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Penetrating neck trauma is most commonly caused by firearm discharge, and is potentially very dangerous, being associated with a high risk of mortality. A 12-year-old patient with a recent history of a gunshot wound to the neck was evaluated in detail; a bullet was located in close proximity to the left common carotid artery. Neck exploration was performed and the foreign body was removed without any complications. The management of the patient is discussed, as are contemporary approaches to the treatment of penetrating neck trauma. However, the choice of treatment for a stable patient with a penetrating neck injury remains controversial.
Subject(s)
Carotid Artery, Common , Foreign Bodies/diagnosis , Neck Injuries/diagnosis , Wounds, Gunshot/diagnosis , Child , Foreign Bodies/surgery , Humans , Male , Neck Injuries/surgery , Tomography, X-Ray Computed , Ultrasonography, Doppler , Wounds, Gunshot/surgeryABSTRACT
INTRODUCTION: Foreign body in respiration tract is a life-threatening emergency and requires urgent treatment. The diagnosis and treatment requires awareness and suspicion of signs and symptoms of foreign body aspiration. CASE: A unique case of total dental prothesis aspiration of a 44-year-old aphasic patient is presented. The prothesis is completely removed from the larynx. DISCUSSION: Foreign-body aspiration is frequently suspected in children, it is rarely thought about in adults with subacute or chronic respiratory symptoms unless an evident history of an aspiration event is obtained. Facial trauma, dental procedures, central nervous system dysfunction due to stroke, mental retardation, metabolic encephalopathy, seizures, and alcoholism are precipitating factors in adults. Careful clinical history and physical examination is mandatory. Foreign bodies located in the laryngeal region are almost always treated with surgery. CONCLUSION: Loose dentures must be avoided especially in mental retarded, aphasic patients, and patients with central nervous system dysfunction.
Subject(s)
Aphasia/complications , Dentures/adverse effects , Foreign Bodies , Larynx/surgery , Adult , Foreign Bodies/complications , Foreign Bodies/diagnosis , Foreign Bodies/surgery , Humans , Respiratory AspirationABSTRACT
OBJECTIVE: Septal deviation-induced nasal obstruction is frequently accompanied by hyposmia. The aim of this study was to evaluate the effect of external approach septoplasty on olfactory function. METHODS: Thirty patients (23 males, 7 females) who had external approach septoplasty were included in the study. The age interval was 18 to 60 years (mean 33±12 years). All subjects had olfactory function and acoustic rhinometry tests in both the pre- and postoperative periods (mean interval 6 weeks ± 3 weeks). Olfactory function was determined by the "Sniffin Sticks" test. The minimum cross-sectional area from the nostril to 2.20âcm backward was referred to as MCA1, and the minimum cross-sectional area from 2.20 to 5.40âcm was referred to as MCA2, determined by acoustic rhinometry. RESULTS: Olfactory threshold, discrimination, and identification function improved significantly after external approach septoplasty. A statistically significant difference was also detected between pre- and postoperative left MCA1 and left MCA2 of the nasal cavities. Postoperative hyposmic and anosmic patient improvement was statistically significant. CONCLUSION: External approach septoplasty has a beneficial effect on olfaction and this effect may be partly due to interactions between the increased perception of nasal air flow, as well as surgery-associated improvement in the internal nasal valve area.
