Clinical Behavior of the Mucoepidermoid Carcinoma of the Larynx-A Scoping Review

OBJECTIVE

Mucoepidermoid carcinomas (MEC) of the larynx account for less than 1% of all laryngeal tumors. The unique features and clinical behavior of these rare entities remain unknown. To fill this knowledge gap, we performed a scoping review of every reported case of laryngeal MEC to study the clinical behavior and the treatment modalities in this rare entity.

REVIEW METHODS

We followed the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) statement.

DATA SOURCES

MedLine, Google Scholar, and Science Direct databases were searched to identify eligible studies.

RESULTS

We concluded with 25 studies and overall 66 cases. Our study revealed that the average age of cases was 55.7 years, and the range was from 12 to 81 years, with younger onset in females. Supraglottic (60%) is the most common subsite of laryngeal MEC s followed by glottis (27.3%). Supraglottic carcinomas frequently present with metastatic neck disease at the time of the initial diagnosis and require more extensive surgical approaches. Surgery with negative surgical margins seems to be the cornerstone in the treatment of MEC. Radiation therapy has not been tested widely as monotherapy but is considered a useful adjuvant modality.

CONCLUSION

This study suggests that negative surgical margins seem to be associated to higher disease control rate and that high-grade supraglottic cases likely benefit from addressing neck disease simultaneously.

LEVEL OF EVIDENCE

NA Laryngoscope, 134:2578-2584, 2024.

Lip angioedema after indirect contact with a sea anemone

Sea anemones are marine animals that can produce toxins causing severe angioedema. Swimmers and divers should be aware of sea anemone species that can cause local and systemic toxic reactions and avoid indirect or direct skin contact. High index of suspicion, full laboratory workup, and treatment with steroids and antibiotics are imperative for an uneventful recovery.

What is the rate of occult nodal metastasis in squamous cell carcinomas of the sinonasal tract? A systematic review

OBJECTIVE

The role of elective neck dissection (END) in the management of clinical N0 (cN0) squamous cell carcinomas (SCC) of the sinonasal tract is unclear. In this systematic review, we evaluate the risk of occult nodal metastasis in sinonasal SCCs with cN0M0 tumors to support clinical decision making.

METHODS

A literature search was conducted in the following three electronic databases: Medline/PubMed, ScienceDirect, and Google Scholar. Articles were assessed for eligibility in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Two independent authors extracted the data. The Methodological Items for Non-Randomized Studies (MINORS) tool was used for the assessment of biases of each included study.

RESULTS

Our systematic review included six studies that met the inclusion criteria, all retrospective in design. The rate of histologically proven metastasis of sinonasal SCC to the clinically negative neck is 12.5%. Almost half of the positive cases are pathologically staged as N2 (6.5%).

CONCLUSION

Our systematic review provides the rate of sinonasal SCC occult metastasis to the neck so that the surgeons can discuss with patients the risks and possible merits of adding an elective neck management in the surgical plan.

Surgery as a Last Resort for Persistent Auricular Perichondritis

Auricular perichondritis is a severe bacterial inflammation of the cartilaginous part of the external ear sparing the lobule and the tragus. Prompt diagnosis and treatment are necessary to avoid necrosis of the underlying cartilage and permanent auricular deformity. Management includes antibiotics and nonsteroidal anti-inflammatory drugs. Surgery to control the inflammation is sometimes necessary. Wide cartilage and subcutaneous tissue debridement with preservation of the helical rim to minimize the resulting auricular deformity is necessary.

A Novel and Simple Technique to Reduce the Rate of Pharyngocutaneous Fistula Formation Following a Total Laryngectomy - our Initial Results

Objective: Pharyngocutaneous fistula (PCF) is a common and often devastating complication of total laryngectomy. Patients undergoing a total laryngectomy need enhancement of the neopharynx to reduce the risk of PCF formation. Our study aimed to evaluate the formation of a PCF following a total laryngectomy in patients that underwent a modified closure technique of their neopharynx. This technique included the recruitment of a flap of the muscular division of the pretracheal fascia that invests the strap muscles as a protective blanket. We called this surgical technique the 'curtain call'. Methods: We conducted a retrospective study for patients who underwent a total laryngectomy in our department between May 2022 and May 2023. Results: Twelve patients were identified. Our results demonstrated that the recruitment of this modified closure technique to cover the neopharynx resulted in a very low rate of postoperative PCF formation (8.3%). Conclusion: The 'curtain call' technique is an excellent method to support the neopharynx with extremely low rates of postoperative chronic dysphagia and with no evidence of impairing the development of esophageal speech. It could sometimes substitute much more time-consuming techniques like major pectoralis flap and supraclavicular flap.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-023-04343-7.

