Occult nodal metastasis in head and neck carcinoma patients treated with chemoradiotherapy.

BACKGROUND AND AIM: Neck lymph node metastasis plays an important role in the prognosis of patients with squamous cell carcinoma of the head and neck. The aim of this study was to evaluate the occult nodal metastasis in patients with head and neck squamous cell carcinoma (HNSCC) treated with chemo radiotherapy. METHODS: In this 5-year prospective study, patients with recurrent head and neck squamous cell carcinomas (HN-SCC) after primary treatment with chemoradiotherapy or radiotherapy that candidate for surgery were enrolled. In total, 50 patients with squamous cell carcinomas of the head and neck with N0 neck were included in the study. Age, initial location of recurrent tumor, T staging in primary and recurrent tumors, neck condition (N0 or N+), and pathology report for neck metastasis, number of affected lymph nodes and duration of tumor recurrence were examined. RESULTS: Out of 50 patients with mean age of 57.04 ± 14.4 years, 13 were female (26%) and 37 (74%) were male. In terms of primary tumor size, 52% (26 patients) were in T2 stage. The primary and recurrent tumor was located in the oral cavity in 33 patients (66%). Nine 0f 50 patients (18%) had occult metastases. CONCLUSION: It seems that END surgery is necessary for treatment the occult lymph node neck metastasis of recurrent head and neck cancers with N0 neck. Therefore, it is possible that END surgery has reduced cervical recurrence in these patients.

Prevalence of submandibular gland involvement in neck dissection specimens of patients with oral cavity carcinoma.

INTRODUCTION: The submandibular gland is commonly removed during neck dissection in patients with head and neck cancer. The patient experiences various complications due to the removal of the submandibular gland. Therefore, the necessity of submandibular gland removal should be evaluated. This study aimed to was to determine the frequency of submandibular gland (SMG) involvement in patients with oral cavity squamous cell carcinoma (SCC). METHODS: In this retrospective study, medical records of patients with oral cavity cancer who were referred to Amir Alam Hospital between 2015 and 2020 were reviewed. Patient data includes surgical report, histopathology report (tumor size, number of lymph nodes involved, and SMG tumor involvement), Tumor Location, History of Smoking, History of Opium, and Alcohol consumption was extracted from patients' medical records and statistically analyzed using SPSS software version 20. RESULTS: Of the total 60 patients, 24 (40%) were female and 36 (60%) were male. Smoking was reported in 55% of patients with a mean of 4.11 pack-year. Alcohol and opium use was observed in 18.3% and 26% of patients. The majority of patients (78.3%) had tongue cancer. More than half of the patients (53.3%) reported tumors of 2 cm or smaller, and 16.7% of patients had tumors larger than 4 cm. The majority of patients (80.3%) did not have cervical lymph node metastasis, 13.1% had 1-2 involved lymph nodes and 4.9% had 3 to 6 involved lymph nodes and there were no cases of metastasis to more than 6 lymph nodes. Finally, no individual had submandibular gland involvement, ie 100% of patients had no submandibular gland metastasis. CONCLUSION: The results confirmed that SMG involvement is very rare in patients with oral SCC and therefore it is not necessary to remove the gland as part of treatment. Preservation of the submandibular gland prevents complications related to the removal of this gland and reduces morbidity and increases the quality of life of patients after surgery.

Can Acetaminophen Pretreatment Decrease the Pain Associated With Closed Nasal Bone Reduction? A Triple-Blind Randomized Clinical Trial.

PURPOSE: Nasal bone fracture is a common maxillofacial injury, which is usually managed under local anesthesia because it is fast and effective but painful. We designed this study to see if pre-emptive analgesia with acetaminophen can reduce the pain associated with nasal bone reduction under local anesthesia. PATIENTS AND METHODS: This was a triple-blind, randomized clinical trial. Our sample was patients with nose fracture (eligible for closed reduction) who presented to our nasal fracture clinic and they were divided into 2 arms. Medication was randomly delivered via packages, and the surgeon, patients, and data analyzer were all blind to the intervention. Demographic data along with the visual analog scale pain scores (1 to 10 score from least to most severe pain) during local anesthesia, during reduction, and 24 hours after reduction were recorded, then analyzed using χ2, nonparametric Mann-Whitney test, and correlation analysis. RESULTS: One hundred participants were divided into 2 arms (placebo or acetaminophen 500-mg tablet 45 minutes before reduction). The patients were mostly men (74%), and the most common mechanism was involvement in a fight (30%). Pain scores, as well as surgeon satisfaction analysis, returned no statistical difference between the 2 groups. Correlation analysis was performed, and the only factor for pain severity during reduction was the number of tries needed. CONCLUSIONS: Acetaminophen pretreatment did not add analgesia any more than that of placebo. Its use before reduction of nasal bone fracture is not justified.

