Functional Surgical Approach to the Level I for Staging Early Carcinoma of the Lower Lip

OBJECTIVE: The management of the neck in patients with T1-T2 carcinoma of the lower lip (LLC) remains controversial. Suprahyoid neck dissection seems a reliable diagnostic approach, although it sacrifices the submandibular gland and its vascularity.

STUDY DESIGN AND SETTING: This study was a prospective, randomized study. Patients with previously untreated T1 or T2 primary LLC underwent either classical suprahyoid neck dissection (CSHD) or functional suprahyoid neck dissection (FSHD) in continuity with the resection of the cancer of the lip.

RESULTS: A total of 48 suprahyoid neck dissections were performed in 36 patients. Among these dissections, 27 were CSHD and 21 were FSHD. The average number of dissected lymph nodes was similar for both classical and functional type operations. The overall follow-up period was 40.5 months.

CONCLUSIONS: The end result of this series supports the idea that FSHD is a reliable diagnostic method for the management of level I lymph nodes in LLC. FSHD can avoid undertreatment or overtreatment of the patients with early LLC while preserving the submandibular gland.

Inflammatory myofibroblastic tumor of the nasal cavity: a case report and review of the literature

Our aim is to describe clinicopathological, histochemical, and immunohistochemical findings of one case of inflammatory myofibroblastic tumor of the nasal cavity. A 10-year-old female presented with a short history of nasal obstruction, epistaxis, nasal discharge and headache. Computerized tomography (CT) scans showed a space-occupying lesion in the right nasal cavity. Histological examination of initial biopsy showed fascicles of spindle cells in a mixed inflammatory background with a predominance of plasma cells, typical of inflammatory pseudotumor. The spindle cells were positive for vimentin and actin. The mass was completely excised without any difficulty under generalized anesthesia. Inflammatory myofibroblastic tumor of the nasal cavity is a localized and completely benign lesion. Simple complete excision is curative.

Brown tumor of the maxilla associated with primary hyperparathyroidism

Brown tumors represent the terminal stage of the remodeling processes during primary or secondary hyperparathyroidism. During the last three decades primary hyperparathyroidism has been recognized much more commonly and the increase has generally been attributed to the routine determination of calcium by new automated methods and the advent of new and more objective parathyroid hormone radioimmunoassay techniques. Early diagnosis and successful treatment of the disease have made clinical evidence of bone disease uncommon. While, the mandible is the most frequently involved bone in the head and neck region, maxillary involvement is extremely rare. A case of brown tumor on the maxilla associated with primary hyperparathyroidism is reported. This patient presented multiple skeletal lesions, which are uncommonly seen nowadays. The diagnosis was suggested by the clinical history and confirmed by biochemical, radiological and histopathological determinations. Excision of a parathyroid adenoma normalized the metabolic status. Excision of the maxillary mass led both histopathological confirmation of the disease and early masticator rehabilitation.

Oxidant and antioxidant status in larynx squamous cell carcinomas

In this study we reviewed 20 patients with laryngeal squamous cell carcinoma to evaluate the oxidant and antioxidant status on tissue level. Superoxide Dismutase (SOD) and Catalase levels, two important antioxidant enzymes, and Malondialdehyde (MDA) levels, a valuable index of lipid peroxidation, were compared in cancerous and normal tissues of the patients. In cancerous tissue SOD activities were significantly lower than in the normal tissue, while there was no significant difference in MDA levels and Catalase activities. It was also observed that SOD activities significantly decreased as the histopathologic malignancy grades increased in cancerous tissue. These changes in oxidant and antioxidant status in carcinomatous tissue of the larynx are considered to be of great interest.

Management of N0 neck in T1-T2 unilateral supraglottic cancer

Early-stage supraglottic cancers (stage I and II) are treated with several different programs. Previously reported data have led us to design a therapeutic protocol in treatment of patients with early-stage squamous cell carcinoma of the supraglottic larynx. From 1991 to 1996, 39 patients with unilateral supraglottic carcinoma were treated according to this protocol. All patients underwent unilateral functional neck dissection and resection of the primary carcinoma in an en bloc fashion. Histopathologic studies showed that 9 (23%) of them had positive nodes, and they received planned adjuvant radiotherapy. None of the 30 patients with histopathologically NO necks received either adjuvant irradiation or contralateral neck dissection. The mean follow-up period was 34 months. All patients are alive, and none have developed any recurrence in either dissected or undissected sides of the neck. This treatment policy seems satisfactory and will avoid unnecessary therapeutic interventions. Routine bilateral neck dissection may not be necessary in the surgical treatment of all supraglottic laryngeal cancers.

Total lymphocyte and T lymphocyte subpopulation levels in head and neck squamous cell carcinomas

This study was performed on 72 patients with head and neck squamous cell carcinoma. Total lymphocyte, natural killer cell and total lymphocyte subpopulation levels in peripheral blood were determined and the correlation of these levels with TNM and Histopathologic Malignancy Grading (HMG) systems were investigated. TNM and HMG systems, which are two important prognostic indicators, were significantly correlated whereas total lymphocyte, natural killer cell and total lymphocyte subpopulation levels in peripheral blood had no correlation with TNM and HMG scores.

Comparison of topical silver nitrate and flunisolide treatment in patients with idiopathic non-allergic rhinitis

In this study, 90 patients with idiopathic non-allergic rhinitis were divided into three groups. Silver nitrate was given to Group I, flunisolide to Group II, and placebo to Group III. Healing results according to symptoms, physical findings, nasal smear findings and biopsy findings were compared. Improvement ws noticed in symptoms (rhinorrhea 93%, sneezing 89%, nasal congestion 80%), physical findings (color of mucosa 89%, concha hypertrophy 87%, rhinorrhea 82%), nasal smear findings (94%) and biopsy findings (epithelium 76%, basal membrane 80%, edema 84%, eosinophilia 95%, inflammation 87%) in Group I. Recurrence was observed in symptoms and physical findings of 30% of the patients in Group I during the 6 months-follow-up period. In Group II, improvement was noticed in symptoms (rhinorrhea 73%, sneezing 70%, nasal congestion 61%), physical findings (color of mucosa 72%, concha hypertrophy 69%, rhinorrhea 62%), nasal smear findings (87%) and biopsy findings (epithelium 67%, basal membrane 63%, edema 70%, eosinophilia 77%, inflammation 70%). But symptoms recurred in all patients in approximately 1-3 months after competition of treatment. There was a statistically significant difference between silver treatment and flunisolide or placebo treatment.