Locally Advanced Laryngeal Squamous cell Carcinoma in a Patient with a Synchronous Second Primary Thyroid Carcinoma

Laryngeal squamous cell carcinoma (SCC) is one of the most common primary tumors of the head and neck region. Unfortunately, patients with laryngeal SCC tend to develop second primary tumors (SPTs), accounting for increased mortality. The lung is the predominant site of a second presentation, followed by the mucosa of the upper aerodigestive tract. In contrast, the thyroid gland rarely hosts an SPT. Our study describes the management and treatment of a 69-year-old female who presented with a rare combination of synchronous laryngeal and thyroid carcinomas.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-023-03968-y.

Sigmoid Sinus Thrombosis as a Complication of Acute Otitis Media in a 6-Year-Old Male

Sigmoid sinus thrombosis (SST) is a potentially life-threatening complication of otitis media which is nowadays rare due to the widespread use of antibiotics. A high index of suspicion is necessary to allow for a timely diagnostic and therapeutic intervention. Intravenous wide-spectrum antibiotics and a cortical mastoidectomy are the mainstay of treatment. There is no consensus regarding the necessity of anticoagulants in pediatric patients. We present a 6-year-old boy who presented with an SST as a result of acute otitis media.

Is the origin of the superior thyroid artery consistent? A systematic review of 5488 specimens

PURPOSE

The superior thyroid artery (STA) point of origin is strongly debated with controversial results among studies. External carotid artery (ECA), carotid bulb, and common carotid artery (CCA) have been presented as points of origin with variable percentages among authors. We conducted a systematic review of all existing studies that included cadaveric, surgical, and angiographic specimens and recorded the origin of STA according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement.

MATERIALS AND METHODS

Fifty-two studies, with an overall of 5488 specimens were included.

RESULTS

Our results indicated ECA as the most common site of origin (55.0 %) followed by carotid bifurcation at 27.5 % and CCA at 15.0 %. Absent STA or branching from the internal carotid artery (ICA) was an extremely rare finding. We proposed a new simple classification system based on our results.

CONCLUSIONS

The huge variability in the branching pattern of STA makes head and neck surgery and radiographic interventions challenging and poses the integrity of STA at risk. Therefore, we strongly recommend preoperative angiographic studies for STA identification to prevent an intraoperative iatrogenic injury.

Quality of Life After Total Laryngectomy: A Retrospective Study

Quality of life is severely affected in laryngeal cancer patients, who have undergone total laryngectomy, particularly with regard to cancer diagnosis and the consequences of total laryngectomy. The aim of the present study is to record and evaluate the problems related with the quality of life in laryngectomized patients. A further goal is to investigate, whether a correlation exists between demographics and clinical characteristics of the patients. Fifty male patients, who underwent total laryngectomy, participated in the study. Two questionnaires were used to test various quality of life parameters, the EORTC QLQ C30 version 3.0 and EORTC QLQ H&N35. Specific demographic and clinical data of the patients were also recorded. The overall quality of life index was similar in both studied patients and the reference group of cancer patients provided by the European Organization for Research and Treatment of Cancer (EORTC). However, the following discrepancies were noted: voice, senses, dyspnoea were more problematic in studied patients, whereas the functional status of cognitive, physical, social and emotional function were better. In most recorded symptoms, the intensity was mild. The demographic and clinical data appeared to have interesting correlations with specific functional aspects and symptoms. Although several quality of life aspects are found to be negatively affected in laryngectomized patients, overall quality of life appears to be satisfactory.

A Case of Neglected Frontal Sinusitis Led to Frontal Sinus Empyema with Ocular Complications

No abstract available.

18F-FDG-PET/CT interpretation pitfalls in patients with head and neck cancer

AIM

The aim of the present study is to raise awareness of ENT Surgeons on the limitations of ¹⁸F-FDG PET/CT in head and neck cancer by presenting illustrative cases from our department archives.

