Trivial trauma to the cheek: significant complications in the chest.

A man in his 30s presented to the emergency department with a history of injury to the face with a crowbar. He was discharged from the department, in the absence of any facial bone fractures and given normal examination findings, except for a puncture wound on the mentum. The patient then re-presented within 24 hours with extensive cervical emphysema extending into the mediastinal cavity.He was referred to ear, nose and throat team for further management. CT scan of the chest and neck showed extensive surgical emphysema and a pneumomediastinum. The patient was managed conservatively and recovered well with no significant sequelae.Even in the absence of facial bone fractures, it is imperative to understand the force of impact which should prompt a consideration of imaging of the chest. Appropriate advice regarding avoidance of Valsalva manoeuvres will help prevent extensive propagation of air through the fascial planes that can result in a pneumomediastinum.

Renal cell carcinoma uvula metastasis leading to airway compromise: an unusual site.

We present a case report of a gentleman presenting with a globular lesion arising from his uvula. Although elective admission was planned, he presented with airway compromise, and emergency excision was required. The patient had a background of metastatic clear cell renal carcinoma; histology confirmed the uvula lesion as a further secondary deposit. Renal cell carcinoma has a recognised metastatic propensity, but spread to the uvula is rare, with only two previously described cases in the literature. This case is notable for the unusual location of the metastasis, as well as the rapid progression of symptoms, which threatened the airway and necessitated urgent surgical intervention.

Variations in the Management of Cervical Thoracic Duct Cyst.

We present an uncomplicated case report of a cervical thoracic duct cyst (CTDC) in a 61-year-old woman treated with surgical excision. We reviewed 47 similar cases since it was first described in 1964 and evaluated the different diagnostic and management approaches. Previously believed to be the gold standard tool for evaluation, lymphangiography is now less popular due to advent of high-resolution imaging combined with aspiration techniques. CTDC treatment includes observation, low-fat diet, repeated aspirations, external pressure, sclerotherapy, embolisation, and surgical intervention. The preferred management of choice to date is surgical excision.

Are Inflammatory Markers Significant Prognostic Factors for Head and Neck Cancer Patients?

INTRODUCTION: Recent studies have reported that elevated levels of platelets and inflammatory markers are associated with poor treatment outcomes among patients with solid tumours, but reports are conflicting in head and neck cancer (HNC) patients. OBJECTIVE: To establish if pre-treatment anti-inflammatory markers can be used as a prognostic tool of overall survival and tumour control among HNC patients. METHODS: We retrospectively reviewed the pre-treatment platelet/lymphocyte ratio (PLR) and neutrophil/lymphocyte ratio (NLR) of 147 HNC patients from 2014 to 2018 and analysed their association with tumour progression and overall treatment outcomes. The optimal cut-off was established at >200 for high PLR and >2.85 for high NLR. RESULTS: After adjusting for age, disease stage, and treatment, patients with higher PLR had an almost 3 times higher risk of mortality during the study period than patients with normal PLR (hazard ratio [HR] 2.79, 95% confidence interval [CI] 1.43-5.47, p < 0.01). Furthermore, the patients with higher NLR had an >2.5 times higher risk of mortality than those with normal NLR (HR 2.62, 95% CI 1.19-5.81, p = 0.02). CONCLUSION: This observational study shows that elevated PLR and NLR in HNC patients, who were treated with either surgery or primarily chemoradiotherapy, are associated with poor overall survival.

Submandibular schwannoma: is excision a 'gold standard treatment'?