Subject(s)
Nasal Septum/surgery , Nose Deformities, Acquired/surgery , Olfaction Disorders/surgery , Rhinoplasty/methods , Adult , Female , Humans , Male , Middle Aged , Smell , Young AdultABSTRACT
The relationship between intermittent nocturnal hypoxia and albuminuria in pediatric patients with adenotonsillar hypertrophy was evaluated in this prospective study. Fifty children with grade 3 to 4 adenotonsillar hypertrophy scheduled for adenoidectomy and/or adenotonsillectomy were selected for study group. Fifteen patients with adenotonsillar grade 1 to 2 or adenotonsillectomized subjects in a similar range of sex, age, and body mass index scheduled for other surgeries were selected for control group. All children were monitored using finger pulse oximeter during the night before surgery. At the day of surgery, first morning urine samples were sent to the laboratory for analysis of albuminuria.Albuminuria was determined in 8 (16%) patients in study group and 1 (6.7%) patient in control group. This difference between groups was determined not to be statistically significant (Pâ>â0.05). None of the pulse oximetry parameters was also found to be associated with albuminuria statistically (Pâ>â0.05). However, the adenoid grade was observed to be associated with albuminuria (Pâ=â0.011).This study revealed no relationship between albuminuria and intermittent hypoxia in children, although previous studies have reported that intermittent hypoxia causes albuminuria in adults. On the contrary, the adenoid grade was found to be in association with albuminuria. The reason seems to be unclear because of the lack of studies investigating albuminuria in children with adenotonsillar hypertrophy. However, inflammatory mediators arising from adenoid tissue may cause increase in renal capillary permeability and urine albumin excretion.
Subject(s)
Adenoids/pathology , Albuminuria/complications , Hypertrophy/complications , Palatine Tonsil/pathology , Child , Child, Preschool , Female , Humans , Male , Prospective StudiesABSTRACT
Tracheoesophageal puncture enlargement in laryngectomized patients is a significant problem due to complications such as aspiration pneumonia. There are several management methods including conservative and nonconservative techniques. A total closure of the enlarged tracheoesophageal puncture is needed in some cases when conservative approaches have failed. At this point, the insertion of a silicone septal button in the puncture site is a useful, inexpensive, and simple technique. The follow-up of 4 patients managed with this technique revealed satisfactory long-term results.
Subject(s)
Esophagus/surgery , Laryngeal Neoplasms/surgery , Laryngectomy/adverse effects , Punctures/methods , Speech Disorders/surgery , Trachea/surgery , Aged , Humans , Male , Middle Aged , Speech Disorders/etiologyABSTRACT
OBJECTIVES: Adenotonsillectomy is one of most common surgeries performed in childhood. Post-operative pain associated particularly with tonsillectomy is still a problem for many physicians. Despite advances in surgical techniques, analgesics, or anti-inflammatory drugs, no unique strategy for post-tonsillectomy pain management has been suggested. The aim of this study is to investigate the analgesic effect of steroid containing nasal spray applied to tonsillar region after tonsillectomy. METHODS: Eighty-two patients were assigned into two groups as study and control. In study group, nasal spray containing steroid was applied to each tonsillar region after surgery for 5 days. Post-operative pain of all patients was assessed using a visual analog scale and results were compared. RESULTS: Pain decreased gradually over time in both the study and control groups. Although the pain scores from 4 h post-surgery to post-operative day 5 were not found to significantly decrease in children that used nasal spray containing steroid, these patients developed less pain on post-operative day 5,with statistical significance (p<0.05). CONCLUSION: Post-tonsillectomy pain was reported to increase around post-operative day 5, which coincides with the time of intense wound inflammation. Therefore, significant pain reduction on post-operative day 5 observed in children that used nasal spray with steroid may have clinical importance for overcoming this problem.
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OBJECTIVES: Salivary gland neoplasms are less than 5% of all head and neck neoplasms (1). Although there are morphological similarities between different neoplasms, there may be catchy morphological differences in a single tumour. According to the World Health Organization (WHO), 4th Head and Neck Tumours Classification oncocytic salivary gland lesions are classified as nodular oncocytic hyperplasia, oncocytoma and oncocytic carcinoma. Oncocytic cells may be a component of other salivary gland neoplasms and metastatic malignities. METHODS: In this study, salivary gland oncocytic lesions diagnosed in 2016-2017 were evaluated with Haematoxylin and Eosin (H&E) sections and PAS, diastase resistance PAS, p63, DOG1, cytokeratin7 (CK7), androgen receptor (AR) and PAX8 stains. RESULTS: Nineteen cases were benign, two cases were malignant. Eighteen of the benign lesions were Warthin tumour (WT), one case was oncocytoma with nodular oncocytic hyperplasia. Acinic cell carcinoma (AciCCA) with oncocytic cells predominant was one of the malignant cases. The other case was high-grade salivary duct carcinoma (SDCA). CONCLUSION: The rarity and heterogeneity of this group of lesions may cause difficulties in diagnosis. We present histochemical and immunohistochemical findings of these lesions in light of the literature.