MATERIALS AND METHODS

A retrospective chart review was conducted for all patients with head and neck cancer treated in our ENT department from 2015 to 2020. Cases with various interpretation pitfalls due to false-positive and false-negative PET/CT results that lead to diagnostic dilemmas and treatment delays either in their pre-therapeutic work-up or in their post-therapeutic monitoring were included.

RESULTS

Five cases of various image interpretation pitfalls (3 false negative and 2 false positive cases) were identified and are presented in detail.

CONCLUSIONS

Although ¹⁸F-FDG PET/CT has gained in popularity and improved head and neck cancer management, clinicians should be aware of its limitations. The combination of ¹⁸F-FDG PET/CT with other imaging modalities can reduce the number of interpretation pitfalls but by no means will substitute sound clinical judgement.

The role of the endoscope in cochlear implantation. A systematic review

OBJECTIVE

To review the role of the endoscope in cochlear implantation (CI).

METHODS

MEDLINE, ScienceDirect, Google Scholar and the Cochrane Library databases as well as other sources were searched by two independent reviewers. Studies including patients undergoing either exclusively endoscopic or endoscopic ally assisted CI were eligible for inclusion. Endoscopic CI approaches and postoperative complications were the primary outcomes. Secondary endpoints included the degree of round window (RW) microscopic visualization according to St Thomas' Hospital classification as well as type of cochleostomy for electrode insertion in the scala tympani (ST).

RESULTS

Fourteen studies met the inclusion criteria comprising 191 endoscopic or endoscopically assisted CI cases. The endoscope was used for better visualization of the RW across all included studies, facilitated the insertion of the electrode in the ST and spared a mastoidectomy in a number of cases. No facial nerve palsy was reported in any of the studies. The most common complication was external auditory canal/ tympanic membrane tear followed by chorda tympani injury.

CONCLUSION

The microscopic CI approach is still the gold standard. The endoscope facilitates the recognition of the RW area and leads to successful and safe implantation particularly in difficult anatomical scenarios, ear malformations and advanced otosclerosis. Endoscopically assisted CI procedures offer the opportunity to avoid a posterior tympanotomy and reduce the risk of facial nerve injury. To date, the lack of long term data does not permit the widespread adoption of completely endoscopic CI procedures without a mastoidectomy.

Human Papillomavirus Vaccine to End Oropharyngeal Cancer. A Systematic Review and Meta-Analysis

ABSTRACT

Oropharyngeal cancer (OPC) is currently the most frequent human papillomavirus (HPV)-related malignancy in high-income countries. Oral HPV16 infection is the cause of HPV-related OPC in more than 90% of cases and is primarily (90%) linked to oral sex. This systematic review and meta-analysis aimed at comparing the prevalence of oral vaccine-type HPV infection in individuals vaccinated with HPV vaccines and unvaccinated controls. Three databases (MEDLINE, ScienceDirect, and the Cochrane Library), as well as other sources, were searched by 2 independent reviewers. Controlled studies testing the efficacy or effectiveness of licensed HPV vaccines were included. The primary end point was multiple oral HPV infections in one individual with low-risk and high-risk types. Secondary end point was the number of oral HPV16 infections. Six studies-2 randomized controlled trials and 4 cross-sectional studies-with a total of 15,240 participants were included in a meta-analysis, which showed that vaccinated individuals were 46% (risk ratio, 0.54; 95% confidence interval, 0.32-0.91) less likely to develop oral vaccine-type HPV infection (P = 0.02). A second meta-analysis of 4 studies (1 randomized controlled trial and 3 cross-sectional studies) and 13.285 participants showed 80% (risk ratio, 0.20; 95% confidence interval, 0.09-0.43) less likelihood of oral HPV16 infection (P < 0.0001). This study suggests that HPV vaccines can protect against oral vaccine-type HPV infection including high-risk HPV16 infection, thus reducing the incidence of HPV-related OPC. Vaccination against HPV, especially in males, who are predominantly affected by HPV-related OPC, could result in the prevention of this disease.

