The management of patients with cervical lymph node metastases from an unknown primary cancer (CUP) remains a matter of controversy. Although new advanced diagnostic tools, such as positron emission tomography, have recently been introduced in oncology, the frequency of this tumour entity in clinical practice means it is still relevant. Recently introduced molecular profiling platforms may provide biological classification for the primary tissue of origin as well as insights into the pathophysiology of this clinical entity, including the characterisation of the Epstein-Barr virus and human papilloma virus genomas in the metastatic cervical nodes. Due to the lack of randomised trials, a standard therapy has not been identified yet. Although neck dissection followed by post-operative radiotherapy is the most generally accepted approach, there are other curative options that can be used in some patients: neck dissection alone, nodal excision followed by post-operative radiotherapy or radiotherapy alone. A major controversy remains in the target radiation volumes that range from ipsilateral neck irradiation to prophylactic irradiation of all potential mucosal sites and both sides of the neck. Finally, the administration of concurrent chemotherapy is currently being advised for patients with adverse prognostic factors.
Haemangiomas of the maxillary sinus are very rare. In this paper we present one case with an inaccurate preoperative diagnosis which was treated by entire excision of the tumour. One year aftersurgery there is no evidence of recurrence. The literature on the topic is reviewed.
Necrotizing fasciitis is a rare condition which usuallyaffects the trunk, perineum and limbs. Head and neck involvement is very uncommon and in most cases it is secondary to orbital or dental infection. We report a case of craniofacial necrotizing fasciitis (CNF) secondary to a maxillary sinusitis. The patient was treated intensively with antibiotics, surgical procedures and life-support measures.Despite all efforts, the patient died one week after admission. This case highlights early diagnosis and aggressive management as decisivefactors for the outcome of the patient.
Objective:
To evaluate the hearing preservation (HP) in cochlear implant (CI) recipients who did not fulfill the criteria for electric acoustic stimulation (EAS).
Study Design:
Prospective study
Setting:
Tertiary academic hospital.
Patients:
Adults undergoing CI with deep insertion electrode arrays who had measurable residual hearing (RH) before surgery.
Intervention:
Demographic data, surgical technique, pure-tone average, and radiological findings were evaluated.
Main Outcome Measure:
Pre- and postoperative pure-tone audiometry. A preservation study was therefore performed for the whole range of frequencies (THP), and for low frequencies (LFHP).
Results:
From the total 25 patients who underwent the surgical procedure, 6 of them (26.08%) did not retain any RH and 17 of them (73.91%) had some degree of HP. A clear association was observed between the use of the atraumatic technique (AT) and the percentage of some degree of HP. In patients who underwent the AT, LFHP was 72.79% and THP was 70.40%. In patients who did not undergo the technique, LFHP was 31.48% (p: 0.003) and THP was 23.50% (p: 0.002). LFHP was complete or partial (more than 25% of initial RH) in 92.3% of patients who underwent AT and in 50% of those who did not. Radiological findings showed that complete insertion is not associated with poorer HP.
Conclusion:
If the appropriate technique is used, preservation of RH is feasible after cochlear implant surgery with deep insertion electrode arrays.
Introduction:Tracheal chondrosarcoma (TCS) is a rare malignancy, with only 19 cases described in the literature to date. Case presentation: Herein, we presented the third-largest TCS with such an airway compromise that neither orotracheal intubation nor jet ventilation or even tracheostomy was possible. So, extracorporeal circulation was needed to excise the tumor in a onestage procedure. The patient presented no tumor recurrences after surgery during an approximate7-years follow-up. So open surgical resection and end-to-end anastomosis probes may be applied as a safe and successful treatment. A review of the previous literature revealed no extracorporeal circulation in previous practices.
Conclusion:Management of tracheal chondrosarcoma is challenging due to its airway compromise during the procedure. Different treatment modalities have been advised but none of them included extracorporeal circulation as an option. We believe that this approach allows for better control of the resection and ensures better oxygenation of the patient.
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