Serum and salivary levels of lactate dehydrogenase in oral squamous cell carcinoma, oral lichen planus and oral lichenoid reaction.

BACKGROUND: Increased levels of lactate dehydrogenase (LDH) as a tumor marker have been reported in malignant and some premalignant oral lesions such as oral lichen planus (OLP) and oral lichenoid reactions (OLRs). This study aimed to assess the level of total LDH in the saliva and serum of patients with oral squamous cell carcinoma (OSCC), OLP and OLRs. METHODS: In this case-control study, the participants were divided into four groups (n = 25) of healthy controls, OLP, OLRs, and OSCC. The serum and stimulated/unstimulated salivary levels of LDH were spectrophotometrically measured using standard LDH kits (Pars Azmoun). One-way ANOVA, Chi-square test, Pearson's correlation test, and receiver operating characteristic (ROC) analysis were applied to analyze the data. RESULTS: The serum and salivary levels of LDH in OSCC patients were significantly higher than that the corresponding values in other groups (P = 0.0001). The serum level of LDH in OLR group was significantly higher than that in the control and OLP groups (P = 0.0001), but the difference in salivary level of LDH was not significant. The ROC analysis showed that both the serum and salivary levels of LDH had significant diagnostic ability for detection of OSCC and OLRs. Significant associations were noted between the serum and salivary levels of LDH. CONCLUSIONS: Patients with OSCC and OLRs had higher serum levels of LDH than OLP and control groups. Further prospective longitudinal studies are required to assess the tissue level of LDH and monitor the transformation of OLRs because they have low rate of malignant transformation compared with other oral premalignant lesions.

Comparison of Grafting Success Rate and Hearing Outcomes between Primary and Revision Tympanoplasties.

INTRODUCTION: There are a few studies that compare the outcomes between primary and revision tympanoplasties. The purpose of the present study was to compare the results of type I tympanoplasty (i.e., synonymous to myringoplasty) and revision myringoplasty based on the closure of tympanic membrane perforation and hearing improvement. MATERIALS AND METHODS: This prospective single-blind study was carried out on a total of 240 patients with tympanic membrane perforation at a tertiary referral center. The subjects underwent primary or revision myringoplasty. Grafting success rate and hearing results were measured and the comparison between the primary and revision groups was drawn. RESULTS: Grafting success rate was reported as 96.6% (112 out of 116 cases) for myringoplasty, while in revision myringoplasty the success rate of 78.2% (97 out of 124 patients) was achieved (P=0.001). Speech reception threshold was 23.1±9.2 dB and 24.9±13.1 dB in the primary and revision groups, respectively (P>0.05). However, the percentage of air-bone gap on audiometry≤20 dB were 83.8% and 76% in the primary and revision groups, respectively (P=0.26). CONCLUSION: The findings of the present study have shown that although grafting success was reported significantly better in myringoplasty (tympanoplasty type 1), compared to that in revision myringoplasty, it did not reveal any superiority over revision tympanoplasty regarding the hearing outcomes. No consensus was achieved due to a great number of controversies in the literature.

Effects of Adenotonsillectomy on Serum Levels of IGF-1 and IGFBP-3 and Growth Indices in Children with Adenotonsillar Hypertrophy or Recurrent Tonsillitis.

INTRODUCTION: Adenotonsillar hypertrophy (ATH) may present with growth retardation. Insulin-like growth factor 1 (IGF-1) mediates the anabolic effects of growth hormone (GH) on tissues. Most of the circulating IGF-1 molecules are bound to insulin-like growth factor-binding protein 3 (IGFBP-3). IGF-1 and IGFBP-3 serum levels reflect the levels of daily mean serum GH and are used as indices for evaluating the serum level of GH. This study aimed to determine the effect of adenotonsillectomy on IGF-1 and IGFBP-3 serum levels in patients with ATH or recurrent tonsillitis. Furthermore, we aimed to investigate the effect of adenotonsillectomy on growth indices such as weight and height. MATERIALS AND METHODS: A total of 100 randomly selected children with a diagnosis of ATH or recurrent tonsillitis with a mean age of 10.2 ± 1.4 years (range, 3-17 years) were enrolled in the intervention group. Of those, 53 were boys and 47 were girls. The control group included 100 healthy children (62 boys and 38 girls) with a mean age of 8.5 ± 1.5 years (range, 4-15 years). Growth indices such as weight and height were measured and documented at the time of surgery and 6 months after the operation. Blood samples were taken preoperatively and repeated 6 months after adenotonsillectomy. The coated-tube immunoradiometric (IRMA) method was used to measure IGF-1 and IGFBP-3 levels. RESULTS: Postoperative IGF-1 and IGFBP-3 serum levels as well as weight and height showed were significantly greater in comparison with preoperative measurements in both the intervention and control groups (P<0.001). At the end of study, the intervention group showed significantly greater changes from baseline in IGF-1 and IGFBP-3 serum levels, weight, and height in comparison with the control group (P< 0.001). CONCLUSIONS: This study shows that adenotonsillectomy in children with ATH or recurrent tonsillitis increases IGF-1 and IGFBP-3 serum levels in comparison with preoperative levels by affecting the GH-IGF-1 axis, and subsequently leads to a faster increase in growth indices compared with healthy peers during the same period.