A Rare Case of Hemoptysis Caused by a Laryngeal Leech

The larynx is an uncommon location for live foreign bodies. The leech can reach the glottis during consumption of contaminated water but is usually expelled by an effective cough reflex. Patients present with hoarseness and dysphagia and occasionally with dyspnea or hemoptysis. Endoscopically, a mobile mass is usually noted in the supraglottic area. We present a rare case of a laryngeal leech in a 62-year-old-male farmer who lives in a rural area. The leech was removed successfully with direct laryngoscopy under general anesthesia.

Conventional Microscopic Stapedotomy: An Obsolete Technique or Still the Gold Standard for the Management of Otosclerosis?

Background and objectives Clinical otosclerosis is a relatively common entity, accounting for 0.5%-2% of the general population. Otosclerosis is characterized by an abnormal bone formation in the temporal bone that eventually causes conductive hearing loss. Bilateral involvement is fairly common. Treatment can be either conservative with medications and a hearing aid, or surgical. Stapedotomy is considered, nowadays, the most effective surgical technique for the management of otosclerosis. The purpose of the present study is to present our long-term results with stapedectomy, the audiological outcome, as well as the complications encountered. Subjects and methods This is a retrospective single-centre study. All patients diagnosed with otosclerosis and treated operatively with a stapedotomy from January 2010 to December 2019 were included in the study. Demographic data, air and bone conduction thresholds, complications and length of the prosthesis were recorded.  Results The study included a total of 72 patients. The audiological results showed a statistically significant improvement in the air conduction thresholds in all the affected frequencies (p<0.001). Post-operative complications included deterioration or severe hearing loss up to 100 dB (n=1, 1.39%), loss or distortion of taste (n=4, 5.6%) and tinnitus (n=2, 2.8%). Conclusions Our results demonstrate that stapedotomy is an effective technique for the management of otosclerosis. Stapedotomy, when performed by an experienced surgeon, provides excellent outcomes, with limited complications.

Necrotizing Bacterial Rhinitis in an Immunocompromised Patient

Specific bacterial infections can cause rapid necrosis of the nasal mucosa in immunocompromised patients, mimicking an invasive fungal infection. The exclusion of the latter is a priority because rapid deterioration and death may ensue within hours to days. The time lag between investigations and final diagnosis warrants empiric administration of Amphotericin B but patients are exposed to significant side effects. Histopathology and culture of the nasal tissues provide the necessary diagnostic clues to avoid inappropriate treatment.

Parotid Gland Tumors in Northern Greece: A 7-year Retrospective Study of 207 Patients

&lt;b&gt;Introduction:&lt;/b&gt; Parotid gland neoplasms represent a heterogenous group of tumors, either benign or malignant. The diagnosis and management of parotid gland tumors is complicated by their relative infrequency and their diverse biologic behavior. &lt;br&gt;&lt;b&gt;Aim:&lt;/b&gt; The aim of this study is to investigate the epidemiological characteristics, the recurrence rates and the surgical approach employed for parotid gland tumors in Northern Greece. &lt;br&gt;&lt;b&gt;Material and methods:&lt;/b&gt; This is a single-center retrospective study. All patients admitted to the ENT department of "G. Papanikolaou" General Hospital of Thessaloniki from January 2012 to June 2019 with the diagnosis of parotid gland tumor were included in the study. Patients with incomplete charts and patients that underwent revision surgeries were excluded. Chi-squared tests were used to assess the associations between variables. &lt;br&gt;&lt;b&gt;Results:&lt;/b&gt; A total of 207 patients with a mean age of 54.97 (range 16-91) were included in the study. Benign neoplasms accounted for 87.9% of the cases. Warthin's tumor was the most common neoplasm encountered, with an incidence of 46.8%, followed by pleomorphic adenoma (31.9%). There was a higher incidence of parotid gland tumors in males and smokers (P = 0.025, P = 0.001 respectively). The majority of the patients were treated with an extracapsular resection (60.4%) or with a partial superficial parotidectomy (22.6%). In 12 cases (5.7%), there was a recurrence of the lesion. The most common complications encountered were facial nerve injury, Frey's syndrome and hematoma formation. &lt;br&gt;&lt;b&gt;Conclusions:&lt;/b&gt; Parotid gland tumors are typically benign, non-aggressive tumors, more frequently seen in men than women. There is a positive association between smoking and parotid gland tumor development. Comprehensive information regarding recurrence and complication rates is presented.

