Solitary large malignant lymphoma in the head and neck region.

The present study examined the clinical characteristics of patients with a final diagnosis of solitary large malignant lymphoma of the head and neck after surgery. Between January 2015 and December 2022, 13 patients with a final diagnosis of solitary large malignant lymphoma of the head and neck after surgery were enrolled. The most common symptom of solitary large malignant lymphoma was a neck mass (n=11; 84.6%). The most common sites of the head and neck were neck level II (eight patients), neck level IV (two patients), parotid glands (two patients) and the tongue (two patients). The number of malignant lymphomas was as follows: 11 patients had one large tumor and two patients had two large tumors. The mean tumor size was 4.0±1.3 cm (range; 2.7-6.8 cm). Among the two patients with two lymphomas, the size of the second neck mass was 3.2 cm in one patient and 2.7 cm in the other patient. The most common type of solitary large malignant lymphoma was diffuse large B-cell lymphoma (n=6, 46.2%). A total of 12 patients are currently under follow-up without disease recurrence after treatment completion and one patient diagnosed 1 month ago is currently undergoing radiation therapy. The follow-up period was 47.3±19.0 months (range; 1-62 months). The possibility of solitary large malignant lymphoma of the head and neck should be considered. As it is difficult to accurately diagnose solitary large malignant lymphoma before surgery, surgical resection is required for differentiation from other diseases.

Growth rates over time of unoperated parotid benign tumors.

INTRODUCTION: The treatment of parotid benign tumor is in principle surgery, but observation may be necessary in some cases. The purpose of this study was to investigate the growth rates over time of unoperated parotid benign tumors. METHODS: We retrospectively reviewed the medical records of 63 patients with unoperated parotid benign tumors diagnosed at our institution between January 2010 and December 2022. RESULTS: Forty-nine of the 63 patients had a Warthin tumor and 13 patients had a pleomorphic adenoma. On average, the unoperated parotid benign tumors grew 0.02 cm in length and 0.4 cm3 in volume per year. Compared to pleomorphic adenomas, Warthin tumors were more predominant in male patients and in those with a smoking history and a longer duration of smoking history; patients with Warthin tumors were also followed up longer (p < 0.05). However, the length and volume growth rates of unoperated Warthin tumors and pleomorphic adenomas did not significantly differ. CONCLUSION: Surgery is the standard treatment for parotid benign tumors. However, small benign parotid tumors identified during preoperative examination can be observed through close follow-up, taking into account the patient's medical and general condition.

Diagnostic tips for parotid lymphoma.

OBJECTIVES: Parotid lymphoma is a rare disease and proves challenging to differentiate from other masses. In this study, we aimed to analyze the clinical characteristics of parotid lymphoma to identify diagnostic factors to facilitate a diagnosis of parotid lymphoma. MATERIALS AND METHODS: We retrospectively enrolled 7 patients with parotid lymphoma, which was diagnosed at our hospital from 2012 to 2023. RESULTS: All participants had a well-defined, homogeneous solid mass; moreover, 5 patients had bilateral multiple lymphadenopathy that was detected on neck computed tomography (CT). Three patients had lymphocyte-related findings in fine-needle aspiration cytology (FNAC). CONCLUSION: Despite the challenges in diagnosing a parotid lymphoma, CT and FNAC findings can facilitate a differential diagnosis of parotid lymphoma.

Toxoplasmic Lymphadenitis of the Head and Neck Region.

OBJECTIVE: We analyzed the clinical characteristics and treatment results in patients with a final diagnosis of toxoplasmic lymphadenitis after surgery. METHODS: A total of 23 patients with a final diagnosis of toxoplasmic lymphadenitis of the head and neck region after surgery from January 2010 to August 2022 were enrolled. RESULTS: All patients with toxoplasmic lymphadenitis presented with a neck mass and a mean age of over 40. The most common location of toxoplasma lymphadenitis in the head and neck was neck level II in 9 patients, followed by level I, level V, level III, the parotid gland, and level IV. Three patients had masses in multiple regions of the neck. Preoperative diagnosis (based on imaging tests, physical examination, and fine-needle aspiration cytology results) was benign lymph node enlargement in 11 cases, malignant lymphoma in 8 cases, metastatic carcinoma in 2 cases, and parotid tumors in 2 cases. All patients underwent surgical resection and were diagnosed with toxoplasma lymphadenitis based on the final biopsy. There were no major complications after surgery. A total of 10 patients (43.5%) received additional antibiotics after surgery. There was no recurrence of toxoplasmic lymphadenitis during the follow-up period. CONCLUSIONS: It is challenging to assess the diagnostic accuracy of preoperative examination in toxoplasma lymphadenitis; hence, surgical resection is necessary to differentiate it from other diseases.