Evaluation of Patients with Delayed Endolymphatic Hydrops by Videonystagmography, Vestibular-Evoked Myogenic Potentials, and Electrocochleography.

INTRODUCTION: The categorization of delayed endolymphatic hydrops (DEH) based on the ear which produces vertigo may sometimes cause misdiagnosis. OBJECTIVES: The aim of this study was investigating the vestibular-evoked myogenic potentials (VEMPs), electrocochleography (ECoG), and videonystagmography (VNG) in cases with DEH to determine the ear that originates symptoms. METHODS: In this cross-sectional study, 34 patients - 20 males and 14 females - with profound unilateral sensorineural deafness and vertigo attacks were recruited and evaluated by the ECoG, VNG, and VEMPs tests. RESULTS: The average age was around 43; the summating potential/action potential was abnormal in 29.4% of patients in their normal auditive ear. In 32.4, 17.6, and 50% of cases with a deaf ear, absent, normal, and abnormal VEMPs results were sequentially observed, respectively. In normal-hearing ears, absent, normal, and abnormal VEMPs were observed in 23.5, 50, and 26.5%, respectively. In the normal-hearing ear, the distribution of abnormal VEMPs was 26.5%, and in the deaf ear, this parameter was abnormal in 50% of the opposite ear (p value = 0.00021). In the VNG test, among patients with a normal-hearing ear, results in 27 and 7 patients were sequentially normal and hypofunction. CONCLUSION AND SIGNIFICANCE: The probability of a hypofunction VNG test in a normal-hearing ear might be greater when the VEMPs results of the contralateral deaf ear are normal. In patients with a normal-hearing ear, the distribution of abnormal VEMPs in the contralateral deaf ear is greater, although the intact side may also manifest abnormality in VEMPs tests. The initial evaluation should begin in a deaf ear as well as for the normal-hearing ear ere utilizing ablation surgery.

The role of core needle biopsy in parotid glands lesions with inconclusive fine needle aspiration.

OBJECTIVES: Usefulness of preoperative tissue sampling and pathology diagnoses in parotid gland tumors were accepted worldwide. We investigate the role of CNB in the parotid gland lesions when FNA results are inconclusive. METHODS: We conducted a cross sectional study to evaluate CNB results from fifty-two patients with history of parotid gland lesion and inconclusive previous fine needle aspiration. RESULTS: In this study, 45 out of 52 CNB results determined definite histological subtype diagnosis. Four CNB reports were inconclusive and three CNB results were compatible with malignancies, but did not define definite diagnosis. Calculated sensitivity for diagnosis of malignancy was 96% and specificity was 85%. Negative predictive value, positive predictive value, and accuracy for CNB in detecting malignancy, were calculated 94%, 90%, and 92%, respectively. CONCLUSIONS: When FNA is not conclusive, CNB may be used as a precise method to evaluate the parotid gland lesions.

Omega-3 Adjunctive Therapy in Idiopathic SSNHL: A Randomised, Triple-Blind, Placebo-Controlled Trial.

Introduction: Idiopathic Sudden Sensorineural Hearing Loss as a subset of sensorineural hearing loss will be confirmed by a progressive hearing loss of at least 30 dB at three contiguous frequencies over 72 hours or less. A sudden or abrupt hearing loss correlates with the time course, and a vascular event is presumptive aetiology. There is an inverse association between Omega-3 consumption and hearing loss. This study aimed to evaluate the efficacy of Omega-3 adjunctive therapy in Idiopathic Sudden Sensorineural Hearing Loss by audiometric assessments. Materials and Methods: In this randomised, triple-blind, placebo-controlled trial, all participants aged 18-70 with a history of sudden deafness (within 12 hours and ≤ 30 days) were eligible for enrollment. They were included if audiology diagnostic tests confirmed the SSNHL. Ultimately, they were randomised to the Omega-3 group and the placebo group. Results: Thirty-three patients were randomly allocated to the Omega-3 group and thirty-two to the placebo group. Vertigo (32.3% of all patients) and underlying conditions had significant relationships with complete response (C.R.)-final hearing level ≤of 25 dB in pure-tone average (P < 0.05). There was no significant difference between both groups before and after treatment. Although it was not statistically significant, patients in the Omega-3 group had faster recovery than placebo. Conclusions: Omega-3 adjunctive therapy did not have a therapeutic effect on SSNHL patients. Moreover, C.R. happened in half the patients. Vertigo and underlying conditions considerably worsen the recovery from SSNHL.