Endoscopic versus microscopic ossiculoplasty in chronic otitis media: a systematic review of the literature

OBJECTIVE

The aim of this study was to compare the endoscopic and microscopic ossiculoplasty in patients with chronic otitis media.

METHODS

MEDLINE, ScienceDirect, and the Cochrane Library databases as well as other sources were searched by two independent reviewers. Controlled studies comparing endoscopic and microscopic ossiculoplasty in patients with chronic otitis media were included. Mean air-bone gap closure was the primary outcome. Secondary outcomes were operation time and complications.

RESULTS

Three studies met the inclusion criteria. No statistically significant differences in audiometric outcomes between endoscopic and microscopic groups in all three included studies were reported. Although endoscopic technique was related to a fewer number of postoperative complications and a shorter operation time, these outcomes did not reach statistical significance.

CONCLUSION

Endoscopic ossiculoplasty is associated with similar postoperative hearing results compared to the traditional microscopic approach. A trend towards a shorter operative time and reduced morbidity for the endoscopic approach has been observed, but well-designed randomized controlled trials are warranted to confirm this finding.

Lateralized olfactory difference in patients with a nasal septal deviation before and after septoplasty*

BACKGROUND

Patients with a smell disorder and less often, healthy people, exhibit an olfactory difference between the two sides of the nose. Higher olfactory thresholds are correlated with the obstructed side of a nasal septal deviation (NSD). With this prospective study we sought to investigate if a NSD compromises the olfactory identification.

MATERIALS AND METHODS

Thirty patients with nasal obstruction due to a NSD were recruited. The patients were listed for primary septoplasty with or without radiofrequency reduction of the inferior turbinates. Pre- and postoperatively, patients were assessed by visual analogue scales for symptoms and by the bilateral nasal spirometry (nasal partitioning ratio-NPR) for the side/degree of obstruction. Olfactory identification was tested separately for each nasal cavity by means of the 12 item Sniffin Sticks test (12-SS test) and a 3-point difference between the nasal sides was considered significant.

RESULTS

The mean age of patients (25 males/5 females) was 33 years (range 17-52). No complications or anosmia were reported postoperatively. Subjective hyposmia, nasal obstruction and the NPR were reduced (p<0.001). Significant lateralized differences were present in 20% and 13% of patients before and after septoplasty respectively; the change was not significant (p=0.754). Patients with a significant lateralized olfactory difference had a greater NPR pre- (p=0.031) but not postoperatively (p=0.783). The sides of obstruction and worst olfactory performance did not differ in these patients before surgery.

CONCLUSIONS

Olfactory identification may be compromised on the convex side of a large NSD. Post-operatively, patients exhibit a lateralised smell identification difference as often as healthy people. The effect of a clinically significant NSD on the different aspects of olfactory performance warrants further study.

The value of bilateral simultaneous nasal spirometry in the assessment of patients undergoing septoplasty

PROBLEM

There is no consensus regarding the best approach to select patients for septoplasty. Patient dissatisfaction after septoplasty implies that clinical examination alone is inadequate to detect a clinically relevant nasal septal deviation (NSD). Objective testing provides an in-depth analysis of nasal obstruction and its underlying anatomic causes but it is effort consuming, requires training and it is not widely available.

AIM

We studied the role of bilateral simultaneous nasal spirometry (BSNS) in the preoperative selection of patients for septoplasty.

PATIENTS, SUBJECTS AND METHODS

Thirty patients with nasal obstruction and NSD were assessed by subjective measures and BSNS before and after septoplasty. The decongested nasal partitioning ratio (NPR) was used as a measure of the degree of NSD. Thirty healthy controls were recruited for providing a normal range of NPR values.

RESULTS

All patients were subjectively improved after septoplasty but only those with NPR out of the normal limits had a significant reduction of NPR. Patients with unilateral symptoms and NPR beyond normal limits were also able to identify the more obstructed side preoperatively. For this group of patients, physicians were able to identify the convex side of NSD preoperatively. No correlation between subjective measures of nasal obstruction or airflow asymmetry and NPR was observed.

CONCLUSION

BSNS is a rapid, easily interpretable, noninvasive technique, which identifies patients with large NSDs who, irrespective of concomitant mucosal factors of nasal obstruction, warrant septoplasty. BSNS is not applicable in cases with a septal perforation or an S type septal deviation, it cannot detect an insufficient nasal valve and it does not substitute rhinomanometry or acoustic rhinometry.