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INTRODUCTION: Although the nose and lungs are separate organs, numerous studies have reported that the entire respiratory system can be considered as a single anatomical and functional unit. The upper and lower airways affect each other either directly or through reflex mechanisms. OBJECTIVE: In this study, we aimed to evaluate the effects of the radiofrequency ablation of persistent inferior turbinate hypertrophy on nasal and pulmonary function. METHODS: Twenty-seven patients with bilateral persistent inferior turbinate hypertrophy without septal deviation were included in this study. All of the patients were evaluated using anterior rhinoscopy, nasal endoscopy, acoustic rhinometry, a visual analogue scale, and flow-sensitive spirometry on the day before and 4 months after the radiofrequency ablation procedure. RESULTS: The post-ablation measurements revealed that the inferior turbinate ablation caused an increase in the mean cross-sectional area and volume of the nose, as well as in the forced expiratory volume in 1s, forced vital capacity, and peak expiratory flow of the patients. These differences between the pre- and post-ablation results were statistically significant. The post-ablation visual analogue scale scores were lower when compared with the pre-ablation scores, and this difference was also statistically significant. CONCLUSION: This study demonstrated that the widening of the nasal passage after the reduction of the inferior turbinate size had a favorable effect on the pulmonary function tests.
Subject(s)
Hyperostosis/surgery , Nasal Obstruction/physiopathology , Nasal Obstruction/surgery , Radiofrequency Ablation/methods , Respiratory System/physiopathology , Turbinates/physiopathology , Turbinates/surgery , Adult , Endoscopy/methods , Female , Forced Expiratory Volume , Humans , Hyperostosis/physiopathology , Male , Middle Aged , Nasal Obstruction/diagnostic imaging , Organ Size , Peak Expiratory Flow Rate , Postoperative Period , Prospective Studies , Reference Values , Rhinometry, Acoustic , Statistics, Nonparametric , Treatment Outcome , Turbinates/diagnostic imaging , Turbinates/pathology , Visual Analog Scale , Vital Capacity , Young AdultABSTRACT
OBJECTIVES: Chronic otitis media (COM) reveals a spectrum of otoscopic findings, and both ears may be affected to a different degree. The analysis of contralateral ear in patients with COM is important to detect the early signs of the disease. This may enable the follow-up and treatment of abnormalities in contralateral ear without delay. Therefore, in this study, we aimed to investigate the otoscopic and audiologic findings of contralateral ears of patients with COM. METHODS: The institutional data of patients who underwent surgical treatment between 2014 and 2017 due to COM were reviewed. Suppurative ears with cholesteatoma, polyps, and otorrhea refractory to medical treatment and ears with dry middle ear mucosa, with otorrhea responsive to medical treatment, and without cholesteatoma were divided into two groups (Group 1 and Group 2, respectively). All patients were examined with regard to the presence of perforation, retraction, myringosclerosis, atrophy, and audiological results before the groups were compared. RESULTS: Approximately 50% of contralateral ears of patients with COM showed abnormalities at an otoscopic examination in both groups. Tympanic membrane retraction in Group 1 was greater than in Group 2, and the difference was statistically significant (p<0.05). Both the mean air and bone conduction thresholds of the contralateral ears in Group 1 were also found to be elevated when compared with Group 2, and the differences were statistically significant (p<0.05). CONCLUSION: COM may be seen bilaterally due to the same predisposing factors affecting the ears. Therefore, detection, follow-up, and early treatment of abnormalities of contralateral ear associated with otitis media have clinical importance in the prevention or delaying progression of these abnormalities to COM.
