Communication is a serious problem for patients with ventilator-dependent tetraplegia. A 73-year-old man was presented at the emergency room in cardiopulmonary arrest after falling from a height of 2 m. After successful resuscitation, fractures of the cervical spine and cervical spinal cord injury were found. Due to paralysis of the respiratory muscles, a mechanical ventilator with a tracheostomy tube was required. First, a cuffed tracheostomy tube and a speaking tracheostomy tube were inserted, and humidified oxygen was introduced via the suction line. Using these tubes, the patient could produce speech sounds, but use was limited to 10 min due to discomfort. Second, a mouthstick stylus, fixed on a mouthpiece that fits over the maxillary teeth, was used. The patient used both a communication board and a touch screen device with this mouthstick stylus. The speaking tracheostomy tube and mouthstick stylus greatly improved his ability to communicate.
BackgroundSquamous cell carcinoma (SCC) as the malignant component of carcinoma ex pleomorphic adenoma (CXPA) occurring in upper lip is rare.Case reportA 55-year-old male patient presented with an asymptomatic mass of the upper lip that had noticed 8 years previously. The mass was clinically suspected to be a benign salivary gland tumor based on palpation and magnetic resonance imaging findings. A needle biopsy was then carried out, and the pathological diagnosis was pleomorphic adenoma. The tumor was removed under general anesthesia. Histopathological examination revealed well-demarcated tumor tissues showing typical histologic features of pleomorphic adenoma. However, SCC tissue with several mitotic figures was found in the central area of the tumor tissue. The tumor was finally diagnosed as CXPA. There was no evidence of recurrence or metastasis 6 years postoperatively.ConclusionThis is the first report of CXPA of the upper lip with an unusual malignant component of SCC.
We report two cases of lymphorrhea after neck dissection (ND) successfully treated with negative pressure wound therapy (NPWT) . The first was a case of squamous cell carcinoma (SCC) of the left buccal mucosa with cervical lymph node metastasis (T2N2bM0) in a 71-year-old man. Lymphorrhea was continuously seen after ND. Ligation of the lymphorrhea site was thus performed when hemostasis was carried out for abnormal bleeding caused by rupture of the anastomotic vessel 12 days after ND. Lymphorrhea, however, continued after re-operation and NPWT was thus applied.One week later, lymphorrhea disappeared completely. The second was a case of late nodal metastasis of the tongue SCC in a 64-year-old man. Lymphorrhea continued for 15 days after ND. NPWT was thus used for 26 days, and lymphorrhea disappeared completely. These results suggest that NPWT could be a useful conservative treatment for lymphorrhea after ND.
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