Applicability of Dynamic Risk Stratification for Differentiated Thyroid Cancer (DTC) in a Resource Limited Setting.

Dynamic risk stratification (DRS) in DTC has been considered necessary to deliver correct follow-up (FU) treatment, avoiding overtreatment of low risk/intermediate risk patients as well as inadequate treatment of high risk patients. However, it's clinical applicability has been questioned in comparison with more conventional FU protocols. We aimed to know the predictive reliability of DRS in monitoring FU of DTC in a resource-constrained setting across various risk groups, especially when compared with clinical examination alone.

The role of distraction osteogenesis in mandibular reconstruction.

PURPOSE OF REVIEW: Distraction osteogenesis is finding increasing application in the management of mandibular defects. It provides an alternative method of mandibular reconstruction in varied clinical settings, notably following trauma and ablation of malignant tumors. Many recent studies have explored modifications in surgical technique, refinements in device design, and experiments in animal models. This review attempts to discuss all of the above. RECENT FINDINGS: In addition to managing the segmental mandibular gap, the vertical distraction technique is highly useful for increasing fibular bony height, allowing osseointegrated implant placement and dental rehabilitation. Variations in distraction planes, parameters and device placement have made it possible to tailor appropriate reconstructive strategies to the specific patient. Newer developments in distractor design and constituents, and the application of staged distraction procedures, have facilitated optimal management of the challenging defect. SUMMARY: Distraction osteogenesis is a continually evolving field of research and study, and an aesthetically and functionally acceptable option for managing extensive mandibular defects, and those not amenable to conventional methods. It offers distinct advantages over other available reconstructive options, but does have its disadvantages. With further improvement in devices and technique, it has the potential of being much more widely used in the future.

Role of socioeconomic factors in deep neck abscess: A prospective study of 120 patients.

OBJECTIVE: To assess the socioeconomic factors, presentation, aetiological factors, microbiology, and management of deep neck abscesses. DESIGN: Prospective study. SETTING: Tertiary health care centre. PATIENTS AND METHODS: We studied 120 patients with deep neck abscess who were managed in the department of otolaryngology between May 2004 and December 2005. RESULTS: There were 54 male patients (45%) and 66 female (55%) with ages ranging from 18 months to 60 years. Most of the patients were of low socioeconomic status and 84 (70%) were illiterate. None were aware of the predisposing factors and potential complications of deep neck abscess. Ninety-six (80%) had poor orodental hygiene with dental infections and extraction as the most common predisposing factor followed by recurrent oropharyngeal infections. The median duration of delay before the patient presented to us was 1 week, and only 6 (5%) were aware of the primary health services available in their locality. The most common site was the submandibular region. Pain, fever, and dysphagia were the most common presenting symptoms, and Staphylococcus aureus was the most common micro-organism. All patients were treated by incision and drainage, and 10 required emergency tracheostomy. All patients responded with no complications. CONCLUSION: Socioeconomic factors, particularly ignorance, illiteracy, and poverty, are important contributory factors towards the high incidence of deep neck abscess in developing countries.

Outcomes of nonsurgical management of locally advanced carcinomas of the sinonasal cavity.

OBJECTIVE: To determine the outcome of definitive concurrent chemoradiation with platinum for locally advanced sinonasal carcinomas. STUDY DESIGN: Retrospective cohort. METHODS: Twenty-three nonsurgically and definitively treated patients diagnosed between July 1998 and February 2009 were analyzed. Patients with adenoid cystic carcinoma or adenocarcinoma were treated with photons and neutrons; the other histologies received photons alone. The vast majority received chemotherapy. Descriptive statistics were utilized, and Kaplan-Meier estimates were computed. RESULTS: Female (57%) and Caucasian (74%) preponderance were observed. Eighty-seven percent were unresectable; the maxillary and nasoethmoid sites were equally prevalent. Intensity-modulated radiation therapy (IMRT) and photons alone were utilized in 74% and 70%, respectively. Platinum agents were given in 95% of chemotherapy patients. Complete response was observed in 64% of patients. Median progression-free survival (PFS) and overall survival (OS) were 28.8 and 65.3 months, respectively. Three-year PFS and OS rates were 44% and 72%, respectively; 5-year PFS and OS rates were 30% and 60%, respectively. Intensity-modulated radiation therapy and a maxillary site of origin showed a trend toward superior PFS; higher-dose regimens were associated with somewhat shorter PFS. Relapse was observed in 59% of patients, predominantly local. There were few unanticipated adverse effects, and no grade IV/V events were reported. CONCLUSION: Advanced sinonasal carcinomas are chemoradiosensitive tumors, albeit with a high propensity for local relapse. There is a definite indication for IMRT and a potential curative role of platinum-based chemoradiation regimens. LEVEL OF EVIDENCE: 4. Laryngoscope, 127:855-861, 2017.

Pharyngeal perforation with deep neck abscess secondary to isolated hyoid bone fracture.

We report the case of a 26-year-old man who presented to us with dysphagia secondary to blunt trauma to the neck. The patient was found to have a hyoid bone fracture with pharyngeal perforation and resultant neck abscess. The patient responded to prompt surgical and medical management. We believe this to be the first report of such a case.

Understanding the Risk Factors and Long-Term Consequences of Cisplatin-Associated Acute Kidney Injury: An Observational Cohort Study.

