showed that the irradiated cartilages retained both their shape and their viability. This may be a useful clinical technique for in situ remodeling of a deformed cartilage in operations such as septoplasty.

The challenge of esophagoscopy in infants with open safety pin in the esophagus: report of two cases

Among all foreign bodies impacted at the esophagus, the safety pin still seems to be a challenge for the specialist. This is a report of 2 cases presenting infants with open safety pin impacted in the esophagus. The strategy and intraoperative management of this rare finding is discussed in detail.

Fibrous dysplasia of the temporal bone: report of a case and a review of its characteristics

Fibrous dysplasia is an uncommon benign disorder of unknown etiology. It represents a disturbance of normal bone development--specifically a defect in osteoblastic differentiation and maturation that originates in the mesenchymal precursor of the bone. Because fibrous dysplasia shows a predilection for the facial and cranial bones, where it causes deformity and dysfunction, the disease is of particular interest to the otolaryngologist. In this paper, we report a case of fibrous dysplasia of the temporal bone, the first symptom of which was a mixed hearing loss. We discuss the characteristic features of this specific location of the disease, the differential diagnosis, and the treatment policy. We also address the issue of secondary sensorineural hearing loss.

In vivo detection and staging of epithelial dysplasias and malignancies based on the quantitative assessment of acetic acid-tissue interaction kinetics

A novel approach to the problem of non-destructive detection and staging of tissue lesions is presented. The method relies on the in vivo quantitative assessment of the spatial and temporal alterations of light-scattering properties, induced in epithelial dysplasias and malignancies of the cervix and larynx, after topical application of acetic acid solution. Initial clinical trials show that the method is capable of detecting incipient lesions and that differences in the dysplasia and malignancy grade are clearly manifested in the measured temporal characteristics of the phenomenon.

Risk factors for local recurrence of adenoid cystic carcinoma: the role of postoperative radiation therapy

PURPOSE

Postoperative radiation therapy is often advocated in the treatment of patients with adenoid cystic carcinoma (ACC) of the head and neck. A retrospective analysis was performed to determine prognostic factors for local recurrence after surgery and to examine the role of postoperative radiation therapy.

MATERIALS AND METHODS

A retrospective analysis of 58 patients undergoing surgery for ACC of the head and neck at the University of Pittsburgh Medical Center from 1974 to 1994 was performed. Patients were followed up for a minimum of 24 months for the development of recurrent disease. The association of recurrence was correlated with clinical factors (age, sex, site, and stage); postoperative treatment (radiation therapy v no radiation); and pathologic variables (grade, margins of resection, and perineural invasion), and appropriate statistical analysis was performed.

RESULTS

Recurrent disease developed in 59% of patients, despite the addition of postoperative radiation therapy in 83% of patients. Tumor site was the single most important factor for the development of locally recurrent disease and was correlated with primary tumor stage and resection margins. Local recurrence rates were decreased (P = .07) in patients with negative surgical margins who were irradiated.

CONCLUSIONS

Larger perspective randomized trials are necessary to evaluate the efficacy of postoperative radiation, and new treatments need to be investigated to improve local control rates for ACC of the head and neck.

Assessment of nasal mucosa blood supply by quantitative endoscopic imaging of the back-scattered light

In this article we present a method for the objective assessment and monitoring of tissue blood supply using a specially developed endoscopic imaging colorimeter that enables quantitative color modeling of the back-scattered light during endoscopic examination. Tissue blood volume changes in the nasal mucosa, induced by xylometazoline hydrochloride nasal spray, were evaluated with this method. It was found that quantitative imaging provides sensitive, reproducible, and reliable means for the monitoring and mapping of tissue blood supply and is easy to use routinely. The results showed that saturation decreases with time, being the most sensitive color parameter to the vasoconstriction procedure. It appears that objective indexes for optical tissue characterization and analysis may be promising in the understanding of the pathophysiology of tissue changes and in the objective evaluation of their response to different therapeutic schemes.

The role of skull base surgery for the treatment of adenoid cystic carcinoma of the sinonasal tract

BACKGROUND

Adenoid cystic carcinoma (ACC) of the sinonasal tract is an aggressive malignancy associated with a poor 5-year survival rate. The role of skull base surgery for the treatment of patients presenting with sinonasal ACC and its impact upon their survival has not previously been evaluated.

METHODS

A retrospective review of 35 patients with ACC of the sinonasal tract who were treated with surgery and radiation therapy at the University of Pittsburgh Medical Center was performed to evaluate patient outcome.

RESULTS

Local recurrence of tumor following surgery and radiation therapy was observed in 36% of the patients originally treated at the University of Pittsburgh Medical Center. Fourteen percent of these patients developed a regional tumor recurrence, and 21% developed distant metastases. We did not identify any tumor-related factors that predicted patient outcome. Local recurrences were treated with salvage surgical excision, and, despite aggressive management, only 1 of 17 patients with local recurrence was considered cured (NED) at 24 months (follow-up after salvage surgery). Overall, disease-free survival was 46.4%, at a median follow-up of 40 months.