Occult renal cell carcinoma manifesting with epistaxis in a woman: a case report

Introduction

Metastatic disease in the sinonasal region occurs rarely and the primary site may be elusive. This case highlights the possibility of an occult renal tumor manifesting with nasal symptoms and the risk of severe bleeding following nasal biopsy.

Case presentation

We report the case of a 79-year-old Caucasian woman who presented with a six-week history of intermittent left-sided nosebleeds. She was fit, without previous surgery or anticoagulation. Nasal endoscopy and computed tomography showed a hemorrhagic mass occupying her left ethmoid cells and middle meatus. After a highly hemorrhagic biopsy, the lesion was histologically confirmed as clear cell carcinoma. Screening revealed a right kidney mass with widespread metastases. Palliative radiotherapy to the sinonasal metastasis and systemic treatment rendered her free of symptoms nine months after initial presentation.

Conclusions

General practitioners and ear, nose and throat (ENT) doctors are very often confronted with epistaxis. A small minority of patients with epistaxis show a primary or metastatic nasal mass. Detection of the origin of secondary sinonasal masses requires a high index of suspicion and examination of infraclavicular sites by a multidisciplinary team. Renal cell carcinoma metastases are prone to severe bleeding during any surgical intervention, therefore, preoperative embolization is recommended. Resection or radiotherapy to the sinonasal metastasis of renal origin is justified in order to prevent recurrent nosebleeds.

Tracheostomy in young patients: indications and long-term outcome

Diagnostic and treatment modalities have changed substantially over the past years in the field of pediatrics and neonatal medicine. As a result, the indications and outcome after tracheostomy in young patients have evolved. The aim of this study is to present our experience with pediatric tracheostomies and provide an up-to-date review of the literature with special focus on current trends. The complete medical records of 85 children and adolescents (up to age 18) which underwent tracheostomy from January 1990 until March 2008 were reviewed. Telephone interviews were conducted to evaluate the childrens further clinical course. The indications for tracheostomy were upper airway obstruction (27%), craniofacial syndromes (3.5%), long-term mechanical ventilation (22.3%), neurological deficit (25.9%), trauma and sequelae (16.5%) and bilateral vocal cord paralysis (4.7%). The average age of patients at the time of tracheostomy was 4.7 years (range, 2 days-18 years) but there were significant differences between the six indication groups. Children under the age of 7 years comprised 72.9% of all patients. The mean cannulation time was 21.6 months; 50.6% of the patients could be successfully decannulated. Life-threatening complications occurred in 6 patients (7%). The total mortality rate was 18.8%; the tracheostomy related mortality rate was 0%. In the past 30 years, short-term tracheostomy was commonly performed for infectious causes such as epiglottitis. Nowadays, the majority of patients are very young children with severe and chronic diseases. This fact accounts for the relatively low decannulation rates, long cannulation times and high mortality. The tracheostomy related mortality on the other hand, is comparatively low.

Unsuspected breast carcinoma presenting as orbital complication of rhinosinusitis

We report a rare clinical presentation of breast carcinoma metastasis to the ethmoid sinuses, orbit and cavernous sinus in a 70-year-old lady with unsuspected breast carcinoma who presented with clinical features of acute ethmoiditis, orbital cellulitis and cavernous sinus thrombosis. The patient underwent endoscopic ethmoidectomy and histology of the necrotic tissue from the ethmoidal cells was positive for endovascular neoplastic emboli. Subsequent examination revealed a large mass in the left breast, tethered to the skin, which was histologically confirmed to be a carcinoma. The patient died 2 months post-diagnosis. To our knowledge, this is the third case manifesting with combined features of ethmoiditis, orbital cellulitis and cavernous sinus syndrome from an unsuspected breast carcinoma. This case highlights the importance of imaging and thorough physical examination when a dramatic clinical picture presents in the paranasal sinuses of an otherwise healthy individual. Such manifestation of breast carcinoma is difficult to diagnose, and therefore, a high index of suspicion should be maintained. Skull base metastases from breast carcinoma behave aggressively and if diagnosed early, treatment may prolong survival and improve quality of life.