Clinical characteristics analysis of sinonasal diffuse large B-cell lymphoma and extranodal NK/T-cell lymphoma.

KEYPOINTS: Extranodal NK/T-cell lymphoma (ENKL) was the most common sinonasal lymphoma at our hospital. ENKL occurs at a younger age, and is more prevalent in the nasal cavity. ENKL had a lower Ann Arbor stage, and a better prognosis than diffuse large B-cell lymphoma (DLBLC).

Comparative analysis of benign and malignant parotid gland tumors: A retrospective study of 992 patients.

OBJECTIVE: We analyzed and compared the clinical characteristics of benign and malignant parotid gland tumors. PATIENTS AND METHODS: A total of 992 patients who underwent surgical treatment for parotid gland tumors from January 2010 to December 2020 were included in this study. This study population was subdivided into benign (n = 812, 81.9 %) and malignant parotid gland tumors (n = 180, 18.1 %). RESULTS: Pleomorphic adenoma is the most common benign tumor and mucoepidermoid carcinoma is the most common malignant tumor. The patients with malignant parotid gland tumors were older than the patients with benign lesions. The duration of symptoms was longer in patients with benign parotid gland tumors compared to those with malignant lesions. The size of the malignant tumors was larger than that of the benign lesions. Preoperative fine-needle aspiration cytology had a diagnostic sensitivity of 50.3 %, diagnostic specificity of 98.7 %, a positive predictive value of 89.5 %, a negative predictive value of 89.9 %, and accuracy of 89.9 % for diagnosing malignant parotid gland tumors. For benign parotid gland tumors, superficial parotidectomy was most frequently performed, and for malignant parotid gland tumors, total parotidectomy was most frequently performed. Facial palsy was observed in 19.4 % of the patients with malignant parotid gland tumors compared to 5.4 % of those with benign tumors. CONCLUSION: The clinical features of benign and malignant parotid gland tumors showed differences in age, symptoms, duration of symptoms, size and site of the parotid tumors, surgical procedures, and postoperative facial nerve palsy.

Mononostril Endoscopic Approach for Bilateral Sphenoid Sinus Lesions.

INTRODUCTION: A mononostril endoscopic approach was attempted for bilateral sphenoid sinus lesions. The objective of this study was to introduce the surgical method along with treatment results for patients. METHODS: We retrospectively analyzed 16 patients who underwent a mononostril endoscopic surgery for bilateral sphenoid lesions from 2018 to 2022. RESULTS: Endoscopic mononostril surgery for bilateral sphenoid lesions was performed for 13 cases under general anesthesia and 3 cases under local anesthesia. The surgical approach to the sphenoid sinus was transnasal approach in 8 cases and transethmoidal in 8 cases. Among those with bilateral sphenoid sinuses lesions, fungal ball and sinusitis were the most common. After surgery, the size of the sphenoid sinus opening remained almost the same in 14 patients. It decreased but maintained in 2 patients. There was no recurrence of sphenoid lesions. CONCLUSION: The mononostril endoscopic approach for bilateral sphenoid lesions is a feasible, safe, effective, and minimally invasive surgical technique.

Patients with Epiglottic Collapse Are Less Adherent to Autotitrating Positive Airway Pressure Therapy for Obstructive Sleep Apnea.