CONCLUSIONS

ACC of the sinonasal tract is an aggressive malignancy. Skull base surgery has facilitated the gross total excision of advanced lesions that were deemed inoperable in the past, but has not resulted in an overall improvement in disease-free survival. Local recurrence portends a very poor prognosis, despite aggressive salvage regimens. Alternative therapies for local recurrences warrant further investigation. Prospective, randomized studies are necessary to evaluate the outcome of patients treated with aggressive multimodal treatment regimens, including chemotherapeutic regimens.

Negative pressure suction in nasal septum surgery

Operations for the correction of septal deviations are among the most common in otorhinolaryngology. Several approaches and techniques have been proposed, for securing the mucoperichondrial flap back in place. A new method of stabilizing the septum by applying a negative pressure suction tube, without the insertion of any kind of packing, is described. The advantages of the negative pressure suction are that the patient can breathe through the nose immediately after the operation, there is no pressure sensation and the pain, if any, is reduced, there is no epiphora, no skin edema and the patient feels very comfortable. Risks for complications are minimal.

A new stapedotomy prosthesis: preliminary report

Our study describes a newly designed stapedotomy prosthesis which consists of two components: (1) a platinum ribbon, and (2) a Teflon shaft. The first innovation is a flattened 'tab' on the posterior aspect of the platinum ribbon. The second innovation concerns the dual diameter cylinder-like shaft. Our prosthesis was implanted into 25 individuals, who underwent stapedotomy for stapes fixation, and the results are shown and discussed. Our innovations offer a proper and safe insertion of the prosthesis into the oval window associated with excellent manipulation and handling. At the same time, maximum visualization of the surgical field is achieved, while the stepped-down design of the shaft prevents the prosthesis protruding into the vestibule.

Management of chylous fistula using the fibrin adhesive set

Chylous fistula complicates 1.1% of all radical neck dissections, and 2.4% of left-sided dissections. The standard treatment of established chylous leak in the reported cases is a pressure dressing applied to the lower neck. Here we present a case of chylous fistula, where conservative methods failed to cope with this complication. The additional application of a fibrin adhesive set was a successful modality of treatment.

Primary malignant lymphoma of the parotid gland

OBJECTIVES

To document the clinicopathologic features of primary malignant lymphoma of the parotid gland based on analysis of our cases and to compare the results with similar studies in the literature.

DESIGN

Retrospective, nonrandomized case study.

SETTING

Academic, tertiary medical center.

PATIENTS

Forty-one consecutive cases of malignant lymphomas of the parotid gland were identified among 820 patients who had undergone parotid surgery during the course of 22 years. Thirty-three (80%) of these were primary lymphomas and were included in the study. Eight (20%) occurred in patients with a history of malignant lymphoma and were therefore excluded.

INTERVENTION

Diagnosis was established by open parotid biopsy in 8 patients, superficial lobectomy in 23, and total parotidectomy in 2. After diagnosis, lymphomas were staged and treated with local irradiation and/or chemotherapy.

RESULTS

Fifteen men and 18 women aged 26 to 100 years (mean, 66 years) had an enlarging painless mass on initial examination. Seven (21%) had an underlying autoimmune disease and 20 (61%) had Ann Arbor stage 1 disease at diagnosis. Of 25 patients available for a minimum 2-year follow-up, 16 (64%) were alive with or without disease. Histological grade was the only prognostic feature associated with outcome (P<.01).

CONCLUSIONS

Our study, when viewed collectively with those in the literature, indicates that malignant lymphomas of the parotid gland are uncommon and often not suspected clinically. The disease affects both sexes equally and is unusual before the age of 50 years. Most are B-cell, non-Hodgkin lymphomas, and about 80% of patients have Ann Arbor stage I or II disease at diagnosis.

Nd:YAG laser treatment of recurrent epistaxis in heredity hemorrhagic telangiectasia

OBJECTIVE

Hereditary hemorrhagic telangiectasia (HHT) is an inherited abnormality passed down as a dominant autosomal feature. Recurrent epistaxis usually constitutes the major clinical manifestation of this disease. The unsatisfactory results of conservative therapy have stimulated a research interest for the role of laser photocoagulation in telangiectatic vessels associated with this clinical entity.

METHOD

The Nd:YAG laser was used to treat a group of 11 individuals suffering from HHT, all of whom had been previously treated using other modalities.

RESULTS AND CONCLUSION

The excellent results of Nd:YAG laser irradiation are addressed in view of all treatment modalities proposed for the treatment of recurrent epistaxis in HHT.

Osteoblastoma of the nasal cavity arising from the perpendicular plate of the ethmoid bone

The presence of a benign osteoblastoma in the ethmoid sinus is rare and only a few cases have been reported. This is a case of a benign osteoblastoma arising from the perpendicular plate of the ethmoid bone with extension to the nasal cavity. The diagnosis and management of this unusual lesion, as well as the histopathology and the imaging characteristics are reviewed. We also review the previously reported cases of benign osteoblastomas of different origin, with nasal cavity involvement.