Unilateral Maxillary Sinus Plasmablastic Lymphoma in an Immunocompetent Patient. An Unusual Occurrence Report and Literature Review.

Plasmablastic lymphoma (PBL) is a rare and aggressive form of mature B cell neoplasms almost exclusively identified in patients infected with the human immunodeficiency virus (HIV). The small number of HIV-negative PBL cases reported in the literature to date is composed of single case reports and small case series which characteristically are present involving the oral cavity mucosa or gingiva. We present a 72-year-old HIV-negative Australian patient without any cause of immunodeficiency, with an isolated left maxillary sinus PBL.

Trans-oral robotic surgery: a safe and effective tool in head and neck surgery in an Australian rural setting.

BACKGROUND: Trans-oral robotic surgery (TORS) facilitates surgical resection of tumours as an alternative to open surgery and has demonstrated favourable oncological results. Given the novelty of TORS and the paucity of evidence on TORS-specific complications in a rural setting, we report our experience with TORS at an Australian rural head and neck centre. METHODS: A retrospective review of all robotic cases performed at a regional head and neck centre in Queensland was undertaken from 2014 to 2019. Patient demographics, pre-operative surgical risk, complications and outcomes such as margins and cancer recurrence were recorded. Complications were graded based on the Clavien-Dindo grading system. Descriptive statistics were used to present patient characteristics and statistical analyses were performed using Stata. RESULTS: Forty-two TORS surgeries were performed. Twenty-one had histology confirming malignancy. There were no adverse intraoperative effects. Overall, seven patients (16.7%) had at least one complication. Four were recorded as a Clavien-Dindo 3b (post-operative bleed, wound infection and drain dislodgment). Of two cases with residual positive margins, one declined further surgery, and another received chemoradiotherapy. One patient recurred with distant metastatic disease, and another had locoregional nodal recurrence. The distribution of complications was significant across the pre-operative risk categories for both American Society of Anaesthesiologists and surgical risk score (P = 0.02). CONCLUSION: TORS in a rural head and neck centre is a safe and viable treatment option for patients so long as this is undertaken with appropriate training, mentorship and teamwork.

To divide or manipulate the chorda tympani in stapedotomy.

The objective of this study is to determine the nature, duration and severity of chorda tympani symptoms in post-stapedotomy patients when the nerve has been known to have either sustained surgical manipulation or division. The study design was retrospective and blind, based at a tertiary Otology Referral Center (Gloucestershire Royal Hospital). All successive patients undergoing stapedotomy operated upon by the senior author (JMR) between November 1991 and October 1998 were included. The main outcome measures were postoperative graded dysgeusia (questionnaire) and post operative electrogustometry score, comparing the chorda tympani cut group and the chorda tympani preserved group. Sixty stapedotomies were performed in the study period. After a minimum interval of 8 months, questionnaire data were obtained in 55/60 (92%), and electrogustometry studies were carried out in 48/60 (80%). Symptoms of dysgeusia were experienced in the chorda tympani nerve cut (CC) group in 95% and in the chorda preserved (CP) group in 52%. For those with symptoms, duration was 6.7 months (+/-4.9 SD) and 3.4 months (+/-3.7 SD) for the CC and CP groups, respectively. From the electrogustometry data, after 8 months, the risk of total loss of response is significantly higher in CC patients (94%) than in CP patients (25%) (P = 0.0001). Also at 8 months, 54% of CP patients had normal ipsilateral electrogustometry responses compared with 6% in the CC group. In conclusion, cutting the chorda tympani results in significantly greater symptoms than when subjected to manipulation only, and these symptoms are likely to be more long lasting. Therefore, it is our recommendation that where possible the chorda be preserved. The risk of severe chorda symptoms when the chorda is cut is small (<5%). Preoperative consent to include dysgeusia is advised.