Rationale: The anatomic orientation of the epiglottis is such that it points in the opposite direction to inspiratory flow, thereby potentially making positive airway pressure (PAP) treatment challenging in patients with epiglottic collapse. However, no previous studies have analyzed PAP adherence in these patients. Objectives: This study aimed to analyze adherence to autotitrating PAP (APAP) treatment in patients with epiglottic collapse. Methods: We performed an age- and sex-matched case-control study. On the basis of their overnight level-I polysomnogram, patients were prescribed APAP in a tertiary hospital between July 2018 and March 2019. The site of airway collapse was diagnosed with drug-induced sleep endoscopy. Demographic factors, sleep questionnaire, polysomnography, and APAP usage statistics were analyzed. Results: Eighteen patients with epiglottic collapse (epi-group) and 36 without epiglottic collapse (control group) were analyzed. We found that 22.8% of patients in the epi-group terminated APAP within 2 weeks, whereas only 2.8% of patients in the control group terminated APAP within 2 weeks (P = 0.048). The percentage of days with usage over 4 hours was significantly lower in the epi-group (64.6% vs. 75.6%; P = 0.008). In addition, the adherence failure rate was 66.7% in the epi-group and 33.3% in the control group (P = 0.039). Patients with epiglottic collapse were also found to have lower body mass index, which is an unfavorable predictor of APAP adherence. Conclusions: This study suggests that patients with epiglottic collapse have a higher APAP adherence failure rate than patients without epiglottic collapse. Thus, patients with epiglottic collapse should be followed closely during treatment, and alternative therapies should probably be considered for these patients.

Multiple synchronous neoplasms in the ipsilateral parotid gland: case series.

BACKGROUND: Multiple synchronous neoplasms in the ipsilateral parotid gland are very rare. We intend to analyze the clinical characteristics and treatment results of multiple synchronous neoplasms in the ipsilateral parotid gland managed at our hospital. METHODS: The study included 21 patients of multiple synchronous neoplasms in the ipsilateral parotid gland from January 2010 to December 2020. RESULTS: Twenty-one cases of multiple synchronous neoplasms in the ipsilateral parotid gland were identified among 994 cases of parotid surgery, with a frequency of 2.1%. Multiple synchronous neoplasms in the ipsilateral parotid gland occurred in all males and one female. Except for one case, all of them involved histopathologic neoplasms. Warthin tumor (n=19, 90.5%) was the most common. Among 21 lesions, there were 9 patients of right parotid gland, 4 patients of left parotid gland, and 4 patients of bilateral parotid gland. The main symptoms were slowly enlarging mass within the parotid gland (n=20), followed by incidental detection (n=1). CONCLUSIONS: Clinicians should be aware of the possibility of multiple synchronous neoplasms in the ipsilateral parotid gland. Preoperative imaging tests, clinical examinations, and careful palpation during surgery are important for accurate diagnosis and treatment.

Natural killer cells have a synergistic anti-tumor effect in combination with chemoradiotherapy against head and neck cancer.

BACKGROUND: The use of natural killer (NK) cells is a promising approach in the field of cancer immunotherapy; however, combination treatments are required to enhance the effects of NK cell immunotherapy. In this study, we assessed the potential of irradiation and cisplatin as a chemoradiotherapy (CRT) regimen to augment the effects of NK cell immunotherapy in head and neck squamous cell carcinoma (HNSCC). METHODS: NK cells were expanded using our recently established K562-OX40 ligand and membrane-bound interleukin (IL)-18 and IL-21 feeder cells in the presence of IL-2/IL-15 from peripheral blood of healthy donors. RESULTS: The results showed an increase in the purity of NK cells and expression of activation markers such as NKG2D and lymphocyte function-associated antigen 1 during the expansion process, which is positively correlated to the NK cell infiltration and overall survival in patients with HNSCC. CRT induced NK cell activation ligand (ULBP2) and adhesion molecules (ICAM-1, -2 and -3) on HNSCC, leading to enhanced cytotoxicity of NK cells against HNSCC. CONCLUSIONS: Our findings suggest that the NK cells have a potent anti-tumor effect in combination with CRT against HNSCC.

Bilateral auriclar and external ear canal cartilage calcification.

Calcification of auricular cartilage is a rare condition. This phenomenon might be associated with frostbite, local trauma, inflammation, or systemic diseases. Calcification that progresses to the external ear canal cartilage is even rarer. We present an extremely rare case of bilateral auricular and external ear canal cartilage calcification in a patient with acromegaly. Clinicians should be aware that auricular and external ear canal cartilage calcification can occur in a patient with acromegaly.

Head rotation improves airway obstruction, especially in patients with less severe obstructive sleep apnea without oropharyngeal collapse.

