Etiology and therapy of delayed facial paralysis after middle ear surgery.

PURPOSE: This review focuses on the etiology, incidence and therapy of delayed paralysis of the facial nerve (DFP) after different types of middle ear surgery. METHODS: Retrospective review of studies published in English from 1970 until 2019 reporting DFP after tympanoplasty, tympanomastoid surgery, stapedotomy and stapedectomy. The search used the databases of PubMed, Scopus and Cochrane Library. Studies reporting from adult patients and DFP onset after 48 h after surgery were included. Studies dealing with iatrogenic or preexisting facial palsy and case reports were excluded. The initial literature search resulted in 52 studies. The relevance of the publications was verified using title, abstract and full-text analysis. Data were analyzed with descriptive statistics using median, simple sum and statistical significance. RESULTS: Ten studies having 12,161 patients could be included in this review. The incidence of DFP after the middle ear surgeries varies between 0.2 and 1.9%. The surgical stress of the middle ear surgeries is the main trigger for the development of DFP and leads to a virus reactivation and/or neuronal edema. Patients with a dehiscence of the facial canal have a significantly higher probability for a DFP. The recommended therapy of DFP based on the data of the therapy of Bell's palsy, consists of the administration of a steroid. For patients having a case history of previous viral infections, an antiviral prophylaxis is recommended. CONCLUSION: Overall, DFP has a very good prognosis, with mostly complete healing with appropriate therapy. Viral reactivation is the most favored genesis of DFP. Immunization or antiviral prophylaxis is recommended to those patients being at risk for a viral reactivation.

UV light-based decontamination: an effective and fast way for disinfection of endoscopes in otorhinolaryngology?

BACKGROUND: Reprocessing of endoscopes becomes increasingly complex, due to rising demands of hygiene. Established methods are often expensive/time-consuming. Recent studies suggest beneficial aspects of disinfection by UV light. In this study we analyzed the efficiency of UV light disinfection of rigid otorhinolaryngological endoscopes. MATERIALS AND METHODS: After mechanical pre-cleaning, the endoscopes were decontaminated for 25 s in the D25 using Impelux™ UV C light technology (UV Smart B.V., Delft, The Netherlands). First, the surface contact samples were taken from 50 used endoscopes to evaluate the bacterial load. Additionally, surface contact samples were taken from further 50 used endoscopes after reprocessing with the D25. Another 50 endoscopes were tested on protein residuals. Furthermore, the absolute effectiveness of the D25 was tested on 50 test bodies (RAMS) with a standardized contamination of 107 colony-forming units (CFU) of Enterococcus faecium. RESULTS: The used endoscopes showed a high bacterial contamination with an average value of 66.908 (± 239.215) CFU. After reprocessing, only a minimal contamination on 10% (n = 5) of the endoscopes with a mean value of 0.12 CFU (± 0.39) was found, resulting in a log-5 reduction in a clinical environment. The documented bacteria were components of the normal skin flora. All tested endoscopes were practically protein-free (< 1 µg). Furthermore, the average absolute germ reduction of the D25 was about 106 CFU on the tested RAMS. CONCLUSION: The D25 UV light system seems to be an effective device for the reprocessing of rigid ORL endoscopes, and therefore, might be suitable for the usage in clinical practice on site.

Increased incidence of Warthin tumours of the parotid gland: a 42-year evaluation.

AIM: To evaluate the frequency of Warthin tumours among parotid neoplasms over the past 42 years in a population in rural Germany and to identify potential risk factors. METHODS: We conducted a retrospective case note evaluation from all patients who underwent parotid surgery between 1975 and 2017. The 42-year time period was evenly split into four quartiles. RESULTS: A Warthin tumour was diagnosed in 265 out of 806 patients (32.9%). The frequency of Warthin tumour increased steadily from 20.6% in the first decade between 1975 and 1986 to 44.9% in the fourth decade between 2008 and 2017. The age of the patients decreased from 68 years in the first to 62 years in the fourth decade. The male-to-female ratio in Warthin tumour was reduced from 1:5.3 in the first to 1:2.1 in the fourth decade. CONCLUSION: A Warthin tumour was the most common histological tumour type in the period from 1997 to 2017. We also found a high incidence of multiple tumours, a growing incidence in women and a decreasing age of patients. We propose a re-evaluation of the existing view of the epidemiology of benign parotid tumours, which proposes that pleomorphic adenoma is the most common benign parotid tumour.

Correction to: Increased incidence of Warthin tumours of the parotid gland: a 42-year evaluation.

In the original publication, in Table 2, the last value of third column, referring to `Number of cases' has been misprint. It should read "265" instead of the "235". The corrected table 2 is given below.

Diagnostic relevance of metastatic renal cell carcinoma in the head and neck: An evaluation of 22 cases in 671 patients.