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OBJECTIVES: General anesthesia is preferred in most otorhinolaryngologic surgeries. The aim of the present study was to evaluate upper airway complications secondary to intubation including sore throat, cough, dysphonia, and dysphagia considering endotracheal tube (ET) cuff pressure, tube diameter, and duration of intubation. METHODS: After the assignment of 67 patients to the study and control groups, ET cuff pressure was adjusted to be between 20 and 30 cm H2O using a cuff pressure manometer in the study group. In the control group, the cuff pressure was decided by the anesthesiologist using the conventional palpation method. Sore throat, cough, dysphonia, and dysphagia were compared between the groups at 4, 8, and 24 h postoperatively. RESULTS: Cuff pressure was significantly higher in the control group than in the study group. In the control group, sore throat was more frequently observed at 4, 8, and 24 h, whereas in the study group, cough and dysphonia were more often observed at 4 and 8 h. At 4 and 8 h, cough was found to be related to the duration of intubation. CONCLUSION: Arrangement of cuff pressure using a cuff manometer is suggested to decrease complications of the upper airway secondary to intubation because of the higher rate of these complaints in patients whose cuff pressure is arranged by the conventional palpation method.
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Mucoepidermoid carcinoma is the most common malignant tumor of the parotid; however, its synchronous occurrence in both of the parotid glands is extremely rare. Herein, we presented a case of 53-year-old man with bilateral synchronous mucoepidermoid carcinoma of the parotid gland treated with surgery. The patient mainly complained of a painless mass in the left parotid gland. A mass located in the right parotid gland was incidentally detected by imaging. Based on cytopathology, left total parotidectomy was performed while preserving the facial nerve with ipsilateral neck dissection, and 5 weeks later, right superficial parotidectomy was performed. At the 3-year follow-up, there was no recurrence in the parotid regions and the neck. A detailed examination for parotid masses is suggested for identifying possible occult synchronous tumors in the contralateral side or in other salivary glands. A close follow-up is also recommended for the risk of future occurrence of metachronous tumors.
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Although extranasopharyngeal angiofibroma (ENA) is a rare condition, its diagnosis should be considered during differential diagnosis of nasal masses. We report a rare case of ENA originating from the left lateral side of nasal tip. A 43-year-old man with an ENA mass located on the left lateral side of the nasal tip presented to our hospital. The nasal mass caused nasal obstruction and swelling at the nasal tip and was surgically removed. Histopathological examination revealed ENA. The patient is being followed up and remains free of disease. ENAs are rare and differ from nasopharyngeal angiofibromas regarding clinical and radiological features. Although it is rare, the diagnosis should be considered during differential diagnosis of a patient with one sided nasal mass and/or with refractory epistaxis, regardless of the patient's age or sex.
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OBJECTIVES: For the treatment of the inferior turbinate hypertrophy that is unresponsive to medical treatment, turbinate surgery with radiofrequency is a widely used method. This study aims to evaluate the efficacy of turbinate surgery with radiofrequency ablation for the treatment of turbinate hypertrophy, and compare the results of patients with allergic rhinitis and non-allergic rhinitis. METHODS: A total of 59 consecutive patients aged 18-67 years (mean 37±13) who underwent radiofrequency ablation to the inferior turbinate at our tertiary care hospital from September 2017 to January 2018 were enrolled in this prospective nonrandomized clinical study. The patients with allergic rhinitis (n=23) were classed as group 1, and the patients with non-allergic rhinitis (n=36) were classed as group 2. Endoscopic nasal examination and an acoustic rhinometer were applied, and a standard 0-10 visual analog scale (VAS) was used to assess nasal symptoms preoperatively and postoperatively at the third and sixth months. RESULTS: The study found a significant reduction in nasal obstruction for both groups postoperatively. This reduction was higher in group 1. The decrease in nasal VAS scores for itching, rhinorrhea, and sneezing were statistically significant in group 1, whereas the decrease in nasal VAS scores for sneezing was significant in group 2. CONCLUSION: This study demonstrates that radiofrequency appears to be an effective and safe treatment option for inferior turbinate hypertrophy of patients with allergic rhinitis or non-allergic rhinitis. It also provides a better perception of all nasal symptoms in patients with allergic rhinitis, and a better perception of nasal obstruction and sneezing in patients with non-allergic rhinitis.
