[Malignant transformation of a branchial cleft cyst]

Branchial cleft cyst is the most common birth defect involving the neck. Malignant transformation is known, however, differentiating from a neck metastasis of a squamous cell carcinoma of unknown primary is challenging. Even though there are strict criterias, the diagnosis of this entity remains controversial. We present the case of a 69-year-old woman, who presented with a swelling under the left side of the mandible. After diagnostic workup, fine-needle aspiration biopsy raised the suspicion of a cystic squamous cell carcinoma metastasis, therefore we performed panendoscopy and modified radical neck dissection. The pathological examination confirmed branchial cleft cyst carcinoma. After surgery, the patient received adjuvant radiation and chemotherapy. During the case workup, we present the difficulties of the diagnostic process, differential diagnostic problems, and the review of the international literature. In the case of a solitary, cystic mass on the neck without a primary tumor, we should consider the possibility of a branchiogenic carcinoma. Orv Hetil. 2023; 164(10): 388-392.

Transorbito-maxillary percutaneous endoscopic gastrostomy

Összefoglaló. Fej-nyaki daganattal diagnosztizált és kezelt betegeknél a szájon keresztüli táplálás gyakran nem lehetséges vagy nehezítetté válik a kezelés valamelyik fázisában. A beteg enteralis táplálásának biztosítására tartós és hatékony megoldást kell nyújtanunk, erre megfelelő választás lehet a percutan endoszkópos gastrostomia. A fej-nyaki régióban a daganat elhelyezkedése, kiterjedtsége és a műtétek miatt megváltozott anatómiai viszonyok sokszor gátat szabnak a gasztroszkóp hagyományos, szájon át történő sikeres levezetésének, és így különleges megoldásokra lehet szükség. Közleményünkben egy, a szakirodalomban is ritkán alkalmazott percutan endoszkópos gastrostomakészítésről számolunk be. A bemutatott esetben egy kiterjedt, rosszindulatú fej-nyaki daganat miatt totális maxillectomián és orbitaexenteratión átesett betegben a műtét következtében kialakult arcdefektuson át történt a gastroscopia és a tápszonda levezetése, ugyanis komplett szájzár következtében a beteg a táplálkozásra képtelen volt. A fent említett módszerrel sikerült a beteg hosszú távú enteralis táplálását megoldani minimálinvazív módon. Az összetett kóros esetek gyakran állítják kihívások elé a gyakorló klinikust. Esetbemutatásunkkal szeretnénk felhívni a figyelmet a hagyományos, megszokott módszerek helyett sokszor nagyobb sikerrel alkalmazható, személyre szabott terápiás lehetőségekre. Orv Hetil. 2022; 163(3): 116-119. Summary. Peroral, enteral feeding is often impossible in patients with head and neck cancer. Percutaneous endoscopic gastrostomy is a well-established, quick, minimally invasive, and safe procedure for providing long-term enteral feeding. Space-occupying tumour mass and altered anatomy due to surgery inhibit the gastroscope's peroral introduction and the feeding tube's placement in some instances. Various access routes and modified insertion techniques are recommended to overcome the feeding tube insertion challenges. We present a rare case of a 64-year-old head and neck cancer patient who was unable to eat orally due to trismus and had a facial soft tissue defect following total maxillectomy and orbital exenteration. A complete oesophago-gastro-duodenoscopy and feeding tube insertion were performed transfacially. Percutaneous endoscopic gastrostomy was successful and uneventful via the maxillary and orbital soft tissue facial defect. No complication was noted, and long-term enteral feeding of the patient was provided in a minimally invasive way. Surgeons often face challenging cases when treating patients with head and neck cancer. The modification of standard procedures is sometimes required to adapt surgical techniques to the patient's specific case. Orv Hetil. 2022; 163(3): 116-119.

[Temporal bone cholesterol granuloma penetrating into the middle cranial fossa]

The authors present a case report of a patient who was treated conservatively for a non-specific headache for more than a decade, while an arachnoidal cyst in the middle cranial fossa, over the temporal bone tegmen was diagnosed, but ruled out as the cause of the headache. The patient was referred to our ENT department with left, purulent ear discharge. Besides a chronic purulent otitis media, a cholesterol granuloma occupying the antrum, eroding the tegmen of the pyramid bone and penetrating into the middle cranial fossa was diagnosed. Case presentation of a patient with cholesterol granuloma, surgical options, differential diagnostic problems, and a literature review are presented. Tympanoplasty with cortical mastoidectomy was carried out to treat the chronic purulent otitis media, and the cholesterol granuloma was removed during transmastoid craniotomy. The iatrogenic temporal meningo-encephalic tissue herniation was repaired and the bone defect of the tegmen was reconstructed with septal cartilage. The patient's headache diminished immediately after the surgery. The chronic ear discharge stopped, the cholesterol granuloma was excised completely and the cerebral herniation was repaired successfully. Neither CSF leak, nor further herniation or meningitis were noticed. Two years after the operation the patient is asymptomatic. A large cholesterol granuloma, eroding into the middle cranial fossa can cause serious complications, and needs a high level of attention besides individualized surgical treatment based on the surgeon's abilities and skills. Orv Hetil. 2019; 160(52): 2067-2072.