PURPOSE: Head rotation is thought to have an effect on obstructive sleep apnea (OSA) severity. However, keeping the head rotated fully during sleep is difficult to maintain, and the effect of head rotation is not the same in all OSA patients. Thus, this study aimed to identify whether less head rotation has an effect on airway patency and determine the responder characteristics to the head rotation maneuver (HRM). METHODS: We recruited 221 patients who underwent overnight polysomnography and drug-induced sleep endoscopy (DISE) in a tertiary hospital from June 2019 to July 2020. Airway patency and the site of airway collapse were determined in the supine position with the head at 0, 30, and 60 degrees of rotation (HRM0°, HRM30°, and HRM60°, respectively) during DISE. The site of collapse was determined using the VOTE classification system: the velum (palate), oropharyngeal lateral walls, tongue base, and epiglottis. Each structure was labeled as 0, 1, or 2 (patent, partially obstructed, and completely obstructed, respectively). Airway response to the HRM30° and 60° and the clinical characteristics associated with airway opening were analyzed. RESULTS: The study population had a median age of 52 (25-61) years, a body mass index of 26.7(24.6-29.4) kg/m2, and the apnea-hypopnea index (AHI) of 28.2(13.7-71.9) events/h. HRM influenced airway patency positively not only with HRM60° (p<0.001) but also following limited rotation (HRM30°, p<0.001). Patients with tongue base (40.0% with HRM 60°) and epiglottic (52.6% with HRM 60°) collapse responded particularly well to HRM. Multivariate analysis revealed that lower AHI (p<0.001) and an absence of oropharyngeal lateral walls collapse (p = 0.011) were significant predictors of responders to HRM. CONCLUSION: Head rotation improved airway obstruction in OSA patients, even with a small degree of rotation, and should be further explored as a potential form of therapy in appropriately selected patients.

Antrochoanal Polyp and Migrated Dental Implant in the Ipsilateral Maxillary Sinus.

Antrochoanal polyp is usually a benign solitary mass lesion originated from maxillary sinus mucosa and emerging through maxillary ostium. We report a rare case of antrochoanal polyp and migrated dental implant in the ipsilateral maxillary sinus. Clinicians should be aware that ACP may have other concomitant conditions such as migrated dental implants.

Metastasis of Sublingual Gland Adenoid Cystic Carcinoma to the Upper Gingiva.

Adenoid cystic carcinoma (ACC) of the sublingual gland is rare. There are no previous reports of the metastasis of sublingual gland ACC to the upper gingiva. Herein, we report the first case of a patient with metastasis of sublingual gland ACC to the upper gingiva. It should be recognized that although metastasis of sublingual gland ACC to the upper gingiva is very rare, it can occur.

Clinical features and recurrence factors of benign neoplasms of the tongue base.

INTRODUCTION: Neoplasms of the tongue base are rare, but they range from benign neoplasms to congenital diseases and malignant neoplasms. The purpose of this study is to analyze the clinical features and recurrence factors of benign tumors of the tongue base. METHODS: The study included 27 cases of benign neoplasms of the tongue base from January 2010 to February 2022. RESULTS: Of these 27 patients, 19 were male and 8 were female. Most cases were found incidentally without any specific symptoms, and squamous papilloma was the most common tumor. We performed microscopic or endoscopic transoral resection of benign neoplasms of the tongue base under general anesthesia in all patients without any complications. The recurrence rate was 14.8%, and we found that the younger the patient, the higher the recurrence rate (p < 0.001). CONCLUSION: We performed transoral resection of benign neoplasms of the tongue base in all patients without any complications. The recurrence of benign neoplasms of the tongue base was statistically significant only in terms of age.

Metastasis of parotid adenocarcinoma to the external auditory canal.

Metastatic carcinoma of the external auditory canal (EAC) is extremely rare. Herein, we report the first case of a patient with metastasis of parotid adenocarcinoma to the EAC. Clinicians should include it in the differential diagnosis of tumors of the EAC. In patients with parotid carcinoma, a physical examination of the entire head and neck, including the EAC, should be performed before surgery.

Long-Term Results of Fibrous Dysplasia of the Paranasal Sinuses.