Bilateral multiple sialolithiasis of the parotid gland in a patient with Sjögren's syndrome

The presence of multiple calculi in the major salivary glands is an uncommon finding. Sjögren's syndrome is a chronic autoimmune disease characterized by lymphocyte-mediated destruction of the exocrine glands. The case is presented of a 49-year-old female with Sjogren's syndrome found to have bilateral multiple sialolithiasis in the parenchyma of the parotid glands. The patient presented with a right sided painful inflamed swelling of the parotid region. Even though she had been diagnosed with primary Sjögren's syndrome 3 years prior to admission, she did not report any previous episode of sialadenitis. Full blood count showed leukocytosis (white blood cells = 14,900/10(6) L) with neutrophilia (75%). Radiological assessment included ultrasound and computed tomography scan of the parotids which demonstrated intra-parenchymal multiple calculi of both parotid glands and obstruction of the right Stensen's duct. The patient was treated with intravenous antibiotics and anti-inflammatory drugs. On the second day of hospitalisation, she reported spontaneous extrusion of a calculus during massage of the gland, with immediate relief of symptoms. In patients with Sjögren's syndrome and radiological findings of calculi in the major salivary glands, close observation is mandatory for better control of recurrent sialadenitis and early recognition of mucosa-associated lymphoid tissue lymphomas.

Endoscopic versus open surgical interventions for inverted nasal papilloma: a systematic review

Inverted nasal papilloma is a unique neoplasm characterised by a tendency to recur following excision, an association with malignancy and an ability to destroy bone. The coexistence with nasal polyps (not always sent for histology), the lack of a universally accepted staging system and the fact that most data on Inverted papilloma come from tertiary centres (selected cases probably the most aggressive) account for the difficulty in determining its true incidence. Treatment is surgical. The gold standard approach was an open radical procedure. The introduction of endoscopic surgery for primary or recurrent lesions has shown potential advantages. Lack of complications of open surgery together with improved access to specific nasal areas suggests that the endoscopic techniques in experienced hands and for selected lesions may be a good alternative. The aim of this review was to assess the effectiveness of the endoscopic versus open techniques for management of inverted papilloma. There is not enough evidence in the literature to support one or the other treatment option for management of inverted papilloma. There is a trend though towards endoscopic approach. Ideal management should aim at complete removal of all diseased mucosa with creation of wide cavities and long term follow-up to detect subsequent recurrence or malignant transformation.

Primary aneurysmal bone cyst of the maxillary sinus in a child: case report and review of the literature

Our case report describes a primary aneurysmal bone cyst (ABC) of the maxillary sinus in a 12-year-old girl. The young patient presented with progressive diplopia, strabismus, and rapidly growing painless swelling of the left cheek. Imaging studies showed a heterogeneous contrast enhancing mass expanding the left maxillary sinus. The lesion was completely resected endoscopically and histological examination reported it as an ABC. The patient recovered well and is free of recurrence 9 months following surgery. ABC is a benign lesion usually associated with other bone pathology (fibrous dysplasia). It may behave aggressively and invade the orbit; so resection is necessary. Minimally invasive techniques such as endoscopic sinus surgery can be performed successfully in select cases. Long follow up is important because recurrence may occur, in which case further resection is warranted.

Cutaneous metastasis to the face from colon adenocarcinoma. Case report

BACKGROUND

Facial skin metastases from colorectal cancer are extremely rare and appear several years after resection of the primary tumour. They are an important finding, often being the first sign of metastasis from a previously treated colon cancer.

CASE PRESENTATION

We describe a case of a 69 year old patient with cutaneous metastasis to the chin from a previously treated adenocarcinoma of the colon. The patient presented with dyspnoea, pleuritic pain and loss of weight. A chest x-ray revealed a right upper lobe mass of the lung which on subsequent surgical exploration proved to be metastatic from colorectal adenocarcinoma resected three years ago. During the postoperative course, a nodule was noted on the chin and excision biopsy revealed it was also a metastasis from the initial colorectal cancer. Palliative chemoradiotherapy was administered and the patient survived 8 months.

CONCLUSION

High index of suspicion is necessary for the early detection of facial cutaneous metastases from colorectal cancer. The aim is to start treatment as soon as possible before widespread visceral metastases occur. Cutaneous metastases from colorectal cancer carry a better prognosis in comparison to those of other epithelial tumours.