Validity and Reliability of the Persian Version of Reflux Symptom Score-12 in Patients with Laryngopharyngeal Reflux Disease.

OBJECTIVE: Cross cultural adaptation of the reflux symptom score-12 (RSS-12) into Persian language and to evaluate its validity and reliability in the assessment of patients with laryngopharyngeal reflux disease (LPRD). STUDY DESIGN: A cross-sectional and prospective cohort design. METHODS: A standard forward and backward translation was followed to cross-culturally adapt the RSS-12 into Persian language. To study discriminative validity, the RSS-12p was administrated to 63 patients with LPRD (40 men and 23 women; mean age: 39.26 ± 9.79 years) and 50 healthy volunteers (31 men and 19 women; mean age: 37.24 ± 10.28 years). The patients completed the reflux symptom index (RSI) to assess construct validity. The test-retest reliability was investigated in 31 patients (time interval = 7 days). RESULTS: There were no missing responses and floor or ceiling effects. The assessing of discriminative validity showed that the questionnaire was able to discriminate between patients with LPRD and healthy participants (P<0.001). Construct validity was confirmed by the Pearson correlation between the RSS-12p and the RSI (rp= 0.87; P<0.00). The internal consistency was confirmed with Cronbach α 0.85 and 0.72 for the RSS-12p and quality of life (QoL), respectively. Test-retest reliability was excellent (ICCagreement = 0.98 for the RSS-12p and 0.94 for QoL). CONCLUSIONS: The Persian version of RSS-12 is a valid and reliable self-administered questionnaire for assessing LPRD in Persian-speaking patients.

Core Needle Biopsy in Suspicious Malignant Thyroid Nodules with Repeated Nondiagnostic Fine Needle Aspiration.

Key message: The clinician could have CNB in mind for thyroid nodules when FNA results were nondiagnostic. Our study would suggest CNB a safe and efficient method for investigating thyroid nodules. Abstract: Usefulness of preoperative tissue sampling and pathology diagnoses in thyroid tumors were accepted worldwide. We investigate the role of Core needle biopsy (CNB) in the thyroid nodules lesions when FNA results are nondiagnostic. We conducted a cross-sectional study to evaluate twenty-six CNBs results of suspicious malignant thyroid nodules with nondiagnostic repeated fine needle aspiration. 25 from 26 CNBs were diagnostic. Twenty-one needle biopsy reports were papillary thyroid carcinoma, three CNB samples diagnosed medullary thyroid carcinoma and one of them had anaplastic results. All diagnostic needle biopsies results were compatible with final pathology. Our study would suggest CNB a safe and efficient method for investigating thyroid nodules while repeated FNA yielded nondiagnostic results.

Perfusion Computed Tomography Scan Imaging in Differentiation of Benign from Malignant Parotid Lesions.

Introduction The most common site of salivary gland tumors is the parotid gland. Computed tomography (CT), magnetic resonance imaging (MRI), and sonography are imaging modalities to differentiate benign from malignant parotid tumors. Objective The aim of this study is the evaluation of the diagnostic value of perfusion CT for differentiating histological categorization of benign and malignant parotid tumors. Methods A total of 29 patients with parotid neoplasms were enrolled in this study. Mean age and all CT perfusion variables (gradient and permeability, blood flow [BF], blood volume [BV], mean transit time [MTT], permeability surface [PS], maximum intensity projection [MIP], time-density curve [TDC], and time to peak [TTP]) were compared among three groups (malignant tumors [MTs], Warthin's tumor [WT] and pleomorphic adenomas [PA]). Results The mean age of the patients was 55.9 ± 14.1 (26-77), and 15 of them were male (51.7%). Eleven lesions were PAs [37.9%], 8 lesions were WTs (27.6%0 and 10 lesions (34.5%) were MTs (6 acinic cell carcinomas [ACCs], 3 adenocystic carcinomas [AdCCs], and 1 mucoepidermoid carcinoma [MEC]). The mean age of the patients with WTs was 62 ± 7.5 years; 52 ± 14.2 for patients with Pas, and 55.2 ± 17.2 for those with MTs ( p = 0.32). The mean MIP was 122.7 ± 12.2 in WT, while it was 80.5 ± 19.5 in PA, and 76.2 ± 27.1 in MTs ( p < 0.001); The mean MIP for WT was higher than for PAs and MTs; the values of MTs and PAs were not statistically different. The average of BF, BV, and curve peak were higher in WTs in comparison with the other two groups, and curve time 2 and TTP were higher in PAs in comparison with MTs. Conclusion Based on this study, perfusion CT of the parotid gland and its parameters can distinguish between benign and malignant parotid masses.

Results of End-To-Side Hypoglossal-Facial Nerve Anastomosis in Facial Paralysis after Skull Base Surgery.