PURPOSE: Renal cell carcinoma (RCC) is a malignant tumor that metastasizes early, and patients often present with metastatic disease at the time of diagnosis. The aim of our evaluation was to assess the diagnostic and differential diagnostic relevance of metastatic renal cell carcinoma (RCC) with particular emphasis on head and neck manifestations in a large patient series. PATIENTS AND METHODS: We retrospectively evaluated 671 consecutive patients with RCC who were treated in our urology practice between 2000 and 2013. RESULTS: Twenty-four months after diagnosis, 200/671 (30%) of RCC had metastasized. Distant metastases were found in 172 cases, with 22 metastases (3.3%) in the head and neck. Cervical and cranial metastases were located in the lymph nodes (n=13) and in the parotid and the thyroid gland, tongue, the forehead skin, skull, and paranasal sinuses (n=9). All head and neck metastases were treated by surgical excision, with 14 patients receiving adjuvant radiotherapy and 9 patients receiving chemotherapy or targeted therapy at some point during the course of the disease. Five patients (23%) survived. The mean time of survival from diagnosis of a head and neck metastasis was 38 months, the shortest period of observation being 12 months and the longest 83 months. DISCUSSION AND CONCLUSION: Our findings show that while RCC metastases are rarely found in the neck, their proportion among distantly metastasized RCC amounts to 13%. Therefore, the neck should be included in staging investigations for RCC with distant metastases, and surgical management of neck disease considered in case of resectable metastatic disease. Similarly, in patients presenting with a neck mass with no corresponding tumor of the head and neck, a primary tumor below the clavicle should be considered and the appropriate staging investigations initiated.

The Heterogenicity of Parotid Gland Squamous Cell Carcinoma: A Study of 49 Patients.

BACKGROUND/AIM: The aim of this study was to critically evaluate diagnostic workup, treatment and outcome of parotid gland squamous cell carcinoma (SCC). PATIENTS AND METHODS: We retrospectively examined 844 consecutive cases of parotid surgery in a German teaching hospital between 1975 and 2017. RESULTS: A total of 748 patients had parotid surgery. A total of 118 patients (15.7%) had a malignant tumour. Of those 49 patients had SCC accounting for 6.6% of all cases, and 41.5% of all malignant tumours. SCC typically affected males (79.6%) of advanced age. A total of 86% of patients had metastatic disease; three cases were primary SCC. Most primary carcinomas were skin (n=26) or pharynx (n=10). Four cases were carcinomas of unknown primary. We performed radical parotidectomy in 47 cases, neck dissections in 42 cases and adjuvant chemo-radiotherapy in 44 cases. CONCLUSION: The majority of parotid SCC are metastases. In cases without known primary lesion and lack of infiltrative tumour growth, a carcinoma with unknown primary should be considered.

Sialendoscopy plus laser lithotripsy in sialolithiasis of the submandibular gland in 64 patients: A simple and safe procedure.

OBJECTIVE: To demonstrate the safety and efficiency of holmium laser-assisted lithotripsy during sialendoscopy of the submandibular gland using a retrospective, interventional consecutive case series. METHODS: We performed 374 sialendoscopies between 2008 and 2015 and evaluated all patients regarding clinical symptoms, clinical findings, therapy and outcome. We performed 109 procedures of holmium laser-assisted lithotripsy in 64 patients whose sialoliths measured 5 mm or more in diameter. In addition to retrospective case note reviews, we performed telephone interviews of all patients in January 2017. RESULTS: We performed 374 consecutive submandibular gland sialendoscopy procedures in 276 patients between 2008 to 2015. Sialolithiasis had either previously been diagnosed, or symptoms highly suggestive of sialolithiasis of the submandibular gland presented in 197 patients. Holmium laser-assisted Laser lithotripsy was performed in 109 cases (64.9%). Smaller mobile concrement was removed directly either by forceps or wire basket, or following marsupialisation of the submandibular duct. This was the case in 88 patients (29.1%). Three patients (0.8%) required surgical removal of the submandibular gland due to early abscess. The majority of patients (n = 374 procedures; 90.1%) remained symptom-free after two or more years following intervention. In the remaining procedures (n = 37 procedures; 9.9%), patients reported discreet postprandial problems but did not seek medical attention. In total, we managed to preserve the submandibular gland and avoid open surgery in 99% of patients through endoscopic management of submandibular concrement and duct stenosis. CONCLUSION: Holmium laser-assisted lithotripsy is a simple, safe, and effective procedure for treating patients with sialolithiasis of the submandibular gland. Removal of the gland is rarely required, and removing the gland without prior sialendoscopy is no longer recommended. It should be offered to all patients with submandibular gland sialolithiasis, or such patients should be referred to the appropriate centre for sialendoscopy before submandibulectomy is considered.

Health-related quality of life in oropharyngeal cancer survivors - a population-based study.

