Necrotizing fasciitis of the neck after total laryngectomy.

Necrotizing fasciitis (NF) is an unusual, life threatening, rapidly advancing infection characterized by widespread fascial and subcutaneous tissue necrosis and gangrene of the skin. It most commonly affects the extremities, abdominal wall and perineum, whereas cervical NF is rare. NF of the head and neck is often caused by both aerobic and anaerobic microorganisms found in the upper aerodigestive tract. Usually, cervical NF originates from odontogenic, tonsillar and pharyngeal infection, and it is very rarely a complication of surgical procedure. Without immediate surgical treatment, cervical NF leads to mediastinitis and fatal sepsis. There is only one case of cervical NF after total laryngectomy described in the literature. We report two cases of cervical NF after total laryngectomy, selective neck dissection and primary vocal prosthesis insertion. In both cases, the infection spreads to thoracic region and in one of them NF was associated with Lemierre's syndrome, i.e., thrombosis of the internal jugular vein. In both patients, vocal prosthesis was inserted during the infection and did not influence the healing process.

[Parathyroid hormone values in thyroid gland surgeries by harmonic scalpel and by conventional methods]. / Usporedba vrijednosti paratiroidnog hormona pri operacijama stitne zlijezde ultrazvucnim rezacem i konvencionalnim metodama.

We have examined if there are any differences in intraoperative and early postoperative concentrations of parathyroid hormone between the first group of patients, who had thyroidectomy surgery performed by harmonic scalpel, and the second group of patients operated on by standard techniqes with the use of electrocoagulation and ligature as primary hemostatic procedures. All the patients having total thyroidectomy had their blood taken in four measurement points; immediately after the induction anesthesia, 10 minutes after the first thyroid gland lobe removal, 10 minutes after total thyroid gland removal and 24 hours after the surgery. The blood samples were used to determine concentrations of the parathyroid hormone by an immunoradiometric test. The concentration comparison of parathyroid hormone between the first and the second group has not shown statistically significant difference for any of the four measurement points. The concentration comparison of parathyroid hormone within the same groups in relation to preoperational values (the first measurement point) has shown that in both groups the parathyroid hormone concentration, in all three post-incision measurement points, has been significantly lower in relation to the concentration measured before the surgery (p < 0.0005).

Inferior turbinate osteoma as a cause of unilateral nose obstruction.

Osteomas are benign, slow growing bone tumors often seen in paranasal sinuses, mostly in the frontal sinus, whereas they are rare in the nasal cavity. Inferior turbinate osteoma is extremely rare and our case is the third reported in the literature to date. Symptoms vary depending on the location, size and spreading and nasal obstruction is the most common symptom. Treatment of osteomas is surgical and is reserved only for rapidly growing osteomas with symptoms of infection or compression. Although endoscopic surgery is preferred modality, external approach with lateral rhinotomy should be considered with larger osteomas especially those that involve the ethmoid labyrinth. In cases like ours, when large osteoma is localized on the inferior nasal turbinate, sublabial incision through the vestibulum is very suitable approach because it provides wide access and good visibility and leaves no visible scar.

[Trigeminal trophic syndrome--diagnosis, treatment and prognosis]. / Troficki sindrom trigeminalnog zivca--dijagnoza, lijecenje i prognoza.

Trigeminal trophic syndrome is a rare clinical entity, which appears in cases where patients have a central or peripheral lesion of the fifth cranial nerve. Although the symptoms are visibly clear, the diagnosis is not easy to establish. There have been about 100 cases reported in Anglosaxon literature up to now. In Croatia, according to our findings, there are only 4 recognized cases of diagnosed trigeminal trophyc syndrome. The aim of this paper is to make an easier diagnosis and to give treatment guidelines for this, for a patient very unpleasent syndrome.

Relapse of Pleomorphic Adenoma from Childhood to Adulthood: Case Report.

Pleomorphic adenoma is rarely seen in childhood. After detailed literature search, we did not come across a case of frequent relapse of this benign tumor from childhood to adulthood. The World Health Organization defines relapse of pleomorphic adenoma as a histologically benign tumor that can have local or distant metastasis. There is one hypothesis how benign tumor can metastasize. According to this hypothesis, probably during the first operative procedure the tissue around the tumor becomes permeable for tumor cells, which can lead to implantation of tumor cells into the surrounding tissue. In this case report, we present a case of a 30-year-old woman with pleomorphic adenoma of the submandibular gland, which relapsed three times. The patient was first operated on in 1993, at the age of 7 years. The first two relapses occurred in 1998 and 2001, at the age of 12 and 15, respectively. The last relapse occurred in 2015, at the age of 29 years. All relapses were localized in the submandibular region on the right side of the neck, where the primary tumor had been operated on.