Acute kidney injury (AKI) is a well-known complication of cisplatin-based chemotherapy; however, its impact on long-term patient survival is unclear. We sought to determine the incidence and risk factors for development of cisplatin-associated AKI and its impact on long-term renal function and patient survival. We identified 233 patients who received 629 cycles of high-dose cisplatin (99±9mg/m2) for treatment of head and neck cancer between 2005 and 2011. These subjects were reviewed for development of AKI. Cisplatin nephrotoxicity (CN) was defined as persistent rise in serum creatinine, with a concomitant decline in serum magnesium and potassium, in absence of use of nephrotoxic agents and not reversed with hydration. All patients were hydrated per protocol and none had baseline glomerular filtration rate (GFR) via CKD-EPI<60mL/min/1.73m2. The patients were grouped based on development of AKI and were staged for levels of injury, per KDIGO-AKI definition. Renal function was assessed via serum creatinine and estimated glomerular filtration rate (eGFR) via CKD-EPI at baseline, 6- and 12-months. Patients with AKI were screened for the absence of nephrotoxic medication use and a temporal decline in serum potassium and magnesium levels. Logistic regression models were constructed to determine risk factors for cisplatin-associated AKI. Twelve-month renal function was compared among groups using ANOVA. Kaplan-Maier curves and Cox proportional hazard models were constructed to study its impact on patient survival. Of 233 patients, 158(68%) developed AKI; 77 (49%) developed stage I, 55 (35%) developed stage II, and 26 (16%) developed stage III AKI. Their serum potassium and magnesium levels correlated negatively with level of injury (p<0.05). African American race was a significant risk factor for cisplatin-associated AKI, OR 2.8 (95% CI 1.3 to 6.3) and 2.8 (95% CI 1.2 to 6.7) patients with stage III AKI had the lowest eGFR value at 12 months (p = 0.05) and long-term patient survival (HR 2.1; p<0.01) than patients with no or lower grades of AKI. Most common causes of death were recurrent cancer (44%) or secondary malignancy elsewhere (40%). Cisplatin-associated severe AKI occurs in 20% of the patients and has a negative impact on long-term renal function and patient survival. PEG tube placement may be protective and should be considered in high risk-patients.

Factors predictive of severity of osteoradionecrosis of the mandible.

BACKGROUND: An analysis of risk factors predictive of severe mandibular osteoradionecrosis (ORN) is needed to aid prophylaxis and management of this condition. METHODS: We retrospectively analyzed 46 patients diagnosed between June 2002 and March 2009: 93% had mandibular ORN, which was staged 0 to III (Store and Boysen). Patient, tumor, treatment-related, and other variables were analyzed for association with mandibular ORN severity. RESULTS: Oral or oropharyngeal tumors comprised 85% of our primary tumors, 80% were stage IV, and 91% were squamous cell carcinomas. Most patients (87%) received 3-dimensional (3D) conformal radiation therapy (RT), with 60 Gray (Gy) median dose; 28% and 72% received primary and adjuvant RT, respectively; 78% received chemotherapy, mostly concurrent (97%) and platinum-based (96%). Median time to development of ORN was 7.5 months. White ethnicity and secondary infection correlated significantly with stage III mandibular ORN (p = .038, p = .0007, respectively). Advanced age, stage IV, RT dose, post-RT, and lack of pre-RT dental extractions appeared predictive of severe mandibular ORN. CONCLUSIONS: The above-cited factors are predictive of severity and can potentially guide prophylaxis and management.

Intraparotid facial nerve neurofibroma: an uncommon neoplasm / Neurofibroma intraparotídeo del nervio facial: una neoplasia poco frecuente

Intraparotid facial nerve neurofibromas are a rare entity, and are grossly and histopathologically distinct from the comparatively more prevalent schwannomas. We report a rare case of an intraparotid facial nerve neurofibroma with intratemporal extension in a 48-year-old female. The tumor was surgically excised with cable grafting of the facial nerve. Electroneurography may eventually assist in the preoperative diagnosis. Facial nerve resection should be more readily contemplated in a patient with neurofibroma than in a patient with schwannoma; however, facial nerve preservation with serial follow-up electroneurography and computerized tomography remains a viable option in patients with small facial nerve neurofibromas when electrical testing reveals minimal evidence of progressive neural degeneration. Close monitoring, especially in neurofibromas associated with Von Recklinghausen's disease, is mandatory because of an increased risk of sarcomatous degeneration.

Los neurofibromas intraparotídeos del nervio facial son una entidad poco frecuente, macroscópicamente e histopatológicamente diferentes de los comparativamente más frecuentes schwannomas. Se presenta un caso raro de un neurofibroma del nervio facial con extensión intraparotídea intratemporal en una mujer de 48 años de edad. El tumor se extirpó quirúrgicamente con injerto del nervio facial. La electroneurografía puede llegar a ayudar en el diagnóstico preoperatorio. La resección del nervio facial debe ser realizada con mayor facilidad en un paciente con neurofibroma que en un paciente con schwannoma, sin embargo, la preservación del nervio facial con electroneurografía de seguimiento y tomografía computarizada sigue siendo una opción viable en pacientes con pequeños neurofibromas del nervio facial, cuando las pruebas eléctricas revelan mínima evidencia de degeneración neuronal progresiva. Una estrecha vigilancia, especialmente en los neurofibromas asociados con la enfermedad de Von Recklinghausen es fundamental debido al aumento del riesgo de degeneración sarcomatosa.

Clear cell myoepithelioma of the hard palate

Salivary gland myoepitheliomas are rare tumours. We report the case of a 40-year-old female who presented to us with a hard palatal mass. The tumour was excised with a healthy rim of surrounding tissue. Histological and immunohistochemical analyses revealed the tumour to be a myoepithelioma of the clear cell variety.