Distant metastases in laryngeal squamous cell carcinoma.

Distant metastases (DM) is the point of concern and seems to be on the rise with the improved control of the laryngeal cancer in the primary site and neck regions. Prognostic factors must be evaluated to improve the detection of DM at early stage of the disease. Therefore, we have analyzed our cases of laryngeal squamous cell carcinoma with DM to find out the risk factors in these patients. We analyzed the records of laryngeal squamous cell carcinoma patients with DM. The records were evaluated according to distant metastases site, TNM staging, the metastases at the neck, treatment and survival. The incidence of DM was 7.2% in our series. Lung is the most common site of DM in laryngeal squamous cell carcinoma. Staging grouping has been helpful in predicting DM, most of the cases were in stage III and IV (85%). Supraglottic lesions is the most common site in patients with DM. The recurrence in the locoregional site was observed in 47% of cases. The overall survival with DM is 28 months, without DM 22 months. The patients with DM in laryngeal squamous cell carcinoma were from the group with supraglottic lesions, stage 3, 4a and 4b. Stage grouping seems to be a better indicator of DM rather than T or N stage alone. The most common site of metastasis is the lung.

Topical use of mitomycin C in laser myringotomy: an experimental study in rats.

OBJECTIVE: Ventilation tubes are used to a large extent for the treatment of otitis media with effusion. As this has some drawbacks, laser myringotomy was suggested as a treatment alternative. The use of laser has some advantages but its use is limited in prolonging the patency rate of myringotomy. Mitomycin C (MMC) is being used in some surgical applications to reduce stenosis as it has the property to inhibite activity of fibroblasts. We explored the use of mitomycin C as an adjunct in prolonging the patency rate in laser myringotomy on rats. METHODS: We performed laser myringotomy on both ears of 20 rats. We, then applied MMC with a concentration of 2 mg/ml on 10 rats to one of their ears (Group 1). In group 2 we used MMC with a concentration of 1 mg/ml. After a follow-up of 8 weeks we calculated the patency rate for the two groups and the total ears with MMC and without MMC. RESULTS: The mean patency rate observed for group 1 was found to be 6 weeks whereas for group 2, it was 5.8 weeks. The overall patency rate for the ears with and without MMC is 5.9 and 1.5 weeks, respectively. While there was a statistical difference between ears with and without MMC (P<0.01), there was no difference between the two groups according to concentrations. CONCLUSION: Mitomycin C has an adjunct effect in laser myringotomy in prolonging the patency rate of myringotomy on rats. Low concentrations of mitomycin C have the same effect in this issue.

Subdural empyema and blindness due to cavernous sinus thrombosis in acute frontal sinusitis.

In this era of antibiotics, the complications of acute sinusitis are much less frequently encountered. Although orbital complications are most common, intracranial complications carry a high rate of mortality and morbidity. We describe a case of acute frontal sinusitis with subdural empyema and blindness due to cavernous sinus thrombosis and carotid artery thrombosis with a discussion of treatment of these complications and the etiology of blindness in sinusitis.

A venous anomaly of the neck.

Vascular anomalies localize mostly in the head and neck region. Besides the complications they present, when they are left untouched, they are cosmetically ugly. A vascular lesion in any part of the body of a child is always bothersome to the parents and may be a problem for the family. The confusion about classification of these lesions and the delay in seeing the physician may adversely affect the child also. There has been a debate concerning the classification of vascular malformations, their clinical presentation, and their treatment modalities. In this paper we reviewed the classification as accepted in the literature and presented a case of huge venous anomaly in the neck region with its angiographic and MRI views and discussed the possible complications and modes of treatment.

Cherubism: a radiological and clinical presentation.

Cherubism is the hereditary form of the fibrous dysplasia of the jaws, but it may be seen sporadically as well. The disease has a self-limited nature and is rarely apparent before the age of two. There is no need to interfere surgically with these lesions of the mandible or the maxilla unless the child is severely affected, i.e. the disease deteriorates respiration, deglutition, vision, or the psychiatric makeup of the child due to cosmetic reasons. The clinical presentation and radiological evaluation of these children are so typical that the pediatrician and pediatric otolaryngologist need to be informed about this rarely seen disease. A case of a cherubic child, with his clinical appearance as well as his radiological evaluation, and discussion about the clinical outcome are presented.

Nasopharyngeal angiofibroma in a patient with haemophilia A: a bleeding tumour in a bleeding-prone patient.

Nasopharyngeal angiofibroma is a highly vascular tumour which occurs almost exclusively in adolescent males. Although it is histologically benign, it may cause serious clinical problems because of its tendency to bleed profusely during surgery. This paper presents the first case of nasopharyngeal angiofibroma in a patient with haemophilia A, another well-known disease of bleeding tendency. In this case the tumoural mass was surgically removed with effective factor VIII replacement without any bleeding complication.