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OBJECTIVE: Evaluating preepiglottic space involvement in laryngeal cancer by CT may lead misinterpretation. We sought to understand the causes of misinterpretation in evaluating the preepiglottic space by CT and assessed the effects of misinterpretation in treatment plans of patients with laryngeal squamous cell carcinomas. METHODS: Specimen histopathology reports of 102 (99 male, 3 female) patients who underwent total or partial laryngectomy due to supraglottic and/or transglottic laryngeal carcinoma were reviewed. Neck CTs were also re-assessed for preepiglottic space involvement by three radiologists. The initial surgical treatment choices were re-examined according to the current radiological evaluation in combination with pathological results of the specimens and physical examination findings in the patients. Interobserver agreement regarding image interpretation was based on a kappa analysis. RESULTS: The interclass correlation coefficient in predicting preepiglottic space invasion was 0.74; this was considered 'good.' Among the three radiologists, sensitivity, specificity, accuracy of CT in detecting preepiglottic space involvement were 86-93%, 75-93%, and 77-93%, respectively, while the negative and positive predictive values were 97-98% and 38-50%, respectively. Given the previous treatments applied, false-positive diagnoses for PES involvement resulted in overtreatment in 2.9% of cases. False-negative diagnoses of PES involvement (1.9% of cases) did not result in any undertreatment. CONCLUSIONS: Although CT is a practical and inexpensive imaging tool for evaluating laryngeal carcinomas, the PPV of CT in assessing preepiglottic space invasion, especially in advanced tumors, is low and may lead to overtreatment.
Subject(s)
Carcinoma, Squamous Cell/diagnostic imaging , Head and Neck Neoplasms/diagnostic imaging , Laryngeal Neoplasms/diagnostic imaging , Aged , Carcinoma, Squamous Cell/pathology , Carcinoma, Squamous Cell/surgery , Female , Head and Neck Neoplasms/pathology , Head and Neck Neoplasms/surgery , Humans , Laryngeal Neoplasms/pathology , Laryngeal Neoplasms/surgery , Laryngectomy , Male , Middle Aged , Neoplasm Invasiveness , Retrospective Studies , Squamous Cell Carcinoma of Head and Neck , Tomography, X-Ray ComputedABSTRACT
OBJECTIVE: Pediatric neck masses (PNMs) are a frequently encountered problem in otorhinolaryngology practice. The clinical approach to cervical masses in childhood varies from that of adults. Due to differences among clinicians in the assessment of a PNM, studies investigating this subject are significant contributions to the literature. For this reason, a review was conducted of pediatric PNM cases with an open biopsy (incisional/excisional) and a histopathological diagnosis. METHODS: The hospital records of 98 (34 girls, 64 boys) pediatric patients aged between 8.5 months and 16 years were reviewed. The history, physical examination findings, blood tests, medical treatments, imaging reports, and the pathology and/or microbiology results of the patients were recorded and evaluated. The cervical masses were categorized according to the etiology, imaging features, size, and location. RESULTS: Surgical biopsy was planned due to the suspicion of malignancy, typical clinical presentation or location, or size greater than 20 mm despite antibiotherapy for 2 to 6 weeks. Excisional biopsy (91.8%) was the first choice for histopathological sampling. Infectious masses were observed most commonly, followed by congenital and neoplastic masses, at a rate of 49%, 27.6%, and 23.4%, respectively. Hodgkin lymphoma was the most frequent type of malignancy (39.1%). Thyroglossal and branchial cysts constituted 74.1% of congenital masses. Sixty-seven percent of all masses were solid, and the lateral levels of the neck were the most affected locations (44.9%). CONCLUSION: In most cases, the diagnosis can be made with a detailed history and physical examination. In the presence of nonspecific findings, blood tests, imaging, and histopathological sampling are required. Ultrasound should be the first preference for imaging, and excisional biopsy is suggested rather than fine needle aspiration biopsy for histopathological sampling in pediatric neck masses.