INTRODUCTION: The primary aim of facial reanimation surgery is to restore tone, symmetry, and movement to the paralyzed face. Hypoglossal-facial end-to-side anastomosis provides satisfactory facial reanimation in the irreversible proximal injury of the facial nerve. This study discussed the facial function results of end-to-side anastomosing of hypoglossal nerve to facial nerve when the injury occurred during skull base surgery. MATERIALS AND METHODS: The present study enrolled a total of 10 patients who underwent end-to-side hypoglossal-facial nerve anastomosis after facial nerve paralysis due to skull base surgery. The data of the patients were gathered from hospital records, pictures, and movies during the 18 months of follow-up. RESULTS: At the 18 months of follow-up, seven (70%) and three (30%) patients were reported with grades III and IV of the House-Brackmann scoring system, respectively. In total, out of the seven grade III patients, six subjects underwent early anastomosis (within the first year of the paralysis). On the other hand, among patients with grade IV, two subjects had late anastomosis. CONCLUSION: It seems that early end-to-side hypoglossal-facial anastomosis can be a favorable surgical option with good facial function results for reanimating the facial function of patients with facial paralysis following skull base surgery.

Prevalence of Tracheostomy and Its Indications in Iran: A Systematic Review and Meta-Analysis.

BACKGROUND: Tracheostomy is common among intensive care unit (ICU) patients. Reconsideration of tracheostomy indications in patients can be effective in modifying and reducing irrevocable patient complaints. The present study aimed to analyze the prevalence of tracheostomy indications and to estimate the prevalence of tracheostomy in Iran. MATERIALS AND METHODS: In this systematic review and meta-analysis, scientific databases were searched from January 1990 to April 2018. The inclusion criteria were as follows: 1) use of the term "tracheotomy" in the title; and 2) studies conducted in Iran. On the other hand, the exclusion criteria were: 1) studies that did not specify the type of mechanical ventilation; 2) studies that did not quantitatively report the indications; 3) studies without access to the full-text; and 4) case studies, letters to the editor, and/or prefaces. Data were extracted from published reports. Our preliminary results included estimations of tracheostomy indications in Iran. RESULTS: In the preliminary search, a total of 325 articles were found, 24 of which were considered eligible. Among 2860 patients who had undergone tracheostomy, 21 indications were identified. Decreased mental status, respiratory disease, and tumors were the most frequent indications. The prevalence of tracheostomy was 40.59% in Iran, with the highest and lowest rates reported in Birjand and Ardabil, respectively (136.50 and 6.63 in 100,000 people, respectively) based on the random effects model. CONCLUSION: The most prevalent indications in Iran are different from those reported in other countries. This difference may be due to the lack of trained medical personnel and available technologies.

Perfusion Computed Tomography Scan Imaging in Differentiation of Benign from Malignant Parotid Lesions

Abstract Introduction The most common site of salivary gland tumors is the parotid gland. Computed tomography (CT), magnetic resonance imaging (MRI), and sonography are imaging modalities to differentiate benign from malignant parotid tumors. Objective The aim of this study is the evaluation of the diagnostic value of perfusion CT for differentiating histological categorization of benign and malignant parotid tumors. Methods A total of 29 patients with parotid neoplasms were enrolled in this study. Mean age and all CT perfusion variables (gradient and permeability, blood flow[BF], blood volume [BV], mean transit time [MTT], permeability surface [PS], maximum intensity projection [MIP], time-density curve [TDC], and time to peak [TTP]) were compared among three groups (malignant tumors [MTs],Warthin's tumor [WT] and pleomorphic adenomas [PA]). Results The mean age of the patients was 55.9±14.1 (26-77), and 15 of them were male (51.7%). Eleven lesions were PAs [37.9%], 8 lesions were WTs (27.6%0 and 10 lesions (34.5%) were MTs (6 acinic cell carcinomas [ACCs], 3 adenocystic carcinomas [AdCCs], and 1 mucoepidermoid carcinoma [MEC]). The mean age of the patients with WTs was 62±7.5 years; 52±14.2 for patients with Pas, and 55.2±17.2 for those with MTs (p=0.32). The mean MIP was 122.7±12.2 in WT, while it was 80.5±19.5 in PA, and 76.2±27.1 in MTs (p<0.001); The mean MIP for WT was higher than for PAs and MTs; the values of MTs and PAs were not statistically different. The average of BF, BV, and curve peak were higher inWTs in comparison with the other two groups, and curve time 2 and TTP were higher in PAs in comparison with MTs. Conclusion Based on this study, perfusion CT of the parotid gland and its parameters can distinguish between benign and malignant parotid masses.