Endoscopic marsupialisation of the lateral frontal sinus mucocele with orbital extension: a case report.

INTRODUCTION: Frontal sinus mucoceles are the commonest among all paranasal mucoceles. With introduction of functional endoscopic sinus surgery, surgeons prefer endoscopic management of sinus mucoceles, but lesions that appear in the lateral part of the frontal sinus can be difficult to access and often need external approaches. CASE PRESENTATION: We described a lateral frontal sinus mucocele with intra-orbital extension, which was successfully managed by endoscopic sinus surgery. CONCLUSIONS: Endoscopic sinus surgery is the treatment of choice in most frontal sinus mucoceles including lateral frontal mucoceles.

Nasal Eosinophilic Angiocentric Fibrosis with Orbital Extension.

Eosinophilic angiocentric fibrosis (EAF) is an extremely rare, chronic, benign, idiopathic disorder that mostly affects the upper respiratory tract, particularly the nasal cavity, and features progressive submucosal perivascular fibrosis. To the best of our knowledge, only seven cases of EAF with orbital involvement have been reported. We report a case of sinonasal EAF with orbital extension that presented with left nasolacrimal duct obstruction. A 35-year-old man presented with left epiphora, proptosis, anterolateral globe displacement and nasal obstruction. Endoscopic sinus examination showed a firm, gritty, creamy, yellow, fibrous, adherent mass of maxillary sinus. Diagnosis was established with histopathological examination of excisional biopsy of the lesion. Although EAF is very rare, it should be considered in the differential diagnosis of lesions of upper airway tract, particularly the nasal cavity. Biopsy is necessary for diagnosis and treatment planning. Resecting of the involved tissues completely is essential for prevention of recurrence.

Maxillary Sinus Mucopyocele in a Fifty-eight-year-old man: A Possible Late Complication of Irradiation to Head and Neck.

INTRODUCTION: A mucocele is an epithelial-lined, mucus-containing sac that can fill the sinus completely and expand gradually. Mucopyocele is an infected mucocele. CASE REPORT: We presented a case of left maxillary mucopyocele in a 58-year-old man that developed after radiotherapy for nasopharyngeal carcinoma. Computed tomography scan showed opacification of the left maxillary sinus expanding through the medial wall of the antrum with thinning and destruction of the adjacent structures. Endoscopic marsupialization of the lesion and left partial maxillectomy were performed. The cystic mass had yellowish thick mucopurulent fluid that was completely drained. CONCLUSIONS: A few cases of sphenoid sinus mucocele as a late complication of radiation therapy have been reported. Maxillary mucocele and mucopyocele can be considered as one of the late complications of radiotherapy to head and neck as a result of occlusion of sinus ostia by scarred mucosa.

Iatrogenic submandibular duct rupture complicating sialography: a case report.

INTRODUCTION: Sialolithiasis is the most common disease of salivary glands. Sialography is particularly important for the assessment of the outflow tract and in diagnosing obstructive salivary gland lesions including calculi. CASE PRESENTATION: We report on a 38-year-old female with sialolithiasis whom had Wharton's duct perforation, complicating the sialography. She was treated conservatively with a course of co-amoxiclav, oral prednisolone for three days and pain-killers. The patient was clinically well on follow-up reassessments at the end of the first week and three weeks post procedure. CONCLUSIONS: Perforation of salivary duct complicating the sialography is rare. Awareness of this potential complication and utilizing a good sialography technique need to be advocated amongst radiologists. Response to treatment by conservative management is preferred as illustrated in this case.

Iatrogenic aspiration of custom-made keel: a case report.

INTRODUCTION: Laryngeal stenosis has various causes and treatment options. Endoscopic resection of the stenotic part with CO2 laser is one of the treatment options of laryngotracheal stenosis. Keels are useful for preventing adhesion formation, restenosis and web formation, which may happen during the later stage. They can be put in place either via the endoscopic approach or through a micro thyroidotomy and are held in place with a heavy suture through cricothyroid and thyrohyoid membranes. They are left in place for two to four weeks, and then removed through the endoscopic approach under general anesthetics. CASE PRESENTATION: We report on a case of anterior glottis stenosis with keel aspiration for two weeks, after endoscopic CO2 laser resection of the stenotic section and keel placement. The patient was admitted to our center, where bronchoscopy was performed and the keel was removed. A new custom-made silastic keel was properly placed in raw areas and fixed to the skin with suture through the cricothyroid and thyrohyoid membranes. The keel was removed three weeks later. CONCLUSIONS: Endoscopic keel placement should be done with heavy suture through cricothyroid and thyrohyoid membranes. Surgeons should suture the keel to the anterior laryngeal wall with specially designed Lichtenberger's needle-carriers to prevent complications such as keel aspiration, adhesion formation and imposing a second trip under general anesthetics, which put the patient at increased risk. The false vocal cord microflaps, as biological keels and a relatively new method may replace silastic keel placement in the future.