A 58-year-old man was referred to ear, nose and throat (ENT) with an 8-week history of painless right submandibular swelling with no history of weight loss, dysphagia or difficulty with mastication. On examination, there was enlargement of the right submandibular gland, which was diffuse, nodular and firm; but no calcification of the duct or cervical lymphadenopathy. ENT examination including fibreoptic laryngoscopy was normal. Fine-needle aspiration of the lump was inconclusive. Neck ultrasound scan showed a well-defined 3 cm × 3.8 cm × 4.3 cm heterogeneous mass with significant internal vascularity, anterior to the right submandibular gland. MRI (T2-weighted MRI) revealed a neurogenic tumour or a non-sarcomatous soft tissue lesion. Complete excision of the lump was performed by intracapsular dissection and the specimen was submitted for histology, which confirmed the diagnosis of 'Ancient schwannoma' of the submandibular gland. The management resulted in complete resolution of symptoms with no cranial nerve deficits.

Fourier transform infrared for noninvasive optical diagnosis of oral, oropharyngeal, and laryngeal cancer.

The 5-year survival rate for advanced head and neck cancers is 50%. There is currently no noninvasive method or effective screening procedure available to diagnose head and neck cancer at the earliest stages when it is still highly curable. This study aims to show how Fourier transform infrared (FTIR) spectroscopy could be used as a sensitive, noninvasive, low cost technique to diagnose head and neck cancer at an earlier stage and, thus, increase the likelihood of survival. Sputum samples were collected from 16 cases with oral or oropharyngeal cancer, 8 cases with laryngeal cancer patients and 15 normal controls. Cell pellets were produced from each of these samples and used to generate FTIR spectra within the 'biochemical fingerprint' wavenumber region of 1800 to 950 cm(-1). Discrimination between cancer and normal sputum was achieved using infrared wavenumbers 1650 cm(-1), 1550 cm(-1), and 1042 cm(-1) determined by robust feature selection. These 3 wavenumbers were used to develop potential models to discriminate both oropharyngeal and laryngeal cancer from normal control. In cancer cases, the absorbance levels for 1550 cm(-1) were increased relative to controls, whereas 1042 cm(-1) absorbance was decreased suggesting changes to protein and glycoprotein structure within sputa cells. This preliminary study shows potential for how FTIR could be developed into a simplistic diagnostic tool that could easily be implemented by a nonspecialist to diagnose and monitor head and neck cancer. The method could especially provide a means for detecting laryngeal cancer hidden from noninvasive observation.

Subsequent publication rate of studies from India presented at the annual congresses of SIOP.

Subsequent publication as a complete manuscript is a desirable end-point for studies presented at scientific meetings. Between 2001 and 2005, 191 studies from India were presented at annual congresses of the International Society of Paediatric Oncology. Of these 24 (12.6%) were published with a median time to publication of 20 months. This subsequent publication rate is lower than previous reports of SPR for either paediatric or oncological meetings. A lower proportion of oral presentations and randomised clinical trials (RCTs) could partly explain our findings. Further research is needed to understand barriers to subsequent publication of presented data from India.

First branchial arch fistula: diagnostic dilemma and improvised surgical management.

First branchial cleft anomalies are uncommon, and only sporadic case reports are published in the literature. They account for 1% to 8% of all the branchial abnormalities. The often variable presentation and tract siting of first arch fistulae have led to misdiagnosis. The misdiagnosis results in inappropriate/ineffective treatment and recurrence of the sinus tract. We present a 19-year-old woman who presented to the ENT outpatient department with episodic discharge from a long-standing fistula anterior to the left sternomastoid muscle. This was associated with repeated episodes of ipsilateral tonsillitis. In relation to the history and because of the position of the fistula, a diagnosis of second branchial arch fistula was made. An attempt at excision was unfortunately followed by early recurrence of discharge. At review following the procedure, a defect of the left tympanic membrane in the form of a fibrous band was noted, and a revised diagnosis of first branchial arch sinus was made. Wide surgical excision of the tract with partial parotidectomy was performed. An uneventful postoperative course followed, with no recurrence of symptoms after 24 months of review. We discuss the case, the diagnostic pathway, and the wide local excision technique used for removal of branchial fistulae.

Comparing the efficacy of alkaline nasal douches versus decongestant nasal drops in postoperative care after septal surgery: a randomised single blinded clinical pilot study.