OBJECTIVE: The aim of this study was to compare QoL of oropharyngeal cancer survivors who had received different treatments. SUBJECTS AND METHODS: We contacted 954 survivors. Each survivor received the QoL questionnaires EORTC QLQ-C30 and EORTC QLQ-H&N35. RESULTS: A total of 263 survivors completed the questionnaires (28% responses). Forty-five of them had undergone surgery, 20 had received definitive radiotherapy or chemo-radiotherapy, 85 surgery plus adjuvant radiotherapy, and 111 surgery plus adjuvant chemo-radiotherapy. Survivors who had received adjuvant radiotherapy and surgery reported significantly more problems with swallowing (B=13.43 [95% Confidence Interval (CI) 1.83-25.03]), senses (B=24,91 [CI 11.86-37.97]), eating (B=16.91 [CI 3.46-30.36]), dry mouth (B=26.42 [CI 12.17-40.67]), sticky saliva (B=22.37 [CI 6.23-38.50]) and nutritional supplements (B=18.59 [CI 0.62-36.56]) than those who had received surgery only. Survivors who had received adjuvant chemo-radiotherapy and surgery reported significantly many more problems with dry mouth (B=34.15 [CI 18.91-49.39]) and sticky saliva (B=22.90 [CI 5.65-40.16]), and fewer problems with physical functioning (B=-12.07 [CI 0.49-23-64]). CONCLUSION: Survivors who participated in this survey and who had undergone surgery alone reported in some head- and neck-specific domains a better health-related quality of life than patients who had undergone multi-modal treatment or adjuvant radiotherapy.

Are Multiple Tumors of the Parotid Gland Uncommon or Underestimated?

BACKGROUND/AIM: Parotid gland tumors are mostly solitary tumors of the salivary gland tissue. There is limited evidence about multifocal tumor growth of the parotid gland. PATIENTS AND METHODS: We reviewed medical records of 796 consecutive parotidectomies in 758 patients over the last 40 years in our department, and investigated the incidence and histological type of synchronous and metachronous parotid tumors. Multifocal recurrent tumors and hybrid tumors were excluded. RESULTS: We identified 93 (13%) patients with multiple parotid lesions. Their mean age was 63 (range=15-93) years. Multiple parotid tumors were found unilaterally in 59% and bilaterally in 41% of cases. The contralateral tumor was diagnosed synchronously in 13 of 38 (34%) cases and in 25 of 38 (66%) cases metachronously. The time separating the diagnoses of both contralateral tumors ranged between one and eleven years. The same histological type was found in 95% of the tumors, and 96% of the parotid tumors had lymphatic origin. Warthin tumors (65%) were the most frequent histological type. CONCLUSION: Every sixth patient with a parotid tumor has multifocal tumor lesions. The majority of multifocal parotid tumors have a lymphoid element, while multifocal growth is uncommon in other histological types.

The value of PET compared to MRI in malignant head and neck tumors.

BACKGROUND: Reliable diagnosis plays an important role in the early detection of head and neck tumors. The objective of this study was to compare the value and clinical relevance of magnetic resonance imaging (MRI) and positron emission tomography (PET) regarding the assessment and the identification of head and neck tumors. PATIENTS AND METHODS: From January 1, 2005, to January 1, 2007, 120 patients suffering from carcinomas of the oropharynx and larynx were examined by means of MRI and PET. RESULTS: The difference between sensitivity and specificity of MRI and PET was not significant with regard to the diagnosis of primary tumors, recurrence, or cancer of unknown primary. A statistically significant difference between both methods only occurred for detectron of malignant lymph nodes of size >10 mm. CONCLUSION: In particular, the assessment of small tumors by MRI and PET is characterized by a high number of false-negative findings. The future of diagnostic imaging is likely to be a combination of both techniques, as a hybrid technique.

Diagnostic relevance of metastatic renal cell carcinoma in the head and neck: An evaluation of 22 cases in 671 patients

ABSTRACT Purpose Renal cell carcinoma (RCC) is a malignant tumor that metastasizes early, and patients often present with metastatic disease at the time of diagnosis. The aim of our evaluation was to assess the diagnostic and differential diagnostic relevance of metastatic renal cell carcinoma (RCC) with particular emphasis on head and neck manifestations in a large patient series. Patients and methods We retrospectively evaluated 671 consecutive patients with RCC who were treated in our urology practice between 2000 and 2013. Results Twenty-four months after diagnosis, 200/671 (30%) of RCC had metastasized. Distant metastases were found in 172 cases, with 22 metastases (3.3%) in the head and neck. Cervical and cranial metastases were located in the lymph nodes (n=13) and in the parotid and the thyroid gland, tongue, the forehead skin, skull, and paranasal sinuses (n=9). All head and neck metastases were treated by surgical excision, with 14 patients receiving adjuvant radiotherapy and 9 patients receiving chemotherapy or targeted therapy at some point during the course of the disease. Five patients (23%) survived. The mean time of survival from diagnosis of a head and neck metastasis was 38 months, the shortest period of observation being 12 months and the longest 83 months. Discussion and conclusion Our findings show that while RCC metastases are rarely found in the neck, their proportion among distantly metastasized RCC amounts to 13%. Therefore, the neck should be included in staging investigations for RCC with distant metastases, and surgical management of neck disease considered in case of resectable metastatic disease. Similarly, in patients presenting with a neck mass with no corresponding tumor of the head and neck, a primary tumor below the clavicle should be considered and the appropriate staging investigations initiated.