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INTRODUCTION: Ultrasound is the most frequently used imaging method to evaluate thyroid nodules. Sonographic characteristics of thyroid nodules which are concerning for malignancy are important to define the need for fine needle aspiration biopsy or open surgery. OBJECTIVE: To evaluate malignancy risk of solid thyroid nodules through sonographic scoring. The effects of nodule size ≥2cm and associated pathologic cervical lymph node in scoring were examined in addition to generally excepted suspicious features. METHODS: Medical data of 123 patients underwent thyroid surgery were reviewed, and 89 patients (58 females, 31 males) were included in the study. The presence and absence of each suspicious sonographic feature of thyroid nodules were scored as 1 and 0, respectively. Total ultrasound score was obtained by adding the positive ultrasound findings. Differently from the literature, nodule size ≥2cm and associated pathologic cervical node were added in scoring criteria. The diagnostic performance of nodule characteristics for malignancy and the effect of total US score to discriminate malignant and benign disease were calculated. RESULTS: A significant relationship was found between malignancy and hypoechogenity, border irregularity, intranodular vascularity, and microcalcification (p<0.05). Pathologic cervical node was observed predominantly in association with malignant nodules. Positive predictive value of suspicious cervical node for malignancy was 67%, similar to microcalcification. Nodule size ≥2cm was not distinctive for diagnosis of malignancy. The number of suspicious sonographic features obtained with receiver operating characteristic analysis to discriminate between malignant and benign disease was three. CONCLUSION: Sonographic scoring of thyroid nodules is an effective method for predicting malignancy. The authors suggest including associated pathologic node in the scoring criteria. Further studies with larger cohorts will provide more evidence about its importance in sonographic scoring.
Subject(s)
Lymph Nodes/diagnostic imaging , Thyroid Nodule/diagnostic imaging , Adult , Aged , Aged, 80 and over , Biopsy, Fine-Needle , Female , Humans , Lymph Nodes/pathology , Male , Middle Aged , Neck , Retrospective Studies , Sensitivity and Specificity , Thyroid Nodule/pathology , Ultrasonography, Doppler, Color , Young AdultABSTRACT
OBJECTIVE: The aim of this study was to re-evaluate the open partial horizontal laryngectomies (OPHLs) performed at our institution in terms of the new classification of the European Laryngological Society and compare the differences with the new classification system. METHODS: A retrospective analysis of 45 patients diagnosed with T1b, T2, and T3 laryngeal carcinoma who were treated with OPHLs in our department between 2010 and 2016 were conducted. RESULTS: All supraglottic laryngectomies (31 operations) were classified as OPHL Type 1. Among these, 11 operations required a resection of an additional structure including arytenoid (ARY) in five operations, piriform sinus (PIR) in four operations, the base of tongue (BOT) in one surgery, and ARY + PIR in one patient. Five supracricoid laryngectomies with cricohyoidoepiglottopexy (CHEP), five supracricoid laryngectomies with cricohyoidopexy (CHP), and four near-total laryngectomy operations constituted Type 2 OPHL (7 operations) and Type 3 OPHL (7 operations). Among these operations, two were classified into Type 2b OPHL and four into Type 3b OPHL as the superior margin of incision included epiglottis. CONCLUSION: We consider that, this new classification, because it allows understanding the content of the surgery from the related title, will be useful in comparing different series and techniques.