To compare the efficacy of alkaline nasal douches and decongestant nasal drops following nasal septal surgery. This was a prospective, randomised, single-blind pilot study. Twenty patients were included in each arm of the study undergoing elective nasal septal surgery. The primary outcome measure was nasal congestion. Secondary outcome measures were anosmia, facial pain, nasal discharge, and sneezing/itching. This study does not show any statistically significant difference between the two treatment groups. Symptoms of nasal congestion (P = 0.3), facial pain (P = 0.932), nasal discharge (P = 0.98), sneezing (P = 0.59) and anosmia (P = 0.208) were analysed before conclusion. Three patients in saline group and one patient in the nasal drops group had poor compliance to follow the advice, scoring 2 on a VAS score but the treatment was tolerated well in majority of the patients. No statistical significant differences were noted on analysing the post operative complications in either group. In this study, both nasal douches and decongestant nasal drop were well tolerated. Both treatments provided good postoperative relief from nasal congestion, nasal discharge, sneezing, facial pain and anosmia as days progressed. The post operative examination of the nose among these patients revealed no significant complications in either of the study arm.

Mucoepidermoid carcinoma - unknown primary and late distant metastasis: an unusual course of the disease.

The authors report the case to understand this unusual presentation and prognosis of mucoepidermoid carcinoma following treatment. We present a case of mucoepidermoid carcinoma in a 67-year-old man. The cancer was diagnosed in the right side of his neck but the primary tumor remained unknown despite attempts at staging. The neck was treated successfully and followed up for 2 years. Metastasis of the primary lesion to the left triceps was diagnosed following a swelling noticed by the patient during the 2-year follow up period. Mucoepidermoid carcinoma can be a low, intermediate or high-grade malignancy and can metastasize to different parts of the body. However, this is the first case report of a metastasis to the triceps muscle.

Nitric oxide: pros and cons in tumor progression.

Nitric oxide (NO), synthesized by NO synthase, is a mediator involved in different processes varying from neurotransmission, to affecting the vasculature. The role of NO in tumor development is multifaceted and depends on a variety of conditions that exist with in the cell. This review will discuss the pros and cons of NO in tumor progression and provide an overview of their significant part in metabolism, angiogenesis and their role in the activation of macrophages as well as tumor-associated macrophages. The role of natural products in the regulation of NO will also be discussed.

Foam nasal packs: a prospective, randomised, patient-controlled study.

OBJECTIVES: To compare the efficacy of Spiggle and Merocel foam packs following routine nasal surgery. DESIGN: Prospective, randomised, single-blind, paired study. PARTICIPANTS: Twenty adult patients undergoing elective nasal surgery. INTERVENTION: At the end of nasal surgery patients were randomised to have a Spiggle pack inserted in one nasal cavity and a Merocel pack in the other. Packs were removed the following morning. MAIN OUTCOME MEASURES: The primary outcome measure was pain due to the presence of packs in the nose and pain associated with their removal. This was measured using a visual analogue scale. Secondary outcome measures were bleeding, crusting and adhesion formation. RESULTS: Both packs were effective at preventing postoperative haemorrhage. Bleeding following removal was minimal. There were no significant differences between the packs in terms of levels of discomfort experienced 6 hours after surgery or the following morning prior to removal (p = 0.3 and p = 0.3 respectively). However, the Spiggle foam pack caused significantly less pain on removal compared with the Merocel foam pack (mean difference 1.4; 95% CI 0.4 to 2.4, p = 0.005). There were no significant differences in terms of crust and adhesion formation. CONCLUSIONS: In this study, both the Spiggle and Merocel foam nasal packs were well tolerated while in the nose. Both provided good postoperative haemostasis and were not associated with bleeding on removal. The Spiggle foam pack had the advantage of causing significantly less pain on removal. However, it must be borne in mind that in this study the Spiggle pack was more likely to be positioned in the non-incised nasal cavity, the side that would generally be expected to be associated with less pain.