Perioperative immunonutrition in head and neck cancer.

OBJECTIVES/HYPOTHESIS: Immune-modulating nutrition (IMN) support before and after surgery has the potential to promote host defense, antitumor activities, and wound healing. The purpose of this study was to examine the nutritional, immunologic, and wound healing outcomes in patients receiving IMN versus standard formula. STUDY DESIGN: A prospective, blinded, randomized design was used for this study. Fifteen patients with head and neck squamous cell carcinoma received either an IMN formula (treatment group) or a standard stress formula (relative comparison group [RCG]) for a period of 7 days pre- and postoperatively. METHODS: Albumin and prealbumin were measured at baseline, day of surgery (DOS), and postoperative day (POD) 1, 4, and 8. Immunologic outcomes included C-reactive protein and total lymphocyte count with lymphocyte subset counts (CD3, CD4, CD8, CD4:8 ratio, CD19, CD56) at baseline, DOS, POD1, 4, and 8. Cell-mediated immunity was evaluated by delayed-type hypersensitivity. Wound healing was assessed using the ASEPSIS tool. RESULTS: CD3+ and CD4+ T cells demonstrated a significant difference between groups on POD 1 (P = .03 for both) and CD56 NK cells on POD 8 (P = .04). In general, wounds healed without complications except for tracheoesophageal fistula development in two patients in the RCG. CONCLUSIONS: A trend toward less immune suppression in patients receiving IMN is supported in this study.

Nasoseptal chondrosarcoma resection requiring anterior fossa floor repair: a case report.

We present a case in which a 23-year-old male patient diagnosed with nasoseptal chondrosarcoma with anterior cranial fossa extension underwent combined surgical approaches to optimize complete resection of the tumor. Surgery was followed by a 6-month course of proton-beam radiation therapy. Extensive tumors of this type with significant intracranial extension require surgical repair of the anterior fossa floor. We employed a repair technique not previously associated with the resection of these tumors, using a split-calvaria osteoplastic rotational flap. This method provided structural integrity while avoiding the risks associated with the use of free bone grafts and metallic meshes.

An unusual case of adult airway obstruction from a lymphovenous malformation.

Lymphatic, venous, and mixed lymphovenous malformations are low-flow lesions that are present at birth and grow proportionately with the patient. We describe an unusual presentation of a lymphovenous malformation in an adult. A 19-year-old man presented to the emergency department with complaints of recent upper respiratory tract symptoms, increasing left-sided sore throat, voice change, odynophagia, dysphagia, and occasional subjective fevers and blood-tinged sputum. Examination revealed the presence of a left peritonsillar bulge consistent with a peritonsillar abscess; however, findings on needle aspiration were negative. The patient was admitted for intravenous steroid and antibiotic therapy. Within 24 hours, his airway became compromised, and he underwent an awake tracheotomy and biopsy, which showed a lymphovenous malformation. Magnetic resonance imaging the following day revealed a large, poorly circumscribed, heterogeneous left parapharyngeal mass consistent with a vascular malformation. With continuation of the steroids and antibiotics, the lesion regressed, and the patient was subsequently decannulated. At the 1-year follow-up, he exhibited no clinical symptoms, and he was in good health off steroids.

Complications after the surgical treatment of malignant thyroid disease.

OBJECTIVES: Our objectives were to document the complication rates after total thyroidectomy or lobectomy for malignant thyroid disease and to compare these rates with previously documented complication rates after operations for benign thyroid disease. METHODS: This is a retrospective chart review of patients diagnosed with thyroid carcinoma at a tertiary military medical center from 1996 to 2000. RESULTS: Eighty-two patients were identified with thyroid carcinoma, of which 81 underwent surgical treatment. Nine patients had complications related to their treatment, four were permanent. This included two cases of permanent postoperative hypoparathyroidism, one case of phrenic nerve injury, and one case of unilateral vocal cord paralysis. There is a statistically significant higher overall complication rate of this series (10%) in comparison to a similar series of patients surgically treated for benign thyroid disease (2%) when comparing only recurrent laryngeal nerve injury and hypoparathyroidism (p = 0.02). There is also a higher overall complication rate (11% vs. 4.9%); however, this does not reach statistical significance (p = 0.16). CONCLUSION: Recurrent laryngeal nerve injury and hypoparathyroidism complication rates after operations for malignant thyroid disease are statistically higher in this series than complication rates after operations for benign thyroid disease. Overall complication rates are also higher for malignant thyroid disease as compared to benign thyroid disease. Before surgical treatment for malignant thyroid disease, patients should be counseled accordingly.

Midline maxillary odontogenic keratocyst.

Odontogenic keratocysts are odontogenic cysts of the jaw, usually the mandible. We present a recurrent case in the maxilla. Immunohistochemical staining is necessary to distinguish the entity from other cystic lesions of the jaw, and aggressive surgical management is required.

A rare case of a sebaceous nevus in the external auditory canal.

We report the case of a patient who came to us for evaluation of a progressive unilateral hearing loss and who was found to have a sebaceous nevus in an unusual location: the external auditory canal. A sebaceous nevus is a congenital organoid mass that occurs primarily on the face, scalp, and periauricular regions. Despite the predilection of sebaceous nevi for the head and neck, reports of this lesion rarely appear in the otolaryngology literature. Left untreated, the lesion can progress through three stages of gross and histopathologic development; a sebaceous nevus begins as a small benign papule, grows into an enlarging mass with different characteristics, and ultimately becomes a secondary neoplasm. The lesion's potential for malignant transformation and its association with syndromes underscores the importance of prompt recognition and appropriate management. This case report adds the sebaceous nevus to the differential diagnosis of external auditory canal lesions and provides essential information about this rare mass.

Squamous cell carcinoma of the buccal mucosa: one institution's experience with 119 previously untreated patients.

BACKGROUND: Squamous cell carcinoma (SCC) of the buccal mucosa is a rare, but especially aggressive, form of oral cavity cancer, associated with a high rate of locoregional recurrence and poor survival. We reviewed our institution's experience with 119 consecutive, previously untreated patients with buccal SCC. METHODS: We reviewed the charts of 250 patients who were seen at The University of Texas M. D. Anderson Cancer Center between January, 1974, and December, 1993. Of these, 119 were untreated and were subsequently treated exclusively at our institution. Patients who were previously treated elsewhere or whose lesions arose in other sites and only secondarily involved the buccal mucosa were excluded. RESULTS: Patients with T1- or T2-sized tumors had only a 78% and 66% 5-year survival, respectively. Muscle invasion, Stensen's duct involvement, and extracapsular spread of involved lymph nodes were all associated with decreased survival (p <.05). Surgical salvage for patients with locoregional recurrence after radiation therapy was rarely successful. CONCLUSIONS: SCC of the buccal mucosa is a highly aggressive form of oral cavity cancer, with a tendency to recur locoregionally. Patients with buccal mucosa SCC have a worse stage-for-stage survival rate than do patients with other oral cavity sites.