INTRODUCTION: Fibrous dysplasia (FD) is a benign, idiopathic skeletal disorder, in which the normal bone and marrow are replaced by fibrous tissue and immature woven bone. The authors aim to analyze the long-term results of patients diagnosed with FD of the paranasal sinuses via imaging or surgical biopsy. METHODS: The authors retrospectively enrolled 21 patients with FD of the paranasal sinuses from 2006 to 2021. RESULTS: The mean age at the time of diagnosis of FD of the paranasal sinuses was very high at 45.9 years. The most common site ofoccurrence was the sphenoid sinus (71.4%). During the mean follow-up period of 52.8 months, there was no significant change in the size of FD of the paranasal sinuses, and there was no worsening of symptoms or complications. Endoscopic sinus surgery was performed in 16 patients (76.2%), of which 13 underwent only biopsy and 3 underwent partial resection. CONCLUSIONS: The most common site of FD of the paranasal sinuses was the sphenoid sinus, and the age at diagnosis was higher thanthat of patients with FD at other sites. Observation with serial radiologic examinations is recommended for asymptomatic FD of the para-nasal sinuses.

Surgical Treatment of Parapharyngeal Space Salivary Gland Tumor.

INTRODUCTION: Parapharyngeal space salivary gland tumors are very rare. The authors sought to examine the clinical features, treatment methods, and treatment results of parapharyngeal space salivary gland tumors in our hospital. METHODS: The authors retrospectively enrolled 15 patients who were finally diagnosed as having parapharyngeal space salivary gland tumors from January 2010 to January 2021. RESULTS: All parapharyngeal space salivary gland tumors arose from the prestyloid compartment. This study included 3 males and 12 females. The main symptoms were incidental diagnosis during imaging tests, followed by neck discomfort, oral mass, neck mass, and headache. Surgical methods for parapharyngeal space salivary gland tumors were performed in the following order: transcervical approach (n = 10), transcervical-parotid approach (n = 3), transoral approach (n = 1), and transparotid approach (n = 1). Pleomorphic adenoma was the most common tumor among parapharyngeal space salivary gland tumors. CONCLUSIONS: In the surgery of parapharyngeal space salivary gland tumors, a transcervical or transcervical-parotid approach was mainly used by predicting the origin site through radiologic examinations.

Carcinoma ex pleomorphic adenoma of the parotid gland.

INTRODUCTION: Carcinoma ex pleomorphic adenoma (CXPA) is a rare malignant tumor of the parotid gland. We analyzed the clinical characteristics and treatment outcomes of CXPA of the parotid gland in patients managed for 11 years at this hospital. METHODS: The study included 17 cases of CXPA of the parotid gland from January 2010 to December 2020. RESULTS: Over 11 years, CXPA was the fourth most common parotid carcinoma, accounting for 9.4% of the 180 cases finally diagnosed as parotid carcinoma. Of the 17 cases of CXPA of the parotid gland, 12 lesions were removed by superficial parotidectomy, four lesions by total parotidectomy, and one lesion by radical parotidectomy. Four patients underwent neck dissection. The most common histopathology type was salivary duct carcinoma (n = 13, 76.5%). Postoperative radiation therapy (RT) was performed in 15 patients. Two patients (11.8%) experienced CXPA recurrence 14 and 19 months after surgery. CONCLUSION: CXPA of the parotid gland was treated without recurrence in about 90% of the patients through surgery and postoperative RT. In the case of frankly invasive or adverse factors in the histopathological examination, more attention is required because CXPA recurrence may occur more frequently.

Anatomical Characteristics of the Anterior Jugular Vein and Its Clinical Relevance.

INTRODUCTION: The anterior jugular vein (AJV) is part of the superficial venous drainage system of the head and neck. Recently, interest in AJV is increasing as various surgical procedures have been developed. The authors conducted a cadaveric study to determine characteristics of AJV in Koreans. METHODS: A total of 44 cadavers were dissected. Anatomical characteristics were analyzed for 34 cadavers in which AJV was well observed. RESULTS: In this study, 21 were males and 13 were females. There were 8 cadavers with only 1 AJV from both sides. There was no significant difference in anatomical characteristics according to gender or AJV variation except for a difference in the length of the neck according to gender. However, it was possible to find a safety zone at the main landmark of the neck that could avoid AJV damage. CONCLUSIONS: By using this safety zone, it is possible to prevent damage to the AJV and reduce complications during various surgical procedures on the head and neck.