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Importance: Performing an open-approach extracorporeal septoplasty (OAES) without simultaneous rhinoplasty could have adverse effects. We sought to understand the effects of OAES without simultaneous rhinoplasty on nasal tip projection and rotation in patients with severe septal deviation. Objectives: To evaluate the outcomes of OAES without simultaneous rhinoplasty in terms of nasal tip projection and rotation using objective measurements. Design, Setting, and Participants: This retrospective study was conducted at a training and research hospital using medical records of 32 adult patients who underwent OAES without simultaneous rhinoplasty between April 10, 2012 and June 12, 2015. Patients who underwent endonasal septoplasty, revision septal surgery, septorhinoplasty, open-approach septoplasty with nasal tip plasty, or open-approach septoplasty without removal of the entire septal cartilage were excluded from the study. Postoperative photographs of the patients were taken at a mean (range) time of 16.4 (6-36) months after surgery. Nasolabial angle (NLA), nasofacial angle (NFA), and projection index (PI) were measured by the same surgeon on preoperative and postoperative lateral images. Main Outcomes and Measures: Projection index was measured using the Goode method; NLA and NFA were measured drawing lines between specific facial points according to the literature. All measurements were compared statistically. Results: Thirty-two adult patients (26 men and 6 women between ages 20 and 57 years) with severe septal deviation and underwent OAES without simultaneous rhinoplasty were included in the study. The postoperative values of NLA and NFA were observed to be decreased in all patients (100%). The PI was also determined to be decreased in 27 patients (84.6%) whereas it remained unchanged in 5 patients (15.4%). The overall postoperative mean values of NLA, NFA, and PI were found to be lower compared with preoperative mean values and the difference between them were determined to be statistically significant (NLA: 95% CI, 0.40-2.55, P = .005; NFA: 95% CI, 0.48-2.06, P = .003; and PI: 95% CI, 0.004-0.015, P = .002). Conclusions and Relevance: This study reveals that the nasal tip lost height from facial plane and rotated caudally in most patients who underwent OAES without simultaneous rhinoplasty. Patients demanding only relief of nasal obstruction and scheduled for OAES have to be informed about the potential cosmetic alterations when a simultaneous rhinoplasty is not requested.
Subject(s)
Nasal Septum/surgery , Nose/anatomy & histology , Adult , Aged , Female , Humans , Male , Middle Aged , Photography , Postoperative Complications , Postoperative Period , Retrospective Studies , Treatment OutcomeABSTRACT
Squamous cell carcinoma of the larynx is rarely encountered in HIV (human immunodeficiency virus)-positive patients compared with HIV-associated malignancies. Standard protocols are absent for the management of laryngeal carcinoma in HIV-positive patients. HIV infection-associated immune suppression increases the mortality and morbidity of laryngeal carcinoma treatment. In the management of laryngeal carcinoma in HIV-positive patients, beside the clinical staging, the detection of CD4+ cell count is important. Regular antiretroviral treatment may have favorable effects in the management of laryngeal carcinoma. The treatment modality in the presented HIV-positive case with the diagnosis of laryngeal cancer was determined with a multidisciplinary approach.
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OBJECTIVES: We investigated the frequency of hypothyroidism in patients treated with total laryngectomy, hemithyroidectomy-isthmectomy, and postoperative radiotherapy for T3 or T4 larynx cancers. PATIENTS AND METHODS: Twenty-nine male patients (mean age 54 years; range 43 to 72 years) with T3 or T4 larynx cancers were prospectively included in the study. Preoperatively, thyroid function tests were normal in all the patients. Following radiotherapy, serum thyroid-stimulating hormone (sTSH), free triiodothyronine (FT3), and free thyroxine (FT4) levels were measured every three months at least for a year. Detection of an increased level of sTSH together with decreased or normal levels of FT3 and/or FT4 indicated clinical and subclinical hypothyroidism, respectively. The relationship was assessed between hypothyroidism and both age and radiotherapy dosage. Statistical analyses were made with the use of the Student's t- test and Mann-Whitney U-test. RESULTS: Following radiotherapy, thyroid function tests remained normal in 12 patients (41%), while 12 patients (41%) and five patients (18%) developed subclinical and clinical hypothyroidism, respectively. No significant relationship was found between age and thyroid dysfunction (p>0.05), whereas radiotherapy dosage was found in significant relationship with the development of hypothyroidism (p<0.05). CONCLUSION: Due to high rates of subclinical or clinical hypothyroidism following combined therapy, thyroid functions should be closely monitored in patients undergoing laryngectomy for T3 or T4 larynx cancers.